How to Build a Telepsychiatry Program for Your Hospital or Health System

Many hospitals and health systems have never implemented a psychiatry or telepsychiatry program. Other hospitals have dabbled in telemedicine by providing telestroke or teleradiology services. Now, due to the COVID-19 pandemic, many health systems and community hospitals are turning to telepsychiatry to help meet the enormous behavioral health needs of their backed-up clinics and swamped Emergency Departments (EDs) caused by a shortage of mental health providers.

If you’re considering launching a formal telepsychiatry program at your hospital to help support mental health patients in your EDs and beyond, keep reading! This post will break down the benefits of a telepsychiatry program, tools for analyzing whether telepsychiatry is a good fit for your hospital, criteria for evaluating vendors, and helpful hospital implementation logistics.

How a telepsychiatry program can benefit your hospital or health system

Since the onset of COVID-19 in March 2020, hospitals have seen overdose and relapse rates of patients dealing with substance-abuse disorders increase by 30%. Patients are dealing with more stress and anxiety about the pandemic and the subsequent economic and health fallouts. At the same time, more and more mental health patients are turning to EDs for care — which they may not be able to provide with current staff.

Fortunately, changes in healthcare regulations are expanding hospitals’ abilities to offer telepsychiatry in new settings that will help improve timely access to high-quality behavioral healthcare. That means, when caring for patients, hospitals will have additional opportunities to provide telepsychiatry and meet patients’ behavioral health needs more quickly and seamlessly.

Telepsychiatry services can be beneficial for patients with comorbidities of psychiatric conditions coupled with existing medical challenges (this combination often contributes to more severe health risks, higher utilization of EDs, longer hospital stays, and higher cost per patient). In addition, telepsychiatry benefits populations living in rural areas as they can have the opportunity to access health resources and services.

All things considered, when implemented effectively, a telepsychiatry program can go a long way towards helping hospitals meet their quadruple-aim goals of better outcomes, higher patient satisfaction, reduced costs, and improving the clinician experience.

Setting yourself up for success with your hospital’s new telepsychiatry program

Once you’ve determined a telepsychiatry solution may be a good fit for your hospital or health system, you should first evaluate the goals for your program. Plan for a long-term relationship with whatever telepsychiatry solution you choose (whether it’s a vendor like Iris Telehealth or an individual, local provider).

Initial steps should include: Identifying gaps and pain points, auditing your EHR to understand how often you’re addressing psychiatric conditions, discussing staff feedback on current processes and needs, and working through your overall psychiatric needs (including potential hourly and budgetary needs to launch a successful program).

As with any implementation plan, it’s important to outline how you’ll measure success. You should determine which metrics you plan to track to ensure your telepsychiatry program works well for your organization and your patient populations.

Potential metrics might include:

  • ED boarding times
  • Resources spent on sitters for behavioral health patients
  • Med/Surge behavioral health patient volumes per shift or diagnosis type
  • Financial metrics
  • Patient satisfaction measurements

Later, you’ll look back at these goals and metrics to determine how successful your telepsychiatry program has been for the community and patients you serve.

Free Whitepaper: Building a Sustainable Telepsychiatry Program

Choosing the vendor or telepsychiatry partner who’s right for your hospital

Choosing a vendor can feel like an overwhelming process — because it’s often difficult to tell if someone will be a good fit for your organization.

But there are some key steps that can help you make your decision (and be confident it’s the right one):

  1. Create a checklist to understand your non-negotiable requirements for a telepsychiatry program to ensure potential vendors meet your needs.
  2. Request referrals from current or past clients from similarly-sized hospitals serving patient populations like yours.
  3. Research the leadership structure of potential vendors and the company’s ownership (companies run by physicians will likely have more experience providing quality care).
  4. Ask for quotes from potential telepsychiatry vendors.
  5. Analyze their bandwidth for technology support, support hours, and whether they’ll be ready by your program’s go-live date.

Keep in mind that vendors with Joint Commission accreditation are typically a step ahead of competitors. Joint Commission accreditation speaks to the quality of the vendor’s services and the vendor’s ability to enforce compliance and maintain effective processes.

Implementing a telepsychiatry program at your hospital

The implementation process for a telepsychiatry program can be time-consuming. Still, it’s worth doing it right so you’re setting your program up for success as soon as it officially goes live.

One of the biggest hurdles to launching a telepsychiatry program is the process of licensing and credentialing your telepsychiatry providers. This process involves confirming the clinician’s work history and education history while verifying references to provide an in-depth vetting of the clinicians. You’ll also contract and panel with health plans including Medicaid and Medicare as well as local, regional, and relevant private health plans.

