Table 4:

Promising Strategies/Advice

Strategy	Quote/Specific Application of Strategy
Start each visit asking the patient whether they are concerned about their privacy ad take steps to ensure that they are in a private place. If they do not have privacy, reschedule the session	“I always ask people if they’re comfortable with the level of privacy they have and we try to problem solve if they say no, but maybe they say yes, but really then do worry that somebody is listening or overhearing them.”
Brainstorm with patients about their options for finding a private place for visits. Some patients have used their car, closet, or bathroom or gone on a walk. Offer these options to patients.	“People have been creative. I’ve had a couple of patients go to their car outside their house and do the visit from the car so that they could have quiet and be able to concentrate on the visit.”
	“I would encourage practitioners to encourage their patients to be as creative as necessary in order to be able to establish that safe space where they can have their psychiatry sessions. So like I’ve had patients who didn’t feel that they had enough privacy in their own homes, but what they would do is they would either sit in the car in the driveway or they would actually drive to a place where they felt that there was a lot of privacy and they would just sit in their car with their smart phone or their iPad and we would do tele psychiatry with the patient sitting in their car. Which I think is actually very clever.”
Ask the patient for their location and a call back number at the start of each session. This will be helpful if you are disconnected or if there is an emergency.	“Patients need to tell me where they are. And we do that in case, one, is because I think Medi-Cal is expecting us to document it. And two, because in case there’s an emergency situation, we do know their location and we can send first responders.”
	“So we’re actually entering the actual address of each patients at the time of the phone call, of the video call.”
Psychiatrists should conduct video visits from the same spot in their home or office rather than switch locations. This is reassuring for patients.	“[At home] I’m going to set up in exactly the same place every time.”
Some patients are self-conscious about video and don’t want the clinician to see the inside of their home. Provide FAQs that explains how to change the background (i.e., options to not show your surroundings) in platforms like Zoom.	“I have suspected that a few patients don’t want to do a video session because they don’t want me to see their space”
Call each patient prior to the telemedicine visit to explain what to expect and why telemedicine is being used.	“It is very important to inform the patients in advance. I appreciated the help from the front desk, because when they expect it, especially in psychiatry, they don’t like short notices. Not all of them, but some patients get nervous when they are not familiar with the situation, but when they know, when they expect what is going to happen, they feel much more comfortable and they make themselves available as well.”
	“And they also get a phone call ahead of time telling them not to come into the office and that I’ll reach to them at their appointment time.”
Identify patient “at risk” of having difficulty with video visits (e.g., older adults, adults with cognitive impairments) and explore if there is someone in their environment who can aid them. Also, do test calls with this population.	“I had one patient who I did do FaceTime with, and her daughter came in and showed her…if there was somebody who can help them work through it, it’s easier than they would think it is. I don’t know if that’s a way. I don’t know if there’s a way to kind of encourage, explain it, have it explained to them or a service that they could use that would make it clear.”
	“We really took our time identifying the patients that are most at risk and we actually out reached to them and explored how we can help them implement by guiding them over maybe one, two, or even three phone calls or see if somebody in their environment can assist them. We also have case managers that do have the ability to visit patients. We call them care navigators. Sometimes they’re able to physically help patients.”
Choose a platform where you can ensure that the patient will not see your personal phone number or work out process to block your personal phone number.	“The biggest issue that I contend with is that FaceTime for the most part requires the patient to usually see your cell phone. And I don’t use my personal cell phone for psychiatric patients you see.”
	“For telephone calls, I’ve just been using my home phone and blocking the number.”