ACA March 20 2013

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Donna Ford and Marlene Maheu give a telehealth workshop to the American Counseling Association (ACA) conference on March 21, 2013 in Cincinnati, Ohio. They presented on the topic, "Skype? Email? 7 Legal & Ethical Considerations for Best Practices Online.”

The above event is sponsored by the TeleMental Health Institute, Inc. We are the premier professional training site for professionals seeking training in telehealth. Our courses are offered in a state-of-the-art, 100% online learning environment that is fully mobile compatible. Professional training is now available from your desktop of mobile device, 24/7, at your home or office.

To receive our FREE monthly newsletter related to telemental health, telecounseling, online therapy, telepsychology or telepsychiatry and telenursing, send an email to: tmhinews@aweber.com You will also receive notices of our bonuses and discounts for professional training for CEUs and CMEs.

See our offerings at www.telehealth.org
Send questions or comments to us at www.support.telehealth.org
Contact Dr. Maheu to speak at your next workshop or conference at: www.support.telehealth.org

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ACA March 20 2013

  1. 1. Skype? Email? 7 Legal and Ethical Considerations for Best Practice Online AMERICAN COUNSELING ASSOCIATION ACA Learning Institute March 20, 2013 Donna Ford, MS Marlene M. Maheu, Ph. D.
  2. 2. Donna Ford, MS ACA President 1999-2000 “ Best Practices for Online Counseling (Cybercounseling) “ Ethical Code for Online Counseling ' Cybercounseling and Cyberlearning: Strategies and Resources for the Millennium “ Online Counseling Task Force
  3. 3. ACA Resources ° ACA Ethical Standards: Technology htt : www. counse| in . or Resources Code OfEthics[TP[Home[CT2.aspx ° Licensure and Certificates: htt : www. counse| in . or Counselors Licens ureAndCert[TP[State Reguirements[CT2.as| gx
  4. 4. ACA Resources The ACA Ethics Revision Task Force ~ Town hall meeting on the proposed revisions * Saturday, 2:00pm—3:30pm * 205 Convention Center
  5. 5. . , ,, 7.. I ‘I ‘L! telehealth. org Oregon Administrative Rules for Online Counsehng - BOARD or LICENSED PROFESSIONAL COUNSELORS AND THERAPISTS : DIVISION 90 DISTANCE COUNSELING - http: //arcweb. sos. state. or. us/ pages/ ru| es/ oars_800/ oar_833/833_090.htm|
  6. 6. ((6 (}II'~IIl'«. V-, IIli. ~'. '~I(-L ACA Publications * Licensure Requirements for Professional Counselors: A State —By-State Report Office of Professional Affairs, 2010 edition * The Counselor and the Law: A Guide to Legal and Ethical Practice, Sixth Edition by Anne Marie ”Nancy” Wheeler and Burt Bertram
  7. 7. ((6 (; ‘lI‘~IIl= .i-, IIli. ".'vI(-T Definition of Counseling ”Counse| ing is a professional relationship that empowers diverse individuals, families and groups to accomplish mental health, wellness, education and career goals. ”
  8. 8. ((6 (; ‘lI‘~IIl= .i-, IIli. ".'vI(-L Seven Principles for the Future * Sharing a common professional identity is critical for counselors “ Presenting ourselves as a unified profession has multiple benefits ' Working together to improve the public perception of counseling and to advocate for professional issues will strengthen the profession
  9. 9. ((6 q; ‘4(-4.i¢. m._. ;.. ,.. Seven Principles for the Future * Creating a portability system for licensure will benefit counselors and strengthen the counseling profession. “ Expanding and promoting our research base is essential to the efficacy of professional counselors and to the public perception of the profession.
  10. 10. ((6 q; ‘4(-4.i¢m: ._. ‘_’. .,. . Seven Principles for the Future * Focusing on students and prospective students is necessary to ensure the ongoing health of the counseling profession. in Promoting client welfare and advocating for the populations we serve is a primary focus of the counseling profession.
  11. 11. Ll : ‘L’-< I “ telehealth. org ACES TECHNICAL COM PENTENCIES ° TECHNICAL COMPETENCIES FOR COUNSELOR EDUCATION: RECOMMENDED GUIDELINES FOR PROGRAM DEVELOPMENT ° http: [[fi| es. acesonline. net[doc[2007 aces tec hnology competenciespdf
  12. 12. NATIONAL BOARD FOR CERTIFIED COUNSELORS (NBCCI PQLICY REGARDING THE PROVISION or DISTANCE PROFESSIONAL SERVICES at http: //www. n bcc. org/ Assets/ Ethics/ N BC C%20Po| icy%20Rega rding%20the%2OPr actice%20of%20Distance%20Counse| ing %20-Board%20— %20Adopted%20Version%20- %2OJu| y%202012-%20PDF. pdf
  13. 13. TeIeMenta| Health Institute, Inc. MARLENE M. MAHEU, PH. D.
  14. 14. ( (, V’; " '. .‘, ‘.: |‘, i : » . .. . ((6 l_'-l('~lIi= .h, lli‘i. ~."l(-i Disclaimer WHO I AM: I am a licensed psychologist, not an attorney, physician, marketing or information technology (IT) professional. MY GOAL: My goal is educational only. I will outline the issues and alert you to what's happening in a way to help think through the issues, help you move forward, and protect yourself as well as your clients or patients. I hope to inspire you to use technology in ways that help you, your clients and our profession. No warranty, guarantee, or representation is made as to the accuracy or sufficiency of the information contained in my presentation for your specific circumstance. I assume no responsibility in connection therewith your choices. YOUR PART: You are encouraged to seek specific advice from your specific legal, regulatory, ethical and malpractice bodies before offering any online services or programs to consumers. Get all such opinions in writing, and have your informed, trusted, local, legal counsel review them for their full significance.
  15. 15. Learning Objectives 1. Objective 1: Participant will be able to identify and understand definitions used in telecounseling, online counseling, telemental health as well as telemedicine and telehealth. 2. Objective 2: Participant will be able to identify 3 ethical best practice issues for working online. 3. Objective 3: Participant will be able to identify 3 legal best practice issues for working online 9/21/2012 15
  16. 16. l r‘ —‘ ' Copyright 2012 TeIeMental Health Institute, Inc, All righs reserved.
  17. 17. ((< §: ¢5"' ‘telehealthprg 7 ACA Convention 2013 Web Page --5 - Resources: —S| ides F9‘. -"1 « . _ 1‘ H’ . - — Social Media Policy — Bibliography — Time—Limited Bonuses TMH Institute Website: www. te| ehealth. org/ aca2013
  18. 18. C H A N E Change is good you go first. — Dilbert
  19. 19. Change Change is good you go first. — Dilbert
  20. 20. OCPM: Online Clinical Practice Management Step 1: Training Step 2: Referrals Step 3: Client Education Step 4: Legal Issues Step 5: Assessment Step 6: Direct Care Step 7: Reimbursement
  21. 21. ‘E 2007 by Randy Glasbergen. www. g|asbergen. (om a’; B‘ “How can I trust your information when 9/mm you’re using such outdated technology ” ,1
  22. 22. _ll_IH_A_T’§ HAPPENINQ? sun II II. " Coming next. .. The Past Now
  23. 23. (6 lELEME-NTAL HEALTH tdeheakh-org ‘A"l III fit. "7? 1 : - vl * - I I ‘L47 2 . . . 9 I I 1- ' . “ , ‘V 5 I . -- . .2 w. " L ‘ 4 "‘ . 0 Ion VI-‘pVO'lI1lMCDll’hlIv(’V. It¢‘ln(
  24. 24. telenealth . or u TeleMental Heat Edited by H. GERNS8PiCl-( 25 Cents April I924 over 200 Illustrations THE RADIO a yb e! IN THIS ISSUE: 5;. Oliver Lodge. FR 5. Dr. J. A. Fleming. F. R.S. F. V. Dunmom mi F. H. Eng: -I n! I . .4.. .v. nstitute, nc.
  25. 25. l[LEME’IIlI«LHLALI»i ((( y _‘ K‘ : I V U V I teIeheaIth. org TELEPHONE-BASED CARE
  26. 26. ! !H. A.1."§ r! AP? §!. '!! ‘£, , NOW? Coming next. .. The Future has Arrived
  27. 27. Telehealth vs. Telemedicine Telehea lth . Regional Health Health ' professions Information Education sharing I Consumer Ad . . . j Telemedicine E°'”“a“°“ ministration I Public Evaluation Health Research ' Homeland Security
  28. 28. I v . . ! —‘. ”“"'_—‘: """‘—""": '|5""! "' (= II’—IIlV«IIII. ‘.0I| I Rea| —Time Telemedicine Remote doctor exammes a Patient in rural ER gets benefit of patient’s inner ear from a local Car‘? P1u5_rem0te _ _ remote looatioo consultation with specialists.
