How to Make Your Group Telehealth Appointment a Success
Telehealth is a new frontier in the practice of group therapy. Despite the slough of information on individual telehealth since the pandemic began, fewer resources exist to guide clinicians in implementing group therapy online.
Don’t be daunted by group telehealth. Careful planning and adherence to best practices can make your online group treatment a resounding success. In fact, this mode of care even boasts some advantages over in-person group treatment.
Here’s how to prepare for and implement a successful online therapy group as a clinician.
Setting Up Group Telehealth
To get started, you’ll need a HIPAA-compliant videoconferencing tool. Telehealth software options are plentiful thanks to the pandemic, but not all solutions are created equal. You’ll get the best results from a software that integrates with your EHR. Check to see if your EHR offers a built-in videoconferencing solution.
Second, consider your environment. You must lead group telehealth appointments from a private, distraction-free location with strong internet bandwidth. If you plan to conduct these appointments from home, you’ll need a space that is free from housemates, family members, and pets. You’ll also need to create guidelines for group members on choosing an appropriate location, and make sure all participants agree to these guidelines before group therapy begins.
Third, create processes to support group telehealth implementation. Check with your payers regarding which code(s) to use. Decide how you will evaluate potential group members for appropriate “fit” in an online environment. Establish an automated system of appointment reminders for group members. If you work in a large practice, check in with administrative staff about the logistics of establishing, enrolling, and billing for these appointments.
Best Practices
Successful group telehealth depends on adhering to best practices. The following strategies will help you maximize success and minimize pitfalls.
Technology and Processes
Whatever videoconferencing software you’ve chosen, you’ll want to ensure it meets high standards of security. Use a password-protected service so only approved group members can access the meeting. As meeting facilitator, you should be able to turn off any recording features in the software to discourage participants from recording these confidential sessions.
Double-check that your telehealth platform allows more than one patient to join the call. Some platforms only allow one provider and one patient into the meeting at a time. Invest in brief training on your videoconferencing solution so you can help participants troubleshoot technical difficulties, since even one struggling participant can affect the whole meeting.
To optimize the flow of the meeting itself, you’ll want the following:
- The ability to “mute” participants’ mics when they’re not speaking
- A chat feature so that participants can share important thoughts without interrupting one another
- Whiteboarding capabilities
- Screensharing capabilities
When it’s time to bring patients on board, orient them to the purpose and format of online group therapy. Before their first group meeting, they’ll need login directions, camera/microphone instructions, guidelines for setting up their environment, information about the meeting structure or agenda, and any other issues that might affect their first group session. Make this orientation material available on the patient portal and send it through email ahead of the first meeting. If you’ll conduct individual screening calls with potential group members, go over the information verbally with each potential participant. Refer back to this information at the beginning of the first group session and remind patients where to find it.
Finally, be up-front about the limits of privacy guarantees in group telehealth. You can’t guarantee other group members will keep sensitive information confidential, and you can’t control whether other participants allow someone else to enter their environment during the meeting. Secure an informed consent signature from each client.
Setting Up Your “Office”
Whether you conduct telehealth appointments from home or an office, consider the following pointers for a distraction-free video call.
- Choose a neutral background. Sit in front of a solid-colored wall if possible, in order to minimize visual distraction. Depending on the videoconferencing service you use, you may have the option to “blur” your background, another solution to cut down on visual clutter.
- Stabilize your camera. Place your laptop or webcam on a sturdy, unmoving surface. A shaky video is not only distracting, but can actually cause nausea for some users.
- Ensure your privacy. Conduct your video chats from a private location, behind a closed door if possible.
- Kill the noise. Don’t lead the video call next to an open window with traffic or neighborhood noises. Avoid areas with loud background sounds like music or construction work. Silence your phone.
- Gather everything you need. Have necessities like notepads, pens, and water at the ready before patients join the call.
Getting Patients on Board with the Rules
Potential group members should understand the unique responsibilities of confidentiality and tech management that they’re assuming before their first meeting. If you conduct pre-screening appointments, this is the perfect time to set expectations verbally and in writing. Make it clear to all participants that they will need to:
- Access the meeting from a private location where others will not overhear
- Minimize distractions in their environment
- Refrain from recording or taking screen shots
- Keep sensitive information confidential (patients aren’t usually bound to this by law, but emphasize it as an expectation anyway)
Also share strategies they can use to protect their privacy. Participants need not use real names; they can use a nickname or fake name for their screen name if they choose. They must leave their camera on but can shield their face or wear a (non-threatening) mask.
Challenges and Solutions to Group Teletherapy
If you haven’t used telehealth in a group setting before, you may need to work out some bugs. Here are some common challenges to group teletherapy, and what you can do about them.
- Decreased group cohesion. Group members may have a harder time forming bonds over video chat. You will need to bring extra attention to the task of building group cohesion through icebreakers, games, and carefully-guided discussion. Stay alert for members who seem distant and don’t contribute, and gently bring them into group dynamics whenever possible.
- Less privacy. In face-to-face group treatment settings, the therapist controls the group’s environment, including the atmosphere and privacy of the room. When multiple patients sign onto a telehealth session, however, they control the level of security and privacy. Address this topic clearly from the very beginning. Lay out expectations for privacy and, if a client violates these expectations, address it with them. Work to find alternatives for any patient who is too uncomfortable with group telehealth.
- Technical difficulties. Some group members may have faster internet connections or be more computer savvy. Just as you should prepare clients ahead of time for privacy rules, you should prepare them ahead of time for troubleshooting computer or internet problems. Provide a user guide for your telehealth software along with resources on how to improve slow internet speed. Participants with a slow or shaky connection can also type in the chat box or use the “raise hand” feature to make sure they’re heard.
- Limitations on who you can treat. While limitations on telehealth treatment across state lines were relaxed during the pandemic, check the most up-to-date regulations for your state before allowing out-of-state participants into the group.
- Loss of body language. Most videoconference users will show only their faces. This erases the context of body language that most of us use to gauge others’ feelings and reactions. Compensate for this by becoming very observant of facial expressions. Faces may actually be easier to read on a video screen than they would be from across a large room in a physical setting.
Advantages to Group Telehealth
Despite its challenges, group telehealth isn’t necessarily a “second-best” solution. In some regards, it has distinct advantages over gathering in person.
- Safety. Many patients may fear catching COVID-19 or passing it along to a vulnerable individual. Online meetings ensure that group members will only be sharing thoughts and feelings—not germs.
- Accessibility. Accessing group therapy on the computer breaks down accessibility barriers for patients with mobility issues, social anxiety, agoraphobia, or a lack of transportation.
- Communication styles. Some participants may feel more comfortable using the chat feature than speaking aloud. These individuals can participate in teletherapy more easily than face-to-face interactions.
- Discretion. Clients who are self-conscious about seeking therapy can attend a telehealth meeting without the worry that a friend or acquaintance will see them at the treatment facility.
- Increased attendance. Many therapists believe that attendance is more consistent in telehealth groups than in-person groups, possibly because of the convenience of accessing it and the other benefits listed above.
Pulling It All Together
When done right, group telehealth can yield the same breakthroughs and benefits for patients as traditional in-person care. Although the online environment allows clinicians less control, it empowers patients who face barriers to physical attendance.
You increase your odds of success by establishing smooth processes for group telehealth, including integration between videoconferencing and the EHR, automated appointment reminders, and organized billing. A robust EHR with built-in telehealth capabilities can help.
Contact Valant today to see how we can support the success of your online therapy groups.
