Introduction to Virtual Mental Health Care 1hr

            Hello and welcome to the Introduction of Discovery Behavioral Health’s Virtual Mental Health Care Training. I am Andrea Piazza, and I am your instructor for this training. I am the Director of Virtual Programming for Discovery Behavioral Health. I am a licensed mental health counselor from Florida. I went to the University of Florida for my undergraduate degrees, Go Gators, and the University of Central Florida for my master’s in Clinical Mental Health Counseling, Go Knights. I also completed advanced training in integrated health care where I had residencies working on teams of internal medicine physicians, physical therapists, pharmacists, etc. to understand the dynamics of their unique disciplines and to promote improved health outcomes for underserved communities. Prior to becoming a mental health counselor, I worked as an applied behavior analyst and behavior researcher with the Autism Spectrum community. 

 I got started in telehealth when I was working as a primary therapist at the Center for Discovery Maitland Outpatient Center. After that, I started my own private practice which is fully virtual and won Orlando’s Best Mental Health Practice of 2021. I also worked as the artistic director for an award-winning international inclusive dance organization. Through learning how to operate as a clinician, dance educator, key-note speaker, and leader online I began to develop a philosophy on what makes virtual care and education most effective. I also sought out additional education for myself as a certified telebehavioral health provider through the American Board of Telehealth, as a certified telemental health provider and as a certified Telehealth Director/Manager and Coordinator through the Telehealth Certification Institute. I am currently in the process of becoming a board certified telemental health provider with the National Board of Certified Counselors. Other fun facts about me are that I am a best-selling author and am working on my 3^rd children’s book, I have a Bachelor of Fine Arts in dance and love creative therapies, I am an advocate for the special needs community which is reflected in a lot of my work, and I love exploring my new home of Southern California. I am also happy to connect over virtual coffee chats about shared interests so don’t hesitate to reach out. 

This training will serve as a comprehensive and practical training for DBH telehealth providers who work remotely full-time and who may go virtual for an in-person program due to a COVID related crisis or another facility emergency. In this introduction to the course, we are going to cover definitions and terms of telehealth as well as some telehealth fundamentals. We will discuss some of the differences between working remotely and providing distance care versus providing care while in the same space as a patient, some of the potential benefits and drawbacks of telehealth, different types of telehealth technology, different terms used for provider and client locations and different roles involved in our current telehealth staffing strategy. We are going to cover some of the history of telehealth, research, reimbursement information, and effective telehealth care. I will also review resources available to you to help you in your telehealth role. 

A couple disclaimers before we proceed. I am not an attorney, and this course is not meant to provide legal counsel and is only for educational purposes. For legal questions, please contact me outside of this training and I can connect you with the appropriate internal sources or external legal resources. Participants acknowledge they understand their duty to abide by the laws, regulations and policies that regulate their specific industry and state.  

In the past several years and especially because of the COVID-19 pandemic, many states have reported an increase in behavioral health diagnoses along with increased barriers to behavioral health care. COVID-19 has even been shown to have neurological and mental complications that are contributing to an increased mental health care need (HRSA.) Thankfully telehealth in general has expanded exponentially to help meet the need. As a part of DBHs commitment to expanding access to care, we will be enhancing and expanding our telemental health services. This training is a small piece of this process but one of the most important ones so thank you in advance for your focus and commitment to this process. 

First let’s talk about the terminology you need to know for this course and to navigate the various resources available to you. We will start with defining telehealth, telemedicine, and telemental/telebehavioral health. “Tele” just means distance so television means distance-vision and telephone means distance-speech. The Health Resources and Services Administration defines telehealth as “the use of electronic information and telecommunication technologies to support long-distance clinical health care, patient and professional health-related education, health administration, and public health.” It is very broadly defined and encompasses a variety of different techniques for care delivered across a distance. Telehealth is perfectly positioned to help us achieve universal health coverage because it increases a patient’s access to high quality and effective care. Telehealth can be particularly valuable for vulnerable populations and in remote areas. 

