Telehealth and the evolving health care system: Strategic opportunities for professional psychology.

Telehealth (previously telemedicine)—the use of telecommunications to provide health information and care across distance—has recently reemerged as a potentially effective way to provide general and specialty health care services and appears poised to enter mainstream health service delivery. Because telehealth may become a significant part of the future of health care, it is critical to all professions that it be defined broadly. Barriers to the appropriate development of telehealth must be examined and addressed. Professional psychology's ongoing integrated legislative, legal, marketplace, and consumer education strategies for dealing with recent broader market-driven changes in the health care system provide a solid framework for analyzing and ensuring that psychological practice is poised to manage the opportunities and challenges presented by this emerging field. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

General guidelines for providers of psychological services.

Presents the 2nd revision of the principles of conduct originally adopted by the American Psychological Association in 1974. Implications of the guidelines are discussed for promoting mutual understanding between providers of psychological services and users, greater uniformity in legislative and regulatory actions, the concept of ethical practice, training models, and desirable organizational structure in psychological facilities. Definitions of terms used in these guidelines—providers of psychological services, psychological services, psychological service unit, and users—are presented. The guidelines, accompanied by illustrative statements, are arranged under the following general headings: providers, programs, and accountability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preparation for the delivery of telehealth services: A self-study framework for expansion of practice.

Linked to increasing consumer demand for access to health care information and to the worldwide expansion of telecommunication services, telehealth has emerged as a new domain of practice within professional psychology. Psychologists who plan to incorporate telecommunication technologies (e.g., Internet and point-to-point videoconferencing) into their practices should first conduct a self-assessment and then enhance their knowledge and skills in using these alternative forms of service delivery. The current article provides a self-study framework, known as STEPS, for psychologists to use in planning for telehealth practice. STEPS focuses on 5 key domains of telehealth practice and organizes specific self-study questions around each of these domains. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Practise wise: Five faces of ethical issues.

Wise practice in the daily provision of psychological services, requires continual good judgment in the application of the principles of professional standards and ethics. Self-regulating professions are responsible for judging and applying sanctions in cases of reported misconduct. However, this is not sufficient to ensure that the aspiration of a generally high level of ethical practice is indeed a reality. Ethical issues have many faces in the field of professional practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Professional ethics in rural and northern Canadian psychology.

Although the literature in rural, northern, and remote (R&N) psychology and professional ethics for this setting is limited, it is clear that this area of psychological practice presents a specific context which must be considered for ethical decision-making. Existing literature suggests that overlapping relationships, community pressure, generalist practice, interdisciplinary collaboration, and professional development concerns are aspects of R&N practice that may be more prevalent. When they are, they pose risks by complicating professional practice and the resolution of related ethical issues. This article highlights the ways that demographic and practice characteristics may instigate ethical issues in R&N professional practice. We briefly review these considerations in relation to the literature, professional ethics, the Canadian Code of Ethics for Psychologists (Code), and case examples from our own practices. More specifically, we discuss how the Code provides guidance in applying the ethical principles to decision-making in R&N communities. Further, we suggest practical applications for ethical decision-making acumen inherent in the Code. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Regulation of telepsychology: A survey of state attorneys general.

State attorneys general were surveyed regarding legal and regulatory issues related to delivery of behavioral health services in their states by electronic means. The data are discussed in the context of rapidly evolving technology and practice innovations that involve delivery of professional services by teleconference, the Internet, and other electronic media. Licensing, regulatory, and professional liability barriers are discussed, along with suggestions for practitioners who are considering engaging in behavioral telehealth services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"High-Tech With the Human Touch: Using Telehealth to Reach America's Children." Correction to Wasem and Puskin (2000).

Reports an error in "High-tech with the human touch: Using telehealth to reach America's children" by Cathy Wasem and Dena Puskin (Professional Psychology: Research and Practice, 2000[Feb], Vol 31[1], 3-4). On page 4, the last sentence of text incorrectly reads, "For additional telehealth project, policy, legal, and funding information, visit OAT's web site at http://www.telehealth.hrsa.gov." The correct web site address is http://telehealth.hrsa.gov. (The following abstract of the original article appeared in record 2007-17617-001.) In the past decade, we have seen new telecommunication and information technologies used to provide health services, health professional and consumer education, and public health and administrative services. The application of these tools to health care, commonly referred to as telehealth, provides an unprecedented opportunity, as we embark on a new millennium, to take services to those in need-to "carry the water to the desert." Telehealth provides both a means to increase access, and to reengineer the processes of care, enhancing the equality and effectiveness of health services. This article illustrates how telehealth has helped children and youth in various health care settings. Many of these projects have been initiated with federal funds from OAT or other federal agencies. Some of the projects use technologies that require special phone lines and expensive equipment ranging from $15,000 to $50,000; others run over regular phone lines and use equipment costing between $500 to $1,000. Psychologists are involved in many of these projects as initiators of services, as members of multidisciplinary teams, and as researchers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contracting for supervision.

