Clinicians may need to assess a client’s psychomotor skills and other symptoms through direct observation. The lack of face-to-face presence may limit this type of information that can be gained during an assessment; however, it should also be considered how utilization of the client’s home environment may result in more natural observations, assessment, and treatment. As previously mentioned, the therapist should know the emergency medical facility closest to where the client is located in case an emergency arises (Swenson et al., 2016). Emergency management is discussed in further detail in other sections of this training; however, the following is a case example of a therapist in private practice initiating a telemental health intake with a patient. The patient lives in a rural setting within the same state as the therapist, and the patient has never received therapy via telemental health. Therapist: Hi, Sarah, so wonderful to meet you. In a moment, we will begin our intake. But first, I’d like to ask you a few questions to ensure that we have the best session possible over video. How familiar are you with video chatting? Have you done this before with friends, family, or a therapist? Patient : Yes, I’ve video chatted with friends and family before, but never with a therapist. Therapist : That’s great—so you have done this before! What we will do is very similar, but there are some slight differences. First, if you were to come into my office, we’d have a private space. For our sessions, I’d like you to pretend like you are coming into an office. So you’ll need to have a quiet and private space to limit distractions with no children and no one listening in, and you will act just like you would as if we were in a session together in my office. What this means is that you need to be fully dressed as if you were coming into an office and stay in our session for the full time (don’t take a break in the middle to do chores, answer your door, make a snack, etc.). You will also need to be in one location, for example, you should not be in a moving vehicle. Do you have any questions about that? Patient : No, that makes sense. My video chats are usually with friends or family, so I can see how these sessions will need to be a little different so that I can concentrate during the session. Therapist : Exactly, Sarah. The next thing we need to discuss is what to do if our technology stops working. Do you have a phone that I could call if we lose our connection? Patient : Yes, you could call my cell phone because I’m on my computer. The number is 123-456-7890. Therapist : Great! I will write that down and have it just in case something happens. Next, if you were in my office and something unexpected and awful happened, like you fell to the ground or had a heart attack, I would have a specific procedure to follow. We do the same for video sessions, so you and I need to come up with a specific procedure to follow. First, I need to know your current address; that is, what location are you video chatting from? Patient : My address is 100 Rural St., Countrytown 01234. Therapist : Thanks! I will check this at the beginning of each session just so I know where you are. Next, let’s review your emergency medical services nearby. From what I can tell [therapist looks up address online for emergency medical services], it looks like your nearest hospital is Countrytown General Hospital—is that correct? Patient : Yes, that’s right. Therapist : Great. So if something unexpected were to happen—for example, if you have an unexpected acute physical problem, or if you tell me you are going to harm
yourself or someone else and you are unwilling to safety plan with me—I am going to call 9-1-1 and follow-up with that hospital. Does that make sense? Patient : Yes, that sounds good. Therapist : The next thing I’d like to see is if there is anyone else in your home or a neighbor who is home whom I could try to contact to come and check on you while we are waiting for the emergency medical technicians to arrive if something were to happen. Patient : My husband is usually at work, but he works close by, so you could call him. His number is 987-654-3210. Therapist : Great, so the plan would be to call 9-1-1 and then call your husband. This sounds like a solid plan. Is there anyone else in your home whom I should know about in a situation like this? For example, are there any children, animals, or parents that you take care of? Patient : No, just me. Therapist : Ok, great, I will check every time just in case. Do you have any concerns about video chatting? I want to make sure we cover everything before getting started. Patient : The only question I have is what happens if I don’t feel connected to you. I’ve only seen therapists in person, and I end up really liking going to therapy, but I’m not sure if I will feel that way just video chatting because I don’t really know you and I’m not sure I’ll be able to open up. Therapist : Thank you so much for sharing that with me. I agree—sometimes it can be hard to feel connected if you’ve never met someone in person, and it can be hard to open up. Sometimes, the opposite happens in teletherapy sessions though, too, and people feel like they can open up more because we have a little bit of “space” between us— or they may feel more like themselves being at home. Patient : That makes sense. I could see that happening too. Therapist : Either way, let’s make sure we check in on that. I’ll make sure to regularly check in about these things so that we can figure out if this is the best mode of therapy for you, or if we are not a good match for therapy, so that we can get you to a provider or a mode of therapy delivery that will work for you. My goal is to make this experience as helpful as possible and to help you on your road to recovery. So if this doesn’t work out, we’ll look for a different option. Knowing that, are you willing to give telemental health a try and start our session today? Patient : Yes, that sounds good. There are advantages of using telemental health capabilities for behavioral and mental health assessments. It can reduce the costs of transportation and travel for practitioners and/or clinicians, increase access to services that might otherwise be unavailable, and provide services that are convenient to use (Luxton et al., 2014). For clients with anxiety symptoms, such as those with posttraumatic stress disorder (PTSD), agoraphobia, and panic disorder, telemental health services may be one of the best ways to conduct assessments and offer treatment. Clients with severe anxiety may feel that going to a clinic for services is overwhelming. In these cases, home-based telemental health services can allow clients to receive treatment in a place where they feel safe. However, if there is a high risk of self-harm or severe symptoms that may need immediate management, clinicians may want to consider another option or have an emergency plan in place prior to beginning treatment. For example, a clinician may need to refer the client to an on-site provider at a clinic to intervene in a crisis situation. A practitioner may ask a staff person at the originating site, who may or may not be a therapist, to act as a personal attendant during a therapy session.
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Book Code: PCUS1525
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