Telehealth and telemedicine are often used interchangeably but there are subtle differences depending on the organization and therefore neither of these terms has a definitive definition. These inconsistencies have led to variability in policy and state regulations which contribute to limited access to care. For example, the Federal Communication Commission or FCC defines telehealth, telecare, and telemedicine. The FCC defines telemedicine as care exclusively between a medical doctor and patient and telehealth as care provided by other providers such as social workers, nurses, or pharmacists. They define telehealth as being like telemedicine but as going outside of the doctor-patient relationship. They also use telehealth to refer to a wider array of services included patient education. Telecare, on the other hand is often used in relation to the technology that provides patients HIPAA compliance while in the safety of their own homes. Telecare could include something like a meditation app or a medication reminder. Essentially telehealth is the broadest term, while telemedicine and telecare can refer to more specific care practices or technologies. It can absolutely be said that DBH provides telehealth services because we do provide many services at a distance and use a variety of treatment modalities and technology to do so. 

The last terms I want to touch on before we move forward are telemental health, telebehavioral health, and virtual program. In DBH we often use the term “virtual program”, but this is only one of the many terms in the industry. I have also seen online-program, internet-based program, telehealth program, and digital program which are all variations of the same care delivery. We typically use virtual program to describe our partial hospitalization and intensive outpatient programs for patients with behavioral or mental health diagnoses that the patients use their technology to participate in via video for group and individual sessions. I find it most helpful to describe this type of care as telemental health or telebehavioral health. Per my license as a mental health counselor, I use telemental health most often to describe providing mental health services at a distance, although telebehavioral health is still appropriate. The American Board of Telehealth provides a definition for telebehavioral health which states that it is” the delivery of mental health or substance use care by means of technology when physical and/or temporal distance separates the participants.” 

Some other terms that fall under the umbrella of telehealth are mobile health and remote patient monitoring. To discuss these, we will use definitions from the California Telehealth Resource Center. They use the term mobile health or M-health to describe health care, health education, and health communication provided via a mobile device application such as a cell phone or tablet app. These apps can look like public health alert messages, appointment reminders, mood tracking apps, etc. They define remote patient monitoring or RPM as personal health and medical data collected from an individual or individuals at a specific location through electronic communication technology like Bluetooth which is transmitted to a provider in a different location for use and care. All this to say, telehealth is very broad, and it covers direct care but also distance health education, care coordination, consultations, etc. Technically I am providing telehealth to you now because I am providing health education at a distance. 

Now another consideration is that terms like telehealth, telemedicine, telecare, telemental health, etc. also have a legal definition which can vary by license and by state. It’s important to check with your licensing board or regulators to be aware of how they define these terms. In a study done by Jay Ostrowski, he found that there were over 40 terms used by licensing boards which is why a lot of this can get so confusing (2016.) At DBH we also may use terms differently than other organizations. For example, we say face-to-face sessions or in-person sessions to mean sessions held at a brick-and-mortar facility with a mental health professional and patient in the same room. However, the telehealth certification institute would label that as same location sessions because they feel the other terms are misleading because you’re still seeing your patient’s face and they’re seeing yours and you’re not out-of-person when providing video telehealth sessions.  My point here is that you need to be aware of the various terms and who uses them to mean certain things. The best things to do is to check with your licensing or regulating board and your employer for their terminology because it is not standardized.

Your best resource beyond checking with your regulators and knowing our DBH telehealth terminology is going to be the American Telemedicine Association. They have a page on the terms related to telehealth and several other valuable resources.

