Episode 16

Telehealth Training and Technology with Raymond Barrett

Published on: 7th October, 2022

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.

Transcript
Danielle:

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

Danielle:

Upper Midwest Telehealth Resource Center.

Danielle:

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

Danielle:

the Telehealth Certification Institute.

Danielle:

Welcome Raymond.

Raymond:

Hi.

Raymond:

Thank you very much for having me.

Danielle:

Yeah, thanks for being here.

Danielle:

So could you tell me a little bit about yourself?

Raymond:

Yeah.

Raymond:

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

Raymond:

private practice about 18 years ago.

Raymond:

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

Raymond:

Because I was providing executive coaching before that which was all

Raymond:

providing, coaching over the phone.

Raymond:

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

Raymond:

client wanted sessions over the phone.

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So I thought, Hey, this is perfect.

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

Raymond:

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

Raymond:

In my graduate program.

Raymond:

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

Raymond:

of the telehealth world ever since.

Danielle:

Wow.

Danielle:

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

Danielle:

Correct.

Raymond:

Yeah.

Raymond:

Yeah.

Raymond:

I've always been very interested in it.

Raymond:

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

Raymond:

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

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

Raymond:

virtually for, yeah, for their hospital.

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

Raymond:

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

Raymond:

a bunch of articles, , and that was it.

Raymond:

The more I learned, the more questions I have.

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So I didn't find it very practical.

Raymond:

So I ended.

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Just creating some really practical training.

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

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

Raymond:

telehealth certification institute.

Raymond:

So yeah I was really passionate about it.

Raymond:

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

Raymond:

that struggle with getting access to behavioral health services.

Raymond:

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

Raymond:

health services that they need.

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So I, I saw it just so important.

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

Raymond:

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

Raymond:

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

Raymond:

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

Raymond:

Yeah, I had a lot of passion for it.

Raymond:

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

Raymond:

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

Raymond:

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

Raymond:

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

Raymond:

based upon solid evidence and research.

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

Raymond:

is and how to do it appropriate.

Danielle:

And that all naturally led into the telehealth

Danielle:

certification institute, I imagine.

Raymond:

Yes.

Raymond:

Yep.

Raymond:

Yep.

Raymond:

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

Raymond:

kept growing and expanding our services.

Raymond:

Yeah.

Raymond:

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

Danielle:

And obviously training related to telehealth is something we really.

Danielle:

For at the UMTRC as well.

Danielle:

So we're a telehealth resource center.

Danielle:

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

Danielle:

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

Danielle:

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

Danielle:

but specific telehealth training?

Raymond:

Yeah, it's so important.

Raymond:

What I find is that.

Raymond:

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

Raymond:

telehealth services and they use technology in their personal life

Raymond:

all the time, even at work also.

Raymond:

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

Raymond:

Smartphone, computers, video conferencing phone, audio, sending

Raymond:

documents, all this kind of stuff.

Raymond:

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

Raymond:

They use that technology anyway.

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

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or really having bad things happen.

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

Raymond:

really understand the The privacy and security of using technology.

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

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

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are possibly a fit for healthcare.

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

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

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

Raymond:

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

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

Raymond:

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

Raymond:

assume those people can hear me.

Raymond:

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

Raymond:

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

Raymond:

bad, or the audio's crackly and just.

Raymond:

a poor experience is just gonna turn people away.

Raymond:

and or having privacy issues or other risks.

Raymond:

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

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so critical that clinicians understand how to make that transition into

Raymond:

providing services virtually for clients.

Raymond:

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

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

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

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

Raymond:

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

Danielle:

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

Danielle:

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

Raymond:

That's right.

Raymond:

Yeah.

Danielle:

more complicated than that.

Raymond:

But it does happen

Danielle:

right?

Raymond:

Usually things don't go like terribly wrong.

Raymond:

Like usually it works out just fine.

Raymond:

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

Raymond:

patients having a poor experience.

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And we still wanna uphold those same standards that we

Raymond:

have in place for healthcare.

Raymond:

Yeah.

Danielle:

A lot of clinicians quickly pivoted to telehealth

Danielle:

during the Covid 19 pandemic.

Danielle:

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

Raymond:

There was just a lot more demand.

Raymond:

Yeah.

Raymond:

Is is what it was.

Raymond:

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

Raymond:

months, and then it tapered back down.

