Telehealth issues in consulting psychology practice.

Consulting psychologists have recognized the importance of providing comprehensive consultation and clinical services for consumers with special needs. Often because of distance and access to consultation services, remote and underserved populations may not have the necessary access to consultant specialists in psychology and other disciplines. Such services are now available through an innovative model of telehealth. Telehealth technology and services have gained the attention of scientists, clinicians, consultants, and health educators in a variety of settings. Examined are consultation case scenarios using telehealth qualitative observations of consultants who have used telehealth and liability issues consultants may face using this technology. A model release of liability is provided for consulting psychologists who may consider its use in their consultation practice. Case examples using telehealth applications are discussed, as are special applications for health care delivery to undeserved rural populations using telehealth technology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Telecommunications and rural health care

Telehealth has many applications, including the education and training of health professionals. This article describes the use of advanced telecommunications technology to educate family nurse practitioners in rural areas of Kansas. Four Kansas universities use compressed video technology (an interactive audio and video system) to offer five common core courses in primary care to students enrolled in FNP programs at the respective institutions. Using technology to educate FNPs in rural communities has resulted in a greater percentage of graduates (approximately 67% of 258 graduates) going to work in rural underserved communities. In addition to learning the course content, students learn to use technology as a tool to access telehealth information and services Knowing how to use these technologies provides greater opportunities to rural health care providers, as well as the recipients of health care.     

Reaching underserved HIV-positive individuals by using patient-centered psychological consultation.

HIV disease is spreading most rapidly among populations for which psychotherapy is not routinely utilized, such as individuals from African American, Hispanic, rural, and low socioeconomic backgrounds. To more effectively address barriers to care, the authors propose and implement an innovative model of consultation that allows patients to request and receive a psychological consultation concurrent with their HIV medical care. Psychological consultations from a 2-year period before and after model implementation are compared. Results indicate that this model increases consult utilization and holds much promise for reaching underserved individuals in HIV clinics. Implications for usage in other medical settings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Manitoba's Rural and Northern Community-Based Training Program for Psychology Interns and Residents.

This article describes a unique internship training experience developed by the Department of Clinical Health Psychology of the Faculty of Medicine of the University of Manitoba. Interns live in and provide services to remote northern communities for half of the internship year and receive supervision from a psychologist in the community, supplemented by telehealth. The department also offers a full-year, postdoctoral rural residency. Ten interns and 4 residents have been trained so far. The community-based generalist training model and responses to the challenges, for both supervisors and trainees, of working in small underserved communities are described. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Telehealth Brain Injury Training for Rural Behavioral Health Generalists: Supporting and Enhancing Rural Service Delivery Networks.

Rural psychologists are frontline primary behavioral health care providers for nearly 60 million Americans, but they face limited access to peer consultation and continuing education. This article describes a program that matched 70 rehabilitation inpatients who had new brain injury with rural clinicians from patients' home communities. Neuropsychologists provided one-on-one training for clinicians through telehealth video teleconferencing. Clinicians showed gains in brain injury knowledge, and clients rated trained providers higher than untrained providers. Families seeking brain injury services can connect with these trained rural providers through a Web site, which receives more than 800 hits per month. Telehealth offers potential for rural clinicians to receive support, reduce professional isolation, gain working knowledge of specialty conditions, and deliver high-quality services for their rural clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rural backwaters or front-runners? Rural telehealth in the vanguard of psychology practice.

Over 20% of the United States population lives in rural areas, and rural clients often face serious access barriers to receiving psychology services. The acuity of rural need and growing ubiquity of the Internet among rural communities create opportunities for psychologists to provide assessment and treatment services to support rural clients at a distance using telehealth. This article reviews recent developments in telehealth that can improve quality of care for rural clients, including a review of cutting-edge technologies (monitoring devices, sensors, smart homes, etc.), methods of electronically mediated service delivery, and next steps for validation of telehealth psychology services. Also addressed are payer issues, privacy and confidentiality, and methodology concerns for this rapidly growing field of telehealth. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

La consultation: Un r?le professionnel à mieux définir.

There are currently increasing requests for psychologists to provide “consultation” services to their peers, other professionals (ex., physicians, social workers, school teachers) or community services (ex., school, community agencies, mental health services, mass-medias). However, so far, there are few empirical works systematically aiming at defining the character of that professional activity and consultation may still be confused with the competency of intervention in the field of clinical psychology. This article aims at defining “consultation” as a specific professional activity, presenting the models of consultation and exploring clinical examples of consultation. Then, practical, ethical and training considerations related to “consultation” activities are discussed and some recommendations are provided, based on available literature. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ten interdisciplinary principles for professional practice in telehealth: Implications for psychology.

