Abstract
Despite its effectiveness, limited research has examined the provision of telemental health (TMH) and how practices may vary according to treatment paradigm. We surveyed 276 community mental health providers registered with a commercial telemedicine platform. Most providers reported primarily offering TMH services to adults with anxiety, depression, and trauma-and stressor-related disorders in individual therapy formats. Approximately 82% of TMH providers reported endorsing the use of Cognitive Behavioral Therapy (CBT) in their remote practice. The most commonly used in-session and between-session (i.e., homework) exercises included coping and emotion regulation, problem solving, mindfulness, interpersonal skills, relaxation, and modifying and addressing core beliefs. CBT TMH providers had a higher odds of using in-session and homework exercises and assigning them through postal mail, email or fax methods, as compared to non-CBT TMH providers. TMH providers, regardless of treatment paradigm, felt that assigning homework was neither easy nor difficult and they believed their patients were somewhat-to-moderately compliant to their assigned exercises. CBT TMH providers also collected clinical information from their patients more often than non-CBT TMH providers. They reported being less satisfied with their method, which was identified most often as paper-based surveys and forms. Overall, TMH providers employ evidence-based treatments to their patients remotely, with CBT TMH providers most likely to do so. Findings highlight the need for innovative solutions to improve how TMH providers that endorse following the CBT treatment paradigm remotely assign homework and collect clinical data to increase their satisfaction via telemedicine.
Highlights
Mental health disorders affect approximately 20% of adults and up to 50% of youth in the United States (U.S.), and less than half of these individuals will receive mental health services in a given year (Merikangas et al, 2010; SAMHSA, 2020)
Telemedicine has revolutionized the provision of mental health care worldwide by bringing accessible and personalized treatment to patients, families, and caregivers at a distance (Sable et al, 2002; Misra et al, 2005; Doolittle and Spaulding, 2006; Griffiths et al, 2006; Darkins et al, 2008; Lee and Park, 2016)
With little research examining the administration of between-session exercises within remote care contexts, we explored differences in the frequency and methods used to assign between-session exercises and collect clinical data among providers depending on whether they endorse following the Cognitive Behavioral Therapy (CBT) treatment paradigm
Summary
Mental health disorders affect approximately 20% of adults and up to 50% of youth in the United States (U.S.), and less than half of these individuals will receive mental health services in a given year (Merikangas et al, 2010; SAMHSA, 2020). The technology behind TMH is largely attributed to programs that host two-way transactions between patients and their providers (Breen and Matusitz, 2010) This includes realtime videoconferencing with providers to communicate about a diagnosis or remotely monitor an individual’s health status and progress related to care (Smith, 2007). In addition to its effectiveness, telemedicine transcends socio-cultural (i.e., stigma of mental illness and treatment) and geographic (i.e., limited transportation, remote location with shortages of medical professionals) barriers that have traditionally impeded patients’ access to and use of mental health services (Rojas and Gagnon, 2008; Baker et al, 2011; Wootton et al, 2011; Thaker et al, 2013)
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