  29. 29. ((( "L*_ML’I'i'ILH‘. /ILI" telehealthflrg : Ii’: I '. »‘. '«’I'AI i«-. Ivi. I: I” I" II~
  30. 30. telenealth . OI ti " Ifi‘i°= 'i°a RBKIUOITI People VBITIDIYBS AIIIITIBIS RODOIS Vehicles T’ This * I my you will initially appear In Second Life You can customize 'I, ‘DLli apaearance later
  31. 31. 3" __ Wearable Computers (Google Glasses)
  32. 32. «( IELEMEPIIAL HLALIH te'ehea| th. °rg ‘I I"i D I01’VF‘fv"“flI. "C§IThIlV“V, ITn‘| pg
  33. 33. Reviews News Download CNEITV How To Deals f '* Log In | Join s, .IIIsu~G The Next Big Thing For Business is Here 3 % I is war: IZZNET News Crate i, r’I' SAMSUIIIG Confirmed: Goolg| e Glass arrives the Next Big Thing in 2013, and under $1,500 fsOl, §,ff"“eSS -Googles atigmented-realm specs are ahead of schedtife Are you react); ‘ V I ‘"19! >1 ricm to get *, ‘OLlrS€! f fitteo for a set7 EricMacK- . i“I WWII /43 Q‘) mg f Follow 55"‘ fi I. » I 3:- W. » E; H I; : r-v1.3Ie. . ; r:. . i: '. Comments 98 HottestReVie. _._, s ‘ iPhone 5: Finally, everything we hoped it would be -8 I. .»II. ,;. —IIs199.99 ( sh _ 7 ‘, ~k>‘<*~k~k J Microsoft Surface Pro: Smart almostlaptop nearly nails it ‘II: i‘Ii. -If: Ill 5899,99 ‘k*)<>'~1 Chromebook Pixel: Brilliant touch Possibly the ‘must—have‘ gadgelforthe 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 , & deslgni Pfemlum PMS Google originally targeted 201-1 for a consumer release when it revealed Project Glass last year,
  34. 34. ERW6 Personal Robots Group mit media lab in *. 'I. :; tr: -.'. 'r: : ‘. '.. nu'v . ’C't. u;‘n' ; , Home Welcome to the Personal Robots Group
  35. 35. nsl M O The Wand 5 Most Advanced Humanoid Floboi AS(MO v NEWS EDUCATION V TRAVELS ASIMO TV v GALLERY DOWNLOADS ASIMO IS DESIGNED TO HELP PEOPLE I 0 Ir turn sound off 43)) EXPLOIE UVE SHOW 3 ‘ FEATURING » ‘I ; ‘ GALLERY 2 V" AS| MQ TV HIgh Oualrty Photos IIfASI| .IO DOWNLOADS Offnczai ASIMO downloads for your Mac, PC or SEE ASIMC LIVE 4, INNOVATIONS 3 VIDFO HISTORY «) 5'T'a”°"°"e _ > _ TRAVELS go: yfs can siedgsnao See TOOW roiaots In b Cf‘IetC: (yDU1HDnd8 s mo: flIty'm finegkiout ? )Vt: dED msturyhof yam of ASIMO: “Wm Amencan Tum captured In ms 8| 8 ISHE)’ H EVE pmen now can flflg W00 DGSGITIDOWEFE W 0!! ESFO 0 CSVSSEBFC nomdournal nutthe best In us in the future ASIMO-derived Iechnolcgy D ""“"‘°" HONDA Facebook ! hnPawmu1DmarrI
  36. 36. I , '|I‘H A. §_L! ,;! !]: r . , ‘ ’. ' ' tillihll-I| lI. ‘.v| l' Electronic Health Record
  37. 37. Coming next. .. What mental health consumers want online
  38. 38. r Google AdWords ilnlli. -. I-. -1'» Tools Keyword Tool V Include terms (0) V Exclude terms (0) V Match Types / Broad [Exact] ‘Phrase’ Help — why should I use the Keyword Tool’? How do I use the Keyword Tool’? How can I refine my ideas’? Help Center Saved ideas (0) Blirly keyword ideas ElMy ad group ideas if-l('~II'i= r., il{’I. ~'. '-It-I US. English I E E | Report an issue Sign In : :—. ii. Find keywords Based on one or more ofthe Iollowing: Word or phrase online therapy Website Category fl Only show ideas closely related to my search terms T_l Advanced Options and Filters :1‘ "1 United States )1 ifl English x "1 Desktops and laptops -V» 1»; Sign In with your Adwords login infomiation to see the full set ofideas for this search. About this data Download V Sorted by Global Monthly Searches v Columns v J Save all Search terms (1) 1~1 of1 El Keyword Competition V Global Monthly Searches Local Monthly Searches l online therapy V High 165.000 74.000 / Save all Keyword Ideas (100) 1- 50 of100 E > Keyword Competition v Global Monthly Searches Local Monthly Searches W‘ therapy online V High 165,000 74,000 l online physical therapy V High 60,500 12,100 P T physical therapy online V High 60.500 12.100 T online counseling therapy v High 33,100 18,100 I online therapy counseling V High 33,100 18,100 l therapy online free V High 1% 9,900
  39. 39. Coogle AdWords it-: IIi: 'l. li: ' Tools Keyword Tool V Include terms (0) V Exclude terms (0) V Match Types Broad i , [EXad] ‘_ ‘Phrase’ Help — Why should I use the Keyword Tool’7 How do I use the Keyword Tool’? How can I refine my ideas’? Heln Center Saved ideas (0) Flhly keyword ideas Billy ad group ideas if-itai‘i¢. ,i us. English | us Dollar (USD 5) E] | Remit an issue sign in Itzjli Find keywords Based on one or more ofthe following: Word or phrase online counseling Website Category E Only show ideas closely related to my search terms B Advanced Options and Filters : ' "2 United States at 2 r : . English at ": Desktops and laptops V :2». IDA I Sign in with yourAdWords Iogin infonnation to see the full set of ideas for this search. About this data Download V Sorted by Relevance V Columns V J Save all Search tenns (1) 1-1 of1 El Keyword Competition Global Monthly Searches Local Monthly Searches online counseling V High 110,000 50,500 J Save all Keyword ideas (100) 1 - 50 of100 El > Keyword Competition Global Monthly Searches Local Monthly Searches l free online counseling chat V High 3,600 1,600 i 7 online counseling degrees V High 9,900 8,100 i 7 online counseling services V High 1.000 720 _ online counseling degree V High 12,100 9,900 free online marnage counseling V High 1,600 1,000 free online counseling services V High 320 Q
  40. 40. Google AdWords i{u; Ill: hull Tools Keyword Tool V Include terms (0) V Exclude terms (0) V Match Types E Broad Help — Why should I use the Keyword Tool’? How do I use the Keyword Tool? How can I refine my Ideas’? Heln Center Saved ideas (0) l-lMy keyword ideas l; lMy ad group ideas US. English Find keywords Based on one or more oltl1efolIowing' Word or phrase telecounseling Website category I Hi Advanced Options and Filters , :2 only show ideas closely related to my search terms : 'e United States x ,3 ; i. a;e English at Download v / Save all Search Iemis (1) Keyword Competition telecounseling ' Low / Save all Keyword ideas (0) Keyword Competition I US Dollar (USD 5) : I & Sign in ml. , » : :e Desktops and laptops About this data Sorted by Relevance v Columns v 1 - 1 of1 El Global Monthly Searches Local Monthly Searches 480 320 0 — 0 of0 El Global Monthly Searches Local Monthly Searches No search results were found. Please try again, Important Note: We cannot guarantee that these keywords Wlll improve your campaign performance We reserve the right to disapprove any keywords you add You are responsible forthe keywords you select and for ensuring that your use of keywords does not violate any applicable laws ©2013Goog| e l AdWords Home I Editorial Guidelines l Pnvacy Policy
  41. 41. rds US. English I I El I Report an issue Sign in : :.. viii-. fi. I]l- mi. T°°" Find keywords Keyword T00| Based on one or more ofltie following: ' '"°'“d° ‘Elms (0) Word or phrase tele-counseling V Exclude terms (0) websne - Category V Match Types Only show ideas closely related to my search terms E Broad + Advanced Options and Filters . :3‘ 2 United States x ,1’; I _fE English 2: .5 :55 Desktops and laptops [EXaCll i 7 ‘Phrase’ “"' "‘ H I About this data e p — why should I use me Keyword Too” Download v Sorted by Relevance v Columns V How do I use the Keyword Tool? How canlrefine myldeas, /Save all Search temrs (1) 1-1ot1 El H""" “'_"’""°' Keyword Competition Global Monthly Searches Local Monthly Searches Saved ideas (0) _ Iqmy keywmd idea5 i teIe_counse| ing V Medium 320 210 ~ My ad group ideas / Save all Keyword Ideas (0) 0 - 0 of 0 El Keyword Competition Global Monthly Searches Local Monthly Searches No search results were found. Please try again. Important Note: We cannot guarantee that these keywords Wlll improve your campaign performance We reserve the right to disapprove any keywords you add You are responsible for the keywords you select and for ensuring that your use of keywords does not violate any applicable laws ©2013Goog| e | AdWords Home I Editorial Guidelines I Privacy Policy
  42. 42. Google Adwords D. -lL' Tools Keyword Tool V Include terms (0) V Exclude terms (0) V Match Types / _ Broad IEXBGI 'Ph ras e‘ Help - Why should I use the Keyword Tool’? How do I use the Keyword Tool? How can I refine my ideas? Heln Center Saved ideas (0) — My keyword ideas ElMy ad group ideas 4f~I(ur‘i¢-, l US. English | us Dollar (uso s) Elai- Find keywords Based on one or more oflne following: Word or phrase online counselor Website Category E Only show ideas closely related to my search terms Advanced Options and Fllters , ,1‘ , - United States at _. « _ _ : English x i» , :s Desktops and laptops . -e». r. . Sign In with your Adwords Iogin information to see the full set of ideas for this search. About this data Download v Sorted by Global Monthly Searches v Columns v / Save all Search tanns (1) 1-1 of1 El Keyword Competition V Global Monthly Searches Local Monthly Searches i__ online counselor ' High 40,500 27,100 / Save all Keyword ideas (49) 1 - 49 out! El Keyword Competition v Global Monthly Searches Local Mommy Searches : counselor online V High 40,500 27,100 I online counselor free ' High 6600 4,400 1 free online counselor ' High 6,600 4,400 if counselor online free ' High 6,600 4,400 free counselor online ' High 6,600 4,400 V " online free counselor ' High 6,600 411% E i Report an issue Sign in
  43. 43. Google AdWords Home Tools V Tools Keyword Tool v Include terms (0) 7 V Exclude terms (0) 7 V Match Types 7 V Broad IEXGCII 'Ph rase' Help - why should I use the Keyword Tool? How do I use the Keyword Tool? How can I refine my ideas? Heln Center Saved ideas (0) - My keyword ideas - My ad group ideas US. English I US Dollar (USD 3) : I Report an issue Sign in Help Find keywords Based on one or more orthe following: Word or phrase online social work Website _; l>, r, ,.~. iml Category »«: ::sr9l 7 only show ideas closely related to my search terms 7 + Amanced Options and Filters Locations’ United States X Languages: Engish x Devices‘ Desktops and butane About this data 7 Download v v Sorted by Global Honlhly Searcha v Colinlis v ~ ~/ Save all Search tom: (1) 1-1 on E < > Keyword Competition V Global Monthly Searches 1 Local flonttily Searches 7 — online social work V High 40,500 33,100 E Jsaveaii Keyword ideas (100) 1 -50of100 2| < > Keyword Competition V Global lloiitlily Searches ? Local floiitlily $arches 7 — social work online V High 40,500 33,100 7 online degree social work V High 14,600 12,100 _ online degree for social work V High 14,800 12,100 _ social work degree online V High 14,800 12,100 — online degree in social work V High 14,800 12,100 7 social work online degree V High 14,800 12,100
