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ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling
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ICA Conference 2014: Legal & Ethical Strategies for Successful Distance Counseling

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  • 1. K 'l¥.5.4'. “"‘, '5“’_e"; i‘*_‘-’-‘_—’I*iE"" ’<, =If= ’Ii'i: _rllliiI. ‘_-'i'a3' ‘« I-'l»'ri~'L'= Legal & Ethical Strategies for Successful Distance Counseling IDAHO COUNSELING ASSOCIATION
  • 2. Tfl wrwrm. HEALTH I H i Y I U T I, teleheaIth. org Learning Objectives ° 1. Describe 3 ethical dilemmas related to Skype, Google and Facebook, blogging and the ethical codes that help practitioners think through those dilemmas. ° 2. Discuss the legal issues related to practicing over state lines or international borders, HIPAA and informed consent when practicing online. ° 3. Outline 3 key elements of a risk management plan for working online with clients to deliver care.
  • 3. Tfl rurwrm. HEALTH I H i Y I U T I, teleheaIth. org 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 seekto 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 circumstancefrom your qualified authorities. D2014 TEIEHEMJI Hailifl manna. Inc
  • 4. - — —~A~—— —« -. .—_—‘-_—. ».—‘—_—_. .‘; ‘i I Housekeeping Schedule Restrooms Questions WiFi Twitter @ica ' = ':'! a=»f, ’ ’*— w ’ ‘”~: ?»—: :”"'-E-. "’. #:_= s.-. ,3 w. I .4 Pl r~ , ’ is ~ 02014 meuemzi mam insrmite, mg I
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  • 7. ' THEMFNT/ ll. HFALTH ((( l N V; 1 I U T F I telehealtrnorg Real-Time Telemedicine Remote dOCtO1.eXalmneS 3 Patient l111'L11'al ER gets benefit patients inner ear from a remote Qt 10°31 CW3 P133 1'em°_te _ location coiisultatioii with specialists. 0 2011 Tllellemil Health lnsnfle. Inc.
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  • 10. VIRTUALLY B THE CLINIC Bringing lnleraclive Technology to Be avioral Heallhcare for Treatment and Training News Avatars May Help Children With Social Anxiely T)'1E7f'(fll9 fears 4 till I . /ii1Li. il reality tmnles Pl SI) The Daily I IIEJIIIILI lenr of flying I. -/illi '4 I’) ‘-iIl| llIdI(. )I"- University of Alabama adds VR Exposure to School of Social Work Eiama Piol A‘-m. Tia. lor isn i .3 new»': cimer to using ‘. ‘R in 5-Iicial won and C9I‘l3.‘lOl'EI health 3 e s :9-: -n worrrng . -.IIn ‘(El colleagues lire PSIIICI" EiI: vrdnIr: b' and former CEO hen Grasp tor Iear-5 30 ‘. ‘BI IS pic-ur1iov: onlir. mthai we -VIII be I3-3Il‘. ‘€I| |'lD 3 3.519-rn to 5-. I3D3FT1.3lO(USC‘lI'lII‘I|3 School of Social ‘-'-‘DIV CNECI" CIUI Il'I€ GEIEIIS l‘l£'! E VR based Treatments get "Exposure" on Fox 5 viituall. Better welcomed Nista Litil-Jlielc lI0."l -'-llama 5 For 5 news last week for .3 feature on VR case»: treatments Tnanrs lxnstal Atlanta News -. ‘.‘ealner Traffic and Sports I Fox : PRODUCTS COMPANY ADHD: Not just a school problem. Dimculnes wllh locus '3ieI3Cll'u1I‘r l'Y'lDlJISIv‘é' '5-I-T'v3.‘lC/ TS annincr-: -ssed em: -banal r-2acir. it~. are >: cI'~Irnon SrI'T'l[JI’. ‘VT1S ol ~‘<lIET‘lllOl'l Cl*3llC1I. l'I“IiD€l3ClIIiIv Disorder Ii~DHDI These and other +‘-DHD 3v"lDl0f! l$ can usreai l'l.3‘-DC in -school However School -grades and : I>2I'l3I/ IDIS are noting -uni, areas Il'I1CZiCl€'G andthei are often not even me most negaii-rel, effected Childreri with lI‘il5 disorder are also "wore lirel. to Suffer tram speech
  • 11. Reviews News Download CNET TV How To Deals 1‘ Log In I Join SAMSUNG The Next Big Thing For Business Is Here - 3 "T A ‘ @un '", llE'i H-'_'»I. 'S L" :3‘. -; SAMSUNG Confirmed: Google Glass arrives me lJe>_<t Big Thing in 2013, and under $1,500 f; O,; §,F§"‘eSS Google s at; gi~>enteci—realitj. ~ soecs are ahead of scrwecluse Are _, ‘OU ready. ‘ ‘ _ f _; a ‘A . ... . 3 to get , .~o-arselt nttec or a se: i» En: Ma-: ‘r. i ‘ ’fi KW _:3 fl lollow 9" fl ‘ '" “ 3 ’ T~'1W~" * ' ' ' 3 3=”“““"‘l? 93 Hottest Rei'ie'. '.‘s ‘ iPhone 5, Finally. everything we r hoped it would be ¢-—- . ‘“«'~ —x’ ' mi: ~ M 5139 99 7 5 ~: «~x~A«~: r ' r i Microsoft Surface Pro Smart _ almoslrlaptop nearly nails it [ ( v Iflrl m, l SSE»-3 99 iriokvi ‘ - - Cliroinebook Pixel Bnlliaiit touch Possibly the 'mu5t—have' gadget lor the 2013 holiday season (Click the image lot a Google Glass slideshow) . ‘ . screen. hefty pnce (Credit Google) " F . . Regular people will be able to purchase Google Glass eyewear by the end of 2013 for less than 31,500 sources have confirmed to CNET . I HIC One wows with stunning & design, premium parts Google originally targeted Elill -l for a consumer release when it revealed Proiect Glass last year,
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  • 14. “S I M O The Wood 5 Most Advanced Hu'78DOId Robot Asimo - PEWS EDUCATDN v YRAVELS PSIMO W U GALLERY DOWNLOADS ASIMO IS DESIGNED TO HELP PEOPLE : i c Q i turnwundofltll) UVE SHOW FEATURING GALLERY '-igri O-Juicy Photos of I-SWO r an M DOWNLOADS O1f. u:ia= ASWO C0-'1r'. |c5¢s! cryr. ‘u. 't. taC PC or tNl(‘/ A ‘ I Vilil-1) ms rim ’"‘°"‘”"°”° TRAVELS Now you can see ASIMO See how robots r- Check out rtonda 5 Molly Criect out a veto HSXMY of ye”: C, ‘SRO 5 “Mn Am€_, mn 70“ “pm” K, ms duty at Dsneyianoa develoorrierii now can bring prototypes eriioowered wtn Honda‘: robotics resear. -,n : __m_mm! out the best n us n ttie nature ASi! .!O-denied technoiogy HONDA ‘lIufiwua&Ivn
  • 15. Electronic Health Records
  • 16. OCPM: Online Clinical Practice Management Ste 1: Trainin Step 2: Referrals Step 3: Patient Education Step 4: Legalities Step 5: Assessment Step 6: Direct Care Step 7: Reimbursement
  • 17. TELEMENTAL HEALTH ((( ‘ teIehealth. org . I N S I I I U I E Telehealth vs. Distance Counseling (working model notto scale) Telehealth Regional Professions Information Education Sharing Behavioral Telehealth Disciplines, including Consumer Administration Distance Counseling, Training 8‘ managementfl Supervision Evaluation Research Homeland Security | 0 mt: ‘rtieueini Hum inmle. IIE.
