Behavioral Health

Information
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Conference

San Diego,  CA 92120
April 4, 2013
TELEMENIAL HEALTH
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Marlene M.  Maheu,  Ph. D.
Te| eMenta|  Health Institute,  Inc. ...
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CiMH Behavioral Health Information Management Conference, April 2013

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Marlene Maheu gives a telehealth workshop to the California Institute for Mental Health (CiMH) conference in April 2013 in San Diego, California.

The above event is sponsored by the TeleMental Health Institute, Inc. We are the premier professional training site for professionals seeking training in telehealth. Our courses are offered in a state-of-the-art, 100% online learning environment that is fully mobile compatible. Professional training is now available from your desktop of mobile device, 24/7, at your home or office.

To receive our FREE monthly newsletter related to telemental health, telecounseling, online therapy, telepsychology or telepsychiatry and telenursing, send an email to: tmhinews@aweber.com You will also receive notices of our bonuses and discounts for professional training for CEUs and CMEs.

See our offerings at www.telehealth.org
Send questions or comments to us at www.support.telehealth.org
Contact Dr. Maheu to speak at your next workshop or conference at: www.support.telehealth.org

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Transcript of "CiMH Behavioral Health Information Management Conference, April 2013"

  1. 1. Behavioral Health Information Management Conference San Diego, CA 92120 April 4, 2013
  2. 2. TELEMENIAL HEALTH I N : I 1 ‘ u 7 r teIehealth. org 2 O 201) Ielewlennl Nnlllh Immuu, Inn
  3. 3. 1 , |55=, ‘,l_3r| y;t_ : ~:m; .x: : , , ( I A _ (Jl: hI: r.IllI. .-Iv Telehealth vs. Telemedicine Telehealth Regional Health Health . professions Information Education Sharing Consumer Telemedicine Education Administration I Public Evaluation Health Research Homeland Security J < arr»: 2-= ;._: -‘r 2;»,
  4. 4. ( ! ’:. ‘!5". 'EI, "!"T“‘| ":E: “gW K-«Il': )nrj-r-IIli. .-v‘(9': Video Teleconferencing (VTC) Copyright 2013 Te| eMenta| Health Institute, Inc. All rights resen/ ed.
  5. 5. '3.’5p*"'o5“o'~"j‘~‘»‘f”“v? "‘ ‘(’: ll': )nr_'~r-Illiu-! ‘(91 Reach 8». Benefits of Telehealth Increased client satisfaction Decreased travel time Decreased travel, child & elder-care costs Increased access to underserved populations Improved accessibility to specialists Reduced emergency care costs Faster decision—making time Increased productivity / decreased lost wages Improved operational efficiency Efficacy is on par with in-person care for many groups Decreased hospital utilization
  6. 6. ( '3’5“"‘5°'*"A%‘—‘» : f'€: "g': ‘ ‘('-Ifinrf-r<llIiu°l‘(". Recent Supporting Research Backhaus and colleagues (May, 2012) reported in their abstract of a meta—analysis that: V 821 potential articles were identified, and 65 were selected for inclusion. r The results indicate that VCP is feasible, has been used in a variety of therapeutic formats and with diverse populations, is generally associated with good user satisfaction, and is found to have similar clinical outcomes to traditional face—to—face psychotherapy. — Videoconferencing psychotherapy: A systematic review. Backhaus, Autumn; Agha, Zia; Maglione, Melissa L. ; Repp, Andrea; Ross, Bridgett; Zuest, Danielle; Rice—Thorp, Natalie M. ; Lohr, James; Thorp, Steven R. Psychological Services, Vol 9(2), May 2012, 111-131. doi: 10.1037[a0027924
