Question 1

Has research been done to prove forensic telepsychiatry works? What’s the evidence base?

Accepted Answer

Yes, telepsychiatry has been comparable to in-person care among inmates in jail, prison, and correctional facilities. Video visits with telepsychiatric evaluations are used used to treat inmates with a variety of psychiatric illness in a range of severity, including severe mental illness. Decades of studies demonstrates telepsychiatry’s usefulness.

Vacancies and staffing issues in correctional facilities can impact access to care. Physical space requirements, security requirements, and correctional work culture pressures discourage healthcare providers from working in the correctional facility environment.

Telepsychiatry fills these vacancies, can ease burden on clinicians and providers, and takes less physical space than having more personnel on-site.

With the adoption of telepsychiatry, inmates can be seen early in their incarceration. Patient satisfaction has been shown to be high in forensic psychiatric patients with remote video visits. Acceptability has additionally shown to be high amongst jail personnel.

A meta-analysis — a study of multiple studies — looked at telepsychiatry used in acute settings, including inpatient units. They showed that the quality of clinical interaction is similar to in-person face-to-face encounters, and that telepsychiatry has been cost-effective.

Sources:

* Kaftarian, Edward. "Lessons Learned in Prison and Jail-Based Telepsychiatry." Current psychiatry reports 21.3 (2019): 15.
* Salmoiraghi A, Hussain S: "A Systematic Review of the Use of Telepsychiatry in Acute Settings" Journal of Psychiatric Practice. 2015; 21 (5):389-93
* Brodey et al, 2000. Satisfaction of forensic psychiatry patients with remote telepsychiatric evaluation. Psych Services: Oct 51(10): 1305-7.
* Leonard S: "The Successes and Challenges of Developing a Prison Telepsychiatry Service" Journal of Telemedicine and Telecare. 2004; 10 (S1): 69-71
* Zaylor C, Whitten P, Kingsley C: "Telemedicine Services to a County Jail" Journal of Telemedicine and Telecare. 2000; 6 (S1): 93-95

Question 2

Does working for the federal government allow you to see patients via telepsychiatry, wherever you are?

Accepted Answer

Working for the federal government does not necessarily allow you to see patients via telepsychiatry, wherever you are. While there are no absolute contraindications to patients being assessed or treated using telemental health, you have to check with your supervisor — and any applicable administrative rules and trainings — for these rules.

Ask your supervisor about federal telework agreements, contingency plans for persons who appear in-person or who are unable to connect by video, and whether support staff are available to guide your patient in case of an outage.

Furthermore, telemedicine requires you to know which state a patient is located. You would need to follow that state's licensing laws and regulations. Usually, this means you must have a license to practice in that patient's state, have malpractice cover your practice in that state. Some states allow for a single state license to cover multiple states — the Interstate Licensure Compact, for instance — but not all states participate in this.

Resources, such as the [American Medical Association Telehealth quick guide](https://www.ama-assn.org/practice-management/digital/ama-telehealth-quick-guide), can help you determine which laws apply.

Question 3

How does Orbit Health provide mobile response teams?

Accepted Answer

Orbit Health’s innovative mobile response team works with local law enforcement agencies to provide alternatives to arrest and incarceration for those suffering from mental and emotional difficulties.

We provide urgent [telepsychiatry](https://www.orbithealth.com/what-is-telepsychiatry/) evaluations to assess the safety and stability of patients in the community. Our mission is to help end the cycle of mass incarceration by providing ways to divert vulnerable people from incarceration, and toward the help that they need to be a productive member of society.

To learn more, [contact Orbit Health today](https://www.orbithealth.com/contact-us/)!

Question 4

What hardware and apps should I use for telehealth visits for those with hearing impairments?

Accepted Answer

If you see enough patients, you are bound to run into patients who may be hard of hearing or deaf. Persons with disabilities deserve great care. Effective communication is essential to ensure a high quality of care.

Consider using the following computer equipment, hardware setup, and apps, for your telehealth and telepsychiatry visits:

* Make sure that there is as little background noise as possible on both sides of the camera. This can be challenging in certain facilities that are inherently noisy, such as jails or inpatient units.  Its helpful to have a dedicated office for telepsychiatry that can be insulated against background noise.
* Use a high-quality microphone speaker on both sides of the telehealth session. These are easy to use and inexpensive devices.  You just plug and play, with a USB port.
* If the quality is still not good, you can connect the audio through the telephone while keeping video with the telemedicine platform.
* Provide the patient with headphones (noise cancelling preferred). This allows the patient to increase the volume and minimize the diffraction of noise.
* There are several closed-captioning apps on the market. Also, some videoconferencing platforms include closed captioning as an option.  Just be sure that these technologies are all HIPAA compliant.

