Comparison to other forensic/correctional telehealth programs

Vora, S., King, C. M., Matthews, S., Bomysoad, R. N., Gonzalez, K., Faust, T., & Ossai, C. (2023, March 16–18). Comparison of prior forensic telepsychology approaches to a pilot telehealth Dialectical Behavior Therapy skills training program [Poster presentation]. American Psychology–Law Society Conference.

The COVID-19 pandemic beget a massive shift toward telepsychology in the interest of maintaining access to psychological services during a time of social distancing. Of course, the comparative utility of telepsychology as a service modality had been recognized prior to the pandemic, including for its potential to increase accessibility, flexibility, and privacy for services; and reduce the amount of time and money necessary for such services. Nevertheless, the unprecedented nature of telepsychology’s widespread implementation during the COVID-19 pandemic presented, among other things, an opportunity to examine telepsychology implementations across various settings and populations.

While research pertaining to telepsychology has experienced an expected surge in recent years, the research base for forensic and correctional applications of telepsychology (forensic telepsychology) remains limited—especially considering the range of potential applications in this area. The lack of a robust and diverse evidence base for forensic telepsychology is notable, as justice-involved persons may specially benefit from this service modality. With respect to treatment, given the elevated rates of mental health problems among such justice-involved populations, the flexibility of telepsychology may well help to reduce historical barriers to such persons accessing interventions services. For instance, individuals recently released from correctional institutions may encounter financial and transportation challenges in seeking to access psychological services.

As a case in point, telepsychology made feasible the MSU Telehealth Dialectical Behavior Therapy (DBT) Individual Skills Training Program for clients participating in a court reentry program given the respective locations of the university-based clinic and court (two neighboring states)

MSU Telehealth DBT Individual Skills Training Program

The pilot program was developed by Dr. King, who is licensed in both the states where the clinic was located and where the referred clients resided (he obtained licensure in the latter jurisdiction specifically for this program). Doctoral student therapists and master’s student administrative staff are trained and supervised by Dr. King in traditional and forensic/correctional adaptions of DBT, and the use of telepsychology, including via weekly DBT consultation team meetings. The telepsychology program makes use of several technologies, including TherapyNotes (electronic health records and videoconference sessions); Qualtrics (administration of self-report measures to clients and therapists using anonymous ID numbers); Microsoft Word (report and session note templates, consultation team meeting template, client skills training manual, etc.); Microsoft Excel (various data bases, client diary card); and Adobe Acrobat Reader (fillable forms). Clients are also provided with recommendations for phone applications for supplemental mindfulness training, as well as supplemental skills training media (e.g., YouTube, podcasts). Clients complete an intake session and 12 sessions of individual skills training, in exchange for credits provided by the reentry court for productive achievements during their reentry process, toward reductions in community supervision intensity. The first cohort of referral clients has demonstrated the feasibility of this telepsychology program. Quality assurance activities and delivery of the program to future cohorts of clients are anticipated.

Comparison to Other Forensic/Correctional Telehealth Programs

A literature search was conducted for reports describing uses of forensic/correctional telepsychology for treatment purposes, to which the pilot program was compared. Relative to other reviews of forensic/correctional telepsychology literature, our number of reports is smaller given our focus on treatment programs delivered on an outpatient basis.

We identified six reports, published between 2008 and 2022, that examined treatment-focused telepsychology implementations rendered on an outpatient basis to justice-involved populations in the community. Several justice-involved populations were targeted—juveniles, adults, and veterans—with three reports focusing on justice-involved youth. Clients were most often male.

Most programs utilized cognitive-behavioral strategies (e.g., cognitive restructuring, DBT) to target mental health or substance use needs; one used a brief solution-focused therapy. One report explicitly incorporated the Risk–Need–Responsivity (RNR) model for targeting criminogenic needs, though most reports evidently attended to criminogenic needs via assessment and treatment planning. Some programs involved the use of a multidisciplinary team, including psychiatrists and nurses. Two studies utilized case management services. Session modalities consisted of individual or group telepsychology, with only one report describing a program that involved both session formats. Most treatment programs ranged from 10 to 16 weeks in duration; one program required only three one-hour sessions.

Several programs used videoconference platforms (e.g., WebEx) to deliver services. One program involved a computerized program with a virtual therapist and two entailed cellphone-based interventions. Some reports elaborated on encountered technological challenges, such as technology malfunctions that resulted in session cancellations.

The pilot program exhibits both similarities and differences to forensic/correctional telepsychology examples available in the literature. Beginning with similarities, the duration of the pilot program and use of videoconferencing appears on par with several other programs. Some prior programs also facilitated access to a multi-disciplinary team or involved case management. As a rough parallel to this, the current pilot was part of a suite of multidisciplinary reentry services overseen by a reentry court judge and coordinated by probation staff persons. Notably, technology limitations emerged as an important theme in the literature and in our own experience (e.g., clients’ inconsistent Internet access).

As for relatively distinctive features of the pilot program, while some prior programs utilized a group session format, the referring court for the pilot program requested individual sessions due to scheduling challenges it anticipated the clients to present. The absence of group skills training is a notable way in which the pilot program deviates from, e.g., full-model DBT. Also, relative to most prior programs, the pilot program expressly incorporates concepts from the RNR model—including administration of measures of RNR factors, and often recasting criminogenic needs and responsivity factors in terms of freedom- and therapy-interfering behaviors. Moreover, while some reports described applying DBT principles, few were specifically focused on telehealth DBT. Ultimately, quality assurance activities will help determine the data-driven merit of the pilot program’s shared and distinctive features.