  44. 44. Coogle Adwords ilI: ii. : full’ Tools Keyword Tool V Include terms (0) V Exclude terms (0) V Match Types J Broad Help - Why should i use the Keyword Tool’? How do I use the Keyword Tool’? How can I refine my ideas’? Heln Center Saved ideas (0) Mly keyword ideas My ad group ideas 4f~Itu. ‘i¢-, i U. S. English l EW E i Report an issue Sign in : i3i| V Find keywords i Based on one or more ofltie following: Word or phrase online social worker Website Category fl only show ideas closely relatedto mysearch terms l: Advanced Options and Filters ,1: 2 Unned States 3: .3 _. u f5 English x _: :: a Desktops and laptops V . . Sign in with your Adwords Iogin infonnatiori to see the full set of ideas for this search. About this data Download v Sorted by Global hlonttity Searches v Columns v I Save all Search tienns (1) 1 -1 of1 El Keyword Competition V Global Molllllly Searches Local Monthly Searches online social worker V High 22.200 14.800 / Save all Keyword ideas (25) 1 - 25 or 25 El Keyword Competition V Global Monthly Searches Local Monthly Searches 7* social worker online V High 22,200 14,800 social worker degree online V High 8,100 6.600 social worker online degree V High 8.100 6,600 ’ online social worker degree V High 8.100 6,500 social worker degrees online V High 6,600 5,400 nnlime social wnrltnr rlenrepr. V Hinh 6 600, 5,400
  45. 45. ((6 If-l(‘~lI‘t= .f-, lli‘i. ~‘. "l(-i Practitioner Adoption? Over 1.7 million Google search results with these search terms embedded in metatags: online counseling = 842,000 results online counselling = 354,000 results online therapy = 484,000 results online psychotherapy = 40,000 results internet therapy = 28,700 results telecounseling = 15,000 results = 1,763,700 results
  46. 46. OCPM: Online Clinical Practice Management / . Step 1: Training Step 2: Referrals Step 3: Client Education Step 4: Legal Issues Step 5: Assessment Step 6: Direct Care Step 7: Reimbursement
  47. 47. Myths vs. Realities Not same No research It's too expensive No reimbursement It's illegal or unethical All telecounseling involves direct care No guidelines Doesn't need to be 1000s of articles Saves SS Reimbursable Legal and ethical Se| f—he| p can be developed Many guidelines exist
  48. 48. Copyright 2002 by Randy Glasbergen. wvw/ .glasbergen. coin ”lF AT FIRST YOU DON'T SUCCEED, BLAME YOUR COMPUTER. " 0
  49. 49. ailing . .. , . , '-'"" l_'-l(‘-lit? -,lli‘I. ~.-l('i Telemental Health Standards & Guidelines American Medical Association. (2000). Guidelines for Patient-Physician Electronic Mail American Counseling Association. (1999, 2005, 2013). ACA Code of Ethics American Mental Health Counselors Association. (2000). Code of Ethics of the American Mental Health Counselors Association, Principle 14, Internet On-Line Counseling American Psychological Association. (1997). APA Statement on Services by Telephone, Teleconferencing, and Internet, A statement by the Ethics Committee of the American Psychological Association American Psychological Association. (2010). Ethical principles of psychologists and code of conduct American Telemedicine Association. (2009). Evidence-Based Practice for Telemental Health American Telemedicine Association. (2009). Practice Guidelines for Videoconferencing-Based Telemental Health Australian Psychological Society. (2004). Guidelines for Providing Psychological Services and Products on the Internet British Psychological Society. (2009). The Provision of Psychological Services via the Internet and Other Non-direct Means Canadian Psychological Association. (2006). Ethical Guidelines for Psychologists Providing Psychological Services via Electronic Media Federation of State Medical Boards of the United States, |nc. , Report ofthe Special Committee on Professional Conduct and Ethics. (2002) Model guidelines for the appropriate use of the Internet in medical practice National Association of Social Workers. (1999), 2008). Code of Ethics National Board for Certified Counselors and Center for Credentialing and Education, (2001). The Practice of Internet Counseling. (2001) New Zealand Psychological Psychologists Board (2011). Draft Guidelines: Psychology services delivered via the internet and other electronic media Ohio Psychological Association. (2010). Telepsychology Guidelines
  50. 50. ACA Ethics Code 2014 * The first draft of the 2014 ACA Code of Ethics is now posted on the ACA website. * Please review and comment. Your input is essential and will determine your future online.
  51. 51. ‘V7 ‘ . .‘, I.: |j, :I . _ . ((6 ’ (}lK'~lIt#-, llli. ~.'0l(-I ACA Code of Ethics (2005) A.1.b. Records Counselors maintain records necessary for rendering professional services to their clients and as required by laws, regulations, or agency or institution procedures. Counselors include sufficient and timely documentation in their client records to facilitate the delivery and continuity of needed services. Counselors take reasonable steps to ensure that documentation in records accurately reflects client progress and services provided.
  52. 52. ((6 1,51!‘-lii= .*-, llli-~'-"Its APA Ethical Standard 6: Record Keeping 6.01 Documentation of Professional and Scientific Work and Maintenance of Records Psychologists create, and to the extent the records are under their control, maintain, disseminate, store, retain and dispose of records and data relating to their professional and scientific work http: //www. apa. org/ ethics/ code/ index. aspx
  53. 53. Primary Focus: Not the technology, but rather, the service we deliver Ina‘) . I | ’'| |IllH| ll l". H|llllllll ‘I I However, Different Modalities Require Different Skill Sets - In—person - Text (email, chat, texting) - Audio - Video 9/21/2012 55
  54. 54. V . ;m. Is. .I. ... ;.. ..I ACA Code of Ethics (2005) * Discuss time zone differences, local customs, and cultural or language differences that might impact service delivery.
  55. 55. (6 TELEMENTAL HEALTH ‘l"l'I| l te| ehealth. org 57
  56. 56. ((( ’i*‘j"""""Ll‘; ’f‘L"‘ telehealth. org Linguistic & Cultural Diversity
  57. 57. - 1.‘| r.= e - .5 . .. . (}"'-iIl74.V-, il‘lI'. 'l('I Multicultural/ Multilingual Issues Se| fhe| pMagazine. com Canada It Singapore Netherlands It Greece United Kingdom It South Africa Australia <0 Malaysia ' Japan <0 Israel Germany <* Belgium NewZea| and Sweden
  58. 58. [L H ta-| elIealth. oiq Multicultural/ Multilingual Issues Se| fhe| pMagazine. com ° Malaysia - Ireland ° Israel ° France ° Belgium ° Russia ° Sweden ° Spain ° Mexico ° Brazil ° Finland ° Austria ° SaudiArabia ° Poland
  59. 59. Multicultural/ Multilingual Issues Se| fhe| pMagazine. com ° Denmark ° Thailand ° Argentina ° Croatia ° Turkey ° Indonesia ° Philippines ° Norway ° Portugal ° Romania ° Peru ° Italy ° Hong Kong - United Arab Emirates - Pakistan ° Cyprus
  60. 60. ((6 4éIt‘4i‘i2., Illi. ~‘. '-I1-I Multicultural/ Multilingual Issues Se| fhe| pMagazine. com Brunei Darussalam Latvia Ecuador Venezuela Mauritius Bosnia—Herzegovina Slovak Republic South Korea (1 (1 (1 Bulgaria Uruguay Former USSR Lithuania Kazakhstan Ukraine Zimbabwe Georgia
  61. 61. . , n : , . .. _" " ‘ 1ElK‘~lIt#-, lll‘I. ~.'l1II Multicultural/ Multilingual Issues Se| fhe| pMagazine. com Iran Nicaragua Guatemala Virgin Islands (USA) Macedonia Netherlands Antilles Botswana Oman (1 (1 (1 Aruba Qatar El Salvador Jordan Kenya Papua New Guinea Dominica Madagascar Malta Namibia
  62. 62. . 1,! _r_: ) . .. , . , l ' ‘_: '(. ’;'I: ).; ,'i“'v'n"‘. ‘ Multicultural/ Multilingual Issues Se| fhe| pMagazine. com I Andorra I Iceland I Jamaica I Egypt Maldives I China I SriLanka I Chile Faroelslands I Czech Republic II Zambia I Luxembourg Estonia I India I Trinidad and Tobago I Colombia
  63. 63. ((6 4éIt‘4i‘i2., Illi.5.'-I1-I Multicultural/ Multilingual Issues Se| fhe| pMagazine. com Taiwan I Moldavia Lebanon I Yemen Dominican Republic I Switzerland Yugoslavia I Bolivia Bermuda I Ethiopia Slovenia I Burkina Faso Hungary I Bahamas Costa Rica I Belarus
  64. 64. ((6 (r: “{. —"i¢V'| “"“‘V. '{. I ACA Code of Ethics (2005) I A.12.b. Assistance I Counselors seek business, legal, and technical assistance when using technology applications, particularly when the use of such applications crosses state or national boundafies
  65. 65. ((6 4f4t‘~ii‘i2.. Illi. ~‘. '-I1-I ACA Code of Ethics (2005) I A.12.c. Inappropriate Services — When technology—assisted distance counseling services are deemed inappropriate by the counselor or client, counselors consider delivering services face to face.
  66. 66. T E T TH ((( “E” " ‘”'”“ ] teIehealth. or9 1 I N S T I T U I’ l Australian Psychological Society (2011 revision of Internet Guidelines) Research—based protocols — 1.6 ”Psycho/ ogists using the Internet to provide a psychological service should be aware of the extent to which therapeutic interventions via the Internet are supported by research or may be contra—indicated . ... ”
  67. 67. ((( IELEMENTAL HEALTH ltelehealth-org OCPM Step 1: Training Know how to find and follow peer—reviewed research protocols before offering services to consumers — http: //telehea| th. org/ bibliogr phv ° Look at: — funding sources — meta—analyses
  68. 68. YELEMENTAL HEALTH (6 l _ V 5 Y I Y U Y ‘ ] teIeheaIth. or9 Ical Standard 2: Research—based Protocols ° 2.04 Bases for Scientific and Professional ‘ Judgments ‘ l Psychologists‘ work is I/ / ‘ f / ‘ based upon established ,2 ' ' scientific and professional ‘ ' knowledge of the , I ‘*9 *‘ discipline.
  69. 69. V ' _, ‘g_a, g.'I§: .t. i;. ;L= ,~L! .=« ((( >‘. “L, T’V’l L V, ’ (: l[: hi9-lliv. <.~I1- OCPM Step 1: Training Boundaries of competence — Limits of technology <‘ Authentication “ How & when to respond, and when to use telephone instead — Role of research-based interventions and protocols
  70. 70. ((6 q; ‘4r-4.i¢m*. _.; .., .: OCPl/ I Step 1: Training “ Choice of Communication Channel (modality) — Responsibility of Professional? ' Technology specific training/ proficiency for each modality + combination of modalities ' Confidentiality for each modality to Client authentication for each modality * Practitioner authentication for each modality
  71. 71. ((6 (5‘lK'~lI‘l'«. V-, llli. ~‘. '-I1-I OCPl/ I Step 1: Training In Training for each technology " Training for dealing with boundaries between multiple Internet technologies: — Email / Chat Rooms — Telephones / Cell Phones / "Apps” / Texting — Videoconferencing (Public / VPN / Cloud) — Websites / Forums / Social Networking ' Which technology for which patient -- and when?
