Tele-Supervision for Online Therapy

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Hello and welcome to the Online Counseling Podcast. I’m so grateful that you’ve chosen to spend some time with us as we explore how technology is changing the field of online psychotherapy. It’s another cold and dreary day in New York City. Another advantage of online therapy, I can take my caseload with me when I travel. But this year we had a little family event, and that caused us to stay close to home, and it’s pretty big news for us.


Our podcast today came as a result of a previous guest’s suggestion, Mona Goshe. And Mona I’m sorry if I’m butchering your last name. I apologize. Anyway, Mona was in New York City a few weeks ago and we had a quick hello meeting in my office. So cool to get to know people face-to-face after working with them online. And she suggested that I look into the work of Dr. Carly McCord who heads up the Telehealth Counseling Clinic in Texas. So I did. It turns out Carly helped develop this program from scratch, and it’s connected with Texas A&M. There is this huge need for mental health care in rural Texas, and a lot of problems obtaining it. And Texas A&M had all these wonderful doctoral candidates, and you add all this together with technology and you get an incredible program that has served 800 clients over the past 10 years, that’s 8,000 sessions or more totalling around a million dollars in free mental health care.


Clay: So Carly agreed to come on the podcast, and she brought one of her students, a former Kentucky guy we found out mid-interview. And we get to talk to them about how the program started and its outreach and what it’s like to do telesupervision and the goals in training current counseling students, doctoral students, to do online counseling with a challenging population. And so, they’re doing this wonderful training, and they’re meeting a need in their community, and it is… I was just so inspired by her and I hope you are too. It’s a great example of how technology can fill a need. So here is Dr. Carly McCord and Donny Klinencrockt of the Telehealth Counseling Clinic at Texas A&M.


I am thrilled to have as my guest today, Dr. Carly McCord of the Telehealth Counseling Clinic through Texas A&M, and she has brought one of her students. And then I’m gonna make sure… I hope I get this name correct. Donny Klinencrockt. Is that pretty close?


Donny: Pretty close, not bad.


Clay: Alright, good. Well, thank you so much for joining us. Carly, tell us a little bit about the history of how this clinic came to be and some of the services that you are providing.


Carly: Sounds good. Thank you so much for having us. This all started through community needs assessments that were conducted regularly at the School of Public Health here in our region, and those needs assessments routinely came back with lack of access to specialty services, especially mental health care, problems with transportation. And so one of the faculty members, Dr. Jim Berdine said, “Well, let’s create an interdisciplinary partnership and reach out to the Counseling Psychology Program at Texas A&M to see if maybe their doctoral students would be interested in providing telehealth counseling.” So it’s just kind of a wild idea, that was probably back in 2007 or before, he might correct me but… And that was our… That’s our executive director that he reached out to, Dr. Tim Elliot. And he agreed and they started to pursue funding opportunities, and our first clinic opened through a HRSA grant and we went to the most rural, the most underserved of the counties, in our seven county region, and started providing those services.


Carly: That was actually my first year in the graduate program at Texas A&M. So my first assistantship, I got paired up and at the time didn’t really realize all the things I was learning about community capacity building and how to really serve communities well. You gotta know the county judge, and how county commissioner’s court works, and who the local leaders are. And helping in that process of deciding where’s the best fit place to have people access the service, and then seeing all the technical hurdles of the roll out, and then growing to serve that first clinic and it was a big success. And so then the neighboring county said, “Well, we want access to those counseling services.” And so we started a second site in Madisonville, and then found another funding source through the Medicaid 1115 waiver, which was in large part created to help regions find local solutions to local problems and fund programs like ours. And so we expanded our existing sites and added three more. So now we serve five of the seven counties in the Brazos Valley region all through doctoral students in counseling, and clinical, and full really actually now that we’ve grown.


Clay: That’s phenomenal. So how many students now are participating?


Carly: We have trained over 50 doctoral counselors, and I would say another way that the clinic has grown is through adding other disciplines. That it really is a public health and counseling partnership, and so I have lots of students from public health that come and apply the things that they’re learning in the classroom, whether it’s outreach and health promotion, or research and data management skills. But we’ve got students from a variety of disciplines now that are really applying what they’re learning in the classroom to a clinic setting. So it’s not just the counseling students that are getting trained, but they certainly are getting the most. They’re the only ones doing the actual therapy.


Clay: The actual therapy. And this is online therapy through an audio video platform. What platform are you using?


