Summer 2024 Issue

Telehealth: Optimizing Telehealth Therapy Sessions
By Betsy Cauble, PhD, MSW
Social Work Today
Vol. 24 No. 3 P. 6

Eight Essential Tips for Social Workers

As virtual options such as remote work and telehealth go from a pandemic-driven necessity to an accepted part of daily life, social workers have had to navigate this transition with patients and, at the same time, maintain the quality of their care.

While the pandemic pushed a sudden move to telehealth, in the time since, patients and mental health professionals have found that virtual therapy is similar to—and can be as effective as—in-office visits, and for some patients, even helps ensure they can more easily access the treatment they need. The personal relationship dynamic is the same, as is the professional service offered, so almost all of the same principles apply. There are still several key differences, however, that social workers branching into telehealth must keep in mind.

1. Establish ground rules at the beginning of client service, with the initial consent discussion, ie, robust informed consent focused on telehealth.
Many states require official documentation of informed consent before practitioners can offer telehealth services. As with anything else, clients need to know exactly what it is that they’re agreeing to. Walk them through these documents, explain what telehealth services entail, and then confirm that they understand and are willing to proceed. Preparing this explanation beforehand ensures that the clients are fully aware of all pertinent details before continuing with treatment. This preliminary step protects both the client and the practitioner from future misunderstandings or miscommunications.

2. Confirm that the client is safe and alone.
Conversations between a client and a practitioner are strictly confidential. Protecting a client’s privacy is paramount. Verify that the patient is in a safe and private environment. This should be the first step in every telehealth therapy meeting. Clients who are driving with other people in the car or in a room full of people are not in a position to receive telehealth effectively or safely. Just as practitioners wouldn’t conduct an in-person therapy session in public, they should never allow clients to take a telehealth meeting in a public setting.

3. Know how to troubleshoot your equipment.
Nobody enjoys a video call that’s choppy or lags, but these inconveniences become more serious when a client is in the middle of a difficult personal conversation. Knowing your equipment well enough to prevent or, if necessary, troubleshoot technical difficulties is essential to giving your clients a seamless telehealth experience. Simple steps such as keeping your software updated and protecting your technology from malware can go a long way toward preserving your connection with your clients.

4. Have a game plan if the internet fails.
Unfortunately, the internet can be a fickle friend. Instead of hoping that it will always be able to support a video call, work with your clients to establish a backup plan in case the internet cuts out. The last thing you want is for clients to be left hanging in the middle of an emotionally raw or vulnerable conversation while you work to figure out a viable solution. Don’t be caught by surprise—plan ahead. Ask your client what alternative modes of communication work best for them, such as email, phone call, or text message, and store the information somewhere where you can access it quickly if you lose connection to minimize the conversation gap.

5. Have an emergency plan for a mental health or medical crisis.
Seeing clients virtually rather than being physically present doesn’t affect your ability to administer care—until there is a crisis. Sudden medical or mental health emergencies can strike in an instant, and sometimes a video call isn’t sufficient. Make sure you have the information you need to help your client in case of an emergency. Know their address, phone number, and emergency contact so that you can spring into action immediately.

6. Prepare the client for what will take place if you have a personal emergency.
Good communication is the bedrock of every relationship, so be sure to make sure your client knows what to expect at every turn. Just as you have contingencies and policies concerning cancellation, you owe your clients the same respect for their time. Especially when they are reliant on these appointments for mental health reasons, last-minute cancellations can have a real impact. Since changes are part of life, be proactive about preparing and planning for it together. Help them understand what steps you would need to take and how those would affect them. It’s always best to prepare your clients for emergencies to ensure they’re not caught by surprise and left hanging. Even if a personal emergency seems unlikely, going the extra mile to establish a game plan will help you both know how to respond in the event something does happen.

7. Let clients know that you will be taking notes throughout the session.
One difference between in-person and telehealth is the physical cues and signals that one takes for granted in the office. Through a screen, your client can’t tell if you are typing or jotting down notes as they may have been able to when sitting across from you in a room. Seemingly small details such as these can make or break the transition from in-person visits to telehealth therapy. Ensure that you are clearly alerting your clients to anything they would know if they were in your office, including notetaking. Don’t leave them to wonder why you are looking down at a notepad or typing as they talk. Check that typing sounds don’t distract them, and prepare to take notes another way if necessary. Working with your client to make these calls as productive and fruitful as possible takes consistent and clear communication about all aspects of telehealth therapy.

8. Make sure you are practicing legally.
It can be easy to slip into a familiar routine of logging on to a computer and taking a video call, especially as it’s something we’ve all grown accustomed to. Practicing across state lines—even through telehealth—is illegal unless it is approved by the relevant licensing boards. Always verify that everything you do while providing telehealth therapy is in accordance with the relevant rules and regulations.

Telehealth has significant potential to expand social workers’ impact, but it requires intentionality and foresight. By following these principles, social workers can make a smooth transition into telehealth as they seek to serve clients who may not be geographically close.

— Betsy Cauble, PhD, MSW, is a board member at Preferra Insurance Company RRG, a behavioral health liability insurance company overseen by social workers, and the retired department head and associate professor of social work emeritus at Kansas State University.