COVID-19 and disease containment precautions prompted sweeping shifts in the look and feel of mental health services on a global scale. Among the most apparent changes has been the move from in-person to telepsychology.
In May, a team of researchers led by Bradford Pierce of Virginia Commonwealth University surveyed a national sample of 2,619 licensed psychologists in the US about their approaches to practice in the context of social distancing and disease containment precautions. Their results, recently published in the American Psychologist, identified the staggering finding that those practicing in outpatient facilities reported a 26-fold increase in telepsychology in response to the pandemic.
Of all survey respondents, 67.32% indicated that they were actively performing all of their clinical work through telepsychology. Survey results also provided a variety of compelling insights regarding telepsychology in relation to relevant contextual variables (i.e., clinician demographic characteristics). They suggested that many practitioners intend to continue integrating elements of telepsychology well into the future.
“Telepsychology, according to the APA, is the use of any of a number of telecommunication technologies to deliver psychological services,” the researchers explain. “Therefore, telepsychological services may run the gamut from smartphone apps meant to enhance treatment adherence to Internet-based self-management tools for individuals with depression and other extensions of in-person services, to the synchronous provision of audiovisual telepsychotherapy.”
During China’s countrywide shutdown, swift adaptations were made to mental healthcare to address preexisting demands in addition to emergent needs stemming from increased anxiety, stress, and depression surrounding COVID-19 in the general population. Platforms such as WeChat and TikTok were harnessed by medical professionals to disseminate psychoeducation resources. Clinicians also used apps and various telehealth platforms for counseling and assessment. Similar trends have since been seen across the globe.
As is highlighted by Pierce and colleagues, there are a host of positives potentially associated with the rapid, widespread adoption of technologies to facilitate telepsychology. For instance, telepsychology can expand opportunities for care to populations historically underserved. Telehealth initiatives may reduce time and resource barriers to care. To some patients, virtual therapy and assessment may be experienced as less cumbersome than the steps required to engaging in in-person psychological supports.
Advantages aside, initiatives to expedite the rollout of telehealth programs have not been seamless. Concerns surrounding the ethics, privacy, data management practices, and efficacy of virtual provision of mental health services warrant continued research.
Given the new and precarious nature of the current landscape for practice, many researchers have begun to assess what’s working about the shift to virtual services versus what is not. Pierce and colleagues’ work sheds light on some of the immediate implications for practice among licensed psychologists amid COVID-19 distancing precautions and their future intentions regarding telepsychology.
“The pandemic has […] coincided with what some have called a ‘telemedicine revolution,’ although no research to date has examined precisely how the use of telepsychology by psychologists has changed during the pandemic, nor what variables may account for the change in use,” the researchers write. “The purpose of this study was to examine (a) the amount of psychologists’ telepsychology use before the COVID-19 pandemic, during the pandemic, and anticipated use after the pandemic; as well as (b) the demographic, training, policy, and clinical practice predictors of these changes.”
Pierce and colleagues recruited psychologists via email through professional organizations, counseling centers, mental health clinics, and psychology newsgroups to participate in their survey featuring demographic items and items on telepsychology. Their questions pertained to personal characteristics, professional setting, and their “telepsychology use, training, and organizational policies relative to January 20, 2020, when the first COVID-19 case was confirmed in the United States.”
Data were analyzed in aggregate, as well as stratified according to demographic/contextual characteristics. Respondents (N = 2,619) were predominately female, with an average age of 57.29 years.
“Woman-identified gender, nonrural practice setting, increased organizational policies supporting telepsychology, and increased training in telepsychology were all associated with increases in the percentage of telepsychology use. Age and race/ethnicity were not associated with changes in telepsychology service provision.”
Consistent with previous research, the results indicated that very few respondents engaged in much telepsychology in their clinical work before January of 2020. The spread of COVID-19 contributed to a massive spike in engagement in telepsychology, and many respondents indicated that they plan to sustain this increase (albeit, to a lesser degree) even once COVID-19 is less of a public health threat. Psychologists from rural communities and those heavily engaged in testing and assessment were liked to shift to a virtual approach.
“Psychologists in the current study estimated performing 7.07% of their clinical work with telepsychology before the pandemic. This is in stark comparison to psychologists’ estimates that telepsychology comprised 85.53% of their clinical work during the pandemic, an over 12-fold increase. Moreover, participants projected that 34.96% of their clinical work would be conducted via telepsychology even after the pandemic ceases, reflecting an important shift in attitudes toward the use of telepsychology.”
More comprehensive research is needed to establish a clearer picture of what has been done and, perhaps most importantly, what’s been working in this distant-service climate. According to the authors, the sweeping shift to virtual services may have facilitated a rapid reduction in the barriers to the provision of telepsychology (e.g., privacy and security regulations, reimbursement, etc.). However, just because service modality changed rapidly to meet unprecedented demands does not mean refinement is unnecessary.
“The substantial changes in the percentage of telepsychology use observed in the current study suggest that many of the previously documented barriers to telepsychology have been addressed, at least on a temporary basis, either by procedural changes or by the immediate needs of patients and providers during the COVID-19 pandemic. While some facilitating changes may be short-lived, these results also show that psychologists plan to continue using telepsychology at greater rates in the future relative to before the pandemic, suggesting important shifts in attitudes toward the use of telepsychology.”
Pierce, B. S., Perrin, P. B., Tyler, C. M., Mckee, G. B., & Watson, J. D. (2020). The COVID-19 telepsychology revolution: A national study of pandemic-based changes in US mental health care delivery. American Psychologist. DOI:10.1037/amp0000722 (Link)