Telehealth for rural diverse populations: telebehavioral and cultural competencies, clinical outcomes and administrative approaches

Abstract

Rural health care settings are challenged to provide timely and evidence-based care, particularly for culturally diverse patients with behavioral health disorders. Telepsychiatry and telebehavioral health improve access to care and leverage scarce resources. This scoping review from January 2000 -July 2019 was conducted to see if the literature had data for two related the research questions, "What are the components of culturally competent, telepsychiatric clinical care, and what approaches have clinicians and systems taken to implement and evaluate it?" The review focused on key words in four concept areas: (I) competencies; (II) telehealth in the form of telepsychiatry, telebehavioral or telemental health; (III) culture; and (IV) health. It was done in accordance with the six-stage scoping review process in PubMed/Medline and otherdatabases. The screeners reviewed the full-text articles for final inclusion based on inclusion (mesh of the key words) and exclusion (e.g., need for only, skills abstractly discussed) criteria. From a total of 1,118 papers, the authors found 44 eligible for full text review and found 7 papers directly relevant to the concepts. Few studies specifically discuss skills and competencies of both telehealth and cultural factors. Many organizations are attending to cultural competencies and approaches to care, but there are no specific competencies that integrate telepsychiatry or telebehavioral health with culture. Existing telepsychiatric (i.e., video, social media, mobile health) and one set telebehavioral health competencies included cultural component, including use of interpreters and language matters. Administrative adjustments are suggested to promote culturally competent care by telehealth via clinical, educational, quality improvement, program/system evaluation, and other (e.g., finance and reimbursement) interventions. More structured research is needed on development, implementation and evaluation of combined competencies in rural settings.

A Survey of Residents/Fellows, Program Directors, and Faculty About Telepsychiatry: Clinical Experience, Interest, and Views/Concerns

“…The effectiveness of TP for assessing patients (Hilty et al 2013 ; Nelson and Sharp 2016 ; Gloff et al 2015 ; Hubley et al 2016 ) and establishing a therapeutic relationship (Hilty et al 2020c ) runs counter to many of these concerns; yet, the TP evidence base needs improvement related to (1) dealing with emergencies (Freeman et al 2020 ); (2) doing inpatient and acute care (Hilty et al 2013 ); and (3) working with culturally diverse populations (Hilty et al 2018a ). A conceptual framework has been suggested for cultural and video competencies (Hilty et al 2020b ), along with administrative approaches to reduce barriers, implement successfully, and evaluate outcomes (Hilty et al 2018a , 2020b ; Guerra and Kurtz 2017 ). TP studies related to the treatment of patients with psychosis and delusional frameworks are limited, but few experienced clinicians have concerns; initial assumption that such patients may feel monitored have not been found to be true (Hilty et al 2013 ).…”

Telemental Health Use and Refugee Mental Health Providers Following COVID-19 Pandemic

“…As mental health agencies grapple with the sudden need for telemental health trainings due to the COVID-19 pandemic, clinical social work practitioners and policymakers must prioritize the integration of skills and competencies of both telemental health and cultural factors (Hilty et al, 2020 ). For example, the majority of the refugee population are from cultures that utilize a “high context” communication style, which values underlying context, implicit messages, and nonverbal communication such as voice tone, facial expression, gestures, and eye movement (Zwi et al, 2017 ).…”

A Survey Comparing Adult and Child Psychiatry Trainees, Faculty, and Program Directors’ Perspectives About Telepsychiatry: Implications for Clinical Care and Training

“…A model of core residency and augmented child TP training has heuristic value, but PDs may be more inclined to design/obtain rotations for electives rather than required rotations due to time constraints, faculty expertise and other factors. As many training programs may struggle to amass the resources required to meet the suggested competency requirements for video, social media, mobile health, and asynchronous technologies in combination with cultural competencies (Hilty, Gentry, McKean, Cowan, Lim, & Lu, 2020;Hilty, Crawford et al, 2015;Hilty, Maheu et al, 2018a, b, c;Zalpuri et al, 2018), a strong case can be made for an inter-institution pooling of resources (i.e., curricula, faculty teachers/supervisors, evaluation processes). Institutional competencies have been suggested, which would consolidate clinical care, residency/fellow training, and faculty development missions around core competencies Hilty, Unützer, Ko, Luo, Worley, & Yager, 2019).…”