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Arrowhead Telepresence Coalition
Need: Individuals in northeastern Minnesota who experience mental health crises have often taken action in ways that are harmful to themselves or others.
Intervention: The Arrowhead Telepresence Coalition connects behavioral health providers to rural patients in traditional and non-traditional medical settings through a telehealth platform.
Results: The service is used by 378 registered users in 7 Minnesota counties and 3 tribes.
Individuals who experience mental health crises have often taken action in ways that are harmful to themselves or others. Because of the complexity between mental illness and substance use, these co-occurring disorders can often go undiagnosed or undertreated. Many people in the criminal justice system have co-existing disorders and are in need of integrated treatment.
The Arrowhead Region of Minnesota includes 7 counties and 3 tribes, all of which are designated Mental Health Professional Shortage Areas. Because of the need for mental health services, the Arrowhead Health Alliance (AHA) began a telehealth project to bring these services directly to residents living in the Arrowhead Region.
AHA, a collaboration of 5 county public health and human services departments, approached the Minnesota Department of Health and Human Services (HHS) to request the use of the state's tele-mental health service, pitching Carlton County to be the location for the pilot project.
Permission was granted and the pilot project was a success. From there, Arrowhead Telepresence Coalition (ATC) was launched in January 2016 to host the charter project called "Collaborative Integration in Person Centered Services: Integrated Behavioral Health." The project integrated telehealth into traditional and non-traditional medical and service groups. Telepresence, or the tele-mental health platform, allows providers to easily engage with each other for consultations.
The ATC operates in collaboration with the Minnesota Department of Human Services and Minnesota IT Services (MNIT). ATC works with public and private agencies throughout AHA's partnering counties to provide these services. Equipment for the telepresence unit was purchase through a grant from the Blue Cross Blue Shield of Minnesota Foundation. Through a partnership with DHS, MNIT provides device licenses to all telepresence users in the region. The ATC is currently able to cover equipment costs for participants that are unable to provide or purchase equipment.
ATC gives geographically-separated behavioral health providers and patients the sense of being together during a virtual appointment. This allows for the diagnosis and treatment of behavioral health disorders and brings coinciding services to 7 counties and 3 Native American tribes in northeast Minnesota.
Jails and Law Enforcement
Providing telepresence has introduced new services and improved on old ones at Carlton County Jail. Inmates can now be connected to a mental health or chemical dependency specialist to receive help on-site, rather than having to be transported to an off-site location. Pharmacists can also provide virtual education to inmates on the medications they are receiving from afar.
Telepresence expands access to mental health crisis stabilization and ongoing care in schools. School therapists who are located far away from rural areas can connect with students in a matter of seconds. It has also allowed for students who have participated in a treatment program outside of school to continue care virtually while remaining in the school building.
Rural Hospitals and Primary Care Providers
Integrates behavioral crisis response into hospital emergency rooms and provides clinical consultations for rural healthcare providers.
Telepresence allows mental health providers to connect to patients in rural areas anytime and from any of their locations.
Crisis Response Centers
Rural locations can connect with a mobile crisis team immediately to get assistance during a crisis.
Tribal Health and Human Services
The Native American territory Grand Portage's Department of Health and Human Services has been using telepresence to connect people to clinicians from the Human Development Center.
Fond Du Lac is currently performing Rule 25 Assessments with tribal members at the Carlton County Jail. The Assessment determines the type of treatment chemically dependent individuals need in order to recover from addiction. The Assessment will also determine how much funding the jail will receive for treatment efforts.
Provided Bois Forte with telehealth equipment to connect with all 3 of its tribal sectors in the Arrowhead region.
County Health and Human Services
With ATC, counties can better collaborate regionally, reduce travel time, and increase service time.
Map showing the places that the Arrowhead Telepresence Coalition is working to reach.
As of August 9th, 2018, there were 378 users registered with the ATC tele-mental health platform. These users have reported the following benefits:
For behavioral health providers
Increased engagement with patients
Elimination of drive time to patients in rural locations
Improvements in access to clinical behavioral health consultations and expertise
Reductions in hospitalizations from mental health crises
Access to behavioral health services for children and adolescents in rural northeastern Minnesota has improved
Students are able to stay in school for behavioral health appointments, reducing time away from the classroom.
Children have been observed to engage more quickly with the therapist.
It has relieved pressure from parents who previously had to take time off work to transport children to regular therapy appointments.
For jails and law enforcement
Tele-mental health appointments have lowered the costs previously spent on transportation and saved on time it took to transport inmates. Telepresence has also introduced mental health programs in jails where there previously were none.
Arrowhead Health Alliance received the 2016 'County Achievement Award' from the Association of Minnesota Counties.
Arrowhead Telepresence Coalition received the Minnesota Local Government Innovation Award from the Humphrey School of Public Affairs at the University.
Behavioral Health: Fixing a System in Crisis, Modern Healthcare, 2017.
The therapist is online, Duluth News Tribune, 2017.
Tele-behavioral health care reaches rural residents, County News, 2017.
County and its partners get creative, and technical, with mental health issues, Pine Journal, 2016.
Spotty internet connectivity and limited cell service in some of the region's rural areas has made it challenging to get clear connections using telepresence.
At first, the lack of face-to-face communication seemed awkward for some patients, but as meetings continued, they appeared more comfortable with the virtual appointments.
Providers are generally more reluctant to try new technology; however, if it relates to behavioral health, they tend to be more willing due to the lack of resources in the behavioral health continuum.
Prior to ATC, cost of supporting telepresence was barrier because many of these small organizations do not have the financial means to build and support a telehealth network. Finding a low-cost solution was essential to building a sustainable network.
With the new expansion of 4k video quality, a challenge was finding compatible equipment that accompanies their programs, computers, and cameras.
A 2016 Report to the Minnesota Governor and Legislature's State Advisory Council on Mental Health & Subcommittee on Children's Mental Health recommended the following:
A program that is planning to launch a telehealth service in schools should first gauge the culture, age, and developmental appropriateness of the students and school in order to meet their needs.
A program should consider a telepresence platform that has already been tested and is being used throughout the state. This would save time, cost, and allow for collaboration among other users.
Whether an administrator, counselor, or IT professional, a person with a technical understanding of the telepresence software that can troubleshoot and assist others in its operation has been helpful. Also consider having a regional help desk with someone available for further assistance.
Minnesota groups interested in taking part in the ATC tele-mental health service can contact Savanah Bennett (savanah.bennett@arrowheadhealthalliance.org).
ATC provides downloadable forms for users that allow easy access and clear instruction for joining and using their tele-mental health platform.
Savanah Bennett, Regional Telepresence Coordinator
Arrowhead Health Alliance
savanah.bennett@arrowheadhealthalliance.org
American Indian or Alaska Native
Date updated or reviewed
Suggested citation: Rural Health Information Hub, 2018. Arrowhead Telepresence Coalition [online]. Rural Health Information Hub. Available at: https://www.ruralhealthinfo.org/project-examples/975 [Accessed 21 January 2021]
Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community's needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.
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