Mental health evaluation Project

2005
Canada health infostructure partnerships program (CHIPP)

Synopsis

The Centre for Telehealth @Mheccu at the University of British Columbia, the Yukon Territory, Peace Liard Health, Coast Garibaldi Health, the Alberta Mental health Board, and the Sal'i'shan Institute collaborated in developing a mental health service model to deliver services to rural and remote communities including aboriginal communities.

Using videoconferencing technology over ISDN or switched datadial56 public networks, the project provided clinical services, continuing education, and collaborative care programs to a network of communities in British Columbia and the Yukon. BC sites were located in the Northeast (Dawson Creek, Fort Nelson, and Fort St.John) and Sunshine coast regions (Cechelt, Squamish, and Powell River). Of the six Yukon sites included, Whitehourse was envisioned as providing central support within the Territory to other rural and remote locations connected by their internal Internet Protocol (IP) videoconference network. The remaining sites were UBC, and the Sal'i'shan Institute at Chilliwack, B.C. Collaboration with the Alberta Mental Health Board for distance education was also carried out during the project.

Outcomes

All of the main objectives of the project were achieved and included:

• Installation of videoconference systems in selected rural and remote areas of British Columbia;
• Increase in access to clinical mental health services in rural and remote areas of British Columbia and the Yukon;
• Improvement in efficiency and quality of mental health services to consumers in rural areas of British Columbia and the Yukon;
• Increase in access to distance education programs for consumers, mental health professionals and physicians in British Columbia, the Yukon, and Alberta; and
• Evaluation of the project across all key domains.

Increases in activity were apparent across all applications over the course of the project. The rise in activity was attributable to: an increase in the numbers of sites participating in the network; the emergence of unanticipated clinical sessions; and increased demand for distance learning modules.

Policy and Research Implications

Major finding #1: consultation between specialists and local providers, as well as distance education sessions, were the most valuable applications of telehealth media.

Policy implications: it is possible that this model of practice may have a larger impact on a greater number of patients, however, encouraging specialists to consult would require realigning incentives.

Applied research implications: there is an opportunity to examine optimum structure and approaches for training sessions. Additional research is needed to assess whether the same material delivered through alternative means results in ratings comparable to those ascribed to videoconference.

Major finding #2: clinical service providers and consumers rate clinical treatment via video as similar to face-to-face treatment and the view the medium as an acceptable means for service.

Policy implications: policies regarding telehealth planning and financial management require attention, including: clinician payment, management of equipment and human resources, connectivity expenses, etc.

Applied research implications: need to examine other tenable clinical services such as cognitive, personality and neuropsychological testing; cognitive-behavioural therapy for individuals or groups; guide self-care; and home care.

Major finding #3: communities will use equipment for unanticipated applications in order to meet their needs.

Policy Implications: projects should have the latitude to encourage communities and service providers to explore the use of telehealth equipment in novel ways if deemed appropriate. There is considerable need for increased collaborative care in relation to mental health, and in rural and remote communities where the advance of shared care requires support through telehealth.

Applied research implications: to examine community and service provide differences to determine what factors contribute to interest in specific applications across communities.

Major finding #4: results indicate that rural and remote professionals have relatively limited access to sources of continuing professional development, particularly those that involve interaction (examples: demonstration of techniques, opportunities for discussion, connections with other locations beyond the local facility and peer group).

Policy implications: distance learning for health professionals may be one aspect of an overall strategy for health care reform. Planners and policy makers may wish to include telehealth and distance learning as components of health reform agenda.

Applied research implications: programmatic approach to testing this hypothesis would need to go beyond appraisals of satisfaction and agreeableness, and directly assess changes in professional practice and changes in client outcomes. In addition, further research to assess the capability of videoconferencing technology to assist with the recruitment and retention of professionals.

The Future

The CT@M project partner received funding from Mental Health and Addictions, Ministry of Health Services, to implement videoconference equipment and supports in up to 42 additional sites.

During the CHIPP period, the regional governance of health in British Columbia underwent a significant change. Regional partners, such as the Coast Garibaldi and Peace Liard, were subsumed by larger regional authorities. Members of the CT@M have worked closely with the new Health Authorities to develop agreements to provide ongoing telehealth services.

The Yukon has requested a continuation of clinical services and CT@M has finalized an agreement to support this request.

Documents or Products Generated:

Document or Product Name	Available electronically
Templates for vendor RFP	Yes
Templates for vendor contracts	Yes
User guides and/or training manuals	Yes
Policy and procedure manuals	Yes
Job descriptions and/or recruitment material	Yes
Software applications/evaluations, including: E.H.R. application security/access altert software telehealth scheduling software Standards include: data (including minimal data sets) image: messaging other	Yes Yes Yes Yes Yes Yes Yes
Clinical training protocols	Yes
Video conference protocols and Etiquette Guide	Yes
Quality assurance procedures	Yes
Confidentiality and privacy documents Consent forms	Yes
Sustainability planning	Yes

For more information on this project please contact :

James Coyle at 604-822-1642 or at james.coyle@ubc.ca.