Introduction to Telepsychology Part 2
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This document outlines key aspects of providing telepsychology services discussed in Part 2 of an introduction to telepsychology presentation. It defines important telepsychology terms and highlights that psychologists must understand definitions, technology like bandwidth, and the platform they are using. They must also follow standards of care for assessment, treatment and managing emergencies when providing remote services. The document emphasizes that telepsychology requires ongoing evaluation of a patient's suitability and that services must meet the same standards as in-person care.
Introduction to Telepsychology Part 2
- 1. INTRODUCTION TO TELEPSYCHOLOGY: PART II JOHN D. GAVAZZI, PSYD, ABPP PENNSYLVANIA PSYCHOLOGICAL ASSOCIATION AUGUST 2016
- 2. QUICK REVIEW • Outlined the prevalence of online use • Myths of telepsychology • Patient resistance and patient benefits • Psychologist resistance and benefits • The Migration Model • Legislative efforts in Pennsylvania
- 3. OUTLINE FOR TODAY • APA Guidelines for the Practice of Telepsychology • Definitions • Competence of the Psychologist • Standards of Care
- 4. LEARNING OBJECTIVES At the end of today’s presentation, the participant will be able to: 1.List three important definitions in the Telepsychology Guidelines, 2.Describe what bandwidth is and why it is important to providing high quality telepsychology services, 3.Write two important points related to the delivery of telepsychology services.
- 5. DEFINITIONS SECTION: WHAT ARE THE DEFINITIONS? WHY IS THIS IMPORTANT?
- 6. DEFINITIONS OF TELEPSYCHOLOGY • Telecommunication technologies: are not limited to telephone, mobile devices, interactive videoconferencing, email, chat, text, and Internet (e.g., self-help websites, blogs, and social media). • Client or patient: the recipient of psychological services, whether psychological services are delivered in the context of healthcare, corporate, supervision, and/or consulting services. • Remote: refers to the provision of a service that is received at a different site from where the psychologist is physically located.
- 7. DEFINITIONS OF TELEPSYCHOLOGY • Security or security measures: encompass all of the administrative, physical, and technical safeguards in an information system. • Confidentiality: the principle that data or information is not made available or disclosed to unauthorized persons or processes. • Information System: An interconnected set of information resources within a system and includes hardware, software, information, data, applications, communications, and people. • Jurisdictions or jurisdictional (think interjurisdictional): when referring to the governing bodies at states, territories, and provincial governments.
- 8. WHY DOES THIS MATTER? • Delineates how telepsychology services are different than face- to-face • Addresses synchronous and asynchronous formats • Very broad-based and non-specific • Addressing interjurisdictional practices • Association of State and Provincial Psychology Boards (ASPPB) has 12 points to differentiate face-to-face from telepsychology
- 9. COMPETENCE • Difficult to quantify • Know APA’s Ethical Principles of Psychologists and Code of Conduct • Know this Guideline • Know basic concepts related to technology (which are coming) • Know how to use the technology well enough to teach it to your patient • Know HIPAA as it applies to telepsychology (such as a BAA from platform that you are using) • Pay attention to the rest of today and tomorrow
- 10. BASIC TECHNOLOGICAL KNOWLEDGE • Bandwidth • Wi-Fi • HIPAA Rules • Synchronous versus asynchronous communication • Know the platform that you are using • Know how to seek assistance from your videoconference provider • Know the location of your patient
- 11. BANDWIDTH • Bandwidth is the amount of information that can be “pushed through” your internet services. • The bigger bandwidth, the better. Rural versus urban areas. • DSL (Digit Subscriber Line) vs. High Speed Internet access • Usually measured in kilobytes/sec (Kbps) or megabytes/sec (Mbps) • Higher bandwidth allows information to be passed more quickly, which translates into better image quality/voice quality. (Download speed 44 Mbps and Upload of 10 Mbps).
- 12. MORE BANDWIDTH • Use internet-based video conferencing software programs should provide such services at a bandwidth of at least 500 Kbps in each of the downlink and uplink directions. Such services should provide a minimum of 640 x 480 resolution at 30 frames per second. • Depending on the service provided, higher bandwidth speeds may be needed, like MRIs and • The platform security code makes the software bulkier, meaning your system may use Skype well, but does not work with doxy.me. • Most current phones and computer have sufficient resolution and frames per second
- 13. EVEN MORE ON BANDWIDTH • The best, most secure way to use telepsychology services is to use your Ethernet cable and tap directly into the internet. • At a minimum, you will need to know how to plug your Ethernet cable from your computer to your modem.
