In a world of social distancing, the need to communicate effectively when we can’t meet face-to-face is more important than ever. That is especially evident for counselors and mental health therapists, who must still work with clients even when it is over a distance.
At Loras, the Counseling program has adapted to training students on telehealth to address the current concerns in the world, continuing students’ training, and helping the public by being able to help cover mental health services.
“I am impressed with the professionalism and flexibility of our graduate students to adapt to this new style of learning and new way (to them) of providing services to clients,” Steffanie Schilder, Ph.D., Program Director of Counseling and Psychology Graduate Programs, said. “Like most in this situation, there are good days and difficult days, but they have rallied together to provide support to each other virtually, address how to best support clients, and how to continue in light of our current circumstances.”
The Health Resources Services Administration defines telehealth as the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.
Traditional counseling practices happen face-to-face, in person, in an office where the mental health therapist is practicing. The in-person dynamic allows the therapist to build rapport with a client and work with them to meet clients where they are to address the goals for treatment.
Telehealth differs in that the therapist and client are not in the same location, rely on the internet for video and sound to best communicate, and have additional privacy concerns to contend with to ensure that the client has the confidentiality to which they are entitled.
“In order to address telehealth, we had to switch to covering all of the additional legal concerns, including HIPAA, appropriate documentation, and client-fit. Assessing client fit includes addressing ethical issues such as determining appropriateness for an online format versus not abandoning clients. Some clients traditionally would not be a good fit, but were already in counseling and it is essential not to end therapy abruptly, which could be detrimental to the person,” Schilder explained. “For our practicum and internship students who had to make an abrupt shift in service delivery, along with their sites, we added a 12-hour training to help increase competence in the area. For their indirect hours, all students completed the training ‘Telehealth for Mental Health Professionals.’
“Our students became very resourceful in finding ways to make this adjustment ethically and competently and we utilized a forum in eLearn to share different resources to best adapt to these new circumstances. In addition, those students who still had presentations to complete on various mental health topics researched and taught the class about the effectiveness of telehealth vs. traditional therapy and HIPAA guidelines, amongst other topics,” she said.
The shift in focus to telehealth coincided with a change to online-only learning with the campus closed down due to the COVID-19 pandemic, forcing students to adjust to a new format in addition to new content.
“We meet via Zoom each week for our practicum and internship class to meet the group supervision requirements for the State of Iowa Board of Behavioral Science. Our students, like all others, are facing increased distractions, loss of employment, homeschooling their own children, and continuing their education. We start class with a mental health check-in, help each other navigate self-care issues, and then move on to work with clients and what is happening at sites.”
An emergency proclamation, allowed Loras to change the practicum and internship requirements, which allowed students the flexibility to remain on the same timelines. However, with future client welfare being of the utmost performance, Schilder worked with site supervisors to determine if our students are at a point in their training for the semester that they can have reduced hours, if necessary.
“All eight of our students in this situation have pushed to complete their training and have not used this to try to lessen their workload,” she remarked. “The ethical decisions I have seen our students making without any prompting from me shows me the amazing clinicians they will be in the future. I am beyond proud of what I have seen during this situation from our MA Counseling Graduate students. They have far surpassed any written measure of competence by the display of their ethical decisions, dedication to work with clients, and work towards competence in new areas, such as telehealth.”
While telehealth is not new, the need to use it has opened the format up to more clients and makes the education more valuable to those students in the counseling program.
“There are clients who have appreciated the shift to telehealth, which allows flexibility in scheduling, flexibility around childcare, and not having to take an extended lunch to leave work, attend a session, and drive back to work, etc. Whether or not managed care allows for the continuance of reimbursement of this and whether or not clinicians want to continue to provide services this way will be what will determine what we see in the future. Telehealth is a different skill set and one that necessitates competence in that area. If practitioners were required to switch or wish to continue in this way, it is best if they complete appropriate continuing education and have supervision in the area, just as would be expected if developing a new competency in the therapy realm. Our students are now trained to do this,” Schilder said.