History
telepsychiary has been around since ________
it started at __________ psychiatric institute using video conferences to provide
1950
Nebraska
group therapy, Long term therapy, consultation liaison psychiatry, and medical student training
Pt ________ & ________ are similar to in person care
privacy and confidentiality
PMHNP are not trained in _________ communication skills
Recommendation from APA (2022)
media
providers review their own virtual performance and continuously critically evaluate and improve performance
Emergency flexibilities of Ryan Haight Act
emergency flexibilities extended until 12/31/24
1, pts can be prescribed schedules 2-5 without a prior in person appt. as long as it is in scope of practice
DEA registration allows prescription of controlled substances in ANY state
MI involves a ___________
Founded on the person has _________ to change
MI is _________ of communication
partnership
desire
method
1969 Mass General offered ______ __________ of adults and children at Logan International airport
psychiatric consults
APA Advocacy Requirements
1. maintain privacy and confidentiality
2, patient preference and provider judgement
build knowledge through research
3. reimbursement rates should be same as in person
******* home base office to see pt if needed
How can you use technology to your advantage
1, can you show ne your living space
2. how do you keep your medication.?
3. Who is yelling in the background?
4. witness child abuse-call 911
Safety and Security
APA recommendations
use approved platforms
get permission for telehealth service
have safety plan preprepared-KNOW pt's address
conform identity of person-confirm identity, especially of you are not familiar with them
make sure it is a GOOD time for appt- not driving
email, text, IM, messaging only be used for pt with in pt f/u
What is OARS
Open ended questions
Affirming
Reflecting
Summarizing
1990 gained interest across the world practically in ___________ to facilitate ________ to care and overcome___________ obstacles
Australia
access
geographical
promote quality outcomes
environmental factors- have a good space to work
resist temptations-can you be out of the country and see pts? digital footprints
need for structure- some need structure of office
adequate technology, including a plan B if power failure
confirm right patient, right time
prepare for emergencies - confirm name, address, and phone #
What is telehealth fatigue
can leave providers sluggish/disinterested
staring at computer takes a toll
"performing" all day for the camera
technical issues can lead to delays in schedule-pts frustrated
no time to walk one out and another in--no change in position
led to cosmetic therapy --TURN OFF SELF camera
Telehealth and Social media
be mindful of confidentiality an intentionality when reviewing a pt's social media accounts
What YOU say and post CAN and will BE HELD AGAINST YOU.
OARS applied to phases of change
Engagement
Focusing
Evoking
Planning
Eng- establish trust and helping relationship
Foc-identify direction/target of chane
Evk-bring forth motivation for change
Pla-elicit plan that will be followed
2000s what to associations were developed to organize telepsychiatry?
American telemedicine Assoc
&
American Psychiatric Assoc.
Nothing is sacred
anticipate outcomes if you overshare
Have appropriate time and space.
BOUNDARIES don't introduce family
Barriers to care
Advocate for pts
digital divide not all pts will be comfortable with technology or have adequate internet
not all pts have privacy
homeless or restricted funds
work around- use telephone
Safety & Emergency Management
1. ALWAYS assess pt level of agitation, potential for harm to self and others, and additional safety hazards evident during the session2. know pt's physical location local geography (county), and closet resources
3. call 911 will take you to closet location of caller inform them you are NOT the pt
know the county where located crisis resources are divided.
Transtheoretical 5 stages Model of Change
Precontemplation-no, not me=denial
Contemplation- well/maybe =thinking about change
Preparation-what do I do know= making plans
Action- let's do this
Maintenance- It is possible
telepsychiatry is ________ to in person care in diagnostic accuracy, treatment effectiveness, and pt satisfaction
equivalent
Lessons learned from case clinical application doing telepsychiatry
right pt
address & phone #
drug use
weapons
animals in home
Ryan Haight Online Prescribing Pharmacy Consumer Protection Act 2008 (article)
1.Act requires any practitioner issuing a prescription for a controlled substance to conduct an in person medical evaluation prior to prescribing controlled substances' additional visit are not mandated
2. covering practitioner who conducts a medical evaluation(by telemedicine) at the request of provider who conducted at least 1 in person medical eval of the pt or an eval of the pt through telemedicine with in a 24 month period
3. psychiatrist need to make sure they comply by federal, state, and organizational rules & policies around prescribing controlled substances
Cultural considerations
1. educate yourself in advance
2. be flexible & adapt
3. know your limits when it comes to language and NEVER fake it until you make it
4. use caution when make assumptions-ask for clarification
FRAMES approach to feedback
Feedback results of standard test
Responsibility
Advise providing permission
Empathy and Empowering
Self-efficacy