# Helping Give Away Psychological Science/Telepsychology

HGAPS is finding new ways to make psychological science conferences more accessible!
Here are examples from APA 2022 and the JCCAP Future Directions Forum. Coming soon... ABCT! ~ More at HGAPS.org ~
This page is intended for clinicians who provide psychological services. If you are a patient or someone looking for information about receiving telepsychology services, you can find more information on Telepsychology Guide for Patients.
The coronavirus pandemic is causing a lot of clinics and clinicians to use telehealth. This page provides information and practical considerations for the clinician, as well as tips and suggestions for how to make telepsychology most successful. We have a suggestion box herewhere you can drop links, add ideas, and leave comments. You also can make edits directly on this page or on the discuss page if you are comfortable with editing.
Share this page by clicking the following social media and interactive platforms: Email | Facebook | Twitter | LinkedIn| Mendeley | ResearchGate

# Guidelines for conducting mental health services with technology

Watch this Youtube video, "Introduction to Telehealth with Dr. Bosch", by Jeane Bosch, PhD, MPH for an introduction to telemental health research, getting started, preparing for the first session, conduction telemental health sessions, and common issues and troubleshooting in the case of technological issue.

## Getting started

Telepsychology is defined as the provision of psychological services using telecommunication technologies, which include telephones/smartphones, video conferencing, email, texting, and self-help materials (blogs, social media, etc.). The services can be delivered synchronously, with multiple parties interacting in real-time or asynchronously, with parties responding to one another at their convenience.
Telepsychology offers convenience and can be helpful for coaching patients/clients between appointments. There are also circumstances during which it is not possible to see patients in person, and telepsychology is necessary to provide continuity of care. This is an overview, including resources to help practitioners provide telepsychology safely, effectively, and in alignment with professional standards.
In order to build competence in telepsychology, consider taking an online course to familiarize yourself with telepsychology and read American Psychological Association, American Psychiatric Association, and APPIC guidelines on the topic. To find recommendations and tips on conducting Telepsychology, read Recommendations for Policy and Practice of Telepsychology. Additional resources can be found on APA’s website.
Specific information on conducting teletherapy during COVID-19 can be found at Intro to Telepsychology in the Age of COVID-19 and Telepsychology in the Age of COVID-19, Telepsychology during a pandemic, Psychotherapists' attitudes toward online therapy during COVID-19 and Psychotherapists' experiences with telepsychotherapy.
Additionally, Health and Human Services has a site dedicated to Telehealth, which provides up-to-date information about government-related policies, including reimbursement.

## Consent for telepsychology

It is important to introduce the idea of telepsychology and to give your patient/client an opportunity to ask questions about it and to make a choice about whether telepsychology is right for them.
* If your original consent for treatment did not include telepsychology (including communication by text message or email), it is important to talk with your patient/client about what telepsychology entails and to collect and document their consent for these services.
* Some patients/clients may choose to consent to only some services (e.g., email and phone therapy, but not video).
* You should create a new consent form or update your existing form and go over it with your patient/client over the phone. You can then email them a copy to sign and return to you. If it is not possible for them to print/sign the document, you can consider an online signing service, such as DocuSign or DocHub. Examples of consent for telepsychology can be found here and here.
* When explaining telepsychology, ask whether the patient/client has ever seen a doctor on a phone or computer. If the patient has not used telehealth, it may be helpful to explain how it works by relating telehealth to technology (i.e., Facetime, Skype, or Zoom) with which they are likely to have some familiarity.
* Let patients/clients know why telepsychology is being used and whether there are alternatives available.
* Discuss security and address any concerns about who else can hear or see them. Additional information regarding technical specifications should be available if requested. Some patients appreciate being reassured that the session is not “on the internet” in the sense that it can neither be openly viewed nor will it be made available online.
* It is important to inform patients if a session is being recorded. If you want to record a session you must obtain explicit consent from the patient/client.

## Consent for resuming in person sessions

It also may be helpful to document informed consent when you and the client decide to resume in person sessions. The American Psychological Association has provided an example consent form here.

## Technology
### Email

Email is a convenient, but not necessarily secure, method of communication. Some organizations provide encrypted email for their employees, which enables the safe transmission of protected health information. Even when the message is encrypted, there are some risks to using email and other things of which to be aware.
It is wise to have a conversation with your patient/client about how the two of you will use email. Some use email only for scheduling and other logistical matters, whereas others will engage in coaching and other services by email.
Many professionals include an agreement about email as part of their consent form. If this was not done initially, you might want to have a conversation with your patient/client and then send an email indicating your agreement. They can respond affirming the agreement, and this exchange becomes part of their record.
Email is not secure. Even when encrypted, it can be forwarded or compromised in other ways. It can be helpful to include a message after the signature to remind patients of this.

### Phone

Most practitioners are comfortable communicating with patients/clients through the phone to set appointments and occasionally check-in. Conducting therapy over the phone can be more complicated. A few things to keep in mind:
* Make a plan with your patient/client ahead of time, so that they are prepared for the call and are situated in a quiet, private place.
* Set expectations, so that your patient/client knows how long the call will last and whether it will be a “typical” therapy session over the phone or something else (e.g., a short check-in).
* If you are using a cell phone, make sure you have adequate reception to limit call disruptions.
* Consider using a hands-free headset, so that you can take notes.
* Find a quiet, private place to conduct the call, so you are not distracted and there is no background noise.
* Prepare materials you might need ahead of time. For example, make sure you have your notepad and a pen. If you use worksheets or other materials, make sure your patient/client has a copy ahead of time, so you can review it together.

#### Mental Health Applications (Apps)

* Mental Health App Guide: One Mind PsyberGuide
* ABCT's Recommended Apps

### Video Conferencing

Videoconferencing is a nice alternative to phone for communicating with patients/clients and particularly for conducting therapy or assessment. It also presents some extra challenges for people who are not familiar with the technology. Although recent circumstances have led to the relaxation of HIPAA for the provision of teletherapy, typically, order to assure the Health Insurance Portability and Accountability Act (HIPAA)-compliance of a software tool, it is important to have a Business Associate Agreement (BAA) with the service provider. A business associate is someone who performs functions or provides services on behalf of a covered entity which requires them to have access to protected health information. The BAA establishes the permissible uses and disclosures of protected health information and ensures that the business associate will uphold these rules and take appropriate measures to safeguard protected health information from any non-permitted uses or disclosures.
Not all video conferencing software is HIPAA-compliant. It is important to be aware of this, and to consider the functionality you need (e.g., do you conduct groups that require multiple participants) when choosing a platform to use. There are several options (e.g., Skype for Business / Microsoft Teams, Updox, VSee, Zoom for Healthcare, Doxy.me, ZEBOC, Google G Suite Hangouts, Meet, Cisco Webex Meetings/Webex Teams, Amazon Chime, GoToMeeting, Spruce Healthcare Messenger).
Better Connection Tips: To reduce technical issues with video conferencing services, clear your browser history (under the History menu for most internet browsers), close all unnecessary windows and applications before and during sessions, and use incompatible web browser; encourage your patient to do the same. If you are experiencing delays, try using cloud web-based services (e.g. Zoom), instead of peer-to-peer services (e.g. doxy.me, ZEBOC), as they tend to have fewer bandwidth-related issues.
Commonly used video conferencing software:
Doxy.me
* Both free and premium versions are available and easy-to-use on all devices.
* All versions are fully functional, HIPAA-compliant, and include a Business Associate Agreement at no cost.
* The premium versions give providers the freedom to customize features including the waiting room, logo, text and videos.
* Other benefits to the premium versions include real-time support, file transfer, payment processing and text and email notifications.
* Doxy.me operates using any web-browser; there is no installment or download necessary for provider or patient
* It may not be best for those with average to weak internet connections, but for those with higher speed connections, it will provide high-quality audio and video.
* Check out these tips for a better experience while videoconferencing with Doxy.me.

#### thera-LINK

* A HIPAA-compliant option that provides a Business Associate Agreement
* It can be used on all devices.
* There are three packages: Basic plan, at $30, per month, offers five sessions a month for one provider and a scheduler. The Plus plan and Ultimate plan, at $45 and $60 per month offer unlimited monthly sessions, secure file sharing, advanced payment and scheduling options, and office manager accounts; the Ultimate plan also includes client notes, secure messaging and a branded portal.
* theraLINK requires both providers and patients to have their own login.
* theraLINK is relatively easy to navigate and offers the ability to customize aesthetic features such as imagery and music options for the waiting room.
* theraLINK can only be used on WiFi and may be harder to master than other options.

