by: Meghan Barlow, Ph.D., Meghan Barlow and Associates
Telemental health is the term used for mental health sessions that are conducted via phone or video conferencing.
Research on telemental health suggests that it can be as effective as in-person therapy in terms of clinical outcomes. Clients engaged in telemental health report high levels of satisfaction and rapport with their clinicians. It’s actually the clinicians who tend to be more hesitant to engage in telemental health. The legal, technical, and practical aspects of offering telemental health can be daunting and many clinicians report that it’s harder to pick up on nonverbal communication during virtual visits. Clinicians who work with younger children may find it hard to develop rapport with kids over video conferencing.
Mental health clinicians should be specially trained to deliver telemental health. There are ethical and legal considerations that need to be understood by a clinician. Additionally, there are also clinical issues to consider.
Under normal circumstances, platforms like Zoom, Skype, or FaceTime should not be used to deliver telemental health. These systems are not HIPAA compliant. However, during this pandemic, some rules have been “relaxed.” Clinicians are encouraged to make every attempt to comply with the usual regulations, but are given some leeway to use their best clinical judgment in order to make sure that their client or patient’s mental health needs are being met while we are all being asked to stay at home.
Telemental health sessions are not always covered by insurance or Medicaid/Medicare. You should check with your carrier to see if your sessions will be covered. In the past, video conferencing sessions were more likely to be covered than phone sessions because they are considered “face to face” care. During this pandemic, it is acknowledged that not everyone has access to the required technology for video sessions and, therefore, phone sessions may be covered.
One aspect of telemental health that clients and clinicians need to be aware of is confidentiality. It is sometimes difficult for a clinician to know whether or not a session can be overheard by someone else and therefore, clients share some responsibility in making sure that they are in a private area. Clinicians working from home during the pandemic have a responsibility to make sure sessions can not be overheard by others in their home.
While we’re all getting used to using video conferencing platforms, we have to be prepared for technology related glitches. If the internet connection is poor, clients and clinicians should have a back up plan for how to get in touch.
If you’re going to engage in telemental health, your clinician (or your child’s clinician) should provide you with an informed consent form. This document outlines the potential limitations of telemental health and the roles and responsibilities of the clinician and client/family.
If a child is already working with a therapist who can offer telemental health, I would encourage the parents to talk to their child’s clinician. A clinician should be able to make a recommendation for a specific client regarding the utility or need for televisits. If parents are looking to begin therapy for their child, I would encourage them to call the clinician they have in mind to get some information and give some information. There isn’t necessarily an age criteria for when and if a child could participate in telemental health. If it is determined that the child might not benefit from telemental health sessions, there is still a possibility for the clinician to work with the parents through televisits.
Personally, I would make a decision about whether or not I thought we should have a virtual consultation - an initial visit where the parent or caregiver would give me pertinent background information, share their current concerns, and answer any questions I have related to their child’s development, behavior, or emotions. I might “meet” the child during the televisit and try to gauge the child’s willingness and ability to interact over the video conference. For a very young child, I may be observing their play in the background while I talk with the parent. I would be able to give some recommendations about how to move forward. That might include parent coaching (me working with the parents who would then adjust or modify their approach with their child in order to achieve the identified and desired outcome), me working with the parent and child together, or me working with the child individually. I also might make recommendations about involving other specialties or services. It would depend on the questions and concerns the parent brings to the table and the information and observations that I could glean from the televisit.
Clinicians can utilize telemental health in ways that are innovative and convenient with children. Using creativity, clinicians can find ways to engage with younger clients in a playful way. Screen sharing can help clinicians use visuals in therapy, as they would if they were meeting in person. My colleague, Dr. Dukes-Murray, recently attended a training in assessing autism in toddlers using telemedicine. In one of the telemedicine webinars I attended, the psychologist leading the training mentioned that she runs groups for children as young as 8 years old through video conferencing.
Transitioning my practice to telemental health has been eye opening for me. Until a few weeks ago, I only engaged in telemental health on a very limited basis and only under certain circumstances (an established patient away at college, phone sessions with a parent whose work schedule prohibits attendance at in-person sessions, etc). As I adapt to the need to stay at home and keep others at home while still being able to meet the needs of my patients and families, I’ve been able to stretch my own skill set and learn new approaches. I’m excited about the possibilities that will open up for me and the families I work with now that I’ve had training in telemental health and the necessity to become comfortable with the technology.