Rogers' Telehealth Treatment

A: Children, adolescents and adults can benefit from virtual treatment.

A: Access to telehealth is currently available to residents of Illinois, Minnesota, Tennessee, and Wisconsin for a variety of PHP and IOP programs. Our admissions coordinators will work with you to determine availability as well as review all available treatment options. Learn more about what is available in each state here.

A: Rogers offers the same evidence-based treatment virtually that it provides in person. Through online treatment you will engage in diagnosis education sessions as well as cognitive behavioral therapy and dialectical behavior therapy. Individually, you will work with your treatment team to create a customized treatment plan that may include behavioral activation, exposure and response prevention, and relapse prevention. You may also be one member of a small group of patients working with the therapist to learn and practice various skills. You can do a surprising number of things virtually. Some people practice social interactions, presentations, or introductions to individuals and groups to address social anxiety. Others might engage in behavioral activation tasks under the supervision of their therapist. Still others might eat meals “together” with each person dining in their home in front of the computer, while a dietitian monitors and supports participants throughout the meal.

A: Partial Hospitalization Programming (PHP) is between five and six hours of treatment time per day, Monday through Friday. Intensive Outpatient Programming (IOP) is usually three hours per day, four or five days a week. Although treatment and circumstances differ for each person, the general difference has to do with the individual’s level of functioning. Those who are unable to attend work or school due to their symptoms usually begin treatment at the PHP level. Once symptom severity is reduced and the level of functioning is boosted, the individual transfers from PHP to IOP and begins reintegrating back into the classroom or workplace while still receiving significant support.

A: When we go through the screening process with you, which includes an interview before admission, our clinical treatment team goes over the information you’ve provided and determines how much support you are likely to require. A recommendation will be made as to whether PHP or IOP will be a better fit for you.

A: The schedule is almost identical to what you would get in-person. Your day typically starts with a morning or mid-day check-in. For those in PHP, each day includes time for some independent exposure or behavioral activation work, as well as group time for diagnosis education and therapy. For those in IOP, the three hours consist of exposure or activation work. Your behavior specialist will create hierarchies, conduct individual therapy sessions, and assign exposures or exercises. Regardless of the program, the day will end by doing a check out process where homework is assigned. In addition, you will have scheduled time throughout each week to meet with the psychiatrist or other prescribing provider, a nurse, and if applicable, a family therapist and/or dietitian.

A: Everyone, regardless of program, will meet virtually with a psychiatrist or other prescribing provider, typically once weekly for IOP or twice weekly for PHP. During these meetings, the psychiatrist will check in with you to ensure any prescribed medications are working as designed, that any changes in dosage are recommended and followed, and that any side effects are reported and addressed accordingly. You will receive an invitation, so you are aware of when your appointments are, and you will join the session in Microsoft Teams® just like you would a group session.

A: You will need access to a private space during your program’s treatment hours, a device to access the groups and individual meetings, and a reliable Wi-Fi connection. Our virtual treatment allows video communication with everyone using a secure and comprehensive suite of virtual conferencing software. Patients only need their laptop, desktop computer, tablet, or smartphone; there is no special software to install or application to purchase. We are also able to share electronic files such as your patient binder, forms, and treatment expectations, with you. You can either print the electronic worksheets at your home or fill them out on your device as you follow along. Many worksheets only require you to read the topics and don’t require printing or filling out.

A: The cost of telehealth is similar to in-person treatment. The literature suggests that using PHP or IOP when clinically indicated (whether in-person or virtually) significantly reduces the duration of treatment necessary, the overall total cost of treatment, and the likelihood of relapse to requiring additional treatment in the future. The specific benefits of intensive treatment compared to traditional outpatient remain the same: Rogers uses individualized, specialized, and intensive evidence-based treatment, delivered by a multidisciplinary treatment team, utilizing a variety of modalities (independent, therapist-led, and group therapy).

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It is not at all surprising that many of our younger patients refuse or resist participating in treatment. This is also something that occurs face-to-face in our clinics. We address this in two ways: by starting slowly, allowing each of us to learn about the other; and by having other patients in the programs model what “treatment” looks like. Usually, we find that if we can get a child to push through even a single day of treatment, there will be something about the activities that the child won’t want to miss in future days. A large part of our job, particularly at the beginning of treatment, is to figure out what those things are and remind our patients of them when they have a hard time getting started.