#### ZEBOC

* ZEBOC is fully equipped to support a telepsychology session.
* It’s free business model is aimed at empowering solo practitioners.
* It provides all the premium features including Stripe-powered payments, Conversational transcription and more for free.
* It’s HIPAA-compliant and provides Business Associate Agreement for free.
* Allows providers focus on patient care while ZEBOC takes patient notes with automatic text-to-speech conversion in real-time.
* No download or installation required. Works intuitively in most popular browsers.
* Instant appointments allow providers to send an invitation to their patients in just two clicks.
* Appointment booking website widget can be configured in providers’ practice website.

#### Zoom

* Zoom is not tailored specifically for mental health, but it is popular for business and education, so many people are familiar with it.
* Its healthcare version is HIPAA-compliant and includes a Business Associate Agreement. Plan costs start at $200 per month.
* Zoom is customizable and works on all devices, though it may not be suited for low bandwidths.
* Due to the cost, Zoom may be best for those who have midsize to large practices which require the tool to have multiple functions (i.e. training, recording, seminars, etc.).
* Zoom’s popularity has also made it a target for mischief. "Zoombombing" is when an uninvited participant uses Zoom’s screen-sharing feature to disrupt meetings.
** It is important to take steps to ensure that your video call is secure and accessible only by you and your client, this includes keeping the link private and setting a password. View additional guidelines here.

## Get ready for your telepsychology session

* Some clinicians make the mistake of not preparing for a telepsychology session because it may feel more informal than an in-person session. However, it can be more challenging to keep a client engaged in telepsychology, and it is especially important to set an agenda and to have your goals for the session planned ahead.
* As noted above, you may want to use worksheets or other materials in your session. These can be emailed to the patient/client ahead of time. You may also want to use the “share your screen” feature that most video conferencing services provide. Other features might include a “whiteboard” or chat functions that can help you to share materials with your patient/client.
* If you want to use some of the special features, be sure to test them beforehand, so you know how everything works.

#### Prepare your space and practice

* Make an effort to minimize potential distractions in your environment. This means things that will be visible in the background to your patient/client and things that may distract you during the session.
* Turn off all email and messaging notifications on your computer and cell phone and encourage your patient/client to do the same.
* Pick a spot that is quiet and private. Try to use the same space week-to-week to facilitate familiarity and an office-like experience. Many video conferencing programs have a "Virtual Background" option where you can use an image to cover the actual scene behind you.
* Remember that lighting is critical; back lighting will darken your face. Position your device so you have adequate front lighting or add front lights.
* Make sure you are comfortable and have everything you need (water, notes, etc.) before you start.
* Ensure your video is sufficiently “zoomed in” for the patient to see your facial expressions
* Try to maintain a constant gaze into the camera, rather than frequently looking away at your computer or notes. It can be tough to maintain a constant gaze while on a video call, but there are ways you can simulate eye contact with your patients with just a few tricks.
* Try to focus on a point behind the camera lens; this will focus your eyes and make it clearer where you are looking. Much of perceived eye contact through video calling is related to the rotation of your eyes. The further back you sit, the less your eyes need to rotate, so sit further from the screen and zoom in closer to your face if you need to.
* Center the video of your patient/client under your webcam, so when you look at their eyes, you are looking directly into the camera.
* If possible, use picture-in-picture feature (e.g., where you can see both yourself and the patient) to see how you are being viewed by the patient, or if there is something distracting in the background (e.g., your cat!)
* Ask a friend or colleague to do a practice session with you before you attempt a video session with a patient/client - there will be early snafus, and it is good to figure them out before you are in a real session.
* Wear office-appropriate clothing.
* If possible, give yourself a break between sessions to stretch or take a brief walk.

#### Prepare your patient/client

* As with phone calls, encourage your patient/client to find a quiet and private space for the session.
* Using a laptop or desktop computer is likely to be more comfortable, but a smartphone can also be used.
* Set the client’s expectations for the session and send any materials (e.g., worksheets, mood rating scales) ahead of time
* Make your expectations clear. Let your patient/client know that they should arrive on time, complete their homework, have the room set-up to minimize distractions, and dress appropriately.
* Make a contingency plan, in case the technology doesn’t work.
* Consider showing patients/clients your workplace/office. Using the camera’s zoom and pan features or manually moving your device, you can give patients a virtual tour to assure them that no one else is present and to provide context.
* Immediately discuss any technical difficulties as they arise. For instance, if there is a slight lag in audio that makes it seem as if you and the patient are talking over each other, you can suggest adding a small pause after each statement

### Guidelines for conducting individual teletherapy

Below are some resources for how to adapt psychotherapy while practicing physical distancing and via telecommunication instead of in-person sessions and practice:
* Cognitive therapy
* Social anxiety exposures while physical distancing
* Treatment for OCD
* Telepsychology for General Anxiety Disorder
* Telepsychotherapy with youth at high risk for psychosis
* Behavioral Activation Techniques while Physical Distancing

### Guidelines for conducting group teletherapy

Group therapy can be conducted effectively remotely using phone or video conferencing, but special care is often necessary to ensure that all group members participate and are able to benefit. It can be helpful to review group rules and consider whether additional guidelines are necessary when moving an in-person group to a virtual format. Privacy can be a particular concern if some group members are in close proximity to others while attending the group. It is also important to set expectations for whether everyone will be required to keep their camera on and other guidelines to ensure all group members are comfortable. Below are some additional tips for conducting group therapy online:
* APA Guidelines for conducting group therapy online
* American Group Psychotherapy Association guidelines
* Tip sheet for virtual group therapy

## Appropriate clients

Meeting virtually may not be appropriate for all patients/clients. Some may not be comfortable with the technology or may have privacy concerns. Other patients/clients may be high risk, which can lead to safety and liability issues when communicating with them through email, phone, or video. It is important to consider these issues and to discuss other options with your patient/client.

#### Patients/Clients who are not comfortable with technology

Many patients/clients may be unfamiliar with videoconferencing and hesitant to use this technology for mental health services. Plan to spend some time answering questions and helping them to get set-up prior to your appointment.
* Ask if there is a software they already use to communicate with family or other providers and try to use the same one, if possible.
* YouTube is a good source for tutorials on setting up a video conference.
* Your patient/client may also have friends/family who can help them get set-up, encourage them to seek help.

#### Patients/Clients who have privacy concerns

* Some patients/clients may not have access to a private space in their home. Help them brainstorm other options. For example, can they sit in their car? Or go to a quiet place in a local park?
* Others may be concerned about the possibility that communication (whether email, phone, video) will be breached in some way. You can help with these concerns by making sure to use HIPAA-compliant services and encrypted email. However, if the patient/client is not comfortable with telepsychology, it is important to have alternative options for them. This may mean referring them to another provider who is offering in-person services.

#### Patients/clients at high risk

Patients at high risk for suicide present special concerns for telepsychology. Taking the steps below will help ensure that you are able to adequately manage risk.
* Update emergency contact information before providing any telepsychology services.
* Make sure you know the patient/client location (address, apartment number) at the start of the session in case you need to contact emergency services.
* Make a plan for how you will stay on the phone with the client while arranging emergency rescue if needed. It may be helpful to recruit a colleague who can support you during this process (i.e., call 911 on your behalf). Do not hang-up on the patient/client if there is an imminent risk.
* The circumstances that make telepsychology necessary (e.g., illness, injury) may also increase suicide risk, it is important to continue to assess suicidal thoughts and behaviors on a regular basis.
* Risk may also increase if the patient/client has access to lethal means while house-bound. Reviewing and updating existing safety plans to account for current circumstances is wise.
* As part of safety planning, work with the patient/client to identify the closest emergency facility and how they could get there if necessary.
* Consider making a plan for more frequent check-ins until risk abates.
* Provide crisis hotline numbers like the National Suicide Prevention Lifeline: 1-800-273-8255 and they can Text HOME to 741741 to connect with a Crisis Counselor to help at Crisis Text Line.
* Provide disaster distress helplines like SAMHSA's free 24/7 counseling via 1-800-985-5990, they can text: "TalkWithUs" to 66746, or visit DisasterDistress.samhsa.gov to help them maintain and improve their mental health during distress.
* More information for working with high risk patients is available:
* Telehealth tips for suicidal clients
* Telehealth treatment for suicidal patients
* Zero Suicide Guidelines
* Guidelines for telepsychology with youth at risk for suicide or self injury
* The COVID-19 pandemic and treating suicidal risk
* It is also important to consider the risk of domestic violence and child abuse during this time. SAMHSA has guidelines for helping those at risk and this list of resources is also helpful.

