NRNP 6654 Week 9 Telehealth Plan Example

Telehealth Plan for Psychiatric Follow-Up With Shelter Residents: Preconditions and Their Failure Routes, Location at Every Visit, and Who Video Leaves Out

Student Name

College of Nursing, Walden University

NRNP 6654: Psychiatric Mental Health Advanced Practice Nursing Care of Vulnerable/Special Populations

Instructor Name

Month Day, Year

Telehealth Plan for Psychiatric Follow-Up With Shelter Residents: Preconditions and Their Failure Routes, Location at Every Visit, and Who Video Leaves Out

Preconditions, Each With a Failure Route

The plan covers video follow-up visits between in-person clinic afternoons for adults staying in or near a city's emergency shelters. Before any video visit, three things must be true, and for each the plan states what happens when it is not.

A working device. Most homeless adults own a phone, but phones and numbers change often: in one study, more than half had changed their phone or their number in the past 3 months (Rhoades et al., 2017). Failure route: the shelter's case management office keeps a clinic tablet that residents can borrow for the visit, and the clinic records a second contact, such as the case manager's line, so a changed number does not end follow-up.

Enough data. A prepaid plan may run out mid-month. Failure route: visits are scheduled on the shelter's Wi-Fi during day center hours, and if video cannot connect, the visit switches to audio on the clinic's call.

Somewhere to speak without being overheard. A dormitory or day room is not private. Failure route: the case management office is reserved for 30 minutes; if it is not available, the visit is limited to what can be said in the space, the patient is asked what they are comfortable discussing there, and the rest is held for the next in-person afternoon.

Identity and Location, Established Every Time

At the start of every visit, the clinician confirms who the patient is and asks where they are right now, down to the address or the nearest cross streets, and records it. For a person without a fixed address, location is not a formality: a clinician who cannot say where the person is has no way to send help if the visit reveals an emergency. The APA and ATA resource document on videoconferencing-based telemental health calls for confirming the patient's location and having an emergency plan tied to it (Mishkind et al., 2024). The plan adds the shelter's front desk number to each record, since shelter staff can reach a resident faster than emergency services can find them.

Licensure and consent bind at the same point. The clinician must be licensed where the patient is physically located during the visit, which matters when a resident moves to a shelter across a state line. Consent to telehealth is obtained and documented at the first video visit, including the risks of being overheard and what happens if the connection fails. Each note records the modality, the location, who else was present, and whether the visit fell back to audio.

What Changes by Video, and What Compensates

This plan does not restate the in-person assessment; it names what video observes less well. Psychomotor changes, tremor, and gait are harder to judge on a small screen. Hygiene, smell, and signs of intoxication are partly lost. Eye contact is distorted by camera angle. What compensates: asking the patient to stand and walk briefly if the space allows; asking directly about sleep, eating, and substance use rather than relying on observation; and, with consent, a short check with the case manager, who sees the patient daily. Where a finding cannot be judged by video, such as a new tremor, the patient is seen in person at the next clinic afternoon.

Degraded, as Distinct From Failed

A degraded visit is one that happens but with less: audio only, a frozen picture, a noisy room. It still counts, and the note records what was lost, for example, "Audio only; mental status limited to speech and thought content." A failed visit is one that does not happen at all: no device, no connection, no answer. A failed visit triggers outreach, not a no-show mark: the case manager is contacted the same day, and the patient is offered the next in-person afternoon. Treating a failed video visit as a missed appointment would repeat the barrier the plan exists to reduce.

Who the Format Excludes

Video is not neutral. After the pandemic expanded telehealth in the VA, video use in primary care among veterans with homelessness rose from 1.37% to 20.56% of patients, but older veterans were much less likely to use it, and patients in homeless-tailored primary care were also less likely to use video than other primary care patients (Leung et al., 2024). The plan therefore names the people it will not reach well: older adults who do not use smartphones; people with hearing or vision impairments that the tablet does not accommodate; people who need an interpreter, unless one can join the call; people whose paranoia makes a camera frightening; and people living unsheltered who rarely come to the shelter where the tablet is kept. For each of these groups, in-person visits remain the default, and telehealth is offered only if they want it.

References

Leung, L. B., Zhang, E., Chu, K., Yoo, C., Gabrielian, S., & Der-Martirosian, C. (2024). Characteristics of veterans experiencing homelessness using telehealth for primary care before and after COVID-19 pandemic onset. Journal of General Internal Medicine, 39(Suppl. 1), 53-59. https://doi.org/10.1007/s11606-023-08462-3

Mishkind, M., Shore, J. H., Barrett, R., Caudill, R., Chiu, A., Hilty, D., Idigo, O. B., Kaftarian, E., Khan, S., Krupinski, E. A., Malik, T. S., Thackaberry, J., Torous, J., & Yellowlees, P. (2024). Resource document on best practices in synchronous videoconferencing-based telemental health. Telemedicine and e-Health, 30(5), 1330-1340. https://doi.org/10.1089/tmj.2023.0174

Rhoades, H., Wenzel, S. L., Rice, E., Winetrobe, H., & Henwood, B. (2017). No digital divide? Technology use among homeless adults. Journal of Social Distress and the Homeless, 26(1), 73-77. https://doi.org/10.1080/10530789.2017.1305140