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Telehealth Care in Behavioral Health: Case Vignettes

Vignette 1: Implementing a Web-Based Prevention, Outreach, and Early Intervention Program for Young Adults

1. Behavioral health service providers and program administrators must always ask questions and critically examine the evidence to determine whether a particular technology works or does what it purports to do.

A. True

B. False


2. Which of the following is a characteristic of digital comprehensive assessment tools?

A. Use of digital tools saves time and cost, and can also free up clinicians’ schedules so that they can focus on other issues.

B. Digital assessment tools can reach people in need who are reluctant to access services through traditional delivery methods.

C. Using digital assessment tools can provide continuity of care with automated message reminders about appointments, medication reminders, or preventative health facts.

D. All of the above.


3. Which of the following is an issue to consider in developing a Web-based outreach and early intervention program?

A. If the developer’s references can be checked.

B. If the program explicitly uses evidence-based principles to guide behavior change.

C. If there is assurance that all data entered into the system by participants are confidential and encrypted.

D. All of the above.


4. All of the following are advantages of using Web-based programs in counseling, except for:

A. It encourages self-assessment

B. It provides diagnostics with clear, scheduled follow-up and action plans

C. It reinforces stress management strategies / plans

D. It fosters provision of well-developed, clear action plans


5. Web-based programs in counseling are contraindicated for work with all of the following, except for:

A. Substance abusing clients

B. Suicidal clients

C. Homicidal clients

D. Psychotic clients


6. How can one encourage clients to use, and continue using, Web-based programs?

A. Demonstrate access and use of the program before the client leaves the office.

B. Emphasize confidentiality and protection of private information.

C. Use a reminder system, such as text messaging, email, or an electronic calendar.

D. All of the above.


7. Counselors and administrators should be sure that clients fully understand how their agency’s Web-based communications system works so that clients have realistic expectations about counselor availability, how long it may be before they receive responses to messages they send, and how the system is monitored.

A. True

B. False


Vignette 2: Using Computerized Check-In and Monitoring in an Extended Recovery Program

8. All of the following are situations in which a check-in process can be particularly beneficial, except for:

A. Transitions from a lower to a higher level of care.

B. Periods of obviously increased stress with a risk of relapse to substance use or exacerbation of mental illness.

C. Adjustments or alterations of medication for mental or substance use disorders.

D. Increases in a client’s need for motivation and support to continue treatment.


9. Clients who express reservations about a technology-based intervention may be reacting to discomfort with:

A. Using a computer

B. The introduction of something new into their daily regimen

C. Both (A) and/or (B)

D. None of the above


10. How can a health care provider help increase the likelihood that clients use and benefit from an automated check-in system?

A. Encourage the client to tailor the information exchanged to his or her own recovery goals.

B. Allow the client to practice using the system with a staff member present to assist with the process and answer any questions that arise.

C. Use motivational interviewing to assess the client’s willingness, plan to engage, and perceived obstacles.

D. All of the above.


11. Which of the following is a common point of resistance that clients have to computerized check-in?

A. Limited reading skills or illiteracy

B. Fear that the information provided will be used against them

C. Both (A) and/or (B)

D. None of the above


12. Client privacy should be protected by setting machines within the treatment setting to delete cookies, search histories, and other private information that may otherwise be stored on the computer.

A. True

B. False


13. Computers within the treatment setting should not be set to block access to nontreatment sites as this may cause the client to feel rejected by the treatment facility.

A. True

B. False


14. In general, studies of computer-assisted self-interview instruments demonstrate that clients are usually less forthcoming about sensitive, embarrassing, or shameful information when disclosing to a computer program than they are during in-person interviews.

A. True

B. False


15. To support the client in repeatedly filling out the check-in form over time, the form must:

A. Be relatively brief in length.

B. Take only a few minutes to fill out.

C. Be meaningful to the client to sustain the motivation to complete it each day.

D. All of the above.


16. The goal of the check-in form is to identify a few questions that are meaningful and important to:

A. The client

B. The provider

C. Both (A) and (B)

D. None of the above


17. Supportive messages should be all of the following, except for:

A. Designed and selected to be important to the client.

B. Worded to emphasize what should be avoided.

C. Sent by peer support staff or peer counselors.

D. Tailored to the circumstance of the client.


18. Text messages are a secure way to send reminders and support.

A. True

B. False


Vignette 3: Conducting a Telephone- and Videoconference-Based Pretreatment Group for Clients With Substance Use Disorders

