A new emphasis on telehealth
How can therapists and psychologists stay ahead of the curve — and keep patients safe?
Telehealth stands to overcome barriers by giving patients the chance to access services in their own homes, offices, cars – wherever and whenever needed. And that access is enabled through a laptop, tablet or smartphone, rather than the doctor’s office. It’s an avenue both discreet and personal, appealing to a growing population struggling with sensitive feelings.
Therapeutic Solutions is one of a growing number of behavioral health agencies seeing patients via video teleconferencing. The practice has been in place for almost 20 years at the Department of Veterans Affairs and other government organizations that serve patients in rural areas. But over the last decade, more therapists and psychologists have begun offering “telepractice,” also often referred to as “telepsychology” or the newer term, “telemental health” and the older, more generic “telehealth.” The terms refer to providing psychological services remotely, videoconferencing.
Those in the telehealth trenches say it improves access to care for people who live in remote areas or who, due to illness or mobility problems, can’t leave home. The practice also enhances psychological services by allowing therapists and psychologists to support clients between visits. Medicare, Medicaid and other third-party reimbursement is available for therapists and psychologists who deliver such services via videoconferencing and follow specific guidelines.
“By insisting that patients come to our offices, we’re excluding potentially millions of patients who need care,” says Carolyn Turvey, PhD, a professor of psychiatry at the University of Iowa and vice chair of the American Telemedicine Association’s Telemental Health special interest group.
Timely diagnoses by behavioral clinicians via telehealth, for example, can help a child with autism in a rural community remain in school and improve socialization, she says. Or a quick check in via telehealth can help an older adult in a nursing home control her temper. “Being more open to telepsychology is really going to help many needy people who just can’t meet the requirements of current face-to-face practice,” she says.
Turvey says much of telepsychology’s growth can be attributed to consumer demand — particularly from younger clients. As people become more accustomed to the convenience of online commerce and keeping up with friends and family via social networking websites, interacting with a therapist online may become just another convenience that’s expected.
The expansion of telehealth would help address several hurdles to securing mental health services. Nearly 80 million Americans live in a mental health professional shortage area, according to the U.S. Health and Human Services Health Resources and Services Administration. Even in urban environments where therapists and psychologists abound, cost, transportation and time constraints often prevent people from seeking mental health services.
In addition to these structural barriers, a 2009 Substance Abuse and Mental Health Services Administration survey found that less than one-quarter of the estimated 45 million American adults who have a mental illness received treatment. One major reason for the low number: stigma and embarrassment about making contact with a therapist. Telehealth — be it video conferencing — can help solve many of these access problems, says Eve-Lynn Nelson, PhD, assistant director of research at the University of Kansas Center for Telemedicine and Telehealth.
“Technology really helps us get more bang for our buck and extend our service reach,” says Nelson, who has been researching and providing video-based mental and behavioral health services to children and adults for nearly a decade.
A 2008 meta-analysis of 92 studies, for example, found that the differences between Internet-based therapy and face-to-face were not statistically significant (Journal of Technology in Human Services, Vol. 26, No. 2). Similarly, a 2009 review of 148 peer-reviewed publications examining the use of videoconferencing to deliver patient interventions showed high patient satisfaction, moderate to high clinician satisfaction and positive clinical outcomes (Clinical Psychology: Science and Practice, Vol. 16, No. 3).
Online safety and security
In addition to understanding the licensing barriers around telehealth, psychologists must also educate themselves on the ethical and legal challenges of providing telepsychology.
Successful telehealth programs traditionally follow an in-person assessment by a licensed health or mental health professional, such as a licensed therapist, psychologist, physician or nurse, who then gives a referral to a telehealth practitioner. The in-person intake allows for thorough assessment, history taking, proper identification of the patient, including examination of a driver’s license, assessment of grooming and hygiene, substance abuse, movement and speech aberrations, general health and social skills. This model leads to a greater likelihood of adherence to evidence-based treatment as well as safety precautions.
“Greater use of online therapy is definitely realistic,” Maheu says, “but only with focus on research-based patient safety and other protocols.”