Behavioral Telehealth

This forum will host discussions about such topics as:

  1. Computer-assisted behavioral assessments
  2. Behavioral symptom monitoring
  3. Psychophysiological monitoring and Rx
  4. Computer-assisted therapy
  5. Behavior change tools
  6. Adherence to treatment
  7. Lifestyle modification and risk reduction
  8. Decision support and education

In addition, this forum will include discussions about telehealth applications such as:

  • Behavioral aspects of disease management applications
  • Pure behavioral health implementations
  • Managing comorbid mental disorders
  • Behavioral risk stratification
  • Behavior change
  • Adherence issues
  • Public health emergencies (e.g., pandemic avian flu)
  • Disasters
  • Terrorism
  • Outbreaks

Behavioral telehealth also addresses the intersection of primary care and psychiatry where there is behavioral comorbidity:

  • Depression
  • Anxiety disorders (GAD, PD, SAD, PTSD)
  • Substance use disorders
  • Domestic violence
  • Lifestyle related (obesity, sedentary)
  • Somatization (sub-syndromal)
  • OCD spectrum disorders
  • Somatoform disorders (chronic pain)

Controversial and/or unresolved issues in the delivery of behavioral telehealth services include:

  • Reimbursement for telecare or telecoaching
  • Licensing and inter-state practice: coaching vs. therapy
  • Liability exposure
  • FDA approval for “medical devices”
  • Acceptance into practice mainstream
  • Penetration into the marketplace
  • Competition vs. “Coopetition” among vendors
  • Clinical effectiveness research
  • Cost effectiveness research

Steven Locke, MD will serve as your forum editor. Dr. Locke is a principal in Veritas Health Solutions, a behavioral telehealth consulting group based in Boston. He is also an Associate Professor of Psychiatry at Harvard Medical School and an Associate Professor of Health Sciences and Technology at MIT. Dr. Locke is a research psychiatrist at the Harvard Center for Medical Simulation and in the Center for Clinical Computing at Beth Israel Deaconess Medical Center. He serves as a member of the Scientific Advisory Council of the Harvard Center for Public Health Preparedness and chairs the Pandemic Flu Task Force in Wayland, MA.

Member Comments

I have been interested in the idea of organizing a conference around the issue of whether “telecoaching” — providing self-care guidance over the web or telephone — is an educational intervention, and therefore not governed by state licensing regulations that govern health professionals such as doctors and nurses. This is of considerable interest to providers, patients, health plans, and disease management (DM) vendors, among others. One medical director of a DM company told me that in one U.S. state, anything a nurse does in a relationship with a patient is considered by the nursing board to be nursing practice and requires a license in that state, even if they are calling by phone from another state. The patchwork quilt of regulations varying from state to state regarding telehealth licensure is an impediment to the growth of behavioral telehealth applications. It might be useful to have a one-day invitational meeting to address the licensing issues. Key stakeholders to invite would be directors of boards of registration in nursing and medicine from the Northest region, medical directors of health plans and large medical groups, providers, patients, employers, and vendors. What do you think of this issue and the proposed idea for a meeting? – Stephen Locke

I am a lifestyle fitness coach (and personal trainer) with certifications, and I have had success with national telecoaching of men and women in eating, exercise and self care. I believe that fitness educated coaches that do telecoaching can provide a valuable service to the medical community and would be invaluable to your discussion. – Alice Greene

The industry of Health Coaching would gain momentum if there was a national (global) certifying entity that defined the role and qualifications. Currently under Health Coaching fall Health Guides, Health Advocates, Health Navigators, Nurse Coaches and other roles that are defined only by individual producers as no industry standard exits. The standards for licensed professional are defined by state. Health Coaches are not licensed, are not defined by state and cannot diagnose and prescribe. Thus, a nurse can add health coaching skills, as a physician can add health coaching skills, to their medical practice, however, if that nurse practices in the role of Health Coach as a professional Health Coach, then they would need to abide by Health Coaching professions guidelines. The question remains as to who is setting those guidelines. We at World Health and Healing Collaborative produce and offer telphonic health coaching services and training programs. Most of the web based inquiries we receive are individuals inquiring about certification! Their education level ranges from high school through MD and PHD and their health coach training range is likewise from minimal to maximal. It would be tremendously useful to have a one-day invitational meeting to address the licensing and or certification issues. – Ryma

Thanks Alice and Ryma for your important comments about health coaching. One related and interesting issue was highlighted during a conversation I had recently with a medical director of a disease management organization. He said the Director of the Board of Registration in Nursing in one state told him that any time a nurse talks to a patient about a clinical matter she consideres that to be the practice of nursing and thus requiring a license in her state. If the nurse is located in a call center in another state, and the patient is in her state, the nursing board director considers the care manager or health coach, no matter what she calls herself or her activity, to be engaged in the practice of nursing and would require that the nurse be licensed in her (the director’s) state. So this is likely to vary state by state, making it important that the Federal Government, a major stakeholder due to MediCare, weigh in and try to fix this problem. – Steven Locke

Hello, I am very happy to be part of this group. I have been very much engaged in the implementation of virtual reality environments for therapies and emergency preparedness. I would like to point to this group our ongoing work in emergency preparedness training in a virtual environment ( My team is primarily on the technical end of the things, and we have to resources to create virtual environments. I will be very happy to create a virtual 3D meeting place for on one of my virtual islands. This will be a great start and a way to introduce to this group the potential of the next evolutions of the web. We have talked a lot about web2.0 but it seems that web 3.0 is already round the corner. – Ramesh

A Connected Health resource.