The COVID-19 pandemic ushered in the age of telehealth. Perhaps too quickly in many cases, but most clinicians agree that without the nudge from COVID-19 they never would have encouraged the widespread use of telehealth. The coronavirus changed that in an instant, significantly accelerating the adoption of telebehavioral health services. Statewide lockdowns forced providers to find virtual means of meeting with clients and appointments were moved to the telephone and /or video chats.

Challenges

The use of telecommunication and video chatting was the ideal solution to a unique situation, but it did not come without serious challenges.

1. Experience - Clinicians who had, for the most part, learned and gained experience delivering in-person services suddenly had to find a way to do the same job virtually. Engaging with clients face-to-face is an inbred methodology of behavioral health clinicians. The intensity of engagement is radically altered when attempted virtually. Even experienced clinicians need tele-health training.
2. Privacy - What type of security is needed when conducting confidential treatment over the internet? How about on the client's end where the client is being treated in his/her home environment with relatives and friends coming and going?
3. Safety - Many behavioral health clients become volatile during treatment. How do you see to the client's safety if you're not physically there and can call a nurse in from down the hall? If a suicidal client is in your office, you can get rapid response from a mobile crisis team while you support them through the initial crisis. During a tele-health session, on the other hand, how can you prevent the client from simply hanging up?
4. Logistics - What about clients who don't have computers or access to the internet, or elderly clients who can't work modern technological wonders, or indigent clients who own neither cellphones nor landlines?

Effectiveness

Studies indicate that there are largely no significant differences between telehealth and in-person care for adults with anxiety, depression, substance use disorder, and post-traumatic stress disorder for the following outcomes:

• Symptom improvement
• Patient satisfaction
• Quality of life
• Medication and treatment adherence

Patients have reported that behavioral health treatment delivered by synchronous telehealth was convenient and reduced barriers to accessing treatment.

Moving Forward

"What I think you’re going to see is the need to train clinicians on best practices for telehealth delivery,” says John Jay, strategic product marketing manager at Relias. “As organizations adapt to and become more accustomed to delivering telehealth, telehealth is going to be more prevalent in behavioral health moving forward. You’re going to see a mix of best practices when you’re engaging via technology.”

Melissa Lewis-Stoner, MSW, LCSW-C, says that when creating content moving forward, “We will need to be mindful of the practice scenarios with telehealth...Even after the pandemic, services will be a combination of telehealth and in-person," she says. "There are swaths of individuals who have to be seen face to face, either because of internet/telephone service barriers or because of diagnoses and other extenuating circumstances. However, the move online is not a temporary one. It is a sign of what’s to come."

Conclusion

"Of course, with the pandemic ongoing and the uncertainty of additional lockdowns and surges, it’s unclear exactly what lies ahead for behavioral health services. But what is known is that tomorrow’s new normal will be much more virtual than yesterdays. Providers need to be ready and well trained." (Sue Coyle, MSW)