Security Health Plan: Telehealth therapy appointments

MARSHFIELD – A game of Connect Four over video chat was not in Clinical Psychologist Dr. Michael Schulein’s daily schedule before the COVID-19 crisis. He got creative as therapy appointments via telehealth video chat or phone call emerged as a very effective alternative to in-person therapy.

Many patients are experiencing telehealth therapy appointments right now because of the COVID-19 crisis, and it will remain a valid option for many even after social distancing requirements have been relaxed.

“Patients are already untreated or undertreated for their behavioral health problems; nationally, only 35% of patients with serious behavioral health issues get the care they need,” said Michael Schulein, Ph.D., a clinical psychologist at Marshfield Clinic Health System. “Telehealth removes barriers for those who are undertreated or not treated at all.”

Telehealth therapy appointments are an increasingly effective option for many reasons:

Lack of transportation: Patients with a long commute to their closest health care center, especially from rural locations, can now more easily access therapy appointments. Dr. Schulein has patients who have saved over three hours of drive time by having a telehealth therapy appointment over video.

Busy schedules: It’s much easier for busy families to schedule a therapy session because of the shorter time commitment. They are much more likely to add the sessions to their busy schedules if they have less of an impact on their time.

Weather challenges: Living in a part of the country where weather disrupts school, jobs, and ability to attend health care appointments makes telehealth a very powerful tool to handle those kinds of unpredictable difficulties.

More relaxed conversation: Patients have the ability to show therapists their lives, including their home environment, pets, and interests in ways that are much more clear than during an office visit. “I’m in essence doing home visits,” Dr. Schulein said. “It’s helped me to see that part of their life that previously I was only hearing about.”

Dealing with behavioral health issues this way is not a one-size-fits-all approach, however. Providers must look for the best fit for the type of care the patient’s condition requires.

“I can’t say overall it’s perfect for everyone, but the research is clear that the benefits of telehealth therapy can be similar to the benefits of being seen in an office,” Dr. Schulein said.

The quality of a patient’s internet connection, and their familiarity with doing video chats and/or willingness to learn how can affect how well telehealth appointments work. Some patients are initially hesitant to do it and would rather talk on the phone, but then realize they’ve done similar things on Facebook Messenger or FaceTime. At times the audio may lag or cut out depending on internet connections, which can be challenging.

Video meetings are the most preferred method for virtual therapy sessions, followed by phone call. Dr. Schulein views text messaging as a form of support, rather than actual therapy, as in texting you cannot hear or see the patient — important elements of therapy. The research is primarily about video effectiveness in therapy in the last 10 years.

Dr. Schulein does still prefer to do an initial evaluation appointment in person before beginning telehealth appointments. And sometimes with his younger patients it’s harder to inject a lighthearted playfulness over video to help them transition out of the difficult therapy work and back to their families. Dr. Schulein likes to end a therapy session with a game to help them, and playing Connect 4 over video is a way to make that important transition for the kids.

His technique is just one way providers are adapting to the new normal. The adaptation to telehealth appointments for behavioral health issues certainly has the potential to offer improved access to mental health resources for many patients.