Emerging telecommunications technology is changing psychological practice by enabling the provision of services across time and distance, yet there are significant concerns about these applications. In response to developments in telehealth—the term used for health services provided through these technologies—an interdisciplinary group developed a series of principles to inform health care practice. In this article, the authors review these principles and their implications for psychological telehealth, emphasizing that psychologists' ethical and professional requirements do not change with the introduction of a new tool. The principles provide a framework of critical ethical and professional issues that psychologists must consider in undertaking telehealth practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Making telehealth a viable component of our national health care system.

Technological advances and the development of a national information infrastructure give telehealth the potential to overcome barriers to health care services that rural Americans confront. This technology can range from simple use of the telephone to high-tech equipment that enables a psychologist at an urban medical center to counsel a patient in a small town hundreds of miles away. This technology includes interactive video equipment, fax machines, and computers, along with satellites and fiber optics. Although there is a temptation to get caught up in the wizardry of high-tech telecommunications, telehealth will not solve all the access and distribution problems that now plague our health care system. It can, however, be an important part of the solution. Throughout the country, health care providers in fields such as mental health, dermatology, and pediatric cardiology—just to name a few—are taking advantage of this technology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical applications of telehealth in mental health care.

This article introduces the concept of telehealth and examines how telehealth expands both provider and patient access to health care. Current clinical applications are presented including equipment, research, and examples of direct clinical care. The article focuses on store-and-forward and video teleconferencing technologies providing information about the equipment and research pertaining to the clinical use of the equipment. The status of behavioral telehealth programs in the United States is reviewed and two case examples are provided. The first example discusses a direct patient care system and the second a remote clinical supervision system. The article concludes with suggestions for determining the value of adding telehealth to existing clinical practices. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Training professional psychologists in school-based consultation: What the syllabi suggest.

This article reports the findings from consultation syllabi from 25 American Psychological Association-approved school psychology programs (40% response rate). Most responding programs offered 1 consultation course and many programs' syllabi stated expecting students to conduct 1 consultation case. The analysis showed most syllabi listed training in multiple models of consultation, with almost all mentioning the problem-solving model. Almost all syllabi listed training in treatment, but fewer than half suggested that students would learn about the use of consultation to promote prevention. Most programs' syllabi mentioned considering others' culture in consultation, whereas fewer than half mentioned considering the impact of the consultant's culture in consultation relationships and even fewer mentioned social justice. The discussion addresses the need for a better understanding of school-based consultation preservice training, consultation training in a diverse and inequitable world, and how practitioners' cognitive appraisals of consultation services could inform school-based consultation training. Considerations for consultation syllabi design are given. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Rural Hawai'i Behavioral Health Program: Increasing access to primary care behavioral health for native Hawaiians in rural settings.

Health care access issues present significant challenges for rural populations and health providers. Psychology can support improved access and quality of rural health services through the development of integrated behavior health programs within primary care settings. This article reviews a clinical training and service delivery program, the Rural Hawai'i Behavioral Health Program, which has evolved in response to the pressing health needs of Native Hawaiians in rural communities. Native Hawaiian cultural factors and components of the primary care model that have supported the development of this program will be reviewed. Program expansion, sustainability, and treatment efficacy research will be discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"High-Tech With the Human Touch: Using Telehealth to Reach America's Children." Correction to Wasem and Puskin (2000).

Reports an error in "High-tech with the human touch: Using telehealth to reach America's children" by Cathy Wasem and Dena Puskin (Professional Psychology: Research and Practice, 2000[Feb], Vol 31[1], 3-4). On page 4, the last sentence of text incorrectly reads, "For additional telehealth project, policy, legal, and funding information, visit OAT's web site at http://www.telehealth.hrsa.gov." The correct web site address is http://telehealth.hrsa.gov. (The following abstract of the original article appeared in record 2007-17617-001.) In the past decade, we have seen new telecommunication and information technologies used to provide health services, health professional and consumer education, and public health and administrative services. The application of these tools to health care, commonly referred to as telehealth, provides an unprecedented opportunity, as we embark on a new millennium, to take services to those in need-to "carry the water to the desert." Telehealth provides both a means to increase access, and to reengineer the processes of care, enhancing the equality and effectiveness of health services. This article illustrates how telehealth has helped children and youth in various health care settings. Many of these projects have been initiated with federal funds from OAT or other federal agencies. Some of the projects use technologies that require special phone lines and expensive equipment ranging from $15,000 to $50,000; others run over regular phone lines and use equipment costing between $500 to $1,000. Psychologists are involved in many of these projects as initiators of services, as members of multidisciplinary teams, and as researchers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluating psychosocial aspects of telemedicine and telehealth systems.

