Journal of Technology in Behavioral Science

, Volume 2, Issue 3–4, pp 190–210 | Cite as

An Interprofessional Framework for Telebehavioral Health Competencies

  • Marlene M. MaheuEmail author
  • Kenneth P. Drude
  • Katherine M. Hertlein
  • Ruth Lipschutz
  • Karen Wall
  • Donald M. Hilty


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.


Telebehavioral 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 (, 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 for pricing). The authors alone are responsible for the content and writing of the paper.

Supplementary material

41347_2017_38_MOESM1_ESM.docx (101 kb)
ESM 1 (DOCX 101 kb)


  1. Aboujaoude, E., Salame, W., & Naim, L. (2015). Telemental health: a status update. World Psychiatry, 14(2), 223–230. Scholar
  2. American Association for Marriage and Family Therapy. (2015). Revised American Association for Marriage and Family Therapy code of ethics. Retrieved from AAMFT/Content/Legal_Ethics/Code_of_Ethics.aspx.
  3. American Nursing Association. (2012). Scope & standards of practice. Washington, DC: American Nurses Association.Google Scholar
  4. American Counseling Association. (2014). Code of ethics. Retrieved from
  5. 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
  6. The American Psychiatric Association Resource Document on Telepsychiatry by Videoconferencing. (1998). Retrieved from:
  7. American Psychiatric Association. (2014). Resource document on telepsychiatry and related technologies in clinical psychiatry. Retrieved at
  8. American Psychological Association Guidelines for the Practice of Telepsychology. (2013). Retrieved from
  9. Association of State and Provincial Psychology Boards. (2014). Maintenance of Competence for Licensure (MOCL) White Paper. Retrieved from
  10. American Telemedicine Association. (2017). Practice guidelines for telemental health with children and adolescents. Retrieved from:
  11. American Telemedicine Association Practice Guidelines for Video-based Online Mental Health Services (2013). Retrieved from
  12. American Telemedicine Association Practice Guidelines for Videoconferencing-Based Telemental Health. (2009). Retrieved from
  13. Angelini, D. (2011). Interdisciplinary and interprofessional education: what are the key issues and considerations for the future? The Journal of Perinatal & Neonatal Nursing, 25(2), 175–179.CrossRefGoogle Scholar
  14. Association of Social Work Boards. (2015). Model regulatory standards for technology and social work practice. Retrieved from
  15. Australian Psychological Society. (2011). Guidelines for providing psychological services and products using the internet and telecommunications technology. Retrieved from:
  16. Barr H. Interprofessional education today, yesterday and tomorrow. (2002). Occasional paper 1. Higher Education Academy: Health Sciences and Practice Subject Centre Scholar
  17. 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. Scholar
  18. Bienenfeld, D., Klykylo, W., & Knapp, V. (2000). Process and product: development of competency-based measures for psychiatry residency. Academic Psychiatry, 24(2), 68–76. Scholar
  19. Bloom, B. (1956) Taxonomy of educational objectives. Vol 1. (or Handbook I). New York: David McKay Co.Google Scholar
  20. Blumer, M. L. C., Hertlein, K. M., & Vandenbosch, M. L. (2015). Towards the development of educational core competencies for couple and family therapy technology practice. Contemporary Family Therapy, 37, 113–121. Scholar
  21. Bodenheimer, T., & Sinsky, C. (2014). From triple to quadruple aim: care of the patient requires care of the provider. Annals of Family Medicine, 12(6), 573–576. Scholar
  22. 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. Scholar
  23. Canadian Psychological Association. (2006). Providing psychological services via electronic media: Draft ethical guidelines for psychologists providing psychological services via electronic media . Retrieved at
  24. 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, p. 12
  25. Coleman, C. A., Hudson, S., & Maine, L. L. (2013). Health literacy practices and educational competencies for health professionals: a consensus study. Journal of Health Communication, 18(1), 82–102. Scholar
  26. Council for Accreditation of Counseling and Related Educational Programs, (2015). 2016 CACREP standards. Retrieved from
  27. De Villiers, M. R., De Villiers, P. J. T., & Kent, A. P. (2005). The Delphi technique in health science education. Medical Teaching, 27, 639–643.CrossRefGoogle Scholar
  28. Dombo, E. A., Kays, L., & Weller, K. (2014). Clinical social work practice and technology: personal, practical, regulatory, and ethical considerations for the twenty-first century. Social Work in Health Care, 53(9), 900–919. Scholar
  29. Dreyfus, S. E., & Dreyfus, H. L. (1980). A five-stage model of the mental activities involved in directed skill acquisition. Washington, DC: Storming Media.CrossRefGoogle Scholar
  30. Epstein, R. M., & Hundert, M. (2002). Defining and assessing professional competence. Journal of the American Medical Association, 287, 226–235. Scholar
  31. Godleski, L., Darkins, A., & Peters, J. (2012). Outcomes of 98,609 U.S. Department of Veterans Affairs patients enrolled in telemental health services, 2006–2010. Psychiatric Services, 63(4), 383–385. Scholar
  32. 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
  33. 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
  34. Hanley, B., Scott, H., & Priest, H. (2017). The impact of organisational change on professionals working within a Community Mental Health Team (CMHT): a psychodynamic perspective. Psychoanalytic Psychotherapy, 31(2), 176–194. Scholar
  35. Harrison, A. L., & English, L. (2001). Interdisciplinary health assessment of the older individual: a conceptual framework for curricular integration. Journal of Physical Therapy Education, 15(2), 17–22.CrossRefGoogle Scholar
  36. HCPro. (2008). Evidence-based competency management system: toolkit for validation and assessment (2nd ed.). Marblehead, MA: HCPro, Inc..Google Scholar
  37. 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. Scholar
  38. 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.
  39. 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
  40. 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. Scholar
  41. 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
  42. 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
  43. Institute of Medicine. (2001). Crossing the quality chasm: a new health system for the 21st century. Washington, DC: The National Academies Press.
  44. Institute of Medicine. (2003a). Health professions education summit. Retrieved from
  45. 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:
  46. Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: report of an expert panel. Washington, DC: Interprofessional Education Collaborative.Google Scholar
  47. Johnson, G. (2014). Toward uniform competency standards in telepsychology: a proposed framework for Canadian psychologists. Canadian Psychology/Psychologie Canadienne 2014, 55(4), 291–302.CrossRefGoogle Scholar
  48. 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
  49. Joint Commission Resources. (2008) Comprehensive accreditation manual for hospitals: the official handbook. “HR2–HR13.” Oakbrook, IL: Joint Commission Resources.Google Scholar
  50. 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. Scholar
  51. Kaslow, N. J., Grus, C. L., Campbell, L. F., Fouad, N. A., Hatcher, R. L., & Rodolfa, E. R. (2009). Competency assessment toolkit for professional psychology. Training and Education in Professional Psychology, 3(4S), S27–S45. Scholar
  52. Kennedy, P. E., Chyung, S. Y., Winiecki, D. J., & Brinkerhoff, R. O. (2014). Training professionals' usage and understanding of Kirkpatrick's level 3 and level 4 evaluations. International Journal of Training and Development, 18(1), 1–21. Scholar
  53. Kirkpatrick, J., & Kirkpatrick, W. (2009). The Kirkpatrick four levels: a fresh look after 50 years, 1959–2009. Retrieved from hitepaper.pdf.
  54. Luxton, D., Nelson, E. & Maheu, M. (2016). Telemental health best practices. Washington, DC: American Psychological Association.Google Scholar
  55. Maheu, M. M. (2003). The online clinical practice model. Psychotherapy: Theory, Research, Practice, Training, 40, 20–32.–3204.40.CrossRefGoogle Scholar
  56. 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
  57. Marrelli, A. F., Tondora, J., & Hoge, M. A. (2005). Strategies for developing competency models. Administrative Policy and Mental Health, 32(5–6), 533–561.CrossRefGoogle Scholar
  58. Martínez-Rodrigo, J. J., & Martí-Bonmatí, L. (2008). Professional competencies: from conflict to opportunity. Radiología, 50(1), 5–10.PubMedCrossRefGoogle Scholar
  59. 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. Scholar
  60. Miller, G. E. (1990). The assessment of clinical skills/competence/performance. Academic Medicine, 65(9), S63–S67.–199009000-00045.PubMedCrossRefGoogle Scholar
  61. Meyer-Adams, N., Potts, M. K., Koob, J. J., Dorsey, C. J., & Rosales, A. M. (2011). How to tackle the shift of educational assessment from learning outcomes to competencies: one program's transition. Journal of Social Work Education, 47(3), 489–507.CrossRefGoogle Scholar
  62. National Association of Social Workers Standards for Technology and Social Work Practice. (2005). Retrieved from
  63. 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
  64. National Hospice and Palliative Care Organization. (2010). Interdisciplinary team competency grid. Retrieved from
  65. NAADAC. (2016). NAADAC/NCC AP ethical standards. Retrieved from
  66. 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. Scholar
  67. 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. Scholar
  68. Ohio Psychological Association. (2013). Areas of competence for psychologists in telepsychology. Retrieved from
  69. Philipsen, N. C., Lamm, N. H., & Reier, S. L. (2007). Continuing competency for nursing licensure. The Journal for Nurse Practitioners, 3(1), 41–45. Scholar
  70. 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
  71. 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
  72. 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.–7028.36.4.347.CrossRefGoogle Scholar
  73. 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. Scholar
  74. Swick, S., Hall, S., & Beresin, E. (2006). Assessing the ACGME competencies in psychiatry training programs. Academic Psychiatry, 30(4), 330–351. Scholar
  75. Tilley, D. D. S. (2008). Competency in nursing: a concept analysis. Journal of Continuing Education in Nursing, 39(2), 58–66.–20080201-12.CrossRefGoogle Scholar
  76. United States Medical Licensing Examination. (2014). USMLE physician tasks/competencies. Retrieved from

Copyright information

© Springer International Publishing AG, part of Springer Nature 2017

Authors and Affiliations

  • Marlene M. Maheu
    • 1
    Email author
  • Kenneth P. Drude
    • 2
  • Katherine M. Hertlein
    • 3
  • Ruth Lipschutz
    • 4
  • Karen Wall
    • 5
  • Donald M. Hilty
    • 6
  1. 1.Telebehavioral Health Institute, Inc.San DiegoUSA
  2. 2.Private PracticeDaytonUSA
  3. 3.Couple and Family Therapy Program, School of MedicineUniversity of Nevada, Las VegasLas VegasUSA
  4. 4.University of Illinois at Chicago & Institute for Family Studies at Northwestern UniversityChicagoUSA
  5. 5.VA Palo Alto HCS – Menlo Park DivisionMenlo ParkUSA
  6. 6.UC Davis Department of Psychiatry & Behavioral SciencesSacramentoUSA

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