Search

BackgroundThis study investigates outcomes from two federal grant programs: the Evidence-Based Tele-Behavioral Health Network Program (EB THNP) funded from September 2018 to August 2021 and the Substance Abuse Treatment Telehealth Network Grant Program (SAT TNGP) funded from September 2017 to August 2020. As part of the health services implementation program, the aims of this study were to evaluate outcomes in patient symptoms of depression and anxiety across the programs' 17 grantees and 95 associated sites, with each grantee having data from telehealth patients and from an in-person comparison group.MethodsThe research design is a prospective multi-site observational study. Each grantee provided data on a nonrandomized convenience sample of telehealth patients and an in-person comparison group from sites with similar rural characteristics and during the same time period. Patient characteristics were collected at treatment initiation, and clinical outcome measures were collected at baseline and monthly. The validated clinical outcome measure instruments included the Patient Health Questionnaire-9 (PHQ-9) for depression symptoms and the Generalized Anxiety Disorder-7 (GAD-7) scale for anxiety-related symptoms. Linear mixed models, with grantee as the random effect, were used to determine the association of behavioral health delivery (telehealth versus in-person) on the one-month change in PHQ-9 and GAD-7 while adjusting for covariates.ResultsAcross a total of 1,514 patients, one-month change scores were improved indicating that PHQ-9 and GAD-7 scores decreased from baseline to the one-month follow-up at similar rates in both the in-person and telehealth groups. Reduction in scores averaged 2.8 for the telehealth treatment group and 2.9 for the in-person treatment group in the PHQ-9 subsample and 2.0 for the telehealth treatment group and 2.4 for the in-person treatment group in the GAD-7 subsample. There was no statistically significant association between the modality of care (telehealth treatment group versus in-person comparison group) and the one-month change scores for either PHQ-9 or GAD-7. Individuals with higher baseline scores demonstrated the greatest decrease in scores for both measures. Upon adjusting for baseline scores and grantee program, patient demographics were not found to be significantly associated with change in anxiety or depression symptoms.ConclusionIn our very large pragmatic study comparing behavioral health treatment delivered to a population of patients in rural, underserved communities, we found no clinical or statistical differences in improvements in depression or anxiety symptoms as measured by the PHQ-9 and GAD-7 between patients treated via telehealth or in-person.

Telehealth has become an integral part of integrated behavioral health (IBH) service delivery in light of the global pandemic. In order to accommodate the rapid changes in service delivery, integrated behavioral health settings have transformed to provide services via telehealth alongside in-person services. While traditionally believed to be an in-person model, this article demonstrates the potential for using telehealth technology to continue offering training and service delivery in an IBH setting in response to the COVID-19 pandemic and beyond. The purpose of this catalyst report is to describe an IBH service delivery and training model including creative adaptations to the model using telehealth and present an evaluation plan of health service psychology trainee experiences. A mixed-methods design will be used to capture student experiences and competency. Data methods will include interviews with participants (qualitative) and the Interprofessional Collaborative Competency Attainment Survey (quantitative). Keywords: telehealth, integrated behavioral health, health service psychologist, training, primary care, Behavioral health diagnoses are common in primary care settings with approximately a third of patients meeting criteria for a mental health disorder (Kessler et al., 2005). Thus, behavioral health services [...]

Background:Treatment crossovers occur when one mode of treatment is begun and then a different mode of treatment is utilized. Treatment crossovers are frequently examined in randomized controlled trials, but have been rarely noted or quantitatively evaluated in usual care treatment studies. The purpose of this analysis is to examine the extent of modality crossovers during behavioral health treatment. Methods:The nonrandomized, prospective, multisite research design involved two active treatment groups—a telehealth treatment cohort and an in-person treatment cohort. Treatment modality (telehealth or in person) during each encounter was compared overall and across two time periods (pre- and during the COVID-19 pandemic) between the telehealth cohort and the in-person cohort. Results:Overall, modality crossovers were relatively uncommon (6.3%). However, patients in the in-person treatment cohort were more than twice as likely to have an encounter through telehealth (8.5%) than patients in the telehealth treatment cohort were to have an in-person encounter (3.4%) even though they had the same average number of encounters. The occurrence of off-mode encounters was particularly influenced by the onset of the COVID-19 pandemic. Conclusions:In this multisite usual care study comparing telehealth and in-person behavioral health treatment, modality crossovers were more common in the in-person cohort than the telehealth cohort, especially during the COVID-19 pandemic. Because telehealth availability has increased, crossovers are likely to increase in patients receiving multiple encounters for behavioral or chronic conditions and their occurrence should be noted by both researchers and practitioners. [ABSTRACT FROM AUTHOR]

Objective: To determine if service utilization behaviors varied with the remoteness of clients served by a telepsychology clinic in a predominantly rural health professional shortage area (HPSA) in Texas. Methods: Archival data from 290 low‐income clients were analyzed to test associations between service utilization behaviors and clients' distance from the nearby access points where they traveled to receive counseling services from remotely located counselors. Results: Distance to access points did not predict differences in service utilization behaviors. However, clients in rural counties traveled farther to receive services than clients in metropolitan areas. Some utilization behaviors varied by demographic variables and depressive symptom severity. Conclusions: A "hub and spoke" model of telehealth service delivery is an acceptable model for improving access to mental health care services in rural and underserved communities, even for clients who live relatively far from access points. Telehealth providers should consider geographic, socioeconomic, transportation, and health‐related barriers to care experienced by clients when implementing services and policies. [ABSTRACT FROM AUTHOR]

Objective: Individuals living in rural areas die by suicide at higher rates than those living in metropolitan areas. Telemental health interventions provide rural residing individuals with access to needed care. Identifying telemental health clients at risk for suicide is an important task for clinicians and policymakers. This study evaluated to what degree rural status and other demographic variables predicted suicide ideation in clients seeking services at a telemental health clinic. Methods: Study participants included 457 low‐income clients residing in the medically underserved, geographically diverse Brazos Valley region of Texas. Clients completed the patient health questionnaire during their initial counseling appointment, which assessed depression severity and suicide ideation in the 2 weeks prior to assessment. Results: Suicide ideation was common among telemental health clients, with approximately 40% of clients in all demographic groups reporting some recent thoughts of suicide. Rates of suicide ideation did not significantly differ by geographic designation (ie, rural/metropolitan status), gender, or race/ethnicity. However, depression was a strong predictor of recent suicide ideation. Conclusions: Telemental health programs can effectively connect clinicians with rural residing clients who are otherwise isolated from health care services. However, clinicians working in high‐need, historically underserved areas should be prepared to encounter a high prevalence of suicide ideation and depression. In these regions, clinical and diagnostic features may be better indicators of suicide ideation than demographic variables. [ABSTRACT FROM AUTHOR]

Telehealth can overcome access and availability barriers that often impede receiving needed mental health services. This case report describes an interdisciplinary approach to treatment for an individual with chronic physical health conditions and comorbid mental health concerns, which resulted in high utilization (and associated costs) of preventable emergency services. The report describes clinical case progression on anxiety symptoms and emergency service utilization while concurrently highlighting telehealth‐specific practice implications, especially as they pertain to training settings. [ABSTRACT FROM AUTHOR]