Addiction Telehealth Using a Patient Gateway: A Multi-Cultural Case Study

While many practitioners have been using telehealth systems for years, many have as yet to begin using patient gateways to augment their services, in-person or through telehealth systems. The following article is written as a series of articles explaining how to integrate an emerging technology into one’s clinical practice and how to do so in a culturally appropriate manner. First, the emerging topic selected is that of patient gateways or portals. Because patient gateways have been visible in medical spheres throughout many parts of the United States for almost a decade, the article below illustrates how the jump can be made from medical applications of this emerging technology to behavioral ones. Secondly, a case study format will be used below to describe the many benefits of using a patient gateway with a behavioral health client dealing with addiction. The following addiction telehealth scenario involves a recently immigrated Nigerian wife and mother struggling with opioid addiction. It will set the stage to illustrate how a culturally sensitive,  21st Century counselor or psychotherapist can best leverage increasingly available technologies to help a young woman requesting urgently needed assistance.

Case Conceptualization: Adebola’s Recovery Using Addiction Telehealth & a Patient Gateway

Adebola, a 31-year-old Nigerian immigrant, grappled with opioid addiction and depression after sustaining severe injuries in an automobile accident. She had migrated to the United States the year prior with her husband and 2-year-old son. Feeling isolated and out of control with her pain medication, she reluctantly sought help from a primary care physician.

She was treated medically and referred to a mental health professional specializing in addiction telehealth who worked in an associated recovery center. The primary care office suggested that using a teletherapy system and teaching Adebola to use the patient portal to augment her therapy may be more successful than attempting to schedule in-person care. These technologies would allow her to receive needed care without leaving her home and young child while forming a therapeutic bond with a professional, who then could gauge her interest in using some of the newer technologies connected to the office’s patient portal. 

Adebola’s Presenting Concerns

• Opioid Addiction. Adebola grapples with opioid addiction, likely resulting from using pain medication following her accident. The addiction has impacted her emotional well-being, daily functioning, and relationships.
• Major Depression. Adebola experiences major depression, likely influenced by the physical and emotional toll of the accident, the challenges of cultural adjustment, and the loss of her previous way of life in Nigeria.
• Cultural Identity and Integration. Adebola faces the complex task of integrating into the US culture while preserving her Nigerian cultural identity. She struggles with feelings of isolation, the pressure to assimilate, and maintaining a sense of belonging in a foreign land.
• Religious Orientation & Beliefs. Adebola possesses a robust Christian faith. She and her husband joined a local Nigerian Christian church, but their attendance has been sporadic.
• Trauma and Recovery. Adebola’s accident has resulted in physical trauma, emotional distress, and prolonged recovery. These factors contribute to her psychological distress and challenge her ability to adapt to her new environment.

Goals

• Overcome Opioid Addiction. Assist Adebola in addressing and overcoming her opioid addiction, focusing on relapse prevention, developing healthy coping mechanisms, and improving emotional regulation skills.
• Alleviate Major Depression Symptoms. Reduce the impact of major depression on Adebola’s life by implementing evidence-based interventions targeting depressive symptoms, improving her emotional well-being, and fostering resilience.
• Culturally Integrated Identity. Help Adebola navigate cultural adjustment by exploring her Nigerian cultural identity, integrating it with her experiences in the US, and cultivating a sense of belonging within both cultures.
• Support Religious Resources. Provide support and problem-solving to help Adebola gain added strength from her religious background and possibly participate in more church-related activities. Discuss her beliefs related to healing through her faith.
• Trauma Healing and Resilience. Support Adebola in healing from the trauma of her accident, promoting resilience and helping her regain a sense of safety and control in her life.
• Assess Digital Literacy. Although reluctant to appear for in-person sessions, Adebola’s age suggests that she may be inclined, as a digital native, to possess technical skills. If given a positive response, the addiction therapist can inquire about such interests and offer increasingly sophisticated resources through the primary care office’s patient gateway. 

Available Interventions

• Addiction Telehealth Sessions. Conduct addiction telehealth sessions with Adebola using a HIPAA-compliant telehealth platform, allowing her to engage in therapy from the comfort of her home. Utilize video calls for face-to-face interactions, ensuring a therapeutic connection and providing a safe space for exploration and processing.
• Patient Gateway for Secure Communication. Utilize the patient gateway as a secure communication channel between sessions. Adebola can contact her therapist, ask questions, discuss concerns, and receive support, fostering ongoing engagement and maintaining therapeutic support between sessions.
• Cognitive-Behavioral Therapy (CBT). Implement CBT techniques through telehealth to address Adebola’s addiction and depression. Focus on identifying and challenging negative thoughts, developing healthy coping strategies, and fostering relapse prevention skills. Utilize telehealth tools to deliver CBT-based exercises, worksheets, and interactive materials.
• Trauma-Informed Care. Employ trauma-informed telehealth interventions to address the accident’s psychological impact. Provide grounding and relaxation exercises, and use telehealth tools to guide Adebola through trauma-focused exercises, such as narrative therapy or trauma processing exercises
• Cultural Exploration and Integration. Support Adebola in connecting with her Nigerian cultural identity while navigating the US culture through telehealth. Utilize telehealth tools to share cultural resources, articles, and videos that explore Nigerian traditions, practices, and community groups. Encourage Adebola to participate in virtual Nigerian community events and engage with cultural support networks. Encourage her to explore the availability of a 12-step program or recovery from her addiction through her church or an affiliated group if that seems appropriate as the therapy continues
• Self-Care Practices. Teach Adebola mindfulness techniques and self-care practices through telehealth sessions. Utilize guided mindfulness exercises and provide resources such as self-care apps or online platforms. Incorporate telehealth tools available through the patient gateway for tracking progress and fostering accountability in self-care practices
• Collaboration with Other Healthcare Professionals. Collaborate with Adebola’s healthcare providers, including her prescribing physician, pain management specialist, and other professionals, through secure messaging on the patient gateway. Coordinate care, discuss medication management, and ensure a comprehensive approach to her well-being
• Evaluation. Regularly assess Adebola’s progress using addiction telehealth tools and measures, monitoring changes in opioid use, depressive symptoms, cultural adjustment, and well-being through a patient gateway and in-session. Continuously evaluate the effectiveness of interventions and adapt them as needed to meet her evolving needs and goals.

