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ICA Conference 2014: Keynote Presentation
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ICA Conference 2014: Keynote Presentation

  1. 1. TFIF‘-IENTAI HE‘«lTH ((( H _ ‘ ’ te| ehea| th. org Counseling: Looking toward the Future IDAHO COUNSELING ASSOCIATION MARLENE M. MAHEU, PH. D. MMAHEU@TELEHEALTH. ORG EXECUTIVE DIRECTOR TELEMENTAL HEALTH INSTITUTE
  2. 2. THE CHRONICLE OF HIGHER EDUCATION Jaruery 12. 2014 Home M Global Technology Opinion & Ideas Facts 8: Figures Blogs Advice .12; Commentllj Carnpus Psychological Counseling Goes Online for Students at U. of Florida Sheryl Benton directs the counseling center at the U. of FIorida, which has begun an online program for students struggling with anxiety. By A/ Iegan O'Neil Three years ago. facing a particularly acute demand for selvices, the Counseling and = "ellness Center at the University of Florida managed to . ... JJ 5.. .. E. .H -: ... ... . . ... _-: .:. ... .- -. _ -L. .. . ... v: i. .. '1") 'l'L_-L. ... ..L- -1.. . . J:. ... .,_-. ... Log In Events Subscribe Today Forums M Search The Chronicle Sherry Benton Most Popular . lost '1e''ed. Most Commented 1. College Leaders Leave "l-lite House Summtt Inspired to Act 2. Lessons From Colleges That Have Improved Their Students‘ Success 3. The Cost ofa Ph. D.. Students Report I-lefty Debt Across M-any Fields 4. We Are . 'ever Ever Getting Back Together (Probably) 5. Details of College Commitments to Help Low-Income Students
  3. 3. BHM OUTCOMES: INDMDUAL FACE TO FACE, TAM, AND TAO 3.3:)’15.a4f:5.a-t5$; oAJ'45;44J'53.:4“r5£.4a' 2' —F~to-F TAO ~TAll. l 3 green 5' : -as urges * .4-. ~.e: .'s-. ~rc: :-Ts s: r:s. s U: -'so_. ‘3': :s : -.-is 6:-war , F~! O-F '5-r rg U‘. -.‘«". I. : ,s V *3 G'. .o '. =.-. ' 5-: 'rers, osi . ssst-: -4 cm '9 . . D-‘. —'L‘l£-“. /C‘. :-- eg é'»3t‘; .e's. -I-st: -‘rs 26 3 9': -"rs , r: -~-c-'c-: - ea-st: «mat: -' — 'v~ 1 This was for our first pilot group, 26 TAO participants, compared with 27 TAM group participants, and 700 regular individual therapy clients who reported anxiety. Other data, Drop out rate: TAO 42"/ o, TAM 38% Face-to-Face 48% There are some definite limitations, the TAO participants tended to be early adopters enthusiastic about this option who selected this treatment. In addition, we screened out students for TAO who were suicidal, had co- existing substance abuse problems, or who had multiple severe problem areas. Nevertheless this is pretty
  4. 4. »u: u M telehealtnovg Poonam Sharma, Ph. D. Marlene‘sAmazon mm Todays Deals em Cams Sell Help Search i*. r«’E ' E Books Advanced Search amazgri Shop by Department ~ New Releases Best Sellers The New Yorit Timesi Best Sellers Hello. Marlene Your Account v Children's Books Textbtxiks Textbook Rentals ‘oi Your Wish Prime v u . cart - List v ’ Sfwr. 1-: s~ Sell Us Your Books strong Women, Strong Love and over one million other books are available for Amazon Kindle. Learn more Strong Women, Strong Love: The Missing Manual for the Modern Marriage 3a: er‘: a«: ~. by Dr. Poonam Sharma »'-I. .'. <l: r ' ‘I5customerreviews STRO WOME STRONG See all 2 formats and edmons Kindle Paperback 99 513 —'§ Pn‘-nu -I. ILI v3l_| sed' $29 91 14New"" s1< I3 I11cMinugManinl‘iirIhr. |odanM. inugr @ l‘nozm: ii SILirm. i. l‘Ii. l ). Why do strong women struggle with marriage problems even though they are so successful in other areas of their lives? How do you stop feeling trapped. resentful. and alone in your relationship? is it really possible for a woman to be strong and have a happy marriage too? Q Flip to back _ . . In Strong Women. Strong Love: The Missing Manual for the Modem Mamage. Buy New Qty: 1 v In Stock. Ships from and sold by Amazonoom. GiIt—'. vrap available. Add to Can Buy now with 1-CIick® Order within 9hr 55min to get it Wed Thu +3 99 Free Ship to: Marlene Maheu- SAN DIEGO ' 1 4
