Professional Psychology: Research and Practice

Preparing for the telehealth world: Navigating legal, regulatory, reimbursement, and ethical issues in an electronic age.
As technology advances, psychologists increasingly have the opportunity to engage with patients or other users of psychological services via less traditional methods. However, little guidance exists to prepare psychologists to navigate the legal, regulatory, reimbursement, and ethical issues that can arise when providing psychological services via technology. A review of relevant state and federal laws reveals inconsistencies even in the terminology used to describe provision of services via technology with some referring to “telehealth,” others to “telemedicine,” and others using additional terms. The following overview of laws, regulations, and existing guidelines in the area of telehealth and telemental health provides some preliminary guidance for psychologists as they attempt to meet the needs of their patients using available and emerging technologies. Specific issues addressed include the applicability of the HIPAA Privacy and Security Rules, informed consent and reimbursement by third party payers. (PsycINFO Database Record (c) 2011 APA, all rights reserved)
Risk management in the digital world.
The literature is replete with articles addressing how the electronic age has created new and improved ways to deliver health care services. This change, however, has raised many questions regarding how professionals can utilize this new technology in a fashion that is consistent with both ethics and law. In this article we attempt a point in time survey of the problems created by practicing psychotherapy in the digital age focusing on a conceptual overview of two specific areas. We review various perceptions of the current state-based regulation of digital interstate practice by psychologists and provide an overview of some basic ethical and risk management principles that have to be addressed by practitioners before proceeding to offer these services given an uncertain regulatory environment. (PsycINFO Database Record (c) 2011 APA, all rights reserved)
Security management in telepsychology.
Psychologists increasingly rely upon “telepsychology” (e.g., e-mail and Internet-based client communications) despite the growing presence of threats to online security. However, practitioners may overestimate the benefits of electronic communications and underestimate their risks. Using the example of the availability heuristic as one cognitive bias, which may promote this imbalance, this article reviews a number of resources for practitioners that provide enhanced security and confidentiality in the digital realm. Governmental, regulatory and professional bodies provide pertinent and detailed guidance that can achieve these goals. To illustrate this process, this article reviews and augments a number of safeguards (administrative, physical, and technical) within the HIPAA Security Rule. It also surveys opportunities for continuing education and credentialing that may enhance professional competence in electronic communications. It concludes with a list of recommendations for enhancing security and reducing the influence of the availability heuristic in telepsychology. These recommendations range across several categories of professional practice: hardware and software management, confidentiality, informed consent, competence, consultation, and continuing education. This article can help practitioners reap the benefits of telepsychology while successfully enhancing confidentiality and security. (PsycINFO Database Record (c) 2011 APA, all rights reserved)
Electronic medical records in a multidisciplinary health care setting: A clinical perspective.
The electronic medical record (EMR) is increasingly sought as the standard of documentation in health care. There has been relatively less experience with EMRs within mental health care. This article provides an overview of EMR use within health care and mental health care, with a particular focus on an implementation experience within an integrated health care setting. The potential for how an EMR can enhance effectiveness of mental health treatment in the communication, coordination, and delivery of mental health care is presented, along with how psychologists can help in the development and implementation of EMRs in mental health settings. (PsycINFO Database Record (c) 2011 APA, all rights reserved)
Critical incidents in the marriage of psychology and technology: A discussion of potential ethical issues in practice, education, and policy.
We identified critical incidents in psychologists' use of technology in their service provision with clients. Study coordinators sent messages out to various listservs requesting that practicing psychologists respond to an online survey for their reports of how the integration of certain technology advances (e.g., e-mail, electronic health records, social-networking websites, etc.) may have compromised client privacy or confidentiality. Twenty-eight participants responded to the survey and noted a variety of concerns, including themes of (a) unauthorized access to electronic client records, (b) inappropriate dissemination of client information via technology, and (c) unique client concerns associated with social-networking websites (e.g., Twitter, Facebook, etc.). We discuss ramifications and strategies related to these ethical concerns in education, practice, and ethical standards and principles. (PsycINFO Database Record (c) 2011 APA, all rights reserved)
A snapshot of child psychologists' social media activity: Professional and ethical practice implications and recommendations.
