Telehealth and telepsychology

Telehealth is a broad term that does not have a single, universally accepted definition.

According to the Health Resources Services Administration, telehealth is “the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration.”¹

The APA Guidelines for Professional Practice of Telepsychology defines telepsychology as the provision of telehealth services by a psychologist, which may include supervision of appropriate personnel.

Telecommunication technologies include but are not limited to telephone, mobile devices, interactive videoconferencing, email, chat, text, and the internet (e.g., self-help websites, blogs, and social media). The information that is transmitted may be in writing, or include images, sounds, or other data.

Technologies may augment traditional in-person services (e.g., psychoeducational materials online after an in-person therapy session) or be used as stand-alone services (e.g., therapy or leadership development provided over videoconferencing).

These telecommunication technologies may be synchronous with multiple parties communicating in real time (e.g., interactive videoconferencing, telephone) or asynchronous (e.g., email, online bulletin boards, storing and forwarding information).

Asynchronous technologies, ranging from remote patient monitoring to medical image sharing, and chatbot-based applications are playing an increasingly important role in interactions between patients and health care professionals. These asynchronous tools are ubiquitous in multiple types of health care settings including mental health, primary care, emergency medical care, and many more. Learn more about asynchronous telehealthopens in new window.

Use of telehealth dramatically increased during the Covid-19 pandemic:

• In 2019, mental health and substance use outpatient visits represented 9–11% of all outpatient telehealth visits.²
• In 2020, mental health and substance use outpatient visits represented 40% of all outpatient telehealth visits, and 35% of all outpatient telehealth visits in 2021.²

Practitioner response:

• During the beginning of the pandemic in 2020, approximately 97% of surveyed practitioners were either using a hybrid model, or exclusively remote model to treat patients.³
• The percentage of psychologists offering a hybrid option to their patients increased from 33% to 67% from 2020 to 2023.³
• The percentage of psychologists utilizing exclusively remote services has remained stable in 2024, with 19% practicing fully remote, 69% practicing hybrid, and 12% practicing fully in person.²⁰

An overwhelming number of psychologists (96%) said they believed the use of telehealth during the pandemic has proven its worth as a therapeutic tool.⁴

Patients generally report high degrees of satisfaction with telehealth visits for their medical care.^{5, 6, 7} Patients also generally report high degrees of satisfaction with their virtual mental health care^{8, 9, 10} and report interest in continued access to virtual care postpandemic.^{8, 9, 11}

Teletherapy, including services delivered via telephone or videoconferencing, has been shown to have similar outcomes to traditional, in-person therapy.^{12, 13, 14, 15, 16, 17} Teletherapy has been shown to be an efficacious treatment modality for a variety of mental health concerns, including anxiety,^{15, 17} depression,^{12, 14, 15, 16} PTSD,^{12, 14, 15} and adjustment disorder,¹⁵ among others.

Research into potential differences among demographic groups’ use of telehealth has yielded mixed findings. Some data suggest that older adults, rural residents, people of color, and people who are of low SES use telehealth services at lower rates than other groups.^{5, 6} Other data show that telehealth use increases with age, such that individuals age 65 and older use telehealth more frequently than younger individuals.^{16, 17} Additionally, some research suggests that Black and White individuals use telehealth at comparable rates.¹⁷

Access to broadband internet significantly impacts telehealth use.^{6, 18}

The type of telehealth modality used may differ by demographic group. Older adults and people of color may be more likely to use telephone compared to video services; whereas younger individuals and White individuals may be more likely to use video services.^{17, 19}

Given these findings, ongoing advocacy is needed to continue access to audio-only care, to expand broadband access, and to design telehealth services using a digital health equity lens to ensure access for all.

The decision to provide telepsychology services involves numerous considerations, including, but not limited to:

• Assessing if telepsychology is an appropriate modality for a provider’s services
• Considering patients’ cognitive, auditory, visual, mobility, language, or other needs to determine whether additional supports may be required for patients to engage fully in virtual services
• Provider comfort with and the selection of appropriate, HIPAA-compliant technology
• Patient comfort with and access to technology
• Patient and provider access to private physical environments for services
• Informed consent regarding specific risks and benefits of virtual care
• Reimbursement considerations
• Knowledge and understanding of relevant local, state, and federal laws governing telepsychology practice and data privacy requirements
• Emergency procedures specific to providing services at a distance
• Appropriate professional liability coverage
• Ongoing training in telepsychology delivery and the relevant technologies

• Informed consent checklist
• Telepsychology services checklist

Education and training

• APA continuing education
• APA telepsychology resources
• American Telemedicine Association: Telehealth resourcesopens in new window
• Health Resources and Services Administration: Office for the Advancement of Telehealthopens in new window
• U.S. Department of Health and Human Services (HHS): Telehealth resourcesopens in new window

Interjurisdictional practice

• The Psychology Interjurisdictional Compact (PSYPACT)opens in new window
• PSYPACT participating states mapopens in new window
• State, Provincial, and Territorial Associations

Policy and reimbursement

• American Telemedicine Association: Policy resourcesopens in new window
• Center for Connected Health Policyopens in new window
• HHS: Billing for telebehavioral healthopens in new window
• HHS: Telehealth policy temporary and permanent changes following Covid-19 public health emergencyopens in new window