Below are tools that you may find helpful when working with clients during the COVID-19 outbreak if and/or when services can no longer be provided on a face-to-face basis at your agency.
It is our hope to compile some of the best resources and guidelines we've found or have been shared with us that may be useful to guide your continued service for your clients.
Remember: Every state is different regarding its particular rules for telecounseling (and other counseling activities). Please reach out to your state board for information regarding your state’s compliance rules. Also see general information on HIPAA compliance.
Topics:
Spotlight Resource:
The National Clearinghouse of Rehabilitation Training Materials (NCRTM) sponsored by the Rehabilitation Services Administration (RSA) is the Gateway to RSA Technical Assistance and Training. NCRTM offers vocational rehabilitation and education communities an opportunity to contribute new knowledge to their specific fields and gain visibility for their work.
Choosing an Online Platform
The CRCRE has heard from clinicians that the following are options used for telecounseling. However, the CRCRE does not endorse any product specifically. Please review any software to ensure it will fulfill all compliance and other needs of your state, company, etc. prior to use.
Remember that while a platform may offer HIPAA-compliance features, every package may not offer them, so please read carefully.
Training to Provide Telecounseling
Telebehavioral Health Information and Counselors in Health Care
Telebehavioral health, or distance counseling, is the use of a digital platform that provides secure, encrypted, audio-video conferencing to communicate with a client in real time. Find out more about the practice of telebehavioral health.
Source: American Counseling Association
14 Benefits of Teletherapy for Clients
- from Psychology Today
- Online counseling is the new frontier. Reasons to consider taking the plunge.
PESI
This non-profit organization is offering a 12-hour online distance-learning seminar for conducting telemental health services. This training, typically $440, is being offered for $219.
Additionally, on the site’s homepage, you will find offerings of webinars on virtual teaching and counseling.
Moving Counseling Instruction Online: A Special Edition Webinar Series
- Includes information on best practices and resources
- Access recordings from information sessions:
Technology, Social Media, & Distance Counseling
- Presentation will assist participants in developing protocols for working with these new technologies. More about the Technology, Social Media, and Distance Counseling Training
- Cost: The video-based course costs $22 for members and $32 for non-members.
- Source: American Counseling Association (ACA)
Ethical Issues Related to the Use of Technology in Clinical Supervision
- Ethical guidelines that are available for counseling supervisors and the underlying ethical principles and virtues to consider in the use of technology-assisted-supervision (TAS). More about the Ethical Issues Related to the Use of Technology in Clinical Supervision
- Cost: The video-based course costs $22 for members and $32 for non-members.
- Source: American Counseling Association (ACA)
Ethical and Legal Guidelines
Note: This document primarily discusses guidelines for storage, transmission, etc. It does not explicitly discuss telecounseling, but issues related to the use of technology.
- Recorded March 20, 2020
- Source: American Psychological Association
APA Telepsychology Guidelines
The APA offers Guidelines on Telepsychology that can be very helpful for all mental and behavioral health counselors.
These guidelines include, but are not limited to, guidance that a professional:
"apply the same ethical and professional standards of care and professional practice that are required when providing in-person psychological services"
“consider the client's/patient's familiarity with and competency for using the specific technologies involved in providing the particular telepsychology service.”
“assess carefully the remote environment in which services will be provided, to determine what impact, if any, there might be to the efficacy, privacy and/or safety of the proposed intervention offered via telepsychology.”
“discuss fully with the clients/patients their role in ensuring that sessions are not interrupted and that the setting is comfortable and conducive to making progress to maximize the impact of the service provided since the psychologist will not be able to control those factors remotely.”
“assess carefully the remote environment in which services will be provided, to determine what impact, if any, there might be to the efficacy, privacy and/or safety of the proposed intervention offered via telepsychology.”
“discuss fully with the clients/patients their role in ensuring that sessions are not interrupted and that the setting is comfortable and conducive to making progress to maximize the impact of the service provided since the psychologist will not be able to control those factors remotely.”
“If there is a significant change in the client/patient or in the therapeutic interaction to cause concern, psychologists make reasonable effort to take appropriate steps to adjust and reassess the appropriateness of the services delivered via telepsychology. Where it is believed that continuing to provide remote services is no longer beneficial or presents a risk to a client's/patient's emotional or physical well-being, psychologists are encouraged to thoroughly discuss these concerns with the client/patient, appropriately terminate their remote services with adequate notice and refer or offer any needed alternative services to the client/patient.”
