The Coronavirus and the need for self-quarantining have resulted in many therapists quickly moving their in-person office practice to online practices known as telehealth, telemental health, telebehavioral health, distance counseling, etc., which are relatively new modes of providing therapy. The switch to telehealth and the adaptability of therapists is important in providing continued mental health services to people who are struggling with ongoing mental health challenges and perhaps increased emotional difficulty due to the current pandemic. However, switching quickly to telehealth can be challenging for therapists; here are some tips on how to follow legal and ethical guidelines during the switch to telehealth:
Do Your Research
Start by researching the laws and ethics regarding telehealth in your particular state and get familiar with your licensing board’s information on laws and ethics. Laws vary from state to state, and it’s important to stay on top of what applies in your area for your profession. Once you have this foundation, it’s a good idea to take continuing education on telehealth to increase knowledge and understanding of best practices as a telehealth provider. Due to the current need for telehealth, there are existing telehealth trainings that have been reduced in price or are free to clinicians. You can not only expand your knowledge, but also earn continuing education credits through telehealth trainings. Telehealth is relatively new and the telehealth world is continuing to evolve; therefore, training in telehealth must be ongoing for therapists. It can help to have a “best practices” mindset as a therapist using telehealth—do everything you can to gain knowledge and put that knowledge into practice, and then continue to expand your knowledge.
Choose the Right Video-Conferencing Platform
When choosing your video-conferencing platform to use in session, make sure it is HIPAA-compliant. For example, Doxy.me is well-known as being HIPAA-compliant with a free version for practitioners. Other options include VSee.com and Zoom for Healthcare. The Office of Civil Rights did provide an announcement on March 17th that the OCR and HHS will exercise its enforcement discretion and will not impose penalties for noncompliance with the regulatory requirements under the HIPAA Rules against covered health care providers in connection with the good faith provision of telehealth during the pandemic public health emergency. Although this may allow for increased flexibility, it is best practices to use a HIPAA-compliant platform for sessions if possible. Plus, you may want to continue doing telehealth long-term, beyond the current pandemic.
Creating a Telehealth Informed Consent
Some states require documentation for informed consent and you may want to create a telehealth informed consent anyway to better protect yourself and increase your clients’ understanding of telehealth-related issues. The American Psychological Association provides a list of things you may want to include, including the benefits and risks of video-conferencing. Risks such as the inherent risk to privacy due to using technology (even if it is HIPAA-compliant) can be outlined in your informed consent for telehealth. This document can also set the stage for how your clients will create a session space to increase their own privacy. Clinician and Client can sign and date this document.
Tricky Scenarios to Consider with Telehealth
- Client Outside of State
In some states, the therapist can only provide therapy services to clients while the client is in that state (the state in which you are licensed). For instance, if one of your regular clients is a college student who moved back home to another state to quarantine with their family, you may not be able to provide telehealth services until they return. Know the laws and ethics for your profession in your state to be sure of what is allowed.
- Crisis Situations, Including with Minors
Additionally, always keep the client’s safety in mind and be prepared. You will need to be sure you have the location where the client is using telehealth from in case the client is in crisis and you need to get them connected to more support quickly. Know what you will do if your client is in crisis and have phone numbers and resources on-hand, just as you would in-person. It may be helpful to know what resources, such as hospitals, are close in proximity to your client. If you are working with a minor through telehealth, you may want to discuss with the parent the need for them to be present at the location of the session (such as at home), while also allowing privacy for the child (perhaps being in the next room). You want the parent/guardian available in case there is a safety issue.
- Set the Standards and Respond to Situations
Some clinicians who have been using telehealth have all kinds of horror stories such as a male client showing up without a shirt, a young child client trying to take their laptop to the bathroom with them while in session, or a client having session while family members are in the room, watching outside of the clinician’s view. Set the standard with the client (and client’s parents’ for minors) that a telehealth session will be treated like an in-person session. Of course, you also set the right tone by being professional, addressing any possible concerns that arise head-on, and providing clear standards to the client. If anything compromises the client’s privacy, address the concern and take measures. For instance, if the client’s private therapy session is no longer private—someone else has entered the client’s room—it may be best to pause the therapy and figure out how to proceed.
It may seem like a lot to consider in making the adjustment to telehealth, but there is also a lot to gain. People need mental health support now more than ever due to the pandemic, and telehealth allows them to stay connected to support while practicing social distancing. The increased flexibility of telehealth also makes therapy possible for people living in rural areas, people with difficult schedules, and clients who might be reluctant to seek therapy in-person. Additionally, telehealth allows you as a therapist to continue earning an income and doing your important work even if you are not able to be in your office.
Need help creating your telehealth informed consent, other documentation, or using telehealth in a HIPAA-compliant manner that abides by state laws? We can help. Contact us or give us a call at 505.715.5700