#### Patients/clients with ASD or intellectual disabilities

In some cases, patients with ASD or other intellectual disabilities may particularly benefit from telepsychology, as it enables them to remain in an environment where they are comfortable. However, it can also present some challenges. If the patient is a child, many/all of the considerations listed below may be relevant. Additional considerations for working with people with ASD or ID include: Do they have a caregiver who will be able to assist them with technical difficulties if need be? Are they able to participate productively, with or without the assistance of a caregiver, during a remote session? If they need help staying in frame and engaged, is there someone with them to fill that role? Do you have the necessary resources to maintain evidence-based services while working remotely (e.g., online-friendly assessment and therapeutic tools)?
These resources provide additional helpful information for working with these populations:
* Considerations and tips for providing Applied Behavior Analysis via telehealth
* Tele-ABA activities for youth with ASD
* COVID-19 resources for people with I/DD or ASD
* COVID 19 Resources for Parents of Children With Intellectual or Other Developmental Disabilities

## Working with children

Telepsychology with youth can be effective but requires some special considerations. Adolescents are likely to be comfortable with phone or video, but it may be a challenge to get them to focus on you and limit distractions. Younger children may also be distracted by their environment or may struggle to stay engaged. It may be necessary to modify your typical approach to work effectively with youth. Check out this video that covers the basics of telepsychology with youth. If you conduct groups with youth this video may also be helpful.

#### Setting the scene

* Encourage caregivers to minimize distractions in the room where the young patient/client will be completing the session by:
** Removing toys, books, extra screens/electronic devices/games, pets, and food
** Providing a clear desk/table space
** Notifying everyone in the home that the child will need privacy and quietness especially if the child is undergoing testing
* Young patients may prefer a “less formal” room set-up, so you might want to avoid having a table between the patient and the video-recording device (or you and the video-recording device).
* Ask the guardian to make sure that the youth wakes up at least an hour before the session, has eaten, used the restroom at least 15 minutes beforehand, and taken their prescribed medications.
* Consider the best seating arrangement. Young children can sit next to a caregiver, between the caregivers, on a caregiver’s lap, or in front of the caregiver in either their own chair or on the floor.
* You may want to ask the caregiver to put a blanket on the floor to indicate the "therapy boundary" that the child needs to stay within during the session. This helps ensure that you can see them at all times and that they aren't too active during the session.
* A hyperactive child or a child on the autism spectrum may have difficulty remaining in the camera frame. Consider keeping the caregivers in frame and call the child back to the camera when they need to answer a question.
* If an anxious or defiant youth refuses to sit within the camera frame, try to use typical behavior management strategies first. Then, prior to the next session, ask the caregiver to turn off the self-monitor image and seat the youth farther away from the camera so as to remain in the frame. Another strategy is to allow the youth to have more privacy for part or all of the session.
* If possible, larger rooms tend to work best with younger patients, so they can move around. In addition, if a child's motor skills, play, exploration, and movements are being assessed, the room should be large enough for this activity to fit within the camera frame.
* Adolescents may prefer to be seen without a caregiver present or within earshot. Help them brainstorm how to create privacy, even in tight quarters.
* Establish that you are seeing the patient/client in real-time. Young children may enjoy seeing you mimic their gestures, or comment on what they are wearing.
* Socialize youth to the videoconferencing system, and highlight that it might take time to acclimate to the technology and ‘‘not talk over each other.’’
* Give patients an opportunity to ask questions before starting the session.
* Ask children or caregivers to prepare some toys, drawing materials or other supplies that you may want to work with during the session at least 24-hours ahead of time and send them a reminder. Try to recreate your office as much as possible.

#### Maintaining engagement

* It is especially important to leave adequate time to build rapport and adjust to the new circumstances when working with youth.
* If you are using or creating worksheets or other visual activities, consider allowing the patient to choose the colors/fonts/pictures in order to provide them with some control.
* Use exaggerated expressions and gestures if needed to engage the youth (virtual high fives, thumbs up, etc.).
* Children may enjoy drawing pictures that they can then share through the camera while telling a story. These drawings may help you assess children’s attention, fine motor skills and creativity. Children may also use play figures (e.g., dolls, action figures) to demonstrate their ability for symbolic play and reveal their thought content.
* For younger children, ask them to share their favorite things about home — toys, books, blankets, etc. as long as it is related to clinical activities and is not disruptive.
* For older youth, ask if they have any art, journaling, music, or anything else to share with you. Consider engaging adolescents by exploring an online site, such as YouTube or Facebook through screen sharing
* Children and teens may appreciate getting to know clinicians as well. Consider using a brief question-and-answer game to share some facts about you and gather information about your patient. For example, you and your patient can take turns answering: “What is your favorite TV show?”, “What is your favorite color?”, “What is your favorite food?”, “How many siblings do you have?”
* Mirror the language patterns of the youth and handle any threats to rapport with genuineness (including using informal language).
* Arts-based therapeutic methods may help engage younger patients. You can have the patient show you their work on the camera or use screen share options to create art together (based on your platform’s capabilities).
* Consider sharing handouts and working through them in session if your platform has the functionality (e.g., Zoom screen share with editable documents or PowerPoints).
* Try utilizing different functions to increase engagement (e.g., Zoom has a “whiteboard” feature where a patient and clinician can draw together or play tic-tac-toe). Check with technology services at your site for specific training/tips on functionality for your platform.
* Especially with younger patients, recognize that staying engaged via telehealth is challenging. Adjust your expectations of how long sessions should last if you are having a hard time keeping your patient engaged.
* Consider incorporating games or other activities as appropriate. There are online games available that can be helpful for maintaining interest such as Board Game Arena or PlayingCards.io
* Research shows that youth’s satisfaction with telehealth will likely increase with repeated use; encourage young clients to stick with it for a few sessions to see if they become comfortable.
* It is important to continue conversations related to technical difficulties, unique challenges, or benefits that come from using telehealth throughout the treatment course. Keep an open dialogue about how things are going.

#### Additional resources

* Comprehensive guide for supporting children and families
* Telehealth testing with children: Important factors to consider
* Yale Child Study Family Resources and Suggestions for Coping with Coronavirus
* Interventions and activities for children and youth teletherapy
* First Aid for Feelings: A Workbook to Help Kids Cope During the Coronavirus Pandemic
* Webinar on family mental health during the pandemic
* Book for young children about coronavius
* Guided Imagery audio clips for kids
* Helping Children and Families Cope with the COVID-19 Pandemic
* Considerations for telepsychology with youth at risk for suicide or self injury
* Telepsychology with children and families

## Conducting assessment

Conducting assessment through telepsychology may seem challenging, but it is possible to continue to incorporate assessment in your practice. In some cases, it may be necessary to split an appointment to conduct some assessments via telepsychology and save others for when an in-person meeting is possible. APA has issued multiple statements on psychological and neuropsychological testing, important considerations when conducting teleassessment, and , including information about reimbursement and billing. There are also guidelines for conducting assessment with youth.

#### Self-report

Many practitioners administer self-report rating scales to assess patients over time. These are relatively easy to continue:
* Self-reports can be emailed to patient/clients to be completed and sent back
* Self-reports can be administered through HIPAA-compliant survey tools
* Self-reports can be read to the patient and they can respond orally

#### Interview-based

* Diagnostic interviews and clinical rating scales are often feasible to administer via telepsychology
* Behavior ratings may be more difficult to ascertain, though, so it is important to consider the information you need to collect and plan accordingly. If a certain interview relies on behavior observations, consider whether there is an alternative that may be more appropriate

#### Cognitive/Achievement and Neuropsychology

* Tests of cognition are likely to be the most difficult to administer via telepsychology.
* Given the importance of administering these tests under circumstances similar to those under which the norms were established, it is important to look into data supporting the administration of specific tests with telepsychology.
* Some tests have online versions. Although there would likely be additional costs associated with this approach, it is likely to be easier and more valid than adapting tests intended to be administered in person
* The Inter Organizational Practice Committee (IOPC)​ work-group has released guidelines for teleneuropsychology (Tele-NP) that may be helpful.
* IOPC has also released provisional recommendations and guidance regarding teleneuropsychology during the pandemic Practice Guidelines and Recommendations for Tele-NP

## Legal considerations

As noted above, it is important that your patient/client understand the potential risks of telepsychology (e.g., confidentiality, safety) and that they consent to the provision of services using telepsychology. In addition to patient consent, it is incumbent upon the provider to follow the rules related to HIPAA and other legal and professional guidelines. Although some of these rules have been relaxed due to the COVID-19 crisis, it is best to confirm the current rules in your area before engaging in telepsychology. Rules about telepsychology are typically governed by states, so you should be familiar with the rules in the state where you are licensed and practice as well as the state(s) where your patient/client may be at the time of the service.

