Written by: Keelan Quinn, PhD., Co-chair of OPA Communications and Technology Committee
As Ohio's Stay at Home order gradually begins lifting, many psychologists may slowly begin returning to the physical office. Although the original choice to close and that of whether to return may not be yours, depending on the setting where you practice, the choice of which clients/patients to see in-person versus through telepsychology may be. Like so many other scenarios in this field, there are no concrete answers as to how to make this decision. To help with this process, the American Psychological Association (APA) has provided a number of guidelines for us to consider as we brave this next phase of COVID-19.
Considerations for In-Person Sessions
APA published an excellent article written by Galietti, Wright, Higuchi, and Bukfa (2020) describing the process of returning to the office. It can be found here and I highly recommend everyone read this informational piece. Among other considerations for the process of returning to the physical office included in the article, the following are guidelines specific to determining whether in-person services are necessary:
- Review state and local orders: verify whether or not in-person sessions are advisable before moving forward with in-person sessions.
- Technological access and competence: consider whether the client/patient has continued and secure access to a telepsychology platform and is able to understand and use it competently. Treatment may be impacted if issues arise in any of these areas.
- Progress and mental health risks: consider the diagnosis, whether the service is ongoing, and if the client/patient is making progress through telepsychology. Those who may benefit from resuming in-person therapy may include those who appear to be worsening, are in acute crisis, pose of safety risk, or who require a more intense level of care that is not met via telepsychology.
- Next phase of treatment: consider whether it is feasible to continue working with the client/patient remotely of if the next steps of treatment may require face-to-face contact.
- Review the physical risks: psychologists need to be aware of any and all physical health risks, which include the possible transmission of COVID-19 during in-person sessions. Assess the client/patient’s health and consider whether the individual’s behaviors (e.g., willingness to follow social distancing rules and other health-conscious recommendations), health, occupation, and exposure to others place him/her at a higher risk for contracting the virus and spreading it to others through in-person sessions.
- Clinician health: do not put your own health, or that of your family, staff, or other patients at risk. You are not ethically or professionally obligated to offer in-person services to your clients/patient.
- Documentation: just like every other aspect of therapy, it is very important to document each step of the process you take when making this decision. This includes noting the client/patient’s clinical progress, discussions about the benefits and risks of telepsychology, plans for next steps, and rationale for why you believe providing services via in-person or telepsychology is clinically appropriate. APA is currently working on an informed consent form for in-person services specifically for this period of COVID-19. A sample can be found here.
The majority of psychologists have undoubtedly been using telepsychology as a primary delivery of services for the last couple months. For many, the transition to telepsychology was sudden and mandatory as businesses and offices were immediately closed to reduce the spread of COVID-19. Although using telepsychology may now be second nature for many of us, it is always helpful to review the recommended guidelines of use. A copy of the guidelines provided by Ohio Psychological Association (OPA) is found here while APA’s guidelines can be found here.
Both associations highly recommend an assessment of the appropriateness of using telepsychology for each individual client/patient. This includes examining the potential benefits (e.g., accessibility, convenience, etc.) of delivering telepsychology services relative to the risks (e.g., additional screen time, not in-person, safety, etc.). Both should be communicated to the client to help him/her understand potential options.
APA provides additional guidelines that may be helpful to determine which clients may be appropriate to begin or continue telepsychology services. The following suggestions under the Standards of Care in the Delivery of Telepsychology Service guideline are just a few to consider in this decision-making process:
- Progress and mental health risks: consider the diagnosis and whether the presenting concerns can safely and efficiently be treated through telepsychology.
- Client/patient preference for telepsychology: many individuals continue being hesitant to leave their homes and enter public places, and for good reason. Take into account each client/patient’s physical health status and comfort level regarding coming into the office. Client preference does not have to be the sole determinate of whether or not to continue telepsychology.
- Client/Patient competence: consider the client/patient’s familiarity with and competency for using the specific technology platform involved in providing telepsychology services.
- Remote environment: assess carefully whether the client/patient has the capacity and access to resources necessary to continue services via telepsychology. This includes verifying the client/patient has a confidential space for services with limited distractions and interruptions.
Whether you decide to work in-person or to begin/continue through telepsychology, it is important to examine each client/patient individually. Assess the appropriateness of in-person sessions versus telepsychology for each individual client/patient and the unique presenting concern. Continue monitoring client/patient progress no matter the choice you make. It does not have to be a permanent decision or an either/or scenario; some clinicians are electing to provide a combination of both options depending on the specific case. Examples include seeing new clients/patients in-person until rapport is built before transitioning to telepsychology services; scheduling an in-person session every third or fourth session; and asking those at high-risk to be seen in-person. No matter your decision, documentation is extremely important during this time. Note each step of your decision-making process, discuss it with clients/patients, and add it to his/her file.
Have questions or an idea for a future CTC blog? Email Keelan Quinn.
Disclaimer: This post is for informational purposes only and it is intended to assist other clinicians in the practice of psychology. It is not intended for legal, ethical, or medical advice.
Galietti, C., Wright V., Higuchi, S., and Bufka, L. (2020, May 1). COVID-19: When is it OK to resume in-person services? American Psychological Association Services, Inc. https://www.apaservices.org/practice/news/in-person-services-covid-19
Joint Task Force for the Development of Telepsychology Guidelines for Psychologists. (2013). Guidelines for the practice of telepsychology. American Psychologist, 68(9), 791–800. https://doi.org/10.1037/a0035001
Ohio Psychological Association Communications and Technology Committee. (2008). Telepsychology guidelines. https://telehealth.org/wpress/wp-content/uploads/2013/11/TelepsychologyGuidelinesApproved041208.pdf