  72. 72. ‘V7 ‘: . . '.‘. :I‘, « : . , .. . ((6 (5lK'~ht#-, llli. ~.'-I1-I Clinical Competence Client/ Patient Selection " 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
  73. 73. §| .-! .'l! !-. -,'. - IAIQREP‘) FQR §t. J9§§§§ SUPPQBTEQ E. T! -!E Evnomcg §. A.§§ Coming next. .. Which models Are supported by research?
  74. 74. VELEMENYAL HEALTH ((( WHHUH )teleheaIth. or9 —‘-7' Nursing Homes 0 ID]! I‘¢<‘eMou-ml nulvh lrurllslle‘ Inc
  75. 75. A 7 f ‘F ‘ 1 . 1 . ac J &’ J‘ 51 3. ‘-5‘
  76. 76. Hospitals
  77. 77. Rural Hospitals
  78. 78. Correctiona Facilities 80
  79. 79. Home Health
  80. 80. Military & Veteran's Administration
  81. 81. I I fl _ ’ Opinion 62° Sunday". June 17. 2012 Last update: 8:28 pm. NEWS POLITICS BUSINESS HEALTH SPORTS OUTDOORS LIVING OPINION DBITIZARIES EVENTS . I_-RRYME CONTACT II-: —.: : I; l‘: ‘lTl cur I: I:Im~: >_IrIIt State I Art: II I‘-. I_I«; Li-ata I Ban-; I:<rI Donn East I H3nI: I:II: F’ : LewIstI Aiufiurn I l. llC! —lI: lEllfl-E‘ I l. III3cI: =ast I Pen . rI: ItI F‘isI: atauuIs I Portland . Search this site : I:; i:I-1: Prewous story: Next story: -- Republicans are moving Maine backward ALBERT . -. I]STII' DL'I'TO. ' >> Eorroms 3" ‘ IE] GET NEWS EMAIL UPDATES Surviving war to die in Maine T % T . ‘ ' " ” News .1 . ~.. .- 1. 2o~_‘earAold Appalachian Trail hiker drowns in pond in remote toivnship 2. 4 motorcyclists die in crashes across J. _ , ',c13M , mi NH at start ofbike week . ~s‘tVhe national antheni was played. .Iaine‘s 'orld War II veterans and other me1r. bers 02 the milir. ar_' and 3. Police identify man killed in Amherst -d thousaiids of spectators as they saluted the I_’. S. tlag during the 2010 is. banqordailvnews. com/ ,nm, I,. “ash
  82. 82. ValueOptions and American Well Partner to Deploy the First National Behavioral Telehealth Network NORFOLK, Va. and BOSTON, June 27, 2012 / PRNewswire/ -- Va| ueOptions®, a health improvement company that specializes in emotional wellbeing and recovery, and American Wellm today announced a partnership to bring critically-needed behavioral healthcare to patients wherever they are, whenever they need it. Using American WeIl's industry-leading Online Care telehealth solution, Valueoptions will transfonn behavioral healthcare by offering members immediate, live and clinically meaningful consultations. With American Well technology, Valueoptions will develop a first-of-its-kind, national network of telehealth-enabled providers. Through Online Care, Valueoptions members will have secure and private access to skilled behavioral specialists from home, work or any location where they have Intemet connectivity. Telehealth removes many barriers to healthcare such as distance, mobility and time constraints and can help lessen the stigma sometimes associated with behavioral health. Online Care provides Valueoptions an efficient and convenient solution to dramatically enhance behavioral healthcare access and quality for its diverse membership, which includes both commercial and public sector employees and their families; military servicemen and women and their dependents; as well as Medicaid, Medicare and dual eligible populations. "With over 130,000 provider locations, we have one of the nation's largest behavioral health networks. However, the reality is that there are still not enough providers to serve the growing demand for quality behavioral health services in every comer of the United States. Access to care is an issue for many, " said Heyward Donigan, president and CEO of Valueoptions. "Growing demand for telebehavioral health services is evidenced by the speed at which reimbursement is accelerating. Today, 34 state Medicaid programs have recognized the need and the value of telehealth services. These 34 states already reimburse for such services, and 14 states are mandating telehealth reimbursement. Additionally, we continue to witness increased demand for telehealth in the Federal marketplace as well as a growing interest in our commercial business segments. " "On| ine Care telehealth allows us to bring behavioral health directly to our members, " adds Dr. Hal Levine, chief medical officer of Valueoptions. "Whether location or transportation inhibits access, or perhaps a member is simply having trouble taking that important first step toward engaging available services, telehealth enables us to connect with the member where they are —— not just where they are located, but where they are in mindset when it comes to seeking treatment. " Valueoptions will harness telehealth to reduce the rate of missed appointments and increase compliance. Moreover. with Online Care, Valueoptions will build a more efficient. more convenient model for care delivery that will complement existing in-person services, lead to better health outcomes for members, enhance the bottom line for providers, and eventually, reduce costs 8:4" the system of care.
  83. 83. lLLLVl['-l"LHi; ‘«L"* ((( ‘ J‘ _ ‘"4 ‘ I i teIehea| th. org Migration Model ° Start with your current clients ‘ ° Select those who are reliable, have good support systems and with whom you have a good working relationship ° Considertheir diagnosis ° Take the time to prepare them 0 Plan In—person sessions at ______, .. _ regular Intervals ° Do not work through their . . secretaries or others
  84. 84. International Telehealth New York Times: Fighting Depression, One Wllage at a Time (lP and CBT discussed in a non-Western setting) Inbox X -3- Q Les pose" Q 3114 PM (55 minutes ago) Os - X0 LES ' Fighting Depression, One Village at a Time By TINA ROSENBERG Fixes looks at solutions to social problems and why they work, http: //opinionatorblogs nytimes com/2012/07/18/flghting—depression-one»viIlage-at»a~time/ ” . I‘ ’ .1 _ Greg Miller/ Science magazine A community mental health nurse discussed stress management with women in a village near the town of Bireuen. on Aceh’s east coast, What is the most burdensome disease in the world today? According to the Wond Hearth Organization. the disease that robs the most adurts of the most years of productive life is not AIDS. not heart disease. not cancer it is depression,
  85. 85. . (:3 4’ I. ((( Y[| LE‘~: E:”| AyL: L;AL"” ytelehealthnrg H ’ 5' ACA Convention 2013 Web Page ""‘. ° Resources: % —S| ides heft‘ . ha‘ I — Social Media Policy — Bibliography — Time—Limited Bonuses TMH Institute Website: www. te| ehea| th. org/ aca2013
  86. 86. t‘lE‘llEvIlil“l_O: ‘(; Where Are the Problems? ° Email ° Chat ° Text Messaging ° Telephone / VoIP ° Video Chat ° Smartphone ° Tablet PC ° Peripherals - VPN / Cloud Video ° Google Phones, Robots ° Electronic Health Records (EHRs)
  87. 87. ux~4.i~. r.il1.. !.-up Australian Psychological Society (2010 proposed revision of Internet Guidelines) Research—based protocols — 1.6 “Psychologists using the internet to provide a psychological service should be aware of the extent to which / , ‘ therapeutic interventions via the ii , internet are supported by it E research or may be contra- indicated for a particular disorder or psychological problem. ” 1.}
  88. 88. , ‘! ':‘i"‘m‘: ""'{""; "‘: 'i‘! "‘~. ':‘ l'—ll: l1l'—‘-ll3I. ~.-lI. - Definition of Terms Behaviorai 1-eieheaith Telehealth vs. Technology? Eheahh ‘ ' Telehealth ‘ ‘ , ,l ' Telemedicine ' Telemental Health ' Telepsychology Online Counseling “ Online Therapy mHea| th ' Telecounseling
  89. 89. ((6 4_‘«lt‘4u‘i2., ilt’-.5.’-it-I Effective Conversations? Different Professions / P““““““' "““’ations & Their Respective Ethic — Psychiatrists " — Psychologists — Social workers V V — Counselors 5‘, " Regular '* Family & Child '* Pastoral V3.7 " Substance Abuse
  90. 90. l'—l[= lvi9-lliI. <.-lv Online Norm / s. Standard of Care No Contact with Other Treating Clinicians No Authentication of l . --~ ‘ DI ‘ , V __‘. ::“" Consumer/ , M “f Professional ‘lit’: L . :i No Emergency Backup Q. __, . Z "-g§. .—_3l-l Procedures ’ in ‘S. Misunderstanding of gt Clinical Processes , (suicide) Operating w/ o Needed Research for Unsupervised Settings
  91. 91. 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
  92. 92. 4 Key Aspects of Risk Management - Know the Applicable Standard of Care for Your Patient Population and within Your Discipline - Legal Code - Ethical Code ° Malpractice insurance
  93. 93. OCPl/ I Step 4-: Liability Insurance <* Likely to be nullified if practitioner is practicing criminally (e. g., w/ o proper license or improper billing practices, depending on state) <‘ For benefits to apply, must have: — a formal client agreement for clinician to be considered as providing professional services <* Often can have ”coaching” added to policy for additional fee if certified by recognized group
  94. 94. ((6 4_‘«lt‘4I‘i= .r. ,ilt’-.5.’-I1-I Risk Management Save all proof of training or consultation to prove you've ”sought the advice of your peers” Record Keeping: " _. ' — Document, document, document , - Protocols Followed / - - Time in, time out '31 - Dropped connections ’ - Intrusions - Lighting - Adaptive Equipment - Progress toward establishedl goals . 1"‘
  95. 95. l? —l[3lIl'—‘«ll3l. ‘.'ll. ' Inter-jurisdictional Issues (practicing over state lines or national borders) Practitioner must be Hcensed: s In a state 6* In the local state of patient 0 Both Government House of Representatives Approve Internet Doctor Treatment State Representative Dan Winslow (R-Nor1oil<) who represents Medfield saw his proposal to ease Access and reduce medical costs pass the House this past week June 16 2012 , !’Tweet 0 Email Print 6 COTTIFFIEMS Editor's note The following was submitted by the Dan Winslow Committee In a move that could revolutionize the delivery / ‘ access and cost of primary healthcare in Massachusetts. the House of Representatives I ’ approved a plan to allow doctors licensed ’. . . anywhere in the United States to consult ‘ E T , ' / M ‘, . Y" . 4 diagnose and treat Massachusetts residents by I ‘ ‘ , ‘ I" ' internet video examinations V » [ I “Telemedicine will allow qualified physicians to be immediately available 24/7 and as near as your computer or smanphone "said lVledfield's State Representative Dan Winslow (R—Norfo| k) who sponsored the legislation "It approved by the Senate and signed by the Governor this new technology will be a godsend to worried parents in the middle of the night to seniors who are confined to home to residents in rural areas who lack convenient access to primary care physicians and to anyone who can't wait a tew days or a week to obtain a prescription " said Winslow (3) Upload Photos and Videos Under the plan as approved by the House Massachusetts‘ Board ot Registration ol Medicine will develop and implement standards for a "telemedicine" license for which physicians licensed in any state will be eligible to apply Massachusetts is home to a number of high tech companies that are developing telemedicine technology including Americanwell com which provides more than 100 jobs Telemedicine can range trom computer or sman phone consultation to high tech video booths at drugstores that include blood pressure and temperature sensors Telemecl doctors can expedite referrals to specialists and in person exaniiriations when needed Related TODICSI Dan VVll'lSlOW HOUSE Ol REDIESEDIEIIIVES and lDlEfl1El DOCIOI
  96. 96. ((( '"L"'H"lLH/ 'L‘” teleliealthpio Benefits of Traditional Video—Based Te| ehea| th* - Increased client satisfaction ° Decreased travel time ° Decreased travel, child & e| der—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 Maheu, Pulier, Wilhelm, McMenamin & Brown-Connolly. (2004). The mental health professional and the new technologies. Erlbaum, New York.
