Trauma-Informed Child & Pediatric Telehealth Training 12.8.22 FINAL-FINAL 8-10 PM.pptx
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- The document outlines strategies for conducting trauma-informed telehealth sessions with children and families. - It discusses preparing families for sessions by having private spaces, muting devices, turning on cameras, and completing to-do lists. - The document provides tips for working with caregivers, such as preparing children and environments, enlisting aid, and getting informed consent. It also discusses sending materials to families' homes.
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Trauma-Informed Child & Pediatric Telehealth Training 12.8.22 FINAL-FINAL 8-10 PM.pptx
- 1. Trauma-Informed Child & Pediatric Telehealth Training
- 2. Marlene M. Maheu, PhD Telehealth pioneer for three decades. • Consult, train and write • Five textbooks, 50 book chapters & journal articles • Founder and CEO of Telehealth.org • Founder CEO of the Coalition for Technology in Behavioral Science (CTiBS) • Founder of the Journal for Technology in Behavioral Science (JTiBS) • Blog.Telehealth.org • 55 Telehealth Newsletters
- 3. Preventing Interruptions Maximize your learning by: • Make a to-do list • Turning on your camera & join the conversation throughput this activity • Muting your phone • Asking family and friends to stay away
- 4. Audio-On Mode • Please raise your hand and wait for me to acknowledge you. • Telehealth.org assistants are here to help you with administrative issues, such as not hearing me. • Please text your messages as they occur to you rather than waiting. • Want to have a discussion with you throughout the event as much as possible. • Help us stay on track.
- 5. © 1994-2021 Telehealth.org, LLC. All rights reserved. 5 Look to the left of your Telehealth.org Digital Training Center screen for platform functions. This is where to access slides, download handouts, review documents, and complete your evaluation and posttest if you are taking CMEs, CNEs or CEs for this program.
- 6. © 1994-2021 Telehealth.org, LLC. All rights reserved. Learning Objectives 6 • Outline an evidence-based approach to conducting telehealth with children who have experienced trauma. • Name multiple sites where evidence- based information is available at no cost for working with children • Describe the leading telemental health guidelines for children and teens.
- 7. © 1994-2022 Telehealth.org, LLC. All rights reserved. 7 And you? Please introduce: 1. Yourself with 2. City and 3. Specialty …
- 8. Many Types of Trauma
- 10. © 1994-2022 Telebehavioral Health Institute, LLC All rights reserved. 10 Aleki 9-years old Lives with father, who works from home as a freelancer for a publisher • Maternal physical and emotion abuse • Father has sole custody as of March of this year • Low-average IQ • Motor & speech delays • Depressed • Loss of appetite • Nightmares
- 11. © 1994-2022 Telebehavioral Health Institute, LLC All rights reserved. 11 Death of a Sibling • Older sister was fatally wounded in an automobile accident while Dad was driving. • Leilani was in back seat with sister at time of accident • Dad is hard-worker, often travels & when home, absent from family life • Family is generally non- communicative about emotions Leilani • 5-years old • High average IQ • Anxious • Defiant • Nightmares • Detached, uncooperative parents
- 12. © 1994-2021 Telehealth.org, LLC. All rights reserved. Darius is 12-years-old and a survivor of childhood leukemia. He is anhedonic, depressed, doesn’t like going outside and overeats to cope. He says he is not suicidal but is socially isolated, refuses to engage with former friends or attempt his schoolwork. Darius
- 14. © 1994-2021 Telehealth.org, LLC. All rights reserved. What is your #1 most important question today? 14
- 15. Assumptions & Limitations • Impossible to find images for every situation with children, youth or adults • Training is dependent on your involvement • Ask all your questions • Your privacy is assured • Comment freely • Your images and messages will not be included in the video recording.
- 16. © 1994-2021 Telehealth.org, LLC. All rights reserved. 16 • Optimal set up is to have family members in separate rooms (or parked cars), each with their own device, if possible. • All sharing 1 screen does not allow members to look at each other and speak. • Multiple in 1 room can create havoc if not carefully instructed to mute all but one device – then the other 3 people won’t be clearly heard… • May need extra set-up time. In a family of four people, what would be the optimal video setup for family therapy?
