Slide 1
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Telepsychology
101
Best Practices
MARLENE M. MAHEU,
PHD
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EXECUTIVE DIRECTOR
TELEBEHAVIORAL HEALTH
INSTITUTE
CONTACT@TELEHEALTH.
ORG
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619-255-2788
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Slide 2
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TBHI Certificate
Training
Programs
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Level I / Level II
CEs & CMEs
100% Online
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www.Telehealth.org
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Slide 3
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Disclaimer/Disclosure
GOAL: Educational only. No warranty, guarantee,
or representation is made as to the accuracy or
sufficiency of the information contained in this
webinar series for your specific circumstance.
YOUR PART: You are encouraged to seek practicespecific advice from your legal, regulatory, ethical
and malpractice bodies before offering any online
services or programs. Get all such opinions in
writing. Ask your informed, local, legal counsel
review written responses for their full significance.
I have no conflicts of interest with any groups
identified in this training.
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C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
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Slide 4
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Optimizing
Your
Learning
❖
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You may want to
turn off your cell
phone’s text
messaging
and/or email
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Slide 5
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Optimizing Your
Learning
Perspective
❖ Consider this training an
introduction / resource
guide, similar to
Psychology 101
❖ Glimpse of relevant topic
areas
❖ Limited time & detail
needed for legal/ethical
compliance, → quick dive
into assessment as an
example of the focus
needed
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C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
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Slide 6
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Perspective: Time
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❖
❖
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If you are here, you are
considering the gravity of a
telepractice.
Not rocket science, but does
involve hundreds of little
decisions.
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Camera/email/text/app/phone
all change our processes.
Is doable, but different.
Takes time to do it correctly.
Must stop and think of every
client/patient from different
angles.
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C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
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Slide 7
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Perspective: Time
Time Investment
❖
Many clinicians are working
online without adherence to
basic legal and ethical
requirements.
❖
Please speak with your licensing
and/or ethical board members
about any of the issues that we
discuss in these Best Practices
segments.
❖
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For them, setting up was a
snap.
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C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
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Slide 8
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Perspective: Time
❖
❖
❖
Chaired first group to
examine “telehealth” at
APA (1994).
History of personal time and
expense to ask difficult
questions, read the most
informative documents, to
give the most accurate,
most succinct,
interprofessional/international summaries possible
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Steadfast diligence over
time.
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C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
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Slide 9
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Perspective: Time
❖
❖
❖
Many uninformed,
differing opinions.
If in doubt, consult with
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your licensing and/or
ethical board members
about any of the content of
this training.
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Reach more clients/pts.,
with less effort, lower costs
& higher profits –- but setup
will take time…
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C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
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Slide 10
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You may want to:
1. Organize your set up by
making a to-do list for yourself
as we go.
2. Rank order your to-dos by
priority
3. Consider meeting with likeminded colleagues to develop
your implementation plan
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Make a To-Do List
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Slide 11
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Theory & Theory
Integration
Definitions,
Concepts,
Competencies
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Who
are
you?
