On Wednesday, June 10, 2019 the Office of Juvenile Justice and Delinquency Prevention (JJDPA) and the Western Regional Children’s Advocacy Center conducted a webinar “Tele-Mental Health: The Clinician’s Perspective” to discuss the need for web-based psychotherapy sessions. The webinar also addressed issues that arise with trying to deliver virtual therapy.
Christopher Walsh, Director of Operations at Chadwick Center for Children and Families, and Al Killen-Harvey, co-founder of The Harvey Institute, described their personal experiences with providing tele-mental health therapy. They are strong advocates for such virtual therapy in appropriate circumstances.
The Western Region of the United States is currently lacking in mental health services especially in rural areas that lack an adequate number of available care providers including providers that specialize in trauma informed therapy or child therapy. In addition, these areas have other hurdles including limited access to providers because of severe weather or living hours away from care providers. Rural areas may also face unique challenges such as confidentiality in a small community where there is little privacy. For these reasons, the Western Regional Project is trying to implement more two-way, real time, interactive communication between patients and clinicians.
Current randomized, gold standard trials are showing that tele-mental health treatment is effective with adults and there is growing evidence that it is effective with children and teens. In comparison to in-person treatment there is no significant difference in the ways the patients are being diagnosed or treated, and the retention rates of patients are promising.
Both Walsh and Killen-Harvey described what tele-mental health therapy looks like in practice. They described that there can be benefits to allowing a patient to hold sessions wherever is convenient to them, such as being more willing to open up in a place they feel comfortable and being able to have more flexible timetables for sessions. They emphasized the need for practicing with technology before using it with patients, so it feels and looks as natural as possible. They also discussed the limiting ability to see facial expressions and body language, which can sometimes be a barrier to therapy if not practiced.
For tele-therapy to advance, there needs to be more access to HIPAA compliant forms of communication. HIPAA is the Health Insurance Portability and Accountability Act of 1996 that established certain health insurance confidentially protections. States must have universal policies regarding billing and reimbursement, and written policies need to be in place and transparently discussed with patients. The presenters addressed ethical concerns, such as making sure the patient is in a confidential space and not recording sessions.
One main concern they expressed was needing to have procedures in place in case there is an emergency during the session. Often this means having the patient’s community’s emergency contact information, or having someone such as a parent, friend, or teacher on site, but not in the patient’s room, that can intervene if necessary, during a session. Ultimately, both Walsh and Killen-Harvey concluded that if the correct precautions are taken and it is practiced carefully, tele-mental health therapy is very useful in situations where it can be difficult to get to a patient.
The link for the Western Regional Children’s Advocacy Center is here.
