Establishing Telemental Heath Services from Conceptualization to Powering up

Presenting a Framework for Telebehavioral Health Implementation

PURPOSE OF REVIEW

This paper presents OPTIC as a framework to guide the conceptualization and implementation of telebehavioral health (TBH) in a comprehensive, structured, and accessible manner.

RECENT FINDINGS

There is a need for comprehensive frameworks for TBH implementation, yet current models and frameworks described in the literature have limitations. Many studies highlight favorable outcomes of TBH during COVID-19, along with increased adoption. However, despite the plethora of publications on general telehealth implementation, knowledge is disparate, inconsistent, not comprehensive, and not TBH-specific. The framework incorporates five components: Originating site, Patient population, Teleclinician, Information and communication technologies, and Cultural and regulatory context. These components, abbreviated using the acronym OPTIC, are discussed, with examples of implementation considerations under each component throughout the project cycle. The value and larger implications of OPTIC are discussed as a foundation for stakeholders involved with TBH, in addition to key performance indicators, and considerations for quality enhancement.

Rapid Conversion to Telemental Health Services in Response to COVID-19: Experiences of Two Outpatient Mental Health Clinics

Background: The COVID-19 pandemic triggered changes across health care systems, with many sectors seeing significant drops in patient visits. Rapid transition to telemental health (TMH) allowed for the continued delivery of mental health care. Although several guidelines and best practices are available for the methodical development of a TMH service, there are few documented procedures on rapidly converting to fully virtualized services. We discuss how two outpatient mental health clinics at the University of Colorado Anschutz Medical Campus rapidly virtualized clinical services during the COVID-19 pandemic. Methods: All current clinical appointments were converted to virtual, and all new clinical intakes were scheduled as virtual visits starting March 16, 2020. Virtualization included a modified needs assessment, updated clinic procedures, focused patient and staff training on TMH, and increased frequency of team meetings. We conducted a retrospective evaluation of clinic log and electronic health record data to examine the number of appointments and no-shows before and after COVID-19 virtualization. Results: Virtualization was operational within two business days. Scheduled appointments decreased 10.6% immediately postvirtualization, followed by an increase of 17.8% across the 6 months postvirtualization. No-show rates dropped from 11.9% pre- to 6.8% postvirtualization, leading to a 26.2% increase in completed visits. Discussion: Rapid virtualization of mental health services can occur effectively. Wider use and acceptance of TMH, especially to patient-homes, is likely in the foreseeable future as health care providers and systems reconceptualize service delivery. Future research must include analyzing the impact such changes make on clinical outcomes and patient visit volumes.