May 06, 2020
The following recommendations must be adapted to the developmental age of the patient:
Ask whether the patient has ever seen a doctor on a phone or computer. If the patient has not used telehealth, it may be helpful to refer to common lay technology (i.e. Facetime, Skype, or Zoom) and explain key differences.
Let patients know why telehealth is being used. For example, "mental health clinicians are using technology to meet with patients during the COVID-19 outbreak so that everyone can stay as healthy as possible," or "I am using this so I don't have to use a face mask to see you today."
Communicate to patients that the session is happening in "real time," if needed. You may demonstrate this by commenting on the patient's gestures, or what they are wearing, saying that "everything you can see about me, I can see about you. For instance, you are wearing..." and "you just..." Children in particular seem to enjoy this exercise and proof that they are being seen.
Discuss security, if needed. For example, teens might understand the concept of encrypted technology, which is the HIPAA (Health Information Portability and Accountability Act) standard. If younger children express any concerns about who else can hear or see them, it can be described as having an "electronic tunnel from the camera where the clinician is sitting to the one where the patient is sitting." Additional information regarding technological specifications should be available if requested. Some patients appreciate being reassured that the session is not "on the internet" in the sense that it can neither be openly viewed nor will it be placed online.
It is important to inform patients if a session is being recorded. If you want to record a session, then you must obtain explicit consent from the patient. Teen patients who are recorded may appreciate information about what recorded information may be shared with their parent (e.g. substance use, sexual activity, etc.). As appropriate, provide information about mandatory disclosures. If sessions are being recorded solely for supervision purposes, this may also be shared with the family so as to diffuse any worry about loss of privacy.
Establish a visual context of where you are sitting. Ask patients if they would like to see your office. Using the camera's zoom and pan features or manually moving your device, you can give patients a virtual tour of your workspace to assure them that no one else is present and to provide context to the clinical setting. After the tour, let the patient know that the camera will be zoomed in so that the patient can see your facial expressions.
Discuss any technical difficulties noticed immediately as they arise during the introduction. For instance, if there is a slight lag in audio that makes it seem as if you and patient are talking over each other, you can suggest adding a small pause after each statement. Socialize youth to the videoconferencing system, and highlight that it might take time to acclimate to the technology and ‘‘not talk over each other.'
Give patients an opportunity to ask questions before starting the session. This may be especially helpful to younger and older patients who are not as comfortable with electronic media.