Telehealth is a mode of service delivery that has been used in clinical settings for over 60 years and empirically studied for just over 20 years. Telehealth is not an intervention itself, but rather a mode of delivering services. This mode of service delivery increases access to screening, assessment, treatment, recovery supports, crisis support, and medication management across diverse behavioral health and primary care settings. Practitioners can offer telehealth through synchronous and asynchronous methods.
Telehealth is the use of telecommunication technologies and electronic information to provide care and facilitate client-provider interactions. It is comprised of two forms:
- Two-way, synchronous, interactive client-provider communication through audio and video equipment. It is also referred to as telemedicine. This is the real time interaction between the client and provider utilized for assessments, ongoing treatment services, and at times, crisis calls/interventions with clients. Consists of telephone, web-based video conferencing platforms and video calls.
- Asynchronous client-provider interactions using various forms of technology. This includes sharing of health information that is collected at one point in time and responded to or interpreted at a later time to direct the next steps of a client’s treatment or care plan and complement synchronous treatment. Methods can be interactive to include the client actively sending information to the provider, or passive as the client data is transmitted to providers through portals, sensors, or peripherals. This may include the use of signature programs. Asynchronous interactions are utilized for clinical assessments, symptom management, client education, and treatment reminders that complement synchronous client-provider interactions and inform updates to treatment plans through methods such as:
- Store and forward (i.e., client uploads and transfers medical information, such as health histories, to identify or refine a treatment plan)
- Remote client monitoring (i.e., collecting medical and health data in one location and transmitting to another)
- mHealth (i.e., capture of health information by the client and transmission of the information to a provider through mobile applications, mobile devices, smartphones, tablets, or computers)
- Client education (e.g., online psychoeducation sessions and workbooks)
A variety of providers (e.g., psychiatrists, primary care providers, mental health counselors, social workers, psychologists, addiction counselors, case managers, opioid treatment providers, peer workers) can implement telehealth methods. In addition, practitioners can use telehealth with a hybrid approach for increased flexibility. For instance, a client can receive a combination of both in-person and telehealth visits throughout their treatment process depending on their needs and preferences. Telehealth practices can expand capacity to provide direct client care when inperson, face-to-face interactions are not possible due to geographic barriers or a lack of providers or treatments in a given area. However, implementation of telehealth methods should not be reserved for emergencies or to serve as a bridge between providers and rural or underserved areas.
Benefits of Telehealth
Telehealth treatment has been documented to improve client and provider experience, improve overall population health, and decrease costs of receiving mental health treatment services. Providers may improve the quality of care they provide and experience benefits from implementing telehealth, including the ability to share information with clients for psychoeducation and assessment, efficient connection to address crisis related issues, provision of timely care, effective coordination of care and treatment, and accessing client in the home environment despite potential barriers to meeting in person. Clients benefit by having increased access to experienced providers, and convenience that removes barriers of geography, psychological barriers due to issues of anxiety, severe depression, or other debilitating mental health, barriers of accessibility to access facilities for treatment, employment, and childcare needs.
Best Practices for Use of Telehealth
- Provide the client with an overview of expected norms and behaviors for telehealth.
- Talk with clients about confidentiality and the need to be in a confidential space during telehealth interactions.
- The camera angle and quality, screen size, and other factors can limit the ability to read a client’s behavior. Ask the client to adjust the camera angle, if possible, to aid in reading non-verbal cues and behaviors.
- While the session may be taking place in the client’s home, ask that the client dress appropriately.
- Remind clients not to multi-task while engaging in the session, such as texting or using the Internet. Empower the client to share if they are having difficulties hearing or engaging with the provider.
- Remind the client that while the provider may be taking notes or documenting in the medical
- record, the provider’s attention is focused on the client.