Check out our full post on ["Telepsychiatry for the Hearing Impaired – Top 10 Tips."](https://www.orbithealth.com/telepsychiatry-for-the-hearing-impaired-top-10-tips/)

Question 5

Has research been done to prove child & adolescent telepsychiatry works? What’s the evidence base?

Accepted Answer

Yes, children, adolescents, and families can benefit from telepsychiatry. In a variety of mental health conditions such as ADHD, autism, and OCD, studies have indicated that video visits are useful in accessing psychiatric specialists and improving symptoms.

In attention deficit hyperactivity disorder (ADHD) studies with telepsychiatry, for instance, improvement in hyperactivity and combined ADHD has been shown in hundreds of children in randomized clinical trials, combining video visits with child psychiatrists along with caregiver behavior, versus treatment with their primary care providers augmented with telepsychiatry consults. In autism, clinicians can use telepsychiatry videoconferencing for diagnosis & assessment. And, in obsessive-compulsive disorder (OCD), video visits reduced symptoms versus a waitlist control in a randomized clinical trial.

We additionally see video visits used to give behavioral parent training, with live therapists, showing treatment response and improvements in children ’s symptoms as well as easing of parental burden. Video visits can also help with parental coaching for children with autism, to help conduct home assessments, and for communication coaching.

The American Academy of Child and Adolescent Psychiatry provides expert guidance on how to deliver psychiatric services to this population, including optimizing clinical visits. This guidance is assembled by experts on the Committee on Telepsychiatry and the Committee on Quality Issues.

### Sources:

* Myers K, vander Stoep A, Zhou C, et al. Effectiveness of a telehealth service delivery model for treating attention-deficit hyperactivity disorder: results of a community-based randomized controlled trial. J Amer Asso Child Adolesc Psychiatry 2015;54(4):263-74.
* American Academy of Child and Adolescent Psychiatry Committee on Telepsychiatry and the Committee on Quality Issues. Clinical Update for Telepsychiatry with Children and Adolescents. Journal of the American Academy of Child and Adolescent Psychiatry. 2017;56(10):875–893.
* Comer JS, Furr JM, Miguel E, Cooper-Vince CE, Carpenter AL, …Myers KM & Chase R. Remotely delivering real-time parent training to the home: An initial randomized trial of Internet-delivered Parent-Child Interaction Therapy (I-PCIT). Journal of Consulting and Clinical Psychology. 2017; 85 (9): 909–917.
* Lee JF, Schieltz KM, Suess AN, Wacker DP, Romani PW, Lindgren SD, Kopelman TG, Padilla Dalmau YC. Guidelines for developing telehealth services and troubleshooting problems with telehealth technology when coaching parents to conduct functional analyses and functional communication training in their homes. Behavior Analysis Practice DOI 10.1007/s40617-014-0031-2; Published online 27 November 2014.
* Myers K and Roth DE. Telepsychiatry with children and adolescents. In: Martin A, Volkmar FR, and Bloch MH (Eds), Lewis's Child and Adolescent Psychiatry: A Comprehensive Textbook, 5th Edition. Wolters Kluwer, Philadelphia, 2018; Chapter 6.3.5.
* Reese RM, Jamison R, Wendland M, Fleming K, Braun MJ, Schuttler JO et al. Evaluating interactive videoconferencing for assessing symptoms of autism. Telemedicine and J E Health. 2013;19(9):671-677.
* Storch EA, Caporino NE, Morgan JR, Lewin AB, Rojas A, Brauer L et al. Preliminary investigation of web-camera delivered cognitive-behavioral therapy for youth with obsessive-compulsive disorder. Psychiatry Research. 2011;189(3):407-412.
* Vander Stoep A, McCarty C, Zhou C, Rockhill CM, Schoenfelder E, Myers K. The Children’s Attention-Deficit Hyperactivity Disorder Telemental Health Treatment Study: caregivers’ outcomes. Journal of Abnormal Child Psychology. 2016; 45(1):27-43.

Question 6

What is Zoom Fatigue, and why does it occur?

Accepted Answer

As the COVID-19 coronavirus pandemic continues into its second year, people have become accustomed to handling most or all of their personal and professional interactions remotely.  Videoconferencing has become a normal part of daily life.  Videoconferencing fatigue, now commonly called “Zoom fatigue” in reference to one of the most popular videoconferencing platforms, refers to the exhaustion caused by constant video calls.

While Zoom fatigue is not yet an official diagnosis, many psychologists state that the condition is both real and prevalent in the new pandemic era.

Constant video calls on any platform, including Google, Skype, Microsoft Teams, FaceTime, and other professional platforms can lead to fatigue.  People can start to feel extra irritable, less energized, constantly “on the clock” for work, confused or awkward during meetings, and isolated even while communicating with others.

