The Voice of Telemedicine Series: Teletherapy with Chris Nealy

We are excited to introduce Chris Nealy as our next guest blogger. Chris Nealy practices teletherapy in North Carolina with his practice Halcyon. Teletherapy has become an important part of his practice.

About Chris Nealy, MSW, LCSW
I co-operate a private practice where we deliver services from multiple locations around Charlotte, NC. Teletherapy has become an invaluable tool for maintaining consistency for people who have difficulty fighting traffic, are traveling, or who live in rural areas with limited access to quality providers.

What is your background? Specialty? How long have you been in telemedicine?
I earned both my Bachelor’s and Master’s Degrees from the University of North Carolina at Chapel Hill (BA ‘05, MSW ‘11). My research and areas of study were heavily focused on Autism, specifically dual diagnosis and impacts on the family. Currently, I provide office-based, nature-based, and in-home services with a primary focus on individuals, families and couples affected by Autism or ADHD. I embrace nature and technology, spending most of my time meeting with patients at Triple Play Farm where we practice Equine Facilitated Psychotherapy, often integrated with GoPro recordings for video modeling, mobile apps for behavior tracking and journaling, and mindfulness education through interactive programs.

As a tech geek hobbyist, I’m very interested in the impact of technology on the provision of healthcare services, especially the security and privacy implications set forth by HIPAA/HITECH. Finding that many colleagues and truly gifted providers are unaware of the risks and benefits offered by accessible technology, I offer trainings and consultations on compliancy standards and ways to utilize telecommunications appropriately in small practice.

I have been providing teletherapy services for about 3 years, and have made many adjustments along the way to balance patient accessibility with necessary protections to safeguard their information.

What motivated you to start adding telemedicine to your practice?
I was naturally drawn to teletherapy as a tool bridging providers with patients. Whether barriers involve anxiety about leaving home, access to transportation, or simply scheduling conflicts, teletherapy is a method which has yet to be seriously tapped for maximum potential.

How has telemedicine changed in the last year?
In the past year, the awareness of “tele- health/therapy/medicine/sessions” has grown within the public eye. Hospitals, VAs, and larger providers may have been delivering services in this platform for quite a while, but only recently have small practices had access to affordable, HIPAA-informed resources such as Therapist circles frequently debate the topic from angles of diagnostic limitations, interstate practice laws, HIPAA standards, and general ethical considerations. This reflects the growing interest by consumers as well as providers.

Where do you see the telemedicine and teletherapy market 1 year from now?
As with many new technologies, growth in the teletherapy market is likely to continue. The longevity greatly depends on factors including quality of service delivery experienced by the public, affordability and accessibility for the providers, and the continued respect for the ethical and legal regulations which struggle to keep up. Clearer federal regulations, state-to-state licensing agreements, and education on telemedicine and teletherapy will be even more necessary as interest continues to grow.

From your POV, how do patients like meeting with providers by telemedicine/teletherapy?
I have several patients who attend college. They all express appreciation in being able to maintain a primary therapist consistently instead of dealing with student health or disruptions due to holiday breaks. Working with folks affected by Autism and ADHD, consistency and familiarity is absolutely necessary in providing quality treatment.

Do you have any insightful, interesting, funny, or notable experiences from your tenure in the telemedicine space?
When accessing someone remotely, s/he may be in any situation. It isn’t uncommon for an early morning teletherapy appointment to begin with the patient staring at me groggy-eyed and in pajamas, having clearly forgotten about the appointment (remember, I work with a lot of college students with ADHD). The amazing thing is this doesn’t disrupt a session or result in a missed appointment as would otherwise be the case. We are able to discuss the scenario from a therapeutic perspective providing a truly unique opportunity of embracing a teachable moment and exploring natural consequences.

What challenges have you seen providers experience with telemedicine and/or teletherapy?
The greatest challenge aside from being unaware of the tool is misinformation about the technology and HIPAA applicability. Many providers continue to use public services such as Skype and Hangouts because they don’t understand the privacy and security risks being taken. I have used these options as well during \various technical complications (patient’s new phone doesn’t have the app, campus firewalls blocking access to, etc.), but I’m able to explain the risks to the patient each time. I question our ability as providers to truly provide Informed Consent about these tools when so many of us are not equipped with the knowledge to be informed ourselves. I view this as the greatest challenge because such inappropriate uses may lead to harsher restrictions for the entire field.

What advice would you give to other healthcare providers interested in starting telemedicine?
Take your time! Take your time to learn about the laws in your state and your Board’s policies on telemedicine. If there isn’t a clear answer (as is often true), contact your representatives and ask. Connect with social media groups where there are frequently several tech-savvy providers to point you in the right direction and save you from getting lost in the HIPAA research rabbit hole. Find trainings that cover not just how to use the tools, but offer ethics CEUs to support exploration of risks you may not have considered. Practice with the tools by connecting with colleagues, friends, and family to become familiar with the options, settings, and how to respond when something doesn’t work (it’s the internet, it’s going to happen). Lastly, BE SURE to incorporate a telehealth and teletherapy section in your Policies and Procedures; you don’t want to go through the process of setting up a golden service just to have it collapse due to a desk audit!

Lastly, use It’s the bee’s knees.

Please connect with Chris Nealy via Facebook, Triple Play Farm or his website.

If you are interested in offering Teletherapy to your patients, is free and easy to use. You can learn more here.

Dylan Turner

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