Virtual Psychiatric Care vs. On-Site Psychiatric Care

Telepsychiatry has evened the playing field for people in need of mental health help by providing psychiatric services, most often through video conferencing. This allows patients, no matter their location, to receive high-quality psychiatric care. The great thing about telepsych is that conducting an appointment virtually does not impact the quality of care received. There are very few differences between getting psychiatric care virtually and psychiatric care on-site.

With the COVID-19 pandemic and the U.S.’s ongoing shortage of psychiatrists, offering telepsychiatry services just isn’t going to be optional anymore. It’s now necessary that organizations and providers be able to treat patients virtually when on-site care isn’t possible.

Fortunately, the nationwide shift to telemedicine early in the pandemic has proven that there’s little to no difference between the quality of virtual psychiatric care and on-site psychiatric care. Telepsychiatry has made psychiatric services more accessible, affordable, and convenient than ever — for patients, providers, and healthcare organizations alike.

For organizations still debating whether to invest in virtual psychiatric care vs. on-site psychiatric care for their long-term care strategies, this piece will address four common questions you may have:

1. Is the length of treatment different for a virtual appointment?

There’s a huge misconception that there’s a difference in the level of care between a virtual psychiatric appointment and an on-site appointment. The truth is, a virtual appointment runs much the same way an on-site appointment does. There’s no difference in the length of treatment, the type of care, or how the provider conducts the appointment.

Just like in an on-site appointment, the patient will be connected directly with their provider (either in a healthcare organization or in their own home) for a private, confidential session. The provider will then conduct an in-depth evaluation and work with the patient towards a diagnosis and treatment plan that is specific to their needs. If patients require medication, a virtual psychiatrist can prescribe that as well — often through your organization’s existing system. Additionally, follow-up care will be set up as needed.

However, while the approach to care can be similar, the biggest advantage of using a telepsychiatry provider is expanding access to quality psychiatric treatment for people in rural and underserved areas.

2. Can a patient’s mental health condition impact the level of care they receive?

In almost all cases, patients can receive care virtually just as they would be on-site. However, sometimes the decision comes down to personal preference and availability. In some rare cases, a virtual appointment would not be ideal for patients who are in mechanical restraints, not willing to consent to receive mental health treatment virtually, or not able to conduct an appointment in a safe, private environment wherever they are located. In these scenarios, on-site treatment (if possible) is recommended.

Other than these few exceptions, a patient’s particular mental health condition does not impact their ability to receive adequate care virtually. At Iris Telehealth, we work with providers to ensure patients are safe, comfortable, and experience the highest level of care possible.

3. Do virtual and on-site psychiatric appointments have the same level of effectiveness for children and adults?

There is no major difference in patient outcomes or patient satisfaction for virtual care vs. on-site care. In a study published by The American Journal of Managed Care, 62.6% of patients and 59% of clinicians cited they did not see a difference in quality in a virtual visit compared to an on-site visit with most patients preferring virtual psychiatric visits. With the onset of the pandemic, adults and children have both been struggling to maintain their mental health while being isolated and dealing with day-to-day life. When an on-site appointment is not feasible, children and adults can seek psychiatric help virtually to get their mental health back on track.

4. What are the top concerns providers have with virtual appointments vs. on-site appointments?

Some providers have to overcome patient concerns around telepsychiatry because they’re worried about being recorded during their sessions. During the session, the provider will never record patients without telling them, and they must ensure they receive patient consent before conducting any appointments. Just like at an on-site appointment, providers will review everything patients need to know before the appointment and ensure they understand how everything will flow.

Providers also have to work through using technology to speak with their patients who may not be tech-savvy. When providers partner with Iris Telehealth or another telehealth vendor, they will be properly trained, educated, and given adequate support to address patient concerns and work through any technology fears patients may have.

Another concern providers have is whether they will have the same connection with their patients virtually as they would on-site. Most providers and patients find this answer to be a resounding yes! According to a study performed by APA, 82 percent of people tried virtual care due to the pandemic, and about half had a positive response to it. Fifty-nine percent say they would use it for a mental health concern in the future — and most patients who take advantage of virtual care report positive experiences and satisfaction.

How Iris Telehealth can help

Whether your organization chooses to implement virtual psychiatric care or on-site care, you can rest assured patients will receive the same level of care and treatment with both options. One is not inherently better than the other. However, telehealth makes mental health help available to more people across the U.S. and breaks down barriers to receiving help.

If you would like more information on how to implement telepsychiatry into your organization — or how it can help you meet the mental health needs of your community — contact us today.

Understanding and Treating Eating Disorders in Children

Thank you for following along the journey through common pediatric care disorders and treatments! This is our fourth and final post in our series on pediatric behavioral health conditions. For more, visit our posts on pediatric stress and trauma, pediatric depression, and pediatric anxiety.

In this post, we’ll discuss the prevalence and risk factors surrounding pediatric eating disorders, screening challenges, and treatment for eating disorders in primary care — while considering additional challenges that have popped up during the COVID-19 pandemic. Because you’ll probably see Anorexia Nervosa and Bulimia Nervosa most often in pediatric care, we’ll spend more time on those two.

