Adapting an Outpatient Psychiatric Clinic to Telehealth During the COVID-19 Pandemic: A Practice Perspective (Preprint)

Abstract

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.

Experiences of Mental Health Professionals in the Rapid Pivot to Telehealth

“…Respondents mentioned the creative ways they had discovered to deliver services, and felt that they had more frequently engaged with clients. Much of the available research on the effectiveness of telehealth is promising, and efforts are ongoing to explore the use of these technologies in greater depth (Bashshur et al, 2016;Gentry et al, 2021;Haque, 2021;Hilty et al, 2013;Mishkind et al, 2021;Mochari-Greenberger & Pande, 2021;Sasangohar et al, 2020;Tse et al, 2021).…”

“…While many providers were forced to take a deep dive into the world of telehealth, with time, end users were in a better position to assess the relative strengths and weakness of this service delivery modality. Certainly, there is growing evidence that telehealth is effective and acceptable to service recipients (Bashshur et al, 2016;Gentry et al, 2021;Haque, 2021;Hilty et al, 2013;Lowden & Hostetter, 2012;Mishkind et al, 2021;Mochari-Greenberger & Pande, 2021;Sasangohar et al, 2020;Tse et al, 2021). Some of the impediments that were encountered in this tumultuous time were predictable.…”

“…Emerging and challenging issues around confidentiality were also seen, along with the now permeable boundary between home and work for therapists, and between home and services for clients (Crockett et al, 2020;Jeffrey et al, 2020;Sasangohar et al, 2020;Yellowlees et al, 2020). It is also clear that telehealth is not suitable or palatable for every client, is not effective in every situation, and cannot serve as the lone platform for needed assessments and intervention for all (Mishkind et al, 2021;Tse et al, 2021).…”