Telemental health services are a flexible, research-informed video or phone alternative to the same-location sessions that occur in a behavioral health provider’s office. Although tech-assisted therapeutic tools have been around for decades, support for their use in practice settings spiked during the pandemic. According to Sepúlveda-Loyola et al., building social connection is one of the most important protective interventions for psychological well-being. For community members who have undergone lockdown precautions due to the COVID-19 pandemic, online contact has been a key resource for mental health professionals.
According to research by Lorraine Buis, there has been a tremendous increase in virtual visits among adults ages 50 to 80. Whereas only 4% of individuals in this age range had used telehealth services during 2018, by June 2020, this number increased to 30%. Between May 2019 and June 2020, comfort in using video conferencing platforms also rose from 53% to 64% for this demographic. A meta-study by Hilty et al. showed that telemental health is effective for diagnosis and assessment, and comparable to same-location treatment. Another meta-study by Langarizadeh et al. showed that telemental health is effective for patients with various mental illnesses.
Telemental health can mean using various technology and formats. Clinicians can provide clients with behavioral health apps, online resources, remote monitoring, client portals, video conferencing and audio-only meetings. Also falling under the telemental health umbrella and regularly used are online therapy groups, recreational groups and psycho-educational groups.
Using telemental health approaches comes with noticeable advantages, especially with older clients—some of whom may be at a higher risk for developing mobility restrictions, cognitive challenges or other medical conditions that impair travel to appointments.
‘Older adults’ level of digital literacy had no impact on their program satisfaction.’
Clinicians should be mindful of how biases can influence caregiving decisions. In their book on social work practice with other adults, Chonody and Teater explained how the perpetuation of negative stereotypes can adversely affect treatment outcomes for older adults. The wisdom of fitting a telemental healthcare plan to a client’s needs, fears, constraints and strengths should not be underestimated.
Digital Literacy Varies Widely
At the beginning of the COVID-19 shutdowns in early 2020, Telebehavioral Health.US’ Director of Senior Services Amy Mansfield expressed concern that older adults may “decline and possibly die” as a result of isolation. Acknowledging the impact isolation could have on this population, Telebehavioral Health.US began exploring options to engage older adults and their caregivers with telehealth.
According to Mansfield, the level of digital literacy ranged widely among older adults. Telebehavioral Health.US also found that older adults’ level of digital literacy had no impact on their program satisfaction.
By better understanding this population and expanding how Telebehavioral Health.US engages with them, Telebehavioral Health.US created programs like Art for the Young at Heart—a clinically supported art therapy group offered to older adults in Northern California that was reimbursed by Medicare Part B. Interestingly, when group members were asked to complete satisfaction surveys at the end of the group, it was determined that the online format did not affect their level of satisfaction. When asked what group participants would change about the program, there was no mention of problems related to technology, but most respondents indicated a desire for the group to last longer.
In her clinical work, Mansfield has seen how telemental health services have been a lifeline for this population to address their mental health needs, especially in light of significant isolation from family, friends and communities during the pandemic. Developing programming for older adults makes sense if the goal is to reduce barriers to care such as transportation, chronic pain, community exposure and mobility challenges.
Solving for Social Isolation
One of the services Telebehavioral Health.US is looking to expand in 2022 is the Boomer to Zoomer program that provides tablets, access to a continuum of Cognitive Behavioral Therapy interventions and online social-recreational activities for older adults living in care facilities. According to Langarizadeh et al., “online technologies” can be used to provide social support networks and a sense of belonging for older adults in isolation. The Center also noted that “increasing social engagement with family, peers, volunteers, and healthcare organizations and providing access to clinically supportive Cognitive Behavioral Therapy interventions can decrease loneliness and improve mental wellbeing” for this vulnerable population.
Boomer to Zoomer partners with senior care facilities to prevent and address social isolation. Through the program’s three phases, the goal is to help individuals maintain important bonds and connections while in isolation by improving their ability to build and navigate an online community.
‘For clinicians, receiving more training on telebehavioral health competencies is critical.’
In phase one, the individual is paired with a licensed clinical social worker in a one-on-one therapeutic environment to assess how isolation has impacted them. The person also identifies strengths and key connections, like family members, who can be included in their online support network. Once the individual has created and acclimated to their online community, they are invited to join therapist-facilitated therapy and psychoeducational groups with other program participants.
The final phase of Boomer to Zoomer focuses on peer support by providing participants access to peer-led, online social-recreational activities, such as open mic nights, bingo, book clubs, poetry jams, art classes or singles nights. Most of the services offered through this program are covered by Medicare Part B, making them even more accessible to older adults.
For clinicians, receiving more training on telebehavioral health competencies is critical. Behavioral health clinicians often spend several years learning how to provide services to clients who are in the same room as them, and although offering these same services online is not a drastic leap, additional training is needed to ensure a positive experience.
Training should include the laws and regulations pertaining to telemental health; ethical standards related to telemental health; how to create private and therapeutic environments; the skills of using video technology for sessions; emergency management planning; how to assist clients with technology; and how to respond to difficult situations. Telemental health training should also cover how to adapt therapy styles to the online environment, how to select technology, and how to use new technology as it becomes available. Being trained in telemental health can give clinicians greater confidence, better outcomes and the knowledge they need to provide telemental health services.
Raymond Barrett, LMHC, the CEO of the Telehealth Certification Institute LLC, in Blacksburg, Va.