Telemental Health the Dilemma Over Research Paper

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" (Tyson, 1)

The participants in the program has responded universally in favor of the program and have described it as a way of gaining access to critical support services which are inaccessible due to age, travel restriction and disability. Though the Tyson article denotes that many participants in the program do require some adjustment time to become comfortable with the flow of videoconferencing, most have ultimately reported that the reduction in travel time has been an enormous assistance in removing barriers to counseling. In this particular program, a focus on relieving alcohol and drug addiction symptoms following rehabilitation in the remote rural regions of Montana would demonstrate the importance of having a more accessible mode of gaining such support services. (Tyson, 1)

Indeed, the Tyson article suggests that the counterpoint to providing these opportunities is the danger that such individuals are likely to lapse back into addiction. This is a clear imperative for the ethical imperative to help improve outreach where it is likely to bear a positive impact. So denotes that text by Tschirch et al. (2006) which alternately examines the scenario for residents of a women's shelter who were reported as victims of domestic violence. The research here conducted would suggest that without the access to mental health support provided by telemental health technologies, most women demonstrated a higher likelihood of regressing back into an abuse relationship. Tschirch et al. indicate that "all of the women involved in the study had significant mental health issues and other health concerns that were not being addressed by the existing health care delivery system. Without the use of telehealth, these women would have had limited access to primary health care and virtually no access to mental health services. The East Texas Tele-Mental Health Network demonstrates the value of the clinical and organizational skills that nurses bring to innovative models of mental health service delivery." (Tshcirch et al., 1)

According to the Utah Division of Substance Abuse & Mental Health (2007), there is a social responsibility which is assumed by the mental health professional to serve those in need of mental health support when they present. This converges with the opportunity to meet a wider array of social demographics presented by the implementation of telehealth strategies. Accordingly, the UDSAMH indicates that "it is clear that mental illness crosses entire populations. Just like many disciplines are working together to study mental health and illness, all professional treatment providers -- public and private must come together in order to provide the most effective interventions on all levels -- from prevention to tertiary intervention." (Callister, 2)

This impetus as defined by the state of Utah implies something of the social imperative to not just improve services for our existing clients but to approach with greater dynamism though who reflect the problems dictating a need for telemental health services. As this relates to the legal liability of firms practicing telehealth strategies, the text by Godleski et al. (2008) is an appropriate source for consideration. This article employs consideration of the Department of Veteran Affairs approach to mental health video-conferencing, which it identifies as an essential tool in suicide prevention. However, it notes that in stating that goal, there are also certain legal liabilities for which an organization must take steps to protect itself. Accordingly, Godleski reports that "remote assessment of suicidality . . . involves complex legal issues: licensing requirements for remote delivery of care, legal procedures for involuntary detainment and commitment of potentially harmful patients, and liability questions related to the remote nature of the mental health service. VA best practices for remote suicide risk assessment include paradigms for establishing procedures in the context of legal challenges (licensing and involuntary detainment/commitment), for utilizing clinical assessment and triage decision protocols, and for contingency planning to optimize patient care and reduce liability." (Godleski et al., 271)

For our counseling firm, this would mean that adoption would involve the enlisting of legal services intended to provide inbuilt consideration of and protection from any such liability. This would also mean specialized training for all counselors such that legal considerations specific to telemental health conferencing could be imparted.

Methodology:

Most of the questions of legal liability about which our personnel have expressed concern will have been addressed by the review of sources cited here above. These provide a basis for the responsibilities and ethical demands which enter into the general counseling profession as this is practiced in the State of Utah and into the particulars of telemental health support.

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Before adopting the strategy for our group of practitioners, it would be appropriate to gather data from a sample population of counseling professionals who have already used telemental health services as part of their treatment strategy for a sustained period of time, which is identified hear as one year.

Research design:

For this research endeavor, it seems that the interview would be most appropriate. It is anticipated that there would be roughly one dozen participants in the survey-interview process. It is also expected that amongst the participants at the selected practices, a variance of internal cultural realities, responsibilities and pay scales would make it most efficient to garner information in each individual context by engaging practitioners one-on-one in their own practice facilities.

The sampling frame would be constituted of the head practitioner at each practice. This study would operate under the demand to isolate individual case causes of counselor perspectives from those which reflect more universal positions on telemental counseling. The interview design will allow us to take on the views of individual study subjects, using a framework that is guided by a line of questioning but which is also given over to a broad variance of possible data sets due to the open-ended nature of the approach.

Perhaps the most distinct advantage to conducting research with an interview questionnaire acting as the prime tool for data gathering is its capacity to yield first-hand accounts which may be protected by anonymity and which enable researchers to formulate data analyses that are not influenced by their personal perceptions of subjects. This benefit is supplemented by the ability which the interview offers researchers to craft data-gathering questions according to the needs of the study. With this method of qualitative data accumulation, questions can be shaped to cast a broad reach in terms of that which can be utilized to formulate conclusions. This means that the questionnaire can not only help to acquire data but can be instrumental in determining that data which is most useful or applicable

The methodological interest in provoking detailed insight into the benefits of employing telemental health strategies through the perspective of individual practitioners denotes a need for a form which is inherently structured to allow for unpredictable extrapolation within gathered data. This is a necessary aspect of the case study methodology and thus provides researchers with a degree of confidence in the balance offered by the interview.

Data Collection Process:

The interview will be formed as a questionnaire but will be applied differently. This is to say that its use as an instrument for collecting data will not necessitate that the subject actually fills out a survey form his or herself. Instead, the researcher is intended to proctor the interview verbally in a one-on-one session with the respondent. This means that the instrument will be an interview guide, rather than a hard and fast set of questions demanding rigid response parameters. The limitations of a survey are, instead, here at the discretion of the researcher(s) administering the interview. This means that a broad and far-reaching set of questionnaire questions will serve as directives for the overarching discussion.

To the aid (and also to the discretion) of the researcher, each of the broad questions, of which there will be 12 in this study concerning the relationship between telemental health services, operational costs and demographic reach, may be accompanied by any number of subquestions, notes and comments which are designed to facilitate further discussion where needed in the context of any one broader directive. These subquestions et al. may not be applied at all, or may be used selectively, with the primary intent of simply being available to the researcher for the purposes of accommodating more fluid discussion where such is needed. This can be a significant aid in exacting a sufficient enough data collection process. Additionally, we can see that this aspect of the instrument differentiates it in capability from the survey, which must naturally be significantly more rigid in terms of that which it includes. The absence of a mediator in its administration demands that specificity.

Ethical research practices:

Once an agreement to participate has been gained by telephone, subjects are mailed a statement of intent and a self-addressed stamped envelope. Respondents are simply required to review that statement of intent, sign and date the statement and return it in the envelope provided. The statement of intent would indicate the counseling group's dilemma, reiterating the concerns over the feasibility implications.....

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