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Reid M, Moerenhout T. Ethical assessment of virtual consultation services: scoping review and development of a practical ethical checklist. J Prim Health Care 2024; 16:288-294. [PMID: 39321085 DOI: 10.1071/hc24027] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 06/08/2024] [Indexed: 09/27/2024] Open
Abstract
Introduction The use of telephone and video consultations has vastly increased since the onset of the COVID-19 pandemic. Health care providers in traditional clinical practices have embraced these virtual consultations as an alternative to face-to-face consultations, but there has also been a simultaneous increase in services offered directly to consumers via commercial entities. One of the main challenges in telemedicine (and the broader field of digital health) is how to conduct a meaningful ethical assessment of such services. Aim This article presents a novel framework for practical ethical analysis of direct-to-consumer virtual general practitioner consultation services in Aotearoa New Zealand. Methods First, a scoping review of academic and policy documents identified the core ethical challenges arising from virtual consultations. Second, a qualitative analysis was conducted to translate the main ethical themes and subthemes into practical questions to assess virtual general practice services. Results A total of 49 relevant documents were selected for review. The six key ethical themes related to telemedicine were: privacy, security, and confidentiality; equity; autonomy and informed consent; quality and standards of care; patient empowerment; and continuity of care. A practical ethical checklist consisting of 25 questions was developed from these themes and their subthemes. Discussion The checklist provides an accessible way of incorporating ethics into technology assessment and can be used by all relevant stakeholders, including patients, health care providers, and developers. Application of the framework contributes to improving the quality of virtual consultation services with a specific focus on ethics.
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Affiliation(s)
- Madeleine Reid
- Otago Medical School, University of Otago, Dunedin, Otago, New Zealand
| | - Tania Moerenhout
- Bioethics Centre, University of Otago, 71 Frederick Street, Dunedin 9016, New Zealand
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2
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Zhang Y, Stayt L, Sutherland S, Greenway K. How clinicians make decisions for patient management plans in telehealth. J Adv Nurs 2024; 80:3516-3532. [PMID: 38380577 DOI: 10.1111/jan.16104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/23/2024] [Accepted: 02/06/2024] [Indexed: 02/22/2024]
Abstract
AIM This systematic integrative literature review explores how clinicians make decisions for patient management plans in telehealth. BACKGROUND Telehealth is a modality of care that has gained popularity due to the development of digital technology and the COVID-19 pandemic. It is recognized that telehealth, compared to traditional clinical settings, carries a higher risk to patients due to its virtual characteristics. Even though the landscape of healthcare service is increasingly moving towards virtual systems, the decision-making process in telehealth remains not fully understood. DESIGN A systematic integrative review. DATA SOURCES Databases include CINAHL, APA PsycInfo, Academic Search Complete, PubMed, Web of Science and Google Scholar. REVIEW METHODS This systematic integrative review method was informed by Whittemore and Knafl (2005). The databases were initially searched with keywords in November 2022 and then repeated in October 2023. Thematic synthesis was conducted to analyse and synthesize the data. RESULTS The search identified 382 articles. After screening, only 10 articles met the eligibility criteria and were included. Five studies were qualitative, one quantitative and four were mixed methods. Five main themes relevant to decision-making processes in telehealth were identified: characteristics of decision-making in telehealth, patient factor, clinician factor, CDSS factor and external influencing factor. CONCLUSIONS The decision-making process in telehealth is a complicated cognitive process influenced by multi-faceted components, including patient factors, clinician factors, external influencing factors and technological factors. IMPACT Telehealth carries higher risk and uncertainty than face-to-face encounters. CDSS, rather than bringing unification and clarity, seems to bring more divergence and ambiguity. Some of the clinical reasoning processes in telehealth remain unknown and need to be verbalized and made transparent, to prepare junior clinicians with skills to minimize risks associated with telehealth. PATIENT OR PUBLIC CONTRIBUTION Not applicable.
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Affiliation(s)
- Yuhan Zhang
- Oxford University Hospital NHS Foundation Trust, Oxford, UK
- Oxford Brookes University, Oxford, UK
| | - Louise Stayt
- Oxford University Hospital NHS Foundation Trust, Oxford, UK
- Oxford Brookes University, Oxford, UK
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Anil K, Bird AR, Bridgman K, Erickson S, Freeman J, McKinstry C, Robinson C, Abey S. Telehealth competencies for allied health professionals: A scoping review. J Telemed Telecare 2023:1357633X231201877. [PMID: 37787172 DOI: 10.1177/1357633x231201877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
INTRODUCTION Telehealth has become one of the main methods of delivering allied health professional services world-wide, yet many professionals do not have sufficient training to deliver high-quality telehealth services. This review aims to identify what competencies allied health professionals require for effective telehealth service delivery. METHODS This scoping review used the Population Concept Context framework and searched the following databases: MEDLINE, CINAHL, PsychInfo, Cochrane, EMBASE, Web of Science, PEDro, United Kingdom Health Forum, WHO, Health Education England, and all UK and Australian AHP professional bodies. RESULTS A total of 37 articles were included out of 92,525 identified by the literature search. Competencies were related to two areas: (1) delivery of the telehealth consultation and (2) service management of telehealth consultations. The first area included the following competency themes: clinical reasoning, communication, effectively using technology, person-centred care, practice-based assessment and intervention knowledge/behaviour/skills, privacy, security, and patient safety, professionalism, and setting up the technical environment. The second area included the following competency themes: digital infrastructure, informing practice, and management. Although findings emphasised the importance of telehealth competencies, none have been implemented within education. One-third of the articles were from the discipline of psychology. CONCLUSION This is the first scoping review to combine telehealth competencies reported across allied health disciplines. Although there were a vast range of competencies, they need implementation into teaching and learning to be practically useful. Most competencies were from psychology, but potentially applicable for other allied health professionals. A shared and adaptable standard for telehealth competencies would be useful to ensure high-quality practice across all allied health professionals.
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Affiliation(s)
- Krithika Anil
- School of Health Professions, University of Plymouth, UK
| | - Adam R Bird
- School of Allied Health, Human Services & Sport, La Trobe University, Melbourne, VIC, Australia
| | - Kate Bridgman
- School of Allied Health, Human Services & Sport, La Trobe University, Melbourne, VIC, Australia
| | - Shane Erickson
- School of Allied Health, Human Services & Sport, La Trobe University, Melbourne, VIC, Australia
| | | | - Carol McKinstry
- School of Allied Health, Human Services & Sport, La Trobe University, Melbourne, VIC, Australia
| | | | - Sally Abey
- School of Health Professions, University of Plymouth, UK
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Tomlinson SRL, Gore N, McGill P. Family carer and professional perceptions of the potential use of telehealth for behavioural support. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:531-546. [PMID: 36919000 DOI: 10.1111/jir.13026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/20/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Telehealth (i.e. the use of technology across distance) is widespread in many fields. Although its use for behavioural support for people with intellectual or developmental disabilities (IDD) is emerging, there are no known studies examining stakeholder perceptions of this. METHODS A four-round Delphi consultation was conducted with 11 professionals and six family carers of children with IDD to generate consensus on what would influence participants' use of telehealth for behavioural support. Data were collected prior to the coronavirus pandemic. RESULTS Thirty-six items reached consensus for professionals (26 advantages and 10 disadvantages/barriers) and 22 for family carers (8 advantages and 14 disadvantages/barriers). A range of solutions were also identified for the disadvantages/barriers. CONCLUSIONS Participants were willing to use telehealth for behavioural support. However, disadvantages/barriers need to be addressed, and guidelines relating to the use of telehealth in this field are needed. We report a number of practice recommendations including combining telehealth with in-person supports where possible, incorporating video technologies, and considering client perspectives and confidence with telehealth methodologies.
