County eyes use of health services via video

HUDSON–Telehealth is coming, Columbia County Director of Human Services Michael Cole told the Community Services Board Intellectual and Developmental Disabilities Subcommittee meeting February 26. With Telehealth, clients consult with health care providers via interactive video screens.

The meeting also covered challenges to proving to regulators that clients “make progress” through subsidized mental health treatments. This and Telehealth apply to people using or needing human services, whether or not they have disabilities. (Topics that apply primarily to people with disabilities appears in the accompanying story.)

“We will start looking at using Telehealth for all things we now do face to face,” once regulations change to make it “flexible enough” and “easier for us to use,” Mr. Cole said. The services could include psychotherapy, occupational therapy, and consultations about mental health, behavior, substance abuse and medication. A therapist or prescriber would be at one screen and a client with the appropriate technology at another screen, wherever those screens are available.

“Managed Care California is using Telehealth,” Mr. Cole said. “That’s the way of the future. They’ve programmed artificial intelligence to do assessments and recommend interventions by the book.”

According to the TeleHealth Services website,, the company “is the leading provider of interactive patient experience solutions to the U.S. healthcare industry,” with

over 2,500 client hospitals and clinics and “60 years of point-of-care expertise.”

People at the meeting said other states use this technology for occupational therapy via teleconference and pointed out that child clients need to be accompanied by adults when using the system.

“It would be really helpful, really helpful, to have a tele-doctor,” said Kim Short.

But Christine Fish-Aker, co-chair of the subcommittee voiced reservations, saying, “There is not one patient who’s by the book,” she said. “If I were a practicing psychiatrist, I’d have trouble not seeing someone face-to-face.”

One person at the meeting pointed out that physical therapy is “impossible” if not face-to-face.

Even for drug-only treatment, prescribers have to be able to handle children and non-verbal clients, Mr. Cole said. And if the consultation is via video phone, the prescriber needs to “read” drug needs via video phone.

Also at the meeting participants reported that regulators want each client to make “progress” from funded treatments. But Ms. Fish-Acker said that some people don’t make progress with counseling but revert without counseling.

“We do treatment, not prevention,” said Mr. Cole. “We can be audited and must show progress, improvement for our treatment. We get cited for plans that don’t comply with regulations. We get told, ‘So-and-so isn’t making progress. What plans do you have?’”

Some people have “the mindset that drugs are the primary tool,” he said. But even with drugs-only treatment, we still need to show “progress.”

One observer said that approach creates the potential for a cycle: client gets treatment; client is not progressing; treatment is discontinued; client backslides; client gets treatment again.

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