Table 1.
Prerequisites and precautions necessary for DHI
| Field | Aspects to consider | |
|---|---|---|
| Competences of patients and therapists | Personal Preferences | For specific devices/programs |
| Personal Skills | Competence to handle electronic device/software | |
| Confidence | In treatment effectiveness | |
| Data security | Software requirements | Use of software approved for psychotherapy by respective health care authorities |
| Software protects data from external access | ||
| Data storage | Secure storage of patient data (including access control, encryption, and external backups) in accordance with requirements of the respective health care regulations | |
| Implementation | Legal basis | Informed consent by patients and parents |
| Environmental factors | Privacy at the patient’s home | |
| Adequate lighting (e.g. not too dark/no window in the background) to be seen well over webcam | ||
| Neutral background at the therapist’s workplace | ||
| Technical aspects | Stable high speed internet connection | |
|
Webcam with high video resolution (at least in the range of Full High Definition [1080p]) Headset to avoid background noise | ||
| Therapeutic alliance | Increased self-reflection/explanation about therapist behaviour (e.g. tell the patient when taking notes and thus not looking into the camera) | |
| At risk patients and suicidality | Type of DHI for at risk patients | DHI without direct contact to a therapist or only asynchronous types of communication are inappropriate for patients with suicidal ideations. These comprise the risk that the therapist does not recognize suicidal ideations that would have become apparent within a personal contact |
| Warning signals | Therapists have to be highly sensitive regarding key signals (e.g. severely depressed mood, hopelessness) | |
| Interventions in case of aggravation and safety precautions | Increase of the frequency of synchronous communication e.g. via video conferencing as a tool to deliver support during vulnerable episodes | |
| At least one parent has to be present in the house during video therapy sessions | ||
| Therapist needs patient’s/parents’ contact information at hand to be able to initiate emergency services when needed | ||
| Cooperation with local professionals (paediatrician, psychiatrists) for emergency support |