Can you remember the last time you had to get up and walk to the TV to change the channel? Neither can I. But when I made the transition to a remote control and felt that joy of flipping through 100 channels in mere seconds, I’m pretty sure I didn’t need specific training to be able to do it. I didn’t need to concern myself with data security protocols. And I know I didn’t have to worry about whether the changing of the channels would be as effective.
Ongoing advancements in technology have widened the reach of mental health services significantly. With that said, one must always consider the potential consequences when using new technology, and whether the benefits outweigh the potential concerns. The use of telepsychology has been growing by leaps and bounds. Research is showing largely positive results in establishing rapport, effective service delivery, and treatment outcomes when compared to traditional face to face treatment. Independent examinations such as fitness for duty examinations (FFDs) can now be conducted via telepsychology as long as special precautions are put into place.
Providing FFDs via telepsychology has the benefit of providing access to more people than face to face delivery. A 2005 study found that only 11.4% of all physicians practiced in rural areas, yet nearly 80 million Americans live in an area of the country considered to have a mental health professional shortage. Telepsychology provides the opportunity to reach these underserved areas, with the added value of being more cost-effective by eliminating transport costs. The option of using telepresence to provide FFDs also reduces the likelihood of dual forensic/clinical relationships where a provider who performs an FFD later must provide treatment because there’s nobody else in the area qualified to do so.
Another important advantage to providing FFDs via telepresence is that the employees being evaluated may feel more comfortable, which makes them less guarded and more cooperative. In 2009, a Substance Abuse and Mental Health Services Administration survey found that less than ¼ of the estimated 45 million Americans with a mental illness received treatment, in part because of stigma and embarrassment associated with contacting a mental health professional. Provision of services via telepsychology serves as a protective layer, making the employee more comfortable and willing to engage in the process.
On the other hand, there are some common concerns employers, employees, and evaluators often have when considering FFDs via telepresence. An evaluator may have to be licensed in the state where the employee is located. However, there is growing support for this method of service delivery and it is now possible to obtain temporary licenses in most states that are not cost- or time-prohibitive.
Another issue often raised when considering FFDs via telepsychology is keeping the evaluation confidential and secure. There are many HIPAA compliant video-conferencing and electronic messaging systems currently available to ensure the confidentiality and security of the employee’s protected health information and clinical data.
Establishing rapport across videoconferencing has also been a source of concern. However, the data is showing that isn’t the problem people worried it might be. In 2009, a meta-analysis of 148 peer-reviewed publications examining telepsychology services showed high levels of patient satisfaction, positive outcomes, and moderate to high provider satisfaction. A 2008 meta-analysis of 92 different studies found the differences between internet-based therapy and face to face therapy were not statistically significant. Another study in 2008 found no difference in perceived connectedness between those who received services in person versus those who received services through telepsychology.
A lack of experience with advanced technology is also an obvious concern. Knowing how to use the equipment and programs to provide FFDs via telepsychology is essential. The only way to alleviate this obstacle is to get training and practice. If the right steps are taken in preparation; to train, practice, ensure appropriate licensure, and use of HIPAA-compliant services, the benefits of providing FFDs via telepsychology far outweigh the concerns.
About the Author: Jennifer Kurtz is a licensed clinical psychologist with expertise in the areas of psychological assessment and crisis counseling who brings with her extensive experience in conducting civil commitment assessments; and psychological and intellectual functional evaluations. She has over 10 years of experience conducting disability reviews and has held various leadership positions in quality assurance, clinician training, and clinical supervision. Dr. Kurtz has authored and co-authored several published articles on the evaluation and management of disability claims, assessing functionality, and the impact of diagnosis on disability claims. She has presented on psychological assessment, independent evaluations, and functional assessment in the absence management industry at conferences and multiple nurse case manager trainings.
