Uses of Telehealth to Support Identification and Treatment of Health Disorders in the Criminal Justice System

TYPES OF TELEHEALTH SERVICES USED IN CRIMINAL JUSTICE

Different types of telehealth include technologies that can be delivered in real time (synchronous) — such as live video — or technologies delivered with some delay (asynchronous) — such as store and forward, remote patient monitoring (RPM), and mobile health (mHealth).3

Live Video

Store and Forward

Remote Patient Monitoring

Mobile Health

https://doi.org/10.30953/tmt.v5.205
https://doi.org/10.30953/tmt.v5.205

CONSIDERATIONS WHEN IMPLEMENTING TELEHEALTH IN CRIMINAL JUSTICE SETTINGS

Five key domains to consider for telehealth in the criminal justice system include selecting services, identifying related policies and procedures, training staff, preparing patients, and analyzing costs and benefits.

Selecting services

Selecting the type of telehealth services is based on factors such as needs of the population, availability of providers, and feasibility of providing the service. Another way to identify services to provide is to examine overall population health areas that need improvement that could be refined through telehealth.5

Identifying and modifying organizational policies and procedures

After service selection, criminal justice officials must review how telehealth will affect their facilities. Items to review include roles and responsibilities, scheduling and workflow, assessment approaches, technical infrastructure, and physical space and security. It might be difficult to find an appropriately private and secure place with connectivity in a facility, so this must be addressed as part of implementation planning. In addition, coordination and information exchange between the originating site (i.e. where the patient is located) and the distant site (i.e. where the provider is located) must be considered. Legal and regulatory considerations must be monitored as well, such as changing rules around electronic consents, security, and provider types eligible to provide services.6,7 A variety of regulations must be considered around offering virtual services and prescribing. These include regulations around payment options upon release, types of providers who can offer telehealth services, and locations of patients and providers.

Training staff

Staff roles and responsibilities will change with telehealth implementation, and these changes vary with the security of the facility. Thus, it is important that leaders take an active, hands-on role in supporting telehealth implementation to infuse support and engage staff throughout the organization.68 As with any change, considering staff members’ perspectives before, during, and after telehealth implementation can promote successful implementation. Identifying champions and promoting education and awareness are two considerations that will improve the chances of successful implementation.

Preparing patients

Many people may be intimidated by technology or may not be used to interacting with providers using technology. It is important to understand the population’s experience with technology and access to devices such as tablets (in facilities and upon reentry) to understand whether they will be amenable to telehealth.7 Those with high health literacy are more likely to embrace telehealth9,10 than those with lower health literacy.11 In addition, it is important to prepare people and identify needs for telehealth post-release such as the need for a private space, need for a device, and internet or cellular connectivity. If people see the benefits of telehealth and how it can help them, they will be more motivated to use it and see better outcomes even when they are no longer incarcerated.12

Analyzing costs and benefits

Costs and benefits of telehealth will vary by the type of service selected and the institution.1316 Telehealth can affect physical infrastructure, technical infrastructure, workflow, and cost.9,17 Telehealth programs have a variety of funding sources such as states, federal programs, foundations, and payers.18 Regardless of the funding source, identifying telehealth’s costs and benefits (e.g. improved outcomes, reduced costs, avoided costs) is critical.

CONCLUSIONS

Many facilities are already using telehealth to help improve care and reduce costs throughout the criminal justice system. The COVID-19 pandemic has highlighted the utility of telehealth in providing vital services to people during incarceration and reentry. Telehealth can be used in several ways, such as supporting peer counseling, increasing access to specialty services, and supporting transitions upon reentry. Telehealth can improve access to care, enhance care coordination, and reduce costs of providing care to people who are incarcerated. In addition, telehealth can be used to prepare people for release from prison or jail and improve coordination of care during community reentry. To achieve the promise of telehealth, grantees should consider their readiness to participate in using telehealth. Selecting services, identifying and implementing changes to policies and procedures, training staff, preparing patients, and analyzing costs and benefits must be addressed before telehealth implementation or expansion.

REFERENCES

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