Providing mental health using telehealth requires all clinicians to take extra steps to make sure their clients are safe during sessions, and that they are in a private location where no one can listen in.
But providing telehealth services gets even trickier when you are in the middle of the COVID-19 pandemic, and your clients are young sexual abuse survivors. Some may even be living with their abusers.
Patsy Fuller is a counselor in Louisiana with more than 10 years of experience. She’s worked with clients coping with severe mental illnesses, addiction, and childhood sexual trauma. She’s currently with Sexual Trauma Awareness and Response, or S.T.A.R, an agency that supports survivors of sexual trauma.
Fuller was working with addicted clients at a psychiatric hospital when she discovered that many of her clients also had a very different issue.
“I realized that a great percentage – at least 70% of the population – had some form of sexual-related trauma as children or as adults,” she told Raymond Barrett, Founder, and CEO of the TeleHealth Certification Institute.
The past trauma contributes to their desire to use substances to cope with the trauma rather than working through the trauma, Fuller said.
Now, Fuller is working to help abuse survivors restabilize their lives during a pandemic.
Fuller’s agency transitioned to video conferencing to provide telehealth services to her clients when COVID-19 started spreading across the US in March.
“It is the closest to in-person treatment that I can get,” she said. “I still need to see their face. I still need to have that interaction … especially when first meeting them.”
Fuller finds providing telehealth over video conference to be particularly helpful for the initial client assessments. After she gets to know her clients, Fuller does allow some clients to use phone sessions for crisis calls.
S.T.A.R. has established special protocols for security, privacy, and informed consent for telehealth clients. Clients are sent a comprehensive consent form. “It's a blanket document … that’s the phone, that's text, that's email – anything that's not in person.”
The agency has another layer of consent for some clients because S.T.A.R. has a contract with the Louisiana Department of Children and Family Services. In these cases, both caseworkers and foster parents must also sign consent documents. If the child is over 15 years old, they also must give consent to telehealth services.
Fuller said clients with suicidal ideation and past suicide attempts require extra precautions during telehealth sessions. These clients must have a support person with them during sessions. Both the client and the support person must agree to the informed consent policies and procedures. An additional consent form is required to allow S.T.A.R. to contact the support person if the client goes offline during their session. The support person agrees to check on the client.
Another concern for Fuller – environment. She takes extra steps to make sure she knows where her clients are located, and that they are safe from their abuser. This is why she requires video. “If they are in an environment with their abuser they have an option to attend services at the hospital because they have SANE nurses [Sexual Assault Nurse Examiners].”
S.T.A.R. is also using telehealth to conduct support groups for existing clients, especially to help clients cope with isolation during the pandemic. Clients are assessed to make sure they are a good fit for the groups.
“I like the [virtual] support groups … that’s my favorite. It has worked out the best.”
She said the individuals who have chosen to participate in the telehealth support groups have been very engaged in the sessions. She added they were more likely to show up for sessions and they liked not having to leave home.
“They would be in their pajamas at 10 o'clock,” Fuller said. “You have some on laptops, some on their phones … so it was a whole lot better.”
You can find more about Patsy Fuller here.
Amanda Barnett, LPC, NCC EDS