Telemental Health Resources

The federal government has authorized the use of telehealth services for mental health care and relaxed existing HIPPA regulations. Telemental health, sometimes also referred to as Telemedicine, Telementalhealth, Telebehavioral health, Telehealth or E-Health, is counseling or client services provided over the phone or Internet. Many practitioners who are new to this method of delivery may be wondering “How do I conduct sessions remotely?” or “How do I start to use telehealth services in my practice?”

APA Telehealth Guidance by State during COVID-19

APA has created a resource that summarizes current state emergency orders relevant to licensed psychologists. Practitioners can use this resource to understand how to provide psychological services via telehealth to patients during the coronavirus outbreak. Please visit the APA website for guidance

APAIT Statement on In-Person Psychological Services during COVID-19

Click here to read The Trust’s Statement

Telehealth 101

In the video below, "Telehealth 101," Dr. Bruce Ecker offers a helpful primer on Telehealth for mental health professionals. Further down this page is a  list of resources to help answer other questions providers may have. This list will be updated periodically.

Telemental Health 101

Guidelines for Conducting Teletherapy Sessions

The following guidelines were created by Dr. Bruce Ecker, co-director of the William James College Youth and Family Psychotherapy Services.  Download a PDF copy of these steps, here.

Initial Steps:

  • Decisions regarding which clients are appropriate for Telebehavioral health (TBH) services will be made jointly by YFPS interns and their supervisors. Factors to consider include the severity of the disorder, and safety concerns (particularly of self-injury or violence and thus the need for emergency care), and whether or not the client has access to an appropriate web-connected device, such as a tablet, smart phone, or computer.
  • All encounters must be done via a HIPAA-Compliant platform. However, the federal Office of Civil Rights has relaxed this requirement for a temporary period as we acclimate to Covid-19 related service needs.
  • At the start of shifting to telehealth services, verify the client’s (and guardian’s if applicable) contact information (email, address and telephone numbers). Read the TBH consent (with the guardian present) and get verbal consent. Either email or mail a copy of the consent to client or the guardian and have them sign this.
  • Test your technology with a colleague before the first time you use it and occasionally thereafter.

Conducting the Session:

  • The first order of business in each session is to identify and/or confirm the client’s location, including the address, to identify who else is in that location, and to ask if anyone else can hear what is spoken.  Then, problem-solve how to ensure privacy unless this is intentionally a joint session. Also, be sure to get a back-up phone number in case the computer technology fails.
  • Prior to each session, be sure that you have phone numbers for the local emergency services agency and/or hospital.  If the client is in a new location, pause the session for a minute or two while you obtain this.  In that case, say something like: “I need a few minutes to find where the emergency resources are in that area...” and you pause the session to do so. If the client says, “I don’t need that,” say something like,” I know...but I do it because it’s my policy  and because if there was ever an urgent situation then I would want to be able to respond in a way that keeps you and others as safe as possible.”
  • You should have a list of emergency service phone numbers, by geographical location, available whenever you connect via TBH. Note that you handle emergencies in much the same way you would if a client was in the office: you maintain contact on-screen, find out if anyone in the client’s location can sit with him/her, and use your phone to secure resources. Dial 911 and get police help if needed.
  • At the start of each session, anticipate with the client what you will do if someone walks into the room (on either side), if there are noises in the clinician’s space you anticipate, or if the equipment fails. Also, encourage the client to put a sign on his/her door, noting “Do not Disturb.” Do the same where you, the clinician, are. Also, at the start of each session, ask if anything is going on in the client’s location that you, the clinician, should know about...and thereby might be relevant to the session.
  • If anyone else joins the session, even child or a sibling, you need a release of information signed (verbal is initially okay, but chart this and then send a release via email)
  • You need to document in the chart that this was a TBH session, the reason for using THB (to protect medical safety due to the risk of Covid-19), where the client was during the session, the extent to which there was privacy, and whether or not there were any interruptions during the session (e.g., someone entered either space, technical problems, etc.).

These guidelines were developed on 3/16/20 in response to the coronavirus outbreak.  They are subject to change.

Additional Resources
Recommended Reading

Informed consent: An adaptable question format for telepsychology
Murphy, Jason M.,Pomerantz, Andrew M., Professional Psychology: Research and Practice, Vol 47(5), Oct 2016, 330-339

Practice Guidelines for Video Based Online Mental Health Services
The American Telemedicine Association (ATA), May 2013

American Telemedicine Association Practice Guidelines for Telemental Health with Children and Adolescents 
Telemedicine and E-Health. Mary Ann Liebert, Inc. VOL. 23 NO. 10. OCTOBER 2017. See especially pp. 12-14 re: emergencies.

Telebehavioral Health Child and Adolescent Practice Guidelines
A practitioner’s guide to telemental health. American Psychological Association. Luxton, Nelson & Maheu, 2016. 

A Practitioner's Guide to Telemental Health: How to Conduct Legal, Ethical, and Evidence-Based Telepractice
Luxton, D.D., Nelson, E., & Maheu, M.M., 2016

A Telepsychology Casebook: Using Technology Ethically and Effectively in Your Professional Practice
Campbell, L., Millán, F., & Martin, J., eds., forthcoming

Critical Concerns When Incorporating Telepractice in Outpatient Settings and Private Practice
Palomares, R.S., Bufka, L.F., & Baker, D.C. Journal of Child and Adolescent Psychopharmacology, 2016

Answers to Other Questions You May Have

What are the changes that have been put into effect for the Health Insurance Portability and Accountability Act (HIPAA)?

HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA): Effective immediately, the HHS Office for Civil Rights (OCR) will exercise enforcement discretion and waive penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communications technologies, such as FaceTime or Skype, during the COVID-19 nationwide public health emergency.  For more information: https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/index.html

The National Law Review posted an overview of the temporary expansion, which included these resource links:

“On March 17 the Trump Administration announced expanded reimbursement for clinicians providing telehealth services for Medicare beneficiaries during the COVID-19 Public Health Emergency. The Centers for Medicare and Medicaid Services (CMS) published an announcement, a fact sheet and Frequently Asked Questions.  To further facilitate telehealth services, the Office for Civil Rights (OCR) issued a notification describing certain technologies that would be permitted to be used for telehealth without being subject to penalties under the Health Insurance Portability and Accountability Act regulations (HIPAA). In addition, the Office of Inspector General (OIG) announced it will allow healthcare providers to reduce or waive cost-sharing for telehealth visits.”

Read the full article: “Government Significantly Expands Telehealth Reimbursement During COVID-19 Public Health Emergency.”

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