Danielle speaks with Raymond Barrett , CEO of the Telehealth Certification Institute, LLC about tele-behavioral health and the importance of telehealth training. Join us for a discussion of the present state of telehealth training and a look at what the future of telehealth might look like.

welcome to a Virtual View, a telehealth podcast, brought to you by the

Upper Midwest Telehealth Resource Center.

This is Danielle Ley, your host, and today I'm joined by Raymond Barrett, the CEO of

the Telehealth Certification Institute.

Welcome Raymond.

Hi.

Thank you very much for having me.

Yeah, thanks for being here.

So could you tell me a little bit about yourself?

Yeah.

I am a mental health counselor and I started practicing in my

private practice about 18 years ago.

And so I very much, out of the gates got into providing telehealth services.

Because I was providing executive coaching before that which was all

providing, coaching over the phone.

So actually when I started my private practice for counseling, my very first

client wanted sessions over the phone.

So I thought, Hey, this is perfect.

But I didn't know like the regulations around it or how I'm supposed to

be doing that appropriately cuz I didn't receive any training.

In my graduate program.

But that was my first start with telehealth and so I've been in the kind

of the telehealth world ever since.

Wow.

So you've been involved in telehealth like throughout the majority of your career?

Correct.

Yeah.

Yeah.

I've always been very interested in it.

So I focused on that and other providers in the area knew that's what I was doing.

So an EAP program hired me to do telehealth for them.

And then years after that, a hospital system hired me to do some assessments

virtually for, yeah, for their hospital.

And then I realized that there was a real need for practical and comprehensive

training cuz the trainings that I went to on telehealth basically comprised of read

a bunch of articles, , and that was it.

The more I learned, the more questions I have.

So I didn't find it very practical.

So I ended.

Just creating some really practical training.

I started training other clinicians in telehealth about 10 years ago and

then started our training institute eight years ago, which is the

telehealth certification institute.

So yeah I was really passionate about it.

I found it to be very important because there's so many people

that struggle with getting access to behavioral health services.

and not only just having access, but even being willing to get the behavioral

health services that they need.

So I, I saw it just so important.

Like it was critical to people getting the care that they need.

But then on a personal level, I just loved it because of the convenience.

Like it worked really well for me being a dad, right?

I have four kids and love working from home and the availability and so forth.

Yeah, I had a lot of passion for it.

And then a lot of providers had a lot of resistance.

To telehealth and that just even put more fire under my butt.

, it gave me even more passion because there was so many inaccurate thoughts

about telehealth just based upon people's preferences rather than being

based upon solid evidence and research.

So I thought it was just really important to inform people on what telehealth

is and how to do it appropriate.

And that all naturally led into the telehealth

certification institute, I imagine.

Yes.

Yep.

Yep.

And we just just kept putting, I just kept putting all my efforts into that and we

kept growing and expanding our services.

Yeah.

So it's been a real joy doing the work that I'm doing.

And obviously training related to telehealth is something we really.

For at the UMTRC as well.

So we're a telehealth resource center.

So getting providers connected to training is something that we're always trying

to do, but for those who may not have that background knowledge or understand,

why do you think it's so important for clinicians to have, not just training,

but specific telehealth training?

Yeah, it's so important.

What I find is that.

A lot of clinicians get into a situation where they have to provide

telehealth services and they use technology in their personal life

all the time, even at work also.

But like non-clinical situations, they use technology, right?

Smartphone, computers, video conferencing phone, audio, sending

documents, all this kind of stuff.

A lot of clinicians have the assumption that they can just jump into it.

They use that technology anyway.

But we really don't want a situation where patients are having a poor experience

or really having bad things happen.

So time and time again, like when I speak with clinicians, they don't

really understand the The privacy and security of using technology.

They're not really sure how to vet out technology vendors to determine

whether or not they are a fit for healthcare and then even if they

are possibly a fit for healthcare.

How to evaluate their functionality, how to configure it appropriately for

healthcare how to set up an appropriate workflow, but then even their skills of

using the technology, like communicating effectively through, through technology.

Is sometimes missing because there's a difference between having a video

meeting with a friend, versus having a video meeting with a patient, right?

