Advocating Access - Dr. Michael Aharoni Brings Mental Health Services to Underserved Populations

ADVOCATING ACCESS

DIALOGUE:

THE CALSOUTHERN INTERVIEW THE CALIFORNIA SOUTHERN UNIVERSITY FORUM FOR

EXC ELLENC E IN P S YC HO LO GY

Founded in 1978

Dialogue: The CalSouthern Interview

ADVOCATING ACCESS CalSouthern alumnus Dr. Michael Aharoni, a pioneer in the field of video therapy, brings mental health services to underserved populations.

By Tom Dellner

“ With the proliferation of laptops, smartphones, tablets like the iPad, and near-ubiquitous wifi access, we’ll be able to provide mental health services practically everywhere—borders and barriers to therapy are rapidly dissolving.”

For Dr. Michael Aharoni, the seed of inspiration was sewn more than 10 years ago. It was the result of a conversation he had had with his sister-in-law. She owned an agency that supplied interpreting services for the hearing impaired, and was experimenting with an application that could enable her to provide these services to her clients via video, rather than having to dispatch sign language experts to remote locations. It would result in tremendous business efficiencies. Would Dr. Aharoni be interested in investing in the idea?

Today, realizing that potential is Dr. Aharoni’s life’s work. The CalSouthern alumnus is now a pioneer in video therapy and the Founder and Clinical Director of Access to Therapy Network, a nationwide pool of licensed therapists and specialists who provide mental health services via video to clients across the country utilizing high-definition video and audio conferencing technology.

CalSouthern sat down with Dr. Aharoni to discuss Access to Therapy Network, the evolution of video therapy, and its unique application to a variety of populations, including the military.

Dr. Aharoni passed—thinking that the technology wasn’t quite there yet—but the conversation stuck with him. He became increasingly intrigued with the notion of delivering therapy via video, and the potential to reach the many thousands of individuals who might not otherwise have access to mental health services.

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Dialogue: The CalSouthern Interview

CalSouthern: In your experience, what sorts of

Dr. Aharoni: Regarding the first question, the short answer is “no”—video therapy essentially duplicates the types of therapy that would be conducted in an office setting for the benefit of clients that don’t have access to therapists for faceto-face sessions. It does require a bit of practice on the therapists’ part, but we’ve found that the adjustment is easy to make. And it compares very well with traditional therapy; it’s in the 90th to 92nd percentile in terms of efficacy. However, it’s important to keep in mind that video therapy is not designed to replace in-office sessions for those that are able to undergo traditional therapy, but rather to provide access to those who are suffering needlessly due to a lack of access to mental health professionals.

populations benefit most from video therapy?

Dr. Michael Aharoni: There are hundreds of thousands of people suffering from mental health disorders who don’t have access to traditional therapy. Many are confined to their homes because of physical or emotional limitations. In addition, 50 to 60 percent of the country’s population still live in remote areas or rural communities that may have a limited number of mental health providers.

And military service members—who we know face a disproportionate number of mental health issues—are extremely underserved when it comes to mental health. There may be an insufficient number of therapists on or around the bases where they are stationed, or few practitioners in service members’ communities with experience dealing with their unique issues and needs. Video therapy allows us to connect these populations with licensed therapists who can provide the services they need.

CalSouthern: What do you think accounts for that slight difference in efficacy?

Dr. Aharoni: I think it has to do mostly with the atmosphere, with being in the presence of a video image instead of a warm body. A certain percentage of people might have difficulty connecting with a therapist over the video medium or just aren’t comfortable with it. The other issue is that there are certain diagnoses or issues that simply aren’t wellsuited for treatment via video therapy.

CalSouthern: Does video therapy require the practitioner to make significant modifications to their therapeutic techniques? Is its efficacy comparable to traditional therapy?

“ The majority of issues we deal with— behavioral issues, relationship issues, depression, anxiety, post traumatic stress disorder (PTSD), that which makes up the vast majority of what most therapists see on a day-to-day basis—can be treated via video therapy.”

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a hub, a place where people can come to get information on a variety of psychological issues and to connect with a network of therapists all over the country. The idea was to make it as easy and intuitive as possible.

Dr. Aharoni: People who have suicidal ideation or who otherwise need hospitalization or assessment for psychotic disorders; these people are simply not stable enough. But the majority of issues we deal with—behavioral issues, relationship issues, depression, anxiety, post traumatic stress disorder (PTSD), that which makes up the vast majority of what most therapists see on a day-to-day basis— can be treated via video therapy.

Say a client in California, for example, is looking for a therapist. Because licensed therapists can only work with residents of that state, the client will click on California from a map of the country and is then presented with a directory of network therapists in the state, complete with bios and any other information the therapists would like to make available.

CalSouthern: Are there any technological barriers to treatment?

Once the client selects a therapist and supplies his/ her contact information, the therapist will contact the client to discuss his/her condition, schedule a time, and agree on a fee.

Dr. Aharoni: Good question. The major components that one needs—whether it’s the therapist or the client—are a computer, Internet connection, and a webcam. Of course, Internet connection reliability and/or speeds can vary, which can affect either the audio or video aspects of the experience, creating issues of clarity. However, connection speeds have improved dramatically in recent years and in most cases, picture and audio quality, as well as audio-video synchronization, are excellent. Also, the clients’ confidentiality is maintained; the network is fully HIPAA-approved.