  97. 97. i. ‘4t-4-H-. ilI, '-.5.’-it-I 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) r 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
  98. 98. ((( '"L"'”M'k: /'L‘H teleliealthpio 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 te/ ecare 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.
  99. 99. ((( V"l""l'll‘ll“"lLlull. ” telehealtnoiq 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[a0027924
  100. 100. ‘<, .,__) J / (c; . .i. ... ... ... ... ... av’ Email Relative lack of literature when compared to video teleconferencing (TVC) Most insurances won't reimburse Reimburse_men_t is usually _ based on time intervals — email work is time consuming Lack assessment and intake tools Perhaps most useful when client is known to a system, EAP, VA, corrections
  101. 101. , ‘l'; “"“‘l‘l“: "l"“'&"“-: 'l‘l! ’l‘-ll‘ l'—l[: l1l'—*-llin. ~.-lI. - K‘. 1.; l . 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). * , 4 I l / ;' ; ‘ ‘ 3 ls such use appropriate / " §'( “* k without training? * Jacobsen, T. & Kohout, J. (2010). 2008 APA Survey of Psychology Health Service Providers: Telepsychology, Medication and Collaboration. APA Center for Workforce Studies.
  102. 102. OCPM: Online Clinical Practice Management / Step 1: Training Step 2: Referrals Step 3: Client Education Step 4: Legal Issues Step 5: Assessment Step 6: Direct Care Step 7: Reimbursement
  103. 103. ((6 1,-lK'4ui¢, illi. !.-in OCPM Step 2: Referrals or Internet Marketing (IM) Provider lists Colleagues with telehealth training in Professional websites, blogs, apps All iPhone Apps for "mental health" iiiiiii Kr-all i ~'. .ai ; IIAIK ms; - ll IIRFH I “ I‘ x U‘ H I l u. -«mi u. -um no-ml. .., $3: me" me um Dunn» rnz-my um Rum! lur)-"VIII u-um N-A «-. ~:. ,-. i wear -_m : rm» : Ie: .;- l , ‘ _ a. .¢. ua~. ..r»' .1’, lllll'k i. -.: «.. :=¢ ~20-: V , lonnv: ".a(I' : : -~ u. -sum - ’ i _ um . u.iv -
  104. 104. ((6 fill! ‘-llli. ’-, il‘lI-"-"| ('~ Vignette of Email Referral “ You receive an email referral. You're not sure of the referral source, because it isn't mentioned. The person doesn't mention where they live, so you ask. They type their street address, and you see they are in your county.
  105. 105. ((6 (5llK‘~lIl= .i-, llli. ~'. 'vI(-i Vignette of Email Referral * The email describes the details of how a prospective patient ”had to punish" her elderly grandmother for not eating and not bathing last night. The consumer is requesting your professional services for managing her anger toward her grandmother.
  106. 106. l «_-‘4x-4.i2., ilI‘. .~‘. '-nu. Vignette of Email Referral “ You have her name, street address and telephone number, as well as that of her grandmother. 1* The note describes the punishment in enough detail that you have reason to report her for elder abuse. The consumer awaits your response. * What do you do?
  107. 107. ((6 (5llK'~lI‘l'«. V-, llli. ~'. '-I1-1 OCPM Step 2: Referral Solutions — Only give referrals to professionals you trust are following state and federal legal (civil court — tort law), regulatory (state board) and ethical (professional association) codes — If your colleagues can't discuss the required codes related to telemental health intelligently, and are using technology for their practice, they probably aren't following them carefully — How much liability are you prepared to accept?
  108. 108. OCPM: Online Clinical Practice Management / Step 1: Training Step 2: Referrals Step 3: Client Education Step 4: Legal Issues Step 5: Assessment Step 6: Direct Care Step 7: Reimbursement
  109. 109. 9 Discuss risks and benefits of email communication in your informed consent process 9 Outline how your mandated duties to report/ warn will be handled 111
  110. 110. ((6 (}lK‘~JI‘l'«. V-, llli. ~‘. '0I1-I Clinical Email Acquaint your patient with technology's limitations — Speed of response — Language skills of both participants Admonition: Not for emergencies — 911, ER, local provider — Emergency back—up can be difficult to arrange and all but impossible to assure — Extract a written pledge
  111. 111. V ‘= . . '.l. :I‘, i : i . . . ((6 4,41-4.x~. .v. ,iiz‘. ... ‘-it-. Clinical Email, 2 is Joe Friday: Just the facts, ma’am — Not the time to be clever, flippant, cute, amusing, humorous , Proof your email by re-reading before E‘ . .;. <. _. sending ‘ ” Check the ”To” line 3;‘ K Al V : ll‘ ‘"0" -l " l‘‘-: i'i1' -9 ‘
  112. 112. l tflll‘-IIl= .’-. llli. ~'. '-I1-I PafientEducauon Email / Texting ' Social networking 1‘ File exchange : ‘ Computer repair In Clinical records 1* Insurance * Reports ' Lateness / Missed sessions Non-compliance/ Avoidance
  113. 113. ((6 (_3l(‘~JI‘l= .f-, ll{i. ~‘. '0I(-I Board of Behavioral Sciences (BBS), California The informed consent procedure shall ensure that at least verbally and in writing: (1 ) . ... option to withhold or withdraw consent at any time (2) . ..potential risks, consequences, and benefits of telemedicine. (3) All existing confidentiality protections apply. (4) All existing laws regarding patient access to medical information and copies of medical records apply. (5 ) Dissemination of any patient identifiable images or information . ..shall not occur without the consent of the patient.
  114. 114. ‘V’ ‘ . .‘, l.: |‘, I : I . .. . ((6 (_= Il‘vIII1-, ll{i. ~.'-I1-I 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.
  115. 115. APA Ethical Standard 9: Assessment ' 9.01 Bases for Assessments In 9.02 Use of Assessments ' 9.03 Informed Consent in Assessments ' 9.04 Release of Test Data In 9.05 Test Construction In 9.06 Interpreting Assessment Results In 9.09 Test Scoring and Interpretation Services * 9.10 Explaining Assessment Results In 9.11 Maintaining Test Security
  116. 116. (0 '; ,;'. I‘. 'lI'-Ll-1/-L"' te| eI1eaIth. oi :4 ° Save all proof of training or consultation ° Records: — Document, document, document Clinical Issues ° Have a social media policy ° Have an addendum to your informed consent ° Communicate often to your local, state and national professional associations
  117. 117. ((6 (§‘ll'~I| 'l’4.*-, Illi. -'. '-I('I OCP| /I Step 6: Direct Clinical Care «:1 Explain & sign informed consent document «:1 Conduct a formal intake — no shortcuts Meet in-person or video, take full history, medications, illnesses, abuse, stressors, support system, use of other technology, drug/ alcohol use, suicide/ homicide intent, mental status Decide if then which technology is appropriate : - Obtain names of all other key providers, get all appropriate
  118. 118. - 1.‘ Jil - .4 . .. K ' (_= l{‘-M1-, IllKI. ~.-I1-I ACA Code of Ethics (2005) It A.12.g. Technology and Informed Consent — 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.
  119. 119. tzllzlvifi-Ilin. <.-I1‘ APA Standard 10: Informed Consent 3.10 Informed Consent T F (d) Psychologists 0 appropriately document / written or oral consent, permission, and assent. — http: //www. apa. org/ ethics/ c ode/ index. aspx II
  120. 120. I lLLlTlllL'llKlllLll; ’KKlLK'“ telehea| th. org Risk Management ° Have an addendum to _ your informed consent — Include a social media policy - Communicate often in writing to your local, state and national professional associations ° Have written emergency plans
  121. 121. ((6 can-I. ‘Iar, lIII. :;-It-I APA Standard 10: Informed Consent 3.10 Informed Consent (a) When psychologists obtain the informed consent of the individual or individuals using language that is reasonably understandable to that person or persons except when conducting such activities without consent is mandated by law or governmental regulation or as otherwise provided in this Ethics Code.
  122. 122. I£LEME'-II'LHUILI ((( , ., . , INK. KK , ll teleheaIth. org PA Standard 10: Informed Consent ° 3.10 Informed Consent (d) Psychologists appropriately document written or oral consent, permission, and assent. — http: //www. apa. org/ ethics/ code/ index. aspx
  123. 123. ((6 (}‘ll'~lIf= .f-, llli. ~‘. '-I1-i Secure Email * Internet, email, SMS and other teleccommunications from clients are not forwarded by psychologists to others without the consent of the client. “ Psychologists are particularly aware of ‘strings of messages’ contained within communications.
