General Tips for Mental/Behavioral Health Integration into Telehealth

Leveraging Telehealth for Follow-up Mental/Behavioral Health Appointments

One practice increased access to mental/behavioral health by leveraging telehealth for follow-up appointments. Strategies and preliminary results include:

• After an initial in-person clinical appointment, hold a follow-up visit via telehealth from the patient’s home.
  • Update practice workflows to help the patient and family/caregiver set-up for a telehealth visit within their home, including setting up a link and ensuring a good broadband/internet connection.
  • Build in time to train patients, families/caregivers and staff on using telehealth.
• Work with adolescents to find as private of a space as possible, such as the adolescent’s bedroom, for the telehealth visit.

Preliminary outcomes include improved follow-up for mental health visits, reductions in driving and travel time for patients and families/caregivers and continued access to care within the medical home.

^{The tips and strategies outlined in this promising practice were provided by Bozeman Health.}

Integrating Mental/Behavioral Health into Pediatric Medical Homes using Telehealth

One practice hosted joint telehealth visits between a child and adolescent psychiatrist and a pediatric trainee to better integrate mental/behavioral health services into pediatric medical homes and increase access to mental/behavioral health services for patients and their families/caregivers. Strategies and preliminary results include:

• Use video-conferencing platforms to include multiple clinicians and families/caregivers in the same mental/behavioral health follow-up visit. This practice included a child and adolescent psychiatrist in the visit along with a pediatric trainee.

Preliminary outcomes include:

• Increased support for residency training in mental/behavioral health.
• Decreased wait times for follow-up appointments with mental/behavioral health specialists.
• Integrated mental/behavioral health services within a patient/family-centered medical home.

^{The tips and strategies outlined in this promising practice were provided by Weill Cornell Medicine.}

Utilizing a Virtual Group Therapy Model

One hospital developed a guide for mental/behavioral health providers to support best practices in providing virtual group therapy for a variety of mental/behavioral health diagnoses. Tips and strategies are based on the experiences of clinicians who adapted their group therapy sessions at the onset of the COVID-19 pandemic. Strategies and preliminary results include:

• Develop a guide with recommendations for mental/behavioral health providers who traditionally provide group therapy in-person to adapt to providing virtual group therapy. The guide may include the following components:
  • Recommendations related to processes, roles & responsibilities, technology tips, and therapeutic considerations.
  • Information on building rapport in a virtual group setting and ensuring how to run group sessions effectively and on time.

To implement virtual group therapy, practices may need to prepare the following:

• Access to a private location
• A reliable internet connection
• Basic video-conferencing skills
• A laptop or computer with a camera and microphone
• Support families/caregivers in accessing as private of a space as possible, internet connection, and a device with a camera and microphone.
• Adapt workflows to assign an additional facilitator to the group, or to assign roles of facilitator and clinician group leader for the sessions.
• Obtain patient consent before starting a virtual group therapy session.

Preliminary outcomes, evaluated through interviews with clinicians providing group therapy and via patient post-group surveys, include:

• Continued care for patients and families/caregivers during the pandemic.
• Expansion of access to care for families/caregivers in rural and remote regions.
• Expansion to a larger geographical location; increase in referral numbers.
• Improved family/caregiver participation for those who were unable to travel previously.
• Increased scheduling flexibility.
• Positive feedback from providers and patients/families/caregivers.

^{The tips and strategies outlined in this promising practice were provided by BC Children's Hospital.}

Increasing Access to Mental/Behavioral Health Services in a Pediatrics Inpatient Setting

This promising practice designed an intensive remote mental/behavioral health support strategy to increase access to mental/behavioral health services for patients who tested positive for COVID-19 on an inpatient pediatric ward and could not transition to inpatient psychiatric units. The goal of this program is to reduce inpatient length of stays, while increasing patient and medical provider satisfaction. Strategies and preliminary results include:

• Utilize a licensed secure telehealth platform to connect the patient and family/caregiver to therapy sessions via tablets.
• Obtain patient consent before providing the tablet to the patient for the virtual therapy session.
• Patient answers video call without being required to login for scheduled appointments.
• Emulate the same care the patient would receive in an inpatient psychiatric unit.
• Virtual appointments are scheduled with a social worker, psychiatrist, an education specialist, and a mental health counselor.
• Virtual group therapy sessions are also held.
• Provide the patient, family/caregiver and nursing staff with clear expectations at the beginning of the inpatient stay.
• Train staff on utilizing the technology for the virtual appointments, including use of the tablets.
• Create partnerships with pediatric hospitalists who were the admitting physicians and bedside nursing staff.
• Adapt nursing staff workflows and communicate with rounding pediatric hospitalists to minimize interruption of the virtual therapy sessions.
• Collaborate with the medical floor team on any changes in programming and to communicate any acute safety concerns.
• Medical staff buy-in and satisfaction with results helps to incorporate change in workflows.
• Adjust therapeutic interventions to adapt to the telehealth platform/visit type, such as bringing supplies to the medical floor for group sessions ahead of time.

Preliminary outcomes include:

• Most patients were engaged in effective treatment sessions and no longer required inpatient supervision to maintain safety. Many were able to complete quarantine at home while participating in an outpatient virtual program.
• Potential for decreased inpatient length of stay.
• Improved coordination of the inpatient medical and psychiatric teams.
• Increased access to mental/behavioral health services to all patients on the inpatient pediatric unit, including underserved populations.

^{The tips and strategies outlined in this promising practice were provided by Anonymous Contributors.}