Question 1

How can telepsychiatry help your correctional facility?

Accepted Answer

Orbit Health brings the most qualified mental health professionals right to your facility, without the need for in-person contact. Telepsychiatry allows your facility access to qualified, capable psychiatrists, including specialists in the field of incarceration, located anywhere around the country. Telepsychiatry offers benefits such as:

You are not limited to the services of the nearest mental health treatment center.
Doctors are not put at risk by being placed in direct contact with inmates.
Increased access, including compliance with state and federal health regulations, at a reduced cost.
Reduced gaps in care: Get help from experts in post-traumatic stress disorder, incarceration, violence, gender transition, and any other specific issues faced by your inmates.

Question 2

How can I improve the telehealth experience for those with hearing difficulties or who are deaf?

Accepted Answer

You and your team may treat persons who have hearing difficulties, whether they are hard of hearing or death. Consider the following in your workflow, such as involving staff to troubleshoot audio quality, involving a sign language interpreter, and sharing your screen:

Check to make sure if the patient is understanding you. Have them repeat back what you said from time to time.
If you have a telepresenter (a staff member on the patient side), they can tell you if its poor audio quality or if its good quality but the patient just can’t hear you because of their impairment. You can have the telepresenter repeat your words to the patient during your appointment.
If the patient knows American Sign Language, you can easily include an ASL interpreter into the videoconferencing session as part of a group chat.
Type out what you want the patient to know and screen share it with them. Make sure to use a big text so they can easily see the words. You can put your words in a Word document or the like, then click screen share. Problem solved!
If all else fails, arrange for the patient to be seen in person. Usually this is not necessary as there are so many ways to ensure good quality of audio. These days, audio via technology should not differ much from the audio in person.

Check out our full post on "Telepsychiatry for the Hearing Impaired – Top 10 Tips."

Question 3

Can medication be prescribed via telepsychiatry?

Accepted Answer

Yes. Our licensed psychiatrists are able to prescribe medications for patients they diagnose and treat remotely. Our providers will write and sign the prescriptions, which can then be transmitted to the clinic for local fulfilment.

Question 4

What is Forensic Psychiatry?

Accepted Answer

Forensic psychiatry is a branch of medicine at the intersection of psychiatry and the law. Forensic psychiatrists are often hired by lawyers and judges to act as expert witnesses for both criminal and civil cases. They conduct psychiatric evaluations and offer opinions about how mental health issues relate to the case. Forensic psychiatrists can also be utilized as consultants to other doctors or administrators of organizations.

Forensic psychiatrists are in short supply, and it is often difficult to find one close by. Geographical distances can cause evaluation delays and involve expensive travel costs. With Orbit Health, the most qualified and experienced forensic psychiatrists can be added to your legal team, no matter your location, and on a much more reasonable budget.

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

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 7

How can Orbit Health serve residential youth homes?

Accepted Answer

Orbit Health believes in protecting the health and wellbeing of our precious youth, especially those who have mental/emotional problems and developmental disabilities. Working in partnership with residential youth homes, Orbit Health has vast experience serving vulnerable youth remotely, through state-of-the-art videoconferencing technology (“Telepsychiatry”).

At pivotal moments in a child’s journey, we are there to ensure high quality and trauma informed care. Our mission is to keep these children on the right path of life and out of the cycle of mass incarceration.

To learn more, contact Orbit Health today!

Question 8

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

Accepted Answer

Yes, telepsychiatry is comparable to in-person visits. In fact, studies have shown that telepsychiatry is effective for diagnosing mental disorders across ages — children, adults, and the elderly — and across ethnicities. Across studies, telepsychiatry has shown to provide clinical outcomes equivalent to face-to-face visits. Plus, across studies, diagnoses, and demographics, patients generally achieve improved symptoms and improved quality of life.

In fact, telepsychiatry has advantages over in-person care. Video visits increase access to a psychiatric practitioner, and can assist with collaborative care. Even those in rural communities and remote areas of the world — in other words, geographies with sparse populations — can access specialty care with the help of telepsychiatry.

Telepsychiatry is cost-effective. A study limited to the cost of providing clinical service has shown 10% reduction in cost per patient, when telepsychiatry was used versus in-person care. In the majority of studies, telepsychiatry is more cost-effective.

And both patients and providers are satisfied with telepsychiatry video visits. Patients feel they get along with their provider

Sources:

Hubley, S., Lynch, S. B., Schneck, C., Thomas, M., & Shore, J. (2016). Review of key telemental health outcomes. World journal of psychiatry, 6(2), 269.
Hilty DM, Ferrer DC, Parish MB, et al. The Effectiveness of telemental health: A 2013 review. Telemed J E Health 2013;(19):444-454.
Janca, 2000. Telepsychiatry: an update on technology & implications. Curr Op Psych 13: 591-7.
O'Reilly R, Bishop J, Maddox K, Hutchinson L, Fisman M, Takhar J. Is telepsychiatry equivalent to face-to-face psychiatry? Results from a randomized controlled equivalence trial. Psychiatr Serv. 2007;58(6):836-43.
Bashshur, R. L., Shannon, G. W., Bashshur, N., & Yellowlees, P. M. (2016). The empirical evidence for telemedicine interventions in mental disorders. Telemedicine and e-Health, 22(2), 87-113.

Question 9

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."

Question 10

How can Orbit Health provide COVID-19 psychiatry services?

Accepted Answer

Identify a small confidential area accessible for clinical use. All you really need is internet access, a desk, and a chair. We will place a video screen there and provide psychiatrists via high quality videoconferencing technology. We can use your existing computers or devices to stream a connection over a web-based telepsychiatry platform. Alternatively, we can provide a portable device that is dedicated to telepsychiatry and is always on. The technologies we use are specifically designed for telehealth encounters and are HIPAA compliant. Clinical encounters are not recorded.

When the patient is ready to be seen, our telepsychiatrist will appear on the screen to provide expert clinical care. After the session, the telepsychiatrist will submit the clinical documentation directly into your electronic health record.

What are the advantages of Orbit Health Telepsychiatry?

Providing telepsychiatry staff with expertise and training in COVID-19 and mental health
Providing psychiatric medication management and psychotherapy
Participating in treatment team meetings and consultation with onsite staff
Increasing patient satisfaction
Improving patient outcomes
Reducing costs of recruiting, hiring, managing and retaining onsite staff