COVID-19 Telehealth and Remote Evaluations

Limited in-person visits for psychological therapy services are currently being conducted to mitigate the risk of COVID-19 and most appointments are being held remotely via telehealth. Telehealth includes the practice of health care delivery, diagnosis, consultation, treatment using interactive secure HIPAA compliant audio-video communications. If families are temporarily outside of New York State at any time during the telehealth treatment, they will need to attest that they are a permanent resident of New York State. Aside from being licensed to practice in NYS, Dr. Robokos has received emergency licensure in several other states due to the COVID-19 Pandemic as well to care for patients who have relocated.

Similar to in-person therapy services, the same careful steps will follow with for telehealth psychological services. There will be an initial consultation to determine the proper course of treatment while reviewing all pertinent history. This will be followed by a prescribed and targeted treatment plan ensuring the highest level of sensitive care and attention. Parent meetings for children and teens usually take place regularly so that there is consistent communication and generalization of outcomes. Telehealth efficacy research has abounded for over the past decade, however, if it is deemed to not be feasible or effective to treat a patient remotely at any point, further options will be discussed to determine the best plan.

As a result of the novel coronavirus (COVID-19) pandemic, many of the typical clinical services, such as therapy and evaluation appointments cannot be conducted fully in person. It should be noted that even with remote assessment procedures, one or more visits will be planned to be held in person at the Manhattan or Westchester offices.  The remote assessment platform indicates that the clinician and the patient will be in different locations, and the assessments will be conducted using video and audio technology. Any remote assessment will require access to some form of technology and access to the internet. The type of technology required will vary depending on the assessment(s) being conducted and we will work together to access HIPAA compliant options.

Evaluators who conduct evaluations utilizing remote assessment platforms must use care in selecting assessment tools and techniques that are appropriate to the technology and take into consideration the family’s cultural, linguistic, and educational background. Assessment materials and procedures will need to be modified in order to account for the lack of physical contact. Typical evaluation instruments are not normed on telehealth/teletherapy and reporting scores from norm-referenced instruments would be outside of typical standardization procedures, however, for over a decade there has been an increase of data regarding assessment via telehealth with very promising results (not a significant difference between face-to-face administration and telehealth assessments with valid and reliable data on many tests; meta-analysis study by Brearly et al., 2017).

All steps will be taken to appropriately, thoughtfully, and ethically conduct evaluations remotely in determining a child’s functional abilities and the evaluation results will also rely on detailed behavioral observations of the child, parent interview, and informed clinical professional opinion. The evaluator will be prepared to make appropriate diagnoses, clinical recommendations and suggestions to address concerns and the reasons for referral and there will always be the highest level of clinical experience and tools when working remotely with children and their families. Before proceeding with tele-services, Dr. Robokos will arrange an initial phone conference with the parent(s)/guardian(s) to review the expectations of what the evaluation will look like. Aside from reviewing the reasons for the evaluation, specific determinations will be made with the family if it is best to have the evaluation done fully in person in special circumstances (i.e., very young age of a child, limited attention span for remote testing, limitations with technology). Currently, however, the remote/teleservice evaluation is the most viable and safe means of working together while also allowing for flexibility.

If it is determined to proceed with a tele-service evaluation, the parent/guardian will be provided with a pre-evaluation set-up/orientation to the evaluation. A discussion will take place about what device(s) the family has available (e.g., smart phone, tablet, iPad, computer), how to set up the home space for the testing with minimal environmental distractions and quiet conditions, as well as other aspects related to the set up. Descriptions will be provided about how the evaluation will be conducted virtually and what this will be like depending on the age of the child. We need to be able to see and hear each other at the same time. What do you have that will allow for this? What do you think will work or what is a concern? All these questions will be considered and discussed carefully.

Similar to in-person assessments, part of the evaluation will involve making observations of the child. There will be observations of caregiver-child interactions when appropriate (depends on age of child). Observations of how the child performs during requested activities will be part of the assessment. Caregivers are asked to not coach their child during assessment procedures and allow the child the time and space to answer on their own. I will ask to speak with other caregivers, educators, and/or therapists who have knowledge of the child if the family authorizes this as a means of gathering all necessary clinical data. There will also be the standard review of relevant medical or educational records or prior evaluations. Observations of the child at school can also take place either remotely or in person.

If a determination is made by the psychologist that the patient’s/client’s need for services cannot be adequately met through telehealth/remote options, substantial caution will be applied in the decision-making processes when considering whether to proceed with in-person care (i.e., if it is allowed by local and community laws, if health reasons prevent that from happening, ethical standards of health care). Psychological evaluation and therapy services are important, but have to be balanced against the risk of COVID-19. If a determination is made that testing should discontinue entirely, then the same rules and policies apply as stated in the Office Policy document. The ultimate goal is to always develop meaningful and actionable recommendations and to advocate for each patient and their families with quality care at every step.

In compliance with the guidelines set forth by the Department of Health (DOH) and Centers for Disease Control and Prevention (CDC) regarding a safe work environment due to COVID-19, there are safety measures for the in-person visits which include: 1) maintaining social distancing measures to the extent possible by limiting the number of patients in the main office and waiting areas, 2) office rooms and waiting areas are fitted with HEPA filters, 3) to the extent possible, appointments will be scheduled with gaps between visits to ensure proper sanitization/disinfection between each appointment, 4) you will be asked to not wait in the waiting area whenever possible to reduce contact, 5) as per legal requirements for health care settings, masks will be expected to be worn at all times regardless of anyone's vaccination status. This rule applies to patients and families as well. Masks will be supplied to patients and families as needed, 6) all materials (i.e., test materials, writing utensils, manipulatives, toys/games) given to a patient will not be passed back and forth and will be properly cleaned between sessions. We assure you that there will always be the highest level of clinical experience and evaluative tools when working remotely and in-person with children and their families.