Hello and welcome to our training on best

practice and clinical application for virtual programming.

I've had to rerecord this one several

times, so please cross your fingers.

This is the magic recording

and everything goes smoothly.

I really appreciate it.

All righty, let's jump in.

So in this training, we are going to review

our DBH Clinicians Desk Reference, and then we're going

to go through several best practice guidelines by discipline.

This is very much an overview of each of those.

I am not speaking on behalf of any of

these associations, but I want you to know, sort

of like the highlights of each and where you

can find them for your profession.

So that's what we're going to do.

Then we're going to talk

through indications and contraindications for

treatment, clinical preparation, cultural competency.

We'll review our telepresence framework, and then we

will touch on examination and assessment in virtual

programming and just some specific considerations.

We'll finish up with care models, peripheral

devices, some use cases, and then, of

course, follow up in collaboration.

Let's do it.

All right.

So welcome to Discovery behavioral health

training on best practices and clinical

application for virtual programming.

This will be a comprehensive overview of the

various telehealth best practice guidelines for each profession.

Clinical applications and considerations.

We have talked about what telehealth is,

how to demonstrate telepresence, and how to

maintain security while doing so.

In this training, we're going to focus on

the particular clinical applications for telemedical health according

to the most up to date guidelines available.

Our learning objectives are to review the best

practice guidelines by field, the times that telehealth

is the most appropriate or inappropriate cultural competency

in telehealth, examination and assessment in telehealth, and

then current telehealth care models.

By the end of this presentation, you will

be able to answer the questions, what are

the best practice guidelines for my field?

Who is telehealth appropriate for?

How do I conduct examinations

and assessments using telehealth?

What are the current telehealth care

models pertinent to my field?

And then where can I find more

resources on telehealth clinical application skills?

So we're going to start with one of our

own resources, and this is the Clinician's Desk Reference.

So I'm going to show you where to locate this,

and we're going to take a peek at it.

But it's a very handy tool that I find

myself going back to time and time again, it

goes over our just philosophy in general here at

DBH, and then the supervision models we use recommend.

And there's a lot of just great things hidden in there.

Hopefully I have screen shared correctly and

you will be able to see everything.

This specific one is really getting the best of these.

So I apologize.

All right, so as we've kind of talked about before,

you're going to go to our Internet to SharePoint.

And then for this, I just want to show you how easy

it really is to look up what you need one more time.

So we're going to look for our clinicians.

All right, so that is going to be in our Csqm folder.

Just going to make this full screen for us here.

And we've already taken a peek at this.

But just to reiterate how useful of a tool

this is for you and how important it is

to be familiar with all of this.

Oh, there it is.

Let's go again.

All right, so highlight this again.

In case you've missed it, this is our

clinical quality resource room and there are so

many fantastic resources in there that could help

you in whatever role you're in.

Please take a look at that.

Now we're going to go ahead and hop over to

our desk reference and as you can see, it's right

there on the Csqm page and that's going to open

up in its own browser for you.

And then we can go through it.

We're not going to go through a piece by piece.

This is not going to be an in depth review

of the reference, but I want to give you enough

of an overview that you know what you can find

in here when you need it and hopefully inspire you

to go through and read it for yourself.

All right, so some things that you'll be

able to find in here is our clinical

philosophy and supervision model definitions pertinent to you,

the elements of the philosophy.

The Best Practices is what we're

going to take a peek at.

And then our four pronged approach

and more stuff specific to supervision.

I also just appreciate you can

find general Best Practices in here.

We're going to go through ones

that are specific to telehealth.

However, knowing your basic ones

is obviously very important.

All right, so let's go to our Best Practices.

Actually even easier.

Let's go ahead and click on that

and it'll take you right to it.

So for our Best Practices, all of these kind of

relate to what we feel is helpful for everybody to

be aware of and to know in their work.

You can go through information on the Therapeutic Alliance

and then I think it is helpful at all

times to be aware of the Joint Commission overview.

So be sure to check there.

We're actually going to look at some

Joint Commission stuff later in this training.

I think the collaborative documentation stuff

is very helpful, especially the impact

of personcentric planning and collaborative documentation.

I think that's just helpful to know.

And then going down to our

Best Practices Best Practices here.

And you can see under our evidence based practices

what is endorsed by the company, what's important for

you to be applying in your work.

Alrighty, let's go back to our presentation here.

Just because I will be going

in and out of the PowerPoint.

We won't have subtitles the entire time.

If you do really rely on subtitles,

I would recommend referencing the transcript that

will be uploaded alongside this video.

All right, moving right along.

So let's get into some of the best

practice guidelines from the field, starting with SAMHSA.

