Tell us your experiences with video counseling

August 15, 2012
8 Comments

 Can video counseling serve as a useful and accurate tool for assessment and treatment of substance-using patients who live a good distance from primary treatment sites? A reader contacted me the other day and would like some guidance from her colleagues as her facility plans to incorporate use of this technology.

Kathy Wikman is an addiction counselor who works at the Jonathan Wainwright VA Medical Center in Walla Walla, Wash., and she is admittedly skeptical about the potential of video in place of face-to-face counseling. Kathy writes that “some of my general concerns include completing accurate assessments in the absence of ability to smell (!), observe body language, and even check out physiological indicators of withdrawal (can’t see those pupils at all on VTEL, or see if there’s a tremor in those hands, which are not in view).”

Wikman adds, “I also wonder about the difficulty of establishing a sound therapeutic relationship using a ‘television.’ The technology seems a bit ‘cold’ to me.”

The VA facility in Washington is seeking to use video telephone counseling in screening, assessment, and individual and group counseling, and hopes this could lessen the amount of time that clinicians have to spend traveling to community-based outpatient clinics scattered across the service area.

What are your experiences with use of video technology in clinical services for people with addictions? Should our reader be optimistic or wary about the possibilities?

Topics

Comments

I believe counseling in

I believe counseling in person is more effective rather than video counseling. I've read a lot of articles about video counseling and have read different feedbacks of it. Some are good, some are bad. My friend Ed Rodieck, a legal expert also believes counseling in person is more effective than video counseling. The same process works for addiction counseling and legal counseling.

Technology in clinical services works.

> Kathy's concerns are consistent with what I hear when I speak of the eServices we use at Operation PAR, a comprehensive addiction treatment organization. Operation PAR's eServices, which consist of various forms of technology including the web-video, has faced the challenge of people assuming it will not engage or help our consumers. We have found just the opposite. Although eServices is never going to replace all services and has specific challenges - what service doesn't have challenges? Operation PAR has gone through great effort to identify challenges and barriers as eServices is not for everyone. We have specific admission criteria, protocols, standards, and expectation to continue services using the technology.
>
> The response from our clients as well as other providers has been overwhelmingly positive. The eServices we have available include assessment, brief screening, individual sessions, family sessions, groups sessions, medication monitoring, and treatment teams, as well as clinical supervision. All of our clinical services are evidence based and we have been able to replicate traditional office based EBP's to the virtual office!
>
> The feedback we get directly from the clients is they really like the service, as evident by a no show rate of less than 10%! One example I can provide is one of a young Veteran that was discharged due to disability, started abusing pain pills and his alcohol consumption increased. The client had attended counseling off and on at the VA, but in he reported not caring for the counseling because it was with a female counselor. That resistance brought up flags at our program, since I am a female counselor. He agreed to try, we had our first session of MET/CBT and at the end of the session we discussed his feeling of continuing sessions with me. He agreed to continue and after a few session he shared that talking over the web took away that negative feeling he had about talking to a female counselor. He continued the sessions, actually asked for additional sessions, and brought his significant other into the virtual sessions for couples counseling.
>
> Operation PAR has found it is important to assist/train/supervise our counselors to have the understanding and skills specific to eServices -they are different than in office sessions. We have developed an in-depth training program that includes supervision sessions prior to providing eServices to our consumers. This training also covers the required training for the Certification in eTherapy for the State of Florida. Through our experience over the last four years providing this treatment modality we have found it to be a successful and much needed modality for our customers!

Wendy Danicourt
Operation PAR, Inc
eservices@operpar.org

eTherapy Certification for Florida

After reading your post on eTherapy you mentioned that there is a eTherapy Certification for the state of Florida. This is new to me. I know of therapist who are using technology without this eTherapy certification. Is this a state law to be eTherapy certified before you could practice?

Tell us your experiences with video counseling

Gary
Check out Part 1 & 2 of our three-part blog series on Video Counseling at http://blog.acswa.org/
Mike Brooks
-Center for Clinical Social Work
-American Clinical Social Work Assn. (ACSWA)
-American Board of Examiners in Clinical Social Work (ABE)

video counseling

Thank you for the link. I appreciated Parts 1 & 2 and am looking forward to Part 3 (when will that be posted?). The blog points out several key issues about which I retain some reasonable skepticism: Who bears responsibility for public protection and maintains security? What about therapeutic connection? In addition, Shepell·fgi acknowledges that some concerns are not appropriate for "VTEL" and I would include all addiction issues (who defines which ones as "severe") along with those noted -- clients facing crises. Individual and even group VTEL sessions may trigger emotions which merit clinical support in "real" face-to-face time. It seems that backup support on the "receiving" end must be accommodated.

VA Medical Center

Hope some of you can give me some feedback.
Just a brief correction -- Jonathan M. Wainwright VA Medical Center is located in Walla Walla, WA.

V-Tel

I am a licensed Addiction Counselor, I worked at a CBOC in North Dakota. I completed drug/alcohol assessments for DUI's, ASAM level I programming and placement for inpatient treatment for surrounding VA programs. I met with veterans and their families for individual sessions. Most veterans were fine with meeting on V-Tel. It was used for Mental Health appointments also. Due to the rural area it worked very well for those who would of had to travel long distances. I was able to make a therapeutic connection with my veterans. It was nice to be able to meet with veteran from all over the state. I enjoyed it very much. VA staff were helpful on the other end of the V-tel to deal with any emergency type situations, which rarely occurred. I did not experience anyone coming intoxicated, they usually were a no show for the appointment.

Hope this helps
Kelly M

VA Vtel

Hi, I worked at a CBOC (VA),in North Dakota, I am a Licensed Addiction counselor. V-Tel was very useful for meeting with veterans who could not access the VA hospital or were wanting indivdual sessions rather than group treatment. I was able to access any CBOC by V-tel. I was able to complete DUI evaluations and have individual sessions, complete assessments and referrals to inpatient VA treatment programs in Minnesota and South Dakota. Veteran were also seen for Mental Health appointments.It worked very well since North Dakota is very rural. Most veterans are fine with meeting via V-tel. It is important to have VA staff on the other end of the V-tel for intoxication and suicidal issues. All the staff I worked with were wonderful and very supportive.

Hope this was helpful

Kelly McCormick