Table 1 Clinicians’ Experiences Conducting Remote Asylum Evaluations. (In parentheses are the specialty of the evaluator and the number of remote evaluations conducted as part of this pilot project)

Connecting with the client and building rapport

Rapport was easy to establish I thought, I think we connected. (psychologist, 1 evaluation)

My efforts to make the connection were exhausting, and I was left feeling generally tired and less than satisfied after 3–4 h of hard work.

Building rapport is certainly more challenging especially since your trying to collect information that is very sensitive and painful (neuropsychologist, 12 evaluations)

[In the in-person evaluation it] is much easier to establish rapport, easier for me to allow time for the client to reflect, take a step back emotionally as needed (med-peds, 2 evaluations)

I was not able to comfort him well without being there in person… It felt very awkward over the computer and I was not able to establish the kind of connection that I am able to create when I do these exams in person. (pediatrician, 1 evaluation)

Achieving the goals and objectives of the encounter

I was able to gather sufficient information from the clients about their pre-immigration histories, experiences of migration, current symptoms and circumstances (psychologist, 1 evaluation)

The encounter overall was successful, and the client was granted asylum (med-peds, 2 evaluations)

Overall, considering the circumstances, one is able to get the work completed. (psychiatrist, 1 evaluation)

I was glad that I was able to perform a full physical exam and psych eval without needing to travel to Matamoros. That made it very convenient and I was gratified to be able to do this. (pediatrician, 1 evaluation)

It is ideal when an evaluation is conducted in-person. However, considering that that is not always feasible, this is a good alternative. (psychiatrist, 2 evaluations)

While I was able to technically complete the exam, it was not the same kind of evaluation as my usual ones. I got them done despite the conditions. (neuropsychologist, 12 evaluations)

Comparing Remote vs. in-person evaluations

It felt very similar to in person assessments I have done. (child psychiatrist, 1 evaluation)

Very comparable—it really was not very different from meeting in person, to my mind. (psychiatrist, 1 evaluation)

[No challenges] because of remote nature of the interview— but many of the usual challenges of assisting client to focus his/her story (psychiatrist, 1 evaluation)

I worked extremely hard to try to put more expression than usual into my voice, and to compensate for the loss of verbal and physical connection. (neuropsychologist, 12 evaluations)

I was comfortable with the remote format and felt well-equipped to establish rapport with the clients and gather necessary clinical information (psychiatrist, 2 evaluations)

I think I was able to assess for the psych diagnosis and assess for credibility, etc. fine. (pediatrician, 1 evaluation)

I did not feel this significantly altered my ability to make a diagnosis, however, nor to comment on the client’s credibility (med-peds, 2 evaluations)

With clients who are more reserved, this mode of conducting an evaluation would be more problematic. (psychiatrist, 1 evaluation)

When I do interviews in person, I can make a full assessment and diagnosis in a conversational manner. In contrast, too often with the remote interviews, I had to go through a checklist of symptoms with the person. Furthermore, I could not make visual observations—of dress, grooming, general physical appearance, bodily movements. I could not observe hyperactivity, tics, or abnormal movements. I could not see the condition of their skin, nails or hair. I could not see body type or weight. (neuropsychologist, 12 evaluations)

I definitely prefer in-person interviews if possible. (med-peds, 2 evaluations)

I was not able to observe the client’s gait. Due to being on-screen sometimes full facial expressions were not fully visible which was challenging in doing a mental health evaluation.(forensic psychiatrist, 1 evaluation)

The distance reinforced the avoidance aspects of her defenses as it was far more difficult for her to bear the pain of describing some of her experience (child psychiatrist, 2 evaluations)

It was also much harder to make a psychiatric diagnosis (neuropsychologist, 12 evaluations)

Set up, technical Issues and their impact on the evaluation

There were several moments in which the interpreter lost her connection to the online videoconferencing site we were using (Skype). However, this technical glitch created only short (2–3 min) delays with minimal discernible impact on the flow of the assessment. (psychiatrist, 2 evaluations)

Given the couple of connectivity issues, it was difficult to return immediately to the same thread we were on before. I did not feel this significantly altered my ability to make a diagnosis, however, nor to comment on the client’s credibility. (med-peds, 2 evaluations)

It is also harder to assess things such as affect of the individual due to poor connection (psychiatrist, 1 evaluation)

We worked around [the audio] issues by repeating things that were sometimes lost (forensic psychiatrist, 1 evaluation)

Lower video quality made it more difficult to pick up on non-verbal cues. For example, it took longer than usual for me to realize the client’s father was becoming emotional. (child psychiatrist, 1 evaluation)

In one instance, the phone connection was so poor, and the client was so frustrated, that she was becoming upset and I chose to stop. (neuropsychologist, 12 evaluations)

Several times the communication either got stalled or completely disconnected. Had to call back and forth 2 times. (psychiatrist, 1 evaluation)

Having 3 people in 3 different locations on this particular platform was not ideal, especially when dealing with highly sensitive and emotion-laden information. (child psychiatrist, 1 evaluation)

Difficulty making the initial connection; losing the connection repeatedly and calling back; poor signal, difficulty hearing the client. I was glad that I had a video connection for at least a few minutes, because I could see where they were: on the street, or in the doorway of a store. Neither of them had told me that they were outside. (neuropsychologist, 12 evaluations)

The legal representative did not set up the interview or do introductions, so it was an awkward start. [He stayed] in the room, which made the client even more reticent (psychologist, 2 evaluations)

Coordination

The scheduler was there on time and stayed to ensure that things were properly connected. (child psychiatrist, 2 evaluations)

It was well organized and timely; I was able to contact the liaison and the attorney to get additional information that was required (Psychiatrist, 1 evaluation)

When I was not able to see the scars well, [coordinator] sent me close up photos on WhatsApp so that I could see better. (pediatrician, 1 evaluation)

If neither interviewer nor interpreter could be in the same room with her, it might have been useful for her to have another support person present. (child psychiatrist, 2 evaluations)

The client actually started crying, and then I asked [coordinator] to please get him a tissue. If I were there, I would have put my arm around the guy. (pediatrician, 1 evaluation)