Managing risks of telepsychology

By Julie Jacobs, Psy.D., J.D.
August 7, 2018



telepsychologyMany psychologists are eager to use technology to enhance their practices, and the field of telepsychology is quickly gaining popularity. Clients and providers alike often value the convenience of using videoconferencing technology for the provision of mental health services, but as with all emerging interventions, there can be risks.

This article will provide a brief overview of some of the things that psychologists should consider to mitigate some of these risks.

Know the Rules

It is important for psychologists to understand the rules, regulations and guidelines for the practice of telepsychology. Many state psychology boards have issued policies or guidance about the provision of teletherapy and many state legislatures have enacted laws related to telepsychology.

If you choose to engage in telepsychology services, you should be aware of and comply with the relevant guidance in your state. An important resource is Guidelines for the Practice of Telepsychology developed by the APA, ASPPB and The Trust. Review these guidelines carefully before engaging in teletherapy. (https://www.apa.org/pubs/journals/features/amp-a0035001.pdf)

It is important to note that state laws and regulations only address practice within one’s state. Practicing across state lines, known as interjurisdictional practice, is generally prohibited unless you are licensed in the state where the client is located.

Competence

If you are going to engage in telepsychology services, you need to ensure that you are competent in providing distance therapy as well as competent in the use of the technology you choose. Look for workshops or CE opportunities related specifically to telepsychology to gain competence in the unique skills required to provide these services.

Seek consultation from IT professionals if you are not comfortable with the technology that you will use. You not only need to know how to use the technology, but you must also be able to teach your clients how to use it.

Appropriateness for services

Not all clients or interventions are appropriate for teletherapy services. It is important that you identify criteria for clients who are appropriate for this kind of intervention and carefully screen clients to ensure they meet these criteria. Clients who are high risk or who need extensive support between sessions are not likely to be good candidates for teletherapy.

Security and privacy concerns

You must identify and implement appropriate safeguards for privacy and security of confidential information. This includes utilizing a videoconference platform that has adequate encryption and security measures in place. If a platform is willing to enter into a Business Associate Agreement with you, that provides some assurances that the vendor will meet the privacy and confidentiality requirements of HIPAA.

In addition, you will want to ensure that your client takes steps to ensure the privacy of the communications, including choosing a setting that is private where the sessions will not be overheard by others.

Informed consent

You should develop an informed consent document that is specific to telepsychological services. This document should address the unique issues associated with such services, which can include things such as the way you will use telecommunications technologies with your client, the boundaries on the use of such technologies, security and confidentiality issues, risks involved and billing issues.

Emergency/crisis services

When engaging in therapy from a distance, you will not have the same ability to deal with crisis situations as you do when providing in-person services. It is important to have a plan in place for dealing with crises before you engage in teletherapy.

This plan may include things such as identifying a contact person who is located near the client and who the client authorizes you to contact in case of a crisis or emergency as well as identifying resources near your client where emergency services can be accessed if needed. You should create a customized plan for each client based on their individual circumstances to be sure you can address crisis situations adequately.

As with any psychological intervention, there are risks associated with providing telepsychology services. The above considerations can get you started in developing a plan to manage the risks associated with this emerging field.

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Julie Jacobs, Psy.D., J.D., is an attorney and psychologist in Colorado who provides risk management consultations to psychologists insured by The Trust as well as assisting mental health providers in Colorado with setting up and maintaining their practices. She may be reached by email at: Julie.Jacobs@colorado.edu.

 

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