Utilizing What We Know About Tele-Mental Health in Tele-Financial Planning: A Systematic Literature Review

Executive Summary

  • The coronavirus pandemic expanded the adoption of virtual financial planning, or tele-financial planning practices, as it’s referred to in this paper. Unfortunately, limited empirical research on tele-financial planning exists to guide planners through this transition. However, there are similarities between financial planning and counseling; therefore, a systematic literature review on tele-mental health interventions was conducted to provide guidance for financial planning practices and future research.
  • Research suggests the efficacy of tele-mental health is comparable to face-to-face delivery while creating greater efficiency for the therapist and the patient. The breadth and severity of conditions treated suggest that this delivery method is a viable channel, not a convenient stopgap for extraordinary circumstances or lower-value engagements.
  • These findings suggest financial planners might leverage a virtual delivery channel to provide effective recommendations while expanding their reach and providing an experience that is less stressful and more convenient. The operational efficiencies experienced in tele-mental health suggest that financial planners could also improve the efficiency of their practices.
  • Planners should proactively ensure that all clients have the resources and knowledge to engage in a virtual capacity and review their data security measures.
  • For the financial planning profession to advance, practitioners cannot solely rely on research and best practices from related disciplines. Thus, this paper serves as a call for further study on tele-financial planning.

Derek J. Sensenig, CFP®, is senior vice president of financial planning for Encompass Advisory Services LLC in Houston, Texas. Previously, Sensenig served as a military training instructor for the United States Air Force. He is currently pursuing a Ph.D. in personal financial planning from Kansas State University.

Brian Walsh, CFP®, leads financial planning at SoFi. His advice has been quoted in dozens of media outlets such as CNBC, Fortune, Money, and Yahoo Finance. He is currently enrolled in Kansas State University’s personal financial planning Ph.D. program and was previously the director of financial planning solutions at TIAA.

Ives Machiz, CFP®, is the treasurer and CFO of Weight Watchers of Arizona. He previously owned his own firm and practiced as a fee-only financial planner for 22 years. Machiz is currently pursuing a Ph.D. in personal financial planning from Kansas State University.

Nicolas Stanley, CFP®, is a financial planner at Merrill in New York City, where he manages the planning process for financial advisers in the Rockefeller Center market. He is an incoming student in the personal financial planning doctoral program at Kansas State University.

Matthew Russell is an investment executive at Fifth Third Securities in Bloomington, Ind., where he assists clients in financial planning. Previously, Russell was a Peace Corps volunteer in Costa Rica focusing on community economic development. Currently, he is pursuing his Ph.D. in personal financial planning from Kansas State University.

Megan McCoy, Ph.D., LMFT, CFT-I™, is a professor of practice and the director of the personal financial planning master’s program at Kansas State University. McCoy is secretary for the board of the Financial Therapy Association and is the associate editor of profiles and book reviews for the Journal of Financial Therapy.

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Acknowledgements: The authors acknowledge the contributions from Stephen Pomanti, CFP®, and Emily Purdon, CFP®, EA. Their involvement was instrumental to the detailed review of the articles presented here.

Technology that facilitates virtual meetings has existed for almost a decade, and that technology could be embraced as a primary method to conduct business, as social distancing becomes the norm in light of the coronavirus pandemic. Though the coronavirus pandemic has opened the door for mainstream adoption of virtual or tele-financial planning, questions remain about the best practices and efficacy of tele-financial planning.

To the authors’ knowledge, no empirical research exists on tele-financial planning. Research does exist on robo-advising (D’Acunto, Prabhala, and Rossi 2019) and on anecdotal best practice articles (Lopez, Babcic, and De La Ossa 2015); however, nothing has been published using empirical design to establish best practices for tele-financial planning driven by peer-reviewed research. 

Therefore, we sought to explore a similar profession to examine its use of tele-conferencing. The choice of profession came easily, as Dubofsky and Sussman (2009) investigated the rates of counseling-like incidents that financial planners face and argued there were parallels between mental health work and financial planning. Moreover, the recent emergence of client psychology in the CFP Board curriculum signifies overlaps between the professions (Chaffin and Fox 2018). Therefore, this paper conducts a complete systematic literature review on tele-mental health to derive implications for best practices in tele-financial planning. 

