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Telehealth growth is one of the few silver linings to the COVID-19 pandemic. Now that offices are beginning to re-open, many professionals and their organizations are forced to decide if they will continue offering telehealth or go back to exclusive in-person care. As discussed in Telehealth.org’s The Future of Telehealth, knowing how to position oneself with payers is one of the most important factors of relevance to the growth and sustainability of telehealth services. Another key factor is getting adequate professional training and certification in the issues that will keep you out of hot water, particularly concerning clinical, legal, ethical, and the many practical aspects of sustaining successful telehealth services and managing risk.
Telehealth as a Modality, Not a Panacea
While telehealth has been a true blessing during the COVID pandemic worldwide, it is not a panacea. It isn’t for every client or patient. Examples of groups for whom telehealth may not be appropriate include people with more severe behavioral health needs; those who cannot maintain the privacy required; or those who need a controlled, supervised environment. Other patients and clients may prefer an in-person visit. Others may prefer the flexibility of having both in-person and telehealth sessions as options. For more information about Hybrid Counseling: Telehealth and In-Person Healthcare.
Telehealth is not for all clinicians, either. To each their own – but for those who choose to sustain a hybrid or exclusively telehealth practice are likely to experience greater scheduling flexibility; more geographic freedom; less overhead expense; and significantly more ability to market their specialty services across their state of licensure. Licensed professionals wishing to serve over state lines and international borders can also develop specialty niches that otherwise might be difficult to build into a thriving practice because of limited access. Unlicensed professionals such as coaches and peer-support counselors can also benefit from working in groups that serve populations across state lines. Thoroughly understanding issues related to telehealth reimbursement are also central to expanding telehealth practice.
Similar, Yet Different
With the tremendous growth of telehealth comes the need for therapists to be competent in their telehealth practices. While a telehealth visit still allows a client and provider to see each other, significant differences exist. See Telehealth “Not the Same” as In-Person Care?. Given that many factors can hinder one’s professionalism when delivering a telehealth session, proper telehealth training pointed toward competencies increase one’s ability to render required services and manage risk.1,2, 3,4,5,6,7
What Is a Reasonable Amount of Telehealth Training?
While most clinicians have been offering care via telehealth since the start of the COVID pandemic, many had no telehealth training at all. By now, they may have cobbled together free or low-cost training from a variety of sources online. Whether or not they have enough competency to avoid harming the people who trust them for care will be seen as licensing boards prepare for much stricter enforcement of relevant regulations in the years ahead.
Many professional associations are just now organizing to offer more formal and structured telemental health training programs, otherwise known as telebehavioral health training, at their annual meetings. If earlier studies are any predictor of the need for telehealth training, it is noteworthy that a report published in 2018 found that more than 1/3 of psychologists still believed that no legal or ethical rules applied to telehealth.8 While this finding was an improvement over that of a study published in 2000, where 2/3 of the professionals polled endorsed items related to the absence of applicable laws and ethics codes.9 Given today’s vantage point, one has to wonder how many of the remaining issues are unrealized by professionals who still don’t know how much they don’t know about evidence-based telehealth practice, even though most have been practicing via telehealth systems more than a year.
Moving forward, many research articles are calling for telehealth training to be a part of all healthcare/behavioral health education programs.10 The nuances of providing telehealth therapy should be mastered before a clinician considers offering these services professionally. See Telebehavioral Health Competencies in Interprofessional Education and Training for a free author’s copy of a publication that outlines needed competencies for telemental health, otherwise known as telebehavioral health.
Example of a Needed Competency: Professional Collaboration
While the published competency article linked in the last paragraph offers seven telebehavioral health competency domains, we will take only a few moments to outline two that are often lacking in the current repertoire of many behavioral professionals today:
A competent telehealth clinician has been exposed to and practiced responses to various clinical emergencies and their reasonable resolution online. Just as they did in graduate school when faced with suspicion of abuse, suicidal or homicidal intent, they have practiced what to say and do and adapted in-person skills for those needed when on-camera, in full view of the client or patient. They have all immediately needed resources at their fingertips and can reasonably predict the best local resources to engage and how to do so expediently and without causing alarm in the client or patient watching them.
