Facts and Figures

Licensed psychology practitioners still favor using the telephone over the Internet and less traditional media to provide telehealth services to patients, according to new data from APA's Research Office.

The survey defined "telehealth" as health services in which health-care professionals and their clients use interactive, real-time communication media to connect across distances. Included in the definition are media such as Internet chat rooms, video and audio-only transmissions via the Internet, closed circuit television and even the traditional telephone; excluded are media such as electronic mail and facsimiles because these are not interactive or in real time.

According to the study, only 3 percent of licensed psychologists provided services using Internet "chat rooms." Even fewer used media such as closed circuit television, audio-only Internet connections and video Internet connections. Instead, and not surprisingly, the telephone was the primary telehealth medium used by most psychologists--more than 80 percent of them. The health services most often provided by telephone were patient referrals (91 percent), emergency care/triage (79 percent), consultation/education (71 percent) and individual psychotherapy (69 percent).

Psychological and neuropsychological assessments were least likely to be provided using the telephone--not surprising, given that most standardized assessment instruments require in-person contact.

Several professional and logistical issues may be at the root of the infrequent use of newer technologies such as the Internet to provide telehealth services. To begin with, it is not a standard part of the curricula in graduate psychology programs to train students to use this form of service delivery as a supplement to or alternative for traditional face-to-face services.

Also, advanced technologies such as ultra-speed Internet connections and computer video cameras are not yet common items in practitioners' offices or patients' households. Several legal and ethical uncertainties also may cause psychology practitioners to shy away from newer technologies.

For instance, will the Internet be secure enough to guarantee the same level of confidentiality as would be ensured with traditional, non-telehealth services? If "hackers" can breach large Internet companies such as E-bay and Amazon, what is to prevent a breach of a therapy session conducted over the Internet? Is it legal for a licensed psychologist to provide chat-room services to patients who are in a state in which the psychologist is not licensed? Will certain patients be excluded from telehealth services because they lack the financial resources to access the Internet and other communication devices, and if so, would this be perceived as discriminatory? Or will the new technologies actually provide access to underserved groups and patients in rural areas who would not ordinarily have access to face-to-face health services? Finally, would the quality of health services be compromised due to less interpersonal, real-live contact? APA continues to collect data on telehealth, and is committed to exploring its advantages and disadvantages.

--STEVEN WILLIAMS, PHD ASSISTANT DIRECTOR, APA RESEARCH OFFICE