Presented by Nate Rhoad, B.S., Olivia McFarland, B.S., Jennifer
Ripley, Ph.D

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What is Telehealth?
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Telemental Health
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General Ethical Considerations
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E-Hope Couples Consultation
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Ethical Issues Specific to Couples Work
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Case Studies

http://www.apa.org/divisions/div46/technology-1.jpg

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Advancement in technology o Increased pace and decreased cost
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Increasing popularity of social media
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Familiarity with technology
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Consumer Demand o
Needs of younger generation o
Individual’s in rural areas
Maheu et al., 2012

The use of electronic info and telecommunication to support and improve clinical health services, health administration, patient info, public health, and professional education and supervision (Baker
& Bufka, 2011 )
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Technologies include videoconferencing, the internet, streaming media, store and forward technologies, and terrestrial and wireless communications (Baker & Bufka, 2011)

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Did you know?… o
Concept of Telehealth not a novel one o o o
1879- Article in the Lancet discussed using phone to reduce office visits (Nesbitt, 2012)
1925- Cover of Science and Invention shows doctor diagnosing patient by radio (Nesbitt,
2012)
Video teleconferencing used in Dept. of
Veterans Affair for almost 20 years (Novotney,
2011)

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Terms include “telemental health”, “e-mental health”, and
“telepsychology”
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Email use with clients more than tripled from 2000 to 2008 among psychologists
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Teleconferencing increased from 2 to 10 percent in same time period
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Ability to potentially provide services to millions of people who could ordinarily not access psychological services due to immobility, illness, or geographic location o Nearly 80 million live in a “mental health shortage area”
Novotney, 2011

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Has been used to treat various psychological problems (Novotney, 2011) o
PTSD, substance use, anger management
• Is it effective?
o
2008 meta-analysis of 92 studies did not find sig. difference between face to face and telemental health approaches o o
Has been found to effectively treat PTSD symptoms and anger problems o
Study of 98,000 mental health patients (Godleski, Darkins & Peters,
2012)
Hospitalization utilization decreased by average of 25% between
2006 and 2010 when teleconferencing was used

• Is therapeutic alliance diminished when videoconferencing is used?
• Study conducted examining the difference in alliance between face to face and videoconference therapy (Germain et al.,
2010)
• 46 participants diagnosed with PTSD (17 over video, 29 in person)
• Assessments analyzing alliance administered five times throughout treatment
• Alliance was found to develop similarly in both conditions
• Those who had concerns about technology had no trouble building alliance with their therapist
• Therapists can impact client’s view by maintaining positive attitude about videoconferencing

• Study investigated the outcomes of 11 couples who participated in solution focused marital therapy (Jedlicka &
Jennings, 2001)
• Conducted via email
• Outcomes were similar to face-to-face therapy, with strength of outcome associated with couples investment in problem solving

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Currently, APA does not have official policy regarding use of telemental health
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However… APA and Association of State and
Provincial Psychology Boards (ASPPB) Model
Acts of Licensure of Psychologists note that psychological care may be provided electronically or over the phone
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Jurisdictional Restrictions
Baker & Bufka (2012)

• Telepsychology 50- State Review
• States differ in statutes and regulations in place for telepsychology (many states do not have them)
• All states have regulations for licensed psychologists who practice telepsychology in states they aren’t licensed in
• All states implement a penalty for those who practice telepsychology without license (just as in the general practice of psychology)
• http://www.apapracticecentral.org/advocacy/state/telehealthslides.pdf

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Informed Consent
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Safety and Security Online o
Email o
Videoconferencing- Use of Skype?
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Reimbursement Concerns
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Training
Baker & Bufka (2012)

• American Association of Marriage and Family Therapists
• “When using electronic methods for communication, billing, recordkeeping, or other elements of client care, marriage and family therapists ensure that their electronic data storage and communications are privacy protected consistent with all applicable law.” AAMFT Code of
Ethics, 2012, 2.7 Protection of Electronic Information
• American Counseling Association
• “Counselors take precautions to ensure the confidentiality of all information transmitted through the use of any medium.” ACA Code of Ethics, 2014, B.3.e
• National Association of Social Workers
• “Social workers should take precautions to ensure and maintain the confidentiality of information transmitted to other parties through the use of computers, electronic mail, facsimile machines, telephones and telephone answering machines, and other electronic or computer technology. Disclosure of identifying information should be avoided whenever possible.” NASW
Code of Ethics, 1996, Revised 2008, 1.07.m
http://www.zurinstitute.com/ethicsoftelehealth.html#aamft