- 19. © 1994-2021 Telehealth.org, LLC. All rights reserved. Families may be like this… 19
- 20. © 1994-2021 Telehealth.org, LLC. All rights reserved. 20 Maybe the caregiver isn’t health literate?
- 21. Clear Health Communication by Using Plain Language • Health literacy • Joint Commission considers clear health communication is an issue of safety
- 22. Clear Communication to Support Health Literacy in Clinical Settings • 3/10 people in rural communities don’t have a smartphone • More than half of low income families don’t have Internet at home • Only 12/100 of adults in US has proficient health literacy to be able to find, read, understand and use health information
- 23. Agency for Healthcare Research and Quality (AHRQ) https://www.ahrq.gov/health- literacy/publications/ten- attributes.html 10 Attributes of a Health Literate Healthcare Organization Leadership • Policy that support understanding • All policies are written in plain language • Kitchen talk that most of us would use with our grandparents. Common, everyday language. • Teachback. Pause and ask patient to feed instructions back to you so ”I can make sure I did a good job explaining that to you.” • If not actionable, caregivers may not be able to do the best possible for the child. • Also there are programs to help patient build skills.
- 24. To answer the question of what we can say to a family, it would depend on the technology they have and their skills for using that technology. General Suggestions • Keep it simple • Give them resources • Walk them through the resources and give them print outs • An admin can help do this basic patient education • Or you can make a video and send it them if they have the right technology
- 25. How to Work With Cargivers to Enlist Their Aid (When Possible) Ask caregivers to take the time to help set up the session and be available during the meeting: • Explain optimal multi-camera setups if they have more than one digital device • Help find resources for funding if they do not have resources needed: https://raisingchildren.net.au/disability/service s-support/services/telehealth-therapy-tips- children-disability-autism-additional-needs
- 26. How to Work With Parents or Caregivers to Enlist Their Aid (When Possible) Caregivers should consider helping with the transition into session by accompanying the child at the start of the session by: • Introducing or reminding the child of who you are and your role • Describing any recent milestones, achievements, or setbacks • Reporting how the child’s mood was just before the start of a session • Have them text these answers or any other concerns to you ahead of time (use HIPAA-compliant technology).
- 27. © 1994-2021 Telehealth.org, LLC. All rights reserved. Concurrent Video Games? Have family turnoff or remove games from virtual environment 27
- 28. How to Work With Parents or Caregivers to Enlist Their Aid (When Possible) Room Preparation • Create distraction-free space • Just a few toys – not too many • What are names of toys so you can refer to them? • Private room? Are other people in earshot? Can they be asked to step and stay away? • Ambient music if people are home and walls are thin
- 29. Tasks for Caregiver to Prepare for a Video Session • Private, quiet room • Closed door • Give the child earbuds or a headset • Comfortable seat for child • No distractions • Give the child a computer that is charged • Make sure household members stay away • Can any interruptions be anticipated?
