Tip Sheet: Telehealth and Persons with Disabilities: What Psychologists Should Know

What is telehealth?
  • Telehealth: The provision of medical or mental health care services using technological modalities in lieu of, or in addition to, traditional face-to-face methods.

  • Telepsychology or Telemental health: The provision of behavioral and/or mental health care services using technological modalities in lieu of, or in addition to, traditional face-to-face methods (e.g., provision of therapy using the phone, diagnostic interviewing via videoteleconferencing, using applications to track mood states, consultations via email).

  • Synchronous: Service provision in real time between a psychologist and a consumer. 

  • Asynchronous: Service provision in a time-delayed manner between a psychologist and a consumer.

What should I know when implementing technology in my practice? 

What is important to know about technology and disability? 

  • As of December 2012, the APA in conjunction with ASPPB and ABAIT have created Draft Guidelines for the Practice of Telepsychology. This document is under review.
  • Approximately 54 million Americans have a disability (sensory, motor, physical, cognitive and/or emotional).
  • Legislation is a lengthy process requiring a significant amount of data collection prior to action. As such, laws and guidelines about telehealth lag significantly behind the rate of technology innovation.
  • People with disabilities, especially women and people of color, experience significant mental health disparities compared to people without disabilities due to programmatic, sociocultural, economic and physical barriers.
  • States are increasingly developing laws and guidelines governing the use of telehealth by psychologists.
  • In general, medical and mental health providers do not provide the appropriate access to mental and  behavioral health care due to unfamiliarity with the needs of individuals with disability.
  • Check state laws as well as licensing board standards and procedures regarding this practice.
  • People with disabilities have less access to the internet and those that do tend to have slower connections.
  • Currently, 12 states mandate health insurance reimbursement for certain telehealth services. These mandates do not necessarily include telemental health services.
  • People with disabilities report owning fewer cell phones or similar devices.
  • Medicare and Medicaid reimburse for certain telehealth and telemental health services.
  • People with disabilities may use assistive (adaptive) technology or equipment, require assistive technology services, and/or require support from assistive technology providers (e.g., certified assistive technology professionals or rehabilitation engineers).
  • If accepting third-party reimbursement, check with the respective agency regarding the extent to which they cover telehealth and telemental health services.
  • People with disabilities may rely on telerelay or videorelay services to communicate.
  • Policies and procedures regarding technology implementation and use will vary by institution.
 

 

How do I provide telehealth services to individuals with disability?
  • Assess the individual’s needs as well as the benefits and risks of using technology to provide services. 

  • Consider the products, services and environmental factors that are required to provide effective telehealth services to the consumer. 

  • Become aware of existing barriers for the individual with disability. Work to remove these barriers. 

  • Consider the compatibility of phones, equipment and computer-based programs used by the consumer and whether the products can work effectively with your method of service delivery. 

  • When using home-based or consumer technology, be mindful of the needs of your consumer regarding website accessibility, captioning and assistive technology and equipment. 

  • Learn about accessibility features and functions on software programs and apps that you might use. 

  • If services are provided via a telehealth center, be mindful of the needs of your consumers (e.g., access for  wheelchairs and power-driven mobility devices, service animals, use of videorelay interpreters, use of assistive technology and equipment).  

  • Work with an assistive (adaptive) technology professional or rehabilitation engineer if necessary. 

  • Be mindful that some individuals with disability work closely with a family member, caregiver and/or home health care provider. What is the role of this person, if any, in the consumer’s treatment? Consider the potential impact this may have on the provision of services. 

  • Develop a specific plan with the consumer that addresses emergency and/or unusual situations. If an emergency arises, ensure that the consumer knows of a local hospital, clinic, and/or professional equipped to provide them the appropriate support or care.  

  • Increase awareness and skills related to cultural competency and linguistic sensitivity. 

  • Working with an individual with a disability? Unsure about their needs? Just ask.

Carefully consider the advantages and concerns when evaluating whether to add telehealth services to your practice.

Advantages Concerns
  • Outreach to consumers in areas with few mental health resources or professionals trained to work with them
  • Effectiveness/Outcomes
  • Access for individuals with physical, medical or mobility concerns
  • Rapport/Therapeutic alliance
  • Access to disability specialists regardless of geographic area
  • Licensing issues
  • Access to therapy in native language (e.g., American Sign Language)
  • Portability and practice across state lines
  • Flexible scheduling
  • Reliability of technology
  • Ability to collect patient data outside of sessions
  • Access to technology
  • Help individuals for whom going to therapy may be difficult (e.g., PTSD, Agoraphobia)
  • Lack of physical presence in emergency situations
  • Youth outreach
  • Informed consent
  • Limited access to nonverbal behavior and cues
  • Increased difficulty accessing appropriate services in their local community in the event of an emergency
  • Increased isolation
  • Therapist liability

Areas with Both Advantages & Concerns

Privacy and confidentiality 
  • Advantage: Psychologist is able to provide service to a consumer in a small community, who may not receive services otherwise due to dual roles and other ethical conflicts. 

  • Concern: Environment not under the control of the psychologist. Consumer may not be alone at home, or session might be interrupted, overheard or intercepted by a third party. 

Participation and engagement 
  • Advantage: Easier to attend sessions, fewer barriers (e.g. car trouble) preventing consumer from attending sessions, consumer engagement.

  • Concern: Easier to skip sessions, sessions may not have the same perceived importance as in-person sessions, potential hardware and software malfunctions, consumer engagement.

Cost
  • Advantage: No commuting costs.

  • Concern: Cost and maintenance of equipment.

Discuss the advantages and concerns with each consumer to determine whether telehealth services are suitable for that consumer.

Where Do I Learn More?