So SAMHSA is our Substance Abuse Mental Health Services

Association, and they have a variety of resources.

There is no shortage of valuable information through SAMHSA if

you are not associated with them, if you don't get

their emails, if you don't follow them on social media

or check with them regularly, please do so.

They put out a lot of great research.

Some of the research from this presentation has come

directly from them, specifically on how many people are

using telehealth in the past couple of years.

All of that jazz, how many people

are still not having their needs met.

Some highlights you're going to find in

this guide are going to be evidence

based resources, just an issue brief.

That one is very simple.

What the research tells us.

I think this is important not only for you

to know, but also to make your patients aware

of, especially when they're not sure about telehealth.

Even if they've received bad information about telehealth,

it is not accurate to its effectiveness.

Important to connect them with that

guidance for implementing practices, examples of

telehealth implementation and programs, and resources

for evaluation and quality.

All right, let's take a peek at that one.

I really wish I could have embedded the PDFs directly

into PowerPoint with some versions of PowerPoint you can, but

it would not let me put them in there.

So we are going to have to just click back and forth.

But this is the SAMHSA guy.

It is 75 pages and it is jam packed information.

We're just going to do kind of

a quick flip through this one.

There's really so much that it can be

somewhat difficult to navigate in a timely manner,

as I'm sure you can understand.

So we're going to look through it here.

Some things that I'll point out that I

find helpful are these red breakout boxes.

Oftentimes summary effects are just really hard hitting

facts that I think will stick with you.

Another really great thing to do here is to go

through all of the references that they do provide.

You can see there's plenty a lot

of the best research comes from SAMHSA.

So if you don't have time to read all

of this, go through and look at the research.

I think you're just going to find a

wealth of valuable information there for yourself.

They do a really great job at including graphics also.

And I think some of those

visual elements can be super helpful.

All right, so that is SAMHSA.

I think everybody can benefit from looking at

the SAMHSA resources, no matter your professional discipline.

However, our mental health counselors, our substance

use specialists, you guys are going to

find really what you need here.

Next we're going to talk about what

our marriage and family therapist or marriage

and family counselors have from their practice.

So the Am Ft put together best practices

and online practice of couples and family therapy.

Online practice.

You see this, like the variety in the language, and

this is what makes it so hard to find this.

I did dig to find us a little bit

more because I was looking for telehealth best practice

guidelines or virtual program best practice guidelines.

I wasn't expecting to find online practice.

And you'll see a lot of that variability reflected throughout

these guys, but it is a very good one.

Highlights from here, are they going to

go through compliance, HIPAA compliance, mainly infrastructure.

I think that section is very helpful.

I think it's always just important to

be aware of the technology you're using.

What's appropriate, what's not appropriate?

Advertising and marketing.

That's also something I think it's

kind of unique to their guideline.

And I think it's helpful for us all

to go and look at that section.

Informed consent, initial assessment,

ongoing services, crisis management.

We will have our own training

on emergency management, including crisis management.

It's the next one actually failures and

breaches and then accountability and review.

So let's take a peek at that one.

It's much shorter, so we can go

slightly more in depth with it.

We'll come back to you, ACA.

All right.

So here's our Am Ft.

The other thing I'll point out here

is this one is pretty pandemic.

So I do feel that if they were to go in

and update this, we would see some very helpful changes.

It's still recent enough, I mean, being within the

last five years, just past the last five years,

but information that we all need regardless, hopefully they

will have an update coming out soon. Okay.

So some things I do love the FAQ and

the way they've kind of structured it here, but

I wanted to show you something specific.

All right.

And then we're going into their best practices here.

Infrastructure.

We've talked about a lot of this, and

we're going to continue to talk about it,

but nonetheless, please go through it.

And then the advertising and marketing, I think

is very helpful to just have reminders on.

Sometimes I see clinicians working in the virtual

sphere who the lines get a little bit

blurred just as far as what is appropriate,

what is an appropriate and like patients reaching

out, Instagram, DMs and stuff like that.

So just to be aware, make sure we're always

directing patients to the appropriate pipelines and they can

easily access secure messaging platforms via your social media

if you are using that as an advertising tool.

But all of it is very helpful.

It's not too long and the last couple of

pages are references, so it really is quite succinct.

All right.

Now we're going to talk about our ACA guidelines.

So ACA is the American Counseling

Association, and it's the national organization.

We have a few, but it's one

of the national organizations for our LMHCs.

Lmfts absolutely have connections to the ACA as well.

But in my role as a mental health

counselor, I often go to the ACA first.

So the ACA actually does not have guidelines put together

in the way that SAMHSA or Am Ft does.

I piece this one together for you based on a web page.

I will absolutely make all of these accessible to you.

