ABSTRACT
Since the onset of the COVID-19 pandemic, counselors have had to adapt and evolve to meet the needs of clients and the growing need for mental health services. In addition to a lack of experience providing telemental health (TMH) services, many counselors had received little or no TMH training or continuing education prior to the onset of the COVID-19 pandemic. Counselor self-efficacy (CSE) may be an important factor in determining how counselors have been impacted by the increase in provision of TMH services, and the areas where they are needing more support. The purpose of this quantitative study was to explore how the amount TMH training and continuing education received, the amount of time spent providing TMH services, and the amount of time spent providing counseling services predict CSE. Participants (n=84) completed an online survey containing items from the Counseling Self-Estimate Inventory (COSE). Results of a bivariate regression and one-way ANOVA indicated that TMH training and continuing education did not predict CSE;however, differences between groups revealed an interesting phenomenon which prompted further discussion. Results also showed that both the amount of time spent providing TMH services and the amount of time spent providing counseling services predicted CSE. Counselors and counselor educators can use results from this study to advocate for more resources and support for counseling students and counselors who are providing TMH services. Furthermore, results from this study indicate a need for more research on CSE and TMH to improve counselor education and support. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
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In a recent contribution to this journal, Cummings (2023) reports findings from a preliminary qualitative study of practitioner viewpoints regarding digitally delivered mental health support to care-experienced young people. Cummings' study highlights the need to engage with professional experiences of using digital methods with this group, both during and outside of the COVID-19 pandemic. A response to - and commentary on - Cummings' contribution is provided, to advance discussion of issues identified by the research. We reflect on our experience as practitioners and researchers working in and alongside specialist child and adolescent mental health service teams serving care-experienced children and young people. We focus on workspaces in remote working, therapeutic technique in online and telephone-based care, and virtues and challenges of remote care delivery. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
ABSTRACT
While COVID-19 has caused significant mental health consequences, telemental health services have the potential to mitigate this problem. But due to the sensitive nature of mental health issues, such services are seriously underutilized. Based on an integrated variance-process theoretical framework, this study examines the impact of applying different education strategies on individuals' attitude toward telemental health and subsequently their intention to adopt telemental health. Two different education videos on telemental health (peer- or professional-narrated) were developed based on social identity theory. A survey experiment study was conducted at a major historically black university, with 282 student participants randomly assigned to the two education videos. Individual perceptions of the telemental health service (usefulness, ease of use, subjective norms, relative advantage, trust, and stigma) and their attitude and usage intention data were collected. The results show that ease of use, subjective norms, trust, relative advantage, and stigma significantly influence individuals' attitude toward telemental health in the peer-narrated video group. Only trust and relative advantage were found to be significant factors toward attitude in the professional-narrated video group. This study highlights the importance of designing education strategies and builds a theoretical foundation for understanding the nuanced differences in individuals' responsiveness to different educational materials.
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BACKGROUND: Remote mental health consultations were swiftly implemented across mental health services during the COVID-19 pandemic. Research has begun to inform future design and delivery of telemental health services. Exploring the in-depth experiences of those involved is important to understand the complex, multi-level factors that influence the implementation of remote mental health consultations. The aim of this study was to explore stakeholder perspectives and experiences of the implementation of remote mental health consultations during the COVID-19 pandemic in Ireland. METHODS: A qualitative study was conducted whereby semi-structured, individual interviews were undertaken with mental health providers, service users, and managers (n = 19) to acquire rich information. Interviews were conducted between November 2021 and July 2022. The interview guide was informed by the Consolidated Framework for Implementation Research (CFIR). Data were analysed thematically using a deductive and inductive approach. RESULTS: Six themes were identified. The advantages of remote mental health consultations were described, including convenience and increased accessibility to care. Providers and managers described varying levels of success with implementation, citing complexity and incompatibility with existing workflows as barriers to adoption. Providers' access to resources, guidance, and training were notable facilitators. Participants perceived remote mental health consultations to be satisfactory but not equivalent to in-person care in terms of quality. Views about the inferior quality of remote consultations stemmed from beliefs about the inhibited therapeutic relationship and a possible reduction in effectiveness compared to in-person care. Whilst a return to in-person services was mostly preferred, participants acknowledged a potential adjunct role for remote consultations in certain circumstances. CONCLUSIONS: Remote mental health consultations were welcomed as a means to continue care during the COVID-19 pandemic. Their swift and necessary adoption placed pressure on providers and organisations to adapt quickly, navigating challenges and adjusting to a new way of working. This implementation created changes to workflows and dynamics that disrupted the traditional method of mental health care delivery. Further consideration of the importance of the therapeutic relationship and fostering positive provider beliefs and feelings of competence are needed to ensure satisfactory and effective implementation of remote mental health consultations going forward.
