The ever expanding availability of technology-based mental health services and resources has opened up new areas of psychological practice and research. There are many reasons to embrace this technology movement, whether specialising in providing e-mental health services, conducting research on e-mental health or using technology to assist you in your work in other fields of psychology. e-mental health services not only offer more treatment choices for clients but they provide health professionals with an array of free and comprehensive resources that can help streamline their face-to-face work. This growth in ePsychology (the application of e-mental health by psychologists) also opens up an exciting range of research and teaching possibilities. In this article we cover what ePsychology can offer the early career psychologist.
Integrating ePsychology into clinical practice
As technology becomes more and more a part of our everyday lives, it is no surprise that it is also becoming an important tool in mental health prevention, intervention and service delivery (Ben-Zeev, 2014; Cunningham et al., 2014). As practitioners, to meet this fast-changing world of ePsychology, it is crucial to be adequately equipped and able to integrate this technology into clinical practice. While this can be challenging, there are some simple steps you can take to better understand the e-mental health (eMH) field and how it can be implemented and utilised within clinical practice to help you as the practitioner along with your clients.
Raising awareness
Not surprisingly, an important first step is to become aware of the different types of eMH services that are available. There are a number of useful web resources that can help you become familiar with what programs, apps and other mobile and computerised resources are available and how they operate. Key web resources include:
- mindhealthconnect provides information and links to online mental health resources (websites, apps, and online communities) from leading Australian health organisations (www.mindhealthconnect.org.au)
- Beacon provides information including a rating of the quality of evidence behind national and international online mental and physical health resources (websites, apps and online support groups) (www.beacon.anu.edu.au)
- The Toolbox developed by Reachout.com provides details of mobile apps that have been endorsed by health professionals and young people (www.au.reachout.com/sites/thetoolbox)
- eMHPrac provides a detailed resource guide and online community for health professionals developed as part of the Australian Government funded e-Mental Health in Practice project. The guide lists eMH programs by target group, diagnoses, and delivery method (e.g., online, telephone, apps) while the online community includes such things as an online journal club, forums, and other resources (www.emhprac.anu.edu.au; see also eMHPrac insert in this edition of InPsych for a detailed listing of eMH services and resources).
Experiencing
Step two in the eMH in practice journey is to become connected and experience the e-psychology world as a consumer. Download apps, register for online programs and try them out first hand! Many programs allow health professionals to log in and trial programs. This provides the practitioner with opportunities to assess content as well as the relevancy, utility and accessibility of programs before using them with a client, in a session, or before referring clients to a particular program as an adjunct to face-to-face intervention.
eMH knowledge building
Another important step in understanding eMH practice is to learn about different models of integrating eMH into your clinical practice. Reynolds et al. (2015) have developed a conceptual framework that proposes five clinical practice models for integrating eMH into primary care. Developing an appreciation of the different clinical models can enhance understanding and integration into one’s own practice (see Table 1 for an outline of the models).
Table One. Five clinical practice models for integrating eMH into routine care.
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Practice model
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Role of eMH resource and clinician
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1) Awareness /promotion
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Clinician makes information about evidence-based resources available (e.g., in waiting room, on practice website)
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2) Case management
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Clinician provides assessment, referral and follow-up
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3) Coaching
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Clinician supports a client in their engaging with and completing an eMH program
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4) Integrated into discrete symptom focused intervention
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eMH enhances/extends clinician-delivered therapy – e.g., CBT intervention is provided partly through sessions with the therapist and partly through an online program or app
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5) Integrated into complex therapies
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eMH is used flexibly as one part of comprehensive, mixed methods intervention
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Adapted from Reynolds et. al., 2015.
Bringing ePsychology into an academic career
It is an exciting time to be working in ePsychology in academia. The Australian government has increased funding in the area over recent years, thus enabling a number of academic researchers to be at the forefront of the eMH movement. Many eMH programs have been developed and evaluated by psychologists working in academia (Klein, 2010).