  5. 5. ((( TEKL? MENTMHE: mH telehea| th. org iii V [i « in [ii w/ ‘ M [ii V. /V _iL_ , -M , L Jeii ii in F J i . [ J. ' A emu meuemai mam lnsmme. nu; I
  6. 6. <(( TELEMENTAL HEALTH teleheamwrg INSTITUTE Telehealth vs. Distance Counseling (working model not to scale) Telehealth Behavioral Telehealth Disciplines, including Distance Counseling, Training & Supervision 02011 meuental mam lnslilz. he
  7. 7. ((( TELEMENTAL HEALTH ~ teleheamhorg | N'>liT‘Jll 02014 meuemal mam Institute. Inc.
  8. 8. ~ retooling
  9. 9. (' TElEMENT/ l HEAITH rnlnhnal[n_org D 2014 Teleuemzl Health Insllma, Inc,
  10. 10. ((( TELEMENTAL HEAl, TH teleheainhorg lN'>lliJlr 62014 Tueuenhl Health Institute. rm:
  11. 11. (_ (_ Accelerating Pace of Developing Tools Stone Implements 9 Iron Hunting & Gathering 9 Farming Scribes 9 Printing Press 9 Typewriters 9 Microsoft WORD Horses (100 years ago) 9 Automobiles 9 Jets In-person 9 Distance via Information & Communication Technology (ICT), mHea| th & Medical Homes
  12. 12. <-—ir: ‘rn: mrr. .--. -‘: a_. * Mental Disorders in America ° 26.2 percent of Americans ages 18 and older — about one in four adults — suffer from a diagnosable mental disorder in a given year. 0 Equals 57.7 million people ~ http: //www. nimh. nih. gov/ health/ publications / the-numbers—count-menta| -disorders-in- america/ index. shtml
  13. 13. <-It: ‘inzmIa‘. .--. -‘: '«_-' Mental Disorders in America * Mental disorders are the leading cause of disability in the U. S. 8 Many people suffer from more than one mental disorder at a given time. 9 45% of those with any mental disorder meet criteria for 2 or more disorders, with severity strongly related to comorbidity * http: //www. nimh. nih. gov/ heaIth/ publications/ th e—numbers—count—menta| —disorders—in- america/ index. shtml
  14. 14. <-—II: In: mrr. .--. -‘: a_. * Why Use Technology? ° More than two thirds of individuals struggling with a mental illness do not receive treatment (see Kessler et al. , 2005) 0 Rates of unmet need are even higher among minority populations (Wells, Klap, Koike, & Sherbourne,2001)
  15. 15. Video Teleconferencing (VTC)
  16. 16. Reviews News Download CNETTV How To Deals f '* Log In | Join snmsuwfi The Next Big Thing For Business Is Here 3 % I ‘V war: IZZNET News njrawe i. r’I' SAMSUNG Confirmed: IGooIg| eI Glass arrives The Ne>_<t Big Thing in 2013, and under $1,500 §’[§ff"“eSS -Googles atigmented-reality‘ specs are ahead of schedufe Are you reach; ‘ V I ‘Eat >1 ricm to get *, ‘OLlrS€! f fitteo for a set7 EricMacK- . I‘ ‘I IINII /43 Q‘) ; _3 f Follow 55"‘ fi n. » I 3:- W. » E; '— : ;: r-,1.ye. . ; r:. . i: '. Cornments 98 H0tteStReVie. _._, S ‘ iPhone 5: Finally, everything we hoped it would be -8 mI. ,;. —ns199.99 ( ‘E _ 7 ‘, *k>‘<‘~k*k J Microsoft Surface Pro: Smart almostlaptop nearly nails it ‘Iiii‘«I. -If: Kit $899.99 ‘k*)<>'~1 Chromebook Pixel: Brilliant touch Possibly the ‘must—have‘ gadget forthe 2013 holiday‘ season (Click the image for a Google Glass slideshow. ) screen, hefty price (Credit Google) Regular people will be able to purchase Google Glass eyewear by the end of 2013 for less than r- " I HTC One wows with stunning $1.500, sources have confirmed to CNET. ,& design, Pfemlum PMS Google originally targeted 201 -1 for a consumer release when it revealed Project Glass last year,
  17. 17. 3 1 O 2 r e b m e C e D
  18. 18. ((( TE‘Lé_'. Mfi”A’:1‘t‘WH telehealth. org! ‘ IR‘'<3 Persona| Robots Group mi! media lab “M-rJlm'1"' t Home Welcome to the Personal Robots Group oi 5'; ,V? Xéi. F§. »‘. (=)I€E: M’v1I| 'I. |§fI-1'1’ ‘v .3“"“"‘5’I>.
