Appendix A
Supplementary Online Material
We are interested in your perceptions and experiences of using telemental health (TMH) before and during the COVID-19 Pandemic. All responses will be kept confidential and anonymous.
Demographics & Professional Information
Discipline (Psychology, Psychiatry, Social Work, Nursing/APRN, Other _____ )
Age: ______
Gender (Female, Male, Transgender, Other) optional
Race/Ethnicity (Caucasian, African American, Latino/a, Asian/Pacific Islander, Middle Eastern, Mixed Race, Other _____) optional
Sexual Orientation (Heterosexual, Homosexual, Bisexual, Queer, Other ____ ) optional
Employment Setting (Veterans Affairs Healthcare System, Academic/Medical Center, Hospital, Clinic, Community Mental Health Center, Private Practice,
Education/Academia, Government, Research, Other ____ )
State you work in (drop-down list)
Position type (Full-Time Staff, Temporary/Trainee)
o Licensed (Yes, No) Supervised (Yes, No) o Years in Current Position _____
o Years Licensed ______
Do you currently live alone? (I live alone; I live with others)
o If living with others Who do you live with? (select all that apply)
Spouse or domestic partner
Child/Children
Roommate or Friend
Romantic partner
Other: _____
Do you have children (Yes, No)
o If YES How many children are currently at home with you?
o List their ages: ________
Do you have pet(s)? (Yes, No)
Experience with Telemental Health Prior to the COVID-19 Pandemic:
Had you had any experience with TMH? (Yes, No)
o If YES How would you categorize your experience with TMH? (Rarely Used, Occasionally Used, Sometimes Used, Above Average Use, Regular Use)
Had you had any formal training in TMH? (Yes, No) o If YES Where did you receive your training from?
National organization (APA, ApA, NASW), State Association/Group, Veterans Affairs Healthcare System, Hospital/Clinic, Practice, Online Continuing Education, Other _____-
Had you received any information about how to use TMH in terms of logistics and technology? (Yes, No)
I had positive feelings about TMH (1-5 likert; “not at all” “very much”) o Please elaborate: ___________
I had negative feelings about TMH (1-5 likert; “not at all” “very much”) o Please elaborate: ___________
I felt that TMH was important (1-5 likert, “not at all” “very much”)
I felt that TMH was necessary (1-5 likert, “not at all” “very much”)
I was interested in learning about and utilizing TMH in my practice (1-5 likert, “not at all” “very much”)
I believed that TMH was an effective method of providing psychological services (1-5 likert, “not at all” “very much”)
I believed that TMH was as effective as face-to-face service delivery (1-5 likert, “not at all” “very much”)
How would you most accurately describe your experience with TMH prior to COVID- 19? (select all that apply)
o I had used TMH once or twice in my practice to see what it is like o I had used TMH with select clients to accommodate a specific need
o I had used TMH with several of my clients based on need and their preferences o I regularly offered TMH to my clients as an option for their care
o I used TMH regularly in my clinical practice o I used TMH exclusively in my clinical practice
How would you most accurately describe your attitude towards TMH prior to COVID- 19? (select all that apply)
o I had no interest in using TMH in my clinical practice o I had used TMH, but only because my job/clinic required it o I had used TMH, but only when a client requested or required it o I was ambivalent about TMH
o I liked using TMH and saw it as a viable option for clinical service delivery o I did not like TMH and preferred not to have to use it in my clinical practice During the COVID-19 Pandemic:
I am using TMH for the first time (Yes, No)
I am required to use TMH as part of my job or due to state mandates/social distancing (Yes, No)
I am choosing to use TMH for clinical service delivery (Yes, No)
I am continuing to provide services as I normally would in my practice, e.g. face-to-face (Yes, No)
I am choosing not to practice as I do not feel able to, or comfortable seeing, clients face- to-face (Yes, No)
How would you categorize your experience with TMH during the COVID-19 Pandemic?
(Rarely Using, Occasionally Using, Sometimes Using, Almost Always Using, Always Using)
Before using TMH for the first time, did you receive any formal training in TMH? (Yes, No)
o If YES Where did you receive your training from?
National organization (APA, ApA, NASW), State Association/Group, Veterans Affairs Healthcare System, Hospital/Clinic, Practice, Online Continuing Education, Other
Did you receive any information about how to use TMH in terms of logistics and technology? (Yes, No)
o If YES Where did you receive your information from?