- 30. How to Work With Parents or Older Household Members to Enlist Their Aid (When Possible) • Plan for distractions and make agreements ahead of time with parents • Will child or parent need to be mobile at any time during session? • Has child gone to restroom? • Send a written list sent to parents for how to prepare the children for a video session • Set limits & have backup plans for possible interruptions, distractions, connection breakdowns
- 31. © 1994-2021 Telehealth.org, LLC. All rights reserved. • Send email about child's behavior and progress one day before his or her session. • Include in that email about child’s reaction to the last session. • Pre-emptive problem solving: Send appointment reminder by text secure messaging to parents before session on the day of the meeting if they have missed appointments -- or haven’t set up the child appropriately for sessions in the past. More Parent Engagement Strategies 31
- 32. Permission & Informed Consent Agreement • Clearly outline your responsibilities and what they can expect from you • Emailing summaries, testing reminders, • Get free or paid online templates (JotForms.com) • Will session be recorded? By whom? • Outline their responsibilities • Setup room, being available during session • Privacy rules
- 33. © 1994-2021 Telehealth.org, LLC. All rights reserved. • Consider possibility of sending materials to a child’s home or doorstep with instructions about how to use in the therapy session • Consider offering parents or caregivers free digital tools to educate themselves Sending Materials to the Home for Child? 33
- 35. © 1994-2022 Telebehavioral Health Institute, LLC All rights reserved. 35 See PDF in your “Documents” Tab on left side of screen in Training Center
- 36. © 1994-2022 Telebehavioral Health Institute, LLC All rights reserved. 36 See PDF in your “Documents” Tab on left side of screen in Training Center
- 37. © 1994-2022 Telebehavioral Health Institute, LLC All rights reserved. 37 See PDF in your “Documents” Tab on left side of screen in Training Center
- 38. © 1994-2022 Telebehavioral Health Institute, LLC All rights reserved. 38 See PDF in your “Documents” Tab on left side of screen in Training Center
- 44. © 1994-2021 Telehealth.org, LLC. All rights reserved. • Consider showing/sending recording or part of the recording of the session to parents to use as a resource in the future if that fits your teletherapy treatment model. • If recordings are shared with parents, advise them to protect privacy when storing these files in their own technology. • Explaining how and where to upload such recordings to a HIPAA-compliant service is crucial. • SEE for HIPAA concern: https://blog.telehealth.org/hipaa-compliant- cloud-storage/ Share recording with parent(s)? 44
- 45. © 1994-2021 Telehealth.org, LLC. All rights reserved. • Encourage a caregiver to be either present or close by during each session for client and clinician support, and particularly if their telephone rings with a call from you, the therapist. • Texting works well because it might not disturb the session with the child. • If a caregiver is using their phone to help with the session, the video platform that you select for telehealth would need for all incoming calls to be heard if you plan to have an audio rather than a video exchange. Telephone Access
- 46. © 1994-2021 Telehealth.org, LLC. All rights reserved. Problem Solving: Do you do anything else to engage with parents or families? 46
- 48. © 1994-2021 Telehealth.org, LLC. All rights reserved. • Develop a written telehealth protocol for your practice, based on existing research: • Cite references • Look at sample size, methods, and discussion for suggestions to include in your protocol • Have colleagues review and comment in writing - document • Explain exactly which aspects of the research document or consensus paper being used Develop Your Evidence Based Clinical Protocols 48
- 49. © 1994-2021 Telehealth.org, LLC. All rights reserved. 49 • Research telehealth articles of relevance to your practice: • University library • PubMed • Google Scholar • Academia.edu • Research Gate • Journal for Technology in Behavioral Science (JTiBS) – Published CTiBS Interprofessional Framework for Telebehavioral Health Competencies Develop Your Evidence Based Clinical Protocols
- 50. © 1994-2021 Telehealth.org, LLC. All rights reserved. Relevant Research • Consensus Documents • Summarizes the Evidence Base in New & Evolving Areas (plus add voice of experience from the field) 50
- 51. © 1994-2021 Telehealth.org, LLC. All rights reserved. Use Consensus Documents • Developed in emerging fields by experienced professionals who carefully consider needs that have not yet been addressed by research • Can legitimately be referenced in documentation • Be careful of “collegial opinions,” uninformed supervisors or practices of online employers who are ignoring the rules • Examples are some association guidelines or guidance documents produced by a Delphi process, etc. 51
- 52. © 1994-2021 Telehealth.org, LLC. All rights reserved. Publication title: An Interprofessional Framework for Telebehavioral Health Competencies Coalition for Technology in Behavioral Science (CTiBS) 52
- 53. Your Free Copy of: An Interprofessional Framework for Telebehavioral Health Competencies https://telehealth.org/telebehavioral-health-competency- framework/
- 54. © 1994-2021 Telehealth.org, LLC. All rights reserved. Clinical Telepresence Technical mHealth Ethical & Evidence-Based Legal & Regulatory Practice Development CTiBS TBH Competency Domains (We will look at three of them today) 54
- 55. Telehealth Used the Most by Behavioral Health Pediatric Subspecialists March 31, 2022 Findings The study included 549,306 patients, representing a total of 1.8 million visits from eight pediatric medical groups from the Children’s Specialty Care Coalition (CSCC). • 65% of patients were served via telehealth Uscher-Pines, L., McCullough, C., Dworsky, M. S., Sousa, J., Predmore, Z., Ray, K., ... & Schulson, L. (2022). Use of Telehealth Across Pediatric Subspecialties Before and During the COVID-19 Pandemic. JAMA Network Open, 5(3), e224759- e224759.
