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.

 

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Critical reflections and reflexivity on responding to the needs of LGBTQ+ youth in a global pandemic

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AFFIRM Online: Utilizing an affirmative cognitive-behavioural digital intervention to improve mental health, access and engagement among LGBTQA+ youth and young adults