“monitor and assess regularly the progress of their client/patient when offering telepsychology services in order to determine if the provision of telepsychology services is still appropriate and beneficial to the client/patient.”
We encourage you to visit the American Psychological Association website for more information on:
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- Competence
- Standards of Care
- Informed Consent
- Confidentiality of Data and Information
- Security and Transmission of Data and Information
- Disposal of Data, Information and Technologies
- Testing and Assessment
- Interjurisdictional Practice
National Board for Certified Counselors (NBCC) Policy Regarding the Provision of Distance Professional Services
Following an excerpt of the NBCC policy document.
Standards for Distance Professional Services
- NCCs shall adhere to all NBCC policies and procedures, including the Code of Ethics.
- NCCs shall provide only those services for which they are qualified by education and experience. NCCs shall also consider their qualifications to offer such service via distance means.
- NCCs shall carefully adhere to legal regulations before providing distance services. This review shall include legal regulations from the state in which the counselor is located as well as those from the recipient’s location. Given that NCCs may be offering distance services to individuals in different states at any one time, the NCC shall document relevant state regulations in the respective record(s).
- NCCs shall ensure that any electronic means used in distance service provision are in compliance with current regulatory standards.
- NCCs shall use encryption security for all digital technology communications of a therapeutic type. Information regarding security should be communicated to individuals who receive distance services. Despite the use of precautions, distance service recipients shall be informed of the potential hazards of distance communications. Not the least of these considerations is the warning about entering private information when using a public access or computer that is on a shared network. NCCs shall caution recipients of distance services against using “auto-remember” user names and passwords. NCCs shall also inform recipients of distance services to consider employers’ policies relating to the use of work computers for personal communications.
- To prevent the loss of digital communications or records, NCCs who provide distance services shall maintain secure backup systems. If the backup system is also a digital mechanism, this too shall offer encryption-level security. This information shall be provided to the recipient of professional services.
- NCCs shall screen potential distance service recipients for appropriateness to receive services via distance methods. These considerations shall be documented in the records.
- During the screening or intake process, NCCs shall provide potential recipients with a detailed written description of the distance counseling process and service provision. This information shall be specific to the identified service delivery type and include considerations for that particular individual. These considerations shall include the appropriateness of distance counseling in relation to the specific goal, the format of service delivery, the associated needs (i.e., computer with certain capabilities, etc.), the limitations of confidentiality, the possibility of technological failure, anticipated response time to electronic communication, and any additional considerations necessary to assist the potential recipient in reaching a determination about the appropriateness of this service delivery format for their need(s).
- Because of the ease in which digital communications can inadvertently be sent to other individuals, NCCs shall adopt behaviors to prevent the distribution of confidential information to unauthorized individuals. NCCs shall discuss actions the recipient may take to reduce the possibility that they will send information to other individuals by mistake.
- NCCs shall provide recipients of distance professional services with information concerning their professional credentials and links to the respective credentialing organization Web sites.
- NCCs, either prior to or during the initial session, shall inform recipients of the purposes, goals, procedures, limitations, potential risks, and benefits of services and techniques. NCCs also shall provide information about rights and responsibilities as appropriate to the counseling setting. As a part of this type of service provision, NCCs shall discuss with recipients the associated challenges that may occur when communicating through distance means.
- In the event that the recipient of distance services is a minor or is unable to provide legal consent, the NCC shall obtain a legal guardian’s consent prior to the provision of distance services. Furthermore, NCCs shall retain copies of documentation indicating the legal guardian’s identity in the recipient’s file.
- NCCs shall avoid the use of public social media sources (e.g., tweets, blogs, etc.) to provide confidential information. To facilitate the secure provision of information, NCCs shall provide in writing the appropriate ways to contact them.
- NCCs shall provide recipients of distance services with specific written procedures regarding emergency situations. This information shall include emergency responders near the recipient’s home location. Given the increased dangers intrinsic to providing certain distance professional services, NCCs shall take reasonable steps to secure reasonable referrals for recipients when needed.
