Think telehealth to complement services

Technology options are growing fast. According to Terra Hamblin, project manager at the National Frontier and Rural Addiction Technology Transfer Center Network (ATTC) in Reno, Nev., more than 100 different computer-assisted therapy programs have been developed for a range of mental disorders and behavioral health problems to date.

Most people in the U.S. have access to a cell phone and are ready to interact online. And the culture is primed.

A survey of eight urban drug treatment clinics in Baltimore showed that more than 90 percent of clients owned a mobile phone and nearly 80 percent used text messaging. Although cell phone access was the most pervasive, between 39 and 45 percent had Internet access, email, and or a computer.

Another study of teens being treated in emergency rooms found that 95 percent of them had access to mobile phones and used text messaging, making it a good tool for interventional therapy communication in this age group.

Reaching people with a substance use disorder (SUD) living many miles from providers is another problem. Making quality treatment and recovery services available to this group is the focus of ATTC. Funded by the Substance Abuse and Mental Health Services Administration, ATTC focuses on bringing interactive technology-assisted care (TAC) programs to those living in remote and rural areas. 

Speaking at the Behavioral Healthcare Summit attendees in St. Louis, ATTC's Hamblin shared two TAC programs that have been validated through National Institute on Drug Abuse (NIDA) research.

TES, the Therapeutic Education System, is a web-based interactive psychosocial intervention for SUDs that combines community reinforcement, cognitive behavior therapy and contingency management. TES doubled the odds of abstinence among clients testing positive for substances through its interactive modules and prize-base incentive system. Findings suggest that TES improves outcomes when combined with face-to-face encounters.

CBT4CBT (Computer-Based Training for Cognitive Behavioral Therapy) is a computer-based version of cognitive behavioral therapy (CBT) designed for use in conjunction with clinical care for current substance users. Its multimedia program is based on elementary level computer learning games.

A serious restriction on the adoption of such telehealth programs at this time is reimbursement. Provisions to reimburse providers for such initiatives are just now beginning to emerge in both private and public health insurance plans, says Hamblin, and depend on State licensing. She urges providers to try to recapture costs in other ways such as a value-added service that assists providers in meeting other contractural obligations.