As the demand for telepsychiatry increases during the COVID-19 pandemic, the strengths and challenges of telepsychiatry implementation must be articulated to improve clinical practices in the long term. Currently, observations within US contexts are lacking; therefore, we report on the rapid implementation of telepsychiatry and workflow experiences in a psychiatric practice based within a large health care system in southeast Texas with a national catchment area. We discuss the logistics of the implementation, including modes of communication, scheduling, coordination, and capacity; the psychological effects of web-based services, including both the loss of the physical therapeutic environment and the unique interpersonal dynamics experienced in the virtual environment; and postadoption patterns of engagement with our services and with other clinical functions affected by the rapid adaptation to telemedicine. Our art therapy group programming serves as an applied case study, demonstrating the value of a well-managed web-based program (eg, patients were receptive and well-engaged, and they appreciated the continuity of accessible service) as well as the challenges (eg, the need for backup plans and technological fallbacks, managing interruptions and telecommunication learning curves, and working around the difference in resources for art and music therapy between a well-stocked clinical setting versus clients’ home spaces). We conclude from our experience that the overall strengths of telepsychiatry include receptive and well-engaged responses from patients as well as the expansion of boundaries, which provides a directly contextualized view into patients’ home lives. Challenges and corresponding recommendations include the need for more careful safety planning for high-risk patients; maintaining professional boundaries in the newly informal virtual setting; designing the physical space to both frame the patient encounter and maintain work-life balance for the therapist; allowing for delays and interruptions (including an initial acclimation session); and preserving interprofessional care team collaboration when the physical locations that normally facilitate such encounters are not accessible. We believe that careful observations of the strengths and challenges of telepsychiatry during this pandemic will better inform practices that are considering telepsychiatry adoption both within pandemic contexts and more broadly thereafter.

This study examined the role language plays in mediating the influence of verbal descriptions of persons on trait ratings of those persons. Subjects were given written descriptions of the behavior of fictitious persons in a work situation and were asked to rate them on fifteen trait- adjective scales. In one condition of the experiment, specific information about certain traits was withheld, forcing subjects to rate persons on traits for which they had no direct behavioral clues. In the other two conditions, the specific information was provided. Providing specific information about a trait directly influenced ratings on that trait even when sufficient general information on that trait was given. In one condition, the influence on the ratings of the additional behavioral clues was such that a new latent variable representing an additional component of meaning was called for in the structural equation model.

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The health care delivery system in the United States, structured to provide single-disease care, presents unique challenges for patients with complex physical and psychiatric comorbidities. Patients in these populations are often referred to multiple specialty clinics, encounter little continuity of care or collaboration among their providers, incur high health care costs, and experience poor treatment outcomes. Given these barriers, questions remain about the extent to which siloed and fragmented care, as opposed to the complex nature of the illnesses themselves, contribute to poor outcomes. If given the opportunity to receive well-integrated, consistent, and personalized care, can patients with historically difficult-to-treat comorbid medical and mental illnesses make progress? This article describes an innovative model of care called functional rehabilitation that is designed to address existing barriers in treatment. The functional rehabilitation program seeks to disrupt the escalating effects of interacting comorbidities by offering highly collaborative treatment from a small team of clinicians, personalized interventions using a shared decision-making framework, multipronged treatment options, colocation in a large hospital system, and significant 1:1 time with patients. The article includes a case example with longitudinal outcome data that illustrates how progress can be made with appropriate programmatic supports. Future research should examine the cost-effectiveness of this model of care.

UNSTRUCTURED As the demand for telepsychiatry increases during COVID-19, articulating strengths and challenges of telepsychiatry implementation are needed to improve clinical practices long-term. Currently, observations within United States contexts are lacking; therefore, we report on the rapid implementation and workflow experiences as a psychiatric practice based within a large healthcare system in Southeast Texas with a national catchment area. We discuss implementation logistics including modes of communication, scheduling, coordination, and capacity; psychological effects of online services, including both the loss of the physical therapeutic environment as well as unique interpersonal dynamics experienced in the virtual environment; and post-adoption patterns of engagement in our services and other clinical functions affected by the rapid adaptation to telemedicine. Our art therapy group programming serves as an applied case study, demonstrating the value of a well-managed online program (e.g., patients were receptive, well-engaged, and appreciated the continuity of accessible service) as well as the challenges (e.g., the need for backup plans and technological fallbacks, managing interruptions and telecommunications learning curves, and working around the difference in resources for art and music therapy between a well-stocked clinical setting versus clients’ home spaces). Overall, we conclude from our experience that overall strengths of telepsychiatry include surprisingly receptive and well-engaged response from patients, and the expansion of boundaries allowing for a directly contextualized view into patients’ home lives. Challenges and corresponding recommendations include the need for more careful safety planning for high risk patients, maintaining professional boundaries in the newly informal virtual setting, designing the physical space both to frame the patient encounter and to maintain work-life balance for the therapist, allowing for delays and interruptions (including an initial acclimation session), and preserving interprofessional care team collaboration when the physical hallways normally facilitating such encounters are absent. We believe careful observations on strengths and challenges of telepsychiatry during this pandemic will better inform practices considering telepsychiatry adoption both within pandemic contexts and more broadly thereafter.