Subject(s)
COVID-19 , Mental Health Services , Remote Consultation , Humans , Mental Health , COVID-19/epidemiology , PandemicsABSTRACT
Background/objectives: Telemental health (TMH) care has received increased attention, most recently due to the COVID-19 pandemic. Many treatment settings and clinicians were forced to rapidly shift to TMH modalities, including clinicians with limited exposure to and possibly negative attitudes toward alternative treatment delivery formats. With the shift to new modalities, effectiveness research is necessary to understand if patients are receiving the same quality of care as before the pandemic and their receipt of mostly in person services. This study compared the naturalistic treatment outcome trajectories for a cohort of patients who received in-person services prior to the pandemic and a distinct cohort of patients who received TMH services after the onset of the pandemic, in a community mental health setting with limited exposure to TMH prior to the COVID-19 pandemic. Materials and methods: We adopted a retrospective cohort design to examine treatment modality as a between-group moderator of symptom change trajectory on the self-report Patient Health Questionnaire (PHQ-9) in a sample of N = 958 patients in the Northeast United States. Treatment durations differed in the naturalistic treatment setting and we examined patient-reported outcomes up to a maximum of one year. Results: Statistically significant average decreases in symptom severity were found over the course of up to one year of treatment, yet the average outcome trajectory was not significantly different between two modality cohorts (in person delivery before the pandemic versus TMH delivery after pandemic onset). Conclusion: These findings suggest that even in a setting with limited exposure to or training in TMH, the average outcome trajectory for patients who received TMH was statistically similar to the outcome trajectory for patients in an earlier cohort who received in-person services prior to the pandemic onset. Overall, the results appear to support continued use of TMH services in community treatment settings.
ABSTRACT
The rapid shift to telemental health (TMH) during the COVID-19 pandemic left mental health providers scrambling to adapt, raising concerns about the effect on the quality of the therapeutic alliance. This article explores the impact of TMH on the therapeutic alliance and how relational psychotherapists can support their patients and engage best practices in a way that helps all participants feel connected to the work. It defines the therapeutic alliance, explores the concepts of tasks, goals, and therapeutic bonds, and highlights the importance of developing a positive bond in the context of relational therapy. The paper also describes common challenges encountered while providing psychotherapy virtually, provides guidance on what contributes to a more positive attitude toward TMH interventions, offers a list of recommendations for improving the therapeutic alliance in TMH, and makes recommendations for future study.
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The COVID-19 pandemic has prompted unprecedented disruptions to the daily lives of children and adolescents worldwide, which has been associated with an increase of anxiety and depressive symptoms in youth. However, due to public health measures, in-person psychosocial care has been affected causing barriers to mental health care access. This study investigated the feasibility, acceptability and preliminary effectiveness of iCOPE with COVID-19, a brief telemental health intervention for children and adolescents to address anxiety symptoms. Sessions were provided exclusively using videoconferencing technology. Feasibility and acceptability were measured with client satisfaction data. The main outcome measure for effectiveness was anxiety symptom severity measured using the Screen for Child Anxiety and Related Disorders (SCARED). Results indicated that the treatment was well accepted by participants. Significant reductions in anxiety were noted for social anxiety, and were observed to be trending towards a mean decrease for total anxiety. The findings suggest that this brief telemental health intervention focused on reducing anxiety related to COVID-19 is acceptable and feasible to children and adolescents. Future research using a large sample and with a longer follow-up period could inform whether symptom decreases are sustained over time.
