PS380 Unit 10 Telehealth Current Topics Paper Example

A Screen Instead of an Eighty-Mile Drive: A PS380 Unit 10 Current Topics Paper on Telehealth in Rural Clinical Practice

[Student Name]

Purdue University Global

PS380: Clinical Psychology

Unit 10 Current Topics Paper

[Instructor Name]

[Date]

The clinic, its staff and its clients are composite; the guidelines and meta-analyses cited are real.

The Problem Telehealth Might Solve

Three clinicians, one psychologist and two therapists, serve our corner of the Iron Range, and new clients wait about four months. Its service area covers several thousand square miles of small towns, mining communities and lake country, and some clients drive more than an hour each way. Winter roads close regularly. Before 2020, the clinic offered almost no telehealth. During the pandemic it moved most sessions to video, and since then it has kept about a third of its sessions online.

Telehealth is one of the most important current topics in clinical practice, and rural clinics are where its promise and its problems are clearest. This paper asks three questions. Does therapy delivered by video or through guided internet programs work as well as office visits? What standards should clinicians follow? And for whom does telehealth help or fall short, judging by the clinic's own clients?

Does It Work?

Batastini et al. (2021) conducted a meta-analysis comparing mental and behavioral health services delivered by videoconference with the same services delivered in person. Across a range of outcomes, including symptom change and client satisfaction, they found that videoconferenced services were generally not meaningfully different from in-person services. The authors cautioned that some studies were small and that results varied by type of service, but the overall pattern supported video as a reasonable alternative.

Guided internet-based treatment goes further. In these programs, clients work through structured online modules, such as lessons and exercises in cognitive behavioral therapy, with brief support from a therapist by message or phone. Andersson et al. (2014) reviewed trials directly comparing guided internet-based cognitive behavioral therapy with face-to-face cognitive behavioral therapy for psychiatric and somatic conditions, including panic disorder, depression and social anxiety. They found that the two formats produced similar effects overall. Because the therapist spends far less time per client in guided programs, they could in principle allow one clinician to help many more people.

If guided internet programs work about as well as office therapy for some conditions, a clinic with a four-month wait has a reason to use them that goes beyond convenience.

What Standards Apply

Guidelines for telepsychology issued by the American Psychological Association (2013) ask psychologists to be competent in the technologies they use, to meet the same standards of care online as in person, to obtain informed consent that covers the specific risks of telehealth, to protect the confidentiality and security of data, to plan for emergencies at a distance and to follow laws in both their own jurisdiction and the client's. They also note that tests designed for in-person use may not perform the same way online.

Several of these standards shape the clinic's practice. Before the first video session, staff confirm the client's physical address and a local emergency contact, since a crisis cannot be managed by walking down the hall. Consent forms explain that video is encrypted but that the clinic cannot control who else is in the client's room. Dr. Lund does not give some of her standardized tests by video, because they were normed in person. Licensing law also matters: clients who spend winters in Arizona must be seen under rules that apply where they are located, which an interstate compact for psychologists has made easier for some cases.

Who Benefits and Who Is Left Out

The clinic's clients show that telehealth helps some people much more than others. Travis, a taconite plant electrician treated this year for panic disorder, completed most of his cognitive behavioral therapy by video after his first three office sessions. Video saved him an hour of driving each time and let him schedule sessions around rotating shifts. Interoceptive exposure exercises worked well on screen, and Dr. Lund could watch him practice in the stairwell of his own building.

Darlene, who was treated for insomnia and grief, chose to come in person. Her home was full of relatives during her mourning period, and she had no private place to talk. Her case illustrates a common limit: video assumes a private room and a reliable connection, which not every client has. Some of the clinic's clients live in areas with poor broadband, and others share small homes or worry that a partner might overhear.

Other limits apply to the work itself. Dr. Lund prefers in-person sessions for clients at high risk of suicide, for first assessments of complex cases and for children's testing. Guided internet programs require literacy, motivation and comfort with technology, and they are designed for specific conditions rather than the mixed problems many rural clients bring.

There is also a question of equity. The clients who find video easiest, those with private homes, good broadband and flexible jobs, are often those who already had the easiest time reaching the clinic. If the clinic shifts its capacity toward video without attention to who is left out, the waiting list may shorten for some and stay the same for the people who most need help. The staff now ask every new client about privacy, connection and transportation at intake, so that the choice of format follows the client's circumstances rather than the clinic's convenience.

What the Clinic Should Do

The evidence and the clinic's experience point toward a mixed model. The clinic should keep video as a standard option for therapy, especially for clients who live far away, work shifts or face winter travel. It should consider adding a guided internet program for panic disorder and mild to moderate depression, the conditions with the strongest evidence, which could shorten the waiting list for those clients. It should continue in-person care for high-risk clients, testing and those without privacy or a reliable connection. And it should track outcomes, using the same symptom measures for video and office clients, to see whether the research findings hold in its own population.

Conclusion

Telehealth is a current topic because it is changing where and how clinical psychology is practiced. For a rural clinic with a long waiting list, the research is encouraging: video and guided internet programs appear to work about as well as office visits for many people. The APA guidelines set the conditions for doing it responsibly. The clinic's own clients show that it is not a replacement for in-person care, but an addition that can reach people who might otherwise wait months or never come at all.

References

American Psychological Association. (2013). Guidelines for the practice of telepsychology. American Psychologist, 68(9), 791-800. https://doi.org/10.1037/a0035001

Andersson, G., Cuijpers, P., Carlbring, P., Riper, H., & Hedman, E. (2014). Guided Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: A systematic review and meta-analysis. World Psychiatry, 13(3), 288-295. https://doi.org/10.1002/wps.20151

Batastini, A. B., Paprzycki, P., Jones, A. C. T., & MacLean, N. (2021). Are videoconferenced mental and behavioral health services just as good as in-person? A meta-analysis of a fast-growing practice. Clinical Psychology Review, 83, Article 101944. https://doi.org/10.1016/j.cpr.2020.101944