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Dan Ford of The Better Sleep Clinic: “Be prepared for worst case scenarios before they happen”

Be prepared for worst case scenarios before they happen. Have screens for suicidality built into intake forms so you know what’s coming in the virtual door, have your protocols for remote suicide management worked out and on hand to make the client safe, and have emergency numbers ready. Include practice management policies, that clients must […]

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Be prepared for worst case scenarios before they happen. Have screens for suicidality built into intake forms so you know what’s coming in the virtual door, have your protocols for remote suicide management worked out and on hand to make the client safe, and have emergency numbers ready. Include practice management policies, that clients must sign, that the client is aware there are limits to managing risk in telehealth appointments and if suicidal the client should call emergency numbers as first response.


One of the consequences of the pandemic is the dramatic growth of Telehealth and Telemedicine. But how can doctors and providers best care for their patients when they are not physically in front of them? What do doctors wish patients knew in order to make sure they are getting the best results even though they are not actually in the office? How can Telehealth approximate and even improve upon the healthcare that traditional doctors’ visits can provide?

In this interview series, called “Telehealth Best Practices; How To Best Care For Your Patients When They Are Not Physically In Front Of You” we are talking to successful Doctors, Dentists, Psychotherapists, Counselors, and other medical and wellness professionals who share lessons and stories from their experience about the best practices in Telehealth. As a part of this series, I had the pleasure of interviewing Dan Ford.

Dan Ford is the founder and Principal Sleep Psychologist at The Better Sleep Clinic, a specialist insomnia and behavioral sleep disorders clinic. He’s a Registered Psychologist, qualified in Cognitive Behaviour Therapy (CBT), & specialist trained in CBT for insomnia (CBT-I). Dan’s had careers in the corporate sector & the military (as well as having his own family) so he has first-hand knowledge & experience of the pressures & challenges of modern life. In addition to working across the Army, Airforce & Navy, Dan’s been a performance psychologist with military special operations teams, Olympic, & professional sports teams.

When not out running with an audiobook playing, Dan can be found chilling out with his family or pretending to be a handyman.


Thank you so much for joining us in this interview series! Before we dive in, our readers would love to “get to know you” a bit better. Can you tell us a bit about your ‘backstory’ and how you got started?

I trained in psychology at the University of Auckland in the early 2000’s. I started my working life as a business consultant, but after around eight years I started to think of using my psychology qualifications. I saw an opportunity to become a psychologist in the military, so I attended and passed an officer selection board and spent 10 years working as an army officer and military psychologist. During that time I was lucky enough to have postings in the Army, Air Force, Navy (where I served as acting head of Navy psychology) and special operations. In 2018 I transitioned to working as a sports performance psychologist, working with Olympic and professional sports teams. The COVID pandemic impacted the sports contracts and gave me a chance to consider my career direction. I had done a lot of work in sleep and mental health during my time in the military, and it was an important but under recognized area of work in performance psychology. I found sleep to be in fascinating area to work in so I opened my own sleep clinic focusing on the treatment of insomnia and other behavioral disorders of sleep and the business has gone from strength to strength.

Can you share the most interesting story that happened to you since you began your career?

Across my career I worked for a number of different leaders and although they were all aware and often taught the research on effective leadership I felt they rarely actually displayed that kind of leadership.

When I became eventually took up a leadership role I felt like I had nothing to lose an opportunity to experiment in the leadership space by simply doing the opposite of the leadership that I had experienced. That would also align me with what research said would be effective leadership. The team I inherited was experiencing low morale when I came on board but by simply following the research on good leadership, giving people good support, backing them with their initiatives, giving them autonomy, clear feedback, and being upfront and open about what I did and didn’t know about leadership, I received some very positive feedback from the team, and my performance reports as a leader were strong. I’ve now coached leaders through my practice and found the same principles work when my clients apply them. I often reflect on that experience and wonder what stops people from doing such simple behaviors, especially when it makes such a big difference to those around you.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

Life is a series of natural and spontaneous changes. Don’t resist them, that only creates sorrow. Let reality be reality. Let things flow naturally forward in whatever way they like.

(Lao Tzu)

None of us are able to achieve success without some help along the way. Is there a particular person who you are grateful towards who helped get you to where you are? Can you share a story about that?

