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.
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
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