Next let’s talk about why telemental health, specifically, is important. After COVID-19, it feels like a massive understatement to say but nonetheless, competency in telehealth is a crucial facet of modern healthcare. Patients with limited access to care due to geographic hardship, immune deficiency, agoraphobia, or another circumstance have historically been underserved. According to the National Survey on Drug Use and Health, 30.5% of people 18+ reported they did not receive the mental health care they needed for their mental illness (2021.) 49.7% of people 18+ felt they did not receive the mental health care they needed for severe mental illness (2021.) Both statistics are from 2020 and are slightly elevated compared with previous years. I think it’s interesting how high the barriers to access to care were prior to the pandemic and was not surprised to see that they had risen. Another interesting statistic is that the US government looks at what the behavioral health professional shortage areas are. A Health Professionals Shortage Area or HPSA is a designated area of medically underserved populations in which the ratio of mental health professionals to residents is smaller than 1 per 30,000. These shortages are often in rural areas where patients need to travel twice the distance for care when compared to urban areas. If you look at this map you will see that except for the areas in yellow, most of the country has a shortage of behavioral health professionals. The areas are awarded a score from 1-25 where 1 is minimal need and 25 is the highest need. These scores are based on 3 primary criteria: population to provider ratio, percentage of the population below 100% of the Federal Poverty Level (FPL), and travel time to the nearest source of care (NSC) outside the HPSA designation (HPSA.) The darkest blue color reflects the highest need, and the lightest blue reflects the lowest need where a need for providers still exists (HPSA.) In 2009 there weas a research study on how often primary care physicians get behavioral health sessions for their patients (2009.) Two-thirds of the time they could not. Most mental health referrals come from PCPs, so this is very significant (2009.) Telehealth is also very convenient because it requires no travel. It creates more options for patients in small towns who may worry about their privacy within the nature of a small community. Telehealth can also help those in medical deserts who would otherwise not have access to a specialized provider, and it can help individuals who do not have personal transportation. 

The government has recognized the need for technology-based health care services and provides several grants and reimbursement incentives. The benefit for us here at DBH is that this has resulted in a wealth of resources for telehealth providers. The Department of Health and Human Services, the VA and military, and the Department of Defense all provide resources for telehealth care. There is also an Agency for Healthcare Research and Quality with great resources, and they collaborate with the Substance Abuse and Mental Health Services Administration (SAMHSA). The Office for the Advancement of Telehealth can be an especially helpful resource. They support 14 telehealth resource centers throughout our nation that are great for helping providers to navigate challenges within telehealth. You can access these resources and get connected to your local region by visiting telehealthresourcecenter.org which is the National Consortium of Telehealth Resource Centers. 2 of their 14 centers are national and the remaining 12 are regional. The Center for Medicare and Medicaid Services is yet another resource for telehealth support. Surprisingly, they have been reimbursing for telehealth since 1997, albeit very restrictively.

We have talked about who I am and why I am leading this training, what telehealth is and many of the related terminology, a bit about the importance of telehealth and a few of the many resources available to you. Next let’s talk about the effectiveness of telemental health. 

Thankfully for us and the thousands of people we serve, telemental health is very effective. In 2020 4.1 million people received substance use treatment virtually, and 28.8 million people received mental health treatment virtually (2020.) There are many studies that prove telemental health is as effective as face-to-face or in-person care (2017.) Telemental health can be especially patient centered, meaning it allows us to give many of our patients options for what type of service delivery makes healing more accessible to them, whether it be distanced or in-person. It can also promote continuity of care because even if a patient or a provider moves, as long as it’s in the same state, they are more likely to be able to continue working together. Telemental health can also offer improved safety in terms of avoiding illnesses like COVID-19 and from being in the same space as patients struggling with aggression or other difficult behaviors. It is also an inclusive and accommodating form of mental health treatment. Often counseling offices are not ADA compliant, and they do not allow for individuals who use assistive technology, say a wheelchair, to move about easily in the space. Safe transportation is another major barrier for those with disabilities or special needs and telemental health treatment can be a real game changer. There are of course still considerations we need to make to ensure the accessibility of telemental health, but it inherently overcomes some of the more traditional barriers. 

