Correction to: An Interprofessional Framework for Telebehavioral Health Competencies

Abstract

The Coalition for Technology in Behavioral Science (CTiBS) has developed an interprofessional, evidence-based, measurable framework for telebehavioral health (TBH) competencies. The paper presents the development of the CTiBS TBH framework, identifies the theoretical rationale and need for such competencies; outlines methods used; provides two detailed discussions of applications; presents a tabulized form of the framework, then discusses limitations and future research. In the CTiBS TBH competency framework, the term telebehavioral health is meant to include telemental health and e-therapy. The TBH competency framework is offered as an initial working document to identify and organize discreet, measurable telebehavioral practices derived from a review of the literature, technological advances and day-today clinical practice. It reflects core knowledge, skills and attitudes needed for competent telebehavioral health practice. The competency framework is directly applicable to psychiatry/medicine, psychology, social work, counseling, marriage/family, behavior analysis and other behavioral sciences. The CTiBS TBH framework organizes seven topic domains and five subdomains according to competency level i.e., Novice, Proficient or Authority. In turn, each competency level is categorized into 51 discrete telebehavioral objectives, which are then distinguished by 149 cumulative and measurable telebehavioral practices. The seven TBH competency domains identified by CTiBS include: 1) Clinical Evaluation & Care, with three subdomains addressing Assessment & Treatment, Cultural Competence & Diversity and Documentation & Administrative Procedures; 2) Virtual Environment & Telepresence; 3) Technology; 4) Legal & Regulatory Issues; 5) Evidence-Based & Ethical Practice, with two subdomains addressing Standards and Guidelines and Social Media; 6) Mobile Health and Apps and 7) Telepractice Development.

Barriers to Use of Telepsychiatry: Clinicians as Gatekeepers

“…39,46 They have reported discomfort due to focus on staying in view and that fear of making the screen jerky impeded note taking. 51,57 Eye contact can also feel artificial across technology. 46 Clinicians have also expressed discomfort in being unable to take physical steps to reassure or comfort.…”

“…46 Specific educational core competencies have been suggested to teach telepsychiatry clinicians how to facilitate the therapeutic relationship by adjusting clinical interview skills, attending to rooms and furnishings, and preventing distractions. 57 In one highly experienced center, they note that rapport was quickly established by exhibiting use of the equipment and allowing youth and their parents to become familiar with screen controls. 48 Clinicians reported lower therapeutic alliance in telemental health conditions when randomly assigned to evaluate in-person or videoconference therapy sessions 58 and remain hesitant to use video conference therapy sessions because they believed that the therapeutic alliance was at risk.…”

“…111,112 Other guidelines have outlined clinical evaluation and care; administration; cultural competence and diversity; legal and regulatory issues; evidence-based and ethical practice; and mobile health, smartphone, and apps. 57,111 The American Telemedicine Association now offers accreditation and webinars. 8 Training handbooks and book chapters 113 as well as online courses are also available to help train and educate interested clinicians.…”

“…47,50 Education for clinicians should include instruction on best practices, strategies for ways to establish and maintain relationships at a distance, and guidance about reimbursement and billing. 47,57,77,112,114,134 In addition, there is support for a "hybrid model" that extends and supplements in-person care, a model with potential to improve physician and patient satisfaction and acceptance. 8,19,30,68,69,103,135,136 Benefits that attract psychiatrists to telepsychiatry that deserve further exploration include flexibility in scheduling and increased diversity of practice by working in different settings (schools, prisons, homes, and hospitals) and with different populations (prisoners, students, employees, hospital patients, and outpatients).…”

A consolidated model for telepsychology practice

“…Support and energy are mounting for developing for telepractice competencies (Colbow, 2013; Hilty et al, 2015, 2017; Johnson, 2014; van Houwelingen, Moerman, Ettema, Kort, & ten Cate, 2016). Some are focusing on specific disciplines, while others are calling for an interdisciplinary effort (Hilty et al, 2017; Maheu et al, 2020). A coordinated effort across disciplines, will likely lead to the best and most utilitarian practices.…”