There are scientific reasons for these feelings. Video calls can make people feel like they are always “on.”  People are hyper-aware of their appearance, their mannerisms, the sound of their voice, and they can begin to feel like they are “performing” in a way that is not true of in-person interactions.  The silence on the other end of the line when people mute their microphones, delays in response time, as well as the added effort necessary to identify nonverbal cues via video chat, contribute to stress and fatigue as well.

Video calls from home also allow us to become easily distracted.  When technology fails us--the WiFi goes out, someone’s camera or microphone fails to work, etc.--we can feel even more overwhelmed.

Learn more in our complete article, ["Videoconferencing Fatigue and What to Do About It."](https://www.orbithealth.com/videoconferencing-fatigue-what-to-do/)

Question 7

Why choose Orbit Health for your correctional facility?

Accepted Answer

Orbit Health is different from other telepsychiatry companies because Orbit Health's primary mission is to [end the cycle of mass incarceration of the mentally ill.](https://www.orbithealth.com/telepsychiatry-services/correctional-care/cycle-of-mass-incarceration-of-the-mentally-ill/)   Led by the world’s leading experts and pioneers in correctional telepsychiatry, Orbit Health has specialized knowledge, skill, and experience to provide the finest quality of services to jails, prisons, juvenile detention centers, and forensic hospitals.

Many correctional settings struggle to meet State and Federal mental health care mandates, often due to limited psychiatric resources.  Patients behind bars struggle to achieve psychiatric stability, making it difficult to function in these settings and leading to worsening outcomes, such as rules violations and enhanced sentences.  Time and again, Orbit Health has improved access to care while reduced patient backlogs, thereby helping facilities function safely and efficiently.

Orbit Health's goal is to ensure patients attain stability before, during, and after incarceration in order to achieve success in any setting.  Mental and emotional stability reduces the rate of recidivism, and nobody in the world does this better than Orbit Health.

If you are looking for correctional telepsychiatry services for your facility, or you are a provider looking for a job opportunity in corrections, [contact Orbit Health today](https://www.orbithealth.com/contact-us/)!

Question 8

What services does Orbit Health offer?

Accepted Answer

Orbit Health offers all of the key psychiatric services to all 50 states.

Weekday, weekend, on-call, overnight, flexible, subspecialty care, consultation, remote medical director.

* **Community outpatient & inpatient services:** Orbit Health provides telepsychiatrists to your ED via high quality videoconferencing technology. To the patient, this is no different than having an onsite psychiatrist. The doctor reviews the medical record, meets with the patient, and submits the clinical documentation directly into your electronic medical record. [Read More](https://www.orbithealth.com/telepsychiatry-services/outpatient-and-community-clinics/)
* **Addiction Treatment Centers:** Telepsychiatrists are made available to clinics and residential treatment programs. Face-to-face appointments with patients happen virtually, and will look and feel almost identical to in-person appointments. The telepsychiatrists are also available to consult with other members of the treatment team via videoconference. [Read More](https://www.orbithealth.com/telepsychiatry-services/addiction-treatment-centers/)
* **Emergency Departments & Crisis Centers:** Orbit Health provides telepsychiatrists to your ED via high quality videoconferencing technology. To the patient, this is no different than having an onsite psychiatrist. The doctor reviews the medical record, meets with the patient, and submits the clinical documentation directly into your electronic medical record. [Read More](https://www.orbithealth.com/telepsychiatry-services/emergency-departments-and-crisis-centers/)
* **Skilled Nursing Facilities & Assisted Living:** Orbit Health provides telepsychiatrists at the patient’s bedside via high quality videoconferencing technology. From the patient’s perspective, there is little difference between an appointment with an onsite psychiatrist and that of a telepsychiatrist. The doctor reviews the medical record, meets with the patient, and submits the clinical documentation directly into the electronic medical record. [Read More](https://www.orbithealth.com/telepsychiatry-services/skilled-nursing-facilities-and-assisted-living/)
* **Forensic Telepsychiatry Services:** In many cases, forensic evaluations and testimony can be accomplished remotely, via videoconferencing. Forensic telepsychiatry makes sense, and it saves time and money. Attorneys and judges are increasingly accepting the concept of forensic telepsychiatry as a convenient and effective way to utilize expert testimony. [Read More](https://www.orbithealth.com/telepsychiatry-services/forensic-telepsychiatry-services/)

Question 9

How can I combat Zoom fatigue symptoms?

Accepted Answer

Videoconferencing and remote professional services are now a regular practice in many industries. However, these remote calls can lead to feelings of fatigue.

