clinical engagement in telemental healthjune 16: risk management in telemental health register @...
TRANSCRIPT
![Page 1: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/1.jpg)
Clinical Engagement in Telemental Health
Sara Smucker Barnwell, PhD
Tuesday, June 2, 2020
![Page 2: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/2.jpg)
Telehealth Learning Series: Tuesdays, 5-7 PM May 12: Introduction to Telemental Health
May 19: Preparing your office for Telemental Health
May 26: Client selection, intake, and assessment in Telemental Health
June 2: Clinical engagement in Telemental Health
June 9: Emergencies, disruptions and pitfalls in Telemental Health
June 16: Risk Management in Telemental Health
Register @ NWATTC website
![Page 3: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/3.jpg)
Your presenter
Sara Smucker Barnwell, PhD
Licensed clinical psychologist in WA
VA Telemental Health Team
APA Telepsychology Guidelines
CESATE fellow
Unapologetic telehealth evangelist
![Page 4: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/4.jpg)
Learning objectives
Environmental factors
Behavioral factors
Engagement
![Page 5: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/5.jpg)
Class structure
Didactic lecture
Live Q &A at section breaks
Video demonstrations
Submitted questions [email protected]
Live Q & A
![Page 6: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/6.jpg)
Disclaimers
During a technology presentation, technology will fail
Offer best practice recommendations based on clinical work, literature review and regulatory experience
Identifying personal best practices and guidance in developing area
![Page 7: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/7.jpg)
Disclaimers
Always review state regulations
Consult with your own legal counsel
Consult with your risk management coverage
I do not provide legal advice nor clinical advice
![Page 8: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/8.jpg)
Conflicts
Provides telehealth training Known telehealth evangelist
![Page 9: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/9.jpg)
Agenda: Clinical engagement
Engagement
Environmental factors
Locations, technology
Behavioral factors
Provider, client
![Page 10: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/10.jpg)
The balance
Brief review
Deep dives
Your questions answered
On demand prior classes
![Page 11: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/11.jpg)
Definitions and examples(Abbreviated!)
![Page 12: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/12.jpg)
Operational definitions
Telemental Health (TMH):
The provision of any mental health service using telecommunication technologies
…videoconferencing
Access is at the heart of this mission
![Page 13: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/13.jpg)
HIPAA
Health Information Portability and Accountability Act (HIPAA):
Federal law (Pub.L. 104-191, 100 Stat. 1936, enacted August 21, 1996) that aims to make it easier for people to keep health insurance, protect the confidentiality and security of healthcare information and help the healthcare industry control administrative costs
HIPAA Privacy Rule
HIPAA Security Rule
![Page 14: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/14.jpg)
Protected Health Information (PHI)/ ePHI
• Names
• Full-face photographic images
• Geographical subdivisions smaller than state
• All dates (birth, death, discharge)
• Phone/ fax numbers
• Electronic mail addresses
• Social Security numbers
• Medical record numbers
• Health plan beneficiary numbers
• Account Numbers
• Certificate/license numbers
• Vehicle identifiers and serial numbers, including license plate numbers
• Device/ serial numbers
• Web Universal Resource Locators (URLs)
• Internet Protocol (IP) address
• Biometric identifiers, including finger and voice prints
• Any other unique ID numbers, code, or characteristic
![Page 15: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/15.jpg)
Business Associates Agreement (BAA)
Contract between HIPAA covered entity and HIPAA Business Associate (BA) that is used to protect personal health information (PHI) in accordance with HIPAA guidelines.
