First, even though the local departments of health had telepsychiatry capabilities, they were resistant to allowing their equipment to be used by an outside agency. All of the health departments declined requests to utilize their equipment to provide telemental health services. The therapist then contacted the core service agency, the oversight body for all mental health services in the region. When the core service agency offered a request for proposal (RFP) that would allow agencies to purchase the equipment, provided that they work with Arundel Lodge, one agency stepped forward. In later years, with persistent and consistent outreach from both the therapist and the core service agency, other agencies eventually decided to partner with Arundel Lodge. MOU was created between Arundel Lodge and the partnering agency. The MOU outlined the purpose of the agreement: (1) To increase the accessibility of services by establishing outpatient mental health services via teletherapy on the eastern shore and (2) to facilitate the referral and delivery of outpatient mental health services between the two agencies and outline individual and shared responsibilities. Arundel Lodge, the distant site, agreed to provide the following. ● Individual and group psychotherapy ● Intake evaluations and diagnostic assessments ● Development and monitoring of the individual treatment plan ● Referrals to other service professionals as deemed medically necessary (e.g., psychiatric evaluations or medications) 4. Establish memoranda of understanding (MOU) to outline responsibilities for each site. A seven-page ● Collaboration with members of the service team ● Collaborations with other partnering agencies ● Management of emergency and crisis intervention The originating site would provide the following: ● Psychiatric evaluations and medication management ● Lab requisitions required for medication management ● Accessibility and assistance to clients using videoconferencing equipment ● Collaboration with members of the service team ● Collaboration with other partnering agencies ● Management of emergencies and crisis intervention The MOU also included specific steps for each agency to coordinate a plan of safety for the client in case of emergency (see sample described earlier). All telemental health sessions in the early stage were required by state regulations to have an attendant in the office at the originating site. However, recent changes in the regulations allow for home-based therapy (discussed later in the case example). Billing issues, such as who would bill for what services, were also addressed in the MOU. In Maryland, the originating site can bill the state for the telehealth fee for each session. The MOU also specified the type and amount of certifications and professional liability insurance required by each agency. Once the terms of the MOU were satisfactory to both parties, then signatures of the chief executive officers (CEO) would implement the agreement. 5. Create marketing materials. Once the service was ready to launch, marketing materials were created, which consisted of postcards that were mailed to private clinicians as well as clinics, hospitals, vocational rehabilitation agencies, local health departments, and other organizations that might make referrals. The postcards highlighted the services Arundel Lodge provided as well as the sites where equipment was located and contact information. These served
as materials that were offered at presentations, conferences, and organized outreach events. 6. Train staff. Staff members were trained at both the distant site (i.e., Arundel Lodge) and originating sites (i.e., local mental health clinics) about how to make referrals for telemental health, make appointments, set up the equipment, and call the distant-site therapist when clients arrived. Training was an essential component of the telemental health program. Initially, the coordinator and therapist providing direct services received approximately 40 hours of online training from the Telebehavioral Health Institute. Training included such topics as confidentiality, security, technology, and informed consent. Once training was received and the coordinator and therapist had hands-on practice with the equipment, face-to-face training was offered to staff members at the partnering agencies. In addition, the coordinator created a flyer for staff about how to call Arundel Lodge on the Polycom system and provided contact information for both therapist and coordinator. Training is offered to sites yearly or as needed now that the telemental health program has been running for multiple years. 7. Hold community outreach events. Once both the originating agency staff and distant staff trainings were completed, the coordinator hosted individual and group outreach events for consumers and local agencies to learn about the new service. One outreach event included professionals with expertise in a variety of areas, such as substance abuse, psychiatry, and behavioral health, as well as consumer-group advocates to present information not only about the telemental health project but also about mental health in general. Individuals and professionals from the targeted community attended the outreach event and offered assistance with spreading information about the program to others. Other successful outreach efforts allowed non behavioral health professionals to schedule informal chat sessions with their clients. The coordinator would meet at an agency at a prearranged day and time, then have an open-hour informational session with individuals the agency recommended. Additionally, the coordinator participated in local behavioral service network meetings that included representatives from other agencies, such as homeless shelters, inpatient substance abuse providers, police departments, services for aging adults, and agencies for individuals with developmental disabilities. 8. Receive referrals and coordinate intake appointments. Initially, referrals for telemental health services were slow while information about the new program circulated throughout the local community. When an agency contacted the coordinator with a potential referral, the coordinator often helped educate the staff member about the services and explain the process for intake. First sessions with a new client were always conducted face to face. Clients were often unfamiliar with telemental health services and felt reluctant. However, because other options for behavioral health were absent, clients were most often willing to try the service. At the first session, the coordinator explained the service and demonstrated how the session would occur. At these meetings, the psychotherapist would answer the video call and then converse with both the coordinator and the client, who were at the originating site. When the individual decided to try the telemental health service, the coordinator assisted with completing the intake paperwork and assessments.
EliteLearning.com/Counselor
Book Code: PCUS1525
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