Caregiver’s New Telepsychiatry Program Delivering Improved Continuity, Quality of Care for Individuals with Dual IDD/Mental Health Diagnoses
In 2017, Randi Morgan, RN BSN and Senior Nurse Consultant at Caregiver, Inc. (pictured), knew there had to be a far better way to help the people they serve who had dual-diagnoses of intellectual and developmental disabilities and mental disorders.
Among the 2800 individuals cared for by Caregiver teams throughout Texas, over 1300 individuals were scheduled for as many as 9000 off-site psychiatric appointments annually, sessions that required extensive scheduling, logistical, transportation and experiential challenges. Local Caregiver staff arranged appointments with psychiatrists, when available, that almost always took place across town or in another city entirely, then organized transportation for the individual, the care team and guardian. Stress levels and expenses commonly grew. Mental health outcomes often declined. Morgan’s research identified a way to deliver excellent psychiatric care, simplify coordination for visits, dispense with extensive travel time, avoid crowded waiting rooms and reduce stress for everyone involved: telemedicine.
“The solution is telepsychiatry,” Morgan said.
Morgan, with over two decades of experience working with individuals with IDD, worked previously with Daybreak (a Caregiver affiliate company), EduCare Community Living, Tarrant Dialysis and Texas Health Harris Methodist Hospital.
She is a member of Developmental Disability Nurses Association and Providers Alliance of Community Services in Texas. She is an alumna of Texas Christian University.
Telepsychiatry, while still relatively new, utilizes HIPAA-compliant televised videoconferences to deliver psychiatric services. In the last decade, televised healthcare (telehealth) has grown in popularity and acceptance. The platform is rapidly becoming a standard of care, particularly when reaching patients in rural areas.
Morgan recognized that telepsychiatry could transform services for Caregiver’s dual diagnosis individuals. The telemedicine psychiatric service delivery model could be a safer, more productive psychiatric appointment protocol for their individuals.
To adopt the protocol in Texas, Morgan first had to identify an ideal psychiatric group to serve their individuals via telemedicine. By 2017, the company had selected Frank Floca, MD, PLLC, and his Austin-Texas based Psychiatric Associates of Central Texas (PACT). Dr. Floca and his team of licensed physician’s assistants (PAs) and nurse practitioners (NPs) with psychiatric specialization treat a variety of mental health conditions, including a sizeable cohort of IDD patients.
Morgan enlisted the support of Caregiver CEO Mark Lashley, who committed to fund a significant investment in technology, including the purchase and installation of and training for staff in to use required secure, encrypted webcams, video equipment and connections that adhere to HIPAA privacy rules. Via a secured link through email to Dr. Floca’s office, Caregiver’s new system was soon installed, tested and underway at 15 Caregiver facilities.
The program would also require a systematic, organized migration process. Morgan’s plan was to take a full year to introduce and positively engage individuals with dual-diagnosis to switch to telepsychiatry. The methodical process would help ensure a smooth transition. Understandably, there was some initial skepticism and reluctance.
“Change can be difficult,” said Morgan, “but this transition has been broadly welcomed. Outcomes are showing dramatic improvements.”
Individuals can remain in their Caregiver day habilitation facility or travel just a few minutes to their nearby Caregiver nurse’s office.
Before each appointment, PACT’s Nurse Practitioner receives and reviews up-to-date information like primary care physician orders, neurologist reports, and recent lab results. During each private, secure telepsychiatry appointment, the Nurse Practitioner visits with and monitors the individual, and the behavioral supports team, family member or guardian, and onsite nurse are on hand to provide important patient history and data, interacting with the individual and the psychiatric professional to answer questions in real time.
According to Morgan, with telepsychiatry services from PACT’s experienced group of professionals and compliant systems in place, Caregiver maintains the integrity of continuity of care seamlessly and easily.
“Individuals are so much more relaxed and comfortable,” stressed Morgan. “More people on our individual’s team and from their family can readily attend the appointments.”