If you choose to partner with Iris Telehealth, Iris can provide complete credentialing packets from our own Joint Commission accredited privileging process. Our TJC accreditation enables you to take advantage of credentialing by proxy and eliminates a large portion of your team’s workload while dramatically cutting down the time to go live with services dramatically.

Along with licensing and credentialing, we also recommend you assemble an on-side implementation team and a telepsychiatry care team to work with your telepsychiatry vendor as you prepare to launch.

You’ll also want to train your front desk and medical support staff on any necessary workflows around your telepsychiatry program.

Launching a telepsychiatry program can seem like a lot of work — but it’s worth it

Starting a new telepsychiatry program at a hospital or health system can seem like a daunting task. It involves understanding your patients’ needs, evaluating telepsychiatry companies, facing new logistical and workflow challenges, and leveraging technology effectively on both your and your patients’ end. But it can go a long way to alleviating pressure on your EDs, reducing unnecessary psychiatric bed holds, and decreasing your length of stay.

Plus, if you choose the right telepsychiatry vendor, they’ll be with you every step of the way to ensure your program is a success.

To learn more about how Iris Telehealth can help you build a successful telepsychiatry program at your hospital or health system, contact us, and we’ll get you the information you need.

The Future of Mental Health Care in the Virtual World

The way we talk about mental health has changed during the pandemic. Over the past year, COVID-19 and the subsequent mental health crisis have helped decrease the stigma around discussing mental health and have increased awareness of the vast need across the country for access to quality care. And, with the emergency telehealth protocols, we’ve seen an improvement in access to care across the country.

However, we also know because of the pandemic, there’s a higher need for care across patient populations, which will likely persist for years to come.

So what does that mean for the future of mental health care?

We need to keep breaking down barriers to high-quality care

Some of the barriers, thankfully, have been eliminated during the COVID-19 emergency protocols:

  • Insurance payers are reimbursing for virtual care where they weren’t in the past, which signals an improvement in the types of visits that are covered and what’s considered “mental health care.”
  • The philosophy of what is the point of care has been stretched and become more creative so we are providing continuity of care.
  • The stigma around mental health care is improving because of our shared challenge and experiences during the pandemic.

Now, we’re starting to see more and more states make their temporary protocols permanent, which will help behavioral health organizations better incorporate telehealth into their long-term strategies and continue to increase access to mental health services.

On top of these policy changes, I hope that, moving forward, more people will see the incredible need for mental health care and hopefully go into the field. Because, one of our biggest, persistent barriers to care is our ongoing psychiatrist shortage.

Embrace hybrid-models of care as the key to future success

Throughout most of the pandemic, folks have relied on virtual resources to help them connect with friends, loved-ones, and co-workers. But, long-term, exclusively virtual contact can still feel isolating for many people.

As things are starting to open back up, many people are longing for those in-person interactions, which is completely understandable. As a result, many healthcare organizations who pivoted quickly towards telehealth when the pandemic started may wonder how best to move forward.

It’s important to note that there won’t be a sudden change back to the way things were. The transition will be very gradual, and will likely result in a hybrid care model where both in-person and virtual appointments are available.

There will certainly be circumstances where providers want to see clients in person. But, over the past year, we’ve learned that telemedicine can be a fantastic option for certain kinds of care — particularly in the behavioral health space.

As people are slowly getting back to the new normal, there are still unknowns. People will have understandable anxieties about exposures, and there will be a subset of patients who will prefer to continue virtual care. So, a combined approach where organizations and providers offer different kinds of care will be important.

Patient challenges and demographics might be different moving forward

The pandemic has uprooted families for well over a year. Across the board, we’ve seen an increased need for caretaking within the home. With school closures, the shift to virtual learning, and parents figuring out how to care for their children while still maintaining their careers, there’s been a substantial impact on families and family life. Now we’re understanding how this long-term trauma is affecting kids, and what the school closures have meant in terms of social and emotional learning for these children.

As schools open back up and we inch ever-closer to “normal,” providers and healthcare organizations on the whole should expect to see an influx of children in need of mental health care, with different challenges than we’re used to.

On an individual level, providers and patients should work to ensure they’re taking care of themselves emotionally

This pandemic has impacted everyone to a degree, and we all can’t help but be affected emotionally and mentally by the past year. There’ve been so many unknowns during this time that it’s just brought emotional wellness into the forefront. That shift has directly improved awareness of mental health needs and decreased any negative stigma that was attached with mental health.

As we look to the future, I hope people will be less hesitant to take care of themselves emotionally and make sure they have the support they need.

