Telephone therapy technique brings more Iraq and Afghanistan veterans into mental health treatment

Medicalxpress.com

Originally published July 26, 2012

A brief therapeutic intervention called motivational interviewing, administered over the telephone, was significantly more effective than a simple "check-in" call in getting Iraq and Afghanistan war veterans with mental health diagnoses to begin treatment for their conditions, in a study led by a physician at the San Francisco VA Medical Center and the University of California, San Francisco.

Participants receiving telephone motivational interviewing also were significantly more likely to stay in therapy, and reported reductions in marijuana use and a decreased sense of stigma associated with mental health treatment.

The study was published electronically recently in General Hospital Psychiatry (May 25, 2012).

Lead author Karen Seal, MD, MPH, director of the Integrated Care Clinic at SFVAMC and an associate professor of medicine and psychiatry at UCSF, noted that 52 percent of the approximately half-million Iraq and Afghanistan veterans currently being seen by the VA have one or more mental health diagnoses, including post-traumatic stress disorder, depression, anxiety or other related conditions.

The entire story is here.

ASPPB Receives Licensure Portability Grant from Federal Government

Any questions can be directed to Alex Siegel, JD, PhD, Director of Professional Affairs of ASPPB

ASPPB Receives Grant

Study Compares Effectiveness of Telephone-Administered vs. Face-to-Face Cognitive Behavioral Therapy for Depression

The JAMA Network
Originally published June 5, 2012

Patients with major depression who received telephone-administered cognitive behavioral therapy (T-CBT) had lower rates of discontinuing treatment compared to patients who received face-to-face CBT, and telephone administered treatment was not inferior to face-to-face treatment in terms of improvement in symptoms by the end of treatment; however, at 6-month follow-up, patients receiving face-to-face CBT were less depressed than those receiving telephone administered CBT, according to a study in the June 6 issue of JAMA.

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“The findings of this study suggest that telephone-delivered care has both advantages and disadvantages. The acceptability of delivering care over the telephone is growing, increasing the potential for individuals to continue with treatment,” the authors write. “The telephone offers the opportunity to extend care to populations that are difficult to reach, such as rural populations, patients with chronic illnesses and disabilities, and individuals who otherwise have barriers to treatment.

The entire release is here.

Thanks to Tom Fink for this information.

Maryland becomes 13th state to mandate telehealth services coverage

Law may be part of a growing trend toward reimbursement for telehealth services

By Legal & Regulatory Affairs staff

May 10, 2012—On October 1, 2012, Maryland will become the 13th state to require private sector insurance companies to pay for telehealth services. Maryland joins California, Colorado, Georgia, Hawaii, Kentucky, Louisiana, Maine, New Hampshire, Oklahoma, Oregon, Texas and Virginia in mandating that private payers cover telehealth services that are considered medically necessary and would otherwise be covered when provided face-to-face.

While reimbursement varies by insurer and state, this latest legislation seems to be part of a growing trend toward reimbursement for telehealth services.

The entire release is here.

Law OKs Cross-State Counseling Services

By Joe Gould
Army Times

The recent passage of the National Defense Authorization Act in Congress will make it easier for active-duty personnel and veterans to get mental health care wherever they are, officials said.

A provision of the act, aimed at expanding federal exemptions for behavioral telehealth consultations across state lines, removes the requirement for health care providers to be licensed in the state in which their patients are being treated.

Gen. Peter Chiarelli, then-Army vice chief of staff and an advocate for providing behavioral health counseling to soldiers in their homes via telehealth, praised the new law as a “big victory.”

“It’s the biggest step forward we’ve seen in two years,” Chiarelli told Army Times. “For me, it is huge. We have just to take advantage of it.”

Chiarelli retired Jan. 31, and Gen. Lloyd Austin has since assumed the post as Army vice chief.

Nearly 20 percent of military personnel returning from Iraq and Afghanistan showed symptoms of post-traumatic stress disorder, according to a Rand Corp. survey.

Patients are plentiful, but the doctors who are needed to treat them are not. Chiarelli acknowledged a shortage of behavioral health specialists in the Army, as well as the challenge of attracting, hiring and retaining them to the rural areas that surround some posts.

“I find when I get closer to large metropolitan areas, I don’t have as many problems,” Chiarelli said. “But when I go to the Fort Stewarts, when I go to the Fort Braggs, when I go to the Fort Hoods, my ability to attract a shortage population in society is difficult. But we’re working very, very hard to get everything we possibly can to hire those folks.”

The hope is that connecting patients to care by video teleconference skirts this problem, allowing a provider in Seattle, for example, to speak with a patient across state lines in rural Montana.

The entire story is here.

APA/ASPPB/APAIT Joint Task Force - Telepsychology- Summary Statement 2

Telepsych_TF_2

Discussion Paper on Developing Guidelines for Online Psychology Services

New Zealand Model of Internet Guidelines

Ohio State Board of Psychology Telepsychology Rule Amendments

Ohio SBOP Telepsychology Rule Amendments

Canadian Model Standards for Telepsychology Service Delivery

Adopted June 4, 2011

Canadian Model Standards for Telepsychology

Update: APA/ASPPB/APAIT Telepsychology Guidelines for Psychologists

Telepsych_TF



A full page link can be found here.

