Telemental healthcare is a well-supported and effective method for delivering clinical services, with a growing body of evidence behind it. In 2016, our national healthcare system, which provides behavioral healthcare for eating disorders (ED), mood disorders, and anxiety disorders, launched a Virtual Intensive Outpatient Program (VIOP) for college-aged students with eating disorders. A pilot study showed significant and clinically meaningful improvements in ED symptoms, depression, and quality of life (Blalock et al., 2020).
The COVID-19 pandemic accelerated the expansion of telemental services, driven by increased care needs and the desire to reduce health risks. Emergency federal and state orders temporarily allowed cross-state practice and insurance reimbursement, enabling a smooth transition to virtual care. Our established clinical model supported the delivery of high-quality, evidence-based treatment. A study focused on the ED population showed that patient satisfaction remained high across all age groups (Rienecke et al., 2024). The post-pandemic landscape now includes numerous virtual programs with varying clinical models, some potentially influenced by the expiration of emergency orders and associated licensure restrictions, which may limit the number of licensed professionals involved in care delivery. This variability is an important factor for patients and families to consider when selecting a program. In terms of reimbursement, telemental healthcare has benefited from continuity of third-party payor reimbursement from most major insurers utilized.
Our patient-centered model emphasizes collaboration, integrating families and support systems through education and therapy. Upon discharge, patients have access to robust alumni services. A dedicated care team of a primary therapist and a dietitian (for those in the ED program) as well as clinical leaders provide individual and/or family treatment throughout the patient’s VIOP journey. Collaboration with outpatient providers is emphasized with coordinated care throughout treatment.
VIOP treatment comprises three 3-hour group sessions weekly (9 hours total), plus weekly individual or family therapy and nutrition counseling for ED patients, totaling approximately 10–10.5 hours per week. Evidence-based therapies including Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and Acceptance and Commitment Therapy (ACT) are core components. ED programs include three supported meal groups per week and use Family Based Treatment (FBT)-informed care for younger patients. Additional virtual support groups are also available. All clinicians are credentialed and licensed to provide telemental health services in the patient’s state of residence. Ongoing training, supervision, and oversight by experienced clinical leadership ensures high programmatic standards for care delivery and strong patient satisfaction.
Recovery Record (RR), a therapeutic mobile app (Tregarthen, et al., 2015), was integrated into treatment from the inception of virtual programming. It is an ED specific app which allows patients to self-monitor and report their meals, emotions, thoughts, and behaviors directly to their treatment team members in real time via the mobile app. RR partnered with our healthcare system to customize targeted evidence-based coping strategies to provide the most therapeutic benefit for a given patient. We recently incorporated the RR Family App (Bright Therapeutics, 2025) which is intended for use by parents/caregivers with children and adolescents in ED treatment. The app allows clinicians to support caregivers with individualized coping strategies and therapeutic interventions while compiling a self-monitoring record of progress from the caregiver perspective between family sessions. These applications foster and maintain connection among treatment team members, caregivers, and the patient in between sessions. Additionally, care team members receive real time information allowing for superior communication and alignment on patient care. For those in our mood and anxiety disorders programs, Mood Links (Bright Therapeutics, 2025) is the mobile app utilized to monitor patient progress, tailor coping skills, view outcome data and enhance therapeutic alliance.
Given the group-based nature of our program, group therapy principles are central to our approach. Group cohesion, analogous to therapeutic alliance in individual therapy, is the cornerstone. We find that maximizing consistent and authentic member-to-group, member-to-leader, and member-to-member connections maximizes positive treatment outcomes. Thus, our clinical model intentionally fosters group cohesion through a dedicated care team, use of mobile app interventions, a consistent group schedule, focused curriculum, and stable group cohort.
In the largest study to date (of which we are aware) comparing virtual treatment to in-person care, results demonstrated comparable reductions in eating disorder symptoms in both our VIOP and in-person intensive outpatient programs, with VIOP demonstrating a greater reduction in reported depression (Blalock et al., 2025). Patient satisfaction data, collected from January 2022 to September 2023, revealed that approximately 90% of patients reported a helpful experience, 92% reported confidence in using coping skills, and 91% of caregivers reported increased parental self-efficacy. Data collection and evaluation are ongoing across all programs.
In conclusion, telemental health and technology-supported interventions offer powerful, scalable solutions for delivering high-quality treatment to those who may otherwise lack access to care. Continued research is essential to refining best practices and shaping future standards in telemental health.
References
Blalock, D. V., Le Grange, D., Johnson, C., Duffy, A., Manwaring, J., Tallent, C.N., Schneller, K., Solomon, A.M., Mehler, P.S., McClanahan, S.F., & Rienecke, R. D. (2020). Pilot assessment of a virtual intensive outpatient program for adults with eating disorders. European Eating Disorders Review, 28(6), 789–795. https://doi.org/10.1002/erv.2785
Blalock, D.V., Mehler, P.S., Michel, D.M., Duffy, A., Le Grange, D., O’Melia, A.M., & Rienecke, R.D. (in press). Virtual versus in-person intensive outpatient treatment for eating disorders during the COVID-19 pandemic in United States based treatment facilities: A naturalistic study. Journal of Medical Internet Research.
Bright Therapeutics. (2025). Mood Links (Version 2.7.7.) [Mobile app]. Bright Therapeutics. https://apps.apple.com/us/app/moodlinks-anxiety-depression/id1490372837
Bright Therapeutics. (2025). Recovery Record for Families [Mobile app]. Bright Therapeutics. https://apps.apple.com/us/app/recovery-record-for-families/id1552498936
Rienecke, R. D., Blalock, D. V., Tallent, C. N., Duffy, A., & Mehler, P. S. (2024). Eating disorder virtual intensive outpatient program: Patient satisfaction according to age group. Eating Disorders, 32, 493-508. https://doi.org/10.1080/10640266.2024.2325296
Tregarthen, J. P., Lock, J., & Darcy, A. M. (2015). Development of a smartphone application for eating disorder self-monitoring. The International Journal of Eating Disorders, 48(7), 972–982. https://doi.org/10.1002/eat.22386