However, there are so many resources available now that it can be overwhelming. If you ever have a question about a health or wellness app, ask your healthcare provider what they recommend. One resource that I personally have been recommending is the American Academy of Child and Adolescent Psychiatry has a COVID-19 resource library with recommendations and guidelines for parents and families.

At the organizational level, we should all work to continue improving access and expanding behavioral health care programs

From a healthcare policy and delivery perspective, we’ve seen an increase in depression, anxiety, and substance use behaviors over the past year. But we’ve also had more conversations about the need for treatment as well as the need for access. My hope is we continue in this direction, work to improve access, and continue to think creatively about how to deliver it — whether that be virtual, in-person, or through new, innovative mediums.

It’s important that we pay attention to what our patient populations want and need, and don’t move behavioral health programs and mental health services backwards. Already, more and more states are taking permanent steps to support telehealth and audio-only virtual care. And, patient and provider preferences are here to stay, so continuing with that flexibility will be important for the long term success of your programs.

If you’re hoping to build out a sustainable telepsychiatry program at your organization but don’t know where to start, Iris Telehealth is here to help. Contact us and we’ll help you get all the information you need.

What Pediatricians Need to Know About Diagnosing and Treating Pediatric Anxiety

This is our second piece in our series on pediatric behavioral health conditions. Check out our first post on diagnosing, treating, and supporting children experiencing pediatric depression here.

Over the past few years, child and adolescent anxiety has become an increasingly common and concerning trend. And, over the past year, COVID-19 and the resulting school closures have only exacerbated the situation. As a pediatrician or healthcare organization providing pediatric behavioral health services, you’re likely experiencing the impact of that trend first-hand.

Keep reading for a breakdown of the increased demand on pediatricians, the most common anxiety orders in the DSM-5 anxiety disorders, best practices for screening and assessment for anxiety in primary care, and the algorithm for treating pediatric anxiety.

Anxiety disorders are the most common mental health condition for children and adolescents

Anxiety disorders have a 30% lifetime prevalence, meaning 30% of people in a population develop anxiety disorders at some point in their lives.

According to The Journal of Pediatrics, of the 4.4 million children aged 3-17 years with diagnosed anxiety, more than one in three have a behavioral disorder, and about one in three are experiencing depression. Only six in 10 children aged 3-17 years with anxiety received treatment. The disparity between the number of children with anxiety versus the number of children in treatment is alarming, and it speaks to the role providers must play in screening and raising awareness about anxiety disorders for children and families.

The DSM-5 classifies anxiety disorders in children

If you or your healthcare organization are providing behavioral health services to children and adolescents, you should be able to differentiate between the unique DSM-5 childhood anxiety disorders as you diagnose and treat patients.

The most common DSM-5 anxiety disorders we see include:

  • Generalized anxiety disorder: excessive worry about a variety of subjects such as grades, family relationships, or relationships with peers.
  • Separation anxiety disorder: developmentally inappropriate and excessive anxiety concerning separation from attachment figures.
  • Selective mutism: a newly added anxiety disorder in DSM-5, selective mutism is a consistent failure to speak in specific social situations in which there is an expectation for speaking despite speaking in other situations.
  • Specific phobia: marked and persistent fear of a specific object or situation that causes significant distress and interferes with usual activities.
  • Social anxiety disorder: also known as social phobia, social anxiety disorder is an intense fear of social and performance situations and activities (for example, being called on in class or starting a conversation with a peer). Social anxiety can significantly impact school performance and attendance as well as the ability to socialize with peers and develop friendships.
  • Panic disorder: diagnosed if a child suffers at least two unexpected panic or anxiety attacks followed by at least one month of concern over having another attack.
  • Agoraphobia: fear of going into certain situations where they may experience panic or be uncomfortable and without help.
  • Substance/medication-induced anxiety disorder
  • Anxiety disorder due to another medical condition

As a healthcare provider treating pediatric anxiety, you should be wary of differential diagnoses

Many symptoms of anxiety disorders overlap with other conditions. It can be difficult to determine whether symptoms stem from real anxiety diagnoses or other diagnoses or reactions to acute events.

Some differential diagnoses include:

  • Adjustment reactions to acute stressors
  • General Anxiety Disorder vs. OCD
  • Bullying
  • Substance Use Disorders
  • Autism Spectrum Disorder
  • ADHD
  • Excess caffeine/energy drinks and/or nicotine use

In addition to differential diagnoses, your medical workup of conditions that can present with anxiety symptoms should include investigating other conditions and reactions to medical treatments.

