The Definitive Guide to Telehealth for Therapists

July 22, 2020

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While telehealth used to be viewed as a last resort for providing mental health services, it’s now taken a prominent role in practices across the country. As the COVID-19 pandemic swept the world, the popularity of telehealth experienced a meteoric rise. In fact, Forrester Research now expects the number of telehealth appointments to exceed one billion for 2020. In many ways, telehealth today looks a lot like a second-string field goal kicker who’s been called in to score the game-winning point — and actually pulls it off. 

With telehealth adoption rates rising so quickly, we’re providing a definitive resource for therapists using telehealth. In this guide, we’ll examine the benefits of telehealth from the client and therapist’s perspective, government regulations and their impact on telehealth services, and best practices for telehealth etiquette during sessions. We’ll also look at the research on the effectiveness of providing telehealth services in mental health settings and specific considerations for some forms of treatment. Then we’ll wrap up with thoughts on where telehealth services may be headed next.

Benefits of Telehealth

The benefits of telehealth are many, both for the client and the therapist. If you’re evaluating whether implementing telehealth is worth the effort, here are the key advantages to consider.  

Advantages of Telehealth for Therapists

  • Scheduling Flexibility — When it’s no longer a requirement to drive into the office to see a client, it becomes possible to provide care outside of the typical 9-5 workday if you wish. Working with clients in the evenings or weekends is easier when you don’t have to leave the house. If you have commitments that make it challenging to meet with clients during standard working hours, telehealth may be the ideal solution for expanding your current client base.
  • Higher Efficiency — When you don't have people physically coming in and out of the office all day, you naturally save time otherwise spent getting up to look out the window for the next client and ushering clients in and out. With that time savings, you can polish up your notes from the last session or take a mini coffee break.
  • Broader Reach — By removing the need to be in a specific location at a specific time to receive care, telehealth opens the door for people in remote or rural areas. If you prefer to live outside high-population areas, telehealth gives you broader access to clients who wouldn’t want to drive regularly to your out-of-the-way office.
  • Reduction in Client No-shows and Last Minute Cancellations — Life gets crazy sometimes. When a work meeting gets called, childcare falls through, or the car breaks down, people cancel their in-person therapy sessions. Telehealth appointments can often be kept, on the other hand, despite the monkey wrenches that life presents. Greater convenience results in fewer canceled sessions.

Advantages of Telehealth for Clients

  • Increased Time Savings — Telehealth removes barriers to receiving care. Even more time is saved for clients than for therapists since they don’t need to drive to your office. Work, childcare or eldercare obligations, and a myriad of other scheduling demands can be mitigated when clients don't need to leave work or home to attend a  session.
  • Expanded Access to Specialized Care — For clients looking to connect with a therapist who specializes in a specific type of therapy, telehealth can provide options to connect with a provider that would simply not be available for in-person care. This is especially true for those who live in more rural areas.
  • All-Weather Access — Since telehealth removes the need for travel, receiving care is no longer dependent on weather conditions. Especially for clients living in areas prone to harsh weather, the ability to attend a therapy session no matter what conditions are like is especially helpful.

Telehealth Regulations You Should Be Aware Of

At the outset of the COVID-19 pandemic, the U.S. Department of Health and Human Services waived several key federal mandates concerning the provision of telehealth services for Medicare and Medicaid recipients. First, the originating site requirement was removed. In most instances pre-COVID-19, telehealth services could not be provided in a client’s home. Instead, clients were required to travel to a remote location, often a clinic or doctor’s office to receive telehealth services from a provider located elsewhere. 

Second, there are now no HIPAA violation enforcement actions for those who provide telehealth in good faith using a non-secured platform like FaceTime or Skype. (As you can imagine, all providers are still encouraged to use HIPPA-compliant software, however.) Previously, only HIPAA-compliant, secure connection services were permitted. The final requirement to be suspended was the requirement that only established clients were eligible to receive telehealth services. While no one can know if these regulations will continue to be as relaxed as they are currently, the trend toward telehealth is likely to mean that at least the originating-site requirement and the established-patient requirement are likely to stay gone for good.

State Requirements

The governmental regulations that are currently in place for telehealth kick in on the state level, as requirements from Medicare and Medicaid programs. Because the federal government provides each state with quite a bit of leeway on how they administer these programs, each state’s requirements differ. The good news is that although regulations and reimbursable services for telemedicine vary greatly, all states reimburse for telehealth provided via live video. 

For specific guidance on regulations state-by-state, see Telehealth Regulations: Federal, State, and Private Payer.

Private Payer Insurance 

Similar to the conundrum caused by the patchwork of state regulations mentioned above, private payer insurance companies also differ in how they reimburse for telehealth services, both by payer and by state. The federal government does not require that private payer insurance companies provide reimbursement for telehealth services. However, at present (during the pandemic), forty-two states and Washington D.C. have laws that govern private payer reimbursement for telehealth. Most states simply require that private payers reimburse for telehealth delivered services in a way that’s equivalent to how they handle in-person care. Only a handful of those states mandate that reimbursement rates for telehealth services match those for face-to-face visits. Because requirements differ, you’ll want to check with each of your clients’ insurers. 

