Article 1 - November 2022

The Fast and Furious: The Rapid Implementation of Tele-mental Health Practices Within a Children’s Advocacy Center

Lisa Conradi, Andrea Hazen, Jill Covert

From abstract: “This article provides an overview of the rapid implementation of TMH practices within a large, urban CAC setting. [The authors] share the specific tele-mental health practices and implementation strategies that were put into place because of COVID-19 and how they align with the Consolidated Framework for Implementation Research, as well as recommendations for how agency leadership can better facilitate the implementation of innovative practices in similar settings.” 

This article gives a detailed account of the process and specific strategies employed to implement TMH services. While the featured CAC is hospital-based, the lessons learned are helpful to many types of agencies and CACs. To facilitate the transition to TMH during COVID-19, the CAC focused on the following key activities: (1) Agency expectations; (2) Providing training and resource sharing; (3) Technology and space considerations; and (4) Creating communication and collaboration opportunities for staff to support one another.¹ Lessons learned include the following:

• Exceptions to being seen through TMH needed to be considered and planned for. Situations where exceptions to being seen through TMH were cases with significant safety or confidentiality issues, clients who had no access to technology, clients who refused to be seen unless it was in-person, and very young children who could not engage in TMH services.
• Numerous training activities were provided, ranging from those designed to support staff with the technical aspects of TMH to trainings focused more on the application of therapy practices within a TMH environment. Both types of training were important to equip staff with the skills to effectively transition to TMH.
• Family education about TMH services was a critical component to delivery, including providing families with printed/virtual resources as well as supplies and equipment. For example, funds were donated to provide “teletherapy kits” that included play therapy supplies such as toys, memory games, and Play-Doh for many families who initiated treatment at the beginning of the pandemic. However, these funds were not sustained for the entire pandemic. When implementing TMH, it is recommended that organizations ensure that resources are continuously available.
• Gaps in access to and understanding of technology among clients and staff need to be considered early and include technical assistance for clients, funding for technology, ongoing training and resource development, and improved equipment for staff.
• One of the more important challenges identified from TMH implementation was supporting providers in doing the work and preventing burnout. Monthly meetings with staff are recommended to provide support and further reinforce the fact that they are valued by the organization. Keeping staff connected to each other and the organization is important, especially when teams are remote.
• To address the safety concerns of working with clients who have been victims of abuse and neglect, it was critical to develop a safety planning policy and procedures for TMH services. This policy was included in the article, and it addressed strategies to create safety before, during, and after the TMH session. 

Article 2 - February 2022

Provider Perspective on Telemental Health Implementation: Lessons Learned During the COVID-19 Pandemic and Path Forward

Jessica M. Lipschitz, Samantha L. Connolly, Rachel Van Boxtel, Julia R. Potter, Neil Nixon, and Niranjan Bidargaddi

Impact statement from article: “This qualitative study evaluated mental health clinicians’ attitudes toward telemental health (TMH) after a period of use necessitated by the coronavirus disease (COVID-19) pandemic. Findings indicate that clinicians see substantial clinical advantages to continuing TMH services. Most clinicians, however, emphasized that some services should still be offered in person and infrastructure to support TMH use—such as professional guidelines and reimbursement equity—will be essential moving forward.”

• The results of this study might be surprising as many people assume that both clients and providers would prefer in-person sessions to TMH. This article is about perceptions by both providers and patients of TMH for delivery of therapeutic services. It does not focus on the effectiveness of TMH in achieving therapeutic outcomes. Providers reported on perceived advantages of TMH for specific patient populations and presenting problems. When asked about quality of care provided via TMH, many providers commented that it depends on the patient population and type of session. The more severe impairment (severe mental illness), the less confident providers were about TMH delivery.
• Providers reported that they found TMH to be quite useful for clients with the barriers of transportation and child-care.
• Providers indicated that, prior to COVID-19, both they and their patients assumed that the efficacy and interpersonal richness of treatment would be diminished by TMH, but they have been pleasantly surprised by the advantages of TMH services.
• The majority of providers in the study reported that they felt the overall quality of care that TMH provided for clinically appropriate clients was the same or slightly better than in-person services. 

Article 3 - December 2021

 Patient Perceptions of Trauma-Focused Telemental Health Services Using the Telehealth Satisfaction Questionnaire (TSQ)

Bianca T. Villalobos, Aubrey R. Dueweke, Rosaura Orengo-Aguayo, and Regan W. Stewart

Impact statement from article: “This study presents findings from the use of a new satisfaction survey that can be used by clinicians to assess satisfaction with telemental health services delivered via videoconferencing. High levels of satisfaction and comfort were demonstrated among youth and their caregivers who used tablets and laptops to connect to their clinicians for trauma-focused therapy. Many of the families in this study reported that they experienced barriers to traditional office-based services, which telehealth can help address.”

This study provided valuable information from a satisfaction questionnaire, developed by the Medical University of South Carolina, administered to clients receiving trauma services via TMH. Thirteen clinicians delivered home and school-based Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) via videoconferencing on tablets and computers to 60 child patients (71.7% Latinx, 18.3% Black, and 10.0% non-Hispanic White). Patients and caregivers completed the Telehealth Satisfaction Questionnaire (TSQ) at discharge via telephone, videoconferencing, or in-person interviews.² The results showed the following:

• Most youth and caregivers felt comfortable using the telehealth equipment from the outset of therapy, and all participants who were not initially comfortable using the equipment reported feeling more comfortable over time.
• Rapport with children and caregivers did not appear to be significantly hindered with TMH delivery. Many clients participating in the study reported they preferred using telehealth services over coming to a clinic for in-person services.
• Transportation was often a barrier regardless of how far clients lived from the clinic, and most families would not have been able to attend sessions if services were office based.² Given that, the authors concluded that the need for telehealth services exists not only for those living in rural areas hours away from service sites but also for those residing in urban underserved areas near their clinic. 

[2] Villalobos, B. T., Dueweke, A. R., Orengo-Aguayo, R., & Stewart, R. W. (2021). Patient perceptions of trauma-focused telemental health services using the Telehealth Satisfaction Questionnaire (TSQ). Psychological Services, 20(1), 107–121. https://doi.org/10.1037/ser0000605