  19. 19. TELEMENTAL HEALTH ((( I telehealth. org l N S Y i T U T F No Appointment Necessary: Treating Mental Illness Outside the Therapist’s Office ° 2013 -— Face—to—face talk therapy is not always required to effect sustained, meaningful psychological change. There are now a myriad of delivery methods for mental health services to reach people in need (see Kazdin & Rabbitt, 2013) — interactive computer programs — downloadable apps
  20. 20. What's Happening with Health Care Reform & Behavioral Health?
  21. 21. TELEMENTAL HEALTH ((( teIeheaIth. org I N 5 l l T U T F Quick Summary of Health Care Reform Goals Changes for Healthcare Changes for Practitioners 1. Documentation requirements 1. Lower costs _ _ 2. Organize documentation 2' | mpr°Ved Outcomes through Electronic Health 3. Increase access for more Records (EHR5) Citizens who need health 1. Standardize information for care outcomes analysis and treatment refinement 2. BIG DATA (informatics) 3. Work in groups 4. Paid for outcomes 0201! Ttlellemil Meillil lnslllz. Inc‘.
  22. 22. TELEMENTAL HEALTH ((( I telehealth. org l N S Y i T U T F Affordable Ca re Act (ACA) Repercussions for Counselor Preparation & Practice ° Much current funding for private agencies will be shifted to the expanding Medicaid programs to support Health Care Reform - Referrals to for ACA clients may come from primary care physician's offices to large groups of practitioners — Integrated care settings with teams of professionals — Patient—centered homes — 85% of care delivered to the home in the next 5 years (patient monitoring devices)
  23. 23. <-—ii: ‘i/ iizmiai. --. -‘ia_. * Affordable Ca re Act (ACA) Repercussions for Counselor Preparation & Practice * Fee for service models are being sun—setted ‘i Success of private pay model will decrease in long term — Exception: concierge practices a Practitioners will be held accountable for outcomes and paid accordingly — Documentation will demonstrate adherence to the evidence—base, tracked through electronic health records
  24. 24. ( (‘—ll= l’| i’: ?=lli'u-'. -'i'(_o' Affordable Ca re Act (ACA) Repercussions for Counselor Preparation & Practice ° Small group and private practices will likely be replaced — Large groups can contain costs across practitioners and clients
  25. 25. M3 USA i Home About M3 USA For Physicians For Clients FAQ About M3 USA Main Page Management 9 Press Room For Investors MDLinx Doc Survey: 26% of Small Private Practices Say They Could Close Within A Year More than 75 percent report austerity measures, going into debt or tapping personal assets to keep practices open Washington, DC, June 27,2012 - In an MDLinx (www. mdlinx. com) survey of US. physicians with ownership of practices of ten physicians or less, 26.4 percent reported that given the financial environment, they could foresee closing their practices within the next year. MDLinx. a web physician portal. “This poll is quite startling in the revelations about small practices. the healthcare lifelines to many communities, " said Stephen Smith. Chief Marketing Officer for MDLinx. “Physicians have had missiles raining in on their practices at an increasing pace - the economy, regulations.
