1. An Introduction to Telebehavioral Health Jodi Polaha, Ph.D., East Tennessee State University

2. Overview Presentation Style Dealing with Distance Setting It Up Example and Research

3. Overview Setting It Up Presentation Style Dealing with Distance Staff Scheduling Equipment Example and Research

4. Setting It Up: Equipment Provider Site: Teleconferencing Client site: Teleconferencing

5. Setting It Up: Equipment Types: POTS, e-mail, internet, etc. Store-and-forward Robotic telepathology Home health devices Real-time video/two-way videoconferencing

6. Setting It Up: Equipment Home Health

7. Setting It Up: Equipment Monitor-Based PC-Based, “Web Cams” Polycom, LIfeSize, TandbergLogitech, Via-Video, ViGO Videoconferencing

8. Setting It Up: Equipment Dedicated Line “T1” Faster/Clearer More stable More secure Internet “High-Speed”/Cable Cheaper Easier More flexible Transmission:

9. Setting It Up: Equipment Provider Site: Teleconferencing FAX/e-records Telephone access Good lighting Forms Client site: Teleconferencing FAX/e-records Telephone access Good lighting Forms Toys/Specialized equipment

10. Overview Setting It Up Presentation Style Dealing with Distance Staff Scheduling Equipment Example and Research

11. Setting It Up: Staff Provider Site: IT person (on call) Coordinator Client Site: IT person (on call) Coordinator

12. Setting It Up: Staff Provider Site Coordinator: Maintains list of all sites, connection info Orients new sites Provides central point of contact for all parties Manages billing/insurance for provider Manages other paper work

13. Setting It Up: Staff Client Site Coordinator: Coordinates room/equipment in advance Assists in insuring paperwork is administered Tests client equipment, demonstrates, troubleshoots *Insures professionalism, privacy at client site Provides point of contact for all parties during the visit

14. Setting It Up: Staff Checklist

15. Overview Setting It Up Presentation Style Dealing with Distance Staff Scheduling Equipment Example and Research

16. Setting It Up: Scheduling Patient/ Referral Source Clinician Site Coordinator Clinician Patient Site Coordinator Both “yes” Either “no” ConfirmRepeat

17. Overview Setting It Up Presentation Style Dealing with Distance Staff Scheduling Equipment Example and Research Camera Skills and Set Up Meeting the Client Theatrics

18. Presentation Style: Camera Skills and Set Up Sit > 8’ to improve “eye contact.” Frame head and tops of shoulders. Use PIP to insure your image. Practice with the remote. Be aware of “mute.” If possible, keep your materials in front of you.

19. Overview Setting It Up Presentation Style Dealing with Distance Staff Scheduling Equipment Example and Research Camera Skills and Set Up Meeting the Client Theatrics

20. Presentation Style: Meeting the Client Checklist

21. Overview Setting It Up Presentation Style Dealing with Distance Staff Scheduling Equipment Example and Research Camera Skills and Set Up Meeting the Client Theatrics

22. Presentation Style: Theatrics Wear blue, or at least, no stripes. Exaggerate nonverbal behavior. Label your “off screen” behavior. “Mute” your microphone when not talking.

23. Overview Setting It Up Presentation Style Dealing with Distance Staff Scheduling Equipment Example and Research Camera Skills and Set Up Meeting the Client Theatrics Building Rapport Cultural and Related Issues

24. Dealing with the Distance: Building Rapport Discuss concerns or skepticism at outset and throughout. “Shape” interaction with equipment by reinforcing verbalizations, use of remote, response to delay, etc. Consider having children or others who may be disruptive “skip” the first visit. Vocalize/ask about what you can’t see/hear. Reinforce patient responsiveness to atypical framework.

25. Overview Setting It Up Presentation Style Dealing with Distance Staff Scheduling Equipment Example and Research Camera Skills and Set Up Meeting the Client Theatrics Building Rapport Cultural and Related Issues

26. Dealing with the Distance: Cultural and Related Issues The State of New Mexico is importing its mental health services for the prison system from Indiana. What problems might be encountered from a therapeutic perspective? Can these be overcome? If so, how? If not, why?

