Western U.S. Health System Says “Telepsych Has Huge Role”
We sat down with Dr. Lisa Giles, Interim Division Chief of Pediatric Behavioral Medicine for University of Utah Health and the Medical Director of Behavioral Health at Intermountain Primary Children’s Hospital, to talk about telepsychiatry. One of the key developments is how the health system tries to use the same team of psych professionals for virtual visits as they do for in-home stabilization with families.
Intermountain is a non-profit health system consisting of clinics, medical groups, affiliate networks, hospitals, homecare, telehealth and health insurance plans in Utah, Idaho, Nevada, Colorado, Montana, Wyoming and Kansas.
How does the telepsych process work from start to finish?
· A: “I see the role for telepsych as one component of the service that is offered. There are aspects of it embedded into most of our programs. Our primary children’s service line covers a huge range on the continuum from inpatient psych to day treatment to outpatient clinic and in-home stabilization- to providing support to pediatricians. It’s the whole continuum of care. The goal is how do we get those services to kids at the right time and place. Telepsych plays a huge role in so many of those places.”
What’s COVID’s Impact On Telepsych?
A: “In outpatient clinics we were all forced to set up telepsych quickly in 2020 and now we have a couple years experience so it’s all integrated. A hybrid model of both virtual and in person visits works well for a lot of patients because we’re doing vitals, exams and having virtual visits in between. It’s more convenient for families.”
“Primary Children’s Hospital is the biggest children’s hospital in the state of Utah. [We] really do cover a lot of rural areas so telepsych has been huge in reaching those rural areas. It’s played a huge role in all these models of care and intensive day treatment programs - it’s a huge barrier if you can’t drive 30 minutes. So, in that area we’ve partnered to refer to virtual IOP where families can access that 3 times a week for a couple hours as well as a family group therapy component.”
How do you use telepsych during a crisis?
A: “We partner with the state of Utah on the stabilization and mobile response teams – in those crisis moments we are thinking: how do we divert from the ER? It provides that acute stabilization and crisis management in the home. This is all pediatric up to age 21. We use a van that goes to a home that responds to a mental health crisis consisting of licensed clinical professionals after a phone triage. Phone triage helps to assess the situation sometimes they need resources over the phone or sometimes there is a crisis in the home setting to determine what the next steps need to be. Stabilization is ongoing support which will be 8-weeks in which a team comes back to the home multiple times a week to make sure that the family has stabilized, and connect them to ongoing resources.”
“This is a benefit for patients to stay out of the ER, not call law enforcement and get the help where they need it in the home setting. So vans are only in Salt Lake County. 5 or 6 of the most populated counties have access to in-home and then rural counties rely on telepsych.”
·How are you using telepsych to handle demand in the ER?
· A: “The majority of triage gets someone to telepsych services and it’s more based on geography and the presenting concern. Over these last couple years with telepsych there are diagnoses that are challenging to treat virtually whereas with others are more conducive to telepsych. We make those decisions on clinical indication and geography and what is doable for the family. We use telehealth to help support all of the Intermountain emergency rooms – kids in crisis present here but because of broad geography you get folks coming into ERs across the state in rural areas. Kids need psych help and are waiting in hospitals for those beds so we do provide some crisis consultation support to those other ERs through telepsych. But it tends to be much more proactive.”
Do you partner with outside companies or employ everyone?
· A: “Our team is all employed by Intermountain at the hospital so we do not contract with outside agencies but we do have partnerships with Charlie Health, which has virtual outpatient services. The majority of all the services are within our team. We will do virtual on some of the days of the week. It’s the same team that goes into the home. Charlie health is the one outlier of the partnership so we can refer to that for a specific niche of needs.”
How many telepsych visits are done by Intermountain?
· A: “I think if you’re looking at all of our services from crisis stabilization, OP, day treatment and virtual it’s 95-98% and then it is still a very small percentage we’re referring to Charlie Health.”
After COVID, will the demand and need for telepsych keep going up?
· A: “The need clearly expanded - we were doing very little telepsych in 2019 but we had plans back then and recognized a need. We had a 5 year plan and then had to pivot quickly in 2020. Now we’re trying to find where does that pendulum lie - telepsych doesn’t solve all our issues. You do have to see some patients in person for some diagnoses and have good triage. So much revolves around access and telepsych is a huge part around that. Now as the pandemic has become the norm we have that opportunity moving forward around how we incorporate telepsych and this entire continuum of services as part of everything going on.”
Background:
Primary Children’s is part of Intermountain Healthcare, a nationally recognized not-for-profit healthcare system based in Utah and served as a pediatric specialty teaching hospital for the University of Utah School of Medicine.