A note about the COVID-19 information and resources shared here
The resources shared here are being developed as we continue to learn more about COVID-19 and the impact it has on our ongoing treatment workflows. Our clinical team is continuing to monitor the quickly evolving landscape and are updating our offerings regularly. Please check back often for updates.
Responding to COVID-19 with Telemental Health Measurement-based care (tMBC)
Telehealth has always held great promise to increase access to mental health care, never more so than in the age of COVID-19, when clients and clinicians cannot be in the same physical location. Telemental health measurement-based care (tMBC) goes a step further, offering clinicians the ability to send questionnaires and rating scales to patients prior to telehealth sessions. tMBC is an ideal complement to enhance ongoing monitoring, shared understanding, and treatment engagement in the context of the virtual encounter. To this end, tMBC can help agencies respond to the COVID-19 crisis in several ways including:
- Screening for symptoms and risk of exposure to the COVID-19 virus.
- Tailoring rating scales and standardized measures to assess for heightened risk of problems like anxiety, trauma reactions, etc.
- Using individualized items to track unique challenges that may not traditionally appear in rating scales (e.g., stresses of working remotely, social isolation, etc.).
For individuals and agencies implementing tMBC, the following questions are helpful to consider:
- Do you currently have patients complete measures PRIOR to sessions (e.g., patients receive their assigned measures prior to coming in to the office)?
- Do you currently collect email and/or cell phone information for your patients, and is this information included in their record in your selected MBC platform?
- Is it is possible to monitor implementation and best support the use of measurement-based care, including measure completion by clients, feedback viewing by clinicians, and use of feedback to inform sessions and clinical decision-making more broadly?
- Do you or your agency have procedures for collection and use of measurement-based care data that have been reviewed and approved for risk-management purposes?
Making tMBC Feasible and Accessible to Clients and Providers
How to Introduce tMBC to Your Clients
- Present tMBC as an important communication tool and as a standard part of care as well as a tool that helps providers to do their job, especially while conducting telemental health visits.
- Help clients understand that tMBC provides another way that providers can be in touch, allowing clients to communicate additional information about their struggles and progress even when not in session with their providers.
Send Clients Links to Complete Measures by Text Message (SMS) or Email
- Increases feasibility and ease of access.
- Helps with HIPAA compliance and privacy (clients are brought directly to a secure, HIPAA-compliant tMBC platform).
- Allows data collection to occur between sessions rather than taking up session time.
- Increases the likelihood of clients completing assessments prior to sessions.
Set Up Windows on Your Computer Screen(s)
- If possible, it is best to have multiple windows open and facilitate simultaneous viewing of key tMBC elements (see video below for helpful example) such as live video of the client and client feedback reports or progress graphs.
- Open a window for taking notes (if you tend to take notes during session. Writing notes digitally may offer important advantages over hand-written notes, plus you can maintain eye-contact with your clients while typing. Another advantage is that digital notes can be easily imported into your electronic medical record.
Share Feedback With Your Clients
- Sharing feedback is a core element of tMBC, of course, based on the your understanding of the client and the clinical issues at hand.
- Screen sharing functions can be used in a number of videoconferencing services (e.g., Google Hangouts, Zoom, etc.) to share feedback reports directly with your clients.
- When you set up your screen appropriately, all -- or just a portion of a feedback report can be shared with your client.
Submit Billing for Reimbursement for tMBC
- The Coronavirus Aid, Relief, and Economic Security (CARES) Act passed in March of 2020 encourages the use of remote patient monitoring for home health services.
- CPT code 96127 can be used for the administration of brief behavioral or emotional assessments, including scoring and documentation using standardized instruments.
- tMBC, as described above, satisfies these requirements.
How-to-Video: Preparing for tMBC
Watch this quick video to see how simple it is to use tMBC as part of your telehealth sessions. This brief video shows you how to have your telehealth and tMBC platforms open at the same time.
Selecting Measures for tMBC
Appropriate Measures are:
- Brief (e.g., screeners or symptom rating scales with established norms and cutoffs)
- Sensitive to clinical change (e.g., improvement, deterioration, limited progress)
- Clinically actionable (items provide feedback to providers and clients about next steps in care)
Measures Include Individualized Items:
- Items that focus on a client’s particular treatment goals can be especially useful.
- Such a flexible and tailored approach can help to improve client buy-in to tMBC and the therapy process.
Measures Provide Risk Monitoring
Rating scales or individual items can be used to monitor risk, including suicide risk, risk of relapse, violence, etc.
Particularly when providers cannot be in the same physical location as the client, additional data points to better understand the client’s risk can be tremendously helpful in clinical decision making.
Treatment Process Measures
Regularly assessing therapy processes, such as clinical alliance, can be particularly valuable and to that end, additional data, as assessed by tMBC, can be particularly helpful.
While clinicians may get a better sense of this information while in the same physical space as a client, it may be more challenging to understand the quality of the alliance when engaged in telemental health care.
COVID-19 Specific Suggestions
COVID-19 screening questions can be incorporated into existing tMBC protocols.
This provides a method for clients to be screened for potential COVID-19 symptoms or contact
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