1. Introduction to Telemental Health © 2016 Behavioral Health Innovation Introduction to Telemental Health Jay Ostrowski, MA, LPC-S, NCC, DCC, ACS, CTCP jay@behavioralhealthinnovation.com

2. Introduction to Telemental Health © 2015 Center for Credentialing & Education Introduction to Telemental Health Outline How TMH has changed over time Need for Telemental Health (TMH) services Increase your business with TMH Research and laws regarding TMH Answers to common questions What it takes to get started and additional resources

3. Introduction to Telemental Health © 2015 Center for Credentialing & Education Modalities 1. Text-Based 2. Video 3. Avatar

4. Introduction to Telemental Health © 2015 Center for Credentialing & Education Terms 40+ Terms Used: 1. Avatar counseling22. Online therapy 2. Avatar therapy23. Remote counseling 3. Chat therapy 24. Remote therapy 4. Clinical video therapy 25. Second life therapy 5. Cyber-counseling 26. Skype therapy 6. Cyber-psychology 27. Sms therapy 7. Cyber-therapy 28. Technology-assisted 8. Distance counseling 29. Telebehavioral health 9. Distance therapy 30. Telecounseling 10. Electronic means 31. Telehealth 11. Electronic practice 32. Telemedicine 12. Electronic methods 33. Telemental health 13. Email counseling 34. Telepractice 14. Email therapy 35. Telepsychology 15. Ecounseling or E-counseling 36. Via telecommunications 16. Etherapy or E-therapy 37. Video chat 17. Icounseling or I-counseling 38. Video counseling 18. Internet mediated 39. Video therapy 19. Internet therapy 40. Text therapy 20. Internet counseling 41. Web counseling 21. Online counseling 42. Web therapy. + © Ostrowski 2016 In Press

5. Introduction to Telemental Health © 2015 Center for Credentialing & Education Terms Most CommonThis Presentation Telemental HealthTelemental Health - means live Online Therapy secure video services for both Online Counseling mental health and behavioral health License Boards Distance Provider = any licensed Electronic professional Technology Tele…

6. Introduction to Telemental Health © 2015 Center for Credentialing & Education Telemental Health Grew Up High speed internet Secure technology Reimbursement Liability insurance Ethics and guidelines Provider Training Networks of providers Assistance for starting or growing

7. Introduction to Telemental Health © 2015 Center for Credentialing & Education Need for Telemental Health Scenario Family member needs treatment. Closest treatment is 2 -3 counties away. How likely are they to obtain and sustain treatment?

8. Introduction to Telemental Health © 2015 Center for Credentialing & Education The Need = 58 Million do not get adequate care Two-thirds of PCPs struggle to refer to mental health providers ~ Commonwealth Fund (Includes adults (htt://1.usa.gov/MPYzPQ, http://1.usa.gov/N5kwH4) and children (http://1.usa.gov/N5kDma, http://1.usa.gov/LDRbU6, http://bit.ly/RwQkaW)

9. Introduction to Telemental Health © 2015 Center for Credentialing & Education Mental Health Service Shortages

10. Introduction to Telemental Health © 2016 Behavioral Health Innovation Access Problems Millions of clients lack access Mis-match of specialty and need Providers waiting for clients Clients & provider mobility issues Travel and operations costs with multiple clinics

11. Introduction to Telemental Health © 2016 Behavioral Health Innovation In-Person Limitations No Telehealth * Limited * Service area * Types of services * Talent pool * Growth options * Satellite offices are expensive * Many unreached

12. Introduction to Telemental Health © 2016 Behavioral Health Innovation Good for Business Expanded Reach Reach new markets Increase service Volume Type - New talent Reduce operating expenses Increase efficiency

13. Introduction to Telemental Health © 2016 Behavioral Health Innovation Settings Clinic-to-clinic Clinic-to-X School/Prisons/Corp Clinic to client home (DTC = Direct-to-Consumer) Clinician home to client home (DTC = Direct-to-Consumer)

14. Introduction to Telemental Health © 2016 Behavioral Health Innovation Telemental Health Support Dept of Health and Human Services SAMHSA - TIP 60: Using Technology-Based Therapeutic Tools in Behavioral Health Services Office for the Advancement of Telehealth Telehealth Resource Centers DOD - VA White House 3,000 + peer reviewed journal articles

15. Introduction to Telemental Health © 2016 Behavioral Health Innovation Telemental Health Momentum VA - 280,000 cases in 2013 and growing Increase in Corporate Offerings According to the National Business Group on Health, 74% of large employers, those with over 1,000 employees, are expected to offer telehealth services, including telemental health, to employees in 2016 Veterans Services compared to 48% in 2015 (Grensing-Pophal, 2015). (Grensing-Pophal L. (2015). Tracking healthcare trends. Human Resource Executive Online website. www.hreonline.com/HRE/view/story.jhtml?id=534359199. Published September 2, 2015.) www.hreonline.com/HRE/view/story.jhtml?id=534359199

16. Introduction to Telemental Health © 2016 Behavioral Health Innovation Common Questions Research on effectiveness? Is it legal? Can I cross state lines? Best practices? Reimbursements? HIPAA-secure technology? How to Start? Where to find assistance?