There's not as much information here as there

are with the other guides, and most of

their references are directing you towards those guides.

So just something to keep in mind.

The highlights here would be be aware of the standards

of care and laws that apply where you're practicing.

I know you've heard from me about 100 times so far.

Resist the temptation to

redefine the counseling relationship.

That kind of goes back to what I

was just saying with that Instagram example.

Regularly review your authorization to practice temporarily

in another state based on a state

emergency proclamation or executive order.

Those waivers are those orders.

Those proclamations are disappearing

pretty quickly, unfortunately.

Make sure you check regularly, if not

every month, like every other week.

Make sure you are on the emails that

come from whatever licensure granting organization or waiver

granting organization you are practicing with.

And then, if needed, have a plan to

appropriately transfer services to a licensed practitioner in

the state where the client resides.

If, for whatever reason, you were practicing based on a

waiver in a state, make sure that you have kind

of those referrals in that state set up so that

whenever this expires, you are ready to transfer quickly.

And that conversation has been

ongoing with your patient.

Let's go ahead and take a peek at this one.

We'll come back for you.

Social work, hang tight.

So here's our ACA guide, all of two

pages, but something very easy and quick to

look over, referencing kind of just our basics.

Make sure you're within your ethical

standards, all of that stuff. Okay.

Next, we're just going to talk about social work.

So social work, similarly does not have

their own best practice guidelines in the

way that like SAMHSA or AMFG does.

They do have a bit more resources than

the ACA, though, and they have some unique

things that I found really helpful here.

So let's talk about the highlights and

then take a peek at this one.

So it reviews before providing telemetry help, what

you got to do, and then informed consent.

And then they have some pretty good stuff on video.

Conferencing platforms at Discovery Behavioral Health, more often

than not, you're going to be using Zoom.

And it is the HIPAA compliant Zoom.

For like, medical companies.

It's not regular.

Anybody can get it Zoom.

However, there is divisions.

Maybe Discovery MD, who is not going to use Zoom.

And the platform that we partner

with will absolutely be medical grade.

It'll be HIPAA compliant.

But I think it's still important to know the

ins and outs of that of this technology.

You're using.

And if you are working outside of DBH, just

to be aware of all this stuff, professional liability

coverage, we touched on that a little bit. Essentially.

Just make sure your liability

coverage extends to telehealth.

And if it does not, make sure you

have coverage to practice telehealth Privacy and confidentiality.

And then we have our telemental health chart.

And this actually covers what HIPAA, CMS,

center for Medicare and Medicaid Services and

Licensure looked like pre and postcoded.

And I just think it's very interesting and I

appreciate that they took the time to highlight that.

So we're going to take a peek at

social work now that's our EPA guidelines.

Let's see where social work is hiding in here.

We found it.

All right.

So we touched on kind of the highlights.

We're just going to move a little bit quicker.

So the video conferencing platform, I would just give

that a quick read when you have time.

I'm not going to read it to you because we're

going through so much other information, just some of the

basics as they address what you could use, what HIPAA

compliant video conferencing platforms are out there, and then what

a VA is a little bit.

And then here is that chart,

the Before Covet and During Covet.

It'd be interesting to see postcodett if

we ever managed to get there.

Now let's talk about what we have for our psychologist.

So the American Psychological Association has

guidelines for the practice of telepsychology.

This is a very detailed, jam packed

article and it is clean cut.

There is no beautifully colored graphics

to be found like SAMHSA.

So this is a really good example of what I

would go through with a highlighter and make notes of.

I am going to go through this one a

little bit more in depth just because there's a

lot of great stuff kind of buried in there.

But let's go over the highlights before we switch over.

So it's going to touch on, of course,

the guidelines and then competence of the psychologist

to perform telepsychology, informed consent, confidentiality of data,

security and transmission of data and information, disposal

of the data and information and technologies, testing

and assessment, which we're going to talk more

about as well, and then enter jurisdictional practice.

And the reason that is as prevalent as it

is in this article is psychologists have Psy packed

and that's the compact where they can practice in

multiple States if they're a part of that compact.

To my knowledge, it's 13 States.

Although I've been reading all about

the compact, I got mixed up.

I wouldn't be too surprised.

We do cover compacts in either

the previous or next training.

So you will get that information as well?

Oh, no, I just closed it.

Bear with me here.

It's hiding. Ok.

So this is our guidelines for telepsychology.

Aba has several resources.

This is the one I found to be the most

helpful and applicable of a read it's really telling you

how to do the things, not just that they're important.

We know they're important.

We know HIPAA compliance is important.

How do we remain HIPAA compliant?

All of that job.

So I'm going to scroll through it with you also.

We have the competence of the psychologist.

