Convanagh: Competencies for Behavioral Health Professionals in Digital Health
Competencies Needed for Behavioral Health Professionals to Integrate Digital Health Technologies into Clinical Care: a Rapid Review
Abstract and Introduction
This rapid review examines literature on training and competencies required for behavioral health professionals (BHP) to integrate digital health technologies (DHT) into clinical practice.
Despite growing evidence supporting DHT use in behavioral healthcare, professionals have been slow to integrate these technologies due to various factors.
The review's aim is to inform BHP about the necessary competencies to support the adoption of DHT.
A search of PubMed and Google Scholar (articles from 2010 to 2020) using terms related to DHT, BHP, and competencies yielded 1972 articles.
23 articles met the inclusion criteria, focusing on foundational core competencies.
Data was extracted and organized by profession and technology platform to identify similarities and differences.
Findings were used to generate an interdisciplinary approach for the clinical integration of digital health.
Recommendations focus on foundational digital health competencies applicable across all behavioral health disciplines, rather than technology- or discipline-specific training.
Universal Digital Health Inter-Professional Competencies Identified:
Privacy, security, and patient safety
Digital health technical skills
Ethical and legal considerations
Clinical skills
Art of therapy and digital health
Administrative tasks
Further research is needed to determine if the development of these competencies improves patients' behavioral health outcomes.
Rapid Integration of Technology in Healthcare
Technology is rapidly integrating into all healthcare settings, including behavioral healthcare.
BHP are increasingly using DHT to support or deliver treatments.
The full extent of how BHP are developing competencies for DHT use remains unclear.
Definition of Digital Health (WHO, 2016): "The use of digital, mobile and wireless technologies to support the achievement of health objectives." This includes telehealth, electronic health (eHealth), and mobile health (mHealth) technologies.
DHT's Role in Reducing Treatment Barriers:
Addresses BHP shortages.
Combats stigma (e.g., anonymous internet-based care via eHealth).
Overcomes lack of transportation (e.g., telehealth via video conferencing for underserved areas).
Enables patient self-management (e.g., mHealth apps for coping skills).
Support for DHT in various behavioral health conditions: Insomnia, PTSD, depression, anxiety.
Slow Integration of DHT: Despite benefits, integration has been slow, with an average of 15 years for new DHT implementation (Wind et al., 2020).
Barriers to Clinical Integration (from a Department of Defense mHealth training program; Armstrong et al., 2018):
Uncertainty on how to integrate technology into care.
Lack of or unclear policies around mHealth use.
Concerns regarding privacy and security.
Lack of employer support.
Employer restrictions about technology use.
Concerns regarding the effectiveness of mHealth.
These challenges underscore the critical need for education, training, and policy development for DHT use.
Professional Organizations' Recommendations and Policies
Many professional organizations have disseminated recommendations and policies for DHT use.
Some integrate DHT use into their ethical codes (e.g., American Association of Marriage and Family Therapists [AAMFT]).
Others develop guidelines for specific platforms (e.g., American Telehealth Association [ATA] for videoconferencing) or disciplines (e.g., National Association of Social Workers [NASW] Standards for Technology and Social Work Practice).
However, there is limited evidence that these efforts translate into increased integration of digital health training programs.
More research is needed to assess if demand for DHT leads to increased training and improved behavioral healthcare outcomes.
Impact of COVID-19 Pandemic
Though not central to the review, the COVID-19 pandemic significantly accelerated DHT implementation due to social and physical distancing restrictions in 2020.
While some reduction in use is expected post-pandemic, DHT use is unlikely to return to pre-pandemic rates.
A survey of BHP during the pandemic (Békés & Aafjes-van Doorn, 2020) found:
Overall positive attitudes towards telehealth, especially among those with prior experience.
BHP concerns included: patients' physical surroundings, technical issues, perceived lack of competence with telehealth/DHT, and feeling less connected to patients.
The reported lack of DHT competence is a major concern, given risks to patient safety and potential legal/ethical violations.