In the face of the ever-growing popularity of social media, psychologists continually encounter new dilemmas regarding our ethical and professional principles. Negotiating the balance between the intrinsically public nature of social media participation and the highly private nature of the therapeutic relationship can be a challenge. Psychologists working with children and adolescents are of particular interest, given both the popularity of social media among children and teens and the specific treatment concerns on which clinical work often focuses. The authors surveyed 246 psychologists and psychologists-in-training regarding their own blogging and social networking practices, as well as their behavior around their clients' online presence. A majority of respondents indicated that they participate in some form of social media and a lesser, though sizable, percentage reported viewing information about their clients online. Many respondents indicated that they have encountered concerning material on their clients' social media pages, and there does not appear to be a clear consensus about how psychologists handle matters of Internet safety and privacy with their underage clients. Based on the responses to this survey, a series of considerations and guidelines for our professional practice are proposed, and psychologists are encouraged to engage in thoughtful self-reflection as they establish their own policies regarding these matters. (PsycINFO Database Record (c) 2011 APA, all rights reserved)
Technology, telehealth, treatment enhancement, and selection.
Telehealth and other technological innovations have become increasingly more popular in the practice of psychotherapy and the training of psychotherapists. From the use of e-mail and online therapy to virtual reality (VR) technology and to patient and clinician interactive web-based systems, technology has resulted in a number of improvements, such as financial savings and time reductions. Additionally, technology has allowed clinicians to reach more people and provide potential patients with greater access to information about their presenting problem(s) and available treatments. The self-help movement in psychotherapy has also benefited from technological advances. This article will summarize some of the key developments in the field and underline some of the ethical and clinical implications of these technological applications in clinical psychology. It will briefly describe different approaches to telehealth and extract from extant research literature suggestions for future research in areas of overlap between technology and psychology. Some of these implications will be illustrated by reference to the establishment of a web-based assessment and monitoring system designed to capitalize on the strengths of telehealth procedures in facilitating improved treatment outcomes. (PsycINFO Database Record (c) 2011 APA, all rights reserved)
afterdeployment.org: A web-based multimedia wellness resource for the postdeployment military community.
Practicing psychologists and other health professionals are facing a growing patient population of United States military service members with significant psychological and behavioral health concerns returning from war zones in Afghanistan and Iraq. Some of these issues are new and unfamiliar to many health providers. Furthermore, because of a military culture of self-reliance, strength, and the perceived stigma of seeking mental health services, a second and substantial population of service members-in-need is choosing not to consult health professionals at all. The Internet and other networked multimedia technologies now offer a rich expert resource for providers, and an anonymous, less stigmatizing venue for self-management for service members and their families. Over the last 2 years the U.S. Defense Department's National Center for Telehealth & Technology has developed afterdeployment.org, a Web-based set of resources, tools, and aids for service members, veterans, and their families. afterdeployment.org provides education and skills-development exercises aimed at overcoming challenges to the adjustment process after a deployment. The Website also provides health professionals with a comprehensive resource to serve as an adjunct to face to face treatment of individuals in the military community. (PsycINFO Database Record (c) 2011 APA, all rights reserved)
Considerations in the development of a therapist-assisted internet cognitive behavior therapy service.
There is mounting evidence in clinical trials that therapist-assisted Internet cognitive behavior therapy (TAICBT) is efficacious in the treatment of depression and anxiety. Nevertheless, many clinical service providers (both individuals and organizations) question whether offering this form of treatment in clinical practice is feasible. As such, having information on the factors involved in the development of this service is essential. In this article, we describe the steps taken to develop a TAICBT service that registered professionals and students (under supervision) can use with clients suffering from symptoms of depression, generalized anxiety, and panic disorder. We share salient decisions made in developing this web application and the necessary unit policies and procedures. We also offer lessons learned and practical recommendations to providers who may want to translate this promising TAICBT research into practice. (PsycINFO Database Record (c) 2011 APA, all rights reserved)
Text messaging as an adjunct to CBT in low-income populations: A usability and feasibility pilot study.
This article outlines the development and usability–feasibility testing of an automated text-messaging adjunct to cognitive–behavioral therapy (CBT) for depression in a public sector clinic serving low-income patients. The text-messaging adjunct is aimed at increasing homework adherence, improving self-awareness, and helping track patient progress. Daily text messages were sent to patients, inquiring about their mood. Additional daily messages corresponded to themes of a manualized group CBT intervention. These included (1) thought tracking (both positive and negative), (2) tracking of pleasant activities, (3) tracking of positive and negative contacts, and (4) tracking of physical well-being. We tested the adjunct in 2 CBT groups (1 English & 1 Spanish) consisting of 12 patients total during and after treatment. Participants responded at a rate of 65% to text messages, and they reported overall positive experiences. We propose that text messaging has the potential to improve mental health care broadly, and among low-income populations specifically, with cost-effective means. (PsycINFO Database Record (c) 2011 APA, all rights reserved)
Internet-based maintenance treatment for patients with eating disorders.
