Getting Started with Telehealth

Getting started. Prior to COVID 19, none of the therapists at CAFB had experience with providing therapy via telehealth, also known as “distance therapy.”  We didn’t know how trauma treatment with children and teenagers would translate to telehealth.  How would we ensure that the children and teenagers we work with have a private space to maintain the confidentiality of their therapy sessions?  If we’re not physically present with them, how can we help them in the event of an emergency, whether medical or psychological?  Will we be able to keep children and teenagers engaged in therapy sessions when we’re just a face on a screen?  How will we help them regulate without the tools we have in our offices?  How will we handle technology problems that come up in the middle of a session?  With these questions in mind, we began planning our transition to telehealth.

Training Required

Mental health professional licensing boards require that practitioners are competent in the treatment modalities they utilize.  Some of the licensing boards leave it at that, while other boards have very specific requirements.  For example, the Texas board of licensed marriage and family therapists requires 15 hours of continuing education in telehealth before therapists can provide treatment via distance therapy.  Because of this, our first step was to obtain the necessary training.  We were fortunate that PESI, one of the leading providers of continuing education in the mental health field, offered a 2-day, 12-hour virtual telehealth training.  This training normally costs hundreds of dollars, and they offered it to the mental health community for free.  The training provided strategies for addressing many of our concerns.

Informed Consent

Next, we needed to create an informed consent document specific to distance therapy.  Informed consent provides information to the client regarding the risks, benefits, and potential outcomes of therapy treatment so that they can make an informed decision as to whether they wish to participate in treatment or not.  While we have a detailed informed consent document and process for face-to-face therapy, distance therapy presents unique risks, benefits, and outcomes.  The next hurdle was determining how to obtain written consent to therapy treatment, which is required by law prior to beginning treatment.  Without access to an electronic signature program, such as DocuSign, we needed to balance the protection of the family’s personal information with legal requirements for written consent.

During this time, we were also researching telehealth video platforms.  While the Department of Health and Human Services waived the requirement that telehealth must be provided through HIPPA-compliant platforms, the therapy team decided to protect client confidentiality by using a HIPPA-compliant video platform called Doxy.me.  One reason we chose Doxy.me was because clients can easily access and use it.  We also created our own CAFB landing page for our distance therapy program, which you can visit here.

Our Challenges

We faced some challenges as we planned this transition to distance therapy.  First, many families we serve do not have access to the technology required to use the Doxy.me video platform.  Some families don’t have laptops, smartphones, or internet access. Some families have older laptops or phones that cannot support video.  Other families live in areas with poor internet connectivity.  And many families don’t have a space where their child can have privacy during their therapy session.  With everyone in the family at home due to COVID 19, it is difficult to ensure that the child will have the confidentiality needed to fully participate in therapy treatment.

The therapists had our own challenges to address, including computer hardware issues, problems with internet connections, and glitches in Doxy.me.  We each needed to create a private, professional, calming space with good lighting in our homes where we could conduct our therapy sessions.  With spouses also working from home, and children and pets vying for our attention, this was no easy feat.

The Up Side

While we would prefer to provide trauma therapy to children and teenagers at our office, we’ve learned that we can do it through telehealth, when necessary.  Now children can still attend their therapy session if the car broke down or their parent is sick.  Distance therapy also gives the therapist a bigger picture of the child and their family in their real-life environment.  Children, and even teenagers, are excited to show their therapist things in their home that are meaningful to them.  Our therapists have learned how to provide therapy without the use of the tools and resources that they rely on in the office.  They have tapped into their creativity to adapt their knowledge and skills to a new format.  As we move forward and back into the office, the lessons we have learned from distance therapy will inform how we continue to provide face-to-face therapy services.

Jessica Hernandez, LPC, LMFT
Manager of Therapy Services