- 58. © 1994-2022 Telehealth.org, LLC. All rights reserved. ATA Guidelines For Children & Adolescents 2017 58
- 59. © 1994-2021 Telehealth.org, LLC. All rights reserved. Download link for: ATA Practice Guidelines for Telemental Health with Children and Adolescents • https://www.cdphp.com/-/media/files/providers/behavioral- health/hedis-toolkit-and-bh-guidelines/practice-guidelines- telemental-health.pdf?la=en 59
- 60. © 1994-2021 Telehealth.org, LLC. All rights reserved. 1. Telemental health for child trauma treatment during and post-COVID-19: Limitations and considerations Racine, N., Hartwick, C., Collin-Vézina, D., & Madigan, S. (2020). Telemental health for child trauma treatment during and post-COVID-19: Limitations and considerations. Child Abuse & Neglect, 110, 104698. https://www.sciencedirect.com/science/article/pii/S0 145213420303537 Other Research 60
- 61. © 1994-2021 Telehealth.org, LLC. All rights reserved. Over the last decade, with the increased access and availability of technology around the world, an emerging body of research has evaluated the efficacy of implementing psychosocial interventions for mental illness more broadly, via telemental health. Telemental health has been shown to be as effective in treating children’s general mental health difficulties when compared to in- person treatment (Gloff, LeNoue, Novins, & Myers, 2015). Evidence Base 61
- 62. © 1994-2021 Telehealth.org, LLC. All rights reserved. • Indeed, evidence-based mental health interventions over the telephone have been shown to be effective for children with behavior problems and anxiety (McGrath et al., 2011). Telemental health has also been shown to reduce barriers to treatment access (e.g., transportation; Nelson, Cain, & Sharp, 2017). Evidence Base 62
- 63. © 1994-2021 Telehealth.org, LLC. All rights reserved. • An early pilot study of 15 children demonstrated that Trauma-Focused Cognitive Behavior Therapy (TF-CBT), a gold standard evidence-based treatment for addressing post-traumatic stress symptoms in children and adolescents (Cohen, Mannarino, & Iyengar, 2011), offered via telemental health. It was effective in reducing post-traumatic stress symptoms at rates comparable to in-person therapy (Stewart, Orengo-Aguayo, Cohen, Mannarino, & de Arellano, 2017). Evidence Base 63
- 64. © 1994-2021 Telehealth.org, LLC. All rights reserved. • Reduced barriers to access, particularly for rural families • Increased cost-effectiveness • Reduced travel costs • Broader availability of specialty services • Reduced child-care & elder-care costs • Increased likelihood of treatment attendance which can lower treatment duration and increased clinical capacity for the agency Benefits of Telebehavioral Health (TBH) 64 Aleki
- 65. © 1994-2021 Telehealth.org, LLC. All rights reserved. • Limitations are exacerbated for children & families who are most marginalized & facing the highest levels of social and economic barriers • Challenges with attention and emotion regulation skills • Difficulties identifying dissociative symptoms • May have experienced increased time with perpetrators of abuse due to shelter in place orders • Client safety during sessions Unique Limitations of TBH within a Child Maltreatment Population 65
- 66. © 1994-2021 Telehealth.org, LLC. All rights reserved. • The potential for safety concerns to arise (i.e., harm to self or an abrupt disconnection), particularly given the risk profile of maltreated children, requires attention to safety when providing TBH. Unique Limitations of TBH within a Child Maltreatment Population 66
- 67. © 1994-2021 Telehealth.org, LLC. All rights reserved. • A systematic literature review on safety of providing TBH services outside of a clinically supervised setting has demonstrated that safety plans and protocols can be effectively used for TBH with adults (Luxton, Sirotin, & Mishkind, 2010). • Limited studies compare the safety of clinic- based treatment TBH outside of clinically supervised settings for children and adolescents (Kramer & Luxton, 2016). Unique Limitations of TBH within a Child Maltreatment Population 67
