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Telemental Health Services for Sexual and Gender Minority Youth

Recommendations for providers developed by scale-it-up program

Key points

  • Telemental health is a subset of the broader and more commonly used term “telehealth.”
  • There are several issues unique to telemental health clients who are SGM youth, particularly with regard to safety.
  • The practitioner must uphold the ethical and professional standards that would be present in an in-person meeting.

This post was co-authored by Kendall Lauber, Nadia Dowshen, Diana Parrish, Elizabeth Gonzalez, Sylvie Naar, Juan C. Jauregui, and Gary W. Harper.

Telemental health services have become more popular in the wake of the COVID-19 pandemic. Here’s what providers need to know to better support patients, especially sexual and gender minority youth.

Ethical and legal requirements

  • Uphold all ethical and professional standards that would be present in an in-person meeting.
  • Educate yourself on the different telecommunication technologies available, as well as considering the privacy and security for the client that each could provide.
  • Different telecommunication options may work better for some clients and not others, so be willing to be flexible. For example, some clients may not have access to any sort of video camera or may feel uncomfortable seeing themselves on their screen, and thus an audio-only (phone call) telemental health session would be ideal.
  • Protect and maintain the confidentiality of information relating to the client, as well as explain to them the risks of loss of confidentiality involved in the use of technology. This involves using appropriate security measures, such as password protection for video conferencing, to protect data from unintended access, as well as proper disposal of data.
  • Get into the habit of asking clients for their current location at the beginning of every telemental health session so that you can be aware of any safety or security concerns that may arise throughout the meeting. Collecting this information at the beginning of the session is especially important for clients with active suicidal ideation to ensure that you are prepared to call emergency services on behalf of the client if necessary.
  • Before conducting a telemental health appointment, familiarize yourself with all laws and regulations related to providing such services. These may vary state by state, so be sure to familiarize yourself with the legal/regulatory issues in the state where you reside, as well as the state where your clients reside. Specific legal and regulatory areas to explore include 1) licensure, 2) malpractice liability, 3) credentialing and privileging, 4) informed consent, 5) security and privacy, and 6) emergency management.
  • The U.S. Centers for Medicare & Medicaid Services (CMS) has broadened access to telehealth services, including telemental health, so that beneficiaries can receive a wider range of services without having to travel to a health care facility. CMS is expanding this benefit on a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act.

Issues unique to telemental health with clients who are sexual or gender minority (SGM) youth

  • Recognize that the living situations of the client may not be safe and supportive of their identity(ies). Be careful with your use of language relating to a client’s sensitive information that involves their serostatus or SGM identity when it is possible you could be overheard by family or roommates. Check in with the client regarding their comfort level with their surroundings at the beginning of each telemental health appointment.
  • Understand that it is not always feasible for a client to move—either permanently or temporarily—to a location that is private or around people who are affirming of who they are. Clients may have economic constraints that prevent them from moving out of their current place of residence and may also depend on the Wi-Fi provided within the home to connect to telemental health technologies (i.e., they cannot go to their car for privacy since it is outside of their home’s Wi-Fi range).
  • Communicate with your client before the session to problem-solve in case of the aforementioned location privacy issues. This can be solved by having the session at a time of day when others are not in the house, from another room of the house, or at a supportive friend’s house. Discourage the use of cellular data or public Wi-Fi signals at a coffee shop or library, as these connections are not secure and should be avoided to protect the client’s confidential data.

Benefits unique to telemental health with clients who are SGM youth and clients with HIV

  • Understand that some clients will be more comfortable with telemental health appointments than in-person meetings and that this comfort level is often more important than your decision regarding a meeting’s location. Many clients have experienced stigma from health care environments in the past or fear encountering stigma in the future and thus prefer telemental health appointments conducted in the comfort of their own home.
  • Consider the benefits of telemental health when it comes to scheduling meetings. Many clients may not be able to meet during regular business hours due to work or school. Telemental health provides an opportunity to meet with clients in need in a timely manner and in a way that is most accessible for them.
  • Consider the cost of telemental health meetings in comparison to in-person meetings. For clients who may be experiencing homelessness, are financially unstable, or do not have their own source of income aside from that of their parents, telemental health can be a more reasonable option compared to in-person appointments. Eliminating the cost of transportation as well as any lost pay from time off work encourages many clients to consider telemental health meetings rather than in-person meetings.
  • Since arranging transportation may no longer be a constricting factor in when youth clients are able to schedule a telemental health appointment, consider having shorter but more frequent meetings. Alternatively, consider meeting at different times of the day or different days of the week. These new options that are more practical with telemental health than standard in-person meetings can yield added insight into an adolescent’s day-to-day life and experiences.

Conclusion

Ultimately, the opportunities provided by telemental health services for SGM youth and youth living with HIV outweigh the drawbacks, as long as professionals performing telemental health are conscious of the added complexity that comes with virtual meetings. In preliminary U.S. studies regarding the use of telemental health services during the COVID-19 pandemic, telemental health via video-call has been shown to be as effective as in-person meetings, has increased retention rates, and has decreased no-show rates among adolescents. Note that further research regarding audio-only telemental health is needed before conclusions can be drawn as to its effectiveness, but researchers are optimistic about the future of telemental health services in improving psychological outcomes.

References

American Psychological Association’s “Guidelines for the Practice of Telepsychology”: http://www.apa.org/practice/
guidelines/telepsychology

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