17. Introduction to Telemental Health © 2016 Behavioral Health Innovation Effectiveness Research on Telemental Health Positive Outcomes High Patient Satisfaction Moderate to High Clinical Satisfaction Meta-analysis of 92 studies of Meta-analysis of 148 peer-reviewed studies on online therapy the use of video therapy online Journal of Technology in Human services, Vol. 26, No. 2 Clinical Psychology: Science and Practice, Vol. 16, No. 3

18. Introduction to Telemental Health © 2016 Behavioral Health Innovation Telemental Health Laws By Profession All Board Have Specific TMH Law Counseling Board Only Psychology Board Only Social Work Boards Only Two Boards have Regulations No Official Law

19. Introduction to Telemental Health © 2016 Behavioral Health Innovation Professional Guidelines AAMFT - American Association of Marriage and Family Therapists - Code of Ethics ACA - American Counseling Association - Code of Ethics AMA - American Medical Association - Resolution 317 in favor of quality telemedicine policies APA - American Psychological Association - Guidelines for Ethical Practice of Telepsychology ATA - American Telemedicine Association - Guidelines for Video Telemental Health NASW - Standards for Technology and Social Work Practice NBCC - National Board for Certified Counselors - Code of Ethics for Distance Services

20. Introduction to Telemental Health © 2016 Behavioral Health Innovation Reimbursement 40+ states have States with Coverage for Telehealth Services Medicaid and Medicare reimbursement 20+ states & DOC Mandate 3rd party insurance reimbursement in some form Most 3rd party payers BCBS, Aetna, OPTUM + Private pay Medicaid and Private Insurance Coverage for Telehealth Medicaid Coverage for Telehealth Private Insurance Coverage for Telehealth No Required Coverage for Telehealth or No Data

21. Introduction to Telemental Health © 2016 Behavioral Health Innovation Dangers There are dangers in Telemental Health Proper training and procedure makes driving safer.

22. Introduction to Telemental Health © 2016 Behavioral Health Innovation Best Practices 16 Best Practices 9 can be managed by Technology 7 can be handled by creating a simple routine

23. Introduction to Telemental Health © 2016 Behavioral Health Innovation Best Practices: Technology Consider Security Oversight Workflows Referrals Mobility Growth https://www.telementalhealthcomparisons.com

24. Introduction to Telemental Health © 2016 Behavioral Health Innovation Secure Technology Provider and client connect through… Server Collects: * IP Address * Username * Email address Encrypt in transit (over internet) AND in resting state (storage). www.yourweb siteurl.com YourTextYourText YourTextYourText YourTextYourText

25. Introduction to Telemental Health © 2016 Behavioral Health Innovation HIPAA-Secure Technology https://www.telementalhealthcomparisons.com Made for Telehealth http://www.adaptivetelehealth.com/ http://securevideo.com/ http://wecounsel.com/

26. Introduction to Telemental Health © 2016 Behavioral Health Innovation Best Practices Training Security and Privacy Jurisdiction Client suitability

27. Introduction to Telemental Health © 2016 Behavioral Health Innovation Best Practices Informed Consent specific to TMH Back-up communication plans Display professional credentials Emergency procedures (and 8 more)

28. Introduction to Telemental Health © 2016 Behavioral Health Innovation How to Start?

29. Introduction to Telemental Health © 2016 Behavioral Health Innovation How to Start Depends on your organization, goals and requirements Get mentorship Get training and technology Create workflows and practice Start with a pilot Make adjustments Scale up http://telehealthresourcecenters.com/ http://behavioralhealthinnovation.com/ Center for Credentialing & Education: Email BCTHP@cce-global BCTHP@cce-global American Telemedicine Association

30. Introduction to Telemental Health © 2016 Behavioral Health Innovation Summary Telemental Health has lots of names TMH solves an access problem to MH/BH services TMH can grow your business TMH is growing in many areas - schools, hospitals, etc. New technology, efficacy research, Laws and best practices available Reimbursement improved and mandated Support by major Mental Health organizations Dangers are present Overcome the dangers with secure technology, training and practice protocols Assistance is available to help you get started

31. Introduction to Telemental Health © 2016 Behavioral Health Innovation Conclusion Take the next step to get started in Telemental Health. More than 58 Million people are waiting for our help. Your Text

32. Introduction to Telemental Health © 2016 Behavioral Health Innovation Introduction to Telemental Health Thank you. Contact me for assistance with telementalal health technology, laws, training, and support for starting services. Jay Ostrowski, MA, LPC-S, NCC, DCC, ACS jay@behavioralhealthinnovation.com

33. Introduction to Telemental Health © 2016 Behavioral Health Innovation Telehealth Resource Centers 14 Federal funded agencies are focused on supporting telehealth. http://www.telehealthresourcecenter.orghttp://www.telehealthresourcecenter.org/