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Affiliation(s)
| | - N Gore
- Tizard Centre, University of Kent, Canterbury, UK
| | - P McGill
- Tizard Centre, University of Kent, Canterbury, UK
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Yingling ME, Ruther MH, Dubuque EM. Geographic Access to Registered Behavior Technicians among Children with Autism Spectrum Disorder. Behav Anal Pract 2023; 16:501-509. [PMID: 35822165 PMCID: PMC9263038 DOI: 10.1007/s40617-022-00729-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 11/25/2022] Open
Abstract
Research has documented inequities in geographic access to board certified behavior analysts (BCBAs) among children with autism spectrum disorder (ASD). Unexplored is geographic access to registered behavior technicians (RBTs), the frontline ABA providers BCBAs supervise. In this study we examined county-level geographic access to RBTs in the United States, including change in their geographic distribution over time, the current distribution of RBTs related to the distribution of BCBAs, and the current distribution of RBTs as a function of children with ASD. The sample included all U.S. counties in all 50 states and the District of Columbia (N = 3,138). County-level ASD/RBT ratios indicate that the number of children with ASD far exceed RBTs, and the geographic accessibility of RBTs appears to be superior to that of BCBAs.
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Affiliation(s)
| | - Matthew H. Ruther
- Department of Urban and Public Affairs, University of Louisville, Louisville, KY USA
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Palesy D, Forrest G, Crowley ME. Education guidelines, frameworks and resources for building virtual care capacity: An integrative review. J Telemed Telecare 2023; 29:222-243. [PMID: 36628539 DOI: 10.1177/1357633x221149230] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Despite its reported benefits, the accelerated adoption of virtual care since the COVID-19 pandemic has occurred without critical consideration of clinician education and training. This integrative review aims to better understand the necessary education guidelines, frameworks and resources for building the confidence and capability of the workforce for virtual care delivery. METHODS Whittemore and Knafl's (2005) five-stage methodological framework informed this review. Using a clearly articulated search strategy and reporting process, over 8000 pieces of literature were analysed. A final 46 publications comprising 26 scholarly papers and 20 pieces of grey literature were included for review. RESULTS A set of key curriculum inclusions under three domains: clinical, administrative and technical are proposed. Many publications emphasise a domain-specific approach as the most effective means of translating virtual care knowledge and skills to practice. A number of new domain frameworks have been tailormade for specific disciplines, while well-established frameworks such as the ACGME, CanMEDS, AAMC and IPEC have been adapted for virtual care education. Virtual care checklists, clinical champions and models that involve frontline clinicians, content experts and care recipients are considered useful resources for virtual care education. DISCUSSION Moving beyond the COVID-19 pandemic, virtual care education for current and future clinicians requires a cohesive, interprofessional approach. This approach should be rigorously evaluated as part of a continuous quality improvement process.