  124. 124. ((6 (; ‘ll'~lIf= .f-, llli. “.'-I1-i Texti n g * Convergence (2 HIPAA compliance “ Lost/ Stolen Phones (2 HiTECT Act - report to client ' Download to patient file
  125. 125. Obarna’s Antiquated Cell Phone Breach! : :m-rw‘él'l Now playing on your HDTV CElISuo‘_Z‘n Seams‘ Daily Intel 1 . ' =2 t| :" _': i a- IESSICAPILSSLER W 5 ”cF°‘ '3 1: E-r~. -.aIl zl- NI CK E‘. -1'L'I'. ‘CI «Eel are P55 lees DANAMIEA iur i-, n N‘ll>. |l¥V. I. ECEV'I' N"E'S All Blogs Daily Intel On. re :51» rear '/ oi. con‘. 8 — . . As President-elect Obama comes to grips with the fact that he may very well be Did 33'adle. ' -“inning Share — facing four or more years without a BlackBerry. here's some news that might Cl, a5,5ified D°C“m’"t5,“Vith , , , , . . N1k1Leaks for Attention? make it a bit easier for him to unplug: In an internal company e-mail sent on : 'ednesda_‘. Verizon Wireless revealed that Obamas wireless account had been ' 7’ _ f "accessed by employees not authorized to do so. ‘ Chilling! Or not. really? The %’ account had been inactive for several months. so it's just. like. shady. ' ” Police Help Harlem . Ian Set New Verizon claims that these rogue staffers were just looking at billing records and Bullet-VVound Record ‘nobody was monitoring voicemail or anything like that. ’ Good — that makes it _ easier to resist indulging our half-baked theory that the Verizon Guy is a spy for Naomi Canipbell Disappointed That Hillary. It would’ve been a lonely tangent. So we guess this was just a matter of Blood Diamonds V‘eren't Shinier kindly Verizon employees volunteering for some non—campaign-finance V - _ monitoring? That's nice of them to help keep track of the not-so—rele'ant books. Chopsticks-I-'riendl_‘ Pop-Tarts Are. But really, rather than get all indignant and paranoid about it. let's be realistic Fi| '13”. '- 3 9-€3hl'. ' about what probably happened: On some boring summer night in Boise, a few _ stoner employees probably went out for some beers after work —- and dude. Campaigning Denis Asking for wouldnt it be hilarious if they went back to the office right now and. like. looked F1-OTVS up famous names on the billing computer? Just to see what comes up? I-ia. — —- yeah. lets finish smoking this and then well go screw around! Right. BP's Cernent Plug Has Hardened - Also worth mentioning: The wireless account in question was 'a simple voice flip~phone' that couldn't access email or the Web. .-w! ‘'e remember our first StarTAC like it was just yesterday. .. I’a‘~v fltsnbsvunvn Donna‘ A6 . .91. MOST COBQETED Obanaa 5 Cell Phone Records Breached [C. ‘3.'] Daily “"3. Vumfle Grub Shea me cm
  126. 126. ‘ ! ,:_! _3‘l'l'3.-'3". -l; V-, ':l3I HIPAA compliant email companies 1. 4securemail Y 2. Hea| thBI 3. Hushmail -- /4 V ‘. offers free accounts L/ /E_“”7;<— 2 ‘ 4. | |eomai| box K’ l’— l 5.Luxsci 6. SendInc -- offers free accounts
  127. 127. ‘ 7 , : an . I l. u_: l I : . , ‘LL 13' ’ ‘L’ '_"! "~' l'J. [:l1I'—‘-lHI. i.-lI. - 3 l , . Conduct a Search for Your Own Name in Google l. lar-lei: -,— l. '.al~. -:-L. ' - sh. -ma _ _ K‘ ; / - l Vs l Marlene Maheul marlene maheu marlene maheu phd marlene maheu online therapy marlene maheu telehealth manene maheu san diego ca marlene maheu san diego maheu marlene m phd manene m maheu marlene m. maheu ph. d dr. marlene maheu Google Search l‘m Feeling Lucky r; _
  128. 128. English ~ Near (Address. Neighborhood. City, Slate or. San Francisco, CA Search for (e. g. taco, cheap dunner. Max's) Real people. Real reviews. 5 Find Reviews Welcome Aboume WrlteaRevlew FlndFriends Messaging Talk Events don't miss TODAY'S deal from A781’ Keely Kolmes, PsyD Category: Counseling 8. Mental Health [Edit] 220 Montgomery Street {lg Suite 400 (between Bush St& Pine St) San Francisco, CA 94104 Neighborhood: Financial District www. drl<koImes. com Hours: 9! Appointment Only: Yes Mon 1 pm - 7:30 pm Tue-Wed 11 am- 7 pm Thu-Fri 11 am — 5 pm View Larger Mapll Edit Business Info Browse Neamv: Restaurants | Nightl 4 Write I Review Deals Nearby 0 10% oh Ayurvedic consunations at Ayurveda for Balance - Debra Riordan CAS fell: Ad 575 for 5 . _‘ 6 reviews . Magnoli: .yelp. com/ nap/ keely-lcolms-psyd-San-francisco lifestyle recommendations and seasonal cleansing with , "" l 33" Fla‘
  129. 129. - : '.l‘. 'l r-Li--. /.L‘~ telenealthci Q Rating Sites: Yelp (Keely Kolmes, Psy. D.) - Your right / Gently discourage for these reasons: 1. The American Psychological Association's Ethics Code states that it is unethical for psychologists to solicit testimonials: Principle 5.05 ”Psycho/ ogists do not solicit testimonials from current therapy clients/ patients or other persons who because of their particular circumstances are vulnerable to undue influence. " Since you may decide to return to therapy with me at a later date, I do not request testimonials from people who have ended therapy with me.
  130. 130. . 1,! _[: y . .. , . , l ' (}"'-‘I17.’-, l“lu'. 'I(" Rating Sites: Yelp (Keely Kolmes, Psy. D.) * 2. Unlike other business owners who may respond to their Yelp reviews, as a psychologist, I must provide confidentiality to my clients. This means I am restricted from responding in any way that acknowledges whether someone has been in my care. Thus, I do not intend to respond to any reviews.
  131. 131. ((6 4f~ll‘~iui¢. llli.5.'-not Rating Sites: Yelp (Keely Kolmes, Psy. D.) ' 3. I hope that if we work together, we can discuss your feelings about our work directly and in person. This may not always feel comfortable, but the discussion of positive and negative reactions to our process can be an important part of your therapy. If it is simply a matter of poor fit, I ’m always happy to help you find a therapist who is a better match.
  132. 132. ((6 £4!‘-lIi: .*-, llli-"-"|1'l Rating Sites: Yelp (Keely Kolmes, Psy. D.) * 4. If you still choose to write something about my practice on Yelp, remember that this is a public forum and you may be sharing personally revealing information with a wide range of readers. To preserve your privacy, consider using a pseudonym that is not linked to your regular email address or friend networks.
  133. 133. ((6 (}‘“'~lIi= .*-, lllil. “."I('i Internet Ratings: Where are we going? “ Expect ratings and quality surveys by healthcare providers to become standard operating procedure by smartphone app users. “ Yelp — They can rate you but you can't fully defend yourself without violating confidentiality
  134. 134. Social Media Is Not Private ° ”. ..assume that anything you post will be seen, read, and open for comment. Anything you say, post, link to, comment on, upload, etc. , can and may be used against you by your peers, colleagues, employer, potential employers, fellow members, and so on. ” - APA http: //www. apa. org/ about/ socia| —media—po| icy. aspx
  135. 135. HK. R up SanDlego, CA 03 fl_J_(_l__J1/182010 Qfirsteoneview Stay awayll No therapist who works for them, no matter how good, worth the bl. 2 of their ttlerapists at2 different stages in my lite. The tirsttime. I canceled an an for the doctor. The receptionist never gave the doc the message and then they ha payment Countless hours wasted on phone calls 8. letters of documentation. The 2nd time (it was years later 8. I'd forgotten that I already hated them - big mist copay. I called my insurance co. and the representative called Psycare with me tc 45 minutes 8. 3 transfers later. we finally talked to someone in Billing. By thattiml Ever hear your insurance rep do your yelling for you? Its hysterical! Along the same lines, every time I called, regardess of the reason, I was on hold exaggeration. Wasthisreview ---'-’-(4) -(3) § . Bookmark — Send to a Friend ‘Link to This Review
  136. 136. ‘ ' . i: uii= ..'v. .». .=i= _l_I-: - ( 1‘ "L: _"~ l'—ll3lIl'—‘«ll3l. ‘.'lI' It is ethical to have a "Time| ine” Page on Facebook or a similar advertising page on Goog| e+ ? 'T, l!l': l:'l! lI]t- . -:— : ' ‘ I ; e:. : , ia: e,-: ' ,5 .4‘ ; _», ,'_, _.; .-. .; .»i. :.i 'i-7‘-- Ti- ( I Telemental Health Institute rnnenne v now v Highfigllts v Admin Panel Te| eMental Health Institute g M / i I I I bhicalgglilgeiulirlrtfi. » ; (; web‘ Val. ’ , « A. , I o"-: Telehea| l:h(§ (E. '7 "'13 Lmé ‘K ‘teléii. i1éhua -a~e! §5tE9.l$. t:. “;: ‘, g-. ‘;‘: :fS% I l'l. l 3 ’ é "”'Eo> ~ xw 11 ‘II! » ~= -~~~l.2 It Telemental Health Institute -5 like iii -v ‘ W I'l-‘~41’ ll Reseerelnsesed eroreseioneirreining furTelel‘lealtti, ‘ . ;-__‘* "’ £1 ' ( V _ ( reiemeniaiHeaimsonimerherepy v: '.. li. g. , N as 164 ' 3* 8’ ‘HQ : *'¢‘°‘4‘ r-me: (welcome LIKES Status 3? Photo / video Event, Milestone + ( 'le| ementa| HealthInstitute: V : — — rl : . if" '1 3 Easy Mobile Security Tips, Telel-Iental Health News, August , '_; ‘,‘, I-lake A Fan Page A Success 8} ifri-erig, —:' —, :“= 138 Goodtherapymg
  137. 137. ((( ; ,:l. l‘. 'lr'-Ll‘: /-L“' telehealth-Om APA Ethics Code — Standard 5 - 5.01 Avoidance of False or Deceptive Statements —— ads, endorsements, resumes, CVs, published materials ° 5.02 Statements by Others —— we remain responsible, do not compensate media, clearly identify paid ads — webmasters and plagiarism ° 5.03 Descriptions of Workshops and Non—Degree—Granting Educational Programs — accurate ° 5.04 Media Presentations — based on literature and practice ° 5.05 Testimonials — not from current clients - 5.06 | n—Person Solicitation — protect others from our undue influence 9/21/2012 139
  138. 138. OCPM: Online Clinical Practice Management Step 1: Training Step 2: Referrals Step 3: Client Education Step 4: Legal Issues Step 5: Assessment Step 6: Direct Care Step 7: Reimbursement
  139. 139. All Existing Legal and Ethical Rules Apply
