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Background: Treatment crossovers occur when one mode of treatment is begun and then a different mode of treatment is utilized. Treatment crossovers are frequently examined in randomized controlled trials, but have been rarely noted or quantitatively evaluated in usual care treatment studies. The purpose of this analysis is to examine the extent of modality crossovers during behavioral health treatment. Methods: The nonrandomized, prospective, multisite research design involved two active treatment groups-a telehealth treatment cohort and an in-person treatment cohort. Treatment modality (telehealth or in person) during each encounter was compared overall and across two time periods (pre- and during the COVID-19 pandemic) between the telehealth cohort and the in-person cohort. Results: Overall, modality crossovers were relatively uncommon (6.3%). However, patients in the in-person treatment cohort were more than twice as likely to have an encounter through telehealth (8.5%) than patients in the telehealth treatment cohort were to have an in-person encounter (3.4%) even though they had the same average number of encounters. The occurrence of off-mode encounters was particularly influenced by the onset of the COVID-19 pandemic. Conclusions: In this multisite usual care study comparing telehealth and in-person behavioral health treatment, modality crossovers were more common in the in-person cohort than the telehealth cohort, especially during the COVID-19 pandemic. Because telehealth availability has increased, crossovers are likely to increase in patients receiving multiple encounters for behavioral or chronic conditions and their occurrence should be noted by both researchers and practitioners.

Background: Telehealth and in-person behavioral health services have previously shown equal effectiveness, but cost studies have largely been limited to travel savings for telehealth cohorts. The purpose of this analysis was to compare telehealth and in-person cohorts, who received behavioral health services in a large multisite study of usual care treatment approaches to examine relative value units (RVUs) and payment. Methods: We used current procedural terminology codes for each encounter to identify RVUs and Medicare payment rates. Mixed linear regression models compared telehealth and in-person cohorts on RVUs, per-encounter payment rates, and total-episode payment rates. Results: We found the behavioral health services provided by telehealth to have modest, but statistically significantly lower RVUs (i.e., less provider work in time spent and case complexity), per-encounter payments, and total episode payments than the in-person cohort. Despite Medicare rates discounting payments for nonphysician providers and the in-person cohort using clinical social workers more frequently, the services provided by the telehealth cohort still had lower payments. Thus, the differences observed are due to the in-person cohort receiving higher payment RVU services than the telehealth cohort, which was more likely to receive briefer therapy sessions and other less expensive services. Conclusions: Behavioral health services provided by telehealth used services with lower RVUs than behavioral health services provided in-person, on average, even after adjusting for patient demographics and diagnosis. Observed differences in Medicare payments resulted from the provider type and services used by the two cohorts; thus, costs and insurance reimbursements may vary for others.

Background and Objectives : There is little published evidence for the effectiveness of telehealth in the treatment of substance use disorders. Methods: We analyzed Drug Use Disorders Identification Test - Consumption (DUDIT-C) scores from 360 patients who completed the measure as part of outpatient behavioral health treatment at rural clinic sites. Some patients received in-person care, while others received telehealth. Results were analyzed using multiple regression. Results : Mean DUDIT-C scores improved with treatment in both cohorts. Changes on the DUDIT-C were related to initial scores. Treatment modality (telehealth vs in-person) had no distinguishable association with outcomes. Discussion and Conclusions: Results showed no discernible difference in outcomes between telehealth and in-person cohorts. Telehealth was as effective as in-person care in the treatment of substance use disorders, and appears to be equivalent to in-person care in rural outpatient settings.

