2.  Lana.Frankenfield@va.gov from the Rocky Mountain TeleHealth Training Center. We are here for your Clinical Video Telehealth training needs. Lana.Frankenfield@va.gov  Please place your phone on mute and do not place on hold to avoid noise and distractions. If you do not have a mute button, please dial *6 to turn on mute. Dial *6 again to un- mute when you want to ask a question or make a comment.  If you are personally not logged into LiveMeeting because you are sharing the meeting with someone. Email Lana.Frankenfield@va.gov so you may receive credit. Lana.Frankenfield@va.gov

3.  We will have a Q& A discussion following the presentation  Type your questions into the Question the Presenter box on the LiveMeeting Console  We will revisit them in order following the presentation  Or just hold and we can discuss after the presentation

4.  For full screen view – Press F5 To return to LM Console – Press Esc  SharePoint under construction  You can download the presentation from the Handout resource in LiveMeeting  The Forum is recorded  Sue is not available today so any technical problems I can email presentation to you

5. References: Telemental Health Suicide Prevention and Emergency Planning Emergency and Contingency Guidelines on website Lana Frankenfield, LCSW

7.  Technology Emergencies  Mental Health Emergencies  Disruptive Behavior  SI/HI  Medical Emergencies  Policies and Procedures  Patient Selection?  Q & A

8.  Know your equipment.  Do you have a POC/resource guide near you when are conducting CVT? Such as: Telehealth Team Contact List and End Point Phone Numbers.  What is it you can do (need to know) before calling your IT personnel if technological problems happen? Such as: video issues local site/remote, audio issues local site/remote site, connectivity/ alternate connections?  What are yours and patient end Service procedures for any technical emergencies?  Basic troubleshooting guide close at hand

9.  Do you know the existing emergency procedures for patients verbally or physically acting out at each patient site?  What if the patient becomes imminently dangerous to on-site staff and/or their caregiver while is session?  How will you notify the patient end (local) staff that there is a dangerous patient? Who would they call on-site, how would they respond? What if the person designated does not respond?  Do they have Security/Police on site? If not, how quick can Police respond/be on campus? Who will call them? Other numbers besides 911? Where is the pt located (room/floor/address).  What if the patient leaves the Telehealth room visibly/verbally upset and you cannot locate him physically or by phone?

10.  What if the patient is making statements regarding feeling suicidal and/or homicidal?  How would you alert the patient end staff the patient needs a Mental Health Evaluation or Urgent Mental Health Care? What if they do not respond?  If you have or are a telepresentor: who takes the lead, who implements the procedures? Do you know the procedures for the patient site?  What is your role after the patient is seen by local MH staff?  What is the process you take with your patient at the next visit?

11.  What if the patient is making statements/ has a plan regarding suicidal and/or homicidal ideation/intent?  What are the procedures for CVT assessment?  Do you know the existing policy for voluntary psychiatric hospitalization at the patient site?  How would you alert the patient end staff that the patient needs voluntary hospitalization? What if they do not respond?  Would the patient go to the VA or a local facility? What are the local emergency mental health resources? Who decides?

12.  Do you know your state's laws/VA policy on governing involuntary hospitalization? Do they allow remote clinicians to get detention orders? If not, who will get the order? Can another on-site clinician obtain detention orders?

13.  What is the existing procedure at the remote site for handling medical emergencies?  How would you notify the patient end sight there is a medical emergency in the Telehealth room? Who would they contact?  Would the patient go to a VA or other (closer) hospital? Who decides that?  Who would call for the ambulance, how would family members be addressed or notified?

14.  How would you manage your appointment if a fire alarm, weather alert, bomb threat, or any other emergency alert system is conducted?  How would you manage the situation if the equipment is in use due to a local emergency?

15.  Are there any transportation policies in place for patients with medical or mental health emergencies?  How will the patient be transported? Who would arrange the transportation? Who would wait with the patient until transportation arrives?

16.  How are prescriptions disseminated from the remote clinic?  Will on-site staff need to be involved?  Will a local pharmacy need to be involved if medication is needed imminently?  Will the prescription be called in and by whom? Or will a prescriber on-site write an urgent prescription?

17.  Conditions of Participation (CoP)  49 CCT: The VISN CCT program maintains an emergency plan and implements strategies to minimize the risks of disruption of care due to environmentally related and technology related emergencies in accordance with CCS guidance (EC)  22 CCT: The CCT program has a mechanism for managing urgent health issues (PC)  MH typically has ER templates: in handouts

18.  Judgment is the key  Pt hx (Flags, Disruptive Behavioral Notes, medical/MH)  Face to face assessments/initial appointment  Have they used Telehealth before?  Did the pt have traumatic experiences on deployment while Video conferencing equipment?  Risk and protective factors  Available support resources at the patient site