My mother has been a big influence on my life. She’s always given me really frank and unvarnished feedback, and although it’s been painful at times, if I’m able to move past the emotion and take the advice, I’m better off for it.

I recall during my university days I was struggling to get good grades on my essays. My mother had been through university and offered to review my essay drafts. Her feedback was often pretty harsh and I’d get upset. But eventually I got over myself and took her feedback on board and my grades started to go up. As my writing improved, so did her feedback. When I finished my university studies one of my lecturers wrote a reference for me stating that I was one of the best scientific writers he had taught in 20 years. I credit my mum for that reference. Amazingly, English is her second language!

Ok wonderful. Let’s now shift to the main focus of our interview. The pandemic has changed so many things about the way we behave. One of them of course, is how doctors treat their patients. Many doctors have started treating their patients remotely. Telehealth can of course be very different than working with a patient that is in front of you. This provides great opportunity because it allows more people access to medical professionals, but it can also create unique challenges. To begin, can you articulate for our readers a few of the main benefits of having a patient in front of you?

Face-to-face interactions are the norm so everyone is familiar and used to them. There are no technology barriers to overcome, and the likelihood of the interaction “dropping out” without warning is zero.

When a patient is in front of you, risk in terms of safety issues, such as with suicide, is far easier to manage because the patient is in front of you and you can ensure they don’t leave your sight until the risk is managed.

Last, when the client is physically in front of you can clearly see how they are presenting and it is easier to spot any behaviors that could be problematic to treatment.

On the flip side, can you articulate for our readers a few of the main challenges that arise when a patient is not in the same space as the doctor?

Technology can and does fail, impacting on your ability to deliver effective treatment. Further, not all clients are technology literate so understanding and providing multiple communication options is important in the event that there is a technology issue.

When you are not in the same room there can be limits on your ability to share information in certain ways for example writing on a whiteboard is quite straightforward in a physical consultation. You also have to consider the protection of patient privacy and security of their real-time communication as a breach of communication security would be harmful to the patient.

Patient safety can be hard to manage in risky situations as you are not in the same location as them and therefore don’t have the option to physically prevent them from harming themselves (or others).

You also don’t have the same amount of visual information you’d have in a in person interaction which can lead to the potential to miss important cues and clues, relevant to the client’s issues.

Fantastic. Here is the main question of our interview. Based on your experience, what can one do to address or redress each of those challenges? What are your “5 Things You Need To Know To Best Care For Your Patients When They Are Not Physically In Front Of You ? (Please share a story or example for each.)

Be thoroughly familiar and well versed with the communication technology (e.g. video software & hardware) that you are using so that you can quickly troubleshoot any issues that arise on both your side or the patient’s side. When I started out, I read up on the software and the hardware I chose to use so that I would know the most common issues and conflicts. Now, when a client is experiencing technology issues I can quickly go through the most likely solutions. I also have a good idea if it’s an issue on my side and how to quickly change to different hardware.

Have multiple backups that include “no download” browser-based options (for technically challenged clients) and make sure phone numbers have been exchanged and are on hand to fall back to voice communication if all else fails. I started with a browser-based video app built into my practice management software but eventually I moved to software that most clients were familiar with and kept the browser-based app as a backup. Every client is informed of the backup system when they sign up and recently when a client had unexpected trouble with our main video app they quickly requested we switch to the backup software, which didn’t work, and then we re-tried with a third option, all the while communicating by phone to get the issues worked out.

Know the communication limits of your software and look for options to plug the gaps either by using add-ons or by manual ‘technology’. For example, diagramming on, and sharing a whiteboard, is an important tool in therapy but often not featured in video software or can be clunky. I found a chrome plugin that can be used with video software that doesn’t have a built-in whiteboard options, but also have as a backup, a small whiteboard that I can hold up to the screen (it’s not ideal, but it works).

Understand the security features of your software, encryption standards, how to lock rooms, use pin access etc so you can be sure client privacy is protected throughout your interactions. I use unique links and pins for every appointment for quite some time until I became comfortable and familiar enough to implement a ‘waiting room” feature without unique links.

Be prepared for worst case scenarios before they happen. Have screens for suicidality built into intake forms so you know what’s coming in the virtual door, have your protocols for remote suicide management worked out and on hand to make the client safe, and have emergency numbers ready. Include practice management policies, that clients must sign, that the client is aware there are limits to managing risk in telehealth appointments and if suicidal the client should call emergency numbers as first response.

