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Wk 5 Discussion - Telehealth Crisis Response

Respond to the following in a minimum of 175 words: 

As the need continues to rise for increased accessibility of services, there are more options available for using telehealth. Since telehealth counselors are not in the same location as their clients, it is important to obtain a client’s current physical location if safety concerns come up during a session.

Watch the following excerpt from a telehealth intake assessment with a client who has experienced significant trauma and loss. The client has reached out to her employee assistance counselor after being urged by her supervisor to seek help.

What are some considerations that a counselor must make when conducting a telehealth session? Is there anything that concerns you about observing or interpreting a client’s mood, affect, vocal tone, or body language using telehealth? What are some goals that you might include in this client’s safety plan? What resources local to your area might you offer this client?

Respond to each classmate in a minimum of 175 words: 

SW – Classmate

Some considerations a counselor must make when conducting a telehealth session are safety, local reporting laws, and confidentiality. The counselor will need to know where the client is physically in case they need to send help. The counselor in this video asked the client where she was and for the exact address. Some other considerations might be differing laws in various states, as the client and counselor may be in different states. Reporting laws for child abuse, threats of suicide, or threats of homicide might be different in the client and counselor’s states. Another consideration is confidentiality. The counselor must know that the client’s environment allows for confidentiality, and the client must know that the counselor will adhere to rules of confidentiality.

In general, studies are showing that telehealth screenings and assessments are similar in effectiveness to in-person sessions (SAMHSA, 2021). In the video, I think it is clear what the client’s mood, affect, and vocal tone are. I thought the client presented with a subdued mood, flat affect, and monotone vocal tone. Body language, however, might be more difficult to ascertain. We can observe facial expressions and upper-body states, but we might be missing fidgeting feet or hand movements. So, I do have some concerns about not being able to see a person’s whole body. For the most part I think observing their upper body will give a clear enough picture of what their body language is.

Some goals I might include in this client’s safety plan are to identify three warning signs that a crisis is developing, three coping mechanisms they can use, three people they could call for help or distraction, three agencies they can call or visit for various helps (crisis lines, support groups, legal help, etc.), three places they can go to change their environment, and three strengths they possess to empower them to persevere and overcome this crisis (University of Phoenix, 2022).

In my area, LDS Social Services and Catholic Community Services could be referrals. Catholic Community Services can help find temporary, affordable housing. LDS Social Services can provide food and household supplies such as cleaning and personal hygiene items. Their thrift store, Deseret Industries, is sometimes used to provide free items such as furniture and clothing. Other times, Deseret Industries is just a large thrift store where they might buy furniture and kitchen supplies for their home when they get one. The goal of providing these resources is to help the client return to a sense of normalcy as soon as possible (Ruzek, et. al., 2007). The University of Utah has a mobile crisis unit that can be called to attend to mental health crises. The client could use that phone number to call if they are having escalating mental health issues. They could also download the SAFEUT app, which has crisis lines, therapists available to chat anytime, and many other resources.

Ruzek, J. I., Brymer, M. J., Jacobs, A. K., Layne, C. M., et al. (2007). Psychological first aid.  Journal of Mental Health Counseling, 29 (1), 17-49.

SAMHSA. (2021). Telehealth for the treatment of serious mental illness and substance use disorder. https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/PEP21-06-02-001.pdf

University of Phoenix. (2022) How to complete a safety plan. https://vle.phoenix.edu/ultra/courses/_299831_1/outline/edit/document/_29808224_1?courseId=_299831_1

CN – Classmate

A factor of consideration when conducting a telehealth session may involve audio and/or video quality. Although using video has fewer complications than other modalities, inconsistent video or audio information disrupts communication resulting in a lack of fluidity, which “… can at the very least lead to frustration and at worst lead to misunderstandings if important words or expressions are lost” (Brew & Kottler, 2017, p. 182). For example, I noticed there was a slight lag present in the communication. It was barely noticeable, and the counselor wasn’t rattled by it, but if it continued and got worse, especially during crisis intake assessments, could be very disruptive. A second factor concerns legal codes about doing therapy across state lines. The counselor may only do telehealth sessions within the state he or she is actually licensed, as well as the client receiving telehealth services must be in the same state. In addition to the modality quality and legal code held by specific states, counselors need to be aware any security and confidentiality restrictions a state may have specifically regarding telehealth. (SAMHSA, 2020) 

Some goals I would include in the client’s safety plan would focus on discussing the client’s coping strategies, which the counselor brought up during the intake assessment. Also, since the client is very new to the area, only having just moved and not yet familiar with the community, I would recommend a support group so she can connect to others in her community and not feel isolated, helpless, and anxious. The client also shared that she lost all of her clothes, except the pajamas she was wearing. I would offer the United Way website for the CSRA (central savannah river area) in Augusta, GA. The United Way offers many services, including the 211. “211 is powered by real people — trained specialists who work to identify and address the root causes of a client’s problem. That means from the first hello, someone in crisis is reaching a real person who can provide a connection to help. In a crisis, in a disaster, in a pandemic, 211 is here to help every person in every community find food, pay for housing and bills, and connect to other essential services” (uwcrsa.org, 2021, para. 1). The Salvation Army and Center of Hope are also some recommendations.