Navigating the Telehealth Terrain: Recognizing the Limits and Understanding When to Pivot to In-Individual Care

Previous to March of 2020, solely 17% of clinicians have been commonly utilizing telehealth, and now most clinicians are (Zhu et al., 2024). The various advantages of telehealth therapeutic companies make this format fascinating, notably for treating OCD. Telehealth permits for elevated entry to care, offering a versatile choice for households, and permits for publicity work within the residence setting the place compulsions will be the strongest.

But, telehealth doesn’t come with out challenges; there are particular conditions the place telehealth just isn’t one of the best format for therapy. It will be significant to not prioritize comfort over effectiveness by setting clear boundaries for digital therapy and figuring out when in-person care is required.

Boundaries

Though there’s already a lot to cowl with sufferers on the onset of remedy, it’s best to debate telehealth boundaries on the first remedy session. Boundaries to contemplate and make clear for sufferers embody:

1. When will you be obtainable for periods? Whereas elevated flexibility is a good thing about telehealth service provision, it may be difficult because it blurs the traces between work and residential life. Sufferers could assume that you could be obtainable anytime, when this is probably not the fact.
2. What kind(s) of platforms will you employ? Make clear whether or not you’ll use synchronous platforms (e.g., Zoom, Doxy), asynchronous platforms (e.g., texting), or each.
3. The place ought to the affected person be positioned when becoming a member of a telehealth session? There are actually instances when it’s possible you’ll ask your affected person to affix from a unique location to facilitate publicity work; nevertheless, except indicated by the clinician, sufferers ought to plan to attend telehealth periods from a personal, quiet house, and never in a transferring automobile, throughout the state the practitioner is licensed.  
4. What’s required of the affected person/household throughout digital periods? The house atmosphere could naturally create a extra “relaxed” really feel, however it is very important convey to sufferers that “in-person” expectations apply to digital periods as effectively. Applicable apparel is required, a guardian ought to be accessible for minor sufferers, and sufferers shouldn’t be engaged in different actions throughout session.  

If a boundary is damaged, discuss to the affected person or household immediately and point out that telehealth could now not be an choice for periods if future violations happen.

When In-Individual Providers are a Higher Match

Apart from repeated boundary violations, different variables could point out in-person companies are advisable over telehealth:

1. The affected person has know-how challenges or doesn’t have entry to a personal house. For instance, if the affected person repeatedly takes periods from areas the place the connection is poor or doesn’t have constant entry to a pc or cell system, telehealth wouldn’t be advisable. Frequent technological issues usually are not solely an “annoyance;” they will result in misunderstandings and distractions that intrude with the success of therapy.
2. The affected person has difficulties interacting just about. Some sufferers display decrease engagement and extra discomfort with digital interactions, which might make it difficult to construct rapport. If the affected person solely responds by way of the chat or provides repeated obscure responses, in-person periods could be useful for producing extra engaged interactions.
3. The affected person displays defiant or avoidant behaviors throughout periods. Sufferers collaborating in periods from residence could exhibit behaviors, equivalent to muting themselves, turning off the digicam, leaving the room, leaving the session early, and/or not permitting a check-in with their caregiver. Whereas these behaviors could be anticipated at first of therapy, after they persist, it’s a signal that telehealth just isn’t match.
4. Scientific points with telehealth. At instances, it may be clinically counterproductive to proceed with telehealth. Have you ever accomplished all of the exposures which might be doable throughout the residence? Would in-person exposures let you improve the issue or mannequin courageous conduct? Is the house setting a ‘security sign’ that decreases the robustness of exposures?  

If in-person therapy just isn’t obtainable attributable to logistical components, equivalent to geographic location, transportation difficulties, and many others., telehealth could also be a “higher than no therapy” choice. Nevertheless, when varied therapy supply strategies exist, it’s important to contemplate the above components when deciding which method(es) will finest transfer your affected person in direction of their objectives. 

References

Zhu, D., Paige, S. R., Slone, H., Gutierrez, A., Lutzky, C., Hedriana, H., … & Bunnell, B. E. (2024). Exploring telemental well being follow earlier than, throughout, and after the COVID-19 pandemic. Journal of telemedicine and telecare, 30(1), 72-78.