So going through rationale and application,

lots of good information in there.

Again, highlighter it's.

Jampacked Standards of Care I found this

to be a very interesting read.

And essentially it asserts that we want to maintain the same

standard of care that we would for in person and to

set just very clear expectations around that and plans on how

to continue to meet the standards of care.

Informed consent, confidentiality of data, the security

and transmission of data and information.

I would recommend reading through if

you do have the time.

It brings up a lot of the issues with transmission of data

in a way that is accessible and I think in a much

more in depth way than I have seen in other guides.

That's something unique here.

I would take a second to read through, and then

it talks about the disposal of data very short, quick.

And we also have our own policies at the

disposal of records and data to be aware of,

but nonetheless knew that if you are psychologist, you

are still beholden to their standards as well.

I mean, it's reasonably long, but

there's more to testing and assessment.

And they have additional resources on testing

and assessment in virtual on their website.

So if that's something you're practicing in or

just very interested in, I'd really take the

deep dive there and then their interjurisdictional practice.

Okay, moving right along.

So let's talk about what we have available for

our dietitians are just our dietary team members.

So on the Academy of Nutrition and Dietetics website,

which is Eatbright Pro, they have a web page

about telehealth in general and then a quick guide.

So similar to ACA and the social work organizations.

This is not like a downloadable best

practices guide, but best practices are absolutely

built into this web page.

And I did go ahead and create that PDF for you.

Once again, they will all be uploaded.

So you'll have access to all of these.

So in this guide, you're going

to find first steps preparation.

It does talk about the telehealth

platform and vendor selection also.

Then it talks about workflow and patient care.

That is something I found unique to this guy and I

think would be beneficial for everybody to give a read.

If you're not a dietician but you're working collaboratively

with dietitians, I think all of this information is

helpful to know so you can best support your

team member and understand just their discipline.

It does acknowledge Medicare rules.

We don't accept Medi throughout all parts of

Discovery Behavioral Health if you are in a

part of Discovery Behavioral Health where you do

accept Medicare or Medicaid no matter what state.

Definitely be sure to review the center for

Medicare and Medicaid Services and any pertinent information

to Medicare and Medicaid in these guys.

And then it goes through coding and billing.

Most of you don't really need that, but interesting

and helpful to know if you are working with

another company or for some reason you have a

specific billing role and then additional resources.

We're going to take a peek there.

I've probably really lost my place at this point.

I tried so hard to have these all organized for you.

Okay, that wasn't too bad.

So this is 13 pages.

It's still a pretty good amount of information.

And I went ahead and just included everything I can.

And then we'll just look at

a couple of unique things here.

I do think it's helpful the way

that they review the video platforms.

Again, you're going to be decide which video

platform to use, but nonetheless, we never want

to be using FaceTime, God forbid, Facebook Messenger.

Whatsapp?

Not regular Zoom.

We use HIPAA compliant Zoom.

Zoom Health, I think.

Alrighty, keep moving with me here.

There we go.

The workflow and patient care is the section I

would recommend reading through, taking your highlighter through making

some notes on and just being aware.

And then again, if you're not a dietitian, but

you're working with dietitians, like run through all of

that with them to make sure you really understand

their needs, how to best support them.

And you guys'cooperation. All right.

And on we go.

Okay, so for our nurses, you

guys have the connected health principles.

So there are 13.

Pretty sure we're going to peek at it. Anyway.

I've been reading through these for weeks and weeks.

So all good information, but at

points it's kind of metal together.

Another good example of not standardized language.

It was difficult to find the nursing telehealth

best practices because they call it connected health

as opposed to telehealth, but that is most

certainly what it's referring to.

So some highlights here.

Technologies do not alter the standards

of care for professional practice.

We are subject to the same

healthcare laws and board oversight.

As an in person provider, we must

prioritize improving access to quality healthcare that

is guided by the best available evidence.

Accepted clinical standards and best practices mandates

that healthcare professionals meet state specific regulatory

and institutional requirements responsible for developing their

own competencies and then should be congruent

with in person care and must adhere

to best available evidence.

There's many more of these highlights here.

Couldn't fit them all reasonably on the

page, but let's take a peek.

Yeah, it was right there. 13.

This one is a quick read.

I think it's helpful to go ahead and go

through all of them if you obviously are a

nurse or if you are collaborating with nurses.

Good, simple, clean resource.

Not that one.

Here we go.

Next, let's talk about our playbook highlights.

I love this resource.

There is so much good stuff in here, no

matter which area of telehealth you're working in.

And I just appreciate them for that.

So this is 131 pages

actually, but it's incredibly helpful.

Similar to SAMHSA's guide.

It's very detailed.