  140. 140. Skip in Content I Footer I Accessibility DepartmentofCansumerAffairs ( -GOV Board of Behavioral Sciences Search BBS Home Board Activity CONSUMER RELATED TOPICS . ... ... ... -_ D D D D V QUICK HITS >) >) >> >) >> D >) >> >) >) us What's New Board Meetings Customer Satisfaction Survey Consumer Complaint Form Department ofconsumer Affairs Frequently Asked Questions Online License Verification Pending Decisions and Opportunities for Public Participation Recommended Links Statutes and Regulations q. .r. enal. .. I Eat iH>n- / /unulu 1-: nru/ Consilineis App| icanlJRegistralit LPCC Exalns Licelisees Forln5IPlll)s ContaclUs ’. ‘-: -rtal ~93 ti‘ Aiilal>: -I‘ . ..C‘. .’. ¥.'§! .1}! l.‘? ..1.‘. l!! f9!T! ¥!%! i9I! §§S? !F!1i§S.9¥! li! !§. lT§X9l!9Fl!9¥i! P¥ . ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. Notice to California Consumers Regarding Psychotherapy on the Intemet The Board of Behavioral Sciences (BBS) would like to make the following recommendations to Califomia consumers who choose to seek therapy or counseling over the Intemet. Individuals who provide psychotherapy or counseling, either in person, by telephone, or over the Intemet, are required by law to be licensed. Licensing requirements vary by state. Individuals who provide psychotherapy or counseling to persons in Califomia are required to be licensed in Califomia. Such licensure permits the consumer to pursue recourse against the licensee should the consumer believe that the licensee engaged in unprofessional conduct. Be a cautious consumer lr/ rlen seeking therapy over the Internet, or by any other means, by doing the following: -->> Verify that the practitioner has a current and valid license in the State of Califomia. -~» Be sure you understand the fee that you will be charged for the services to be rendered and that you flllly understand how and to whom the fee is to be paid. -~>> Be sure you are satisfied with the methods used to ensure your communications with and by the therapist will be confidential. -->> Be sure you are aware of the risks and benefits of doing therapy, over the Internet or by any other means, so you can make an informed choice about the therapy or counseling to be provided. ~>> According to Business and Professions Code Section 2290 5, prior to the delivery of health care via telehealth, the health care provider at the originating site shall verbally inform the patient that telehealth may be used and obtain verbal consent from the patient for this use. The verbal consent shall be documented in the patient’s medical record. All laws regarding the confidentiality of health care inforrriatlon and a patients right to his or her medical information shall apply to telehealth interactions. Business and Professions Code Section 2290.5 (a) For purposes ofthis division, the following definitions shall apply: (1) ‘Asynchronous store and forward‘ means the transmission of a patient’s medical information from an originating site to the health care provider at a distant site without the presence of the patient. (2) ‘Distant site’ means a site where a health care provider who provides health care services is located while providing these services via a telecommunications system. (3) ‘Health care provider’ means a person who is licensed under this division. (4) ‘Originating site‘ means a site where a patient is located at the time health care services are provided via a telecommunications system or where the asynchronous store and forward service originates. (5) ‘Synchronous interaction‘ means a real-time interaction between a patient and a health care provider located at a distant site. (6) Telehealth‘ means the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, om-romnno Ml. ..--. or. » . --m. n. -en-uummno and unit m-in-mnmnno .6 -. n-| OinnO'H kn-IIOH 1--In! Iuhlln elm IL-I. lhll§ ; .- -Id ORA nelnzn-loin. an. and um Inn-ll». .--m. nlnniflnr in -in -. Al. -o-mo em.
  141. 141. l£LEME'-tl'LHLM_l ((( , ., . , I", _ , I " telehealth. org Competence ° (i) A psychologist shall not practice outside his or her particular field or fields of competence as established by his or her education, training, continuing education, and experience. Cal. Bus. & Prof. Code 2915.
  142. 142. Business and Professions Code Section 2290.5 (a) For purposes of this division, the following definitions shall apply: (1) ‘Asynchronous store and forward‘ means the transmission of a patient's medical information from an originating site to the health care provider at a distant site without the presence of the patient. (2) ‘Distant site’ means a site where a health care provider who provides health care services is located while providing these services via a telecommunications system. (3) ‘Health care provider‘ means a person who is licensed under this division. (4) ‘Originating site‘ means a site where a patient is located at the time health care services are provided via a telecommunications system or where the asynchronous store and forward service originates. (5) ‘Synchronous interaction’ means a real-time interaction between a patient and a health care provider located at a distant site. (6) ‘Telehealth’ means the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient's health care while the patient is at the originating site and the health care provider is at a distant site. Telehealth facilitates patient self—management and caregiver support for patients and includes synchronous interactions and asynchronous store and forward transfers. (b) Prior to the delivery of health care via telehealth, the health care provider at the originating site shall verbally inform the patient that telehealth may be used and obtain verbal consent from the patient for this use. The verbal consent shall be documented in the patient's medical record. (c) The failure of a health care provider to comply with this section shall constitute unprofessional conduct. Section 2314 shall not apply to this section. (d) This section shall not be construed to alter the scope of practice of any health care provider or authorize the delivery of health care services in a setting, or in a manner, not otherwise authorized by law. (e) All laws regarding the confidentiality of health care information and a patient's rights to his or her medical information shall apply to telehealth interactions. (f) This section shall not apply to a patient under the jurisdiction of the Department of Corrections and Rehabilitation or any other correctional facility. (9) (1) Notwithstanding any other provision of law and for purposes of this section, the goveming body of the hospital whose patients are receiving the telehealth services may grant privileges to, and verify and approve credentials for, providers of telehealth services based on its medical staff recommendations that rely on information provided by the distant-site hospital or telehealth entity, as described in Sections 482.12, 482.22, and 485.616 of Title 42 of the Code of Federal Regulations. (2) By enacting this subdivision, it is the intent of the Legislature to authorize a hospital to grant privileges to, and verify and approve credentials for, providers of telehealth services as described in paragraph (1 ). (3) For the purposes of this subdivision, ‘telehealth’ shall include ‘telemedicine’ as the tenn is referenced in Sections 482.12, 482.22, and 485.616 of Title 42 of the Code of Federal Regulations. lfyou believe you have been treated unprofessionally by a BBS licensee, either through treatment over the Intemet, or by any other means, review our information on filing a complaint llnrfatr-rd‘ . l:-rniranr 73 701?
  143. 143. Ht‘-hi? -llir. i.-ll' Duty to Report / Duty to Warn (v) Failing to comply with the i fl child abuse reporting requirements of Section 11166 H‘ ’ I of the Penal Code. V’. ' ‘X (W) Failing to comply with the elder and adult dependent abuse reporting requirements . . , of Section 15630 of the 1 a , , r “_: ji. !. Welfare and Institutions Code. 1» T ‘A if I. CA Business and Professions Code , , 5,1,1}: “Mi g 1 H Sections 4989.54(cont. ) A , ;
  144. 144. ‘IE L‘-'l1Il2ll2I Fl: intlg. r Glaebergen. iiwrw. g|: isbergeii. com "Information security is beeerrring a big problem here. Be jreu still have my Captain llruneh rleeeder ring, Ilila? "
  145. 145. a ‘ _' ‘ I Practicing Over‘ State Lines
  146. 146. Cross-Border Practice Licensing Boards that may assert jurisdiction: — The one in your state — The one in the patient’s state — Both “ Safest: — Provide services only where licensed — Require pt to attest to his or her citizenship there
  147. 147. Cross-Border Practice - Decline clients where you are not licensed ° Require prospective client to legally represent he/ she's a citizen of a state — Use authentication services ° Biometric — Voice — Thumb — Iris — Use traditional proof of residency — Driver's license, registered to vote, utility bills %
  148. 148. Question ° What harm am I doing if I practice over state fines?
  149. 149. j’ L fit ‘It I TOOK THE ‘:3 I-' LAST cup ' OF C0FFE, E I TOO MUCH arrests -< MAKE A I U / wfireqseio Kpueu oooz is 6m9 WHITE COL. _LAl2 CRIMES
  150. 150. Licensure How Much Land Does a Man Need? — Leo Tolstoy
  151. 151. Question ° I'm ok if my malpractice carrier says they cover me online, right?
  152. 152. Question ‘ Can licensing restrictions be put aside if no money is exchanged?
  153. 153. What if you just ask a consumer to sign a disclaimer? You can ask, but most courts will not support your having asked a vulnerable patient to sign away their basic U. S. rights —— such as the right to privacy.
  154. 154. What if I claim Beneficence vs. Malfeasance? r Are you in an emergency situation? < Did you document your rationale adequately to defend yourself if something goes wrong? C Did you run your rationale by your own local attorney? < Did you describe your rationale in writing to your licensing board, ethics boards and other colleagues? r Are you sure your malpractice ca rrier will cover your civil as well as regulatory risk? Get it in writing.
