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Community Champion

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Intake Summary

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Computers 8. Programming »
Professional Counseling )

Addictions (66)

— C...
OCPM:  Online Clinical Practice Management

Step 1: Training

Step 2: Referrals

Step 3: Patient Education
Step 4: Legalit...
((( TELEMENTAL HEALTH 1 teleheainmorg

INSIITIJTF

Where to Get Reimbursement for Telemental Health? 

Contractual & Grant...
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Where to Get Reimbursement for Telemental Health? 

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Telemedicine

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2014 Reimbursement Bill

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To download, 
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American
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CCHP PROJECTS

National Telehealth Resource
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ACA 2014: Skype, HIPAA & Licensure - Nine Evidence-Based, Distance Counseling Best Practices
ACA 2014: Skype, HIPAA & Licensure - Nine Evidence-Based, Distance Counseling Best Practices
ACA 2014: Skype, HIPAA & Licensure - Nine Evidence-Based, Distance Counseling Best Practices
ACA 2014: Skype, HIPAA & Licensure - Nine Evidence-Based, Distance Counseling Best Practices
ACA 2014: Skype, HIPAA & Licensure - Nine Evidence-Based, Distance Counseling Best Practices
ACA 2014: Skype, HIPAA & Licensure - Nine Evidence-Based, Distance Counseling Best Practices
ACA 2014: Skype, HIPAA & Licensure - Nine Evidence-Based, Distance Counseling Best Practices
ACA 2014: Skype, HIPAA & Licensure - Nine Evidence-Based, Distance Counseling Best Practices
ACA 2014: Skype, HIPAA & Licensure - Nine Evidence-Based, Distance Counseling Best Practices
ACA 2014: Skype, HIPAA & Licensure - Nine Evidence-Based, Distance Counseling Best Practices
ACA 2014: Skype, HIPAA & Licensure - Nine Evidence-Based, Distance Counseling Best Practices
ACA 2014: Skype, HIPAA & Licensure - Nine Evidence-Based, Distance Counseling Best Practices
ACA 2014: Skype, HIPAA & Licensure - Nine Evidence-Based, Distance Counseling Best Practices
ACA 2014: Skype, HIPAA & Licensure - Nine Evidence-Based, Distance Counseling Best Practices
ACA 2014: Skype, HIPAA & Licensure - Nine Evidence-Based, Distance Counseling Best Practices
ACA 2014: Skype, HIPAA & Licensure - Nine Evidence-Based, Distance Counseling Best Practices
ACA 2014: Skype, HIPAA & Licensure - Nine Evidence-Based, Distance Counseling Best Practices
ACA 2014: Skype, HIPAA & Licensure - Nine Evidence-Based, Distance Counseling Best Practices
ACA 2014: Skype, HIPAA & Licensure - Nine Evidence-Based, Distance Counseling Best Practices
ACA 2014: Skype, HIPAA & Licensure - Nine Evidence-Based, Distance Counseling Best Practices
ACA 2014: Skype, HIPAA & Licensure - Nine Evidence-Based, Distance Counseling Best Practices
ACA 2014: Skype, HIPAA & Licensure - Nine Evidence-Based, Distance Counseling Best Practices
ACA 2014: Skype, HIPAA & Licensure - Nine Evidence-Based, Distance Counseling Best Practices
ACA 2014: Skype, HIPAA & Licensure - Nine Evidence-Based, Distance Counseling Best Practices
ACA 2014: Skype, HIPAA & Licensure - Nine Evidence-Based, Distance Counseling Best Practices
ACA 2014: Skype, HIPAA & Licensure - Nine Evidence-Based, Distance Counseling Best Practices
ACA 2014: Skype, HIPAA & Licensure - Nine Evidence-Based, Distance Counseling Best Practices
ACA 2014: Skype, HIPAA & Licensure - Nine Evidence-Based, Distance Counseling Best Practices
ACA 2014: Skype, HIPAA & Licensure - Nine Evidence-Based, Distance Counseling Best Practices
ACA 2014: Skype, HIPAA & Licensure - Nine Evidence-Based, Distance Counseling Best Practices
ACA 2014: Skype, HIPAA & Licensure - Nine Evidence-Based, Distance Counseling Best Practices
ACA 2014: Skype, HIPAA & Licensure - Nine Evidence-Based, Distance Counseling Best Practices
ACA 2014: Skype, HIPAA & Licensure - Nine Evidence-Based, Distance Counseling Best Practices
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ACA 2014: Skype, HIPAA & Licensure - Nine Evidence-Based, Distance Counseling Best Practices

