Transitioning Child Clients from Office Sessions to Telemental Health

With all the changes happening around the country and the mental health world, the therapy field has had to rapidly transition from in office sessions to Telemental Health sessions.  I wrote HERE about my scripts to orient children and their families to Telemental Health sessions BUT what now? What about from the time you say your last good by to clients in the office (for now) and before you turn on the camera for your first appointment?   

I want to be really honest here – this feels so different than when I offered this service and began the journey of Telemental Health a little under a year ago.  There is a general anxiety around the conditions for transitioning AND we haven’t been preparing for weeks and months for the transition as I did with my in office clients when transitioning my practice from the twin cities area of Minnesota to Duluth. 

First and foremost – it is our job to be prepared, have a plan, and be able to talk about options with clients.  My scripts spell out how I’ve been talking about the transition with parents.  However, in this case because there is SO MUCH anxiety and quick decision making I know that everyone, including me, is not fully in their prefrontal cortex and some (if not most) of the information gets lost.  So I put together two cheat sheets for parents to read and reflect on before our first session.  You can find them both for free to use and edit to your heart’s desire HERE!

The fist sheet simply orients to WHY online, what it might be like, and what are the specific nitty gritty things you need for a good call.  These include a fast internet speed, closing out all other programs, having headphones, how to get on the appointment and instructions for accessing the platform.

The second sheet was a quick takeaway of strategies for HOW to set things up.  In my past transitions these again were things we talked about and touched on for weeks if not months as our in person sessions were winding down.  The second handout includes how to find a good room, how to ensure confidentiality (which was the biggest question my young people had) including not having a sibling bust in the room during their time, safety procedures, and so on!

Another bonus of handouts is it sends the message to clients that you really have your stuff together.  That you have thought this through and have a plan in place! One of my favorite quotes is "trauma is chaos, structure is healing" and this my friends, is the structure! 

Now, before you turn on the camera to start the session I have found that if you are shifting to directive techniques, or even if that was your camp before, there needs to be prep before the session.  You need to think about what specific activity you will be doing with clients and think through what supplies they may need.  My post of Telemental Health and Children: 20 Free and Minimal Supply Activities takes you through some ideas with a specific supply list for each. If you use any of these you can copy and paste from the post. 

Okay – so you have emailed the parent about what supplies they need, ensured they actually have these supplies, and you have the supplies you need on your end.  As you turn on the camera you need to have an Orientation Session that includes the following:

Confirming address and best number to reach the client: This is one of those safety procedures to ensure that you can have contact with a parent at all times. Make sure that the number you have listed in their chart is the number you can actually reach them at and set the stage that they will be available to enter the room at any time via this number.  ALSO make sure the address you have on file is actually their address.  How many times have you had clients move and in the chaos of it all forget to update their address with you? Additionally many families I work with reside in two homes - make sure you have the correct address for the correct parent or guardian! I have begun to create cards for each child (on bright pink index cards of course) of address, best number to reach them, and number of local police department.  This as well as my cell phone (which they have the number to be able to contact me if they need) sits out by the computer during the session.  

Assessment of technical aspects: Process if there was any difficulty accessing the technology.  Address any questions they may have.  Go over technology safeguards.  Mine is that if it glitches for over 2 minutes I will call them while we attempt to re-logon.  With some children it might be immediately if it goes off you call a parent for assistance.  Explore what this might mean for the specific family and child.

Assessment of space selected: Together process what went into picking the space, if others can hear, how the parent will keep siblings out of the room (if applicable), and if there needs to be any additional safeguards such as a radio outside or sound machine.

Assessment of parental involvement: For each child assess what the set-up will be with how active and involved the parent is.  Will the parent set up the technology and have the child take the lead from there?  Do you have a child where the parent will need to be an active member in the session OR will they need to be present in the room but not involved in the session?  Each family will be different so this discussion will be helpful to determine what fits for each specific child.

Assessment of session structure: This has been the question that comes up most with families – “will it be the same”? I am attempting to keep my sessions as similar as possible to in office work.  For me that means checking in at the beginning (with or without the child depending on the client) and the child having the majority of the session to themselves BUT I am now adding a “check out” at the end.  I usually do a casual goodbye in the waiting room, so for the young people I work with that will be in the session by themselves for a period of time I have developed a procedure to “check out” with the parent at the end – just a friendly wave that we are done! For teens this may be less important or necessary. For some clients a new structure might be transitioning from nondirective sessions to directive sessions.  Orient the client to these any any other changes with the structure of their time with you! 
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SO as I roll this out to families my motto with parents and families has been “assess, pivot, assess, pivot, assess, pivot”! Meaning that each session we will spend a small amount of time assessing how things are going and pivoting if necessary. 

What additional tips do you have for your first session? Drop them in the comments below! 

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