We hope this guide will empower you to understand and treat this increasingly prevalent pediatric health condition.

Anorexia Nervosa is a battle against body and mind

Anorexia Nervosa (AN) is a tricky disorder that’s not just physical, but a combination of psychological characteristics leading to physical changes. Common characteristics associated with Anorexia Nervosa include:

  • Lower body weights than minimally expected (less than 85% of expected BMI)
  • Intense fear of gaining weight
  • Persistent behavior that interferes with weight gain
  • Undue influence by body weight or shape
  • Failure to recognize low body weight
  • Secret exercising and/or compulsion to stand or move
  • Baggy clothes and complaints of being cold

Look out for AN in children who participate in activities where weight or appearance plays a role and picky eaters or children significantly affected by societal pressure.

As always, keep an eye out for comorbidities as AN is comorbid with at least one other psychiatric disorder in 55.2% of cases.

Restricting type and binge eating/purging type are the two subtypes of Anorexia Nervosa, though binging and purging is less likely in children than adults:

  • The restricting type is defined by restricted food consumption, and you’ll see symptoms such as fasting or avoiding “risk” foods.
  • The binge/purging type includes children who demonstrate both binging and purging symptoms and are severely underweight.

The good news is that prognosis for teens with Anorexia Nervosa is more promising than the same diagnosis for adults. If you can catch and treat Anorexia Nervosa in a patient’s childhood years, you can take the necessary steps to improve their development.

Screening and treating Anorexia Nervosa is a family affair

Screening for AN is tough. Children may keep their eating disorder a secret by including attempting to pad weight by putting objects in their pockets during weight checks, drinking excessive water prior to appointments, or explaining weight loss through a medical illness. And they may deny the psychological characteristics of AN.

For this reason, an honest parent/child rapport is essential for diagnosing children with AN. You’ll need to advise parents about symptoms to watch throughout the screening process, especially if they note any unexpected weight loss or failure to gain expected weight. Also, be sure to require a medical workup to understand the physical symptoms children may be experiencing and schedule frequent follow-up visits.

Remember that family relationships can be essential to effective treatment. One of the most commonly used treatment models, the Maudsley Model, includes intensive family therapy to educate and empower parents. It’s an outpatient model and includes programs that meet regularly for 6-12 weeks. It has proven successful in weight restoring children, who in turn learn increased autonomy over time.

For children who don’t have access to family therapy, we’d recommend a model focused on individual therapy to restore autonomy over eating.

Bulimia Nervosa is another secret battle

Anorexia Nervosa goes hand in hand with Bulimia Nervosa (BN). Approximately 60% of patients diagnosed with AN develop BN, and BN often develops at 14-22 years of age. As with AN, Bulimia Nervosa (BN) can be a secret battle, and patients can have BN symptoms for up to five years before seeking treatment. The good news is that 50% of patients are symptom-free 5-10 years after receiving treatment.

BN patients are often within the normal expected weight range, making it more challenging to see the physical characteristics of the condition. However, teens with BN may be secretive and note difficulty with interpersonal relationships, and males with BN may overexercise or use steroids.

Keep on the lookout for BN as it’s relatively prevalent — 1-2% of adolescent females and 0.5% of males meet DSM-5 criteria for BN.

Of course, differential diagnoses also exist, so be wary as you diagnose patients with BN. What may appear as Bulimia Nervosa could be the Anorexia Nervosa binge/purge subtype, Binge Eating Disorder (BED), or other conditions.

Family and social factors are risk factors for Bulimia Nervosa

Family factors such as PTSD or perfectionistic temperaments are major risk factors for Bulimia Nervosa. These risk factors are compounded with dieting and social pressures to be thin, and when combined, they can create the feelings of guilt and shame we associate with BN.

Remember comorbidities as you’re investigating factors. One study showed lifetime psychiatric comorbidity of 88%, and most teens had at least one comorbid psychiatric illness with BN.

As a provider screening for Bulimia Nervosa, you must stay vigilant

As with Anorexia Nervosa, you’ll face significant challenges screening for Bulimia Nervosa. Adolescents with BN will often want to keep their eating disorder a secret and be ashamed of binging and purging symptoms. Because weight is often within the normal range, physical characteristics are less obvious than AN. Children with AN may not be aware of their feelings or able to verbalize shame, and they may not even understand their behavior is abnormal.
As with AN, patients will often deny the psychological aspects of BN, and you’ll have to stay suspicious throughout screening to understand the full picture.

Treating Bulimia Nervosa is a family affair

Research on both therapy and medication for Bulimia Nervosa is still ongoing. The two therapy types for BN include Family-Based Treatment (FBT) and Dialectical Behavioral Therapy (DBT). As with AN, family-based Maudsley therapy is the most effective. Educating the entire family system also alleviates behaviors that will encourage binging and purging. DBT should also be integrated into any therapy for eating disorders to help cope with stress symptoms.

COVID-19 is making eating disorders worse

During the first lockdown period in spring 2020, grocery shopping, doctor visits, and social support systems were interrupted, exacerbating eating disorders.