State-level Initiatives: Some states (e.g., Massachusetts, Washington) have mandated training for all healthcare providers, including BHP, to ensure a basic understanding of digital health. These are foundational initiatives to meet increasing demand.
Increased Need for Behavioral Health Services and DHT Solutions
Depression, anxiety, substance use, and PTSD are expected to rise due to pandemic-related factors.
At-risk groups (essential workers, healthcare workers, educators, law enforcement, vulnerable populations) may experience higher rates of behavioral health symptoms.
These groups face barriers to treatment: atypical work schedules, stigma, socioeconomic factors, cultural norms, distrust in the medical system, and racism.
Digital health offers solutions: anonymity, flexibility (location and time), lower cost, and potentially less bias compared to in-person treatment.
Key Terms and Definitions (Table 1)
Digital Health (WHO, 2016): "The use of digital, mobile and wireless technologies to support the achievement of health objectives. Digital health describes the general use of information and communication technologies for health and is inclusive of both mHealth and eHealth." Includes eHealth, mHealth, telehealth.
Electronic Health (eHealth) (Eysenbach, 2001): "eHealth is an emerging field in the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the Internet and related technologies." Includes internet-based treatments, social media, email.
Mobile Health (mHealth) (WHO, 2011): "Medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants and other wireless devices…" Includes mobile apps, text messaging.
Telehealth (Health Resources & Services Administration, 2021): "Telehealth is defined as the use of electronic information and telecommunication technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health and health administration." Includes video conferencing, remote health monitoring.
Behavioral Health Professionals (NAMI, 2020): Psychiatrists, psychiatric nurse practitioners, psychologists, clinical social workers, marriage and family therapists, professional counselors, and drug and alcohol abuse counselors.
Digital Professionalism (Ellaway et al., 2015): Professional behaviors of healthcare professionals and students related to their use of digital health technologies, based on principles of proficiency, reputation, and responsibility, encouraging deliberate, ethical, and accountable use of digital media.
Methods
Type of Review: Rapid review of the literature.
Timing: Conducted in October 2020.
Databases: PubMed and Google Scholar.
Search Terms:
("technology" OR "mobile applications" OR "telehealth" OR "social media" OR "gaming" OR "web-based" OR "mhealth" OR "mobile health" OR "virtual health" OR "telemedicine")
AND ("mental health" OR "behavioral health" OR psychiatry OR psychology)
AND "professionals"
AND (competencies OR skills OR training OR "best practices" OR frameworks OR ethics)
Inclusion Criteria:
Articles from 2010 to 2020.
English language.
Research-based articles focused on training BHP in the USA and Canada to use technology in practice.
Discussion of competencies, training, or best practices (including attitudes, skills, knowledge).
Included pre-practice or professional training recommendations.
Any technology platform: mobile apps (mHealth), telehealth, or other electronic health (eHealth) technology.
Exclusion Criteria: General terms not yielding relevant results (e.g., "digital health," "education").
Search Process: Medical librarian searched PubMed and focused Google Scholar searches. Hand searching, snowballing, and grey literature searching were not completed.
Quality Assessment: Not conducted for included articles.
Selection Process (Figure 1):
Initial database search: 1972 articles.
Filtered by title for relevancy & duplicates: 1896 articles.
Abstract review: 76 articles.
Articles removed after abstract screening: 47.
Full-text eligibility assessment: 29 articles.
Articles excluded after full-text review:
Didn't discuss competencies, training, skills (n=3).
Not mental health-related (n=3).
Final Articles Included: 23.
Results Organization
Results are organized into subheadings based on behavioral health disciplines:
Behavioral Health Professionals (multiple or unspecified disciplines)
Marriage and Family Therapists
Psychologists
Psychiatrists
Social Workers
Separation by professional group was necessary due to distinctions in ethical codes, discipline-specific guidelines, and responsibilities.
Each section further divided by specific DHT type:
Digital Health (multiple technologies or unspecified platform)
Telehealth (e.g., video conferencing, remote health monitoring)
mHealth (e.g., mobile apps, text messaging)
eHealth (e.g., social media, email)
Summary of Included Articles
Of 23 articles:
8 focus on unspecified BHP using digital health.
