Telebehavioral Health Competencies
Authors: Marlene M. Maheu & Kenneth P. Drude & Katherine M. Hertlein & Ruth Lipschutz & Karen Wall & Donald M. Hilty
The TELEBEHAVIORAL HEALTH INSTITUTE Announces the publication of a recent article titled “An Interprofessional Framework for Telebehavioral Health Competencies”
Cheyenne, Wyoming – June 26, 2018: “An Interprofessional Framework for Telebehavioral Health Competencies” has recently been published by a team led by Marlene M. Maheu PhD, the Executive Director of the Telebehavioral Health Institute, Inc.“An Interprofessional Framework for Telebehavioral Health Competencies” was an outgrowth of a Task Force appointed by the Coalition for Technology in Behavioral Science (CTiBS), who identified a need for competencies in the licensure and training of behavioral health professionals.
Dr. Maheu served as Chair of the Task Force. She explained, “The competencies were developed in response to a report released by the Institute of Medicine which called for competencies in workforce development(IOM, 2001). The IOM urged educators to consider the need for evidence-based competencies to not only be developed for all aspects of healthcare education and training but also that all educational and training programs follow such competencies when educating healthcare professionals.” Telebehavioral health is also known as telemental health, behavioral telehealth, electronic services delivery, digital services delivery, and distance counseling (as well as almost two dozen similar terms). It involves the delivery of behavioral health care using telecommunication technologies of various types to provide clinical services, professional training, administrative and other services at geographically separate sites.
Dr. Maheu and colleagues used the term “telebehavioral health” to describe the field in deference to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) decision several years ago to replace and combine the pejorative concepts of mental health and substance abuse with the more neutral, less stigmatizing term, “behavioral health” and when using technology, “telebehavioral health.”
Dr. Maheu explained, “In telebehavioral health practices, service can be delivered in ‘real time’, using the telephone or interactive video conferencing. It also can be used to deliver services asynchronously, that is, through systems known as ‘store-and-forward,’ which rely on the transmission of images and/or data for review at a later time by a qualified professional. Email, text messaging and a wide range of other software applications (“apps”) can also be used to facilitate telebehavioral health. Maheu continued, “While a number of national groups have identified standards (ethical codes) and guidelines for how to ethically use technology with clients or patients in behavioral care, none have identified competencies.” She further explained, “The best definition of competencies in the context of health care is that they are the “amino acids” of skilled service delivery, in that they are the basic building blocks of care. They then include the knowledge, skills and attitudes that differentiate a professional who is worthy of trust from one who is not”.
The CTiBS article “An Interprofessional Framework for Telebehavioral Health Competencies” was published in the Journal for Technology in Behavioral Science by Springer, and can be found here. It is the reflection of four years of work with an interprofessional team representing psychiatry, psychology, social work, counseling, nursing and marriage and family therapy. As part of the team, professionals from each of these disciplines worked diligently to identify elements of telepractice that can help differentiate levels of expertise in workforce development. The CTiBS TBH competencies then describe a framework for telebehavioral health using these seven domains: Clinical Evaluation & Care, Virtual Environment & Telepresence, Technology, Legal & Regulatory Issues, Evidence-Based & Ethical Practice, Mobile Health and Apps and Telepractice Development. Fifty-one telebehavioral objectives were identified, along with 149 discreet and measurable competencies, or “telebehavioral practices.”
Maheu further elaborated, “The framework is meant to foster the legal and ethical use of behavioral services through competency-based clinical practices related to the legal and ethical use of technology. It will hopefully help regulators and educators develop criteria for appropriate licensure and training related to when and how licensed professionals can safely use technology in the delivery of behavioral health care.”
The CTiBS TBH framework organizes seven topic domains and five subdomains according to competency level i.e., Novice, Proficient or Authority. In turn, each competency level is categorized into 51 discrete telebehavioral objectives, which are then distinguished by 149 cumulative and measurable telebehavioral practices. The seven TBH competency domains identified by CTiBS include:
1) Clinical Evaluation & Care, with three subdomains addressing Assessment & Treatment, Cultural Competence & Diversity and Documentation & Administrative Procedures;
2) Virtual Environment & Telepresence
4) Legal & Regulatory Issues
5) Evidence-Based & Ethical Practice, with two subdomains addressing Standards and Guidelines and Social Media
6) Mobile Health and Apps and
7) Telepractice Development