About Gina Sprague, M.S., M.A., I am a psychology doctoral student at California School of Professional Psychology-Los Angeles, I currently obtain my practicum hours at One Neuro a clinic of psychologists, neuropsychologists, medical doctors, and neurologists. I have worked in the field of mental health for the last 12 years, in a variety of settings, including, in-home mental health support, psychosocial rehabilitation, maximum security forensic settings, VA settings, community based step down for paroles, psychiatric hospitals, and private practice. My area of specialization is in the treatment of severe mental illness, and my theoretical orientation is integrative with focus on cognitive behavioral, and systems (i.e. family, community) approaches.
How did you decide to focus on telehealth? Though the area of telehealth has been my research focus for the last 3 years, I would say the last 10 years have brought me to this research effort. I studied psychology during my undergraduate program at University of Wisconsin-Stout which provides laptops to every student on campus, depending on your major you either are provided a Hewlett-Packard (HP), or Apple. This university was in a rural city in Wisconsin about an hour from Minneapolis-St. Paul, MN.
What I didn’t know then was that I was starting the foundation for my passion for rural communities and technology, and starting to understand how psychology can better use the strengths of each to serve individuals who need mental health services. This experience led me to focus on Telehealth Implementation in Rural Communities for my doctoral clinical dissertation.
Why do you think telehealth experiences resistance in the field of mental health? Telehealth can invoke a lot of fear in clinicians in the field of mental health, I think we have to be honest with ourselves new can be scary. The important thing to understand is that telehealth is not here to replace traditional therapy. We can have both and the powerful thing is we can reach more individuals, collaborate as a field, and stay relatable with the use of technology.
What are the ethical and legal barriers to telehealth implementation in psychology? In the field of psychology, we need support for telehealth through addressing issues related to national licensure, currently psychologists cannot ethically practice across state lines unless they are licensed in state they are located in and the state the patient is located in. This can be a very expensive endeavor. The American Psychological Association (APA) has created telepsychology guidelines.
Continual growth with changing technology and research on best telepsychology practices will help further develop support in both health care legislation and insurance company reimbursement. Additionally, psychology programs increasing educational experiences that incorporate this type of treatment modality will help facilitate clinician’s application of technology in psychology practice, as well as increase competent and ethical telehealth practice.
How is treatment being provided using telehealth in the field of mental health?
Telehealth is being used in several different clinical applications: individual therapy, couple therapy, medication management, psychoeducation, videoconferencing, mobile phones, forensic testimony, psychological testing, professional consultation/training, dementia, autism spectrum disorders, attention deficit hyperactivity disorder, depression, eating disorders, and substance use disorders. In collecting research literature for my dissertation, I found the treatment of Autism Spectrum Disorders (ASD) and for persons with dementia (PWD) using telehealth applications to be very interesting.
An (ASD) study by Vismara et al.[^1] used the Early Start Denver Model (ESDM) program which focuses on the everyday learning that takes place in the home. Vismara et al.[^1] targeted interaction between parent and child with therapist observing, and providing feedback discussion. The educational component of this study was multi-faceted, with focus on website modules in order to follow treatment goals, videos on good and poor implementation of weekly intervention, and the impact this had on the child’s behavior[^1].
Technology features included, messaging system, calendar, photos, feedback survey, media-sharing (audio and video). Results highlighted that parents increased confidence in their ability to meet their child’s needs and in sharing the learned information with the other caregivers.
Lastly, smart technologies are being utilized in monitoring executive functioning, learning new things, social behavior and in finding information. A study by Bossen et al.[^2] highlights how smart technologies are being used to help early stage dementia patients take medication on time, engage with others through group chats, monitor whether they have left home, fallen, left the heat on, spilled water on the floor or started a fire. These smart technologies are developing algorithms for individuals that highlight deviations from normal patterns of everyday behavior and trigger warning signs if an intervention may be need [^3].
What rural mental health challenges make telehealth a viable option?
Rural communities have a lack of mental health professionals which increases patient reliance on their primary care providers. In 2007, the American Psychological Association reported findings identifying that 16 psychologist are available per 100,000 residents of rural areas in comparison to their urban colleagues.
A study by the American Journal of Psychiatry highlighted that 50% of individuals who committed suicide contacted their primary-care provider in the month before completing suicide[^4] . Consistent and available providers in rural community settings can help address mental illness and the increased dependence on alcohol and drugs. Additionally, telehealth can help connect individuals with physical disabilities living significant distances from mental health services an option that is cost effective and practical [^5].
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Vismara, L. A., McCormick, C., Young, G. S., Nadham, A., & Monlux, K. (2013). Preliminary findings of a telehealth approach to parent training in autism. Journal Autism Developmental Disorders, 43, 2953-2969.
Bossen, A. L., Kim, Heejung, Williams, K. N., Steinhoff, A. E., & Strieker, M. (2015). Emerging roles for telemedicine and smart technologies in dementia care. Smart Homecare Technology and TeleHealth, 3, 49-57.
Lexis, M., Everink, I., van der Heide, L., Spreeuwenberg, M., Willems, C., & de Witte, L. (2013). Activity monitoring technology to support homecare delivery to frail and psychogeriatric elderly persons living at home alone. Technology Disability, 25, 189-197.
Clay, R. A. (2014). Psychologists are finding innovative ways to reach out to people in isolated communities. Monitor on Psychology.45(4), 37-39.
Loh, P. K., Sabesan, S., Allen, D., Caldwell, P., Mozer, R., Komesaroff, P. A., Talman, P., Williams, M., Shaheen, N., Grabinski, O., & Withnall, D. (2013). Practical aspects of telehealth: financial considerations. Internal Medicine Journal, 43, 829-834.