## Reimbursement and fee collection

Services delivered via phone or video are billed under a separate code and, under typical circumstances, may be reimbursed at a different rate than in-person services. Medicare has modified its rules and will cover a wider range of telepsychology services, including testing and group therapy, during the COVID-19 crisis. Most private health insurance providers are also reimbursing for telelpsychology, but in order to ensure payment, practitioners should check with individual payers prior to providing services and submitting bills. If there are financial implications for patients/clients related to using telepsychology, these must be discussed and agreed upon.
Practitioners in private practice may be used to collecting fees by cash or check. Alternative methods for payment may be preferable for telepsychology. Patients/clients can mail a check, but the practitioner should consider where the check is sent and whether they are comfortable receiving payment at their home address. Electronic payment methods avoid this complication, but not all patients/clients will be comfortable transferring funds. Providing some education about the pros/cons of electronic payment and coaching on how to implement it will be helpful. A few options include:
* Zelle is a payment method that moves funds between bank accounts. It works across different banks and is integrated into many banking apps.
* PayPal is a more flexible option that can link with both credit cards and bank accounts. It also includes accounts for both businesses and individuals, which may be appealing for some who plan to collect fees electronically on an ongoing basis.
* Venmo is a popular payment tool that allows users to send funds from their bank account or from their Venmo account (if they have been paid by others through Venmo). An important consideration with Venmo is that payments are not necessarily private. You can set your preferences to be private, but if this is not done, others on the app can see payment exchanges.
If your practice is significantly affected by the COVID-19 crisis, you may be able to get a business loan.

## Information for Trainees

Trainees should follow the guidelines set by their institution and rely on their supervisors to provide instruction and support. Additionally, the Council of Chairs of Training Councils (CCTC) published guidelines related to training during the COVID-19 crisis. A video summarizing telepsychology guidelines for trainees is also available. Self care is also important to pay attention to during this challenging time when may aspects of training may be in upheaval.
To further aid trainees, free clinical hour tracking software is available, which contrasts with other services that typically charge monthly fees. This resource can be a significant support in managing and organizing clinical hours at no cost to students and professionals seeking licensure.

## Supervision

Supervision can be especially valuable when initiating a new approach to mental health services - including telepsychology. Trainees should be sure to maintain a consistent meeting schedule with their clinical supervisor, and even licensed practitioners may want to seek supervision from someone experienced in telepsychology until they feel comfortable with it. Although some aspects of supervision can be conducted without modification (e.g., session planning, self-report about a previous session), other aspects require some change, similar to modifications that are necessary for providing services. Telesupervision is remote clinical supervision by mentor health professionals over their graduate students, trainees, fellows, or assistants through innovative means like video-conferencing, teleconferencing, and emailing. Fortunately, evidence suggests that telesupervision can be just as effective as supervision received in person Seek guidance from your program to ensure supervision continues to meet APA or other professional requirements. The APA posted considerations for training clinics conducting telesupervision during COVID-19. The Association for Behavioral & Cognitive Therapies has released videos on strategies for effective telesupervision and on the experience of being a trainee conducting telepsychology.

#### Observation

* Many programs are set-up to video or audio record assessment and therapy sessions so that supervisors can watch/listen to them later and provide feedback. Some video conferencing programs allow for the recording of sessions, which is helpful, but before using this option, make sure that:
* The video service is HIPAA-compliant and that the recording is stored in a HIPAA-compliant fashion
* The video is shared with the supervisor in a HIPAA-compliant way (e.g., secured file sharing program)
* Sessions can also be audio recorded, particularly if done through speakerphone, but the way the audio file is shared with the supervisor must be HIPAA-compliant

#### Progress Notes

* Many organizations use an electronic medical record (EMR) to store notes. If you have access to this from outside the office, no change in your typical approach may be necessary.
* Other organizations have paper records or an EMR that is not accessible outside the institution. In these cases, it is still important to document what occurred in your sessions and to make plans for transferring this information to the record when possible. Be sure you have a HIPAA-compliant way of storing these notes until you have access again to the EMR, this could be an encrypted digital folder or in a paper file.

#### Evidence-Informed Practical Tips for Telesupervision

These tips are adapted from a published literature review in 2017 on effective and efficient use of technology in clinical supervision.
* The first step in a successful telesupervision partnership is to set explicit goals and expectations in an agreement or contract. This should be done within the first couple of sessions face to face (or via video conference) and revisited regularly.
* There is no one size fits all with the type and way of telesupervision. Consider trying different types of telecommunication to find out what is going to be most feasible/effective for the people involved.
* As with in-person supervision, guidance should be based within an established framework. This will help provide structure to supervision sessions and connect back to therapy sessions.
* The supervisory relationship is critical for success. Fostering a positive relationship will help make telesupervision feel more like face-to-face supervision.
* Make a plan to manage technical problems. This should be included in the telesupervision agreement that was made in the beginning, so that there is a set protocol when tech issues arise. This will help to save time and avoid miscommunication.
* Pay attention to communication, especially when there is a lack of physical cues available. This means taking turns talking, allowing silence for reflection, limiting distractions, muting sound when appropriate, and avoiding multi-tasking while in a supervision session.
* To make up for the lack of proximity, supervisors should make sure to be available to the supervisee between sessions. The expectations for availability should be discussed and written out during the formation of the telesupervision partnership.
* Protect online security, safety, and confidentiality.
* Factor in additional time to accommodate technical problems and make sure to set an agenda, so that the time is used efficiently.
* Discuss how telesupervision is going on a regular basis. This means evaluating set goals, the quality of the relationship, the success of the current telecommunication mediums, the helpfulness of supervisor feedback, the satisfaction level of learning from the supervisee, etc. Update the supervision contract as necessary to ensure both parties remain pleased.

## Telepsychology Services

If you are not comfortable or able to provide telepsychology services, consider referring patients/clients to an alternative provider to ensure they are able to get the help they need when you may not be available.
* Optum online
* Joyable
* Talkspace
* Popular mental health apps
* For those with OCD or related disorders like Hoarding, Skin excoriation, and Trichotillomania NOCD

## Research on the effectiveness of telepsychology

Research comparing clinic-based psychotherapy to video-based services have largely found that therapy delivered via telecommunication has similar outcomes. Similarly, although the administration of assessment can be more complicated, in may cases valid results can be achieved. Below is a list of references comparing in-person and telepsychology services.

