Getting help for stress and behavioral health via videoconferencing or telephone session

COVID-19 prompted a rapid transition to virtual meetings, including accessing behavioral health care services by telephone and videoconference. The federal government relaxed many telehealth regulations due to the pandemicopens in new window, helping to expand access to services, including treatment for stress management, anxiety, panic attacks, depression, or substance use. 

For farmers and rural area residents, telehealth can be advantageous, saving time and money on driving long-distances to access services. It is also convenient for older adults, people with disabilities, and chronic conditions who may be at a higher risk for COVID and need to be extra vigilant about practicing physical distancing. 

Whether you live in a rural, urban, or suburban area, if you are not accustomed to using telehealth options for behavioral health services, the following are tips for first-time users.

• Ask providers if they offer video conferencing or telephone services, also referred to as audio-only by Medicare and private insurers.
• Determine whether videoconferencing or audio-only will work best for you. Videoconferencing requires good Wi-Fi reception. If Internet access in your area is limited, the telephone may be a better choice.
• Make sure that you have essential technology resources for a videoconference such as a webcam.
• Consider your comfort level with technology. Talk to your provider about any technology concerns or issues you might have.
• Keep in mind that psychologists and behavioral health professionals can provide services only where they are licensed. So, it is unlikely that you can work with a provider by videoconferencing or telephone in another state.
• It is customary for providers to ask patients for informed consent before beginning treatment. The informed consent usually covers benefits, potential risks involving telehealth, including limitations to patient confidentiality, security issues of patient data, emergency planning, and billing and payment policies.

• A provider will request your informed consent and ask questions to help determine your treatment needs and considerations.
• Just as with in-person health care visits, a provider usually needs a plan for managing emergencies like having information for emergency contact.
• Treat your virtual session like an in-person visit. Be on time and fully present. Do not use substances like alcohol beforehand. Remember that you are on video.
• Use a mobile phone or landline for therapy sessions. If you are not alone at home, consider using earbuds during the session instead of a speakerphone. Bluetooth devices are not best suited for a therapy session.

• Make sure to use secure Wi-Fi for videoconferencing. Your provider should use safety measures such as a passcode or a waiting room feature that requires him/her to let you into the videoconferencing platform.
• Secure your device to prevent others from seeing activity on your phone or names of specific contacts like a provider.
• Choose a private space for a session so you can speak openly with the provider without being overheard by others.
• Avoid using public or unsecured Wi-Fi for calls on a mobile phone or other devices. A headset improves sound quality, is comfortable, and offers more confidentiality than using a speakerphone.
• Confirm that no one will record the session without permission. This is in accordance with privacy laws.
• Psychologists and behavioral health providers are obligated to follow state licensing and privacy laws and regulations, or organizational policies if they work out of a clinic, hospital, or university setting.

• Make sure you are free of distractions so you can focus on the appointment.
• While a separate space for engaging in therapy is essential for privacy concerns, it is also important for focus and concentration. Select a location where you feel comfortable, can be alone during the session, and have privacy from others.
• Ensure all individuals taking part in a virtual session are within view of the camera, so the provider is aware of who is participating, particularly if a spouse or family member joins a session.
• When using a smartphone for audio-only sessions, turn off other apps, ringers, notifications, and alarms that can disrupt the time set aside to address mental and behavioral health concerns. Place the smartphone screen down, so texts or other notices during the session do not distract.
• If you are joining a session using a smartphone device while in a vehicle, make sure that you are parked, and the engine is off for your safety and to help you focus.

• Ask a provider in advance of the first session about the payment process. Will they mail or email you an invoice? Will they accept a check by mail or offer secure online payments by credit card or bank transfers?
• If finances are tight, ask a provider if they offer a sliding scale fee.
• If you have insurance, ask the provider if they accept your insurer for telehealth services or if they will supply an invoice that you can send to your insurer. Be sure to verify coverage for telehealth and audio-only with the provider and your insurer.

• The Centers for Medicare and Medicaid and some states temporarily waived restrictions on telehealth so people can access services remotely during COVID-19. Check with your provider on your state’s status to ensure that you can continue telehealth services.

Audio-only services were not typically covered by insurance before COVID.

• So, the continuation of coverage for audio-only services after the COVID public health emergency is uncertain. Be sure to check with your provider and insurer to confirm the status of coverage for audio-only.

For additional information, check out these resources to find help and choose a licensed professional like a psychologist.