7 focus on psychiatrists.
3 focus on psychologists.
4 focus on social workers.
1 focuses on marriage and family therapists.
Behavioral Health Providers (BHP - General)
This section covers articles focusing on a broad category of BHP.
3 articles address overall DHT use, 1 on telehealth, 3 on mHealth, and 1 on eHealth.
Digital Health
Three articles recognized multidisciplinary BHP and offered frameworks for integrating multiple types of digital health into behavioral healthcare (Hilty et al., 2017; Lustgarten & Elhai, 2018; Maheu et al., 2018).
Seven Digital Health Domains for DHT skills:
Clinical evaluation and care
Virtual environment and telepresence
Technology (patient preference and experience with technology)
Legal and regulatory issues
Evidence-based and ethical practice
Mobile health technologies including apps that demonstrate alignment with therapeutic goals
Telehealth development
Competency Framework (Maheu et al., 2018): Two domains (clinical evaluation and care, evidence-based and ethical practice) included a competency framework with 51 behavioral objectives and 149 discrete, measurable outcomes for BHP.
Levels of Expertise: BHP should achieve three levels within each competency: Novice, Proficient, and Authority (Hilty et al., 2017; Maheu et al., 2018).
Novice: Aware of the scope of issues relevant to the technology.
Proficient: Able to practice within the scope of the technology.
Authority: Can provide feedback and troubleshoot problems.
Prerequisite for Digital Health Competencies: A prior understanding and demonstrated capability with in-person treatment; digital health competencies build upon existing clinical skills.
Training Program Development: Similarities and differences between in-person, mobile-based apps, and synchronous telehealth should be leveraged.
Challenges to Competency Development: Organizational, leadership, and funding issues, highlighting training as a lifelong practice.
Ethical Codes: Lustgarten and Elhai (2018) encouraged adherence to American Counseling Association (ACA) and American Psychological Association (APA) ethical codes, emphasizing legal and ethical risks.
Competencies focused on legal and ethical concerns across five domains: legal, welfare, privacy and confidentiality, security, and boundaries.
BHP should use thoughtful clinical judgment.
Inter-Professional Framework: Hilty et al. (2017) called for an inter-professional framework.
Evidence for Telehealth Competencies: Presented a table of telehealth competencies with 3 proficiency levels (novice, proficient, expert).
Frameworks for Competency Development: From associations like ATA, APA, ACA, NASW, Association of Addiction Professionals, British Psychological Society, and Australian Psychological Society.
Similarities/Differences between Professions: Differences may depend on state and regulatory boards, but article supports inter-professional guidelines.
Telehealth
One article by Turvey et al. (2013) provided recommendations for using telehealth, based on ATA practice guidelines from an interdisciplinary group.
Focus: Real-time synchronous videoconferencing via personal computers or mobile devices.
Therapy as "Science and Art": Guidelines are important but do not guarantee effective care implementation.
Guidelines are not mandatory: BHP may not be required to follow them.
Standard for Care: Proposed standards for safe and effective care, with technology use left to clinical judgment based on patient need.
mHealth
Three articles focused on guidelines and competencies for mHealth utilization.
Hilty et al. (2020): Addressed specific differences for mHealth training based on previous recommendations (Hilty et al., 2015, 2018).
Asynchronous Communication: Platforms like texting necessitate consideration of data delivery delays, leading to therapeutic boundary and data management concerns.
Informed Consent: Opportunity to discuss boundary issues and social media use early in treatment.
Clinical Ramifications: Inappropriate use can have negative clinical outcomes.
Educational Considerations: Using the Accreditation Council of Graduate Medical Education (ACGME) framework to develop skills based on telehealth and social media use.
Faculty involved in assessment during patient care and seminars.
Learners assessed at novice, proficient, and authority levels.
Clinical supervision encouraged; on-call supervision may be needed due to mHealth's asynchronous nature.
