Beyond the Couch

April 2013 16,897 views One Comment


By Meredith Vigil

Envision a world where patients can attend a weekly therapy session—confiding every thought and fear that is preventing them from living their fullest life—but instead of sitting on a proverbial couch in a therapist’s office, they are streaming live in high-depth video from the comfort of their own home.

Sounds a little futuristic?

With technology and social media tools advancing at unprecedented rates, this remote methodology—labeled telemental health—is providing ground-breaking options
for practitioners to deliver effective care and treat patients in an increasingly complex 21st century.

Using encrypted software developed according to strict HIPAA guidelines, Internet and video teleconferencing (VTC) tools are used to connect patients to clinicians remotely on computer monitors and video teleconferencing screens in real time. Security is critical, and the web-based equipment utilized by telemental health professionals needs to ensure a reliable connection.

It’s a complicated endeavor, one that is expanding more rapidly than the industry ever imagined. But as a 2011 pilot program launched within the U.S. Department of
Veterans Affairs (VA)—and pioneered by an alumnus of The Chicago School of Professional Psychology—has shown, it works.

Dr. Peter Shore (Psy. D., ’09) joined the Portland VA Medical Center as a staff psychologist shortly after graduating from TCSPP—quickly becoming an instrumental player as the VA began searching for ways to leverage telemental health tools for veterans who were returning home with a myriad of psychological needs, including post-traumatic stress disorder (PTSD).

The result was the VA’s home-based telemental health program, launched in February 2011—a first-of-its-kind endeavor that allowed any returning soldier who needed help the opportunity to receive treatment in their home via personal computer, web cam, and encrypted software. Access was quickly established for veterans, first at the Portland VA, then throughout the Northwest Health Network’s VISN-20, the largest geographical VA network covering Oregon, Alaska, Idaho, California, Montana, and Washington.

The Portland-based pilot program was well-received by veterans and provided enough data to justify a regional expansion. “We found in the first two years of the program, about 80 percent of those enrolled in the program would not have received mental health care if it had not been available in the home,” says Shore, who is now director of telehealth services for VISN-20.

The VA central office has since adopted this modality and now offers veterans across the country in-home treatment options through the Clinical Video Telehealth (CVT) program. Not only does the in-home treatment eliminate the barriers of travel and access to treatment, it also provides a safe, secure environment where they can feel comfortable confiding in providers.

The program’s success is a model for the rest of the country, and possibly the world.

According to the U.S. Health and Human Services Health Resources and Services Administration, nearly 80 million Americans live in a mental health professional shortage area and could benefit from programs like the one offered by the VA. And that doesn’t even count the need for remotely administered mental health
assistance around the globe.

But here’s the caveat: While the opportunities for success through telemental health might appear to be as endless as the Internet itself, this is still considered an untapped resource for many psychologists, and for good reason.

One of them is the challenge of treating patients remotely across state lines. Current licensing laws do not provide enough guidance as to whether or not psychologists based in one state can provide services to a patient residing in another. Only three states—California, Kentucky, and Vermont—have instituted specific licensing guidelines for the use of telemental health. Another is overcoming the inevitable unknown variables that come with treating a patient in their home using remote technology.

“These include developing a relationship with the patient at a distance, while ensuring their competency and comfort around technology. They also must know how to handle an emergency situation,” adds Shore.

“The idea of not knowing and feeling out of control provokes anxiety for some providers. And your patient can pick up on that anxiety—which in turn may have treatment implications.”

However, changes are coming that could help eliminate some of the industry’s apprehensions and fears. The American Telemedicine Association, the leading international resource and advocate for remote medical technologies, and the American Psychological Association have established task forces to create technical and clinical guidelines and clarify what is acceptable and not acceptable as psychologists work with new technologies. Shore says his experience shows how beneficial telemental health can be, and he encourages his colleagues to consider these new options in their practice.

The results can be life-changing. As a veteran once told him, “I’m in my own bunker, around my things, my stuff. Being in this environment makes me comfortable to speak freely.” Some veterans may be self-conscious about visiting a VA medical center for mental health care.

“It offers less visibility to the general population and is an effective tool in addressing the stigma,” he adds. Additionally, some veterans become less guarded and feel solace in the distance between themselves and the therapist. “They become naturally vulnerable and let their guard down—that vulnerability is potentially a pathway of change.”

Perhaps the next question is, where do we go from here?

While social networking, texting, and emailing have not been HIPAA-approved as secure mediums, Shore and other telemental health leaders are pushing for guidelines and advancements to be able to use these tools in meaningful ways.

The VA’s mental health clinicians have already integrated iPhone applications such as PTSD Coach—an iOS application developed by the VA and the Department of Defense—that can be used as an adjunctive tool to assist in treatment between therapy sessions.

“My hope is to help develop best practices in telemental health by making healthcare available anytime, anywhere, using mobile technology, where you can have the ability to use two-way communications,” adds Shore. “One day, I hope a veteran will be given a choice of where they’d like to receive treatment—at the medical center, community clinic, at home, or on the road.”

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