Julia Reynolds FAPS 21 February 2020

Telepsychology and Video-conferencing

Funding - MBS Telehealth RebatesMBS registered providers

Bush Fire Recovery Access Initiative V/C items • Bulk billing encouraged • Unrestricted location, can self-refer• Can be in addition to already established items like BA• BUT telehealth criteria for established items have not

changed (e.g., MH Plan, location restrictions etc)

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How to let clients/ referrers know ?

List ”Telepsychology” as a service in your usual marketing – e.g., APS Find-a-Psychologist

Approach communities via PHNs

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ACRRM Telehealth Directory

Free

Sourced by PHNs, local pathway

http://www.ehealth.acrrm.org.au/provider-directory

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Rural Doctors NSW

EOI for NSW response

Not specifically V/C, but they welcome EOI

Availability for Recovery Feb- Dec

Telepsychology OutcomesResearch to date suggests similar to F2F

Successfully used with people in RR areas, PTS

Research focus on anxiety, depressionNeeds more research, esp. civilians in RRR

Reviews easy to find online - eg., PubMed(Key references in Handout) 6

Therapeutic AllianceSimilar on average, some variability

Recent metanalysis: Telepsych TA a little lower but didn’t seem to impact outcomes as much as in F2F

Therapists often rate TA lower than clients

(Key references in Handout) 7

Qual Difference: autonomy / equality

Client - more overt role in managing the space

Therapist - planning ahead, coaching, consulting

Both openly discuss “connection”, satisfaction -initially tech but can develop naturally to process

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Areas to consider include:o Safety and support planningo Inter-jurisdictional, legal, insuranceo Protocols incl. informed consent, privacyo Infrastructure: messaging, payment, consulting spaces

o Adapting therapeutic techniques

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Safety & support planning includes:

Clear protocols -• Individualized support plan each client• Each session: confirm location, contact details, plan

for connection loss• Plan to manage risk /distress within, outside sessions• Needs/ options for post session debrief / support

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Informed consent - include Confidentiality, data security and limitations

Telepsychology limitations– e.g., suitability, inter-session support, therapist availability

Client’s role in managing their confidential material and personal support needs

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The consulting spaceVirtual meeting place – healthcare grade ?

Client location - home? local clinic?

Client privacy, unintended disclosure

Potential emotional impact if in personal space

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Adapting communication skillsOpen discussions where appropriate - such as:

• Turn taking (more explicit)

• Eye “contact” - adjust, discuss

• Inward focus when discussing important issues or distressed - remind to check screen

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Adapting Therapeutic techniquesIn session activities such as

– grounding – co-conceptualising - whiteboard ?– sending / receiving monitoring, info, forms

Integration of websites, programs, apps between sessions for psycho-ed, support, skills

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This is just a beginning – where to next?

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• APS Free Telehealth information, resources

• APS Institute e-CBT online modules

• Papers in the handout

• Peers – Black Dog CoP, APS Members’ forums

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