This Photo by Unknown Author is licensed under CC BY-SA
![Page 16: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/16.jpg)
Novel Coronavirus/ COVID-19
Current public health crisis
Social distancing and “stay home” orders
Telepractice as a tool to protect public health
Some providers now mandated to telehealth
![Page 17: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/17.jpg)
![Page 18: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/18.jpg)
A brief synopsis
![Page 19: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/19.jpg)
Videoconferencing appointments
USE A PRODUCT DESIGNED FOR HEALTHCARE, BAA
INFORMED CONSENT, EMERGENCY PLAN
DOCUMENT
![Page 20: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/20.jpg)
Videoconferencing appointment
ASSESS APPROPRIATENESS
CHECK JURISDICTIONAL RULES
PREPARE YOUR OFFICE
![Page 21: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/21.jpg)
Videoconferencing appointment
Determine what services you provide
What population you serve
Documentation transfer, communication, payment
![Page 22: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/22.jpg)
Clinical engagement
![Page 23: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/23.jpg)
Clinical engagement
Enhancing rapport and therapeutic alliance
Impacts outcomes
Across demographic groups, diagnosis, treatments
![Page 24: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/24.jpg)
Clinical engagement
Predicts symptom improvement session to session
Predicts reduced treatment attrition
Predicts outcomes measure performance
![Page 25: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/25.jpg)
Clinical engagement
Willingness to disclose difficult information
Medication adherence
Treatment adherence
Candor with non-adherence
![Page 26: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/26.jpg)
Clinical engagement
Mixed data on SUD outcomes
Good data on program adherence
Decreased probability of board complaint
![Page 27: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/27.jpg)
Methods to promote engagement
EYE CONTACT EMPATHY OPEN DISCOURSE
![Page 28: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/28.jpg)
Methods to promote engagement
Active listening
Mirror affect
Physical mirroring
![Page 29: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/29.jpg)
Methods to promote engagement
RESPONSIVE RELIABLE PROFESSIONAL CONFIDENTIALITY
![Page 30: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/30.jpg)
Challenges in clinical engagement in Telemental Health
Eye contact Body posture Less clarity on emotional expression
![Page 31: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/31.jpg)
Challenges
Technology lags, interruptions
Reliability of technology
Questions about confidentiality
Professionalism
![Page 32: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/32.jpg)
Clinical environment
![Page 33: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/33.jpg)
Your 3 offices
YOUR ENVIRONMENT
CLIENT ENVIRONMENT
TECHNOLOGY ENVIRONMENT
![Page 34: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/34.jpg)
Research
Ample research on therapeutic alliance in telehealth
High client satisfaction
Providers rate it lower
![Page 35: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/35.jpg)
Research
Little research on environmental impacts
Client
Provider
![Page 36: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/36.jpg)
Anecdotally
It is as important to accommodate provider needs as client
The clinical relationship varies as function of comfort
Few codified requirements
Recommendations based on research, experience
![Page 37: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/37.jpg)
Your environment
![Page 38: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/38.jpg)
Your office
Home v. professional office
Same standards as professional office when possible
Not just PHI management
![Page 39: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/39.jpg)
Your office
Class #3, refinements
Focus on home office, individual office
Environmental design in clinical settings (Krupinski 2014)
![Page 40: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/40.jpg)
Distractions: Space
Austere v. unprofessional/ cluttered
Consistent with healthcare v. “cold” clinical
Relatable, accessible
![Page 41: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/41.jpg)
Distractions: Disclosure
What is visible in your space
Your disclosures
Income, family, sexuality, politics, preferences
Your appearance
What degree of formality feels right
![Page 42: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/42.jpg)
Your office
Replication of in office “feel”
Challenging in home environments
Balance between professional and personable
![Page 43: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/43.jpg)
Your office
WHO DO YOU SERVE YOUR USUAL CLINICAL RAPPORT
HOW BEST TO SUPPORT/ BUILD
![Page 44: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/44.jpg)
![Page 45: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/45.jpg)
Distractions: Noise
External noise (windows, traffic)
Noise in the home (kids, pets)
Noise from errant devices
Noise gates
![Page 46: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/46.jpg)
![Page 47: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/47.jpg)
Vignette: Dr. Pepper
Serves rural population
Offers medication assisted treatment for opiate addiction
Lives in urban environment
Working from home office
![Page 48: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/48.jpg)
Considerations
Commute
Appropriateness of home
Disclosure of perceived differences
Comfort disclosing aspects of personal life
![Page 49: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/49.jpg)
Client environment
![Page 50: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/50.jpg)
Client environment
Analog of your office environment
Relevant to appropriateness assessment
Less capacity to dictate
![Page 51: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/51.jpg)
Client environment
PRIVACY INTERRUPTIONS PROFESSIONALISM
![Page 52: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/52.jpg)
Client environment
Scheduling, interruptions
Breaks
Comfort
![Page 53: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/53.jpg)
