An Interprofessional Framework for Telebehavioral Health Competencies
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The Coalition for Technology in Behavioral Science (CTiBS) has developed an interprofessional, evidence-based, measurable framework for telebehavioral health (TBH) competencies. The paper presents the development of the CTiBS TBH framework, identifies the theoretical rationale and need for such competencies, outlines methods used, provides two detailed discussions of applications, presents a tabulized form of the framework, and then discusses limitations and future research. In the CTiBS TBH competency framework, the term telebehavioral health is meant to include telemental health and e-therapy. The TBH competency framework is offered as an initial working document to identify and organize discreet, measurable telebehavioral practices derived from a review of the literature, technological advances, and day-to-day clinical practice. It reflects core knowledge, skills, and attitudes needed for competent telebehavioral health practice. The competency framework is directly applicable to psychiatry/medicine, psychology, social work, counseling, marriage/family, behavior analysis, and other behavioral sciences. The CTiBS TBH framework organizes seven topic domains and five subdomains according to competency level, i.e., Novice, Proficient, or Authority. In turn, each competency level is categorized into 51 discrete telebehavioral objectives, which are then distinguished by 149 cumulative and measurable telebehavioral practices. The seven TBH competency domains identified by CTiBS include (1) Clinical Evaluation and Care, with three subdomains addressing Assessment and Treatment, Cultural Competence and Diversity, and Documentation and Administrative Procedures; (2) Virtual Environment and Telepresence; (3) Technology; (4) Legal and Regulatory Issues; (5) Evidence-Based and Ethical Practice, with two subdomains addressing Standards and Guidelines and Social Media; (6) Mobile Health and Apps; and (7) Telepractice Development.
KeywordsTelebehavioral health Telemental health E-therapy Competencies Competency framework Interprofessional Interdisciplinary
The authors acknowledge the support of the Coalition for Technology in Behavioral Science.
Compliance with Ethical Standards
Conflict of interest
The authors report no financial conflicts of interest. Co-author Marlene Maheu is the Executive Director for the for-profit Telebehavioral Health Institute (https://telehealth.org/), which offers professional training and consultation of the nature advocated by this paper. Tracy Luoma is Executive Director at Optum Behavioral Health Salt Lake County. Telebehavioral health task force member and table contributor, Richard Long, runs a commercial supervision service that could potentially benefit from certification processes (see http://mentalhealth-connect.com/process for pricing). The authors alone are responsible for the content and writing of the paper.
- American Association for Marriage and Family Therapy. (2015). Revised American Association for Marriage and Family Therapy code of ethics. Retrieved from http://www.aamft.org/iMIS15/ AAMFT/Content/Legal_Ethics/Code_of_Ethics.aspx.
- American Nursing Association. (2012). Scope & standards of practice. Washington, DC: American Nurses Association.Google Scholar
- American Counseling Association. (2014). Code of ethics. Retrieved from https://www.counseling.org/resources/aca-code-of-ethics.pdf.
- American Counseling Association. (2015). Competencies for counseling the Multiracial Population Multi-Racial/Ethnic Counseling Concerns (MRECC) Interest Network of the American Counseling Association Taskforce. Retrieved from https://www.counseling.org/docs/default-source/competencies/competencies-for-counseling-the-multiracial-population-2-2-15-final.pdf?sfvrsn=14.
- The American Psychiatric Association Resource Document on Telepsychiatry by Videoconferencing. (1998). Retrieved from: http://www.psych.org
- American Psychiatric Association. (2014). Resource document on telepsychiatry and related technologies in clinical psychiatry. Retrieved at https://www.psychiatry.org/File%20Library/Psychiatrists/Directories/Library-and-Archive/resource_documents/Resource-2014-Telepsychiatry-Clinical-Psychiatry.pdf.
- American Psychological Association Guidelines for the Practice of Telepsychology. (2013). Retrieved from http://www.apapracticecentral.org/ce/guidelines/telepsychology-guidelines.pdf.