  • 18. __, . _ i . __ H %'%: a,% What are the Current Models for Distance Services :1“; in Counseling and Other -‘e E) Disciplines? "it at - E E E . . E E. yr _ -. _ : ,_'_. .___ , _ _ . j _. .._. _a ‘C *3» L“r‘’'‘"‘'‘ * m ’ s': "—‘“§, " ozim meuenizi mam lnmtute. int; i
  • 19. 2 § iii. illfil iii telehealthora ‘ mu Iioivcxtn V Srvtr. ~: :-A; -rrr “(Ky :14 ‘n H; cry‘ 2 {('7"iu7‘ : a' : .~ c. <-r: v~<: u'<~; v.s vex: -:. r're ‘<5! i. rl-a cl‘. :t"'w2‘J! !i < . -we ~imc‘: s--e : 'F' tag, » i -eehmcis T"ie'a: wi BET DA’ :3 E». 'e- : ‘ Jeri st"-st er: -F-: ci. se~: We! ca" «-1- n ‘P no cm . i 1': Ne: fan: ac lbw’; w: . "' : i.. i:-ta sridtri es MQHKIIO ' ‘ . tJIl't'5 ~s. I itr-Mrdi . - see: a aim; m use ‘LE5 . s- aw and Gene . i: -uv - 42- '¢ M”: -r D". '.it . e uca-‘J1 rd :1; wt. ‘ 7': Rt-Inn tic res em ‘or 1-1‘ M 99:. re:
  • 20. "1=Il= ‘li>i= _?‘3,| liiL‘{V_"l"LI': " in‘»'. r,, ')u: ~ Traditional Behavioral Telehealth Model
  • 21. THFMFNT/ ll HEALTH ((( I , Y K ‘ _ , teleheaIth. org . F. ‘ ‘— l I Traditional Behavioral Telehealth Model ° 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
  • 22. ((( TE’. f‘. "if P‘-lTAl llffxl Til telehealthlorg Online Norm vs. Traditional Behavioral Telehealth (or Telemental Health) Traditional Online Therapy Traditional Behavioral Telehealth - Mostly Email & Chat ° Video ° Anonymity ° Verify clients/ patients ° Accept self-referral online - Rely on referrals from clinical 0 Disclaim Responsibility w/ Office-‘5 Website Disclaimers - Use informed consent . No clear Channels for processes/ documentation Mandated Reporting ° Engage in mandated reporting ° No Patient Records ° Document as required by law
  • 23. rir-. irrm. i um Tl ((( t’ N : ‘ _l_ ' telehea| th. org Online Norm vs. Traditional Behavioral Telehealth (or Telemental Health) Traditional Online Therapy No Contact with Other Treating Clinicians No Authentication of Consumer / Professional No Emergency Backup Procedures Misunderstanding of Clinical Processes (suicide) Scant Research for Unsupervised Settings Traditional Telemental Health Obtain signed releases and collaborate Verify identify of both Consumer and Professional Establish emergency backup plan and personnel prior to delivering care
  • 24. OCPM: Online Clinical Practice Management What's happening? . 7 0 2014 Telauemal Helm Insmtla. In:
  • 25. m wrmm llf um ((( teleheaIth. org l? .‘3lli Disruptive Technology Disruptive technology is a term coined by Harvard Business School professor Clayton M. Christensen to describe a new technology that unexpectedly displaces an established technology. Be“)! Frieda" Gloria Steinman 0 1963 book The Feminine ° Sought to transform society MLSTLGE ° Sought to have women be accepted in existing world 0 21114 Telauemzl Health Insmna. Im:
  • 26. ‘(, =Il= ’li'i= ,'t'llli'il. '_-'1" : Society for Technology & Behavioral Health COMMUMCATIOI-I St Practice ‘°", '.‘_. ’E”, .‘j'; ;;§. §§’°"‘ Science a‘e. g.. Internet, Blogging. Social media, Cvbemetics : e.g. . Biosensings‘ Fee<lI: ad: ,So¢ial netwarltingl COMPUTING ll. '.ETHODOLOGIES i‘e. g.. Artificial Intelligence; TELEEOWW U“: _», m0,_5 I-Iatural Lang. Processing; Robotics; User Computer lnter1ace: [e. g., Cumputer ’isionTracling. Haptic Interfaces} Computer Simulations [e. g.. /irtual Human Agents. " 'atars 3 Environments’; In“ l‘ “kin 1.: hlicrocomputers; 3D lmaging, _ Software [e. g.. ."ideo Games: l| I|_all'. u|t: MIt*: Ifl'. in A rimvllrznir In Education Public Interest HEALTH lT& INFORMATICS ie. g.. Big Data; Contmlled Vocab: [e. g.. ICE‘-10:; Decision '“3l<i"€ -~ 5UPP°"£ D3“ OTHERTECHNOLOGIES Mining; Electronic Health and . Personal Health Records; 'e"ir": ;:'ceh‘I: ‘:I: ';yg" Electronic | ZIataPri an. ‘ . . ' Security 2l'I(HmEgI'lYV: HE3nl1 "a"°mEdm"B" Information Exchange, HITEIZH; Information Storage 3. Retrieval; Interoperability
  • 27. Tfl FMFNTAI IIFAITH ((( V , teleheaIth. org l? .“1l -. ,li'i Benefits of Traditional Video-Based Telehea| th* - Increased client satisfaction ° Decreased travel time ° Decreased travel, child & elder-care costs ° Increased access to underserved populations 0 Improved accessibility to specialists ° Reduced emergency care costs ° Faster decision—making time ° Increased productivity / decreased lost wages ° Improved operational efficiency ° Maheu, Pulier, Wilhelm, McMenamin & Broxr-/ n—(onnolly. (2004). The mental health professional and the new technologies. Erlbaum, New York. 0 2014 Telemental Health Insmue. In:
  • 28. "F‘lf'v‘E$TA{HF, m>TH telehealth. 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
  • 29. Tri FMTNTAI IIFAITH ((( teleheaIth. org l? .‘3ll, lTi 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 clinic—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 desktop videoconferencing units transmitting at 384 kbps or greater. Godleski, L. Darkins, A. & Peters, J. Outcomes of 98,609 U8. Department of Veterans Affairs patients enrolled in telemental health services, 2006-2010. Psychiatric Servcies, 63(4). 383-385. i O 2014 Telemental Heami Insmue. Inc
  • 30. Tri FMTNTAI IIFAITH ((( teleheaIth. org l? .‘3ll, lTi 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 I O 2014 Telemental Heami Insmue. Inc