- NCCs shall develop written procedures for verifying the identity of the recipient at each instance of receiving distance services. Examples of verification means include the use of code words or phrases.
- NCCs shall limit use of information obtained through social media sources (e.g., Facebook, LinkedIn, Twitter, etc.) in accordance with established practice procedures provided to the recipient at the initiation of services.
- NCCs shall provide information concerning locations where members of the public may access the internet free of charge or provide information regarding the location of complimentary Web communication services.
- NCCs shall retain copies of all written communications with distance service recipients. Examples of written communications include e-mail/text messages, instant mess ages and histories of chat-based discussions even if they are related to housekeeping issues such as change of contact information or scheduling appointments.
- At a minimum, NCCs shall retain distance service records for a minimum of five years unless state laws require additional time. Due to the nature of most distance services, it may be convenient for NCCs to retain records for longer durations, and thus may be considered useful for research or other professional activities. NCCs shall limit the use of records to those permitted by law, professional standards and as specified by the agreement with the respective recipient of distance services.
- In recognition of the inherent ethical implications which may arise, NCCs shall develop written procedures for the use of social media and other related digital technology with current and former recipients. These written procedures shall, at a minimum, provide appropriate protections against the disclosure of confidential information and the creation of multiple relationships. These procedures shall also stipulate that personal accounts be distinct from any used for professional purposes.
Example Guidelines: District of Columbia
When researching telehealth in D.C. (or any other state, territory, etc.), please make sure you access reputable district (or state) regulations including contacting the state licensing board as applicable to your work.
The D.C. government page offers guidance for Marriage and Family Therapists which includes the following excerpt:
- “…A licensee providing or intending to provide teletherapy to a resident of another jurisdiction where the licensee is not licensed should contact the regulator(s) in that jurisdiction to ascertain and comply with the legal requirements of the jurisdiction.
- A marriage and family therapist providing or intending to provide teletherapy to a District resident should ensure that he or she complies with applicable federal and state laws governing confidentiality and privacy, such as the Health Insurance Portability and Accountability Act of 1996 (HIPAA) privacy and security rules. Accordingly, the therapist should use only a telecommunication system, program, or means that is known to be sufficiently secure to protect the client’s privacy and confidentiality. Based on current information, Skype is not a secure means of telecommunication.
- A marriage and family therapist providing or intending to provide teletherapy to or involving a minor should observe all applicable ethical rules and safeguards to protect the minor’s rights, welfare, safety, and privacy.”
Preparing Your Office for Telecounseling: Tools and Resources
APA Checklist: Informed consent for telepsychological services
Many states require documentation for informed consent. You may want to create such a form for your practice.
COVID-19: Information and Resources
Advice for psychology supervisors and trainees on caring for patients during the COVID-19 crisis
As public health and education officials continue to monitor the spread of the coronavirus, here is advice for supervisors and trainees at psychology training programs on how to prepare for and adapt to fluctuating circumstances specific to patient care.
Source: American Psychological Association
APA Speaking of Psychology: Coronavirus Anxiety Podcast:
Speaking of Psychology is an audio podcast series highlighting some of the latest, most important and relevant psychological research being conducted today.
Produced by the American Psychological Association, these podcasts will help listeners apply the science of psychology to their everyday lives.
What Corona Virus Fears Are Doing to People with Anxiety Disorders
Stress from the corona virus epidemic can be debilitating for people with PTSD, OCD or illness anxiety disorder, formerly known as hypochondria.
Source: The Washington Post
General Resources on COVID-19
- “With meetings banned, millions struggle to stay sober on their own” from The New York Times
- AAHD Discussion: COVID 19 - Tip Cards for First Responders - Persons with Disabilities from UNM Center for Development and Disability
- COVID 19 Support Page from the Disability Rights Education & Defense Fund (DREDF)
- “Coronavirus Pandemic: Reliable Government Information Resources” from Government Book Talk
From ACCSES: The Voice of Disability Service Providers
Additional Client Focused Resources
Free Stress Reduction and Wellness Resources
Online Teaching Resources
As a veteran of online teaching and education technology, I’ll offer my own short list of advice for faculty members who need to move online, fast, with the twin goals of maintaining instructional continuity as much as possible and finishing the semester strong.
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