Kathy Griffith, pictured, Caregiver’s South Regional Director based in San Antonio, has watched their individuals and families grow to trust Caregiver’s recommended new model and give the new service delivery a try.
“We simply asked our individuals to try it and give us feedback,” said Griffith. “Interestingly, most were quick to appreciate the benefits, with everyone so much more relaxed and comfortable. Dr. Floca’s team has been exceptionally professional and responsive.”
Raul Rodriguez, Sr., the father of one of Caregiver’s individuals in Griffith’s area commented: “Now, my son’s entire team can be present, and we can all share our input and observances so that the provider can get the full picture of my son’s current state. We never feel rushed, and we always feel seen and heard. Telepsychiatry has been a wonderful change for our family.”
According to Griffith, the PACT team provides Caregiver individuals with genuine, quality interaction with their Nurse Practitioners.
“It’s remarkable to watch the therapeutic alliance flourish between patient and provider, even though it’s over a screen,” said Malcolm Duncan, RN, MSN, a Psychiatric Nurse Practitioner and PACT Business Manager. “Patients are stabilizing. It is exciting to be on the forefront of what is clearly the future of medicine.”
Duncan emphasizes that the ability to easily access quality, consistent care is a huge win.
“Keep in mind that many of the individuals we treat struggle to get to a traditional office,” he emphasized. “Telepsychiatry allows us to meet the patients where they are, in a positive, relaxed setting.”
Residual benefits abound. Prescription medications are ordered by electronic transmission to the pharmacy and delivered to the Caregiver site—no transport or waiting in lines. Morgan reports improved outcomes as individuals’ care has stabilized, and hospitalizations have been reduced over time due to better medication management. Critical incident reporting has decreased. Caregiver’s staff of frontline Direct Service Providers and their Behavioral Supports team colleagues report that work has become less stressful with the efficiency of the telemedicine model.
“Continuity and thoroughness of and access to care obviously helps us get ahead of any potential crisis,” Morgan said.
For Caregiver, telepsychiatry is helping thousands of individuals in Texas with the greatest needs enjoy improved quality of life and is reducing stress among the dedicated staff caring for them. Caregiver hopes to soon expand the program into their other service areas in Indiana, Ohio and Tennessee.
ABOUT PSYCHIATRIC ASSOCIATES OF CENTRAL TEXAS (PACT)
Founded in 1997 in Austin, Texas, Psychiatric Associates of Central Texas (PACT) is a Texas-based and led organization that specializes in adult psychiatric care. PACT’s comprehensive approach addresses physical, emotional, and social needs. Extensively trained in the management of patients with mental health illnesses, the PACT team includes physicians, advanced practice nurses, and physician’s assistants with years of experience in multidisciplinary collaboration, working closely with primary care and psychotherapy teams to ensure a well-rounded patient-centered treatment plan. Psychiatric Associates of Central Texas is headquartered at 7005 Mira Loma Lane, Suite 102, Austin, Texas 78723. Phone is (512) 795-4344. They are on the web at pactaustin.com.
ABOUT CAREGIVER, INC.
Caregiver, Inc., is a privately-held company with over 3500 employees within the headquarters support group and branded affiliate organizations in four states. The affiliates provide intermediate, home and community care services to nearly 2800 individuals who qualify as developmentally or intellectually disabled or are impacted by related conditions. Caregiver, Inc. was formed in 2015 and now includes these affiliates: Unified Care Group, Southern Concepts, River Gardens, Daybreak Community Services Inc., St. Giles Living Centers, DSA of Indiana, HHC of Ohio, and Omni Support Services of Tennessee. All have similar service offerings and strong reputations in their local communities. Caregiver services include supported home living, family protective services, case coordination, nursing services, respite services, day habilitation, psychology services, dental treatment, specialized therapies, adaptive aids, minor home modifications, and supported employment. Caregiver president and CEO is Mark Lashley. Company headquarters are at 4100 International Plaza, Suite 800, Fort Worth, Texas 76109. Phone is (800) 299-5161. They are on the web at cg-idd.com.
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