Tele-Behavioral Health in HCH Why is it hard, and what can we do?

1. Tele-Behavioral Health in HCHWhy is it hard, and what can we do? September 24, 2019

2. Why we’re here, and what we hope to do • The Idea-to-Implementation Project • HCH telehealth is challenging but promising • We want to hold space for the difficult questions and have frank conversation that may lead to solutions • Reimbursement and regulations differ by state: we’re not addressing that • We’re not talking about remote medical consulting (e.g. Project ECHO) Learning Objectives: 1. Describe the opportunities of tele-behavioral health in homeless health care 2. Describe common challenges in implementing tele-behavioral health for people experiencing homelessness 3. Describe at least one potential strategy to advance tele-behavioral health at your own program

3. Presenters • Lee Thornhill, MHA, MAHealth Care for the Homeless Network Seattle, WA • Debbie Stevens, Psych NP Mercy CareAtlanta, GA • Brandon Cook, BA, and Jennifer Schmucker, LISW-CPNew Horizon Family Health CentersGreenville, SC • Andrew Robie, MDUnity Health CareWashington, DC

4. Health Care for the Homeless Network of King County (HCHN) Catchment Area: King County, Washington • Over 400 sites across 32 cities - urban, suburban & rural • Approx. 70% Seattle Patient Target: 21,852 (100% living homeless) & average 110k visits Service Model Includes: • Services delivered directly at Public Health – Seattle & King County clinics & by 10 contracted community partners • Mobile Medical Vans (medical, behavioral health, & dental) • Street Outreach and Housing Health Outreach Teams (HHOT) • Medical Respite & Mobile Palliative Care • Low Barrier Medication Assisted Treatment Lee Thornhill, Data and Evaluation Manager

5. Scope of Tele-behavioral Health Services Across HCHN Originating & Distant Sites Patents predominantly seen through telehealth within our health center and hospital system sites Past Few Years Challenges • Legal: liability – providers & organizations. HIPAA & other regulations. • Technical & Financial: equipment, software & network infrastructure – costs, capacity & competencies. Limited control in field-based settings –further from traditional telehealth model. • Motivational: belief that patients living homeless & with BH conditions won’t participate. Successes & Strategies • Approach from digital equity perspective. • Reimbursement for some services at state level. • Individual program examples & champions (Palliative Care & Families in Shelter).

6. Mercy Care Atlanta • Patient-centered, integrated primary medical and behavioral health care clinics in Atlanta. • Six Medical Clinic Sites • Five Mobile Sites • In 2018, 60,648 total clinic visits (all service lines) • 67% Homeless • 75% Uninsured At any point in time in 2018, over 3,000 people experienced homelessness.

7. Our Telemedicine Program • Started about 5 years ago – shortly after inception of behavioral health program • Community and Office based • Currently using a web based platform called “pathways” through GA Partnerships for Telehealth • Psychiatry Team – looking at ways to expand to primary care, behavioral health and street medicine • Ongoing challenges, leadership is invested in expanding program and optimizing access for clients

8. About New Horizon Family Health Services • Community Health Center serving Upstate, SC for over 26 years • Provides medical, dental and behavioral health services to more than 26,000 patients annually on over 100,000 encounters • Health Care for the Homeless Program serves over 2,000 patients each year in a 13-county service area • Ryan White Program serves over 1,200 patients each year over a 10-county service area

9. TeleHealth at NHFHS • Pilot program developed to expand the reach of HCH and BH to increase access to BH services for people experiencing homelessness • Partnership with one shelter in our service area to provide much needed BH services

10. Unity Health Care, Inc. Large federally qualified health center (FQHC) in Washington, DC • ~100,000 unique patients and 500,000 patient visits annually • Primary medical, specialty medical, behavioral health and dental services • 9 community health centers • 11 medical sites in homeless shelters and day centers • 2 school-based health centers • DC Department of Corrections • Teaching health center • Community medical school campus • Family medicine residency

11. Telemedicine at Unity Telemedicine specialty care  Research collaboration with George Washington University since 2016 Endocrinology, nephrology, and cardiology televisits with patients at CHC Goals to improve access/decrease no-shows and improve clinical outcomes Telepsychiatry Unity psych NP based at CHC Psychiatry consults at two shelter-based sites Goal to increase access and utilization

12. Discussion Please type your questions and comments in the chat box

13. Stay in touch • Join our mailing list • Become a member • Get Technical Assistance • Follow on social media D. Michael Durham, MTS Technical Assistance Manager mdurham@nhchc.org | 571-335-0066 https://www.linkedin.com/in/dmdurham/

14. HRSA Disclaimer This program is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $1,625,741 with 0 percent financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.

15. Panelist contact information Lee Thornhill, MHA, MAHealth Care for the Homeless Network Seattle, WALee.Thornhill@kingcounty.gov Debbie Stevens, Psych NP Mercy CareAtlanta, GADStevens@mercyatlanta.org • Brandon Cook, BAbcook@newhorizonfhs.orgJennifer Schmucker, LISW-CPjschmucker@newhorizonfhs.orgNew Horizon Family Health CentersGreenville, SC • Andrew Robie, MDUnity Health CareWashington, DC ARobie@UnityHealthCare.org