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Slide 12
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Definitions
❖
Behavioral Telehealth
❖
Telemental Health
❖
eHealth
❖
Telehealth
❖
Telemedicine
❖
Digital Health
❖
Connected Health
❖
Telepsychology
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Slide 13
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Definitions
❖
Teletherapy
❖
Online Counseling
❖
Distance Counseling
❖
Distance Counselling
❖
Online Therapy
❖
mHealth
❖
Telecounseling
❖
E-therapy
❖
Telebehavioral Health
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C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
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Slide 14
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Telehealth
eLearning
Telehealth
Administration
Telemedicine
Evaluation
Research
Regional
Health
Information
Sharing
Consumer
Education
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Public
Health
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Homeland Security
C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
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Slide 15
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Originating vs. Distant Sites
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Slide 16
Originating vs. Distant Sites
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Distant
(Us)
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Originating or Satellite Sites (Client/Patient)
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C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
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Slide 17
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Professional Services
Training
Competencies
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Guidelines
Ethical Standards
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Regulations
Law
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C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
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Slide 18
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CTiBS Interprofessional
Framework for
Telebehavioral Health
Competencies
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7 Domains
5 Subdomains
49 Objectives
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146 Competencies
3 Levels
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C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
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Slide 19
History of Competencies
in Healthcare
Institute of Medicine, 2001→ competencies
needed for healthcare training
Competencies: observable, measurable
knowledge, skills and attitudes that contribute
to enhanced performance
Acknowledged through designations such as
a professional certificate to demonstrate
achievement beyond the basics
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Slide 20
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CTiBS TBH Competency
Domains
Clinical
Legal &
Regulatory
Telepresence
Ethical &
EvidenceBased
Technical
mHealth
Practice
Development
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Slide 21
Interprofessional Framework For
Telebehavioral Health
Competencies CTiBS, 2017

DOMAIN I -- Clinical Evaluation &
Care
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I.A Evaluation & Treatment
I.B Cultural Sensitivity & Diversity
I.C Documentation & Administrative
Procedures
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Slide 22
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C 1994-2019 Telebehavioral Health Institute, LLC All rights
reserved.
Polling Question #1
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Slide 23
Have you received formal
CE training in any aspect
of telehealth service
delivery?
No
Yes
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Slide 24
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CLINICAL EVALUATION
AND CARE
(TBH Domain I)
Evaluation & Treatment
(Subdomain I.A)
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Slide 25
TBH COMPETENCIES -- CLINICAL
EVALUATION & CARE – Subdomain
1.A: Evaluation & Treatment
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1.
Assesses for client/patient
appropriateness for TBH services
2.
Assesses and monitors client/patient
comfort with TBH
3.
Applies/adapts in-person clinical
care requirements to TBH
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C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
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Slide 26
TBH COMPETENCIES -- CLINICAL
EVALUATION & CARE – Subdomain
1.A: Evaluation & Treatment
4.
Implements and adapts a TBH service
plan with policies/procedures adjusted
accordingly
5.
Monitors therapeutic engagement
related to each TBH modality
6.
Establishes and maintains professional
boundaries
7.
Provides training, supervision and/or
consultation to others (for Proficient
and Authority)
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C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
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Slide 27
Assess for Appropriateness:
Screening
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Screening is key. How are you
organized to do so?
❖
In-person assessment?
❖
Referral from professional?
❖
Validated online assessment
system?
❖
Test-messaging employer?
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Slide 28
Assess for Appropriateness:
Screening
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Screen for client/patient
needs and preferences
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Slide 29
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Assessment
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Systematically assess and
identify clinical, diagnostic,
setting, population, and other
factors that would preempt,
complicate or exclude use of
a technology with a
client/patient
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Slide 30
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Assess:
Intake
Process
❖ Conduct a formal intake – no
shortcuts
❖ Meet in-person or video when
possible, identify geographic
location, organizational culture,
take full history, medications
and medical conditions, mental
status/stability, use of
substances, stressors, treatment
history, support system, use of
other technology,
suicide/homicide intent
❖ Identify diagnosis if appropriate
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C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
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Slide 31
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❖ Decide if, then which
Assess:
Intake
Process
technology is appropriate /
Assess technical competence
/ ability to arrange
appropriate setting
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❖ Obtain names of all other key
providers, get appropriate
releases
❖ Verify contact information
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(address, phone, email)
❖ Develop emergency plan in
writing
❖ Explain & sign informed consent
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C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
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Slide 32
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Limited time
Assessment
Example
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Assessment
Robust evidence base
since 1959
Telehealth is far from
the wild west
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C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
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Slide 33
Assessment
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Identify and resolve
conflicting barriers that
are clinical or
administrative (e.g.
disruptive children, need
for frequent emergency
contact, etc.)
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Slide 34
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Assessment
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
Which criteria to use for
online screening?

