The Need to Implement and Evaluate Telehealth Competency Frameworks to Ensure Quality Care across Behavioral Health Professions

Abstract

Technology is rapidly becoming a key player in care delivery, lifelong learning, and education/training. The American Psychiatric Association Practice-Based Learning and Improvement Core Competencies include the use information technology and lifelong learning [1]. Current competencybased education (CBE) focuses on skills rather than on what is taught [2,3]. Competency may be defined as a measurable human capability required for effective performance [4]. The Institute of Medicine (IOM) [5] suggested three key elements for patient-centered care: skills-focused education, interdisciplinary team-based care, and a technology/informaticsoriented administrative approach.A key premise of telepsychiatric competencies published in 2015 [6] is that faculty clinicians and educators have to first improve their care via clinical and technological competence, in order to then oversee trainees' use of technologies in clinical care. Fundamental steps to this work are the alignment of clinical outcomes with teaching/supervisory methods, evaluation, and feedback [6,7]. Professional association standards and guidelines typically do not focus on competencies, are complex, and are frequently incomplete (e.g., diverse populations and settings) [6][7][8], and comparisons across professions are rare [7].Telebehavioral health (TBH) is a broad term inclusive across behavioral health professions and technically includes both mental health and substance use care; in this paper, it will also include TP. Each BH discipline and field has its own nomenclature for telehealth (e.g., telepsychiatry, telepsychology, distance counseling) [9], though competencies related to technological standards were suggested years ago [10,11]. A TBH competency set arrived in [12] and a specific one for use of social media arrived in 2018 [13]. Care delivered by TBH may require additional skills-or adjusted behaviors-compared to in-person care [6,7,[11][12][13].The current paper will:1. Review TBH evidence relevant to competencies, guidelines, and standards and compare similarities and differences across professions related to integrating technology in practice 2. Highlight TBH competency sets to date 3. Discuss implications of implementing TBH competencies across professions. The Telebehavioral Health Evidence-BaseClinical Services, Outcomes, and EvaluationThe most influential papers about TBH over the past two decades are on the following themes: (1) effectiveness [14], (2) guidelines by the American Telemedicine Association (ATA) [15, 16], (3) summary of outcomes including randomized controlled trials [17], (4) models of service delivery [18], (5) hybrid models of care [19], and (6) interventions with population-level impact [20]. Evaluation of TBH has gone through three phases related to effectiveness: ability to increase access to care, validity and reliability compared to inperson services, and delivery models for complex populations [14][15][16][20][21][22]. TBH clinical assessment, psychological and cognitive testing, triage, and management/treatment serv...

Approaches for Departments, Schools, and Health Systems to Better Implement Technologies Used for Clinical Care and Education

“…If psychiatric faculty and administrators fail to technologically progress, young professionals may opt toward other technology-hip areas of medicine, and clinical boundary and privacy violations may become more common. This paper complements the curricular and competency papers [14][15][16][17][18], which provide more operational, concrete examples for faculty, residents, and administrators. This paper aims to help readers in three ways: 1) To understand the technology-related skills, attitudes, and knowledge for clinicians and trainees to ensure the quality of care 2) To provide an approach to make change with technology:(1) assess readiness;(2) create/hardwire the culture; (3) write policies and procedures; (4) establish the curriculum and competencies; (5) train learners and faculty; and (6) evaluate/manage change 3) To provide principles of an approach in the form of institutional competencies to help integrate technology into core academic missions Technology-Related Skills, Attitudes, and Knowledge for Clinicians to Ensure Quality of Care…”

“…If psychiatric faculty and administrators fail to technologically progress, young professionals may opt toward other technology-hip areas of medicine, and clinical boundary and privacy violations may become more common. This paper complements the curricular and competency papers [14][15][16][17][18], which provide more operational, concrete examples for faculty, residents, and administrators. This paper aims to help readers in three ways: 1) To understand the technology-related skills, attitudes, and knowledge for clinicians and trainees to ensure the quality of care 2) To provide an approach to make change with technology:…”

“…Telepsychiatric (2015, 2018), broader TBH (2017), social media (2018), and mobile health (2019) competencies were designed to support clinical care, training, faculty development, and administrative missions [14][15][16][17][18]. Most frameworks use the Accreditation Council of Graduate Medical Education domains [25].…”

“…Most frameworks use the Accreditation Council of Graduate Medical Education domains [25]. The original TP competencies were subdivided according to the Dreyfus model for learners into novice/ advanced beginner, competent/proficient, and expert levels [14,18,40]. Clinical and administrative-based issues related to care include documentation, EHR, medico-legal, billing, cultural, confidentiality, and privacy (e.g., Health Insurance Portability and Accountability Act; HIPAA) [14][15][16][17][18]41].…”

“…New options like "emoticons" or emojis are increasingly popular and contribute to social communication, but they have drawbacks, too. They may not adequately capture the nuances of feelings expressed in-person or by written words, and they may be confusing at times [18,21,22]. Technology-associated change impacts many areas of clinical care, training, and faculty development [14,23].…”