Raymond:

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

Raymond:

Prior to the pandemic, but not by much.

Raymond:

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

Raymond:

All of the same needs are there.

Raymond:

None of the needs have changed.

Raymond:

I think having.

Raymond:

Done telehealth for a long time.

Raymond:

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

Raymond:

this, the same needs have always been there.

Raymond:

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

Raymond:

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

Raymond:

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

Raymond:

everybody needed to meet virtually.

Raymond:

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

Raymond:

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

Raymond:

Yeah, they were ignored through policy and insurance, reimbursement

Raymond:

and availability and yeah.

Raymond:

Which is really unfortunate.

Raymond:

It took the pandemic.

Raymond:

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

Raymond:

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

Raymond:

plans for the services that we provide.

Raymond:

That's always been a standard.

Raymond:

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

Raymond:

I was very impressed at how quickly providers shifted.

Raymond:

When people have an absolute need.

Raymond:

. Man, we humans adapt very quickly.

Raymond:

, we make it happen.

Raymond:

So people have done that?

Raymond:

Yes.

Danielle:

Yeah.

Danielle:

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

Danielle:

but I think the ones that shifted most dramatically for obvious

Danielle:

reasons were related to healthcare.

Danielle:

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

Danielle:

that I'm very interested in.

Danielle:

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

Raymond:

Oh, how behavioral health is adapted?

Danielle:

Yeah.

Danielle:

How have those two things worked?

Raymond:

Oh.

Raymond:

It's always been going on.

Raymond:

It's nothing new.

Raymond:

So behavioral health professionals have been using the phone forever,

Raymond:

ever since the phone existed.

Raymond:

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

Raymond:

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

Raymond:

would write letters back and forth, right?

Raymond:

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

Raymond:

all providing psychotherapy remotely.

Raymond:

But.

Raymond:

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

Raymond:

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

Raymond:

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

Raymond:

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

Raymond:

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

Raymond:

not been backed up by research.

Raymond:

There's not a study that shows that.

Raymond:

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

Raymond:

mindset that has developed over the years.

Raymond:

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

Raymond:

wow, this works really well.

Raymond:

And there's multiple ways to provide.

Raymond:

Behavioral healthcare to clients.

Raymond:

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

Raymond:

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

Raymond:

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

Raymond:

Different people communicate best or they receive therapy best.

Raymond:

Through different mediums of communication at different times.

Raymond:

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

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

Raymond:

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

Raymond:

Applications in digital healthcare.

Raymond:

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

Raymond:

has been rapidly evolving.

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

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tools for help is just incredible.

Raymond:

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

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

Raymond:

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

Raymond:

modality that they say they're using.

Raymond:

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

Raymond:

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

Raymond:

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

Raymond:

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

Raymond:

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

Raymond:

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

Danielle:

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

Danielle:

like bias training and stuff.

Danielle:

That's very interesting.

Danielle:

That's really cool.

Raymond:

Yeah.

Danielle:

But we talk about health equity and access issues

Danielle:

in regards to mental healthcare.

Danielle:

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

Danielle:

populations that could really benefit from increased mental healthcare,

Danielle:

but they just don't have that access.

Danielle:

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

Danielle:

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

Danielle:

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

Danielle:

mitigating those existing.

Raymond:

Yeah.

Raymond:

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

Raymond:

treatment to patients, most definitely.

Raymond:

People.

Raymond:

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

Raymond:

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

Raymond:

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

Raymond:

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

Raymond:

gonna be through the use of technology.

Raymond:

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

Raymond:

People could use internet, broadband, Internet or cellular services

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or they can use hotspots or.

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

Raymond:

for people to connect with clinicians or community healthcare

Raymond:

programs that utilize telehealth.

Raymond:

So they're connecting with specialists outside the area to

Raymond:

provide services to patients.

Raymond:

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

Raymond:

Some ways of providing services to clients are not reimbursed,

Raymond:

and that's a barrier, right?

Raymond:

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

Raymond:

That usually happens easily.

Raymond:

So one of the main struggle seems to be financial.

Raymond:

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

Raymond:

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

Raymond:

clients, they are just as effective.

Raymond:

So in some situations they're more effective.

Raymond:

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

Raymond:

the same room as the client.

Raymond:

Is the clinician.

Raymond:

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

Raymond:

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

Danielle:

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

Danielle:

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

Danielle:

to overcome when you're seeking treatment.

