By Nancy Roget, Cindy Juntunen & Trisha Dudkowski, Mountain Plains ATTC
The onset of the COVID-19 Public Health Emergency (PHE) in 2020 forced many Substance Use Disorders (SUD) treatment and recovery support providers to rapidly switch to virtual and/or telephone-based services. For some providers, as their proficiency and confidence grew, their adoption of videoconferencing and telephone to deliver services increased.
Shore (2020) predicted that lessons learned during the quick virtualization of behavioral health services, due to the PHE, would create a new hybrid model of service delivery that benefits patients. In this hybrid model, treatment services are inclusive, providing a combination of in-person, online, and telephone sessions, including check-ins or consultations.
following narrative includes literature support for telephone-based services; guidance
from the Office of Civil Rights (OCR) and recommendations for a new term; and a
novel product for SUD treatment/recovery support providers in delivering
telephone-based services created by the Pacific Southwest and Mountain Plains
The use of telephone to provide behavioral health treatment and crisis intervention (think hotlines) services is not new.
This finding underscores the importance of providing training on client engagement strategies for both virtual and in-person service delivery.
- Clients/patients/peers like hybrid service delivery including AOTs.
- Outcomes for AOTs are as good as in-person/videoconferencing sessions.
- Some studies showed that drop-out rates were lower with AOTs.
- Mastery of engagement strategies are helpful when using AOTs A majority of clients/patients have access to mobile phones.
- Challenges to implementing AOTs exist but can be addressed through training and policies/ practices.
mental health services for individuals with psychiatric disorders has strong
literature support. Leach and Christensen (2016) identified 14 studies that found
positive outcomes due to telephone-based services.
More recently, Varker et al. (2019) conducted a review of
telepsychology studies and found that in ten out of eleven telephone studies,
telephone delivered therapy was as effective as traditional in-person therapy.
Another systematic review conducted by Irvine and colleagues (2020) found
telephone sessions tended to be shorter in duration, and demonstrated no
significant differences in therapeutic alliance, client disclosure, empathy,
attentiveness by the counselor, or client participation. Several studies
included in this systematic review (Irvine) noted that clients gave
telephone-based services higher ratings identifying how closely counselors
Finally, a study by Zin and colleagues (2021) identified that newer therapists had higher client attrition rates than more experienced therapists in both videoconferencing and telephone sessions. The authors posit that experienced therapists were more proficient in client engagement strategies and utilized/relied upon these strategies frequently in virtual service delivery.
by Pew Research Center (April 2021) found that 97% of the U.S. population owned
mobile phones. Likewise, clients/patients with substance use disorders (SUDs) reported
high mobile phone ownership. Two studies found mobile phone ownership rates for
SUD patients were 93%--95%, matching national data (Ashford et al., 2018;
Winstanley et al., 2018). However, patients with SUDs may have unique phone
ownership characteristics that present considerations.
example, Milward (2015) found that almost three-fourths of clients/patients had
‘pay as you go cell phones’, and more than half had their phone numbers had changed
in the last year. This information can prompt SUD treatment/recovery support
providers to check with clients/patients regarding changes to mobile phone
plans to ensure minutes are available for sessions and if mobile phone numbers
In June, The
Office of Civil Rights (OCR) recommended
strategies to protect privacy/security and suggested using a new term for
telephone-based services: audio-only
telehealth services (AOTs). The utility and benefits of AOTs for clients
and treatment providers are notable. Nevertheless, challenges exist to
effective, safe, and ethical services delivery using AOTs requiring specific
policies and practices, compliance monitoring, and ongoing training. A seminal
article by Brenes (2011) identified challenges provider faced when implementing
AOTs which serves as the foundation for these sample policies/practices. This
new PSATTC/MPATTC product addresses these challenges, along with specific AOTs
tips. The AOTs product can be found here.
Nancy Roget is the
Co-Director of the MPATTC and Executive Director of CASAT at the University of
Nevada. She’s also a licensed marriage and family therapist, addiction
counselor, and trainer on telehealth and digital health technologies.
Cindy Juntunen is Co-Director of
the MPATTC and Dean of the College of Education & Human Development at the
University of North Dakota. She is also a licensed psychologist in North
Dakota, and has a long history of training and education in rural behavioral
health and ethics.
Trisha Dudkowski is a Senior
Project Coordinator with the Mountain Plains ATTC and has been part of the ATTC
network for nine years. She does logistical organization for training/TA
activities, such as facilitating online events, planning in-person state/regional/national
training events, and preparing/editing training materials.