Use of a Research as Intervention Approach to Explore Telebehavioral Health Services During the COVID-19 Pandemic in Southeastern Idaho

Abstract

Introduction: Since the inception of the COVID-19 pandemic, telebehavioral health services have been a key contributor to continuation of care in rural and underserved areas of southeastern Idaho. Providers of telebehavioral health services faced numerous challenges as they navigated rapidly shifting regulations, variable access to internet and their own personal understandings of practice. Objective: This study aimed to characterize provider experiences, generate policy- and practice-level recommendations, and raise awareness among community stakeholders regarding telebehavioral health in southeastern Idaho. Methods: Using a newly developed conceptual/analytical framework, a research-as-intervention strategy was employed to conduct and analyze semi-structured interviews, short writings, and photographs from 7 primary care and behavioral health providers in the region. Results: Providers shared examples from practice that addressed technology and training, access-to-care, safety, changing provider roles, payment for services, treatments that are not well suited to telehealth and the nuances of living and working in newly forged spaces of care. Conclusions: Providers found promise in telebehavioral health’s utility as a hybrid model of care, but it must be supported by flexible legislation and policy. For example, it would help to make reimbursement expansions permanent and to simplify inter-jurisdictional practice options. Cross-sharing of information between licensing boards could help providers from various disciplines understand the parameters within which their colleagues must work.

Patient and provider perspectives of the implementation of remote consultations for community-dwelling people with mental health conditions: A systematic mixed studies review

“…Across studies, participants reported satisfaction with remote consultations, with some patients and providers reporting that remote consultations were on par with in-person consultations. For studies conducted during the pandemic, there was a sense of appreciation for the continuity of care during this time ( Schow et al, 2022 ), and it was suggested by providers in one study that patient acceptability may stem from this appreciation rather than satisfaction with virtual care itself ( Uscher-Pines et al, 2020 ). Some providers acknowledged their reluctance when remote consultations were initially implemented, but quickly realised the benefits of remote care resulting in a more positive attitude.…”

“…Providers also reported that it was more difficult to do therapeutic or behavioural work with patients, in some cases because providers did not have access to resources they would use in in-person consultations, such as whiteboards to draw out diagrams with patients. For example, some providers reported that eye movement desensitization and reprocessing (EMDR) therapy was challenging to conduct remotely ( Freske and Malczyk, 2021 ), with one provider stating that they attempted to teach their patient how to perform this therapy on themselves ( Schow et al, 2022 ). Some providers reported that they would have liked to have received training and education on how to effectively deliver care remotely ( Schriger et al, 2022 ), while others felt confident in their abilities and did not feel there was a need for training ( Budhwani et al, 2021 ).…”

“…Providers endorsed the benefits of working from home such as not having to book rooms ( Buckman et al, 2021 ), having more flexibility in their day, and saving time travelling to the office. The downsides of working from home included missing colleagues and collegial support ( Benudis et al, 2022 ), invasion of privacy, ( Lipschitz et al, 2022 ), and not having an adequate space to conduct consultations from ( Schow et al, 2022 ).…”

“…However, there was a sense of confusion and apprehension among providers that these regulations may return when in-person care resumed following the pandemic ( Freske and Malczyk, 2021 ). Providers expressed concern that re-instating restrictions could impact patient care, and considered this to be a step backwards ( Schow et al, 2022 ).…”