This article provides an overview of some steps you can take as a therapist to determine whether a client is appropriate for telehealth or would benefit from in-person care or a Higher Level of Care (HLOC).
Considerations and Options for Telehealth Suitability
Appropriateness for telehealth is a subjective decision that varies among providers and requires an assessment before being made. However, you can decide to rematch at the end of the first session by submitting a Provider Referral Form.
Rula will match the client with a new clinician to provide a second opinion. If two clinicians do not believe the person is appropriate for telehealth, at that point, our Care Coordination team will coordinate a referral for in-person services.*
Important note:
*Our care coordination team can provide resources from outside of Rula through therapy platforms such as Psychology Today, Therapy Den, and others to assist the client in their search but cannot guarantee their continuity of care with an in-person provider. More details available in the article: Referring to in-person care.
If you are unsure whether a client will be appropriate for telehealth, consider an agreement to conduct a certain number of sessions before committing to ongoing telehealth care.
In addition, telehealth clients need to be able to set up the videoconferencing system, maintain the appropriate WiFi or telephone connection, establish a private space (unless they choose not to do so), and participate in necessary steps for effective safety management.
To assess a client’s ability to complete these steps and whether telehealth services are appropriate for them, consider the client’s cognitive capacity, technical capability, history of cooperativeness with treatment professionals, ability to refrain from substance use during a session, and any other criteria you believe are essential. And no video sessions while driving! Generally speaking, here are a few reasons why a person may not be a good fit for telehealth:
- The client needs more extensive psychosocial support, wrap-around services, or case management that is beyond the scope of an individual private practitioner.
- The client is experiencing domestic/intimate partner violence and cannot establish a safe, private space for therapy.
- The client cannot participate in the session due to symptoms such as paranoia, delusional thinking, hypervigilance, or obsessive thought patterns that are directly related to the telehealth experience or is too distracted.
- The client is unable to navigate the technology required to engage via telehealth
Conduct a Thorough Intake Assessment
Sometimes, clients identified as high-risk may benefit more from in-person care or a Higher Level of Care (HLOC) if individual therapy or regular outpatient psychiatry isn't effectively meeting their needs. To ensure the best fit for each client, Rula's Clinical Quality team encourages all therapists to conduct a thorough intake assessment. This assessment will help determine if telehealth and outpatient services are appropriate.
Complete a Risk Assessment
To ensure the safety and well-being of all clients, we require therapists to complete a risk assessment during the initial evaluation of every new client. This assessment covers potential for self-harm and harming others, using tools like the Columbia-Suicide Severity Rating Scale (C-SSRS). The information gathered helps both the client and therapist decide on the most suitable treatment plan. Therapists are asked to document this assessment to support any necessary referrals.
Create a Safety Plan
For clients who show moderate risk of harming themselves, others, or the public, or who engage in other high-risk behaviors, we strongly recommend creating and documenting a safety plan in their chart. In case of a life-threatening emergency, therapists should treat the client just like they would in person. This means connecting them to crisis services, the emergency room, or calling 911 for a welfare check.
For non-emergency situations, after discussing your clinical recommendations with the client, consider a referral to a psychiatrist who works with Rula if necessary. Referral wait times can take a few weeks, so this option is not suitable for urgent cases.
Additional Resources
- Rula’s Risk Assessment & Safety Planning policy for an overview of our standards of practice.
- Rula Therapist H.E.L.P. Resource Guide which is designed to support clients experiencing a crisis.
- Referring to In-Person Care for an overview of how to find in-person therapy and psychiatry care.
- Connecting your client to psychiatric services for details and instructions on how to connect your clients with a psychiatric provider at Rula.