  • 31. gm (“U M telehealtnorg lnrunzm . n. ¢~nn nol—Iu 120! In R(’. '(’lIl' ' .7 . ‘1I'fi('](’ SYNC] IRO. 'Ol'S TE Ll-II IFALTI I T .1 l. '()I. O(jl PSYCI l()'l"l II-iR. »l’Y I-‘OR DF. PRl£SSl(). ': .lF. 'l‘. »—. A. .-I. 'SlS Vlunlr lr lkrututli I‘)! l) _‘ Kairn I t| 'Rrwn. Ph D _ InIl|4'IA | |hllfn, ‘ Hi I) _ m. I Den-l I 'nml: -nxii. I’? ! I). l I'll Bark nd: Man flliflfl 1-5911-(fn-i lryrrmn larb unuulun array : - 9; :5: .1 my-am. -1 rdrbuhb umdabua II um: mrimiimp. ix OD! nhmn n this pullout. Ibn iunman-(rm nnnmtl Jifimnxrt ll m-up nmvi zfiruuyjorpnrhibrr-p alvuiimvnrl iv vynrhvamii rrldrahlt av «on. pad in inabnl uowidrlinlilt nppvutbn. I((hu<l~ ll ’r laarrl H «rain that -In ilrhnai trltnia nftbr I1! 0/: rycdmonlul Mltbalth Ilolalan [at Inm- -um mi-pmd n . uullavl u-mmmim -4.1», minpariul pup. amt. » Ora-II. 1 mumaih u. ..; .'a-z mm-mu 4.5mm Mmrm Mala W1 am not idruiymv (3 — 0 I4. s1»: — nos. 93''. L‘! — / am, 010/. P — mix. I-' . vl9.74". ). Srrnuflrunn normal: nil uucrarrgvndoa : .-cn and In aud_y: ¢ ibr ronmhmny of up: afruupan-tau pup. lltlfl rimon uulvluv. and m. gnarl Inna! btnltb -Imnlut In -alt-urn: of rfinrt nu (IS) rlmnnn 1-I I-mr-gmnlv fvpr afmnupnuu pup lfn(I~tI—[Art xwnw: (IV! -‘I-I—ln bal Ill: n-routs: inflnmrr on ohrnnl brtrnvgrnnn Jud iaodnrirl ibr nnmiwn rs. in only ltmrnlle lqjiwrnrr in rfiraq amt rrunrml ID mum um um! (arr-«mural M II» anpnuou group 11 — 029, sf 7 “NM. 99%. (J ; I'). Itv. on/ . P I .0111. I-‘ s. N'*. i. ('Amdudon& lhx-nil. m-/ and no rrnlnur in gun. mu Ibr lrlrn-77 a/ p:_y. -«ml? -pi m ryxbn-it "mm: -ti mum" T. la! tficrurv dun lonllltlvtallb nunn Ill ma. -nu. lryrunll lynpvu-1. uqm. new nil. -{many IXH-IO. 30! i ruunou : -vi: n-n Huh uni um--an awtonln . - mi-M on-n wt I lit} vu ocds: Jrprnrnn; Iclrbalalr; Idaurnul bulilt; nun -cnlyru lN’I1{( )Dl‘( . 'l1( ), ' )q. m.. .n . . n mm: -1 1" . my -LIKIIXHHI1 mu" . .4 rm-nu] flrlllh. .. .. u . .sm; .m. i. kn esulzlnhut u. - menu, and t. .-nth Ihrn not «rated . ... ..i. n,~ . .. muuu cum ion Vohhodlh -nu ioamanocy. .iu-.1». ..- Ll-In-HtCPIMfl H-umqnm ~ ». t'(dln nl . .. ..-cm. .-. mm: hnrr-r III e. [-Ira: -uni: L‘ P: l. ?-1| and m ». ,< u . 1.. t-, vv: ':u-u u re. .. »_: vI'u¢1-tug o. um I I u. -. z. (.»-. -um .4 i. -.. Anny rm L-mi. .. l»1‘uvI 4 : ».v. :.. ., 4 p- o. .;. m.. «i- .1 n. u.. ... . 'C. -vo| ¢-‘t-)a0.n » _. .—~»-pr c-.44-. ;i« iv» D mt. .. C. » -— L. bur--r v-5 r. .>. -.~. .,. 1113 mm 4.. .. -. L~. ..« unoon um. Irv 1;. .. tm. uT«. u.u mi man 2 ~. .i a-w. ..». '.e. r.». on. mu no uvoi L». Mu. ~.: .. c: um ac-: « Whoa: can» 3: . 1. man: '1»-4 . -:r : ':1L‘ tr, I’; ;,": nT nth-I~c1 run. in ma. -‘run- i am my rxv-curvy u nil lt‘I| ]l mum in. . m4-vrul r. u.. .n. i.. im ur L' Hrpli. .m. .n_ me i: .m. .mta an-J i. :.«. .m. - pirtxlcnm YIILW Q41‘ . lqItr-ua-in In Ihr tmmi . uu-u . .-. - r. and If-_‘ . in h1lH‘l ‘ t--«mart. ‘. ‘ I in Immnr l1‘ up ‘ix .4 lI»n>-ml: inn In ili-iiln-! l)| -l -lnglyv-cs -1 Arum, l('| Il‘Gy'll rm l-tvn urn} h ma s¢. .i. n;_~ v; nr¢- --I . uut. .I. n. ' An-l iii. -prexxu-I: L’-nu uywunit in 40 lullmri lh Izn L~—. irl m In»: and umv in .1.‘ L . ... .~. i sum . t.. u(lI. nAu'l. 1[DIl| tl]k' ul [nnhmbi-upt hm , .n. m. re. -.mr . n . is. - . m.n. m. ut slr1>frI-III uslxpnvtxu, ‘ lwm-ri_ 1 Iagrfllflkfllt --nun 04lllr| InpI1lllrIl1olI4r»r)hi’ivIlI¢‘l'It'1iVl'l>IlIph ruin‘! - ip. mu n. » . .: unm | 'i. -u ll unit Ll-mt In T. .. i iuui-ulna.11:-lr; iL-suuil Inllul | :[I rm rr9rrTJI M pmrmnmpt, '- m {I| !i. ‘0| . «.n. ... .-m ixmlinp the uuenu n-pun 1 vrl’fl‘rK‘l'¢ «~ IIII run lunlm. 1'1! . ... -mm . an-in - - l‘nuu All-unr—r~n. uir .4: in HIM: so --’m~. a.~ 7--i urn mllm up i uh m has our [vu‘liutnL “mam. .. .. rm I. ..-n mmumi Hut 4)‘ . ..m. ..« J! rm t nrxrd uit~ hnr I di~~rug. 'e . .. mznul la. -mi. ,. ... ».. Jm, ‘ ma al| mLuz: ~ lI’. |J| '|L‘. l . .. FIDIIIIIOGIOII YMIIHGOIIIUS Ganvnnbnlroanmtomflnmmicnunnllmmausk 0 20M TEIEMENBI Hearth lnsmlflé. lril:
  • 32. . -lli'u M _ ItZ‘l€I". l3€IIV. l‘i. CllLI SYNCHRONOUSTELEHEALTH TECHNOLOGIES IN PSYCHOTHERAPY FOR . DEPRESSION: A META-ANALYSIS Janyce E. Osenbach, Ph. D., - Karen M. O'Brien, Ph. D., Matt|1eL~v Mishkind, Ph. D., . and Dereltl. Smolenski, Ph. D., IVl. P.H. 'l'. Bl1' l. Publicati--n ni iii“. .. ill Ininuriil. i. i.. Ii. .imi-ii. I I. "'I. 'i I*‘~I| bII ~L. -.. .iiL. a l i l. .iiiiLl. ii. .iiLIIii. iirL l) :1 nLLi, i.iLLi. .ii. |ItIlIlIlq-Ifllun uhpl in nu-Lin ; i.. irLi L: i, -ma. i'. .iii . .Lii. i.L ‘Hus! IIIJI .1. Li Il. LLU« , ¢i. L., ... ... ... ..ii uri r. ..i. i.. i. i.i. i.. mLLiii. ii . i.ii Lit. ..ii (I I Il‘It(ll-iI| iuDAI-IltIli'1lI. I-III mi. ..iLiiii. iii. ii. ..iii. Illtl lll (mi. .. ill ii. ..t. ..i. .. i., ... ... i.. ..i: l| l'I IAVICII LI Li . ,~iir. i iiiimtii . L.. ... .. . .i. .i. ..LiL I III i "(V(VfiiV(rtlt'Il['IxI! |( Illtl i-i. iii. iL. iii. I'iIflV L, »LL». i.. L .1. K’ i. ..i. ... . ii . i i: i-vi IMIILII iii. .. ..i. .i. ..i< ll I'l . ..i i>. ;.. ... i.. |lil 1‘Ml| ui4|Ii ii. ... . . .~. ..x. .i. ¢. . i.ii. . , .ii. . iiL. iL, iL liLi. ii. i II in-iui iianiri . n.. .i. . ( itI‘I | .il. i LL. .1. .L. .ii. ii4.‘ i I. ‘ II(IU (§lIlll|1!I‘ I I. iLliLlIL: 1 iIiLiL, 1u. . . «( ill I "I4! ii. .ut. i, .i. ,,. ,i LHPLIII ii. .. . .i nth I ill’! Lili-«is! I‘ | .‘: In. -L-Itllll-: -4-ix-uh )fI‘lVH| ~IlI II I(I . ‘(Iii-Il‘|1‘I i: i’i . .i Irlll . .a. .ii. , i>. i.. —L. L.-i mil 4 ». .., ..i. n.i. IYIIII‘ . v.