Navigating Telemental Health: Provider Perceptions and Decision-Making in a Community Mental Health Setting

Background and Purpose: The COVID-19 pandemic has led to increased adoption of Telemental Health (TMH) services. Understanding the decision-making process behind TMH service delivery is vital for navigating the evolving mental healthcare landscape. Research indicates that no specific client subgroup would be harmed by TMH services, allowing providers to make decisions about service modality. However, best practices involve a comprehensive assessment of client suitability, considering factors like preferences, technological literacy, and clinical risk. This study was part of an internal program evaluation at a large community mental health (CMH) organization in Southern California and its aim was to inform organizational leadership on the sustainability of TMH services post-pandemic. Specifically, this study examined provider perceptions and decision-making processes, with a focus on alignment with emerging best practices.

Methods: The research involved collaboration with organizational stakeholders to develop a survey for direct service providers to evaluate their current practices, preferences, and perceptions of TMH (video and telephone-based). The survey assessed several factors influencing service delivery modality (TMH, field-based, and clinic-based), including client and provider preferences, perceptions of TMH effectiveness, barriers and facilitators, technology access, and risk considerations. The survey was administered online to mental health and substance use therapists, counselors, and clinical supervisors (N = 155) between April and June 2023. It had a response rate of 52% (n = 81).

Results: Providers reported considerable variability in client's and personal preference for TMH, but both preferred a hybrid between TMH and in-person. When determining service delivery mode, providers prioritized client-related factors, with 90% of them ranking factors such as client accessibility and preference as top considerations. Additionally, 80% of providers received support for service mode decision-making from their clinical supervisors. While 95% of providers believed video-based TMH could address client needs appropriately, confidence in phone-based TMH was lower at 42%. Phone-based was seen as the least effective across modalities and service types, except collateral sessions. In-person sessions were perceived as the most effective, especially for crisis intervention. Video-based sessions were thought to be effective across many types of service, especially for individual therapy for adults and teens but not for individual therapy for children.

Conclusions and Implications: The study highlights several key implications for CMH organizations. First, it underscores the importance of prioritizing client needs and considerations over personal preferences when determining the mode of service delivery, whether in-person or through TMH. This client-centered approach is crucial for ensuring effective and accessible mental health care. Second, the study reveals positive attitudes among providers towards TMH, with many believing it can enhance access to care and appropriately address client needs, particularly through video-based platforms. Such positive perceptions are vital for maintaining confidence in TMH and its continued use, which may lead to better client outcomes. Lastly, the study offers insights into the perceived effectiveness of different services and modalities. Overall, the results may be used to develop best practices around decision making and structure of services under a hybrid model of care.