Telehealth Safety Tip: Hand Signal

I interrupt your previously scheduled telehealth activity post with a safety tip! Yesterday, the New York Times shared the story of a young girl who had been kidnapped and signaled to another driver that she was in trouble using a hand signal. I recognized the hand signal as something I learned from a telehealth training, and something I have taught in my own telehealth seminar. I realized that this is such an important safety tip that I had not shared here before, so here we are.

One concern that sometimes arises with telehealth is, what if a client does not have privacy? What if there is a safety issue in the home, and the client does not feel able to tell me what is going on without alerting their abuser?

I have used the chat feature for this before, but an abuser who is listening in might wonder why the client has gone quiet or hear them typing. This hand gesture allows your client to signal you that “something is wrong” without indicating to anyone listening in that they have shared this.

The gesture is below:

Step one: four fingers pointing up, thumb crossing the palm.
Step two: lower the four fingers over the palm, trapping your thumb.

Let clients know that this gesture means “I’m not safe, but I can’t talk about it.” When you see the gesture, talk to the client as if everything is normal. You can ask questions in chat and have them use code to let you know what is going on. For example, you can type, “Are you in immediate danger? Talk about your dog if you are.”

If a client indicates that they are in immediate danger, follow your agency’s safety plan for getting them to safety.

If the client indicates that they are not in immediate danger, request that the next session be in person. With a child, you can simply tell the parent that you think they would get more out of an in-person session. You can also claim you had technical issues hearing or seeing your client as a reason to see them in-person.

You can then gather more information in your office, where you have more control and can ensure that they have privacy.

This is a simple, handy way to make sure you are attending to clients’ safety when using telehealth.

Published by Dr Marschall

Dr. Amy Marschall received her Psy.D. from the University of Hartford in September 2015. Her clinical interests are varied and include child and adolescent therapy, TF-CBT, rural psychology, telemental health, sexual and domestic violence, psychological assessment, and mental illness prevention. Dr. Marschall presently works in the Child and Adolescent Therapy Clinic at Sioux Falls Psychological Services in Sioux Falls, South Dakota, where she provides individual and family therapy and psychological assessment to children, adolescents, and college students. She also facilitates an art therapy group for adolescents and college students with anxiety and depression. Dr. Amy Marschall is certified in Trauma-Focused Cognitive Behavioral Therapy and Telemental Health.

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