  7. 7. ’3.’5p*"l5“. '~"j‘~‘»‘f”“v? "‘ zar: .I_-. .~. IIai. ..I‘u: The Is Video Teleconferencing (VTC) Effective? “ Yes — Medicare & Medicaid required to pay C Outcomes are relatively comparable, especially for follow—up care (intakes are still a matter of state law) C Literature for specialty groups is spa rser, but positive (pediatrics) — Also effective for supervision — Can improve some ways service is rendered — See www. te| ehea| th. ORG/ bib| iography “ BUT, traditional VTC isn't the same as Skype Copyright 2013 Te| eMenta| Health Institute, Inc. All rights reserved.
  8. 8. r‘ skype No audit trails Poor Reliability Video platform or social media platform? Hacked 11/14/2012 http: //heartbeat. skype. com/2012/11/security_issue. html 5») A’ By _eonas Sendrauskas on November 14, 2012. We have had reports of a new security vulnerability issue. As a precautionary step we have temporarily disabled password reset as we continue to investigate the issue further. We apologize for the inconvenience but user experience and safety is our first priority l. I :2 reaI; ii. ;-~. s Copyright 2013Te| eMenta| Health Institute, Inc. All rights reserved.
  9. 9. ‘ig53‘. ti: ij'. irs~': .r t= it’3ii_>z= Illi. .-i‘(9‘: Existing Guidelines —— Many Cover Far More than Telehealth - 1998 American Psychiatric Association — Telepsychiatry via Teleconferencing - 1999 (2005) American Counseling Association — Ethical Standards for Internet On—Line Counseling - 2000 American Mental Health Counselors Association — Code of Ethics of AM HCA, Principle 14, Internet On—Line Counseling - 2000 American Medical Association — Guidelines for Patient-Physician Electronic Mail - 2001 National Board of Certified Counselors (NBCC) — Center for Credentialing and Education The Practice of Internet Counseling - 2001 Canadian Psychiatric Association (CPA) — Telepsychiatry Guidelines and Procedures for Clinical Activities - 2004 (2010) Australian Psychological Society — Guidelines for providing psychological services and products on the internet - 2006 National Association of Social Workers & Association of Social Work Boards — Standards for Technology and Social Work Practice - 2008 (2010) Ohio Psychological Association — Telepsychology Guidelines - 2009 Canadian Psychological Association — Ethical Guidelines for Psychologists Providing Psychological Services Via Electronic Media - 2009 American Telemedicine Association — Evidence-based Practice for Telemental Health — Practice Guidelines for Videoconferencing Based Telemental Health
  10. 10. . I . . ._ Ir . I i. .. . 14 . i . . L . . 1.. . I s. V . I . . _ . I N _ . . I I . . . I. . .. . I. .. I. I . I . _ o. .. sl . A . . . . . . . I . . I . . . . . I . . . 1. . II , 1. . , , . . . _ — . . . . . o. I I. . . . . .I. r . .. . . I . . . _. o. .»w l i . . r . .. _. I. . . _ . . . . . h.. .., xI . _ 1. ~ . . I 4. oIA . . . . . . . . I . . . _ II. —.
  11. 11. V ‘ ’ ‘ I’= -‘, .: .‘, =., =.. ¢ l3!V? Il_: Il‘s‘ srilill Ht’-L)ii~. .r-Ilii. t-iv 4 Key Aspects of Risk Management Know the Applicable Standard of Care for Your Patient Population and within Your Discipline Legal Code Ethical Code Malpractice insurance r I‘ T . "I'«""! ‘ V +1“; ' M“ i Z 1, 1‘ .13‘/ ‘ ‘ . .__. ..__ ‘§_’, ."s “. I ,9 '71. 2' ‘E (5 r-’, =:_e. 'I. .' Li. ‘ . ' . « [lg I'5fI'i‘, 'f. "P'i’i? ,{’5'7f~‘J7‘_-
  12. 12. '3.55“"',5“, ""‘f“""f’3“‘? ";‘ zm‘: II_-. .». iiii. .II‘u‘~. Risk Management Save all proof of training or consultation to prove you've ”sought the advice of your peers” Record Keeping: ,~ _ ‘; — Document, document, V-‘ document , ‘ ° Protocols Followed I". ; - Time in, time out » ° Dropped connections - Intrusions - Lighting ° Adaptive Equipment ° Assess progress Copyright 2013 Te| eMenta| Health Institute, Inc. All rights resen/ ed.