  1. 1. ((€"31?§‘i3?’?3i'f3’? ‘§’e‘} <4r4‘-«= r~Ii= ~«= -"nts Skype, HIPAA 8-. Licensure: Nine Evidence—Based, Distance Counseling Best Practices AMERICAN COUNSELING ASSOCIATION March 27,2014 Marlene M. Maheu, Ph. D. Executive Director Te| eMentaI Health Institute, Inc. muAuu_n= JeI1eaIIh. arg 619-255-2788
  2. 2. EEEEEEEEEEEEE TH ((( teIeheaIth. org I N S Y I T U T F Learning Objectives 1. Describe 3 ethical dilemmas related to Skype, Google, Facebook and the ethical codes that help practitioners think through those dilemmas. 2. Name at least 10 acceptable online email and video services that are H| PAA—comp| iant. 3. Name 3 client populations that have been shown by the evidence base to benefit from video—conferenced telemental health.
  3. 3. TE EMENTAL HEALTH ((( L I teIeheaIth. org I N 5 I I T U T F Disclaimer - I am an MFT and clinical psychologist, not an attorney, physician or Information Technology specialist. The information I present is my best attempt to bring you timely and relevant information in a rapidly evolving area. I therefore make no warranty, guarantee, or representation as to the accuracy or sufficiency of the information contained in my training. - My goal is educational only. I seek to outline the issues and alert you to what's happening, including legal, ethical and other risk management issues. You are encouraged to seek specific advice related to your circumstance from your qualified authorities. 0201! Ttlellflnl Health Insllla. tar.
  4. 4. I. .. WI. .. fix elm: .. .. .m. m : «% X . «. 1. m m m E M E m M m 0 Housekeeping Schedule Restrooms Questions WiFi Twitter @aca I I I I I I
  5. 5. TELEMENTAL HEALTH I telehealth-org INKIIIIJIF I Counselor Preparation ° Clinical Competencies — Department of Defense (DOD) — Ohio Psychology Board — Professional Associations - Society for Technology & Behavioral Health -1 T: — Te| eMenta| Health Institute ; .1 3 ‘I, ° Technical Competencies -1 . r — Association for Counselor " Education and Supervision . . (ACES) 7——-—-- 0201! Telellemzl Health Insllme, Inc.
  6. 6. ACES Technical Competencies ° Technical Competencies For Counselor Education: Recommended Guidelines For Program Development (2007) ° htt : fi| es. aceson| ine. n et doc 2007 aces tech nology competenciesp df
  7. 7. Best Practices in Counselor Preparation 1: Fundamentals ° Definitions & Research 2.Lega| ° HIPAA & HITECH Licensing Informed Consent Mandated Reporting 02014 Telelolemzl numi Institute, Inc,
  8. 8. Best Practices in Counselor Preparation 3. Ethical Issues ° Standards&Guide| ines ° Competencies ° Cultural/ Linguistic Competence ° Referrals Supervision 02014 Tuleuemzl nulm Institute, Inc,
  9. 9. Best Practices in Counselor Preparation 3. Equipment ° Needs, Features and Functions 4. Clinical Practice Client Education | ntake/ Assessment Opening Protocols Documentation & Storage Emergency Planning Emergency Interventions 02014 Thleuemal numi Institute, Inc,
  10. 10. Our planet is re-tooling «I VJ T 4* 4* /3. 2 I I , ./ ‘A, /_{[»" J’, +/ _ / / ' n '-"' -)1 ’ 1.“ as IS , / J4) / ¢_; //~ ’ - ’ M1,, ’ / é zszr; ,c%~~, .4 / ;~{ counseling 3 "7" ‘ . ’ L / A f
  11. 11. <-II: InzmIa‘. .--. -‘: '«_-' Health Care Reform ° Most significant upheaval and reorganization of US healthcare system we are likely to see in our lifetimes 0 Law was effective January of 2014 ' 60 million new people will be eligible for US government-backed health care in the US * No extra money
  12. 12. Institute for Healthcare Improving Health and Health Care Worldwide SEIRCH Q ABOUT US TOPICS EDUCATION RESOURCES REGIONS ENGAGE WITH IHI o T key“, Ream‘, , A SHARE IHI PROGRAIS Piirsuel! ieTrpIeAm7 “‘ E’ ‘ W, 4_ ‘D H . :7i5:9 m‘ in 'c an: cctmrrl, Hmwem, The IHI Triple Aim wsmm lsldevials = - smcess sums c T ARE YOU READY TO FUR SUE HI-"P59A'“ " THE TRIPLE MI? Pruutyping Panneis Use the asssssrivfi : c~: l tn find at — MORE The IHI Tune an 15 aiairienurt iieveIc; >:~'I I7,'il: e Insmixe la I-‘ea! .hr. a'e ! mumwnem INFORM-no", Ihai desnnbss an approach In ouirrizirig I'iealII~ system peifiiniimce I115 | H‘s neéefthal new uesegis ITUSI be damped to S: !m1l‘.3'%90IISl)‘l. 'USIIe‘iltI‘éE ameiisiiins mm use cdl me ‘Tnple Ami’ iiiiT7ip[eAim - rnpmrig the pane: expenenze alcaie ainclziding qialty am’! saislacnoni ~ Irriproaiigllieiiemhufpopiilanuns and - Reduorvgtrrepercagmacwcfhealm care
  13. 13. TELEMENTAL HEALTH ~ ((( I N _) Y 1 U I ‘ telehealth. org «W1 , a. , . . . .. .‘ é . .. ..o. . . .. $. ;. irir.
  14. 14. ((( TELEMENTAI. HEALTH I teleheamhorg INEIIIJII
  15. 15. ((( TELEMENTAI. HEALTH l N S I l I U T F teIeheaIth. org O 0 I . I’ II pl. Ii. ’ I S. 0 Data Hi IIII I x‘ llllfi FREE COPY: http: //www. nxtbook. com/ nxtbooks/ gen/ revolution_ bigdata/
  16. 16. VIRTUALLY B THE CLINIC Bnnging Interactive Technology to Behavioral Healthcare for Treatrn nt and Training News Avatars May Help Children With Social Anxiety Overcome Fears CHII l Virtual reality battles PTSD The Daily | Treating tear of flying with 3-D simulators University of Alabama adds VR Exposure to School of Social Work Bama Prof Amy Traylor isn't a new-comerto using VR in social work and zehavior: -il health She's been working with ‘I/ Bl colleagues like Patriclr. Bordnick. and former CEO Ken Graap for years So ‘VIBI is proud to confirm that we will be delivering a system to Alabama for use in the School ofsocial Worlt. Check out the details, here. VR~based Treatments get "Exposure" on Fox 5 virtually‘ Better welcomed Krista Littlefield_ from Atlanta's Fox 5 news. lastvveeklor a feature on 'v‘R based treatments Thanks Krista! Atlanta News, Weather, Traffic. and Sports| FO1«' 9 PRODUCTS COMPANY ADHD: Not just a school problem. Drfficulties with focus, overactivity: impulsive behaviors‘ and increased emotional reactivity‘ are common symptoms of tttention~ Deficit-‘Hyperactivty Disorder IRDHD). These and other AIDHD symptoms can wreak havoc in school However. school grades and behaviors are notthe only areas impacted. andthey are oflen not even the most negatively‘ effected Children with this disorder are also more likely‘ to sufier from speech
  17. 17. Reviews News Download CNETTV How To Deals f '* Log In | Join snmsuwfi The Next Big Thing For Business is Here 3 % I ‘V war: IZZNET News Crave i, r’W SAMSUNG Confirmeil: AGooOg| e Glass arrives The Next Big Thing in 2013, and under $1,500 §’[§ff"“eSS -Googles atigittented-realm‘ specs are ahead of schedtife Are you react); ‘ V I ‘Eat >1 ricm to get yourself fitteo for a set7 EricMacK- . i‘I IINII /43 Q‘) ; _3 f Follow 55"‘ fi I. » I 3:- W. » E; '— : ;: r-v1.ye. I ; r:, . i: '. Comments 98 H0tteStReIieI_. _IS ‘ iPhone 5: Finally, everything we hoped it would be -8 mII, ;.—Iisi99.99 ( gt _ 7 ‘, *»2-~k~k J Microsoft Surface Pro: Smart almostlaptop nearly nails it ‘IIii‘«i. -If: Kit $899.99 ‘k*)<>'~1 Ctiromebook Pixel: Brilliant touch Possibly the ‘must—have‘ gadget forthe 2013 holiday season (Click the image for a Google Glass slideshow. ) screen, hefty price (Credit Google) Regular people will be able to purchase Google Glass eyewear by the end of 2013 for less than r- " I HTC One wows with stunning $1.500, sources have confirmed to CNET , & USSISIII Pfemlum PMS Google originally targeted 201 -1 for a consumer release when it revealed Project Glass last year,
  18. 18. ((( TE‘Lé_'. Mfi”A’:1‘t‘WH telehealth. org! ‘ IR‘'<3 Persona| Robots Group mi! media lab l, .ii: i;; tic. " " t Home Welcome to the Personal Robots Group Bi 5'; ,i? X‘: i.F§. l‘. (=)I€l: fll’v1I| i'i. l§fI-1'1’ ‘v .3“"“"‘5’I>.
  19. 19. nsl M O The Wand 5 Most Advanced Humanoid Flobol AS(MO v NEWS EDUCATION V TRAVELS ASIMO TV v GALLERY DOWNLOADS ASIMO IS DESIGNED TO HELP PEOPLE i 0 it turn sound off 43)) EXPLOIE UVE SHOW 3 ‘ FEATURING » g. ; ‘ GALLERY 2 V" AS| MQ TV High Quality Photos ofASIl. lO DOWNLOADS Official ASIMO downloads for your Mac, PC or SEE ASIMC UVE 4, lNNOVATlONS 3 VIDFO HISTORY «) 5'T'a”°"°"e _ y _ TRAVELS got; yfs can sgedgsllclo See rgiw robots in b Cnetcl<yuut Honda 5 mogflitynh finegkiout ? )Vt: dED msturyhof yam of ASIMOS “Wm Amencan Tum captured In ms 8| 8 lSllEy ll EVE pmen now Cfill flflg W00 DGSGNIDOWEFE W 0!! ESTO 0 CSTSSEBFC nomdournal out the best in us in the future ASll. l0-derived technology D ""“"‘°" HONDA Facebook ! hnPawmu1DmarrI
  20. 20. Electronic Health Records
  21. 21. Best Practices in Counselor Preparation . _l, , F’ Ll i it. «ill i tell lE. «:; l «TM ’ I _ . r:; ' , _ l ,7 _ c) I L: I :3’ N ‘ Eietrliililwiifl «:2. iii “ * T l * ‘ xii 1 . l L 3 Rerflewi ll ii | y “g K 91 fir .1739. . » All‘ ‘V’ g ‘ / (v'‘. ' , fix l '- — .4 I - s —' -’ ‘i j-‘T’ "E; J _ ‘—— We-A W ~ _~- —_~ / . iv
  22. 22. ‘: lT. !'? :"!3‘j"! ”‘—! !r' fE—A~£—e"': } (‘-1 H/ Il’: ?=lli'I nil '1!’ . ‘ _. __. , ‘ . g , 3 Definitions ° Distance Counseling Telehealth vs. Technology? ° Behaviora| Te| ehea| th 6 Eheahh 3‘ ‘i , * Telehealth ‘A. y w b * Telemedicine C 6 Telemental Health ‘ l 2"’ I ° Telepsychology ~ On| ineTherapy » ~ mHea| th 0 Telecounseling
  23. 23. ((( TELEMENTMHEALITH i telehealmorg Telemedicine — 1950's Remote doctor examines a Patient in rural ER gets benefit patient’s inner car from a remote of 10031 C_are P1_uS rem°_te_ location consultation with specialists. 020:4 ‘reieuamzi Harm incline, Inc. ‘
  24. 24. <(( TELEMENTAL HEALTH INSTITUTE teIehealth. org Telehealth vs. Distance Counseling (working model not to scale) Telehealth Regional Hea| th Health Professions Information Education Sharing Behavioral Disciplines, including Distance Counseling, Training & Supervision Consumer Education (and Self- management) 1 Administration Evaluation Research Homeland Security | 02011 ‘llblllmal llalm IIISIIIE. Ill:
  25. 25. ; r‘ ray Q 3"‘: . ‘ e 9, A " 1 ‘ ‘ . . _ V _; I , , ' , .2 , g , k u . T. __)> z z I r <3‘ pr) # fi= .,.4.. ... ... ... .;_: _; .____ _ ; _ ‘ ~'‘_ -7‘
  26. 26. ((( TELEMENTAL HEALTH 1 teleheammorg l N S l l T U T F Benefits of Traditional Video-Based Te| ehea| th* - Hub—and—spoke model — Only work with previously identified clients/ patients who have had an in—person assessment — Detailed and documented referral requests — Detailed health record at fingertips of clinician — Client/ patient is at the ”originating site” — Clinician is at the ”distant” site — Community collaborator is available - Client/ patient is pre—trained by staff - Technology is stable — IT staff is available during entire time of connection to client/ patient 0201! Ttlellflnl Plallil Inslilz. mo‘.
  27. 27. ((( TELEMENTAIHEALITH telehealmorg INKTITIJI Benefits of Video-Based Distance Counseling ° Increased client satisfaction ° Decreased travel time ° Decreased travel, child & elder-care costs ° Increased access to underserved populations ° Improved accessibility to specialists ° Reduced emergency care costs ° Faster decision—making time ° Increased productivity / decreased lost wages ° Improved operational efficiency ° Efficacy is on par with in—person care for many groups Decreased hospital utilization Maheu, Pulier, Wilhelm, McMenamin & Brown-Connolly. (2004). The mental health professional and the ne 020M Telellamzl Haalm Inslme, Inc. ‘
  28. 28. TE EMENTAL HEALTH ((( L l teIeheaIth. org l N 5 I I I U T F Recent Supporting Research ° Godleski, Darkins & Peters reported in April of 2012 that hospital utilization in psychiatric populations at the Veterans Administration were decreased by an average of 25% since the use of telehealth. It is worthy of note, however, that: — This study focused on c/ inic—based, high—speed videoconferencing and did not include any home telehealth encounters. Mental health patients were referred for telecare by clinicians. Typically, telemental health services were provided remotely at community—based outpatient clinics by mental health providers of all disciplines located at larger parent VA hospital facilities. Equipment consisted of either room or personal desktopvideoconferencing units transmitting at 384 kbps or greater. Godleski, L. Darkins, A. & Peters, J. Outcomes of 98,609 U. S. Department of Veterans Affairs patients enrolled in telemental health services, 2006-2010. Psychiatric Servcies, 63(4). 383-385. 0201! Ttlellflnl Meallil Insllla. tar.