Carly: So right now, we have a hub-and-spoke model. So all my counselors are here at Texas A&M, and we have big screen TVs and Cisco high definition video conferencing units where the unit itself is what’s creating the encryption. And we have business class internet lines to each of the five clinics, and so most folks travel to the local clinic to be seen and it’s got matching technology on that site. It’s got a big screen TV and the Cisco unit that’s connecting the two. And that really, I think, grew out of that we started in ’08, and we had to use the university’s T1 lines just to get out that far into the rural communities. There was no business class internet out to those areas at that time. And so, we really would like our next wave to use Webex as a platform so that folks who do have good internet access can then access video services from their homes ’cause right now our really only in-home service is through the phone. And my counselors are doing the same therapies that they’re doing in person, that they’re doing over video, that they’re doing over the phone. But yeah. I’d like for folks to be able to access video from their homes. For a lot of our clients, that may not be possible because of the digital divide and that rural connectivity stinks a lot of times. It’s hard to support a video feed, and then some of our clients also don’t have a smartphone or a computer that would have that kind of access.


Clay: I see. Well, it’s fascinating you use the phrase ‘digital divide’, and I hear that from clients in Guatemala and some communities that have really poor internet. But you’re saying that there in Texas, there are people who do not have broadband connection that would support an audio video platform. Is that accurate?


Carly: Oh, absolutely. Absolutely. We’re about… Texas A&M is about 90 miles from Houston and 90 miles from Austin. But we are just an under-served, health professional shortage area. I live about 15 miles away from campus, and I can’t log into my electronic medical record system or anything from my home ’cause my internet connectivity is so poor. So yeah. The digital divide is alive and well in semi-rural Texas even.


Clay: Well, that’s fascinating. And then even if the capacity was there, there’s a financial aspect that some people can’t afford a broadband connection and that’s limiting their ability really to access the internet at all.


Carly: Absolutely, absolutely.


Clay: So I just wanna make sure that I’m getting this accurately, that you’ve done a needs assessment, almost 10 years ago, and saw that there was a huge need for mental healthcare in rural areas. And you’ve set up this hub-and-spoke model. So your students are there at Texas A&M, and they have a Cisco unit. And then clients will travel to a local space. Is this maybe a clinic that they can travel to? And then there’s a room that they would go into at an appointed time, and that has another Cisco unit that then they connect through audio visual with their therapist. Right?


Carly: Correct, correct. And they have to do that for the first session, and then often follow-ups can be done by phone. And that’s one of the things my counselors are learning, is how to make a distinction. Are there clients presenting concerns that shouldn’t be seen over the phone? ‘Cause then you’re doing in-home services and our folks we serve, some of them are pretty severe, and so they then have access to means to hurt themselves that they don’t typically bring to a clinic. And so sometimes those folks aren’t a good fit, or folks with psychotic symptoms that you really need that visual cue to see how they’re responding to stimuli that aren’t actually present in the room. Or agoraphobia, and maybe part of the treatment plan needs to be getting them out of the house, and so… Yeah. And as far as the sites, some of them are in clinics and then some of them are in resource centers that were kinda one-stop shops that were created to help services like ours access people in the rural areas.


Clay: Wow. So they’re doing that first assessment. They’re looking to see if this client is going to be able to… If they’re a good fit for online therapy or to step down and have phone therapy. And you’re looking at severity of symptoms, suicidal or homicidal ideations, psychosis, that type of thing?


Carly: Right, right. And it’s really, we do it on a client-by-client basis. You’re learning some… They’re learning some general rules about that. But certainly some of our most rewarding cases have been some of our most severe cases. Often the only way to reach them is through the phone, and helping them just maintain some stability and get connected with our local mental health authority that gives them access to a psychiatrist here in Texas.


Carly: And yeah, I guess just to say it’s a case-by-case basis of really tuning in and understanding what that client’s needs are ’cause I think what we run into a lot and rural healthcare is… It’s us or nothing. And so you can say, “This is the boundary of my confidence, this is what we’re able to do. Best case scenario. You should be seen in person at this type of clinic.” And that’s an hour and a half away and 120/180 dollars a session. And so that means you’re just essentially referring them to nothing. So I think that’s another thing I wanna teach my students is, how can you give an informed consent of, “Okay, we’ve assessed you. We’ve conceptualize what’s going on. We’ve gotten to know you a little bit, and here’s what we’re able to offer you via video or via the phone. In the best case scenario, maybe your treatment might look like this, and here’s the closest place to access that service. Which of those services do you wanna choose?” So it’s an informed choice on their part of, “Well, let’s see if we can address some of these symptoms and see where we get from there.”