Telehealth Etiquette 

While telehealth is certainly more convenient for therapists, there are best practices for etiquette and professionalism when using telehealth. When you aren’t in the same room as your client, the different dynamics call for a different approach. Here are some things to keep in mind when you’re meeting with clients remotely.

  • Use High-quality Software and Hardware — Although the use of HIPAA-compliant telehealth connection platforms isn’t currently required, it’s best to invest in a professional-grade video meeting software that’s designed for mental health applications. Also, be sure to use a reliable internet connection and high-quality web-cam. These measures will give clients confidence and ensure the connection doesn’t cut out unexpectedly. When working with clients remotely, having the right equipment is critically important.
  • Fine-Tune the Webcam to Maximize Eye Contact — Be sure your webcam is positioned to make it easy for your client to maintain eye contact with you throughout the session.
  • Keep it Natural — If you’re used to seeing clients in person, shifting to telehealth will take some getting used to. Being familiar with the technology can help a lot. You may want to practice connecting with a colleague first to ensure you’re comfortable with the mechanics of syncing up with clients to begin a session.
  • Narrate Your Movements — If you need to move or look away during a session, let the client know before you do so. Connecting via video link doesn’t allow for the same level of body language that an in-person session does. So talk through what you’re doing off-screen as needed.
  • Look Professional — You’ll probably want to dress as you would for in-person office visits and be sure that your surroundings that appear on-screen look professional. You’ll also want to be sure that there are no distractions that could hinder the effectiveness of treatment.

For more tips on how to provide telehealth effectively, check out our Guide to Telehealth Etiquette

Does Teletherapy Work As Well As In-person Treatment?

It’s smart to wonder if telehealth is as effective as providing in-person treatment. While many therapists and clients prefer in-person sessions, the effectiveness of therapy isn’t diminished by using telehealth to deliver it. Telehealth is a fairly young technology, but there have been several studies that have looked at the efficacy of providing teletherapy remotely. Here are four. 

In 2012, a research study published in the Journal of the American Medical Association examined the effectiveness of CBT delivered via telehealth. The study found that this mode of therapy delivery was as effective at treating individuals with clinical depression as in-person sessions. Interestingly, fewer clients receiving treatment remotely discontinued treatment during the study as compared to the face-to-face control group. 

In 2015, The Lancet published a study funded by the U.S. Department of Veterans Affairs examining the efficacy of Behavioral Activation Therapy delivered via telehealth. This study found that there was no measurable difference in therapeutic outcomes between the group who received therapy remotely as compared to the control group who experienced in-person treatment. 

Providing Prolonged Exposure (PE) therapy via telemedicine also shows initial promise. A pilot study published in the Journal of Traumatic Stress demonstrated positive outcomes when providing PE to veterans experiencing clinically significant PTSD symptoms. 

An open trial study on the effectiveness of EMDR therapy delivered remotely studied the effects of participating in this type of therapy via telehealth. The research was first published in F1000 in 2013. Although a small study, the results indicated that clients experienced positive outcomes with EMDR administered by a therapist in a remote location.

Initial research into the effectiveness of providing therapy remotely using multiple modalities of treatment appears promising. However, with some forms of therapy like EMDR, special considerations come into play. 

For more on how to use telehealth for EMDR, check out our resource, What to Know About Providing EMDR Online Via Telehealth.

The Future of Telehealth

It’s safe to say that telehealth is facing a bright future. Necessity has once again proven itself to be the mother of invention by forcing a rapid, wide-scale adoption of this new means of providing care. As clients and practitioners get a taste for the convenience and cost-savings this technology provides, it’s unlikely that we’ll go back to the way things were. Crystal balls aside, here’s where we see telehealth headed post-pandemic. 

  • Growing Public Support — Many of the federal, state, and private payer insurance policy changes that make it easier for providers to bill for telehealth services are temporary. But this temporary easing has provided an opening for large swaths of the public to experience telemedicine first hand. When the pandemic subsides, public opinion will be a driving force to permanently integrate telehealth into the healthcare landscape.
  • Streamlined Government Regulations — Prior to the pandemic, government regulations around telemedicine were restrictive and complex. These tight controls had largely relegated telehealth for use as a tool for people in underserved communities to access better healthcare. We predict that some of the temporary loosening of restrictions will become permanent. 
  • Improved Technology — Although telemedicine has been around in some form for decades, the rapid expansion of this means of providing care is resulting in increased demand for better, more-secure telehealth platforms. Improvements in technology will result in improved outcomes for clients. 

For expanded coverage on this quickly-evolving topic, dive into our Future of Telehealth Report

In Conclusion

The telehealth industry has entered a crisis-induced time machine and has stepped out on the other side having traveled several years into the future — within a matter of months. The COVID-19 pandemic has created unexpected benefits and challenges for this emerging tool for providing mental healthcare. As time continues on, government regulations, best practices for practitioners, and client expectations for care will continue to evolve. But one thing is certain: telehealth is now firmly established as a leading means for providing care for a diverse population of clients.

See how Thera-LINK, a HIPAA-compliant telehealth platform, can help you connect effectively with your clients.

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