2  TELEPSYCHOLOGY SPECIAL ISSUE
More than any other theme, the articles in this special issue underscore the critical nature of strong telepsychology training as a growth opportunity for the field. Pierce, Perrin, and McDonald (2020) found in their path model that the strongest predictors of psychologists' use of telepsychology were subjective norms, perceived ease of use, and perceived usefulness of telepsychology. Put simply, psychologists who do not use telepsychology do not feel that others are using it or that it is easy to use or useful. For these nearly 80% of psychologists, this has to change, and the primary way to do it is through strong telepsychology training implemented for trainees both early and often in their training, as well as practicing psychologists at various phases of their careers. Indeed, lack of training was the most frequently endorsed barrier to telepsychology use among mental health care providers (Perry, Gold, & Shearer, 2020). Caver et al. (2020) describe some of the excellent telepsychology training programing offered by the U.S. Department of Veterans Affairs (VA) and the VA's strong efforts to overcome barriers to training and implementation. The VA is at the forefront of efforts to support telepsychology provision. Dissemination and implementation (D&I) science is sorely needed in this arena to determine what variables have facilitated the D&I of telepsychology and telemedicine within the VA and other technologically progressive health care systems, as well as to apply those findings to other systems and settings.
In the opening editorial, Elliott (2020) identifies another of the most substantial barriers to the adoption of telepsychology: ourselves. Psychologists' bias against telepsychology can at times be profound, yet that bias runs counter to the overwhelming evidence suggesting that telepsychology is no less effective than in‐person treatment for the vast majority of presenting concerns (Varker, Brand, Ward, Terhaag, & Phelps, 2019) and that it can be an excellent extension to in‐person services such as aiding in assessment (Heesacker, Perez, Quinn, & Benton, 2020). Some seemingly obvious exceptions to this general rule may apply for specific clinical services, such as neuropsychological assessment, although evidence is mounting that certain neuropsychological assessments can feasibly be administered through telepsychology (Galusha‐Glasscock, Horton, Weiner, & Cullum, 2016). Telepsychology trainings and readings have to spend substantial time countering preconceived biases and educating psychologists and trainees that telepsychology works and how it can extend in‐person services (Pierce et al., 2020). Theory‐driven intervention research in this area would identify what barriers are present for psychologists (e.g., Perry et al., 2020), as well as exactly what types of information and experiences effectively help psychologists with strong biases against telepsychology overcome them.
Although psychologists sometimes voice negative views about telepsychology, our field has known for a long time that many potential patients have negative views about traditional psychological treatment. Ironically, telepsychological approaches such as wearable devices may actually be more appealing to people holding negative views toward psychological treatment and who have less experience in help‐seeking (Hunkin, King, & Zajac, 2020). Other extremely promising web‐based approaches that have the potential to reach individuals not entering traditional treatment, or as a supplement to traditional treatment, are showcased in this special issue, including Acceptance and Commitment therapy for college students (Viskovich & Pakenham, 2020), an avatar‐based intervention for military family caregivers (Wilcox, 2020), and a self‐management positive psychology intervention (Görges, Oehler, von Hirschhausen, Hegerl, & Rummel‐Kluge, 2020). As Heesacker et al. (2020) note, web‐based interventions such as these are showing respectable levels of feasibility and efficacy, although treatment computerization represents an extension of traditional mental health care providers, not a replacement.
Despite many of the intrapsychologist variables highlighted in the articles in this special issue that limit the D&I of telepsychology (e.g., bias, lack of preparedness, concerns about usefulness or efficacy), a substantial portion of barriers exist in the external environment, many of which have come to the forefront during the COVID‐19 pandemic, as noted in more detail below. One of the most substantial is psychologist reimbursement issues, which are far less present in the VA and probably account in part for telepsychology and telemedicine's relative success there. Few private insurance companies reimburse for telepsychology services at the same rate as in‐person services, or at all. Federal legislation is critical mandating that insurance companies' reimbursement policies align with the comparative outcome effectiveness of telepsychology and in‐person treatment. Further, widespread adoption of interstate practice agreements in the United States are necessary for the full success of telepsychology, such as the Psychology Interjurisdictional Compact (PSYPACT), which facilitates telepsychology practice across jurisdictional boundaries. In most states, both the psychologist and patient have to be physically in the state in which the psychologist is licensed. By contrast, a licensed psychologist working at a VA medical center can treat a veteran in any other state, again showing the VA's forward thinking on these issues and the potential for public policy to expand the reach of telepsychology.