Telehealth is making gains in popularity for providers and clients alike, but the majority of clinical supervision takes place face-to-face. Telesupervision, though, allows for supervisor and supervisee to meet without being in the same room. Here’s a bit more about telesupervision and how it can be helpful for supervisors, supervisees, and training programs.

What is Telesupervision?

Telesupervision, also known as e-supervision, is defined as the use of video conferencing technologies to supervise graduate students or assistants remotely. Supervisors can utilize video conferencing technologies to meet with students to discuss their objectives, assignments, and caseload, and to provide feedback. Supervision via video conferencing also allows supervisors to observe students working with clients or patients during live online sessions (telehealth sessions).

What are the Benefits of Telesupervision for Universities?

Telesupervision can help with clinical placements in a cost- and time-efficient manner. It can eliminate barriers such as distance or bad weather conditions that supervisors might face in providing weekly supervision. Telesupervision can decrease travel time from facility to facility, allowing supervisors to focus on supervision itself. It can also help with training more students, who may live in remote areas or attend distance graduate programs. Telesupervision allows universities to hire more qualified candidates to supervise students during a clinical practicum, as they can reach more geographic locations.

What are Benefits of Telesupervision for Students?

Telesupervision can help students with their clinical placements, especially if they live in remote areas. It can also provide a more consistent learning experience if other barriers prevent students from consistently attending brick and mortar clinics or university clinics. Telesupervision has been found to increase communication between students and supervisors, as they can instantly connect via video conferencing platforms to discuss their clinical observations, needs, and objectives in more detail, without back and forth emailing. Students may also benefit financially from telesupervision, as it eliminates costs associated with traveling.

Important Considerations for Students

Many students approve of telesupervision; however, students should comply with both their state and professional organization’s rules regarding whether this type of supervision is approved, and if so, for how many hours. Costs associated with obtaining the right equipment, such as a computer, should also be considered. Internet connection speed is also very important, as video conferencing relies heavily on internet speed. Poor connection speed can lead to poor online experience and miscommunication. The greater the internet connection speed, the better the experience. On average, the minimum requirement for internet connection speed is three megabits per second (3Mbps).

Important Considerations for Universities

Universities interested in telesupervision must meet regulations set forth by the state and the accrediting organization, such as the American Psychological Association’s (APA) requirements for supervision and accreditation. Not every state supports telesupervision, and some states might have limits on the number of allowed e-supervision hours. Some states require a few hours of in-person supervision as well. At times, state regulations might be completely different from an organization’s or an accrediting organization’s requirements.

Other Considerations

Consider the following factors when making decisions about telesupervision:

Cost

The costs of video conferencing should be considered to make e-supervision feasible and sustainable. Web-based or cloud-based video conferencing platforms, such as TheraPlatform, are more cost-effective than dedicated teleconferencing technologies, as they don’t require any additional equipment and downloads. Users can simply subscribe to a web-based platform online and have access to the video conferencing platform within just a few seconds.

Technical Requirements

Technical requirements for video conferencing platforms, such as required internet connection speed, network capacities, and the need for additional downloads should be considered. Most video conferencing platforms require at least a 3Mbps connection speed (for a smooth online experience), a webcam, and a microphone. Also, consider which devices will support the video conferencing platforms. Most web-based platforms run on both computers and mobile devices.

Privacy

Video conferencing platforms should be carefully evaluated to ensure the security and privacy of individuals regulated under HIPAA, especially if supervisors plan to use video conferencing technologies to observe students conducting therapy either online (via teletherapy) or in remote clinics or the patient’s home. HIPAA compliant video platforms should follow HIPAA’s administrative, physical and technical regulations, and sign a business associate agreement (BAA) with their users.

HIPAA compliant video conferencing platform should include unique user identification; verification that a person or entity seeking access is the one claimed; encryptions at the database, video conferencing and server’s levels; and have systems in place for breach notifications and audit controls. Some general video conferencing technologies, such as Skype, don’t meet HIPAA regulations.

Also consider the platform’s video and audio quality, as e-supervision and teletherapy conducted via the platform should be equivalent to in-person supervision or therapy. Free video conferencing technologies used by the public, such as Skype, often offer worse quality of both audio and video, and users may experience frequent dropped connections.

Documentation

Also, consider the need for documentation and co-signing by supervisors, as supervisors are required to review students’ documentation and co-sign their reports and notes. Not every video conferencing platform offers an integrated solution for documenting or note taking. TheraPlatform, for example, does allow providers (student therapists) to document assessment findings, goals of therapy and progress in therapy. Students can request co-signatures, and supervisors can review and co-sign all documentation.

Supervisors planning to observe teletherapy sessions, during which students provide live online therapy, should also consider whether the video conferencing platform allows supervisors to join a teletherapy session attended by both a student therapist and the client. TheraPlatform, for example, allows students to schedule a teletherapy session with clients and invite supervisors to the very same session as observers.

The observer in TheraPlatform is “invisible.” This means that a supervisor can hear and watch both the student therapist and client interacting or working together, but the student therapist and client cannot see or hear the supervisor. This observer setup eliminates external pressure or a sense of intimidation that both a student therapist and a client might feel, allowing for better therapeutic rapport.

Tips for Universities on Getting Started with Telesupervision

• Familiarize yourself with both your organization’s and state’s regulations regarding e-supervision.
• Familiarize yourself with your university’s policies and procedure for implementing video conferencing platforms or any additional software or technology.
• Review the budget with the university and review all deadlines for investing in technology.
• Reach out to potential stakeholders who might help with students’ placements.
• Evaluate your current technology, e.g., the age of the computer, internet connection speed and network capacities at the campus or your location .
• Research and evaluate different video conferencing platforms and their technical requirements.
• Sign up for a free trial with a video conferencing vendor.
• Learn how to use the video conferencing platform.
• Run a small pilot with a few student therapists and clients to determine if the video conferencing platform meets your needs.

References and Resources:

Barnett, Jeffrey E. (2011). Utilizing technological innovations to enhance psychotherapy supervision, training and outcomes. Psychotherapy 48(2), 103-108.

Priya Martin, Saravana Kumar, Lucylynn Lizarondo. (2017). Effective use of technology in clinical supervision. Internet Intervention, 2(8), 35-39. doi: 10.1016/j.invent.2017.03.001. eCollection 2017 Jun.

Complying with federal and state laws in online therapy: https://www.theraplatform.com/blog/256/complying-with-federal-and-state-laws-in-online-therapy

Telehealth: Let’s Talk Technology https://www.theraplatform.com/blog/254/telehealth-let-s-talk-technology