This presentation outlines the basics of beginning to work with patients via telehealth. The workshop offers both pragmatic and technical assistance to start working with patients at a distance or online

1. Learning Telehealth in the
Midst of a Pandemic
JOHN D. GAVAZZI, PSYD, ABPP
PSYCHOLOGIST – BOARD CERTIFIED IN CLINICAL PSYCHOLOGY
JOHN.GAVAZZI@GMAIL.COM

2. Learning Objectives
At the end of the presentation, the participant will be able to
1. Outline 2 reasons why bandwidth is important
2. Explain 2 security issues with telehealth services
3. Describe 2 examples of how to practice ethically with telehealth

3. Pandemics Put All of Us in a Tough Spot
1. We have been forced into the telepsychology process due to
physical distancing.
2. Less opportunity to learn in a gradual way.
3. Mixed, confusing, or ambiguous information makes learning
difficult. Many patients becoming telehealth patients
simultaneously is overwhelming.

4. Tough spot (continued)
4. We cannot choose which patients we would typically select for
telehealth services.
5. We may be emotionally overwhelmed, with personal issues (e.g.
childrearing, elder care) that creates additional burdens on our
emotional resilience.

5. Telepsychology as Trial By Fire
1. Mental Health Providers (MHPs) will need to ramp up quickly on
technological expertise.
2. Patients will need to ramp up quickly on understanding how to
access your services.

6. Top Six Technology Issues with Telepsychology
1. Lack of technical skills by patient and MHP.
2. Lack of adequate bandwidth. Bandwidth is basically the amount
of data flowing between your tech and patient’s technology. Too
little bandwidth on the patient’s end or your end is a problem.
More on this soon.
3. Have a back-up plan if the technology fails. What are your
options? In session treatment? Combination phone/video.

7. Top Six Technology Issues
4. Know your Wi-Fi: use a secure Wi-Fi system. Your patient also
needs to be on a secure Wi-Fi. The closer you are to your router
(same for your patient), the better the technology will likely work.
5. Also, the number of people using the Wi-Fi may interrupt your
therapy session. If your patient has four other people at home all
streaming video, then there may be a problem with bandwidth.
6. The newer your technology, the better it will work. Older
equipment, meaning more than 3 years old, may cause problems.
Download updates for your computer.

8. Top Three Suggestions
1. Be patient with yourself and your client.
2. Practice with friends and relatives first. Make sure you can explain
how to access and use your telehealth platform before using it.
3. You may need to practice with your patient ahead of time or give
more education and guidance prior to your session. If it does not
work, try to reschedule later in the day or week.

9. Top Four Clinical Issues with Telepsychology
1. Not all patients are good candidates for telepsychology. We
recognize that this is being forced upon use because of physical
distancing.
Patient complexity, patient motivation, indoctrination
2. How do you strive for competence?
Take additional coursework; read articles; get educated
Review APA’s Telepsychology guidelines

10. Top Five Clinical Issues with Telepsychology
3. Review Informed Consent sheet. Make sure you understand it.
4. Work to treat the individual via telepsychology in the same or
similar manner as with face-to-face sessions.

11. We recognize this is stressful for multiple reasons
• Engage in self-care
• While stressful, this is temporary.

12. We Are Doing the Basics
• This training does not guarantee competence
• Synchronous or live forms of communication. We will not be
discussing asynchronous forms of communication, such as texting
or emailing.
• Not going to cover HIPAA issues in depth. Will mention.

13. Myths About Telehealth
• There is no research to support its use
• It is too expensive
• No reimbursement: There is
• No guidelines: APA Guidelines on Telepsychology, ATA,

14. Patient Benefits
• Increased patient satisfaction
• Decreases costs
• Decreases travel time
• Improved attendance
• Improved access to specialists
• Potential for faster
appointments
• Depending on client, may be
able to use avoid using sick
time

15. Downsides of Telehealth
• Need to be competent
• Need to know technology
• Treatment and rules are
slightly different
• Potential for problems increase
• Higher risk treatment
modalities can be an issue
• May need to spend more time
with patients to get them up to
speed

16. Higher Risk Model
• Patient is at great geographical
distance from you.
• Patient lives alone
• Or, patient has no privacy
where they live
• You have never met the patient
• You and the patient (or family
member) lives in a different
state
• After the assessment, what to
do if the patient is not a good
candidate for telehealth?

17. We have been thrown into this situation
• Ethical dilemma: To treat or
not to treat based on
treatment complexity
• Indoctrination: Educate about
setting up the scene
• Privacy and boundaries
• Limited assessment: Less
information (gait, smell)
• No recordings
• Bathroom breaks?

18. Informed Consent
ISSUES TO CONTEMPLATE

19. Informed Consent
• Talk about your competence
and your ability to carry out
services through telehealth
(transparency)
• Reinforce issues related to
confidentiality
• Review issues related to safety:
physical and technical
• Benefits/risks to telehealth
• Create a safe therapy space at
home. Some of my patients
use their car
• Importance of a secure
connection/secure Wi-Fi

20. Informed Consent
• Make sure you have a back-up
plan if the connection is lost
• Provide one phone number to
contact
• Permission from parent(s)
• Discuss emergencies
• For most professionals, this is a
temporary measure
• Discuss options to resume in-
person treatment and what
conditions need to be met,
meaning masks, disinfectant,
etc.

21. Competence
ISSUES TO CONTEMPLATE

22. Competence
• Education, experience, and
supervision
• Understand technology and
delivery of services
• Legal and regulatory rules
regarding telehealth
• Patient care
• Technical skills
• Professionalism
• Feedback from patients

23. Professional Boundaries
ISSUES TO CONTEMPLATE

24. Professional Boundaries
• What exactly are your office
hours?
• Office sets up natural
boundaries: time and space
• How to handle intrusions in
the process?
• Using the camera to insure
safety and privacy
• Discuss options to resume in-
person treatment and what
conditions need to be met,
meaning masks, disinfectant,
etc.

25. Professional Boundaries
• Eating during therapy
sessions?
• Drinking during session?
• Check yourself from time to
time on the camera
• Commenting on patients who
go off frame?
• Multiple intrusions: Would you
stop and reschedule?

26. Confidentiality
ISSUES TO CONTEMPLATE

27. Confidentiality
• Rules remain pretty much the
same
• Transmission security
• Are you aware of breach?
• HIPAA-compliant programs
• Social media platforms
• Don’t treat or communicate
through social media platforms
• Don’t use texts or email to
discuss confidential
information

28. What Are Other Clinicians
Saying About Telepsychology?
ISSUES TO CONTEMPLATE

29. Enhanced Emotional and Physical Exhaustion
• Clinicians are reporting more
physical and emotional
exhaustion after telehealth
sessions.
• Blue Light?
• Smaller Focus?
• Neck/shoulder strain?
• Screen needs to be at eye level
• Use earbuds/earphones
• Don’t scream or squint
• Good ergonomics

30. Therapeutic Presence
• Social animals who do well in
person
• Being involved with patient
• No smell
• No feelings
• Nonverbal communication
• Will take notes on a pad
• Comfortable with silence or
gaps
• Check in at end of session

31. Telehealth Indoctrination
• Role indoctrination
• Accepting feedback
• Providing more feedback
regarding in session behaviors
• Eye contact?
• More significant/deeper
conversations
• More intimate disclosure
• Office or territory? Power
• Age: Younger may be better

32. Questions and Answers
COURSE EVALUATIONS