Ask The Experts with Terica Toliver, innovaTel’s Director of Teletherapy

Historically, tele-behavioral health implementations require thoughtful planning to develop protocols and robust provider training to ensure successful implementations. Due to COVID-19, organizations are rolling out telehealth overnight, and while everyone is grateful that this technology exists, there are a lot of questions on how to best practice remotely.  

At innovaTel, our providers have always worked remotely via telehealth and want to share our knowledge with those of you that may be doing this for the first time.

Lauren Lashbrook, Director of Strategic Partnerships, sat down with Terica Toliver, Director of Teletherapy at innovaTel Telepsychiatry to share her experience in providing teletherapy over the last six years remotely.

Terica is a Licensed Clinical Social Worker and a board approved supervisor by ASWB.

She operates a virtual psychotherapy private practice in multiple states, has experience working for various telehealth companies and innovaTel is excited to have her join our team.  She is an experienced child therapist, forensic interviewer, and has been qualified as an expert witness in several jurisdictions in human behavior. Her preferred modalities include trauma-focused CBT, mind-body techniques and dialectical behavior therapy.

How did you get started with telehealth?

I began conceiving the idea of a virtual private practice shortly after having my first child. I had worked for some years as a child therapist & forensic interviewer. Personally, I desired a more flexible schedule so private practice seemed fitting. I recall around that time reading an article on the future of telemedicine and the burgeoning telehealth companies with a behavioral health component. I wholeheartedly believe that everyone should have access to psychotherapy and I wanted a way to immediately reduce common barriers. Taking into consideration, that our lives are busier than ever combined with social stigma, affordability and access these often make prioritizing mental health at the bottom of most people’s to-do-list. By solely introducing a virtual solution, my desired client essentially trumped the thought of creating another brick and mortar practice.  It has not been appropriate for every client, however, in my experience it has been ideal for most.

Right now, with the COVID-19 crisis, a lot of clinicians are starting telehealth for the first time and doing so quite quickly. What advice do you have from a clinicians’ perspective for first time telehealth providers?

Now is a great time more than ever to expand or begin seeing clients virtually.  Fortunately, you are beginning at a time when there’s a wealth of HIPAA-compliant resources and policies in place to guide you.  Many licensing boards and associations have taken the COVID-19 crisis to update and alter their telehealth statutes to become more supportive of this modality of treatment. If you are not familiar with your licensing boards’ criteria please become knowledgeable before seeing clients.

Speaking of licensing boards, I am multi-state licensed which greatly expands the area in which I can obtain clients.  If you desire to increase your client outreach you should also consider becoming licensed in different states. It should be noted that each state does have different requirements, so it pays to stay organized. Most therapists have a system for keeping up with their CEUs but it becomes a whole other level when you need to stay abreast of several license requirements.  Don’t be dismayed by this task, as there are many options that can assist with keeping you in compliance. Some of which include: CE Zoom, CE Broker and NASW CE tracker. 
Even a well-developed excel sheet can keep you on track.

Do you have any expert tips that you can share?

I’m sure you’d agree that frozen screens or a dropped video are not ideal while in the midst of your client recounting a traumatic memory.

Now is the time to ensure that you have a strong internet connection and high-quality webcam, there are some extremely cost-effective options out there on the market.

If using a headset, I’d also recommend selecting one with a background noise canceling feature. It really comes in handy with reducing distracting sounds such as echoes.

It’s very important to maintain eye contact with your clients via telehealth, just like you would in-person. So do some tests with colleagues or friends before your first visit, camera positioning is really critical to successfully do this. For our providers at innovaTel that are doing concurrent documentation in their electronic medical record, we recommend putting your EMR and video platform stacked on top of one another in the same monitor so that you can maintain eye contact while you are documenting.

Speaking of documenting, typing can be noisy, at innovaTel, we invest in silent keyboards for our providers so that patients on the other side to not hear typing.

When setting up your remote office, be sure it has pleasant lighting and a desirable background.  You don’t have to obtain “Pinterest” level worthy office decorations to be deemed therapeutically effective, however, your intent should be to create a similar environment as though it were a face-to-face session. 

Confidentiality is critical, so please also account for making sure you have a quiet space to connect with your patients, just like you would in an office setting.

Do you have a favorite telehealth story you can share with us?

A common saying in the mental health field is the desire to meet the client where they are. I’d say that teletherapy has taken that phrase for its literal meaning. 

Take for instance a client who presents with a depressed mood. Seriously, consider each task expected to adhere with an in-office visit. In the midst of depression, the client is expected to get out of bed, be showered, dressed and off to the location to meet with their clinician generally bi-weekly. Yes, it is effective for many.

However, what is also effective is having the option for that same client to remain in their safe environment (possibly even in bed) and access their virtual clinician.  Most will agree the latter will typically provide a more achievable task when managing the impact of depressive symptoms.  This is the reality that my clients have been provided…including the option of staying in bed!

When setting up your remote office, be sure it has pleasant lighting and a desirable background.  You don’t have to obtain “Pinterest” level worthy office decorations to be deemed therapeutically effective, however, your intent should be to create a similar environment as though it were a face-to-face session. 

Confidentiality is critical, so please also account for making sure you have a quiet space to connect with your patients, just like you would in an office setting.

Pictured above: Terica in her office located within her home.

How do your patients feel about connecting with you virtually?

Virtual is not necessarily acceptable nor safe for all clients. My clients who find me are looking for a telehealth therapist as opposed to traditional therapy, however, the current crisis with COVID-19 has definitely changed this. 

My clients enjoy the flexibility in scheduling, privacy and I’ve observed that clients are less nervous so it provides an opportunity to build rapport more easily because they are in their own comfortable environment.