locating in-network behavioral health providers. There are high rates of authorization denials and barriers that inhibit access to psychiatric medications. Individuals experience high out-of-pocket costs for prescriptions and mental health visits. Finally, clients often do not have sufficient information about mental health treatment and insurance plan coverage. Once clients have access to telemental health services, they typically report high levels of satisfaction and acceptance (Bergquist et al., 2014; Bischoff et al., 2017; Crowe, 2016, 2017a, 2017b; Lustgarten, 2017; Martin-Khan et al., 2015; Vernig, 2016). They also report increased knowledge, enhanced confidence, and decreased isolation (Lauckner & Whitten, 2016; Lustgarten, 2017). In addition to client satisfaction and accessibility, telemental health services can be used to deliver an array of behavioral health services. It should be noted, however, that even with recent expansions, there appear to be barriers to telemental health access for those of increasing age, lower socioeconomic status, and/or a history of schizophrenia and psychiatric hospitalization (Connolly et al., 2021).
Residents of rural Minnesota experience a variety of stressors that result in increased numbers of individuals with depression and substance use problems. The Minnesota Department of Health 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
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. 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). 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).
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