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Client selection, intake, and assessment in Telemental Health Sara Smucker Barnwell, PhD Tuesday, May 26, 2020

Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

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Page 1: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Client selection, intake, and assessment in Telemental

HealthSara Smucker Barnwell, PhD

Tuesday, May 26, 2020

Page 2: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Telehealth Learning Series: Tuesdays, 5-7 PM May 12: Introduction to Telemental Health

May 19: Preparing your office for Telemental Health

May 26: Client selection, intake, and assessment in Telemental Health

June 2: Clinical engagement in Telemental Health

June 9: Emergencies, disruptions and pitfalls in Telemental Health

June 16: Risk Management in Telemental Health

Register @ NWATTC website

Page 3: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Your presenter

Sara Smucker Barnwell, PhD

Licensed clinical psychologist in WA

VA Telemental Health Team

APA Telepsychology Guidelines

CESATE fellow

Unapologetic telehealth evangelist

Page 4: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Learning objectives

Client selection

Intakes, assessment

Building your practice

Page 5: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Class structure

Didactic lecture

Live Q &A at section breaks

Video demonstrations

Submitted questions [email protected]

Live Q & A

mailto:[email protected]
Page 6: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Disclaimers

During a technology presentation, technology will fail

Offer best practice recommendations based on clinical work, literature review and regulatory experience

Identifying personal best practices and guidance in developing area

Page 7: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Disclaimers

Always review state regulations

Consult with your own legal counsel

Consult with your risk management coverage

I do not provide legal advice nor clinical advice

Page 8: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Conflicts

Provides telehealth training Known telehealth evangelist

Page 9: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Agenda: Preparing your office

Client selection

Inclusion, exclusion

Intakes, assessments, termination

Special populations (neuropsychology, forensic, youth)

Building your TMH practice

Advertising, staff

The role of physical space

Page 10: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

The balance

Brief review

Deep dives

Your questions answered

On demand prior classes

Page 11: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

You look familiar…

Is this your first class?

Please respond in chat window

Page 12: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Definitions and examples(Abbreviated!)

Page 13: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Operational definitions

Telemental Health (TMH):

The provision of any mental health service using telecommunication technologies

…videoconferencing

Access is at the heart of this mission

Page 14: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

HIPAA

Health Information Portability and Accountability Act (HIPAA):

Federal law (Pub.L. 104-191, 100 Stat. 1936, enacted August 21, 1996) that aims to make it easier for people to keep health insurance, protect the confidentiality and security of healthcare information and help the healthcare industry control administrative costs

HIPAA Privacy Rule

HIPAA Security Rule

Page 15: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Protected Health Information (PHI)/ ePHI

• Names

• Full-face photographic images

• Geographical subdivisions smaller than state

• All dates (birth, death, discharge)

• Phone/ fax numbers

• Electronic mail addresses

• Social Security numbers

• Medical record numbers

• Health plan beneficiary numbers

• Account Numbers

• Certificate/license numbers

• Vehicle identifiers and serial numbers, including license plate numbers

• Device/ serial numbers

• Web Universal Resource Locators (URLs)

• Internet Protocol (IP) address

• Biometric identifiers, including finger and voice prints

• Any other unique ID numbers, code, or characteristic

Page 16: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Business Associates Agreement (BAA)

Contract between HIPAA covered entity and HIPAA Business Associate (BA) that is used to protect personal health information (PHI) in accordance with HIPAA guidelines.

This Photo by Unknown Author is licensed under CC BY-SA

http://www.lawtechtv.com/home/2013/03/digital-download-omnibusruleready-view-the-contentof-our-business-associate-contract-and-realize-the-full-value.html
https://creativecommons.org/licenses/by-sa/3.0/
Page 17: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Novel Coronavirus/ COVID-19

Current public health crisis

Social distancing and “stay home” orders

Telepractice as a tool to protect public health

Some providers now mandated to telehealth

Page 18: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Client selection

Page 19: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Client selection criteria

Research suggests equivalence of in-person and many remote treatments and high satisfaction