= .iii iIl’H'I-4’ iii. .. n; ;.. L.. ..i Iiizxii n. .i. iiiL ll(lVAul lll)I viii. L. .i l'Ul uIu'Ii| ’I- xi. n. i.. L.. i.. mu. “ 4 i. . . ii. iii. rli| I ii | AF| u 4.. .i. i.i. i.. ii-Liii. .rii- (ill! ) . i.. .i. ... ... . "l4(’II . . Liiii. P(IllVvl| lIlyl nuLL‘L2Lu Lll! ll'l L- ll)! "l| I4]llVl “L-Ii--It . ~-. .Li. L.i min til‘! Ilvl mi ll .1 i: <~it. Iur¢UL . umi. ..4 I ti l‘I iii. ,.. ... , -. ..; . in Li ulLmIV . .i i<JKl’Il ‘I’ " 1"1'”‘0 i. .iirii. .LmL LL nun. Illlilu . i.. .i. Li ll ri. .i. i.iL. iii. Li-i . .:i . .. IVliIl i- iii. LiiiLiL. iii. .. mu i. .i. .i. LL tllllllii i‘I-4~‘(I m Illll Iuk Llqucuun urn-i. l I Afls-1V uuul I III I Lupuliu»t>LIiAi«LulILILl>L: l:li -Ltixniit IIJI Lliililnn n. IL| i:uv. inir-Lriuiiu . || ». '| LI: |-inmin Atwsott m. I-Inn ~11: H) i. ... .i. i.. . «. ii-_- , ..i. ..i IrJlIi¢| tn<*VlntrIII| |vr nun» ii. i.. iii. ... .i. ... ... ... ... Liii. ... Li. iism: IIlvmIIiArvrHu4[vqlIrliv . i., ... ... ... i “K! L . i., nnl , .. .L. i.. .ii, .i_in ii. ... i . ... i.. Li i-mis, ..i. i-ii. II HIIIMIIIAIliK}vll*i4I: V<I(i: Vi-ill . .i. It I . ... x.. »i. ... r.. ... -.. a‘. .iiiiL: xi‘! .i. ,i, ... -.. ... ... i.. i.. .L. ..iiiiii. .iiri ll i. i.. ... .i. ... ... lIII i. :.~. i.. .iLi iL. iiii r . .. i.. ... .i: .L. ..L Published in DEPRESSION AND ANXIETY 0021-10 (2013) O 23!-1 TEIEMEFIBI -Ieatm IHSKIIIJIE. In:
  • 33. Primary Focus: Not the technology, but rather, the service we deliver (also allows for reimbursement) Nonetheless, Different Modalities Require Different Skill Sets __ —/ ° In-person ° Text (email, chat, texting) ° Audio ° Video
  • 34. . 1,1- ____, ___# _ _ l I Social Media ozim Tueuenizi mam Institute, Int"; I
  • 35. ((< ”f""”’j""‘f‘f""”" telehealthprg facebook *9; Vc. uleoo¢u'Io, cnil! utwIg,1dItIq askteirimtd realm Ilnvbtr - l Ihlllur I'll Iiaiieiir u Mali. -L_— ( Telunental Healh lnstiute Tlneite ' Now ' Mighights ' Admit Panel ‘'3 *l"*V Q) 33 1;. .. §= I , _. _ D V_ in. . O . I | t is ethical TeleM3gta| Health Isrgtitutegg 5» __ to have a A Hea| t;h= :,z: ;.. ;:g~lr; sEuhacai§§ page on Fa ce boo k 'TiéiéMe"fia"i3°é'i°i"3~'-5.E’i7§ft§, sirg3.. :.9.: ' or a simila r §“§li. ”éfiS£°i$i r3,g22.'§i. <i€? ..+>: .4;. ... ;;; g Tags advertising grrea . 164 * pa 0 n I-~12»: .-L-. . . »., L.~e Telemental Health Institute we a v G 0 I e + ? Slnlus Ft Photo 1 vuieo lvrnI, HI|1-alone 4 2 gm”, Ho S4-(unly has ieIL-new-to Mealh item. Mlvlnt ' 15,201: E mu A fan Pnoc A Sucttss i l“r-2 .0
  • 36. Google Google Seatcn I'm Feeling Lucky The ptnyqrcum 45 open '9». V m ml ~'-~ um, » mu:
  • 37. rmwmm llfLTH ((( ml [ : ‘ telehealthorg Social Media Is Not Private - ”Anything you say, post, link to, comment on, upload, etc. , can and may be used against you by your peers, colleagues, employer, potential employers, fellow members, and so on. ” ° APAhttp: //www. apa. org/ about/ social-media—policy. aspx O ZEIIA YEIEMEMEI Heal‘? ! Insmme, In:
  • 38. THFMFNTAI HFAITN ((( _ _‘ W Y ' _ , teleheaIth. org OCPM Step 1: Professiona| ’s Self Care - Boundanes — Office hours — Unplug - Reputation management 0 Community of| ike— minded pros
  • 39. E, emu ewwg l l All Existing Legal & Ethical Rules Apply 02014 meuemzn mam mstmlte, Inc; 1
  • 40. ((( 'E"ME"T"“"“”” teIehea| th. org ’nI, »v; s,a: r; "I'"A'“I'I. ;lfllflsvl'lv‘iI: IllI€vlI§lI’ll: -L5.; ;-’, ]i'§.3‘H-3IIfq": :jl$R3:III‘I» | N"~l ILJTF I. ‘lr. ‘?; ll. lF"I§-1 ". '1>‘l‘= ,l, III‘fi‘l“u-‘I. :»'| .-; ' fglslélf Ii: i;IIlE: !é«iImIiiEir+‘l§i; "!{f: -;; }é: .gI€I§3f; iiVI'1;1it-*5‘ PRAbTIcE GUIDELINES FOR VIDEO-BASED ONLIl, iE MENTAL HEALTH SERVICES Mayima IIIIIIIIIIIII IIIII II’ I I II I I I IIIIIII IIIIIIIII II II I I II II I I ”IVIIIIIliIIIIIIII_I_ III Ii I IIIIIIIIIIIIIIII IIIII I I II 'I____—I. -—-3-— A"“A 1 Amukan Trlemrdldno Anodallan til»: :’: o~3!flii§IIi>II= I.4?. = I‘ -Vflfillui -«'ar: I.-Izu‘-= nII‘m: (—
  • 41. I-OI-dl-It-it-‘O-OI-II-II-III-I €x. I3/ |&AlI)U-‘$€xl3-’| &IJ')'-‘ GUIDELINI-IS 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 as the provision of psychological services ming telecommunication technologies as expounded in the “Definition of Telepsychology. “ The 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 opportunities. 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 including the following: Ethical Principles of Psychologists and Code of Conduct (“APA Ethics Code’) (APA. 2002a. 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
  • 42. /(crs. -:_= —1;= §:'a'a«f'3r; L:i-=1 . ,q. i.»a; .._a. .., .., . Multicultural Issues & Diversity . .. ..3~‘ '55‘ E - . ,~. .»--. A . ’ . .‘ ‘ - F ‘ . l_ , r u l. __ 1 ‘ K , ‘ I. -c T _. i I , ' ‘ I . 'j ’ an‘ . —!I-fl . x : p—Fg T_ E — pl ‘
  • 43. THFMFNT/ ll HEALTH ((( I , Y K ‘ _ , teleheaIth. org . F. ‘ ‘— ‘. l I Multicultural / Multlingual Issues Issue How to measure? ° Global nature of the ° Search online for various lnternet— worldwide instrumentsthat 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 — Easyto take nOt mentioned — Get to know the norms ° Rarely mentioned anywhere ° Spoken English is different from written English O 2014 Teleueinil Health Insmua. Inc
  • 44. ( l'? '§f_5l3l;1li'%‘‘f*'35L1_'’‘l ‘<, =IiaI. u,r: ItiI. .;-m. » In-Person Contact APA Telepsychology Guidelines: is In addition, psychologists may consider some initial in-person contact with the client/ patient to facilitate an active discussion on these issues and/ or conduct the initial assessment. p11
  • 45. Do you see well enough? -Image Resolution ° ATA Guidelines Are you conducting an intake orfol| ow—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? . O ZEIIA YEIEMEMEI Health ITISUILIIE, lnl:
  • 46. T'lF‘. 'l. VNT; '-I IIFAITII (G K’ _; Y : ‘_ telehealthorg ACA Code of Ethics (2005) ° 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. —How do you decide what's appropriate? 1| Copy right 2011 Telelvlemal Health In nitute. Inc. -‘all rights re served.