Telemedicine and telehealth evaluations often address the technological aspects of health care while neglecting the psychosocial implications of the technology. Currently, little is known about the meaning of telehealth care in terms of access, quality of care, or financial impact. This article focuses on the human aspects of using technology to provide mental health care and the insight that psychology can bring to the evaluation process. It discusses telehealth's impact on and interface with health care facilities, specifically in relation to training, informatics, remote consultations, patient outcomes, provider health, and professional practice. It also presents guidelines and suggestions for the implementation of a telehealth evaluation. It also presents guidelines and suggestions for the implementation of a telehealth evaluation, including evaluation design, examples of outcome-related questions that may be pertinent to telehealth evaluation, and suggestions for psychology's continuing role in telehealth. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Inpatient rehabilitation diabetes consult service: A rehabilitation psychology approach to assessment and intervention.

Problem: Diabetes clinical practice recommendations call for assessment and intervention on diabetes self-management during inpatient hospitalization. Although diabetes is prevalent in inpatient rehabilitation settings, diabetes self-management has not traditionally been a focus of inpatient rehabilitation psychology care. This is because diabetes is often a secondary diagnosis when an individual is admitted to rehabilitation for an acute event. Objectives: The authors provide a rationale for a role for rehabilitation psychologists in assessing and intervening on the psychosocial, behavioral, and functional self-management needs of individuals with diabetes within the rehabilitation setting. The development of a rehabilitation psychology Inpatient Rehabilitation Diabetes Consultation Service is described. Theoretical and empirical bases for compilation of the assessment and intervention materials are provided. Format and implementation of the service on a university-affiliated inpatient rehabilitation unit is described, with special consideration given to professional issues faced by rehabilitation psychologists and teams. Results: A flexible consultation model was implemented using a guided diabetes psychosocial assessment with brief educational handouts addressing selected key topics (i.e., hyperglycemia, hypoglycemia, blood sugar monitoring, nutrition, physical activity, medication, and, A1C and average blood sugar). The consultation service was feasible and well-accepted by treated individuals and the rehabilitation team. Conclusions: Rehabilitation psychologists are uniquely positioned to address the functional, psychosocial, and behavioral needs of individuals with diabetes. With further research to assess clinical outcomes, this approach may further address practice recommendations for inpatient diabetes care. Moreover, such a diabetes consultation model may be useful on an outpatient rehabilitation basis as well. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

High-tech with the human touch: Using telehealth to reach America's children.

[Correction Notice: An erratum for this article was reported in Vol 31(2) of Professional Psychology: Research and Practice (see record 2007-17403-001). On page 4, the last sentence of text incorrectly reads, "For additional telehealth project, policy, legal, and funding information, visit OAT's web site at http://www.telehealth.hrsa.gov." The correct web site address is http://telehealth.hrsa.gov.] In the past decade, we have seen new telecommunication and information technologies used to provide health services, health professional and consumer education, and public health and administrative services. The application of these tools to health care, commonly referred to as telehealth, provides an unprecedented opportunity, as we embark on a new millennium, to take services to those in need-to "carry the water to the desert." Telehealth provides both a means to increase access, and to reengineer the processes of care, enhancing the equality and effectiveness of health services. This article illustrates how telehealth has helped children and youth in various health care settings. Many of these projects have been initiated with federal funds from OAT or other federal agencies. Some of the projects use technologies that require special phone lines and expensive equipment ranging from $15,000 to $50,000; others run over regular phone lines and use equipment costing between $500 to $1,000. Psychologists are involved in many of these projects as initiators of services, as members of multidisciplinary teams, and as researchers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological consultation with primary care physicians: Obstacles and opportunities in the medical setting.

This article discusses the relationship between psychologists and primary care physicians and describes the training and practice of physicians in the areas of mental and behavioral health care. Issues affecting the relationship between psychologists and primary care physicians are then reviewed. Different models of psychological consultation are discussed, and an integrated behavioral systems model of psychological consultation is presented as a potentially effective model for consultation with primary care physicians. This model provides a framework for psychologists to function as coproviders of primary health care services. Practical strategies to enhance collaboration between psychologists and primary care physicians in private practice are discussed. The need for more research on primary care and for the inclusion of psychologists in managed care and health care reform are also highlighted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rural telepsychiatry

Telepsychiatry is the use of telecommunications technology to connect patients and health care providers, permitting effective diagnosis, education, treatment, consultation, transfer of medical data, research, and other health care activities. Telepsychiatry has been used as a partial solution to the problem of limited psychiatric services for clinics and hospitals in remote areas of areas underserved by psychiatrists and other mental health care specialists. In the United States, eastern Oregon's RodeoNet telepsychiatry program and the telemedicine program of the Kansas University Medical Center, which has a psychiatric component, are excellent models. Telepsychiatric applications can be cost-effective, but careful evaluation is needed.