The changing job market has increased the demand for psychologists to serve as clinical supervisors of other mental health service provides; however, such supervisory arrangements inevitably increase legal exposure and pose unique ethical challenges for the supervising psychologist. A detailed sample supervision contract incorporating ethical and practice standards of psychology is offered. Although such contracts may not be legally binding, these agreements help facilitate (a) an adherence to these professional and ethical standards, (b) effective supervisory practices, and (c) the quality of care for the persons receiving psychological services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Telehealth: A clinical application model for rural consultation.

This article describes how a child psychologist in a rural community provides the necessary comprehensive consultation and clinical services using a video telephone and the services of Kentucky Telecare. The authors present a clinical consultation model of health care for underserved populations where professional consultation with a team of professionals may benefit service providers in rural communities. The article examines an innovative model of telehealth care delivery through a university-based telehealth system to an underserved regional school system. A number of applications within a broad spectrum of services using telehealth technology are offered. Finally, shifts in administrative paradigms, clinical models, and information technology prevention services through telehealth are addressed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

High-tech with the human touch: Using telehealth to reach America's children.

[Correction Notice: An erratum for this article was reported in Vol 31(2) of Professional Psychology: Research and Practice (see record 2007-17403-001). On page 4, the last sentence of text incorrectly reads, "For additional telehealth project, policy, legal, and funding information, visit OAT's web site at http://www.telehealth.hrsa.gov." The correct web site address is http://telehealth.hrsa.gov.] In the past decade, we have seen new telecommunication and information technologies used to provide health services, health professional and consumer education, and public health and administrative services. The application of these tools to health care, commonly referred to as telehealth, provides an unprecedented opportunity, as we embark on a new millennium, to take services to those in need-to "carry the water to the desert." Telehealth provides both a means to increase access, and to reengineer the processes of care, enhancing the equality and effectiveness of health services. This article illustrates how telehealth has helped children and youth in various health care settings. Many of these projects have been initiated with federal funds from OAT or other federal agencies. Some of the projects use technologies that require special phone lines and expensive equipment ranging from $15,000 to $50,000; others run over regular phone lines and use equipment costing between $500 to $1,000. Psychologists are involved in many of these projects as initiators of services, as members of multidisciplinary teams, and as researchers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rights of clients, responsibilities of therapists.

Discusses ways in which ethical principles can be put into practice in the client–therapist relationship. Historically, ethical codes for therapists were drawn up to protect the professions from regulation by external agencies. Implicit in the ethical codes, however, is a model for the client–therapist relationship that fosters the goals of mental health. It is suggested that just as ethical codes have been given specific content in standards for providers of psychological services in human service facilities, ethical codes can be given specific content in the client–therapist relationship. It is recommended that therapists take responsibility for incorporating ethical standards into their practices so that clients' rights will be an integral part of therapy. Four illustrative situations are presented: providing clients with information to make informed decisions about therapy, using contracts in therapy, responding to clients' challenges to therapists' competence, and handling clients' complaints. (63 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Applied sport psychology in professional sports: The team psychologist.

Professional sports has become a significant worldwide business in which highly paid athletes are considered substantial assets to be carefully selected, developed, and protected. Psychologists have become increasingly involved with professional sport organizations, providing a wide range of psychological services, such as performance enhancement consultation, clinical or counseling interventions, and psychological testing. As increasing numbers of psychologists enter the sport domain, the specific roles and responsibilities of practice, unique ethical considerations, and psychological services and professional demands most often placed upon the team psychologist in professional sports must be clarified and articulated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Telehealth Interventions for Individuals With Chronic Illness: Research Review and Implications for Practice.

This article reviews outcome research on telehealth interventions for individuals with chronic illnesses. Only randomized controlled trials that provided data on specific health, quality of care, or clinical interview outcomes were selected. The overall findings suggested that telehealth interventions have shown promise as effective modes of treatment for people with chronic health conditions. Suggestions for improving the rigor and quality of future research are proposed, including the use of larger samples, conceptually meaningful control groups, cost analyses, strategies for enhancing ethnic minority recruitment, and experimental designs that examine interactions among different types of telecommunication technologies, specific health problems, and different patient populations. Implications for incorporating telehealth into psychological practice are also addressed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The commerce of professional psychology and the new ethics code.