Next, we are going to talk about potential drawbacks and barriers. Patients may not always have access to technology and if they do it may not be of high quality. A patient’s skills with technology can also vary greatly. We are very dependent on good and consistent internet for these services. We may run into issues with poor technology workflows that make it difficult to navigate the systems effectively. And then of course we have the security issues we need to mitigate with the use of any technology. These issues can include risks related to HIPAA compliance, but they can also include patients struggling to find a safe place to engage in treatment because they may live somewhere that there are no private spaces and may have family members or others who eavesdrop. Other people might have access to the technology the patient uses, or they could have malware or other viruses on their computer. The clinicians may have similar struggles where they do not have their own private space to conduct sessions, or they do not understand the security requirements they need for their own technology. There is also the difference in methods of communication where it can be easier to miss nonverbal cues when working via video sessions. Other barriers include inherent personal or organizational resistance to change, technology illiteracy, legal concerns, bandwidth limitations, technology training cost and costs associated with the infrastructure necessary for effective telehealth. Reimbursement still serves as a primary barrier to the expansion of telemental health care, although this is slowly improving. There are also some specific acts that provide barriers to telebehavioral health. The Ryan Haight Act requires patients to be seen in person and not telehealth before they can be prescribed certain substances like stimulants and Medication Assisted Treatments like suboxone. However, the “most significant barrier to telebehavioral health adoption is providers themselves” according to the American Board of Telehealth. For telehealth to be implemented, traditional workflows and health care delivery need to transform, and the adoption curve can be slowed by resistance to new technology and treatment models. According to patient satisfaction surveys on telehealth, patients tend to embrace telebehavioral health relatively quickly (2017.) Lastly, telebehavioral healthcare needs to be done well to generate patient satisfaction and the development of effective programing takes time and this can lead to frustration for providers. These are all important considerations to be aware of and to be prepared for to effectively navigate when providing distance services. 

Now we are going to talk a bit more about the different types of telehealth and telemental health. We have two main categories which are synchronous and asynchronous. Synchronous means in real time while asynchronous means not in real time. When two people are talking simultaneously, say in a therapy session, they are communicating synchronously. When two people are communication at their own time, say via secure emails to schedule an appointment or share lab results, they are communicating asynchronously. There are a lot of communication platforms that can be used in telehealth including email, video conferencing, phone calls, secure text messaging, virtual reality, message boards, social media, automated programs like apps, avatar programs, AI powered chat bots, and more so it’s helpful to understand the best practices for both synchronous and asynchronous communication styles. For example, have you ever known people who are warm and easy to communicate with in person but via email they present as cold and difficult to understand? That person would have room for improvement in terms of their asynchronous communication. As telehealth-based clinicians, it’s important we communicate effectively via both styles and consistently work to make the improvements we need to communicate optimally. 

Next, we are going to discuss another category that is important to be aware of. In telehealth we have patients who are either at a supervised site or an unsupervised site. A supervised site is where the patient has a staff member available for them during the session to help them with technology or in the event of a crisis. At an unsupervised site they’re on their own. For example, when a psychiatrist meets with a patient virtually while they are at a residential or outpatient site, they are still technically having a telemedicine session but at a supervised site. 

Similarly, it’s important to know the difference between a distance site versus an originating site. The originating site is wherever the patient is even if it’s not a supervised site and the distance site is wherever the provider is. Even if the therapist is working from a treatment facility while the patient is at home, they are still technically at the distance site because wherever the patient is, is the originating site. Some synonyms you may encounter in the various resources for distance site could be specialty site or consulting site. Synonyms for the originating site could be the client site, patient site or referring site. This is because they’re being referred to the clinician. 

Another term to know is hub and spoke. Usually by this we mean that the clinician is at the hub and they’re connecting to different sites or spokes to provide services. For example, let’s say we have a psychiatrist that serves multiple outpatient programs, but they see them all via telemedicine. They would be the hub and the different entities would be the spokes. However, some resources may refer to the inverse where the patient is the hub and the various services that they receive are the spokes. It’s just something to be aware of when you use resources to make sure you understand how they’re using these terms in best practice guidelines, program strategies, etc. 

