Remote Viewing

Using Telehealth Can Help Decipher Behavior Issues

By Sally Foote, DVM, CABC-IAABC

Using Telehealth Can Help Decipher Behavior Issues

Animal behavior is one area of medicine that affects every aspect of care. First, day-to-day behaviors at home can affect appetite, movement, and the ability to exercise. In addition, how easily a patient can tolerate traveling to a clinic or an examination or accept a practitioner into the home determines the ability to assess the health of the animal. And finally, the relationship between the patient and the pet parent means everything for the success of the home care plan during recovery from illness to injury. When veterinarians are limited to our in-clinic view of the patient, we miss many aspects of behavior that affect complete care.

My background is in general practice ownership with a behavior focus for prevention and low-stress care. In my 30-plus years of practice, I saw how behavior integrated much of the healthcare I provide and how my clients could comply with home care. As I grew in my expertise and limited my scope to behavior consultations and education in low-stress veterinary care, I saw the comparison of in-clinic versus in-home versus telehealth behavior consultation. Each approach has benefits and limitations, yet for behavior assessment and modification plans, telehealth consultations provide me more information in a shorter time than either an in-clinic or home visit.

Why Telehealth Over In-Person Consultations?

Veterinary behavior consultations can be challenging to provide in a clinic setting. The practitioner needs to gather accurate information about the animal’s body language, environment, and the severity of the behavior. In my years of providing consultations, I have tried various methods, including for the client to provide videos and history in advance. But in my practice, dogs who were aggressive toward other dogs and people were the most common consultation requested. These dogs were often stressed at the visit due to the aggression triggers of being around unknown people and dogs awaiting general care. These dogs were generally not on medications yet and were too anxious to accept rewards or other low-stress care techniques. They were a risk to myself and my staff and other clients, and in addition, I couldn’t get a clear read on what they really needed. So, I tried video call consultations for the most aggressive dogs.

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In just the first three minutes, I could see the triggers to aggression brewing in front of the webcam.

The first video consultation with two dogs proved how effective and efficient the telehealth method was. In just the first three minutes, I could see the triggers to aggression brewing in front of the webcam. The clients dismissed the growling dogs as “just playing.” The dogs were standing over a rawhide, staring at each other. I immediately instructed the owners to call the dogs apart, pick up the rawhide, and put it out of sight. The dog’s tension dissolved in front of their eyes. In that case, it was clear that resource-guarding was a trigger for housemate aggression. I would not have had this information through any client-provided history, as the clients did not see growling as a problem, only the lunging up to a bite. So, in less than five minutes, a primary trigger was identified, and we came up with a specific plan to manage it.

Feline behavior consultations are another telehealth consultation I offer. This provides me the ability to see the home and the cat in the home. In my first feline telehealth consult, I could see the cat engage in subtle staring and resource guarding as well as analyze the need for enrichment in the home. It was much easier for me and the client to walk around the home and point out exactly where to put additional perches, how to improve the litterbox set up, and then teach the cats to redirect away from each other positively.

How to Use Telehealth Consultations for Behavioral Issues

While live video consultations are great for giving instant feedback, sometimes the behaviors that clients are worried about aren’t caught when we’re meeting. Because of this, I also encourage clients to send videos of behavior concerns. This way, I can provide asynchronous consultations and chat services, leveraging technical staff for common issues like puppy socialization problems, early litter box difficulties, and fear-based behaviors. After viewing videos, I can send the client an email with my suggested plan, including handouts or video demonstrations. It is important to make sure that work like assessing videos, photos, or behavior histories still has a set fee; often, this kind of work goes unnoticed even though it takes a lot of time.

I also always record consultations. It saves time with report writing, and you can send the video to the client so they can reference it as needed or share it with family members who couldn’t attend the consultation. This is also helpful when collaborating with the primary care veterinarian. When I see gait affected by possible pain or difficulty of the animal in rising, managing stairs, or getting onto perches, I can tell the primary veterinarian. Then, they have a more complete view of the animal’s home and ability to function so they can discuss medications, diagnostics, and other therapies to improve health and behavior.

Veterinary behavior consultations can be challenging to provide in a clinic setting.

Lastly, one more use of telehealth services is to support low-stress home care and help the client prepare for any in-person veterinary visits. This service can be a live video call or video assessment of client home care. I coach the client directly about setting up a care area and exactly how to go about the care, such as using muzzles with rewards or the proper approach for eye drops, ear drops, insulin injections, and physical therapy. For pre-exam preparation, the client can email a video of the pet loading into the car or carrier and how they react as they travel to the veterinary clinic. I use this to provide a specific plan to decrease stress, and then the veterinarian can assess for the right medication and rewards to create calm travel and good outcomes at the veterinary clinic.

Saving and sharing the recorded consultation is easy with certain platforms. You can use a program like GoToMeeting where your recordings are saved in your account with a link that is open for a year—no downloads or uploads and the storage is included in a reasonable monthly fee. Zoom offers a similar program. You could download and then upload the video to a private YouTube channel, Google Drive, or other cloud storage option. The main point is recording the consultation and sharing it.

