This document provides guidance on best practices for using telehealth, including different modalities like phone conferencing, video conferencing, and app-based services. It discusses dos and don'ts for each approach, such as finding a private space for video sessions and ensuring technology is set up properly. Engaging clients in telehealth is also addressed, with tips like explaining any security measures and checking in frequently on their experience. A variety of free or low-cost technology options are presented. Overall, the document outlines how telehealth can increase access to care during crises while maintaining standards of privacy and effectiveness.

1. Best Practices
for Telehealth*
ALLURA L. RALSTON, M.A.
DEPARTMENT OF PSYCHOLOGY, UNIVERSITY OF
NEBRASKA-
LINCOLN
*Note: This webinar will not address recent OMH guidance on
Telehealth.
For OMH guidance on Telehealth during this time, please visit
https://ctacny.org/covid-19-resources
March 23, 2020
https://ctacny.org/covid-19-resources
Overview
• Types of telehealth
• Dos and Don’ts of each type
• Common barriers and overcoming them
Poll Question
What are some concerns you have in using
technology for telehealth?
1. I have no concerns
2. Logistical use (I'm not tech savvy)

2. 3. Participant engagement
4. Confidentiality
5. Other
Telemental Health
• Phone conferencing (e.g.
by telephone or cell phone)
• Videoconferencing
• Text messaging
Phone Conferencing
• Phone conferencing is the most simplistic form of telehealth –
it just
requires both parties to have a landline or mobile phone
• Generally, phone conferencing is not the most ideal option as
it makes
it difficult for both the client and therapist to read social cues
• It can also be difficult to complete certain elements of
treatment – such
as exposure therapy
• However, while trying to establish a new norm phone
conferencing can
be a better alternative than not providing services at all
• Additionally, many insurance carriers now cover providing

3. services by
telephone which has not been true in the past
Phone Conferencing – Dos and Don’ts
Do’s
✓ Decide what phone number you’d like to provide clients
✓ When working from home – find a quiet place you won’t be
disturbed
✓ Limit distractions (e.g. set phone to silent or do not disturb,
turn off
computer, etc.)
Don’ts
✓ Forget to set boundaries with clients if you provide them with
your
personal cell phone number
✓ Forget to be kind to yourself if it feels like conducting
therapy by phone
does not feel the same as in-person
Video Conferencing
• This is the best studied and most widely used technology for
disseminating mental health treatments
• Studies examining the use of video conferencing to provide
treatment
have shown similar reductions in anxiety, depression, and PTSD
compared to in-person treatment

4. • There are few therapy techniques that cannot be completed via
video
conferencing
• In fact, our clinic ran a study examining whether treatment for
social
anxiety could be conducted according to a standardized protocol
with
limited modifications and found that treatment was executed the
same
way and with the same beneficial results
Programs for Telehealth via Video
• There are numerous programs that can be used for telehealth –
our
training clinic at UNL uses VSee
• Zoom is another popular option
• Both provide encrypted video services and messaging features
which can
be incorporated into therapy
• This link provides a nice overview about selecting a vendor
and common
vendors used to provide telehealth services:
https://nosorh.org/wp-content/uploads/2016/11/NOSORH-
Telehealth-Vendor-Fact-Sheet-FINAL.pdf
https://nosorh.org/wp-content/uploads/2016/11/NOSORH-
Telehealth-Vendor-Fact-Sheet-FINAL.pdf

5. Video Conferencing – Dos and Don’ts
Do’s
✓ Make sure your audio and video work prior to session start
time and make
✓ Be aware of your background (e.g. when working from home
what's behind you?)
✓ Have a back up plan if video is not working for you/your
client
✓ When working from home – find a quiet place you won’t be
disturbed and
purchase headphones to maintain privacy (unless you have a
soundproof room)
✓ Limit distractions – close other programs, silence your phone,
etc.
Don’ts
✓ Forget to practice video conferencing if you are unfamiliar
with this practice – look
at the camera if it is in your line of sight, otherwise look at the
client on the screen
✓ Speak too quickly or for too long, if possible – sometime
video/audio lags
App-Based Mental Health
Application-based – “Apps”
• Occur through mobile technologies
(e.g., phones or tablets)
• Internet-based - app continuously uses
the internet to deliver its content
• Native - the app is downloaded once

6. and needing further connection to the
internet
Shown to be effective in reducing
mental health symptoms
App-Based Mental Health
• Using apps right now may be beneficial to meet clients needs
if they
are unable to engage in weekly therapy due to various barriers
(e.g.
time, cost, lack of internet/data access, etc.)
• Apps are also a nice way to engage clients in aspects of
treatment
between sessions or after termination to keep skills sharp
• Apps generally have some of the lowest risk associated with
them –
though it is important for providers to research the apps they
are
suggesting but often the question is – what should I be looking
for?
Do’s and Don’ts of
App-Based Mental Health
Do’s
◦ Look at security features, reviews, and research evidence
✓ What are the security features of the app? Do the app creators

7. have
access to the user's information? What information are they
collecting
✓ What do reviews from users say? Does the app have a lot of
bugs/issues? Does it seem useful?
✓ Has any research been conducted using this app evaluating
efficacy?
Don’ts
◦ Don’t assume apps will work for everyone
✓ Providers should carefully consider which clients would
benefit from using
apps and which clients require more “hands on” approaches
Examples of Apps for Mental Health
• MoodTools is a CBT-based app primarily used for treating
depression
• Anxiety Coach is a CBT-based app used for treating
depression
• PTSD Coach created by the National PTSD Center
• There are a few websites that will provide an overview of
various apps
including user ratings, research evidence, etc.
◦ https://adaa.org/finding-help/mobile-apps
◦ https://psyberguide.org/
◦ https://www.psycom.net/25-best-mental-health-apps
◦
https://www.mentalhealth.va.gov/communityproviders/clinic_te
ch.asp