  26. 26. ‘: l;. !': !.f"!3‘j"! ”‘—! !r' fE—A~£—u': 'l (‘-l l= l/Il’: ?=lli'I nil '0' . . _. __. , ( . g . 3 Affordable Care Act Repercussions for Counselor Preparation & Practice ** Reimbursement tied to outcomes, not time (minutes per session) * More specific documentation — Documentation will require proof of interventions being tied to the evidence-base (”treat-to-target”) — Required use of electronic health records (to measure outcomes) - Decreased reimbursement for free—f| owing sessions and note-taking * Increased reliance on master's level practitioners — Increased need for vision / graduate education and professional education * Increased reliance on technology — Apps and other self help tools will proliferate
  27. 27. . 7 — at A ' i. -1‘? -=" -1‘ Models for Distance Services in Counseling and Other What are the Current I I l Disciplines? I I I I , $x 9;" - -. -V - * . 'r- - i fir’, -.’_~ _ : §_ -’ -—~-: '"-'-“‘ ’ »' »"'%ga'*= » zzrtghai ‘gay “I g‘ ‘Elli 1 y: l ll’ emu ‘raieuemai mam inmime. (no
  28. 28. Video Teleconferencing (VTC)
  29. 29. ‘UT-I telehealthpiq fl Helpouts _ fl fi Browse Helpoutsv ‘ Vour Helpoms v About Helpouts I | ] Health Strerigtlis-Based Psychotherapy and Coaching short or long-term therapy building on your strengths to ii'TiDi0'/ E communication ovcrcoine challenges, or discover new insights an build self-av/ aiervess I use a variety of techniques including mindiulness CBT (CO§l‘iI(I'r‘E BEl‘flVi0l&l Therapy) DBT (Dialectical B€l‘flVIOl Tberapyfi SDMBUC rnten. -entions and Solutions-Focused Therapy I $55.00 can work with individuals from ages 7 and up I also work with couples ard families A1 'v-rut: 3.00 Meet Kale S - Masters in Social ‘i'. 'ori< from Columbia University S ocial '. 'orit 0 l. |CEl"S€d Clinical Social l'i'orl<ei California License - specialized trarning in addressing eating disorders, trauma amtiety and depression Sc Ha ha I Fluert II" French - working together to aciiie-: e positive. supportive and creative SDlI. TIDl‘S Next avahbie min i 2 3: P ). I Cancellation Policy ZJ'i: i.. rs F: I(E'E: l.‘lE. ‘S. 'a Reviews No lEVIEVi‘S for this Helpom yet
  30. 30. ti‘-1t4;i‘. 'u= .'r. Ila‘. '.—. -my Types of Health Care Technology Fhuivlnliv = fI«nnmmn: ‘t«~ lkltwsum 3 W‘ 'Jm(. _;, m”‘~ -‘. 'ii>l'. 'Fil"»‘ ’ u. (mm:1«nIIr.1i! «:u: ~ “ ii! -mmvw 'iiiI: ’-Manic" . » . |’in. "]Hl| :'”‘ Jhmnfl‘ | ‘MIi'iI['-‘n('-P . ,,, L,_, ,.mm. ir. Iu-mmm- IN: I-1-1In)<uniu: u1iIuy m"“‘"‘m“"""‘ llinuir‘ ‘V(“! '-i{l: r“Y ; -‘v/ iwiv: 31 Ir, “ 7Hi I‘ i M‘ I! With permission from Teri Louden of the Louden Network and Adapted from: Biology, Bioconvergence, Information and Enterprise: Taking the Broad View, May 20, 2004, Alan Barrel
  31. 31. TFLFMENTAI HEHTH ‘ ((( K N by Y } J ‘ te| eheaIth. org Goal: Deliver Care - Email ° Chat - Social media - Video — Synchronous — Asynchronous - Apps and other self-help - Smart devices and self-monitoring devices to collect diagnostic, biometric and education information
  32. 32. »— — gr. A — i. _E. =~ _; A What evidence do we have that distance counseling is l effective when done i thoughtfully? l (L 9’! V’ ‘ ' _ - V V — ’ ‘t 1" ~ ”““ “"‘ ’— “""”'_—“_‘ _3. h ' gv‘ ‘ A-— — V‘-_—_-_—__—a. r3;' "‘. §<»: V 1 J if? ’ it}: . (A 02014 meuemai mam lnstilma. inf.