- 68. © 1994-2021 Telehealth.org, LLC. All rights reserved. • Lack of access to reliable technology • Lack of a private or confidential space for sessions • Reluctance to process trauma in the absence of a safe environment Barriers of Telebehavioral Health (TBH) for Child Trauma Treatment 68
- 69. © 1994-2021 Telehealth.org, LLC. All rights reserved. • There is also evidence to suggest that TF-CBT treatment delivered via telemental health may reduce rates of treatment drop out (Stewart, Orengo- Aguayo, Cohen et al., 2017), which has historically been a challenge in the child trauma-treatment literature (Ormhaug & Jensen, 2018). Evidence Base 69
- 70. 2. Pediatric telehealth in the COVID-19 pandemic era and beyond. 2021 American Academy of Pediatrics Review Suggested that telehealth may be well suited for behavioral health concerns, chronic condition management, presurgical visits, and follow-up visits after hospitalizations and emergency department visits Curfman, A., McSwain, S. D., Chuo, J., Yeager- McSwain, B., Schinasi, D. A., Marcin, J., ... & Olson, C. A. (2021). Pediatric telehealth in the COVID-19 pandemic era and beyond. Pediatrics, 148(3).
- 71. 3. Supporting survivors of child sexual abuse during the COVID-19 pandemic: An ecosystems approach to mobilizing trauma- informed telemental healthcare. (Open Source, 2022) a) Proposed an ecological systems framework to telemental health for child sexual abuse b) Described their administrative and clinical processes c) Shared their clinical observations Azzopardi, C., Shih, C. S.-Y., Burke, A. M., Kirkland- Burke, M., Moddejonge, J. M., Smith, T. D., & Eliav, J. (2022). Supporting survivors of child sexual abuse during the COVID-19 pandemic: An ecosystems approach to mobilizing trauma-informed telemental healthcare. Canadian Psychology/Psychologie canadienne, 63(1), 43–55. https://doi.org/10.1037/cap0000298
- 72. Supporting survivors of child sexual abuse during the COVID-19 pandemic: An ecosystems approach to mobilizing trauma- informed telemental healthcare. Conclusions a) Some barriers to healthcare access and social isolation have seemingly been reduced, and therapeutic alliance and treatment completion have not been significantly compromised. b) We have been able to maintain a high standard of clinical care while physically distancing and remotely connecting in meaningful ways. c) Grounded in our virtual practice observations, our reflections are anecdotal
- 73. 4. Promotion of Maternal– Infant Mental Health and Trauma-Informed Care During the COVID-19 Pandemic (Open Source 2020) In this commentary, we present recommendations for practice, research, and policy related to mental health in the perinatal period. These recommendations include the use of a trauma-informed framework to promote social support and infant attachment, use of technology and telehealth, and assessment for mental health needs and experiences of violence. Choi, K. R., Records, K., Low, L. K., Alhusen, J. L., Kenner, C., Bloch, J. R., ... & Logsdon, M. C. (2020). Promotion of maternal–infant mental health and trauma-informed care during the COVID-19 pandemic. Journal of Obstetric, Gynecologic & Neonatal Nursing, 49(5), 409-415.
- 74. 5. A trauma- informed approach to the pediatric COVID-19 response By employing the “CARES” framework, pediatric providers can openly discuss the pandemic with patients and families, collaborate to build resiliency, and encourage engagement in activities and resources that are protective. This approach could potentially prevent both the short- and long-term health consequences resulting from the toxic stress and traumatic exposure of COVID- 19 Chokshi, B., Pletcher, B. A., & Strait, J. S. (2021). A trauma-informed approach to the pediatric COVID- 19 response. Current problems in pediatric and adolescent health care, 51(2), 100970.