1. Diagnosis: highly
anxious, depressed,
psychotic, chemically
dependent, acting out
clients are not good
candidates.
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Slide 35
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Assessment
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Criteria to use for online
screening?
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2. Setting: For difficult
clients/patients, settings
are crucial to consider.
Prisons, in-patient units,
other treatment facilities
provide support
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Slide 36
Clinical & Safety Issues
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❖
Once treatment has begun, adapt/adjust in-person
policies and protocols to formulate and
spontaneously implement a TBH service plan
❖
Address evolving client/patient needs
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C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
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Slide 37
Clinical & Safety Issues
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Articulate evidence-based strategies to work through
dangerous situations
❖
Firearms in the home
❖
Chemically dependent adults
❖
disruptive children
❖
Violence
❖
Illegal activity
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C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
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Slide 38
Clinical & Safety Issues
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Articulate and document evidence-based strategies
to work through your treatment plan
❖
Document reasons for treatment via telehealth
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Modify treatment as needed to adapt telehealth
❖
Develop back-up and safety plans
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Document risks, accommodations, dynamic
informed consent
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C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
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Slide 39
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Clinical & Safety Issues
Monitor engagement by tracking/commenting
on behaviors that are ambiguous
❖
Innuendo
❖
Nuance
❖
Colloquial expressions
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Use of technology slang
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Others that may reflect discomfort
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C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
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Slide 40
MM3
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Clinical & Safety Issues
(Your Own)
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ANXIETY
FEAR
POWER
Articulate evidence-based strategies to work through
your own powerlessness (e.g. in the face of domestic
violence, self-mutilation, aggression, un-invited visitors,
inappropriate sexuality, premature termination)
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Slide 41
MM3
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Clinical & Safety Issues
(Your Own)
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ANXIETY
FEAR
POWER
Be able to articulate evidence-based strategies to work
through dangerous situations (e.g. firearms in the home,
chemically dependent adults, disruptive children)
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C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
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Slide 42
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Assessment
❖
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All assessment approaches
have advantages and
disadvantages. The
teleclinician should balance
approach selection based
on balancing quality and
access, with close
consideration of the
client/patient safety.
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C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
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Slide 43
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Assessment
❖
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Administration of diagnostic
tools may be completed:
❖ at
the time of the
evaluation
❖ beforehand
on paper and
faxed to the
telepractitioner
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❖ beforehand
using an
automated phone dialing
system
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C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
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Slide 44
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Assessment
❖
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Administration of diagnostic
tools may be completed:
❖ over
the internet using a
secure interface
❖ via
an “app” on a
smartphone or tablet
provided at the distant
telehealth site or on the
client/patient’s own mobile
device
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C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
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Slide 45
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Kane, R. L., &
Parsons, T. D. (Eds.).
(2017). The role of
technology in
clinical
neuropsychology.
Oxford University
Press.
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Slide 46
Other Telehealth
Assessment References
❖
Cullum, C., Weiner, M.,
Gehrmann, H. &
Hynan,
Linda. Feasibility of
Telecognitive
Assessment in
Dementia.
Assessment, 13(4), 385390. doi:
10.1177/107319110628
9065
❖
Wadsworth, H. E., Dhima,
K., Womack, K. B., Hart Jr,
J., Weiner, M. F., Hynan, L.
S., & Cullum, C. M. (2018).
Validity of
teleneuropsychological
assessment in older
patients with cognitive
disorders. Archives of
Clinical
Neuropsychology, 33(8),
1040-1045.
