Question 1

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 2

Why are mental health problems pervasive in correctional facilities?

Accepted Answer

There is a growing scientific consensus that proper mental health care is one of the most important parts of rehabilitation for incarcerated individuals.  Mental health treatment is one of the most effective components in reducing the likelihood of repeat offenses.  Although mental health disorders are neither a necessary nor a sufficient factor in either criminal activity or violence, mental health issues undoubtedly contribute to the likelihood of running afoul of the law.

In the United States, there are more mentally ill people in correctional facilities than there are in mental health hospitals.  Many criminal offenders struggle with mental illness and wind up in a correctional facility, and many incarcerated individuals develop psychological conditions as a result of their confinement.  The rate of mental illness in prisons may be as high as two to four times greater than in the general public.

Providing proper mental health services to people in jails, prisons, halfway houses and other facilities helps everyone.  Inmates get the psychiatric care that they need to become more productive members of society. In addition, the risk of suicide and other dangers can be mitigated, and healthy inmates are less likely to be involved in altercations with guards or other inmates while incarcerated.

By giving your correctional facility access to telepsychiatry, you can provide the mental health care that your inmates both need and deserve, without incurring the risk, inconvenience, and cost of either transporting inmates to treatment centers or transporting mental health professionals to your institution.

Question 3

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 4

How can Orbit Health help your forensic evaluations?

Accepted Answer

Orbit Health brings qualified expert witnesses directly to your conference room and courthouse.

Many legal matters, both civil and criminal, turn on the opinions offered by expert witnesses. Whether a case involves the damaging effects of personal injury, the reasonableness of a medical professional’s diagnosis and treatment, or the proper operation of a piece of complicated machinery, expert opinions often form the backbone of each party’s arguments to the judge and jury. Experts in the field of forensic psychiatry, in particular, are necessary for a wide variety of legal matters.

Not every jurisdiction has access to every type of expert, however.  Some parties and some matters cannot justify the expense of flying a medical professional thousands of miles to draft an opinion and testify. Moreover, with limitations imposed during the COVID-19 coronavirus pandemic and other natural disasters, it can be difficult, if not impossible, to bring an expert to the locale where a matter is taking place. Thankfully, with the use of telecommunications, you can now bring the expert to your conference meeting or courtroom immediately, efficiently, and with much less cost.

Orbit Health connects the best and brightest forensic psychiatric specialists from around the country to litigants in need of expert opinions and testimony, no matter their location, without all the extra expense and complication of travel.

If you have a pending legal matter that would benefit from advice, opinion or testimony from a qualified psychiatric expert, you do not need to rely on whoever happens to be located nearby.  It does not matter if there are no such experts in your area.  Orbit Health will connect you with a qualified, professional, and effective forensic psychiatric expert, transmitted to any location that has internet access.  Reach out to Orbit Health to discuss your options for telepsychiatry today.

Question 5

Is telepsychiatry subject to specific guidelines and laws?

Accepted Answer

Orbit Health psychiatric professionals strictly adhere to the federal and state guidelines that apply to their practices.  Additionally, different states may implement and apply different guidelines specific to telepsychiatry.

For example, telepsychiatry practitioners must carefully follow laws that regulate prescriptions for controlled substances. This is done by a rule called the “Ryan Haight Online Pharmacy Consumer Protection Act of 2008,” enforced by the DEA (Drug Enforcement Agency).

The Ryan Haight Act requires a practitioner to conduct in-person medical evaluation before they can prescribe a controlled substance. Some exceptions apply for systems like federal healthcare providers at Indian Health System.

With the COVID-19 public health emergency, an in-person medical evaluation is not feasible. This is where telepsychiatry has a protective advantage for clinical staff and for patients. For instance, the DEA will allow prescriptions to be issued for audiovisual telemedicine communication.

Question 6

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 7

Is special software and training needed?

Accepted Answer

When you contract with Orbit Health, we will provide your medical practice with all of the software and training necessary to implement our telepsychiatry services.  The process is simple and requires very little setup.

Question 8

What are the benefits of telepsychiatry?

Accepted Answer

In addition to the obvious benefit of being able to see a mental health professional while under quarantine, telepsychiatry offers many additional advantages to traditional mental health care. Telepsychiatry can be much more economically feasible for many individuals who are unable to afford mental health care. Seeing a doctor from the comfort of your home eliminates the need to deal with travel, lost work hours, childcare, and other expenses that may arise from the need to travel to a specific location. It can also lead to lower co-pays by reducing overhead costs for mental healthcare providers.

Telepsychiatry also brings mental health care to regions that are currently under-served, such as rural areas. Not every locale has licensed, available mental healthcare professionals, and telepsychiatry allows qualified professionals to treat patients anywhere they can find an internet connection.

Moreover, telepsychiatry can help to escape some of the stigma associated with mental health care. Patients do not need to drive to a hospital or medical office and sit in a waiting room with strangers while at their most vulnerable. Instead, patients can simply log on and connect directly with their mental healthcare professionals.

If you are an administrator of a health system or a healthcare provider in need of a way to deliver mental health services, [reach out to Orbit Health](https://www.orbithealth.com/contact-us/) to discuss how telepsychiatry can expand your options for healthcare delivery and meet the needs of patients in today’s challenging environment.

Question 9

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 10

Are psychotic patients appropriate for telepsychiatry?

Accepted Answer

There is no absolute contraindication for telepsychiatry and virtually any mental health condition can be treated via telepsychiatry.  Generally, the concerns about psychotic patients becoming more paranoid or distrustful with telepsychiatry are overblown.

However, in rare cases, a patient may not be appropriate for telepsychiatry if they are truly fearful about a delusion that involves the camera or videoconferencing equipment.  Does this mean that telepsychiatry is inappropriate or impossible to effectively treat such as patient?  Not necessarily...

It is important to remember that psychotic patients can incorporate anything from their environment into their delusional beliefs.  For example, a patient may be delusional that they are being held captive in a secret Nazi prison camp. This does not mean that they should be discharged from the unit out to the street.  Likewise, a patient who has delusions about telepsychiatry does not necessarily fail to benefit from telepsychiatry.

Nevertheless, it is theoretically possible for a patient to be so paranoid about telepsychiatry that they become mute or refuse to participate in the telepsychiatry session.  If that same patient is willing to converse with a psychiatrist in the facility, then perhaps onsite psychiatry may be a more effective option.   This would be a clinical decision based on the case factors.  Ultimately, if the treatment team feels that the patient fundamentally cannot benefit from telepsychiatry due to their delusional beliefs about that modality of care, then other arrangements should be made to provide care onsite.

In summary, there are certain clinical situations where a patient's mental status or condition may require that arrangements are made for onsite psychiatric care.  However, this happens very rarely.  Overall, telepsychiatry is an effective option in the vast majority of mental health cases.

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