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Building rapport can always be a challenge, but what we have found is that often our kids and families are more comfortable, particularly at the beginning of treatment, because they are in a familiar environment rather than in a clinic, which some perceive as a strange new place. This level of comfort can make it easier for our families and kids to start off on a good foot with the therapist and treatment team.

Studies indicate that telehealth results in strong engagement between patients and telehealth providers. These studies have also investigated the level of therapeutic “alliance” or engagement that users felt with their telehealth therapists.

• Stubbings et al. (2013). Found significant reductions in depression, anxiety, and stress and increases in quality of life. No differences between telehealth and in-person were found.
• Yuen et al. (2013). Found significant reductions in social anxiety, depression, disability, and improvements in quality of life. Some results exceeded those found in-person delivery.
• Bouchard et al. (2004). Found significant reductions in panic symptoms and agoraphobic avoidance. Also, users felt developed “excellent” therapeutic alliances with tele-provider. No differences found between telehealth and in-person.

A: It can be challenging to coordinate school and, if applicable, parent work schedules. Please keep in mind that kids recommended for the PHP level of care are often unable to attend school – they may be on Hospital-Homebound, are not currently enrolled, or are being home-schooled. Therefore, for PHP, little coordination is necessary to accommodate school schedules. At the IOP level of care, most of our sites offer at least two options for programming time – morning from 8 am to 11 am, or afternoon from 3 pm to 6 pm. In most cases, we can arrange the entirety of programming outside of the required school schedule. It is incredibly important that this information be communicated to your child’s treatment team during the admissions process, which will help us minimize the impact of treatment on your child’s academic needs.

A: It can be confusing when we hear about how bad it is for our kids to have excessive amounts of screen time, and then to hear how important or necessary it is for our kids to spend time in front of the screen – for school and for treatment. It is helpful to remember that not all screen time is equal. There is a difference between social media and video games and schoolwork or therapy. The guidance related to screen time is based upon two concerns: first when screen time is an unstructured “babysitter” for kids in lieu of more structured or supervised activities; and secondly, when screen time is not balanced with ‘real-life’ activity time. Telehealth treatment delivery addresses both concerns. All activities occurring via the virtual room on Teams are highly structured and led by members of the treatment team. In addition, the activities assigned during the day and for homework by your child’s therapist very rarely involve screen-based tools. Instead, we utilize on-screen time to model and discuss the skill or activity in question, then assign the child with practicing the skill in question, preferably in real-life settings within the home and/or with family members who are present. In this manner, virtual treatment provides the maximum structure possible for any on-screen time and minimizes the amount of time required to be spent in front of the screen.

A: It can be quite difficult to put interventions in place for school refusal without knowing more about what’s causing the refusal in the first place. However, take comfort in knowing that you are not alone in having a child who is refusing or resisting going to school. Rogers offers some excellent resources on school refusal, including a podcast series on techniques to assist parents and providers in addressing school refusal and helping students get back to class. Visit our website to learn more.

A: Telehealth is heavily researched and found to be effective, and the clinical outcomes are comparable to in-person treatment. In addition, some patients say they feel more comfortable speaking up in a virtual treatment environment.

Studies indicate that telehealth is a very effective way to deliver evidence-based treatments resulting in significant symptom reductions as well as strong engagement between patients and telehealth providers. For example, in mood and anxiety disorders, research has investigated the use of evidence-based treatments delivered via telehealth with mood (depression) and anxiety disorders. These studies have also investigated the level of therapeutic “alliance” or engagement that users felt with their telehealth therapists.

• Stubbings et al. (2013). Found significant reductions in depression, anxiety, and stress and increases in quality of life. No differences between telehealth and in-person were found.
• Yuen et al. (2013). Found significant reductions in social anxiety, depression, disability, and improvements in quality of life. Some results exceeded those found in-person delivery.
• Bouchard et al. (2004). Found significant reductions in panic symptoms and agoraphobic avoidance. Also, users felt developed “excellent” therapeutic alliances with tele-provider. No differences found between telehealth and in-person.

Conclusion: CBT delivered via telehealth significantly reduces symptoms of depression and anxiety, produces strong therapeutic engagement between users and their providers and outcomes that are comparable to in-person treatment.

A: As a part of the telephone screening process, we will do a free benefits assessment. We are in network with most commercial insurance plans. Many commercial insurance plans cover virtual therapy. Our admissions coordinators will work with you with all available options.