  • 47. K j3,"l, T:. ""_l‘: "l{. "}“f‘l"l’: I3”l ‘r, -.lIiI’r"I= ,r-'l[i’iI. ‘_-I15‘: ‘- I. 'lr. rw, ': 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
  • 48. ‘ Pm teleheaIth. 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
  • 49. ( ‘I'v''.9'fl_', *''‘. ‘;3.''L'*7‘‘f*‘*’l‘i‘5'‘‘’ ‘K, ’-lIiIr"I= ,I'lll3iI. ‘_-Iii: Caution — Consider Context Online Norm vs. Standard of Care Mostly Email / Chat vs. Video ° Anonymity / No Patient Records * Avoid Responsibility w/ Website Disclaimers it No Clear Channels for Mandated Reporting
  • 50. TMHI 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
  • 51. 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
  • 52. ( ‘I'v", ¥'. "“_l~"‘7{. "§‘%‘-f~‘~’. *i‘£"" ‘(; —llili"I= r§l[iiI. '_-I'(5‘: ‘- I. 'lr. :w, ': Who is Responsible * . ..if you make a referral to a | ong—trusted ~ ’ , ‘ colleague who suddenly ‘T2 * /5 conducts distance counseling with a client a you referred? ‘ ‘ * . ..what if the client suddenly decompensates and makes a suicide attempt?
  • 53. ( ‘I‘r''.4'. ‘.'~''‘. ‘»! .''; ‘*_‘-f*‘~’I*i‘§’‘‘’ ‘K, ’-lI= ’I’r"I= ,I'lll‘iI. ‘_-Iii: ‘- I. 'lr. :w, ': Know the Practices of Your Colleagues * Ask ' . * Keep them informed of ‘ .3 I/ ' your practices and I ‘H rationales K’ , ‘ Suggest training when " _j needed _«. ;.fj * Document training suggestions when appropriate
  • 54. Step 4: Legal Issues Step 5: Assessment Step 6: Direct Care , I_ Step 7: Reimbursement - M‘ P” I "'” ll”s. .,, ll Step 1:Training I Step 2: Referrals 5 : Step 3:C| ient Education "‘ is l I l E35” “"<‘-‘er-— . . I W. ‘ I‘ It till 3 I‘: ‘IN: ’ 9:» ‘l~ I: ozrm reieuenrzi mam Institute, use I
  • 55. 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
  • 56. m FMFNTAI. HEALTH ((( I r ‘ _ , teIeheaIth. org Tech Check ° Tech check — review potential technology and infrastructure issues prior to initiating the delivery of ca re — 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)
  • 57. 5: Explain technical aspects {camera position, lighting, audio, noise, clock, etc. )
  • 58. - ~ —~A~—— —« ~. ——_—¢-. —.»«‘—; q:¢‘i L . I _. .i’_ __. _ . _e___. ‘ ' ‘ ' , '_; _'_'__'__m all’ T *. :. v. . . I It Tell It kl. Ii; I ‘ii I I What are the types of problems that clients / patients have reported when working with clinicians using videoconferencing? _. _._. .—r . ._. _.. r— ' . _, — - Ea‘ ozrm reieuenrzi mam Irtsttlute, use I
  • 59. Client/ Patient Training ° Email/ Texting/ Telephone/ Video ° Social networking— social media policy ° File exchange ° Computer repair ° Clinicalrecords ° Insurance ° Reports ° Lateness/ Missed sessions ° Non—comp| iance/ Avoidance
  • 60. m FMFNTAI, HEALTH I H i Y I U T I, teleheaIth. org 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
  • 61. - — —~A~—— —« -A—_~¢-. —;». .‘—; .:¢‘i _. _._. .»r . ,___. . _ ' ~__ , What should I do when someone enters a client's/ patient's room during a call? I ozou meuemzn mam mstm; te, int’; i
  • 62. ((( THFMFNT/ ll HFALTH . I l'I‘ * T ' * teleheaIth. 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 ° Askfor an agenda ° Reschedule for another day/ time
  • 63. - — —~A~—— —« -A—_—¢-. —.». .‘—; .:¢‘i _. _._. .»r . ,_, _.. _ v , _V _ What should I do when someone enters my room during a call? I 02014 meuemzn mam lrIsm; te, Inc’; J
  • 64. ((( THFMFNT/ ll HFALTH . I l'I‘ * T ' * teleheaIth. 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 ofthe room — Reschedule for another day/ time
  • 65. - — —~A~—— —« -A-—_«= -.—; -». .‘~; .:¢‘i &____ _g___ V V__Tj_j____T‘_j. g Tu: 3» ' v_ >4 _ , :¢, . arsauhfiwm grf. %: ‘§r—‘-“’. £»'. t.-‘E’-‘.2;-= E.. , X‘ _. _._. .»r . ,_, _.. _ T , _V _ l Why use initial protocols when videoconferencing? "ix ozou meuemzn mam lnmlL; t2. 1111'; l
  • 66. m FPMNTAI ur um ((( teleheaIth. org : lll 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 ? lfanyone 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? 0 2014 Telahlemzl Health lnsmney lm:
  • 67. - — —~A~—— —« -: —_~¢-. —4». .‘—; .:¢‘i i. . I ‘. ..if -_. . . _a___. ‘ ' ‘ ' , '_; _'_'__'__A if T ,3 v. . . l‘ ‘T 12355?‘ I: 2?. ‘ix I ‘ii l _. _._. .»r . ,___. . , — ' ~__ , I Can I get paid for the time used in helping a client/ patient set up and manage their equipment? ozou meuemzn mam Ind1lL;1e, Inc’; I
  • 68. ((( TFIFMFNT/ ll HEALTH . Ii'. “’—ll‘, ,Ii'f teIeheaIth. org 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[CMEsl
  • 69. - — —~A~—— —« -: —_~¢-. —-. ».. ‘—; .:¢‘i _. _._. .»r . ,___. . , — ' ~__ , I How do I handle technical issues created by my video teleconferencing (VTC) system during a call? ké. _V. _:. __. ,_____j__. _., :.. _.: A ’ '€'I""“? §’ ? §’? ?—_"”}‘**“: ’.¥: -_-s. -, X I ozou meuemzn mam Ind1lL;1e, Inc’; I
  • 70. ( ‘l‘r''.4'. ‘;'~''‘: ‘»! :''; ‘*_‘-f*‘~’I*i‘§’‘‘’ i, '—II= ’Ii'i= ,rlll3n. ‘_-1'15? ‘- w. 'ir. :w, ': Tech Problems During a Call * Practice before you work with clients/ patients ** Relax — trust your training ° Have an agreement with your client/ patient that you will call each other using a designated telephone number A Always have that phone number on hand when you conducta session * Have an agreement about who will call the other
  • 71. - — —~A~—— —« -A-—_<= -.—= ».. ‘~; q:¢‘i Tu: F. -:——. _.1_ V, g 4 _ 7 :6, . ‘: "$= :. __ % §'‘S‘“*‘_, . . .V_‘ l i E . :‘vL _. _._. .»r . ,___. . I’ ' ~__ — I What is a community champion and when is it appropriate to use one? "ix ozou meuemzn mam Inmuxe, left’; I
  • 72. m FMFNTAI, HEALTH I H i Y I U T I, teleheaIth. org 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
  • 73. TFIFMFNT/ ll HFALTH ((( I I I I I _ I teIeheaIth. org . F. ‘ ‘— I I 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 contactthem O 2014 Teleuemal Helm lnsmua. Inc
  • 74. _: _, . _ I . __ %'T*a§II What are the must—dos for communitychampions and ii; informed consent to -‘e III minimize my risks? : I, L “ . l , i’_ , _ __'__' ' ‘ ', ;;'_; ;___ if ’ ¥'“"‘“*7” ozou meuemzn mam Imm. Inc; l
  • 75. m EMFNT/ ll, HEALTH I II I I I II I I teleheaIth. org 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
  • 76. Aw I I -—— M. LII, Step 1: Training Step 2: Referrals Step 3: Client Education Step 4: Legal Issues Step 5: Assessment Step 6: Direct Care I. Ste, pI7.: Reimbursement- I 02014 meuemzi mam Institute, Inc; I
