Why Telehealth Matters.
By Ellen Hallsworth, Director, Bradley REACH
Necessity is the mother of invention. Few things demonstrate this better than the exponential growth of telehealth over the past few years.
The Beginning of Virtual PHPs and IOPs:
Back in March 2020, when the Covid-19 pandemic forced Bradley Hospital to offer its partial hospitalization programs (PHPs) and intensive outpatient programs (IOPs) virtually, almost no-one thought it would work. It seemed like it would be impossible to keep kids engaged on screen all day, and to build the connections between adolescents, their peers and the clinical team that are the lifeblood of our programs.
But when we looked at the outcomes data, it told a different story. The acuity of children entering the program actually increased during the pandemic, but they improved at a rate at least as good as in-person patients had previously. We saw other benefits too. Without transportation barriers, teens came from a wider geographic area and from more diverse backgrounds. Family therapy is at the heart of our programs, and suddenly it was much easier for parents to participate from different locations, even from their car in the parking lot at work.
Realizing The Potential:
We then realized the huge potential of virtual intensive programs to address the national emergency in children’s behavioral health. Day treatment programs like PHPs and IOPs play an important role as a “step down” for teens who have been in inpatient care or have visited the ED in crisis; and as a “step up” for kids who are struggling but could avoid an inpatient stay with the right support. These programs have worked well in Rhode Island for more than a decade, partly because it’s a small state with limited drive times. While there’s still a behavioral health workforce shortage in New England, the situation is generally far better than in most of the US.
Nationally, however, the need for this type of care is desperate. Partner organizations tell us that they often have no way of helping kids beyond adding them to burgeoning outpatient waitlists or sending them to the ED (itself often a traumatizing experience) followed by a long wait for an inpatient stay. More than 80% of rural counties do not have a single psychiatrist. This can result in patients and families driving for hours to the nearest acute mental health facility.
Virtual treatment gave us the ability to expand the high-quality, evidence-based programing we offer to other parts of the country for the first time. Only three and a half years after those tentative first steps on Zoom, Bradley’s interdisciplinary teams of clinicians from more than 10 states care for teens across New England and Florida. None of this would be possible without telehealth.
The Future of Telehealth, Post-Covid:
Rapid innovation and expansion of access to quality care may have been driven by necessity, but it was supported by an unprecedented level of flexibility in terms of state licensure, reimbursement and prescribing. As the public health emergency unwinds, so do many of these flexibilities, both at a state and federal level. Last week, the DEA held listening sessions designed to address the overwhelming level of concern about the return to pre-pandemic rules for telehealth prescribing of controlled substances. There is uncertainty in many states about how telehealth regulations will be enforced, and continued reimbursement of some care.
The necessity created by the pandemic may have receded, but the need to address the crisis in child and adolescent behavioral health is still huge. This Telehealth Awareness Week marks a pivotal moment where we must ensure that we continue to move forwards and not backwards in an attempt to meet these needs. Telehealth remains a truly amazing invention for getting care to the children and families who need it most.
ABOUT THE AUTHOR:
Ellen Hallsworth
Director, Bradley REACH