Clay: Wow. So it’s really a judgement call, and I imagine through supervision, you’re assisting them in making that judgment call of, “Ideally yes, you need to go see someone face-to-face, but you just don’t have the ability. So, while this may not be the best option, it’s your only option, and maybe we can give you some assistance.” Right?


Carly: Absolutely, absolutely.


Clay: Okay. And well, tell me a little bit about these. You’re in five clinics in your area, right?


Carly: Yes.


Clay: Tell me a little bit about that space. Is this a dedicated space? A community mental health agency or just some office that’s been rented? Is there a receptionist there? Tell me a little bit about that.


Carly: Sure. They look a little bit different in every county. That was part of that meeting with the local leaders and really deciding, what’s the best place for folks in your community to be able to access these services? And so, in one county, we’re in a free primary care clinic, and yes, there’s a dedicated room there, and they’re greeted by the clinic staff there, and just escorted back to the room where the telehealth equipment is. In three of our counties we’re in these health resource centers. That was another thing that the school public health here helped initiate. These one-stop shops where a variety of social service agencies can have office space ’cause it’s impossible for all these non-profits to pay rent in each of the seven counties, to be able to serve folks in those counties. Especially, if really you only need a half a day or a day to provide those services. And so they have created sustainable solutions to have office staff. They’re not clinically trained, and we train them on our emergency procedures, and honestly there’s little involvement from them. But there are office staff that, again, greet the clients, fax us paperwork and walk the clients back to the room.


Clay: Okay. And so, how many clients are you serving on a weekly basis? And historically, how many people have you been able to serve?


Carly: We have served over 800 clients for over 8,000 sessions. You calculate that at a $120 an hour rate, which is the average in our area, that’s almost a million dollars in free counseling services. That we’re… Pretty excited about that number. But on a weekly basis, we probably serve I guess about 50… 50 sessions or so.


Clay: Okay. And what’s the feedback from local leaders? What are they saying about the online therapy program?


Carly: They’re very glad to have the service. We’ve got other communities reaching out to us, “Can we have this too?” And we use a satisfaction survey to just kinda check in with our clients, and over 90% of them in our rural area say they would have gone without services if it weren’t for ours.


Clay: That’s phenomenal. That’s just phenomenal.


Carly: High 90s of satisfaction with services, would you recommend to a friend, would you use again. High 90s in do you feel like the quality of the service was as good as what you would have received in person? And most people agree or strongly agree with that, that they are really happy to have connected with a helper. That that human connection can transcend technology through people trying to find a solution together, and it really doesn’t matter the modality. And that’s what our research says too. We’re providing a service, we’re training counselors, and then on the backend, we’re always looking at our data, whether it’s satisfaction data or effectiveness. Are people getting better? And we’ve found that it doesn’t… The modality of in-person versus phone versus video versus some mix of all of them, doesn’t really impact people’s outcomes.


Clay: What an example of using technology to connect with an unmet need in your community. Donny, tell me a little bit about you and what your experience has been with this program.


Donny: Sure. Let’s see, I guess I started off as an online counselor here at the telecounseling clinic. And to be honest, when I first started I probably looked at it just as another practicum experience in counseling, and I was excited about working just like with rural populations, but I won’t lie, I had a little bit of a bias, I think, at that time about telecounseling and… It’s probably good, but it’s probably not as good as in person. And I’ve actually been, in some way, working with the TCC for now probably a little more than three years, and honestly, without a doubt, it’s completely changed my view on counseling as well as just the effectiveness of telecounseling. I think this is something too… I’ve been talking to Dr. McCord here a while about kind my next step in my career, and I very much plan… I’m originally from Kentucky, so I’m originally planning on maybe one day going back and starting up a very similar model. Like a training clinic that also serves rural, no-income populations through telecounseling. So that’s my dream, my goal going forward.


Clay: Well, my listeners are… They know that I’m originally from Kentucky. What part of Kentucky are you from?


Donny: Oh, great! Well, I’m right outside Lexington. I’m in Nicholasville, Kentucky is where I’m originally from.


Clay: Okay. Donny, we’re gonna have to talk after this. I went to school at Asbury and so we’re gonna have a little conversation after this. But okay, so you… Seems that your eyes have been opened, then. That the technology can be just as effective to the… So what were some of the hurdles then for you and your learning curve as you went through this?