Screening for pediatric anxiety is quick, free, and easy

The Pediatric Symptom Checklist-17 is generally the first step for evaluating anxiety and screens for cognitive, emotional, and behavioral problems in children ages 4-17. If you see a total score of 15+ points, you should conduct a formal assessment.

After a score of 15+ points, your next steps will include a clinical interview and using the applicable symptoms rating scale.

Use SCARED (Screen for Child Anxiety Related Disorders) for ages 8-18

  • 41 item inventory
  • Parent and child version
  • Score 25 or greater significant

Or GAD-7 (Generalized Anxiety Disorder 7) for ages 12 and up

  • 7 item inventory
  • 1-2 minutes to complete
  • Score 10 is moderate, 15 is severe

Assessing for avoidance is the most important step, as avoidance of activities and circumstances that provoke anxiety often are the most disabling aspects of anxiety disorders for children and adolescents. Remember avoidant behaviors often become habitual and may be reinforced by family members and teachers.

In addition to avoidance, be sure to assess for acute and chronic stressors which may be contributing to presentation, current, or previous self-injurious behavior or suicidal ideation. Other common co-occurring psychiatric diagnoses include ADHD, depression, and Substance Use Disorders.

The patient and family-first approach to treating anxiety disorders

An anxiety disorder diagnosis can be scary for families new to mental health discussions. Be patient as you’re determining a treatment plan, and be sure to determine treatment based on the severity of the child’s anxiety disorder.

For subclinical to mild anxiety, you can prescribe supported self-management and follow-ups, including at-home guidance for children and families. For moderate depression or mild depression that does not respond to supported self-management, you’ll have to provide a therapy referral (Cognitive Behavioral Therapy preferred) or a medication trial. For severe anxiety, you should always refer patients for therapy (Cognitive Behavioral Therapy preferred) and medication until the child’s anxiety is stable. Be sure to establish clear goals, expectations, and communication workflows to support families through severe anxiety treatment — it can be an emotional time.

SSRIs: the gold standard

SSRIs are the gold standard of care for treating anxiety. Whenever you prescribe SSRIs, you should conduct an in-depth screening for family history of bipolar disorder or suicide, establish a plan for follow-up and emergency access to care, and educate the family about potential side effects and protocols for adequate trials. SNRIs can be used as a second option if SSRIs treatment isn’t successful.

Fluoxetine and Sertraline are the two most studied SSRIs and, consequently, are recommended the most. For both medications, you should give test doses and closely monitor the children’s response. If a child responds well to treatment, you or your providers can slowly taper them off the medication while reevaluating their reaction throughout.

Evidence from a 6-year CAMS (Child/Adolescent Anxiety Multimodal Study) indicated that a combination of Sertraline and Cognitive Behavioral Therapy showed the most benefits for patients compared to treating with just one or the other. This is an important reminder that medication is not a “cure-all” for all mental health conditions, and approaches to anxiety are often complex and multi-faceted.

Treating anxiety disorders requires a holistic regimen and candid conversations with children and families throughout the process to provide the best possible care.

Next steps: resources for providers

Treating childhood anxiety will become increasingly important as anxiety rates continue to rise. As always, Iris Telehealth is here as a resource for providers and healthcare organizations that need support. If your organization is feeling the weight of an influx of patients experiencing pediatric anxiety, contact us today. We’d love to talk to you about how we can help!

How FQHCs Can Build an Effective, Sustainable Telepsychiatry Program

Many Federally Qualified Health Centers (FQHCs) have never implemented a formal psychiatry program — much less a telepsychiatry program. But as COVID-19 continues to impact communities around the country, you and your team may find yourselves considering how to build a telepsychiatry program that provides safe, accessible psychiatric solutions to your patients.

Starting a program to provide behavioral health services from the ground up can feel overwhelming. But following these guidelines can help you successfully build a telepsychiatry program for your FQHC that meets patient needs and helps you achieve your holistic care goals.

