Psychology telehealth services continue to expand


John G. Mehm, Ph.D., suggests that telehealth practices look to online retail businesses as models of success. Mehm is the associate director of the University of Hartford's Graduate Institute of Professional Psychology in Connecticut. (photo by Kathryn Hardy)

By Phyllis Hanlon

Telecommunications, primarily the telephone, have been used in the practice of psychology for the past 40 years. In the current high-tech world, telehealth, defined by the American Psychological Association (APA) as the use of telecommunications to provide health information and care across distance, adds the use of long-distance videoconferencing, email and the Internet to traditional techniques. Psychologists are, for the most part, open to these new innovations, but are proceeding cautiously.

David Nickelson, Psy.D., J.D., assistant executive director of technology, policy and the practice directorate, reports that the APA continues to see a "reasonable and appropriate expansion" in telehealth services, particularly in rural and underserved areas. He says that more than 90 percent of APA members use email, but whether for personal or professional use is not known. "There is not a lot of recorded information," he says. "Very few companies that provide e-therapy are willing to quote figures."

Nickelson has extensive experience with telehealth as applied in rural areas of North Dakota, where it has been widely adopted by clinicians as well as by insurance companies. "Blue Cross/Blue Shield immediately saw the benefits of this practice regarding age, geography, weather and other factors," he says. "This area only had certain available resources for crisis intervention in a local clinic. They found the most efficient, safe and effective way to treat patients was to teleconference."

Using telehealth services for the prison population makes good sense, both medically and economically, according to Nickelson. Between transportation, increased security and special arrangements at an outside hospital or clinic, the price of off-site mental health care can skyrocket and the risk of flight increases as well as the potential danger to the community. "You can deliver quality care and see quicker results with lower cost by seeing inmates by video teleconference," Nickelson says. To date, such systems have been installed in a number of federal prisons, he reports.

According to Nickelson, under the proper circumstances other populations could also benefit from electronically delivered healthcare. A psychologist who applies intervening activities by phone or email for a pre-existing relationship where there is mutual understanding and trust most likely will achieve some benefit. As long as ethically responsible decisions, based on information drawn from a technologically derived combination of therapies can be applied, this high-tech therapy might help an individual, he says.

Leigh Jerome, Ph.D., director of research at Pacific Telehealth and Technology Hui in Hawaii, regularly engages in videoconferencing with seven countries in the Pacific Basin. In this case, the issue of distance necessitates technological intervention to treat patients scattered across the miles. She cautions that, as valuable as videoconferencing and remote connections might be, a number of problems still exist. In addition to transmission issues because of low-tech equipment, some fundamental psychological signals might be missing or difficult to detect. "You can't participate in side conversations and there is no eye contact," she says. "The cues aren't there so it might impact the quality of the exchange."

Jerome's research focuses on medical issues relating to the military. Her current project, a special biosensor, will collect and transmit biomedical data to a central base of operations. "The possible psychological services [from this device] include immediate debriefing for PTSD in the field," she says.

In 1997, Louis Kruger, Psy.D., director of the school psychology program at Northeastern University, in Boston, Mass., conceptualized the Global School Psychology Network as a way for school psychologists and teachers to communicate day or night to solve problems concerning children. Since then, the group has collected significant longitudinal data and created an international online community for school psychologists. "We have discussions about cultural differences," he says.

The group has developed a glossary of terms in an effort to break down the arbitrary boundaries that exist. "It's been a good learning experience," he says. "We are transcending geographic boundaries not particular to psychologists." He emphasizes that technology should be an integral part of practice, not a stand-alone therapy. "You can't use the technology in isolation but as one of a few tools to help us become better as service providers and at delivering guidance. It's just as important to know what and what not to use it for," Kruger says.

Sandra Rose, Ph.D., of Great Bay Mental Health Associates in Dover, N.H. finds videotaped feedback an important assessment tool that helps patients gain insight into problematic behaviors. "I have used tape recorders to help clients with social skills and attention problems gain insight into their speech patterns and pragmatics, but would use video playback to better capture mannerisms and provide accurate feedback for modification," she says.

John G. Mehm, Ph.D., the associate director of the Graduate Institute of Professional Psychology at the University of Hartford, suggests that telehealth practices look to retail stores as an example. "A good model for what will be successful is the online retail business," he says. "Companies that are successful will be the ones with a physical presence. It goes back to the idea of 'bricks and clicks.' If you can visit the actual place, it's better than if it's completely virtual."

Mehm cites increased collaboration among individuals, practices and agencies as another benefit to emerging telehealth practices. He asserts that shared responsibility is necessary to make a technologically savvy system work. "Health and Human Services has a joint group working on telemedicine. This cuts across 10 or 12 federal agencies and encourages collaboration between different disciplines and health care providers," he says.

Psychologists have almost always faced an uphill battle when it comes to reimbursement. In the case of telehealth, those challenges are multiplied. Mehm wonders if psychologists will be shortchanged if they engage in electronic healthcare delivery. "It requires more work to get a practice set up to deliver e-services and get reimbursed for them," he says.

"We have no illusions about how well a provider can use an online platform," Nickelson says. He contends that, in spite of the challenges, the issues of isolation, lack of research and connectedness to other practices, providers are driving the technology forward. "We are building a community where all those things will happen, help them be better and expand their reach."

Psychology telehealth services continue to expand (January 2004 Issue)

Psychology telehealth services continue to expand
(January 2004 Issue)