  29. 29. TELEMENTAL HEALTH ((( l teIeheaIth. org I N 5 I I T u T F Recent Supporting Research Backhaus and colleagues (May, 2012) reported in their abstract of a meta-analysis that: ° 821 potential articles were identified, and 65 were selected for inclusion. - The results indicate that VCP is feasible, has been used in a variety of therapeutic formats and with diverse populations, is generally associated with good user satisfaction, and is found to have similar clinical outcomes to traditional face-to-face psychotherapy. — Videoconferencing psychotherapy: A systematic review. Backhaus, Autumn; Agha, Zia; Maglione, Melissa L. ; Repp, Andrea; Ross, Bridgett; Zuest, Danielle; Rice—Thorp, Natalie M. ; Lohr, James; Thorp, Steven R. Psychological Services, Vol 9(2), May 2012, 111-131. doi: 10.1037[a0O27924 0201! Ttlelltmil Meillil Inslllz. Inc‘.
  30. 30. DPPRI. .1o 1 'D . -l. II I’) W1.-I-Ill (211! 3) R€. S‘E{l7‘£‘lJ Article SYNCHRONOUS TELEHEALTH TECI-INOLOGIES IN PSYCHOTHERAPY FOR DEPRESSION A META-ANALYSIS Vl'. u1)'L'e Osunlnch, Ph. D.. ‘ Karen M. O'Brien. Ph. D.. Alanhew Ahshkind, Ph. D., and Derek]. Smnlcmlzi, Ph. D.. M. l’. l I. nd: Mnry puiam ncflhingfiom depression lad immcdhn mm to rare. The In qfxyntbrnuour rrlcbmllb modalitia In drlivrr psyrbotbrrngy is one mturion to Ibir problem. 7711': nma-analysis cawmintd dtflhenres in l'7‘tfll- mau ¢fli(uy/ brpqyrbotberugy udminiurnd 1-in sjvnrlmonalu trldvulab 1: (Mn- parrd to no-ndanl nomzkbmltlv approaches. Method: We lorned (4 anidex lbat ma iiuiuion rn'rn1'4 vfibr use of l xyubronom rtleballb modality for treat- mau romp: -rrd ton sunda-rd nomdebmhb modality mmpnrimn gvwp. Results: Oman. 0 nuixtitolly rigvnflruu Lynaluric dlflhrncz lmmn modes ofddiv. -njy was not idemflicd (g - 0.14. SE = 0.05. 95% CI : [-0.01 0.10], P = .093. 3 = 49.74%). Smmfiarion mnlvodt Ind menrrgroxilm rm yard to tnalyu Mu (onnibufionx oftypr ofrnmpnium group. inrawmion Modality, llll tar- gdtd menu! bealtb omronu to moderation of eflen size (E9) exrimua and heterogeneity. Ivpe ofromparirou grvup firnm-fur vemu mn--4:-usual) bd lb: terangm hflumrc on obrnvd bclerogrntily and moderami lb: summary ES. 71»: only ddcmalrle hflrrrnre in qfiracy u-as rcmintd to medics lblt and Iar(—a1-usual at 15! nrmpariron grvup (g = 0.29. SE = 0.06. 97% CI = [0.I6. 0.4!]. P -: .001. F : £14"/ n). Conclusions: Ovrrlll. Irtflnmd no tridtaa In nrggext [bu lb! d¢lh'(-r)l afpsydvolbernwy via Jjmcbronoux ltltbtlllb modalities it kn efihrive zban mnuelzbultb menu in rnbringdepnxxion ly-mpmm. r. Drprn- rion and Am-iely 00.-l—IU. 2013. hour: -at 20H. TH: nvkk in 1.15. Glnvnrmau wovkondilmtbrpflkhmainin we Liil. Key words: depren-ion; Itkbnltb; tdemalul bnltb: ma: -oulysix INTRODUCTION epmnun n ufien referred to n, the “conlnlon cold" ofmcnml health; in | SI'ln‘leS[1l'(‘nJ. l|fIS L-smhlliht-d meal» menus. and n c(mJ_v when nnl In-nwd . -ccunling n. N-so-I c-nun Gov Yolohuunh -no Vodmclaqy. Joint-Bun Lnvivllncl-uni. Wnuhinuwn rne opmloma or nssamlxu cnnlnmad hevaln nu; ma pnvma vlswx cl ma ammrs and are no: to be aonanueu as alficlzll or navlacnng me views of she Depanrnem ol we Anny. me Delenae cenxsrs ol Excellence. or the Deparlmenl ol Delense ‘Conespomsence to Janyee E Osenbach. Pro. Nahonal Can» lac loo Teleneallr and recnnology. 9933 wen Hayes Sweet. Madigan Annex Jo<r1(—Base Lawla-MCCDKIG. WA 9843! E—mall yanyca a osannacn cno mall rvul Reserved by publlcauon 07 May 2013' Revised 09 July 20:3 Ac- caviar! 1: July eala DOI lo lCO2ada 22ls5 Publlshao online In wlley Online umary lmeyonlnellnmrymml rusuln from the Nmon-. Il onnmbnlny Sun A! _' Repli- *ncv rates for canon. lhk‘ 12-month and llfeume pr aepmann In yhn [nned Smn; -5 are respeLuvcl}'. ""l Moreover. 72.1-. ~.. of llfleuml: cm and Txml of I2-mnnzh Cases hm! cumnrhid l>s. l. lv Lllagnoscs,1 Vor| d~lde. depression h1~ been cncd at on leading name uldlsahlln ‘- and depression cons upw-. m.l~ nno hllllon dollan yearly in last nnrk Llmc . n Ll1I: Unm: cl slams nlnnc-.1‘ I-hrxunmely, vtlnnut types nr pnychurllcrnp) ham pruven um-mm III the Lrcamlent or depression s}1npmm. ‘I how ever. -.1 slgnlfilsmnt punlon nnhe pnpulclunn who stands In benefit lnnn psychother- up_‘vullnl. n or « I'| Ul1L‘L'css n. Only nlnnn 2 olpzluems wnh depression follow up on referrals for p , chuzhur. |p_V. In spite uflcommcnt nncllngs [hill p-Juems report a preference l'nr p<ychmhcr- am over mel. licauun. l"' *= l Praajml bnrrlen to care nr. [cranes ufrmwvns forvlhy follow up rams nm ll. » for y hi-. unc amcems as n has been esumtucd ma. . . ul ulunul: s | l1 Ll'| e Unllell Smxm haw: a ~hon: )gc oimcnul heflllh prrnrlllcn, ‘‘ and cllnlclans Lralncd no Pub| lIhod2013.ThiI Inldohllts. Govornnlontworlund Is mm public domain intha USA.
  31. 31. v-—. .., ,_ _. _.. ..—u TABLE 1. Publication descriptions . 'nnI_- l)unIIy-n u al. (SUI! ) Fnrll cl : I. (ILIJ7) lk-rkmnn uni (‘arlum (IIIIT) I. AV‘€II cl JI. (Elli? -) Lu-Ilu-I ¢u| .{1CllT) Lyncll cl al. (200-4) . lil| cl and ': l§MnlII (. ‘0(IZ) Mind". -ll u ml. (mlnl) . IuIII' cl al. (. ‘mu> . l«-In cl II. (2011) Napdlunncl II (24!! !) Nclum :1 II. (IINII) Sulull cl al. (ZIIH) Sna. -Iun cl : I.(. ‘l)l| ) Nut: BDI. Itch llqrcvniml | n-u| mr_’. (IlL'. Cir: -asvusual; (ZB'I'I’, cup1|nc~ I-‘IT. ‘ICC-l1>r: ll‘(; (GHQ. gs-nu-: I Iacallh qunuonnain; H-. I-I). Ilmnllun «Icprcsuun rum; walr; HRSI). llalmlum rump walc fur dqm. -ssmll; H$( ilicnl-In-Irul; I’(), lS. pmlilc of mum! amen ¢Iq: n:snun—duc<nun aIc. R(. 'I'. ruulmnimnl mnunllnl (rial; SCI’. xupputiw cumnclinlz vIII: IcI1u| III; TC lcluunlirrnm. T. |Il_ Itlclncnul lvnlllu; '(2. vulcutunlhunct. lnlcn-cnnnn llII| l.I'l| lI| T ln»wc<Isl_v Iusnmn uf SCT CAL‘ :4 uukly gulp neuuun nf(IB1'l' rn-' 8 weclly gmup ncnium uf K(l[| |l| _K ( LL' IllI| lIYI'tllD¢l| I (iB'I'l' I1! weakly scuulls uf €I| H§IR (2I| 'I'I‘ FIT‘ X semi-munlllly sevuuu nI‘(. ‘H'l'I' zul (LAP pharnunuln-rapy I: vocckly «canon: of pml-Inn «lung (l. U (IlI'I'T I I u': tk| _~st1sulI ul S( 71' (LU 21] wuinm nf (IHTT umr Iv‘: wcch FIT Th: -nuuu uf wcckly (lB'I'I' (LL' I K scvomm uf (I| 'I'l'I' uvcr IN wccls FIT: It vrc<Uy snmnm uf ('. B'I'I' (Ll' X W rvkly scsxium uf ( Ifl'I'I‘ I'"I‘I" II wc<‘LIy scssunu of (Zl1‘l'I' CAL" )1 vi ccldy l¢1lIlInI ui (IEUT FIT Ps_-Ilnlug Ira‘ {nun licncrnl I! I¢1IllIIN: IIII| Pmuramu Inc an-n lhamlcr (Emu-al lucnul Ionhln tlhsaslvc-uxlvlpulsuw ahunln l)qn-«nu Hql can II I): ]l&sNII Bnlnun ncn-ma l)qIr: -mm I); -]I'e'mul (kucral rncnul Inullll I); -yrnsuul lkyrcmun Pmmauumuc slum lhon| n Published In DEPRESSION AND ANXIETY 0021-10 (2013) I)¢| msniun nulmlnc musurc l). 'S-I I Bl)! EDI I! l)l I IS( II. III)! I IRSI) RD! I’( ). IS | IrI-I) (II ll. ) dzprcmnn (IHI I ISCI. IIDI Suupk ()uqnanum {rum in ayunal mlums rrlulnlllauc-n u-mcr (inulm I-ucrnu lII'-pcmurc Imliricllul» 1 )uquncnrs {mm : ps_vlIoI<1y chm: Uuqunum In-In I myrlmhlgy CIIIIIC ()urpmull Iium IIIlIIII_‘| II'1CII(‘t clmlc Onguing lullgllmliml slmI_'uI' uIIuuI (lumnulvily qnqlc Uuqmmlu vn‘lIl . ‘lulup| : Sdcnnla ()uquncnn fmm pnlnay rnv: (Irma Fnio. -nu awmlng lung tranqnl-n (ilnlllln-n. Ago I‘ In I4 ()urp. Im-um Iium ll pnmory are cllnlc (‘A-mh: rcun-am r wiur: rclchcallh l. IItrl]i)‘; (LDI. dIll«In-n'adqm: sumn ilwcnlnry. I)l. 'S-2 L dcprnmnn, anncty. nldslrcssx t; . lluphm ’1u| m-nu dun-klsl; I’ 2013 Meta—Ana| ysis Comparing in—person and Synchronous Telehealth Modalities for Depression SYNCHRONOUS TELEHEALTH TECHNOLOGIES IN PSYCHOTHERAPY FOR DEPRESSION: A META—ANALYS| S Janyce E. Osenbach, Ph. D., * Karen M. O'Brien, Ph. D., Matthew Mishkind, Ph. D., and Derek J. Smolenski, Ph. D., M. P.H. Q ’l"’9"'7""O
  32. 32. lELEMENlAl. HELlH ((( I 5 V I _ ‘_ ' teIeheaIth. org The is Video Teleconferencing (VTC) Effective? - Yes — Medicare & Medicaid required to pay ° Outcomes are relatively comparable, especially for follow—up care (intakes are still a matter of state law) ° Literature for specialty groups is sparser, but positive (pediatrics) — Also effective for supervision — Can improve some ways service is rendered — See www. te| ehea| th. ORG/ bibliography - BUT, traditional VTC isn't the same as Skype
  33. 33. ( ‘: '5_E. f"l3‘l""L" f'"’. f‘.5.°"': " <-ll= ‘lnzmla. .--. -l'. _-' . . _. _. , ‘ . I . . Distance Counseling & Other Services
  34. 34. 2011 ‘ ' TFlF‘. ‘lIl‘ITl1IHEr'lTH (( M , _ ‘_ telehealtnorg Online Norm vs. Traditional Behavioral Telehealth (or Telemental Health) Traditional Online Therapy Mostly Email & Chat Anonymity Accept self-referral online Disclaim Responsibility w/ Website Disclaimers No Clear Channels for Mandated Reporting No Patient Records Traditional Behavioral Telehealth Video Verify clients/ patients Rely on referrals from clinical offices Use informed consent processes/ documentation Engage in mandated reporting Document as required by law
  35. 35. ((( "l": "l. ":'T“: ’jEf‘: ” ltelenealmorg Online Norm vs. Traditional Behavioral Telehealth (or Telemental Health) Traditional Online Therapy Traditional Telemental Health - No Contact with Other - Obtain signed releases and Treatlng Cllnlclans Collaborate - No Authentication of . . . Consumer / Professional ° Venfy 'dent'fy of both_ Consumer and Professional - No Emergency Backup Procedures - Establish emergency backup - Misunderstanding of plan and personnel prior to Clinical Processes (suicide) delivering Care - Scant Research for Unsupervised Settings
  36. 36. ( <-ll= iil’: z=Ili‘i. -;-‘ii; TMHI Clinical Competence Client Selection ~ Most of the studies mentioned above include the assistance of a local collaborator ll Treatment to the home has , , 4. V‘) not yet identified full range of *1 ‘ risk a Understand differences when / delivering care to clients in ‘ . l, , ‘ different settings (hospitalvs. ._ : _. car, park, bed etc. ) ~ Establish procedures to minimize attendance & compliance issues
  37. 37. ( <-ll= iil’: z=Ili‘i. -;-‘ii; TMHI Clinical Competence Client Selection * Study the evidence base (research) ° People with almost all diagnostic symptoms have ‘ 4, r— been documented as “x. ’ ' - ' successfully treated with y traditional telehealth / ' * Clients experiencing severe ll, , , anxiety, flagrantly psychotic _-_. ... , symptoms or suicide/ homicide intent may not be optimal choices while symptom patterns are exacerbated
  38. 38. K <-il= iii’: z=Ili‘m-‘: '«_~' Service to the ’’Home’’ " Scientific evidence base for contact to the home is p r much thinner, less ' reliable than traditional ; telehealth - . / F Risk management is a "‘ '- serious concern ‘ p A F Likelihood of ‘ r , , 3 : .?]‘i. ‘ » lurkers, intruders or ~ .4‘ interruptions is increased “’- ” , " , ‘, .c*.1~: Develop signs, code i: V words or phrases to i » %_. .-, /-u~ir-“i i signal something is amiss
  39. 39. Best Practices in Counselor Preparation 2.Lega| HIPAA & HITECH Licensing Informed Consent Mandated Reporting 02014 Tuleuemzl nulm Institute, Inc,
  40. 40. I All Existing Legal I & Ethical 5 Rules I App| v , M“ +— — """i—'*i_“f_ ; _*-. . %* _. ;"L""' — . §=__. __. a7 ’ 7 -G: '7 7 V »' ‘mm “*~ : ::. ‘#‘>~v. .$_a; > gl ill 5 I 02014 meuemai mam innmn; .’. .;-LI
  41. 41. OCPM: Online Clinical Practice Management Telemental Health: HIPAA, HITECH & Your State Law
  42. 42. :~ Three HIPAA Rules: - Transmission ° Privacy ° Security
  43. 43. TELEMENTAI. HEALTH ((( teIeheaIth. org l N S Y I T U T F HIPAA Privacy Rule ° Data are "individually identifiable” if they include any of the 18 types of identifiers, listed below, for an individual or for the individual’s employer or family member, or if the provider or researcher is aware that the information could be used, either alone or in combination with other information, to identify an individual:
  44. 44. ((( TELEMENTAI. HEALTH l telehealflmorg HIPAA Privacy Rule (cont. ) 2. Address (all geographic subdivisions smaller than state, including street address, city, county, zip code) 3. All elements (except years) of dates related to an individual (including birth date, admission date, discharge date, date of death and exact age if over 89) 4 Telephone numbers 5. Fax number 6. Email address 7 Social Security number 8 Medical record number 9 Health plan beneficiary number 10. Account number 11. Certificate/ license number 12. Any vehicle or other device serial number 13. Device identifiers or serial numbers 14. Web URL 15. Internet Protocol (IP) address numbers 16. Finger or voice prints 17. Photographic images 18. Any other characteristic that could uniquely identify the individual 0201! Ttlellulil Heillil irlslllz. Inc‘.
  45. 45. <'-ll: li1’: z=lli‘m-1i_o’ HIPAA Risk Analysis * Process of risk analysis Documentation of risk analysis (K. — Know your ' vulnerabilities 1_ — Realize you may not be _ able to find all problems — Identify 10 biggest things I (.1 that are risks "1 — Document that you are 5 diligently working to fix those things