Observe usual standards of care/ APA ethics code

Technology is not a clinical specialty though it requires competence

Page 20: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Cultivating clients

Assess why remote service v. in-person

This assessment is evolving

Little empirical/ few legal reasons to exclude specific clients; question of risk management

Assessing service appropriateness is ongoing

Page 21: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Your practice

What population do you serve

What services do you offer

What practice do you want

Page 22: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Client characteristics

Client vision and hearing

Preference for modality

Practical adaptability

This Photo by Unknown Author is licensed under CC BY-NC

http://www.allwhitebackground.com/headphones.html
https://creativecommons.org/licenses/by-nc/3.0/
Page 23: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Client characteristics

Health status/ status of loved ones

Jurisdictional requirements/ rules

Care access (e.g., distance, medical, financial)

Page 24: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Client clinical characteristics

Diagnosis

Avoidance, Delusions regarding technology, others

Treatment history

Stability

Page 25: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Client SUD history

SUD considerations (UAs, reporting)

Transportation concerns

Medication assisted treatment for opioids

DHHS/ OCR announcements also apply

Special considerations for controlled substances

Page 26: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Client characteristics

Client care environment (e.g., office, home)

Insurance/ reimbursement

Privacy/ stigma

Page 27: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Client technical

capabilities

Technical ability

Teaching

Age, gender, education, experience < good explanation

This Photo by Unknown Author is licensed under CC BY-NC

http://www.musingsoverapint.com/2012_03_01_archive.html
https://creativecommons.org/licenses/by-nc/3.0/
Page 28: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Client technical capabilities

Does the client possess technical resources

Computer/ mobile device access

Adequate internet speed

Hardware/software

Mobile device, phone

Page 29: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Not the perfect client

Page 30: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Emergency probability

Clients receiving interactive remote care have emergency plan

Consider what you will do in case of medical or psychiatric emergency (e.g., local hospital, wellness check, others).

Page 31: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Emergency probability

Problems that do not meet mandated reporting threshold but cause concern

Availability of support person

Where will patient discharge if no longer appropriate

Page 32: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Remember your clinical considerations

Page 33: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Assessment

Telehealth Appropriateness Assessment Delivering psychological services through remote technology provides the opportunity to reach clients who might not otherwise receive care. However, not every client will be appropriate for telehealth services. The questions below provide guidance regarding clinical and technical factors that you may wish to consider before committing to deliver telehealth care. Clinical Assessment

1. What is the patient’s age? a. If a minor, how will you gather the parent’s consent?

2. Is the client currently in crisis? 3. In the past 12 weeks, have they had thoughts, intention or plans to hurt

themselves? a. About hurting someone else?

4. Have they ever been hospitalized for emotional health reasons? a. When? b. What happened?

5. Explain that telehealth services typically serve in non-crises. Explain manner in which telehealth providers support patients who later develop crises, but may need to supplement care with in-person meetings or transfer care.

6. Is this issue related to an accident or legal action that is pending? a. Are they seeking an assessment related to legal action?

7. Are they hoping to use insurance to pay for your visit? a. Who is their insurance carrier? b. Are you/ they familiar with your mental health benefits? c. With the insurance carrier’s policy regarding telehealth? d. Will you or the client contact insurance to discuss the telehealth policy?

8. Why are they seeking telehealth care vs. in-person care? a. Is in-person care available in their community?

9. Are they available to meet in person with the provider now or in the future? 10. How do you plan to verify the client’s identity? 11. In what state does the client intend to receive care?

a. Does the client intend to travel often while receiving remote care?

Technical Assessment

1. Do they have access to a private space in their home? 2. Is it relatively soundproof? How easily can conversation be overheard?

a. Explain to the client the critical importance of keeping this space secure and confidential during appointments

3. Do they have access to a computer or mobile device?

a. What kind (e.g., desktop, laptop, tablet)? b. How old is it (< 7 years old)?

