Virginia Telehealth Network

Expanding and Integrating Care through Telehealth

By now you’ve heard the story about the healthcare provider whose world turned topsy-turvy during the pandemic, only to realize that employing telehealth into their practice could transport them into a world approaching normalcy.  Then, two years later they come to realize that telemedicine has so many advantages that they decide to make it a regular part of how they take care of their patients.

We’ve heard that story. This is not that story.

No, this is a story about a rural free clinic whose roots with telehealth go back years before the word COVID had entered our lexicon.

It was 2016, and the Fauquier Free Clinic had just hired Shannon Raybuck as its first mental health care coordinator.

Creating a new practice area is always a challenge, but for Shannon there were some atypical complications, the biggest one being that the facility had no onsite mental health practitioner. Not only that, there really were no available therapists anywhere around, a drought that was particularly acute in Virginia.

But in the world of telemedicine, none of that matters. And before long, Shannon was recruiting mental health professionals as far afield as California and Boston.

“Our mental health patients have used telehealth from the get-go,” Shannon says.

Integrated care

What’s remarkable about the two-footed leap into telemedicine for mental health patients is that most of the patients were already being treated at the clinic in person for other medical needs. Behavioral health was being integrated into the practice, but only through telehealth.

“Both our free medical providers as well as the community-based medical providers in their brick-and-mortar practices – they all recognized that patients were coming through their doors with increasing mental health needs,” Shannon explains. And so, it just made practical sense to begin coordinating mental health services as part of the clinic’s comprehensive services, a decision that was made that much easier after the clinic received grant funding to support Raybuck’s position.

The clinic had begun issuing a nine-question evaluation to its onsite patients to determine the extent to which they may need mental health therapy. “That’s when our medical doctors started realizing how many of our patients were struggling with depression because the results were right there in front of them, and they were able to use the data to support the need to start the program,” Shannon says.

Currently, the clinic facilitates between 170 and 200 mental health-related visits per month, with about half of the mental health professionals residing outside of Virginia, a fact that has Shannon paying extra attention to time zones when making appointments.  Patients with acute psychoses or those suffering from substance abuse are typically referred to in-person facilities with appropriate levels of expertise.

Social determinants of health

One area where telehealth has helped significantly has been in helping determine the factors in the community that impact a person’s quality of life – factors like access to food, transportation and medical care, or even social activities. How, for example, would a diabetic manage his diabetes if he did not have access to a refrigerator for his insulin?

To help make these determinations, the clinic started formally tracking various factors by initiating its PRAPARE (Protocol for Responding to and Assessing Patient Assets, Risks and Experiences) survey, a 21-question assessment tool that asks patients questions ranging from their housing situation to stress levels. Some of the results were surprising, while others were predictable.

“We know that almost half of our patients struggle with transportation or are unemployed but we were shocked by the fact that 19% of our patients are on the verge of social isolation,” Shannon says.  “They are having less than one significant interaction with another human being that they cared about each week, and it is just heartbreaking.”

The clinic began connecting many of them to the local food bank as well as to a government program that provides a free cell phone, helping maintain an important sense of connectiveness.

And in the world of telehealth, more screen time is never a bad thing.