Telehealth has become an integral part of integrated behavioral health (IBH) service delivery in light of the global pandemic. In order to accommodate the rapid changes in service delivery, integrated behavioral health settings have transformed to provide services via telehealth alongside in-person services. While traditionally believed to be an in-person model, this article demonstrates the potential for using telehealth technology to continue offering training and service delivery in an IBH setting in response to the COVID-19 pandemic and beyond. The purpose of this catalyst report is to describe an IBH service delivery and training model including creative adaptations to the model using telehealth and present an evaluation plan of health service psychology trainee experiences. A mixed-methods design will be used to capture student experiences and competency. Data methods will include interviews with participants (qualitative) and the Interprofessional Collaborative Competency Attainment Survey (quantitative). (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Introduction: Prior to the COVID-19 pandemic, telehealth utilization was growing slowly and steadily, although differentially across medical specialties in the United States. The pandemic dramatically expanded physician use of telehealth, but our understanding of how much telehealth use has changed in primary care in the United States, the correlates of physician telehealth uptake, and the frequency with which primary care physicians intend to use telehealth after the pandemic are unknown. This paper is designed to assess these important questions., Methods: Using data from an original national survey of 625 primary care physicians conducted from May 14 to May 25, 2021, we investigate the frequency of physician telehealth use before and during the pandemic and intended use after the pandemic. We also assess the correlates of changes in telehealth use by physicians, comparing telehealth use before the pandemic to use during and after the pandemic., Results: The proportion of primary care physicians using telehealth often, jumped from 5.3% (95% CI 3.5, 7.0) before the pandemic to 46.2% (95% CI 42.3, 50.2) during the pandemic. More importantly, over 70% of physicians intended to use telehealth at least occasionally after the pandemic compared to just 18.7% before, with younger physicians, physicians without telehealth training in medical school, and Asian physicians most likely to increase their telehealth use long-term., Discussion: The COVID-19 pandemic has spurred expansion in telehealth use by primary care physicians that will continue to shape care delivery well beyond the pandemic. Policy change could be needed to facilitate this growth of telehealth long-term.

Objective: In this paper, we identify available telepsychology guidelines, understand similarities and differences, and organize the contents into a model of core practice domains pertinent to a variety of applications of telepsychology practice., Method: A scoping review of current telepsychology guidelines was conducted to identify, organize, and distill available telepsychology guidelines (Arksey & O'Malley, 2005, Int J Soc Res Methodol, 8, 19-32)., Results: We identified overlap among five sets of telepsychology guidelines currently available and presented a consolidated model including nine practice domains influenced by practice setting and modality., Conclusions: Telepsychology has the potential to address current issues in availability, accessibility, acceptability, anonymity, and affordability of mental health services but establishing or engaging in telepsychology practice has been daunting for many practitioners. Telepsychologists can disseminate applications of this model in different settings and with different modalities and this practice model can inform future development of competencies., (© 2020 The Authors. Journal of Clinical Psychology Published by Wiley Periodicals LLC.)

Objective: To determine if service utilization behaviors varied with the remoteness of clients served by a telepsychology clinic in a predominantly rural health professional shortage area (HPSA) in Texas., Methods: Archival data from 290 low-income clients were analyzed to test associations between service utilization behaviors and clients' distance from the nearby access points where they traveled to receive counseling services from remotely located counselors., Results: Distance to access points did not predict differences in service utilization behaviors. However, clients in rural counties traveled farther to receive services than clients in metropolitan areas. Some utilization behaviors varied by demographic variables and depressive symptom severity., Conclusions: A "hub and spoke" model of telehealth service delivery is an acceptable model for improving access to mental health care services in rural and underserved communities, even for clients who live relatively far from access points. Telehealth providers should consider geographic, socioeconomic, transportation, and health-related barriers to care experienced by clients when implementing services and policies., (© 2019 Wiley Periodicals, Inc.)

Objective: Individuals living in rural areas die by suicide at higher rates than those living in metropolitan areas. Telemental health interventions provide rural residing individuals with access to needed care. Identifying telemental health clients at risk for suicide is an important task for clinicians and policymakers. This study evaluated to what degree rural status and other demographic variables predicted suicide ideation in clients seeking services at a telemental health clinic., Methods: Study participants included 457 low-income clients residing in the medically underserved, geographically diverse Brazos Valley region of Texas. Clients completed the patient health questionnaire during their initial counseling appointment, which assessed depression severity and suicide ideation in the 2 weeks prior to assessment., Results: Suicide ideation was common among telemental health clients, with approximately 40% of clients in all demographic groups reporting some recent thoughts of suicide. Rates of suicide ideation did not significantly differ by geographic designation (ie, rural/metropolitan status), gender, or race/ethnicity. However, depression was a strong predictor of recent suicide ideation., Conclusions: Telemental health programs can effectively connect clinicians with rural residing clients who are otherwise isolated from health care services. However, clinicians working in high-need, historically underserved areas should be prepared to encounter a high prevalence of suicide ideation and depression. In these regions, clinical and diagnostic features may be better indicators of suicide ideation than demographic variables., (© 2018 National Rural Health Association.)