### Psychotherapy

APA Division 12 (Society of Clinical Psychology) compiled a list of publications on teletherapy. The publications are grouped by disorder (e. g. Depression) or directed focus of the therapy (e.g. Couples and Family Therapy). This systematic review also provides a helpful summary.
The Journal of Psychotherapy Integration also published a Special Issue on Telepsychotherapy in the Age of COVID-19. All articles are open access.
Anxiety
Arnberg, F. K., Linton, S. J., Hultcrantz, M., Heintz, E., & Jonsson, U. (2014). Internet-delivered psychological treatments for mood and anxiety disorders: A systematic review of their efficacy, safety, and cost-effectiveness. PloS ONE
Brenes, G. A., Ingram, C. W., & Danhauer, S. C. (2012). Telephone-delivered psychotherapy for late-life anxiety. Psychological Services, 9(2), 219.
Carpenter, A. L., Pincus, D. B., Furr, J. M., & Comer, J. S. (2018). Working from home: An initial pilot examination of videoconferencing-based cognitive behavioral therapy for anxious youth delivered to the home setting. Behavior Therapy, 49(6), 917-930.
Durland, L., Interian, A., Pretzer-Aboff, I., Dobkin, R. D. (2014). Effect of telehealth-to-home interventions on quality of life for individuals with depressive and anxiety disorders. Smart Homecare Technology and Telehealth, 2, 101-119.
Khatri, N., Marziali, E., Tchernikov, I., & Shepherd, N. (2014). Comparing telehealth-based and clinic-based group cognitive behavioral therapy for adults with depression and anxiety: A pilot study. Clinical Interventions in Aging, 9, 765.
McCall, T., Bolton, C. I., McCall, R., & Khairat, S. (2019). The Use of Culturally-Tailored Telehealth Interventions in Managing Anxiety and Depression in African American Adults: A Systematic Review. Studies in Health Technology and Informatics, 264, 1728-1729.
Rees, C. S., & Maclaine, E. (2015). A systematic review of videoconference‐delivered psychological treatment for anxiety disorders. Australian Psychologist, 50(4), 259-264.
Varker, T., Brand, R. M., Ward, J., Terhaag, S., & Phelps, A. (2018). Efficacy of synchronous telepsychology interventions for people with anxiety, depression, posttraumatic stress disorder, and adjustment disorder: A rapid evidence assessment. Psychological Services.
Whiteside, S. P. (2016). Mobile device-based applications for childhood anxiety disorders. Journal of Child and Adolescent Psychopharmacology, 26(3), 246-251.
Wootton, B. M., Steinman, S. A., Czerniawski, A., Norris, K., Baptie, C., Diefenbach, G. J., & Tolin, D. F. (2018). An evaluation of the effectiveness of a transdiagnostic bibliotherapy program for anxiety and related disorders: Results from two studies using a benchmarking approach. Cognitive Therapy and Research, 42, 565-580.
Yuen, E. K., Herbert, J. D., Forman, E. M., Goetter, E. M., Juarascio, A. S., Rabin, S., … & Bouchard, S. (2013). Acceptance based behavior therapy for social anxiety disorder through videoconferencing. Journal of Anxiety Disorders, 27(4), 389-397.
Autism Spectrum
Ferguson, J., Craig, E. A., & Dounavi, K. (2019). Telehealth as a model for providing behaviour analytic interventions to individuals with autism spectrum disorder: A systematic review. Journal of Autism and Developmental Disorders, 49(2), 582-616.
Hepburn, S. L., Blakeley-Smith, A., Wolff, B., & Reaven, J. A. (2016). Telehealth delivery of cognitive-behavioral intervention to youth with autism spectrum disorder and anxiety: A pilot study. Autism, 20(2), 207-218.
Bipolar Disorder
Aref-Adib, G., McCloud, T., Ross, J., O’Hanlon, P., Appleton, V., Rowe, S., … & Lobban, F. (2019). Factors affecting implementation of digital health interventions for people with psychosis or bipolar disorder, and their family and friends: A systematic review. The Lancet Psychiatry, 6(3), 257-266.
Hidalgo-Mazzei, D., Mateu, A., Reinares, M., Matic, A., Vieta, E., & Colom, F. (2015). Internet-based psychological interventions for bipolar disorder: Review of the present and insights into the future. Journal of Affective Disorders, 188, 1-13.
Chronic Pain
Connolly, K. S., Vanderploeg, P. S., Kerns, R. D., Grant, C., Sellinger, J., & Godleski, L. (2018). Nationwide Implementation and Outcomes of Cognitive Behavioral Therapy for Chronic Pain Over Clinical Video Teleconferencing. Journal of Technology in Behavioral Science, 3(1), 26-31.
Glynn, L. H., Chen, J. A., Dawson, T. C., Gelman, H., & Zeliadt, S. B. (2020). Bringing chronic-pain care to rural veterans: A telehealth pilot program description. Psychological Services.
Couples and Family Therapy
Doss, B. D., Feinberg, L. K., Rothman, K., Roddy, M. K., & Comer, J. S. (2017). Using technology to enhance and expand interventions for couples and families: Conceptual and methodological considerations. Journal of Family Psychology, 31(8), 983.
Kysely, A., Bishop, B., Kane, R., Cheng, M., De Palma, M., & Rooney, R. (2019). Expectations and Experiences of Couples Receiving Therapy Through Videoconferencing: A Qualitative Study. Frontiers in Psychology, 10.
Wrape, E. R., & McGinn, M. M. (2019). Clinical and ethical considerations for delivering couple and family therapy via telehealth. Journal of Marital and Family Therapy, 45(2), 296-308.
James Riegler, L., Raj, S. P., Moscato, E. L., Narad, M. E., Kincaid, A., & Wade, S. L. (2020). Pilot trial of a telepsychotherapy parenting skills intervention for veteran families: Implications for managing parenting stress during COVID-19. Journal of Psychotherapy Integration, 30(2), 290-303. http://dx.doi.org/10.1037/int0000220
Depression
Acosta, T., Meltzer-Brody, S., & Tolleson-Rinehart, S. (2017). Academic and Community Partnerships: Telepsychiatry for Perinatal Depression in a Rural Setting [31D]. Obstetrics & Gynecology, 129(5), 49S-50S.
Arnberg, F. K., Linton, S. J., Hultcrantz, M., Heintz, E., & Jonsson, U. (2014). Internet-delivered psychological treatments for mood and anxiety disorders: a systematic review of their efficacy, safety, and cost-effectiveness. PloS ONE.
Choi, N. G., Marti, C. N., Bruce, M. L., Hegel, M. T., Wilson, N. L., & Kunik, M. E. (2014). Six‐month postintervention depression and disability outcomes of in‐home telehealth problem‐solving therapy for depressed, low‐income homebound older adults. Depression and Anxiety, 31(8), 653-661.
Choi, N. G., Wilson, N. L., Sirrianni, L., Marinucci, M. L., & Hegel, M. T. (2014). Acceptance of home-based telehealth problem-solving therapy for depressed, low-income homebound older adults: Qualitative interviews with the participants and aging-service case managers. The Gerontologist, 54(4), 704-713.
Deady, M., Choi, I., Calvo, R. A., Glozier, N., Christensen, H., & Harvey, S. B. (2017). eHealth interventions for the prevention of depression and anxiety in the general population: a systematic review and meta-analysis. BMC Psychiatry, 17(1), 310.
Dobkin, R. D., Interian, A., Durland, J. L., Gara, M. A., & Menza, M. A. (2018). Personalized Telemedicine for Depression in Parkinson’s Disease: A Pilot Trial. Journal of Geriatric Psychiatry and Neurology, 31(4), 171–176. https://doi.org/10.1177/0891988718783274
Fairchild, R. M., Ferng-Kuo, S. F., Rahmouni, H., & Hardesty, D. (2020). Telehealth increases access to care for children dealing with suicidality, depression, and anxiety in rural emergency departments. Telemedicine and E-Health.
Garcia, R. A. (2017). Population Health Management Telehealth Intervention Medical Research Treating Comorbid Clinical Obesity and Depression in Geriatric Patients Part One: Review of Tele-Medicine Scientific Research. Research in Medical & Engineering Sciences, 1(5), 1-4.
Gellis, Z. D., Kenaley, B. L., & Have, T. T. (2014). Integrated telehealth care for chronic illness and depression in geriatric home care patients: The Integrated Telehealth Education and Activation of Mood (I‐TEAM) study. Journal of the American Geriatrics Society, 62(5), 889-895.
Khatri, N., Marziali, E., Tchernikov, I., & Shepherd, N. (2014). Comparing telehealth-based and clinic-based group cognitive behavioral therapy for adults with depression and anxiety: a pilot study. Clinical Interventions in Aging, 9, 765.
Kim, S. C., Shaw, B. R., Shah, D. V., Hawkins, R. P., Pingree, S., McTavish, F. M., & Gustafson, D. H. (2019). Interactivity, Presence, and Targeted Patient Care: Mapping e-Health Intervention Effects Over Time for Cancer Patients with Depression. Health Communication, 34(2), 162-171.
Kim, E., Gellis, Z. D., & Hoak, V. (2015). Telehealth utilization for chronic illness and depression among home health agencies: A pilot survey. Home Health Care Services Quarterly, 34(3-4), 220-231.
Kim, E. H., Gellis, Z. D., Bradway, C. K., & Kenaley, B. (2019). Depression care services and telehealth technology use for homebound elderly in the United States. Aging & Mental Health, 23(9), 1164-1173.
Lichstein, K. L., Scogin, F., Thomas, S. J., DiNapoli, E. A., Dillon, H. R., & McFadden, A. (2013). Telehealth cognitive behavior therapy for co‐occurring insomnia and depression symptoms in older adults. Journal of Clinical Psychology, 69(10), 1056-1065.