Many large universities have eMH centres or units and these include postgraduate students, research officers, postdoctoral fellows and senior academics. Research on eMH is vital in order to keep up with changes in technology, to ensure eMH programs are evidence-based and to understand how to encourage health professionals and clients to embrace eMH.
eMH programs have been largely web-based but the increasing use of technology is leading to a growth in smartphone and tablet apps and wearable technology which also poses more opportunities for researchers. New and innovative ways of demonstrating efficacy will become more important because apps, for example, can have a short usage life.
eMH presentations are now appearing at many conferences around Australia and overseas. These conferences allow for emerging research on eMH to be presented and allow further collaborations to develop. There are also research grants and prizes aimed at early career researchers, including the APS ePsychology Interest Group’s Student Research Prize.
Early career researchers should consider eMH as an emerging area to become involved in. They will have the opportunity to work in groundbreaking research in a new and exciting area. They will have the chance to work in interdisciplinary collaborations, present emerging research on eMH at conferences, be able to support the work of clinicians and see the results of their work in the community.
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Understanding the ethical, practical and legal aspects of ePsychology
Working in ePsychology, whether in clinical practice or academia requires a strong understanding of the ethical, practical and legal issues involved in working with clients within an online environment. The rapid advances in technology make it a challenge to keep up to date with the latest security features and vulnerabilities, as well as the evidence for the quality and effectiveness of eMH services. It is also imperative to consider whether your eMH practice is covered by the same ethical codes and professional indemnity insurance as face-to-face practice. Careful consideration needs to be given to how you will manage client safety within an online environment. Clients also need to be kept fully informed of the details of what eMH services you will offer, their benefits, limitations and risks and measures they can take to minimise risks.
In addition, there are a number of potential financial barriers to consider before setting up an eMH practice or conducting eMH research such as the cost of purchasing secure technology platforms or developing eMH programs and apps and the lack of Medicare rebates for online psychology services.
A number of guides have been developed to assist practitioners providing psychological services and products online (see Kyrios et al., 2015, Chapter 11; APS guidelines, 2011; APA guidelines, 2013). There are also training initiatives for students and health professionals (see next section on continuing professional development). In addition, becoming part of ePsychology networks can provide valuable support (e.g., the APS ePsychology Interest Group; the Australasian Telehealth Society; and the International Society for Research on Internet Interventions to name a few).
Continuing professional development in the e-world!
In order to keep abreast of the rapid developments in this burgeoning field, it is recommended that young and more experienced psychologists consider up-skilling through continuing professional development opportunities on offer.
In addition to the earlier suggestions of Raising awareness, Experiencing, and Knowledge building to upskill in this area, there are a range of training opportunities on offer from programs that integrate online therapy into postgraduate training, to brochures, workshops and online training programs for practitioners.
Postgraduate training programs in eMH recognise the need to expose trainee health professionals to eMH from an early stage so that they emerge equipped with the skills and confidence to incorporate eMH resources into the treatment options available for clients. Two examples are the National eTherapy Therapy Centre at Swinburne University of Technology which currently offers eTherapy training to postgraduate psychology students and their supervisors from Australian universities (Shandley et al., 2011) while the University of South Australia has recently introduced video therapy training into their postgraduate psychology program (Simpson et al., 2014, 2015).
For the more experienced practitioner, there are a number of more formal training programs on offer including those available via the eMHPrac project (www.emhprac.org.au/training), the APS Institute (www.psychology.org.au/apsinstitute/) and other CPD providers as well as several programs in development by the eMHPrac team and The Young and Well Cooperative Research Centre (www.vichealth.vic.gov.au/programs-and-projects/young-and-well-cooperative-research-centre).
Final thoughts
As you continue your journey as an early career psychologist consider how you can integrate technology into clinical or academic practice. Increase your familiarity with existing eMH services, take up opportunities for professional development in eMH and network with eMH practitioners and researchers.
Technology can offer increased flexibility and choice to you and your clients or your research participants. It is not a replacement for face-to-face clinical practice, but in a world where we are time poor and captivated by advances in technology, utilising this interest in technology-based self-management is a way we can all strive to increase the number of people getting help for mental health problems.
The lead author can be contacted at [email protected]