- 75. A trauma- informed approach to the pediatric COVID- 19 response. (Open Source 2021) A trauma-informed response to COVID-19 The central tenet of trauma-informed care is to consider what happened to a person, instead of what is wrong with a person. Cares Framework 1. Consider the context 2. Ask about COVID-19 effects 3. Resiliency & Resources 4. Educate about trauma, stress & health 5. Self-care
- 76. 6. Telemental health for child trauma treatment during and post-COVID-19: Limitations and considerations. (Open Source, 2020) This article discusses both the benefits and barriers to telemental health in a child maltreatment population and offers considerations for child trauma service provision, program development, and policy during and post the COVID- 19 pandemic. Racine, N., Hartwick, C., Collin-Vézina, D., & Madigan, S. (2020). Telemental health for child trauma treatment during and post-COVID-19: Limitations and considerations. Child Abuse & Neglect, 110, 104698.
- 77. Telemental health for child trauma treatment during and post-COVID-19: Limitations and considerations. (Open Source, 2020) While the benefits of telemental health have been identified, including reduced barriers to access, increased cost effectiveness, and broad availability of services, there are unique limitations to its implementation within a child maltreatment population, such as: • challenges with attention and emotion regulation skills, • difficulties identifying dissociative symptoms, • and increased time with perpetrators of abuse due to shelter in place orders.
- 78. Telemental health for child trauma treatment during and post-COVID-19: Limitations and considerations. (Open Source, 2020) These limitations are exacerbated for children and families who are most marginalized and facing the highest levels of social and economic barriers. Lack of access to reliable technology, lack of a private or confidential space for sessions, and reluctance to process trauma in the absence of a safe environment, are all barriers to conducting effective trauma treatment over telemental health.
- 79. 7. ‘When it comes to relational trauma, you need people at the table’ Therapist experiences of online therapy for families with a prior disclosure of sibling sexual abuse during Covid‐19 pandemic lockdowns. (Open Source, 2022) This study aims to contribute to the evaluation of online therapy during Covid-19 pandemic lockdowns, by exploring family therapists’ experiences of therapy for twelve Sibling Sexual Abuse (SSA) families in the Netherlands. Simons, A., Noordegraaf, M., & Van Regenmortel, T. (2022). ‘When it comes to relational trauma, you need people at the table’ Therapist experiences of online therapy for families with a prior disclosure of sibling sexual abuse during Covid‐19 pandemic lockdowns. Journal of Family Therapy.
- 80. ‘When it comes to relational trauma, you need people at the table’ Therapist experiences of online therapy for families with a prior disclosure of sibling sexual abuse during Covid‐19 pandemic lockdowns. (Open Source, 2022) First, the Dutch therapists reported no acute worries about their clients’ sexual safety during the pandemic lockdowns. Nonetheless, the switch to online therapy for the SSA families created concern regarding victim safety in speaking out freely at home. Second, while the sudden switch to online therapy enabled SSA therapists to stay connected with their SSA families, therapists experienced a decline in therapy quality and in their own well-being.
- 81. Resource: National Child Traumatic Stress Network (NCTSN) TRAUMA-INFORMED SCHOOL STRATEGIES DURING COVID- 19 Reach out to trauma-informed mental health agencies, including NCTSN members, to learn about services available to families, such as both telehealth services and in-clinic services. HTTPS://WWW.NCTSN.ORG/RESOUR CES/TRAUMA-INFORMED-SCHOOL- STRATEGIES-DURING-COVID-19
- 82. © 1994-2021 Telehealth.org, LLC. All rights reserved. • To date, no specific theoretical orientation or approach has been contraindicated for telehealth. • CBT seems to work well due to its structured approach. • Best practices for working with children and adolescents is both typically involve working both together and alone with the child and with their parent(s). 82
- 83. © 1994-2021 Telehealth.org, LLC. All rights reserved. • When entry into the treatment site is complicated, working with presenters is suggested. • Be aware of your national association’s guidance regarding both telehealth and working with children and adolescents. 83
- 84. © 1994-2021 Telehealth.org, LLC. All rights reserved. • Engagement: Lead with something fun – games, music, movement to help them focus on you and what you are saying/doing: • What is…? • I see something BLUE… • Play music in the background from YouTube or Amazon, get up and dance with them 84
- 85. Engaging Children & Teens through Telehealth
- 87. How to Engage Children in Telehealth • Use art creatively • Finger puppets • Rock art • Make booklets of stories reflecting their feelings
- 89. © 1994-2021 Telehealth.org, LLC. All rights reserved. Work with images that you find online to tell stories from which you can elicit feelings 89
- 91. © 1994-2021 Telehealth.org, LLC. All rights reserved. As the child to lightly color ridges with chalk or side of a crayon, then tell you a story about what they see… 91
- 92. © 1994-2021 Telehealth.org, LLC. All rights reserved. 92 Have clay or similar toys as child on your side to model next steps.