  13. 13. - ~ A it 'l« ‘ te| ehea| th. org I OCPM Step 6: Direct Clinical Care 9 Explain & sign informed consent document 9 Conduct a formal intake — no shortcuts 0 Meet in-person or video, take full history, medications, illnesses, abuse, stressors, support system, use of other technology, drug/ alcohol use, suicide/ homicide intent, mental status 9 Decide if then which technology is appropriate 9 Obtain names of all other key providers, get all appropriate releases
  14. 14. (' |5ii: §,i_: .‘ir; ‘ : ~:r; ii-i: I , . (( " ” ' I (JI: lii: r.Il3II. -iv , 5 I I, , -‘_: I . .-“L. ” . II’? - - - rs- ? I) _ :7’ U’ --: H I 4;} V 1") -‘ I ‘ , I‘ . "I 1' 4, '. ''‘ij‘. ‘’ , , ; ss -‘sI ‘N. ‘ i s , !: i ' - . .' r t _. ,I “I, x i . ( ' (47 _, '-if‘-' . -T" » . ..—- . '. I": K Ii’. ' I ‘-. 'p‘’ 'C ‘ -. — - r I» r I “ 2 < 7; ’. ,,-. ‘7%’, ,*- , » I -. ,/ I/7,; Hi. ) I" ff 1: , - I. I . _n' It . .."i I J" l’I. II‘7, . Boundaries of Competence Racial, Linguistic, Gender, Religious & Cultural Diversit Copyright 2013 Te| eMenta| Health Institute, Inc. All rights reserved. . , .
  15. 15. i ‘ = .*= '~ II ; :II: . ( "3’fi“—‘y*"A: —‘» _'I' if-' ‘ uI‘2II-. niitI. ..I‘I. Risk Management: Research—based Protocols & HIPAA-compliant Platforms 1000+ Reference Bibliography S ‘N’ rI': ":_ htt : te| ehea| th. or biblio ra h (1 “ 1); l , V‘) H ‘ . .SIs 1-I-—; ——-—_—; _»: ‘.s ii’ 50+ Video Platforms I I / ‘I I http: //telehea| th. org/ video Copyright 2013 Te| eMenta| Health Institute, Inc. All rights resen/ ed.
  16. 16. INSTIYUYI ((( TELEMENTAL HEALTH telehealm-org Australian Psychological Society (2011 revision of Internet Guidelines) Research—based protocols — 1.6 ”Psychologists using the internet to provide a psychological service should be aware of the extent to which therapeutic interventions via the internet are supported by research or may be contra—indicated . ... ” Copyright 2013Te| eMerita| Health Institute, Inc. All rights reserved.
  17. 17. telehealthorg Inter-jurisdictional Issues (practicing over state lines or national borders) Practitioner must be Hcensed: - In a state ° In the local state of patient - Both Government House of Representatives Approve Internet Doctor Treatment State Representative Dan Winslow (R-Noriolk) who represents Medfleld saw his proposal to ease Access and reduce medical costs pass the House this past week June 16 2012 ‘Tweet D Email Print - Gcomments Editor's note The i’oi‘loiving was submitted oy the Dan Winslow Committee In a move that could revolutionize the delivery access and cost of primary healthcare in Massachusetts the House of Representatives approved a plan to allow doctors licensed anywhere in the United States to consult diagnose and treat Massachusetts residents by internet video examinations "Telemedicine will allow qualified physicians to be immediately available 24/7 and as near as your computer or smanphorie "said | Vledfield's State Representative Dan Winslow (R—Nortolk) who sponsored the legislation "It approved by the Senate and signed by the Governor this new technology will be a godsend to worried parents in the middle of the night to seniors who are confined to home to residents in rural areas who lack convenient access to primary care phvsicians and to anyone who can't wait a few days or a week to obtain a prescription " said Winslow - upload Photos and Videos Under the plan as approved by the House Massachusetts‘ Board of