The sustainability of treatment effects is a major challenge in clinical practice. As in most other mental disorders, patients with eating disorders frequently experience relapses following treatment termination. This calls for feasible maintenance strategies that can be implemented in clinical routine at reasonable cost and effort for both treatment providers and patients. This article introduces an Internet-based intervention for maintenance support of patients with bulimia nervosa (BN) and related eating disorders not otherwise specified (EDNOS). The program comprises several online components for psychoeducation, self-help, peer support, and professional counseling. In the present pilot study, 22 women had access to the program for 4 months. The intervention proved feasible and well accepted, and participants' satisfaction with the program was high. Adherence to the various program components was overall acceptable. Patterns of utilization support the assumption that patients with eating disorders have heterogeneous needs for support following treatment termination. The study confirms the potential of flexible and individually tailored Internet-based interventions for the optimization of care for these patients. (PsycINFO Database Record (c) 2011 APA, all rights reserved)
Live coaching of parenting skills using the internet: Implications for clinical practice.
Many parents who would benefit from parenting skills training via live coaching do not receive it due to barriers such as time, distance, and the unavailability of skilled providers. This report describes an innovative web-based parenting skills program for families of young children with traumatic brain injury (TBI)—Internet-Based Interacting Together Everyday, Recovery After Childhood TBI (I-InTERACT). I-InTERACT is a web-based parenting skills program of 10–14 sessions that combines self-guided web modules with live coaching via videoconferencing. We describe the feasibility and utility of this approach, as well as the unique nature of the therapeutic process, detailing the perspectives of 13 parents of children with TBI who participated in the program and 6 therapists who delivered the program. Nine of 13 parents preferred the web-based coaching to traditional treatment; they cited its ease of use and the comfort of doing it at home. Therapists uniformly liked coaching over the web despite the need to address boundaries and troubleshoot technological difficulties. Therapeutic alliance was comparable to traditional therapy with nearly all families expressing a strong connection to the therapist. Individuals with less computer experience particularly liked the program because it gave them access to the web and a sense of empowerment. These preliminary findings support the utility of web-based parenting skills training for families from diverse backgrounds, while underscoring the potential for clinical use with other underserved populations. (PsycINFO Database Record (c) 2011 APA, all rights reserved)
Internet-based approaches to collaborative therapeutic assessment: New opportunities for professional psychologists.
Collaborative (or therapeutic) assessment is an empirically supported procedure that involves the client as an active participant in the assessment process. Clients discuss data they provide with the assessor in a collaborative manner designed to provide insights and assist in setting mutually agreeable treatment goals. Internet-based procedures allow for ongoing (including daily) tracking of psychological variables and provision of immediate graphic feedback to therapists, clients, and clinical supervisors. As an example, we describe one such system: Evidence-Based Assessment System for Clinicians that contains more than 30 brief and empirically validated assessment instruments that can be completed via the Internet or smartphone. We also provide examples from a stress management intervention demonstrating how single-client data from a Web-based daily stress and coping diary tied to the Evidence-Based Assessment System for Clinicians were utilized to provide clients with individualized feedback, assess progress, identify idiographic patterns of cognitions, affect, and coping strategies, and test clinical hypotheses. Internet- and computer-based technological advances can improve service delivery and help bridge the gap that currently exists between science and practice. (PsycINFO Database Record (c) 2011 APA, all rights reserved)
mHealth for mental health: Integrating smartphone technology in behavioral healthcare.
The rapid growth in the use of smartphones has opened a new world of opportunities for use in behavioral health care. Mobile phone software applications (apps) are available for a variety of useful tasks to include symptom assessment, psychoeducation, resource location, and tracking of treatment progress. The latest two-way communication functionality of smartphones also brings new capabilities for telemental health. There is very little information available, however, regarding the integration of smartphone and other mobile technology into care. In this paper, we provide an overview of smartphone use in behavioral health care and discuss options for integrating mobile technology into clinical practice. We also discuss limitations, practical issues, and recommendations. (PsycINFO Database Record (c) 2011 APA, all rights reserved)
Using everyday technology to enhance evidence-based treatments.
