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1.
Telemed J E Health ; 26(4): 446-454, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31120378

RESUMO

Background and Introduction: Given the shortage of child psychiatrists in most areas, telepsychiatry may increase accessibility of psychiatric care in schools, in part by improving psychiatrists' efficiency and reach. The current study assessed consumer and provider satisfaction with school-based telepsychiatry versus in-person sessions in 25 urban public schools and compared the efficiency of these service delivery models. Materials and Methods: In total, 714 satisfaction surveys were completed by parents, students, school clinicians, and child psychiatrists following initial (26.3%) and follow-up (67.2%) visits (6.4% did not indicate type of visit). Most of these surveyed visits were for medication management (69.9%) or initiation of medication (22%). Efficiency analyses compared time saved via telepsychiatry versus in-person care. Researchers also conducted focus groups with providers to clarify preferences and concerns about telepsychiatry versus in-person visits. Results : Consumers were highly satisfied with both in-person and telepsychiatry-provided school psychiatry services and showed no significant differences in preference. Providers reported both in-person and telepsychiatry were equally effective and showed a slight preference for in-person sessions, citing concerns about ease of video equipment use. Telepsychiatry services were more efficient than in-person services, as commute/setup occupied about 28 psychiatrist hours total per month. Discussion and Conclusions: Findings suggest that students, parents, and school clinicians perceive school-based telepsychiatry positively and equal to on-site care. Child psychiatrists have apprehension about using equipment, so equipment training/preparation and provision of technical support are needed. Implications of study findings for telepsychiatry training and implementation in schools are discussed.


Assuntos
Psiquiatria , Telemedicina , Criança , Humanos , Pais , Satisfação Pessoal , Instituições Acadêmicas
2.
Gen Hosp Psychiatry ; 53: 12-18, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29702377

RESUMO

OBJECTIVE: To describe the clinical severity of patients for whom Primary Care Providers (PCPs) requested consultation from Maryland's Child Psychiatry Access Program (CPAP), and examine the proportion and associated characteristics of severe cases being managed alone by PCPs versus co-managed with mental health specialists. METHODS: Data were collected for 872 cases based on calls received between October 2012 and December 2016. Severity was measured by consultant-assigned Clinical Global Impression-Severity (CGI-S) score. The unadjusted odds of a PCP managing a case alone for select patient and provider characteristics was calculated in a sub-sample of 229 severe cases. RESULTS: 73.8% of cases were categorized as mild-moderate (CGI-S 1-4) and 26.3% as severe (CGI-S 5-7). 67.3% of severe cases were managed by a PCP alone; 32.8% were co-managed. The unadjusted odds of a severe case managed alone was lower for cases with greater numbers of psychotropic medications (OR 0.76, 95% CI 0.6, 0.96), prescription of antidepressants (OR 0.51, 95% CI 0.28, 0.95), or antipsychotics (OR 0.45, 95% CI 0.22, 0.94) compared to co-managed cases. CONCLUSIONS: PCPs manage patients with severe mental health concerns, often without assistance from specialists. CPAPs should systematically consider how to support the PCPs' role managing clinically severe cases.


Assuntos
Psiquiatria Infantil/estatística & dados numéricos , Transtornos Mentais/terapia , Médicos de Atenção Primária/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Maryland
3.
Eval Program Plann ; 60: 56-63, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27685163

RESUMO

Increased attention has been placed on evaluating the extent to which clinical programs that support the behavioral health needs of youth have effective processes and result in improved patient outcomes. Several theoretical frameworks from dissemination and implementation (D&I) science have been put forth to guide the evaluation of behavioral health program implemented in the context of real-world settings. Although a strong rationale for the integration of D&I science in program evaluation exists, few examples exist available to guide the evaluator in integrating D&I science in the planning and execution of evaluation activities. This paper seeks to inform program evaluation efforts by outlining two D&I frameworks and describing their integration in program evaluation design. Specifically, this paper seeks to support evaluation efforts by illustrating the use of these frameworks via a case example of a telemental health consultation program in pediatric primary care designed to improve access to behavioral health care for children and adolescents in rural settings. Lessons learned from this effort, as well as recommendations regarding the future evaluation of programs using D&I science to support behavioral health care in community-based settings are discussed.


Assuntos
Serviços de Saúde Mental/organização & administração , Atenção Primária à Saúde/organização & administração , Avaliação de Programas e Projetos de Saúde/métodos , Consulta Remota/organização & administração , Serviços de Saúde Rural/organização & administração , Adolescente , Criança , Difusão de Inovações , Humanos , Disseminação de Informação/métodos , Serviços de Saúde Mental/normas , Atenção Primária à Saúde/normas , Consulta Remota/normas , Serviços de Saúde Rural/normas , Estados Unidos
4.
Int Rev Psychiatry ; 27(6): 513-24, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26540584

RESUMO

Most children and adolescents across the USA fail to receive adequate mental health services, especially in rural or underserved communities. The supply of child and adolescent psychiatrists is insufficient for the number of children in need of services and is not anticipated to grow. This calls for novel approaches to mental health care. Telemental health (TMH) offers one approach to increase access. TMH programmes serving young people are developing rapidly and available studies demonstrate that these services are feasible, acceptable, sustainable and likely as effective as in-person services. TMH services are utilized in clinical settings to provide direct care and consultation to primary care providers (PCPs), as well as in non-traditional settings, such as schools, correctional facilities and the home. Delivery of services to young people through TMH requires several adjustments to practice with adults regarding the model of care, cultural values, participating adults, rapport-building, pharmacotherapy and psychotherapy. Additional infrastructure accommodations at the patient site include space and staffing to conduct developmentally appropriate evaluations and treatment planning with parents, other providers, and community services. For TMH to optimally impact young people's access to mental health care, collaborative models of care are needed to support PCPs as frontline mental health-care providers, thereby effectively expanding the child and adolescent mental health workforce.


Assuntos
Psiquiatria do Adolescente , Psiquiatria Infantil , Serviços de Saúde Mental/provisão & distribuição , Telemedicina/métodos , Comunicação por Videoconferência , Adolescente , Psiquiatria do Adolescente/métodos , Criança , Psiquiatria Infantil/métodos , Humanos , Internet , Encaminhamento e Consulta , Estados Unidos , Comunicação por Videoconferência/instrumentação
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