A well-designed telehealth setup can improve rapport and signal a safe environment to the client or patient; this article describes how you can achieve that.
Last Updated: March 2024
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On this page:
- Lighting
- Audio quality
- Positioning
- Telehealth workspaces
- Technical requirements
- References
- More support options
Lighting
The most important aspect of any telehealth setup is lighting, as it determines the client’s or patient's ability to see the provider. Without adequate lighting, clients or patients will miss the non-verbal cues required to help build rapport. Providers can improve lighting using natural and artificial sources.
- Natural light
Windows should be situated behind the webcam to illuminate the provider's face. If the window is located behind the provider (in front of the webcam), a shadow will be cast across the provider's face making it difficult to see. If a window can be seen within the video, blackout blinds are an effective way to block the light and improve the image. - Artificial light
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 provider'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
Audio quality
The second most important aspect of the telehealth setup is the audio quality. Poor audio may cause the client or patient to mishear important information or miss cues from the provider.
Microphones
Embedded microphones in most laptops are highly sensitive to background noises which can distract the client or patient and impede rapport building. Directional microphones filter out the background noise and more accurately encode the provider's voice. Directional microphones are often found in wireless earbuds (such as Apple AirPods) and headsets with in-built microphones.
Headphones
Some providers prefer headphones to accurately hear their clients or patients, whilst some providers avoid headphones to better resemble in-person consults. Providers should have headphones available in case the client or patient begins hearing their voice echoing. Echoing occurs when there is feedback between the microphone and speaker on the provider's device, causing the client's or patient's voice to be played back to them. Wearing headphones is the simplest method of eliminating this feedback. Providers can proactively ask clients or patients 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
Positioning
In telehealth, positioning is about the placement of the camera. Providers should be placed squarely in the centre of the frame with the camera at the eyeline. If the camera is too low, the provider will appear to be looking down at the client or patient. 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 provider for the best positioning.
The best way to improve your positioning is by practising with a mirror or camera application. Providers 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. Practising helps providers to get a feel for the camera.”
Dr Wendy Kelso, Pearson Clinical
Telehealth workspaces
A good workspace should not detract from the therapeutic alliance but enhance it. Below are some recommendations for setting up the best telehealth workspace.
Privacy
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 provider's phone and computer should be disabled to avoid distracting the client or patient.
Location
Conducting all sessions from the same locations helps establish a familiar, safe, and stable space for the client or patient. Providers should avoid moving the workspace and limit changes to the background, particularly when offering trauma-informed therapy.
Backgrounds
Providers 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 provider's environment.
Second screens
A second screen makes it easier to take notes during the telehealth consult, whilst still being able to see the client or patient on the primary screen. When using a second screen, providers should narrate the process in real-time, so the client or patient knows the provider is not distracted.
Tablets
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.
Technical requirements
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.
Computers
When purchasing a new computer, providers should ensure they are capable of running browser-based video calling applications. The following are the minimum device requirements for Coviu:
- Windows PC
- 2GHz dual-core, i5 processor, 3GB of RAM with Microsoft Windows 7 or later
- Apple Mac
- Intel 2GHz dual-core, i5 processor, 3GB of RAM with macOS 10.15 (Catalina) or later
- Android tablet or smartphone
- Less than two years old, with a front-facing camera with Android 5.1 or later
- Apple iPhone or iPad
- iPhone 5S or later, iPad Air or later, iPad Mini 2 or later, iPad Pro with iOS 14.3 or later
Note: Xiaomi Redmi Note 3 and Oppo A73 do not support Android/Chrome to iOS/Safari video calls.
Browser requirements
To ensure a smooth video consultation, providers should ensure the latest version of their browsers is installed. Providers can check their browser version at www.whatismybrowser.com. The following are the minimum browser requirements for Coviu:
- Google Chrome Version 82+ (Windows, macOS, Android)
- Microsoft Edge Version 82+ (Windows, macOS, Android)
- Mozilla Firefox Version 75+ (Windows, macOS)
- Apple Safari Version 12+ (iOS, macOS)
Internet requirements
A standard telehealth call requires a minimum of 350 kbps (kilobits per second) upload and download for each participant and a response delay (or latency) of less than 400 ms (milliseconds).
While this does not mean you can't make a call, you might face some quality issues, such as slower video or delays. The bandwidth requirement also grows as you add more call participants. Click here for more information about internet requirements.
References
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
More support options
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