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Affiliation(s)
- Debra Palesy
- Sessional Academic, University of Technology Sydney, NSW, Australia
| | - Gail Forrest
- Senior Manager Clinical Education Strategy, Research and Evaluation, Health Education and Training Institute, NSW Health, St Leonards, NSW, Australia
| | - Margaret E Crowley
- Director, Professional Practice & Interprofessional Collaboration Portfolio, Health Education and Training Institute, NSW Health, St Leonards, NSW, Australia
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Anvari S, Neumark S, Jangra R, Sandre A, Pasumarthi K, Xenodemetropoulos T. Best Practices for the Provision of Virtual Care: A Systematic Review of Current Guidelines. Telemed J E Health 2023; 29:3-22. [PMID: 35532969 DOI: 10.1089/tmj.2022.0004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background: Telemedicine has emerged as a feasible adjunct to in-person care in multiple clinical contexts, and its role has expanded in the context of the COVID-19 pandemic. However, there exists a general paucity of information surrounding best practice recommendations for conducting specialty or disease-specific virtual care. The purpose of this study was to systematically review existing best practice guidelines for conducting telemedicine encounters. Methods: A systematic review of MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) of existing guidelines for the provision of virtual care was performed. Data were synthesized using the Synthesis Without Meta-Analysis (SWiM) guideline, and the Appraisal of Guidelines for Research & Evaluation Instrument (AGREE II) tool was used to evaluate the quality of evidence. Results: A total of 60 guidelines for virtual care encounters were included; 52% of these were published in the context of the COVID-19 pandemic. The majority (95%) of provider guidelines specified a type of virtual encounter to which their guidelines applied. Of included guidelines, 65% provided guidance regarding confidentiality/security, 58% discussed technology/setup, and 56% commented on patient consent. Thirty-one guidelines also provided guidance to patients or caregivers. Overall guideline quality was poor. Discussion: General best practices for successful telemedicine encounters include ensuring confidentiality and consent, preparation before a visit, and clear patient communication. Future studies should aim to objectively assess the efficacy of existing clinician practices and guidelines on patient attitudes and outcomes to further optimize the provision of virtual care for specific patient populations.
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Affiliation(s)
- Sama Anvari
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Samuel Neumark
- Translational Research Program, Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rhea Jangra
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Anthony Sandre
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Keerthana Pasumarthi
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ted Xenodemetropoulos
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Division of Education and Innovation, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Pandya A, Waller M, Portnoy JM. The Regulatory Environment of Telemedicine After COVID-19. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY: IN PRACTICE 2022; 10:2500-2505. [PMID: 35842133 PMCID: PMC9277986 DOI: 10.1016/j.jaip.2022.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/31/2022] [Accepted: 07/06/2022] [Indexed: 11/19/2022]
Abstract
The COVID-19 pandemic has created many barriers to providing health care, yet it also has created new opportunities. Although telemedicine was a nascent means of health care delivery before COVID-19, it now is one of the principal means for doing so today, and it is likely to remain so. Whether this will happen may depend in part on continued relaxation of regulations that hampered it before the pandemic. Whereas enforcement of compliance with Health Information Portability and Accountability Act will most likely resume, platform operators and providers have had an opportunity to prepare for this. State licensure requirements may also resume; however, the regulations were in the process of becoming more liberal before COVID-19 so that process might continue. There is no reason to anticipate that payment for telemedicine services including check-ins, remote physiologic and therapeutic monitoring, and relaxation of location and service requirements will end. For these reasons, telemedicine therefore is likely to continue as an important part of medical practice.
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Ruppel PR, Juanico JF, Johnson KLD. The Effects of Remote Instructions, Rehearsal, and Feedback on Preference Assessment Implementation. JOURNAL OF ORGANIZATIONAL BEHAVIOR MANAGEMENT 2022. [DOI: 10.1080/01608061.2022.2078455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Paula R. Ruppel
- University of Kansas, Department of Applied Behavioral Science, Lawrence, Kansas, USA
| | - Jessica F. Juanico
- University of Kansas, Department of Applied Behavioral Science, Lawrence, Kansas, USA
| | - Kayt-Lyn D. Johnson
- University of Kansas, Department of Applied Behavioral Science, Lawrence, Kansas, USA
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Araiba S, Čolić M. Preliminary Practice Recommendations for Telehealth Direct Applied Behavior Analysis Services with Children with Autism. JOURNAL OF BEHAVIORAL EDUCATION 2022; 32:1-35. [PMID: 35464786 PMCID: PMC9013273 DOI: 10.1007/s10864-022-09473-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 06/14/2023]
Abstract
This article provides preliminary practice recommendations for telehealth direct applied behavior analysis (ABA) services for children with autism. In the face of COVID-19, there is an immediate need for discussion on how to implement various ABA procedures via telehealth for ABA practitioners. Alongside emerging scientific evidence on the effectiveness of telehealth direct service as well as various service-related guidelines, we provide preliminary practice recommendations that are based on the existing literature on in-person and telehealth ABA procedures. We also discuss these recommendations with case studies of two boys with autism. Social validity measures indicated that families were satisfied with telehealth direct services. Even after the COVID-19 pandemic has resolved itself, telehealth direct ABA service will still be a valuable option for remote and international locations where direct ABA service is limited, and thus, practice recommendations continue to be relevant for all practitioners that use telehealth direct service.
