Telebehavioral health for American Indian and Alaska Native communities
Providing telebehavioral services starts with understanding your community’s needs.
American Indians and Alaska Natives have higher mortality rates and lower health outcomes than the general population in a variety of behavioral health categories, including:
- Intentional self-harm (suicide)
- Alcohol- and drug-induced death
- Depression and psychological distress
- Behavioral disorders in children
Telebehavioral health allows American Indian and Alaska Native communities to receive vital behavioral health services from the comfort of their own safe space. Other benefits include:
- Easier, more convenient access to specialists and unique treatments that may not be available in a given tribal community or local area
- More opportunities for patients to connect with providers who come from a similar cultural background
- More confidence for patients who are unwilling to seek out in-person behavioral health treatment, but feel comfortable with telehealth
- Allows the patient to remain near community support systems and family while receiving care, rather than in unfamiliar settings
- Enables provider to engage with supportive co-habiting relationships (family, roommates, etc.) to assist the patient in ongoing care (means restriction, nutrition support, medication routines, etc.)
Setting up a telebehavioral program
Providing telebehavioral care takes planning. Learn the requirements to determine if this type of care is right for your practice.
Identifying your community’s needs
Common telebehavioral health services include:
- Psychiatric assessments
- Individual online counseling for anxiety and depression
- Online group therapy
- Treatment related to substance use disorder
- Telepsychiatry for prescription monitoring and refills
Speak with Tribal elders, local leadership and community members to determine the types of services that would be useful in your community.
If the population primarily needs someone who is well versed in medications for mental health, then a psychiatrist may serve these needs best. If the population is seeking in-depth work with a counselor, then a psychologist or master’s level counselor may be most appropriate.
Select a Telebehavioral Health Coordinator
A Telebehavioral Health Coordinator is the primary point of contact for patients and partner organizations like pharmacies. Given the health care staffing shortages common in American Indian communities, the Telebehavioral Health Coordinator does not necessarily have to be mental health provider and can be multiple people sharing the responsibilities of the position.
Telebehavioral Health Coordinator duties include, but are not limited to:
- Maintaining the patient schedule
- Educating the patient about telehealth and obtaining their consent to conduct a visit
- Introducing patients to the provider
- Ensuring the confidentiality and privacy of the telebehavioral visit
- Coordinating follow up appointments, if necessary
Electronic Health Record
Your practice must grant IHS access to the local Electronic Health Record (if applicable) before the telehealth provider can see patients. If you use Indian Health Service (IHS) resources, you will already have granted access.
Pharmacy staff often play a key role in telebehavioral health in American Indian and Alaska Native communities. Make sure someone from your staff is assigned to coordinate with the pharmacy, and involve pharmacy staff early on to avoid confusion later on.
Establish an emergency plan
Telebehavioral must be well-integrated with your practice’s overall emergency plan. The Telebehavioral Health Coordinator for your location will serve as the critical link in getting patients and the provider help, information and resources in the event of an emergency.
The emergency plan could include:
- The patient’s closest emergency contact and phone number
- The patient’s phone number and address (and/or coordinates, mile markers, PO boxes) in an easily accessible location if you need to call emergency medical personnel
- The closest hospital or medical facility that can handle a behavioral health emergency
Meet and greets and test runs
Before launching your telebehavioral practice for your local communities, schedule a “meet and greet” video call with all of the relevant stakeholders. Providers, staff and partner organizations can discuss generalities, communication styles and prescription methods.
Once the care team is familiar with one another, set up a “test run” to ensure all processes run smoothly. The Telebehavioral Health Coordinator can lead the session and serve as the “patient”.
- Step-By-Step Guide for Setting Up Telebehavioral Health Services (PDF) - from IHS
- Telebehavioral Health Center of Excellence (TBHCE) — from IHS
- Best practice guide: Telehealth for behavioral health care — from Health Resources and Services Administration (HRSA)
The Blackfeet Tribe of the Blackfeet Nation
The Blackfeet Tribe used funding from Health Resources and Services Administration (HRSA) to provide mental health support via telehealth in response to the COVID-19 public health emergency. Members of the community can work with an expert in cultural practices, who utilizes traditional methods such as medicine bags, meditation, and grounding (or coping) skills. Offering these behavioral services virtually allows the Blackfeet Tribe to reduce the spread of COVID-19 and ensure a rapid response when care is needed most.