Telebehavioral Health is Psychology’s Future

By Jodi Andes, Associate Editor
July 31, 2017

teleconference therapyThe practice of having psychologists treat patients in different cities via teleconferencing is not only becoming more common, research is also proving it is more beneficial in some cases.

And, thanks to the recent approval from two states this year, the practice of treating patients via teleconferencing across state lines also is moving closer to reality.

The practice of psychologists treating and diagnosing patients through teleconferencing has taken on many different names over the years, though it is becoming more commonly referred to as telebehavioral health, said Marlene Maheu, Ph.D.

Maheu has studied the practice for more than 20 years and said research is showing that when done properly, telebehavioral health has benefits for both the patient and clinician. She is the executive director of the Telebehavioral Health Institute, who lectured a group of psychologists and social workers in Columbus, Ohio, on June 2 and 3.

Studies have shown that online treatment can not only be as efficient as in-person care, regular telebehavioral health treatment can also decrease a patient’s hospitalization rate. The practice also provides patients with an increased access to specialists.

One of the most noted studies on the topic is also one of the largest in terms of survey size, Maheu said. The Godleski study, as its commonly called, looked at 98,609 patients in the Veterans Administration who utilized teleconferencing for at least six months.

Patients in the study were then followed for four years. When the study was published in 2012, it showed the use of teleconferencing had decreased patients’ hospitalization rate by as much as 25 percent.

Another benefit of telebehavioral health is that patients have more access to specialists than ever before. For example, teleconferencing allows the patient to be treated by a local psychologist and have a second clinician conference in for a consult, she said.

Someday, state licenses may not be as much of an issue, she said. That’s because a movement for a compact agreement among psychologists in different states is gaining traction.

The Association of State and Provincial Psychology Boards (ASPPB) created the Psychology Interjurisdictional Compact (PSYPACT) in February 2015 “to facilitate telehealth and temporary in-person, face-to-face practice of psychology across jurisdictional boundaries.”

It took a year before any state signed the agreement. Then Arizona became the first to recognize the compact in 2016. Nevada and Utah followed by approving the agreement in May and March of this year, respectively. More work is needed before psychologists can practice in states other than where they are licensed. For the compact to be binding, at least seven states must sign.

More states are expected to follow in the coming years, said Kenneth Drude, Ph.D. Drude is a psychologist in Fairborn, Ohio, who served on the American Telemedicine Association’s committee that came up with guidelines for practicing telebehavioral health.

“I think it’s just a matter of time. This is a natural development. Psychology needs to get on board. We are a very mobile society,” Drude said.

Illinois, Rhode Island and Texas have legislation pending that could add them to the list. And state boards have recommended the agreement in Missouri, New Mexico, Ohio and Wisconsin.

Though research supports the practice of telebehavioral health, psychologists should do some pre-planning and exercise caution before first using teleconferencing, Maheu said.

For starters, it is important for a psychologist to know in advance where the patient will be during the session and who will be around. Will their children or others be there who can disrupt the patient?

A release form should address those issues, as well request that the patient not record the session, she said. In addition, the psychologist should know in advance who emergency contacts are in the area – such as a nearby hospital or first responders – just in case anything goes wrong.

During the session clinicians also need to stay in charge, just like they would for an office visit. For example, if someone enters the room with the patient while the session is on-going, she recommends ending the session and rescheduling for a time when the patient can be alone.

And always remember, she said, treating someone online doesn’t eliminate face-to-face contact. Maheu recommends that psychologists continue to see the patient in person on a regular basis. How often depends on the patient.

For example, in-person visits could be merited every fifth or tenth time – depending on the patient and the severity of the condition.

Currently, states don’t require certification for practicing telebehavioral health, but some insurers do. Maheu said she recommends certification and training so the practitioner is up to date. When there are questions, go to experts for help, she said; guidelines have been devised by the American Telemedicine Association. And she suggests follow the literature and research.

A word of caution she shares is to avoid what is generally being called anonymous care. That is when companies hire you to care for patients they bring to you; there is no way to verify who the patient is. The company gets a cut for bringing the psychologist the patient, but the psychologist assumes all the liability.

Work only with previously identified patients who are brought in at times for an in-person assessment. In general, care should be the same in telebehavioral health as is done in person: “good, traditional responsible care. All the same legal and ethical issues apply,” Maheu said.

Some countries, including Australia, Great Britain and New Zealand, have been doing this for much longer and offer guidelines. So even though a psychologist may be in practice alone, they don’t need to learn this alone.

It is the future in psychology, she said: “There is hope. It is happening.”

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