By exploring prior studies in tele-mental health, we gained insight into methods that improve the understanding of tele-financial planning. Throughout this examination, some themes emerged, such as effectiveness, efficiency, and obstacles surrounding tele-mental health that apply to the financial planning profession. The goal of this research is twofold: (1) to help financial planners understand the role of tele-conferencing in client engagements, and (2) to assist financial planning researchers in the next steps for empirical research in this area.

Methods

A systematic literature review of the tele-mental health literature was conducted in the most common databases used in mental health research. These included: PsycInfo (from the American Psychological Association) Web of Science (maintained by Clarivate Analytics), and ProQuest for the period January 1, 2010 to May 1, 2020. This time period was selected due to the common practice of using research that is 10 years old or less in the humanities fields and due to the last 10 years being a time of tele-conferencing advancements (for example, Zoom was established in 2011). Additionally, Google Scholar was used to ensure saturation (Kraus, Breier, and Dasí-Rodríguez 2020). Keywords included in the search were virtual, online, video, mental health, therapy, counseling, tele-mental, effective, best practice, compare, face-to-face, and in-person.

The initial search resulted in 699 articles. Duplicates were removed from the three database results, and the article titles and abstracts were reviewed by the authors to see if they were applicable to the theme of comparing tele-mental health with face-to-face services. In total, 168 articles were initially reviewed for this research; 140 were then excluded because they lacked information or data comparing tele-mental health to face-to-face, focused on group interventions, and/or used samples that were children or college students. These exclusions were made to provide a sample most similar to a financial planner’s clientele (e.g., not children) and practice (e.g., not group or self-guided). The articles that remained were then reviewed to identify additional articles that may have been missed by the keyword search; this resulted in the addition of five articles. The final count of this systematic literature review was n = 33. A summary of these articles is available in the appendix.

Results

A systematic literature review on tele-mental health found evidence to suggest that virtual delivery of therapy services is as effective and more efficient than face-to-face therapy, while expanding access and lowering costs. This systematic literature review organizes and presents key insights from tele-mental health research that might affect tele-financial planning best practices and future research.

Effectiveness of Tele-Mental Health

The systematic literature review showed the breadth and severity of underlying conditions treated through tele-mental health, which ranged from basic therapy for young adults to treatment of veterans with extreme post-traumatic stress disorder (PTSD). Of the studies included in the review, only Clancy and Taylor (2016) and Preschl, Maercker, and Wagner (2011) found evidence to suggest that face-to-face therapy interventions were more effective than virtual interventions with the same population.

Clancy and Taylor (2016) found that face-to-face intervention was associated with greater engagement—as represented by the amount of sessions attended—which resulted in greater effectiveness, compared to virtual interventions. Preschl, Maercker, and Wagner (2011) found that the relationship between the therapist and the patient was similar—virtual intervention was not as effective in reducing depression symptoms as face-to-face interventions. Most studies included in the analysis found evidence to suggest that tele-mental health interventions resulted in comparable or superior outcomes to face-to-face interventions.

Two studies compared the effectiveness of tele-mental health for clients experiencing depression and found evidence to suggest that the reduction in symptoms was comparable to clients treated with face-to-face therapy interventions (Wagner, Horn, and Maercher 2014; and Choi et al. 2014). Choi et al. (2014) analyzed the effectiveness of tele-mental health for underserved clients with lower income and found that by implementing a consistent and efficient process, therapists could lower the cost of delivery while maintaining effectiveness.

Five studies compared the effectiveness of cognitive-behavioral therapy on clients experiencing PTSD and found evidence to suggest that virtual treatment conducted via the internet or phone was comparable to face-to-face treatment. It is worth noting that patients in these studies were generally veterans referred by the U.S. Department of Veterans Affairs (VA), which impacts the generalizability of the findings (Boykin et al. 2019; Glassman et al. 2019; Gros, Lancaster, López and Acierno 2018; Maieritsch et al. 2016; Morland et al. 2015). Glassman et al. (2019) differed from the other studies by implementing a slightly different intervention for males and females. Overall, the effectiveness of virtual intervention was comparable to face-to-face treatment, but it suggests that financial planners might adjust the experience by client segment rather than treating all clients the same.