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Slide 47
Validity of
Teleneuropsy
chological
Assessment in
Older
Patients with
Cognitive
Disorders:
Methods
The sample consisted of 197
older subjects, separated into
two groups, with and without
cognitive impairment. The
cognitive impairment group
included 78 individuals with
clinical diagnoses of mild
cognitive impairment or
Alzheimer’s disease. All
participants completed
counterbalanced
neuropsychological testing using
alternate test forms in both a
teleneuropsychology and a
traditional face-to-face (FTF)
administration condition.
https://academic.oup.com/acn/a
rticle-abstract/33/8/1040/4797076
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Slide 48
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Validity of
Teleneuropsy
chological
Assessment in
Older
Patients with
Cognitive
Disorders:
Objective
The purpose of this study
was to determine the
ability of video
teleconferencing
administration of
neuropsychological
measures
(teleneuropsychology) in
discriminating cognitively
impaired from nonimpaired groups of older
adults….
https://academic.oup.com/acn/a
rticle-abstract/33/8/1040/4797076
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Slide 49
Validity of
Teleneuropsy
chological
Assessment in
Older
Patients with
Cognitive
Disorders:
Conclusions
Results derived from
teleneuropsychologically
administered tests can
distinguish between
cognitively impaired and
non-impaired individuals
similar to traditional FTF
assessment. This adds to
the growing
teleneuropsychology
literature by supporting
the validity of remote
assessments in aging
populations.
https://academic.oup.com/acn/a
rticle-abstract/33/8/1040/4797076
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Slide 50
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Neuropsychological test
administration by
videoconference:
A systematic review
and meta-analysis.
Brearly, T. W., Shura, R. D.,
Martindale, S. L., Lazowski,
R. A., Luxton, D. D.,
Shenal, B. V., & Rowland,
J. A. (2017).
Neuropsychological test
administration by
videoconference: A
systematic review and
metaanalysis. Neuropsychology
review, 27(2), 174-186.
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Slide 51
GUIDELINES FOR THE PRACTICE OF
TELEPSYCHOLOGY
Testing and Assessment
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Guideline 7: Psychologists are encouraged to
consider the unique issues that may arise with
test instruments and assessment approaches
designed for in-person implementation when
providing telepsychology services.
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Slide 52
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❖
Other
Telehealth
Assessment
References
A compilation of
references/abstracts related
to telehealth & assessment
has been compiled by the
Coalition for Technology in
Behavioral Science (CTiBS).
❖
It is available upon request
by writing to me at
contact@telehealth.org
❖
(Could use a hand updating
it if anyone has recent
articles.)
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C 1994-2019 Telebehavioral Health Institute, LLC All rights
reserved.
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Slide 53
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Think about using a
tele-presenter
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Slide 54
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Telepresenter
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❖ The telepresenter is an assistant who is
trained to aid a professional by being at
the originating site in telehealth
❖ They can aid with setting up the
client/patient with the technology,
following instructions from the
professional, who may be miles away
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C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
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Slide 55
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Telepresenter
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❖ The telepresenter might also be
involved in the room with the patient,
in re-positioning the camera so that a
distant clinician can see a patient’s
feet for a gait analysis, or in placing
blocks or other test items in front of the
client/patient in neuropsychology
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C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
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Slide 56
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Telepresenter
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❖ Telepresenters are usually pretrained and approved by the
clinician to perform specific tasks
as needed for the consult or
assessment
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Slide 57
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Think about
using a local
collaborator
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Slide 58
Safety Issues to Consider
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Identify and use of a local collaborator
(family member, friend, community member,
spiritual leader, AA sponsor, local physician)
❖ Enter name and contact information into
informed consent for written permission
❖ Stipulate conditions for them to be
contacted
❖ Consider making contact prior to
treatment if you deem it helpful
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C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
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Slide 59
Safety Issues to Consider
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Local collaborator can be helpful for:
❖ Providing information about the
patient’s history / local customs
❖ Monitoring mood and behavior
❖ Assisting with treatment planning and
coordination
❖ Coordination with local 911 service
when needed
❖ Manage the technology
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C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
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Slide 60
Safety Issues to Consider
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Assess when using a local collaborator
may not be advisable:
❖ Safety – may be best to rely on trained
911 responders
❖ Be cognizant of potential deleterious
effect of disclosures made during
emergency management on patient
confidentiality and relationships, (small
communities)
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C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
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Slide 61
Other Clinical
Working with a Collaborator
& Safety
Issues
 Assess when using a local
collaborator may not be
advisable:
 Safety of local
collaborators must be
carefully considered – may
be best to rely on trained
911 responders
 Be cognizant of potential
deleterious effect of
disclosures made during
emergency management
on patient confidentiality
and relationships,
especially in small
communities
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C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
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Slide 62
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APA & ATA
Guidelines,
2013
Consider other individual
characteristics (e.g.,
medical status, psychiatric
stability, physical/cognitive
disability, personal
preferences for using
technology)
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Slide 63
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In-Person Contact
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APA Telepsychology Guidelines:
❖
In addition, psychologists
may consider some initial inperson contact with the
client/patient to facilitate an
active discussion on these
issues and/or conduct the
initial assessment (P11)
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Slide 64
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Clinical & Safety
Issues
❖
❖
___________________________________
Know and have ready
access to local referrals for
all major needs
❖
Chemical dependency
❖
Wellness checks,
❖
Emergencies, etc.