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During the COVID-19 pandemic, it became increasingly important to understand how licensed professional counselors used telemental health applications (apps) to establish therapeutic relationships in rural areas. In the past decade, technology has undergone significant changes in its purpose and design. During the COVID-19 pandemic, telemental health was a tool that provided access to mental health services by developing and sharing innovative and effective treatments. The literature suggested that telemental health apps are effective for providing counseling services to clients living in rural areas. Therefore, this technology provided added support to individuals who faced treatment barriers. In this generic qualitative study, data were collected and analyzed regarding the perceptions of therapeutic relationship development among licensed professional counselors using telemental health apps in rural areas during the COVID-19 pandemic. The data collected from the semi-structured interview were analyzed using inductive analysis, through which six themes emerged: (a) relational components of therapy, b) methods and approaches used to guide sessions, (c) client concerns about ethical and privacy issues, (d) barriers to engaging clients in the sessions, (e) the value of videoconferencing platforms to help connect with clients, and (f) evolving new roles and responsibilities. The themes that emerged helped answer the research question: "How have professional counselors used telemental health apps in rural areas to develop the therapeutic relationship during COVID-19?" Counselors may better understand, empathize, support, engage, connect, and develop therapeutic relationships with clients when utilizing these applications. In future research, it would be worthwhile to examine clients' viewpoints, since telemental health applications are designed with clients in mind. Also, associate-level professionals used telemental health to work with clients, and this experience may be useful to gain a perspective from counselors in training. Finally, when it comes to participation recruitment, it may be beneficial to reach out to various social networks, Listservs, and other professional organizations. Counselors may report different experiences regarding their engagement with clients. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
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Guided by the conservation of resources (COR) theory, this study investigated how regional variation in mental health needs and resources may have impacted early efforts to curb the spread of COVID-19. Publicly available data were analyzed to evaluate states' initial responses (i.e., February 2020-March 2020) to the COVID-19 pandemic. Each of the 50 U.S. states, as well as the District of Columbia, were included in the analyses, providing a total sample size of N = 51. U.S. states with greater mental health needs and barriers to treatment tended to: be slower to implement shelter-in-place orders;have residents who showed less increase in time at their residences in response to the crisis;be more rural, economically disadvantaged, and more conventional;and have less access to the internet. Considering this cultural context provides insight for tailoring and implementing interventions in a culturally competent manner. Furthermore, mental health resource sharing across states and regions may be needed to address future mental health care gaps resulting from the pandemic. (PsycInfo Database Record (c) 2022 APA, all rights reserved) Impact Statement Rural and financially strained areas with fewer resources and greater mental health needs tended to spend less time under shelter-in-place orders and showed less increase in time spent at home during the early phase of the COVID-19 pandemic. Special attention is needed to strengthen community resources and health care infrastructure to support recovery from the pandemic. Access to finances and resources may facilitate more rapid and flexible change in routines required by future pandemics and large-scale threats. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
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The use of communication technologies to provide psychiatric services is broadly termed telepsychiatry. While telehealth is not new and has been in existence for over 50 years, the COVID-19 pandemic accelerated the use of this modality and demonstrated its advantages in healthcare delivery. Although on the surface telepsychiatry may simply appear to be the practice of psychiatry through videoconference, like any innovation it presents nuanced regulatory, liability, and practice considerations. Familiarity with relevant rules regarding licensure, prescribing, credentialing, malpractice coverage, and privacy and security is important prior to getting involved with providing virtual services. Clinical issues such as informed consent, establishing a physician-patient relationship, documentation, and standard of care must also be considered. In this chapter, we will review these key issues through the lens of enhancing clinical practices and reducing the risk of medical malpractice and licensure violation when providing these services. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
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The current study investigated the effectiveness of a group on-line positive psychology intervention (OPPI) designed to mitigate the psychological impact of the COVID-19 pandemic and the subsequent measures to control it. Study participants (N = 82, M age = 33.07, SD = 9.55) were all Greek adults divided into an intervention (n = 44) and a control group (n = 38). The intervention group attended a voluntary, online, two-week, six-session (each 50 min), group intervention. The intervention aimed at enhancing participants' personal strengths and resilience in order to cope more effectively with the psychological impact of social distancing (e.g., feelings of anxiety, sadness, fear, and/or loneliness). All participants completed an online questionnaire one week before the intervention's implementation, which included scales measuring their: demographic characteristics, empathy, resilience, affectivity, feelings of loneliness, depression and anxiety levels, and feelings of fear regarding the outbreak. Participants in both the intervention and control group completed the same measures the week following the intervention's termination to examine its effects, and two weeks later to examine its long-term effectiveness. The intervention was found to be effective in alleviating the impact of the pandemic and in strengthening participants' resilience. More specifically, the results showed significant decreases for the intervention group in all measures of psychosocial distress (anxiety, depression, loneliness and fear) and significant increases in empathy, resilience, and experience of positive emotions. The study's implications for the development and implementation of online psychological interventions during a crisis are discussed.
