Presented to the KC Digital Drive Health Innovation Team March 31, 2021

1. TELEHEALTH
TECHNICAL ASSISTANCE
HEARTLAND TELEHEALTH
RESOURCE CENTER
SERVING KANSAS, MISSOURI, AND OKLAHOMA
1

2. • HTRC one of twelve regional and two national
Telehealth Resource Centers committed to
implementing telehealth programs for rural and
underserved communities funded by the U.S. Dept.
HHS, HRSA
• HTRC serves Missouri, Oklahoma, and Kansas
• Great Plains TRC serves Nebraska: www.gptrac.org
• Focus in rural communities, Federally Qualified Health
Centers (FQHCs), and Rural Health Clinics (RHCs).
• Work to help organizations and practices overcome
barriers, advance telehealth education, and provide
resources.

3. • Regional Expertise in telehealth implementation.
• TRCs are equipped to provide technical assistance,
education, and resources.
• Able to provide a wide range of assistance targeting
local community needs.
• One national TRC (Center for Connected Health Policy)
focuses on state and national policy related to
telehealth.
• The other national TRC (Telehealth Technology
Assessment Resource Center) focuses on technology—
”Consumer Reports” for telehealth technology

4. HOW HTRC CAN HELP
. . .
• On-line resources
• Webinars and workshops
• Presentations
• Staff training
• Peer to peer connections
• Consultation services
…and more!
Heartland Telehealth Resource Center

6. HEARTLAND TELEHEALTH RESOURCE CENTER
University of Kansas Medical Center
University of Missouri
Oklahoma State University
Email: htrc@kumc.edu
Phone: 877-643-HTRC(4872)
Website: http://heartlandtrc.org/
/

7. KU TELEHEALTH ROCKS/KANSAS DISASTER
OUTREACH TO COMMUNITIES
Robert Stiles, MA, MPH
Telehealth ROCKS/Kansas Disaster Outreach
Program Director
University of Kansas Medical Center,
rstiles4@kumc.edu
/

8. PEDIATRIC BEHAVIORAL
KU TELEHEALTH ROCKS
SCHOOLS/
KANDO PROGRAMS:
INTEGRATING BEHAVIORAL HEALTH
AND THE SCHOOL AND COMMUNITY
8

9. Poverty: Telehealth ROCKS focuses on the poorest nonurban
region of the state, with 30% of children living in poverty, many
at risk for behavioral and developmental difficulties. The
negative health impact stretches into adulthood (Beck et al.
2016),
Outcomes: KIDS COUNT (2017) data reflects that Kansas
Southeast counties have some of the worst health outcomes
(mortality, immunizations, mental health), education indicators
(Early Head Start, Head Start), and economic indicators
(poverty, free & reduced lunch) in the state.
Need: 20:20 Rule in child behavioral health, delays to
treatment in rural communities
Technology: Professional version of zoom over multiple
devices

10. SCHOOL-BASED TELEHEALTH ANSWERS
“THE CALL” IN A NEW WAY
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School nurse, counselor, psychologist, special
education linchpin linking patient/guardians,
education system, specialty behavioral health, and
primary care

11.  In general, youth accommodate well to technology
 Safe, convenient place with trusted personnel and
interest in the child’s well being
 The multisystem approach enhances evaluation and
treatment—ON SAME PAGE
 Positive school impact: Stay healthy and ready to
learn in nonstigmatizing environment
 Provides many families a point of entry into health
and mental care systems
 Greater understanding of the cultural needs of the
student shared with the healthcare team, including
trainees
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13. TRANSLATE SAME QUALITY
SERVICES TO THE TELEVIDEO
ENVIRONMENT
 F2F-Face to Face
 Individualized child telebehavioral health decisions with consideration:
 developmental considerations
 parents’ preferences
 resources at the patient site
 behavioral health provider comfort
(Myers & Nelson, 2017)
System
Change
½ F2F
Approx-
imate
F2F

14. Family/Behavioral Therapy
• Modified Parent-Child Interaction Therapy
• Psychological strategies for behavioral
concerns, trauma, and chronic conditions
• Behavioral strategies for autism/comorbid
concerns
Medication Management & Consultation
• Behavioral medication management
• Medication consultation related to
developmental concerns
Parenting/Prevention
• OASIS intensive parent/guardian training
Assessment
• Autism assessment
• Functional behavioral
assessment
Feeding & Weight Issues
• Feeding difficulties
• Pediatric obesity
Toileting Concerns
• Toileting
https://www.telehealthrocks.org/

15. KANSAS DISASTER
OUTREACH (KANDO)

16. UNIVERSAL/COMMUNITY
INTERVENTIONS VIA
TELEHEALTH
• Online training in Psychological First Aid for Schools and
Communities, with telehealth coaching specific to the
pandemic and disaster preparedness—anyone in community
• Child-Adult Relationship Enhancement (CARE)—those who
work with children
• Parent Child Interaction Therapy (PCIT)-Clinicians
• Skills for Psychological Recovery, disaster-focused-Clinicians
• Ongoing Project ECHOs

17. CLINICAL INTERVENTIONS
VIA TELEHEALTH
• Continue to offer the menu of telebehavioral health
evidence-based treatments
• Psychiatry
• Psychology
• Developmental Medicine
• Behavior Analysis
• Workforce development—training rural partner therapists in
Parent-Training Interaction Therapy

18. • Began at the University of New Mexico with Hepatitis C
treatment
• Guided-practice model that reduces health disparities in
under-served and remote areas.
• Use of telementoring and a hub-and-spoke knowledge-
sharing approach.
• Expert teams lead virtual clinics
• Amplifies capacity for providers to deliver best-in-
practice care to the underserved in their own
communities.

