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Northern Telepsychiatry Initiative

Summary 
The Northern Tele-psychiatry Initiative will improve the mental health of children and teens, reduce the number of admissions to child psychiatric in-patient units, and help prevent the inappropriate prescribing of psychotropic medications by primary care practitioners to children and adolescents.
Description

There are unique barriers to providing access to high quality, effective and affordable health care in northern New Hampshire. The Northern Telepsychiatry Initiative (NTI) established a creative model for youth to access child psychiatry in the region. The proposed service area, known as The North Country, includes communities throughout the northern half of NH. It encompasses seventeen communities in Grafton County and all of Carroll and Coos County. The North Country spans 4,447 square miles comprising 43% of the total land mass of the State. The region includes 57 small towns with a total population of 105,870 and a density ranging from 18.4 to 47.7 people per square mile.

Services offered

The goal of the NTI was to provide access to child psychiatry through telemedicine and establish the necessary policy and legislative changes to ensure the success and sustainability of the initiative. With the funding provided a network of members worked to:
  • Enhance the consortium of Northern Human Services, New Hampshire Department of Health and Human Services, Bureau of Behavioral Health, NAMI New Hampshire (NAMI) and the Behavioral Health Network (BHN)
  • Start up a teleconferencing network among five Northern Human Services office locations and a child psychiatrist
  • Advocate for the inclusion of telemedicine in the New Hampshire Medicaid state plan
  • Examine legislative options for private payer coverage of telemedicine, and specifically telepsychiatry, in NH.
  • Promote the utilization of child telepsychiatry through advocacy among community leaders and family members of children needing psychiatric evaluations
  • Develop and implement satisfaction and outcome studies of the child telepsychiatry initiative
  • And, as a side benefit, develop an effective model for child telepsychiatry for replication among the mental health care providers in NH.
As the consortium began planning this initiative many potential problems were identified. They included: provider and consumer resistance to the new delivery model, the recruitment and retention of a child psychiatrist and the fear that reimbursement for services would not become a reality. In fact, many of the barriers that were predicted were not an issue. The community (providers, clients and the NH legislative body) all embraced the initiative. The consortium did experience significant difficulty in recruiting a child psychiatrist however the arrangement that was created with Dartmouth have proven to be an incredible asset to the project.

An additional and unforeseen problem was the complexity and cost of the technology. These related problems were solved with the investment in staff development and an aggressive effort to pursue options to decrease the cost of connectivity. These options have included other grants (FCC’s regional project and USAC) as well as a restructuring of the physical network.

Results

In addition to the 360 degree evaluation which was discussed in Section II members of the NTI monitored the overall project work plan. Members made adjustments to the plans as progress was made or the needs of the project changed. The adjustments in the work plan regarding the recruitment of a child psychiatrist is just one example of the NTI’s demonstrated ability to adjust as needed. The outcomes achieved by the NTI have secured a strong foundation for continued growth of telemedicine in NH. Through their efforts the NTI has minimized barriers to service for families as discussed in detail above.

In addition, their efforts have contributed to a culture of readiness in northern NH for the adoption of other telemedicine applications. For example, their efforts have secured financial support for telemedicine through the State Medicaid plan and mandatory 3rd party reimbursement. In addition, the technical capacity and infrastructure that was built for the project will remain a vital component for future telemedicine efforts among partner organizations. Finally, through outreach efforts the NTI has contributed to an increased desire to explore the use of technology and to expand access to health care across many disciplines throughout the State.

Replication

Although it is too early to define the NTI model as a best practice, the initial evaluation of the project was very positive and suggests that we were able to identify elements critical to creation of best practice model.

While the NTI will not continue to be a formal relationship the work of the individual members and the foundation that has been set will ensure that provision of child psychiatry via telemedicine will continue in the North Country. Northern Human Services will take financial responsibility for program costs with hopes that they will be offset by reimbursement for services and additional grants. They also hope to decrease the overhead cost burden by restructuring their network to leverage newer technologies.

Source Outreach Sourcebook, Vol.14, 2006-2009, Office of Rural Health Policy
Contact person Kim Mohan
Northern Human Services
87 Washington Street
Conway, NH
603.447.3347x 3039
603.447.8893 (fax)
kmohan@northernhs.org
Topics Mental health
Youth
States served New Hampshire
Date added January 22, 2007
Date updated or reviewed April 15, 2010

Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RAC for your convenience. The programs described are not endorsed by RAC or by the Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.

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Funding for this project was supported by Grant Number U56RH05539 from the Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services. The contents of this website are solely the responsibility of the authors and do not necessarily represent the official views of the funder.