By: Jean Kurtz RN, MA, LPC Impact Therapy of Wheeling
Phone and telemedicine delivery has long been a part of the behavioral health delivery model. Due to pandemic complications, the use of electronic communication in this growing segment has increased. Implications to effective process and procedure in telehealth delivery include reimbursement, which is frequently discussed. Less prominently covered, however, is the topic of how virtual sessions may be approached to enhance the effectiveness of the therapy delivered. Below are several factors to consider to improve the patient experience and outcome of a behavioral health telemedicine visit.
Location, Location, Location
Consider approaching telemedicine not as a virtual session, but rather a home visit. What better way to understand patients, especially those you’ve been working with for years, than to see them in their home environment? Ask yourself what you can learn about this patient through this home visit. At the beginning of the visit, inquire with the client where they’re located and if they can guarantee their confidentiality. It can be illuminating to ask the patient to use their cell phone or iPad to show you around their house or garden. If comfortable, they can introduce you to people or pets in their life. This helps us to know our patients better and to increase connection between patient and provider. When the house doesn’t provide the privacy necessary, consider car therapy. When the car isn’t moving and the patient is not driving, it can provide a private and secure place for a session to occur. Inform patients that if they’re connected to their car’s Bluetooth system, others outside of their car may be able to overhear their conversation. Remember that wherever the client is located, the visit should be conducted utilizing a HIPPA compliant platform.
Behavioral Assignments
Telemedicine provides an opportunity for the patient to show the results of behavioral assignments. For example, someone with ADD can show the result of a completed project. Dietary changes can be discussed by showing what’s in the refrigerator or pantry. We can be with an agoraphobic as they step outside onto their porch. Changes are more likely to occur if those changes are connected to the patient/provider relationship, if the patient is accountable, and if the patient can share their efforts.
Technical Components and Setup
In respect to the technical components of telemedicine, it can be useful if the provider uses their cell phone for the visit. In this way, the visit can be hosted right above their EMR, allowing the provider to see their notes and the patient at the same time. This also allows notes to be completed at the time of the visit, which increases efficiency.
Let the patient know what you’re doing and consider investing in a noiseless or quiet keyboard, which is less distracting during the visit. Audio quality is crucial, even more so than video. Ask your patient how you look and sound to them, and don’t hesitate to switch to a phone call if audio is not working through video. Investing in an echo canceling microphone can eliminate the need for headphones.
When preparing for the visit, avoid back lighting, which makes you look dark and creates shadows. A simple desk lamp will work to shine light on your face. A tripod with ring lights will allow you to clip the cell phone on the ring, see the patient, see your notes, and provide adequate lighting. The UBeesize Selfie Tripod runs about 50.00 on Amazon.
Maintain a Connection
Eye contact is so important during a session. Be certain to look into the camera and position the patient’s picture as close to the camera as possible so you can feel as if you’re looking directly at the patient. Aim to be slightly more animated during a virtual session, approximately 110% of normal.
It’s important to note that patients like telemedicine visits. Multiple studies demonstrate that patients prefer telemedicine behavioral health visits to in-person visits for the convenience, the creation of a common space between patient and provider, and the safety provided. This allows patient populations who would likely not be seen in-person (e.g., PTSD, agoraphobia and sexual assault victims) to access behavioral health services.
Ultimately, a hybrid model may be the best approach with a mix of telemedicine and in-person visits. In this way, we can learn a great deal more about our patients and facilitate their access to care.