19. RECENT AND ONGOING ECHOS
• Fall 2019-Suicide Prevention and Response
• Spring 2020-Function Fridays for Better Behavior
• Fall 2020-Back to School with Better Behavior
• Fall/Spring 2020/21-KanDO Together Resilience/Self-Care
• Spring 2021-All Under One Roof: Caring for Children with
Medical Complexity
• Spring 2021-Food Allergy Education for the School Setting
• Spring 2021-New Guidelines for the Use of Psychotropic
Medications in Kansas Medicaid
• Spring 2021-Early Interventions for Disaster-Affected Youth
& Families

20. ADULT BEHAVIORAL
CARE COLLABORATIVE:
INTEGRATING BEHAVIORAL HEALTH
AND PRIMARY CARE
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21. • Kansas ranks 32nd in the nation for access to behavioral health
services1
• More than 53% of Kansas adults with mental illness do not receive
treatment2
• Mental health diagnosis often go unrecognized in primary care
• Primary care providers often under treat mental health diagnosis
• Also end up managing medications prescribed by other providers
• Screening alone does not improve outcomes for primary care
• Increases recognition but not considered integrated care by itself
Problems with the current system
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12018 Mental Health America report
2Kansas Institute of Health report

22. • 20 years ago, the Institute of Medicine (IOM) declared
primary care and behavioral health to be inseparable
(National Research Council 1996).
• People who suffer from a chronic disease are more likely to
also suffer from depression1
• Certain factors can increase an individual’s risk of developing
a mental health disorder
Integrating behavioral health into
primary care
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1National Research Council . Primary care: America's health in a new era. The National Academies Press; Washington DC: 1996.
2Chapman DP, Perry GS, Strine TW. The vital link between chronic disease and depressive disorders. Prev Chronic Dis 2005;2(1)

23. • Focus is NOT on mental health but the bio-psychosocial factors
relating to physical health
• Addresses improving patients health and well being
• Focus is on reduction of disease-related problems
• Focus is on treatment adherence and better medication
management across providers, as a care team wrapped around
the patient
Integrating behavioral health into
primary care
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24. • For patient…
• Proximity to treatment with services at usual source of care
• Reduce stigma, privacy concerns, plus decreased travel and time
issues
• For Care Collaborative ACO primary care providers …
• Greater access to specialty resources
• Improves likelihood patients will embrace treatment provided in a
convenient, familiar general healthcare environment
• Enhanced care coordination
BENEFITS OF LOCAL
INTEGRATED CARE
24

25. • Pilot program administered by Care Collaborative ACO
• Leveraging 3-year HRSA grant
• 14 awardees nationwide
• Starting Pilot in 10 Care Collaborative ACO sites
• Focus: using telehealth technology to improve access to behavioral
health specialists in rural shortage areas
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Telebehavioral Health Network (TBHN)

26. • Systematic approach that includes certain tools, routines,
and a team approach to patient care
• 3 components that are key
• Prepared primary care clinician and practice
• Care management
• A collaborating mental health specialist
Variety of models to integration
26

