reported rates of women with depression who live in rural areas as high as 40% compared with those living in urban areas (13% to 20%). Suicide rates have increased, as have rates of births of babies whose mothers tested positive for drugs. One solution
offered by state officials is to implement telemental health services. Although the Minnesota Department of Health reports that it lacks a centralized system for training, the department is working toward improving access to services (McCourt, 2017).
TELEMENTAL HEALTH SERVICE PROVISION
Different types of services can be provided using telemental health technology. Some of these clinical uses are (a) clinical interviews for mental status, evaluation, and diagnosis; (b) psychological testing; (c) treatment interventions; (d) remote monitoring of health; (e) clinical supervision; (f) clinical consultation; and (g) case management (Luxton, Nelson, & Maheu, 2016). Telemental health equipment, including hardware and software, can also be used for nonclinical purposes, such as networking meetings, distance education, research, and quality improvement. Technology Requirements and Security Large-scale organizations, such as the Veterans Administration (VA) and hospitals, have often used integrated, single-purpose teleconferencing equipment manufactured by large companies, such as AVAY/Radvision, Cisco/Tandberg, and Polycom (Lustgarten, 2017). These larger systems have teleconferencing equipment that is often in a designated space for professionals to use with clients or in meetings. With increasing popularity, sustained effectiveness in outcomes, and advances in technology, many of these larger systems now utilize software such as Veteran Affairs’ VA Video Connect (Padala et al., 2020). The basic necessities include having the equipment, such as a computer, camera, and microphone. Smaller agencies and private practitioners often use smaller hardware devices such as webcams, computer monitors, and microphones in combination with software, such as Adobe Connect, Cisco WebEx, Citrix, GoToMeeting, Microsoft Live Meeting, Vidyo, and VSee (Lustgarten, 2017). Commonly used video software platforms, such as FaceTime, Skype, and Google Hangouts, do not currently have the required encryption and should not be used for telemental health sessions until they are compliant with the regulations of the Health Insurance Portability and Accessibility Act (HIPAA; Lustgarten, 2017). The video session must comply with HIPAA requirements and ensure there is an end-to-end algorithmic encryption of the video signal (Lustgarten, 2017; Luxton, Nelson, & Maheu, 2016; Swenson et al., 2016). In the event of a technological failure, there must be a backup plan. This plan should include additional phone numbers or emails for follow-up contact. The details of the plan should be part of the written consent and procedures for the session. This plan is typically developed during the intake, or first session, and the plan should be reviewed at the beginning of each session. If a mobile device, such as a smartphone or tablet, is used, it should have security features, such as a login with a timeout function (Swenson et al., 2016). Licensure and Legislation Licensing and certification requirements for telemental health are evolving; therefore, it is important to read up-to-date state requirements yearly. The provision of telemental health across state borders continues to be refined from ethical and practical perspectives, particularly since the expansions and waivers seen during the COVID-19 pandemic. Professional licensing requirements are typically tied to where the client and the professional are physically located at the time the telemental health services are provided (Johnson, 2014; Swenson et al., 2016). Currently, no state licensing boards expressly prohibit the provision of telemental health practice (Swenson et al.,
To determine whether a client is appropriate for telemental health services, the practitioner must assess whether this type of service can be beneficial and what type should be offered. The clinician should take into account the individual’s cognitive and organizational abilities (Swenson et al., 2016). If home-based services are provided, the client should have a level of comfort with the technology before services are given (Swenson et al., 2016). These clinical considerations are discussed in greater detail later in the course. If the clinician loses the device, they should have the capability of disabling or removing data from it. Two- factor authentication, in combination with a username and password, may add protection. Two-factor authentication adds an additional six-factor token that randomly changes and is texted to a mobile phone (Lustgarten, 2017). Clinicians should be especially careful about the security of the video system. A dedicated computer used solely for telemental health services is ideal (Lustgarten, 2017). Practitioners should avoid allowing others who are not providing telemental health services to use the designated computer. In addition, they should avoid downloading extraneous files, clicking on unverified links, or accepting videoconferencing requests from unknown users (Lustgarten, 2017). Agency administrators and clinicians should ensure that antivirus software is purchased and updated regularly. How well a session works depends in large part on the quality of technology and its security. Outdated computers, slow Internet services, and user inexperience can adversely affect the quality of a telemental health session. If audio and/or video output is poor, both practitioners and clients may experience stress and frustration. Technical malfunctions during a session are likely occur at some point, which can add a further burden. Continual technical malfunctions, computer problems, and user inexperience can influence whether clients are motivated to participate in telemental health and adhere to provider recommendations (Luxton et al., 2014). Agencies and private practitioners may want to identify in advance an information technology (IT) person who is familiar with the telemental health system and can help when there is a problem. Clients using technology at home may want to do the same on their end. One way to do this is to set up a test call with a client prior to intake to ensure the technology is adequate to move forward with the telemental health intake and subsequent sessions. 2016). However, many states lack cooperative licensure reciprocity (Lustgarten, 2017). Clinicians should check the legal requirements in their and their clients’ states for conducting assessments and providing telemental health treatment (Luxton, Nelson, & Maheu, 2016). For example, when a telemental health provider is traveling outside of the state where they practice, it is necessary to be aware of the requirements and restrictions for providing telemental health in the state they are visiting before engaging in a telemental health session with a client. The National Association of Social Workers (NASW, 2021a) advises clinicians to follow the laws of both jurisdictions (where the client is located and
Page 165
Book Code: PYCA2725
EliteLearning.com/Psychology
Powered by FlippingBook