An old adage of psychotherapy is that as therapists, we must “meet the patient where they are at.” Right now, because of the coronavirus pandemic, students are no longer on campus, but they are online. As college counseling professionals, our delivery of behavioral health services has changed drastically as a result of social distancing requirements. In order to continue to provide care to students, providers now meet with student clients through telehealth platforms, such as videoconferencing or phone.
While our times are challenging, this is also a unique opportunity for those who have had little exposure to using telehealth in higher education counseling to begin their journey. In this article, I am excited to share what I have learned in my time providing telehealth services through HIPAA-compliant platforms for Penn State College of Medicine (PSU-COM). I hope this post will be useful in helping those who are ready to take the next steps in providing care to students using telehealth.
Here are some suggestions as you contemplate a move to telemental health at your university counseling center.
- Select your platform & keep it simple. All universities are in the same boat. Consult with your director or other higher education counseling professionals who are using various software platforms to understand your options related to costs and different features. From my own experience, Doxy.me was a great place to get my feet wet. It is free, HIPAA-compliant, and it has a virtual waiting room. Clients can sign up for an account easily and it allows you to send out a message through your email to alert the client to join the session. The Department of Health and Human Services have suspended requirements for HIPAA-compliant platforms. As long as the service is private, it is acceptable during the national emergency. Fortunately, most platforms for telemental health have been built to be very user friendly and applicable to a wide range of populations. From a practical standpoint, you only need a laptop or desktop computer with a video camera, internet, and limited computer skills. The companies who make these platforms also have customer service links and contact numbers for technical support.
- Have a back-up plan. One of the most important things I’ve learned during my telehealth practice at PSU COM is to have multiple back-up plans in the case of a technology failure, which I review explicitly with the client via email or text. Common technology failures are due to the strength of the internet connection or a problem with the computer itself, both of which are not related to the telehealth platform itself. I notice the connection issue is often related to capacity (I have too many tabs open and programs running at once, or the student is not connected to a strong wifi network). If the issue cannot be resolved, I often move to a phone session or reschedule if that is the student’s preference.
- Know your state laws & protect privacy. It is essential to know your state’s laws regarding telehealth. Given the national emergency, federal and state laws have been dramatically changed to support the use of telehealth. As a general best practice, you should have at least two security barriers to protect student PHI and visit information. I use multiple passwords and encrypt all notes in the case my laptop is misplaced or stolen. I have also found it helpful to reach out to my state board with additional questions related to telehealth practice laws or ethics. They often have helpful answers, point me to a board related document, or tell me that they have “not thought of that specific issue related to telehealth” and that guidance will be coming.
- Know the research that supports your telehealth practice. Sharing that there is sound research to support treatment via telehealth may help both new and existing student clients feel comfortable starting or making the transition to a virtual environment. For example, a recent study showed that online group counseling which employed CBT is just as effective as F2F (Weinberg & Rolnick, 2020). Additionally, a current study by a colleague of mine at Oregon State University found that online counseling through a video application was just as effective as F2F counseling in treating mild to moderate anxiety as assessed by the Beck Anxiety Inventory. Finally, the same online clients were able to achieve an equal level of connection with their counselor as their F2F counterparts, as assessed by the Therapeutic Bond Scale (Novella, 2019).
Best Practices for Media and Technology
There are recommended best practices when utilizing technology with your student clients. One seminal textbook that I would recommend is the Theory and Practice of Online Therapy by Weinber & Rolnick. It has been very helpful in my learning and growth as a telehealth practitioner. I will summarize a few best practices here:
- Pay attention to the practical concerns and details of online counseling, as they make a difference. Find a video camera that you are comfortable operating, keeping video placement with the student client in mind. I do this overtly in session, so the student feels I am maintaining good eye contact. Furthermore, I let the student know that I take notes in session and elicit any concern they may have with my breaking eye contact with them. As mentioned above, it is also very important to discuss a back-up plan for what happens if the technology fails, the call is dropped, and is then resumed. Lastly and most importantly, because of a potential lack in proximity to the student client, discuss your crisis response protocols during the intake session with the student and have your emergency policy and procedure explicitly written in your counseling center’s disclosure statement. Providers should also be sure to confirm the student’s current physical location in the case of an emergency.
- Have fun with the technology and play with the features. Most of my student clients at PSU COM have also seamlessly made the transition to virtual sessions. Telehealth vendors build their product to easily fit into a provider's workflow without compromising quality of care, and taking advantage of the features related to the video applications has potentiated the effectiveness of my sessions. For example, I often share links to evidence-based educational websites through my platform’s chat feature to increase my student’s resources and health knowledge. I also share my screen with my client during a session and present a video clip that highlights a concept of our work.
- Be intentional in increasing your understanding and awareness of empirically validated differences between online and face to face counseling (F2F), and how it may impact your clinical practice. Interestingly, research has shown that online counseling environments increase the sense of anonymity and decrease self-control in client populations, leading individuals to be more honest, spontaneous, and open in virtual environments (Weinber & Rolnick, 2020). It may take some time to understand how the delivery of your clinical interventions translates in a virtual medium with college students.
- You may need to adjust some of your theoretical orientation to allow for the psychology of the internet. For example, if you are a dynamically oriented therapist, the concepts of transference or resistance may present differently with student clients when you are providing telehealth in a virtual environment (Weinber & Rolnick, 2020). In addition, the use of long silences as an intervention may come off as a glitch in the technology rather than the pregnant pause of an in-person session.
I hope this short introduction to telehealth has been helpful. My aim was to provide an accurate representation of my own experience using telehealth, and further reduce perceived barriers for those who are new to using technology in their university counseling center practice. I also believe there will be continued demand for face to face counseling, but because of the current health crisis and the pace of technological innovation, the present moment is a great time to add to your clinical offerings at your institution, and give telehealth a try.
Novella, J. K. (2019). A Comparison of Online and In-Person Counseling Using Solution-Focused Brief Therapy for College Students with Mild to Moderate Anxiety.
Weinberg, H., & Rolnick, A. (2020). Theory and practice of online therapy.