McCall, T., Bolton, C. I., McCall, R., & Khairat, S. (2019). The Use of Culturally-Tailored Telehealth Interventions in Managing Anxiety and Depression in African American Adults: A Systematic Review. Studies in Health Technology and Informatics, 264, 1728-1729.
Massoudi, B., Holvast, F., Bockting, C. L., Burger, H., & Blanker, M. H. (2019). The effectiveness and cost-effectiveness of e-health interventions for depression and anxiety in primary care: A systematic review and meta-analysis. Journal of Affective Disorders, 245, 728-743.
Moreno, F. A., Chong, J., Dumbauld, J., Humke, M., & Byreddy, S. (2012). Use of standard Webcam and Internet equipment for telepsychiatry treatment of depression among underserved Hispanics. Psychiatric Services, 63(12), 1213-1217.
Naik, A. D., Lawrence, B., Kiefer, L., Ramos, K., Utech, A., Masozera, N., … & Cully, J. A. (2015). Building a primary care/research partnership: lessons learned from a telehealth intervention for diabetes and depression. Family Practice, 32(2), 216-223.
Price, M., & Gros, D. F. (2014). Examination of prior experience with telehealth and comfort with telehealth technology as a moderator of treatment response for PTSD and depression in veterans. The International Journal of Psychiatry in Medicine, 48(1), 57-67.
Osenbach, J. E., O’Brien, K. M., Mishkind, M., & Smolenski, D. J. (2013). Synchronous telehealth technologies in psychotherapy for depression: A meta‐analysis. Depression and Anxiety, 30(11), 1058-1067.
Roth, D. E., Ramtekkar, U., & Zeković-Roth, S. (2019). Telepsychiatry: a new treatment venue for pediatric depression. Child and Adolescent Psychiatric Clinics, 28(3), 377-395.
Salisbury, C., O’Cathain, A., Edwards, L., Thomas, C., Gaunt, D., Hollinghurst, S., … & Foster, A. (2016). Effectiveness of an integrated telehealth service for patients with depression: A pragmatic randomised controlled trial of a complex intervention. The Lancet Psychiatry, 3(6), 515-525.
Scogin, F., Lichstein, K., DiNapoli, E. A., Woosley, J., Thomas, S. J., LaRocca, M. A., … & Parton, J. (2018). Effects of integrated telehealth-delivered cognitive-behavioral therapy for depression and insomnia in rural older adults. Journal of Psychotherapy Integration, 28(3), 292-309.
Eating Disorders
Anderson, K. E., Byrne, C. E., Crosby, R. D., & Le Grange, D. (2017). Utilizing Telehealth to deliver family‐based treatment for adolescent anorexia nervosa. International Journal of Eating Disorders, 50(10), 1235-1238.
Shingleton, R. M., Richards, L. K., & Thompson-Brenner, H. (2013). Using technology within the treatment of eating disorders: A clinical practice review. Psychotherapy, 50(4), 576.
Insomnia
Gehrman, P., Shah, M. T., Miles, A., Kuna, S., & Godleski, L. (2016). Feasibility of group cognitive-behavioral treatment of insomnia delivered by clinical video telehealth. Telemedicine and e-Health, 22(12), 1041-1046.
Holmqvist, M., Vincent, N., & Walsh, K. (2014). Web-vs telehealth-based delivery of cognitive behavioral therapy for insomnia: a randomized controlled trial. Sleep medicine, 15(2), 187-195.
Lichstein, K. L., Scogin, F., Thomas, S. J., DiNapoli, E. A., Dillon, H. R., & McFadden, A. (2013). Telehealth cognitive behavior therapy for co‐occurring insomnia and depression symptoms in older adults. Journal of Clinical Psychology, 69(10), 1056-1065.
Obsessive-Compulsive Disorder
Aboujaoude, E. (2017). Three decades of telemedicine in obsessive-compulsive disorder: a review across platforms. Journal of obsessive-compulsive and related disorders, 14, 65-70.
Brand, J., & McKay, D. (2012). Telehealth approaches to obsessive-compulsive related disorders. Psychotherapy Research, 22(3), 306-316.
Goetter, E. M., Herbert, J. D., Forman, E. M., Yuen, E. K., Gershkovich, M., Glassman, L. H., … & Goldstein, S. P. (2013). Delivering exposure and ritual prevention for obsessive–compulsive disorder via videoconference: Clinical considerations and recommendations. Journal of Obsessive-Compulsive and Related Disorders, 2(2), 137-145.
Goetter, E. M., Herbert, J. D., Forman, E. M., Yuen, E. K., & Thomas, J. G. (2014). An open trial of videoconference-mediated exposure and ritual prevention for obsessive-compulsive disorder. Journal of Anxiety Disorders, 28(5), 460-462.
Himle, J. A., Fischer, D. J., Muroff, J. R., Van Etten, M. L., Lokers, L. M., Abelson, J. L., & Hanna, G. L. (2006). Videoconferencing-based cognitive-behavioral therapy for obsessive-compulsive disorder. Behaviour Research and Therapy, 44(12), 1821-1829.
Storch, E. A., Caporino, N. E., Morgan, J. R., Lewin, A. B., Rojas, A., Brauer, L., … & Murphy, T. K. (2011). Preliminary investigation of web-camera delivered cognitive-behavioral therapy for youth with obsessive-compulsive disorder. Psychiatry Research, 189(3), 407-412.
Posttraumatic Stress Disorder
Acierno, R., Gros, D. F., Ruggiero, K. J., Hernandez‐Tejada, M. A., Knapp, R. G., Lejuez, C. W., … & Tuerk, P. W. (2016). Behavioral activation and therapeutic exposure for posttraumatic stress disorder: A noninferiority trial of treatment delivered in person versus home‐based telehealth. Depression and Anxiety, 33(5), 415-423.
Acierno, R., Knapp, R., Tuerk, P., Gilmore, A. K., Lejuez, C., Ruggiero, K., … & Foa, E. B. (2017). A non-inferiority trial of prolonged exposure for posttraumatic stress disorder: In person versus home-based telehealth. Behaviour Research and Therapy, 89, 57-65.
Battaglia, C., Peterson, J., Whitfield, E., Min, S. J., Benson, S. L., Maddox, T. M., & Prochazka, A. V. (2016). Integrating motivational interviewing into a home telehealth program for veterans with posttraumatic stress disorder who smoke: A randomized controlled trial. Journal of Clinical Psychology, 72(3), 194-206.
Bolton, A. J., & Dorstyn, D. S. (2015). Telepsychology for posttraumatic stress disorder: A systematic review. Journal of Telemedicine and Telecare, 21(5), 254-267.
Glassman, L. H., Mackintosh, M. A., Talkovsky, A., Wells, S. Y., Walter, K. H., Wickramasinghe, I., & Morland, L. A. (2019). Quality of life following treatment for PTSD: Comparison of video-teleconferencing and in-person modalities. Journal of Telemedicine and Telecare.
Gros, D. F., Lancaster, C. L., López, C. M., & Acierno, R. (2018). Treatment satisfaction of home-based telehealth versus in-person delivery of prolonged exposure for combat-related PTSD in veterans. Journal of Telemedicine and Telecare, 24(1), 51-55.
Gros, D. F., Yoder, M., Tuerk, P. W., Lozano, B. E., & Acierno, R. (2011). Exposure therapy for PTSD delivered to veterans via telehealth: Predictors of treatment completion and outcome and comparison to treatment delivered in person. Behavior Therapy, 42(2), 276-283.
Jaconis, M., Santa Ana, E. J., Killeen, T. K., Badour, C. L., & Back, S. E. (2017). Concurrent treatment of PTSD and alcohol use disorder via telehealth in a female Iraq veteran. The American Journal on Addictions, 26(2), 112-114.
Lindsay, J. A., Kauth, M. R., Hudson, S., Martin, L. A., Ramsey, D. J., Daily, L., & Rader, J. (2015). Implementation of video telehealth to improve access to evidence-based psychotherapy for posttraumatic stress disorder. Telemedicine and e-Health, 21(6), 467-472.
Liu, L., Thorp, S. R, Moreno, L., Wells, S. Y., Glassman, L. H., Busch, A. C., Zamora, T., Rodgers, C. S., Allard, C. B., Morland, L. A., and Agha, Z. (in press). Videoconferencing psychotherapy for veterans with PTSD: Results from a randomized controlled non-inferiority trial. Journal of Telemedicine and Telecare.
Morland, L. A., Greene, C. J., Rosen, C. S., Kuhn, E., Hoffman, J., & Sloan, D. M. (2017). Telehealth and eHealth interventions for posttraumatic stress disorder. Current Opinion in Psychology, 14, 102-108.
Morland, L. A., Hynes, A. K., Mackintosh, M. A., Resick, P. A., & Chard, K. M. (2011). Group cognitive processing therapy delivered to veterans via telehealth: A pilot cohort. Journal of Traumatic Stress, 24(4), 465-469.
Morland, L. A., Raab, M., Mackintosh, M. A., Rosen, C. S., Dismuke, C. E., Greene, C. J., & Frueh, B. C. (2013). Telemedicine: A cost-reducing means of delivering psychotherapy to rural combat veterans with PTSD. Telemedicine Journal and E-health: The official Journal of the American Telemedicine Association, 19(10), 754–759. https://doi.org/10.1089/tmj.2012.0298
Morland, L. A., Macdonald, A., Grubbs, K., Mackintosh, M., Monson, C., Glassman, L., Cretu, J., Sautter, F., Buzzella, B., Wrape, E., Wells, S. Y., Rooney, B. M., & Glynn, S. (2019). Design of a randomized superiority trial of a brief couple treatment for PTSD. Contemporary Clinical Trials Communications. 15:100369
Morland, L. A., Mackintosh, M. A., Glassman, L. H., Wells, S. Y., Thorp, S. R., Rauch, S. A., … & Sohn, M. J. (2019). Home‐based delivery of variable length prolonged exposure therapy: A comparison of clinical efficacy between service modalities. Depression and Anxiety 37(4): 346–355..
Morland, L.A., Mackintosh, M.A., Greene, C.J., Rosen, C.S., Chard, K.M., Resick, P., & Frueh, B.C. (2014). Cognitive processing therapy for posttraumatic stress disorder delivered to rural veterans via telemental health: A randomized noninferiority clinical trial. Journal of Clinical Psychiatry, 75, 470-476.
