In 2018, the Western Regional Children’s Advocacy Center (WRCAC) launched the Rural Mental Health Project to increase access to specialized trauma treatment for children and families served by children’s advocacy centers (CACs) in rural communities. Much of the project’s work, especially during the COVID-19 pandemic, has focused on effective telemental health (TMH) service delivery. WRCAC launched a comprehensive online Telemental Health Resource Center (TMHRC) in 2019, and then launched a Statewide Telemental Health Pilot Project in 2020 in collaboration with Children’s Advocacy Centers of Washington (CACWA) and Children’s Alliance of Montana (CAM), who are now accessing training and technical assistance to plan, develop, and sustain their TMH networks.
A critical step in developing an effective statewide TMH network is the implementation of a technology system that can extend clinical services beyond the geographic boundaries of individual CACs and overcome barriers around equipment and internet access. WRCAC has engaged Blue Moon Technologies, Inc., an IT solutions firm that works closely with the CACs in North Dakota, to assess technology needs in the pilot states of Washington and Montana and provide training and technical assistance on device and network management. I recently sat down with Joe Vadnais, Director of Blue Moon Technologies, Inc., to discuss and demystify TMH technology and talk about how we are working through the following IT issues in our Statewide TMH Pilot.
Devices and security. One of the early decisions CACWA and CAM needed to make as part of the TMH Pilot was what type of devices would be used by both the clinician and the client during the THM sessions (e.g., a laptop, iPad or other tablet). While seemingly simple, the decision became complex as they grappled with several factors – Would clients have their own devices? Would clients live in areas served by adequate high-speed Wi-Fi networks or would they need data plans to connect? How could security risks be reduced? CACWA and CAM ultimately opted to purchase security-enabled iPads that can be loaned to clients (typically via mail) as needed, including some that are Wi-Fi-enabled and some that come with a monthly data plan, to allow for maximum flexibility. The security-enabled feature was key, which means the devices are restricted for TMH services only and other applications, such as social media, are disabled. This adds an additional layer of confidentiality and safety, as Joe notes, “…for the clients, children and the centers themselves. You do not want to introduce any liabilities with [cyber]eavesdropping, or personal information getting out there .”
Video connection platforms. The next challenge for CACWA and CAM was to determine what platform to use to virtually connect clients and clinician. Several HIPAA-compliant platforms have been gaining in popularity among TMH providers, including the HIPAA-compliant version of Zoom and Doxy.me, and CAM and CACWA have chosen to simply continue with what clinicians are already using and comfortable using. These platforms create a secure and encrypted connection between clinician and client, and as Joe explains, once the connection is established, “…none of your traffic travels through the cloud. They call this a point-to-point communication, and this is at minimum encrypted with 256K encryption, so the encryption is really secure.” This encryption further protects client confidentiality and can increase client confidence in THM services once this feature is explained to them.
Connectivity, bandwidth and data plans. In the National Children’s Alliance (NCA) 2020 Census, connectivity or bandwidth issues were cited by more than half of member CACs (55%) as a barrier to implementing TMH. The experience of Montana and Washington is no different. CACWA and CAM are working with Blue Moon to map out what data plans are available across different regions of their states and use that information to determine, based on where a clinician or client lives, whether they are likely to have access to Wi-Fi, (including at school, a local library or at home), or if they will need devices that are cellular enabled. As “data deserts” are identified (where Wi-Fi is inaccessible), the data mapping will help guide decisions about which cellular data providers serve that area (e.g., T-Mobile, Verizon, Sprint, AT&T, etc.) and which can provide the best coverage and the most cost-effective rate that matches client needs.
Clinician training. While many clinicians in Montana and Washington transitioned from in-person to TMH service delivery as a result of the pandemic, few received training specifically on effective TMH delivery and almost none received training related to virtual platforms, cyber-security, device management and other IT challenges. CACWA and CAM are closing that training gap by working with Blue Moon to onboard clinicians and train them not only on the effective and safe use of TMH technology, but also on navigating related issues around virtual fatigue of both children and clinicians, clinician isolation, and client resistance to virtual services.