- 94. Virtual Reality for Pain • Increase the child’s involvement • Access to tools • Tailoring treatment to child’s needs and preferences.
- 95. © 1994-2021 Telehealth.org, LLC. All rights reserved. 95 Talk about Disabilities – Offer Inclusive Pictures of Other Kids w/ Disabilities
- 96. © 1994-2021 Telehealth.org, LLC. All rights reserved. 96 What questions would you ask when using this picture?
- 107. © 1994-2021 Telehealth.org, LLC. All rights reserved. What is he trying to communicate?
- 109. Caution: Plan ahead, prepare for the worst, and allow for decompression time after using evocative imagery.
- 110. © 1994-2021 Telehealth.org, LLC. All rights reserved. 110 What is this person feeling? How can you help yourself feel this way?
- 112. © 1994-2021 Telehealth.org, LLC. All rights reserved. What other game sites have you found online or in apps? Are they HIPAA- compliant? 112
- 120. © 1994-2021 Telehealth.org, LLC. All rights reserved. Use 3 -point system that allows gallery view • Try adjusting the view on your cameras right now, in this zoom room • Adjust your audio settings • Adjust your video settings • Be careful when sharing your desktop • “Oopsies” are not allowed Cameras for Optimal Individual Telehealth 3-Point Camera Setup 120
- 121. © 1994-2021 Telehealth.org, LLC. All rights reserved. Use multiple devices, if possible: • Have participants in different locations: rooms, automobiles or other • All facing their screens • Use gallery view Group Telehealth 121
- 122. © 1994-2021 Telehealth.org, LLC. All rights reserved. Use 3 -point system setup • The primary camera is already positioned on a desktop. • The second device can be positioned to see the child’s hands as well as much of the desktop. • The third camera would optimally be positioned in a far corner of the room, to allow the therapist the ability to maintain visual contact with the child if they get up from their seat and move to another location in the room. Every situation will demand adaptations, but this type of camera configuration has been shown to be optimal. Optimal Individual Telehealth 3-Point Camera Setup 122
- 128. © 1994-2022 Telehealth, LLC All rights reserved. Imani 128 Neurologi- al Consult to be followed over time 4 years old Bonded with Tele- therapist Given age- matched games Sleeps through the night Loves to use finger puppets Somatic complaints subsiding Stable foster Mom who helps with telehealth room setup
- 131. © 1994-2022 Telebehavioral Health Institute, LLC All rights reserved. 131 Leilani • Anxiety decreased in direct proportion to family activates that resulted from family therapy sessions where family members sat in one room with multiple cameras and Leilani was allowed to roam around the room as she desired. • Physical contact was directed by therapist through screen to allow Leilani to better connect with father. • Parents were given written summaries of Leilani’s progress for the first three sessions, then invited to join her. They began preparing the room in response to direct suggestions in these emails
- 132. © 1994-2021 Telehealth.org, LLC. All rights reserved. Darius has been visiting the rehab unit at his local children’s hospital, where he is given Virtual Reality sessions to improve his social skills and depression. He looks forward to his hybrid telehealth visits with a young male therapist who monitors his VR progress along with CBT through video. He is nervous, but planning to go back to a classroom in January. Darius
- 134. © 1994-2021 Telehealth.org, LLC. All rights reserved. 134 Look to the left of your Telehealth.org Digital Training Center screen for platform functions. This is where to access slides, download handouts, review documents, and complete your evaluation and posttest if you are taking CMEs, CNEs or CEs for this program.
Editor's Notes
- What are some of the types of trauma that you have worked with?
- Stop session?
- What is he trying to communicate?