They are then well-versed in managing crises through telehealth and responsibly transitioning clients who need a higher level of care from their local in-person resources. Collaboration with healthcare providers in distance communities is necessary to deliver the best quality of care for many behavioral clients. Knowing how to build local support networks for the local, professional support that you may need and how to grow those areas into thriving referral sources are other keys for success.
It is incumbent upon clinicians to learn how to most effectively provide online services from a technical, ethical, and legal perspective. Getting well-researched professional training geared to instilling basic telehealth competencies is the golden key to quick and replicable success with your telehealth services. When charges are levied against a practitioner or group by a licensing board or civil court, the amount (# of hours) and quality (reputation of the trainer or training group) of professional training obtained is a key factor in supporting one’s defense.
At Telehealth.org, three cumulative certificate programs are available for 15 hours, 36 hours, and 72 hours, and all are pinned to published telebehavioral health competencies. For a ring-side seat on what can happen if you are under-trained for telehealth, see the end of this article for a video recording that is often used with in-person training by faculty of Telehealth.org in discussing how much telehealth training is needed and why: Controversy about Eliminating Telephone Telehealth Coverage.
1 Luxton, D. D., Nelson, E.-L., & Maheu, M. M. (2016). A practitioner’s guide to telemental health: How to conduct legal, ethical, and evidence-based telepractice. American Psychological Association.
2 Hilty, D. M., Maheu, M. M., Drude, K. P., & Hertlein, K. M. (2018). The need to implement and evaluate telehealth competency frameworks to ensure quality care across behavioral health professions. Academic Psychiatry, 42(6), 818-824. https://doi.org/10.1007/s40596-018-0992-5
3 Maheu, M. M., Drude, K. P., Hertlein, K. M., & Hilty, D. M. (2018). A Framework of Interprofessional Telebehavioral Health Competencies: Implementation and Challenges Moving Forward. Academic Psychiatry, 42(6), 825–833. https://doi.org/10.1007/s40596-018-0988-1
4 Callan, J. E., Maheu, M. M., & Bucky, S. F. (2017). Crisis in the behavioral health classroom: enhancing knowledge, skills, and attitudes in telehealth training. In Career paths in telemental health (pp. 63-80). Springer. https://doi.org/10.1007/978-3-319-23736-7_5
5 Maheu, M. M., Drude, K., Merrill, C., Callan, J. E., & Hilty, D. M. (2020). Telebehavioral health foundations in theory & practice for graduate learners. Cognella.
6 Drude, K. P., Maheu, M., & Hilty, D. M. (2019). Continuing Professional Development: Reflections on a Lifelong Learning Process. Psychiatric Clinics, 42(3), 447-461. https://doi.org/10.1016/j.psc.2019.05.002
7 Maheu, M. M., Drude, K. P., & Wright, S. D. (Eds.). (2017). Career Paths in Telemental Health. Springer International Publishing. https://doi.org/10.1007/978-3-319-23736-7
8 Glueckauf, R. L., Maheu, M. M., Drude, K. P., Wells, B. A., Wang, Y., Gustafson, D. J., & Nelson, E.-L. (2018). Survey of psychologists’ telebehavioral health practices: Technology use, ethical issues, and training needs. Professional Psychology: Research and Practice, 49(3), 205–219. https://doi.org/10.1037/pro0000188
9 Maheu, M. M., & Gordon, B. L. (2000). Counseling and therapy on the Internet. Professional Psychology: Research and Practice, 31(5), 484–489. https://doi.org/10.1037/0735-7028.31.5.484
10 Maheu, M. M., Drude, K., Merrill, C., Callan, J. E., & Hilty, D. M. (2020). Telebehavioral health foundations in theory & practice for graduate learners. Cognella.
Introduction to Telehealth Theory & Practice
Enjoy a fast-moving overview of telebehavioral and telemental health. Understand the key points related to telehealth clinical, legal, ethical, technology, reimbursement, social media and other pivotal issues.