children and adolescents (Comer & Myers, 2016; Lau et al., 2021).
CLINICAL CONSIDERATIONS
Much of the research on telemental health describes positive outcomes and benefits for clients. Advocates of telemental health cite convenience, cost savings, and access to services for underserved populations and rural geographical areas as being among the most favorable effects of technology-driven services. However, practitioners should make informed decisions about when to offer services face to face or via telemental health. Developers offer an increasing number of telemental health technologies and applications, but their effectiveness should not be assumed without empirical efficacy studies (Daniel & Sulmasy, 2015). Procedures for some assessments may not lend themselves to remote administration without a physical presence. For example, the Wechsler Adult Intelligence Scale (Wechsler, 2008) involves hands-on interaction, such as administration of the Block Design, Matrix Reasoning, and Visual Puzzles subtests from the Perceptual Reasoning Index, which would be inappropriate and impractical to administer via telemental health (Luxton et al., 2014). In some instances, assessments, such as cognitive functioning tests, may be administered through telemental health technologies with an on-site staff person. The staff member can administer the assessment and then share the results with a remote clinician who scores and interprets them. Practitioners who use remote technologies must consider clients’ cultures, backgrounds, and experiences. Such factors as age, familiarity with technology, and culture- specific norms can determine whether telemental health services are effective (Comer & Myers, 2016; Luxton et al., 2014). For example, the remote physical presence inherent in telemental health may create barriers that inhibit clients’ engagement and therapeutic rapport with the therapist. Individuals from some cultures, such as those that emphasize interpersonal connectedness, may have difficulties using telemental health technologies. Some clients may be less comfortable with or have less experience using technology. Some individuals, such as those who are elderly or who are below the poverty threshold, may be reluctant to engage in treatment using remote technologies. Clinicians should be aware of the impact that the use of technology may have on the client. For example, clients and practitioners can experience eye strain or physical fatigue when using technology. The individual may need technological aids, such as a headset or screen magnification, to use the equipment effectively (Luxton, Nelson, & Maheu, 2016). Individuals may have different levels of knowledge about technology, including vocabulary, device settings, and troubleshooting skills. These facets of telemental health should be addressed and discussed prior to beginning treatment. Many studies of telemental health services show similar clinical effectiveness to traditional face-to-face services. However, the parameters of telemental health’s effects are less studied and not well understood (Agboola & Kvedar, 2016; Comers & Myers, 2016; Daniel & Sulmasy, 2015). Traditional clinical trial designs testing relative efficacies between remote and clinic-based formats may only offer a partial understanding of the effects of telemental health use (Comers & Myers, 2016). For example, studies of telemental health services provided to children for behavioral problems show advantages over clinic-based therapy because telemental health services can be provided in the home
where the behaviors are occurring. However, only those families who have a high level of technological proficiency with access to technology and broadband services have access to the services. Thus, clinical efficacy with those who are not familiar with technology and who may not have the resources to pay for technology may be different. Some practitioners who work with children are not convinced that telemental health is the best way to work with them. Similar to those working with adults, clinicians may have concerns about the therapeutic alliance and engagement with child clients. The safety of the client during telemental health sessions is particularly important when practitioners determine whether to use telemental health (Luxton et al., 2014). A particular concern is what to do if the client becomes distressed or has a medical emergency during the session. Clinicians and clients should develop a written safety plan that includes procedures for contacting emergency services where the client is located and alternative methods of contact in case the telemental health technology becomes disabled. It may be helpful to identify someone locally, such as a family member or friend, whom the clinician can contact in case of an emergency. Similarly, the advancement of mobile applications also raises patient safety and privacy concerns (Agboola & Kvedar, 2016). Telemental health practices have evolved from basic technology, such as telephone communications, to more complex smartphone-based applications. Some developers of these technologies lack medical training and do not involve clinicians in the development and implementation processes. Many of these mobile applications are marketed directly to consumers without the need for clinical assessment prior to their use. Agboola and Kvedar (2016) offer recommendations to improve the safety of telemental health applications for consumer use. ● Incorporate patient safety into all phases of telemental health applications. ● Integrate safety testing as part of the usability and efficacy trials. ● Update and use the most recent data security and encryption systems to protect privacy. ● Encourage regulatory and professional bodies in the development of operational protocols, standards, and guidelines. ● Disclose possible risks of telemental health use in the consent process prior to treatment. ● Create systems for documenting telemental health services as part of the client record. ● Develop alternative systems of care for clients who do not have adequate technology or literacy skills. Clients who have a history of negative, excessive, or adverse reactions to treatment, such as severe panic attacks, impulsivity, or repeated attempts at self-harm or harm to others, may not be appropriate for remote telemental health services (Daniel & Sulmasy, 2015; Luxton et al., 2014). The lack of in-person contact can carry potential risks, such as misdiagnosis, inappropriate prescribing, loss of therapeutic touch, nonverbal miscommunication, potential medical errors, and loss of continuity of care (Agboola & Kvedar, 2016; Daniel & Sulmasy, 2015). However, research up until this point suggests that implementation of telemental health is often effective compared to no treatment when timely in- person services are not available.
Page 134
Book Code: SWFL1825
EliteLearning.com/Social-Work
Powered by FlippingBook