Now let’s talk about the nomenclature for roles within telemental health. Language may vary in different organizations but its important to know the various labels so you can find all the resources that pertain to you. Typically, telemental health leadership starts with a telehealth director, telemental health director, telehealth manager, or in this case a Director of Virtual Programming. Sometimes there are also telehealth, telemental health, or virtual programming coordinators that will oversee a specific department. For example, in a hospital network there may be an internal medicine telehealth coordinator, a neurology telehealth coordinator, etc. My role combines the director and coordinator role so currently I oversee all DBH Virtual Programs from an operations perspective with the support of the division operation leaders and from a programming perspective for Center for Discovery, Discovery Mood and Anxiety, the Substance Use Division, and the Psychiatric Division. As we move into expanding and enhancing our telemental health services I will be your go-to person, at least to start. The next role in the leadership structure will depend on the service line. You might have an executive director who oversees virtual and in-person, a virtual clinical director and virtual milieu manager, a lead virtual therapist, a lead virtual registered dietician or some other configuration. The best thing to do is to ask your supervisor what the specific reporting structure is for your role and service line. Next, we will have the telehealth or telemental health provider. Other terms for this role may be telemental health therapist, telehealth dietician, telehealth substance use counselor, telehealth facilitator, telehealth technician, clinical presenter, tele-presenter, or telehealth consultant. A lot of the literature uses the term telehealth consultant which can get confusing because a consultant could either be someone who provides direct care or someone who provides consultation to another provider. Again, just make sure to consider the context when reviewing your resources. Telehealth facilitator, telehealth technician, clinical presenter and tele-presenter may also refer to the person at a supervised site or originating site who helps the patient to use the technology they need to participate in telehealth, who are there for emergencies, and who help with completion of legal documentation. In DBH, this often falls to the virtual milieu coordinator/manager role or even the group facilitator role depending on the program. Another role in the telehealth world is the patient support person. This is someone that is available for the client during the session. They can be on site, close to the site or have direct communication with the patient. For a lot of our adolescent patients, this is their parent or emergency contact who we can call or ask for additional support if the patient is in need. For our adult patients, it would most likely be their emergency contact or someone else we have identified as being able to help in an emergency and who has a signed a release of information on file. 

Next, we are going to talk about the importance of integrated healthcare. In DBH we often work on integrated health care teams made up of various professionals such as therapists, dieticians, counselors, psychiatrists, primary care physicians, etc. Effective communication amongst these teams is vital to patient success and the research shows that it helps to improve patient health outcomes significantly. The research shows that when integrated healthcare, also referred to as collaborative care, is done correctly that we see patient care is more effective, less costly, more patient centered and more likely to be viewed with high satisfaction. The Institute of Medicine’s books called “Crossing the Quality Chasm” and “Improving the Quality of Health Care for Mental and Substance-Use Conditions (Quality Chasm)” promote the idea that we should promote cooperation between clinicians (i.e. Doctors and therapists) and encourage the free sharing of knowledge and information from all clinical perspectives and from the patient. It should be as collaborative between the providers as it is between the patients and the providers. To do this we need an agreed upon understanding of goals and roles, and effective and timely communication that is understandable, accurate, frequent, and satisfying for the purpose of shared decision making. Other patient support individuals like school counselors, vocational rehabilitation program, coaches, etc. can also be valuable members of the treatment team when appropriate so that the patient’s care is holistic. Providers should share with one another when and how they will provide referrals for outside services and share appropriate and regular updates on labs, mental status, etc. Setting up a schedule for how frequently to have these conversations and deciding on a person to coordinate the effort has also led to better outcomes. Sometimes its most appropriate for a patient’s parent to take the lead while other times it may be the dietician, therapist, or primary care provider who leads the charge. Thankfully this is all a bit easier in terms of using telehealth whether through synchronous or asynchronous communication. To document these efforts, make sure you update the coordination of care notes in KIPU or your respective EHR. Ultimately, we want to do our best to ensure warm hand-offs, and clear communication between care team members because this will lead to improved outcomes for our patients.