  • 77. ( ‘l'v''.9'II‘l_'I: ''‘: ‘;3:''L'%‘‘f*‘: ’I‘i‘5'‘‘’ ‘K, ’-II£Ii'i= ,l'lll3lI. ‘_-1’(! ? Dr. Trow vs. Oklahoma Medical Board * Relevant law —> The case * Skype ° Lessons to be learned
  • 78. Full style: State of Oklahoma ex rel. Oklahoma Board of Medical Licensure and Supervision v. Thomas Edward Trow, ll/ l.D. , License No. 10255, case No. 11-11- 4439 (Sept. 12, 2013)
  • 79. ( ‘l‘r''.4'. ‘'‘; '~''‘7’_: ''; ‘¢_‘-f~‘~’I*i‘§’‘‘’ i, '—II= ’li"L= ,rlll3II. ‘_-1'15? : - I. 'Ir. :II, ': "Physician/ patient relationship” in OK * ”. ..a relationship established when a physician agrees by direct or indirect contact with a patient to diagnose or treat any condition, illness or disability presented by a patient to that physician, whether or not such a presenting complaint is considered a disease by the general medical community. The physician/ patient relationship shall include a medically appropriate, timely-scheduled, actual face-to-face encounter with the patient, subject to any supervisory responsibilities established elsewhere in these rules. ’’ (emphasis added) — OAC 435:10-1-4 — Does not say: "in person”
  • 80. TFIFMFNT/ II HEALTH ((( I I I I I _ I teIeheaIth. org . F. ‘ ‘ I I IC: OK Telemedicine Act, OAC § 36-6804 ° A. Prior to the delivery of health care via telemedicine, the HCP who is in physical contact with the pt shall have the ultimate authority over the care of the pt and shall obtain IC from the pt. The IC procedure shall ensure that, at least, all the following info is given to the pt: 0 1. A statement that the individual retains the option to withhold or withdraw consent at any time without affecting the right to future care or treatment or risking the loss or withdrawal of any program benefits to which the individual would otherwise be entitled (emphasis added)
  • 81. K ’l'r".4'. "“, '~'«“’, :"'_‘%‘-’-‘~’I*i‘3"" ‘<, =lt= ’I‘o'i= ,‘r'illi'vI. ‘-'iig‘: ~. l| '), ',I]I’I’ll ' IC: OAC § 36-6804, 2 * 2. A description of the potential risks, consequences, and benefits of telemedicine; * 3. A statement that all existing confidentiality protections apply; * 4. A statement that pt access to all medical info transmitted during a telemedicine interaction is guaranteed, and that copies of this info are available at stated costs, which shall not exceed the direct cost of providing the copies; and ~ 5. A statement that dissemination to researchers or other entities or persons external to the patient- practitioner relationship of any patient-identifiable images or other patient-identifiable information from the telemedicine interaction shall not occur without the written consent of the patient (emphases added)
  • 82. m EMFNT/ ll. HEALTH I II II I I II I I teleheaIth. org IC: OAC § 36-6804, 3 - B. The pt shall sign a written statement prior to the delivery of health care via telemedicine indicating that the pt understands the written info provided pursuant to subsection A of this section and that this info has been discussed with the HCP or [his] designee. ° C. If the pt is a minor or is incapacitated or mentally incompetent such that the pt is unable to give informed consent, the consent provisions of this section shall apply to the pt’s rep. The consent provisions of this section shall not apply in an emergency situation in which a pt is unable to give IC and the pt's rep is unavailable. .. (emphases added)
  • 83. m EMFNTAI. HEALTH I II II I I II I I teleheaIth. org IC: OAC § 36-6804, 4 - For purposes of the delivery of mental health care via telemedicine, the use of telemedicine shall be considered a face-to-face, physical contact and in-person encounter between the health care provider and the patient, including the initial visit. — Services provided by the Mental Health Dept. : initial evaluation may be virtual — Mental health services provided by others: initial evaluation must be in—person — Otherforms of health care: initial evaluation must be in- person
  • 84. K ‘j': i‘! ,3.B‘, l‘: “1": ‘"| Z“: "‘, ":‘£’: ‘! ‘x, -.1tiii"x= ,r= ’I(i‘ui; .'. "., ~,. ~. l| '), '_I]l’I’l: ' Telemedicine for Mental Health (OK 2008 Policy) ° Telemedicine technology is limited to consultations, psychotherapy, psychiatric diagnostic interview examinations and testing, discharge planning and pharmacologic management. An interactive telecommunications system is required as a condition of the use of telemedicine. ~ The following shall n_ot be considered telemedicine: * (1) Phone conversation (including text messaging) * (2) Electronic mail message 6 (3) Facsimile (fax) * (4) Store and forward
  • 85. ( j3,",3.""_l‘= !'? ’_, ";‘*, “": ““"’: ‘£”‘! ‘<; .Ilil’u"u, r-'l[i‘n. ‘,-1'15‘: ‘- w. 'lr. :w, ': Telemedicine for Mental Health (OK 2008 Policy), 2 * The telemedicine equipment and transmission speed must be technically sufficient to support the service provided. If a peripheral diagnostic scope is required to assess the patient, it must provide adequate resolution and audio quality for decision making substantially equivalent to a face-to-face encounter. Staff involved in the telemedicine visit need to be trained in the use of the telemedicine equipment and competent in its operation. (emphasis added)
  • 86. m FMFNTAI. HEALTH I H (,7 Y I U T I, teleheaIth. org Telemedicine for Mental Health (OK 2008 Policvl. 3 ° The physician who has the ultimate responsibility for the care of the patient must obtain written consent from the patient, in accordance with state law, that states they agree to participate in telemedicine. The consent form must include a description of the risks, benefits and consequences of telemedicine and be included in the patient’s medical record ° Physicians providing mental health care services via telemedicine shall be held to the same standards of care as required in the medical community. — Emphasis added
  • 87. ((( TELEMENTAL HEALTH | N __) Y ‘ I U I F ‘ telehealtfnorg
