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telehealth, teletherapy, Virtual visits The increased efficacy of telehealth, teletherapy, and telemedicine during the pandemic is a well-documented fact for everything from substance abuse–as described on Telehealth.org in Telephonic Telehealth Opioid Treatment Found Effective, to obesity, as in the Telehealth.org piece Telehealth Obesity Treatment Option, and all in between. What’s far more interesting and useful, at this point, indications are starting to appear that telehealth’s importance will endure long past this difficult time. Several studies released in the past few weeks point to an ongoing role for teletherapy and virtual visits and clients’ preference for them.

How Telehealth Reaches Those Left Out

Telehealth has been proven as a safe, easy-to-use, and cost-effective tool to connect clients and patients in need with behavioral health services for the past 16 months. The future of telehealth, however, is not as predictable as many would like to think. A recent study from Psychiatric Services suggests teletherapy can and should play an even more extensive role to ensure that people suffering from the complex stressors related to COVID receive the services they require in the future. The “new normal” with regard to telehealth is serving to bolster previous research that showed the efficacy of telehealth to reach populations that were denied the access needed before 2020.

The fact is, the technology and protocols to safely, effectively, and affordably offer needed telebehavioral health services through videoconferencing have existed for at least two decades. For telehealth history buffs, it may be of interest that published journal articles about the future of telehealth, the future of telepsychology, and the future of telemedicine have been published and have been left to die on the vine due to lack of reimbursement and other, albeit more surmountable barriers.1 Since 1959, research has shown that telehealth is especially effective when telehealth-trained clinicians use established protocols for reaching women, men from ethnic groups who look down on behavioral issues, the young adults, those of lower socioeconomic status, or who have experienced recent job loss, otherwise marginalized such as GLBT community members, the disabled, homebound, incarcerated, hospitalized, alcoholic, addicted as well as the healthy and very busy.

Renewed Interest in the Future of Telehealth

Numerous studies related to the success of telehealth during COVID have added fuel to the fire that has been burning in the bellies of telehealth and telemedicine e researchers and trainers, for more than three decades. A bit more of telehealth history… the first effort that sparked federal attention to telehealth was the formal appointment of Dr. Dena Puskin to a Deputy position at the Office for Rural Health. She was handed the task of dealing with telemedicine for the department. That appointment and her focus led to her success at spearheading Congressional attention to the issue and ultimately to her pivotal role in securing federal funding for the development of telemedicine to address rural health issues. She served as the Director of the Office for the Advancement of Telehealth (OAT) for 13 years. Many battles then were hard-fought to bring us to where we are now.

Enter COVID. The 2021 Psychiatric Services study mentioned earlier found that just over a quarter of the people who screened as needing mental health counseling for anxiety or depression were unable to access services during COVID in 2020, despite unprecedented efforts by the US government to make services available and reimbursable. Sustaining that access through reimbursement for professionals is the future of telehealth, and telepsychiatry services are the key to increasing access for all millions of people who are still in need.  The study has confirmed these findings. The authors make the point that those who are geographically isolated and thus faced with long waiting lists for local providers can find relief in telehealth clinicians who have more availability.

Editorial Comment: Although we at Telehealth.org have not seen much research on the topic come through the news that we access to bring you this weekly newsletter, there is every reason to believe that complicated bereavement is currently being experienced by millions of family members and friends who have lost a loved one to COVID. The lack of participation by loved ones in a loved one’s death can only be complicated by being deprived of the experience of time-honored rituals involved in coming together for assisting a loved one’s passing in a home or hospital, as well as funerals or burials. 2,3,4,5

Commitment to Telehealth

Moreover, it is the kind of relief that prospective clients want. The 2021 Health Care Insights Study found significant trends towards clients seeking telehealth. For example, in Houston, about 56% of survey respondents chose to move to virtual visits. Given the health crisis, this is, perhaps, not particularly surprising.

However, what does stand out is the desire of clients to continue with telehealth even as individuals are increasingly interacting with other in-person professionals and their services. Therapists in the area have noticed that a majority of clients still express a preference to continue teletherapy. One clinician estimated that 70% of her telehealth clients wish to keep seeing her through videoconferencing.

These results seem to build on the case begun by a Harris poll last month that found 84% of patients still preferred to attend their appointments via telehealth.