- Association of State and Provincial Psychology Boards. (2014). Maintenance of Competence for Licensure (MOCL) White Paper. Retrieved from http://c.ymcdn.com/sites/www.asppb.net/resource/resmgr/Guidelines/Maintenance_of_Competence_fo.pdf.
- American Telemedicine Association. (2017). Practice guidelines for telemental health with children and adolescents. Retrieved from: https://higherlogicdownload.s3.amazonaws.com/AMERICANTELEMED/618da447-dee1-4ee1-b941-c5bf3db5669a/UploadedImages/Practice%20Guideline%20Covers/NEW_ATA%20Children%20&%20Adolescents%20Guidelines.pdf.
- American Telemedicine Association Practice Guidelines for Video-based Online Mental Health Services (2013). Retrieved from http://www.americantelemed.org/docs/default-source/standards/practice-guidelines-for-video-based-online-mental-health-services.pdf?sfvrsn=6
- American Telemedicine Association Practice Guidelines for Videoconferencing-Based Telemental Health. (2009). Retrieved from http://www.americantelemed.org/docs/default-source/standards/practice-guidelines-for-videoconferencing-based-telemental-health.pdf?sfvrsn=6
- Association of Social Work Boards. (2015). Model regulatory standards for technology and social work practice. Retrieved from https://www.aswb.org/wp-content/uploads/2015/03/ASWB-Model-Regulatory-Standards-for-Technology-and-Social-Work-Practice.pdf
- Australian Psychological Society. (2011). Guidelines for providing psychological services and products using the internet and telecommunications technology. Retrieved from: https://aaswsocialmedia.wikispaces.com/file/view/EG-Internet.pdf.
- Bates, R. (2004). A critical analysis of evaluation practice: the Kirkpatrick model and the principle of beneficence. Evaluation and Program Planning, 27(3), 341–347. https://doi.org/10.1016/j.evalprogplan.2004.04.011.CrossRefGoogle Scholar
- Bloom, B. (1956) Taxonomy of educational objectives. Vol 1. (or Handbook I). New York: David McKay Co.Google Scholar
- Calhoun, J. G., Dollett, L., Sinioris, M. E., Wainio, J. A., Butler, P. W., Griffith, J. R., & Warden, G. L. (2008). Development of an interprofessional competency model for healthcare leadership. Journal of Healthcare Management/American College of Healthcare Executives, 53(6), 375–397. https://doi.org/10.1080/13561820.2016.1192588.PubMedGoogle Scholar
- Canadian Psychological Association. (2006). Providing psychological services via electronic media: Draft ethical guidelines for psychologists providing psychological services via electronic media . Retrieved at http://www.cpa.ca/aboutcpa/committees/ethics/psychserviceselectronically/.
- Centers for Medicare & Medicaid Services. (2013). Coverage of direct service workforce continuing education and training within Medicaid policy and rate setting: a toolkit for state Medicaid agencies. Retrieved from https://www.medicaid.gov/medicaid/ltss/downloads/workforce/dsw-training-rates-toolkit.pdf, p. 12
- Council for Accreditation of Counseling and Related Educational Programs, (2015). 2016 CACREP standards. Retrieved from http://www.cacrep.org/wp-content/uploads/2017/07/2016-Standards-with-Glossary-7.2017.pdf
- Glueckauf, R. L., Maheu, M. M., Drude, K. P., Nelson, E., Wells, B., Wang, Y., & Gustafson, D. J. (2017). Professional psychology: research and practice survey of psychologists' telebehavioral health practices: technology use, ethical issues and training needs. Professional Psychology: Research and Practice In Press.Google Scholar
- Gros, D. F., Lancaster C. L, López C. M, & Acierno R. (2016). Treatment satisfaction of home-based telehealth versus in-person delivery of prolonged exposure for combat-related PTSD in veterans. Journal of Telemedicine And Telecare, 1758–1109.Google Scholar
- HCPro. (2008). Evidence-based competency management system: toolkit for validation and assessment (2nd ed.). Marblehead, MA: HCPro, Inc..Google Scholar
- Hensley, L. G., Smith, S. L., & Thompson, R. W. (2003). Assessing competencies of counselors-in-training: complexities in evaluating personal and professional development. Counselor Education and Supervision, 42(3), 219–230. https://doi.org/10.1002/j.1556-6978.2003.tb01813.x.CrossRefGoogle Scholar
- Hilty, D. M., Ferrer, D. C., Parish, M. B., Johnston, B., Callahan, E. J., & Yellowlees, P. M. (2013). The effectiveness of telemental health: a 2013 review. Telemedicine Journal and E-Health, 19(6), 444–454. https://doi.org/10.1089/tmj.2013.0075.