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College students have been facing a variety of challenges in the wake of the COVID-19 outbreak. The pandemic generated fear and led to a spectrum of psychological consequences (Liu et al., 2020) ranging from increased anxiety and depression to behavioral changes such as difficulty sleeping. The unprecedented COVID?19 crisis presents an imperative for telemental health interventions. Telemental health has been effective in treating anxiety and depressive symptoms (Brenes et al., 2015), and implementing telemental health can facilitate the delivery of counseling services to address students' pressing mental health concerns (Dorsey & Topol, 2020). Dialectical Behavioral Therapy (DBT;Linehan, 1993) skills training is one evidence-based treatment which effectively targets behaviors associated with difficulties regulating emotions. As DBT aims to teach individuals more adaptive coping skills so that reliance on ineffective coping mechanisms is reduced, DBT provides a fitting model amenable to telehealth. DBT skills training has been implemented in college settings, however, the available research evaluating DBT skills when delivered in an entirely virtual format is scant. This study aimed to evaluate the feasibility, acceptability, and preliminary efficacy of an 8-week virtually delivered DBT skills training program for college students during COVID-19. The intent-to-treat sample included 111 college students between the ages of 18 and 54 years (77% identified as cisgender women;83% identified as White). Participants were randomly assigned to virtual DBT (n = 57) or a waitlist control condition (n = 54). Assessments were conducted at pretreatment, 4-, 8- and 12-week follow up. Results of the study indicate that the intervention was feasible to implement in a virtual platform as evidenced by the retention of 71.9% of participants enrolled and was considered largely acceptable to participants as measured by both quantitative acceptability ratings and qualitative data. The intervention did not demonstrate efficacy in reducing symptoms of depression but demonstrated efficacy at reducing symptoms of anxiety. The intervention prevented participants from getting more distressed as the semester progressed. While the intervention did not demonstrate efficacy in increasing DBT skills use, it was effective in decreasing dysfunctional coping skills. Findings suggest that DBT skills training may serve as a preventative measure in the development or worsening of mental health problems, and that the virtual delivery of DBT skills can enhance mental health outcomes among college students. Recommendations as to how to improve the delivery of virtual DBT are provided. Clinical implications and future avenues of research are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
ABSTRACT
The COVID-19 pandemic and associated sequelae have disproportionately exacerbated refugee mental health due to health disparities, poverty, and unique risk factors. In response to the pandemic, most mental health providers have shifted to virtual platforms. Given the high need for services in this population, it is essential to understand the effectiveness and potential barriers to serving refugees via telehealth. This study is one of the first to examine the extent that socio-cultural and structural barriers impact telemental health services received by resettled refugees during the COVID-19 pandemic. This study also addresses the potential benefits of telemental health service delivery to refugees. We surveyed 85 providers serving refugee and non-refugee clients in the United States. Statistical analyses revealed that more significant socio-cultural and structural barriers, including access to technology, linguistic challenges, and privacy limitations, exist for refugees compared to non-refugee clients. Potential benefits of telemental health for refugees during the pandemic included fewer cancellations, fewer transportation concerns, and better access to childcare. These results highlight the need to address the disparity in telemental health service delivery to refugees to limit inequities for this population.