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Develop these systems as
referral sources, too
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Slide 65
Serving Clients/Patients in
Their Homes
❖ Service to the home is not just about
access
❖ Scientific evidence base to the home is
much thinner, less reliable than
traditional telehealth
❖ Many uncontrolled variables
❖ Different laws are in play
❖ Credentialing and reimbursement are
different
❖ Depending on whom is being served
and the treatment plan, you may want
to mention this added risk in your IC
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C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
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Slide 66
American
Telemedicine
Association
Telemental
Health Guidelines
-2009
Emergencies
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❖
A patient site
assessment shall be
undertaken, including
obtaining information on
local regulations &
emergency resources,
and identification of
potential local
collaborators to help
with emergencies.
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C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
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Slide 67
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Clinical & Safety
Issues
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❖Intrusions
❖ Know how to maintain your
professional boundaries
❖Secure both end points
❖ Notify family and friends
❖ Sign on door
❖ Lock door
❖ Initial protocols
❖ “Talk to me about anything
upsetting that happens
because of the technology”
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Slide 68
___________________________________
Opening Protocol:
Where are you?
___________________________________
Serving clients/patients
in “unsecured” area
(under a bridge, in a
cab, in their home, a
neighbor’s kitchen,
bedside)?
___________________________________
___________________________________
C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
___________________________________
___________________________________
___________________________________
Slide 69
___________________________________
C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
Polling
Question #2
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Slide 70
___________________________________
Which
of these
Training?
technologies have you
used to deliver clinical
services?
___________________________________
___________________________________
1.
Telephone
2.
Video
3.
Email
4.
Texting
5.
App(s)
6.
Virtual
reality
7.
Other
___________________________________
___________________________________
___________________________________
___________________________________
Slide 71
___________________________________
___________________________________
___________________________________
Research
___________________________________
___________________________________
___________________________________
___________________________________
Slide 72
Size of
Telebehavioral
Evidence Base
❖
More than 4,500 references used
in creating the training at the
Telebehavioral Health Institute
(TBHI)
❖
Free list of 1000+ searchable
telebehavioral health references:
___________________________________
___________________________________
___________________________________
www.telehealth.org/bibliography
___________________________________
___________________________________
___________________________________
___________________________________
Slide 73
___________________________________
Increased client/patient satisfaction
Decreased travel time
Benefits of
Video-Based
Telehealth*
___________________________________
Decreased travel, child & elder-care
costs
Increased access to underserved
populations
___________________________________
Improved accessibility to specialists
Reduced emergency care costs
___________________________________
C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
___________________________________
___________________________________
___________________________________
Slide 74
Benefits of
Video-Based
Telehealth*
Maheu, Pulier,
Wilhelm,
McMenamin
& BrownConnolly.
(2004). The
mental health
professional
and the new
technologies.