- Hilty D. M., Maheu M. M., Drude, K., Hertlein K., Wall, K., Long R., Luoma, T., Ford, D. (2017). Telebehavioral health, telemental health, e-therapy and e-health competencies: the need for an interdisciplinary framework. Journal for Technology In Behavioral Science, In PressGoogle Scholar
- Hilty, D. M., Crawford, A., Teshima, J., Chan, S., Sunderji, N., Yellowlees, P. M., Kramer, G., O’Neill, P., Fore, C., Luo, J. S., & Li, S. T. (2015). A framework for telepsychiatric training and e-health: competency-based education, evaluation and implications. International Review of Psychiatry, 27(6), 569–592. https://doi.org/10.3109/09540261.2015.1091292.PubMedCrossRefGoogle Scholar
- Hoge, M. A., Morris, J. A., Laraia, M., Pomerantz, A., & Farley, T. (2014). Core competencies for integrated behavioral health and primary care. Washington, DC: SAMHSA - HRSA Center for Integrated Health Solutions.Google Scholar
- Hoge, M. A., McFaul, M., Calcote, R., & Tallman, B. (Eds.). (2008). The Alaskan crosswalk: exploring competencies and credentialing for the state’s direct care workforce: a report of the Credentialing and Quality Standards Subcommittee (CQSS). Anchorage, AK: The Alaskan Mental Health Trust Authority. Retrieved from http://psycnet.apa.org/record/2016-16689-003
- Institute of Medicine. (2001). Crossing the quality chasm: a new health system for the 21st century. Washington, DC: The National Academies Press. https://doi.org/10.17226/10027.
- Institute of Medicine. (2003a). Health professions education summit. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK221516/
- Institute of Medicine. (2003b). The core competencies needed for health care professionals. Health professions education: a bridge to quality. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/10681
- Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: report of an expert panel. Washington, DC: Interprofessional Education Collaborative.Google Scholar
- Joint Commission on the Accreditation of Healthcare Organizations. (1998). Lexicon (2nd ed.). Oakbrook Terrace, IL: Joint Commission on the Accreditation of Healthcare Organizations.Google Scholar
- Joint Commission Resources. (2008) Comprehensive accreditation manual for hospitals: the official handbook. “HR2–HR13.” Oakbrook, IL: Joint Commission Resources.Google Scholar
- Jones, J., Douglas, M., Rosenberg, A. A., Gilhooly, J. T., & Carraccio, C. L. (2011). Perspective: competencies, outcomes, and controversy—linking professional activities to competencies to improve resident education and practice. Academic Medicine: Journal of the Association of American Medical Colleges, 86(2), 161–165. https://doi.org/10.1097/ACM.0b013e31820442e9.CrossRefGoogle Scholar
- Kirkpatrick, J., & Kirkpatrick, W. (2009). The Kirkpatrick four levels: a fresh look after 50 years, 1959–2009. Retrieved from http://www.managesmarter.com/managesmarter/images/pdfs/trg_20090417_kirkpatrickw hitepaper.pdf.