  155. 155. 1,-lt'4ri¢, rlli. !.-it-I OCPM Step 3 Legal Issues: Which Technologies to Use? -wrung, ’ ma No Guesswork Needed FHPAA Compliant Handoff Sessions _ b ‘I I any Device over any e, }: ,‘; :v‘°"rk . ‘ SWeepIng‘F' ‘ Be iiirobjjem _ i. ,~—--5 “I E Zgfigk j
  156. 156. ((6 ur~4iia. iri. .!. -in Internet-based, VTC Companies Claiming HIPAA Comp| iance* vvvullvil mr HWAA Compliant Handoff Sessions any Device over ansfixfionrk - Sweeping‘- www. te| ehea| th. org/ video * 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. g'. . -"~'i’3‘-| "', "= “:°'5’-i'-, ‘ L3,? ‘
  157. 157. Three HIPAA Rules: Transmission, Privacy, Security -. ,,, .. . ~. “ 3” ’ / ' gk .3, . , , A r ‘V. ‘ Q. , 7 8: ) ' ‘ V"; _, l rah , , , . I r » I _ . , I . I' I ‘_ ‘*4
  158. 158. ll. -e‘i. _Ii-agrei-“mi: -iiii ! lI“: l‘: l"; llili’§. " : l|lI'IlElI>'2'i'sl| ‘n_'l'. -l: ‘~ Iseaiciil azudil . °.| nloi:1 -. ;llI: I:I. ' HHS H0|'flelHHS NEWSIADOIII HHS Font Size ' T Print ; Download Reader '-‘_ . . g » . . N N H IiimrvvlliuIiii; Iit;5llii; ..; mi‘; ijy_2iiiila'1;lIi-iisfliigpvltliirsiltanv 1 Health Information Privacy Office for Civil Rights Civil Rights Health Information Privacy OCR Home :7 Health Information Privacy : : Understandinq HIPAA Privacy " For Covered Entities For Covered Entities and Business Associates HIPAR _ The HIPAA Rules apply to covered entities and business associates. ‘ ' Understanding HIPAA ) HHS announces a E P""acV Individuals, organizations, and agencies that meet the definition of a covered entity under HIPAA must comply with E that l'T'P'e”'e"t5 3 F0, c, ,,. ,., ,,. m number of provisions of the HITECH Act to strengthen the privacy and security protecfions for health infonnation established under HIPAA. the Rules’ requirements to protect the privacy and security of health infomiation and must provide individuals with certain rights with respect to flieir health infomiation. If a covered entity engages a business associate to help it cany out its health care activities and functions, the covered entity must have a written business associate contract or other arrangement with the business associate that establishes specifically what the business associate has been engaged to do and requires the business associate to comply with the Rules’ requirements to protect the privacy and security of protected health information. In addition to these contractual obligations, business associates are directly iable for compliance with certain provisions of the HIPAA Rules. 9 For Covered Entities Special Topics Related Links Summary of tlie HIPAA Privacy Rule : ""‘"§“"; {°| ”"° ""’“ If an entity does not meet the definition of a covered entity or business associate, it does not have to comply with °“"'ty " E the HIPAA Rules. See definitions of “business associate” and “covered entity” at 45 CFR 160.103. Training Materials HIPAA Administrative Simplification Statute and Rules _ _ _ A Covered Entity is one of the following: Enforcement Activities & Results How to File a Complaint _ A Heanh care News Archive A Health Care Provider A Health Plan aearinghouse Frequently Asked Questions _ _ _ I _ 4 I This includes entities that process PSQIA This includes providers such as. This includes. nonstandard health information 0 Doctors 0 Health insurance com anies they receive from another entity Understanding PSQIA . clinics . HMOS P into a standard (i. e., standard C°""d“""‘*"‘V . electronic fonnat or data content), 0 Psychologists 0 Company health plans . PS0” Slam“ 8‘ “me 0 Dentists 0 Govemment programs that pay or “CE verSa' Enforcement Activities 0 Chiropractors for healfli care, such as 9* R€5"“5 0 Nursing Homes Medicare, Medicaid, and the How to Fne a connnann 0 Phamiacies military and veterans health
  159. 159. [7< http: //www. hhs. gov/ ocr/ privacy/ hipaa/ understanding/ coveredentitie s/ index. html HIPAA Administrative Simplification Statute and Rules ’ T . 3* T7 7- ? “' " _ l'J. l1lii’—*-llii. ~.-lI. - A Covered Entity is one of the following: Enforcement Activities & Results How to File a Complaint A Health Care A Health Care Provider A Health Plan . Clearinghouse News Archive Frequently Asked Questions PSQIA V V _ V _ This includes entities that process This includes providers such as: This includes: nonstandard health infonnanon they receive from anoflier entity Understanding P50” 0 Doctors I Health insurance companies into 3 Standard new Standard C°"fide“"a'“V : :: n:: :o‘° ists : 2:35“ heakh [ans electronic format or data content), PSQIA statute & Rule Y . 9 P Y p or Vice V9153. 0 Dentists 0 Government programs that pay Enforcement Activities 0 Chiropractors for health care, such as 5 RESUHS 0 Nursing Homes Medicare, Medicaid, and the How to Fne 3 complann 0 Pharmacies military and veterans health - care programs . ..but only if they transmit any information in an electronic form in connection with a transaction for which HHS has adopted a standard. Are You a Covered Entity? View an easy-to—use question and answer decision tool. Guidance Materials for Small Providers, Small Health A Plans, and other Small Businesses i»’(l-«N l
  160. 160. ;7(F y I'-li3lIl'—‘«lifli‘. 'll. ' http: //www. hhs. gov/ ocr/ privacy/ hipaa/ enforcement/ examples/ Ha‘. ! iiiilaiii -l»"'= l:-reliiii illliihlh ~ —lI'fl! (e! :‘ V I y ks . I, “ ‘f N; 1 Jill! !!ll’/ II]! lifl? lil= El"fp. ,'fiiI; l]) giiiil‘sis! /-‘<jisrliy-ni; im; i.‘t-5 I , , HHS Home| HHS News| About HHS Health Information Privacy Office for Civil Rights Civil Rights Health Information Privacy OCR Home Health Information Privacy Enforcement Activities 84 Results Case Examples & Resolution Agreements Case Examples and Resolution Agreements F; -gggaggwmg HIPAA ; d d_ These examples show how covered entities can effectively comply with the requirements of the Privacy l’ A” Case Exam '95 grivggtan "'9 HIPAA and Security Rules. Periodically, we update this page with case examples of the corrective actions that " j——9I35e EXam Ies b OCR obtains from covered entities through our enforcement efforts. Cwered Em”: HIPAA Administrative " C359 Exam '95 '3 155‘-‘E Simplification Statute and Rules se Examples Enforcement Activities at Results Case Examgles Organized by Case Examples Organized by Enforcement Process Covered Entig Issue r. .i. ..e. ... ... ii. .._. i.i. gi. .. ' General H05 -tals 1 Health Care Providers Authorizations I I Health Plans [ HMOs Business Associates I Outpatient Facilities Conditioning Compliance with the Privacy I I En fnrcement Date Case Examples & Resolution Agreements pharmacles Rule Private Practices Confidential Communications Disclosures to Avert a Serious Threat to Health or Safeg Audit Prograru State Attorneys General How to File a Complaint Imgermissible Uses and Disclosures News , ,,d. ,, e 1 Nonce Frequently Asked Safe Uards , 4‘ Questions PSQIA . Resolution Agreements Understanding PSQIA c°"fide""a"tV Resolution Agreements and Civil Money Penalties —A resolution agreement is a contract signed by HHS and a covered entity in which the covered entity agrees to perform certain obligations (e. g., staff training) and make reports to HHS, generally for a period of three years. During the period, HHS monitors the covered entity's compliance with its obligations. A resolution agreement likely would include the payment PSQIA Statule & Rule Enforcement Activities 8: Results How to File a Complaint of a resolution amount. These agreements are reserved to settle
  161. 161. (: l[‘»hiJ-llin. <.-Iv I-l| PAA Enforcement The most common types of covered entities required " ; } to take corrective action: Private Practices; ’ V General Hospitals; 1 . ‘ Outpatient Facilities; 1 ‘ °‘l V H3, Health Plans (group health l" mi‘ ' _ plans and health insurance issuers); aha‘, it ’““ 9“ Pharmacies. http: //www. hhs. gov/ ocr/ privacy/ hipaa/ enforcement/ highlights/ inde x. htm|
  162. 162. I nforcement Case Examples Organized by Covered Entity Hospital Implements New Policies for Telephone Messages Public Hospital Corrects Impermissible Disclosure of Protected Health Information in Response to a Subpoena Hospital Revises Email Distribution as a Result of an Impermissible Disclosure Radiologist Changes Process for Disclosures Related to Workers Compensation Dentist Changes Process to Safeguard PHI Physician Revises Faxing Procedures to Safeguard PHI
  163. 163. & IPAA Enforcement Case Examples Organized by Covered Entity Entity Rescinds Improper Billing for Medical Record Copies Private Practice Implements Safeguards Private Practice Revises Process to Provide Access to Records Private Practice Revises Process to Provide Access to Records Private Practice Revises Access Policy Private Practice Ceases Conditioning of Compliance with the Privacy Rule Private Practice Revises Access Procedure
  164. 164. Today's teens use media an average of: ~ 10 hours and 45 minutes * every day a 7 days per week* *Kaiser Family Foundation, 2010 16’.
  165. 165. Safety Tips Some large text- messaging system vendors marketing to health care professionals don't bother with HIPAA, and may leave you at risk. Texting with Clients and Patients: Best Practices for Mental Health Professionals 9/21/2012 168
  166. 166. Safety Tips Most cell phones message are unencrypted. Encryption is required when transmitting any form of protected or Personal Health Information (PHI) via text messaging. Use an encryption program. Texting with Clients and Patients: Best Practices for Mental Health Professionals 9/21/2012 169
  167. 167. Remedy for Breaches Under HIPAA, when a device used for text messaging is lost, any text message about a clinical, billing or administrative exchange can be considered a breach of privacy, and a violation of that consumer's confidentiality. The compromised individual must be informed in writing. Texting with Clients and Patients: Best Practices for Mental Health Professionals 9/21/2012 170
  168. 168. Safety Tips The Australian Psychological Society advises against the use of slang and emoticons when communicating with clients and patients __T__ in text rn e S S a ge S . Texting with Clients and Patients: Best Practices for Mental Health Professionals 9/21/2012 171
  169. 169. Safety Tips Download your text messages from your cell phone into your patient files. You can find software for this function online. Texting with Clients and Patients: Best Practices for Mental Health Professionals 9/21/2012 172
  170. 170. Safety Tips Be aware that you can text the wrong person in your address book with information that shouldn't be shared with unauthorized parties. Texting with Clients and Patients: Best Practices for Mental Health Professionals 9/21/2012 173
  171. 171. Safety Tips All text messages reside on your SIM card in your phone, even if you erase them from your visible message area. 9/21/2012 Texting with Clients and Patients: Best Practices for Mental Health Professionals 174
  172. 172. I£L£ll['-l"LllUll_lv ((( V_‘VV VV", V VI ’ teleheaIth. org HIPAA and Email ° Hackers can find copies of email on: laptops mobile devices the exchange server the recipients‘ exchange servers the recipients‘ laptops or mobile devices all those to whom the messages were forwarded
  173. 173. ((< ""’V""""‘“""""' teierweaitixovu, HIPAA 8: Email ° The system must have strong auditing capability. ° All activity on the platform must be logged and monitored for possible breaches of security. ° The system must have auto time—out capabilities. ° The system must have business intelligence capabilities for data mining and quick access to important information. ° Secure email system must leave small footprint while delivering messages and documents to recipients. ° Confidential information, whether encrypted our not, should never reside on devices or the company exchange servers. ° Confidential emails and documents should be sent, received, archived and accessed on the exact same ecosystem.
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