Morland, L. A., Mackintosh, M. A., Rosen, C. S., Willis, E., Resick, P., Chard, K., & Frueh, B. C. (2015). Telemedicine versus in‐person delivery of cognitive processing therapy for women with posttraumatic stress disorder: A randomized noninferiority trial. Depression and Anxiety, 32(11), 811-820.
Morland, L. A., Wells, S. Y., Glassman, L. H., Grubbs, K. M., Mackintosh, M. A., Golshan, S., … & Acierno, R. E. (2019). What Do Veterans Want? Understanding Veterans’ Preferences for PTSD Treatment Delivery. Military Medicine, 184(11-12), 686-692.
Niles, B. L., Klunk-Gillis, J., Ryngala, D. J., Silberbogen, A. K., Paysnick, A., & Wolf, E. J. (2012). Comparing mindfulness and psychoeducation treatments for combat-related PTSD using a telehealth approach. Psychological Trauma: Theory, Research, Practice, and Policy, 4(5), 538.
Olden, M., Wyka, K., Cukor, J., Peskin, M., Altemus, M., Lee, F. S., … & Difede, J. (2017). Pilot study of a telehealth-delivered medication-augmented exposure therapy protocol for PTSD. The Journal of Nervous and Mental Disease, 205(2), 154.
Pelton, D., Wangelin, B., & Tuerk, P. (2015). Utilizing telehealth to support treatment of acute stress disorder in a theater of war: Prolonged exposure via clinical videoconferencing. Telemedicine and e-Health, 21(5), 382-387.
Possemato, K., Ouimette, P., & Knowlton, P. (2011). A brief self-guided telehealth intervention for post-traumatic stress disorder in combat veterans: a pilot study. Journal of Telemedicine and Telecare, 17(5), 245-250.
Price, M., & Gros, D. F. (2014). Examination of prior experience with telehealth and comfort with telehealth technology as a moderator of treatment response for PTSD and depression in veterans. The International Journal of Psychiatry in Medicine, 48(1), 57-67.
Sloan, D. M., Gallagher, M. W., Feinstein, B. A., Lee, D. J., & Pruneau, G. M. (2011). Efficacy of telehealth treatments for posttraumatic stress-related symptoms: a meta-analysis. Cognitive Behaviour Therapy, 40(2), 111-125.
Stewart, R. W., Orengo-Aguayo, R. E., Cohen, J. A., Mannarino, A. P., & de Arellano, M. A. (2017). A pilot study of trauma-focused cognitive–behavioral therapy delivered via telehealth technology. Child Maltreatment, 22(4), 324-333.
Stewart, R. W., Orengo-Aguayo, R. E., Gilmore, A. K., & de Arellano, M. (2017). Addressing Barriers to Care Among Hispanic Youth: Telehealth Delivery of Trauma-Focused Cognitive Behavioral Therapy. The Behavior Therapist, 40(3), 112.
Stewart, R. W., Orengo-Aguayo, R., Young, J., Wallace, M. M., Cohen, J. A., Mannarino, A. P., & de Arellano, M. A. (2020). Feasibility and effectiveness of a telehealth service delivery model for treating childhood posttraumatic stress: A community-based, open pilot trial of trauma-focused cognitive–behavioral therapy. Journal of Psychotherapy Integration, 30(2), 274-289. http://dx.doi.org/10.1037/int0000225
Strachan, M., Gros, D. F., Yuen, E., Ruggiero, K. J., Foa, E. B., & Acierno, R. (2012). Home-based telehealth to deliver evidence-based psychotherapy in veterans with PTSD. Contemporary Clinical Trials, 33(2), 402-409.
Tuerk, P. W., Yoder, M., Ruggiero, K. J., Gros, D. F., & Acierno, R. (2010). A pilot study of prolonged exposure therapy for posttraumatic stress disorder delivered via telehealth technology. Journal of Traumatic Stress: Official Publication of The International Society for Traumatic Stress Studies, 23(1), 116-123.
Varker, T., Brand, R. M., Ward, J., Terhaag, S., & Phelps, A. (2018). Efficacy of synchronous telepsychology interventions for people with anxiety, depression, posttraumatic stress disorder, and adjustment disorder: A rapid evidence assessment. Psychological Services.
Wierwille, J. L., Pukay-Martin, N. D., Chard, K. M., & Klump, M. C. (2016). Effectiveness of PTSD telehealth treatment in a VA clinical sample. Psychological Services, 13(4), 373.
Yuen, E. K., Gros, D. F., Price, M., Zeigler, S., Tuerk, P. W., Foa, E. B., & Acierno, R. (2015). Randomized controlled trial of home‐based telehealth versus in‐person prolonged exposure for combat‐related PTSD in veterans: Preliminary results. Journal of Clinical Psychology, 71(6), 500-512.
McLean, C. P., Miller, M. L., Gengler, R., Henderson, J., & Sloan, D. (2020). The efficacy of written exposure therapy versus imaginal exposure delivered online for posttraumatic stress disorder: Design of a randomized controlled trial in Veterans. Contemporary Clinical Trials, 105990.
Psychotic Disorders
Aref-Adib, G., McCloud, T., Ross, J., O’Hanlon, P., Appleton, V., Rowe, S., … & Lobban, F. (2019). Factors affecting implementation of digital health interventions for people with psychosis or bipolar disorder, and their family and friends: A systematic review. The Lancet Psychiatry, 6(3), 257-266.
Hom, M. A., Weiss, R. B., Millman, Z. B., Christensen, K., Lewis, E. J., Cho, S., Yoon, S., Meyer, N. A., Kosiba, J. D., Shavit, E., Schrock, M. D., Levendusky, P. G., Björgvinsson, T. (2020). Development of a virtual partial hospital program for an acute psychiatric population: Lessons learned and future directions for telepsychotherapy. Journal of Psychotherapy Integration, 30(2), 366-382. http://dx.doi.org/10.1037/int0000212
Lawes-Wickwar, S., McBain, H., & Mulligan, K. (2018). Application and effectiveness of telehealth to support severe mental illness management: Systematic review. JMIR Mental Health, 5(4), e62.
Self-Harm/Suicidal Behavior
Benson, S. S., Dimian, A. F., Elmquist, M., Simacek, J., McComas, J. J., & Symons, F. J. (2018). Coaching parents to assess and treat self‐injurious behaviour via telehealth. Journal of Intellectual Disability Research, 62(12), 1114-1123.
Fairchild, R. M., Ferng-Kuo, S. F., Rahmouni, H., & Hardesty, D. (2020). Telehealth increases access to care for children dealing with suicidality, depression, and anxiety in rural emergency departments. Telemedicine and e-Health.
Gros, D. F., Veronee, K., Strachan, M., Ruggiero, K. J., & Acierno, R. (2011). Managing suicidality in home-based telehealth. Journal of Telemedicine and Telecare, 17(6), 332-335.
Kasckow, J., Zickmund, S., Rotondi, A., Mrkva, A., Gurklis, J., Chinman, M., … & Haas, G. (2014). Development of telehealth dialogues for monitoring suicidal patients with schizophrenia: Consumer feedback. Community Mental Health Journal, 50(3), 339-342.
Kasckow, J., Zickmund, S., Gurklis, J., Luther, J., Fox, L., Taylor, M., … & Haas, G. L. (2016). Using telehealth to augment an intensive case monitoring program in veterans with schizophrenia and suicidal ideation: A pilot trial. Psychiatry Research, 239, 111-116.
Kasckow, J., Gao, S., Hanusa, B., Rotondi, A., Chinman, M., Zickmund, S., … & Haas, G. L. (2015). Telehealth monitoring of patients with schizophrenia and suicidal ideation. Suicide and Life‐Threatening Behavior, 45(5), 600-611.
Leavey, K., & Hawkins, R. (2017). Is cognitive behavioural therapy effective in reducing suicidal ideation and behaviour when delivered face-to-face or via e-health? A systematic review and meta-analysis. Cognitive Behaviour Therapy, 46(5), 353-374.
McGinn, M. M., Roussev, M. S., Shearer, E. M., McCann, R. A., Rojas, S. M., & Felker, B. L. (2019). Recommendations for using clinical video telehealth with patients at high risk for suicide. Psychiatric Clinics of North America, 42(4), 587-595.
Substance Use Disorders
Acosta, M. C., Possemato, K., Maisto, S. A., Marsch, L. A., Barrie, K., Lantinga, L., … & Rosenblum, A. (2017). Web-delivered CBT reduces heavy drinking in OEF-OIF veterans in primary care with symptomatic substance use and PTSD. Behavior Therapy, 48(2), 262-276.
Gilmore, A. K., Wilson, S. M., Skopp, N. A., Osenbach, J. E., & Reger, G. (2017). A systematic review of technology-based interventions for co-occurring substance use and trauma symptoms. Journal of Telemedicine and Telecare, 23(8), 701-709.
Lin, L. A., Casteel, D., Shigekawa, E., Weyrich, M. S., Roby, D. H., & McMenamin, S. B. (2019). Telemedicine-delivered treatment interventions for substance use disorders: A systematic review. Journal of Substance Abuse Treatment, 101, 38-49.
Sugarman, D. E., Campbell, A. N., Iles, B. R., & Greenfield, S. F. (2017). Technology-based interventions for substance use and comorbid disorders: An examination of the emerging literature. Harvard Review of Psychiatry, 25(3), 123.
Young, L. B. (2012). Telemedicine interventions for substance-use disorder: A literature review. Journal of Telemedicine and Telecare, 18(1), 47-53.
Non-Specific/General Publications
Barak, A., & Grohol, J. M. (2011). Current and future trends in internet-supported mental health interventions. Journal of Technology in Human Services, 29(3), 155-196.
Mozer, E., Franklin, B., & Rose, J. (2008). Psychotherapeutic intervention by telephone. Clinical Interventions in Aging, 3(2), 391.
Seager van Dyk, Ilana & Kroll, Juliet & Martinez, Ruben. (2020). COVID-19 Tips: Building Rapport with Youth via Telehealth. 10.13140/RG.2.2.23293.10727.

