The clinician should make arrangements for potential crises with the originating site by outlining agreed-upon plans for managing potential crises. Given that telebehavioral health sessions are not conducted in the same office, assessment protocols may need to be adapted. With minimal adaptation, some psychological tests can be successfully administered remotely (Luxton, Nelson, & Maheu, 2016). Materials for tests may be sent ahead of time to clients to review before the session. A clinician can arrange for a personal attendant to be in the room with the client to administer certain performance measures or provide materials, such as paper and pencils, that are needed. The practitioner should carefully review the informed consent paperwork and treatment protocols prior to the treatment phase. If practitioners administer psychological or behavioral instruments, the instructions and/or manuals should be reviewed with the client prior to the assessment (Luxton et al., 2014). If nonverbal behavior is not readily observed through video, clinicians should ask clients about behaviors such as changes in psychomotor abilities or agitation. The clinician must determine whether instruments are able to be administered through video without a physical presence. If an instrument is administered, the client should be prepared at the site with the materials necessary to complete it. Online assessment may have some advantages over traditional paper-and-pencil instruments. Generally, online assessments are less time-consuming and less expensive (Luxton, Nelson, & Maheu, 2016). When data are entered online, they can be populated into a database, which allows for less error than individual entry. Smartphones and applications (apps) also have become integrated for data collection and assessment. Some apps allow for data, such as mood or anxiety symptoms, to be uploaded into the application in real time to allow for tracking. The interactive nature of technology can allow the clinician and client to track and review data collected in real time rather than by post hoc self-reporting.
Given the numerous telehealth technologies that are available and their increasing use, practitioners who use them need to be cognizant of factors that influence the psychometric properties of psychological assessments when administered via telemental health. Practitioners need to know whether a given measure or assessment technique is appropriate for use and be familiar with the proper administration procedures to ensure competent and ethical practice (Luxton et al., 2014). The primary and most obvious difference between telemental health assessment and in-person assessment is the fact that the client is not in the same room as the clinician. The lack of in-person presence may influence a client’s clinical presentation, including what and how symptoms or other information are assessed or the limits to the range of information available or its observation. For example, clients who are socially anxious may underreport symptom severity when they are assessed remotely because there is anxiety associated with the clinician being physically distant (Daniel & Sulmasy, 2015; Luxton et al., 2014). Individuals who suffer from certain disorders, such as panic disorder, agoraphobia, and PTSD, may find the use of telemental health technologies helpful because they are not required to put themselves in anxiety- provoking environments, such as driving to a clinic or being around strangers in a busy waiting room. Practitioners should consider whether there is an increased risk for dishonest responses from clients who take assessments on the Internet or through other types of remote technologies. In situations where clients take online assessments, clinical control over the environment is reduced (Luxton et al., 2014). For example, a client who takes a depression inventory while attending a social function may enter different responses than one who completes an instrument in the office. When providing telemental health services to a client, the clinician should inquire about the circumstances under which the assessment was completed.
TREATMENT
Before implementing treatment using telebehavioral health, practitioners should know the different technologies that are available and their strengths and limitations (Johnson, 2014). The clinician and client must discuss and agree on the best strategy for treatment within the current context. Some clients may have broadband Internet with adequate speed for live videoconferencing. Others may not have the speed and broadband width necessary for video but may be able to use asynchronous methods, such as email or text messages, to communicate short-term needs. Both practitioners and clients will need to have a basic set of technical skills or training before embarking on a treatment regimen. Providers will likely need to tailor interventions to fit within a telemental health framework. The basic necessities include having the necessary equipment, such as a computer, camera, and microphone. Clinicians may also provide supplemental materials along with their video interventions, such as follow-up emails or texts, an online forum, and/or homework (Johnson, 2014). Many research studies document the effectiveness of telemental health services in treating individuals with a
variety of behavioral health problems (Lauckner & Whitten, 2016; Lustgarten, 2017). Studies reveal that mental health outcomes from telemental health services are as effective as those for face-to- face treatments for individuals who have the following conditions: Panic disorder (Lauckner & Whitten, 2016; Lustgarten, 2017), anxiety (Bischoff et al., 2017), depression (Bischoff et al., 2017; Lauckner & Whitten, 2016; Lustgarten, 2017; Luxton, Pruitt, et al., 2016), PTSD (Lauckner & Whitten, 2016; Lustgarten, 2017), military combat–related PTSD (Acierno et al., 2016; Wierwille et al., 2016; Yuen et al., 2015), substance use (Lustgarten, 2017), chronic pain (Lustgarten, 2017), acquired brain injury (Bergquist et al., 2014), and obsessive-compulsive disorder (Stubbings et al., 2015). There is also initial research to suggest this modality can be effectively implemented for diagnoses seen as too complex for this format before virtual implementation during the COVID-19 pandemic, such as borderline personality disorder (Zimmerman et al., 2022) and psychosis (Chaudry et al., 2021).
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Book Code: PYCA2725
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