Registration oi Medicine Wlll develop and implement standards for a "telemedicine" license for which physicians licensed in any state Will be eligible to apply Massachusetts is home to a number of high tech companies that are developing telemeoicine technology including Arnericariwell com which provides more than 100 lobs Telemedicine can range trom computer or smart phone consultation to high tech video booths at drugstores that include blood pressure and temperature sensors Telemed doctors can expedite referrals to specialists and in person examinations when needed Related TODlCSI Dan WlI'| Sl0W HOUSE 0' REDFESCFNZKIVES and Internet DOCIOF 17
  18. 18. l'3.’5“l'l5‘l. ""‘f‘l"": ’3‘l‘§"; ‘ i: tt'§ni_: ~r-llliu-t‘(9‘: Duty to Report / Duty to Warn California State Law (v) Failing to comply with the ' . child abuse reporting l‘ T ~l requirements of Section ' Vi 11166 of the Penal Code. / (w) Failing to comply with y y the elder and adult dependent abuse reporting ' requirements of Section [ . _ l 3 I " __ 15630 of the Welfare and ~ '1 . 1' “lg”-l: l‘l Institutions Code. CA Business 6 ( (W "I and Professions Code Sections : ‘ ii‘) l (»l I I 4989.54(cont. ) i " will
  19. 19. l‘ telehealth. org ° Communicate often in writing to your local, state and national professional associations ° Have written emergency plans Risk Management
  20. 20. - ~ it --it 'l‘ K ‘ telehea| th. org American Telemedicine Association Videoconferencing Guidelines — Emergencies (2009) . A patient site assessment shall be undertaken, including obtaining information on local regulations & emergency resources, and identification of potential local collaborators to help with emergencies
  21. 21. ‘M ll‘ te| ehea| th. org American Telemedicine Association Videoconferencing Guidelines — Emergencies (2009) . Determine Outside ° Be familiar with local emergency eeverege civil commitment regulations and have arrangements where possible to work with local staff to initiate/ assist with civil commitments ° Establish guidelines for determining at what point other staff and resources should be recruited to help manage emergencies
  22. 22. American Telemedicine Association Videoconferencing Guidelines — Emergencies (2009) . Emergency protocols bf. ‘ f_; shall be created with 1., I em - ' clear explanation of ') I roles & responsibilities ’ _ I in emergencies
  23. 23. CLINICAL TELEI-iEA, i_. ti-i MODELS Eoit succEss SUPPORTED By Tl-lg EVIDENCE BASE Coming next. .. Which models should we follow?
  24. 24. " ' t= ‘ u: ; : . 'E! ‘="lll‘. _'l"1l"rl': ll’l’l' l i'—lt3tIizr-llii. t-to I/ Iigration Model Start with your current clients Select those who are reliable, e have good support systems “ . V . and with whom you have a good working relationship / t. Consider their diagnosis r i’ = 4 Take the time to prepare them ‘ Plan in-person sessions at . - regular intervals V ~ ' ". g l Do not work through their ‘ secretaries or others
  25. 25. irmiwim HELlH ((( r 5 V I V ‘V ' telehealth. org Integrated Model 61> '7‘ A )'t’7l11:s9AM
  26. 26. TELEMENIAL HEALTH ((( N S . Y U V r telehealtlmorg I I Nursing Homes
  27. 27. .. us
  28. 28. Hospitals
  29. 29. Rural Hospitals
  30. 30. eiigi‘ .132) . . i F#? .ii1l; ’[: ii. ;. , , Sill l
  31. 31. Military & Veteran's Administration i / ‘ l ’ , .4 «re 2. I r ' , / -, / . i I I . i X , I ' I .
  32. 32. Home Health
  33. 33. ( ’3.’~? *''l5‘‘. '~’'r%‘~‘f'w‘‘‘*Tj'‘‘ ‘(’: tt': )nij-. hIlli. .-i‘(! C Online Norm vs. Standard of Care * Mostly Email & Chat vs. Video I‘ Anonymity/ Ilo Patient Records ' Avoid Responsibility w/ Website Disclaimers ' llo Clear Channels for Mandated Reporting
