Video communication technologies have become a necessity to sustain clinical practices following the COVID-19 pandemic. Practitioners, scholars, and policymakers are in need of clear guidance for improving the efficiency and quality of telecare.
A number of divisions within the APA have collaborated to produce a program for the 2021 APA Convention in which a multidisciplinary group of panelists will provide real-world examples, interactive critical thinking exercises, and empirically-driven recommendations that will interest not only those working within the legal system, but also those broadly looking to integrate telepsychology into their practice or research program. Panelists will cover topics that include establishing a remote jail-based competency restoration program, improving the science of conducting and reporting forensic telepsychology initiatives, overcoming unique barriers to privacy and confidentiality in carceral settings, developing an infrastructure for telehealth networks, and drafting discipline-specific best practice guidance. Embedded within these talks, panelists will also address considerations for rural and diverse clients. The session will conclude with a general discussion and Q&A with panelists using pre-selected questions. APA Divisions supporting this program include: 12, 14, 18, 41 (lead division), 42, and 46.
The following is a thumbnail sketch of the proposed talks:
- Embracing a new paradigm: Developing telehealth services and practices for jail-based competency restoration
Presenter: Tomina J. Schwenke, PhD, ABPP; coauthor: Douglas Edward Lewis, Jr., PsyD
Emory University School of Medicine, Psychiatry and Law Services
The Emory/Grady Fulton County jail-based competency restoration program serves individuals who are opined or adjudicated incompetent to stand trial. The pandemic interrupted daily operations at the jail, which resulted in several unexpected consequences. This presentation explores the shift from in-person services to remote and telehealth focused programming and will address the following topics: (1) The early steps that were taken to work collaboratively, modify curriculum, and develop resources to enhance groups, individual counseling, and medication management; (2) the use of special programs to intentionally foster a sense of community and pro-social connections and to protect against psychiatric decompensation; and (3) the impact of COVID-19 on the postdoctoral fellowship and the evolution of supervision.
- Privacy and confidentiality considerations when implementing telepsychology in forensic contexts
Presenter: Alexandra Lugo, MS
Palo Alto University, student
The rapid shift to telepsychology services during the COVID-19 pandemic has highlighted ethical concerns related to privacy and confidentiality that are particularly salient among forensic populations. This portion of the program will highlight existing barriers to mental health service utilization and engagement in forensic populations (e.g. stigmatization) that are often compounded along racial and ethnic lines. Considerations specific to correctional settings will be presented, including custodial factors that can leave nonconfidential cell-front videoconferencing as the sole method of delivering mental health services, potentially exacerbating existing barriers. This talk will also address considerations for forensic populations in the community, with a focus on individuals with sexual offending histories who are mandated to treatment. Using reflection questions and prompts, participants will have opportunities to consider the contextual factors associated with the implementation of telepsychology in their organizations or agencies that may increase risks to privacy and confidentiality, compounding barriers to engagement for forensic populations.
- Telepsychology with justice-involved clients: Current state of the literature and moving the science forward
Presenter: Ashley B. Batastini, PhD
University of Memphis
Even before the near overnight shift in practitioners turning to virtual services following restrictions on physical distance, various forms of remote services were infiltrating the practice of psychology. The use of videoconferencing technology (VCT) in particular has increased rapidly over the past decade, and exponentially since 2020 alone. A recent meta-analysis of 57 studies comparing VCT to in-person across clinical contexts and client types produced relatively small aggregate effect sizes, suggesting that being physically present in the room with a client is not imperative for achieving desired outcomes (Batastini, Paprzycki, Jones, & McLean, 2020). However, this meta-analysis pointed to several issues within the literature. Thus, despite the growing use of and support for remote mental health care, there remains comparatively little empirical evidence that meets a high standard of scientific rigor.
This portion of the program will focus on improving the science of telepsychology. First, general considerations will be presented, including the need for controlled methodological designs, larger and more diverse samples, greater attention to effectiveness outcomes, and clearer and more complete descriptions of the technologies used and services provided. Given the growing literature base involving forensic clients and incarcerated persons (see Batastini, McDonald, & Morgan, 2013; Batastini, King, Morgan & McDaniel, 2015), this talk will also address research considerations and directions specific to these populations and settings. The talk will offer attendees an opportunity to critically evaluate how they can conduct research within their own practice or agency through the use of rhetorical prompts and reflection points throughout the presentation (e.g., “I invite you to now pause this video and open a blank document. Jot down any barriers that immediately come to mind when thinking about conducting a program evaluation or other research project within your organization.”). Participants will leave with concrete guidelines for conducting and reporting such research.
- Virtual care for justice-involved populations: Barriers and steps to establishing a telehealth program
Presenter: Courtney L. Helfrich, BS
Telehealth Center of Excellence
University of Mississippi Medical Center
This presentation will focus on systemic barriers in access to care for correctional populations, incarcerated and community-released, and offer strategies detailing how to build out sustainable telepsychology networks for justice-involved populations. Social determinants of health and resulting health inequities relevant to justice-involved populations will be examined, as well as issues faced on a community-level. The conversation will outline what technological and clinical components are needed to build out a telepsychology program in collaboration with county and state-level agencies. The discussion will also highlight how community practitioners and psychologists in private practice may get involved in offering services to justice-involved populations or become connected to larger telehealth networks. The conversation will provide attendees with an opportunity for critical analysis, using interactive prompts to stimulate audience engagement (e.g., “Take a moment to evaluate what barriers in access to care exist within your own communities? Now, choose one issue and identify at least three steps you can take, acting as a practitioner or citizen, towards increasing access to telepsychology in this area.”). Attendees will learn about the development and maintenance of a telehealth program on a larger, state-wide scale, how such networks work to increase access to care for difficult-to-reach and high-risk clients, and the first steps in becoming involved in a telepsychology program focused on individuals with both mental health and criminogenic needs.
- An update on the AP-LS Telepsychology Taskforce: Modeling discipline-specific guidelines
Presenter: Michelle R. Guyton, PhD ABPP; Co-author: Ashley Batastini, PhD
Northwest Forensic Institute
When the COVID-19 pandemic hit and profoundly altered forensic and correctional mental health service provision, the research on telepsychology methods in these contexts was burgeoning, but there were gaps in how research guided evidence-based practice in a suddenly new practice landscape. The research literature regarding use of telepsychology in legal settings has been primarily positive (e.g., Batastini, King, Morgan, & McDaniel, 2016; Luxton & Lexcen, 2018), finding similar outcomes for in-person and virtually administered evaluations. While these publications and existing general practice guidelines (see APA’s Guidelines for the Practice of Telepsychology, 2013) are instructive, the pandemic exposed a host of new questions about the ethics, technology, and procedural aspects of telepsychology for which there was, at that time, little guidance. In response to these challenges, AP-LS (Div. 41) convened a taskforce to identify resources for its members by connecting research with practice within and outside of forensic psychology. The taskforce developed into a more formal structure with intentional selection of members to represent a broad array of professionals across the career spectrum and areas of expertise. In this presentation, the taskforce co-chairs will provide an update of the work to date. Specifically, we will introduce the initiatives of the task force, describe the process of establishing the taskforce team membership, describe progress toward our goals to date, and outline our immediate- and long-term next steps. We will further discuss development and dissemination of best practices, both to work settings specific to Div. 41 as well as how our model may extrapolate to the work of other divisions across APA and work settings.