ABSTRACT
The emergence of the 2019 novel coronavirus (COVID-19) has dramatically altered how psychologists deliver its training. At least for the time being, virtual care has become the primary method for delivering mental health services. This has allowed patients and clinicians to continue to access and provide services in a way that would have been impossible years ago. Not only has this shift impacted patients, but it has also impacted supervision and training. The impact has been especially profound on inpatient units where the psychiatric and medical acuity is high of patients and the therapeutic milieu is an important aspect of treatment. The purpose of this paper is to review the impact of COVID-19 on pre-doctoral psychology interns during their rotation on an inpatient psychiatry unit at the start of the pandemic (January to June of 2020) and use these experiences to onboard the next class of interns in the new academic year (July 2020 to June 2021) using a hybrid model of in-person and virtual training experiences. At the end of 2020/2021 rotation, we voluntarily asked interns to complete a questionnaire that was developed based on the qualitative experiences of the previous class to assess the effectiveness of this hybrid model. We also surveyed multi-disciplinary staff members who were essential personnel and required to work in person during this time about their experiences of safety and support. With this information, we explore and offer guidance to other inpatient training sites who are likely to encounter similar challenges during this time. In particular, we discuss the integration of virtual technology into this training experience, as well as the restructuring of clinical and supervisory experiences. We highlighted several short-term strategies that we have flexibly adapted to our inpatient unit. The lessons learned herein seek to guide supervisors and trainees alike in adapting their psychology training programs to meet the evolving demands of COVID-19.
ABSTRACT
The necessary health measures proposed to mitigate the viral spread of SARS-CoV-2, such as physical distancing and quarantines, have had an impact not only on the mental health of the population but have also forced changes in the provision of psychological services. The present study aims to gather essential information on the concept, advantages, disadvantages, uses and recommendations of telepsychology in times of COVID-19. To this end, a systematic review of the scientific evidence available in the Scopus, PubMed and Web of Science databases was carried out. Among the results, accessibility, reduction of stigma and flexibility in its application are highlighted. Limitations such as insecurity of data privacy, access barriers and low clinical training in the competencies required for this format are also mentioned. On the other hand, favorable evidence was found for its use in the treatment of post-traumatic stress disorder, panic and agoraphobia, generalized anxiety, and trauma. It is concluded that psychotherapeutic intervention through telepsychology, in consideration of certain recommendations and critical suggestions, can offer satisfactory results for the patient and therapist and be suitable for various age ranges and disorders. © 2022, Sociedad Interamericana de Psicologia. All rights reserved.
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Using the electronic health records of 55 foster and adopted youth, this study compared in-person mental health service utilization to telemental health (TMH) service utilization during COVID-19. Clients attended a greater number of therapy sessions, had more accumulated session time, and had shorter sessions via TMH compared to in-person. Similar results were found for school-aged children, females, and caregivers who engaged in their children's treatment. Notably, for non-significant differences in engagement, engagement numbers during TMH were always higher than in-person services.
ABSTRACT
ObjectiveThe present study explored the experiences of service users of Adult Mental Health and Primary Care services in Ireland in receiving teletherapy during the COVID‐19 pandemic to provide an illustration of these experiences which may inform future applications of teletherapy.MethodSemi‐structured telephone interviews about participants' experiences with teletherapy were conducted, the transcripts of which were analysed using reflexive thematic analysis.ResultsSix themes were generated: Early Apprehensions, Adaptations Improving Experiences, The Therapeutic Space, Seeing and Being Seen, Technical Difficulties: The Loss of "The Moment,” and The Security of a Pre‐Existing Relationship.ConclusionGenerated themes highlight both the range of experiences that clients can have during teletherapy, and some of the most significant factors which influence these experiences. The quality and effectiveness of teletherapy are often susceptible to factors outside of therapists' and clients' control. In most cases, it may be best considered as a supplement to, rather than a replacement for, traditional in‐person services.
ABSTRACT
Since the COVID-19 outbreak, children and families in rural communities have been experiencing unprecedented long-term social isolation and insufficient access to mental health services. Prior to the pandemic, access to mental healthcare in rural communities was already inadequate, leading rural populations to be routinely underserved when facing significant social issues and mental health needs. Even though the pandemic has disrupted the traditional delivery of mental healthcare and exacerbated needs, isolated children and families in rural areas can benefit from mental health services through a telemental health approach. This article presents an innovative telemental health practice model that implements solution-focused brief therapy with social work interns in rural university-assisted community schools (UACS). Implications for policies supporting telemental health in rural UACS, social work education, and evaluation are presented. (PsycInfo Database Record (c) 2023 APA, all rights reserved)