Most mental health providers now offer video visits, and many see significant portions of their caseload virtually. But assessment practices haven't always kept pace. Some providers dropped formal assessment when they lost the waiting room clipboard. Others adapted awkwardly, reading questionnaires aloud over video.
Neither approach serves patients well.
Why assessments matter more in teletherapy
Video captures some of what you'd observe in person, but not all. Limited camera angles, lighting variations, and connection quality reduce the observational data you can gather: appearance, psychomotor activity, subtle affect changes. Standardized scores provide objective data points that don't depend on visual observation.
Patients also behave somewhat differently on video. The therapeutic frame differs. The feeling of connection may differ. Early in telehealth adoption, this created uncertainty: is the patient doing better, or just presenting differently virtually? Assessment scores anchor clinical impression in objective measurement, reducing ambiguity. Research suggests teletherapy outcomes are comparable to in-person, and self-administered assessments completed remotely have proven reliable. One mHealth study showed PHQ-9 scores decreasing from 14.69 to 10.50 over 8 weeks of remote monitoring, with suicidal ideation endorsement dropping from 25% to 14.66%.
Delivery methods
Pre-session electronic delivery should be your default approach. The patient receives an assessment link 24-48 hours before the appointment, completes it on their own device, and results are available before the session begins. No session time used. Works regardless of visit modality.
Verbal administration during session works as backup when electronic completion didn't happen. Read questions aloud, patient responds verbally, you score and document. This uses session time and clinician presence may influence responses, but it keeps assessment happening.
Post-session completion captures between-session data but means results aren't available for that session's clinical discussion. Completion rates run lower than pre-session. Best for homework-style tracking or follow-up assessments.
Workflow design
The ideal flow: scheduling triggers assessment delivery 48 hours before the appointment. Patient completes the PHQ-9 and GAD-7 on their phone or computer. Automatic scoring makes results available immediately. A reminder goes out if not completed 24 hours before.
Before logging into the video session, review results and note score changes. When the session starts, reference assessment results early: "Your depression score was 11 this week, down from 15 last time. How have you been feeling?" This shows you reviewed their data, validates their experience, and creates a concrete starting point.
For non-completion, have Plan B ready. Either send the assessment to their phone during the session (it takes two minutes) or administer verbally. For patients who repeatedly don't complete, explore barriers. Are messages reaching them? Is the timing wrong? Do they understand why it matters? Completion rates of 70-85% are achievable with good systems.
Using results therapeutically
Assessment data enables specific conversations. On symptom patterns: "I notice your sleep items on the PHQ-9 are still elevated even though your mood has improved. Let's talk about what's happening with sleep." On progress: "Looking at your scores over the past two months, you've gone from severe to moderate anxiety. That's real progress, even if it doesn't always feel like it day to day." On discrepancies: "Your score suggests things are about the same, but you're telling me you feel much worse. Help me understand what I'm missing."
Progress notes should include the assessment name and score, comparison to previous administrations, clinical interpretation, how results influenced the session, and that service was delivered via telehealth. Example: "PHQ-9 administered electronically pre-session; score = 12 (moderate), decreased from 16 two weeks ago. Results discussed; patient attributes improvement to behavioral activation homework. Session conducted via HIPAA-compliant video platform. Continue current treatment approach."
Platform requirements
For teletherapy integration, your assessment platform should deliver via email or SMS without requiring a special app, provide mobile-optimized completion, score automatically, and display results in a clinician-accessible dashboard before sessions begin. Your video platform and assessment platform don't need to integrate directly, but workflow should be seamless. Can you view results while on video? Is scoring available before session start?
If a patient can do video therapy, they can complete electronic assessments. The technology bar is the same: email or SMS, web browser or smartphone, basic digital literacy.
Privacy and environment
Teletherapy patients complete sessions from home, work, or other locations where privacy may be limited. Pre-session completion allows patients to choose private moments for sensitive questions. Consider whether verbal administration is appropriate when others might overhear. Discuss privacy needs if concerns arise.
A positive response to PHQ-9 item 9 (self-harm) should trigger notification before the session. You can then begin the session addressing safety, or reach out before the appointment if warranted.
Overcoming resistance
Frame assessments as supporting conversation, not replacing it. The questionnaire provides a starting point; the discussion is where therapy happens. Most patient resistance diminishes when they see how results inform care.
For patients struggling with technology, offer phone support for first completion, simplified delivery via direct text message link, or verbal administration as backup. Don't let technology barriers become care barriers.
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The APA's 2024 telepsychology guidelines emphasize that clinicians must understand how telehealth may alter treatment and assessment. For standardized measures, the answer is encouraging: the PHQ-9 and GAD-7 are reliable screening tools (Cronbach alpha 0.86 and 0.91 respectively) whether administered in person or remotely. Pre-session electronic delivery often works better than the waiting room clipboard ever did.