Dr Rockland-Miller is a Clinical Advisor at Mantra Health and Director Emeritus of the Counseling Center at UMass Amherst.
All of us are experiencing uncertainty and worry in the face of the Coronavirus pandemic. Social distancing, while necessary at this juncture, comes at a cost. Connection is always critical to our emotional health. Now, more than ever, it is critically important to find ways to maintain deep interpersonal connection. As therapists, many of us are accustomed to using phone visits when patients are away or sick. During this current public health crisis, I have learned that several of my colleagues have decided to use phone calls and messaging over conducting face-to-face, video sessions. In this article, I outline the reasons I overcame my own internal hurdle to try telehealth, and the reason I feel video sessions are preferable to phone visits.
As clinicians, we have a responsibility to our clients to be clear in our communications, to use the clinical relationship as a vehicle for change and growth, and to never abandon our clients. In the past, when faced with a disruption in care, I always turned to phone calls. Although I am generally proficient with technology, telehealth is something that I previously resisted. Somehow being with a client on a screen just didn’t seem right, and I feared it would not facilitate a genuine connection. In addition, until recently there were many obstacles to the use of video platforms for mental health treatment.
Now, everything has changed. Most of these roadblocks have been, or are in the process of being, removed. High speed internet and sophisticated video platforms allow for smooth communications. Barriers to third party reimbursement are rapidly fading, and state licensure issues are being addressed. Most patients are expecting to be able to connect via video, and it’s unclear just how long in-person care will be impossible.
So, in the context of the public health crisis we are all confronting, and wanting to safeguard the health of myself and others, I moved my clinical practice to a video platform. To start my journey, I rapidly educated myself on the mechanics and ethics of telehealth practice. I quickly took one of the many on-line courses available around telehealth, read several guides, studied the many posts about telehealth on my primary listserv, and subscribed to a HIPAA-compliant video platform (Simple Practice).
For my clients, the transition to video seemed seamless, and I was amazed at the positive feedback I received. Having a practice that focuses on college/university students, they are all already comfortable with video technology—using Facetime, Skype or Zoom with regularity. Indeed, they are “digital natives.” That is, they grew up using technology as an essential component of their social and educational worlds. All report that they are finding the video sessions to be helpful, allowing an opportunity to maintain treatment and an important connection, without a loss to the clinical relationship. They are relieved that their insurance plans have included payment for this service, so that they can continue in therapy even from afar. Many are happy to not be going into the community where they might risk spreading or contracting the virus.
All of us have had occasion to speak with our clients by phone. While an important resource, the video connection is so much deeper than that allowed by phone. It seems to offer real capacity to experience the presence of the other. In addition, seeing my patients in their home environment gives me a new glimpse into their lives. I can see their room, whether disheveled or neat, the way they interact with pets, and much, much more. In this way, I now feel that telehealth offers a unique opportunity to observe and understand my patients deeply. I will be delighted to return to in-person visits, but this experience with telehealth has changed my practice forever.
For those of you who are finally ready to make the switch (whether by choice or by necessity), here are a few key tips that helped me in my conversion to telehealth:
- Technology—get comfortable with the video platform prior to your first clinical session, perhaps doing a trial run with a friend.
- Insurance - Confirm insurance eligibility, and be aware of correct coding modifiers.
- Geography – If operating with a client outside of your state of licensure, confirm that your license is valid in another state. Things are rapidly changing in this domain.
- Privacy: While the government has suspended HIPAA requirements during the national emergency, I recommend you use a HIPAA compliant platform so that you can continue to use the same platform in the future. .
- Be professional—even with a video call, be sure to dress professionally, be aware of background and lighting in the room, turn off phones, etc. Some platforms like Zoom have a feature called “virtual background” that allows you to change the background to a blank screen so that clients cannot see your home.
- Confirm that your client is in a private space. If that is not possible, encourage them to use headphones so that your comments are not heard by others.
- Plan Ahead - Have a backup plan in the event that there are technical glitches.
- Informed Consent - Obtain and document informed consent for telehealth.
- Communicate - You must proactively tell clients about the availability of this modality.
- Have fun! Just as we ask our clients to play with new concepts, try to have fun as you learn a new skill.
- Remember - This is about meeting the needs of our clients during this challenging time. For some, you may be the only helpful person that your client sees at all