Erlbaum, New
York.
___________________________________
Faster decision-making time
Increased productivity / decreased
lost wages
___________________________________
Increased access to underserved
populations
Improved accessibility to specialists
___________________________________
Decreased hospital utilization
Improved operational efficiency
___________________________________
C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
___________________________________
___________________________________
___________________________________
Slide 75
Classic Telehealth: Hub-andSpoke Model
___________________________________
___________________________________
___________________________________
___________________________________
C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
___________________________________
___________________________________
___________________________________
Slide 76
Benefits of Video-Based
Telehealth Maheu, Pulier,
Wilhelm, McMenamin & BrownConnolly. (2004).
❖
Hub-and-spoke model
❖ Only work with previously
identified clients
❖ Originally for patients who have
had an in-person assessment
(changing)
❖ Detailed and documented
referral requests
❖ Detailed health record at
fingertips of clinician
❖ Community collaborator is
available
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Slide 77
Supporting Research #1
Godleski, Darkins & Peters reported in
April of 2012 that hospital utilization in
psychiatric populations at the Veterans
Administration were decreased by an
average of 25% since the use of
telehealth.
Godleski, L. Darkins, A. & Peters, J.
Outcomes of 98,609 U.S. Department of
Veterans Affairs patients enrolled in
telemental health services, 2006–2010.
Psychiatric Services, 63(4). 383-385.
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Slide 78
Supporting Research #2
❖
Backhaus and colleagues (May, 2012)
reported in their abstract of a metaanalysis that:
❖ 821 potential articles were identified,
and 65 were selected for inclusion.
❖ The results indicate that VCP is feasible,
has been used in a variety of
therapeutic formats and with diverse
populations, is generally associated
with good user satisfaction, and is
found to have similar clinical outcomes
to traditional face-to-face
psychotherapy.
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Slide 79
Supporting Research #3
Hilty, Ferrer, Parish, Johnston, Callahan & Yellowlees – 2013
❖ Reviewed 755 studies and included 85 studies
❖ Results: Telemental health is effective for diagnosis
and assessment across many populations (adult,
child, geriatric, and ethnic) and for disorders in many
settings (emergency, home health) and appears to
be comparable to in-person care. In addition, this
review has identified new models of care (i.e.,
collaborative care, asynchronous, mobile) with
equally positive outcomes.
*Hilty, D. M., Ferrer, D. C., Parish, M. B., Johnston, B., Callahan, E. J., &
Yellowlees, P. M. The effectiveness of telemental health: A 2013
review. Telemedicine and Ehealth. 19(6):444-54. doi:
10.1089/tmj.2013.0075.
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Slide 80
___________________________________
___________________________________
___________________________________
___________________________________
C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
___________________________________
___________________________________
___________________________________
Slide 81
Guidelines
❖
Myers, K., Nelson, E. L.,
Rabinowitz, T., Hilty, D., Baker, D.,
Barnwell, S. S., ... & Comer, J. S.
(2017). American telemedicine
association practice guidelines
for telemental health with
children and
adolescents. Telemedicine and
e-Health, 23(10), 779-804.
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Slide 82
Standards
❖
Reamer, F. G. (2018). Ethical
standards for social workers' use
of technology: Emerging
consensus. Journal of Social
Work Values and Ethics, 15(2),
71.
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Slide 83
Topic-Focused Research
❖
Zheng, W., Nickasch, M., Lander, L.,
Wen, S., Xiao, M., Marshalek, P., ...
& Sullivan, C. (2017). Treatment
Outcome Comparison between
Telepsychiatry and Face-to-face
Buprenorphine Medication-Assisted
Treatment (MAT) for Opioid Use
Disorder: A 2-Year Retrospective
Data Analysis. Journal of addiction
medicine, 11(2), 138.
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Slide 84
International Research
___________________________________
___________________________________
❖
Martínez, V., Rojas, G., Martínez, P., Zitko, P.,
Irarrázaval, M., Luttges, C., & Araya, R. (2018).