Page 34: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Take away

Convenience is neither a solely determining nor deterring factor

Not every client is appropriate

No codified exclusion criteria

Page 35: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Take away

Know your jurisdictional rules regarding COVID-19

Decisions made using research and risk management

As with in-person practice, you are not obligated to provide service, but once begun you are obligated to refer for continued care

Page 36: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Vignette: Dr. Evil

Client seeks services for alcohol use disorder

Active use, comorbid Panic Disorder

Avoidance of social circumstances

Moderate suicidal ideation without active plan or intent

History of self harm

Page 37: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Considerations

Accessibility of other treatment options

Client health, willingness for in person care, referral availability

Role of exposure

Client willingness to pursue safe exposure

Your comfort with remote emergency management

Page 38: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Live Q & A

Page 39: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Intakes, assessments, termination

Page 40: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Intakes

Page 41: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Intake preparation

Who: inclusion/exclusion criteria

What: what services

How: which technologies (videoconferencing, telephone)

When: schedule by phone, secure email, EMR

Rules: jurisdictional concerns, initial intakes

Page 42: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Intake preparation

Fee structure

Self-pay v. direct bill insurance

Payment for session in which technology disruption occurs

Surcharges

Collection of fee

Page 43: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Intake preparation

Your space: austere background, adequate lighting, soundproof

Consider use of headphones

Home office v. professional office

Privacy

PHI

Smart speakers

Page 44: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Intake preparation

Intake documentation

Telehealth informed consent, emergency plan, questionnaires, payment, ROI

Simple documents; verbal consent

Page 45: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Intake preparation

Secure document exchange

Mail, fax, downloads from your website

Secure email programs, secure FTP, EMR

Page 46: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Intake preparation

Communicate expectations

Video call mechanics/ embed this in reminders

Boundaries

Interruptions, help

For clients new to modality, 5 minute “test” check in

Page 47: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Initiating the intake

Confirm client can hear/see you

Confirm location and setting security

Silence devices, windows, notifications

Page 48: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Initiating the intake

REVIEW RISKS AND BENEFITS

REVIEW EMERGENCY PLAN ANSWER ANY REMAINING NON-CLINICAL QUESTIONS

Page 49: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Conducting the intake

Advance information Engage with usual skills

Ask questions

Page 50: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Conducting the intake

Consider structured clinical interviewSCID V

Pace may differ

Page 51: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Assessment measures

Collect in advance Verbally review Screen sharing

Page 52: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Behavioral observations

Eye contact, facial expression

May not offer same information

Looking away v. distractions in home environment

Body posture and movements (gait, psychomotor agitation)

Page 53: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Behavioral observations

VOICE VOLUME/ VOCALIZATIONS

OLFACTORY DATA LOSS AND GAIN

Page 54: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,
Page 55: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Intake conclusion

Engagement/ how to meet their needs

Additional intake session is indicated

Discuss future homework/ information transfer

Page 56: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Intake conclusion

Usual concluding statements

If appropriate, propose an engagement (a number of sessions, treatment plan)

If accepted, schedule the next appointment/ invite client to schedule online

Review options or possible referral out/ where will referrals go

Answer patient's questions

Page 57: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Assessment

Page 58: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Remote assessment

Norm availability Licensing, permissions

Consultation

Page 59: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Remote assessment

Observed administration Impacts of remote assessment on self report

Potential secondary gain issues

Page 60: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Online psychometric assessment

Many more tests now online

Remote MMPI administration

Batteries constructed for remote administration

Observations/ psychometricians

Page 61: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Consider

IS REFERRING QUESTION STILL THE SAME

CAN THE TEST BE ADAPTED

ARE NORMS AVAILABLE

Page 62: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Consider

LICENSING ABBREVIATE CAN IT WAIT

Page 63: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Special populations

Page 64: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Forensics

COURT AVAILABILITY IN YOUR

JURISDICTION

WILL ADAPTATION WITHSTAND

EXAMINATION

SECONDARY GAIN GOING INTO JAIL

Page 65: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Youth

Zoom fatigue

Relevance of referring questions for IEP

Consider abbreviated sessions

Consider increased parental involvement where appropriate

Page 66: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Neuropsychological

Permissions, licensing

Necessity of physical exam

Feedback sessions

Watch the marketplace

Interorganizational practice committee

Page 67: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Vignette: Dr. Impossible

