Rural Telemental Health Services
This entry has been selected as a finalist in the
Rethinking Mental Health: Improving Community Wellbeing competition.
A mental health consultative service for rural health providers has been established (Rural Minnesota Telemental Health Network (RMTHN)). This supports rural providers and patients by establishing a telecommunications link - a virtual presence - of mental health professionals to assist in the care of patients in underserved populations.
About You
Section 1: About You
First Name
James
Last Name
Boulger
Country
United States
Section 2: About Your Organization
Organization Name
Center for Rural Mental Health Studies
Organization Website
Organization Phone
218-726-7386
Organization Address
Univ Minnesota Med School Duluth, 1035 University Drive, Duluth, MN 55812
Organization Country
United States
Is your organization a
Non‐profit/NGO/citizen sector organization
Your idea
Name Your Project
Rural Telemental Health Services
Country your work focuses on
United States
Describe Your Idea
A mental health consultative service for rural health providers has been established (Rural Minnesota Telemental Health Network (RMTHN)). This supports rural providers and patients by establishing a telecommunications link - a virtual presence - of mental health professionals to assist in the care of patients in underserved populations.
Innovation
What makes your idea unique?
Rural residents are among the most underserved for mental health as well as general health services in the USA. Most medical care is provided by family physicians in small and rural communities. The Center for Rural Mental Health Studies of the University of Minnesota Medical School Duluth has developed a consultation service for family physicians and other primary care practitioners to provide rural Minnesota residents with rapid access to mental health services through their family physician. The telemental health providers consist of 3.5 FTE doctoral level psychologists, one master’s level trained counselor and .4 psychiatrists. All psychologists volunteer their time and are employed on a full-time basis elsewhere within the Duluth medical school. This off-site shared-care consultative model is a collaboration with the family medicine clinics in the Minnesota communities of Bigfork, Bois Forte Reservation, Cook, Ely, Littlefork, Mora and Paynesville, Minnesota. Services provided give support for rural/small community physicians, rapid diagnosis and treatment of patients within their “medical home”, decreasing access time for mental health consultation and treatment and efficient use of health professional time. The integration within the patient’s “medical home” diminishes stigma attached to behavioral and emotional care.
Do you have a patent for this idea?
Impact
This Entry is about (Issues)
What impact have you had?
Documented results for over 800 patient contacts have been collated and published. Summarized, patients and providers are very satisfied and grateful for the rapid assessment and consultations within their family medicine home. Diagnoses are wide ranging as one would expect, and the goal of having the family physician remain the primary care giver has been successful. More communities are seeking to work with the Center.
It is clear that mental health issues are very prevalent in rural and Native American communities and that the health care providers in those areas are in need of assistance for their patients. Patients are seen quickly – an average of six or more times more quickly than prior to the implementation of the telemental health consultations – and the care of the patient is maintained in the patient’s medical home thus increasing the quality and efficiency of care of the rural, underserved patient.
See: Boulger, J. Patient Acceptance of Integrated Telemental Health Services Within Rural Family Medicine Practices. Presented at the 61st Annual Scientific Assembly of the American Academy of Family Practice, 2008. And Davis, G, Boulger, J, Hovland, J and Hoven, N. The Integration of a Telemental Health Service into Rural Primary Medical Care. J. Agricultural Safety and Health, 13 (3), 237-246, 2007
Problem
Integrating mental health into primary health care settings in underserved rural populations is our objective. Using a shared-care model of service: where care is delivered at the patient’s local Family Medicine clinic results in greater patient anonymity and thus reducines stigma attached to mental health consultations - one of the primary barriers to appropriate treatment in rural communities.
The rural mental health system is dependent on the family physician. The need to support rural physicians in their efforts in mental health care in communities is critical to attracting and retaining physicians in underserved areas. The CRMHS serves patients only in areas that lack mental health providers. Communities that are in our Rural Minnesota Telemental Health Network are all in federally designated health professional shortage areas (HPSA’s, MUA’s and Mental Health HPSA’s). None of the communities has a psychiatrist and rarely are there available mental health professionals of any type.
Actions
The physician-estimated wait time for patients was between six and eight weeks when we began. Currently, following referral, all patients seen to date have been offered an appointment within one week of the original referral date. The family physician makes an appointment for the patient with a Center provider. A brief description of the patient and the general problem for which consultation is requested is FAXed to the Center in advance. The patient is seen in the community medical clinic or hospital via televideo utilizing video conferencing equipment. Following the session(s) with the patient, CRMHS providers call the referring practitioner and summarize clinical impressions and offer treatment or referral recommendations. This initial contact is followed with a written report for the patient’s medical file and a summary letter to the patient that includes the letter to the physician and follow-up instructions, when appropriate.
Results
More than 800 patient contacts have now been accomplished via the telmental health consultative service. Recent studies of patient and provider satisfaction have shown a very positive acceptance rate marred only by an occasional technological “glitch.” Patient and provider satisfaction has been excellent for the services rendered. Using a scale from zero (low) to four (high), the patient satisfaction ratings have averaged 3.6, while the provider average rating has been 3.9. With the addition of part-time psychiatrists and an additional part-time clinical psychologist/pharmacist, the number of patients seen is increasing.
What will it take for your project to be successful over the next three years? Please address each year separately, if possible.
2010: Additional funding will provide expansion of services to additional underserved rural and small communities; additional staff will be required to support expansion. Current faculty efforts will need to be maintained at a time of diminishing State budgetary resources. Commitment from institutional sources will be maintained.