Donny: So yeah, for me I think the main… I think the thing that really opened my eyes about it was just realizing that… It’s like with the Therapeutic Alliance. The alliances on informing and telecounseling are just as real and genuine, and I feel just as strong as they have been before in in-person settings. And I think my rationale behind it is really that the populations that we serve here at this clinic, they just need somebody to hear them. And I think that, for me at least, when I am connecting with them, it’s not necessarily of like, “Oh, okay. Are we matching along ethnicity? Are we matching along age and goals and treatment?” It’s just that validation that someone cares about them. And especially for these disadvantaged populations who are very often neglected.


Donny: So to me that’s been the strongest thing with my Therapeutic Alliance. And I feel like I’ve been able to form that with pretty much elderly, adolescents, doing all kinds of different counseling here at the clinic. So that was very shocking to me, I guess, to see that. And I think that one of the biggest hurdles I see for the field, as well as even in the clinic now, is just really this provider bias that comes from either other counselors or other psychologists who haven’t really experienced telecounseling this way, but still have that feeling or assumption that it’s not quite as good. And I think that’s a bit of a hurdle. I know I’m currently doing some research here at the TCC, as well, that we’re looking at the referral partners, and some of the reasons why referral sources might not refer clients to us. And that’s something that has come up, is that the referral partner feels that, well this person that I’m referring to you probably wouldn’t do well at a telecounseling thing, and they’re just making that assumption. So that’s another hurdle that we still have to face and build better awareness about the effectiveness of telecounseling.


Clay: Yeah. Absolutely. Educating the field, us, and also educating our referral partners and the population that this is an effective option. And I love that… I remember my times in the clinic, and the diversity that you get to work with, and out in private practice so many of us are developing a niche. I’ve got therapists that I know of that work with women going through menopause, or men who are first-time fathers, and that’s who they primarily work with. I’ve got one of my favorite podcast interviews is with Buck Black, who is a therapist that works with truckers. And he uses online counseling to these men and women who are out there on the road, and this is their only option to receive online counseling. So you’re getting the option to… All sorts of diversity and gender, and race, and economic background. All sorts of interesting new clients that you’re able to connect with.


Donny: Yeah.


Clay: That’s great.


Carly: And I think connecting people with specialties is one of the things that excites me most about telepractice, and telesupervision. Which is another area I’m very interested in, in which there’s recommendations from our national governing bodies all the way down to our state legislative bodies that still have guidelines against the use of telesupervision. Where 50% of your supervision has to be in person, and for what reason? And based on what research? I’m not entirely sure. In aims of protecting the public, but when you can match supervisees to specialty supervision and consultation, and match clients to the best fit and counselors… It gets me excited.


Clay: I can hear it. So Carly tell me a little bit about your training program and the telesupervision. You’ve got graduate-level counselors. What’s the process? Are these session recorded? And then you’re doing some telesupervision and reviewing the actual session. Yeah, let’s start there.


Carly: Sure. Yeah, so we train, right now, just doctoral students. Although, I certainly feel like it’s appropriate for master students, but there aren’t any masters programs here in the Bryan College Station area. But we’ve got students in school, counseling clinical psychology and counseling psychology here at Texas A&M, and from some of the nearby universities. As word’s getting out about this cutting edge training, folks are willing to make a bit of a drive to come out here. But the counselors provide all of their services typically via video or via phone. And then they meet with their supervisor once a week for an hour. And early in their training they also have a group supervision element, as well. And for that hour of individual supervision, some students are paired with an in-person supervisor and some students are paired with a telesupervisor. Where they’re meeting with their supervisor via Webex. And in both of those modalities they can review tape together. So if they’re in person, obviously, we’re pulling recordings off of our units. Actually using some gaming hardware.


Clay: Really?


Carly: I think it’s like a hodgepodge. Gosh, I can’t remember the exact name of it. And they were very inexpensive, but gamers wanna pull off what’s on their screen plus be able to record audio over to tell everybody what games they’re making. So yeah, that was the solution that we came up with. And so they’re just recording their videos and we can watch those live in-person or drop them on a shared encrypted drive where the supervisor, and the supervisee can actually…


Donny: And it’s also, it’s a really cool experience as a counselor too. I think that one of the things I didn’t realize until I was watching my own videos, that this is the first time I’m actually able to put up the screen so that I can see myself talking to the client. And so it actually feels like I am the recipient of my own counsel.


Clay: Oh.


