i. Doctoral level professional with experience working with adolescents in schools, the juvenile justice system, and psychometric assessment (Psychiatrist or Clinical Psychologist preferred)
b. Dependent upon the number of students served in the district and district demographics, a 1:6000 professional to student ratio has been workable for the TWITR Project. This may further vary according to individuals differences with schools.
i. Psychiatrist(s): At least one Child/Adolescent Psychiatrist is needed to provide telemedicine services. If the Clinical Director/Project Manager is a psychiatrist then that person could also provide the psychiatric services.
ii. Licensed Professional Counselors, Licensed Clinical Social Workers, or Psychological Associates: The level of training received by these specialties is appropriate to the types of problems seen by the TWITR Project.
i. All mental health assessment must be administered by Licensed Professional Counselor, Licensed Clinical Social Worker, or Psychological Associate. The licensed professional staff will participate in initial assessment training and ongoing training to ensure proper administration and interpretation of all assessments are followed.
a. School District Enrollment: The close collaboration between the TWITR Project, school district administrators, and individual school administrators and personnel are essential to successful project operation. This collaboration begins with the initial contacts between the TWITR Project and the school district superintendent’s office. This smooths the process for getting school board approval and working with the district.
The initial discussion should be clear about the purpose of the program as well as its benefits and limitations. Descriptive materials describing the project, services to be provided, requirements of staff, referral processes, telemedicine requirements and processes, and outcome communication practices should be provided. Parental involvement and permission requirements should be discussed fully along with all documentation requirements. Finally, there should be a discussion of the processes undertaken if a student presents a threat of violence to others or self.
Once a school district agrees to services, a formal Memorandum of Understanding (MOU) should be created which specifies duties and responsibilities of all parties, and procedures for terminating services. This MOU should be signed by all authorized parties from the school district and project.
Preliminary training is provided to each school contract with the Telepsychiatry program. This initial training provides school districts with a concrete definition of mental health services, an understanding of mental health disorders common to the population served, and the Telepsychiatry standards of operations. School Administration staff and teachers can expect to leave the training with increase knowledge of mental health statistics, symptomology, intervention strategies, and crises protocol. In addition, Telepsychiatry programs can continue to provide school districts with specific training to facilitate ongoing mental health awareness.
i. School administration [i.e. counselor, principle, teacher], or guardian notices concerning behaviors as reflected on the Telepsychiatry referral form. This behavior could also indicate the student posing a risk to themselves, or others.
ii. School administration also obtains Telepsychiatry referral form, signed Telepsychiatry authorization form from parent/guardian and submits information to Telepsychiatry staff via fax or secured email.
iii. When the referral is received the assigned Telepsychiatry staff will contact the referring school district and guardian/parent to establish the initial screening appointment. Guardian/parent must be present during the initial screening and all sub sequential Telepsychiatry appointments.
i. Telepsychiatry staff will make contact with the referral school administration when they arrive at the school. The Telepsychiatry staff will follow the school districts procedures for signing in and out of the building.
ii. During this visit the Telepsychiatry staff can request student records [current grades, truancy reports, discipline referrals, and any other pertinent information] to assist in understanding the student’s academic /social history and to monitor changes in student’s behavior throughout the school year.
iii. Telepsychiatry staff will then complete the initial student evaluation and administer required Telepsychiatry assessments to the student and other applicable parties [parent/guardian, teacher/counselor]. Telepsychiatry staff will also obtain guardian/ parent signatures on required psychiatry forms.
B. Assessment Rational
i. Mental health assessments are administered to student and/ or guardians to gain insight into the feelings and thoughts of the referred person. The type of assessment administered varies based on the reason for referral and physicians request. Often when a student is under the age of 18, parents/ guardians, and teachers are administered assessments to help gain a complete picture of how the individual interacts in different settings.
C. Assessment Procedures
i. Child Mania Rating Scale
a. Mood Disorders & Psychosis
ii. Children’s Loneliness Questionnaire [ CLQ]
a. Substance Abuse
iv. Hopelessness Scale for Children [ HSC]
v. Mood and Feelings Questionnaire
a. Mood Disorders
vi. Screen for Child Anxiety Related Disorders (SCARED)
i. At the time of the first telemedicine appointment, the Telepsychiatry staff will take the telemedicine laptop, and speaker to connect to the school’s secure network. The Telepsychiatry staff will use video-teleconferencing software [i.e. Microsoft Lync] to video conference with the Child/Adolescent Psychiatrist.
ii. During all telemedicine appointment, trained personnel [i.e. school nurse] will collect client’s vitals (blood pressure, pulse, temp, weight, and height). Telepsychiatry staff will provide the Child/Adolescent Psychiatrist with collected data.
iii. During this telemedicine appointment, the attending Child/Adolescent Psychiatrist will determine student disposition.
i. Medication recommendation and follow-up telemedicine scheduled.
ii. Medical recommendation and follow-up telemedicine scheduled.
iii. Recommendation for non-medical therapies with no telemedicine follow-up.
iv. Recommendation for medication and non-medical therapies with telemedicine follow-up.
b. Completion of Psychiatry Services
i. Transfer of Care to Child’s PCP for Medication/Medical Management
ii. Psychiatric consultation PCP to Attending Psychiatrist
iii. Further Telemedicine Appointments As Needed In Agreement With Telepsychiatry Services.
B. Telemedicine Requirements
i. Each telemedicine laptops is set up with a unique username and password to log into the computer as well as the video conference software.
ii. Computers are set up by the school district’s IT person in order for Telepsychiatry’s systems to gain access to their secure network (password, network key, etc.).
iii. Attending Psychiatrists will each have a telemedicine laptop that they use from their end and access in the same manner (unique username and password). Attending Psychiatrists will connect via Ethernet cables into a secured network.
iv. At the time of a telemedicine encounter, Telepsychiatry staff transports a telemedicine equipment [laptop, speaker, Ethernet cable] into the school building in a confidential location (counselor’s office, isolated board room, etc.) to which no one can access during the encounter. Telepsychiatry staff either has the room reserved for that time period or provide a notice on the door that no one should enter during the time of the appointment.
v. Telepsychiatry staff connects via a secure wired (Ethernet) network.
vi. The initial telemedicine appointment takes and average of 90 minutes and a follow-up appointment takes an average of 45 minutes.
vii. Once the appointment is concluded, Telepsychiatry staff log out of the call and only connect again if another encounter is scheduled in that specific location.
viii. Telemedicine laptops are only used for telemedicine appointments and are securely locked away in Telepsychiatry staff’s offices when not in use.
i. Throughout the year, Telepsychiatry staff will continue to follow the student; gaining six- weeks discipline reports, truancy reports, and grades. Telepsychiatry staff will enter the information into a secured database for reporting purposes.
ii. The Telepsychiatry staff will continue to consult with school counselors, guardians/parents, should they need further referrals sources or a student needs to be placed back into the TWITR project.