Leveraging the Combination of Telehealth & a Patient Gateway

1. Secure Communication with Healthcare Providers. The patient portal allows Adebola to communicate securely with her healthcare providers, including her therapist, physician, and physical therapist. This feature was crucial for Adebola, as she could communicate her concerns, ask questions about her treatment plan, and receive guidance regarding her recovery progress. The secure communication channel helped bridge the gap between face-to-face appointments, ensuring Adebola felt supported throughout her journey.
2. Medication Management and Refills. When Adebola’s treatment plan involves pain management medication, she can conveniently manage that and other prescriptions through the patient gateway or portal. She could access a clear overview of her current prescriptions, request medication refills, and set reminders for timely intake. This streamlined medication management process supported her physical recovery and ensured continuity in her pain management regimen.
3. Self-Monitoring and Progress Tracking. Adebola utilized the self-monitoring and progress-tracking tools on the patient portal to monitor her recovery milestones. She could record her pain levels, track her physical therapy progress, and log her emotional well-being. This data provided valuable insights to Adebola and her healthcare providers, allowing for adjustments in treatment plans and fostering a collaborative approach to her rehabilitation.
4. Mental Health Support. Recognizing the accident’s impact on Adebola’s mental health, the patient portal provided resources and support addressing major depression. Adebola could access educational materials, coping strategies, and self-help resources tailored to her situation. This comprehensive approach addressed both the physical and emotional aspects of her recovery.
5. Tailored Rehabilitation Resources. If Adebola needs tailored rehabilitation resources specific to her situation, she can be given referrals and ongoing updates through the patient portal. She could explore materials addressing recovery’s physical and emotional aspects after an accident if provided by her care team. These resources provided valuable guidance on pain management, physical therapy exercises, coping strategies, and psychological well-being during rehabilitation.
6. Integration with Community Resources. Adebola can access articles and videos from the patient portal providing information about local community groups and resources catering to Nigerian families. These resources helped her connect with support networks, locate cultural events, and find community organizations that could offer assistance and guidance in her new environment. Adebola thereby be helped to engage with her Nigerian community, fostering a sense of belonging and support during her recovery journey.

By leveraging the patient portal alongside medical interventions, therapy, and rehabilitation, Adebola can potentially receive comprehensive and compassionate support tailored to her needs. The many resources, secure communication with healthcare providers, self-monitoring and progress-tracking tools, medication management features, and integration with community resources made available through the patient gateway collectively contributed to her recovery journey. Over time, Adebola successfully can navigate her path to recovery, healing physically, mentally, and emotionally while finding support within her Nigerian church and the local community. 

Conclusion

Today’s article shows how a culturally sensitive behavioral professional can use an emerging technology with a client struggling with behavioral issues. Similar jumps can be made with any other emerging technology if the clinician takes the time to research or learn about the underlying multicultural and diversity issues.

Culturally Sensitive Care

By employing addiction telehealth and utilizing the patient gateway, Adebola’s therapist offered accessible and culturally sensitive treatment, supporting Adebola’s recovery journey, promoting well-being, and fostering resilience as she adapts to her new life in the US and the challenges she faces as a recent US immigrant. This approach also allows her therapist to develop at least some multicultural education needed to better serve Adebola and her young family. By leveraging the power and reach of the patient portal to collect, organize and make available those resources 24/7, this therapist has served Adebola well.

Applicability to Other Clients and Patients

A robust addiction telehealth system augmented by a patient gateway can be vital in augmenting many patient treatment plans, empowering people to address their unique challenges, and helping them integrate into their communities. Such integration, both digital and geographic, ultimately supports the overall well-being of many people, especially diverse people who have been marginalized and have difficulty accessing care.

Multicultural and Diversity Training

A well-trained, culturally sensitive, addiction telehealth clinician armed with 21st Century technology can reach many previously inaccessible areas blocked by prejudice and fear. Digital inclusion approaches offer evidence-based and useful strategies to help diverse, low-income communities.

Telehealth.org Telehealth & Technology Vendor Resource

Readers interested in reviewing patient portal vendor profiles are invited to visit Telehealth.org’s no-cost platform to check vendor profiles and contact vendors to ask questions. Visit the Technology Vendor Directory, particularly the Practice Management category, to find software packages that include patient gateways.

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