Showing Up Is Half the Battle: The Impact of Telehealth on Psychiatric Appointment Attendance for Hospital-Based Intensive Outpatient Services During COVID-19.

Introduction: The COVID-19 pandemic accelerated telehealth to deliver psychiatric services. Continuation of psychiatric services for individuals with high clinical acuity was critical. This study examined attendance to rapidly deployed telehealth services for psychiatrically high-risk individuals receiving intensive outpatient program (IOP), primarily group-based psychotherapy services for adults and adolescents by race/ethnicity, insurance, and clinical treatment program within a large hospital-based outpatient psychiatric setting. Methods: Chi-square tests compared whether attendance rates for telehealth versus in-person IOP services varied by population group, race, insurance, and clinical program, using observational data of adolescent and adult patients treated between October 1, 2019, and July 31, 2020. Results: Appointment attendance increased for telehealth versus in-person services for adolescents (χ2 (df = 1) = 27.49, p < 0.0001) and adults (χ2 (df = 1) = 434.37, p < 0.0001). For adults, increased appointment attendance for telehealth was observed across insurance type (Medicaid: +11.5%; Medicare: +13.79%; Commercial: +6.94%), race/ethnicity (+6.23% to +15.76% across groups), and for IOP groups across all five diagnostic treatment programs (between 7.59% and 15.9% increases across groups). Adolescent results were mixed; increased appointment attendance for telehealth was observed among commercially insured youth (+7.11%), but no differences were observed for Medicaid-insured youth. Non-Hispanic white youth had increased attendance for telehealth (+8.38%) and no differences were observed for non-Hispanic black youth. Decreases were found in telehealth attendance for Hispanic/Latinx youth (-13.49%). Discussion: Rapidly deployed telehealth increased attendance to intensive services for psychiatrically high-risk individuals, particularly among adults and for adolescents with commercial insurance and non-Hispanic white youth. Trends among racial/ethnic and Medicaid-insured youth warrant further investigation regarding the potential for special challenges or vulnerabilities and advocacy needs. Findings highlight telehealth as an important tool in supporting availability of services for individuals with high levels of psychiatric acuity, particularly for group-based services, during the pandemic.

Rapid design and deployment of intensive outpatient, group-based psychiatric care using telehealth during coronavirus disease 2019 (COVID-19).

COVID-19 has demanded unprecedented actions in the delivery of outpatient psychiatric services, including the rapid shift of services from in-person to telehealth in response to public health physical distancing guidelines. One such shift was to convert group-level intensive outpatient psychiatric (IOP) interventions to telehealth. Historically, telehealth in psychiatric care has been studied in provider-patient interactions, but has not been as well studied for group telehealth service delivery. During the COVID-19 outbreak, providing group-based interventions was important in order to care for high-risk individuals who needed structured psychotherapy group support. However, the delivery of services via telehealth led to special challenges that were unable to be fully accommodated by the preexisting telehealth infrastructure. Rapid feasibility testing and adoption of technology was needed to support IOP services to minimize infectious spread while delivering group services to high-risk psychiatric patients. This article describes the processes and workflows for service delivery and early results of telehealth for IOP services in 2 adolescent treatment programs. In addition, the article highlights early observations around safety and quality and the role of telehealth policy and payment.