If you find yourself exhausted by all of the video calls in your life, here are a few tips:

* **Schedule “no meeting” blocks of time.**  Make sure there are parts of your day when you are away from a screen.
* **Avoid multitasking.**  When you are on a call, focus on the business of the call.  Avoid pulling up a second window to read emails or conduct other work.  Multitasking during calls leads to a loss of productivity and difficulty remembering what occurred in the meeting.
* **Limit the number of calls.**  Do what you can to cut down on your overall number of calls.  Group calls with separate people or teams together where feasible and appropriate.  If a video call is not actually necessary, resolve the issues via phone, email, or a collaborative document.  Do not default to a video call for every type of meeting.  If you are meeting a stranger for the first time, such as a networking connection, for example, video calls can feel personal and invasive; start with a phone call.
* **Take breaks.**  If your call lasts more than an hour, it is important to take breaks.  Get up and walk around, use the restroom, get a glass of water.  Everyone will have more energy and remain more productive as a result.
* **Turn off your self-view.**  Video call programs like Zoom default to displaying your own video as well as others on the call.  Staring at your own face can be distracting and increase stress and anxiety.  Hide yourself from your own view so you can focus on the other people on the call.
* **Limit on-screen stimuli.**  In addition to hiding your face and keeping other windows closed, do what you can to limit what you see on-screen.  Encourage people to take calls in front of plain backgrounds instead of a room full of objects.  Seeing five different rooms full of furniture can cause disorientation and increase mental fatigue.

Learn more in our complete article, "[Videoconferencing Fatigue and What to Do About It](https://www.orbithealth.com/videoconferencing-fatigue-what-to-do/)."

Question 10

What's the standard of care for telepsychiatry, compared to in-person care?

Accepted Answer

Telehealth is increasingly being adopted by providers, patients, hospitals, and clinics as a great way of providing access to much needed healthcare.  Policymakers and lawmakers have generally fallen behind the current practice and therefore there can be some uncertainty around what standard of care should apply.

Moreover, “Standard of care” can be subject to interpretation based on several factors, including, but not limited to:

Specialty or subspecialty, as it relates to the scope of practice of the provider
Circumstances of the care
Community in which care is being provided.
Notably, the applicable community is debatable in telehealth, as the doctor and patient care are in different geographic areas.

The prevailing opinion in telehealth circles is that the standard of care should be based on the location where the patient is located, however, this is not a hard and fast rule.  Each state has its own opinions about standards of care for telehealth and multiple jurisdictions can potentially apply.

As a provider, the best way to think about standard of care is to do what a reasonable and prudent provider do in similar circumstances.  Reasonable and prudent care often depends on several components, such as:

* Patient case factors- although there are no absolute contraindications for telehealth, in rare cases the patient might object to the use of the technology for reasons such as paranoia/fear about being recorded or the technology being hacked, or difficulty keeping themselves in the frame of the camera due to cognitive issues. Also, if the patient is intellectually disabled and does not understand what is going on, perhaps thinking that they are watching TV.

* Setting to which care is being delivered- the environment is noisy, distracting, or not private, this can affect the quality of care provided.

* Types of technologies being used- if the technology does not allow adequate audio or video, this brings down the quality of assessment and treatment.

* Overall framework in which care is being provided- If telepsychiatry is conducted in the absence of other potentially important support for the patient.

* Consent- consent requirements are determined by each state. Some states require specific verbal or written consent from the patient to conduct appointments via telehealth.  Others do not have this requirement or have not opined on it.

* Limitations around AIMS testing. There are ways to conduct AIMS testing remotely, although the provider should be cognizant of potential limitations and this should be factored in the standard of care.

Telepsychiatry, more so than other specialties of telehealth, offers almost the same level of services as onsite psychiatry.  Therefore, the standards of care should be considered very similar.  In fact, some state medical boards [(such as the Medical Board of California)](https://www.mbc.ca.gov/Licensees/Telehealth.aspx) make it clear that the standard of care is the same.

In reality, what a psychiatrist can do remotely may vary somewhat from what can be done in person.  For example, a psychiatrist examining a patient remotely through video cannot physically touch the patient to assess for physical conditions such as cogwheel rigidity.  In these cases, psychiatrists rely on onsite staff or other ways of obtaining a reasonable amount of information to make a diagnosis and adequate treatment plan.

Ultimately, standards of care can be interpreted in a variety of ways, and telehealth makes it even more vague and sometimes confusing.  Therefore, the provider should use their best judgment, considering clinical factors, their means to resources, and the overall nature of the care being provided.

Disclaimer- this article is our best effort to provide useful information and does not constitute legal advice.  Please make sure to consult with entities such as state medical boards, their malpractice carrier, and potentially legal counsel prior to practicing healthcare.

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