If a patient hears people in the background, they're only gonna

assume those people can hear me.

Or if there's background noise, or if you can only see from the forehead

up, or, the person's just a dark silhouette because their lighting's

bad, or the audio's crackly and just.

a poor experience is just gonna turn people away.

and or having privacy issues or other risks.

Yeah, I think it's really important and it doesn't take a lot of training, but it's

so critical that clinicians understand how to make that transition into

providing services virtually for clients.

We got a lot of training in graduate school, medical school supervision on

how to provide services appropriately when someone comes to our office, how

to set up the office appropriately, but people don't usually get a lot of

training on how to set up their home office, how to have the same protocol,

how to uphold the same legal and ethical standards when providing virtual care.

It's not like a provider can just bring their iPhone into

the office, turn on FaceTime and say, We're a telehealth practice.

That's right.

Yeah.

more complicated than that.

But it does happen

right?

Usually things don't go like terribly wrong.

Like usually it works out just fine.

But, we don't want the possibility of bad things happening or of

patients having a poor experience.

And we still wanna uphold those same standards that we

have in place for healthcare.

Yeah.

A lot of clinicians quickly pivoted to telehealth

during the Covid 19 pandemic.

Did that impact your experiences of providing Telehealth training at all?

There was just a lot more demand.

Yeah.

Is is what it was.

So our demand for training spiked for probably about three months, maybe four

months, and then it tapered back down.

So the demand is still slightly higher than it was prior to.

Prior to the pandemic, but not by much.

But during the initial phase the demand for training spiked for a while.

All of the same needs are there.

None of the needs have changed.

I think having.

Done telehealth for a long time.

For me, it's just, hey, like this has been going on for a long time.

this, the same needs have always been there.

But for a lot of clinicians, it's it's new and they're in the, they

haven't noticed the need before, so now it's like a new need.

For me, this is like old news like, During the pandemic,

everybody needed to meet virtually.

But prior to the pandemic, there has always been every single day, thousands

of people that needed to receive services virtually, but they were often ignored.

Yeah, they were ignored through policy and insurance, reimbursement

and availability and yeah.

Which is really unfortunate.

It took the pandemic.

People to kinda wake up to the real need of telehealth.

And when you look at standards it's always been important that we have contingency

plans for the services that we provide.

That's always been a standard.

But yeah, we haven't always been prepared for it, but providers did shift well.

I was very impressed at how quickly providers shifted.

When people have an absolute need.

. Man, we humans adapt very quickly.

, we make it happen.

So people have done that?

Yes.

Yeah.

We talked about the new normal and that's true for a lot of professions,

but I think the ones that shifted most dramatically for obvious

reasons were related to healthcare.

So I know this is your area of expertise and it's something

that I'm very interested in.

So how would you say behavioral healthcare has been adapted to telehealth health?

Oh, how behavioral health is adapted?

Yeah.

How have those two things worked?

Oh.

It's always been going on.

It's nothing new.

So behavioral health professionals have been using the phone forever,

ever since the phone existed.

Even before that, like in terms of virtual or we should say, Providing services from

a distance way back to, say, our founding Father, Freud, Sigman, Freud Sigman Freud

would write letters back and forth, right?

You just hand write a letter and mail it out, . So this is nothing new at

all providing psychotherapy remotely.

But.

It's interesting though that it seems like in the schooling, like in the training

of clinicians, there's a lot of emphasis on the environment that the clinician

and client are sitting in together and reading non-verbals and stuff like that.

So I think clinicians have got into this mindset for a while.

It's just so important to be in the same room as clients which has

not been backed up by research.

There's not a study that shows that.

So I think some clinicians have struggled with the transition because of kind of the

mindset that has developed over the years.

But now people are starting to come around and say, Yeah,

wow, this works really well.

And there's multiple ways to provide.

Behavioral healthcare to clients.

So what I try to train people on is look at the evidence, look at the studies

but then also be aware that studies are looking at a particular population.

It's important for us to look at the individual.

Different people communicate best or they receive therapy best.

Through different mediums of communication at different times.

So a video meeting might be really important to me today and next week

it might be important to me that we have a phone meeting or whatever.