Donny: I can go back and forth. And that’s the first time I think I have ever seen that type of video being recording in that way. Where it’s like, “Wow, I’m really… ” either “I’m really good at eye contact here”, “I’m really not” or “I’m looking away, I’m looking distracted”, which wouldn’t be captured in other ways of doing video recording. So it’s actually a really kind of cool learning exercise that I didn’t even think about until I was experiencing it myself where I’m talking directly into the camera and I’m recording that.


[overlapping conversation]


Carly: Yeah. We’ve done a few of that before, usually at training clinics. The cameras in the corner of the room. And so you kinda see the side of your face, and other things like that. And the other component is the… Ours has a picture in picture. And so you’re actually getting live feedback if you can monitor yourself and your eye contact and things like that, and get a range of reactions from, “That’s distracting,” to “Wow, that’s so helpful ’cause I realize my client’s looking at the top of my head”.


Clay: Yeah, that’s wonderful. I hadn’t thought about that. But you are getting a lot more information, a lot more data to review your own involvement in the session. So that’s kind of an advantage actually for the training. So what other experiences have you had from telesupervision, any kind of a downside or difficulty that either one of you’ve seen?


Donny: Well, I feel like the downsides for me are just based on kind of where we’re at with technology, I think. That there will… Sometimes you will have… I know with one of our remote sites that the weather that affects the connection. So it’s kind of a weird thing it’s just based on limited connection and just in these rural areas, that sometimes the picture itself can get a little bit distorted or sometimes you have to troubleshoot the system. Actually, these are not anything that’s gonna really distract too much from the entire session, but occasionally it may… Your online therapy session might start a minute or two late because you have to restart it and boot it back up. That’s pretty rare, but it does happen.


Carly: Yeah, I think downtime is one. I think access is another, that counselors who are paired with a remote supervisor because there’s counselors here that can… Which they all have access to just walk into my office to talk with me or my postdoc to consult, but then they’re gonna have to circle back and check in with their remote supervisor too. And so there’s definitely an ease of access. If you’re in-person in the same physical space, then you get questions answered at any time. And obviously, the telesupervisors generally are practitioners themselves and so they’re easy to get a hold of at their designated hour, and then it’s hit or miss if you’re handling the crisis in the moment.


Clay: Yeah, absolutely. So, I guess just really quickly, this is question for either one of you, I suppose. Is that, when you are training a doctoral student on how to do online counseling, what are some things that you wanna make sure that they are aware of before they begin this process, from eye contact to building that therapeutic relationship, to… I don’t know, what are some of the hallmarks of things that you wanna make sure that they know about before beginning this?


Carly: I think a big one is client appropriateness and treatment appropriateness of just being able to identify when someone might not be a good fit, which in all honesty, is very rare in my opinion, but… And I hit on this a little bit earlier, handling emergencies from a distance. So really knowing what are you gonna do if someone’s in her home or even at these remote sites. What does that look like? How is that different, really, in some ways, demystifying. If you’ve got a client that you’re seeing in person that doesn’t wanna be hospitalized and needs to be, do you barricade the door to try and prevent that person from leaving, or does that person leave regardless of if you’re there in person or if you’re there from a distance? And yeah, people who are… Get afraid and they’re gonna leave, I’ve had that happen to me in person. I’ve had that happen to me over video. And then the end-result is the same. I have to call the authorities.


Carly: So, handling emergencies. I think the legal and ethical decision making via Telehealth, and I think just some of the little nuances of we encourage them in their intake sessions to directly address the eye contact issue with clients and say, “Hey, with our set-up if I’m looking at the screen, at your face, the camera’s above me, so it may look like I’m looking down.” And just making sure the client understands that. And checking in with the client. “Hey, what do you think about meeting over video, what’s this like for you?” And doing that at the beginning of session and then again at the end of session to just kinda check in and make sure the client feels like that modality is gonna work for them.


Clay: Yeah.


Donny: I would also reiterate at least since I… I feel like I’ve been here a while. So I’m one of the older counselors now, but what I’ve seen working with other online counselors, something that I’ve tried to express to them, is to be confident, I guess, in the telecounseling. And I think that that’s something that we don’t really talk about a lot, but I think that the clients can pick up on that. They can pick up on if you feel like it’s working or not, or your own confidence on it, or your competence with using the technology and if you kind of display a sense of like “Yeah, this is what it’s like. And if you have any questions feel free to ask. I can get those answers for you.” If you display that to them, then they are more likely to kinda buy into it too.


