Navigating the Telehealth Terrain: Recognizing the Limits and Knowing When to Pivot to In-Person Care

Prior to March of 2020, only 17% of clinicians ended up on a regular basis making use of telehealth, and now most clinicians are (Zhu et al., 2024). The lots of benefits of telehealth therapeutic expert services make this structure appealing, significantly for dealing with OCD. Telehealth will allow for improved obtain to care, furnishing a adaptable alternative for families, and will allow for publicity perform in the household setting where by compulsions may be the strongest.

But, telehealth does not appear with out issues there are certain conditions the place telehealth is not the most effective format for treatment method. It is crucial not to prioritize usefulness over success by environment clear boundaries for virtual cure and understanding when in-individual treatment is essential.

Boundaries

Even though there is by now a great deal to address with clients at the onset of therapy, it is very best to focus on telehealth boundaries at the initial remedy session. Boundaries to think about and clarify for patients incorporate:

1. When will you be offered for periods? Although enhanced overall flexibility is a advantage of telehealth support provision, it can be challenging as it blurs the strains between perform and residence everyday living. People could think that you can be out there anytime, when this may well not be the reality.
2. What sort(s) of platforms will you use? Make clear regardless of whether you will use synchronous platforms (e.g., Zoom, Doxy), asynchronous platforms (e.g., texting), or the two.
3. Where by should really the patient be situated when signing up for a telehealth session? There are surely instances when you may well check with your individual to join from a distinct area to aid exposure perform nonetheless, except if indicated by the clinician, sufferers must approach to attend telehealth periods from a non-public, tranquil room, and not in a transferring motor vehicle, inside the condition the practitioner is accredited.  
4. What is demanded of the individual/family members all through virtual classes? The house environment could in a natural way build a more “relaxed” truly feel, but it is important to convey to individuals that “in-person” expectations apply to digital periods as perfectly. Acceptable apparel is expected, a parent should really be available for minimal clients, and individuals really should not be engaged in other pursuits in the course of session.  

If a boundary is damaged, converse to the patient or family members right away and indicate that telehealth may no longer be an solution for classes if upcoming violations manifest.

When In-Human being Solutions are a Far better Healthy

Apart from recurring boundary violations, other variables could point out in-particular person expert services are advised around telehealth:

1. The affected individual has technology difficulties or does not have accessibility to a private room. For case in point, if the affected person regularly takes periods from destinations the place the relationship is lousy or does not have dependable obtain to a laptop or mobile gadget, telehealth would not be advised. Frequent technological complications are not only an “annoyance” they can direct to misunderstandings and distractions that interfere with the results of cure.
2. The client has challenges interacting almost. Some individuals show reduce engagement and a lot more pain with digital interactions, which can make it demanding to develop rapport. If the client only responds by using the chat or provides recurring vague responses, in-person sessions can be practical for producing additional engaged interactions.
3. The patient displays defiant or avoidant behaviors in the course of periods. Individuals taking part in classes from property may possibly show behaviors, this sort of as muting by themselves, turning off the digicam, leaving the place, leaving the session early, and/or not permitting a test-in with their caregiver. Even though these behaviors might be expected at the start out of remedy, when they persist, it is a indicator that telehealth is not a fantastic fit.
4. Clinical issues with telehealth. At situations, it can be clinically counterproductive to carry on with telehealth. Have you done all the exposures that are feasible in the property? Would in-person exposures allow for you to maximize the issue or product brave behavior? Is the dwelling placing a ‘safety signal’ that decreases the robustness of exposures?  

If in-person cure is not accessible thanks to logistical components, this sort of as geographic location, transportation complications, and so forth., telehealth may possibly be a “better than no treatment” alternative. Nevertheless, when numerous cure delivery techniques exist, it is important to look at the above things when selecting which approach(es) will greatest move your individual towards their targets. 

References

Zhu, D., Paige, S. R., Slone, H., Gutierrez, A., Lutzky, C., Hedriana, H., … & Bunnell, B. E. (2024). Discovering telemental overall health apply right before, all through, and just after the COVID-19 pandemic. Journal of telemedicine and telecare, 30(1), 72-78.