● Ensure that the clinician has the client’s physical location documented. ● Both the clinician and client should review the safety plan and the expectations of both parties prior to the beginning of treatment. Additionally, it is recommended to include review of expectations in terms of behaviors that may otherwise
acceptable be in the home environment but would detract from the telemental health session, including maintaining sobriety, not driving or being in a moving vehicle during session, removing drug paraphernalia and potential weapons from where they will complete the session, and being fully clothed.
ASSESSMENT AND DIAGNOSIS
As with any assessment and diagnostic interview, clinicians must understand the concerns, symptoms, and problems that clients bring to therapy. Behavioral health practitioners assess individuals as whole and unique persons who live within an environment that affects health and well- being (Johnson, 2014; Sheafor & Horejsi, 2015). Typical assessments include evaluations of an individual’s cognition, intellect, physical and mental health, communication ability, coping styles, spiritual and religious supports, and community resources. In addition, the clinician should gather information about the client’s economic conditions, culture, legal issues, employment, and family involvement. The practitioner should also evaluate nonverbal communication, such as eye contact, gestures, personal space, body positioning, facial expressions, touch, arm and hand movements, and dress and appearance (Luxton et al., 2014; Sheafor & Horejsi, 2015). In traditional face- to-face settings, these nonverbal cues are readily seen and evaluated; however, conducting assessments through video conferencing requires additional preparation and adaptation. Guidelines for assessment and preliminary diagnosis suggest that clinicians should conduct face-to-face assessments initially when possible (Johnson, 2014; Luxton, Nelson, & Maheu, 2016; Swenson et al., 2016). Practitioners may want to review an individual’s file prior to the first meeting to ascertain the client’s cognitive, intellectual, and psychological needs that may impair the ability to use telemental health (Johnson, 2014; Luxton, Nelson, & Maheu, 2016). One of the first issues that should be addressed is whether a remote video intervention is appropriate for service provision, as discussed later in the course. The risks and benefits of the use of video therapy should be discussed with the client. Practitioners should conduct ongoing assessments of whether remote therapy continues to be appropriate. Clients who exhibit certain symptoms, such as active psychosis or extensive self-harm behaviors, and practitioners who rely primarily on nonverbal or symptomatic client cues, such as those present with individuals who have severe developmental disorders, may need to consider the risks and limitations associated with remote assessment (Luxton et al., 2014). Practitioners may find it difficult to rely on nonverbal senses to gain information about such areas as personal hygiene, alcohol use, or substance use when delivering services using remote video services. 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.
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Book Code: SWFL1825
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