The COVID-19 pandemic has triggered an unprecedented shift toward virtual health care delivery [1]. Telepsychology is the provision of addiction and mental health (AMH) care from a physical distance and includes psychiatric evaluations, therapy, psychoeducation, and medication management [2]. While evidence supports the effectiveness of telepsychology [3-7], clinician hesitancy impedes uptake [5,8,9]. Because telepsychology is expected to play a continued role in service delivery after the pandemic [1,10,11], it is critical to understand clinicians’ perceptions of and attitudes toward telepsychology.

A clinician’s experience with telepsychology may also contribute to uptake. Perceived weakened therapeutic alliance may be a contributor to poor uptake of telepsychology [4,5], with therapists perceiving poorer therapeutic alliance in virtual than in-person settings [12]. In contrast, client ratings of therapeutic alliance are comparable across virtual and in-person services [13-15]. Clinicians also remain divided in their satisfaction with telepsychology services [9,10,16,17].

The unified theory of acceptance and use of technology (UTAUT) [18] predicts uptake of new technology into practice from the following 4 factors: (1) performance expectancy, the degree to which a technology is expected to improve performance; (2) effort expectancy, the user’s self-efficacy with the technology; (3) social influence, the perceived norms of technology use; and (4) facilitating conditions, including availability of training and technology fit [18-22]. The UTAUT is based on the theory of planned behavior, wherein attitudes predict intentions, which predict behavior [23]. While the postpandemic behavior of clinicians cannot yet be measured, their intention to use technology serves as a proxy.

The utility of technology may vary considerably depending on whether the clinician is using telephone or videoconferencing. The literature offers comparisons of telepsychology (either telephone or video) [13,24] to in-person services, but few comparisons between telepsychology modalities. One meta-analysis indicated that videoconferencing was more effective than telephone for depression and posttraumatic stress disorder in veterans [25], yet a comparison between telepsychology modalities is a major gap in the literature.

This study directly compared the experiences of different modalities (ie, in-person, telephone, and video) and further explored factors pertinent to the uptake of telephone- and video-based services in an AMH setting. Specifically, we predicted the following: (1) Clinicians would have the most positive experiences (ie, satisfaction and therapeutic alliance) with in-person sessions, followed by videoconferencing and then telephone; (2) Clinicians would have a greater intention to use videoconferencing than telephone after the pandemic; (3) Clinicians would have more positive technology attitudes toward video than telephone; and (4) Greater performance expectancy, effort expectancy, social influence, and facilitating conditions would predict greater clinician intentions to use virtual services after the pandemic.

This study explored the differences in clinicians’ perceptions of in-person, video, and telephone services, and the prediction of the intention to use telepsychology after the pandemic. As hypothesized, clinicians had more positive experiences with in-person services, followed by video services and then telephone services across measures. Additionally, clinicians reported greater intention to continue using video services over telephone services. These findings suggest that the perceived utility of technologies varies in AMH care [25], and the merits of and attitudes toward each require consideration when integrating them into routine practice.

Consistent with previous work, this study demonstrated the utility of the UTAUT for predicting the intention to use telephone and video technologies [12,16,22,24]. Specifically, performance expectancy was predictive of the intention to use both video and telephone services, while social influence and facilitating conditions were additionally predictive of the intention to use telephone services. Because telephone services are so different from in-person services (ie, no visual information), the intention to use may be related to how well it fits for a particular service (eg, medication refills [28]) and how much it is supported by the clinician’s profession. Thus, facilitating conditions and social influence may be more relevant to the uptake of telephone services than video services.

The limitations of this study include its cross-sectional design, which prevents causal conclusions. Further, clinicians’ intentions to use telepsychology are a proxy for actual postpandemic technology use. In addition, the study’s small self-selected sample of public AMH clinicians, with underrepresentation of some professions and service settings, limits the generalizability of the findings. For example, our sample did not include urgent settings, where virtual care may present additional challenges [29]. While this study did not include private practitioners, its focus on public health is unique, compared with previous studies focusing primarily on private practice [1,12,16].

In this study, clinicians reported consistently more positive experiences with video services than telephone services, suggesting that the uptake of videoconferencing will face fewer barriers than telephone; however, an overall preference for in-person sessions may result in a return to prepandemic practices. For some clinicians, misgivings about videoconferencing may stem from low performance expectancy. Education on the establishment of a strong therapeutic alliance and the effectiveness of video-based care could decrease clinician hesitancy [3,6,7,30]. Regarding telephone uptake, improved facilitating conditions, such as training, and positive social influence (ie, promotion) may aid uptake. Exploration of how clinicians’ demographic characteristics (eg, age, gender, and prior experience) relate to telepsychology uptake would clarify necessary training or support. For example, those with minimal prior experience may require greater support [24]. In conclusion, while there has been a practice shift to telepsychology during the COVID-19 pandemic, AMH clinicians will likely require ongoing support to maintain this practice change.