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Rural Health Information Hub

Telehealth Models

Telehealth is a promising tool for treating and supporting people with substance use disorders (SUDs). Rural populations can use telehealth to overcome shortages of specialized behavioral health providers and resources. Telehealth uses technology to provide access to services for treating SUDs across a distance. It connects patients and providers and makes it possible for patients to receive screenings, counseling, and other services without traveling to a provider's office. The Rural Telehealth Toolkit provides comprehensive information about models for increasing access to behavioral and mental health treatment, including opioid use disorder.

Some screening, brief intervention, and referral to treatment (SBIRT) and behavioral therapy models have tested computerized or web-based versions with promising results. A computer-assisted or web-based version of behavioral therapy could be beneficial to rural communities where transportation and access to care are barriers to treatment.

While more research is needed to explore the effectiveness of telehealth in treating substance use disorders, early research has been promising. A study in the Journal of Substance Abuse Treatment found that participants in an internet-based methadone maintenance treatment program preferred the internet-based service because of its convenience and confidentiality. Another study from the Journal of Psychosocial Nursing and Mental Health Services found improved abstinence from alcohol among rural women, with no significant differences between standard and web-based treatment groups, suggesting that web-based treatments may be as effective as traditional treatment approaches.

Considerations for Implementation

Telehealth treatment of SUD is quickly evolving. A major component needed in order to pursue this model is access to high-speed internet, which remains a barrier in many rural communities. Telehealth requires access to equipment that may be costly to rural clinics with few resources. In addition to the costs of equipment, agencies that develop telehealth programs may need to establish new policies and procedures as well as training on the use of new equipment.

Telehealth programs must adhere to the Health Insurance Portability and Accountability Act (HIPAA) regulations and federal confidentiality rules. For example, healthcare providers need to consider using private networks on encrypted software if choosing to use videoconferencing. And while a large percentage of the population is using traditional short message service (SMS) text messaging, this format is not secure and therefore would not be compliant with HIPAA regulations.

Reimbursement for substance abuse related telehealth services varies by state. The Center for Connected Health Policy maintains a collection of telehealth-related laws and reimbursement policies by state.

Resources to Learn More

Center for Technology and Behavioral Health
Supports the development, evaluation, and implementation of technology-based intervention tools focused on behavioral health. Provides program reviews and current literature on digital health technology applications for substance use disorder interventions.
Organization: Center for Technology and Behavioral Health

National Consortium of Telehealth Resource Centers
A collaboration of 12 regional and 2 national Telehealth Resource Centers (TRCs) providing information on operation tools used in telehealth, reimbursement information, legal issues, training, and webinars on a variety of telehealth related topics.

Rural Behavioral Health: Telehealth Challenges and Opportunities
Discusses the acceptability, availability, and accessibility barriers to mental health and SUD treatment and services in rural communities with a focus on how the implementation of telehealth services can reduce these barriers.
Citation: In Brief, 9(2)
Organization: Substance Abuse and Mental Health Services Administration
Date: 11/2016

Telehealth in State Substance Use Disorder (SUD) Services
Presents the results of a survey on the use of telehealth in mental health and substance abuse treatment systems in the 37 states. Highlights key findings identifying the types of telehealth technology used, the purpose of these technologies, and the regulations affecting their use.
Organization(s): National Association of State Alcohol and Drug Abuse Directors
Date: 6/2009

Using Telehealth to Identify and Manage Mental Health and Substance Use Disorder Conditions in Rural Areas
Examines the feasibility of using telehealth methods to address mental health and SUD in rural communities. Addresses telehealth implementation and use, privacy concerns, barriers and challenges, and sustainability.
Organization(s): U.S. Department of Health and Human Services, Assistant Secretary for Planning and Evaluation, Office of Disability, Aging and Long-Term Care Policy, RTI International
Date: 9/2017