Telehealth Stands Up

A newly released study by the Journal of Medical Internet Research demonstrates this well by analyzing data from back in 2017 when no pandemic forced people to stay home. In the study, 82% of respondents characterized telehealth, otherwise known as teletherapy, as “at least as good as” in-person therapy. Here are more details:

  1. Fifty percent of respondents said their experience proved even better than in-person care.
  2. As quoted in Health Care IT News, the researchers found, “even during a single virtual visit, we found that patients and clinicians could meaningfully engage in relationship-building practices.” This means that not only do many clients want the telehealth experience; telehealth also delivers a comparable level of care as in-person.
  3. Finally, the study showed that, contrary to popular belief, the technology used to make telehealth possible did not intimidate people. Nearly 93% of those polled felt it was easy to use, and nearly 95% felt comfortable doing so. These extraordinary numbers further suggest that with some advanced explanation of the telehealth experience of therapy, those numbers could climb higher. Client and patient education may be warranted for some groups of people.

These three studies paint a very clear picture. People who have used telehealth would prefer to continue doing so. Telehealth and telemedicine can reach even more clients than traditional in-person work, and the care provided is not diminished by being administered digitally. The future of telehealth and the future of therapy, in general, seem well intertwined.

One of the biggest reasons therapists get these kinds of responses is that simply stated, telehealth works. Not only did it work during COVID for these past 16 months, but many of us in the telehealth community or researchers, writers, and trainers have been suggesting for decades, telehealth and telebehavioral health, in particular, have been shown effective for most than 60 years. And telehealth will be even more effective when more clinical community members focus their CME and CE licensure renewal training to better understand the impact of using technology and how to best leverage technology clinically to help those who rely on us for care. 6,7,8,9

The Future of Telehealth: Your Advocacy Is Needed

Another Editorial Comment: It is time that we as a community of professionals take a stand and insist on compensation for our work with telehealth at all levels. We at Telehealth.org encourage all of you to be advocates for this change by contacting each of your elected officials. Here’s a simple formula for making that easy:

  • Identify and contact your elected officials by looking up their names in any search engine. You will find their formal websites, where you can see their contact information.
  • Drafting one letter will suffice – just send the same letter to everyone that you can identify. 
  • Clearly state your desire for them to shepherd or support legislation that will reimburse clinicians to use evidence-based technology to deliver 21st Century healthcare. Ask them to recognize and support the importance of teletherapy going forward.
  • Include a case example without identifying any patient or client. It is only with a groundswell of citizen support will this legislation pass at this moment of opportunity.

If we don’t act in numbers right now, this inflection point will pass without the pivotal changes being argued at many levels of our state and federal governments.

Future of Telehealth Bibliography

  1. Maheu, M. M., Pulier, M. L., McMenamin, J. P., & Posen, L. (2012). Future of telepsychology, telehealth, and various technologies in psychological research and practice. Professional Psychology: Research and Practice43(6), 613.
  2. Diolaiuti, F., Marazziti, D., Beatino, M. F., Mucci, F., & Pozza, A. (2021). Impact and consequences of COVID-19 pandemic on complicated grief and persistent complex bereavement disorder. Psychiatry Research300, 113916.
  3. Harrop, E., Mann, M., Semedo, L., Chao, D., Selman, L. E., & Byrne, A. (2020). What elements of a systems’ approach to bereavement are most effective in times of mass bereavement? A narrative systematic review with lessons for COVID-19. Palliative medicine34(9), 1165-1181.
  4. Marmarosh, C. L., Forsyth, D. R., Strauss, B., & Burlingame, G. M. (2020). The psychology of the COVID-19 pandemic: A group-level perspective. Group Dynamics: Theory, Research, and Practice24(3), 122.
  5. Selman, L. E., Chao, D., Sowden, R., Marshall, S., Chamberlain, C., & Koffman, J. (2020). Bereavement support on the frontline of COVID-19: recommendations for hospital clinicians. Journal of Pain and symptom management60(2), e81-e86.
  6. Glueckauf, R. L., Maheu, M. M., Drude, K. P., Wells, B. A., Wang, Y., Gustafson, D. J., & Nelson, E. L. (2018). Survey of psychologists’ telebehavioral health practices: Technology use, ethical issues, and training needs. Professional Psychology: Research and Practice49(3), 205.
  7. Hilty, D. M., Maheu, M. M., Drude, K. P., & Hertlein, K. M. (2018). The need to implement and evaluate telehealth competency frameworks to ensure quality care across behavioral health professions. Academic Psychiatry42(6), 818-824.
  8. Luxton, D. D., Nelson, E. L., & Maheu, M. M. (2016). A practitioner’s guide to telemental health: How to conduct legal, ethical, and evidence-based telepractice. American Psychological Association.
  9. Maheu, M. M., Drude, K. P., Hertlein, K. M., Lipschutz, R., Wall, K., & Hilty, D. M. (2018). Correction to: an interprofessional framework for telebehavioral health competencies. Journal of Technology in Behavioral Science3(2), 108-140.
  10. Maheu, M., Callan, J., & Hilty, D. M. (2020). Telebehavioral health: foundations in theory and practice for graduate learners. Cognella, Incorporated.
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