Telehealth can overcome access and availability barriers that often impede receiving needed mental health services. This case report describes an interdisciplinary approach to treatment for an individual with chronic physical health conditions and comorbid mental health concerns, which resulted in high utilization (and associated costs) of preventable emergency services. The report describes clinical case progression on anxiety symptoms and emergency service utilization while concurrently highlighting telehealth-specific practice implications, especially as they pertain to training settings., (© 2018 Wiley Periodicals, Inc.)

The Leon County Health Resource Commission sought to increase access to mental health services for their rural community. The commission formed a network of partners who collaborated to increase free transportation to mental health services outside the community and developed a telehealth-based counseling program through a counseling psychology training program. Learning opportunities emerged during the development and implementation of these activities for both the students and the community in how to successfully utilize and sustain this service. This article describes the telehealth counseling model, presents lessons learned in the process, and presents recommendations for others interested in utilizing similar strategies.

Introduction: Training future providers in telehealth and integrated care models can improve access and outcomes, especially among rural and underserved populations. The (blinded) project implemented behavioral health training for health service psychology doctoral students with three partner organizations. Trainees received both experiential and didactic training in telehealth and integrated behavioral health. Telehealth was utilized for remote warm hand-offs, hybrid shared appointments, therapy sessions, coordination with providers, and supervision. Program elements included opportunities for consultations with experts in other disciplines, supportive mentorship, exposure to various parts of a healthcare system, and interactions with diverse clients. Methods: The (blinded) training program evaluated trainee outcomes using fourteen interviews and three focus groups. Interviews and focus groups examined aspects of the program that contributed to trainees' knowledge, skills, and attitudes. Results: Evaluation results revealed increased levels of trainee confidence, autonomy and independence. Training reportedly enabled improved ability to collaborate and communicate with other professions, increased flexibility and adaptability, and openness to others' ideas. Trainees reported the program's use of telehealth enhanced awareness of their own skills and team members' perspectives of technology in care delivery. Discussion: Descriptions of the three care models, lessons learned, and qualitative results about trainee outcomes can be translated into best practices for workforce development and enhance psychology trainees' self-awareness and ability to incorporate others' viewpoints about technology and treatment approaches into healthcare. [ABSTRACT FROM AUTHOR]

Background:Treatment crossovers occur when one mode of treatment is begun and then a different mode of treatment is utilized. Treatment crossovers are frequently examined in randomized controlled trials, but have been rarely noted or quantitatively evaluated in usual care treatment studies. The purpose of this analysis is to examine the extent of modality crossovers during behavioral health treatment. Methods:The nonrandomized, prospective, multisite research design involved two active treatment groups—a telehealth treatment cohort and an in-person treatment cohort. Treatment modality (telehealth or in person) during each encounter was compared overall and across two time periods (pre- and during the COVID-19 pandemic) between the telehealth cohort and the in-person cohort. Results:Overall, modality crossovers were relatively uncommon (6.3%). However, patients in the in-person treatment cohort were more than twice as likely to have an encounter through telehealth (8.5%) than patients in the telehealth treatment cohort were to have an in-person encounter (3.4%) even though they had the same average number of encounters. The occurrence of off-mode encounters was particularly influenced by the onset of the COVID-19 pandemic. Conclusions:In this multisite usual care study comparing telehealth and in-person behavioral health treatment, modality crossovers were more common in the in-person cohort than the telehealth cohort, especially during the COVID-19 pandemic. Because telehealth availability has increased, crossovers are likely to increase in patients receiving multiple encounters for behavioral or chronic conditions and their occurrence should be noted by both researchers and practitioners. [ABSTRACT FROM AUTHOR]