Armstrong et al. (2018): Developed and evaluated a competency-based training program for mHealth integration in military/VA behavioral health settings.
Curriculum Focus: DoD/VA mobile apps, but applicable to any mHealth app.
Five Core Competencies: Evidence base, clinical integration, security and privacy, ethical issues, and cultural considerations.
Workshop Design: Focused solely on mHealth skills, assuming master's/doctoral-level trainees were seasoned clinicians.
Outcomes: Knowledge of mHealth apps improved 3 months after training; 92\% of trainees used apps for patient care. Did not assess patient outcomes but suggested apps could empower patients.
Chan et al. (2017): Literature review and professional experiences on integrating mobile apps.
Key Points for Effective Use: Understanding app capabilities/features, addressing workflow issues, and considering cultural/access issues.
Types of Apps: Ecological momentary assessment (real-time symptom tracking), virtual/augmented reality (for anxiety, substance abuse, pain distraction).
App Evaluation: Important to evaluate clinical, business, and information system aspects using available guidelines.
eHealth
One article by Hilty et al. (2018) addressed eHealth use for BHP.
Guidance: Used previously discussed digital health competencies (Hilty et al., 2015; Maheu et al., 2018) for teaching about asynchronous social media and networking.
Updated Competencies: Novice and proficient levels adapted for nuances between synchronous virtual meetings and sporadic/delayed asynchronous communication.
BHP Recommendations:
Seek help or information from experts/organizations.
Be cautious about privacy and confidentiality.
Be wary of clients using email, text messaging, or social media between scheduled meetings.
Risk Communication: BHP cannot guarantee privacy/confidentiality for emails, texts, social media, and must inform clients of these risks.
Marriage and Family Therapists (MFT)
Only one article in the review addressed MFT competencies for DHT.
This finding is surprising given AAMFT's Code of Ethics emphasizes online therapy competency and MFT board exams include related questions (Blumer et al., 2015).
eHealth
Blumer et al. (2015) conducted a survey exploring MFT's observations and experiences with eHealth training and opinions on online therapy competency.
Key Finding: A significant gap exists between professional expectations (ethical code, board exams) and available training opportunities for eHealth competency.
Recommended Competencies:
Ethical and legal issues related to eHealth.
Confidentiality and privacy concerns.
Information on how to utilize eHealth.
Safety and security issues.
Research on the use of eHealth for therapy.
Recommendations: Integration of eHealth education into graduate school curricula and development of continuing education for current MFTs to align with ethical codes.
Psychologists
Three articles addressed ethics or competencies for psychologists using DHT.
APA Guidelines: Published guidelines for telehealth in 2013 but had not updated them for eHealth or mHealth (American Psychological Association, 2013).
CPA Guidelines: Canadian Psychological Association (CPA) guidelines were lacking, though some individual provinces provided guidance (Johnson, 2014).
Two reviewed articles used APA ethics or CPA guidelines; one focused on mHealth ethical issues (Edwards-Stewart et al., 2019).
Digital Health
Johnson (2014) reported a lack of standard competency guidelines for psychologists integrating digital health in Canada, leading to concerns about substandard care.
Recommendations for Competency Categories (based on CPA framework):
Interpersonal relationships: Telepresence, technical communication skills.
Assessment and evaluation: Client characteristics, assessment via distance technologies.
Intervention and consultation: Selection of distance technologies, general technical skills, tailoring interventions.
Research: Efficacy research, future research.
Ethics and standards: Privacy and confidentiality, emergency and risk management, jurisdiction of practice, competency training and standards.
These competencies, though Canadian-based, may be applicable in the U.S.
Telehealth
McCord et al. (2015) described the Telehealth Counseling Clinic at Texas A&M University, a pre-doctoral psychology internship training program.
Goal: Increase the number of psychologists competent in telehealth to improve access to behavioral healthcare in rural and underserved areas.
Areas of Training: Basic counseling, community, scientist-practitioner, and telehealth.
Telehealth Competencies:
Telehealth technical skills.
Telehealth clinical skills.