- 14. WHY AM I MAKING SUCH A BIG DEAL ABOUT BANDWIDTH? • Higher amounts of bandwidth make the telepsychology session more fluid and real. • Lower amount of bandwidth can lead to poor quality sound and video which can decrease the flow of the session and create multiple clarifications. • Your patient’s bandwidth is as important as your bandwidth.
- 15. WHY AM I MAKING SUCH A BIG DEAL ABOUT BANDWIDTH? • What is coming: Google fiber, clocking in at 1,000 Mbps/sec • Using cell phones for telepsychology can be more effective than computer-based videoconferencing • Cell phones typically use less bandwidth. However, cannot plug directly into the internet with a cell phone. Therefore, you must use Wi-Fi.
- 16. WI-FI, SECURITY AND YOU • Wi-Fi is a technology that uses radio waves to connect you to the internet. • When information become airborne (transmitted with radio waves), there is a higher probability to intercepting or stealing that information. • Please advise patients to not use unsecured Wi-Fi settings. Secure systems typically have a “lock” icon and they have to provide a password to log onto the Wi-Fi.
- 17. WI-FI, SECURITY AND YOU • Your hardware does not have to match your patient’s hardware. So, you can be on your computer, hardwired into the internet via your Ethernet cable, and your patient can be using a secure Wi-Fi network on his/her phone. • If you use a cell phone, you may want to invest in a cell
- 18. WI-FI, SECURITY AND YOU • Phone to phone typically uses the least bandwidth. • Computer to computer uses the most bandwidth
- 19. HIPAA HAS THREE RULES: THEY ALL APPLY Privacy: National standards for the protection of patient’s privacy (Guideline 4). Transmission: Includes transmission of patient information for billing as well as treatment (Guideline 5) Security: National set of security standards for protecting certain health information that is held or transferred in electronic form. (Guideline 5)
- 20. SYNCHRONOUS VERSUS ASYNCHRONOUS Basically, synchronous is live and interactive. Asynchronous is stored and forwarded.
- 21. KNOW THE PLATFORM THAT YOU ARE USING • I recommend practicing with it multiple times. • Use it to talk with friends in state and out of state. • Folks who live in urban and rural areas to get a sense of bandwidth. • Practice so much that you can teach it to someone easily, including set up, connecting, and using.
- 22. REACH OUT FOR HELP FROM YOUR PLATFORM PROVIDER • By using the tool, you may have questions. My suggestion is to reach out the help desk to determine if they respond quickly and resolve your issues. • Most platforms are pretty good at this. • Part of your competence is selecting a good videoconferencing platform that can fulfill your clinical, ethical and legal responsibilities.
- 23. KNOW THE LOCATION OF YOUR PATIENT • Important to somehow verify the location of your patient, to make sure that you are not practicing outside of your licensed jurisdiction. • Preference for the Migration Model • Insurance coverage helps with assessing patient location
- 24. STANDARDS OF DELIVERY OF CARE ASSESSMENT PROVIDING CARE MANAGING CRISES IT MAY ALSO INCLUDE CONSIDERING WHETHER COMPARABLE IN-PERSON SERVICES ARE AVAILABLE, AND WHY SERVICES DELIVERED VIA TELEPSYCHOLOGY ARE EQUIVALENT OR PREFERABLE TO SUCH SERVICES. IN ADDITION, IT IS INCUMBENT ON THE PSYCHOLOGIST TO ENGAGE IN A CONTINUAL ASSESSMENT OF THE APPROPRIATENESS OF PROVIDING TELEPSYCHOLOGY SERVICES THROUGHOUT THE DURATION OF THE SERVICE DELIVERY.
- 25. ASSESSMENT • Is the patient requesting or are you pushing telepsychology? • Have you done a face-to-face assessment? • Can this person be helped with telepsychology services? • What patient factors support using telepsychology? • What patient factors suggest not using telepsychology? • Are you using a Migration Model? If not, why not? • Does their insurance reimburse for telepsychology?
- 26. PROVIDING CARE • Needs to meet same standard of care for face-to-face patients • Ongoing assessment is appropriate for telepsychology patients • Is your patient making progress? How to assess? • If not making progress, what are your choices? • Miscommunications and misunderstanding • Maintaining boundaries between sessions
- 27. MANAGING EMERGENCIES • How will you manage patient crises and emergencies? • What happens if you lose your connection? • What happens if your internet goes out?
- 28. WRAP UP PART 2 DEFINITIONS COMPETENCE: BANDWIDTH, TECHNOLOGY, PLATFORM, ETC. STANDARDS OF SERVICE DELIVERY