Alright we are moving along here! Let’s, talk through a brief history of telemental health. I hear a lot of misconceptions when I talk to people about telemental health related to its novelty and its effectiveness, so I believe it’s important information for patients and providers to have. First, telehealth and telemental health is not new. Providing care remotely is not in the slightest bit as much of a modern invention as we often think it is. Freud famously provided counseling via letter writing to his patients who did not live near him. This is one of the earliest versions of asynchronous telemental health and he was not alone. It was not uncommon for a doctor or medicine man to recommend treatments from a distance via letter, telegram, carry pigeon, what have you. It's as much a part of our treatment history as talk therapy is. There were medical teams on ships who used morse code to prescribe treatments and if you think about it, NASA has always done some form of telehealth. There is even a famous case of a doctor treating whooping cough over the phone is 1879. In 1948 the first transmission of radiological images was sent by telephone between West Chester and Philadelphia, Pennsylvania which resulted in the term Telognosis appearing in medical literature for the first time. The first suicide crisis line was started in 1953 which is a form of telemental health, and it still exists today. Recently I even learned about the University of Nebraska Psychiatry Institute’s use of two-way television for telehealth in 1959 which allowed medical care to be provided across 112 miles. Not sure how they did that, but I find it fascinating. In the 60s Massachusetts General provided emergency and acute care over microwave communication to a “medical station” at Logan airport for staff and travelers. This link then expanded to the Veterans Hospital and remained active for over 10 years. AT&T also released a commercial Picturephone service that allowed people to essentially use a video phone in the 60s. MIT even had an artificial intelligence program called Eliza in 1964-1966 that could simulate Carl Rogers’ therapeutic style through writing back and forth electronically with patients. In the 70s, NASA partnered with the Indian Health Services to provide remote healthcare to the Papago Indian Reservation in Arizona along with astronauts in orbit in their program called “Space Technology Applied to Rural Papago Advanced Health Care (STARPAHC.)” As early as the 1980s we have had support groups that were held online via chat rooms and other avenues. Memorial University of Newfoundland began using telehealth in the 80s, resulting in undertaking 30 projects over 20 years. They are notable the only pre-1986 program that survived into the 90s. 

Another thing that is not new is the resistance to telehealth. What I find somewhat surprising is that according to the research, it’s not patients who tend to be the most resistant to telehealth, its providers. This is in large part due to there not being a lot of regulation around telehealth previously and technology concerns. The pandemic changed that in a lot of ways and now we can use reliable video technology. We also have good insurance reimbursement rates for telehealth which has led to it becoming more accepted. 

As we approach the end of this introduction, lets touch on some of the research. Based on a meta-analysis, meaning a collective analysis of several research studies, it’s clear that telemental health is as effective as in-person services. The research on telebehavioral health has been substantial and continues to expand. The data clearly demonstrates that telehealth is comparable to in person care in terms of therapeutic engagement, quality of care, validity/reliability of assessment and clinical outcomes (2013.) Empirical evidence has been substantiated for the effectiveness of telebehavioral health care across the lifespan. In the survey we conducted on Discovery Behavioral Health’s Virtual programming, our staff reported they believed virtual programming works best for young adults and adults, however the research suggests its beneficial and effective for all ages when executed well. Telehealth has been shown to be especially effective for treating PTSD, depression, and ADHD. With some populations, telemental health has proven to be preferable to in-person services such as the with autism spectrum disorder, severe anxiety disorder, geriatric patients, and those with physical limitations. Some studies show that patients continue with treatment longer. Research demonstrates high satisfaction from both clients and clinicians although clients tend to have higher satisfaction than clinicians. We see that clients can develop rapport and communicate effectively via telehealth. A commonly cited study, “Outcomes of 98,609 US Department of Veterans Affairs Enrolled in Telemental Health Services,” compared the number of inpatient psychiatric admissions and days of psychiatric hospitalization among patients who participated in remote clinical videoconferencing during an average period of six months before and after their enrollment in the telemental health services. What we saw in this study is that between 2006 and 2010, psychiatric admissions of telemental health patients decreased by an average of 24.2% and at points had decreased by as much as 38.7% (2013.) Their days of hospitalization decreased by an average of 26.6% and at certain points decreased by as much as 43.5% (2013.). The number of admissions and the days of hospitalization decreased for both men and women in 83.3% of the age groups (2013.) In summary, telemental health reduced how often patients admitted to the hospital and for how long they required hospitalization. The Center for Connect Health Policy and the Northeast Telehealth Resource are great resources regarding research, and they have several meta-studies available on their website for you. There will also be more great research on telehealth coming out as the services expand so do your best to stay up to date. 