Selecting appropriate clients and interventions.
Initiating, maintaining, and terminating therapy.
These competencies were similar to Johnson's (2014) digital health recommendations despite platform and country differences.
mHealth
Edwards-Stewart et al. (2019) reviewed APA's ethical standards for mHealth use.
APA Ethical Principles: Applied beneficence and non-maleficence, and justice, emphasizing informing patients of benefits/risks and using evidence-based apps.
APA Ethical Standards Focus: Boundaries of competence, informed consent, confidentiality, documentation, and records disposal.
Key Emphases for mHealth Use:
Proficiency in apps used.
Clear expectations with patients regarding risks, benefits, and boundaries.
Obtaining and documenting informed consent.
Understanding and describing data security to patients.
Ways to increase data security (passcodes, mobile device management).
Psychologists are encouraged to use professional judgment.
Psychiatrists
Seven articles discussed ethics or competencies for psychiatrists integrating digital health.
Psychiatry has recognized the importance of digital health since the late 1990s, with APA first providing guidance on telehealth.
Recent resources from APA cover telehealth, legal issues, and internet-based psychiatry (Shore et al., 2018).
2 articles examined mHealth (Hilty et al., 2019a; Torous & Roberts, 2017).
2 articles examined ethical issues related to eHealth (DeJong et al., 2012; Sabin & Harland, 2017).
Telehealth
Three articles addressed telehealth competency development for psychiatrists (Hilty et al., 2015; Saeed et al., 2017; Shore et al., 2018).
Hilty et al. (2015): Overview of telehealth background, competencies for practicing/supervising, and teaching methods.
ACGME Framework: Competencies presented within this framework, using proficiency levels similar to competency-based medical education.
Eight Competency Themes:
(a) Patient care
(b) Communication
(c) Systems-based practice
(d) Inter-professional education
(e) Professionalism
(f) Practice-based learning
(g) Knowledge
(h) TechnologyDetailed skills for each proficiency level within themes.
Saeed et al. (2017): Investigated psychiatrists' interest in telehealth and recommended competencies for graduate medical education.
Findings: Most residents and program directors were interested and believed a telehealth curriculum was needed, despite lack of formal programs.
ACGME Framework: Competencies focused on acquiring telehealth skills, including:
Awareness of patient's location (due to varying laws/licensure).
Protecting patient privacy and security.
Determining appropriateness of telehealth.
Recommendations: Telehealth education in graduate medical school and training for current psychiatrists through continuing education, readings, online programs.
Shore et al. (2018): Guide for psychiatrists on telehealth based on APA and ATA guidelines.
Broad Competencies:
(a) Administrative work
(b) Technical skills
(c) Clinical care
(d) Ethical practices
(e) Cultural factors
(f) Special populations and settings (e.g., home-based synchronous video for geriatrics).Many competencies include subtopics for detail and nuance.
mHealth
Two articles addressed mHealth competencies or ethics for psychiatry.
Hilty et al. (2019a): Adapted previous frameworks/proficiency levels for mHealth (Hilty et al., 2015, 2017, 2020).
Reviewed impacts of mHealth on academics, clinical care, behavioral healthcare culture, and cultural/societal factors influencing adoption.
Torous and Roberts (2017): Examined ethical issues of mHealth in psychiatry using case vignettes and steps for safe care.
Ethical Conflicts: Patients identifying apps not aligned with treatment, confidentiality/data security concerns, misleading information from companies.
Steps for Ethical mHealth Use:
(a) Ensuring patient and rapport benefit.
(b) Weighing app risks.
(c) Obtaining informed consent.
(d) Discussing confidentiality and privacy.
(e) Confirming app fits treatment plan.These largely involve discussion with the patient.
eHealth
Two articles examined professionalism and ethics of eHealth for psychiatrists.
DeJong et al. (2012): Discussed ethical and professionalism issues.
Issues: Liability, confidentiality/privacy, psychotherapy/boundaries, safety/mandated reporting, libel, conflicts of interest, academic issues, "netiquette."
