Texas Governor Greg Abbott (R) recently debuted his plan to expand an innovative telehealth program in schools across the state. Considering the prevalence of mass shootings linked to mental health issues at learning institutions across the country, policymakers are searching for solutions to improve safety and prevent another tragedy. Telehealth may help improve access to mental health services for students.
There are approximately 15 million students in the U.S. in need of psychiatric care but less than 8,500 practicing child psychiatrists – most of which are centered in and around urban metropolitan areas as noted by Dr. Jack Turban, a well-known expert in children’s mental health at Harvard Medical School.
The use of telehealth services in schools has increased over the last few years to help keep chronically ill students from missing school. As of 2017, nearly half of the country has Medicaid rules that consider schools and school-based health centers to be originating sites eligible for payment.
The Texas-based Telemedicine Wellness, Intervention, Triage and Referral (TWITR) program was launched in 2012 in part to help identify and intervene with students struggling with mental health issues. According to an April 2018 data brief, the program has had encounters with almost 42,000 students since its inception, but it currently only operates in a limited number of districts. Part of the governor’s plan is to secure enough funding to ultimately make the program available to every student in the state.
Most states now allow for the reimbursement of telehealth services in some fashion, but the level of reimbursement is still not uniform as noted in Medicare Payment Advisory Commission’s March 2018 report. This report references a primary criticism of telehealth, which is that it increases costs because it complements in-person visits instead of replacing them, driving up utilization. However, in populations and locations where in-person visits are scarce, this concern is irrelevant. Telehealth will allow providers to meet an otherwise unmet patient need.
While telehealth is a promising solution for the gap in adolescent mental health services, policymakers must ensure to protect patients. Policymakers must not, in their haste to address a need, overlook the quality of services provided via telehealth as patients must be provided with the same standard of care as in person visits. While the goal may be to expand the availability of services, access to poor quality care is still access denied.
Quality of services can be validated by an independent, third-party accreditation organization, such as through URAC’s Telehealth Accreditation program. It is designed for organizations providing healthcare-related services, education, and information delivered via telecommunications technology, such as videoconferencing, remote monitoring, electronic consults, and wireless communications. Those who achieve URAC Telehealth Accreditation, such as behavioral health company AbleTo, demonstrate that their programs adhere to quality standards, and engage in evidence-based practices.
Although it remains to be seen if the Texas legislature will enact Gov. Abbott’s recommendations, expect policymakers to continue to look to telehealth to address shortages in mental health services.
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