Beyond the effectiveness of treatment, evidence suggests that tele-mental health results in client satisfaction comparable to face-to-face therapy, despite the concern of practitioners that satisfaction could suffer from a virtual experience (Boykin et al. 2019; Richardson, Reid, and Dziurawiec 2015; Parikh, TouVelle, Wang, and Zallek 2011). The ability to receive expert intervention from home is relevant to individuals who feel a stigma associated with their condition. Wallin, Maathz, Parling, and Hursti (2018) suggested that clients with stigmatizing conditions were six to 12 times more likely to choose an online intervention compared to traditional face-to-face interventions.

Efficiency of Tele-Mental Health

Besides comparable effectiveness, research suggests that tele-mental health increases the efficiency of therapy by reducing the barriers to receiving services. Sometimes, clients served in a virtual capacity had higher satisfaction driven by shorter delays in scheduling an appointment and greater comfort by being able to remain in their home instead of traveling to an office (Germain et al. 2010; Postel et al. 2010).

Furthermore, Jacobs et al. (2019) found that VA clients saved time and money by leveraging tablets to receive treatment, compared to face-to-face treatment. The magnitude of savings depended on the distance from a treatment center and age, with individuals living further away from treatment centers experiencing the greatest savings. Beyond saving time and money, tele-mental health expands critical interventions to individuals in rural communities who otherwise may not have access to care, while providing practitioners with greater efficiency to serve clients at multiple sites from one location (Parikh, TouVelle, Wang, and Zallek 2011).

Tele-mental health also removes some potential friction to continuing a course of treatment, resulting in greater adherence to a treatment plan and a continuation of services between client and provider. Veder et al. (2014) suggested that tele-mental health resulted in a higher show rate among clients and lower withdrawals from the program, as practitioners expanded access to appointments outside of traditional office hours.

Postel et al. (2010) noted that dropouts from tele-mental health programs might occur because of technical issues and some level of dissatisfaction with the protocol. As technology continues to advance, and clients’ comfort level with technology increases, the obstacle of technical difficulties should decrease. Previous research cited several methods to decrease technical obstacles, such as the practitioner installing any software used in virtual engagements, properly training clients before beginning virtual meetings, providing email summary follow-ups, and being responsive to technical problems (e.g., employing an IT support person). 

Beyond efficiency gains from direct client interaction, practitioners replicating tele-mental health technology interventions increase their efficiency when collaborating with other professionals. Fortney et al. (2015) studied veterans with persistent PTSD and found that an online collaborative therapy approach was effective and overcame the issues of distance to a treatment center. Tele-mental health can bring multiple professionals together and may also include family members or others (i.e., affiliated care providers) whose participation will benefit the client; this could be beneficial for complex cases. From the provider perspective, tele-mental health offers the ability to be in many places at once, and the consultation process is much simpler when just opening a new computer window.

Unique Challenges of Tele-Mental Health

The culmination of successful strategies, systems, and processes for a practitioner is measured through the long-term retention of clients. The precedent established by the coronavirus pandemic underscores the importance of including technology as a unique dimension of client retention. Research from related fields within the mental health profession shows that any approach that includes video conferencing as a mode for client communication must address: (a) proper hardware and training (Choi et al. 2014; Gros, Lancaster, Lopez, and Acierno 2018); (b) privacy concerns (Woolf et al. 2016); and (c) dropout concerns (King et al. 2014). 

Naturally, some clients may not have the proper tools to participate in a virtual meeting. As previously mentioned, Postel et al. (2010) noted that dropouts from tele-mental health programs might occur because of technical issues and some level of dissatisfaction with the protocol. Therefore, proactively providing hardware and training on its setup and use may help retain top clients while streamlining implementation and eliminating barriers (Choi et al. 2014; Germain et al. 2010; Gros, Lancaster, Lopez, and Acierno 2018; Parikh, TouVelle, Wang, and Zallek 2011).

Second, any integration of video conferencing as a mode of communication requires addressing security and privacy. Even the smallest infringement of a client’s trust could devastate the relationship, and therefore requires anticipation and forethought to any potential privacy or security violation (Woolf et al. 2016).