  46. 46. ( <-—II: ‘IaIzzi1aa. --. -I'«_r HIPAA Risk Analysis I: Define & constrain your systems, including people involved — Computer, tablets, mobile device, networks you use to I. connect — Coffee shop office, home, car §_ — Computerized files — firewalls? g Passwords? .‘ z; '_ ‘ _ — Mobile phone — address book with names of clients? Passwords _ I ' “T — Text messages on phones ( shared with other people I — Laptop used by children — iPad used with spouse
  47. 47. <-—II: ‘r. I:mIa‘. .--. -‘Ia_. * Managing Risk ~ If you don't need 5 pieces of equipment, use fewer for your practice ' Rule our working on coffee shop network or hotels I: Stop looking at very easy ways to use new technology - they interject new risks ° Only use vendors who give Business Associate Agreements — Mention in informed consent that you are sharing protected health information with vendors — Get paid version of Gmail so they give you a business associate’s agreement
  48. 48. «( TELEMENTAL HEALTH J telehealth-org INSTITUTE Conduct Risk Assessment & Planning Update Policies and Procedures Deve| op& Implement Incident . . F3 ‘ . ; Response Plan Foster Culture of Compliance with ReviewVendor List & Update Business Associate Agreements 02014 Tueuemal mam Inside. mo;
  49. 49. «am-. uIIa~. .--. -I'. ,.— HIPAA Conduit Exception e If service operates as a conduit, then they are not a Business Associate 1 (-5 — Internet Service Provider ~ (ISP) ’ ° Usually involves encryption - Only you have encryption keys (ask ”Who has the encryption key? ”) - Facetime has the encryption key, so you need a BAA to use Facetime
  50. 50. <-—ll: i”oI’: M(i‘o. --. -‘ii; HIPAA Documentation ’ ' iI’31=! 'Ja‘. -JI! e.= I_#? i:e, -,= . ((6 ° Risk Analysis ° Business Associates Agreement 0 Informed Consent
  51. 51. ((( TELEMENTAL HEALTH l telehealthfirg HIPAA Documentation ° Risk Analysis — Define scope - Define your systems — tablet, Gmail, look for vulnerabilities in equipment, threats can be accidentally disclosing power outages that can happen — Rate risk as low, medium or high - Example Risk: High risk is that laptop doesn't have security, your practice is to leave your laptop in your car when running errands - Solution: Put encryption and firewall on your laptop — Document Risk - Examine how all systems are working together - Make you more efficient ° Save money — Should be re—upped every year ° Validate what's been done, review any new risks (clients, technologies) ° Calendar issues you will address throughout year, document progress 0201! Ttlellulzl Health Irlsllla. Inc.
  52. 52. Skype? 1’ l. R , . . . WM 4, lllml . . )u, 1} xx ,3 . , emu meuemai mam lnsmmz. um;
  53. 53. III HIPAA requires an ”audit trai Skype doesn’t provide audit trails — and isn't obligated to M; T e ‘ l. /‘ ‘‘ it .3’. ~ ‘ * _, . ‘ t / _ '. “= - "9 ‘F’ #9 V l ” / . a‘ : l v F
  54. 54. ((( TELEMENTAI. HEALTH 1 teleheaiflmorg lNSlllUTF Skype and Health Privacy - AES 265-bit encryption - Free ° Access to patient’s environment BUT ° Skype makes no claim that its services can be used in a H| PAA—comp| iant fashion ° Skype does not offer a BA Agreement - Cannot verify transmission security ° No audit trails ° No breach notifications ° No offer of technical support - Frequently dropped calls — Emergencies? 0201! Ttlelltmil Health lnslllz. Inc‘.
  55. 55. <‘-ll= 'l”ui’: z=lli‘or. -'i'(_o’ Skype’s Most Recent Hacking — November 2012 ~". n.: :Ii‘r: i-oiiizu: i ii) By Leonas Sendrauskas on November 14. 2012. [UPDATE:14I11I2012@15:28GMT] Early this moming we were notified of user concerns surrounding the security of the password reset feature on our website. This issue affected some users where multiple Skype accounts were registered to the same email address. We suspended the password reset feature temporarily this morning as a precaution and have made updates to the password reset process today so that it is now working properly. We are reaching out to a small number of users who may have been impacted to assist as necessary. Skype is committed to providing a safe and secure communications experience to our users and we apologize for the inconvenience. V es»: t: '»: :l. “E5-lC'. lCIl“IS
  56. 56. Is Skype Reliable? Skype tiles & C pixelates, the audio F gets tinny, echoes develop, and often calls drop entirely. Sometimes consumers can see A you and hear S t- you, without your 8W8 reness.
  57. 57. ((( TELEMENTAL HEALTH 1 teleheaiflmorg Skype’s Privacy Policy ° Skype may gather and use info about us or our clients — Identification data (e. g. name, username, address, telephone number, mobile number, email address) — Electronic identification data (e. g. IP addresses, cookies) — List of your contacts and related data — Content of instant messaging communications, VMs, video messages ° Skype uses its own cookies for a variety of purposes, including to — Provide internal and customer analytics and gain statistics and metrics about our websites ° Skype’s analytics, ad—serving and affiliate partners may also set and access cookies on your computer ° Skype will take appropriate organizational and technical measures to protect the personal data and traffic data provided to it or collected by it with due observance of the applicable obligations and exceptions under the relevant legislation 0201! Ttiellflnl Meallii lnsllla. mi‘.
  58. 58. <-—ii: in: mia‘. .--. -‘: a_. * Dr. Trow of Oklahoma: Unprofessional Conduct * Dishonorable conduct likely to deceive or harm public 9 Prescribing without g r . ’ C V — Proper doctor-patient ‘ / .7 relationship; .. ’ % Overprescribing controlled substances — No documentation of medical need * Inadequate records 6 Using Skype, a non—HlPAA compliant viode service
  59. 59. lllll: Psych iatric Tlmes Page s; i: onnection, either by mobile at U. S. Psychiatric ""f’ Mental Health (songress “"' 3.“-“' T’ DD can make it all feel ovenmhelming. Telepsychiatry: The Perils of Using Skype First released in 2003, Skype offers free. worldwide video access to any patient with an Internet » ns of communication clearly suitable for clinical services—especia| ly‘ in mental health pi’ rgl" an im: ~. ;r~ Saér, .u—. icm= :.m JV'1li’iDll: E‘. ‘El'V evice or desktop computer What it does not offer. however. is a The ility and Accountability Act Ordinarily. neitherfederal nor state law is designedto regulate specific proprietary entities such as Skype and its competitors Video-chat platforms were developed for marketing to the general consumer, and not for health care The Health Insurance Portability and Accountability Act (HIPAA) holds professionals responsible for conducting their own internal risk assessments regarding their chosen technologies. Before using any equipment. the professional should require documentation that explicitly promises ‘HIPAA compliance‘ or ‘HF-‘AA compatibility" One couldtake fi. irther comfort in a designation of Federal Information Processing Standard iFlPS) certification. a standard that may meet and exceed HPAA standards? ‘ HIPAA requires the use of equiprrientthat allows for audit trails According to the American Health Information Management Association. audit trails allow breaches to be traced. ‘ Like other proprietary‘ platforms. Skype makes it impossible to conduct approved security audits via audit trails Skype itself is not WARNING: SUICIDAL THOUGHTS AND BEHAVIORS Antidepressants increased the risk of suicidal thoughts and behavior in children. adolescents. and young adults in short-term studies. These studies did not show an can make it all feel :1 I '2: - Pius. scroll dawn for Imporllnt snmy inromuiion Ind inaimion Int E1 Inlomuthn Presnrilzln hfntlnatinn WARNING: SUlClDAL THOUGHTS AND BEHAVIORS Antidepressants increased the risk of suicidal thoughts and behavior in children. adolescents, and young :4 ults in short-term studies. These studies did not show an SEARCHMEDICA RX Browse drugs byname: Search for drugs: Ll
  60. 60. <‘-ll= lii’: t=lli‘ii-'. -'i'(_o' OCPM Step 3 Legal Issues: Which Technologies to Use? we-uni; -., 4' No Guesswork Needed HIPAA Compliant Handoff S ' any Device eaS: ?:: $£‘: :vccrt . Sweeping. etworlx
  61. 61. TEl. E‘lENTAlHEAl. TH ~ ' Y teleheaIth. org ((. < lh'« T, llr' Internet-based, VTC Companies Claiming HIPAA Comp| iance* - Access Psychiatry _ IVE (Cloud) ' Adobe Connect - Lifesize (Logitech) - MDLive - MyTherapyNet - Behavior Imaging Solutions - CopeToday - Consult a Doctor _ Revation - Counso| .com - EasyShare VC ' eCounse| ing - E Mental Health Center - Forefront Teleca re - Secure Telehealth - SecureVideo. com (FREE) - Shepell fgi - Smart House Calls - Soltrite ' GEMS - Via3 ' G°T°Meeting - VisHea| th (Visual Telehealth) ' lC°”°h - Vsee (FREE) ' Interactive Care - Virtua| TherapyConnect - iTel - WeCounse| * TMH Institute has partnered with some of these companies and will receive a referral fee if you mention TMHI. You may also get an added discount. I | ozuu ‘reieuemzi HEIIM lnsmine. inc.
  62. 62. ( ii ' <4t= inzmta‘. .--. -‘i'«_-' :1 ru; What makes you a ”covered entity”? Engaging in “electronic G Filing electronic covered transactions” insurance claims Isa erson business ora enc a covered health care rovider? Does the person, business. or agency fumish. bill or receive payment for, health care in the normal course of business (1)? STOP! The person, business, or agency is NOT a covered health care provider STOP! The person. business, or agency is a covered health care provider Does the person. business or agency transmit (sencl) any covered transactions electronically? (2)
  63. 63. HIPAA Policies ° Use HIPAA compliant technologies and develop written processes — Document policies ° Security & privacy policies — Repairs — Stafftraining — Breach notification, etc.
  64. 64. TE EMENTAL HEALTH ((( L l teIeheaIth. org N S l l I U T F l HIPAA ’’Final Rule” January 17, 2013 ° Business associates of covered entities are directly liable for compliance with HIPAA Privacy and Security Rules’ requirements. Includes contractors, subcontractors and business service companies working for health care providers, (e. g., companies providing electronic health records software, teleconferencing, data back—up and storage, billing, transcription and other IT services). ° Raises the maximum penalty for data breaches from a previous cap of $250,000 to a maximum penalty is $1.5 million per violation.
  65. 65. <4I= I/.1’-. mIa~. .--. -r. ,— Q HIPAA ’’Final Rule” Infrastructure, documentation, and procedures for information privacy and security, and data encryption and disposal will have to be evaluated and brought into compliance. Companies need to provide formal security training to all employees, designate a security official and implement appropriate business associate contracts with their own subcontractors.
  66. 66. TELEMENTAL HEALTH ((( l teIehea| th. org I N 5 I I T u I F HIPAA ’’Final Rule” ° When HIPAA was first passed in 1996, most health care practitioners, hospitals and insurance companies scurried to bring themselves into compliance with the new standards. In the face of these final rules, business associates will have to engage in the same process. - HHS is stepping up enforcement efforts. ° See Federal Register available online at http: //federaIregister. gov/ a/2013-01073, and on FDsys. gov 0201! Ttlellulil Heillil lrlslllz. Inc‘.
  67. 67. HIPAA, Business Associates & HITECH ' All Business Associates in health care must sign an agreement stating their adherence to HIPAA I, ’ I .1. standards ' Transactions ' Security - Privacy ' True for any service you hire ' It is now enforced by the HITECH ACT
  68. 68. What about email? I l l I In .1 emu meuemai mam insmme. um;
  69. 69. TELEMENTM HEALTH ((( l teIehealth. org I N S I I I U T F Email
  70. 70. ((( TEl. E‘~lENTAlHE»'«lTH I lF"~ll, llr teIehea| th. org Email - A 2009 study by the American Psychological Association showed that 9.8% of psychologists polled reported using email for clinical purposes with clients (Jacobsen & Kohout). * ° Is such use appropriate without training? * Jacobsen, T. & Kohout, J. (2010). 2008 APA Survey of Psychology Health Service Providers: Telepsychology, Medication and Collaboration. APA Center for Workforce Studies. 02014 Teleuemzl Health Institute, Inc,
  71. 71. TELEHENTAI HEALTH I K h'_‘ V } J H ‘ teIeheaIth. org Email ° HIPPA Omnibus Act allows us to have email contact without meeting usual HIPAA standards when risks are fully disclosed in ° Be aware of inherent problems with soliciting email contact from websites and directories.