  33. 33. ‘: lT. !'? :"!3‘j"! ”‘—! !r' fE—A~£—u': 'l (‘-l H/ Il’: ?=lli'I mil '0' . ‘ _. __. , , . g . 3 The Evidence Base Benefits of Telehealth ° Increased client/ patient satisfaction * Decreased travel time ° Decreased travel, child & elder-care costs G Increased access to underserved populations * Improved accessibility to specialists 6 Reduced emergency care costs 6 Faster decision—making time * Increased productivity / decreased lost wages G Improved operational efficiency is - Efficacy is on par with in-person care for many groups ° Decreased hospital utilization
  34. 34. TELEMENTAL HEALTH ((( N teIehea| th. org I N 5 i l T u I F Recent Supporting Research Backhaus and colleagues (May, 2012) reported in their abstract of a meta—analysis that: ° 821 potential articles were identified, and 65 were selected for inclusion. - The results indicate that VCP is feasible, has been used in a variety of therapeutic formats and with diverse populations, is generally associated with good user satisfaction, and is found to have similar clinical outcomes to traditional face—to—face psychotherapy. — Videoconferencing psychotherapy: A systematic review. Backhaus, Autumn; Agha, Zia; Maglione, Melissa L. ; Repp, Andrea; Ross, Bridgett; Zuest, Danielle; Rice-Thorp, Natalie M. ; Lohr, James; Thorp, Steven R. Psychological Services, Vol 9(2), May 2012, 111-131. doi: 10.1037[a0027924 0201! Ttlellulil Heillil irlslllz. Inc‘.
  35. 35. TELEMENTAL HEALTH 1((( N teleheaith. org . I ~ s 1 : r u 1 2 Size of Evidence Base - List of 1000+ searchable distance counseling references: www. te| ehea| th. org[bib| iography ° More than 3500 references exist, including telesupervision
  36. 36. Models of Success to Illustrate the "Evidence Base”
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  39. 39. ( f'"’; ;’.5;°"': :' <-il: ‘inzmu‘. .--. -‘: '«_-' Specialty Schools & Services ' Special Needs * Autism ~ Residential Treatment Centers — Drug & Alcohol — Other
  40. 40. Employers l I, .,: . a 3 _ - _ “/ rig”. "~"'. ’ ; =«. . ~ ~; lit“ / l . ‘ __ , ' . "4’ ) I _. ' . ‘ I l l ~ ; . K I 2
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  44. 44. TELEMENTAL HEALTH <<( ( telehealth. org I ~ s 1 : r u 1 5 Nursing Homes
  45. 45. Home Health .
  46. 46. ‘: lT. !'? :"!3‘j"! ”‘—! !r' fE—A~£—e"': } (‘-l H/ Il’: ?=lli'I rd‘) '1!’ . . _. __. , ‘ . g , . The Migration Model ° Start with known clients ( l ° Assess their need/ willingness to use technology ‘, ,. . . '* Discuss compensation * Slowly migrate online ° Assess effectiveness at regular intervals * Document carefully
  47. 47. College Counseling Centers
  48. 48. Professional Training and Supervision
  49. 49. ((( TELEMENTAL HEALTH 1 teleheamhorg | N'>ll‘Jli z . _ _. ;; > . - _ , ,. _ . _ U_. r‘. ,“ , _ ll ill ll lll l. )-:1 9:2. gl. l gs‘. V. /.l_«l<_>. I cl Tllill fill _ lll. ,-(/ /l_ _L _, lL_ _ _. _. _. - _ -. ,_ | ‘¥K‘| r_’)l/ /f/ /// F‘? :flV| ,1%(-WT[_| ‘l(()|5iIL/ ()| {L}‘Q| ‘/| |(‘| ‘ _ l . _._I"(f l /1%? ’ E. 14." 9} ‘ fix‘ [<6 : -*<~'- / ’ Z ‘ . " In ‘I I v‘ / IX / ’ I , _ : ,-if” 4'71 - . . 94¢? ’ ' Kr ' 152’ L ' - 020:4 meuemi Hum Insmu. Inc.
