Telehealth for Clients with High-Risk Symptoms

Managing high-risk clinical symptoms like suicidality, psychosis, and domestic violence requires more than standard therapeutic skill; it demands a specialized framework for ensuring safety through a digital screen. While many clinicians fear that telehealth amplifies risk, evidence shows that virtual care is just as effective and potentially lifesaving when delivered with appropriate protocols and confidence.

This on-demand training provides a comprehensive, evidence-based roadmap for ethically managing high-acuity cases in a virtual setting. By exploring the latest peer-reviewed research and practical assessment strategies, participants gain the tools to move beyond "better than nothing" care toward clinical excellence and reliability.

Dr. Amy Marschall, Psy.D., a licensed clinical psychologist and certified telemental health expert, brings years of experience in trauma-informed and neurodiversity-affirming care. As a recognized author of tools like the Telemental Health with Kids Toolbox, she provides a grounded perspective on bridging the gap between traditional clinical standards and the unique demands of the virtual environment.

Utilizing a blend of clinical theory and "real-world" case illustrations, Dr. Marschall transforms complex ethical dilemmas into actionable steps. The course emphasizes practical application through de-identified examples that illustrate how to handle high-stakes moments—such as a client disconnecting during a crisis or pushing professional boundaries—from a remote office.

The curriculum covers a wide spectrum of risk factors, including non-suicidal self-injury, active suicidality, substance misuse, and psychotic symptoms. Dr. Marschall dives into specific clinical tools like the Columbia-Suicide Severity Rating Scale (C-SSRS), the DAST-10, and the HARK for domestic violence screening. Key highlights include "Transcript Gold" strategies such as the "7-11 breathing technique," the "TIP" and "Dear Man" skills from DBT, and the "CUES" mnemonic for addressing intimate partner violence safely through the screen.

Key Takeaways:

• Evidence-Based Appropriateness: Methods for using validated screens like the NSSI and SBQ-R to determine if a client is clinically appropriate for virtual care based on their unique history.
• Crisis Coordination: Strategies for building remote safety plans, verifying physical locations, and managing "soft handoffs" to local first responders or crisis lines.
• Regulative Grounding: Practical techniques adapted for telehealth, including "Riding the Wave" for cravings, "Take Two" for impulsive behavior, and sensory grounding for dissociative episodes.

Why this course?

• Specialized High-Acuity Training: This course addresses the difficult topics—psychosis, dissociation, and abuse—often ignored in general telehealth courses.
• Trustworthy Expertise: Dr. Marschall’s insights are grounded in everyday practice with high-acuity children, adolescents, and adults, ensuring the strategies are realistic and attainable.
• Ethical and Legal Readiness: Stay updated on the latest 2024 APA standards, HIPAA compliance, and jurisdictional requirements to protect both your clients and your license.

Learning Objectives:

• Assess clients for appropriateness for telehealth based on risk factors, including suicidal ideation, substance dependence, and abuse, using validated screening instruments.
• Transform existing therapeutic interventions and techniques for in-person sessions in a telehealth setting.
• Apply evidence-based therapeutic interventions for psychosis, dissociation, eating disorders, suicidal ideation, and self-harm behavior via telehealth platforms.
• Develop safety plans for clients experiencing abuse, self-harm, and high-risk behaviors utilizing telehealth platforms for service delivery.

High-risk symptoms do not have to be a barrier to providing accessible, high-quality mental health care. This training empowers you to expand your reach, maintain strict professional boundaries, and provide a vital safety net for your most vulnerable clients, no matter where they are located.