March/April 2016 Issue
Technology Trends: Training Social Workers in Telebehavioral Health Care
Over the past two decades, telebehavioral health care has expanded significantly and is now widely accepted as a legitimate option for providing care. This has been made possible in large part by the availability of high-quality, low-cost, user-friendly digital communication tools. Along with the advancement of these tools is the ever-growing acceptance of technology's presence in our lives; health care practitioners and patients have both shown a willingness to accept and even embrace technology if they see a benefit in terms of time saved and overall convenience.
But with the expansion of these services, there also comes a need for specialized training. Along with the various forms of training currently available to support behavioral health care providers in general, there is a need for comprehensive training programs designed specifically for the social work profession.
Telebehavioral health care offers a cost-effective model for increasing the availability and accessibility of mental health and substance abuse services, especially in rural, remote, and medically underserved areas. In addition to addressing access barriers related to location and transportation, this mode of care also facilitates access in cases where stigma might otherwise discourage a client from receiving services. Points of delivery for such care are diverse, including hospitals, emergency departments, clinics, offices, homes, nursing homes, schools, and correctional settings (Saeed, 2015).
Numerous studies have found that telebehavioral health care is able to offer the same quality of care as that provided via in-person services; studies also indicate that clients are receptive to this type of service delivery. A 2013 report from the US Department of Health and Human Services notes: "Telebehavioral health may be one of the more successful applications of telehealth cross the spectrum of clinical services, as outcomes and patient acceptance for telebehavioral health are comparable to face-to-face visits."
New Legal Issues
Furthermore, while technical competencies don't supersede clinical competencies in the delivery of telebehavioral health services, adequate technical skills and reliable tools are still essential for effective service delivery. A seemingly minor glitch, such as a poor audio connection, has the potential to compromise a patient encounter and lead to misunderstandings or miscommunication. Adequate training and preparation ensures that service providers are thoroughly equipped to deal with these situations, so they can minimize any negative impact on the patient.
Much of the telebehavioral health care training currently available is provided as continuing education units, as standalone courses, or in the form of short webinars. Even though the content of these programs may be sound and reliable, this training is generally designed to accommodate a variety of clinicians and health care practitioners. Such training usually has not been developed to explicitly incorporate a social work perspective, and is therefore limited in its ability to address issues and challenges specific to social work practice.
Telebehavioral Training in Alaska
Developed in 2009, this course was designed by a multidisciplinary team from the university in partnership with the Alaska Native Tribal Health Consortium, and the Alaska Psychiatric Institute Recovery Center. Alaskans have higher rates of suicide and substance abuse than the national average, and the region's widely dispersed population presents a challenge for effective service delivery. The distribution of the population across remote and rural areas means that many people don't have access to behavioral health care services within their communities. The course offered by the University of Alaska Anchorage is part of a larger effort to provide telebehavioral health services that can effectively meet the population's needs.
Training Workforce for Large-Scale Access
With the support of a $15,000 IUPUI Curriculum Enhancement Grant, the Indiana University School of Social Work is developing three new online courses in social work and telebehavioral health. Wilkerson is the principal investigator on the grant, and he explains that each course has a specific focus.
The first course provides an overview on the delivery of behavioral health interventions that are mediated through technology. It addresses legal and ethics issues, and will also help social workers to assess when telebehavioral health services are appropriate for a client. Setting up behavioral care services has an administrative component, with the need for appropriate protocols, policies, and procedures to be established to guide service delivery and assess quality of care (Saeed); students will gain the skills required to deal with these responsibilities.
The two remaining courses are designed to address individual and group-based interventions. For example, the course on group-based interventions will delve into issues such as how to develop delivery systems in a way that can increase client participation and retention and ultimately improve outcomes. "By offering a multisequence set of courses over a sustained period of time," Wilkerson explains, "we can prioritize the course content and determine the sequence in which it gets delivered, in order to best meet the needs of students."
Beyond learning about how to deliver telebehavioral services, students will be in a better position to determine whether or not they want to deliver services in this manner, as they will have the opportunity to explore their own preferred style of helping and how well it fits with the delivery of care using technology.
This level of training also has implications for policy contributions. As the technologies continue to develop and telebehavioral health care advances, new issues and challenges will inevitably arise. Wilkerson notes that the competency and legitimacy offered by a more comprehensive, multicourse, social work specific program supports social workers' ability to contribute to policy development and the establishment of best practices.
Offering courses as part of the university social work curriculum supports the ASWB's objectives by providing specialized content with an explicit focus on social work practice. Graduate level courses are ideally suited for providing in-depth training in the various areas identified by the standards.
Training Grounded in a Social Work Perspective
Regarding the new program at the Indiana University School of Social Work, Wilkerson says: "This type of education program provides an opportunity for the social work profession to develop a more powerful voice on telebehavioral health, and how to deliver services in a way that's consistent with social work ethics."
— Susan A. Knight works with organizations in the social services sector to help them get the most out of their client management software.