8. https://adaa.org/finding-help/mobile-apps
https://psyberguide.org/
https://www.psycom.net/25-best-mental-health-apps
https://www.mentalhealth.va.gov/communityproviders/clinic_te
ch.asp
Communicating with Clients
• This may be one of the most challenging situations to navigate
for
many providers
• Some providers are comfortable texting or emailing with
clients but
are not using appropriate protocols to ensure HIPAA
compliance (e.g.
using personal phones or email addresses with no protections in
place)
• If you are using text or email to communicate with clients
make sure
the service, you are using is encrypted
• A good example of an email service is ProtonMail – this can
be used
to communicate with clients if you find yourself in a situation
where
phone calls are not easy to make (e.g. closure of clinics, no
front desk
staff, etc.)
Overall Do’s and Don’ts

9. Do’s
✓ Check your state guidelines about conducting teletherapy
✓ Conduct informed consent
✓ Determine how terminations, interruption of service, and
payment arrangements
will be handled
✓ Find a way to securely store client information if you are
working remotely
✓ Ensure you have the proper set-up to conduct therapy in
private
Don’ts
✓ Use a non-HIPAA compliant platform
✓ Use a public space to conduct therapy
✓ Use an email service that is not encrypted to communicate
about or to clients
✓ Leave your video service running at all times by logging out
rather than just
closing the window so clients can’t just “drop in”
Types of Technology and the
Barriers they Address
● Telemental Health
● Technology
Mediated Self-Help
● Technology
Adjuncts to Care

10. Things to Consider
Ensure clients have the means to engage in telehealth:
◦ Do they have a working cell phone or landline?
◦ If they only have a cell phone: do they have unlimited
minutes?
◦ Do they have internet access either in their home (e.g. WIFI)
or on a
smartphone?
◦ If they are using a smartphone: do they have unlimited data?
Can they
connect their phone to WIFI?
◦ Are they comfortable with technology? If not, do you have a
plan in place to
walk them through setting things up?
◦ Does your client have a safe, quiet, and private place to
engage in
therapy? Is it away from partners, roommates, children, etc.?
◦ Are there topics that might be difficult to discuss with the
client if someone
were to overhear? Can the client get access to headphones?
✓ This can be one of the trickiest things to navigate - and we’ll
discuss ways to
manage this.
Engaging Clients in Telehealth
• When discussing telehealth with clients it’s important to
assess their

11. readiness and willingness to engage in distance therapy
• It’s also important to allay any fears they may have about
security so
knowing the basics about the technology you are using, and
having a
basic understanding of the security features is important
• Providing a detailed informed consent document can also give
clients
a resource to refer to if they are feeling uncertain
Engaging Clients in Telehealth
• For those using apps, weekly check-ins (or more frequent if
needed) can
be helpful in promoting engagement
• It is also helpful to explain to clients that using tele- or video
conferencing
can be a bit strange at first but that you will work with them to
become
comfortable
• Remember to look at the camera when speaking with clients
(unless you
are using a camera that’s way above you!) and make sure you
test your
video angle before you start! This promotes “eye contact” with
the client.
• Check-in with your clients to assess whether they feel their
needs are

12. being met and if not, work with them to address barriers
Conclusions
• Telehealth is a useful tool in increasing access to care
during a crisis and when care is not easily accessible for
other reasons
• Providers should carefully consider which types of
technologies they are using, how these technologies
might be appropriate for some clients and not others, and
ways to protect both the client and themselves
Helpful Resources
International OCD Foundation. (n.d.). Teletherapy in the Time
of COVID-19.
https://iocdf.org/covid19/teletherapy-in-the-time-of-covid-19/
American Psychological Association. (n.d.). Pandemics.
https://www.apa.org/practice/programs/dmhi/research-
information/pandemics
McGrath, P., Wozney, L., Rathore, S.S., Notarianni, M.,
Schellenberg, M.
(2018). Toolkit for e-Mental Health Implementation. Mental
Health
Commission of Canada. Ottawa, ON
https://www.mentalhealthcommission.ca/sites/default/files/2018
-
09/E_Mental_Health_Implementation_Toolkit_2018_eng.pdf
https://iocdf.org/covid19/teletherapy-in-the-time-of-covid-19/

13. https://www.apa.org/practice/programs/dmhi/research-
information/pandemics
https://www.mentalhealthcommission.ca/sites/default/files/2018
-09/E_Mental_Health_Implementation_Toolkit_2018_eng.pdf
Questions
‣ Contact information:
Allura Ralston
[email protected]
mailto:[email protected]
NYS Office of Mental Health (OMH)
*Note: This webinar will not address recent OMH guidance
on Telehealth.
For OMH guidance on Telehealth during this time,
please visit https://ctacny.org/covid-19-resources
https://ctacny.org/covid-19-resources
Upcoming CTAC Offerings
Screening for Trauma in a Trauma-Informed and Bias
Reducing Way in Children’s Mental Health Services
‣ Monday, March 30, 2020 | 12PM - 1PM
Visit www.ctacny.org to view past trainings, sign-up for
updates
and event announcements, and to access resources.
Please send questions to [email protected]

14. http://www.ctacny.org/
mailto:[email protected]