Presentation on theme: "VISN 12 Telemental Health Coordinator"— Presentation transcript:
1VISN 12 Telemental Health Coordinator TELEMENTAL HEALTH IN VA:HISTORY AND NEW OPPORTUNITIESJamie L. Adler, Ph.D.VISN 12 Telemental Health CoordinatorWith thanks to Linda Godleski, M.D., VHA Lead for Telemental Health for information on the history of telemental health within VA.
2Historical Perspective - 1968 Medical television system connected the University of Nebraska Medical CenterOmaha VA HospitalLincoln VA HospitalGrand Island VA HospitalUsed for a psychiatric treatment and training activitiesCost $48,000/yr to connect one site with limited quality
3Historical Perspective - 1968 Broadening of telemental health to large scale operationsMassachusetts General Hospital to:Logan Airport Medical StationBedford VA HospitalPositive outcomes:2.5 years150 patients
4Historical Perspective – 1970’s and 1980’s 15 federally funded telemedicine projects in the 1970sCumbersome and expensive technologiesResurgence in the 1980s with widespread entry into computer age
5VHA Telemental Health – 1990’s VHA becomes a world leader in telemental health delivery starting in 1997
7New Technical Realities Moore’s Law: Computer processing power and speed per unit of cost doubles every months.Has held true since Moore first stated this in the 1960’s.The impact on TMH is that the capability of the equipment and the network is vastly better and considerably less expensive than it was only a short time ago.
8Old Beliefs Die Hard “The human element is missing.” “Telemental health is less safe.”“It’s less effective than ‘real’ (i.e. face-to-face) therapy.”“Patients won’t like it.”
9Recent ResearchSeveral recent studies have shown that, when comparing mental health services delivered by telemental health (TMH) vs. face-to-face (F2F):TMH & F2F have equal patient satisfaction.No difference in attrition.No difference in symptom and functional outcome reports.No interaction of modality with Axis II diagnosis.No increase in safety issues.
10Limitations to Recent Research Most of the studies have been on telepsychiatry.A couple of small N studies on telepsychology and tele-addiction (same outcomes).Much room for investigation in this area.Despite these limitations, currently no data to suggest worse outcomes or lower satisfaction for TMH.
11Traditional “Scarcity” Model Historically, telemental health (TMH) initiatives in throughout the VA have followed a “Traditional” or “Narrow” deployment strategy.Equipment was expensive and hard to come by, often costing over $8000 for each end point.Less expensive equipment, when available, would not provide useable video resolution or motion for clinical work.
12Traditional “Scarcity” Model Facilities had a single originating room used by one dedicated TMH clinician or shared by several clinicians who each had scheduled time blocks.Services to remote sites were rationed and typically were limited to tele-psychiatry.The traditional model was also labor intensive, requiring associated mental health staff to be in the room with the veteran or nearby.
13In the traditional model of telemental health service deployment, expensive equipment is set up in special rooms at both ends of the connection.Equipment expense may limit field deployment, so that not every CBOC will have telemental health endpoints.Access limitations at the facility end mean that services must be rationed out to the CBOCs. Typically, blocks of clinician time are assigned to each CBOC. Hence, a mental health clinician may not be available to most CBOCs for most of the week. [Point out examples]Service rationing may also apply to the types of services available. Many sites limit telemental health services to telepsychiatry. Some add limited blocks of therapy time.
14Transition to a New Approach GOALS:100% coverage of CBOCs.Access to a wide variety of clinical services at all remote sites.Mental Health clinician access throughout the CBOC clinic day.
15Transition to a New Approach GOALS:Access to same-day assessment & treatment planning.Meet the mental health treatment needs of rural veterans who live far from the hospital or CBOCs.Use existing clinician capacity whenever possible.
16“Broad” Telemental Health Deployment Strategy Many or most outpatient clinicians receive inexpensive, computer based or desktop videoconferencing units.Inexpensive “individual” sized video equipment at all remote sites. Attempt to equip multiple rooms at larger remote sites.Mental Health & CBOC conference rooms equipped with more sophisticated group videoconferencing.
17“Broad” Telemental Health Deployment Strategy Utilize data compression capacity of new equipment to reduce bandwidth needs.New Paradigm: TMH is seen as widely available, rather than as a scarce resource to be rationed.Partner with remote non-VA sites to host video endpoints.
18Non-VA Partnerships Reach rural veterans far from VA clinics. Partner site provides room, reception, and possibly network connection.VA assumes responsibility for MH care of veteran.VA can also provide some specialty consultation via video.
26Point out that clinician can control the remote conference room camera.
27New Initiatives$9 Million in FY 2006 to expand general and specialty telemental health care to CBOCs.Further expansion funds available in FY 2007 for CBOC equipment and for VISN-wide PTSD and Addiction TMH care.
28Opportunities for Psychology Substance Abuse Continuity of Care Performance Measure.Evidence Based Psychotherapy for PTSD, Depression, Anxiety, Addiction, Health Psychology.Assessment and Treatment Planning.Limited psychological / cognitive assessment.Primary Care Integration with CBOCs.
29For More information: Jamie L. Adler, Ph.D. Mental Health Service Line (116)William S. Middleton Mem. Veterans Hospital2500 Overlook Terrace, Madison, WI 53705/ Fax: