Innovations in College Counseling for Distance Learners Student

Innovations in College Counseling for Distance Learners Student

Innovations in College Counseling for Distance Learners Student Health and Counseling University of New Mexico Stephanie D. McIver, PhD Ben J. Klein, PhD Gary K. Borrell, MD Objectives

2 Distance Learning at UNM Campus EA - Online & ITV 2008 2009 2010 2011 2012 1 Yr 4 Yr

N 1,399 1,736 2,641 4,507 6,527 44.82% 275.98% Credits 5,050 7,008 11,359 20,791 30,767 47.98% 339.03% 3

Levels of Service 4 Consultation Ask A Question Form http:// ml

Links at NMEL, TNTA, Parent Association 5 Outreach activity of providing services to populations who might not otherwise have access to those services. groups providing it are not stationary, but mobile; meeting those in need at the locations where those in need are.

educational role, raising the awareness of existing services. Wiki 6 Key Players Becky Adams, Associate Director NMEL Jane Erlandson, Instructional Media Project Manager Mark McKee, Multimedia Development Specialist

NMEL responsible for the administration of online and ITV courses at the University of New Mexico, the implementation and management of UNM's enterprise Learning Management System, and a host of online media and production

services. 8 Enterprise Management and support of UNM's Learning Management System (UNM Learn) Technical support and management of online teaching and learning technologies Course Planning and Instructional Design Course Building and Production

Online Course delivery and engagement Online Course evaluation and student assessment Online Teaching and Learning tools New solutions and emerging technologies Faculty and student technology support Interactive Television (ITV) Television Production Academic Video Conferencing Services Video On Demand and Live Webcasting 9

Blackboard ps/Bb-sites-course-creation-BBLEARN /pages/index.html 10 Direct Service

Guidelines & Technology Key Players Ben J. Klein, Ph.D. - SHAC CS Caroline Bonham, M.D. UNM CRCBH 12 Telemental Health:

Ethical and Competent Practice Practice Guidelines Example: Guidelines for the Practice of Telepsychology, December 2013, American Psychologist, 791-800. Training Example: Marlene M. Maheu, Ph.D., Telemental Health Institute (

13 Informed Consent Is Critical! Telemental Health: Licensure and Regulatory Issues 1. Question: A provider generally must be licensed where? a) Where the provider is located at the time of service b) Where the client is located at the time of service c) Both RESOURCE: Telepsychology 50-State Review. American

Psychological Association Practice Legal & Regulatory Affairs, October 2013 2. Billing and Reimbursement -- Do current research with payors 14 Specialized Informed Consent 1. Consider adding some key Background Information items onto signed Informed Consent

Form - contact telephone numbers, physical street address, emergency contact names and numbers 2. Have Introductory paragraph that defines and describes the process (computers, cameras, videoconference software) 15 Special Considerations and Risks

Included in Informed Consent Some problems in the quality of audio or visual information sent via the internet may occur during discussions with the therapist, making it more difficult at times to fully communicate with the therapist Equipment or internet performance delays or failures may at times make online sessions impossible to conduct, requiring a switch to landline telephone conversations as a backup system While all precautions are taken to utilize systems that are encrypted and compliant with the highest privacy standards, there is some small possibility

that private information shared over the internet during counseling sessions could be intercepted or in some other way misused Emergency interventions cannot be provided via the online therapy sessions directly and as such the client will need to be willing to use local emergency 16 room or other crisis services as needed. Additional Points for Informed Consent 2. None of the sessions will be recorded or photographed.