Remote collaborative depression care program
for adolescents in Araucanía region, Chile:
randomized controlled trial. Journal of medical
Internet research, 20(1), e38.
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Slide 85
___________________________________
Advanced Technology-Specific
Research
___________________________________
❖
Mellentin, A. I., Nielsen, B., Nielsen, A. S., Yu, F.,
Mejldal, A., Nielsen, D. G., & Stenager, E. (2019).
A Mobile Phone App Featuring Cue Exposure
Therapy As Aftercare for Alcohol Use Disorders:
An Investigator-Blinded Randomized Controlled
Trial. JMIR mHealth and uHealth, 7(8), e13793.
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Slide 86
___________________________________
Searchable Database
___________________________________
TBHI searchable database of over 1200
telebehavioral health references:
___________________________________
❖ Telehealth.org/bibliography
___________________________________
___________________________________
___________________________________
___________________________________
Slide 87
___________________________________
Telesupervision
C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Slide 88
___________________________________
Telesupervision
❖
Legal in many states
❖
Many models have been
shown effective:
❖
All theoretical disciplines
(psychoanalytic, CBT,
etc.)
❖
All types of settings
(urban, rural, frontier, oil
rigs, EAPs, etc.)
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Slide 89
___________________________________
CLINICAL EVALUATION
AND CARE
(TBH Domain I)
Cultural Sensitivity &
Diversity
___________________________________
___________________________________
(Subdomain I.B)
___________________________________
C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
___________________________________
___________________________________
___________________________________
Slide 90
CLINICAL EVALUATION AND CARE
DOMAIN, Cultural Sensitivity &
Diversity (Subdomain I.B)
Telebehavioral Objectives
8.
Assesses for cultural factors
influencing care
9.
Ensures communication with a
reasonable language option
a climate that
encourages reflection and
discussion of cultural issues in an
ongoing manner
___________________________________
___________________________________
___________________________________
10.Creates
___________________________________
C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
___________________________________
___________________________________
___________________________________
Slide 91
Cultural Sensitivity &
Preferences for Technology
❖
❖
Client/Patient preferences take precedence
Screen for, differentiate between and synthesize
cultural factors that can impact relationship and
treatment that are technology-specific:
❖ Look for preferences:
groups may prefer traditional telephones
more than video conferencing for treatment, such
Faith-based African Americans, (Robert
Glueckauf, PhD)
❖ Some groups may prefer cell phones to
computers
___________________________________
___________________________________
___________________________________
❖ Some
___________________________________
C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
___________________________________
___________________________________
___________________________________
Slide 92
Bridging Cultural Divides
❖
Adjust clinical care as needed
❖
Eye contact
❖
Use of titles
❖
Use of roles
❖
Use of pronouns to give appropriate
respect / deference
❖
Identify potential micro-aggression
and systematically eliminate
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Slide 93
Bridging Cultural Divides
❖
If you are culturally different
than people who see you for
professional services,
educate yourself about their
culture, then screen for
common cultural themes, as
well as novel ones that may
arise
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Slide 94
Bridging Language Differences
❖
Assesses if client/patient
preferences for a language (e.g.
English, Spanish, French) are
adequate to sustain treatment
(e.g., strong will to use one
language when another may be
more effective)
❖
Use English proficiency tests if
needed to determine verbal vs.
reading comprehension (free
online)
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Slide 95
Bridging Language Differences
❖
Use translator when needed.
