Wtf, Well That's Fantastic: Opportunities and Challenges of Practicing in the Digital Space As a Clinical Social Worker

Background & Purpose:

Academic literature suggests that tele-mental health delivery is not new: the first articles begin to appear around 1996. Yet, social work has been slow to embrace the promise of service delivery --perhaps especially mental health services--via information and communication technologies. However, since approximately 2012, private, for-profit technology companies have begun to exploit the lack of coverage for mental health by offering practitioners access to platforms that enable them to deliver mental health treatment by phone, video conference delivered by computer, or sms/text message. These platforms offer “matching” services, allowing consumers of mental health a new conduit to find and engage a clinical provider. Additionally, platforms offer consumers the ability to customize the delivery mechanism for these services, offering up a menu of options, including phone, sms/text message, email or video, in essence creating an optimized therapy delivery “channel”,  which is highly individualized.

Methods:

This study used a qualitative method --to collect data from 22 social work practitioners. All participants were presently engaged as providers of tele-mental health services on a third party platform at the time of their interview. The study used situational analysis, in the spirit of Clarke, as an analytic strategy. Situational Analysis allows investigators to create analytic maps of social processes, including internal and external forces and relationships, identified using grounded theory.

Results:

This appears to be a moment of both great expansion and experimentation in the provision of and access to mental health treatment. Practitioners engaged as providers of mental health services on third party platforms experience themselves as pioneers in new territory—and they articulate ideas about opportunity, innovation, risk and an impatience with professional structures that are slow to evolve. Themes such as flexibility and autonomy--for both provider and consumer--ran deeply throughout all the respondents’ interviews. Practitioners talk about the anonymity of virtual practice both as a benefit which speeds disclosure and welcomes populations traditionally averse to treatment (like those with pedophilic tendencies, social anxiety disorders and batterers), and as a liability. Many describe a completely new economy of practice, in which rigid expectations of productivity and response time, demanding compensation models and shifting business models all work to challenge traditional concepts of how services are provided and how individual practitioners construct a professional career.

Conclusions & Implications

This digital model of practice—accessible anonymously, at any time and from anywhere--has promise for serving vulnerable communities and for welcoming populations who have traditionally not had access to mental health services. Telehealth has and will continue to alter the marketplace for mental health services, as nonprofits add these forms of access to their menu of services, and for-profit players devise models to maximize earnings. The advent of this form of practice will challenge social work: requiring schools to incorporate training into curricula, forcing the discipline to demonstrate the value of its expertise and the utility of the services it can provide, and challenging professionals to reimagine the arc and potential of their career.