3. Written records summarizing the contents of the discussions and the therapists diagnosis and treatment plan will be maintained in the Student Health and Counseling electronic behavioral health record at the UNM Student Health and Counseling Center, Main Campus, UNM, Albuquerque, NM. 4. None of the behavioral health records referred to above will be shared with anyone without my written consent WITH A FEW POSSIBLE EXCEPTIONS that might require release without my approval, including: 1) if my therapist believes that there is a danger that I might harm myself or someone else in the immediate future, the therapist may have to take actions to prevent that 2) if my therapist believes that a child or incapacitated adult is being abused, the

therapist has to report that 3) the courts, in rare circumstances, may order the therapist to release records, and 4) if I choose to use my mental or emotional condition as an issue in future legal matters, in so doing I may be giving attorneys and/or the courts access to my 17 behavioral health records. Additional Points for Informed Consent 5. Contact with Therapist Between Scheduled Online Student

Counseling Sessions Between regularly scheduled online counseling sessions, it will not be possible for me to have any reliable or timely communication about my condition or life situation with the therapist who is providing Online Student Counseling sessions. 6. In the case of a crisis situation that is not a life-threatening emergency, I may call the NM Crisis line 24 hours per day 7 days per week at 1-866-514-2560. 7. In the case of emergency, I should call 911 and request transport to the nearest hospital.

18 Relative or Absolute Contraindications for Telemental Health Services Severe psychiatric disturbance (schizophrenia, other psychosis, severe depression, personality disorder) Severe substance abuse or addiction problems Ongoing threats of domestic violence

Very unstable social, housing, or family situations Pending legal charges against student Acute crisis or emergency situations Students who have been recently assaulted 19 Telemental Health Vendors Examples: Vsee ( Adobe Connect (

Resource: 20 Direct Service Finding the Critical Mass 21

Key Players Debbi Knots, Director NMEL Dawn Davis, Sr. Program Manager, NMEL Anne Marie Carpenter, Operations Manager, NMEL *HPSAs (Health Profession al

Shortage Areas) *MUAs (Medically Underserv ed Areas) 23 Where are the Distance Learners?

24 Distance Learning Centers

Farmington Gallup Hobbs Kirtland

Los Alamos Santa Fe Taos Tucumcari Valencia Online Correspondence 25 26

ABQ Main Campus 27 ABQ Main Campus 28 ITV

29 Back to the Drawing Board Critical Mass Report Data reported on these variables: UNM Main students (no branch campus students), AND Students residing in New Mexico with non-Bernalillo County personal addresses, AND

Students enrolled Spring 2014, AND Students taking main campus courses with distance delivery types (online, ITV, correspondence), OR Students taking courses offered at remote UNM main campus locations (aka UNM Statewide Centers: Farmington, Gallup, Los Alamos, Santa Fe, Taos, & Valencia). 30 31

CONSIDERATIONS FOR PSYCHIATRY Gary Borrell, M.D. 32 History of Telepsychiatry Impossible to identify who first envisioned it. Early articles (referring to efforts since 1959) discuss those early

efforts and attempts to deal with issues that are still with us. a. Head-to-Head Comparisons; Group neither a problem, nor an asset b. Head-to-Head Comparisons; Individual did not effect either the development of rapport, nor the attitude of either toward the therapy situation c. Technology was Black & White, small screens, and limited audio fidelity d. 1973 a name; Telepsychiatry. 33

North Carolina 1970s Reports of adolescent males interviewed by machine Despite positive findings there was resistance, especially concerning interference with, or distortion of, transference. The Semmelweis Reflex In some cases, Art jumped ahead (the movie, She). Transference not limited to face-to-face interactions Need to provide care for those in rural settings or special populations (e.g. incarcerated, those without transportation), areas with too few

resources or providers. Prescribing 34 Telepsychiatry Today The North Carolina Experience (28 counties without a psychiatrist) The New Mexico Experience a. The VA

b. Project Echo c. UNM Telepsychiatry is fluid, adaptable, titratable, and its only limitations are in the mind of the user. 35 Brian Gady ? 36

Contact Information Stephanie D. McIver, Ph.D. [email protected] Ben Klein, Ph.D. [email protected] Gary Borrell, M.D. [email protected] Student Health & Counseling University of New Mexico Albuquerque, NM 87110 (505) 277-3136 37

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