2011: Again, additional funding will need to be continued to support the expansion of services to additional underserved communities; additional staff will be required to support this. Current faculty efforts will need to be maintained. Commitment from institutional sources will be maintained.
2012: During this year, it is probable that the Director of the Center for Rural Mental Health Studies will retire. A search will need to be conducted to replace him.
Throughout the three years, we project having to constantly look for external sources of funding to support the rural telemental health consultation activities. This commitment of time will, of necessity, make sustainability more difficult.
What would prevent your project from being a success?
A number of events may threaten the continuing success of this project. The co-Director of the Center for Rural Mental Health Studies, Dr. Gary Davis, recently assumed the leadership of the medical school campus in Duluth. This has lessened the amount of time that he has available to see patients. Insofar as his hectic schedule permits, he has maintained his schedule in this regard. It would be beneficial to replace these efforts with time from additional professionals in the community.
As for most clinical services, funding is a perpetual issue. We will continue to seek external funding to bridge the gap between funds recovered from third-party insurers and the actual costs of service delivery. Should we be unsuccessful in these efforts, the project will be jeopardized.
The telemental health consultation service is successful. We hope that it will remain so,
How many people will your project serve annually?
101‐1000
What is the average monthly household income in your target community, in US Dollars?
More than $4000
Does your project seek to have an impact on public policy?
Yes
Sustainability
What stage is your project in?
Operating for 1‐5 years
In what country?
United States
Is your initiative connected to an established organization?
Yes
If yes, provide organization name.
Center for Rural Mental Health Studies, University of Minnesota Medical School Duluth
How long has this organization been operating?
More than 5 years
Does your organization have a Board of Directors or an Advisory Board?
Yes
Does your organization have any non-monetary partnerships with NGOs?
Yes
Does your organization have any non-monetary partnerships with businesses?
No
Does your organization have any non-monetary partnerships with government?
No
Please tell us more about how these partnerships are critical to the success of your innovation.
Our partnershps are with rural and Native American primary care practice sites.. That is the source of the patients and the medical home of our provider/partners.
What are the three most important actions needed to grow your initiative or organization?
Additional funding is required to expand the number of sites to which telkemental health services are offered. Development of additional partnerships with other mental health providers will be necessary to expand further. Additional commeunity assessments of need are required to fuel appropriate expansion.
The Story
What was the defining moment that led you to this innovation?
The goal of the University of Minnesota Medical School Duluth has been to train physicians for service in rural and Native American underserved areas. We have been markedly successful in accomplishing these goals. Half of all Duluth graduates are in Family Medicine, and 46% are in practice in communities smaller than 20,000. Mre Native Americans have received their MD degree from the University of Minnesota since tha school’s inception in 1972 than any other US medical school except Oklahoma.
Support for the patients of our alumni, as well as those practitioners themselves, in these underserved areas is a natural effort for the mental health professionals at the school. Knowing the limited resources available to patients and professionals in the rural areas of Minnesota, the telemental health consultative services were instituted using our alumni and colleagues in smaller communities. The interactions that we have had in training our students in these practices as part of our Family Medicine Preceptorship Program made cooperative links relatively easy to form in a trust-based relationship.
While working with rural family physicians in the medical school curriculum as well as in the supervisory process for Family Medicine residents in the Duluth residency, the need was apparent for collegial support for the providers and their patients via telemedical consultations. Via this method using virtual presence by staff in Duluth, we should be able to decrease the wait time for patients to see mental health providers, be able to assist the primary care physicians and other health care providers with rapid and focused consultative services and deliver comprehensive services within the patient’s medical home.
We are pleased with our success.
Tell us about the social innovator behind this idea.
James G. Boulger, PhD, is the Director of The Center for Rural Mental Health Studies based at the University of Minnesota Medical School Duluth. Dr. Boulger has been on the faculty of the medical school in Duluth for the past thirty-five years in various positions. Currently, he is Professor and Head of the Department of Behavioral Sciences with a joint appointment in the Department of Family Medicine where he has directed the Family Medicine Preceptorship Program for the past 34 years. He has been recognized nationally for his efforts in rural medical education by the National Rural Health Association as well as by the University. From its inception in 2000, he has been the Director of the Center for Rural Mental Health Studies.
The Center is comprised of a multidisciplinary team of faculty and community associates who provides rural Minnesota residents with better access to mental health services through their family physician. The CRMHS telemental health providers consist of 4.5 FTE doctoral level psychologists and one master’s level trained counselor. All psychologists volunteer their time and are employed on a full-time basis elsewhere within the Duluth medical school.
This off-site shared-care consultative model is a collaboration with the family medicine clinics in the Minnesota communities of Bigfork, Cook, Ely, Littlefork, Mora and Paynesville Minnesota. Additional sites are two at the Bois Forte Reservation in rural Minnesota which provide assistance to the primary care providers at that Native American health site.
How did you first hear about Changemakers?
Through another organization or company
If through another, please provide the name of the organization or company
Via the Western Interstate Commission for Higher Education (WICHE) Mental Health Program efforts which were attempting to identi
 | 128 weeks agoNaveen Shakir said: On November 20, 2009 the judges reviewed the entries for the Changemakers Rethinking Mental Health: Improving Community Wellbeing ... about this Competition Entry. - read more > |
| 130 weeks agoRural Telemental Health Services has been chosen as a finalist in Rethinking Mental Health: Improving Community Wellbeing. |
| 136 weeks agoJim Boulger updated this Competition Entry. |
| 137 weeks agoJim Boulger submitted this idea. |