And then one thing that's really changed is the explosion of.

Applications in digital healthcare.

So the way that we're able to help people and help the clinician

has been rapidly evolving.

So the technology that we have now to get people information give them

tools for help is just incredible.

Even if we look at the training of clinicians themselves, so now we can

use AI to analyze clinical sessions, like we can analyze how empathetic

is the clinician, how on track is the clinician with the therapeutic

modality that they say they're using.

Are, so it's really, so we does the clinician have implicit bias?

So we can, like really cri we could really critically analyze

and help clinicians improve the services that they're providing.

So yeah, I think it's we're in a really interesting time and.

I think being open to all the different ways that we can help people and

the way that people are receptive to being helped is important.

I hadn't even thought about the use of AI and things

like bias training and stuff.

That's very interesting.

That's really cool.

Yeah.

But we talk about health equity and access issues

in regards to mental healthcare.

And I know we touched on it a little bit there, but we have a lot of

populations that could really benefit from increased mental healthcare,

but they just don't have that access.

And that's everything from rural populations to other areas where they're

just our provider shortages or populations that are home bound for whatever reason.

So do you think tele behavioral health has a role in kind of

mitigating those existing.

Yeah.

In terms of Telemental Health, just simply using technology to connect and provide

treatment to patients, most definitely.

People.

Have a barrier to access because of where they're located.

They don't have a provider close by that they are, that they're able to pay for.

And that is, that specializes in what they need then.

Yeah, they're gonna have to connect with providers in other way, which is

gonna be through the use of technology.

And luckily there's different, we have different technologies to use.

People could use internet, broadband, Internet or cellular services

or they can use hotspots or.

Or they can go to an organization that sets up telehealth stations

for people to connect with clinicians or community healthcare

programs that utilize telehealth.

So they're connecting with specialists outside the area to

provide services to patients.

Most definitely and again I think it's important to look at research because.

Some ways of providing services to clients are not reimbursed,

and that's a barrier, right?

people can usually get great healthcare if they have a lot of money to pay for it.

That usually happens easily.

So one of the main struggle seems to be financial.

People usually have to have a third party paying for the service.

Phone sessions are pretty accessible to people and they are for most

clients, they are just as effective.

So in some situations they're more effective.

In some situations, they're not as effective as being in

the same room as the client.

Is the clinician.

So yeah, phone sessions is a way to really reach a lot of people.

And then, getting people access to the internet, definitely helpful.

So I think there's also still a stigma against getting treatment for

mental health issues sometimes, and that's something that might be less significant

to overcome when you're seeking treatment.

By just like picking up a phone or sitting in front of a computer

rather than driving to an office, walking in, checking in, all of that.

Would you agree with that?

Yeah.

So for behavioral health we can go down some rabbit holes here, but

there's what we call the medical model where you have, physicians

were the first ones to get licensure.

This is back during the Civil War era where we said, Hey, you have to get a

license in order to practice medicine and.

And then, then as time went on, we have medical insurance, which

is covering for, medical services.

But then in the behavioral health world we also want to get

reimbursed by medical insurance.

So then there's a licensure for behavioral health and which includes, if you.

If you wanna bill insurance, you have to give someone a diagnosis and treatment

plan, and which means it needs to be medical necessity, meaning they're ill.

And so I think yeah, there is definitely there's a stigma around behavioral health.

There's some challenges there.

So hopefully.

Hopefully things will shift with that.

There are a lot of people provide counseling that are not, say, licensed

or adhere to that medical model.

There's a lot of online tools for help.

There's online support groups, There's a lot of online support.

Yeah, I think if you look at some of these services where people can just

go online, they can chat with a helper.

These services are used a lot.

Like they have incredible utilization, and it may have to do with the stigma of

receiving behavioral healthcare, going through insurance where you're getting

the diagnosis and all this kind of stuff.

But then also with the pandemic there has been much more awareness of.

Mental health struggles.

I think it has been normalizing it a bit.

People have been talking more openly about it.

A lot of famous people, have been discussing the struggles that

they've had, professional athletes.

So I think that also really helps get rid of the stigma.