National organization (APA, ApA, NASW), State Association/Group, Veterans Affairs Healthcare System, Hospital/Clinic, Practice, Online Continuing Education, Other What platforms are you using to deliver TMH during the COVID-19 Pandemic?
o VA/VVC, A Non-VA HIPAA-Compliant Platform (Doxy, Simple Practice, VSee), Other Video Platform (Zoom, Skype, Facetime, etc), Telephone o What platform are you using primarily? (same choices)
o How effective is this platform in helping you deliver TMH? (1-5; “not at all effective” “very effective”)
o On average, how good is your connectivity using this platform? (1-5; “poor”
“very good”)
When using TMH, do you feel able to deliver services as you normally would? (Yes, No)
Do you have to make modifications to the way you normally practice in order to use TMH? (Yes, No)
o Please elaborate: _______
What have been the biggest challenges that you are experiencing in transitioning to TMH? ________________
Looking back, what information or experiences do you wish you had ahead of time (prior to the Pandemic?) _____________________
o More formal training in TMH and the relevant technologies o More experience using TMH
o More information about the efficacy of TMH (research data, etc)
What would have been helpful to you as you started to transition to TMH? _________
How prepared do you feel to use TMH, from a psychotherapy perspective? (1-5 likert;
“not at all” “very much”))
How prepared do you feel to use TMH, from a technology perspective? (1-5 likert; “not at all” “very much”)
I have positive feelings about TMH (1-5 likert; “not at all” “very much”) o Please elaborate: ___________
I have negative feelings about TMH (1-5 likert; “not at all” “very much”) o Please elaborate: ___________
I feel that TMH is important (1-5 likert, “not at all important” “very important”)
I feel that TMH is necessary (1-5 likert, “not at all” “very much”)
I am interested in learning more about, and utilizing TMH, in my practice going forward (1-5 likert, “not at all” “very much”)
I believe that TMH is an effective method of providing psychological services (1-5 likert,
“not at all effective” “very effective”)
I believe that TMH is as effective as face-to-face service delivery (1-5 likert, “not at all”
“very much”)
I am receiving positive feedback from clients about TMH (Yes, No) o Please elaborate: ______
I am receiving negative feedback from clients about TMH (Yes, No) o Please elaborate: _______
My clients seem to appreciate the availability of TMH during this time (Yes, No)
Do you have any clients who have declined to receive care via TMH? (Yes, No) o If YES approximately how many clients declined care? ___
o What reasons did they give for declining care? _____
Do you feel able to establish or maintain a strong working alliance with clients using TMH? (Yes, No)
o How similar does your working alliance with clients feel using TMH , compared to face-to-face OR your usual delivery of clinical care? (1-5 likert; “not at all”
“very much” )
How stressful have you experienced the transition to TMH? (1-5; “not at all stressful”
“very stressful”)
Which of the following have you experienced as stressful (select all that apply)?
o Having to rapidly transition to TMH
o Having to rapidly transition to a modality with which I was not familiar o Having to learn new technology, including troubleshooting
o Trying to figure out how to deliver psychological services using this modality o Worry about how TMH would affect my practice
o Worry about how TMH would affect my rapport with clients o Worry about the financial impact of COVID-19 on my practice
How have you changed your clinical practice due to using TMH during the pandemic?
