Telehealth | Advances 2021


The Future of Service Delivery

During a typical counseling session, a small, natural gesture can play a crucial role in establishing a safe and healing space, says Dr. Valeria Romero, a licensed clinical psychologist and the director for psychology training at Pacific Clinics. "The simple act of handing someone who is crying a tissue box – it feels useful and helpful."

Throughout the pandemic, these simple acts of direct face-to-face contact have been less frequent and sometimes replaced with screens. This has required a new level of creativity to strengthen the connection between our therapists and clients, Dr. Romero says. For a teenager coping with depression, a shared poem, which during an in-person session would get passed back and forth, might get created over a series of emails as a session progresses. For preschool-aged children, letting them choose the virtual background on the screen behind their clinician can make a world of difference. "When you leave that decision up to the kids, it helps them to be more engaged in the session," Dr. Romero adds. "It says, 'I'm not there in person with you but I'm still here with you.'"

Previously, Pacific Clinics piloted and grew telehealth sessions for psychiatric services, growing the program from 6 to 11 sites. When the pandemic shut some businesses down and forced work to move online, Pacific Clinics was prepared for the sudden, seismic shift in how it supported clients and met their diverse needs. "We had the equipment," Romero says. "We had laptops. We had cellphones. We were not in a scramble for that. I am very grateful to Pacific Clinics for making it a priority that we had the equipment we needed even before all of this."

During the first months of moving to telehealth services, Pacific Clinics increased the number of sessions provided, averaging more than 9,000 per week.

These increases offer a glimpse into some of telehealth's many benefits. "With telehealth, clients are given the opportunity to engage and participate in treatment even if they face challenges, such as transportation difficulties, phobias or fears of being around people," says Erlinda Uribe, licensed psychiatric technician.

Pacific Clinics' move to telehealth services mirrors the broader mental health field. According to a June survey by the American Psychiatric Association, prior to the coronavirus outbreak, 64% of respondents had never seen clients via telehealth. Two months later, 85% were seeing at least three-quarters of their clients virtually, and far more clients were keeping appointments than when they were having just in-person sessions.

Providing telehealth services is not free of challenges. While telehealth can increase accessibility for some, for those without a computer, a smartphone or reliable internet, access can be a significant challenge. And technological difficulties can disrupt a session, Dr. Romero says. "Using a tiny screen on a cellphone for telehealth services can be difficult."

For all the benefits of taking sessions into clients' homes, for some, the safety and security of being at a Pacific Clinics location were critical to their progress and to the success of their treatment. Clients who live with family, or in smaller spaces with multiple people, may not be able to have a private conversation, Romero notes.

Simply by being new, telehealth also presents challenges for therapists and clinicians. Social, physical and visual cues that can help direct a session come across differently over video or just by phone, Uribe says. "Certain clients may have a better connection in-person versus on a Zoom call or telephone, which can cause regression and cause them to feel disconnected with their therapist."

Both Uribe and Dr. Romero expect telehealth to continue to play a central role in mental health services long after the pandemic has receded.

"I don't see it going away," Dr. Romero says. "I think we were headed in this direction prior to the pandemic. COVID-19 accelerated the process. I think we'll see a hybrid in order to meet client needs – if you like in-person you can get that, if you like telehealth you can have that too."