You'll hear from some clinicians and there have been studies on this,

that sometimes clients are much more disclosing and transparent when

receiving services through telehealth.

because they can distance themselves mentally from the other person they're

communicating with, from the clinician.

And then they also feel safer, right?

They might say you can't hurt me, right?

You're not in the same room as me.

You can't hurt me.

And they feel like they're more in control.

They could be in a, an environment that they feel more comfortable.

So for a lot of clients it does provide More comfort.

But again, clients are different.

Different people need different things in regards to that.

So despite the advantages of telehealth, it's not like we're

going to move every single behavioral health appointment onto a telehealth

platform tomorrow or something.

Yeah.

Yeah, certainly.

There's yeah, everyone, people prefer different things prefer different types

of therapists, different locations, different modality all sorts of things.

Now, one thing that AI, I think can help with that technology can help

with is the selection of a therapist.

That's one thing that is extremely challenging.

I think a real problem.

So I don't know those that are listening to this, have you ever tried to find

a behavioral health therapist for yourself or a friend or family member?

It is quite a challenge.

Like how do you know who to have an appointment with?

This is a real personal relationship you're developing.

Is this person gonna be a risk to the person getting help?

Are, is there actually a connection that's gonna be made?

Do they have a style that you're receptive to?

Are they more directive or non-directive or behavioral or

cognitive or what's gonna work for you?

How do you figure that out?

So I think with ai and being able to really analyze clinical sessions of

clinicians and being able to analyze just all of the data that we have about

ourselves, I think we'll be able to get to the point where we're able to have a lot

better matching of clinician and client.

That's really exciting.

I know from a personal standpoint, I had a younger sibling who I

helped find a therapist and it took.

Oh man, like three or four before we found one he really worked with just

because there were so many sort of different just providers out there

and what works for one person isn't gonna work for the person next to them.

And I think that's an important thing to acknowledge.

I just think there's a lot of improvement with services that technology

and AI are gonna provide us in the future,

Yeah, that's really exciting, . And is there any other sort of

advancements aside from AI in telehealth and telehealth training that you.

Might happen in the future.

Some universities are using again this goes to not necessarily ai,

but using avatar programs for training.

Like in graduate programs student counselors will, they will provide a

session to an avatar and then that could be, analyzed both by the professor and.

Fellow students or ai.

But so the question is besides ai, what are some other advancements?

Yeah.

Gosh it's a little bit hard to take AI out of it, but remote

monitoring is a really big one.

Yeah, like even, right now those listening can only hear us.

But we can see each other in this conversation

Hi.

So there's cameras, we have cameras that can pick up the the

slightest changes of skin tone, so it can actually p pick up on your heart rate

and changes of temperature and so forth.

And so in terms of communication therapists, behavioral health

therapists pride themselves on being able to pick up on emotion and

incongruencies and stuff like that.

But technology's gonna be really good at picking up, hey, like their

temperature increase, their heart rate increase, their breathing has shifted.

Their tone, their pitch.

Humans are really bad at being able to pick up microexpressions, but I'm

thinking computers will be able to pick up even on the microexpressions.

So like you can see like something's happening here with

the client with this conversation.

And yeah.

And then so there's just a lot of digital tools that I think will improve us.

So go, going back to.

Remote monitoring, like how do you know if your client's getting better

or not other than them telling you.

It's very subjective.

So with remote monitoring, they can see for themselves, like how are

their conversations during the day, changing their sleep, their, just

they could monitor their mood by all sorts of metrics temperature, heart

rate breathing movement just their, yeah, again, their voice and so forth.

So the remote monitoring will give us a lot of information.

And then also the care coordination.

We know that's been a real struggle in our country, so I think more and more

so we're able to coordinate care and for providers to be on the same page.

Yeah, so I think the, It's the integrating.

Integrating of data at the same time of having full transparency of who has

the data and what's being done with the data, putting the control of that data

into the patient's hands themselves.

I think there's a lot of effort in this direction.

I think we're coming a long way and I think there's gonna

be a lot of improvements.

Yeah.

Thank you so much for joining us here today, Raymond.

I really appreciate you taking the time.

Thank you very much for having me.