Tele-Behavioral Health in HCH Why is hard, and what can we do?

Tele-Behavioral Health in HCH Why is hard, and what can we do?

Tele-Behavioral Health in HCH Why is it hard, and what can we do? September 24, 2019 Why were here, and what we hope to do Learning Objectives: The Idea-to-Implementation Project 1. Describe the opportunities of tele-behavioral health in homeless HCH telehealth is challenging but promising

health care We want to hold space for the difficult questions and 2. Describe common challenges in have frank conversation that may lead to solutions implementing tele-behavioral Reimbursement and regulations differ by state: were health for people experiencing not addressing that homelessness Were not talking about remote medical consulting (e.g. 3. Describe at least one potential Project ECHO) strategy to advance telebehavioral health at your own Q u a l i t y | A c c e s s | J u s t i c e | C o m m u n i t y program | nhchc.org Presenters Lee Thornhill, MHA, MA Health Care for the Homeless Network Seattle, WA

Debbie Stevens, Psych NP Mercy Care Atlanta, GA Brandon Cook, BA, and Jennifer Schmucker, LISW-CP New Horizon Family Health Centers Greenville, SC Andrew Robie, MD Unity Health Care Washington, DC Quality | Access | Justice | Community | nhchc.org Health Care for the Homeless Network of King County (HCHN) Catchment Area: King County, Washington Over 400 sites across 32 cities - urban, suburban & rural Approx. 70% Seattle Patient Target: 21,852 (100% living homeless) & average 110k visits Service Model Includes:

Services delivered directly at Public Health Seattle & King County clinics & by 10 contracted community partners Mobile Medical Vans (medical, behavioral health, & dental) Street Outreach and Housing Health Outreach Teams (HHOT) Medical Respite & Mobile Palliative Care Low Barrier Medication Assisted Treatment Lee Thornhill, Data and Evaluation Manager Scope of Tele-behavioral Health Services Across HCHN Past Few Years Examples Clinical assessments and testing, including interpretation of results & treatment recommendations

w/patients Specialists provide consultation to providers using e-consultations RNs call CPCs to consult, place orders, and initiate treatment Work with patients via phone who have left inpatient programs, but still require care management and care coordination Calls and texts used for Originating & Distant Sites Patents predominantly seen through telehealth within our health center and hospital system sites

Challenges Legal: liability providers & organizations. HIPAA & other regulations. Technical & Financial: equipment, software & network infrastructure costs, capacity & competencies. Limited control in field-based settings further from traditional telehealth model. Successes & Strategies Motivational: belief that patients living Approach from digital equity homeless & with BH perspective. conditions wont participate. Reimbursement for some services at

state level. Individual program examples & Mercy Care Atlanta Patient-centered, integrated primary medical and behavioral health care clinics in Atlanta. Six Medical Clinic Sites Five Mobile Sites In 2018, 60,648 total clinic visits (all service lines) 67% Homeless 75% Uninsured At any point in time in 2018, over 3,000 people experienced homelessness. Our Telemedicine Program Started about 5 years ago shortly after inception of behavioral health program

Community and Office based Currently using a web based platform called pathways through GA Partnerships for Telehealth Psychiatry Team looking at ways to expand to primary care, behavioral health and street medicine Ongoing challenges, leadership is invested in expanding program and optimizing

access for clients About New Horizon Family Health Services Community Health Center serving Upstate, SC for over 26 years Provides medical, dental and behavioral health services to more than 26,000 patients annually on over 100,000 encounters Health Care for the Homeless Program serves over 2,000 patients each year in a 13-county service area Ryan White Program serves over 1,200 patients each year over a 10-county service area TeleHealth at NHFHS Pilot program developed to expand the reach of HCH and BH to increase access to

BH services for people experiencing homelessness Partnership with one shelter in our service area to provide much needed BH services 9 Unity Health Care, Inc. Large federally qualified health center (FQHC) in Washington, DC ~100,000 unique patients and 500,000 patient visits annually Primary medical, specialty medical, behavioral health and dental services 9 community health centers

11 medical sites in homeless shelters and day centers 2 school-based health centers DC Department of Corrections Teaching health center Community medical school campus

Family medicine residency Telemedicine at Unity Telemedicine specialty care Research collaboration with George Washington University since 2016 Endocrinology, nephrology, and cardiology televisits with patients at CHC Goals to improve access/decrease no-shows and improve clinical outcomes Telepsychiatry Unity psych NP based at CHC

Psychiatry consults at two shelter-based sites Goal to increase access and utilization Discussion Please type your questions and comments in the chat box Stay in touch Join our mailing list Become a member Get Technical Assistance Follow on social media D. Michael Durham, MTS Technical Assistance Manager [email protected] | 571-335-0066 https://www.linkedin.com/in/dmdurham/ Quality | Access | Justice | Community | nhchc.org HRSA Disclaimer

This program is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $1,625,741 with 0 percent financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov. Quality | Access | Justice | Community | nhchc.org Panelist contact information Lee Thornhill, MHA, MA Health Care for the Homeless Network Seattle, WA [email protected] Debbie Stevens, Psych NP Mercy Care Atlanta, GA

[email protected] Brandon Cook, BA [email protected] Jennifer Schmucker, LISW-CP [email protected] New Horizon Family Health Centers Greenville, SC Andrew Robie, MD Unity Health Care Washington, DC [email protected] Quality | Access | Justice | Community | nhchc.org

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