  34. 34. V l‘ tE| eheaIth. org i I Online Norm vs. Standard of Care - No Contact with Other Treating Clinicians - No Authentication of Consumer/ Professional - No Emergency Backup Procedures - Misunderstanding of Clinical Processes (suicide) - Operating w/ o Needed Research for Unsupervised Settings
  35. 35. ( "3!5“l‘l5‘: 'l'r'. ‘l"’: ’§‘l'? "l ui’2ii>. nilti. .-i1- mHea| th (mobile health) _. I 2 . , ‘ ( l l i i ) , l: : l l ‘ l l ' ' l 1: r'ifl fir“. rat I l nu: :4 . »«: ..r; - . ; :.‘, )-v-? 3 X , 1 I‘ l r, ~_. -we: V / m 7 me ° 55% of Americans owned a smartphone in March 6, 2013 (comScore) ' Up from 36% in 2/2011; Up 29% from 10/2010 - Reimbursement will soon make geography a non—issue Copyright 2013 Te| eMenta| Health Institute, Inc. All rights reserved.
  36. 36. '3.55“l'l5‘l. ""rfll""f’3‘l‘? ";l i-lt'§ni_: ~r-llli. .-i‘(9‘: Today's teens use media an average of: <0 10 hours and 45 minutes every day 7 days per week* it Americans are already looking to their smartphones for health care K-
  37. 37. ( ’3.’~? *''l5‘‘o'~’'‘%‘~‘f’w‘‘‘v? '‘‘ i=1l': )nrj-r-llliu-v‘(9': Health 8-. Behavioral Care in 20 Years * Mobile devices and peripherals will deliver most health and mental health care —Sensor—based information gathering “ Mirrors, scales, vests, chairs, mattresses, steering wheels, exercise equipment, etc. —Se| f-report
  38. 38. '3.’5“"',5“, ""‘f“""f’§“‘? ";‘ i-. lt'§nr_'~r-llliu-v‘(, -1 Health 8:. Behavioral Care in 20 Years Mobile devices will be networked into central database that will correlate all real—time data with your genetic profile: — as reported by you, family members, friends and neighbors who share your environment; and — demographics of people who share your habits, lifestyle, and personal preferences for food, drink, exercise; — medical conditions and medication; — combined with latest empirical evidence about each source
  39. 39. ’3.’5M*"l5“o'~"‘%‘~‘»‘f”“v? "‘ ‘(’: ll': )nr_'~r-llli. .-iii: Health 8-. Behavioral Care in 20 Years ” Data will be complied into recommendations that will deliver medications, foods other ingestible substances and behavioral prescriptions in ways that will help remedy diseases and problems before they can even be noticed now. 12;: ,f)
  40. 40. (' , |5n: §,l; rIr; ' : ~:1;V_-‘-1:: ,, ( " ' ' _ (Jl: hI: r.IllI. .-Iv , 5 , ., , "1 r‘ . ,4 as Wearable Computers (Glasses) 51'»: ,': *;. _i-‘I u_‘(.
  41. 41. "3.’5M*"l5"‘. ~"'fl‘~‘»‘f’3“~§"‘ idI'3n(_'—! =llli. {-I‘(9‘: Weight Loss S The BodyMedia Core 2 Armband (the Biggest Loser / 24-hr Fitness / Jenny Craig) but now has "jewe| ry-| ike" customization - Sensors: skin temperature, heat flux, (E ’ ~ . galvanic skin response, and a 3-axis ( _ , > accelerometer (pedometer) .4 ( ~ / - Optional add-on: a continuous heart- xx‘ rate monitor using dry electrodes - Bluetooth Smart connectivity allows BodyMedia data to be uploaded to BodyMedia’s smartphone apps - Waterproof, can be worn for swimming / Size of iPod Nano ° To release in August for $119 - $149
  42. 42. '3.’5M*"':5“: '~"‘%‘~‘»‘f”“v? "‘ ‘(’4t': )nr_'~r-llli. .-iii: Muse to Control Emotions lnterAxon Muse monitors your brainwaves and transmits the readings to your smartphone “ "brain training” software designed to help people ' gain more control over their thoughts and emotions “ The device will sell for $199 when it launches in 2013
  43. 43. ' . E‘. fl:NlA. ~m. 'r« te| ehealth. org Th cmlt Aouf Marlene M. Maheu, Ph. D. Te| eMenta| Health Institute, Inc. Phone: 619-928-2627 Email: drm@te| ementa| hea| th. com

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