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Social Services Innovations: Telephone Behavioral Health Services — Training a Remote Workforce
By Micaela Mercado, LMSW, PhD
Social Work Today
Vol. 20 No. 1 P. 8

Our experience tells us that behavioral health professionals are not adequately trained to provide mental health services outside of traditional clinical settings despite advances made in technology that show promise for improving access to services. In our work, we learned that the workforce is unprepared for this transition—surprisingly, clinicians struggle communicating over the telephone with patients.

Compared with other technologies such as videoconferencing, the telephone is pretty simple. Yet, despite its practicality and universality, the telephone is overlooked—even by clinicians—as an accessible, low-cost modality for delivering timely mental health services. This is especially true in the educational training of behavioral health professionals and those seeking licensure where in-person therapy is the only way of providing treatment.

From our experience, this is a missed opportunity, significantly reducing access to mental health services for individuals who need it the most. We learned quickly that our Concert Health workforce was unprepared to provide telephonic services. More importantly, our clinicians were astounded through their own experiences that telephonic services are comparable to in-person treatment. For many, telephonic services were a new experience.

Making the Leap
According to a 2018 report published by the Behavioral Health Workforce Research Center, about 48% of behavioral health providers use some form of technology to provide services. However, 75% of clinicians are unaware of professional development programs that support their clinical and technical training. We quickly learned that training goes beyond technology. Using the telephone requires a different set of competencies. It requires that behavioral health professionals make adaptations to successfully provide telephonic treatment.

“Training behavioral health professionals is essential for them to effectively use the telephone to do their work. This is especially critical since our entire workforce works remotely across three states—New York, California, and Arizona,” says Virna Little, PsyD, LCSW-R, SAP, CCM, chief operating officer Concert Health’s chief operations officer.

Although novel modalities have been introduced, Little says, very few providers use the telephone to provide mental health services. Compared with the majority of psychiatrists, fewer than one-third of social workers, mental health counselors, psychologists, and case managers deliver behavioral health treatment using the telephone.

The challenge of training providers in telephone-delivered mental health services, according to Little, is the scarcity in workforce development and education initiatives that this workforce is exposed to while pursuing their professional degrees or licensure.

Concert Health trains its workforce in remote telephonic services, increasing access to services and ensuring quality care to all patients. Key areas of workforce development have lagged behind advancements in the field, which have traditionally viewed telephone services as inferior to in-person therapy services, Little says.

Eunice Kim, LCSW, director of training at Concert Health, says that, amid the growth of her organization, several training needs for their workforce were identified. Technical training is paramount. The workforce also needs to learn techniques for engaging patients when they provide remote telephone services, Kim says, and in addition, adaption is essential. Training a workforce to adapt to telephone-based services requires learning new strategies and adapting interventions to make them work for the telephone.

Kim noted several adaptations clinicians must learn or consider for engaging patients. “For example, clinicians need to know the best way to share information with clients—such as using digital platforms for document sharing like safety plans or relapse prevention plans. It’s also important to teach clinicians expectations for how clients need to be engaged on the telephone. We tell clinicians that clients should have a pen or paper handy to take notes, or to direct them to online resources during a session for more information.”

Clinicians also need to be more attuned to nonverbal cues, Kim says. Consistently checking a patient’s understanding during a session is paramount for engaging them but also making sure they are present on the telephone without any distractions.

Harnessing Potential
Telephonic-based mental health service is one way to address care shortages and, by doing so, reduce disparities we find in behavioral health treatment. Evidence shows that those who are most likely to benefit from behavioral services are patients who live in rural areas or those who are homebound, as well as patients who have chronic conditions where in-person therapy is not possible for them.

“We find that many of our patients choose behavioral health services over the telephone for various reasons,” Little says. For patients, services over the telephone offer scheduling convenience and flexibility, especially for those who work during the day or work odd hours, or travel for work. Childcare may be less of a barrier if treatment is over the telephone, and transportation costs might be as well. Telephone services also meet the needs of patients who prefer not to go to a clinic. And for patients who frequently use inpatient care for physical health conditions, services over the telephone minimize disruptions to their care.

“Once patients enroll in telephone services, we’re seeing they keep their appointments at significantly higher rates than in-person treatment,” Little says. These reasons warrant better efforts to train behavioral health professionals in telephone services and address the disparity in behavioral health treatment for those who are underserved by our health care system.

— Micaela Mercado, LMSW, PhD, is the former director of research at Concert Health.

Acknowledgments to Virna Little, PsyD, LCSW-R, SAP, CCM, chief operating officer, and Eunice Kim, LCSW, director of training at Concert Health.