What’s Your Mental Health Professional Association Doing to Support Responsible Internet-based Telehealth Practice?
by Marlene M. Maheu, Ph. D. on 18/06/10 at 12:29 pm
Members of the American Telemedicine Association’s (ATA) telemedicine health special interest groups (SIG) have laudably published a number of “Best Practices” or “Guideline” documents, such such as for telemental health. These guidelines however, expressly exclude practice via the Internet.
Solo and independent practitioners face a different set of challenges than our institutional colleagues.
As small business owners (in essence), we operate with fewer layers of protection from liability and with less oversight by supervisors. We typically work in small offices, free from the same adherence to either treatment or practice protocols as might exist when working in academic, government or other large institutional settings.
We therefore have somewhat different experiences – and risks. It is my opinion then, that those differences with respect to telemental health warrant attention by those associations who accept our yearly dues and set standards for us as a group.
Aside from documents issued by the National Board of Certified Counselors (NBCC) and the International Society for Mental Health Online (ISMHO), two relatively small groups that paralleled each other in strongly advocating the use of e-mail and chat rooms to work with unseen, previously unknown and undiagnosed mental health clients or patients, I have awareness of one formally produced document that addresses the myriad complexities of remote ethical practice for solo practitioners in the United States. That document is the “Telepsychology Guidelines” produced by the Ohio Psychological Association, originally published in 2008.
Since then, most of us have witnessed the rapid proliferation of services such as Skype-type videoconferencing services on the Internet, cell phone use and texting, and have heard of colleagues who use these services. Unfortunately, many of those practitioners seem to be jumping on the new technologies without training in ethical or legal vulnerabilities with respect to consumer protection or their own risk management.
Therefore, I have these question for you, my resourceful colleagues:
1. Are you aware of any other statements, ethical decisions, announcements or other documents for independent practitioners seeking guidance for practice through the Internet as produced by any of the large US professional associations?
2. Do you live in a country other than the US, and have a professional association that has published such a document?
If you are aware of any such resources, please leave links or details in the comments section below.
Karen Graves
Jun 27th, 2010
I am a psychologist living in Ohio so am familiar with the Telepsychology Guidelines referenced above. I currently have a website that rents “virtual office space” to practitioners who wish to provide online services for their clients. The lifeStreams.com website gives practitioners access to communication tools, personal assessments, educational materials, goal-setting and journaling features and offers a HIPPA-secure environment for client-therapist interaction. Although the OPA Subcommittee on Telepsychology were “forward-thinking” in developing the guidelines, committee members do not seem to fully support the notion of engaging with clients *solely* through the internet. I am eager to gain support from others providing online therapy, and am equally eager to read other guidelines and issues being raised in this exciting field!
admin
Jun 27th, 2010
Welcome to this forum, Karen,
While I share your enthusiasm and appreciate the time and energy involved in the process you seem to have undertaken, I have to agree to some degree with the OPA precautions, simply because of the work I’ve done in this field. A lot of that is documented in my text books or the coursework we are beginning to bring online at the TeleMental Health Institute (http://telementalhealth.com). In essence, just because someone wants to use your system, or encrypted email or Google Talk — or even traditional telephone service to deliver professional services doesn’t mean they are de facto “safe” to do so.
Our degree of “safety” depends on our use not only of good, reliable equipment, but much more importantly, good clinical judgment, based on training, and tailored to the individual or family in front of us… Unfortunately, those areas are not as well defined as many of us would like. Please see my next post about “safety” for details.
If you are a front runner as I suspect you are, then join us in trying to educate our colleagues by encouraging them to get at least 15-20 hours of relevant continuing education in this area before treating patients remotely – whatever equipment they use. Many of the above issues can be handled. However, it takes a fair amount of exposure to the issues to understand them and figure out who is a reasonable candidate for remote treatment, how to authenticate clients every session, how to best set up lighting, background, control sound, images, which technology to use, which clinical protocols to use, how to set up emergency backup procedures, etc.
In essence, working online is a new form of practice. Without being able to prove our approaches are indeed acceptable and we that we are competent not only legally/ethically/technically but clinically to do so, we could run into far more trouble ever brought by than HIPAA, or other relevant privacy laws that make HIPAA look like pablum.
Furthermore, most professional association guidelines (such as the APA) literally require specialized continuing education when delivering services via the new technologies.
I hope I’ve given enough of an answer here. If not, ask more questions, and I will encourage others to join in the answering process.
Let’s figure this out and shape it together, and not wait for others to do it for us.
Best Regards,
Marlene M. Maheu, Ph.D.