Telemental Health Background: Practice Considerations

• Assess clients for suitability for telebehavioral health. This may include: ability to engage in and fully understand the risks and benefits of the proposed intervention using specific technologies; cultural, linguistic, socioeconomic, and other individual characteristics (e.g. medical status, psychiatric stability, physical/cognitive disability, personal preferences), and organizational cultures that may impact effective use of telecommunication technologies in service delivery.
• Recent reports suggest that many at-risk populations, including poorer and elderly Americans, lack high-speed Internet access.
• Ensure that clients have access to a private and safe location and verify their location of your client in order to contact emergency services if they are needed. Familiarize yourself with crisis intervention community resources that are local to clients.
• Be aware of the potential challenges, including the potential for distraction from both the provider and patient (multi-tasking and phone/computer messaging interruptions), difficulty with internet and device access and connectivity, lack of technological expertise, and level of appropriateness and acuity. Expect potential interruption i.e. children, spouses, or pet.
• On the other hand, practitioners may gain greater insight into a client’s life by having access to their home and potential encounters with the individuals with whom they live.
• One evidence review identified 4 interventions that met the evidence criteria and improved health outcomes for people experiencing SMI when delivered via telehealth: Behavioral Activation (BA) Therapy, Cognitive Behavioral Therapy (CBT), Cognitive Processing Therapy (CPT), and Prolonged Exposure (PE) Therapy.
• While providers can administer screening tools to assess risk of SUD using telehealth, there is limited evidence for confirmation and diagnosis of SUD through telehealth.
• Pharmacotherapy for SMI can be implemented using synchronous telehealth. In fact, prescribing and monitoring medication using telehealth can lead to reduced length of hospitalization and symptomology.
• Limitations when using teletherapy to prescribe and/or monitor medication may include the ability to evaluate movement disorders and test muscle tone (e.g., in order to gauge rigidity as a side effect of a medication.