Donny: And I think that that’s something that at least… I know that as I’ve gone through the programming and everything that I’ve really built that in myself, and so usually it’s… I kinda go through my spiel with my clients like, “This is kind of what it’s like, and if it doesn’t work out just give me a couple sessions, three sessions or so, and if you don’t like it at all then we’ll try to figure something else out or we’ll try do it a different way.” But usually by that third session, they’re good to go. So I think that there’s just a level of just being comfortable with the technology itself.


Clay: Yeah, absolutely. And it seems like that… Are you aware, either one of you aware, about laws in Texas that address telehealth? Because I remember reading that they were recently in the state legislature going to put in a regulation that the… Anyone doing online counseling, the first session had to be face-to-face and then follow-up could be online using technology. I think that got voted down. Are there any particular regulations in Texas that you’re aware of?


Carly: No, we can thank Teledoc for helping us knock that down out of Dallas, that really wanted to fight against having to have that pre-established in-person connection. Yeah, we… If something like that were to be passed it would be devastating to what we do. We can’t get people to these rural areas. The cost, and transportation travel time, and being able to serve the entire region the way we do there’s just no way we could do that if we had to establish in person session first. From my knowledge, the only legislation that affects us is the telesupervision rule. To have a 50% of supervision needing to be done in person. I think it affects… It might affect reimbursement in different scenarios. I’m not… Very far from being an expert in reimbursement, the services that we offer are free. I haven’t figured out how to reimburse for doctoral student services. Our funding source, primarily is that Medicaid 1115 waiver, that’s not… It’s not like traditional Medicaid.


Clay: Wow. So, just kind of wrapping up, I think that you alluded to, or maybe in our previous call, you talked about that Texas A&M may be the only program, at least that you’re aware of, that are training doctoral students on telemental health. Other programs are asking for advice and guidance here. Could you talk a little bit about that? Or any awareness of other programs that are doing this.


Carly: Sure. Well, so I think that there are other programs that are doing pilot projects or parts of their training clinic are adding in a telehealth component. We’re the only strictly telehealth clinic that I’m aware of. That all of our services are offered primarily from… Via video and telephone counseling, and so every year when we have folks coming for interviews I ask “Has anybody seen a clinic like this or heard of anybody?”


Carly: And keeping my eye on the literature and the news, and I would love to know about other programs that are out there. So if you’re aware of them, please, please reach out.


Clay: Absolutely.


Carly: I just worked with the University of Arkansas and their clinical psychology program. They started a telehealth component using loaner devices for folks that need them. And, I wanna say, go-to-meeting but I could be wrong. And they’ve had some great success stories ranging from reaching out to the homeless and then them being able to gain internet access from the local library, and just great attendance rates, and therapeutic change, and it’s exciting stuff. So…


Clay: Wow. Fascinating. I just see the field going in this direction in so many ways, not just for a private practice, but for clinics to increase their outreach. I can’t thank you enough, both of you, for joining us. Any final thoughts that maybe some of our listeners would be interested in hearing?


Donny: Well, I think just from me… I think the thing that I… It’s just how great telecounseling has really been for these populations. And it’s like I don’t know, I know you guys were just mentioning about laws, and I really do believe that if there was a law that restricted telecounseling in some way that it would be devastating to so many lives, especially so many of the clients that I’ve worked with. I can just… There’s so many experiences and examples of turning lives around that I feel like that… Have been more important I think even in telecounseling, ’cause these are so disadvantaged, then when I’ve been at university settings or things like that where they already have… They have access to water and food, but there are some clients out here that as your role as a counselor you are… You’re helping coordinate that as well. And so, even helping to get one of my clients this past week who was having psychotic episodes all the time, and really being that person between MHMR and getting them evaluated, to really kinda push that as fast as possible. So now, within like a week later, they’re on medication, everything’s going so much better, changing their lives. And I don’t know, I just can’t imagine getting this experience anywhere else. So…


Carly: Well, if it hadn’t been for our services, they would have been in the ER. That’s just… I hate to hear in the rural areas how frequently folks are using the ER for their mental health care. But I guess I would say encourage those who are thinking about it or who are already using it to press on. It’s just an incredibly rewarding thing to be engaged in. Whether it’s pairing up with your specialty population of choice or serving an underserved population, telehealth has such great opportunities to increase access to care and so best of luck in your telehealth endeavors.


Clay: Absolutely. So Dr. Carly McCord and Donny Klinencrockt, we thank you. And if you, as a listener, want to learn more about them, they’ve got a great website at, and we’ll have all that information in the show notes. Thank you both for joining us.


Carly: Thanks for having us.


Donny: Thanks.