This is Part 2 of my interview with Saira Haque, PhD a telehealth expert and the Director of RTI’s Data Interoperability and Clinical Informatics program, and Nick Richardson, PhD a research analyst in RTI’s Applied Justice Research division. Part 1 is here.
What are the benefits to using telehealth?
Dr. Haque: As mentioned earlier, it can be difficult to get specialty care in a jail or prison. This means a JII would need to be transferred to another location that offers these services. Transfers can be costly, time-consuming, and risky. Telehealth can reduce costs and improve facility operations by removing the need for an external transfer.
Dr. Richardson: Alongside cost, another benefit of telehealth is the reduction of stigma for JIIs. When a JII travels for a medical appointment in public, they are shackled and wearing an orange jumpsuit. This can negatively impact the JII’s psychological wellbeing.
What are the barriers to using telehealth?
Dr. Haque: First is internet access to the facility. Since many jails/prisons are in rural areas, they may not have strong broadband access. Consequently, the facility’s internet may not be able to handle the video stream required by telehealth visits. There might also be inconsistent internet access within the facility. This could be due to the physical structure of the building or additional controls around internet access.
Then there’s the cost associated with providing devices. There are also operational considerations for how JIIs will access the devices. These considerations are daunting and facility leadership might be unsure of where to start. Finally, the last item to consider is staff acceptance. The staff may be resistant to operational changes or might not have experience with technology. Without staff acceptance, any change is challenging. Efforts to share the benefits and engage staff can make a big difference in a telehealth implementation.
Dr. Richardson: Jails and prisons are very structured environments. Anything that threatens the structure and routine are usually not well received. Virtual care is something that could change the routine and affect the structure. Consequently, it can be challenging to get staff on board. In addition, security is the main concern. Facilities want to ensure individuals cannot access certain sites on the internet or maybe contact other people they shouldn’t be contacting using the telehealth device.
How has the pandemic affected the use of telehealth in jails and prisons?
Dr. Richardson: We don’t have good data yet on this, but there does seem to be increased interest in telehealth for correctional facilities and in the criminal justice system in general. For example, RTI is currently one of the Training and Technical Assistance providers for the Bureau of Justice Assistance’s (BJA) Comprehensive Opioid, Stimulant, and Substance Abuse Program (COSSAP) project. As part of this project, BJA provides local, state, and tribal jurisdictions with funding to develop responses to address illicit substance use, promote public safety, and support access to treatment and recovery in the criminal justice system. Through the COSSAP project, RTI has recently received more requests about implementing telehealth.
Dr. Haque: In response to these requests, RTI has developed educational materials [PDF] about different aspects of telehealth. We’re also in the process of developing the Telehealth Implementation Support Tool (also under the COSSAP project). This evidence-based tool will involve a self-administered questionnaire coupled with tip sheets on topics related to telehealth readiness, implementation and continuous improvement that stakeholders throughout the criminal justice system can use when implementing telehealth for the first time or when expanding their implementation.
Have any recent changes in legislation or policies affected the use of telehealth in jails and prisons?
Dr. Haque: The public health emergency has led to a number of policy changes. For example, both public and private payers have increased reimbursements for telehealth. We are also seeing increased participation in interstate compacts, which will make it easier to provide telehealth services across state lines. Another change involves the Drug Enforcement Agency’s (DEA) enforcement discretion related to buprenorphine (for opioid use disorder). Before the pandemic, patients needed to be physically located at a DEA-registered facility in the physical presence of a DEA-registered provider to receive a buprenorphine prescription. With the pandemic, the DEA has allowed virtual visits for some of these services.
On the technology side, the US needs more consistent broadband access. The Federal Communications Commission has funded grants to expand broadband access and connectivity. In addition, the Office of Civil Rights (which enforces the Health Insurance Portability and Accountability Act) has allowed consumer-oriented technologies such as FaceTime and Skype to be used for telehealth visits.
What tools are available to guide facilities interested in implementing or improving their telehealth capabilities?
Dr. Haque: As mentioned above, we have the Telehealth Implementation Support Tool under development. This tool will be publicly available, can be completed in 20 minutes, and involves questions across several domains that are key for telehealth implementation support. In addition, the tool has guidance that organizations can follow to help guide their telehealth implementation.
Is there anything we haven’t discussed that either of you wanted to share?
Dr. Haque: Telehealth has great promise throughout the continuum of involvement in the criminal justice system. Telehealth can help connect law enforcement officials with providers when responding to an opioid overdose, support the court system, provide care and coordination in jails and prisons, and then ultimately be a tool to support release. Communities will need to look at what is best for them based on their environmental context and the needs of their populations. Stakeholders will need to work together to identify and prioritize the best use of telehealth. While there’s promise across the spectrum, that doesn’t mean telehealth needs to be used everywhere at once.
Dr. Richardson: If you’re able to intervene with people while they are incarcerated and connect them with the services they need, you’re able to reduce relapse, overdoses, and recidivism and help them transition back into the community. Virtual services can be used to facilitate these connections. This is important and can have a tremendous impact on the community, both from a public health and public safety standpoint.
Alexa Ortiz