All this information is recorded on the website, which sets up an account for the client. If the person is new to the network, Access to Therapy Network will contact the client to ensure that he/ she is set up with the proper equipment, and to conduct a demo session so that the client is comfortable with the technology and that everything is working perfectly prior to the first session.

CalSouthern: Can you tell us a bit about the Access to Therapy model? How does it work?

On the date and time of the session, the client goes to the website, accesses his/her account, and clicks on a provided link to connect directly to the therapist to begin therapy.

Dr. Aharoni: About five years ago I developed a website-based model for a therapy network, which has grown into the Access to Therapy Network.

The website (www.accesstotherapy.com) acts as

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Dialogue: The CalSouthern Interview

CalSouthern: What are some of those issues?

Dialogue: The CalSouthern Interview

CalSouthern: Please tell us a little about your work with the military. Why is video therapy so wellsuited for our service men and women?

Dr. Aharoni: First, there aren’t enough therapists who are trained in military culture. There’s a critical shortage of these practitioners, especially in the areas where the military population is located.

Exacerbating the problem is that there’s a much greater need for therapists. With the extended wars in Iraq and Afghanistan, we are seeing more and more service members coming back with Post Traumatic Stress Disorder, Traumatic Brain Injury, anxiety, etc. Video permits us to summon more therapists to meet the growing needs of the military personnel and their families. (It’s important to remember that it’s not just the service member who is affected. For every military service member, there are another three or four people who are closely related to that person—spouses, children, parents—who are impacted by the experience and may need help.)

CalSouthern: What has the response been?

Dr. Aharoni: Response to the idea has been uniformly positive, and people seemed to “get it” right away—both practitioners and clients.

One reason is that medical doctors have utilized telemedicine for decades to provide specialized diagnoses and treatment to patients in remote locations. So the model is established and proven, at least in the medical community.

We are focusing intently on this population. As you might expect, there’s a significant amount of red tape that one encounters when working with the military, but it’s beginning to open up.

Building out the network has been relatively easy, as well. I’ve been pleased to contract with wellqualified, licensed therapists nationwide who are looking to grow their practices. The client side has grown more slowly. It requires a very significant marketing effort. We are focusing on California— as well as the military—initially, and will expand strategically as we grow. We’ll target Florida, New York, Arizona, Colorado, and Alaska (where there is a substantial population of people in remote areas with limited access to mental health care) next.

For example, TRICARE is the military’s health care program. It’s the first major insurance program to approve payment for psychological treatment via video therapy, and we are currently seeing military clients around the country. (We also expect all major private insurance providers to cover video therapy either this year or next. They are working toward that direction already. Telemedicine has provided them with the model. But changing policies takes time.)

CalSouthern: What types of services do you offer?

Dr. Aharoni: We offer psychotherapy, counseling, life coaching, mediation, crisis management, and conflict resolution, among other services. We also have a psychiatrist that will be joining our team soon. In addition, students in CalSouthern’s School of Behavioral Sciences might be interested to learn that we work with psych interns (students taking practicum/internship courses) and provide supervision—this provides an excellent opportunity for the intern and, for certain clients, a more affordably priced service alternative.

“ There aren’t enough therapists trained in the military culture. There’s a critical shortage of these practitioners, especially in the areas where the military population is located.”

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sessions to seven or eight) on the screen at the same time. Perhaps they meet weekly with a licensed facilitator; the service members get that critical support: they’re able to see each other, speak to one another, and have that contact. It’s a tremendously valuable tool, and another excellent example of video therapy’s application to the military.

Dr. Aharoni: In addition to the main advantage of providing the access to the services in the first place, there are others, as well. Let’s say a marine is coming back from his second or third tour. With video, we can conduct a session with that marine, who may live on a base, and his wife, who may live in another location to conduct marriage or relationship counseling.

CalSouthern: What do you foresee for the future of video therapy?

Dr. Aharoni: The technology is continually getting better and more reliable. In most cases, we’re already doing HD-quality work. With the proliferation of laptops, smartphones, tablets like the iPad, and near-ubiquitous wifi access, we’ll be able to provide mental health services practically everywhere—borders and barriers to therapy are rapidly dissolving. And as people becoming increasingly comfortable with video communication as the technology grows, any resistance or hesitancy to embrace video therapy will fade away.

We can also access that service member’s support system, which might not live in the same area.

This group support is so important. When service members come back from a tour, the unit often breaks up and scatters, making access to that support system (with which the service member has shared the experience of combat) impossible by traditional methods. But through video, we can conduct group therapy with as many as 16 people (although we usually limit these group

Dialogue: The CalSouthern Interview is published in conjunction with the California Southern University Forum for Excellence in Psychology, a content initiative designed to highlight excellence in research, scholarship, practice, and humanitarian work in the behavioral sciences.

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Dialogue: The CalSouthern Interview

CalSouthern: In what ways can video therapy provide advantages over traditional therapy in the military setting?