There was a huge smile awaiting me at the other end of the screen. I had been anticipating this moment with some degree of anxiety. I had been to trainings, conducted several dry runs, and attended scores of meetings to prepare for what was about to unfold. “This is weird,” she said. I validated her feelings and laughed along with her. There she was, my first telemental health client.
When I first interviewed for a mental health job and I discovered the position was for a telemental health therapist who will provide therapy through video, my first thought was: therapy through this mode couldn’t possibly work. So many questions came up: “how can you build solid rapport and trust through a camera”? Is this HIPAA compliant? How could I deal with a client in crisis?
I went home and I was surprised by my strong reactions to the interview. I thought: why was I so certain that this could not work when I have not even tested it?
After some self-reflection and checking in on my assumptions, I discovered that my skepticism and fears emerged from the “not knowing stance.” I had heard about telemental health loosely, mainly through Facebook ads that bombard my account promoting e-therapy through texting and right before that interview I had done some research on using smart phone apps as complement to therapy, where I came across a few articles about telemental health but I had not given this topic too much thought until that interview.
I turned to research and discovered that telehealth, health services provided by a form of technology, has been around for at least 40 years, some say even longer. I learned that telemental health is not just text therapy as we have seen in some ads. It was not this “new shiny thing” I thought was emerging but there has been substantial research on the use of telehealth and telemental health effectiveness with some communities, particularly in rural areas. I also discovered the answers for many of my initial questions—there are HIPPA secure platforms to provide telemental health services and the evidence shows that it is possible to build a therapeutic alliance through video.
After a year of providing telemental health services through a pilot program supported by CareFirst and led by La Clínica del Pueblo, a federally qualified community based health clinic that has been impacting the Latino and immigrant community in the Washington, DC metro area since 1983, I can say I’m truly glad that I looked deeper than my initial fears.
Our experience providing telemental health to some clients validates other research which shows client’s functioning improve to a comparable rate as in “traditional in person therapy.” We are able to reach many clients in distress who otherwise would not be served due to a current shortage of bilingual mental health providers, which results in long waiting for access. I have also dealt with several crisis, which initially I thought would be impossible to do via video.
Currently, the Latino community experiences high rates of mental health disorders and face significant barriers in obtaining services due to stigma, lack of bilingual and multicultural mental health providers, lack of health insurance, among other obstacles. According to the American Psychiatric Association (APA), the lack of access to mental health services is one of the most serious health problems in the Hispanic community.
As the Latino and immigrant community grow, agencies working with this population face challenges and opportunities to meet the demand of mental health services the community needs to thrive.
At La Clínica, we saw an opportunity to better serve our population and through a partner to partner model, we are expanding our services to clients who face a significant barrier in accessing services. Barriers exist because they either can’t get to us due to transportation challenges, which for many of our clients means taking several modes of public transportation and traveling from far distances or because finding a bilingual mental health provider has been difficult due to the shortage of them. Clients conveniently continue to attend their base organization for services and in a private therapy ready room receive services while I provide therapy from a counseling room at La Clínica’s DC based office.
The need to expand services and come up with alternative solutions to meet the demand is true for many of the communities social workers serve. As the primary providers of mental health services, social workers have a unique opportunity to leverage technology to respond to our community needs. To guide social workers in this endeavor, NASW and ASWB have already created standards for technology and social work practice. In addition, ASWB recently approved the Telemental Health Institute telemental health online training program. “And Star Telehealth and the Center for Credentialing Education will launch their training program in the near future. I am currently a beta tester for the initial modules.
Our times are changing. Our client’s needs are changing. Our NASW calls us to become culturally competent, and becoming culturally competent with the use of technology is essential in today’s times. Our communities are more connected than ever before and are turning to technology at records numbers.
Join the dialogue. My colleagues from La Clínica del Pueblo and I will present our findings and insights from our pilot program through our presentation TeleMental Health for Latinos: Expanding Access through Technology at two social work conferences: Sí Se Puede®: Social Workers United for Latino Advancement conference organized by the Latino Social Workers Organization and the Center for Latino Adolescent and Family Health at the New York University of Silver School of Social Work in New York, April 25-27 and later in Washington, DC at the National Association of Social Workers national conference in June 22-25.
We will address:
Demystifying Telehealth: Fears, Barriers, Limitations and How We Overcame Them Planning, Building Protocols, and Training
Program Preparation and Implementation: The Importance of Research,
Technical, Clinical, and Administrative Implications
Cultural Considerations for Implementation with the Latino Community
Ethical Considerations for Social Workers Using TeleHealth
Program Evaluation and Outcomes
The Future of TeleMental Health
Having recently attended the Mid Atlantic Telehealth Resource Center Annual Summit, where I was one of very few social workers providing direct services, I am reenergized to empower more of us to learn about telemental health, get trained, certified and practice, when appropriate and while considering cultural, ethical and clinical implications. And I hope that next year, there will be a lot more social workers at the telehealth table.
Cheryl Aguilar is a licensed clinical social worker, LICSW, LCSW-C, founder and lead therapist of Hope Center for Wellness, LLC, a multicultural behavioral health and training consulting practice serving DC metro area residents and organizations. She founded and co-leads Social Workers United for Immigration, a DC based network of social workers committed to the well-being and the advancement of immigrants and immigrant rights. She can be contacted at email@example.com.