  • 88. m FMYNTAI ur um ((( teleheaIth. org Iuiltii Trow: OSBMLS Telemedicine Guidelines ° Ok. medical practice act requires initial in—person visit before MD can prescribe Rx — Exceptions: ' Emergencies ° DOS ' Interactivetelecommunications system required — TM network standards: all technical, confidentiality requirements under state and federal law ' Permissibletelemedicine functions: — Consultations — Psychotherapy — Psychiatric diagnosticinterview exams and testing - Dischargeplanning — Pharmacologicmanagement 0 NOT TM: phone, email, fax, store—and-forward O 2014 Teleuemzl Helms Insmna. Im:
  • 89. mwrunu urmm ((( I , Y ‘ _ , teleheaIth. org . r. ‘ ‘— Y . , l I Trow: Stipulated Facts ° Dr. Trow is an unemployed 65 yo pain management physician ° Orthopedic problems make travel difficult for him — Used mail, fax, and phone from home 0 RN often served as telepresenter at clinics — Records kept there but not, as Oklahoma telemedicine guidelines require, at Trow’s home office 0 10/20/11: DO reported 3 pts getting large doses of Xanax 0 11/8/11: TL, daughter of deceased, addicted, 62 yo pt RC, complained Dr. Trow prescribed CDS for RC — RC died of HBP and COPD ° No toxicology studies 0 2014 Telemental Helm Insmua. In:
  • 90. m FMENTAI ur um ((( teleheaIth. org Iuiltii Stipulated Facts, 2 ° 8/17/12 Ok. HC Authority (”OHCA”) letter: — No contract with OHCA — Using unapproved equipment — Noinformed consent — Inability to produce 2 of 10 requested charts — Overprescribing CDS — Limited documentation; no physical exam — Verbal orders not countersigned ° 3/13/13: OHCA reported D was — 1) seeing Sooner Care patients via Skype and — 2) writing for controlled substances without an in-person evaluation ° OHCA "is the primary entity in the state of Oklahoma charged with controlling costs of state-purchased health care. ” — SoonerCare: Oklahoma Medicaid l O 2014 Teleuemzl Helms Insmna. Inc
  • 91. m FMENTAI iir um ((( teleheaIth. org Iniltii Stipulated Facts, 3 ° Dr. Trow caused NO patient deaths ° Dr. Trow billed OHCA for Skype services; not an approved telemedicine modality ° Trow did not see all pts, even by Skype. ° 11/9/12: OHCA letter #2: similar to 1; more detailed — No initial contact with patients — lnadequaterecords — H| PAAvio| ations — Inadequate supervision of nurses — Failing to heed drug screen results — VOs ° 11/15/12: OHCA terminated SoonerCare I l O 2014 Teleuemzl Helms Insmna. Inc
  • 92. ( ‘l‘r''.4'. ‘'‘. '~''‘7’_. ''; ‘*_‘-f~‘~’i*i‘§’‘‘’ i, -II= ’Ii‘i= ,rlll3‘n. ‘_-1'15? : - i. 'Ir. :w, ': Procedural Posture * Disciplinary matter, not a private (malpractice) claim a -. — ? Possible infuture? I pl’ T ‘ / ‘ Defendant pled guilty — Waived right to full hearing * D admitted violating OHCA telemedicine guidelines: improper equipment; no proper contracts — Stated he thought those duties fell to his employer
  • 93. ( ‘l‘r‘.4'. ‘'‘. '~''f‘! .'i‘*_‘-f*‘~’i*i‘§’‘‘’ ‘(, -II= ’Ii‘i= ,rlll3‘n. ‘_-1'15‘: :- i. 'Ir. :w, ': Conclusions of Law: Unprofessional Conduct * Dishonorable conduct likely to deceive or harm public * Prescribing without _ ’ . F ” — Proper doctor-patient ,7 Y relationship; == ~ / — Adequate PE * Overprescribing controlled substances — No documentation of medical need * Inadequate records
  • 94. Consequences : : License suspended ° MD to take prescribing course ’ I! :«~ No CDS prescribing until . — 1. Course completed — 2. Dr. Trow meets with Board Secretary * MD is on probation * Reported to National Practitioner Data Bank
  • 95. ( ‘E ‘<, =irai. u,r: im. .;-m‘. » New Ok Definition: ”Face—to-Face Encounter” by TM at ’’It is the position of the OSBMLS that the face- to—face encounter required by OAC 435:10-1- 4.. .to establish a physician/ patient relationship includes real-time telemedicine encounters with audio and video capability. ..[T]o qualify as a face- to-face encounter set out in this definition, the telemedicine audio and video capability must meet those elements required by CMS. ” OSBMLS, 9/25/13, — http: //www. okmedicalboard. org/ download/705/Tele medicine PositionStatement. pdf
  • 96. m FMFNTAI. HEALTH I II I I I II I I teIeheaIth. org Oklahoma Law is In Flux - November 7, 2013: Board held a public forum to discuss the use of telemedicine in Oklahoma - Then, public comment — First public comment period ran overtime; a special session may be needed to complete the process ° Thenzlegislature - Finally, Governor's office
  • 97. What are the take- home lessons from the Trow case? _ W. llll-l. l, lllli l. I ozim Tueuemzi Realm msmme. inc; I
  • 98. m FMFNTAI IIF um ((( teIeheaIth. org Iuiltii Take-Home Lessons ° Case reflects Oklahoma law only — But Oklahoma is relatively telemedicine—friendly (”SoonerCare views telemedicine no differently than an office visit or outpatient consu| tation. .” OHCA Policies and Rules, 317:30—3—27, revised 7/1/13) — Other states could do the same or worse ° Tort liability presumably remains possible — Though wrongful death claims might be problematic — is Dr. Trow insured against this risk? ° Determine what establishing the physician—patient relationship requires in the relevant jurisdiction — Is a virtual visit adequate? ' Be sure to perform the type of initial contact required by your state law for distance counseling I O 2014 Teleuemzl Helms Insmna. Inc
  • 99. m FMFNTAI. HEALTH I II I I I II I I teIeheaIth. org Take-Home Lessons (Cont. ) ° Obtain and document informed consent — In Oklahoma, must be in writing — Check your state's laws ° Maintain proper records - Board's main focus was on excessive prescribing, not Skype per se — Does Oklahoma forbid Skype for telemental health services? ° Nevertheless: Use Skype with caution, if at all — No claim of HIPAA compliance ° Be especially cautious with controlled substances — Potentially acceptable: hospice
  • 100. YFIFMFNTAI HEALTH ((( I I I I I _ I teIeheaIth. org . F. ‘ ‘— I I FSMB, as of 8/12 - 10 state boards issue a special purpose license, telemedicine license or certificate, or license to practice medicine across state lines ° 57 boards + DC Board require that TM physicians be licensed in the state in which the patient is located - Minnesota allows physicians to practice TM if they are registered to practice TM or are registered to practice across state lines — http: //www. fsmb. org/ pdf/ grpol telemedicine | icensure. |:_) Q‘.