Let’s touch briefly on funding. Telemental health can be funded via grants, self-pay, health care sharing, membership programs, organizational contracts, etc. Most of our patients use their health insurance so we are going to focus on that. Using health insurance means that someone has a contract with a health insurance company where they agree to pay that company a monthly rate and in exchange, the company will pay some or all of their medical bills. There are federal health insurance companies like Medicare who insure people 65 years and older, have a disability, have end state renal disease and more. There is also Medicaid who provides insurance to people with very low income, pregnant women, the elderly, and people with disabilities. Medicaid is a cooperative program so it’s both federal and state based. Medicaid will also contract with private insurance companies depending on the state. The Centers for Medicare and Medicaid tend to set the standards for other insurance companies, so they are a great resource for how telemental health services are billed. CMS publishes updates annually so it’s a great resource to check consistently. Anyone taking this training who is in the billing world should be aware of CMS and the updates that they publish around coverage for telemental health services. Historically coverage was restrictive, and they required patients to be at approved originating sites in a specific geographical area which of course created strong barriers to accessible care. Coverage for telemental health does vary significantly per the different private insurance companies, sometimes called payers, and varies from policy to policy. We will talk about effective and appropriate documentation in a later training. For any billing issues I would recommend contacting your local telehealth resource center. They track reimbursement throughout your state for Medicare, Medicaid, and private insurers. The Center for Connected Health Policy can also be helpful. 

Our last point in this training will be program evaluation. We will be using the RAS, PHQ-9, SASE, etc. outcome measure to have a clear picture of patient outcomes so it’s incredibly important these are completed on an ongoing basis. I will also be evaluating the satisfaction of the virtual team members in virtual programs to continue improving the experience of working virtually. We will be evaluating patient satisfaction with virtual programs specifically, which will involve evaluating the knowledge our virtual patients gain from specific groups like DBT and then gathering feedback on the engagingness and effectiveness of the group facilitators. Other resources for program evaluation could come from resources like the National Quality Forum who put together measures for telehealth programs. There is also a tool from Jay Schorr and his team that lists different telemental health program outcome measures. Some other resources for program evaluation tools can are the American Telemedicine Association website, the Telehealth Resources Centers, and various professional associations like the American Counseling Association and Telehealth Certification Institute also has some good resources on program evaluation. 

Thank you so much for completing the Introduction to Virtual Mental Health Care lesson. Next we will be reviewing Telepresence and Engagement.

“Key Substance Use and Mental Health Indicators in the ...” The National Survey on Drug Use and Health, Substance Abuse and Mental Health Services Administration, Oct. 2021, https://www.samhsa.gov/data/sites/default/files/reports/rpt35319/2020NSDUHFFR1PDFW102121.pdf. 

HPSA and MUA/P: HPSA scoring criteria: Guidance portal. HPSA and MUA/P: HPSA Scoring Criteria | Guidance Portal. (n.d.). Retrieved January 28, 2022, from https://www.hhs.gov/guidance/document/hpsa-and-muap-hpsa-scoring-criteria 

Two-thirds of primary care physicians can't get mental health services for patients. Commonwealth Fund. (2009, April 14). Retrieved January 28, 2022, from https://www.commonwealthfund.org/press-release/2009/two-thirds-primary-care-physicians-cant-get-mental-health-services-patients?redirect_source=%2Fpublications%2Fpress-releases%2F2009%2Fapr%2Ftwo-thirds-of-primary-care-physicians-cant-get-mental-health-services-for-patients 

Behavioral Health Workforce Projections. (2020, December). Retrieved from Health Resources & Services Administration (HRSA). 

Hilty DM, Yellowlees PM, Parish MB, et al. Telepsychiatry: Effective, evidence-based and at a tipping point in healthcare delivery. Psych Clin N Amer 2015;38(3):559-592. 

Shore, J. H., & Yellowlees, P. (2018). Telepsychiatry and Health Technologies: A Guide for Mental Health Professionals. Arlington, VA: American Psychiatric Association Publishing.