Community Mental Health Clinicians’ Perspectives on Telehealth During the COVID-19 Pandemic: Mixed Methods Study

Abstract

Background In March 2020, a rapid shift to telehealth occurred in community mental health settings in response to the need for physical distancing to decrease transmission of the virus causing COVID-19. Whereas treatment delivered over telehealth was previously utilized sparingly in community settings, it quickly became the primary mode of treatment delivery for the vast majority of clinicians, many of whom had little time to prepare for this shift and limited to no experience using telehealth. Little is known about community mental health clinicians’ experiences using telehealth. Although telehealth may make mental health treatment more accessible for some clients, it may create additional barriers for others given the high rates of poverty among individuals seeking treatment from community mental health centers. Objective We examined community mental health clinicians’ perspectives on using telehealth to deliver trauma-focused cognitive behavioral therapy to youth. We sought to better understand the acceptability of using telehealth, as well as barriers and facilitators to usage. Methods We surveyed 45 clinicians across 15 community clinics in Philadelphia. Clinicians rated their satisfaction with telehealth using a quantitative scale and shared their perspectives on telehealth in response to open-ended questions. Therapists’ responses were coded using an open-coding approach wherein coders generated domains, themes, and subthemes. Results Clinicians rated telehealth relatively positively on the quantitative survey, expressing overall satisfaction with their current use of telehealth during the pandemic, and endorsing telehealth as a helpful mode of connecting with clients. Responses to open-ended questions fell into five domains. Clinicians noted that (1) telehealth affects the content (ie, what is discussed) and process (ie, how it is discussed) of therapy; (2) telehealth alters engagement, retention, and attendance; (3) technology is a crucial component of utilizing telehealth; (4) training, resources, and support are needed to facilitate telehealth usage; and (5) the barriers, facilitators, and level of acceptability of telehealth differ across individual clinicians and clients. Conclusions First, telehealth is likely a better fit for some clients and clinicians than others, and attention should be given to better understanding who is most likely to succeed using this modality. Second, although telehealth increased convenience and accessibility of treatment, clinicians noted that across the board, it was difficult to engage clients (eg, young clients were easily distracted), and further work is needed to identify better telehealth engagement strategies. Third, for many clients, the telehealth modality may actually create an additional barrier to care, as children from families living in poverty may not have the requisite devices or quality broadband connection to make telehealth workable. Better strategies to address disparities in access to and quality of digital technologies are needed to render telehealth an equitable option for all youth seeking mental health services.

COVID-19 related innovation in Aotearoa/New Zealand mental health helplines and telehealth providers – mapping solutions and discussing sustainability from the perspective of service providers

“…As prior reports have suggested, speedy innovation is often lacking impact analysis but should be considered at a later stage if innovations are to stay ( 14 ). Although accessibility of services was increased for some, switching to one hundred percent telehealth mode illuminated inequities – not everybody had equal access to internet, data, or even hardware; not everybody – both service users and staff – had a safe, confidential, and professional environment for an online consultation, similar to what has been reported in other studies ( 23 , 24 ). Telehealth varied in effectiveness depending on types of presentation.…”

“…Consequently, many providers noted that while innovation was needed and some of it has proven to be effective, as we are settling in to a “new normal” we need a more nuanced discussion about what works and what does not, and what improvements can be made. Prior qualitative evidence echoes these observations with mental health workforce embracing telehealth because of its scheduling flexibility and increase in attendance from service users, but noting potential inequities for service users and potential negative effects on one’s job satisfaction and wellbeing ( 23 ). Our results contribute to the literature emphasising the need to consider hybrid solutions between face-to-face care and telehealth and more flexible working environments where online work is a choice rather than a necessity.…”

Patient and provider perspectives of the implementation of remote consultations for community-dwelling people with mental health conditions: A systematic mixed studies review

“…For example, some providers reported that eye movement desensitization and reprocessing (EMDR) therapy was challenging to conduct remotely ( Freske and Malczyk, 2021 ), with one provider stating that they attempted to teach their patient how to perform this therapy on themselves ( Schow et al, 2022 ). Some providers reported that they would have liked to have received training and education on how to effectively deliver care remotely ( Schriger et al, 2022 ), while others felt confident in their abilities and did not feel there was a need for training ( Budhwani et al, 2021 ). In contrast, phone consultations were acknowledged as an effective and efficient method for some appointments such as medication visits ( Budhwani et al, 2021 ; Wyler et al, 2021 ) and brief follow-up calls ( Christensen et al, 2021 ).…”

Factors Impacting Patient Perspectives on Telehealth and Remote Healthcare during COVID-19: A Mixed Methods Study

“…Several studies have investigated the implementation of telehealth platforms during the pandemic (Olszewski et al, 2022; [25] ). Multiple factors were identified to pose significant challenges, including cost, data privacy, the digital divide, and training programs on the adoption and utilization of telehealth services.…”

“…In addition, challenges and barriers to enabling telehealth services can affect a patient's decision on future selection for the type of visit to receive healthcare services. Factors such as accessibility, mitigating barriers, effective technology, and training programs were crucial in facilitating the utilization of telehealth [25] . However, clinicians' and patients’ perspectives toward telehealth can vary depending on facilities' accessibility and barriers.…”