You can tell a lot of effort was put into this.

It is the Digital Health Implementation playbook.

I'm not even going to say it.

You all already know.

So as far as highlights take you

through Basics, Identifying the need for Telehealth,

Forming a Team, Defining Success.

I love that section.

Designing the Workflow, Preparing the Team, Partnering with

the Patient, another section that I really loved.

Implementation, Evaluating Success and Scaling there's several

things in this playbook that I think

you're unique to this playbook.

It is a lot to get through because it's so long.

So if you were going to focus on

sections here, I would recommend Scaling, Partnering with

the Patient, and then Defining Success.

I think those apply to any field

and found them informative for me.

All right, so let's take a peek.

So they do have several of these playbooks.

This is just the telehealth one or Digital Health.

It's wonderful if you are

working in any medical capacity.

I think it's helpful.

But to be honest, this really

does stretch the continuum of care.

And I think it's good information

for any clinician or practitioner.

Something to look through.

It's very well organized as well.

Some of their pictures are kind of funny.

There's some really good graphics and information here

to just pull for marketing as well.

If for whatever reason, like you're taking this as

not a professional, if you are, honestly, thank you

so much for taking that extra step.

I know this is a very long training, and there's

still so much good stuff in here for you.

There's just no shortage of resources here.

And if you have to pick one of these resources

to go through, even though you want to go through

all of them, you just don't have time.

This would be the one.

And obviously it's the longest.

So it's got the most information, but

it's really just kind of a magazine.

It's not textbook dents or anything.

Okay.

Next, let's talk about specifically what

we have for our psychiatrists.

And we are going to talk about a

video that they have available as well.

I wanted to show you that video, but we'll

see if I can get it to work.

So Best Practices from

the American Psychiatric Association.

They actually partnered with the American Telemedicine

Association to create these best practices.

And they are specific to video conferencing, which is

great for us because we don't rely as much

on phone sessions and stuff like that.

Some highlights.

It talks about patient and setting selection.

So finding the right work environment, finding the

right patient who's appropriate for this care, and

then management of hybrid patient provider relationships.

That is a really big highlight here for me.

You don't see a lot of kind of acknowledgement

of this hybrid work in the field, despite us

knowing that it happens rather a lot.

And that can be frustrating for our hybrid providers

who are working to improve their clinical practice or

just working to feel more competent in general.

And there is somewhat of a lack of resources.

The fact that the APA and Ata put

that in here I think was fantastic.

Ethical considerations, cultural issues and

then specific populations and settings.

Let's take a peek there and then I'm

going to try for like 30 seconds to

get that video to work appropriately for us.

And if it does not, we're just going to go.

All right, so it's not super long either.

Trying to take us to here we go.

So we have our legal and regulatory issues.

It's a quick read.

I would go through those as many

of these best practice guidelines as you

can, especially it just gets so confusing.

The patient provider identification I had

mentioned, I feel is helpful.

You guys are going to know so

much about technical considerations, clinical considerations, and

then we have our key references.

So she's pretty short and sweet.

It's a good read.

I appreciate the recommendations

based on specific populations.

They're not super in depth, but at least they're here.

So how to support with forensic

and Correctional cases, geriatric populations, veteran

populations, you name it.

And they have a lot more

resources on their website as well.

All right, let me see if in a reasonable amount of

time I can get that video up for you all.

I'm going to stop sharing just so you

don't have to watch me fumble with it.

And it's just two minutes.

So it is easy peasy.

They have a lot of resources as well.

So there's no shortage of things that

you can kind of look through on

the American Psychiatry Association's website.

The video is not wanting to play for me

though, so we're just going to keep moving along.

Let me screen share again.

This is what the video looks like on their website.

So if you are interested again, it's only two

and a half minutes and it's not difficult to

locate for whatever reason, just having a technical difficulty.

All right, let's talk about what we

have for our addiction medicine specialist.

So Asam has their recommendations in

like a playbook of sorts. It's great.

So for our discovery MD friends or just PPS division

friends, this is really like where you're going to go.

Also some of our SUV brands.

If you are offering addiction medicine, this is

going to be your primary best practices guideline.

Some highlights here are the

benefits of using telehealth.

Federal policy changes, state

policy changes, private payers.

It's helpful.

General considerations for implementing

telehealth DEA policy.

Everybody should go and read that.

That is very important.

The opioid treatment program guidance is also very important

if you are working or you have patients using

any opioids as a psychiatrist, a nurse what have

you be aware of these policies?

Frequently asked questions, and then the exemption

allowing alternate delivery for methods of medications.

Let's take a peek here.

Where are you hiding?

I had these very well organized at one point.

We found it. All right.

