A social worker listens to a client talk about what’s on her mind. The client, an elderly woman who lives on her own and has several chronic illnesses, is very depressed and has trouble managing her daily life. The social worker talks the client through these problems, helping her find ways to manage her various doctor appointments and medications, as well as how to improve her mood so she can better tackle day-to-day tasks.
Sounds like any normal counseling session, but it’s not.
The social worker is in San Diego, and the client is in San Francisco. They communicate with the help of USC Telehealth, the first university-based clinic to offer mental health services using secure Health Insurance Portability and Accountability Act (HIPAA)-compliant videoconferencing technology.
“USC Telehealth is one of the latest in a series of innovations from the USC School of Social Work,” said Jim Wind, USC Telehealth executive director. “Merging the latest in HIPAA-compliant technology with evidence-based practice has created the ideal marriage of sophisticated systems with the core social work principle of meeting the mental health needs of the underserved, urban or rural, wherever they may be.”
To deliver these much-needed services to hard-to-reach clients, USC Telehealth offers an easily operated online platform that appeals to and is accessible for everyone, from tech-savvy youth to seniors and others who initially may be unsure about using a computer in general. And this tactic is working: 75 percent of clients surveyed have reported they like USC Telehealth the same or better than traditional in-office counseling.
USC Telehealth is also a new option for Master of Social Work student field internships. The clinic is especially convenient for the school’s web-based MSW@USC students, who serve as supervised counselors.
“We provide rigorous training and diverse experiences to graduate social work students who lack access to high-quality field placements due to their geographic location, work hours, family obligations, etc. USC Telehealth dissolves traditional barriers to mental health care for clients and practitioners-in-training,” said USC Telehealth’s Clinical Director Nadia Islam.
MSW interns are given four to six weeks of training based on a cognitive behavioral therapy model, which includes practicing biopsychosocial assessments with templates developed by the Los Angeles County Department of Mental Health. Students then engage in numerous mock therapy sessions with a field instructor, followed by extensive therapy simulations to demonstrate their competency before actually engaging with real clients.
“We are strategically building a strong and dynamic team of field instructors, where each individual adds a new dimension of specialization to our core services and student training in such areas as addiction, interpersonal violence, transitional-age youth, and severe and persistent mental illness,” Islam said, adding that USC Telehealth field instructors are licensed clinical social workers with at least 10 years of post-MSW experience and a USC faculty appointment.
MSW student Marcia Williams, who is in her second semester field practicum at USC Telehealth, understands the importance of delivering tele-mental health services to people who otherwise wouldn’t be able to receive it, such as her elderly client who lives in isolation, as well as people living in rural communities, those who may not be able to afford traditional counseling, or family members of military service members who move often.
“This is such an innovative way to deliver behavioral health care. Clients don’t have to leave their homes; I don’t have to leave my home. They’re comfortable; I’m comfortable,” said Williams, who also works full time as a public health practitioner for the U.S. Food and Drug Administration. “And I see them so we can actually engage. A lot has to do with building rapport with one another, establishing that therapeutic alliance. All my clients are responding extremely well to this environment.”
Williams said that while she has had prior experience with telemedicine, she had never thought about delivering mental health therapy over the Internet.
“This opens up a whole new world of opportunity for social workers, and I hope that others will become engaged in this type of therapy,” she said. “I would love to explore this more as a practitioner some day.”
The idea of broadening social work’s horizons is exactly what led USC to establish this first-of-its-kind clinic, which so far has served more than 350 patients in approximately 3,000 counseling sessions. The results are promising: Clients have demonstrated reliable and significant improvement after six to 12 sessions, and more than 80 percent of clients who have finished treatment have made observable progress, while 50 percent have met all of their treatment objectives.
USC Telehealth’s sophisticated-yet-easy-to-use technology makes it ideal for partnering with community-based agencies in need of mental health services. USC Telehealth has provided services to several nonprofit organizations that serve diverse economic and cultural populations of adults, children, adolescents, couples, families, seniors and veterans, including the American Cancer Society and the California Army National Guard. The clinic is also engaged in a pilot program with USC Student Counseling Services and has provided therapy to more than 100 students.
One of the community organizations whose clients have benefitted from USC Telehealth’s mental health services is the Orange County Social Services Agency (SSA), which operates social services programs in Southern California. The majority of the agency’s population lives at or below the poverty level. Most are uninsured or underinsured; few can afford mental health help on their own, though many need it.
Diana LaRusso, program manager for SSA, said that USC Telehealth has filled a gap in the kinds of services its resource centers can afford to provide. Since a significant number of the agency’s clients come from environments where domestic violence is prevalent, many parents and their children suffer from trauma and abuse, which often goes untreated.
“Clients are coming in with very extreme stories – they’ve witnessed murder, seen family members killed, lived in war-torn or drug-addled areas, been separated from their families, been physically or sexually abused, put into the social services system – and now they’re parents, and we have expectations of them though they’ve never resolved those issues,” LaRusso said. “When you look in their children’s eyes, the lights are out. There’s a darkness, a sadness. And to see the parents with the same sadness because they’re so used to dealing with depression and anxiety, it’s great to see that over time with these mental health sessions, they start to open up and come alive. USC Telehealth is helping us to achieve that.”
LaRusso said that USC Telehealth’s small space requirements—just a private room or office with a computer—makes it much easier to offer. And many of the agency’s clients have reported they like USC Telehealth counseling better than the traditional, in-person kind, which was a pleasant surprise to SSA’s staff.
“We weren’t sure if our clients would be intimidated by the technology, but because they are setting up their own appointments, which are held at a place where they have already built a relationship of trust, I think they feel like they are taking responsibility for their mental health,” LaRusso said. “They feel like it’s theirs.”
Erin Reighard, MSW ’13, who completed her foundation-year field placement with USC Telehealth, felt that her time was well spent because not only did she receive hands-on training and strengthened ties to the university, she also saw improvement in her clients. For her, USC Telehealth is an asset for social workers.
“I didn’t know what the field of telehealth was prior to my field placement, but I think it is the wave of the future,” Reighard said. “Technology is growing at a rapid pace, and people like doing this where they’re comfortable. At USC Telehealth, we’re able to reach out to many different populations, more so than we would have in traditional face-to-face therapy.”