1. Ohio Department of Alcohol and Drug Addiction Services Telehealth Webinar August 25, 2010

2. CSAT TA & Telehealth Blue Ribbon Panel Met monthly from February through May 2010 Explore the benefits and limitations of telehealth Define services – explore how telehealth can be utilized across Ohio How to get paid Establish rules for AoD services Webinar recommendation

3. Telehealth Telehealth, e-therapy, online counseling, telemedicine, telemental health, videotherapy, interactive videoconferencing, distance counseling, Internet-supported therapeutic interventions, e-health

4. Telehealth Definition ODADAS rule – interactive videoconferencing - use of secure, real-time audiovisual communications of such quality as to permit accurate and meaningful interaction between at least two persons This expressly excludes telephone calls, facsimile machines, and text messages without visualization of the other person, i.e., electronic mail.

5. Telehealth Services considerations Assessment Individual Counseling Group Counseling Case Mangement

6. Telehealth Potential Benefits Make it possible for clients to access services at any time, any day of the week Take services to clients in remote and under-served regions Reach out to clients who are physically unable to leave their homes Provide confidentiality for clients in small communities Increase honesty and candor – experience shows clients may be more forthcoming on the Internet than in person Reach clients who are unwilling for a variety of reasons to seek face-to-face services Give clients access to highly specialized practitioners, since geographical proximity is not an issue

7. Telehealth Potential Benefits Make services available to clients who are highly mobile, since they can access services from any internet portal anywhere in the world Reduces the time needed for the client and practitioner to develop rapport Make help available to the client at the time of greatest need Give the practitioner access to a larger pool of potential clients Make it feasible for practitioners to develop more specialized practices Allow practitioners more flexibility in their work schedules

8. Telehealth Limitations The potential for miscommunication may be greater online due to lack of non- verbal and paralinguistic cues Lack of access to client’s non-verbal behavior may make it difficult to correctly assess and diagnose disorders Online services may turn out to be ineffective – little research exists on the efficacy of online services Differential effectiveness – online services may be completely inappropriate for people experiencing psychotic symptoms whereas they may be very particularly appropriate for children with attention deficit disorder Is difficult to insure the confidentiality of online communications The ability to intervene in emergency situations (e.g., suicidal client) may be severely limited Clients may misrepresent themselves, undermining the integrity of the services provided Fewer safeguards for clients increases the burden on them to be intelligent consumers Online services are available only to clients who have access to the internet and the skills to use it

9. Telehealth

12. Establish rules for AoD services How does the state regulate Confidentiality Framework –group/individual/assessment Allow for flexibility

13. Confidentiality All treatment services provided by interactive videoconferencing shall begin with a verification of the client through a name, password pin number

14. Confidentiality All data, including audio, video, text and presentation materials shall be transferred using a minimum of 128 bit-encryption. All treatment services rendered by interactive videoconferencing using the public internet must use at a minimum the Advanced Encryption Standard (AES) algorithim or be rendered through use of a Virtual Private Network (VPN) to ensure the transmission is secure.

15. Resources SAMSHA http://download.ncadi.samhsa.gov/prev line/pdfs/sma09-4450/sma09-4450.pdf http://download.ncadi.samhsa.gov/prev line/pdfs/sma09-4450/sma09-4450.pdf NARBHA http://narbha.org/for- providers/telemedicine/

16. ODADAS Telehealth Next Steps State participation in CSAT regional meeting FAQs Filing of telehealth rule