PRiSMM Telehealth Practices

Telehealth practices all strategies

• Learn how to access or provide telehealth care | Telehealth.HHS.gov.
  
• For patients | Telehealth.HHS.gov.
  
• Incorporate a Health Insurance Portability and Accountability Act (HIPAA) compliant telehealth dimension into your practice, as this can significantly extend your diagnostic and therapeutic reach.
• There are several video platforms readily available for this purpose, such as Zoom, Updox, Webex, Doxy. me, etc.
• HHS Telehealth resources for behavioral health care, direct-to-consumer health care, and emergency departments.

• Familiarize yourself with your specialty's information regarding telehealth practice guidelines and patient-provider identification.

• Use consent forms specially designed for telehealth consultations: 
• Examples: CMU /MMH Patient agreement.
• Provider videos.
  • How telehealth helps providers deliver care.
  • Telehealth power for providers.
  • Telehealth and the underserved.
• Patient videos.
  • Connecting to your telehealth appointment.
  • Making telehealth work for you.
  • Types of telehealth services.
  • What do you need to use telehealth?
• Telehealth for the Treatment of Serious Mental Illness and Substance Use Disorders.

Identify and assist

• It is best to observe basic guidelines when working with a potentially suicidal patient:
• Request the person's location (address, apartment number) at the start of any session in case you need to contact emergency services.
• Request or make sure you have emergency contact information.
• Secure the patient's privacy during the telehealth session as much as possible.
• Inquire about increased access to potentially lethal means.
• Clinical management issues:
• Identify a method of increasing safety as part of your response repertoire, e.g., a safety plan.
• Provide crisis hotline (988).
• Identify individuals in the patient's current environment to help monitor suicidal thoughts and behaviors in-person or remotely; seek permission to have direct contact with those individuals.
• If the risk becomes imminent and cannot be managed remotely, arrange for the client to go to the nearest crisis center or medical ED.
• If the risk is imminent, stay on the phone with the patient until other care is present.
• Safety planning
• If the patient is found not to need emergent management, creating a safety plan with the patient is a way to stay safe without using more emergent settings.
• Arrange a way for the patient to get a copy of their plan (e.g., take a picture or scan, and e-mail or text to the patient).

Identify and Assist

Increase help-seeking

• Review collaborative care.
• Have access to tools that can engage individuals such as interpretative services.
• Use resources that are useful for engagement.

Increase Help Seeking

Care transitions

• If possible, leverage the client's natural supports to assist them during care transitions. They might need someone to stay with them for a while.
• Ask your client about their Safety Plan; go over it with them and collaboratively make any adjustments to the plan if needed.
• Process the experience with your client of going to the emergency department or inpatient setting, etc. These events can be traumatizing, and your client will benefit from processing them.
• Use an evidenced-based treatment upon discharge that is targeted to suicidality (CAMS, DBT).
• Suggest the  SPRC website; search for care transitions.

Care Transitions

Respond to crisis

• Ask the person where they are calling from in case they become disconnected.
• Ask about their location and if anyone is with them.
• Evaluate the risk of access to lethal means and risk for implementation.
• Complete suicide risk assessment and determine the appropriate level of intervention required.
• Develop your practice crisis response.

Respond to Crisis

Postvention

• Consider if an in-person meeting is needed in this circumstance (if at all possible.)

Postvention

Reduce access to means

• Ask about their household firearm storage practices and make recommendations to increase the safe storage of firearms.
• Ask if all firearms can be or are safely stored (e.g., with a locking device such as cable locks, or trigger locks) or use locking containers (e.g., lockboxes, firearm safes, firearm cabinets).
• Engage household members to support safe storage.
• Normalize gun ownership, speak with someone else in the home, move away from the computer when talking- trust is essential, and stress the importance of respecting their right to own a gun.

Reduce Access to Means

Connectedness

• Need to ensure participants have access to technology to utilize services and review guidelines for use of online group meetings.

Connectedness