Introduction

The CAMH TeleMental Health program provides general psychiatric consultations via two distinct models of care: the general provincial referral model (GRPM) and the integrated care model (ICM). In the GPRM, patients are placed on a waitlist for a consultation with the first available psychiatrist. In the ICM, psychiatrists are partnered with a community-based organization for regularly scheduled direct and indirect patient care.

Objectives

The objectives of the study were to:

1) compare the two models

2) determine the effectiveness of a follow-up 3-months post-consultation.

Methods

Assessment measures (PHQ-9, GAD-7, WHODAS and AUDIT) were administered to participants in both the GPRM and ICM at baseline and six months. Half the participants in each group were randomized to the intervention, whereby a social worker re-administered the screening measures and followed-up with both the patient and referring provider regarding recommendation implementation three months post-consultation.

Results

63 patients participated in the study. Preliminary results demonstrate the effectiveness of both models of care, with significant decreases on the PHQ-9, GAD-7 and WHODAS from baseline to 6-months post-consultation. No significant differences were observed between models of care or intervention and control groups, with the exception of the GAD-7 which demonstrated greater improvements in the GPRM. Full results will be shared during the presentation.

Conclusions

Telepsychiatry is an effective model of service delivery in both the GPRM and ICM; however, further research is needed to better understand how the two models of care differ with respect to quality of patient care and mental health outcomes.

Introduction

Project ECHO, originating at the University of New Mexico, uses multi-point videoconferencing to connect primary and community care providers with a team of specialists in an online community of practice. Weekly sessions are comprised of brief didactic presentations alongside anonymous case-based learning. In 2018, CAMH launched ECHO Ontario Psychotherapy to increase access to evidence-based psychotherapies in Ontario, Canada. The 20-session pilot cycle was focused on teaching foundational skills in the delivery of Dialectical Behaviour Therapy (DBT) and Cognitive Behaviour Therapy (CBT).

Objectives

The primary objective of the program was to increase access to evidence-based psychotherapeutic interventions.

Methods

Multiple choice knowledge tests and self-efficacy questionnaires were administered pre- and post- the DBT and CBT modules. Program participants also completed the Counselling Self-Estimate Inventory (COSE) at three time points: prior to the start of the ECHO cycle, between the DBT and CBT modules, and at the end of the cycle.

Results

Results from the 10-session module on DBT demonstrated a significant increase (13.8%) in participant knowledge, as well as a significant increase (28.9%) in participant self-efficacy related to their ability to deliver DBT. The 10-session CBT module demonstrated a more modest improvement in knowledge (4.3%), and a significant change in self-efficacy (15.1%) related to their ability to deliver CBT. Significant improvements in self-efficacy were also observed using the Counselling Self-Estimate Inventory.

Conclusions

ECHO Ontario Psychotherapy addresses geographic disparities in access to mental health care by building knowledge mobilization networks that enhance provider capacity in the delivery of evidence-based psychotherapy.

Introduction

Telepsychiatry is increasingly being adopted as a solution to health systems problems such as regional disparities in access to care, and it requires explicit competencies and skills. Many of the skills around telepsychiatry differ from that of traditional face-to-face psychiatry in clinical settings.

Objectives

This study undertook an in-depth needs assessment to: 1) Identify specific skills required for the practice of effective telepsychiatry, and 2) Collect evidence to support development of telepsychiatry curricula in postgraduate psychiatry training.

Methods

A qualitative, modified grounded theory approach was used to explore residents’ learning needs around telepsychiatry from both residents’ and faculty members’ perspectives. Interviews with faculty and residents were conducted. Data was transcribed and then thematically analyzed.

Results

Three broad thematic areas emerged: 1) Context for postgraduate training in telepsychiatry; 2) Competencies for telepsychiatry training; and 3) Pedagogical approaches to developing competence in telepsychiatry. Additional telepsychiatry specific skills and/or applications were identified: technical skills; assessment skills; relational skills and communication; collaborative and interprofessional skills; administrative skills; medico-legal skills; community psychiatry and community-specific knowledge; cultural psychiatry skills, including knowledge of Indigenous cultures; and knowledge of health systems.

Conclusions

This needs assessment provides an evidence-base to inform development of psychiatry resident competencies and curricula, including content and pedagogical methods on how to disseminate. It also emphasizes the importance of faculty development in order to advocate for telepsychiatry practice.