The Therapist Will See You Now, via the Web

The New York Times
By Randall Stross

SEE a therapist without leaving your home?

In an article in the American Journal of Psychiatry, Dr. Thomas F. Dwyer, a Massachusetts psychiatrist, says he has practiced “telepsychiatry,” via video teleconferencing, for five years. Its “adoption by psychiatrists and patients,” he predicts, “will proceed quickly if the organizers cope with the irrational responses of some users.”

But wait: That article appeared almost 40 years ago. It told how microwave television signals were used to connect a satellite clinic to Massachusetts General Hospital in Boston.

Today, even with the rise of the Internet, virtual therapy hasn’t been widely adopted. But several start-up companies are trying to make Dr. Dwyer’s decades-old vision a workaday reality.

Therapy delivered over the Internet, says Lynn Bufka, a psychologist and staff member of the American Psychological Association, “may open access to those who might be reluctant to go to an office or to those who might be physically or psychologically unable to.”

Proponents of Internet-based therapy point to some research suggesting that it is effective for certain kinds of conditions, like depression and anxiety. Reporting in The Lancet in 2009, a team of researchers found that cognitive-behavioral therapy delivered remotely to depressed patients in Britain continued to show benefits eight months later.

But companies promoting online therapy must contend with uneven or absent support from insurance companies, Medicare and Medicaid. Most states don’t require insurers to pay for “telehealth” services (those not delivered in person). And any reimbursements can be less substantial than for in-person treatment. Medicare offers reimbursement only if providers are very scarce, as in rural areas.

One company that is trying to match patients to therapists online is Cope Today, based in Raleigh, N.C. Tania S. Malik, its chief executive, said the company, which began in 2010, worked with the North Carolina National Guard for a pilot test of its service. It has since opened its service to individuals, whom it attracts primarily with search ads that are keyed to phrases like “online counseling” or “treating anxiety.”

Cope Today lets prospective clients view a list of therapists and their availability for consultation via video, phone or online chat. It provides the first 10 minutes of a session free, then charges $35 for 15-minute increments.

The entire story can be read here.

Distance Therapy Comes of Age: Article Review

John D. Gavazzi, PsyD ABPP
Ethics Chair

A friend recommended that I read Distance Therapy Comes of Age by Robert Epstein in the magazine Scientific American Mind.  While the title seemed appealing, the article treats telehealth and e-therapy quite superficially.  There is little in the way of empirical support for conclusions made in the article.

The article indicates that there is an "avalanche of evidence" supporting the efficacy of e-therapy.  I reviewed one of the sources for this article, "Current Directions in Videoconferencing Tele-Mental Health Research" by Richardson and others.  Here is one important quote from the article that undermines the overall conclusion of the article:

"Compared to symptom reduction and cost effectiveness, satisfaction is a simple variable to measure, and it is perceived to be a necessary first step for the development of good therapist-client relationships (Rees & Haythornthwaite, 2004). However a common weakness of tele-mental health research, particularly in small studies and novel demonstrations, has been to overemphasize patient satisfaction as being the same as clinical effectiveness. Furthermore, the majority of studies examining satisfaction with tele-mental health have typically used study-specific measures of this outcome, and the psychometric properties of these instruments are largely unknown. Finally, we do not know whether patient satisfaction with tele-mental health would remain as high in the presence of alternative mental health services, or if ratings of high satisfaction are a by-product of simply being pleased to receive any service at all."

Additionally, one of the "Fast Facts" in the article states "brief therapeutic communiques using mobile phones can help combat eating disorder, alcohol abuse, cigarette smoking and anxiety, among other problems."  The author cites research from Kristin Heron and Joshua Smyth to support the point; however, there is no reference given as to who published this research or where to find it.

There were some positive components to the article.  The first is a quote from Gerry Koocher, which states "the important thing is that you're practicing competently, no matter how you are delivering the therapy."  Koocher also made the important points that e-therapy may not be appropriate for everyone as well as the potential for fraud exists.

Psychologists need more definitive information and guidelines about telepsychology and e-therapy to practice at the highest level.

Fortunately, there is positive movement for psychologists interested in telehealth, e-therapy, and telepsychology.  The Committee for the Advancement of Psychology recently announced the formation of a new Task Force on Telepsychology.

We are pleased to announce the members of the newly formed Task Force on Telepsychology.  The Task Force members represent the American Psychological Association (APA), the Association of State and Provincial Psychology Boards (ASPPB), and the American Psychological Association Insurance Trust (APAIT).  The purpose of the Task Force will be to develop telepsychology guidelines that will provide direction to psychologists as they navigate the numerous ethical, regulatory, legal and practice issues that arise in their use of technology in the delivery of psychological services.  We want to acknowledge and thank these new members for their leadership and commitment to participate in this multi-organizational Task Force.

Psychologists will need to rely on credible sources of information before embarking in e-therapy and telepsychology.  Some interesting issues include informed consent, practicing across state lines, and the overall efficacy of telepsychology. 

This blog will update our readers on recent research about the effectiveness of telepsychology as well as any outcomes from the Task Force on Telepsychology.  Psychologists need to be informed on the ethical, legal, and competent practice of telepsychology.