In some cases, children who liked the sense of control that came with a scheduled routine turned to controlled, disordered eating to cope with the uncertainty. Social distancing made hiding restrictive behaviors and weight loss easier for children who wanted to keep their behaviors secret. On top of this, virtual appointments have made it more difficult to assess vital signs, weights, and labs, causing eating disorder screenings to be less accurate.

While telehealth, virtual nutrition coaching, and more have led to some creative solutions to address eating disorders, the reality is that COVID-19 is making eating disorders more prevalent and more difficult to treat as a whole.

Keep up the great work!

We understand eating disorders are challenging to diagnose and treat, and the societal pressure on appearances makes your job as a provider even tougher. Know that as you’re supporting children and families, you give them the best chance to overcome their eating disorders and live fulfilling lives.

Research on eating disorders is ongoing, so be sure to follow the most updated guidance. For now, here are a few resources we recommend:

As always, Iris Telehealth is here as a resource for providers who need support. If your organization feels the pressure of increased numbers of patients experiencing pediatric eating disorders, contact us today.

Breaking Down the American Rescue Plan’s Emergency Rural Health Care Grant Program

The American Rescue Plan Act opened up two new categories of Emergency Rural Health Care Grants, which will provide up to $500 million to community-based nonprofit healthcare organizations and federally recognized tribes. The purpose of these grants is to help rural organizations increase access to much-needed healthcare services — including telehealth. If your organization has been impacted by COVID-19 and seeks to expand or improve services, these grants may be a good fit for you.

The two grant tracks: Recovery Grants and Impact Grants

The Emergency Rural Health Grant program is awarding grants in two main tracks: Recovery Grants and Impact Grants.

Track one: Recovery Grants

Recovery Grants must be used in connection with the COVID-19 pandemic to support health care needs in your community. In your application, you can request grant funding to address one or more of the following categories:

  • Vaccine distribution
  • Medical supplies and equipment for medical surge
  • Reimbursement for healthcare-related revenue loss during the pandemic
  • Telehealth expansion
  • Construction or renovation of healthcare facilities
  • Staffing for testing or vaccine administration

Track two: Impact Grants

Impact Grants must be used in connection with the COVID-19 pandemic and to support long-term, sustainable healthcare services — including the development of holistic healthcare programs (that blend behavioral care and other medical services), the expansion of telehealth services, and more. In your application, you can request funding for:

  • Establishing a regional partnership to implement a model that supports the long-term sustainability of rural healthcare
  • Establishing an evidence-based model that organizations in your community can replicate
  • Identifying a health-related problem within your community and developing a solution
  • Establishing a methodology to calculate impact measures
  • Covering the cost of technical assistance necessary for project implementation
  • Paying professional service fees associated with the grant request

Key program dates and details

Here are some of the key details of the Emergency Rural Health Care Grant program:

  • Applications for grant awards are due October 12, 2021
  • Recovery Grant awardees will receive between $25,000 and $1 million
  • Impact Grant awardees will receive between $5 million and $10 million
  • The Recovery Grant period is expected to begin around November 1, 2021, and last approximately 36 months
  • The Impact Grant period is expected to begin around January 1, 2022, and last approximately 36 months

What Recovery Grant applicants need to submit in their application

Each Recovery Grant application must include the following:

  • A summary page including the intended funding track, applicant name, amount of grant request, and project description
  • A detailed table of contents
  • A completed “Application for Federal Assistance” form (SF-424)
  • A completed “Budget Information — Non-Construction Programs” form (SF-424A) or “Budget Information — Construction Programs” form (SF-424C)
  • Organizational documents demonstrating eligibility
  • Additional evidence of eligibility that demonstrates that your healthcare organization primarily serves rural areas
  • A complete budget narrative

What Impact Grant applicants need to submit in their application

Each Impact Grant application must include the following:

  • A summary page including the intended funding track, applicant name, amount of grant request, and project description
  • A detailed table of contents
  • A completed “Application for Federal Assistance” form (SF-424)
  • A completed “Budget Information — Non-Construction Programs” form (SF-424A) or “Budget Information — Construction Programs” form (SF-424C)
  • Organizational documents demonstrating eligibility
  • Additional evidence of eligibility that demonstrates that your healthcare organization primarily serves rural areas
  • A complete budget narrative

How your organization can apply to this grant program

Before your organization officially submits your application, make sure you’ve read the Notice of Funds Availability (NOFA) and reviewed the materials on the program webpage.

Contact your state’s Rural Development office and submit the materials outlined above when you’re ready to submit your application.

For more detailed information about the materials you’ll need to submit, please refer to the Recovery Grant application checklist and the Impact Grant application checklist.

The Emergency Rural Health Care Grant program is a perfect fit for healthcare organizations located in rural, underserved areas looking to impact their communities and improve their services in the wake of COVID-19. It also offers some excellent opportunities for organizations to incorporate or expand telepsychiatry services into their behavioral health programs. If your organization is interested in learning more about how telepsychiatry can supplement and improve your services, contact Iris Telehealth today — we’re always here to help.