Background:Telehealth and in-person behavioral health services have previously shown equal effectiveness, but cost studies have largely been limited to travel savings for telehealth cohorts. The purpose of this analysis was to compare telehealth and in-person cohorts, who received behavioral health services in a large multisite study of usual care treatment approaches to examine relative value units (RVUs) and payment. Methods:We used current procedural terminology codes for each encounter to identify RVUs and Medicare payment rates. Mixed linear regression models compared telehealth and in-person cohorts on RVUs, per-encounter payment rates, and total-episode payment rates. Results:We found the behavioral health services provided by telehealth to have modest, but statistically significantly lower RVUs (i.e., less provider work in time spent and case complexity), per-encounter payments, and total episode payments than the in-person cohort. Despite Medicare rates discounting payments for nonphysician providers and the in-person cohort using clinical social workers more frequently, the services provided by the telehealth cohort still had lower payments. Thus, the differences observed are due to the in-person cohort receiving higher payment RVU services than the telehealth cohort, which was more likely to receive briefer therapy sessions and other less expensive services. Conclusions:Behavioral health services provided by telehealth used services with lower RVUs than behavioral health services provided in-person, on average, even after adjusting for patient demographics and diagnosis. Observed differences in Medicare payments resulted from the provider type and services used by the two cohorts; thus, costs and insurance reimbursements may vary for others. [ABSTRACT FROM AUTHOR]

• Cognitive Processing Therapy delivered over 1 week (CPT-5) can significantly reduce PTSD symptoms in adolescents. • CPT-5 can be effectively administered via telehealth. • Culturally sensitive administration of CPT-5 may be vital for patient engagement. • Condensed trauma treatment via telehealth may be more accessible to many patients. • Clinical trials are necessary to evaluate the acceptability and effectiveness of CPT-5 for adolescents. Cognitive Processing Therapy (CPT) has been thoroughly investigated as an efficacious treatment for posttraumatic stress disorder (PTSD). However, for many, the barriers to receiving treatment in the traditional weekly, in-person format prevent engagement. Recent evidence suggests alternative modalities, such as telehealth, and condensed administration of treatment protocols may reduce barriers, increasing treatment completion. This case study reports the treatment of a gay-identifying adolescent Latino male who received 10 sessions of CPT over the course of 5 consecutive days (CPT-5). The patient experienced significant reduction in PTSD symptoms over the course of treatment, dropping below the clinical threshold for PTSD diagnosis by the 10th session. Treatment gains were maintained, and continued, 6 weeks posttreatment. Further, the patient reported marked reduction in suicidality and substance use. In conclusion, the administration of CPT-5 via telehealth holds promise as an effective evidence-based treatment for adolescents with PTSD, including those holding multiple historically marginalized identities, though further investigation through clinical trials is warranted. [ABSTRACT FROM AUTHOR]

Disparities in access to mental health care, especially in rural areas, demand continued attention from practitioners, researchers, and community stakeholders. Telehealth, or the use of long distance technology to provide mental health services, is one well-recognized solution for reducing mental health disparities. At the Telehealth Counseling Clinic, advanced doctoral students provide telepsychology services to low-income and uninsured individuals living in a rural region in Texas. In response to an identified community need for grief counseling services, an 8-week grief group utilizing videoconference technology was conducted. This article discusses clinical and methodological challenges and lessons learned that are unique to delivering group counseling services over videoconference technology in a rural area, as well as preliminary data of the group's effectiveness as measured by a satisfaction survey, the Patient Health Questionnaire–9, the CORE–B, and the Complicated Grief Assessment are presented. [ABSTRACT FROM AUTHOR]

Training programs that integrate the use of technology are needed to prepare students for the future of service delivery in psychology. Training opportunities in telepsychology can equip students to develop, implement, and evaluate innovative modalities for mental health care. However, few options are available for trainees seeking to acquire these experiences, and while guidelines for service provision using technology are emerging, guidelines for and documented examples of training programs in telepsychology are virtually non-existent. The Telehealth Counseling Clinic, located at the Texas A&M Health Science Center, has developed a training model to prepare the next generation of psychologists to work with new technology to provide counseling services to low-income and uninsured individuals living in designated Mental Health Professional Shortage Areas in rural Texas. Training competencies necessary to serve this population through telepsychology are discussed and preliminary evaluation data of the training program are presented. [ABSTRACT FROM PUBLISHER]