TELEPSYCHIATRY

MARYLAND RURAL DEVELOPMENT GRANT

Delta States September 2009

Brian GradyUniversity of MarylandHolly IrelandMid-Shore Mental HealthJean HoneyProject Coordinator

BACKGROUND

One Year Grant with 2 one-year potential continuations

MSMHS Lead Agency

Partners

Maryland Department of Health and Mental Hygiene (DHMH)

University of Maryland School of Medicine Department of Psychiatry

Garrett County Core Service Agency St Mary’s County Department of Human Services

Mental Health Professional Shortage Area Designations By Rural/ Non Rural Classification at

11/2008

Single (Entire) County

Comprehensive Health Center

Facility

CountiesSeven Rural Counties: St. Mary’s, Garrett, Caroline, Dorchester, Kent, Queen Anne’s and Talbot

Mental Health Care

Professional Shortage Area

Sites

Caroline: Caroline County Mental Health Clinic Dorchester: Wellness Center Mace’s Lane Middle

School Garrett: Garrett County Health Department Kent: A.F. Whitsitt Center St. Mary’s: Pathways, Inc Talbot: Maple Shade Youth and Family Services

Priority Populations: Child/ Adolescent, Geriatric,

Co-Occurring Substance Abuse, Deaf/ Hard of Hearing

Operational Framework

Time Line – Announced May 2008 October 27 – November 5th: Installation of

Equipment Procedures/Schedules/Outreach Targets

– Through April 09: 117 clients/333 encounters

– Through 3 year project: 585 clients/ 1,665 encounters

– 85% Satisfaction

– 95% Completion

University TMH Philosophy

Quality Mental Healthcare Improve Access Cost Effectiveness Utilization of Limited

Resources

BENEFITS

Consumers: Overall Increases Choice, independence and quality of life

Reduces Appointment Wait Times Early intervention and treatment Access to Specialist Providers Continuity Between Appointments Reduced ER visits and Inpatient Length

Providers: Increases clinical capacity Connected to Academic Centers, Meetings,

Training, Group Therapy

Textbook Implementation Strategy*

Alliance Assessment Approach Access Accountability Apprehension Anticipation

*Grady BJ. Chapter 41: TelePsychiatry, Textbook Of Consultation-Liaison Psychiatry, Edited by Wise, MG, Rundell, JR, APP, 2002.

Alliance

Consultant/Consultee• “Ivory Tower”

• Communication

Consultee/Patient• Attitude toward MH

Consultant/Patient Administrative and

Support Staff

Assessment

Needs/Resources of Originating Site• Equipment, Capacity, Staff, Budget

Capabilities/Resources of Distant Site• Equipment, Capacity, Staff, Budget

Personal Investment• Distant Site• Originating Site

Approach

Clinician Driven Consultee Orientation Appropriate Patient Selection/

Evaluation/Treatment

Access

Patient• Specialty Care

Originating Site• Located within the clinic

Distant Site• Located within the clinic

Accountability

Standard Operating Procedure/Protocols

Records Cost

Apprehension

Risk/Benefit Ratio Cost/Benefit Ratio Patient Information

– Security– Privacy– Confidentiality

The Seventh "A"

Hub– Patient Safety

– Equipment Failure

– Staffing Problems

Satellite– Patient Safety

– Equipment Failure

– Staffing Problems

Anticipate

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Success Depends On

Interest Alliance Simplicity Appropriate Use of

Resources

How Are We Doong? Alliance

– Consultant/Consultee – Consultee/Patient– Consultant/Patient – Administrative and Support Staff

Assessment– Originating Site – Distant Site – Personal Investment

Approach– Clinician Driven – Consultee Orientation – Appropriate Patient Selection/ Evaluation/Treatment

How Are We Doing?

Access– Patient

Accountability– SOP/Protocols – Records – Cost

Apprehension– Risk/Benefit Ratio – Cost/Benefit Ratio – Patient Information

Anticipation

Telepsychiatry Development Grant Program Choices:

Factors Uncontrollable – Grant Rural Eligibility Requirements

– State Mental Health Services Organization

Factors Limited Control – Patient eligibility/participation

– Provider participation

– Site participation

– Steering Committee Participation

– Sustainability/Economics

– Clinical Practice Model 21

Telepsychiatry Development Grant Program Choices:

Factors Controllable – Lead Agency– Staffing– Project Management– Grant Reporting– Tech Support– Data Analysis

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THANK YOU

QUESTIONS?