  72. 72. l: li"‘. !': !.f"!3‘j"! ”‘—! !r' fE—; ‘~£—e"': i (‘-l l= l/Il’: ?=lli'I rfll '0' . . _. __. , . . y . . The HIPAA Compliant Email Companies III 4securemai| ~ ~ I-lea| thB| ' I-lushmail -- offers y free accounts «I Luxsci T / : . I’ Sendlnc -- offers free l--I / e/ -——' I 91- K 1 . _ _ . _ accounts
  73. 73. l: li"‘. !': !.f"!3‘j"! ”‘—! !r' fE—A~£—e"': i (‘-l l= l/Il’: ?=lli'I rd‘) '1!’ . . _. __. , , . y , . Privacy, Confidentiality, Diversity ~ Privacy & Confidentiality g ; U — Understand your e :3 ‘ ‘“~ technology F 1 «V i = ‘,_ (email, texting, video) _ V- 7' and its clinical r, ,., :,<. ;:; .<j/ - - . ‘, repercussions related to l MP-I I privacy and technology T” ‘ / 0 Diversity — Mu| ti—cu| tura| , multi- lingual, religious, LGBT, a nd other issues
  74. 74. Interjurisdictional Licensure Issues
  75. 75. Practicing Over State Lines
  76. 76. ABOUT THE INFORMATION IN THIS REPORT The information in this report was compiled through a survey of state counselor licensure boards conducted in fall of 2009. StaIe~by-state analysis of laws and administrative mles was also conducted to add to the survey data, especially for the two jurisdictions—Georgia and Puerto Rico—that did not submit information in response to our request. Every effort has been made to ensure the accuracy of the information presented here, but. due to the complexity of laws and regulations, and the frequency with which state regulations can and do change. we cannot guarantee that this report is completely without enor. Readers are encouraged to bring any errors, omissions. or changes to our attention. For any questions or corrections regarding this chart. please contact: American Counseling Association Ethics and Professional Standards 5999 Stevenson Avenue Alexandria. VA 22304 Web site: www. counseling. ogg U. S. toll-free: 800/347—6647. x314 / DC area: 703/823-9800, x314 Fax: 703/823-3760 E-mail: | mm For additional infomtation. or clarification or interpretation of any of the laws and regulations summarized in this report, please contact the appropriate state licensing board. Written and edited by Christie Lum, ACA Office of Public Policy & Legislation. Howard B. Smith. Ed. D. NCC. CCMHC. LPC (License #1920 Louisiana) reviewed and revised Appendix D: Accreditation. Certification and Licensure Defined and Confidentiality/ Privileged Communication. Copyright©20l0 by the American Counseling Association. American Counseling Association 5999 Stevenson Avenue Alexandria, VA 22304 (800) 347-6647 mm
  77. 77. Licensure Rtquiremenn for Professional C aunselors — 2010 Credential Tit| e(s) Educational Experiential Exam Requirements Requirements Required ALABAMA Licensed Professional Masters degree or higher in 3,000 hours of supervised NCE Counselor (LPC) counseling from a CACREP or experience in professional AL Board of Examiners in A person licensed to render CORE accredited program. or counseling with board Counseling professional counseling the content equivalent. with a approved supervision. 950 22nd Street North, services in private practice for minimum of 48 graduate Suite 765 a fee. semester hours (or 72 An applicant may subtract Birmingham_ AL 35203 graduate quarter hours) from a 1,000 hours of the required 300/822-3307 Associate Licensed regionally accredited academic professional experience for 205/453.3716 Counselor (ALC) institution. every 15 graduate semester 205/458.8713 (fax) A person licensed to render hours (or 22.5 quarter hours) www. abec. aIabama. gov professional counseling obtained beyond the masters services in private practice for degree from a regionally Application packet (if mailed): a fee while under board accredited academic $25 approved supervision. institution, provided that the coursework is clearly related to Application fee; $200 the field of professional counseling. This formula may LPC License fee: $300 be used for up to 2,000 hours. ALC License fee: $150 l3
  78. 78. ( <-it= ‘mzzIli‘. .--. -‘: a_r | nter—ju risdictional P ra ctice Licensing Boards that may assertjurisdiction: * The one in the professiona| ’s state(s) of Iicensure G The one in the client/ client's state of location at time of call ~ Both Safest Practice: G Provide services only where licensed e Require client to attest to his or her location on every call
  79. 79. <-—ll: 'l”ir’: Mli‘o. --. -‘rig "L£u‘mJ#wi | nter—jurisdictiona| Practice (cont. ) Special telehealth and in many cases, ”te| emedicine” laws have led the way ' Prescription—writing initiatives led to development of laws in the 90's _ ' Reimbursement practices for 2?, g, Medicare 7 Medicaid _‘. ‘,"',1i*1,, '=". . ° 32 states now mandate in-person 5), -;l ; Jr" assessment prior to distance contact ' Special informed consent laws also -, - fl. "K". ~'l. v- . rapidly evolving £’.4:*; ‘.= f'' ' . ° Regulatory Case l "' ' Oklahoma case of Dr. Trow ‘ - No in—person assessment - Noinformed consent ° No H| PAA—comp| iant technology (he used Skvnel
  80. 80. Licensure Portability Legislation
  81. 81. X t t V K . In —~4— l -“ . .‘ ‘A -‘ SEARCH FOR BILLS E—mal| lfllke Newsletter SIgn. Up Reouesra Flag ~-J U SJIONGRESSMAN MIKE THOMR 0 “REPRESENTING CAl, :FORNlA‘S FlFTH DISTRICT , =' ‘:3 ’= ’ ‘, ,,, %“ E ; ._. _.. ... . . _.I. § PRESS RELEASES REP. MIKE THOMPSON mmoouces BILL IMPROVING ACCESS TO MENTAL HEALTH CARE n D 6 >3 Washington, DC, Dec 6| 1 comments U 8 Rep MIKE Thompson IjCI‘-:5: Introduced olpartlsan legislation expanding access to mental health care for Medicare reclplents H R 3662. the Mental Health Access Improvement I‘-ct. will add thousands of highly qualified licensed mental health counselors and marriage and family therapists llvll'_TS, ' to the networl: ol providers eligiole to serve Medicare beneficiaries. “Access to quality mental health care shouldn't be dependent on how old you are. where you live or how much money you make, " said Thompson “This legislation will allow thousands of mental health care professionals to provide quality, affordable care to people on Medicare, and it will save money. Right now, there are more than 600 licensed l. 'lFTs in my congressional district and more than 31,000 licensed l. 'lFTs in California that can provide quality mental health services. Our goal should be to expand access to these professionals and the comprehensive and quality care they provide. not limit it. " Medicare currently recognizes psychiatrists, psychologists, cllnlcal social workers and psychiatric nurses to provide covered mental health services However. mental health counselors and l. lFTs. who have equivalent education and training to clinical social workers and provide roughly 40 percent of mental health services. are not ellglcle to De reimbursed by Lledicare. HR 3662 would for this dISCi9p8llCy pv making mental health counselors and l. lFTs ellglple to serve lvledlcare oeneficlarles adding more than 165.000 licensed practitioners to the lvledlcare program that are not pan ofthe normal aging process such as depression, anxiety. mood disorders and suicide lvlany of these mental Illnesses can De diagnosed and properly treated Ifthe appropriate care is available. sought and accessed However, If left untreated, It can lead to higher medical costs and negative health effects Currently. Medicare beneficiaries who were seeking mental health services from mental health counselors or l. ‘ll'_TS prlorto their eligibility for Medicare, oflen stop receiving treatment because their existing provider IS not under Medicare Thompson‘s legislation will ensure lhatsenlors have comprehensive access to qualified mental health providers by Increasing the pool of mental health professionals that are eligible to serve lvledlcare beneficiaries l . , -C
  82. 82. SEARCH FOR BILLS E—mail Mike Newsletter Sign»Up Request a Flag Visiting Washington. DC. Help with a Federal Agency Today in Congress t(Iii‘li‘| ,=tt2i' E-NEWSLETTER SIGN-UP W". Medicare currently recognizes psychiatrists. psychologists, clinical social workers and psychiatric nurses to provide covered mental health services. However, mental health counselors and l~ilFTs, who have equivalenteducation and reimbursed by Medicare. HR. 3662 would fixthis discrepancy by making mental health counselors and Ml-‘Ts eligible to serve Medicare beneficiaries, adding more than 155.000 licensed practitioners to the Medicare program. Studies have shown that seniors in the Medicare program are often atthe highest riskfor mental health problems that are notpart ofthe normal aging process such as depression, anxiety, mood disorders and suicide. Many of these mental illnesses can be diagnosed and properlytreated ifthe appropriate care is available, sought and Currently, Medicare beneficiaries who were seeking mental health services from mental health counselors or MFTs priortotheireligibilityforMedicare, often stop receiving treatment because their existing provider is not under lvledicare. Thompson's legislation will ensure thatseniors have comprehensive access to qualified mental health providers by increasingthe pool of mental health professionals thatare eligibleto serve Medicare beneficiaries. ‘The National Board forcertified Counselors (NEICC) applauds Representative Thompson forhis commitmentto ensuring a robust mental health workforce for older Americans. ‘ said Thomas W. Clawson, President and CEO of the National Board for Certified Counselors. ‘Medicare provides health care to over 49 million people and research ' ' -s thatfe‘ -erthan 40% ofolderadults with mental or substance use disorders obtaintreatment. The Seniors lilentai l . , ess Improvement Act will increase access to needed care by expanding the pool ofqualified mental health profs‘ . ». Adding mental health counselors and marriage andfamilytherapists as eligible providers will make 200.000 licensed professionals immediately available to the Medicare population. This addition will expand . cess and reduce costs by providing care in the community and avoiding expensive inpatientservices. NBCC commens epresen a ive ompson or a ing a eaers ip to e in is impo an egis a ion ’li-lembers ofthe California Association of Marriage and Family Therapists enthusiastically applaud and support Congressman Mike Thompson's bill to provide greater mental health services to our elderly population. ‘ said Guillermo Alvarel, Chairman of the Califomia Association of Marriage and Family Therapists. ‘By allowing Licensed Marriage and FamilyTherapists to become Medicare providers. many Californians will benefitfromtheir expertise in treating a variety of mental health issues. " H. R. 3662 is co-authored by Republican Congressman Chris Gibson (NY-19). The bill has been referred to the House Committees on Energy and Commerce and Ways and Means, of which Thompson is a senior member. Congressman Mike Thompson is proud to represent Calrl'ornia's 5th Congressional District. which includes all orpait of Contra Costa Lake Napa. Sotano and Sonoma Counties He is a senior member of the House Ways and Means Committee and the House Permanent Select Committee on intelligence Rep Thompson is also a member of the fiscally conservative Blue Dog Coalition and chairs the bipartisan bicameral Congressional lltine Caucus ###
  83. 83. page . L. .. -- L , _,: . l Other Legal & Ethical Issues for Distance l Counseling l . :jj‘. jj. .:_; sr —-—-9-. —~ ‘k. ... ~——-w-sr$7_- l V, , . ~. "". i
  84. 84. TFLFMENTAI HEHTH ‘ ((( K N 9. Y } J ‘ teleheaIth. org Duty to Report / Duty to Warn (v) Failing to comply with the child abuse reporting requirements of Section 11166 of the Penal Code. (w) Failing to comply with the elder and adult dependent abuse reporting requirements of Section 15630 of the Welfare and Institutions Code. CA Business and Professions Code Sections 4989.54 (cont. )
  85. 85. Best Practices in Counselor Preparation 3. Ethical Issues ° Standards&Guide| ines ° Competencies ° Cultural/ Linguistic Competence ° Referrals Supervision 02014 Telemental rtultii Institute, Inc,
  86. 86. Best Practices in Counselor Preparation What's the difference between Standards vs. Guidelines?
  87. 87. TFlF’v1fNT/ Kl HE>'llH (G H , _ _ teIeheaIth. org ACA Code of Ethics (2005) ° A.12.c. Inappropriate Services — When techno| ogy—assisted distance counseling services are deemed inappropriate by the counselor or client, counselors consider delivering services face to face. — How do you decide what's appropriate? l l l l A ‘ Copyright 2012 Te| eMenta| Health Institute, Inc. All rights reserved.
