Introduction to TelepsychologyPart 1

John D. Gavazzi, PsyD ABPP

Pennsylvania Psychological AssociationAugust 2016

Part 1 – Just the basics

• General Introduction to Technology and Telepsychology

• The importance of contemplating telepsychology services

• Legislative Issues

Limits to this training

• Prochaska and DiClemente’s model for changing behavior

• Geared toward those in precontemplation or contemplation

• This training does not guarantee competence

Limits to this training• Covering “synchronous” or live forms of

communication (teleconferencing, etc.) and not “asynchronous” forms of communication (texting, emailing, etc.)

• Not going to cover HIPAA issues today, although you need to know HIPAA if you

plan to engage in telepsychology.

Learning Objectives

1. To list three reasons to support further exploration to provide telepsychology services.

2. To describe one model to start using telepsychology services

Myths about Telepsychology• There is no research to support its use• It is too expensive• There is no insurance reimbursement• There are no guidelines for psychologists• It is impractical for individual psychologists

to get up and running• Telepsychology means you

have to use electronic records

Telehealth Statistics

Number of virtual physician visits in US

Wall Street Journal, 2016

Telehealth StatisticsPercentage of providers that have telemedicine programs

Telehealth Statistics

Percentage of larger employers offering telemedicine benefits

Telehealth StatisticsPatient Resistance to Telehealth Services

Telehealth StatisticsPatient Desire for Telehealth Services

Telehealth StatisticsPercentage Open to v. Actually Used

• Increased client satisfaction• Decrease costs with child/elder care• Decrease travel time• Improved access to specialists• Improved attendance

• Potential for faster appointment• Don’t have to use “sick time”

What are the patient benefits?

• Increased client satisfaction• Improved attendance (weather, vehicles)• Greater access to patients (geography)• Can treat agoraphobic patients• Potential for increase office efficiency

• Can deal with emergencies more effectively (and get paid)

What are the psychologist benefits?

• Need to be competent• Need to know technology• Treatment & rules are slightly different• Higher risk treatment modalities• Potential for problems can increase

• May need to spend more time with some patients to get them up to speed with technology

Downsides of Telepsychology?

Know Your Technology

Higher Risk Model

• Patient is at a greater geographic distance from you.

• The patient lives alone• You have never met the patient in person• You and your patient live in different

states, one of which you are not licensed• You promised treatment

without an assessment

Migration Model

• Start with patients you already see in treatment.

• Consider clinical complexity• If patient is complex and needs twice per

week sessions, consider using one session via telepsychology

• Not every patient is a candidate for telepsychology

Migration Model

• Take time to prepare these patients.• Consider their technological savvy• Plan regular, in-person sessions as the

norm• Consider patient’s level of social support

• Pick a distance you feel comfortable

Migration Model

• Make sure you are approved by the patient’s insurance company to provide services

• Make sure you understand the billing codes of that insurance company before offering telepsychology services.

My Story

• Patients wanted to access telepsychology services mainly for convenience

• Became approved provider for Highmark (and now Capital Blue)

• Doxy.me is a free HIPAA-compliant platform

• Used the migration model successfully. One exception.

Current Legislation

• PennPsyPAC• PPA and PennPsyPAC are already

meeting with legislators to have all insurance companies approve telehealth services.

• Payment Issues

Additional Resources

• Ethical Psychology.com: 2 podcasts

• TeleMental Health Institute www.telehealth.org

• Videoconference list• Full bibliography

ReferencesGlueckauf, R.L., Pickett, T.C., Ketterson, T.U., Loomis, J.S. & Rozensky,

R.H. (2003). Preparation for the delivery of telehealth services: A self-study framework for expansion of practice. Professional Psychology: Research and Practice, 34, 159–163.

Grady B. Myers K. Nelson E. (Co-Chairs). Evidence-based practice for telemental health: American Telemedicine Association guidelines. 2009. American Telemedicine Association Publication. Available online.

Maheu, M.M. & Gordon, B.L. (2000). Counseling and therapy on the Internet. Professional Psychology: Research and Practice, 31, 484–489.

ReferencesMaheu, M.M., Pulier, M. L., Wilhelm, F. H., McMenamin, J., & Brown-

Connolly, N. (2005). The mental health professional and the new technologies: A handbook for practice today. Mahwah, NJ: Erlbaum.

Reed, G.M., McLaughlin, C.J., & Milholland, K. (2000). Ten interdisciplinary principles for professional practice in telehealth: Implications for psychology. Professional Psychology: Research and Practice, 31, 170–178.

Richardson, L.K., Frueh, B.C., Grubaugh, A.L., Egede, L., & Elhai, J.D. (2009). Current directions in videoconferencing tele-mental health research. Clinical Psychology: Science and Practice, 16, 323–338.