•  Framing & Arranging Different Clinical Populations
•  David Roth, M.D., FAAP, FAPA

• Telepsychiatrists must immediately engage the patient's attention and convince them that they are trustworthy, competent, empathic, and will be responsive to their needs. It is often not what is said, but how it is said, that matters most to our patient.
• A critical element of nonverbal communication is how the provider and participants see each other on the screen. To this end, careful room selection and thoughtful participant arrangement facilitate rapport and provide an authentic experience for everyone involved.
• After the room at the patient's site is selected, it should be tailored to support videoconferences, accommodate the number of participants, and maximize participants' focus during the session.
• If there is only one participant at the remote site, he/she should sit 2-4 feet away from the camera and screen. For each additional participant another 2 feet back from the camera will keep all participants in the screen's framing.
• Many seating arrangements can work for children. Children can sit next to the parent, between the parents, on a parent's lap, or in front of the parents in either their own chair or on the floor.
• Sometimes a hyperactive or autistic child cannot remain in the camera frame. Consider keeping the parent(s) in the frame and call the child back to the camera when they need to answer a question. If a child's motor skills, play, exploration, and movements are being assessed, the room should be large enough for this activity to fit within the camera frame.
• Occasionally anxious or defiant youth will refuse to sit within the camera frame. If behavior management strategies fail to move the youth, then prior to the next session instruct the parent or session facilitator to turn off the self-monitor image and seat the youth farther away from the camera so as to remain in the frame. Another strategy is to allow the youth to have more privacy for part of all of the session.
• Effective telepsychiatrists create authentic provider-patient relationships by paying attention to room selection, participant arrangement and other aspects of nonverbal communication. With sufficient practice, telepsychiatrists can engage a wide variety of patients in many clinical and residential settings, while feeling as comfortable and as confident as they do in traditional clinical venues.

References

1. Burgoon JK, Guerrero LK, Floyd K. Nonverbal Communication, 201, 1-6, Routledge, Taylor and Francis Group, London, 2015. Retrieved from https://content.taylorfrancis.com/books/download?dac=C2015-0-61479-2&isbn=9781317346074&format=googlePreviewPdf
2. Eaves, M., & Leathers, D. (2017). Successful nonverbal communication: Principles and applications. Retrieved from https://www.taylorfrancis.com/books/9781315542317
3. Feldman, R. (2014). Applications of nonverbal behavioral theories and research. Retrieved from https://www.taylorfrancis.com/books/9781317782667
4. Henry, S. G., Fuhrel-forbis, A., Rogers, M. A. M., & Eggly, S. Patient Education and Counseling Association between nonverbal communication during clinical interactions and outcomes : A systematic review and meta-analysis. Elsevier, 86, 297–315, 2012. https://doi.org/10.1016/j.pec.2011.07.006
5. Knapp, M., Hall, J., & Horgan, T. (2013). Nonverbal communication in human interaction. Retrieved from https://books.google.com/books?hl=en&lr=&id=rWoWAAAAQBAJ&oi=fnd&pg=PP1&dq=6.%09Knapp+M,+Hall+J,+Horgan+T:+Nonverbal+Communication+in+Human+Interaction,+8th+Ed.+Wadsworth,+Boston,+2014.&ots=4RqBTSsXcC&sig=Bq_1D2B9mKHi7NNemn5HfNS6abs
6. Myers, K. M., & Roth, D. E. (2018). Telepsychiatry With Children and Adolescents. In A. Martin (Ed.), Lewis’s Child and Adolescent Psychiatry (5th ed., pp. 885–896). Philadelphia: Wolters Kluwer.
7. Riess, H., & Kraft-Todd, G. (2014). E . M . P . A . T . H . Y .: A Tool to Enhance Nonverbal Communication Between Clinicians and Their Patients. Academic Medicine, 89(8), 8–10. https://doi.org/10.1097/ACM.0000000000000287