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Affiliation(s)
- Sho Araiba
- Positive Behavior Support Corporation, 1645 Ala Wai Blvd., Honolulu, HI 96815 USA
| | - Marija Čolić
- Special Education Department, University of Hawai’i at Manoa, Honolulu, HI USA
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Ninci J, Čolić M, Hogan A, Taylor G, Bristol R, Burris J. Maintaining Effective Supervision Systems for Trainees Pursuing a Behavior Analyst Certification Board Certification During the COVID-19 Pandemic. Behav Anal Pract 2021; 14:1047-1057. [PMID: 33995855 PMCID: PMC8112215 DOI: 10.1007/s40617-021-00565-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2021] [Indexed: 01/11/2023] Open
Abstract
Behavior analysts acting as supervisors of individuals pursuing Behavior Analyst Certification Board certification are tasked with designing effective and ethical supervision and training systems. Behavior analyst supervisors and their trainees may face challenges fulfilling their responsibilities in the midst of barriers that include competing contingencies, transitions, and interruptions. In this article, we review potential obstacles faced by supervisors in designing effective supervision through site closures and transitions to telepractice as a result of the COVID-19 pandemic. We explore related potential barriers faced by trainees serving clients through public school settings, as well as through insurance-funded agencies in the United States. We review some practical solutions and offer tools for supervisors and trainees to consider at this time. We present a template for trainees to help them develop a personalized applied behavior analysis fieldwork plan for their supervision, a client/family needs assessment, and a corresponding trainee needs assessment to assist with adaptations to supervision and service delivery in an individualized manner.
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Affiliation(s)
- Jennifer Ninci
- Department of Special Education, University of Hawai‘i at Mānoa, 1776 University Ave., Honolulu, HI 96822 USA
| | - Marija Čolić
- Department of Special Education, University of Hawai‘i at Mānoa, 1776 University Ave., Honolulu, HI 96822 USA
| | - Ashley Hogan
- Department of Special Education, University of Hawai‘i at Mānoa, 1776 University Ave., Honolulu, HI 96822 USA
| | - Gregory Taylor
- Department of Special Education, University of Hawai‘i at Mānoa, 1776 University Ave., Honolulu, HI 96822 USA
| | - Roxanne Bristol
- Department of Special Education, University of Hawai‘i at Mānoa, 1776 University Ave., Honolulu, HI 96822 USA
| | - Jessica Burris
- Department of Special Education, University of Hawai‘i at Mānoa, 1776 University Ave., Honolulu, HI 96822 USA
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Oblak MK. An analysis of a system under pandemic conditions. J Appl Behav Anal 2021; 54:530-546. [PMID: 33817789 DOI: 10.1002/jaba.836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 03/15/2021] [Accepted: 03/15/2021] [Indexed: 01/05/2023]
Abstract
Recent events have emphasized the need for behavior-analytic service delivery models that can remain clinically consistent and produce high-quality outcomes while adapting to environmental change. This paper reports outcomes of an organization that adapted to changes in its service delivery model during a worldwide pandemic. The organization utilized components from the Comprehensive Application of Behavior Analysis to Schooling (CABAS®) model. The components were interconnected within the system and linked by specific interlocking contingencies. Performance data were used to make decisions within the organization on both individual and organizational levels during the transition to telehealth for clients and staff. Results are discussed in terms of how the interconnectedness of components within the organization contributed to the reliable, positive outcomes of the system during the transition to telehealth.
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