By Ali Gribi, School Psychologist
With the recent demand for a quick transition to online school and therapeutic support, many service providers may find themselves launched into an overwhelming virtual frenzy. In times of uncertainty, it is especially important to make a concerted effort to let students and clients know that they will continue to have access to a system of support, and to maintain routine as much as possible. While not every school or clinical service translates well into the online-sphere, there are some great service delivery options to help facilitate consistency of support for students with behavioral or social-emotional needs.
The term telehealth refers broadly to health care supports that can be administered remotely, and includes services like counseling, consultation, therapy, and even assessment. When considering implementing tele-health, it is important to examine both the benefits and challenges associated with this type of service delivery.
Benefits:
Continuity of care during difficult times - The most effective interventions are those that are delivered consistently and are progress-monitored. Telehealth services provide a means through which clients and students can continue to receive the care and services they need despite changes in routine or environment.
Eliminates issues of distance/travel - Services can be provided through an appropriate and agreed upon virtual modality without the need for clients or practitioners to leave home. This enables greater access to services for those who live in remote areas or may not have access to quality supports within their community.
Compatible forum for cognitive behavioral therapy (CBT) - According to the National Association of School Psychologists (NASP, 2017), research supports the effectiveness of telehealth counseling using a CBT method to treat adults presenting with a range of disorders, including anxiety, depression, bipolar disorder, and obsessive-compulsive disorder.
Ongoing problem solving - Online consultation allows stakeholders to stay connected, problem-solve, and continue to coordinate treatment efforts from afar.
Challenges:
Access to technology - One must not assume that everyone has equal access to working technology, or that all clients understand the potential risks associated with receiving services through an online platform.
Assessment - There is not much information regarding telehealth administration of psychoeducational assessments, and the tools and resources that are required are often difficult to access. In most cases, it is preferable to complete assessments in person, as norming samples for test items do not include data collected through telehealth administration (NASP, 2017).
Confidentiality - Inherent in providing virtual services is the issue of maintaining confidentiality between practitioner and client. Remote service delivery presents a real challenge when it comes to control over the environment. Given the current demand for home-based services, NASP advises that “Practitioners may need to renegotiate confidentiality agreements to manage the limited privacy students may have at home” (2020).
Appropriateness of fit - Not all services can be delivered virtually, nor are all cases suited for a remote support approach. In order to evaluate whether or not to initiate telehealth services, NASP recommends close consideration of the following factors: “the complexity of the student’s condition, the context and environment in which the student interacts, how comfortable the student is with using technology, and the nature and complexity of the service and/or intervention required” (2017).
Advice and considerations from a school psychologist: Lindsey Wixson is a certified school psychologist who is currently providing telehealth services to staff and students in Rome, Italy. Given the current restrictions in Italy, Lindsey is providing counseling and consultation services from home using the Zoom application. Per her report, confidentiality has become very difficult to manage due to the requirement that everyone be housebound. While students and staff may have headphones to use during sessions, it becomes difficult to ensure privacy when there are others in the home. Lindsey noted that it is essential to be transparent about this important shortcoming with clients prior to initiating telehealth services so that they can consider the benefits and risks to continuing services through this modality. When it comes to preparing to deliver telehealth services, Lindsey recommends sticking to a school schedule as much as possible. Given that many students are continuing to take courses through an online platform, it is important to assist in the maintenance of routine and to make attempts to limit interference with E-learning.
Advice and considerations from a psychological counselor: Shani St. Louis is a certified psychological counselor and psychiatric nurse currently working for Linden Global Learning and Support in Berlin, Germany. Shani provides counseling sessions, psychological assessments, and clinical supervision using secure online platforms. To prepare for her sessions, she ensures that she has access to a quiet, private, and comfortable space, and uses headphones to assist with privacy and focus. Further, Shani indicates that it is important to make sure to have a strong internet connection, and to have any materials you would like a client to fill out prepared ahead of time so that they may be administered via a shared-screen or sent in an email. Some of the assessment tools Shani uses to collect information from clients include the Behavior Assessment System for Children, Third Edition (BASC-3), the Beck Youth Inventories, Second Edition (BYI-2), the Patient Health Questionnaire (PHQ-9), and the Generalized Anxiety Disorder 7-item scale (GAD-7). When considering administering assessments remotely, Shani cautions that it can sometimes be difficult for clients to understand expectations. In order to navigate this, she provides explicit directions regarding how to complete each questionnaire, and lets her clients know that she is available via video or phone should they require additional assistance.
For further information, please check out the following online resources:
References:
National Association of School Psychologists. (2017). Considerations for delivery of school
psychological telehealth [Brief]. Bethesda, MD: National Association of School
Psychologists.
Virtual Service Delivery in Response to COVID-19 Disruptions National Association of School
Psychologists. (2020). [handout].