![Page 54: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/54.jpg)
Technology environment
![Page 55: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/55.jpg)
Factors that influence
Internet stability
Connection quality
“Dropped” calls
Redundancy, back-up, improvements
![Page 56: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/56.jpg)
Technology features
Videoconferencing platform
Ease of use, customer support (test call)
Self view, configuration of view
Focus on the content of discourse, not the tech
Gotta hit them angles
![Page 57: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/57.jpg)
Live Q & A
![Page 58: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/58.jpg)
Behavioral factors
![Page 59: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/59.jpg)
Clinician physical presence
Gaze Body positionFace vs. body
Hands
![Page 60: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/60.jpg)
Self view
Who are you on camera
What best suits your clinical style
Record yourself
Watch self view
![Page 61: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/61.jpg)
![Page 62: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/62.jpg)
Somatic therapies
Unique challenges
Consider establishing 2 clinician areas
Allow for transitions
![Page 63: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/63.jpg)
Options for configurations
Space available to client
Number of device
Individuals, groups
Privilege
![Page 64: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/64.jpg)
![Page 65: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/65.jpg)
Boundaries
![Page 66: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/66.jpg)
Establishing expectations
Initial phone call
Informed consent
Test call
First session, each session
![Page 67: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/67.jpg)
Expectations
Privacy, confidentiality of space
Appropriate space
Honesty
Medical appointment
![Page 68: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/68.jpg)
A word about kids and pets
Challenges in home school, parenting
Cats are video stars
![Page 69: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/69.jpg)
Vignette: Dr. Bronner
Client treated for polysubstance use disorder and depression
History of complex trauma
Struggles to find private space in home
Wants to use non-HIPAA compliant platform
![Page 70: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/70.jpg)
Considerations
Jurisdictional reviews
Safety
HIPAA compliance
Why? Clinical relevance
![Page 71: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/71.jpg)
Live Q & A
![Page 72: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/72.jpg)
When things go right/ wrong
![Page 73: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/73.jpg)
When things go wrong
Internet redundancy
Telephone’s role in video calls
Alternative platform
Alternative method (phone, video)
![Page 74: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/74.jpg)
When things go wrong
Informed consent Keep calm, carry on Candor, levity
![Page 75: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/75.jpg)
Client frustration/ termination
Joining
Disclosure
Iterate, experiment
![Page 76: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/76.jpg)
When things go right
View of home Collateral reporters Avoidance
![Page 77: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/77.jpg)
Caring Letters/ Caring Messages
![Page 78: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/78.jpg)
Staying In TouchUsing Caring Contacts to Sustain
Connection with Your Clients
A new online training from the Northwest ATTC
http://attcnetwork.org/northwest
![Page 79: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/79.jpg)
NWATTC Caring Letters
Opportunity to learn about Caring Letters program
Post-crisis suicide prevention program
Research supported
![Page 80: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/80.jpg)
Caring Messages and Telemental Health
Connecting with clients at a distance
Engagement, alliance, good intention
The impact of human caring transcends physical presence
Now Matters Now: www.nowmattersnow.org
![Page 81: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/81.jpg)
Coronavirus considerations
![Page 82: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/82.jpg)
Clinical engagement and COVID-19
Emerging data to suggest significant uptick in mental health need
Significant decrease in availability of in person services
Shared cultural moment of crisis
![Page 83: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/83.jpg)
Clinical engagement and COVID-19
Ability to bring accessible services
Authentic connection and rapport
Challenges in diagnosis
![Page 84: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/84.jpg)
Role of therapy in Coronavirus
Care as usual
Crisis management
Social isolation in quarantine
![Page 85: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/85.jpg)
In summary
![Page 86: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/86.jpg)
3 environments
Your space
Client space
Technology
![Page 87: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/87.jpg)
Support rapport
Minimize distraction (noise, clutter, technology challenges)
Increase accessibility (environment, visibility)
Establish expectations, boundaries
![Page 88: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/88.jpg)
The struggle is real
Zoom fatigue
Client frustration
Awkward moments
Candor, levity, informed consent, slow it down
![Page 89: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/89.jpg)
That’s a good questionPreviously submitted questions
![Page 90: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/90.jpg)
Billing
Specific billing codes
Telehealth location code: 02
Telehealth modifier code: 95
Usual CPT codes
![Page 91: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/91.jpg)
Fees
Usual fees
Additional telehealth fee assessed
![Page 92: Clinical Engagement in Telemental HealthJune 16: Risk Management in Telemental Health Register @ NWATTC website Your presenter Sara Smucker Barnwell, PhD Licensed clinical psychologist](https://reader033.vdocuments.us/reader033/viewer/2022050323/5f7c9d4c4f63a752e74ba74d/html5/thumbnails/92.jpg)
Live Q & A