You guys are all going to think I'm

losing it, but it's just been difficult to

get this specific training recorded for whatever reason.

So here is our mini playbook.

It's only ten pages, so I think everyone

and anyone that has anything to do with

addiction medicine should look through this.

It's not overly wordy.

It's a relatively quick read.

I think there's a lot of misconceptions in this

specific area of practice, though, and that's why I'm

leaning a little bit heavier on this one.

All right, going back to our

presentation, we already went through that.

All right, so let's talk about our just

best practices from the American Board of Telehealth.

And I was able to get this whole document on

here, so we're not take a peek at it.

There's no need.

So this is from the American Board of

Telehealth, and they do have the tele behavioral

provider certification available for you to take.

It's supposed to be kind of

the gold standard for telebehavioral providers.

However, that is not the course you need to take to

become a board certified telemedical help provider, which is a little

confusing if you're not sure which one to take, and you

just want to navigate that and how to increase your telehealth

excellence, please reach out to me and I can kind of

guide you where you want to go.

I completed both, so I can tell

you what you're going to get where.

I just think this is a quick, helpful

guide, and you can see everything on here.

Avoid Candid Camera, state the

obvious, all of that jazz.

I think this is a really good thing, even

in just like if you have a whiteboard behind

your computer to put up for you.

And if you're ever training telehealth professionals, this is

one of the first documents I would share.

Okay, one last resource.

So I wanted to pull something from I end up.

And this is our primary

eating disorder specialist organization.

They don't have best practice guidelines, at

least that I was able to locate.

But they do have a presentation that I believe

they did in collaboration with ERC or the Eating

Recovery Center, all about how to set up and

run a virtual eating disorder practice.

And I found that this was a very good presentation.

It's easy to find it's public, and

it's just a PDF of this resource.

I'll include this for you as well, but just

something I want you to be aware of.

It really walks through some of the pros

and cons of working with eating disorders via

telehealth in a way that we're not going

to be able to do in this presentation.

Hopefully, one day we will.

But as my eating disorder specialists or

my clinicians working in the eating disorder

division or any center for discovery.

This is available to you.

It is very helpful.

Additional considerations before we move away

from our best practice guidelines, consent.

Make sure that when you are getting

consent, it is truly for telehealth.

They know that they are going to be doing telehealth

all of the time unless you are only in telehealth

because of some crisis at your center, like make sure

they're aware of the expectations, acknowledge the benefits and the

cons of telehealth with them, make sure they are empowered

and they know that information, acknowledge the security risks of

using telehealth and what we do to mitigate those security

risks and provide any support that they feel they need

to be secure via telehealth.

And then obviously, our traditional

consent policies as well.

Technology access and Availability not everybody is going

to have access to high quality technology or

high speed Internet, and that could seriously compromise

their ability to participate in effective telehealth.

It needs to be a part of the screening

process that they have access to, the sort of

technology that's going to promote their ability to participate.

And there are some things we

can do to support them there.

But overall, if the technology makes

telehealth inaccessible, there's no perfect fix.

And we need to set them up

potentially with in person services, environmental appropriateness.

So telehealth might not be appropriate in homes

where there's significant drug use, there's severe medical

instability, severe abuse, you name it.

So all of that goes into the screening that we would

normally do for program anyway just to ensure that we are

able to safely support who is attending our programs.

It can be exceptionally important in telehealth because, like, you're

meeting with them in their homes and we need to

make sure that they have spaces where they can have

a private session or that there are things we can

do to help it be more private.

There's some sort of capability there and then the

ability to gain accurate information from the patient.

So when we have patients who are poor historians or

are not honest with themselves or us or they're very

evasive, and that presents the opportunity for a safety risk

we have to consider if we are really safely and

ethically able to treat them via telehealth, we need to

make sure that it's appropriate, appropriate for them.

We are going to cover screening more in depth, but just

some things I wanted to touch on here as well.

So clinical preparation, you guys know this

stuff, but let's go through it.

So plan sessions and identify the main goal.

Don't just chitchat for an hour.

Make sure you know what you're working towards,

working on and how you're going to get

their care model and scoop of practice.

Know your care model.

So if you are treating somebody with

substance use, you're going to use an

evidence based practice for substance use.

You're going to follow the journey set forth

by your site, by your operations later.

So it's designed for that patient.

You're not going to do something like Acupressure if

you are not an Acupressure specialist, stuff like that.

Pre read the chart.

So try not to be reading their chart or

labs in session and taking up their session time.

Sometimes this is somewhat unavoidable if you had a

super busy week, but nonetheless, we want to be

prepared going in so we can hit the ground

running summarize knowledge of the case in previous sessions.

Hi, it's so great to see you again.