27. Dealing with the Distance: Cultural and Related Issues Engage site visits at intervals. Consider focusing on one geographic area. Know as much as possible about client’s town/geographic area. Acknowledge needs while working toward increased cultural competence. Take action when clients are not responding well.

28. Overview Setting It Up Presentation Style Dealing with Distance Staff Scheduling Equipment Example and Research Camera Skills and Set Up Meeting the Client Theatrics Building Rapport Cultural and Related Issues Nebraska Program Other Research

29. MMI Behavioral Health Outreach Clinics 2006 Gordon BHC Est. 2004 at Gordon Medical Clinic Chadron BHC Est. 2004 at Chadron Medical Clinic Columbus BHC Est. 1997 at CCH Pediatric Kearney BHC Est. 2003 at Kearney Clinic Pediatrics Hastings BHC Est. 1998 at Children and Adolescent Clinic, P.C Nebraska City BHC Est. 2004 at Physicians Clinic Plattsmouth BHC Est. 2000 at UMA Plattsmouth Crete BHC Est. 2005 at Physician’s Clinic Omaha-Metro Clinics Papillion BHC, 2000 Eagle Run BHC, 2001 Creighton BHC, 2003 Crawford BHC Est. 2004 at Crawford Medical Clinic Lincoln BHC Est. 2005 Fremont BHC Est. 2005 at Professional Partners Valley BHC Est. 2003 Nebraska Program

30. MMI Behavioral Health Outreach Program Mission 1. Provide Behavioral Health Services 2. Train and Retain Providers 3. Conduct research 4. Address public policy

31. Nebraska Program

32. Adjunct Service: The Pediatric Behavioral Telehealth Clinic Aims Provide temporary services as needed Provide “permanent” services as needed Provide value-added specialty services Give consumers choice Provide supervision for licensure

33. Omaha Nebraska Program Omaha

34. Nebraska Program: Services Provided 13 remote sites 90-420 miles from Omaha 0-45 “consumer” miles (M=10)

35. Omaha Nebraska Program: Services Provided Omaha

36. Nebraska Program: Services Provided 49 families in over 230 visits regular outpatient visits (n=0-18, M=6)

37. Nebraska Program: Services Provided Age: M = 8.2 yrs Insurance:45% Medicaid Referral:75% primary care physicians 20% specialty clinics 5% other

38. Nebraska Program: Services Provided Presenting Complaints:  Disruptive behavior (ODD/ADHD)25  Behavior with MR 9  Toileting 2  Sleep 2  Anxiety/Mood 5  Hair Pulling 1  Feeding Disorder 1

39. Nebraska Program: Outcomes Teleconference Satisfaction Survey (Collected for 50% of the sample) QuestionMean ScoreStandard Deviation Could see doctor clearly5.43.79 Had no trouble hearing doctor5.29.95 Able to speak freely and ask questions5.76.52 Doctor was able to ask me questions5.80.41 Doctor seemed to understand my problem5.44.91 I was comfortable with/understood what doctor told me 5.321.15 The camera made me embarrassed1.721.27 Telemedicine makes care more accessible5.86.38 Telemedicine is as good as face-to-face encounter5.00.82 Overall, I am satisfied with telemedicine5.71.63 1=disagree; 6=agree

40. Nebraska Program: Outcomes Teleconference Satisfaction Survey (Collected for 50% of the sample) QuestionMean ScoreStandard Deviation Would prefer telemedicine visit rather than waiting for face-to-face 4.881.54 Would have traveled if not used telemedicine4.761.59 Traveling would have cut into my work or school time 4.601.86 Traveling would have affected my wages4.432.07 Traveling would have caused other inconveniences 5.001.83 Would prefer face-to-face visit rather than telemedicine 3.141.72

41. Nebraska Program: Discussion Movement to more localized/regional model

42. Omaha Nebraska Program: Services Provided Omaha

43. Nebraska Program: Discussion Movement to more localized/regional model Increased rigor in outcome study Improvements to satisfaction survey

44. Nebraska Program: Overview Setting It Up Presentation Style Dealing with Distance Staff Scheduling Equipment Example and Research Camera Skills and Set Up Meeting the Client Theatrics Building Rapport Cultural and Related Issues Nebraska Program Other Research

45. Nebraska Program: Other Research Feasibility studies Satisfaction surveys Demonstration projects Controlled trials