As New York State has expanded who can provide telemental health/telepsychiatry services to include social workers, I have been thinking about telemedicine a lot… I mean A LOT. Technology certainly has a role in improving mental health care, but how? Electronic health records, apps, and telemedicine are playing an important role in making a difference in timely and affordable access. They can have a positive impact on creating positive experiences for both patients and providers. Mental health still has a long way to go.
There is certainly a lot of promise but how do we get there? Barriers exist in terms of billing, time to learn the technology, understanding regulations, and reimbursement (just to name a few). As I mentioned earlier New York State expanded it’s definition of telemental health services to include social workers. This lead me to start thinking about how this technology can assist in my role as a care manager for youth. I consider doing home visits with complex clients a powerful intervention. Doing home and community based work is a privilege and an excellent way to engage. Telemedicine can serve as a bridge between these face to face contacts. That he opportunities somehow outweigh the barriers.
Although I would never advocate for my clients to be completely reliant on video, doing a check in when weather, illness, or time becomes a factor would be a valuable tool. Rather than having to wait another week I can do a brief session via telemedicine. This would have meaning for both myself and my clients.
The other use case is transitions from inpatient care to the community. Youth are admitted to inpatient services, often with little contact with their families and those that are going to care for them after discharge. In the semi-rural area I work in, families have to travel at minimum 40 minutes to the nearest facility with one being 1 hour and 30 minutes away. It is best practice to involve parents and community providers in care. Having telemedicine to act as a bridge between families and communities could help improve care during this critical time.
These are some of the ways that we can use technology to better scale care but there are many other opportunities that exist. Other models that I have seen are companies like WorkIt Health who provides mix of brick an mortar facilities with telemedicine to provide substance abuse treatment (available in Michigan and California). Another example is Kip Therapy based in San Francisco that provides a similar mix of tech and face to face care.
I really enjoyed this webinar via The American Telemedicine Association and InSight Telepsychiatry on developing a telemedicine strategy. They provided a helpful framework on how to develop a strategy to how it might be beneficial.
A key point was thinking about implementation to grow a programs “across”, “within”, and “around”. This helped me better conceptualize my goals and align with the social work perspective. That creating creating a creating community partnerships and understand the complex challenges our clients and communities face. When we think about adding technology, it’s not just benefiting the organization but the community and systems as a whole….
Now we get to the challenging part. We figured about the “Why” but now the how becomes a little murky. Who pays? What does reimbursement look like? This will vary state to state and locality and their needs. I generated my care coordination wish list for telemental health based on my perceived needs in the community. Now the tricky part is to back this up with numbers and evidence. Will being able to fill gaps due to bad weather benefit client outcomes? Will increasing contact from inpatient level of care to outpatient actually improve outcomes?
This is where data and understanding the needs of a community come in. I started this post with a rather lofty question. Attempting to understand implementation strategy has lead me to think about how technology can be added to the already existing fiber of our mental health system. Social work’s strength in implementing telemedicine is growing from within and across. Rather than creating an entirely new service, growing within existing systems and communities would be my first step.
This is my vision for telemedcine assisting mental health care; what is yours?