Last time we talked about A, B and

C and you were going to do D.

How did that go? Great.

Or I've never met you before, but I read through your

biopsychosocial that was provided to me and I noticed A-B-C and

D and you want to work on me, let's do it.

And this is going to show

them that you know their case.

You remember what you're doing with them,

what you're working on with them is

important and you're engaged in that process.

Test your technology.

We've talked about this to make sure your sound

is working, make sure your video is working.

You have to do it.

I would say every day.

You never know when you're going to

have that day where for whatever reason,

your microphone just won't turn on.

If you can know beforehand, that's going to save you

a lot of session time trying to figure it out.

And that will hopefully also give you time

to put a backup plan into place and

then consider scripting, especially for like the intake.

Make a script of the points you need

to go over with every single patient.

What are the attendance requirements, what are the

expectations you're going to place for homework if

you give clients homework, whatever that is.

Cultural and social Determinants One thing that

I see a lot in the telehealth

research is it's important to be culturally

competent when you are performing telehealth?

Yes, absolutely. I know. How do I do that?

And then there's not a lot of like

here's how you put it into practice.

I have come across some really great research articles.

I'm going to share one of them with you today.

And we're going to talk just about some

of the overlaps of variety of priorities here.

So here we can see the integration of

rural cultural and tele behavioral health missions.

And they're very much aligned.

So cultural and diversity missions appreciating and

celebrating similarities and differences, clinical skills, sharing

best practices, support and interest in the

communities themselves, rule settings.

Our goal here is to have unique local

and regional elements, help seeking in self efficacy,

acculturation over time and acknowledging that that's real.

And then advocacy and outreach.

And then as far as television,

oral health opportunities and best practices,

clinical and technical administrative factors, building

partnerships, bringing people together.

So a lot of these missions are very

much aligned and working towards the same thing.

I would love for discovery, behavioral health to

be able to serve these rural communities even

more so than we already do.

And that's going to take into account,

like, another level of cultural competency.

And although this is important to all of us, cultural

competency can get even more tricky when we're in the

telehealth realm because it's not going to be probably that

unusual to be seeing somebody in a region of the

state or even the country if you're legally able to

practice there that you've never been to and you don't

know the dynamics of that culture.

You don't know, like, the colloquialisms of

that culture or potentially the traumas that

that individual population has gone through because

you can't know everything.

So we need to be especially open, aware,

and interested in what is going on for

them culturally, socially, locally, in that community.

What is playing into, if anything, the mental

illness that they're struggling with or working towards?

What can you use in that

community to help bolster their recovery?

Who can you get them connected to?

Is there anything that's inhibiting

their ability to recover?

It's going to be different everywhere, and we

can never, ever speak to every single situation.

But I can't stress enough the importance

of just kind of like being ready.

The article that I have linked here at the bottom of

the slide was a great read, and I just appreciated that

it was more applicable than a lot of the other resources

I was able to pull for you guys.

Telepresence reminder.

So we talked about this so much,

but nonetheless, deep language, clean and simple

body language, awareness, logistics, and radar.

So always go over.

Just like the logistics of, like, how

are we going to meet again?

How long till we meet again?

But also always be aware of what's around you

and what could potentially be going on with them.

Like, if you know that they have a

little sibling that is constantly sneaking into the

room, be listening for that door so that

if that happens, you can stop talking.

Oh, did somebody enter the room?

Okay, thank you so much.

Know who is listening?

Same thing with that radar.

Be aware of what is in view

of your camera and of theirs.

And if you see something that you know

they wouldn't want on camera appropriately, broke out

with them and give them a chance to

create a more comfortable environment.

As always, dress appropriately.

And I would encourage your patients

to dress appropriately as well.

If they're showing up in their pajamas, that

really could impact their mindset and ability to

participate in session, because pajamas mean sleep.

And if you're telling your brain, Well,

I'm ready to sleep, we're probably not

going to be as focused consent reminder.

So make sure you explain what telehealth

is, the benefits and the cons.

Explain security risks.

You guys know, examination and assessment.

So there's a real art to examination and assessment

in virtual, we can't always see how they're walking.

We can't always see if they're shaking.

We can't always tell if their

lips are looking a little blue.

There's things that we are going to need to be

really intentional about asking, and we are going to need

to be a little bit more overt than if we

watch them walk through the door every single day.

So know what you need to look for.

So if we're treating somebody with a

specific challenge or issue that we're aware

of, like, what goes along with that?

And it is appropriate to ask somebody like, can

you get up and walk around for me? Can we stretch?

And you don't need to make it a command.

You can say, let's do some movement together.

Let's just do all yoga

while you're doing that, observe. How are they looking?

