Adapting clinical skills to telehealth: Applications of affirmative cognitive-behavioural therapy with LGBTQ+ youth
Craig, S. L., Iacono, G., Pascoe, R. & Austin, A. (2021). Adapting clinical skills to telehealth: Application of affirmative cognitive-behavioural therapy with LGBTQ+ youth. Clinical Social Work, 49(4), 471-483. https://doi.org/10.1007/s10615-021-00796-x
Highlights
Background
Online social work services (e.g., telemental health; telebehavioral health; virtual care; telehealth) present significant opportunities for clinical social workers to provide effective care to marginalized populations
Emerging research documents the benefits of online engagement to the mental health and wellbeing of LGBTQ+ youth, including the potential receptivity this population would have to an online intervention
There is limited guidance in the literature, however, to specifically inform the adaptation of offline clinical skills to telehealth for LGBTQ+ youth
Description
This paper presents examples from our experience offering AFFIRM, an affirmative cognitive behavioral therapy (CBT) group intervention now being delivered through telehealth to offer the following:
Key considerations for the delivery of CBT via telehealth to youth;
Clinical skills and strategies to enable successful online implementation;
Clinical case study of cognitive restructuring with a transgender youth
Guidance to support clinicians to adapt their clinical skills to the virtual environment
Discussions
During the transition to online, AFFIRM clinicians received additional individual clinical training and weekly peer supervision to support the effective delivery in this new format
Zoom was established as a familiar and preferred platform for youth participants, and CBT activities were adaptable to the online format through Zoom’s user-friendly interface
Online adaptations and clinical skill considerations were applied to the following areas of focus:
Setting the stage: beginnings
adjusting programs and orienting clients
Therapeutic engagement
increase clarity of the intervention process, demonstrate an LGBTQ+ affirming stance online
Engaging cognitive restructuring processes virtually
Embed cognitive strategies and practices (e.g. ABCD method; thought stopping) into each session using specific Zoom functions such as white board and screen share
Developing behavioural strategies online
Adapt behavioral experiments and exposures (i.e., testing and challenging unhelpful cognitions through specific actions) to online platforms
Developing an LGBTQ+ affirming online social support network
Support community-building online outside of AFFRIM, sharing online resources and activities that support mental health
Endings: post-interventions
Follow-up with members as needed, create opportunities for AFFIRM graduates to engage online (Facebook group; Instagram page), celebrate member’s successes
Conclusions
As demonstrated by the case study and the adaptation processes, critical clinical skills can be tailored to a telehealth platform to benefit marginalized populations.