27. • Evidence-based, rural Telebehavioral Health Network
- The University of Kansas
Hospital (UKH) – hub site
- 10 rural member sites –
spoke sites
- Paced rollout to all sites
- Begin with UKHS sites
• Capture improvements
and apply
UKH
Network participants
UKH
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28. • Services provided through this model from specialists
delivering services for The University of Kansas Hospital,
including:
• Psychiatrists
• Psychologists
• Additional behavioral health teams, depending on future
needs
TBHN PROVIDERS AND
SPECIALTIES
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29. • Zoom platform delivered via computer and tablet
• Common to current telebehavioral practice
• Portable units
• Travel with telebehavioral health coordinators to/from sites
while testing
• Ultimately tablet with camera, speaker, and case kept at clinic
• Providers’ progress notes pdf’d for secure distribution and load
to local EHR
• Connectivity
SECURE TECHNOLOGY
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30. • Primary focus is behavioral conditions that co-occur with chronic
conditions
• Coping with chronic conditions (i.e. adherence, healthy lifestyle)
• Depression and suicide prevention
• Anxiety
• Pain management
• Substance use disorder (i.e. opioids, alcohol)
• Acute life event (i.e. cancer, loss of spouse/child/parents)
• Target population is adults; majority likely Medicare beneficiaries
• Services are being discussed related to pediatric patients
 Primary issues you identify in your community?
TARGET POPULATIONS AND
CONDITIONS
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31. • Central point of contact for this service
• Administration duties
• Coordinate scheduling, gather/provide documentation, ensure BH
provider has patient info prior to consult by starting note in EIPC,
distributes BH provider’s note to appropriate parties after consult to
capture in patient record/EHR
• Patient support
• Ensure technology supports seamless experience, receive patient and
coordinate registration, collect documentation, and room patient
• Data collection
• Abstract key metric performance data and load to tracking tool
TELEBEHAVIORAL HEALTH
COORDINATORS (TBHCS) ROLE
AND RESPONSIBILITIES
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32. HRSA
EMERGENCY MEDICAL SERVICES
FOR CHILDREN INNOVATION AND
IMPROVEMENT CENTER
KANSAS TELEHEALTH QUALITY
COLLABORATIVE
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33. OVERALL PROJECT
MISSION:
To (1)evaluate the impact of public health crises on
children with behavioral health emergencies, (2)assess
telehealth capacities, and (3)develop a strategic plan to
improve access to mental healthcare services for those
children living within a vulnerable rural or frontier Kansas
community.

34. OVERALL PROJECT GOALS:
1) Enhance access to emergency care through the use
of telehealth for behavioral health emergencies
2) Assess, develop, and disseminate best practices to
support the needs to children with behavioral health
emergencies

35. COLLABORATIVE DESIGN:

36. KANSAS TEAM
o Kansas Team led by KDHE and Children’s Mercy.
o Includes participants from Kansas Health Institute, KUMC, rural
mental health and medical providers, rural EMS and other
emergency responders
o Goal: Identify 3 challenges facing children with behavioral health
emergencies due to public health crises
 Complete an environmental scan of the state of Kansas’ telehealth
infrastructure by Dec 18, 2020.
Identify a vulnerable rural or frontier community poised to pilot a
pediatric behavioral telehealth initiative by ___.
Conduct a community-based mixed-methods assessment to
identify factors impacting pediatric mental healthcare provision
within the identified pilot community from ___ to ___.
o Develop and finalize an evidence-based, community-focused
strategic plan to address identified barriers through the
implementation of telehealth services for children with behavioral
health emergencies by June 30, 2020.

37. FUTURE/FURTHER
DEVELOPMENTS
USE OF MHEALTH FOR PATIENT EDUCATION,
CARE COORDINATION EMPOWERMENT, SOCIAL
SERVICES, TRAUMA, AND SOCIAL DETERMINANTS
OF HEALTH
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38. COMMUNITY-BASED
PARTICIPATORY RESEARCH
PATIENT CENTERED OUTCOMES
RESEARCH INSTITUTE
TRANSITIONING RURAL ADOLESCENTS/YOUNG
ADULTS IN PARTNERSHIPS (TRAPEASE)
38

39. • Significant increases in U.S. in the prevalence of any
developmental disability, including attention- deficit-
hyperactivity disorder, autism spectrum disorder, and
intellectual disability.
• Need for healthcare support with transition from pediatric-
focused to adult-focused health care systems.
• The variety of ways in which IDD impacts functioning leads to
challenges both for the adolescent and young /youth adult
(AYA) and the caregivers/guardians in navigating the health
care system.
• Includes supported decision making, co-occurring health and
mental health conditions, therapies/medication and associated
adherence needs and management of side effects.
• Youth with IDD are at a higher risk for accidents, bullying,
substance abuse, and sexual victimization in adulthood.
• Increased risks related COVID19
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TRAPEASE

40. Six Core Elements Approach and Timeline for Youth
Transitioning from Pediatric to Adult Health Care
1. Policy/Guide
2. Tracking & Monitoring
3. Readiness
4. Planning
• Develop Health Care Transition plan with medical summary
5. Transfer of Care
• Transfer to adult-centered care and to an adult practice
6. Transition Completion
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GOT TRANSITION

41. HRSA
OFFICE FOR THE ADVANCEMENT
OF TELEHEALTH
TELEHEALTH ROCKS COMMUNITIES
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42. 42
THR Communities
Application to be submitted April 2, 2021
extension of ongoing outreach and telehealth by the University of Kansas Medical Center with partners in southeast Kansas that include the region’
• Partnership KUMC, Community Health Center of Southeast
Kansas (FQHC), three school districts, and two stand-alone
early learning centers in SE Kansas.
• Focus on use of Direct to Consumer telehealth focused on
meeting primary and specialty behavioral health needs of
pediatric populations.
• In addition focus on social determinants of health/trauma
through use of Community Health Workers to empower and
assist children and families in control of health care and social
services.
• Use of mHealth for consumer-directed (parent/guardian and
patient) services and care

43. WHAT ARE YOUR THOUGHTS
AND WHAT SHOULD WE
CONSIDER AS WE MOVE
FORWARD?
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