Online Clinical Practice Management
(OCPM): Delivering Care
The first four steps of the Online Clinical Practice Management (OCPM) model, discussed in chapters 11 and 12, deal with professional training, generating referrals, conducting patient training, and obtaining consent. The practitioner and the client know with whom they are dealing, the client knows enough about telecommunication services and devices, and the practitioner and the client have signed basic consent agreements. We now discuss clinical issues, the next three steps of the OCPM delivery phase: clinical assessment, direct care, and reimbursement.
Like informed consent, assessment continues throughout a therapeutic relationship. Assessment is mutual: the client is assessing the professional and is being assessed by the professional. Conducting treatment online can affect (enhance, constrict, or distort) many aspects of assessment.
Although how the law will deal with telemental health is uncertain, it probably will hold professionals who communicate with clients through psychotechnologies to in-person standards of assessment. If psychotechnologies are eventually shown to markedly improve the assessment process, standards may be expanded. For now, professionals can assume that assessment at a distance begins at a disadvantage. The virtual world enabled by technology may be the next best thing to being there, but it isn't the same as being there. As we've discussed for professionals who have been trained to detect and discuss the symbolism often manifested in a therapeutic relationship, managing the emotion that often ensues can be difficult enough. It is far more difficult to manage when the exchange is reduced to a text based exchange. This is particularly true it the message is sent electronically and immediately.
Matters become even more complicated through text based technologies. Nonetheless, when clinical assessment is attempted several preliminary assessment instruments use telecommunications. More in-depth analysis is needed to determine whether any of these instruments have been researched and developed sufficiently for environments in which there is no in-person contact with any administrator. Psychological tests have traditionally been administered in very standardized settings rather than in rooms in which distractions are readily available. Offering paper-and-pencil, Rorschach, or thematic apperception tests through Web sites may be a violation of