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The Occasional Case Against Broad Dissemination and Implementation

Retaining a Role for Specialty Care in the Delivery of Psychological Treatments


Mental illness imposes a staggering public health burden in the United States. Although the past 40 years have witnessed tremendous advances in the identification of evidence-based practices (EBPs) in psychological treatments, gaps persist between treatment in experimental settings and services available in the community. In response, considerable attention and large financial commitments have focused in recent years on broad dissemination and implementation efforts designed to improve the quality of psychological services delivered by a variety of generalist practitioners across practice settings. Increasingly, under the influence of the Patient Protection and Affordable Care Act, it is envisioned that these generalists will practice in integrated primary care settings. These advances hold enormous potential, and yet, given the tremendous diversity of mental health problems and human suffering, broad dissemination and implementation efforts to generalists alone may not be sufficient to adequately address the burden of mental illness. Some EBPs may prove too complex for universal dissemination, and the time and expense required for quality dissemination and implementation preclude large-scale training in the treatment of low base rate disorders. As dissemination and implementation efforts work to ensure a quality generalist mental health care workforce, herein we highlight the vital need for available specialty care in the delivery of psychological treatments. Given traditional barriers that interfere with the accessibility of specialty care, we propose the transformative potential of a specialty behavioral telehealth care workforce, transacting with the generalist practitioner workforce to collectively ensure the highest quality and timely delivery of needed treatments to affected individuals.

Keywords: dissemination, implementation, technology, telemedicine, evidence-based practice


Telepsychiatry in the 21st Century: Transforming Healthcare with Technology

Stacie Deslich, MS, Bruce Stec, MS, Shane Tomblin, PhD, and Alberto Coustasse, DrPH, MD, MBA



This article describes the benefits and constraints of telemedicine, focusing primarily on the field of psychiatry in the United States with the current system of healthcare. Telepsychiatry is believed to provide better access and higher-quality care to patients who need psychiatric care and cost savings to providers of such care. Telemedicine has been successfully integrated into psychiatric facilities reaching rural areas, prisons, and urban facilities. It has increased the volume of patients that physicians can reach and diagnose, as well as allowing them to treat patients with limitations in mobility. While telepsychiatry has been shown to be beneficial, this technology does have some limitations. Concerns about reimbursement, licensure, privacy, security, patient safety, and interoperability have been identified and present current challenges that providers using telepsychiatry must overcome in order to provide the most effective patient care. As more insurance companies start to reimburse for telepsychiatry treatments at the same rate as for face-to-face visits, this evolving medical field has the potential to grow exponentially.

Read the Article







Click here for a Good Planning Document from AMD Global Telemedicine

called "10 Critical Steps for a Successful Telemedicine Program"


















AACAP Practice Parameters for Telepsychiatry

are found here






American Telemedicine Association 

Practice Guidelines for TeleMental Health are found here




"Psychiatric consultation and follow-up delivered by telepsychiatry produced clinical outcomes equivalent to face to face"

nurse with laptop

In a randomized controlled clinical trial published in "Psychiatric Services" June 2007, 495 Patients in Ontario, Canada referred by their family physician for psychiatric consultation were randomly assigned to be examined face to face (254) or by telepsychiatry (241).

Patients in the two groups expressed similar levels of satisfaction with service.


Read the study here.


Last Updated on Saturday, 24 January 2015 10:20