  88. 88. ((( T‘K": "‘_": ‘T“: ‘ : “f“f“ telehealth. org ‘n“r: t;', or, //vivAvivAvivi. :Inx; Intcielniistterniacjl. crig; /cjtcxcmficitaihliiliir . -rcliilivczg/ '.-tlii= .|inic: I=. iive: I»'. 'plC= .IC‘. 'iICZ§H;4|. IIdl§IhII§l~¥4?Cl? —‘VflCIl§lCH5I: l~'i; lCl4i‘lIlhII; r nr; Iniit= .IL-i‘nxa= .IIilmxelrvnczaie. .p1ili’2‘: iF-vrrzlinusrii P i not: GUIDELINES Foe VI E0—BASED ONLINE MENTAL H LTIll SERVICES Ma y0B l l l 2 l IIIIIIIIIIIII IIIII II I I II I I I IIIIIII IIIIIIIII II II I I II II I I }IIeIiIiIIIIiIIII III I I IIIIIIIIIIIIII "“'I”iI‘I'I‘I‘ I I II I _. I.. .a—- l o “A A 1 Amarknn Telemedicine Auodntlon
  89. 89. y. .4 IN) o--—-o—-o—-o—-o-o—-o—-o—-o—- cXI3h&NfJP‘$©xJoLh&N GUIDELINES FOR THE PRACTICE OF TELEPSYCHOLOGY Introduction These guidelines are designed to address the developing area of psychological service provision commonly known as telepsychology. Telepsychology is defined for the purpose of these guidelines, as the provision of psychological services using telecommunication technologies as expotmded in the “Definition of Telepsychology. ” 'lhe expanding role of technology in the provision of psychological services and the continuous development of new technologies that may be useful in the practice of psychology present unique considerations and challenges to practice. With the advancement of technology and the increased number of psychologists using technology in their practices. these guidelines have been prepared to educate and guide them These guidelines are informed by relevant American Psychological Association (APA) standards and guidelines. including the following: Ethical Principles ofPs_1-rhologisrs and Code of Conduct (‘APA Ethics Code”) (APA. 20023, 2010), and the Record Keeping Guidelines (APA 2007). In addition the assumptions and principles that guide the APA’s “Guidelines on Multicultural Training. Research, Practice. and Organizational Change for Psychologists" (APA.
  90. 90. Best Practices in Counselor Preparation Cultural/ Linguistic Competence
  91. 91. Multicultural Issues & Diversity "~JI 4 3‘! if , -,1! "‘-~r, if L. ’ "‘fM"; I . . -‘ 9‘ ~r - , - . ’,z ‘ . __-9"‘ 1- _ ,1 ‘__ _ '5 . - , ——— . i q _ <. _‘. ‘. ‘ L ; it ‘ — x. I ‘ , ‘ . "1 "*3, '-_ A _; ‘. -1 . ,- A ‘*3.. . L‘_ I an ' . . ' ‘ ‘X It ‘ _, v -. . _s . . ’. " r " “Cw- . ‘ . ~-’ I. -
  92. 92. TELEMENTAL HEALTH ((( I teIeheaIth. org I N 5 I I T u T F Multicultural / Multlingual Issues Issue How to measure? ° Global nature of the ° Search online for various Internet — worldwide instruments that might be audiences valid for your population ° Multicultural issues are ° Look for English proficiency quite visible in the tests document, but English as a — Free second language issue are — Easy to take not mentioned — Get to know the norms ° Rarely mentioned anywhere ° Spoken English is different from written English 0201! Ttlelltmil Health Inslllz. Inc‘.
  93. 93. TELEMENTAI. HEALTH ((( teIeheaIth. org l N S Y I T U T F ATA Patient Appropriateness for videoconferencing- based Telemental Health ° To date, no studies have identified any patient subgroup that does not benefit from, or is harmed by, mental healthcare provided through remote videoconferencing. Recent large randomized controlled trials demonstrate effectiveness of telemental health with many smaller trials also supporting this conclusion. p9
  94. 94. TELEMENTAI HEALTH ‘ I N K Y ,1 J H ‘ teIehea| th. org Caution — Consider Context Online Norm vs. Standard of Care — No Contact with Other Treating Clinicians — No Authentication of Consumer/ Professional — No Emergency Backup Procedures - Misunderstanding of Clinical Processes (suicide) - Operating w/ o Needed Research for Unsupervised Settings
  95. 95. Caution — Consider Context Online Norm vs. Standard of Care * Mostly Email / Chat vs. Video * Anonymity/ No Patient Records ° Avoid Responsibility w/ Website Disclaimers ° No Clear Channels for Mandated Reporting
  96. 96. ('«Il? Ii‘I'= t’= lli‘o‘r. -'i'd; f TM I-ll Client 8». Patient Selection In Study the evidence base (research) People with almost all diagnostic symptoms have been treated with traditional telehealth ' Treatment to the home has not yet identified which groups are too risky Understand differences between treatment of individuals in 1 setting vs, another (hospital vs. car, park, bed etc. ) ' Consider compliance problems
  97. 97. (‘-ll= ‘lil’: MlimIl '13’ Ethical Dilemma #2 LI; -:r we Ign: -.~s : o:uI I-aiianf‘
  98. 98. OCPM: Online Clinical Practice Management Step 1: Training Ste 2: Referrals Step 3: Patient Education Step 4: Legalities Step 5: Assessment Step 6: Direct Care Step 7: Reimbursement
  99. 99. <= Il: I’u’: z=Ili‘o. --. -': '«_o' Who is Responsible ‘I’ . ..if you make a referral to a long-trusted ~ . colleague who suddenly E I I conducts distance counseling with a client you referred? ° . ..what if the client ,1 suddenly L decompensates and makes a suicide attempt?
  100. 100. Know the Practices of Your Colleagues ° Ask ° Keep them informed of your practices and rationales - * Suggest training when needed ,1 It Document training suggestions when appropriate
  101. 101. Step 1: Training Step 2: Referrals Step 3: Client Education Step 4: Legal Issues Step 5: Assessment Step 6: Direct Care Step 7: Reimbursement . _ _> i (V _; ___. _. — ‘ ‘''%ga'-' '“~ I III’. I (,5 tiar- 02014 meuemai mam Innmn; Int-SI
  102. 102. teIeheaIth. org (<< ". Li”f'? T“i’3Efi‘“ Technical Issues - Discuss the technical requirements with the patient prior to initiating treatment - Consider the level of technology experience of the patient (train if needed) - Have a back—up plan if the video connection is lost — telephone -— landlines are best, but cell phones are better than nothing - Be aware of who is in all involved rooms and which technologies they are using
  103. 103. ((( TELEMENTAL HEALTH teleheammorg l N S I I T U T F Tech Check ° Tech check — review potential technology and infrastructure issues prior to initiating the delivery of care — adequacy of bandwidth (the rate of data transfer) — reliability of telehealth equipment (computers, monitors, video cameras, audio equipment, etc. ). — loss of connection due to inadequate transmission bandwidth or other equipment failure during a clinical crisis situation — insufficient camera resolution or environmental problems (adequacy of room lighting and microphone placement) 0201! Ttlellflnl M2aII1IInsIIn2.InI'.
  104. 104. Do you see well enough? °Image Resolution - ATA Guidelines Are you conducting an intake or follow-up? - Most of the scientific literature described VTC as being used for follow—up care after a primary licensed professional does an intake. - How can you compensate for being able to assess glassy eyes, tremors, gait disturbance, sweaty palms, body odor, other signs of poor hygiene or serious mental illness when no local professional is available? I . O 2014 TEIEMENZI Healm Inslflmz, Inc,
  105. 105. y’ I” ‘Ethical Dilemma #3 it When do you explain technical aspects (camera position, lighting , audio, noise, clock, etc. )?
  106. 106. F l l l T’ »— — are A ' i. -:‘? —= —‘A What are the types of problems that clients / patients have reported when working with clinicians using videoconferencing? l l , $x )1 , ,' , ' ' ' ' ' _ ’ - ’ _ ____ . __. T, _ J ill‘ 3%}: . (x 02014 meuemai mam lnmlme. inc-l.
  107. 107. K <-ll= ii1’: z=Ili‘or. -'1'I_-' Client/ Patient Training * Email / Texting/ Telephone/ Video ° Social networking — social media policy * File exchange ~ Computer repair ~ Clinical records * Insurance e Reports ~ Lateness / Missed sessions ° Non-compliance/ Avoidance
  108. 108. TELEMENTAL HEALTH 1 teIeheaIth. org l N 5 l l T u T F ((< Clinicians have been reported: - Eating ° Taking personal cell phone calls from family ° Burping without excusing themselves ° Picking teeth ° Combing hair ° Rocking incessantly in their seats ° Putting feet on the desk ° Taking a shirt off ° Mindlessly tapping the desk with objects - Being half way off the screen
  109. 109. Ethical Dilemma #4 What should you do when someone enters a client's room during your session?
  110. 110. ((( TELEMENTAI. HEALTH I N 5 l l T u I F N teIehea| th. org If someone enters the client/ patient room: - What would you do in your brick—and-mortar practice? — Stop the session / resume control of the interaction — Ask the client/ patient to speak privately with you ° Obtain permission to continue - Ask for an agenda ° Reschedule for another day/ time 0201! Ttlellulil Heillil lrlslllz. Inc‘.
  111. 111. Ethical Dilemma #5 What should you do when someone enters your room during your session?
  112. 112. ((( TELEMENTAI. HEALTH I N 5 I l I u I F l teIehea| th. org If someone enters your room: - What would you do in your brick—and-mortar practice? — Stop the session / resume control of the interaction — Excuse yourself if it is an emergency and step out of the room — Reschedule for another day/ time 0201! Ttlellulil Heillil lrlslllz. Inc‘.
  113. 113. l“ l l l l » 7 — as A ' i-. ;—= « _; A Why use initial protocols when videoconferencing? _, ,>'(/ A ' , ' ' ‘ ' ' ' 7 ' 7 ' ’ ~’ )1‘ _ _. __ __ _ _ . _________. if T‘ ~wgE$_. M , = '<= a—"5s~. w.. I’ as. “ l ‘fill ft 02014 meuemai mam lnfimdb: lnl: l
  114. 114. TELEMENTAI. HEALTH ((( l teIehea| th. org I N 5 I l I u I F Initial Protocols Educate client/ patient about the need for routine opening protocols that might include: ° Your name and location, name of clinic, hospital, agency ? ° Client/ patient name and location ? — direct phone number for emergency services of today's location (tested? ) ° Reason for meeting ? ° If anyone else is in the room or within earshot? ° Are children cared for ? ° Any expected interruptions ? ° Door locked? ° Room scan? — Scan your room with your camera and ask patient to do the same ° Anything else of note with your population? 0201! Ttlellulil Heillil Irlslllz. Inc‘.
  115. 115. ifiiliffffi ; §§IiI§i”nii1ifi‘if: :E _ _ _ A party carrier for the time used in helping a client %l Should you charge a 3'0‘ I l set up and manage their l equipment? I l I it 3'] ' , ' ' * , ' , ' ' ' ' ’ ’ T“ " —""””‘? '~“%%*£1.; ';‘__, _%L_’~a ‘ll ,5. “If. emu meuemai mam Instflilb: IlII: :l
  116. 116. TELEMENTAI HEALTH ((( teIehea| th. org I N 5 I I T I. ) I I Paid Tech—Time? - No payment for client/ patient set-up time - "Facility fees” are available on a per-session basis for Medicare and Medicaid services that are reimbursable — See: Reimbursement Strategies Increasing Authorization and Payment (3 CEs[CMEsI
  117. 117. F l l l I . _ — A A ' i-.2-= ‘ -1‘ What is a community champion and when is it appropriate to use one? ‘ . V V . . Jr" T ' if "‘ »; . A M: =': :;‘#‘3—'—‘¢v. .$. a;> {I +r~; (I r— ft tiar- 02014 meuemai mam Infimdb: Inl-: l
  118. 118. ((( TELEMENTAI. HEALTH 1 teleheammorg I N S l l T U T F Community Champion ° Local collaborator can be helpful for: — providing information about the patient’s history — monitoring mood and behavior — assisting with treatment planning and coordination — coordination with local 911 service when needed — provide an additional mechanism for contacting patients if a connection becomes lost — provide on-site technical assistance — provide support to a patient during emergency situations 0201! Ttlellflnl Health Insllla. tar.
  119. 119. TELEMENTAL HEALTH ((( l teIeheaIth. org l N 5 I I T U T F Community Champion ° Educate your client/ patient about use of a local collaborator such as a family member or close friend — Enter name and contact information into informed consent document — Stipulate under which conditions these people will be contacted — Outline emergency procedures and when collaborator will be notified — Clearly define expected roles and responsibilities of local collaborators/ champions — Encourage your client/ patient to discuss their choice of champions directly, before you contact them 0201! Ttlellflnl Health Insllla. tar.
  120. 120. What are the must—dos l for community B champions and informed , consent to minimize my ' nsks? l l Il A ; "~/ . V _ . . . _ . V V _ - Jr” ‘ TTTT '_‘‘‘T” ' ‘'''——'—‘__'_‘T .2‘ wag. .. 'M‘ --. :%. ~.. ..$_ab 3; *I fill 5 1y I (ll ll? » :04»: 02014 meuemai mam Infimdb: Inl-: l
  121. 121. TELEMENTAI. HEALTH ((( l teIeheaIth. org N 5 I I I U T F I Community Champion ° Assess when using a local collaborator may not be advisable: — Safety of local collaborators must be carefully considered — may be best to rely on trained 911 responders — Be cognizant of potential deleterious effect of disclosures made during emergency management on patient confidentiality and relationships, especially in small communities
