Diagnostic Considerations
Supplementing past clinical experiences, diagnostic considerations must be assessed. These considerations can relate to both mental health and medical factors. First and foremost, the provider should evaluate if the patient is presenting with serious issues that would preclude general outpatient services, requiring a higher level of care. Simply put, if the patient is not suitable for F2F outpatient work, adding the complexity of videoconferencing is likely not a good idea. Such concerns may include if they are acutely violent, suicidal, or homicidal. Additional concerns that may create pause for general outpatient services include active psychosis including hallucinations or delusions (i.e., requiring pharmacological stabilization prior to therapy processes being implemented), or if they are actively utilizing substances that put them at risk for safety concerns or withdrawal- related medical complications.
Assuming the patient is suitable for general outpatient services, the provider should then consider the research related to the patient’s specific mental health condition(s) that they will be required to assess or treat. Has the research demonstrated positive outcomes of an assessment or treatment related to the patient’s presenting concerns? If it has, under what circumstances was it tested (e.g., was it of a population age and demographic similar to the patient), and what were the outcomes? If the patient would be a general candidate for outpatient services, and the research supports the use of videoconferencing for their specific demographics and concerns, then the provider has a strong rationale for using the technology.
Compounding the mental health-focused concerns are physical considerations of the patient that may hinder effective videoconferencing. For some, disabilities can create auditory or visual impairments. While there are means to overcome many issues, methods of addressing the challenges (e.g., headphones for hearing impairments, gaining access to hearing aids, specific glasses or monitors for visual challenges, purchasing a larger and clearer computer monitor for visual clarity) may not be equally possible for all patients given their location and financial situation. If a physical disability can have a significant impact on the therapeutic processes, and modifications cannot be made, videoconferencing is likely not the best means of reaching the patient if other services are possible.
Finally, the provider must evaluate the patient for any cognitive issues that can create a range of additional videoconferencing-related challenges. First, informed consent may become an issue if the individual’s cognitive abilities create difficulty for their understanding of the benefits and risks of a videoconferencing process. Second, one’s cognitive abilities may create challenges for the logistics of setting up and implementing the videoconferencing technology, even with provider coaching. This is especially pertinent for problem-solving of the technology as challenges arise, as issues with connectivity, the Internet, and the video camera itself are likely to occur and require remedy. Unfortunately, if such issues cannot be reasonably addressed, it could affect both the therapeutic relationship, as well as the outcomes for the treatment. As such, if a patient has mild cognitive issues, but generally understands the processes, is able to provide informed consent, and can problem-solve as the need arises, they are likely appropriate candidates for the videoconferencing. Alternatively, if they demonstrate comprehension issues and problem-solving challenges, potentially evidenced by a history of general issues with daily living, the videoconferencing technology may become a detriment to the patient’s care. However, even if cognitive issues present as impairing, videoconferencing may still be viable if others (e.g., family members, guardian, nurse) are available to assist the patient in the therapeutic and technical processes.
