This document discusses principles for practicing clinical care using behavioral tele-health (BTH). It addresses establishing rapport, assessing client needs, using apps and video conferencing, and addressing technical difficulties online. Developing rapport is especially important for BTH, though it is limited without nonverbal cues. Active listening and descriptive speech can help engage clients. Cultural considerations include comfort with technology and online privacy.

1. Clinical Principles: Practice
Brought to On-line Environment
Hot Topics
SbVC-6

2. Anticipating Client Needs
• Assistance setting appointments
• Websites
• Apps
• Equipment use and needs
• Continuous assessment of client’s
comfort using B T-H

3. Current Trends:
Medical-ECHO
&
PPW ECHO
https://www.youtube.com/watch?v=2lBfyOlL4_shttps://
www.youtube.com/watch?v=2lBfyOlL4_s
Tools for treatment Family-Centered Behavioral
Health Support For Pregnant and Postpartum
Women-Project Echo
MID-America ATTC University of Missouri-Kansas
http://attcppwtools.org/PPWProgram/PPW-ECHO-
Flyer_final.pdf

4. Apps: Pros and Cons
Consider developing a list of Apps you have examined for client use
including any costs associated with use, e-mail address needed,
information collected, etc.
•Convenience
•Anonymity
•An introduction to care
•Lower cost
•Service to more people
•Interest
•24-hour service
•Consistency
•For whom and for what
•Guidance
•Privacy
•Regulation
•Overselling
•Support
•Effectiveness

5. Persuasive Technology
• Text only reminders, Text plus interactive
models
• The Stanford Persuasive Technology Lab
creates insight into how computing
products — from websites to mobile phone
software — can be designed to change
what people believe and what they do.

6. Persuasive Technology
BJ Fogg’s Behavior Model
Ability
Motivation
Triggers

7. Video Conferencing
Demonstrations

8. Persuasive Technology Apps
• https://www.youtube.com/watch?v=dFX4FuBazAU&list=PLBXgZMI_
zqfRKF4N5AgdWwYwEwghTxjt9
• M.Chat-UNT Fort Worth Texas
• Text4baby demonstration

9. Rapport
“There is no substitute for a positive,
caring, non-threatening environment”
- D.R. Spitze
“Rapport my be the single most
important aspect of a counseling
relationship. It has been found to
increase client interest, motivation,
and comfort, all of which contribute to
clinical efficacy” Centore (ADD)

10. Rapport
• Without rapport what do you have?
• How do you develop it face to face?
• What limits do you anticipate building
rapport online?

11. Rapport Online
Kiropoulos and colleagues (2008) CBT for panic
disorder showed, “No differences in ratings of
the therapeutic alliance between those in
Internet-based and face-to-face conditions.
However, individuals in face-to-face format
reported higher levels of enjoyment”.

12. Ponder this:
– 60 to 65 percent of
interpersonal
communication is
conveyed via nonverbal
behaviors. Foley, Gentile
(2010) Up to 60-93% was
found in publications.
– Eye-contact correlation
with the level of counselor-
client rapport-B T-H eye
contact?

13. Ponder this:
– Nodding ones head-B T-H?
– Forward leaning technique of counselors-
BT-H?
– F 2 F body mirroring-BT-H?

14. Ponder this:
– The use of silence with F 2 F rapport
building-On-line silence?
– Minimal use of encouraging statements -
“uh huh”, “hmm” increases rapport
– Highest amounts of rapport - focus on the
clients perspectives and not the
counselors interpretations. Client
Centered.

15. Frustration
• Behavioral Tele-Health - even more
important to choose your words
carefully
• Listening for clients reactions to your
words
• Encourage the client to verbalize any
confusion

16. Culture of the Modality
• Technology Culture
• Wi-Fi/Internet Issues
• On-line privacy issues
• Levels of comfort

17. What about the video and delay
• Impact of the delay in technology
communication
–Delay in video
• No matter the delay severity, there is
no difference in rapport between in-
person and BT-H sessions for men.
• For women, higher rapport was
reported with BT-H with minimal delay.

18. Technical Difficulties
• Your therapeutic style.
• Use humor to defuse technological
difficulties

19. Text Etiquette
• h8t 2 get tx lik ths
• AFAIK
• Use of fonts
• Using Italics and Bold
• Canned text
• WRITING IN CAPS

20. Difficult Clients
• Discerning Truth
• Angry Clients
• Clients that write/text too much or too
often
• Immediacy Issues

21. Active Listening
• Important in all counseling
• Even more important with Behavioral
Tele-Health watching, reading, listening
to the words and emotions of the client

22. Verbal Engaging
• Increase Verbosity:
– Increase the explanation.
• It’s a nice day vs. It’s a nice day, the
sun is brightly shining, there are a few
clouds in the sky. They clouds are like
big bright white puffs.
• Engagement of the client-you do end up
talking more.

23. Descriptive Speech
Humanize yourself - in a professional manner
• Share your reaction/feelings as if the client was face
to face.
• If a client abstained from using at a party. You might
say, “See this smile on my face. I feel very happy
that you were able to reach your goal”.

24. Professional Marketing
• Professional
appearance
• Include a Bio that
demonstrates
your proficiency
in B T-H