Homebound elders often struggle with mental health issues such as depression and anxiety but may have difficulties accessing therapy. Some of the reasons include difficulty walking, fear of falling, chronic pain, fatigue, compromised immune systems, or anxiety related to leaving home. Access to dependable transportation can be a hindrance, and seniors may be hesitant to ask for a ride to a clinician’s office due to the stigma still associated with seeking therapy.
Riverside Community Care was awarded a $500,000 Innovation Grant by the Massachusetts Health Policy Commission to pilot a one-year Telebehavioral Health therapy program. Telebehavioral Health allows the client to stay in his or her own home and meet with a behavioral health clinician at another location using videoconferencing technology. The pilot project wrapped up this past April, and we recently presented the positive results.
The purpose of the pilot was to test the efficacy of Telebehavioral Health as a means of increasing access to necessary behavioral health services for physically homebound or reclusive elders. Telebehavioral Health, while not covered by Medicaid or Medicare except under very restrictive circumstances, has the potential to increase outreach, decrease costs, and reduce hospital emergency visits due to mental crises.
To find willing clients for this one year pilot period, Riverside partnered with Aging Service Access Points (ASAP) providers HESSCO, Springwell, Mystic Valley Elder Services, and a healthcare video conferencing provider, MedOptions Connect. Starting in June 2017, 84 seniors met with their clinicians weekly for 45-minute sessions via videoconferencing. The ASAP case managers assisted the clients with the technology and provided interpersonal support. Clinicians and case managers were impressed by how quickly the clients seemed at ease with the technology. Additionally, both clients and clinicians were surprised that the technology didn’t hinder a therapeutic connection between therapist and client.
The results from the one year trial period were extremely promising. No participants dropped out of the pilot due to the video technology. Ninety-one percent said they were satisfied with the program, with a few stating that they were “dissatisfied” because the program was finishing. At the end of the trial, 89% of the clients reported less depression, and 65% had less anxiety as a result of therapy provided in the project.
In a post-pilot survey, one client said, “It gave me something to look forward to, and helped me to deal with health issues.” Another commented, “It was a blessing to me as I was suffering from anger and helplessness.” Clinicians were also enthusiastic. All of the clinicians surveyed said their experience with videoconferencing was positive. One stated, “Along with discussing any issues that needed discussing, many (clients) had an opportunity to discuss happier times in their lives and laugh remembering those happy memories.” Another clinician commented, “I was very happy to have participated in this program and to be reminded that people are never too old to discuss and improve their situations.”
We are hopeful the positive results of the pilot study will encourage Medicaid, Medicare, and private insurers to treat Telebehavioral Health sessions as they would office visits and reimburse providers who are using this new and helpful technology.