Telemental Health Resources
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 for state telehealth guidelines 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.
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. These guidelines were developed on 3/16/20 in response to the coronavirus outbreak. They are subject to change. Download a PDF copy of these steps, here.
- 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.).
- Telepsychology Best Practices 101: Clinical Evaluation and Care: Cultural Competencies
- SAMHSA Telebehavioral Health Technical Assistance
- HRSA Substance Abuse Telebehavioral Health Program
- Telebehaviorial Health Institute (Bibliography)
- MHS Digital Resource Toolkit
- COVID-19 TIPS: BUILDING RAPPORT WITH YOUTH VIA TELEHEALTH (PDF). Compiled by Ilana Seager van Dyk, Juliet Kroll, Ruben Martinez, Natacha Emerson & Brenda Bursch of the UCLA Pediatric Psychology Consultation Liaison Service.
- American Psychological Association: Experts Review telehealth platforms Doxy.me; thera-LINK; ZOOM
- American Telemedicine Association: Practice Guidelines for Video-Based Online Mental Health Services Guide Book
- American Telemedicine Association: Quick-start guide to telehealth during a crisis
- Ask the Experts: Legal and Ethical Considerations for Remote School Psychologist Services
- Society of Clinical Psychology: Compilation of peer-reviewed papers on telepsychology
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
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
Luxton, D.D., Nelson, E., & Maheu, M.M., 2016
A Telepsychology Casebook: Using Technology Ethically and Effectively in Your Professional
Campbell, L., Millán, F., & Martin, J., eds., forthcoming
Critical Concerns When Incorporating Telepractice in Outpatient Settings and Private
Palomares, R.S., Bufka, L.F., & Baker, D.C. Journal of Child and Adolescent Psychopharmacology, 2016
- AAMFT Best Practices in the Online Practice of Couple and Family Therapy click here
- American Psychological Association's Guidelines for the Practice of Telepsychology click here
- American Psychiatric Association's Practice Guidance for COVID-19 click here
- Guía para la práctica de la Telepsicología click here
- Lineamientos del Colegio de Profesionales en Psicología de Costa Rica para el Uso de la Psicología en Línea click here
- American Telemedicine Association’s Practice Guidelines for Video-based Online Mental Health Services click here
- National Association of Social Workers' Technology in social work practice click here
- Ken Pope's Links to 20 Sets of Professional Guidelines Focusing on Telepsychology and Internet-Based Therapy click here
As states continue to adopt policies regarding telehealth, The Federation of State Medical Boards provides the most up-to-date resource on the modification of telehealth guidelines by each state. https://www.fsmb.org/siteassets/advocacy/pdf/states-waiving-licensure-requirements-for-telehealth-in-response-to-covid-19.pdf