Are they looking off balance?

Is something looking different?

Make sure that you have a baseline for this assessment.

Of course, don't just do it one time and

assume that that's wrong or that that's normal.

It should be kind of a regular

piece of the work for you.

If this is pertinent to

your field that you're including.

There are also peripheral devices we can use.

So, for example, let's see, we'll kind of go, I

think we're missing a slide here, but that's okay.

So there are like telescopes that you can

use that are Bluetooth, and you can literally

have them have the stethoscope at home.

Excuse me, the stethoscope at home so used to

saying Tela, and they can do their own assessment

using the stethoscope, of course, with your direction, and

then that data can be transmitted to you.

Same thing with we've talked about the number of

scale or the blood pressure cuff, and they're going

to send information via Bluetooth or remote patient monitoring

just so you can have more collateral information of

what is going on with that patient.

Not every patient needs every single one of

these tools, obviously, but if it's appropriate, if

it's covered by insurance, it's manageable for them

to have, I would recommend it and making

sure you know how to use the technology.

Of course, there are also cameras that have control.

So this perception, like, we just don't have control

of what we see, but that's not always true.

So with certain patients, it might be appropriate

to ask that they get a telehealth camera.

And oftentimes these are video conferencing cameras

that you have and use control over.

This is usually something that happens when somebody

is receiving telehelp from a supervised site.

So they're going to a site to meet with the

provider, and the provider is zooming in or something.

But we can also have these in

their homes if we need them to.

The video conferencing cameras can be a bit

expensive, and I don't think it's like the

universal solution for Discovery Behavioral Health.

But they are available.

And over time they will

absolutely become more affordable.

And these cameras allow the providers to Zoom in,

Zoom out to pivot and hand the camera.

We can also recommend that they get external webcams.

So, for example, patients with eating disorders

that are needing a lot more meal

support or we're concerned about table behaviors.

And we prefer those patients are in person programs.

But things happen.

A camera that has a little bit more mobility to

tilt, pan, to Zoom out, to Zoom in, it's going

to make it easier to see them having their meal.

And you don't need to start here.

You can start with their laptop webcam, which

is in most cases totally fine, especially if

you can prop it up the appropriate angle.

But if you notice that time and

time again you are just having issues

with that patient using inappropriate behaviors.

I would recommend getting them an affordable webcam.

They can clip to the top of their laptop.

It's external that just has a little bit more range,

zooming in and zooming out and seeing what they're doing.

So care models. We want to be using

validated screening scales and screeners.

We typically use the Ras, the

things that are in keeping.

We review and implement our scheduling process.

Patients know when they have sessions.

They know often they have sessions making sure

that we have emergency plans in place.

We have a whole hour on this.

I'm not going to go that much more into it

and then reviewing any lab work or prescriptions before sessions.

Some special considerations is here's the

additional equipment we can have.

So something you can have for them at

their homes that they can complete is blood

panels for lithium or dispensing, specific medications, glucose

meters, EKG they can complete at home, digital

stethoscopes, telehealth, blood pressure cuffs, telehealth scales, all

stuff you can consider if appropriate for your

practice and your patient.

As far as these use cases,

I would recommend additional training.

There is additional training on each of these

groups and there's things that come into play.

Group therapy is obviously totally manageable online.

The Human Health Services website has really great

resources on group telehappy, children and adolescents.

I would go to DCF for those trainings. Elderly care.

Dcf also provides trainings.

We have elderly here twice because

they're that important medical inpatient.

So if you're doing telehealth with medical

inpatient, you need to make sure that

the medical team is there with them.

Typically, this is when you're zooming into a hospital

where they are receiving treatment and that specific hospital

is going to have, hopefully trainings for you.

But if not, seek those out for yourself.

And then rural communities as well, going to

your telehealth consortium or those 14 resources.

The two national organizations and then

the twelve regional organizations have specific

information on specific rural groups.

And I would go there for just clinical application.

I think we've touched on most

of our key considerations here.

So I'm going to keep moving forward.

The only thing I would add is just like

we've talked about before and all of these cases,

we need to be following up with these patients.

There needs to be adequate discharge planning and there

needs to be adequate team collaboration and communication happening

so in summary, telehealth for many providers Frontier, it

is often daunting as we figure out how to

transform our skillset to be effective online.

It's importantly aware of the best practice

guidelines and recommendations for our professional discipline.

Having awareness of the resources and

equipment available can enable providers to

expand their digital capabilities and comfort.

Effective clinical application of telehealth skills improves

the patient and the provider experience.

Thank you so much.

Here's our gorgeous dancing Queen some

more resources for you here.

And as always, please message me if you have additional

questions and I'll see you in the next training Hi.