• Short term strategic
• Religion-accommodative
• New model: attachment, positive psychology/virtues
• Reviewed one of 4 empirically supported treatments for marriage enrichment (Jakubowski et al., 2005)
• 20 years of research at VCU (Worthington et al) and 14 years at
Regent U.
• Two books on it Worthington (2005) Ripley & Worthington (2014)

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A model based on couple education and enrichment
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Each couple is matched with a consultant who directs and guides them through the process
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The couple can choose their own modules and materials to work through o
Modules consist of worksheets, videos, blogs & Vsee conversation
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The consultant also suggests relevant materials
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The consultant meets with the couple two times a month over a period of two months

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Couples should not have serious psychopathology, serious violence, substance abuse, separation, or significant relational problems
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Emphasis on enrichment rather than counseling
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If serious distress or issues become relevant, couples will be referred for counseling
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Consultant supports couple in meeting their relationship goals and growth o couples counseling is to assist with healing and repair from dysfunctional relationship patterns

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Screening couples for suitability
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Connectivity Issues
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Referral and Safety Issues
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Confidentiality
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Informed Consent
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Education
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Consultation environment
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Couples may not have as secure of an environment as the consultant (Bischoff,
2004)
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Mental Status (Bischoff, 2004)
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May be difficult to obtain for two individuals

• African American Couple
• Mid 40s
• Seeking online couples consultation due to busy schedule
• Main concerns are in the area of communication

Baker, D. C. & Bufka, L. F. (2011). Preparing for the Telehealth World: Navigating Legal,
Regulatory, Reimbursement, and Ethical Issues in an Electronic Age. Professional Psychology:
Research and Practice, 42(6), 405-411.
Bischoff, R.J. (2004). Considerations in the Use of Telecommunications as a Primmary TreatmentMedium: The
Application of Behavioral Telehealth to Marriage and Family Therapy. The American Journal of
Family Therapy, 32(3), 173-187.
Campos, B. (2009). Telepsychology & Telehealth: Counselling Conducted in a Technology
Environment. Counselling, Psychotherapy, and Health, 5(1), The Use of Technology in Mental
Health Special Issue, 26-59.
Germain, V., Marchand, A., Bouchard, S., Guay, S., & Drouin, M. (2010). Assessment of the Therapeutic
Alliance in Face-to-Face or Videoconference Treatment for Posttraumatic Stress Disorder.
Cyberpsychology, Behavior, and Social Networking, 13(1), 29-35.
Godleski, L., Darkins, A., & Peters, J. (2012). Outcomes of 98,609 U.S.
Department of Veterans Affairs patients enrolled in telemental health services, 2006–2010. Psychiatric Services, 63, 383–385. doi:10.1176/ appi.ps.201100206

Jedlicka, D., & Jennings, G. (2001). Marital therapy on the Internet. Journal of
Technology in Counseling, 2, 1–15.
Keeran, D. M. (2009). Effective counseling skills: the practical wording of therapeutic
statements and processes. Vancouver, British Columbia, Canada: Counselor
Publishing.
Maheu, M. M., Pulier, M. L., McMenamin, J. P., & Posen, L. (2012). Future of Telepsychology,
Telehealth, and Various Technologies in Psychological Research and Practice.
Professional Psychology: Research and Practice, 43(6), 613-621.
Nesbitt, T. S. (2012). The Evolution of Telehealth: Where Have We Been and Where are We
Going? In The Role of Telehealth in an Evolving Health Care Environment-Workshop
Summary. Retrieved from http://www.iom.edu/Reports/2012/The-Role-of-
Telehealth-in-an-Evolving-Health-Care-Environment.aspx
Novotney, A. (2011). A New Emphasis on Telehealth: How can psychologists stay ahead of the curve-and keep patients safe? Monitor on Psychology, 42(6), 40.