Explore how interpreter’s
ethnicity, class, interpersonal
communication style and
interpreting may influence the
interaction with client / patient
with analyzing, shaping of
story/narrative; short vs long
interpretations, differences in
tone, idioms, slang)
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Slide 96
Bridging Language Differences
❖
Explore how language
differences can influence the
story/narrative and level of
intimacy (respect need for
distance while attending to just
the most relevant issues at
hand)
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Slide 97
Bridging Cultural Divides
___________________________________
___________________________________
❖
❖
Look for explanatory model(s),
identify help-seeking behaviors
and preferences (e.g. seek
collaborator in family member
[cautiously if at all], trusted
medical advisors, spiritual
leaders, neighbors and friends)
Inquire about cultural /religious
community and local attitudes
towards TBH
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Slide 98
Bridging Cultural/Language
Divides
❖
❖
___________________________________
___________________________________
Manage the two-or-three-site
complexities (originating site “a”
and clinician and/or
interpreter’s distant site “b” and
“c”)
Consider consultation for
complexities and/or relative
skillset “fit” as to whether the
client/patient can be helped by
your treatment (and/or by TBH)
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Slide 99
___________________________________
CLINICAL EVALUATION
AND CARE
(TBH Domain I)
Documentation and
Administrative Procedures
___________________________________
___________________________________
(Subdomain I.C)
___________________________________
C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
___________________________________
___________________________________
___________________________________
Slide 100
Informed Consent
❖ Legal &
Ethical Issue –
all legal and
ethical
requirements
apply with
the use of
any
technology
___________________________________
Verbally Discussed
___________________________________
___________________________________
❖ Active vs.
Static
___________________________________
___________________________________
___________________________________
___________________________________
Slide 101
Forms - Intake
❖
Intake form – compare your existing
form to your state statutes to cover all all
your required bases
❖ Mental status exam
❖ Preferences for technology
❖ Risks/benefits
___________________________________
___________________________________
___________________________________
❖ Diversity
needs
❖ Gait analysis
❖ Hygiene
check
❖ Alcohol
___________________________________
___________________________________
___________________________________
___________________________________
Slide 102
Opening Protocol* &
Documentation
❖
❖
❖
❖
Where are you?
Identify yourself and ask them to
do the same (if warranted)
Is anyone in your room today?
(state if anyone is in the room with
you)
If you hear noises, stop and
ask, Has someone entered your
room? Patients may not
automatically tell you.
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Slide 103
___________________________________
Opening Protocol* &
Documentation
___________________________________
❖
Have there been any
emergencies in your
environment today?
❖
Is there anything else I should
know about before we begin
talking today?
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Slide 104
___________________________________
Forms - Progress Note
___________________________________
Document, document, document
❖ Dropped connections
❖ Intrusions / interruptions
❖ Lighting
❖ Adaptive Equipment
❖ Progress toward established goals
❖ How technology helped/hindered
❖ Peer consultation using telehealth
systems (e-consults)
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Slide 105
___________________________________
TBHI Sample
of Progress
Note
___________________________________
___________________________________
___________________________________
C 1994-2019 Telebehavioral Health Institute, LLC All rights reserved.
___________________________________
___________________________________
___________________________________
Slide 106
Termination Note
❖
Use your general form, but
comment on:
❖ Success/pros/cons
telehealth
___________________________________
___________________________________
of
❖ Problems
encountered and
resolutions if any
telehealth is suggested for
future
___________________________________
❖ If
___________________________________
___________________________________
___________________________________
___________________________________
Slide 107
Termination Note
❖
Use wording from informed
consent agreements about “noshows/termination” if
termination letter is needed
❖
Social media policy about
“friending” (e.g. Facebook)or
giving ratings (e.g. Yelp) and
alternative ways to comment
after meetings come to a close
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Slide 108
___________________________________
Review your to-dos
and bring your
technology-related
questions to
Segment 2 of APA’s
Telepsychology 101.
___________________________________
___________________________________
Wrap-Up of To-Dos
___________________________________
___________________________________
___________________________________
___________________________________
Slide 109
MM2
Question?
___________________________________
___________________________________
Marlene
M. Maheu, PhD
Executive
Director
Telebehavioral
Health Institute, LLC
___________________________________
contact@telehealth.org
619-255-2788
___________________________________
___________________________________
___________________________________
___________________________________