The 1992 version of the American Psychological Association's Ethical Principles of Psychologists and Code of Conduct brings some changes in requirements and new specificity to the practice of psychology. The impact of the new code on therapeutic contracts, informed consent to psychological services, advertising, financial aspects of psychological practice, and other topics related to the commerce of professional psychology are discussed. The genesis of many new thrusts in the code is reviewed from the perspective of the psychological service provider. Specific recommendations for improved attention to ethical matters in professional practice are made. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Telehealth issues in consulting psychology practice.

Consulting psychologists have recognized the importance of providing comprehensive consultation and clinical services for consumers with special needs. Often because of distance and access to consultation services, remote and underserved populations may not have the necessary access to consultant specialists in psychology and other disciplines. Such services are now available through an innovative model of telehealth. Telehealth technology and services have gained the attention of scientists, clinicians, consultants, and health educators in a variety of settings. Examined are consultation case scenarios using telehealth qualitative observations of consultants who have used telehealth and liability issues consultants may face using this technology. A model release of liability is provided for consulting psychologists who may consider its use in their consultation practice. Case examples using telehealth applications are discussed, as are special applications for health care delivery to undeserved rural populations using telehealth technology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluating psychosocial aspects of telemedicine and telehealth systems.

Telemedicine and telehealth evaluations often address the technological aspects of health care while neglecting the psychosocial implications of the technology. Currently, little is known about the meaning of telehealth care in terms of access, quality of care, or financial impact. This article focuses on the human aspects of using technology to provide mental health care and the insight that psychology can bring to the evaluation process. It discusses telehealth's impact on and interface with health care facilities, specifically in relation to training, informatics, remote consultations, patient outcomes, provider health, and professional practice. It also presents guidelines and suggestions for the implementation of a telehealth evaluation. It also presents guidelines and suggestions for the implementation of a telehealth evaluation, including evaluation design, examples of outcome-related questions that may be pertinent to telehealth evaluation, and suggestions for psychology's continuing role in telehealth. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cyberspace: Creating a therapeutic environment for telehealth applications.

Behavioral telehealth innovations promise increased opportunities for access to psychological services. Technological advancements are making available inexpensive interactive televideo (IATV) applications for the provision of mental health services. The emergence of IATV brings with it a new environment that is experienced quite differently than face-to-face interactions. Human communication in the IATV medium is unique. It is subject to different rules and cues. This article explores variables that affect IATV applications toward the development of an optimal IATV environment for effective therapeutic endeavors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to the Special Section: The case for training in the provision of psychological therapy.

Recent trends, such as the national health care initiative, have brought into focus the importance of identifying the qualifications of those who provide mental health services. This special section explores the research evidence for the value of professional training among those who provide psychological therapy. The set of articles describes what is known about the relationship to therapeutic efficacy of professional training, training in ethnic diversity, and clinical supervision. These articles suggest that professional training enhances clinical efficacy, especially if type of training, setting of practice, and nature of patient problems are considered. They also suggest that supervision and specific training in ethnic diversity enhance knowledge and sensitivity among psychotherapists. It is anticipated that this special section will promote a dialogue about these conclusions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Making telehealth a viable component of our national health care system.

Technological advances and the development of a national information infrastructure give telehealth the potential to overcome barriers to health care services that rural Americans confront. This technology can range from simple use of the telephone to high-tech equipment that enables a psychologist at an urban medical center to counsel a patient in a small town hundreds of miles away. This technology includes interactive video equipment, fax machines, and computers, along with satellites and fiber optics. Although there is a temptation to get caught up in the wizardry of high-tech telecommunications, telehealth will not solve all the access and distribution problems that now plague our health care system. It can, however, be an important part of the solution. Throughout the country, health care providers in fields such as mental health, dermatology, and pediatric cardiology—just to name a few—are taking advantage of this technology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Telehealth Brain Injury Training for Rural Behavioral Health Generalists: Supporting and Enhancing Rural Service Delivery Networks.

Rural psychologists are frontline primary behavioral health care providers for nearly 60 million Americans, but they face limited access to peer consultation and continuing education. This article describes a program that matched 70 rehabilitation inpatients who had new brain injury with rural clinicians from patients' home communities. Neuropsychologists provided one-on-one training for clinicians through telehealth video teleconferencing. Clinicians showed gains in brain injury knowledge, and clients rated trained providers higher than untrained providers. Families seeking brain injury services can connect with these trained rural providers through a Web site, which receives more than 800 hits per month. Telehealth offers potential for rural clinicians to receive support, reduce professional isolation, gain working knowledge of specialty conditions, and deliver high-quality services for their rural clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)