Clinical and client support key to success for telehealth

In addition to improving access to care in rural and remote parts of the country, one of the hidden benefits of telehealth is the support it is able to offer clinicians working in areas where resources are scarce, conditions are difficult and staff retention can be an ongoing problem.

Jennylee Wood, a psychologist and co-ordinator of the eChild and Youth Mental Health Service (eCYMHS) telepsychiatry program in Queensland, told the Successes and Failures in Telehealth conference in Brisbane yesterday that one of the hidden successes of the program was the role it has been able to play in staff retention.

eCYMHS is part of the Child and Youth Mental Health Service (CYMHS) at Brisbane's Royal Children’s Hospital (RCH), where it operates from a central hub at RCH in partnership with the University of Queensland's Centre for Online Health (COH).

eCYMHS has been in operation for over eight years and provides child and adolescent telepsychiatry services to eight sites in rural and remote Queensland – Moranbah, Charters Towers, Longreach, Mt Isa, Bowen, Innisfail, Atherton and Mareeba – where ready access to paediatric psychiatrists can be difficult.

Ms Wood considers eCYMHS to be an integrated part of the Child and Youth Mental Health Service in each area it operates, and in her opinion, the practical and psychological support the service can offer to remote clinicians is just as valuable as the clinical support offered to clients.

“We get regular feedback and ad hoc comments from clinicians such as, 'if it wasn't for you guys I wouldn't be here',” she said. “Very often you have clinicians who are straight out of uni and they are in areas were there is a paucity of resources, so it is important that they have that support. Our experience has been that with it, they tend to stay working in rural areas longer than they might have otherwise.”

As co-ordinator of the service, Ms Wood, together with a consultant child and adolescent psychiatrist, takes part in weekly video consultations to each site. The service has five psychiatrists on board, and each session can last between one and a half to five hours.

“At the other end is the clinical team – the Child and Youth Mental Health Service team – and there are two types of discussions,” Ms Wood said. “We have discussions about cases and/or we quite often bring in the client, together with their parents or carers. They will always have the clinician with them.”

Ms Wood said she is yet to find any particular mental health diagnosis that is not suitable for management across the video link. “We cover everything from anxiety to mood disorders to eating disorders to psychosis, schizophrenia – just about anything.

“There are certain times when we might have someone who is really shy and scared about the idea of talking across a videolink, but the clinician at the other end works with them to reassure them and that works really well.”

According to Ms Wood, the service has grown significantly in its eight years, with a dramatic increase in the last six years.

“In 2007/08 we did 645 consultations, including discussions about clients and/or them being present, and in 2012/13 this had increased to 2044 consultations, which reflects the level of need in rural and remote areas for access to the service we offer,” she said.

There are few challenges in providing the service, particularly when it comes to technology. “Occasionally there will be a glitch but not very often. We have been doing telehealth for so long that we can usually deal with those problems pretty quickly and we have the excellent back-up support from the Centre for Online Health where we conduct the sessions; they iron out anything we can’t manage.”

For other services looking to set up a similar program, Ms Wood said there are three main factors to providing a successful paediatric telepsychiatry program.

“One is the fact that it is centrally co-ordinated. I co-ordinate the program in its entirety which means that I have a really good understanding of what is happening in the service across rural and remote Queensland.

“It also enables me to readily identify anything we need to address and we are continually refining the service. It is about managing the service as a whole so we can make sure it keeps running well.

“The second is the provision of support outside of video conference times. We have our scheduled weekly videoconference timeslots, but I make myself readily available so that if a clinician is in strife in between they can ring me for support. I try to have a turnaround time of about an hour, and if I'm tied up I'll text or email them. They always know they've got somebody to ring.”

The third success factor is the great value of outreach trips and seeing clients and clinicians face-to-face, she said. Her team conducts outreach clinics three to four times a year to each site, which she sees as having several benefits.

“One of them is that actually meeting the team face-to-face consolidates our relationship with them, which is really important in the context of the complexities we all manage in this field of work. On both sides we get to know each other really well and we get to understand the challenges the teams face on a daily basis.

“We might fly into Mackay and get in a car and drive for two hours to get to Moranbah and get stuck behind cattle on the road or huge trucks taking coal from the mines, and it is dusk and the kangaroos are out. You get a real sense of what it is like to work as a clinician in a rural and remote area.

“As part of the outreach component of the service, we also work with the community; we might have breakfast meetings with GPs to promote and discuss mental health issues, we might have a multiple stakeholder meeting about a complex case or we could conduct a night meeting at a school where we talk about a particular mental health diagnosis and present a case study.

“We are up-skilling clinicians and communities with the aim of fostering local community capacity building so they are in a better position to manage clients locally and to support each other using a collaborative care framework. This ultimately enables clients, very often, to be treated close to home without the need for transfer to a regional or metropolitan inpatient facility.”

Ms Wood said that while the means by which the team delivers telepsychiatry, such as the videoconference equipment, is clearly important, she sees the role as much broader than that. “The bigger percentage of the work we do is done outside of the videoconference time.”

Posted in Australian eHealth

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