  50. 50. TELEMENTAL HEALTH l telehealth-org lhixilluii l Professional Training .3 ° Clinical Competencies “-"‘ — Department of Defense (DoD) — Ohio Psychology Board — Professional Associations - Society for Technology & Behavioral Health -1 T: — Te| eMenta| Health Institute ; .1 V ‘I, ° Technical Competencies -1 . r — Association for Counselor " Education and Supervision . . (ACES) ‘fj- OIDII Talellamzl Health Insllme, Inc.
  51. 51. TF1F’v1fNl/ Kl HEAITH (G I _ , _ y , teleheaIth. org Myths vs. Realities for Distance Counseling Realities Myths Distance counseling is not the same as in—person care No research Psychotherapy can't change (resistance) We don't need to change (it is uncomfortable and inconvenient to change) Doesn't need to be — we need same or better outcomes 1000s of articles/ books Psychotherapy has already changed, and will continue The world has changed — technology won't wait for us to be ‘’comfortable’’
  52. 52. TF1F’v1fNl/ Kl HEAITH (G I _ , _ y _ teleheaIth. org Myths vs. Realities for Distance Counsehng Realities Myths It's too expensive No reimbursement It's illegal or unethical All distance counseling involves direct care Not enough guidance Quite affordable (free) Reimbursable in many ways Legal and ethical Se| f—help for billions of people worldwide Dozens of professional association guidelines exist in English and can be accessed with the Web
  53. 53. K ‘3'9_1‘3.f“!5‘T~"“, ",‘3'3?? ?“ <-ll= li1’: Mli‘o. -x-1'0’ ' 1 :1 »; v l ' , - : Myths vs. Realities for Distance Counsehng Myth Reality * Ishouldn’t have to change * Personal choice
  54. 54. ((6 "’~. ’i? "‘—l": .’*’H. “3"i—'IfH. ”€"‘v§: ’c"l <=4r4‘-‘e~vt= ~x= -'»'ce: Wish List of Next Steps Essential Points: Understand traditional telehealth vs. how most allied health professional are using telehealth Help move counselors toward change related to Health Care Reform Outline clear statements of needed techno| ogy—based competencies Develop distance counseling protocols for treatment in ”unsupervised settings” — Find malpractice carriers who will carry our entire risk (both civil & regulatory) <7
  55. 55. K Gil; -'l‘nl"-i= lli‘Ii'. -'l'(f_" Wish List of Next Steps <‘ Advocate for your regulatory boards to: — Post clear statements about & enforce existing laws (apply for grants . —— e / ,1 ” to fund licensure portability) My/1;} . g_-, -gm ' — Require minimal techno| ogy— [C: Ii. eeI[. me; / gm: xe. )J competencies be demonstrated as a ‘ I ’ - - ye condition for licensure l ' * *‘ i . ‘7 . J , _.. ._. ... ._. ..= .,< W F, ) I. < _, , <‘ Focus on other areas in addition to direct— . —"- 4 "' care: self help, techno| ogy—assisted care . . . - l <* Start developing services for integrated . l - care, patient—centered homes, group practices is Join us in forming an inter—professiona| group: http: //COBETCH. org it Expand training options for responsible techno| ogy—based practice (CACREP)
  56. 56. ((6 "‘3~. ’i"T? )"—{a’: .*’e. “3“§—'ifH. "€)"v’§: ’:"i He‘-‘i’-¢: ~ilI‘-’«-«-'»'ne. : The Future? Technology isn't just the future — its here today It can already be used legally & ethically It's the right thing to help grow our profession with with health care reform Change starts with us wanting to make it happen and a single click
  57. 57. ((6 ‘'‘%‘. ’:: ‘’‘—l[: ’‘7.’H’H. ‘‘1~f: :f. '’€‘‘V§? ’:‘’' “"5l""-”**‘l""~'«""(9:‘ Questions? Til» . gin_); uollu Marlene M. Maheu, Ph. D. Te| eMenta| Health Institute, Inc. Email: mmaheu@te| ehea| th. ORG Phone: 619-255-2788

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