Social Media Risks: Patients finding personal info, inappropriate relationships/communication.
Email Risks: Liability, "netiquette" (response time, miscommunication due to lack of non-verbal cues, unprofessional responses).
Patient-targeted Web Searches: Could negatively impact therapeutic rapport.
Mitigation Strategies:
(a) Limit publicly available personal details and privatize social media.
(b) Set clear boundaries for email/social media communication.
(c) Pause before responding to emails.
(d) Avoid patient-targeted internet searches without exploring motives and impact on rapport.
(e) Be aware of multiple roles and online endorsements.
(f) Avoid intentional/unintentional plagiarism.
Sabin and Harland (2017): Review of ethics and eHealth in psychiatry.
Crucial Topics: Clinical boundaries, privacy/confidentiality, digital communication, digital professionalism.
Discussed impact of social media, Google, email on patient-psychiatrist relationship.
Digital Professionalism: Requires self-discipline and adherence to ethical norms even when off-duty.
Medical School Recommendation: Discuss digital professionalism and internet/social media pitfalls.
These articles emphasize reputation and professional boundaries, which could be breached through eHealth.
Social Workers
Four articles related to ethics and competency recommendations for social workers were included.
Articles utilized social work ethics to inform competencies and consider legal/ethical issues with DHT.
Digital Health
Two articles by Frederic Reamer (2013, 2015) described DHT use (online chat, phone counseling, telehealth, avatars, web-based interventions, social media, email, text).
Ethical Challenges: First addressed in the NASW Code of Ethics in 1996.
NASW/ASWB Standards: Reamer (2013) and Lopez (2014) referred to 2005 recommended standards for social workers and technology.
Need for Updates: Lopez (2014) suggested strengthening/updating the 2005 recommendations, illustrating that standards struggle to keep pace with technology development.
Reamer (2015) Emphases: Informed consent, privacy/confidentiality, maintaining boundaries, dual relationships, avoiding conflicts of interest.
Case Examples: Being asked to "friend" a patient on social media, requiring attention to professional guidelines.
Impact on Therapeutic Relationship: Considered how DHT affects it.
Eight Risk Management Recommendations:
Consult colleagues with digital technology expertise for ethical decision-making.
Obtain supervision to increase skills and address liability issues.
Review ethical standards of NASW and other professional associations.
Be familiar with relevant regulations, laws, and policies.
Develop a social media policy for clients or staff.
Be familiar with current literature on digital care.
Obtain legal consultation when necessary.
Document decision-making steps to ensure quality care.
eHealth
Mattison (2012) called for professional guidelines for social workers using eHealth.
Email Communication: Discussed benefits and challenges.
Emphasis on Caution: Due to ethical concerns and legal risks (confidentiality, privacy, clear boundaries).
Security Breaches: A constant risk with online communication; privacy can be strengthened with encryption and passwords.
Recommended Competency Standards: Social workers need to be technologically literate and clearly understand "core rules and practices of courteous internet communication" (Mattison, 2012, p. 254).
Overall Similarities and Differences in Competencies
Similar Competencies Across All Platforms and Disciplines:
Clinical skills (ability to deliver behavioral health treatment)
Technical skills (ability to use technology and mitigate risks)
Privacy and confidentiality (ability to maintain patient privacy)
Ethics (ability to use DHT congruent with professional ethical standards)
Differences Across Behavioral Health Professions:
General BHP: Competencies largely focused on clinical skills and ethical/legal considerations. Differences across DHT platforms related to clinical tasks (e.g., informed consent) or digital professionalism (e.g., boundaries, conflicts of interest).
Psychiatrists: Mostly focused on clinical skills or ethical/legal considerations. Technical skills (DHT operational) and administrative tasks (billing) differed most across platforms.
Psychologists: Technical skills and clinical skills were common competencies.
Social Workers: Similarities included clinical skills and ethical/legal considerations. Technical skills differed between general DHT and eHealth platforms.
MFT: Only one article, so cross-platform comparison was not applicable.
Discussion
This rapid review provides an updated overview of available DHT competencies across the behavioral health field.
