At Rula, we believe in empowering therapists to provide care that is both clinically sound and deeply attuned to each client's individual needs. These guidelines are designed to support your clinical judgment as you assess whether telehealth is the right fit for a client, not just at the start of treatment, but throughout the therapeutic journey.
Initial Session Considerations
The first session is a valuable opportunity to assess telehealth suitability. A thoughtful conversation up front can set the tone for collaborative, effective care.
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Invite a Conversation About Telehealth:
Create space for your client to reflect on how telehealth may or may not meet their needs. This dialogue supports shared decision-making and builds trust. You might explore:- Pros: Convenient access to care, no commute time, and the comfort of one’s own space
- Challenges: Technical glitches, lack of privacy, or home-based distractions
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Assess Readiness and Comfort:
Consider how the client interacts with the platform, their access to a private space, and their ability to stay present during sessions.
Suggested questions:- “Do you feel comfortable using video and audio for our sessions?”
- “Do you have a space where you feel safe and uninterrupted?”
- “How are you feeling about virtual therapy so far?”
Special Considerations for Children:
Telehealth can work well for many children, but some may benefit more from in-person care. Indicators that a child may struggle with virtual therapy include:
- Difficulty staying engaged or sitting still
- Limited verbal participation
- No caregiver available to assist with tech
- Intense emotional needs that require in-person support
Ongoing reassessment if the child’s needs are being sufficiently met in a telehealth environment are key, and a parent/guardian will have key information that may inform your clinical decision. If you determine telehealth isn’t appropriate, please communicate clearly with the caregiver before initiating a referral.
When Telehealth May Not Be Appropriate
Some factors may indicate that in-person care or a higher level of care (HLOC) is necessary:
- Technology Barriers: Inability to reliably use video/audio or access a stable internet connection
- Significant Cognitive or Psychiatric Symptoms: Such as active psychosis or disorganized thinking
- Lack of Privacy or Safety at Home: Especially when clients report difficulty securing a confidential environment
- Need for Higher Intensity Services: Clients requiring more than two sessions per week may benefit from HLOC
- Developmental Limitations: Some young children may not yet have the attention span or regulation skills needed for virtual therapy
What is NOT Rule-Outs for Telehealth:
- Risky Behaviors (e.g. suicidality, self-harm, and more): These do not automatically preclude telehealth. Instead, assess the client’s ability to engage safely and meaningfully in virtual care. A therapist’s clinical experience is key in assessing whether telehealth is appropriate for managing these risks.
- Substance Use and Personality Disorders: With strong boundaries and consistent engagement, telehealth can be a clinically appropriate modality.
- Boundary Difficulties: While boundary issues may require the therapist to be firmer, this doesn't automatically exclude telehealth. It’s important to set clear, professional boundaries during virtual sessions.
- Accessibility Needs: Rula offers interpreter and accessibility services to support clients and therapists with varying needs.
Best Practice Considerations
Determining telehealth appropriateness requires ongoing assessment. Here are a few things to consider:
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Check in Regularly: Periodically ask your clients how they’re experiencing telehealth and if there’s anything that could be improved to make their sessions more comfortable and effective.
- Example: Sometimes, clients may note that they find it hard to focus with getting notifications or being interrupted by a beloved pet. Maybe it’s time to put the phone on “do not disturb” or put Fluffy outside? Other clients may simply learn over time they prefer in-person sessions. Be sure to be responsive and solution-oriented when these issues arise.
- Get a Second Opinion: Before deciding that a client may not be well-suited for telehealth, consider having them rematched so they can be assessed by another Rula therapist. If the second therapist agrees with your assessment, the Care Coordination team can assist with referring the client to in-person services or a higher level of care (HLOC).
- Document Your Reasons: When determining whether telehealth or in-person services are more suitable, make sure to document the reasons in the initial assessment or a blank note, outlining why you believe in-person care might be a better fit. Be mindful that other professionals may see this documentation, and this may influence how they conceptualize the patient, so focus on reporting the facts.
Client Needs In-Person Therapy or a Higher Level of Care
If you feel that in-person care or a higher level of care is necessary based on your assessment of the objective factors above, please refer the client for in-person services by completing the Higher Level of Care (HLOC) request form. You can learn more about requesting higher levels of care here.
By following these guidelines and having thoughtful conversations with clients, we can ensure that they receive the most appropriate care in a setting that works best for them.
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