First, Complete an In-Depth Needs Assessment to Determine Whether a Telepsychiatry Program is Right for Your FQHC

Follow this checklist (in order) to evaluate how a telepsychiatry program would fit into your organization and determine what kind of vendor or telepsychiatry program would meet your needs:

  1. Audit Your EHR: Start by auditing your Electronic Health Record (EHR) to understand how often your organization addresses psychiatric conditions. Note which behavioral health conditions you’re diagnosing most frequently. Also, evaluate medications prescribed to understand which medications your FQHC prescribes the most.
  2. Analyze Psychiatry Referrals: Look at external psychiatric referrals to evaluate how many referrals your primary care physicians are making to external psychiatric facilities — and how long the approximate wait times are for those referrals.
  3. Discuss Staff Feedback: Anecdotes and qualitative information will help you understand how your FQHC’s culture would fit into a telepsychiatry program. Consider surveying your counselors, social workers, primary care providers, and patients to identify care gaps and evaluate your stakeholders’ current thoughts on your organization’s psychiatric care.
  4. Understand the Scope of Psychiatric Needs: Consider your patient demographics, the language and gender of your patient populations, and the complexity of your cases to inform how you approach a telepsychiatry partnership.
  5. Hours and Budget: Understanding the number of hours required and how that compares to your budget will help you shape your telepsychiatry program and the kinds of providers you’ll need to hire. You can also pursue grant funding opportunities if there is a disparity between hours needed and budget.
  6. Regulations: Consider regulations in your state and how they might impact telepsychiatry practices, licensing, and prescribing. Regulations might include whether Psychiatric Mental Health Nurse Practitioners (PMHNPs) can practice independently in your state or state regulations about caring for acutely suicidal patients.
  7. Provider Type: You’ll also need to determine whether a physician or psychiatric nurse practitioner best meets your needs. Your state’s regulations will likely inform this decision, as some states might have supervision requirements for PMHNPs.
  8. Other Legal Requirements: Requirements around facility regulations and board certification requirements might affect your ability to implement your telepsychiatry program. If you need help navigating these, let us know. We’re here to help.

After you finish your preliminary needs assessment, you should take a step back and reevaluate your telepsychiatry goals and outline how you plan to measure the success of your program moving forward.

Once You’ve Completed Your Needs Assessment, Evaluate Potential FQHC Telepsychiatry Vendors

You can start evaluating potential vendors if your needs assessment results have proven that your FQHC has the need and the budget to implement a telepsychiatry program.

The first thing you’ll have to do during the evaluation process is to create a checklist to understand your non-negotiable requirements for a telepsychiatry program to ensure potential vendors meet them. Also, ask vendors how their providers are vetted before being recommended for your clinic. Be sure to request referrals from current or past clients to understand how the vendor operates in the FQHC environment. Anytime vendors have Joint Commission Accreditation (JCO), it typically speaks to the quality of their services and their ability to enforce compliance and maintain effective processes.

Because telepsychiatry employs technology differently than traditional psychiatry solutions, you’ll want to evaluate the vendor’s bandwidth for technology support, support hours (whether availability for support is 24/7 or restricted), and whether the vendor will be available on the go-live date. Pay close attention to how they deal with privacy and security, as your telepsychiatry solutions will house sensitive patient information.

After You’ve Chosen a Telepsychiatry Vendor, It’s Time To Begin Implementing Your Program

Implementing a telepsychiatry program at your clinic can be a time-consuming process. These eight steps can help streamline the process:

  1. Credentialing: As soon as you select a member and are matched with a provider, start the credentialing process. Your provider will need to be licensed in your state. Then you’ll need to obtain a license from the DEA and begin credentialing at your facility. This process will vet the provider’s work and education history and verify their references.
  2. Assembling Your Implementation Team: You should begin assembling this team during the credentialing process, and the team should include your clinical lead and key decision-makers.
  3. Assembling Your Telepsychiatry Care Team: Your telepsychiatry care team will be separate from your implementation team and may include desk staff, nurses, medical assistants, counselors, telepsychiatry providers, and administrators.
  4. Training Your Staff: Create workflows specific to your front desk, support staff, and billing/coding team with the ability to scale as your telepsychiatry program grows.
  5. Review Your Technology Workflows: Carefully plan how your technology use and workflows will fit with your telepsychiatry provider before your program’s go-live date, and consider retraining your team on your privacy and security standards.
  6. Decide Your Provider’s Schedule: Consider how many days and hours you will need your telepsychiatry provider to work and ensure you have adequate staffing for that plan.
  7. Market Your Telepsychiatry Services: We recommend beginning recruitment for referrals six weeks before your go-live date — beginning with internal counselors and primary care physicians.
  8. Go-Live: Make sure you plan to do a test run a few days before you’re ready to go live, then you’ll be ready to launch your program!

By Following These Guidelines, You’ll Be Well On Your Way To Starting a Successful Telepsychiatry Program For Your FQHC

Starting a new telepsychiatry program can be intimidating, but fortunately, you don’t have to reinvent the wheel. We’ve seen many FQHCs create successful telepsychiatry programs to serve their communities in creative ways.

To learn more about how Iris Telehealth can help you get your program off the ground, contact us, and we’ll get you the information you need.