the latest information in this fast-moving area, Baker adds.
Make sure that you:
• Periodically check your state legislature’s website for
the latest state telehealth laws and regulations. If there is no
telehealth law in your state, look to see if there is a board
policy statement that provides guidance on telepractice, she
recommends.
• Check whether your state licensing board has issued any
policies related to telepsychology. As of last summer, several
states, including Florida, Massachusetts, North Carolina, Texas,
Virginia and Wisconsin, had such policies in place. (To contact
any state board, visit the ASPPB website.)
• Contact your malpractice insurance carrier to confirm that
telehealth services — both in-state and across jurisdictional
lines — are covered under your malpractice policy. They are
likely to be covered for in-state practice but not necessarily for
interjurisdictional practice, Baker says.
Three states — California, Vermont and Kentucky — have
already passed laws specifying psychologists’ legal obligations
in online therapy. For instance, Kentucky states that at the
outset, a psychologist using telehealth must obtain the patient’s
informed consent, which includes documenting whether the
patient has the necessary knowledge and skills to benefit from
telehealth. Similarly, California requires that providers obtain
both written and verbal informed consent before providing
telehealth services, including a description of the potential risks,
consequences, and benefits of telemedicine. The state does not,
however, appear to extend this requirement to consultations
between providers where the patient is not directly involved,
Baker says.
Ethical telepractice
The ethics of telepsychology are in a similar state of flux,
though there is a lot of good information available, says Jeffrey
Barnett, PsyD, professor of psychology at Loyola University
Maryland, who regularly teaches and writes about ethical
issues in psychology. Included are telepsychology guidelines
developed by both the Canadian Psychological Association
and the Ohio Psychological Association (visit www.ohpsych.
org/resources/1/files/Comm%20Tech%20Committee/
OPATelepsychologyGuidelines41710.pdf and www.cpa.ca/
aboutcpa/committees/ethics/psychserviceselectronically/).
In general, all of the standards of the APA ethics code apply,
says Barnett. That includes standards on informed consent,
competence to practice, confidentiality, doing no harm, and
on how terminations, interruption of service and payment
arrangements are handled.
“In fact, practicing with distance therapies actually raises the
bar, because you also need to be competent in the media you’re
using,” he says.
To this end, get training in using the hardware and
software involved in the treatment you plan to provide,
Barnett recommends. For example, to preserve confidentiality
and therefore meet the requirements of the Health
Insurance Portability and Accountability Act, learn how
to use encryption software, and for maximum ease of
communication between you and your client, how to set up
your equipment to provide good sound and visual resolution.
You also need training on how to deal with some of the limits
of telepsychology. With avatar therapy, for instance, you can’t
read a patient’s expressions or body language, though some
of that is changing due to advances in technology (see main
article on page 49).
Fortunately, there are many continuing education
workshops on these topics, says Barnett. If you’re unsure
how to proceed, contact your state, provincial or territorial
psychological association’s ethics committee, the APA Ethics
Office, your state licensing board, or knowledgeable colleagues,
he recommends.
In addition, when using these technologies, it’s important
to conduct an initial assessment of each client to determine his
or her appropriateness for telepsychology, says Barnett. A client
who is suicidal, for example, may require much more active
and intensive services than telepsychology can provide. Other
factors to consider include making sure you have provided
adequate emergency contact information in case your distance
client faces a crisis, and ensuring that your patient’s privacy
and confidentiality are adequately protected by encrypting
electronic transmissions and records, he says.
Barnett has an article covering these and more topics in the
June 2011 issue Psychotherapy.
A new APA Task Force on the Development of
Telepsychology Guidelines for Psychologists should further
clarify psychologists’ rights and obligations soon. The
10-member group — which includes representatives from
APA, ASPPB and the APA Insurance Trust — met in July to
review the area and discuss results of a survey sent to all APA
governance groups, state associations, state and provincial
psychology boards, telepractice-related organizations and
interested individuals.
The group has developed a working plan and will begin
drafting guidelines in the next several months. In addition, the
task force is creating a Web page that will provide information
about the task force’s work and calls for comments, and will
publicize this information in other APA venues as well.
Putting the proper safeguards in place should help to
ensure that telehealth technologies live up to their promise of
improving care, Barnett adds.
“There are a lot of good data showing that you can form a
good therapeutic alliance using telepsychology, and that these
modalities can help people with all sorts of issues,” Barnett
says. “Now we just need to develop the formal guidelines, and
hopefully the laws and regulations, to make this a successful and
safe area of practice.” n
