A well-designed Telehealth setup can improve rapport and signal a safe environment to the client. This document outlines some tips and tricks to help practitioners set-up for telehealth success.
Last Updated: May 2021
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The most important aspect of any telehealth setup is lighting, as it determines the client’s ability to see the practitioner. Without adequate lighting, clients will miss non-verbal cues required to help build rapport. Practitioners can improve lighting using natural and artificial sources.
Windows should be situated behind the webcam to illuminate the practitioner’s face. If the window is located behind the practitioner (in-front of the webcam), a shadow will be cast across the practitioner’s face making it difficult to see. If a window can be seen within the video, blockout blinds are an effective way to block the light and improve the image.
Lighting can be significantly improved using low-cost ring lights. Ring lights are specifically designed for illuminating people’s faces over video, and can be purchased online for less than $40. Desk-mounted ring lights can be helpful when there is limited space available on the practitioner’s desk. The best lighting can be achieved with two ring lights illuminating the face from different angles, as it minimises shadows on the face.
“It’s helpful for clients to be able to see micro-facial expressions, which can be achieved with good - but inexpensive - lighting”
Dr Aaron Frost, Benchmark Psychology.
The second most important aspect of the telehealth setup is the audio quality. Poor audio may cause the client to mishear important information or miss cues from the practitioner.
Embedded microphones in most laptops are highly sensitive to background noises which can distract the client and impede rapport building. Directional microphones filter out the background noise and more accurately encode the practitioner’s voice. Directional microphones are often found in wireless ear-buds (such as Apple AirPods) and headsets with in-built microphones.
Some practitioners prefer headphones to accurately hear their clients, whilst some practitioners avoid headphones to better resemble in-person consults. Practitioners should have headphones available in case the client begins hearing their voice echoing. Echoing occurs when there is feedback between the microphone and speaker on the practitioner’s device, causing the clients voice to be played back to them. Wearing headphones is the simplest method of eliminating this feedback. Practitioners can proactively ask clients whether they can hear an echo to pre-empt any communication issues.
“It is not necessary to invest in the best technology… Use dedicated microphones that filter out background noise rather than the mic built-in to a laptop and prevent feedback loops.”
Dr Aaron Frost, Benchmark Psychology.
In telehealth, positioning is about the placement of the camera. Practitioners should be placed squarely in the centre of the frame with the camera at eyeline. If the camera is too low, the practitioner will appear to be looking down at the client. If using a built-in laptop camera, raising the height of the laptop may help achieve the right height. The camera should be approximately an arms-length away from the practitioner for the best positioning.
Just Right Too Far Too Close
The best way to improve your positioning is by practicing with a mirror or the camera application. Practitioners can experiment by moving the mirror or camera around until they feel comfortable with the best positioning.
“Imagine the screen is the client. It is a normal clinical interaction…. Practicing is key. Practicing helps providers to get a feel for the camera”
Dr Wendy Kelso, Pearson Clinical.
A good workspace should not detract from the therapeutic alliance but enhance it. Below are some recommendations for setting up the best telehealth workspace.
The telehealth workspace should replicate the office environment by offering a private space. Views of doors and windows should be limited and children should be prevented from entering the room when possible. Audio alerts from the practitioner’s phone and computer should be disabled to avoid distracting the client.
Conducting all sessions from the same locations helps establish a familiar, safe, and stable space for the client. Practitioners should avoid moving the workspace and limit changes to the background, particularly when offering trauma-informed therapy.
Practitioners should be careful when placing reflective objects in the background, such as photo frames, as they might reflect light into the camera. Virtual backgrounds should also be avoided, as they increase uncertainty about the practitioner’s environment.
Second screen makes it easier to take notes during the telehealth consult, whilst still being able to see the client on the primary screen. When using a second screen, practitioners should narrate the process in real-time, so the client knows the practitioner is not distracted.
Although desktop computers have larger screens, tablets can be a portable alternative for delivering telehealth. Consider where you will likely be conducting your telehealth consults.
Telehealth can be delivered on any device with an internet connection; including desktop computers, tablets, or smartphones. Below are some technical requirements to consider when delivering telehealth.
When purchasing a new computer, practitioners should ensure they are capable of running browser-based video calling applications. The following are the minimum device requirements for Coviu:
- Windows PC i5 processor with 3GB of RAM Windows 7 or later
- Apple Mac i5 processor and 3GB of RAM MacOS 10.12 (Sierra) or later
- Android tablet or smartphone Android 5.1 or later
- Apple iPhone or iPad iOS 12 or later
To ensure a smooth video consultation, practitioners should ensure the latest version of their browsers is installed. Practitioners can check their browser version at www.whatismybrowser.com. The following are the minimum browser requirements for Coviu:
- Google Chrome Version 82+ (Windows, Android, MacOS)
- Apple Safari Version 12+ (MacOS, iOS)
- Firefox Version 75+ (Windows, Android, MacOS)
- Microsoft Edge Version 82+ (Windows MacOS)
- Microsoft Edge Version 44+
A standard telehealth call requires a minimum of 350kbps upload and download for each participant. That bandwidth requirement grows as you add more guests to your call. For more information about internet requirements, see this help article.
Thomas, N. & Little, G. (2021). Delivering Quality Mental Health Support [Conference presentation]. State of Telehealth Summit. https://pr.coviu.com/en-au/sts-webinar-replay-form
Smith, A., Caffery, L., Haydon, H., & Banbury, A., (2021). The Telehealth Expert Discussion Panel [Conference presentation]. State of Telehealth Summit. https://pr.coviu.com/en-au/sts-webinar-replay-form
Frost, A. & Matheson, K. (2021). Telehealth Natives: insights from Australia’s telehealth pioneers. [Conference presentation]. State of Telehealth Summit. https://pr.coviu.com/en-au/sts-webinar-replay-form
Haebich, K., Stephens, M., & Kelso, W. (2021). Telehealth Success Stories: Supporting our clients no matter the circumstances. [Conference presentation]. State of Telehealth Summit. https://pr.coviu.com/en-au/sts-webinar-replay-form
Sansom-Daly, U. (2021). Grappling with the human factors in telehealth: Strategies to enhance its ‘human-ness’ and the interpersonal connection. [Conference presentation]. State of Telehealth Summit. https://pr.coviu.com/en-au/sts-webinar-replay-form
Bulkeley, K. (2021). Telepractice: A real choice for quality therapy services for children. [Conference presentation]. State of Telehealth Summit. https://pr.coviu.com/en-au/sts-webinar-replay-form