  122. 122. .3’; » — — A A ' i. -:'? = -1, ll Step 1:Training Step 2: Referrals B Step 3: Client Education I Step 4: Legal Issues Step 5: Assessment 1 Step 6: Direct Care Ste. p7.= Reismbursemefit - ‘I {W -7 fi’: ;j-. .:. .; _ if '_‘’‘‘T’ ‘ ; _;r_5BH’ say“ I. : ‘fill J ‘ If , ls7“’ l ll}, ,», l 0201: meuemai mam Infimdb: Inl-: l
  123. 123. Specific Informed Consent Processes and Documentation
  124. 124. TE EMENTAL HEALTH ((( L I teIeheaIth. org I N S Y 1 T U T F ACA Code of Ethics (2005) A.12.a. Benefits and Limitations ° Counselors inform clients of the benefits and limitations of using information technology applications in the counseling process and in business/ billing procedures. ° Such technologies include, but are not limited to, computer hardware and software, telephones, the World Wide Web, the Internet, online assessment instruments and other communication devices.
  125. 125. ((( TELEMENTN. HEALTH i N S Y i T U T F I telehealth. org ACA Code of Ethics (2005) A.12.g. Technology and Informed Consent ° As part of the process of establishing informed consent, counselors do the following: — 1. Address issues related to the difficulty of maintaining the confidentiality of electronically transmitted communications. — 2. Inform clients of all colleagues, supervisors, and employees, such as Informational Technology (IT) administrators, who might have authorized or unauthorized access to electronic transmissions.
  126. 126. ,". ,=-' L h. ;.- I , IDS. ., >>_4IS A , i§ITQ' * I N -V I I T u I I ‘ J Verify with a Local Telehealth Attorney ° Use next suggestions, but I am not an attorney. - Develop your document and verify with your own informed, local attorney ° Be aware that many association attorneys may not be yet adequately well—versed in telehealth issues ° A good expert should cost you from $500 — $800 to review your agreement
  127. 127. TE EMENTAI. HEALTH ((( L teIeheaIth. org N S I I I U T F I Informed Consent ° Represents a ”meeting of the minds” — Information is influenced by many factors, including ° Client/ Patient’s capacity for absorbing information ° Time limits ° C| inician’s schedule — Subject matter is often complex and technical — Clinician thinks she is speaking English — Client/ Patient may be under stress (or may assert so later) — Mental illness - Document only serves as important evidence
  128. 128. TELEMENTAL HEALTH ((( I teleheaIth. org l N S I I T U T F Informed Consent: Function of State Law - Specific statutes govern informed consent in telehealth - Who's state law controls? ° Solution: assume that the law of the client/ patient residence will most likely be applied - More conservative approach is to determine the law in both your and your client/ patient’s state and follow the mandates of the more stringent law
  129. 129. ((( TELEMENTAL HEALTH I N $ F I T U Y F I teIeheaIth. org TMHI Informed Consent Documentation Basics - Date - Diagnosis ° Outline of intervention - Risks and benefits of each technology used - Risks and benefits of competing approaches ° Including no service
  130. 130. <‘-Ii= 'I’u1’: tlli‘or. -'1'(_o’ TMHI Informed Consent Documentation Basics Q Emergency Resources and Plan including names and contact information for local, trusted person(s) to be contacted at the L) ‘,1 discretion of the clinician . r ; . ’ ”/ It I '' Document advantages and ‘ ; O /9 ‘A disadvantages of using technology 6 . Document evidence—base - I supporting counseling plan ~ Document client preferences re: technology
  131. 131. (‘-lI= 'lil’: ?=Ili‘n-'. Il'(_o' TMHI Informed Consent Documentation Basics * Confidentiality and limits thereof as related to mandated reporting (suicide, homicide, abuse) - Fees, if any ° Statements* similar to: ~ My questions have been answered to my satisfaction in language I understand ° As of the time of my signing, all blanks have been filled in ~ Document method & procedures for data storage ‘I Document adherence to local and distant regulations * Obtain full legal review with a local telehealth attorney prior to using any TMHI sample wording with clients either verbally or in in your informed consent document.
  132. 132. <‘-lI= l’ui’: z=Ili‘oi-'. -'i'(_o’ TMHI Informed Consent Documentation Basics I’ Some risks may not yet be unknown* ' No physical exam* * Identify both _the clinician's & client's/ patient’s physical location ° Statements* such as: Pro essio_nal ill rely on information provided by he client patient and by any on-site practitioners or other sources 6 Potential problems could_ arise with electronic transmission in telepractice: °~ distortion, delays, interceptions, interruptions 9 Document all_ communications with client (written, audio, video or verbal) * Obtain full legal review with a local telehealth atto_rn_ey prior_to using any TMHI sample wording with clients either verbally or in in your informed consent document.
  133. 133. ((( TELEMENTALHEALTH I N s I I T Li I F I teIehea| th. org TMHI Informed Consent Documentation Basics ° Discuss the purpose of remote contact ° Inform clients of who will have access to their email address, phone number, or any other contact information - Inform the client of who else might contact the client on your behalf ° Discuss multi—cu| tura| and diversity issues 02014 TEIEMEIIZI HEIIM IIISIIIE. Inc.
  134. 134. TELEMENTAI. HEALTH ((( I teIeheaIth. org I N S I I T U T F TMHI Informed Consent Documentation Basics ° Describe the specific roles of any consultant or local referring practitioner and who will have ultimate authority over the client's treatment ° Discuss whether client information will be stored in a computerized database ° Provide written procedures for various types of follow—up when client does not appear for remote consultation — Time limit for non-response before collateral person will be contacted if professional is concerned 0201! Ttlellflnl Plallii Inslilz. mi‘.
  135. 135. ((( TELEMENTAL HEALTH 1 teleheaiflmorg I N S I I T U T F TMHI Informed Consent Documentation Basics ° Describe how deficiencies electronic equipment could possibly cause interference with diagnosis or treatment ° Make provision for non—receipt of email, delayed receipt, problems with servers, or unannounced changes in the schedule of email communications ° Mention how easily human error could lead to incorrectly delivered messages or other unforeseen events ° Mention automated services, such as appointment reminders 0201! Ttlellflnl Health Insllla. mi‘.
  136. 136. ((( TELEMENTAL HEALTH l N S i l T U T F I telehealth. org TMHI Informed Consent Documentation Basics ° Document technical requirements with the client prior to initiating treatment ° Document preferences and level of technology experience of the client (train if needed) ° Agree upon alternatives if video or audio connections are lost — telephone —— landlines are best, but cell phones are better than nothing
  137. 137. TELEMENT/ l HEALTH ‘ I N K V y T U H ) telehea| th. org Emergencies Have a plan. ° Discuss carefully ° Write plan in your informed consent document ° Develop prior relationships with local community: Physician Family School personnel Other leaders (AA, religious? ) Emergency response team Know community resources (hospitals, drug/ alcohol treatment facilities, etc. ) Know your local collaborators Know who and when to call for local assistance. - Inform client of when you will contact local leaders, what you will tell them. - Cover your termination procedure ( i. e., ’’I will make 2 telephone calls, leave you 2 messages, send you a letter in surface mail with a copy to your physician. ”) OZDII Telellamzl Helm Inslme. Inc. ‘
  138. 138. ((( TELEMENTAL HEALTH 1 teleheammorg l N S l l T U T F Practical Application: Check on Technology ° Tech check — review potential technology and infrastructure issues prior to initiating the delivery of care — bandwidth (the rate of data transfer) — reliability of equipment (computers, monitors, video cameras, audio equipment, etc. ). — loss of connection due to inadequate transmission bandwidth or other equipment failure during a clinical crisis situation — insufficient camera resolution or environmental problems (adequacy of room lighting and microphone placement) 0201! Ttlellflnl Plallii Inslilz. mi‘.
  139. 139. TELEMENTAL HEALTH ((( ) teIeheaIth. org l N 5 l l T U T F Opening Protoco| * ° Identify yourself and your geographic location - Ask your client/ patient to do the same ° Audio/ video check (e. g., Do you hear & see me clearly? ) ° /5 there anyone in your room or within ear—shot today? (Agree on safety code words, signals or phrases) ° /5 there anything else I might notice and find of interest ifl were in the same room with you today? ° Has there been an emergency in your environment today? ° /5 there anything else lshould know about before we begin talking today? * Obtain full legal review with a local telehealth attorney prior to using any TMHI sample wording with clients either verbally or in in your informed consent document. 0201! Ttlellflnl Meallii insllla. mi‘.
  140. 140. (‘-ll= 'lil’: ?=lli'm-'l'l_o' Local Collaborators or Champions
  141. 141. TELEMENTAI HEALTH ‘ I N _‘ Y (1 J H ‘ telehea| th. org Mention Other Safety Issues ° Have an addendum to your informed consent document — Include social media policy statements* that fit your client population, such as: — I will not ”friend” you on Facebook or other social media sites — I will not respond to you on sites such as Yelp * Obtain full legal review with a local telehealth attorney prior to using any TMHI sample wording with clients either verbally or in in your informed consent document. O20!-I Talellemzl Health Insllme, Inc,
  142. 142. TELEMENTAL HEALTH ((( ) telehealth. org l N S i l T U T F Safety Issues to Consider Is there access to firearms in home—based care? Discuss firearm ownership, safety, and the culture of firearms Be prepared to negotiate firearm disposition with patients and consider involvement of family members when appropriate Use of trigger safety lock devices is an option
  143. 143. ((( TELEMENTAI. HEALTH 1 teleheammorg l N S l l T U T F Safety Issues to Consider ° Assess potential technology and infrastructure issues prior to initiating the delivery of care — adequacy of bandwidth (the rate of data transfer) — reliability of telehealth equipment (computers, monitors, video cameras, audio equipment, etc. ). — loss of connection due to inadequate transmission bandwidth or other equipment failure during a clinical crisis situation — insufficient camera resolution or environmental problems (adequacy of room lighting and microphone placement) 0201! Ttlellflnl Meallii insllla. mi‘.
  144. 144. ((( TELEMENTAI. HEALTH 1 teleheammorg l N S l l T U T F Safety Issues to Consider ° Identify and use of a local collaborator such as a family member or close friend of a patient — Enter name and contact information into informed consent document — Stipulate under which conditions these people will be contacted — Outline emergency procedures and when collaborator will be notified — Clearly define expected roles and responsibilities of local collaborators — Consider discussing these issues with family members directly 0201! Ttlellflnl Meallii lnsllla. mi‘.
  145. 145. ((( TELEMENTAI. HEALTH 1 teleheammorg l N S l l T U T F Safety Issues to Consider ° Local collaborator can be helpful for: — providing information about the patient’s history — monitoring mood and behavior — assisting with treatment planning and coordination — coordination with local 911 service when needed — provide an additional mechanism for contacting patients if a connection becomes lost — provide on-site technical assistance — provide support to a patient during emergency situations 0201! Ttlellflnl Meallii lnsllla. mi‘.
  146. 146. TELEMENTAL HEALTH ((( ) teIeheaIth. org N S i l i U T F l Safety Issues to Consider ° Assess when using a local collaborator may not be advisable: — Safety of local collaborators must be carefully considered — may be best to rely on trained 911 responders — Be cognizant of potential deleterious effect of disclosures made during emergency management on patient confidentiality and relationships, especially in small communities
  147. 147. <-il: ‘iai’: ziiii. --. -‘i'«_-' Safety Issues to Consider it Discuss the technical requirements with the patient prior to initiating treatment ° Consider the level of technology experience of the patient (train if needed) ~ Have a back-up plan if the video connection is lost — telephone —— landlines are best, but cell phones are better than nothing