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While live video consultations are great for giving instant feedback, sometimes the behaviors that clients are worried about aren’t caught when we’re meeting.

Pros and Cons

Everything in life has a good side and a not-so-good side. Telehealth is no different. Here is the list of the good versus the not-so-good to consider when providing telehealth behavior consultations.

Top Tips for Great Telehealth Consultations

Sally Foote, DVM, offers these tips on how to have a great telehealth experience with your clients.

icon-scheduling.png Flexible scheduling—offer appointments when most of the family can be present, including children.
icon-record.png Record the consultation! The family can review this and save you a lot of time. You can share this recording with the primary veterinarian to also see.
icon-time.png Block out a minimum of one to two hours, to include walking the family through the behavior plan and coaching them on the steps to follow. Charge by the hour to include your after-consultation online support.
icon-battery.png Remind the client to plug their phone in—video calls take a lot of battery power!
icon-focus.png Tell the client to go to settings and turn on focus—This prevents phone calls from interrupting your consultation.
icon-contacts.png Enter the client’s name, cell phone number, and email in your phone contacts. You will at once see FaceTime, or Google Duo, or WhatsApp in the contact to use as a backup.
icon-text-email.png Send the video call invite by text as well as email—clients pay more attention to texts.
icon-handouts.png Have handouts open on your computer—use screen share when you supply the evaluation. Include these with your report and the video call recording.
icon-quiet-signal.png Be sure your area is quiet and has a strong internet signal.

Benefits

    1. The access to see the home as it really is: Clutter, household noises, child activity, and human interactions are how they really are day to day.
    2. Subtle brewing aggression and anxiety becomes obvious. Triggers are evident, which allows you to create a customized behavior plan on the spot.
    3. The advantage of demonstrating what the client should do or literally walking them through the process, then allowing them to try it out and get instant feedback.
    4. The capability to assess how feasible the behavior modification plan is for this home, this animal, and this client, making adjustments as needed for personalized care.
    5. The ability to help more clients from varied backgrounds.

Drawbacks

    1. No access to provide medications. Behavior consultations only provide a management plan to help decrease frequency of the behavior.
    2. Some clients may have a technology barrier, whether they are intimidated by using the platform or downloading new apps, making them reluctant to schedule. In this case, ask a tech savvy family member to do the consultation with them.
    3. Slow responses from the primary care veterinarian for prescribing needed medication or medical workup will delay effective treatment. Find out the best way to communicate with the veterinarian—phone or email?—and be to-the-point and available for timely responses.

How to Provide an Efficient Behavior Telehealth Consultation

  1. Use a video call platform that you are accustomed to and has the capacity to store recorded calls in your account. I use GoToMeeting, which costs around $20 per month. I can set as many appointments as I want for as long as I want and store unlimited video calls for one year, though long uploads or downloads tend to slow it down. Be prepared to switch to FaceTime, WhatsApp, Google Duo, or Facebook Messenger if the platform is having streaming difficulty. Ask your client what ways they video call, and use what is easy for them.
  2. Use an online history form that must be filled out before the consultation. Have the link on your website page or send a text or email. Enter the client’s name, phone, and email into your phone contacts.
  3. Contact the primary veterinary clinic, and ask for the medical summary. If you see complex medical problems, do the behavioral consultation, and then set up a separate meeting to discuss medical conditions with the vet. Keep it easy for the primary veterinarian.

    Printable Checklist for Your Team

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  4. Email or text an online invoice for a nonrefundable deposit to secure the appointment. This avoids no-shows. Square or PayPal are two good options.
  5. Email and text the video call invite. People do not always pay attention to email, so I recommend doing both. Be sure to instruct clients to download the app in advance. For the meeting, it is useful to have them shut off home streaming devices to spare bandwidth and have phones set to do not disturb or focus to prevent video call interruption.
  6. Open a Word document or other place to take notes and divide your screen between the video call and the document. Type any notes, evaluation, and ideas for the management plan as you listen and talk. This saves a lot of time.
  7. Use screen share for handouts to educate about body language or other points. Include these handouts as attachments with your emailed report.
  8. Encourage the client to use a Google Drive or iCloud folder for photos, videos, and updates. Video files are often too large to attach to emails, so these cloud-based services are easy to open and share with the primary veterinarian.

I encourage you to try telehealth for behavior consultations. I have a free on demand webinar, “Telehealth Made Easy” with Shawna Garner, DVM, at my shop: www.drsallyjfoote.com/shop/webinar/vet-professional/telehealth-behavior-consults-recording-with-handouts.

I would love to hear from you about how you use Telehealth in your practice—email me at dr.sally@mchsi.com, or find me on Facebook at FooteandFriends, or via LinkedIn.

Photo credits: 101cats/E+ via Getty Images, brazzo/iStock via Getty Images Plus, Alex Potemkin/iStock via Getty Images Plus

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