Finally, incorporating technology introduces additional dimensions by which the client can remove themselves from the financial planning process. Research by King et al. (2014) highlighted the ease by which individuals could drop out from a virtual meeting. Financial planning practitioners would be well-served to handle this issue in advance and address it with the client in an effort to mitigate its potential ramifications.

Practical Implications

The comprehensive literature review found virtual delivery methods of therapy in other professions to have similar or increased levels of effectiveness when compared with face-to-face methods. This information may guide financial planning practitioners as they navigate the opportunity to expand the methods and modes by which they serve clients. Social distancing measures, coronavirus pandemic effects, and contagion concerns have brought the concept of virtual planning, or tele-financial planning, to the forefront as a primary method of meeting, rather than a secondary alternative that is rarely discussed. As new research is developed within this paradigm, planners and their clients may be well served to adopt appropriate parallels from other professions, as it relates to virtual meeting engagements. Adopting a virtual method to engage with clients may lead to higher client satisfaction, greater efficiency, expanded prospecting opportunities, reduced costs, and less friction compared with face-to-face engagements.

Previous research suggested that clients experience greater comfort and more convenient scheduling when meeting virtually with a professional, rather than being required to travel to a physical location (Postel et al. 2010). Although some financial planners have been conducting virtual meetings for years (Trahan, Gitman, and Trevino 2012), other planners may not have considered doing so, pre-coronavirus quarantines. Tele-financial planning may help clients by eliminating the frustrations associated with a commute, and facilitating a meeting virtually may allow clients to experience increased comfort and avoid potentially contagious interactions.

Tele-mental health research has also demonstrated the potential for greater financial efficiency and expanded geographical opportunities for practitioners. A virtual setting expands the potential to serve rural communities that would otherwise go unreached with a traditional face-to-face meeting (Parikh, TouVelle, Wang, and Zallek 2011). Tele-mental health research also  indicates that the virtual setting may remove friction within the financial planning meeting process and result in greater adherence to the professional recommendations of a financial planner while simultaneously providing greater access, continuation of services, and follow-up to the planning process (Postel et al. 2010; Veder et al. 2014). Financial planners may be well-served to leverage potential technology enhancements within their office that eliminates obstacles that typically prevent implementation of financial planning solutions.

Financial planners must also recognize that some clients may not have appropriate technology to facilitate a virtual meeting. Therefore, providing training and hardware may serve as a proactive measure to eliminate barriers (Choi et al. 2014; Germain et al. 2010; Gros, Lancaster, Lopez, and Acierno 2018; Parikh, TouVelle, Wang, and Zallek 2011). Additionally, any integration of technology within a practice requires that security and privacy concerns are proactively addressed. Even the most minor of infringements could be detrimental to the relationship (Woolf et al. 2016). These issues highlight the importance of strategic forethought required by any organization implementing a virtual engagement strategy. Financial planners who can be prudent in addressing the ramifications of the technology dynamic within their planning practice will be well-served to incorporate the technological learnings from related industries.

Finally, practitioners implementing tele-mental interventions increased their efficiency when collaborating with other professionals (Fortney et al. 2015). This provides additional support for the burgeoning discipline of financial therapy. Financial therapy is a combined approach that is “informed by both therapeutic and financial competencies that helps people think, feel, and behave differently with money to improve overall well-being,” according to the Financial Therapy Association. The website, financialtherapyassociation.org, has a “Find a Financial Therapist” function that can help financial planners find professionals with whom to collaborate.

Research Implications

This review of tele-mental health research found that virtual delivery is just as effective and potentially more efficient than in-person delivery. The financial planning profession needs large-sample empirical studies to understand if similar outcomes occur with the delivery of financial planning engagements. Further, some of the reasons for efficiency surrounding virtual practice cited in the articles included in this systematic literature review were access for rural clients (Parikh, TouVelle, Wang, and Zallek 2011), lowering the costs of service providers (Jacobs et al. 2019), shorter delays in scheduling an appointment (Germain et al. 2010), and greater comfort by being able to remain in their home (Postel et al. 2010).