### Assessment

Brearly, T. W., Shura, R. D., Martindale, S. L., Lazowski, R. A., Luxton, D. D., Shenal, B. V., & Rowland, J. A. (2017). Neuropsychological test administration by videoconference: A systematic review and meta-analysis. Neuropsychology Review, 27(2), 174-186. https://www.ncbi.nlm.nih.gov/pubmed/28623461
Grosch, M. C., Gottlieb, M. C., & Cullum, C. M. (2011). Initial practice recommendations for teleneuropsychology. The Clinical Neuropsychologist, 25(7), 1119-1133. https://www.tandfonline.com/doi/abs/10.1080/13854046.2011.609840
Miller, J. B., & Barr, W. B. (2017). The technology crisis in neuropsychology. Archives of Clinical Neuropsychology, 32(5), 541-554. https://academic.oup.com/acn/article/32/5/541/3852214
Barcellos, L. F., Bellesis, K. H., Shen, L., Shao, X., Chinn, T., Frndak, S., ... & Benedict, R. H. (2018). Remote assessment of verbal memory in MS patients using the California Verbal Learning Test. Multiple Sclerosis Journal,24(3), 354-357. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5538936/
Barton, C., Morris, R., Rothlind, J., & Yaffe, K. (2011). Video-telemedicine in a memory disorders clinic: Evaluation and management of rural elders with cognitive impairment. Telemedicine and e-Health, 17(10), 789–793. https://www.ncbi.nlm.nih.gov/pubmed/22023458
Cullum, C., Weiner, M., Gehrmann, H., & Hynan, L. (2006). Feasibility of telecognitive assessment in dementia. Assessment, 13(4), 385–390. https://www.ncbi.nlm.nih.gov/pubmed/17050908
Cullum, C., Hynan, L., Grosch, M., Parikh, M., & Weiner, M. (2014). Teleneuropsychology: Evidence for video teleconference-based neuropsychological assessment. Journal of the International Neuropsychological Society, 20(10), 1028–1033. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4410096/
de Jager, C. A., Budge, M. M., & Clarke, R. (2003). Utility of TICS‐M for the assessment of cognitive function in older adults. International Journal of Geriatric Psychiatry, 18(4), 318-324. https://onlinelibrary.wiley.com/doi/abs/10.1002/gps.830
DeYoung, N., & Shenal, B. V. (2019). The reliability of the Montreal Cognitive Assessment using telehealth in a rural setting with veterans. Journal of Telemedicine and Telecare, 25(4), 197-203. https://journals.sagepub.com/doi/abs/10.1177/1357633X17752030
Galusha-Glasscock, J. M., Horton, D. K., Weiner, M. F., & Cullum, C. M. (2015). Video teleconference administration of the Repeatable Battery for the assessment of neuropsychological status. Archives of Clinical Neuropsychology, 31(1), 8–11.https://www.ncbi.nlm.nih.gov/pubmed/26446834
Grosch, M. C., Weiner, M. F., Hynan, L. S., Shore, J., & Cullum, C. M. (2015). Video teleconference-based neurocognitive screening in geropsychiatry. Psychiatry Research, 225(3), 734-735. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4410696/
Gurnani, A. S., John, S. E., & Gavett, B. E. (2015). Regression-based norms for a bi-factor model for scoring the Brief Test of Adult Cognition by Telephone (BTACT). Archives of Clinical Neuropsychology, 30(3), 280-291. https://academic.oup.com/acn/article/30/3/280/5335
Harrell, K. M., Wilkins, S. S., Connor, M. K., & Chodosh, J. (2014). Telemedicine and the evaluation of cognitive impairment: The additive value of neuropsychological assessment. Journal of the American Medical Directors Association, 15(8), 600–606. https://www.sciencedirect.com/science/article/abs/pii/S152586101400259X
Hildebrand, R., Chow, H., Williams, C., Nelson, M., & Wass, P. (2004). Feasibility of neuropsychological testing of older adults via videoconference: Implications for assessing the capacity for independent living. Journal of Telemedicine and Telecare, 10(3), 130-134. https://journals.sagepub.com/doi/abs/10.1258/135763304323070751
Jacobsen, S. E., Sprenger, T., Andersson, S., & Krogstad, J. M. (2003). Neuropsychological assessment and telemedicine: A preliminary study examining the reliability of neuropsychology services performed via telecommunication. Journal of the International Neuropsychological Society, 9(3), 472-478. https://www.cambridge.org/core/journals/journal-of-the-international-neuropsychological-society/article/neuropsychological-assessment-and-telemedicine-a-preliminary-study-examining-the-reliability-of-neuropsychology-services-performed-via-telecommunication/D2729DB678382952737A493871BA8C92
Kirkwood, K. T., Peck, D. F., & Bennie, L. (2000). The consistency of neuropsychological assessments performed via telecommunication and face to face. Journal of Telemedicine and Telecare, 6(3), 147-151. https://journals.sagepub.com/doi/abs/10.1258/1357633001935239
Lachman, M. E., Agrigoroaei, S., Tun, P. A., & Weaver, S. L. (2014). Monitoring cognitive functioning: Psychometric properties of the Brief Test of Adult Cognition by Telephone. Assessment, 21(4), 404-417. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4050038/
Loh, P. K., Ramesh, P., Maher, S., Saligari, J., Flicker, L., & Goldswain, P. (2004). Can patients with dementia be assessed at a distance? The use of Telehealth and standardised assessments. Internal Medicine Journal, 34(5), 239-242. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1444-0903.2004.00531.x
Loh, P. K., Donaldson, M., Flicker, L., Maher, S., & Goldswain, P. (2007). Development of a telemedicine protocol for the diagnosis of Alzheimer's disease. Journal of Telemedicine and Telecare, 13(2), 90-94. https://journals.sagepub.com/doi/abs/10.1258/135763307780096159
Montani, C., Billaud, N., Tyrrell, J., Fluchaire, I., Malterre, C., Lauvernay, N., ... & Franco, A. (1997). Psychological impact of a remote psychometric consultation with hospitalized elderly people. Journal of Telemedicine and Telecare, 3(3), 140-145. https://journals.sagepub.com/doi/abs/10.1258/1357633971931048
Parikh, M., Grosch, M. C., Graham, L. L., Hynan, L. S., Weiner, M., Shore, J. H., & Cullum, C. M. (2013). Consumer acceptability of brief videoconference-based neuropsychological assessment in older individuals with and without cognitive impairment. The Clinical Neuropsychologist, 27(5), 808–817. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3692573/
Tun, P. A., & Lachman, M. E. (2006). Telephone assessment of cognitive function in adulthood: The Brief Test of Adult Cognition by Telephone. Age and Ageing, 35(6), 629-632. https://academic.oup.com/ageing/article/35/6/629/14743
Unverzagt, F. W., Monahan, P. O., Moser, L. R., Zhao, Q., Carpenter, J. S., Sledge, G. W., & Champion, V. L. (2007). The Indiana University telephone-based assessment of neuropsychological status: A new method for large scale neuropsychological assessment. Journal of the International Neuropsychological Society, 13(5), 799-806. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2747375/
Vestal, L., Smith-Olinde, L., Hicks, G., Hutton, T., & Hart, J. (2006). Efficacy of language assessment in Alzheimer's disease: Comparing in-person examination and telemedicine. Clinical Interventions in Aging, 1(4), 467-471. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699639/
Wadsworth, H. E., Galusha-Glasscock, J. M., Womack, K. B., Quiceno, M., Weiner, M. F., Hynan, L. S., Shore, J., Cullum, C. M. (2016). Remote neuropsychological assessment in rural American Indians with and without cognitive impairment. Archives of Clinical Neuropsychology, 31(5) 420–425.https://academic.oup.com/acn/article/31/5/420/2726825