Technologies such as smartphones and digital cameras are an increasingly ubiquitous part of modern life, and the increasing convenience of these electronic tools provides psychotherapists with opportunities to incorporate these technologies into psychotherapy. In the face of so much opportunity, psychotherapists must learn how to incorporate these tools effectively and responsibly. The authors present three case studies that demonstrate the use of digital technology to individualize and enhance the efficiency of existing evidence-based treatments. In the first, digital pictures were used to track the treatment progress of a client who compulsively hoards. In the second, a smartphone was used to record a personalized progressive muscle relaxation file for a client with agoraphobia, hypochondriasis, and generalized anxiety disorder. In the third, a smartphone was used to photograph and send pictures of in-session work to a client with trichotillomania and generalized anxiety disorder. The implications and ethical considerations of using technology in psychotherapeutic settings are explored, and practical strategies are provided for incorporating common digital technology into psychotherapeutic practice. (PsycINFO Database Record (c) 2011 APA, all rights reserved)
Community capacity and teleconference counseling in rural Texas.
How can psychologists aid in addressing current disparities in accessibility to meet the mental health needs of rural areas? In this paper, we discuss an innovative partnership created between community leaders in a rural county and an APA-accredited doctoral training program and its mental health clinic at a regional Federally Qualified Health Center (FQHC) to provide mental health services. We describe the efforts to build community capacity to develop the partnership and provide sustainable mental health services via teleconferencing to a remote site in a rural county. Also, to present initial evidence of the services' effectiveness in alleviating client distress, as well as meeting the expectations of referral sources and community stakeholders, we used the Patient Health Questionnaire (PHQ), the SF-12v.2, and a qualitative community survey. We examined data from a maximum of 68 clients (M age = 40.5, SD = 14.1; 48 females and 20 males); the number of available client data varied by analysis. We found that clients showed significant decreases in depressive symptoms (M decrease = 5.88, SD = 7.16, p <.001) and significant increases Mental Health Composite Scores (MCS; M increase = 11.39, SD = 7.94, p <.005). Results from the community survey revealed encouraging results as well as areas for improvement. Implications of developing community capacity for sustainable psychological services in rural areas are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)
Reaching rural caregivers with a multicomponent telehealth intervention: The telehelp line for caregivers.
The provision of services to informal caregivers, such as family, friends, and neighbors, in rural areas provides unique challenges for professional psychologists. The Telehelp Line for Caregivers, a clinical telehealth multicomponent intervention for rural caregivers is described. Supportive services and resources through the Telehelp Line for Caregivers were provided during structured telephone counseling sessions. Caregiver knowledge, problem-solving skills, and help-seeking behavior and affect were the major components addressed. An eight-session structured telephone intervention and a call-in helpline was available. All components were available but tailored to individual participants based on caller presenting concerns and assessed needs. The benefits of a telehealth intervention for rural caregivers are addressed, as well as issues related to the applicability of telehealth services in professional practice. (PsycINFO Database Record (c) 2011 APA, all rights reserved)
Implementing psychological services over televideo.
Real-time videoconferencing is an innovative service delivery method to address the striking access gaps to psychological services, particularly in rural communities. The authors draw upon decades of programmatic experience and national guidelines to address key areas in televideo implementation. They describe the initial needs assessment as well as long-term outreach components, including training and sustainability. They summarize protocol-driven service that addresses technology, personnel, sessions, and follow-up. The authors emphasize creative strategies to translate psychology's best ethical practices to the televideo setting. (PsycINFO Database Record (c) 2011 APA, all rights reserved)
Benefits and challenges of conducting psychotherapy by telephone.
Telephone-delivered psychotherapy has increased utility as a method of service delivery in the current world, where a number of barriers, including economic hardships and limited access to care, may prevent people from receiving the treatment they need. This method of service provision is practical and has the potential to reach large numbers of underserved people in a cost-effective manner. The aim of this article is to review the state-of-the-art of telephone-delivered psychotherapy and to identify improvements and possible solutions to challenges. Results of randomized, controlled trials indicate high client acceptance and positive outcomes with this method of delivering psychotherapy. Nonetheless, psychotherapists wishing to deliver psychotherapy by telephone face a number of challenges, including a lack of control over the environment, potential compromises of privacy and confidentiality, developing therapeutic alliance without face-to-face contact, ethical and legal issues in providing psychotherapy by telephone, handling crisis situations at a distance, and psychotherapist adjustment to conducting psychotherapy in an alternative manner. There remains a need for further research, including direct comparisons of face-to-face psychotherapy with telephone-delivered psychotherapy and feasibility of telephone delivery of psychotherapies other than cognitive–behavioral therapy. (PsycINFO Database Record (c) 2011 APA, all rights reserved)

Professional Psychology: Research and Practice - Vol 42, Iss 6