TELEPSYCHIATRY

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TELEPSYCHIATRY

• MARYLAND RURAL DEVELOPMENT GRANT
• Delta States September 2009

Brian Grady University of Maryland Holly
Ireland Mid-Shore Mental Health Jean
Honey Project Coordinator
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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 Marys County Department of Human Services

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Mental Health Professional Shortage Area
Designations By Rural/ Non Rural Classification
at 11/2008
Single (Entire) County
Comprehensive Health Center
Facility
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(No Transcript)
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Counties

• Seven Rural Counties St. Marys, Garrett,
  Caroline, Dorchester, Kent, Queen Annes and
  Talbot

Mental Health Care Professional
Shortage Area
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Sites

• Caroline Caroline County Mental Health Clinic
• Dorchester Wellness Center Maces Lane Middle
  School
• Garrett Garrett County Health Department
• Kent A.F. Whitsitt Center
• St. Marys Pathways, Inc
• Talbot Maple Shade Youth and Family Services

• Priority Populations Child/ Adolescent,
  Geriatric,
• Co-Occurring Substance Abuse, Deaf/ Hard of
  Hearing

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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

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University TMH Philosophy

• Quality Mental Healthcare
• Improve Access
• Cost Effectiveness
• Utilization of Limited Resources

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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

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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.
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Alliance

• Consultant/Consultee
• Ivory Tower
• Communication
• Consultee/Patient
• Attitude toward MH
• Consultant/Patient
• Administrative and Support Staff

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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

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Approach

• Clinician Driven
• Consultee Orientation
• Appropriate Patient Selection/ Evaluation/Treatmen
  t

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Access

• Patient
• Specialty Care
• Originating Site
• Located within the clinic
• Distant Site
• Located within the clinic

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Accountability

• Standard Operating Procedure/Protocols
• Records
• Cost

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Apprehension

• Risk/Benefit Ratio
• Cost/Benefit Ratio
• Patient Information
• Security
• Privacy
• Confidentiality

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The Seventh "A"
Anticipate

• Satellite
• Patient Safety
• Equipment Failure
• Staffing Problems

• Hub
• Patient Safety
• Equipment Failure
• Staffing Problems

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Success Depends On

• Interest
• Alliance
• Simplicity
• Appropriate Use of Resources

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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/Treatmen
  t

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How Are We Doing?

• Access
• Patient
• Accountability
• SOP/Protocols
• Records
• Cost
• Apprehension
• Risk/Benefit Ratio
• Cost/Benefit Ratio
• Patient Information
• Anticipation

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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

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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?

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34 States Nationwide
Reimburse for Telemedicine
Medicaid Reimburses
Telemedicine No Statewide Reimbursement