Forensic assessment case

Parental fitness

Quarantine configuration

Academic impacts

Page 68: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Considerations

Courts open/ closed

Stability of living situation

Withstand attorney’s review

Current school configuration

Is delay appropriate

Page 69: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Termination

Page 70: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Termination and referral

Termination occurs for diverse reasons

Referral resources Know your telehealth community

Page 71: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Termination and referral

Termination due to modality

What is clinically advisable

Role of avoidance v. preference

Your recommendations

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Vignette: Dr. Venture

Client treated for comorbid benzodiazepine use and anxiety disorder

Does not like modality

Frustrated

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Considerations

Willingness/ availability of referral

Medical safety

Legal involvement

Your clinical judgement

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Live Q & A

Page 75: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Building your TMH practice

Page 76: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Building a TMH practice

Role of physical space

Referrals

Documentation

Training and consultation

Page 77: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Advertising

Practice website

National registries

Additional ads

Relationships in community

you wish to serve

Page 78: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Outreach

Primary care

Specialty clinics

SUD, medication assisted opioid care

Community organizations

Consider offering free psychoeducation to membership

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Physical space

Office space

Emergency management, assessment

Jurisdictional requirements

This Photo by Unknown Author is licensed under CC BY

http://oficinapublicasaludable.blogspot.com/2012/06/top-20-oficinas-elegantes-y-saludables.html
https://creativecommons.org/licenses/by/3.0/
Page 80: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Technology investment

Products designed for healthcare

Videoconferencing, telephone

Document transfer (email, fax, secure message)

EMR

Page 81: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Administrative staff

Integrating administrative staff into use of TMH

Coordinate 1 treatment “room” for patient

Administrative login to EMR/ videoconferencing product

Page 82: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Administrative staff

What do we want them to accomplish

Measure collection Confirm privacy, visibility

Review risks/ benefits

Page 83: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,
Page 84: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Coronavirus considerations

Page 85: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Long-term TMH

Transition from short-to long-term Telemental Health

Existing clients, new clients

Investment in long-term

Page 86: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Long-term TMH

Temporary v. a practice you will continue to offer

Balance

Self care

Page 87: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

In summary

Page 88: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Client selection

Determine and document your inclusion/ exclusion criteria

Determine what services you want to offer who

Assessment is ongoing

Page 89: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Intakes

Collect information beforehand

Slow the pace

Ask question, structured interviewing

Focus on rapport

Page 90: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Assessment, special populations

Use appropriate online assessment when possible

Practical considerations

Abbreviated batteries

Some assessments will be delayed

Page 91: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Termination

Know your referrals

Contemplate avoidance

Offer your opinion

Page 92: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Building your practice

Advertise, reach out

Invest in sustainable technology

Role of physical space

Know your jurisdiction

Train staff

Page 93: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

That’s a good questionPreviously submitted questions

Page 94: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Templates

Telepsychology templates

Return to in person care informed consent

https://www.apaservices.org/practice/clinic/covid-19-informed-consent

https://parma.trustinsurance.com/Resource-Center/COVID-19-Resources

https://www.apaservices.org/practice/clinic/covid-19-informed-consent
https://parma.trustinsurance.com/Resource-Center/COVID-19-Resources
Page 95: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

1-page handout

SAMSHA handout

EMR (Simple Practice) may have templates

Page 96: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,
Page 97: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Live Q & A

Page 98: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Questions for future learning series sessions

Please contact [email protected]

mailto:[email protected]
Page 99: Client selection, intake, and assessment in Telemental Health1. tZ ] Z ] v [ P M a. /(u]v} UZ}ÁÁ]ooÇ}µP Z Z v [ }v v M 2. Is the client currently in crisis? 3. In the past 12 weeks,

Thank you!

Sara Smucker Barnwell

[email protected]

mailto:[email protected]

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