  148. 148. TELEMENTAL HEALTH ((( ) teIeheaIth. org l N 5 I I T U T F Intake Summary - Explain & sign informed consent document - Conduct a formal intake — no shortcuts - Meet in—person or video, identify geographic location, organizational culture, take full history, medications and medical conditions, mental status and stability, use of substances stressors, treatment history, support system, use of other technology, suicide/ homicide intent - Identify psychological diagnosis - Decide ifi then which technology is appropriate / Assess technical competence / ability to arrange appropriate setting - Obtain names of all other key providers, get appropriate releases - Verify contact information (address, phone, email) - Have emergency plan in writing
  149. 149. l [if "o': o:: £. Browse Categories Computers 8. Programming » Professional Counseling ) Addictions (66) — Canadian Theragists (11 i Conse eros Profesionales (2 Co in with Crisis Conditions (67) hsial A-no il. ."*L£i. ‘ 'i iiisiiiisa : i= Professional Counseling r-cfessic Get $10 off your session _ V over $35! Meet our Professional Counseling experts Valid for onetime use only. 30.1 by . HE)-. §gEni( '7] Hide busy experts 1 Non-luogniental. compassionate professional ready to listen and help! Aslr. about hypnotherapy sessions! Change your lilel Now certified in Sports P5y‘ I iiwlll I 25+ YEARS Experience Feel Better Now. Caring. Compassionate, Healing Energy"Got instanthelp and encouragementthatl needed‘ "He is one ofthe L R'. ‘—II1|', =Il‘flI. Do you feel stuck, trapped in the same patterns that repeat over 8. over7 Do you feel depressed, anxious, angry. or alone’? I can help Y5“ $2.85.-’minute ‘. ( Got Problems? Get Solutions Results Now! Sexuality. ' Liz‘, J _‘ B Anxiety,0CD, Women‘s Issues. Relationsnips. Porn Addiction *_ K i ' ‘E~ ":1! xsi ‘ . , -f 2 Men's I‘-‘sychology. Dating Coach. 54 20/minute Online ' _ V_ 7 ’ Its a NEW day! Professional. Compassionate and Non- -_. T. X) iudgemental counselor. ..Greatlistener Iastty'pist. ..Contact mel 1, . . ‘rel: E~: x|w! ::“-cijg
  150. 150. OCPM: Online Clinical Practice Management Step 1: Training Step 2: Referrals Step 3: Patient Education Step 4: Legalities Step 5: Assessment Ste 6: Direct Care Step 7: Reimbursement
  151. 151. ((( TELEMENTAL HEALTH 1 teleheainmorg INSIITIJTF Where to Get Reimbursement for Telemental Health? Contractual & Grants Direct Services Government Services US Department of Education Medicare Department of Corrections Medicaid (based on state) Department of Defense Veteran Health Administration Indian Health Service NIH, NIMH, SBIR, State Programs Bureau of Prisons in Department oflustice Private Foundations
  152. 152. TE F‘. "INT'II IIEIITH ((( )_ I i _‘ telehealtnorg l. i': i Where to Get Reimbursement for Telemental Health? Private Pa Fee for Service General Niche (smoking, drug/ alcohol etc. ) Boutique (high—end services, rich & famous) Se| f—he| p llAppsII Private Insurance These 16 states now mandate payment: California, Colorado, Georgia, Hawaii, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, New Hampshire, Oklahoma, Oregon, Texas & Vermont 9 13 more states are pending since Jan.1, 2013 CPT code approval
  153. 153. States Requiring Insurance Reimbursement for Telehealth 8 H Telemedicine Below are the individual states in the U. S. that require some form of reimbursement for services provided by telehealth (usually for serices delivered via video teleconferencing or "VTC")); .5 18 I9 20 21 22 _. _._. _._. ___ . ".°‘E"‘. >‘. -‘. "‘. -‘ ? °.°°. “9‘5"‘. >'. -'-‘. "’. -* Maine Oregon California Colorado Georgia (complications) Hawaii Kansas Kentucky Louisiana Texas (Medicaid) Oklahoma Virginia New Hampshire Maryland flew Massachusetts Arizona . Montana , New Mexico , Mississippi — Mi , Kentucky (Medicaid) http: //telehealth. org/ mandated—states Keep informed by getting our newsletter: http: //telehea| th. org/ news| etter—signup
  154. 154. <-—il: i:. i:mla‘. .--. -‘in: OCPM Step 7: Reimbursement Medicare & Medicaid Reimbursement — Psychiatrists, Psychologists and Social Workers but not counselors yet it Action item for counselor advocates: work with Mike Thompson's office, located in CA)
  155. 155. TELEMENTAL HEALTH I teIerieaIth. org I N 5 I l I u T F 2014 Reimbursement Bill (6 ° As part of the 2014 National Defense Authorization Act, service members transitioning into civilian life are eligible to receive 180 days of health insurance coverage for services provided through telehealth. Rep. Glenn Thompson (R-Pa. ) pushed for the bill, specifically citing its importance in helping service members receive treatment for Post Traumatic Stress. ° ''All too often, symptoms related to Post Traumatic Stress do not appear until eight to 10 months after deployment, " Thompson said. - https: I[www. govtrack. uslcongresslbil| s[113[hr 1960[text (see section 704)
  156. 156. TELEMENTAI. HEALTH ((( teIeheaIth. org I N S I l I U T F Medicare Billing and Reimbursement ° Limited to rural and Health provider Shortage Areas (HPSA) ° Modifiers: — ”GT” for interactive audio and video telecommunications system — ”GQ” for store—and—forward applications ° Failing to use appropriate modifier code may constitute Medicare fraud ° Debate about how to identify location of services ° Many billing services bill inapprorpriately
  157. 157. ((( TFIFMENTAI HEALTH 7 l i' I I. ‘-. ‘rl To download, go to this webpage: Te| ehea| th. org / CPA2013 American Telemedicine Association PAYING FOR TELEMEDICINE IN THE UNITED STATES A Concise Review from ATA CEO, Jonathan Linkous
  158. 158. Center for CCHP PROJECTS National Telehealth Resource Center — Policy State Telehealth Laws and Reimbursement Policies Report Specialty Care Safety Net Initiative Telehealth Model Statute Tele-Dennatology in Medi-Cal Tele-ICU CA Assessment Project 71913 Survey: Some Providers Do teiehealthorq . * National Telehealth Policy Resource Center About CCH P What is Telehealth? CA Telehealth Policy eatrl 3?-?3C. JV£Q Center A 3c 7:. ‘ State Telehealth Laws and Reimbursement Policies Report in Feb. 2013 CCHP released a 5o—state scan of telehealth laws, regulations and reimbursement policies. This ' , offers policymakers. health advocates, health care professionals and others with an interest in telehealth a summary guide of the most recent information available about how each of the 50 states (and the District of Columbia) defines. governs, and regulates the use of “telehealth" or “telemedicine” technologies in the delivery of "5 health care services, Most remarkable about this report is that every state has its own unique set of telehealth policies, Some states have inrnrnnrated nnliries intn law while others have addressed issues such as definition 0 231-1 Telelllertai -warm li'i5KilLlE‘ Inc
  159. 159. Which CPT codes E need to be used? l l.
  160. 160. TELEMENTAL HEALTH ((( ) I ‘ T U I I teIeheaIth. org | N' CPT Codes - Medicare, Medicaid, and 3”‘ Party Payers — Differ by Payer ° Contact your payers and ask them to send you their list of CPT codes for telemental health ° Get your information in writing 02014 meuemai mam inmna, Inc. ,
  161. 161. <-il: i/iizmiii. --. -‘: '«_-' CPT Codes for TMH ° Individual psychiatric interview ° Individual psychotherapy 0 Individual & group health & behavior assessment & intervention *3 Neurobehavioral status examination * Pharmacologic management ° Smoking cessation
  162. 162. TELEMENTAL HEALTH ((( l teIehea| th. org I N 5 i l T u I F Smoking Cessation and CPT codes ° CPT code 99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) ° CPT code 99407 (Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes) ° HCPCS code G0436 (Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes) ° HCPCS code GO437 (Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes) htt : archive. aweber. com tmhinews CD mc h New T elehealth CPT Code Approvedhtm 0201! Ttlellemil Heillii lrlslilz. mi‘.
  163. 163. EEEEEEEEEEEEE TH ((( , l teIehealth. org I N $ Y l T U T F Centers for Medicare and Medicaid Services (CMS) ° GO396 and GO397 —— Alcohol and/ or substance (other than tobacco) abuse structured assessment (for example, AUDIT, DAST) and brief intervention, 15 to 30 minutes and intervention greater than 30 minutes, respectively. - GO442 -- Annual alcohol misuse screening, 15 minutes - GO443 -- Brief face-to-face behavioral counseling for alcohol misuse, 15 minut .
  164. 164. TELEMENTAL HEALTH ((( , l teIehealth. org I N 5 Y i T U T F Centers for Medicare and Medicaid Services (CMS) - GO444 —— Annual depression screening, 15 minutes - GO445 —— High-intensity behavioral counseling to prevent sexually transmitted infections, face-to- face, individual, includes: education, skills training, and guidance on how to change sexual behavior, performed semiannually, 30 minutes ° GO446 —— Annual, intensive behavioral therapy for cardiovascular disease, individual, 15 minutes - GO447 —— Face-to-face behavioral counseling for obesity, 15 minutes
  165. 165. <‘-ll= l’ii’: Mli‘m-'i'(_o’ Distant vs. Originating Sites ° Distant Site — where you are ° Originating Site — where your client/ patient is
  166. 166. <-ii: i/iizmiii. --. -‘: '«_-' TMH CPT Code Modifiers °-GT ° Most insurance carriers will only reimburse ”GT” coded services for telemental health — Some don't require modifiers * Always contact carrier to know rather than assume that you or your billing agent know how to proceed
  167. 167. ((( TELEMENTAL HEALTH l N 5 i i T u T F l teIeheaIth. org CMS Eligible Providers - Physicians ° Nurse practitioners (NP) - Physician assistants (PA) ° Nurse midwives - Clinical nurse specialists (CNS) ° Clinical psychologists (CP) ° Clinical social workers (CSW) — (CPs and CSWs cannot bill for psychotherapy services that include medical evaluation and management services under Medicare. ° Registered dietitians or nutrition professionals - (notice that counselors are not included) 0201! Ttlellemil Meillii lnslilz. Inn
  168. 168. More Information (6 TELEMENTALHEALTH I N 5 r i T u r t HOME ABOUT US BLOC CONSULTING COURSES 8 PROGRAMS NEINS RESOURCES SUPPLIES n SEAR H http: //telehealth. org/ mandated—states States Requiring insurance Reimbursement For B R _ Xe‘ _ _ egis . ~. Telehealth 8Telemedicine ’°rweumr*‘“p Register for webinars, mini-conferences and future Below are the individual states in the US, that require some form of reimbursement for services provided by elem; Using the form on thls telehealth (usually for services delivered via video teleconferencing or "VTC"); menu, “ event: Maine NAME; Oregon California Colorado Georgia (complications) Hawaii EMAIL Kansas Kentucky Sublit Louisiana Texas (Medicaid) telehealth. orq Okla horn a .3.~°9°. ~Ie. we~. ~.~. -
  169. 169. g, _ A . ._: _ l Which ''location of service" category l gets reimbursed most i frequently? __
  170. 170. <-ii: iii’: ziiii. --. -‘ii; Location of Service ° Speak with payer before billing ° Indicating the service was rendered in the ”home” is likely to lead to payment rejection * Service to the home has not yet been approved by many payers * Indicating service was in your office may or may not lead to payment
  171. 171. (‘-ll= lil’: r=lli‘mI'i'(_o' | nter—state Practice & Reimbursement ° Most often, professional must be properly licensed in the geographic location of the client/ patient at the time of contact to practice legally — if practicing illegally, you may be committing insurance fraud — Insurance fraud may lead to forfeiture of malpractice coverage the time of the contact
  172. 172. . _ — A A ' = -1‘ Models Where might you l Evidence—based l 7 earn a legitimate i income? 1. l ,1 . . V _ . , _ _ _ , V , i _ > , - ; )"' ~ ”‘ T“ " ‘—‘i’ — __5.‘ l‘ T -E * " ’ . '_': >§ 1. = 'vr_53‘~’. A$‘a , . 1 ll; i i‘ emu Telellerni mam instnin; flIl: :l
  173. 173. 1.’ l’ / ' _ . l ‘- I ,4‘, I P‘ I I. -_o- . _.t : ( ' S 2?; . , .
  174. 174. Children's Hospitals
  175. 175. ( f'"’. ;l.5;°"': " <-ii: ‘iii’: :iui. --. -‘i'«_-' Specialty Schools & Services ' Special Needs * Autism ~ Residential Treatment Centers — Drug & Alcohol — Other
  176. 176. .— "/5 f ) , ’ i Rural Hospitals
  177. 177. Correctiona Facilities
  178. 178. TELEMENTAL HEALTH <<( l telehealth. org i ~ s r i r u 1 5 Nursing Homes
  179. 179. Home Health t
  180. 180. Employers l I, .,: .9 3 _ - _ “/ ’IIi_(. . "~"'. ’ ; =«. , ~ ~r in / i . ‘ __ , ' . "4’ ) I _. ' . ‘ I l l l , . K i 2
  181. 181. Military & Veteran's Administration i l ‘ 7 Y , .4 r’ l I r ' , / -, / . i I I . l X , I ' l .

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