These findings also have implications for researchers, and they may want to explore if certain demographic groups (e.g., age, race/ethnicity, religion, gender), geographical areas, socioeconomic status, and presenting issues (e.g., financial insecurity, financial anxiety) are best served virtually (Wallin, Maathz, Parling, and Hursti 2018). In addition, research should be done to see if tele-financial planning opens the door to those clients who are currently underserved by financial planners because they do not meet certain financial thresholds, are located in a rural area, etc. Future research may also explore if there are specific clientele who may prefer tele-financial planning over face-to-face engagements. 

Clients will have varying levels of technical sophistication. Some will require hardware to be able to participate in a virtual meeting; in other cases, clients may require significant training to effectively use technology (Choi et al. 2014; Germain et al. 2010; Gros, Lancaster, Lopez, and Acierno 2018; Parikh, TouVelle, Wang, and Zallek 2011). Hagan (2020) outlined steps to introduce clients to technology, including explicitly listing the hardware and software needed, creating training, and determining how technology will be hosted. Security and privacy are also concerning. Woolf et al. (2016) noted that even small breaches of trust have a major impact on the relationship with the client. Technical problems may cause clients to drop out (Postel et al. 2010); therefore, researchers may want to explore how training and technological support affects client satisfaction, trust, and retention.

Finally, tele-mental health resulted in greater adherence to a treatment plan and lower dropout rates (Postel et al. 2010; Veder et al. 2014). Therefore, further research is needed to explore if plan adherence and dropout rates are similarly better in tele-financial planning practices versus face-to-face engagements.

Limitations and Conclusion

This study had some limitations. Most notable was that a similar profession to financial planning— counseling—was investigated due to the lack of empirical research in the financial planning profession. Furthermore, the scope of the systematic literature review was limited to articles that compared virtual delivery with face-to-face practices. Some articles were excluded because there was not an appropriate control group that may be beneficial to examine in an additional, larger systematic literature review. And, the landscape of virtual care is rapidly changing along with consumer use of technology in light of the recent need for social distancing. Despite these limitations, the coronavirus pandemic has brought tele-financial planning into the forefront of the profession. This systematic literature review should be seen as a call to action for practitioners and researchers in the field of financial planning. 

Regardless of the medium of engagement, practitioners and researchers alike must always address the ethical, privacy, and compliance concerns as they relate to the parties involved. While the focus of the articles within this systematic literature review focused on effectiveness and efficiency of in-person versus virtual engagements, it is essential that ethical, privacy, and compliance concerns are the focus in practice and future research endeavors.

Three dimensions exist within this paradigm that must be collectively addressed—the practitioner, the client, and the practitioner-client interaction. Matters of ethics, privacy, and compliance are unique to the practitioner and client’s geographical location, the parent organization’s policies and procedures, and the licensure affiliations—and all of these factors impact the parameters of tele-planning. As virtual engagements become more common, it is essential that financial planners seek guidance and direction from the appropriate compliance and oversight channels, and that future research includes these important considerations.

The articles in this review touched on a few factors regarding the secure transmission of services online. Choi et al. (2012) noted that headphones were provided to protect privacy, yet one participant did not feel her engagement was private because a family member came into the room during the session. Confidentiality issues were proactively addressed by Preschl, Maercker, and Wagner (2011) at the beginning of the meeting, and Woolf et al. (2016) acknowledged that approximately half of the participants expressed concern over security and privacy measures.

These issues closely relate to the financial planning field and are another starting point for future research. We can glean that there have been vast improvements in security concerns for

tele-services, but that does not mean we should be complacent in ensuring the highest ethical standards in our work and address new issues as they arise. As Henebry (2020) stated in regard to virtual practices within the financial planning field, “We have no choice now but to engage customers and prospects through digital channels, so embrace it fully” (p. 38). Similar research findings in the field of financial planning may potentially lead to a transition from the view of tele-financial planning as being the secondary option to potentially the primary choice for clients

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Citation

Sensenig, Derek, Brian Walsh, Ives Machiz, Nicolas Stanley, Matthew Russell, and Megan McCoy. 2020.  “Utilizing What We Know About Tele-Mental Health in Tele-Financial Planning: A Systematic Literature Review.” Journal of Financial Planning 33 (9) 48–58.

Appendix

NOTE: You may click or tap each image below for a PDF version.