Dialing in to the possibilities of telehealth

With one in every three Americans living in an area without access to mental- and behavioral-health services, the need and opportunity to expand care-delivery mechanisms have never been greater.

The rise to prominence of telehealth platforms such as Amazon One Medical and BetterHelp likely mean the shift to virtual care is here to stay, though what that looks like continues to evolve, said Paul Murphy, affiliate faculty member in Health Professions at Metropolitan State University of Denver and an industry consultant.

“The pandemic resulted in an explosion of virtual care, to the point where it became a massive buzzword,” he said. “And though it’s still extremely prevalent, we’re starting to see organizations in the space look more closely at things like how regulations affect profitability and balancing it with brick-and-mortar facilities.”

Telehealth is a type of virtual care that focuses on clinical care, whereas virtual care is a broader term that includes both clinical and non-clinical services. Both terms refer to receiving medical treatment electronically, whether through video conferencing, phone calls, messaging via a secure portal or a combination of multiple methods.

Murphy noted the shakeout faced by some companies, such as Teledoc Health, whose stock has collapsed to 3% of its February 2021 high. At the end of April, Walmart Health announced it was shuttering its 51 one-stop-care centers across five states.

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At the same time, the virtual-care industry — Murphy’s term for the larger umbrella of dispersed service, practice and technology — is seeing an expansion in proactive monitoring and even smart-home integration with the advance of wearable and implantable devices, such as continuous glucose monitoring.

“With the different models for virtual care that we see, there are unanswered questions developing when it comes to various items, such as reimbursement,” he added. “If you have remote patient monitoring, who’s paying for what?”

As an enhanced outpatient counselor, Diana Buccafurni-Huber prioritizes client-centered care and building empathy to help individuals navigate a variety of challenges.

The fact that nearly a quarter of her 50-plus patients never set foot inside the WellPower facility where she works has been a challenge and an opportunity.

“When you think about equity of access, there are folks who are only going to be able to access these kinds of services through telehealth,” said Buccafurni-Huber, who is finishing up her master’s in Clinical Behavioral Health with a focus on addictions from MSU Denver. “I don’t foresee that option ever really going away.”

Awareness of this changing landscape is a driving factor behind why nearly all departmental clinical placements have telepresence options, said Tricia Hudson-Matthew, Ed.D., department chair and professor of Human Services and Counseling at MSU Denver.

“We don’t know what individual agencies are going to require or what clients are going to request, so training students on both in-person and virtual care is critical for maintaining our successful track record,” she said.

State-by-state licensure requirements and ethical standards are a central part of understanding the strengths and restrictions of virtual care, Hudson-Matthew said. Scope also translates differently, as individual- and couple-based practice often proves more effective than group therapy. And since video-chat windows provide a limited field of view, which might obscure body language such as shaking legs, hand placement or fidgeting, it warrants an increased emphasis on eye contact and observable nonverbal communication.

Given its relative newness, she also cautioned against sole reliance on text-only options until more research supports the efficacy and cost-benefit analysis around emerging technologies.

“It’s great that we have these different vehicles such as chat we can use in different ways, but without the visual connection to assess safety, that’s not therapy,” Hudson-Matthew added.

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Still, the benefits of the delivery vehicle are undeniable. The University’s Department of Social Work proactively incorporates telehealth modules into its clinical classes, discusses regulations such as interstate compacts to understand available scope and connects interested students with agencies offering virtual services.

Regardless of the modality, future clinicians must still be grounded in evidence-based practice and conscious of psychotherapy best practices, noted Jessica Retrum, Ph.D., professor and chair of the Social Work Department.

This comprehensive background was helpful for Karina Muro, a 2023 Master of Social Work graduate and adult-outpatient practitioner with Longmont-based Mental Health Partners.

“Telehealth can be really helpful for clients when barriers to care present themselves,” she said. “It helps us ask, ‘How do we give each other grace and accommodation when other systemic structures don’t?’”

Some of those structures can include transportation to facilities (in both urban and rural settings), child care, able-bodiedness and phobias preventing otherwise accessing care. As Muro and Buccafurni-Huber see a large number of Medicaid recipients, socioeconomic status often undergirds many of these contributing factors.

It might not be a panacea to fix the mental- and behavioral-health crisis, but if nothing else, establishing person-centered, effective virtual care practices is proving to be one more tool in the tool kit of tomorrow’s practitioners.

And as Muro noted, the potential benefit isn’t limited only to clients.

“Telehealth isn’t for everybody, and at the same time, it is for everybody,” she said. “It’s not only good for clients but also for us as therapists — we can’t be role models if we don’t create and honor our own boundaries.”