19. Via video feed in most situations:

A. The counselor can see each client and each client can see the counselor.

B. Only the counselor can see each client.

C. Only the client can see the counselor.

D. The counselor can see each client, each client can see the counselor, and each client can see the other participants.


20. All of the following are advantages of telephone conferencing, except for:

A. Convenient for clients, especially when transportation or childcare barriers exist.

B. Leaders do not need special skills in engagement.

C. Less potential for technical problems.

D. Minimal training on equipment required for clients and staff members.


21. Which rule helps minimize issues that can arise in telephone and video conferencing groups?

A. One person talks at a time.

B. Everyone has an opportunity to talk.

C. Indepth or highly sensitive discussions between clinicians and clients should be scheduled outside the group setting.

D. All of the above.


22. With video conferencing, there should be arrangements to redirect the connection of the client in crisis to a separate, private monitor staffed by the cofacilitator.

A. True

B. False


23. Which of the following is a technical consideration for video and telephone groups?

A. The need for encryption of information on provider and client ends of transmission to ensure privacy, which may require software to be downloaded and set up by the client.

B. Providing a land-based telephone line for backup.

C. Asking clients to test the system prior to the group meeting time.

D. All of the above.


24. If group members cannot see each other, they are more easily disengaged from exchanges, therefore, the counselor should communicate to the individual that their struggles are supported and there will be time to talk individually about their situation later.

A. True

B. False


25. For security purposes, clients should be required to access telehealth services through land lines only.

A. True

B. False


26. Which of the following is an effective way to create ownership for change?

A. Asking clients to discuss the goals others have for them.

B. Asking clients to identify what they want.

C. Both (A) and (B).

D. None of the above.


27. Which of the following should be honored in telephone and video group meetings?

A. Anonymity

B. Confidentiality

C. Both (A) and (B)

D. None of the above


28. When scheduling telephone or video groups, plan for backup support to help manage unexpected situations, and remember to:

A. Let the group know what is going on by telling them that you need to exit the group and how long you expect to be gone.

B. Deescalate the situation by offering individual support from another clinician or by offering to engage with the client one-on-one after the group.

C. Avoid disclosing personal information about any individual in group.

D. All of the above.


29. Clinicians should not support out-of-group discussions through chats or blogs as these are not confidential means of communication.

A. True

B. False


Vignette 4: Incorporating TAC Into Behavioral Health Services for Clients Who Are Hearing Impaired

30. A client may choose not to work with a specific interpreter because:

A. They do not find the person to be a good language match.

B. The Deaf community is small and there may be a potential for dual relationships.

C. Both (A) and/or (B).

D. None of the above.


31. A client who seems unwilling to work with all available interpreters may be doing so because of therapeutic resistance.

A. True

B. False


32. The interpreter:

A. Takes the place of clinical staff.

B. Takes on roles typically executed by program staff.

C. Both (A) and (B).

D. None of the above.


33. If assessments and materials used in intake, treatment, or continuing care require reading or writing, they may not be appropriate for use with Deaf clients.

A. True

B. False


34. Certified Deaf Interpreters (CDIs):

A. Have proficient communication skills.

B. Have received interpreter training.

C. Possess knowledge and understanding of Deaf culture and the Deaf community, as well as language fluency to help enhance communication.

D. All of the above.


35. The client needs to be able to have visual access to:

A. The counselor

B. The interpreter

C. Both (A) and (B)

D. None of the above


36. When working with a Deaf client, speak naturally and direct all communication to the interpreter.

A. True

B. False


37. Why may there be a lag during communication between the interpreter and the client?

A. The client may not be familiar with terminology or may use different signs from those the interpreter is using.

B. The interpreter may need to back up if there was a communication error that needs to be corrected.

C. The client may be asking questions that are relevant to the communication but not the content.

D. Any of the above.


38. To get a Deaf person’s attention, it is appropriate to:

A. Tap on the shoulder

B. Wave gently

C. Both (A) and/or (B)

D. None of the above


39. Deaf clients in treatment will likely present with the same types and levels of resistance that hearing clients do.

A. True

B. False


40. Clinicians should remind Deaf clients that emails may not be confidential and may not be an effective medium for counseling.

A. True

B. False


Vignette 5: Using Smartphones To Support Recovery for Clients With CODs

41. Technology-based treatment extenders should _____ the help and support of a counselor.

A. Augment

B. Supercede

C. Either (A) or (B), depending on the technology

D. None of the above


42. Clinicians should advise clients using apps that may contain confidential information to use a lock and password system on their mobile phone or tablet.

A. True

B. False


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