Danielle:

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

Danielle:

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

Danielle:

Would you agree with that?

Raymond:

Yeah.

Raymond:

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

Raymond:

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

Raymond:

were the first ones to get licensure.

Raymond:

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

Raymond:

license in order to practice medicine and.

Raymond:

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

Raymond:

is covering for, medical services.

Raymond:

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

Raymond:

reimbursed by medical insurance.

Raymond:

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

Raymond:

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

Raymond:

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

Raymond:

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

Raymond:

There's some challenges there.

Raymond:

So hopefully.

Raymond:

Hopefully things will shift with that.

Raymond:

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

Raymond:

or adhere to that medical model.

Raymond:

There's a lot of online tools for help.

Raymond:

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

Raymond:

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

Raymond:

go online, they can chat with a helper.

Raymond:

These services are used a lot.

Raymond:

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

Raymond:

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

Raymond:

the diagnosis and all this kind of stuff.

Raymond:

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

Raymond:

Mental health struggles.

Raymond:

I think it has been normalizing it a bit.

Raymond:

People have been talking more openly about it.

Raymond:

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

Raymond:

they've had, professional athletes.

Raymond:

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

Raymond:

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

Raymond:

that sometimes clients are much more disclosing and transparent when

Raymond:

receiving services through telehealth.

Raymond:

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

Raymond:

communicating with, from the clinician.

Raymond:

And then they also feel safer, right?

Raymond:

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

Raymond:

You're not in the same room as me.

Raymond:

You can't hurt me.

Raymond:

And they feel like they're more in control.

Raymond:

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

Raymond:

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

Raymond:

But again, clients are different.

Raymond:

Different people need different things in regards to that.

Danielle:

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

Danielle:

going to move every single behavioral health appointment onto a telehealth

Danielle:

platform tomorrow or something.

Raymond:

Yeah.

Raymond:

Yeah, certainly.

Raymond:

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

Raymond:

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

Raymond:

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

Raymond:

with is the selection of a therapist.

Raymond:

That's one thing that is extremely challenging.

Raymond:

I think a real problem.

Raymond:

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

Raymond:

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

Raymond:

It is quite a challenge.

Raymond:

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

Raymond:

This is a real personal relationship you're developing.

Raymond:

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

Raymond:

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

Raymond:

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

Raymond:

Are they more directive or non-directive or behavioral or

Raymond:

cognitive or what's gonna work for you?

Raymond:

How do you figure that out?

Raymond:

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

Raymond:

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

Raymond:

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

Raymond:

better matching of clinician and client.

Danielle:

That's really exciting.

Danielle:

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

Danielle:

helped find a therapist and it took.

Danielle:

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

Danielle:

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

Danielle:

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

Danielle:

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

Raymond:

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

Raymond:

and AI are gonna provide us in the future,

Danielle:

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

Danielle:

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

Danielle:

Might happen in the future.

Raymond:

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

Raymond:

but using avatar programs for training.

Raymond:

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

Raymond:

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

Raymond:

Fellow students or ai.

Raymond:

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

Raymond:

Yeah.

Raymond:

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

Raymond:

monitoring is a really big one.

Raymond:

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

Raymond:

But we can see each other in this conversation

Danielle:

Hi.

Raymond:

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

Raymond:

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

Raymond:

and changes of temperature and so forth.

Raymond:

And so in terms of communication therapists, behavioral health

Raymond:

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

Raymond:

incongruencies and stuff like that.

Raymond:

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

Raymond:

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

Raymond:

Their tone, their pitch.

Raymond:

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

Raymond:

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

Raymond:

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

Raymond:

the client with this conversation.

Raymond:

And yeah.

Raymond:

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

Raymond:

So go, going back to.

Raymond:

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

Raymond:

or not other than them telling you.

Raymond:

It's very subjective.

Raymond:

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

Raymond:

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

Raymond:

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

Raymond:

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

Raymond:

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

Raymond:

And then also the care coordination.

Raymond:

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

Raymond:

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

Raymond:

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

Raymond:

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

Raymond:

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

Raymond:

into the patient's hands themselves.

Raymond:

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

Raymond:

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

Raymond:

be a lot of improvements.

Danielle:

Yeah.

Danielle:

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

Danielle:

I really appreciate you taking the time.

Raymond:

Thank you very much for having me.

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