It identifies inter-professional competencies for BHP to inform graduate education, continuing education, and training programs.
Recommended Digital Health Inter-Professional Competencies (Table 2):
(a) Privacy, security, and patient safety: Maintain privacy/confidentiality, understand data transmission/security, communicate clearly to patients, identify patient safety methods, create emergency plans (technical problems, risk management like suicide), help patients identify support persons.
(b) Digital health technical skills: Complete training, operate/instruct patients on tools, troubleshoot common problems, understand evidence-based support, recognize when to leverage multiple technologies, continuously expand competencies, identify interdisciplinary education opportunities.
(c) Ethical and legal considerations: Understand relevant laws (provider/patient location), confirm licensure, obtain informed consent, follow ethical codes/standards, set clear boundaries (online presence, social media), demonstrate professional behavior.
(d) Clinical skills: Confirm patient identification/location, establish provider identity/credibility, conduct intake (including prior DHT experience), identify appropriate assessments, consider cultural/diversity factors (access, receptivity), discuss DHT integration into treatment plan.
(e) Art of therapy and digital health: Provide clear expectations for communication (e.g., email response times), identify/adjust appropriate technology, inform patients of risks/benefits, adapt therapeutic presence for alliance, monitor/repair alliance fractures, reflect on skills/areas of growth, seek consultation.
(f) Administrative tasks: Include DHT use in clinical documentation/EHR, use appropriate billing codes, integrate DHT into clinic workflow, coordinate care with team, provide community outreach.
"Art of Therapy and Digital Health" Explanation: Focuses on clinical skills to adapt therapy and rapport to digital format, including understanding technology's impact on non-verbal communication, patient characteristics, and DHT selection. E.g., planning for technology failure, screen framing, lighting, background, sound.
Further Questions Raised: How BHP are currently accessing/learning about DHT, training opportunities, and effectiveness of training on patient well-being.
Importance of Competence: Vital for patient well-being, requires continued education, training, and supervision (similar to other clinical skills).
Challenge: Different behavioral health disciplines may have varying requirements, guidelines, and expectations (e.g., within one clinic, psychiatrists, social workers, MFTs, psychologists each have unique codes of ethics).
Staying Current: As technology evolves, BHP must demonstrate currency with changes.
Targeted Training: A more targeted approach to DHT training can address specific skill development needs without diminishing the importance of ethics, culture, and security.
Delivery Methods for DHT Competencies: Graduate school education, continuing education opportunities, and various training programs.
Variety of options needed for individualized training.
Graduate school integration allows concurrent development of clinical and digital health skills.
Continuing education for practicing BHP to acquire new skills.
Affordable, manageable, and accessible learning for those new to DHT.
Limitations of the Rapid Review
Did not include other behavioral health professionals (e.g., licensed professional counselors, psychiatric nurse practitioners).
Limited to articles from 2010 through October 2020; does not assess pandemic impact on competencies.
Did not include evidence on benefits or challenges of integrating DHT.
Search terms were broad (e.g., "behavioral health" instead of specific professions); general technology terms like "eHealth" and "digital health" that didn't yield unique results were removed from initial search strategy.
No quality assessment of included articles.
Difficult to assess wide variation in nomenclature for DHT across articles.
Ethics and competencies were sometimes used interchangeably, creating potential confusion.
Conclusion and Future Research
This article synthesizes DHT competencies and ethics over the past decade.
Competencies alone do not guarantee effective DHT implementation (Maheu et al., 2018).
Further Research Needed: To assess how identified competencies prepare BHP, including risks and benefits of specific technologies.
Ethics inform competencies, but they are not the same (Torous & Roberts, 2017).
Blurry boundaries exist between risk management (protecting BHP) and patient/client data protection.
Recommendation: Acknowledge intertwined nature of competencies and ethics; BHP should investigate relevant laws and ethical codes for their profession.
Need for Clear Boundaries: To ensure BHP remain focused on the primary goal of integrating technology: improving patients' quality of life and overall health.