As you don’t have the same amount of visual information keep a careful eye on client behavior (e.g. are they looking around their room at someone/something?) and always ask the client if you are unsure of something that might be going on in their environment. For example, a client was sharing some homework with me around thoughts she had written down relating to failure. She showed me the piece of paper and moments later became visibly distressed. Once she calmed, she began moving things around on her desk out of the visual field the video software afforded me, so I asked what was happening. Eventually she revealed she had covered up the piece of paper as the thoughts were too distressing to even have visible in front of her, which gave me a good indication of the importance of these cognitions to therapy. I would’ve missed this entirely if I didn’t ask.

Can you share a few ways that Telehealth can create opportunities or benefits that traditional in-office visits cannot provide? Can you please share a story or give an example?

Telehealth offers a broader reach and availability of treatment to a greater number of people. This is especially important for those that live in remote locations, or alternatively, for treatments such as mine with relatively few qualified treatment providers. For example I see clients from around the country, but I also see clients, such as mums with newborns that would struggle to get to the office but can get on a video appointment while baby sleeps.

Clients save on time and stress by not having to drive to an appointment and find parking. For example, many of my clients in the same city as me still prefer to use telehealth as it can save them 30–60mins of travel time).

It is a time efficient treatment modality so an astute practitioner with a waitlist may be better able to fill gaps in their appointment book, created by last minute cancellations, by having telehealth clients ready to go.

It is easier for new therapists to get started as there are low overheads and less administration involved when you don’t have to rent an office. Since COVID I’ve stopped renting an office and moved to a home office with an in-person and a telehealth space.

It is easier to provide more flexible times for clients who work during the day and match the therapist’s times to their personal schedule. For example I finish in-person appointments at 3pm when my 5yr old son finishes school so I can pick him up (which works well for me). After dinner I see clients by video until 9pm (which works well for clients who are busy professionals).

It makes it easier for clients with anxiety disorders to seek treatment as they don’t have to endure anxiety-provoking travel and interactions in order to get appointments (it’s important that the therapist remains aware of this avoidant behavior though).

Let’s zoom in a bit. Many tools have been developed to help facilitate Telehealth. In your personal experiences which tools have been most effective in helping to replicate the benefits of being together in the same space?

For video appointments I still find Zoom to be the most flexible in terms of tools like whiteboards, and gives the most control over input/output devices. It’s just expensive for the HIPAA compliant version

Doxy.me is good for health practitioners but lacks whiteboard sharing which can be frustrating.

If you could design the perfect Telehealth feature or system to help your patients, what would it be?

Some kind of VR system that projects a hologram of you and hologram of client into a virtual room so you can fully interact would be pretty incredible.

Are there things that you wish patients knew in order to make sure they are getting the best results even though they are not actually in the office?

Every psychological treatment requires experimenting with changing behaviors and trying new things. That is client dependent. It isn’t “in person consult” or “telehealth consult” dependent. So even if you have misgivings about telehealth, effectiveness comes down to action you take outside appointments, not the appointment modality.

Bring a notepad to your consult and make notes about key insights and learnings. I notice that clients that are good at doing this get better results, and get results faster.

The technology is rapidly evolving and new tools like VR, AR, and Mixed Reality are being developed to help bring people together in a shared virtual space. Is there any technology coming down the pipeline that excites you?

I’m not really up on the play in this realm so it’s hard to comment, but I’m keen to give things a go and I quite like the look of VR software that could be used to give clients with anxiety disorders some lifelike scenarios to add to an exposure hierarchy.

Is there a part of this future vision that concerns you? Can you explain?

Real life social interaction and connecting with others is still a core component of emotional health for humans so while I advocate using technology where it works well (e.g. telehealth), it’s still important for people to get out and about in their communities and develop quality relationships.

Ok wonderful. We are nearly done. Here is our last “meaty” question. You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂

Widespread recognition of the role of sleep in mental and physical wellbeing and regular early screening and support for sleep issues in order to reduce the mental health burden across society.

How can our readers further follow your work online?

https://www.thebettersleepclinic.com
https://www.linkedin.com/in/danielfordnz/

Thank you so much for the time you spent doing this interview. This was very inspirational, and we wish you continued success.

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