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TeleMental Health Clinical Relationship Challenges
8 Strategies for Working with Grieving Children

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Psychologist CEs, Counselor CEUs, Social Worker CEUs, MFT CEUs | Grief CEU Courses

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Audio Transcript Questions The answer to Question 1 is found in Section 1 of the Course Content. The Answer to Question 2 is found in Secion 2 of the Course Content… and so on. Select correct answer from below. Place letter on the blank line before the corresponding question. Do not add any spaces.
Important Note! Numbers below are links to that Section. If you close your browser (i.e. Explorer, Firefox, Chrome, etc..) your answers will not be retained. So write them down for future work sessions.


1. What are interjurisdictional and risk management issues to be considered in providing Telemental Health?
2. What are examples of issues to be considered regarding: the mix of cross-cultural interactions and technology which can create a risk for misunderstanding and miscommunication between mental health care providers and the client with whom they work?
3. What do AMA and APA guidelines recommend you consider before using online information about a client? (For example social networking page and concern for well-being regarding - suicidal ideation, signs of distress, bullying, etc.)
4. What is an exercise you might do to overcome your “performing” anxiety and coming crossed as unemotional and flat during the TMH session?
5. What are common ethical considerations that occurs in an attempt to balance benefits and non-malfeasance?
6. In general how is TMH received by the following populations: veterans; adolescents; Caucasians; Asians; and Native Americans?
7. What do HIPPA Privacy rules consider proper education of patients about their rights?
8. What are some themes that can arise during a TMH session from the point of view of the counselor’s experience and the client’s experience?
9. What do studies suggest when TMH CBT is compared to face-to-face CBT in treating depression and anxiety?
10. What points might be covered in an explanation of the technical side of the TMH session?
11. What are some questions to consider regarding “friending” a client?


A. 1. Adaptation (or lack of adaptation) of clinical style and process utilizing TMH to accommodate different cultural communication styles.
2. Proper attire and room set up for direct in-home TMH
3. Differing understandings regarding the use of voicemail and expectations about returning calls when the message is not left.
4. Alternative meetings of text messaging
5. Differing understandings and expectations regarding immediacy of response to emails
B. Where the client will be when tele-mental health services are provided; is there presence in this jurisdiction temporary or time-limited situation; or permanently located; can a local emergency contact be arranged
C. Schedule a practice session for yourself, when a news program is on. Turn off the sound on your TV and study a number of news anchor people. Observe nonverbal behavior; facial expressions; body movements; now turn on the sound and listen to how they accentuate their language with extra emphasis and tone to make their point. This is especially helpful if you feel you may come across as unemotional and flat during the TMH session.
D. 1. Why do I want to conduct this search?
2. Would my search advance or compromise the treatment?
3. Should I obtain informed consent from the client prior to online searching?
4. Should I share the results of my online search with the client?
E. Veteran populations find the additional control and anonymity afforded by the TMH setting appealing, as reported by others who have experienced trauma.
--Adolescence have been reported to quickly accommodate to the technology setting and often like the additional “personal space” offered by TMH.
--Caucasian clients may find decreased direct eye contact to be a challenge.
--Asian and Native American clients have been reported to prefer the decreased direct eye contact.
Best Practice: Use regular verbal “check-ins” with clients to ask about their experience of the technology.
F. --Establishing a procedure related to clients presenting in crisis
--Practicing within the scope of clinical competence
--Assess need for emergency referral
G. Counselor Experience: A two-dimensional experience; accepting cyber counseling as a different experience; increased focus on the cyber counseling process; counseling relationship lacks emotional connection; need to modify counseling skills
Client Experience: More comfortable than face-to-face counseling; unexpected depth of emotions; immersed in the counseling process; empowerment; equal relationship, different connection; skills that facilitate; listening is key; technology is secondary to process
H. Involves providing patients with a written statement that describes how healthcare providers and other covered entities can use or share their PHI. This should be included in the initial consultation both verbally and in a written format.
I. 1. Has the client utilized TMH previously and what questions do they have?
2. Is the session being recorded? If so, can the client access the recording and does anyone else see the recording?
3. Establish the visual context of where you are sitting. Client might be asked if he or she would like to see the clinician’s office. Clinicians can give clients a virtual tour by moving the location of their camera; to assure client that no one else is present; this also gives a visual context to the clinical setting.
4. Encourage the client to discuss any technical difficulties. An audio lag makes it seem as if the clinician and client are talking over each other. The clinician might suggest to the client adding a small pause after each statement.
J. TMH CBT was associated with significant reductions in depressive symptoms, as well as improved treatment adherence.
K. -How will it affect the patient and the therapeutic relationship if the request is denied?
-How should a provider address this issue as it arises with clients?
-Is it appropriate to accept “friend” request from a family member of the patient, the mother of a pediatric patient for example?
-Is it ethical to accept “friend” request from some patients but not others?
-What are the clinical implications of doing so?


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