- Luxton, D., Nelson, E. & Maheu, M. (2016). Telemental health best practices. Washington, DC: American Psychological Association.Google Scholar
- Maheu, M. M., Pulier, M. L., Wilhelm, F. H., McMenamin, J., & Brown-Connolly, N. (2004). The mental health professional and the new technologies: a handbook for practice today. Mahwah, NJ: Erlbaum.Google Scholar
- Melnyk, B. M., Gallagher-Ford, L., Long, L. E., & Fineout-Overholt, E. (2014). The establishment of evidence-based practice competencies for practicing registered nurses and advanced practice nurses in real-world clinical settings: proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldviews on Evidence-Based Nursing, 11(1), 5–15. https://doi.org/10.1111/wvn.12021.PubMedCrossRefGoogle Scholar
- National Association of Social Workers Standards for Technology and Social Work Practice. (2005). Retrieved from http://www.socialworkers.org/practice/standards/naswtechnologystandards.pdf.
- National Association of Social Workers, Association of Social Work Boards, Council on Social Work Education, and Clinical Social Work Association. (2017). Standards for technology in social work practice. Retrieved from https://www.naswpress.org/publications/standards/technology.html.
- National Hospice and Palliative Care Organization. (2010). Interdisciplinary team competency grid. Retrieved from https://www.nhpco.org/sites/default/files/public/education/Competency_level_grid_final.pdf
- NAADAC. (2016). NAADAC/NCC AP ethical standards. Retrieved from https://www.naadac.org/code-of-ethics.
- Nelson, T. S., Chenail, R. J., Alexander, J. F., Crane, D. R., Johnson, S. M., & Schwallie, L. (2007). The development of core competencies for the practice of marriage and family therapy. Journal of Marital and Family Therapy, 33(4), 417–438. https://doi.org/10.1111/j.1752-0606.2007.00042.x.PubMedCrossRefGoogle Scholar
- Njoroge, W., Williamson, A. A., Mautone, J. A., Robins, P. M., & Benton, T. D. (2017). Competencies and training guidelines for behavioral health providers in pediatric primary care. Child and Adolescent Psychiatric Clinics of North America, 26(4), 717–731. https://doi.org/10.1016/j.chc.2017.06.002.PubMedCrossRefGoogle Scholar
- Ohio Psychological Association. (2013). Areas of competence for psychologists in telepsychology. Retrieved from http://www.ohpsych.org/about/files/2012/03/FINAL_COMPETENCY_DRAFT.pdf.
- Roberts, N., Hu, T., Axas, N., & Repetti, L. (2017). Child and adolescent emergency and urgent mental health delivery through telepsychiatry: 12-month prospective study. Telemedicine and e-Health.Google Scholar
- Robbins, E., Dilla, B., The Lewin Group, Sedlezky, L., & Sirek, A. J. (2013). Coverage of direct service workforce continuing training within medicaid policy and rate setting: a toolkit. University of Minnesota Research and Training Center on Community Living.Google Scholar
- Rodolfa, E. R., Bent, R. J., Eisman, E., Nelson, P. D., Rehm, L., & Ritchie, P. (2005). A cube model for competency development: implications for psychology educators and regulators. Professional Psychology: Research and Practice, 36, 347–354. https://doi.org/10.1037/0735–7028.36.4.347.CrossRefGoogle Scholar
- Swank, J. M., Lambie, G. W., & Witta, E. L. (2012). An exploratory investigation of the counseling competencies scale: a measure of counseling skills, dispositions, and behaviors. Counselor Education and Supervision, 51(3), 189–206. https://doi.org/10.1002/j.1556-6978.2012.00014.x.CrossRefGoogle Scholar
- United States Medical Licensing Examination. (2014). USMLE physician tasks/competencies. Retrieved from http://www.usmle.org/announcements/?ContentId=137