_________________
Do you have a home office? (Yes, No)
Tell us about any physical issues or concerns since moving to TMH: _______________
Have you noticed any of the following (check all that apply):
o Digital eye fatigue o General fatigue o Headache o Sitting more
o Muscle tension or tightness
o Difficulty concentrating during sessions o Other:___________
Please share any other thoughts or observations about using TMH for psychotherapy, positive or negative: _________________________
Please share any reactions or perceptions from your clients about receiving TMH during this time: _____________________
Please estimate how many patients you are currently seeing per day? _____
Please estimate how many patients you are currently seeing per day via telehealth? _____
Please rate how effective you perceive TMH to be (1-10 likert, “not at all effective” “very effective”)
Please rate how useful you perceive TMH to be (1-10 likert, “not at all useful” “very useful”)
Overall, how satisfied are you with TMH sessions? (1-10 likert, “very dissatisfied” “very satisfied”)
Do you feel that TMH can be delivered in a comparable way to face-to-face care? (Yes, No) Please elaborate: ________________________
After the COVID-19 Pandemic is over, how often do you anticipate using TMH? (Rarely, Occasionally, Sometimes, Almost Always, Always)
Following the COVID-19 Pandemic:
I have positive feelings about TMH (1-5 likert, “not at all” “very much”) o Please elaborate: ___________
I have negative feelings about TMH (1-5 likert; “not at all” “very much”) o Please elaborate: ___________
I feel that TMH is important (1-5 likert, “not at all important” “very important”)
I feel that TMH is necessary (1-5 likert, “not at all” “very much”)
I am interested in learning more about and utilizing TMH in my practice (1-5 likert, “not at all” “very much”)
I believe that TMH is an effective method of providing psychological services (1-5 likert,
“not at all effective” “very effective”)
I believe that TMH is as effective as face-to-face service delivery (1-5 likert, “not at all”
“very much”)
How would you describe your current plans regarding TMH? (select all that apply) o I will continue to use TMH, because it is required or encouraged in my job/clinic o I will continue to use TMH, because I find it valuable as a modality of care o I will continue to use TMH if/when my clients prefer or request it
o I will maintain a mostly face-to-face practice but may use TMH in the future if specific situations or needs arise
o I will maintain a mostly face-to-face practice but will offer TMH in situations where sessions might otherwise be cancelled (bad weather, etc)
o I am ambivalent about TMH
o I am unsure if I will use TMH in the future
o I like using TMH and see it as a viable option for clinical service delivery o I do not like TMH and would prefer not to have to use it in my clinical practice
How do you anticipate using TMH going forward? (Rarely, Occasionally, Sometimes, Almost Always, Always)
If you are currently using TMH, what platforms are you using for service delivery?
o VA/VVC, A Non-VA HIPAA-Compliant Platform (Doxy, Simple Practice, VSee),, Other Video Platform (Zoom, Skype, Facetime, etc), Telephone o What platform do you use primarily? (same choices)
o How effective is this platform in helping you deliver TMH? (1-5; “not at all effective “very effective”)
o On average, how good is your connectivity using this platform? (1-5; “poor”
“very good”)
When using TMH, do you feel able to deliver services as you normally would?
What modifications do you need to make to your practice in order to continue to provide TMH, if any? ______
What are the biggest challenges you experience or anticipate in providing TMH?
_______
What are the biggest barriers to continue providing TMH in your practice? ______
Do you have a home office? (Yes, No)
Tell us about any physical issues or concerns since moving to TMH: _______________
Have you noticed any of the following (check all that apply):
o Digital eye fatigue o General fatigue o Headache o Sitting more
o Muscle tension or tightness
o Difficulty concentrating during sessions o Other:___________
Do you feel well-prepared to utilize TMH, from a psychotherapy perspective? (Yes, No)
Do you feel well-prepare to utilize TMH, from a technology perspective? (Yes, No)
Are you interested in formal didactics or training in TMH?
o If YES what specifically would you find helpful? ________
Currently, I receive positive feedback from clients about TMH (Yes, No) o Please elaborate: ______
Currently, I receive negative feedback from clients about TMH (Yes, No) o Please elaborate: _______
My clients seem to appreciate the availability of TMH (Yes, No)
Do you have any clients who declined to receive care via TMH? (Yes, No) o If YES approximately how many clients declined care? ___
o What reasons did they give for declining care? _____
Do you feel able to establish or maintain a strong working alliance with clients using TMH? (Yes, No)
o Does your working alliance with clients feel as strong using TMH? (1-5 likert;
“not at all” “very much”)
Please rate how effective you perceive TMH to be (1-10 likert, “not at all effective” “very effective”)
Please rate how useful you perceive TMH to be (1-10 likert, “not at all useful” “very useful”
Overall, how satisfied are you with TMH sessions? (1-10 likert, “very dissatisfied” “very satisfied”)
Do you feel that TMH can be delivered in a comparable way to face-to-face care? (Yes, No) Please elaborate: ________________________
Do you feel that having to use TMH during the COVID-19 pandemic changed your perceptions about TMH? (Yes, No)
If YES Did your feelings about TMH become more positive? (Yes, No) Please elaborate: _____
Did your feelings about TMH become more negative (Yes, No) Please elaborate: ____
If there is any other information you feel it would be helpful to know about your experiences with TMH before, during, or following the COVID-19 pandemic, please share them here _____________________________