A: The schedule is almost identical to what you would get in-person. Your day starts with a morning or mid-day check-in. For those in PHP, each day includes blocks of time for some independent exposure or behavior activation work, as well as one to two group blocks of time for group therapy. For those in IOP, the three hours consist of exposure or activation work. Your behavior specialist will create hierarchies, conduct individual psychotherapy, and assign exposures or exercises. Regardless, the day will end with a check-out where homework is assigned. In addition, you will have scheduled time throughout each week to meet with the psychiatrist or other prescribing provider, a nurse, and if applicable, the family therapist.

A: Keep in mind that being able to do exposures from your home is a huge advantage in your treatment. You know what situations, objects, or actions are the most difficult for you, and you have the ability to create and control the environment in your home much more than you can in any other environment. Your treatment team will be able to help you create exposures in your home that are gradually more difficult – one step at a time at a pace that is right for you – and we will provide the support necessary to help you every step of the way.

A. Research also investigated the use of exposure and response prevention (ERP), an evidence-based treatment for people with OCD and related disorders, delivered via telehealth. A meta-analysis is a “study of studies” published on a particular topic summarizing a large body of work done in a certain area and increasing confidence in the results found.

• Wooten et al. (2016). Meta-analysis (18 studies). Found significant reductions in OCD symptoms via telehealth. No differences were found between telehealth and in-person.

Conclusion: ERP delivered via telehealth significantly reduces symptoms of OCD and produces results comparable to in-person treatment.

A: You will participate in group therapy discussions on topics such as relapse prevention, post-acute withdrawal, triggers, cravings, motivation change, and recovery planning. These group settings can assist you in feeling less isolated. Many times, addiction brings about isolation, and these group settings will assist you in breaking that cycle. In addition, you will also learn about other virtual tools that can support you in the recovery process. You will also participate in individual sessions with your therapist, nurse, and physician. During your individual sessions, you can discuss challenges and struggles, cravings, and needs you may have. If appropriate, the physician may order medications for you to assist in managing your cravings.

A: If your attending provider requests a drug screen during your treatment, saliva testing strips will be shipped to the address provided during your intake screening. These saliva test strips will be done in real time with your nurse during an appointment time that works for both of you. The results will be shared over the video meeting. The frequency and intensity of drug screens will be determined by you and your provider. If you are receiving drug screens elsewhere, we will coordinate with that provider using a signed release of information. It is our goal to assist you with accountability throughout virtual treatment.

A: Research has investigated the use of evidence-based treatment (CBT) delivered via telehealth with substance use disorders. These studies have also investigated the level of therapeutic “alliance” or engagement that users felt with their telehealth therapists.

• King et al. (2019). Found significant reductions in alcohol consumption and strong therapeutic alliances were achieved. No differences between telehealth and in-person.
• Kruse et al. (2020). Found significant reductions in alcohol consumption.

Conclusion: CBT delivered via telehealth significantly reduces alcohol consumption and produces strong therapeutic engagement between users and their providers and outcomes very comparable to in-person treatment.

A: The daily telehealth treatment schedule is almost identical to in-person treatment. You still meet with your therapist for individual sessions multiple times per week, have group every day, structured learning time, and assignments that teach you how to cope with your thoughts and emotions, while also moving toward valued living. The core of the treatment is prolonged exposure, and numerous studies have shown that it is just as effective delivered virtually as it is in-person.

A: There have been many studies on telehealth for individuals with PTSD investigating the use of evidence-based treatment (CBT emphasizing Prolonged Exposure).

• Germain et al. (2009). Found significant reductions in the frequency and severity of PTSD symptoms and improvement in overall functioning. No differences found between telehealth and in-person.
• Gross et al. (2011). Found significant reductions in PTSD, anxiety, depression, stress, and general impairment.
• Yuen et al. (2015). Found significant improvement in PTSD symptoms and high satisfaction ratings. All findings comparable to in-person.
• Acierno et al. (2016). Found significant reductions in PTSD and depressive symptoms. No differences found between telehealth and in-person including at 3 and 12 month follow up.
• Franklin et al. (2017). Found significant reductions in PTSD symptoms.

Conclusion: CBT/PE delivered via telehealth significantly reduces PTSD symptoms and produces outcomes very comparable to in-person treatment.