can manifest in several ways. For example, a healthcare provider might unconsciously give less attention to a patient or make assumptions about their medical needs based on race, gender, or age. The unconscious assumptions can lead to delayed or inadequate care, misdiagnoses, or inappropriate treatments, all of which can adversely impact health outcomes. Addressing implicit bias in healthcare is crucial for achieving equity in medical treatment. Strategies to combat these biases involve education and awareness programs for healthcare professionals. These programs
help individuals recognize and acknowledge their biases, fostering a more empathetic and unbiased approach to patient care. Additionally, implementing policies and procedures prioritizing equitable treatment for all patients can play a pivotal role in reducing healthcare disparities. Ultimately, confronting implicit bias in healthcare is essential to creating a more just and equitable healthcare system where everyone receives fair and equal treatment regardless of their background or characteristics.
INTRODUCTION
Telemental health is a broad term that refers to the provision of behavioral health (e.g., mental health) services to an individual, couple, family, or group using telecommunications or videoconferencing technology (Lustgarten, 2017; Luxton, Pruitt, et al., 2016; Ostrowski & Collins, 2016). Telemental health is also a healthcare concept that embodies remote communication between a practitioner and client. During their initial training, clinicians learn the fundamentals of clinical services, including assessment, diagnosis, treatment, and evaluation. They also learn important information about licensure, ethics, confidentiality, and privacy. However, because technological advances in telehealth and telemental health are developing so rapidly, many practitioners may not have learned about how these advances can be integrated into clinical practice. Videoconferencing technology has been used successfully to conduct psychiatric evaluations in emergency departments (Letvak & Rhew, 2015). Psychiatrists using telemental health services report no changes in the disposition recommendation, diagnosis, and risk of danger in evaluations conducted face to face when compared to teleconferencing. Telemental health service delivery may also result in a reduction in time in treatment, length of hospital stay, and required consultation time. Additionally, psychiatrists report lower recidivism rates and involuntary commitments in rural areas, likely because of the availability of mental healthcare using telemental health services.
Research trials have shown no evidence that telemental health delivery of evidence-based mental health treatment is less effective than in-person delivery, even in the treatment of complex disorders like posttraumatic stress disorder (e.g., Acierno et al., 2017). This is also the case with suicide risk assessment in crisis situations. Instead, there is evidence that in-person and telemental health provision of treatment and risk assessment are not statistically different in outcomes; thus, telemedicine is not inferior. However, this is an important bias that therapists still hold, especially for suicide risk assessment (Gilmore & Ward-Ciesielski, 2017). The purpose of this intermediate-level course is to provide a basic framework for understanding issues relating to telemental health, also called telebehavioral health, services. This course is designed for practitioners who have a foundation in providing clinical services but who may be unfamiliar with telemental health. This course is designed for counselors, marriage and family therapists, psychologists, and social workers who provide mental health services and offers introductory information to support clinicians in their quest for developing telemental health practices. Please note that patient is the standard term used in much of the existing literature and in many treatment settings, whereas client and consumer are equally preferred terms in many settings where behavioral health professionals work with individuals, families, and groups. These terms are used interchangeably throughout the course.
TERMINOLOGY
There are multiple types of telemental health modalities, including synchronous live video, store-and-forward (asynchronous) video, remote patient monitoring, and mobile health (National Quality Forum, 2017). Synchronous live video is a two-way interaction between a patient and practitioner in real time. Store-and-forward asynchronous communication is the transmission of premade videos or digital images through a secured electronic communication system to be viewed at a later time. Remote patient monitoring is a mechanism for collecting health-related data that are transmitted from a patient to a provider at a different location. Finally, technology-based interventions can include mobile health (mHealth), which uses smartphone applications, or web-based interventions that both store and track personal data for use individually or in connection with another provider. Table 1. Terms Used for Telemental Health Telebehavioral health Behavioral health services using video conferencing
There is a body of literature for each of the types of telemental health technologies. This course addresses telemental health services that allow practitioners and clients to converse using videoconferencing in real time (i.e., synchronous interaction; Luxton, Nelson, & Maheu, 2016). The video capability of this type of telemental health service allows clinicians to interact directly with clients as well as observe nonverbal behavior, conduct assessments, provide treatment, and evaluate progress using a video platform. The terminology used by different professionals, state entities, and licensing organizations varies widely. Although many terms essentially refer to the same service provision, telemental health has a number of other names that are used depending on the discipline, setting, and context. Table 1 lists the terms that appear in the literature referencing telemental health.
eHealth/mHealth Internet counseling
Cybertherapy
Video counseling/therapy
Online counseling/online therapy
Telepsychology Video chat Telecounseling E-mail therapy Internet therapy Clinical videotherapy
Telemedicine
E-therapy
Web therapy Digital health Data from Lauckner & Whitten (2016); Luxton, Nelson, & Maheu (2016); National Institute of Mental Health Advisory Board (2017); Ostrowski & Collins (2016). Telepsychiatry
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