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Sb vc 4-clinical principles-2-v.april2018
- 1. Clinical Principles and Standards Conducting a Behavioral Tele-Health Session SbVC-4-Clinical Services 2
- 2. Learning Objectives • Assessing Appropriateness • Conducting Screening and Assessments • Conducting Counseling (and not in the same room) • On-line Communication/Support
- 3. What do we know? • Special Challenges • Confidentiality • Balancing-Clinical Skill and Tech • Use of “different” communication style
- 4. Be Prepared • Because the client is not within the walls of an office – client could increase verbalization of negativity or be more easily distracted, etc.
- 5. Utilize • Description • Feedback • Reflective listening
- 6. The Client Limited Ability for In-Person Contact • Elderly • Persons with limited physical mobility • People with transportation problems • Rural communities that lack comparable services • Would-be consumers whose work schedules conflict with on-site treatment schedules • Those with caretaker roles
- 7. The Client Limited Ability for In-Person Contact • incarcerated persons • Probation and parolees from criminal justice programs whose movements are legally restricted • Active duty military personnel • Would-be consumers concerned about the stigma attached to treatment
- 8. Success Stories “Steve” was able to open up to his Behavioral Tele- Health counselor via web sessions. The tablet enabled him to continue treatment sessions even on a camping trip.
- 10. Assignment: Online Support Meeting Where did you go?
- 11. The Clinician • Foundation of Clinical Skills • Experience • Supervision • Clinicians will be called on for skills and information typically not asked in F2F treatment
- 12. The Clinician Structure of Treatment Services: • Resembles F2F • And then add a dash of: • Confidentiality • Rights & Responsibilities • Commitment to treatment • Boundaries
- 13. Ground Rules • Review - Review- Review • Time • Session after use? • Client Responsibility • Unscheduled chats • Session requests • Emails • When/how communicate
- 14. Ground Rules • Engagement - ACTIVE • Focus - Client Goals • Real Life - Here and now • Proactive • Scheduling • Resources • Boundaries • Varying Modalities • Nature of Therapy
- 15. Termination • Start talking about discharging at ADMISSION • Emphasize termination is a process • Importance of closure • Opening the door to allow discussion on desires to leave • Is behavioral tele-health working?
- 17. Summary: Sessions in Tele- Behavioral Health The nuts and bolts of a session: • Make sure it fits the client • Preparation for the Session • Moving to a Relationship • On-line Ground Rules • Termination of Session and Treatment
- 18. Summary • Encourage fluent/expressive communication • Feeling comfortable where they are • Text/internet/phone/email/camera • Who would best be served? • Who would not? • Structure Resembles F2F • Is the counselor/therapist a good fit?
Editor's Notes
- DISCUSS: What do we know? What are the special challenges with BTH? (Answers participants provide may include): Not able to build rapport No confidentiality Unable to see body language, so don’t know what the person is thinking/feeling Don’t know if client is using It doesn’t feel not natural Person might not be who they say they are Client not honest Unknown variables – not able to control environment Limited peer interaction Enabling the population which is already struggling with appropriate interaction with others. Continue discussion regarding some of the challenges and provide some feedback regarding overcoming some of the challenges and/or weighing cost benefit. Not able to build rapport No confidentiality Unable to see body language, so don’t know what really going on Don’t know if client is using Its just not natural Person – might not be who they say they are Client not honest Unknown variables – not able to control environment Limited peer interaction Enabling the population which is already struggling with appropriate interaction with others.
- Much like in home sessions, you will be in the client’s space and may observe more casual behavior. For those who have worked in-home, what have you experienced with in-home services? What should you be mindful of or need to report? Answers may include: The client may become angry. There may be a need for greater disclosure due to being in their own environment.
- Highly important with all counseling, however, extremely critical with BTH is the use of descriptive language, feedback and reflective listening. The use of silence is not effective through BTH as most begin to question, “Are you there?”, “Can you hear me?”. Increased verbalization is key.
- Certainly, those with limited ability for in-person contact for the reasons you see listed on the slide. One of the main ones we see is lack of transportation. In our area, it is very difficult to navigate the bus system, travel with all the rain in the summer months or travel with children
- I SAY: Here are some more examples of how BTH can take down barriers and serve individuals. We have had individuals who could be recognized in the community and do not feel comfortable seeking services in an agency building where they could be recognized. PAR had a prison program which used BTH to facilitate family sessions. The father logged on from the prison and the family came to the agency to work together via BTH.
- You can add your own success stories here. I can also speak to this one.
- Feel free to speak to any unexpected incidents which have occurred while providing services via video conferencing.
- We’ve discussed when a client is a good fit and when they are not a good fit for BTH. What about the clinician? First and foremost, the clinician needs to have a solid foundation of clinical skills. Depending on the clinician, being brand new to counseling and using a new technology simultaneously may prove to be overwhelming. The clinician should also practice utilizing a video conferencing platform. The skills required in the on-line environment differ greatly from a face to face session. These skills include using a checklist, handling technology glitches, guiding the session using strong communication skills and not being able to rely on seeing the other person’s body language. Therefore, it’s recommended that clinicians have supervised sessions including taped sessions where supervisor and supervisee can both evaluate service delivery.
- Other things to consider are confidentiality assisting your client, understanding the risks and benefits to sessions via Tele-health, Client Rights and Responsibilities in an on-line environment as opposed to face-to-face and boundaries. What do we mean by on-line boundaries? SAY: Online boundaries include: the structure of the session-check list, ICE, etc. EVERYTIME. Recognizing sessions may be shorter as it takes time to go through the check-in and establish ICE, and that you could have technology issues, etc. So, it is business as usual as far as providing a therapeutic service to a client, however, it is not business as usual as in face-to-face treatment. Therefore, clinicians will have to utilize skills they do not traditionally have to use in a face-to-face environment. We focus heavily on videoconferencing in this training, however, we want to recognize and remind everyone chat and phone are considered forms of BTH.
- SAY: We have discussed how you determine if a client is appropriate for BTH. We have discussed how you determine if a counselor is appropriate to provide BTH. Now, let’s examine what a BTH session looks like. This is what we will cover: Determine if the client is the right fit. How to prepare for the session (in just a minute we will go over a check-sheet which helps you prepare, conduct and end a session). How to develop the therapeutic relationship though video conferencing. Ground rules and how to properly end the session and treatment.