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Prabhat Chand MD, DNB, MNAMS�Dept of Psychiatry

NIMHANS, Bangalore

Mental Health in Service Delivery: Technological Advance

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Overview of Mental Health Service Delivery by using technology

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Outline

Need for Knowledge Network
Objectives
Impact
Expansion�

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Advances in treatment/Specialized care is meaningless for vast majority if not Accessible to them

> 75% patients with SUDs do not have access to care(?Quality)

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Patients and Family travel Long miles and Multiple times and to meet Specialists for the treatment need.

Increase in Severity + Comorbidities + Cost of care = Poorer outcome

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Training often one time of few days and no follow up

Cost and Time problem

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Virtual Knowledge Network

NIMHANS ECHO

Linking Academic Multidisciplinary Specialists to Community health professionals

Coordinated and Collaborative Care for Addiction Mental Health, a Complex Health Condition

Prabhat Chand

For Team NIMHANS Digital Academy

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VKN: Capacity building with Coordinated Care

Mr A, 22 year young male, Cannabis, Solvent use, Bipolar versus Schizophrenia versus Schizoaffective: substance induced or Independent from 2000 km from NIMHANS

Mother working, father equally busy, changing psychopathology, visit us once in 3 to 6 months, take flights from 2000 km ,

I am not able to make a clear diagnosis, they speak a language which i do not understand very well

Am struggling with diagnosis, he is continued to use, hallucinate, psychopathology

For last two years I am equally confused

“Can someone be mentored, handhold and share the “wisdom” so that this patient gets a specialist like care in his own place/ own person/ who speaks same language”

Can we make similar “local experts”, “Exponentially” for “Collaborative care”

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Current Challenge

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Can leveraging Digital Technology to empower remote health providers for this GAP especially rural and Underserved areas ?

ISAM 2019

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Focus of Presentation

- Introduction to Virtual Knowledge Network NIMHANS ECHO

Substance Abuse---Rehabilitation---Women Mental Health
NMHP
Impact and Recognition
Mental Health Informatics: NIMHANS Digital Academy

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Objective

Democratizing Knowledge and Amplify the Capacity to provide “Best Practice Care” in Addiction & Mental Health

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Principles

Amplification – Use _________ to leverage scarce resources

Share _________ to reduce disparity

__________Learning

to master complexity

Web-based Database to

_______________

Technology

Best Practices

Case Based

Monitor Outcomes

Use of technology to leverage scarce resources

What does it mean in the context of ECHO? Zoom

ECHO Institute uses Zoom to reach learners in more rural and under-resourced areas to provide access to knowledge and best practices

Share best practices

How does this happen in the context of ECHO? Didactic presentations

We promote an evidenced based approach to sharing best practices in your field/expertise area

Case-based learning

What about this component? How does this happen? Case presentations

Real world situations are shared among the network, while evidence based best practices guide discussion of diagnosis/treatment/situation

Monitor outcomes

How to evaluate? Our recommended method is… iECHO

Using data to create feedback loop for improvements of teleECHO session functioning or outcomes

Fidelity to the ECHO Model

Adhering to these 4 principles is what we refer to as having fidelity to the model. Fidelity ensures high quality ECHO’s and differentiation from other platforms such as webinars and telemedicine.

Other initiatives also use technology. What is the difference? Transition to next slide.

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Telemedicine vs. VKN NIMHANS ECHO

Ask the audience:

From this illustration, can anyone tell me the difference between Telemedicine and ECHO?

Traditional telemedicine (the specialist manages the patient remotely):

1. Focus is direct service delivery

2. Usually billable

3. Usually one-to-one

4. Unidirectional flow of information

5. Single expert providing opinion

ECHO (ECHO supports community based primary care teams; those teams still maintain the patient relationship):

1. Focus is on education and capacity building

2. Not usually billable

3. One-to-many (hub and spokes)

4. Multidirectional flow of knowledge

5. Ongoing, based on learner’s needs

6. Multidisciplinary expert team providing mentoring, advice and support

ECHO is not Zoom

We had a partner once tell us that they love ECHO and they use it for all of their meetings.

Ask the audience:

Before coming here today, did you equate ECHO with telemedicine?

Introduce the features/elements of ECHO next.

