Proper Prep Drives Successful Telehealth Interactions

Telehealth-based counseling services have remained an integral part of substance use disorder treatment delivered by many providers. After use of virtual-based care soared with the onset of the COVID-19 pandemic in 2020, best practices regarding the use of technology have emerged in the ensuing years.

At the East Coast Symposium on Addictive Disorders earlier this month, Melissa Sahlin, LISW-S, LCSW, chief clinical officer for BrightView in Cincinnati, Ohio, discussed creative approaches to distance counseling. Addiction Professional recently caught up with Sahlin to discuss preparation of equipment and setting to set the stage for successful virtual sessions, as well as strategies for minimizing technical difficulties during patient interactions and improving patients’ engagement levels.

Editor’s note: This interview has been edited for length and clarity.

Addiction Professional: What steps should providers be taking with regards to equipment, technology, and setting so that they have a solid telehealth platform that they can work from when they're engaging with clients virtually?

Melissa Sahlin: There are a few items that we found helpful. One was just making sure that there was adequate sound. You can buy some not very expensive equipment, and it really makes a huge difference in terms of picking up whoever's talking and then also being able to hear folks on the other end. Don't take that for granted—invest a little bit into some equipment. It doesn't have to cost a lot, but it makes a huge difference. Additionally, make sure that the camera is set up where you can view people on the other end, and ensure that you're cognizant of making eye contact and muting when you're not talking. Some basic adjustments along those lines can go a long way.

The other thing would be making sure you have a HIPAA-compliant platform. Sometimes, it requires getting a special license. That’s really important in terms of ensuring confidentiality for patients. Having a backup option is also really useful. When you first start the session, get a phone number where you can call the patient back If something happens to your video conference platform.

Something else that is helpful is doing practice runs with the patients in advance. We frequently would have patients come into the office, and we would introduce them to the telehealth platform as soon as we could. We would walk them through the steps and help them troubleshoot. That made them more comfortable. Then, when the time came to use telehealth, they were much more confident.

The last piece would be making sure that you get telehealth consents filled out early and that they have all the required components in them.

AP: Once you have all these pieces in place, do you have any best practices that you would recommend in terms of trying to build a strong therapeutic alliance virtually?

MS: What we found was really helpful is engaging with someone's background. When the patient is in a different setting, you can ask them about things in their background. For example, you could say, “Oh, I see a baseball on your shelf. It sounds like you might be a baseball fan.” Engaging with their environment helps to build that rapport. Narrating what you're doing also goes a long way. For example, you can say, “I'm going to pull up your chart, and I want to see what your doctor has written in their notes” instead of looking disengaged or looking off to the side of the camera. Talking about what you're seeing and doing is very helpful.

The other thing would be just checking in frequently. You don't get the full experience with body language as you do when you're in person. Sometimes, you have to ask and be a little bit more proactive in reading how the person is feeling and what they're thinking. That's especially true when you're doing telephone sessions where you can't see the person. In that scenario, you have to be very verbal and ask and check in.

AP: That makes sense. What are some other ways that practitioners can promote patient engagement with therapy sessions?

MS: Returning to this idea introducing the concept of telehealth early on—if you have that conversation in advance, you can work through any concerns that patients may have and help build their confidence. When you're actually in the sessions, we have found that making it interactive was really helpful. We have “Recovery Jeopardy!” and some other games where you get people engaged with one another. There's also different learning preferences. Some people really appreciate having graphics and visual aids that they can interact with. We also use breakout rooms. Some platforms allow us to have many groups of 2 or 3 people, and then the facilitator can go around and visit each breakout room. That provides the opportunity for those who maybe are a little bit more reserved and won't speak up in a large group. They have opportunity to speak in their smaller group, and digest the topic and the material that we're presenting.

Reference

Sahlin M. Creative approaches to distance counseling for treatment of substance use disorders. Presented at East Coast Symposium on Addictive Disorders. November 3-5, 2023; Ponte Vedra, Florida.