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J Child Adolesc Psychopharmacol ; 31(7): 464-474, 2021 09.
Article in English | MEDLINE | ID: covidwho-1429159


Objectives: To describe the development of a protocol and practical tool for the safe delivery of telemental health (TMH) services to the home. The COVID-19 pandemic forced providers to rapidly transition their outpatient practices to home-based TMH (HB-TMH) without existing protocols or tools to guide them. This experience underscored the need for a standardized privacy and safety tool as HB-TMH is expected to continue as a resource during future crises as well as to become a component of the routine mental health care landscape. Methods: The authors represent a subset of the Child and Adolescent Psychiatry Telemental Health Consortium. They met weekly through videoconferencing to review published safety standards of care, existing TMH guidelines for clinic-based and home-based services, and their own institutional protocols. They agreed on three domains foundational to the delivery of HB-TMH: environmental safety, clinical safety, and disposition planning. Through multiple iterations, they agreed upon a final Privacy and Safety Protocol for HB-TMH. The protocol was then operationalized into the Privacy and Safety Assessment Tool (PSA Tool) based on two keystone medical safety constructs: the World Health Organization (WHO) Surgical Safety Checklist/Time-Out and the Checklist Manifesto. Results: The PSA Tool comprised four modules: (1) Screening for Safety for HB-TMH; (2) Assessment for Safety During the HB-TMH Initial Visit; (3) End of the Initial Visit and Disposition Planning; and (4) the TMH Time-Out and Reassessment during subsequent visits. A sample workflow guides implementation. Conclusions: The Privacy and Safety Protocol and PSA Tool aim to prepare providers for the private and safe delivery of HB-TMH. Its modular format can be adapted to each site's resources. Going forward, the PSA Tool should help to facilitate the integration of HB-TMH into the routine mental health care landscape.

Adolescent Health Services/organization & administration , COVID-19 , Child Health Services/organization & administration , Clinical Protocols/standards , Home Care Services , Mental Health Services/organization & administration , Patient Safety , Privacy , Telemedicine , Adolescent , COVID-19/epidemiology , COVID-19/prevention & control , Child , Computer Communication Networks/standards , Delivery of Health Care/methods , Delivery of Health Care/organization & administration , Home Care Services/ethics , Home Care Services/standards , Home Care Services/trends , Humans , SARS-CoV-2 , Telemedicine/ethics , Telemedicine/methods , United States