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Connecting NIMHANS to Community health care provider

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HUB @ Centre for Addiction Medicine

ISAM 2019

Multidisciplinary Team

Addiction Psychiatrist

Psychiatry residents

Psychologist

Psychiatry Social work

Nurse�Communication Specialists

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Spokes from Community�

VKN: Capacity building with Co-ordinated Care

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Easy to access anywhere:

No cost to participants

Secured, encrypted, HIPAA compliant

Weekly Tuesday 2PM

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Tele-mentoring: the key

Use of technology to provide guidance
Method of transferring specialist knowledge and experience to other providers
Involves mentor and mentee relationship
Educational framework

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1.Sharing “Best Practices” to reduce treatment disparities

SOP
Guidelines
Algorithms
Expert consensus

Delivered Through Mobile app

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2. Case Based Learning & Wisdom to share the complexities

>500 cases were co-managed
Learning from community

NIMHANS ECHO

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3. Patient co-management, Weekly mentoring and Hand-holding

Primary care doctor or counsellor send the anonymize case before three days

He/she mention specific question about the case to the HUB multi-disciplinary team

Presents the case during the weekly virtual tele-ECHO clinic

The Hub facilitator invites other connected doctors/counsellor for clarifications

Hub Experts compiles and at the end give their “recommendations”

Also advise to present case again after 2-4 wks

Ends with a “brief didactic” as per Curriculum

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Recommendation �(shared by secured mobile platform to remote treating doctor/counsellor)

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Blended Certification & Accreditation : mlearning

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ISAM 2019

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Impact

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ISAM 2019

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>1200 Capacity built in last two years in Addiction mental health

VKN: Capacity building with Co-ordinated Care

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1500 partner Spokes
86 tele-ECHO clinics
172 session hours
20 monthly module

Registration

1206 health professionals
2860 instances of participation

Tele-ECHO

Participation

440 Credits Points
101 E-Module completers
473 Feedback (39.22%)

Certification and Credits

Chand P, Arora S, Murthy P, Gupta V, Kandasamy A, Jayarajan D, Sethu L, Benegal V, Varghese M, Komaromy M. Technology enhanced learning in addiction mental health: developing a virtual knowledge network: NIMHANS ECHO. In2014 IEEE Sixth International Conference on Technology for Education (T4E) 2014 Dec 1 (pp. 229-232). IEEE.

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Current NIMHANS-ECHO clinics

Addiction & Mental Health

2014

Road to Recovery R2R

2015

Women Mental Health

2015

Various States

2016 onwards

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2014-17: > 2000 trained, mentored and connected

VKN: Capacity building with Co-ordinated Care

2010-2013: 100 trained one time

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Geographical Distance and Cost should NOT be a barrier for Quality Care

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Chhattisgarh Integrated Addiction and Mental Health ECHOs

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42 Doctors (30 completed+ 12 on going)

52 counsellors

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4000 + Tobacco Users received “best practices” care at their own place

Tobacco Cessation for Remote District Counselors: Karnataka

27 counsellor from 16 districts

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Policy Impact in Translation

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NIMHANS Digital Academy

Slido.com #amrita

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27^th June 2018

The formal Inauguration of NIMHANS Digital Academy

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Lessons Learnt and Challenges�

Feasible in exponentially increase in the Skilled Capacity
Cost effective way of “Knowledge diffusion” & building a “virtual Community of experts”
Benefit is translating the “best practices” to the Community
Can be delivered through simple “Smartphone”

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Continued motivation and engagement from the community health providers
Need of dedicated team of multidisciplinary experts, IT expert, Learning Co-ordinator & Outcome evaluator
Depends heavily on Internet like 4G or Broadband
Govt. involvement and support

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“In the last 5 years, this force-multiplier effect has led to a virtual community of over 10000 connected

health providers being mentored on “best practices” by NIMHANS Hub

who could touch lives of >2,00,000 remote patients from rural and underserved areas to provide Quality care in Addiction & Mental health”

And able to scale up to National Level

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NIMHANS

SUPERHUB

HUBs

MHI SCB Cuttack

HUBs

Gujrat

HUBs

Future: Exponential Capacity Building: Establishing Regional Hubs

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Conclusion

Right Care/

Right Place/

Right Time/

Right Person

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Moving Knowledge: Instead of Patients

vlc.nimhans.ac.in

Wish to start similar initiative in Public Health

vkn@vknnimhans.in