  • 101. ( ‘l'v''.9'; I‘A_', :''‘. ‘;3.''L'%‘‘f*‘*’I‘i‘5'‘‘’ ‘K, ’-IIiIi"i= ,I'lll3II. ‘_-Tu? Full Discussion A The previous slides were from a webinargiven 1/20/2014 through the TeleMental Health Institute. * Guest speaker for that webinar and author of many of the previous set of slides is Joseph McMenamin, MD, JD, McMenamin Law Offices, Richmond Virginia
  • 102. Specific Informed Consent Processes and I Documentation
  • 103. K j3.", T:. ""_l‘: "!. "’_‘*, “f“"I’: ‘3’: ‘! ‘<; .!I£Ii"i= ,I'll[iiI. ‘_-i’(g‘: :- I. 'Ir. III, ': 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 assessmentinstruments and other communication devices.
  • 104. TEI EMFNT/ II. HFAITH ((( I II I I I II I I I teIeI1eaIth. 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.
  • 105. ( ‘i'v''.9'fA_', *''‘, ‘;3,''L'*7‘‘f*‘*’i’i‘5’‘‘’ ‘K, ’-ll: ’ii"i= ,r'lll‘n. ‘_-1'15? 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
  • 106. m wmrm, HEALTH l H K‘ Y I U T F te| eheaIth. org 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
  • 107. ( ‘‘‘r''.4'. ‘;'~''‘: ‘»! :''; ‘*_‘-f*‘~’l*i‘§’‘‘’ ‘K, ’-II= ’Ii"i= ,r= ’ll3n. ‘_-1'15? ‘- w. 'lr. :w, ': 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
  • 108. TELEMENTAL HEALTH ((( l telehea| th. org l N S X I I u T F 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
  • 109. ( ‘E ‘<, =iisi. u,r: itiI. .;-m‘. » TMHI Informed Consent Documentation Basics * Emergency Resources and Plan including names and contactinformation for local, trusted person(s) to be contacted at the -4 51 U discretion ofthe clinician . ;. - —‘‘’'T .3 | ° Documentadvantages and E‘ = 0 / Q 9'" . ._. .ai disadvantages of using , . . technology I? " V I} :2» .5, * Documentevidence-base supporting counseling plan I * Document client preferences re: technology
  • 110. THEMFNT/ ll. HEALTH I r-. ‘ >1 , telehealtnorg IILITF 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 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 COIISQIII (lOCLllll€_‘lll. 0 2014 Tllellemal Mqiml Insmne. Inc,
  • 111. Tfl FMFNTAL HEALTH ((( ‘ _ I, teleheaIth. org Ii’-. ":l ll TMHI Informed Consent Documentation Basics ° Some risks may not yet be unknown * ° No physical exam * ° Identify both the clinician's & client's/ patient’s physical location ° _St tements* suchcfsz Pro essi _nal will rely on in ormation provi ed by he c ient/ patientand by any on-site practitioners or other sources ° Potential problems could arise with electronic transmission in telepractice: ° distortion, delays, interceptions, interruptions ° Document all communications with client (written, audio, video or verbal) * Obtain full legal review with a local telehealth attorney prior_ to usiné any TMHI sample wording with clients either verbally or in in your informe consent document. D2014 TEIEHEMJI Hailtfl lllsmfle. Inc
  • 112. ' Tsi. Ei. iENTxii. iirALTH ((( N _; X I U T F ( teleheaIth. 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 mu| ti—cultura| and diversity issues O 2011 Talellemzl Htimi Insnfle, Inc,
  • 113. Tfl FMFNTAL HEALTH I H (,7 Y I U T I, teleheaIth. org 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
  • 114. Tfl FMFNTAL HEALTH I II I I I II I I teleheaIth. org 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
  • 115. rEi EMFNT/ tl. HFAITH ((( I II I I I II I I I telehealtnorg 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
  • 116. rir-. i.rini-. i MFA Tl (G I IL‘ ’ teIehealth. org I'. ‘i: i 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. 7'. ‘-ll . fii : «1- Z. ° 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 Ietterin surface mail with a copy to your physician. ’’) 0 ZDIA TEIEMEMEI Heal‘? ! Irlsmlfle, lnl:
  • 117. l'IFM¥NTi‘tl llFlTH ((( ‘I II I I III telehea| th. org NBCC: Standards For Distance Professional Services ° NCCs shall carefully adhere to legal regulations before providing . I . ' 1 distance services. This review - ' I shall include legal regulations from the state in which the counselor is located as well as those from the recipient's location. I _ . Given that NCCs may be offering K _ distance services to individuals in - different states at any one time, *’ the NCC shall document relevant state regulations in the respective record(s).
  • 118. K j3,", T:. ""_l‘: "!, "’_‘*, “f“"i’: ‘3’: ‘! ‘(; —ilili"‘i= ,r§l[iii. ‘_-i'(5‘: ‘- i. 'ir. rii, ': NBCC: Standards For Distance Professional Services * Boundanesof competence — NCCs shall provide only those services for which they are qualified by education and experience. NCCs shall also consider their qualifications to offer such service via distance I means. ‘ _ «- — Are counselors competent to deliver traditional service in technical environments? Technical and clinical training may be needed.
  • 119. ( j'v''.9'fA_', *''‘, ‘;3,''L'*7‘‘f*‘*’i’i‘5'‘‘’ ‘K, ’-li= ’li‘i= ,rlll3h. ‘_-1'15?’ Privacy, Confidentiality, Diversity * Privacy& Confidentiality T, , ‘ ll — Understand your ‘ technology (email, texting, video) and its clinical repercussions related to privacy and technology * Diversity — Multi-cultural, multi- lingual, religious, LGBT, and other issues
  • 120. ((6 ‘’‘? '9??1t‘'7%'. ‘¥'%‘“T; ‘’? ‘5f’‘‘ W-‘i<~ti~~<. -It-e‘«» Service to the ”Home” t Scientific evidence base i for contact to the home is , » r much thinner, less S reliable than traditional telehealth 4° Risk management is a serious concern ~° Likelihood of lurkers, intruders or interruptions is increased -9 Develop signs, code words or phrases to signal something is amiss
  • 121. /j(¢ ‘*%'%jf{§f! f€f—ff3§E"‘ ‘<, -!l= ’ti"x= ,i'Jlli'oi; _-mu TMHI Clinical Competence Client Selection * Study the evidence base (research) * People with almost all diagnostic symptoms have ‘ , To been documented as N, ' ' _ - successfullytreated with l traditional telehealth / ' + Clients experiencing severe i_ l A anxiety, flagrantly psychotic _~{~_. —— symptoms or suicide/ homicide intent may not be optimal choices while symptom patterns are exacerbated
  • 122. _ ‘“"' i; -!l£t’u"i= ,r-'lli'n. ‘_-1‘(! ? TMHI Clinical Competence Client Selection Most of the studies mentioned above include the assistance of a local collaborator Treatment to the home has 4. T"? not yet identified full range of , ‘ risk Understand differences when / 4 delivering care to clients in (it, different settings (hospital vs. _ A _ car, park, bed etc. ) Establish procedures to minimize attendance & compliance issues
  • 123. Interjurisdictional Licensure Issues 1 trlfcvwmrts . I . .. .uu. E kl‘
  • 124. ABOUT THE INFORMATION IN THIS REPORT The information in this report mu compiled through a survey ofslatc counselor licemure board» conducted in full M2009. Stzitc-by-state analysis of lain‘ and administmtitc nrles was also conducted to add to the survey data. especially for lhc mo jurisdictiom. —Gcorgia and Pucrto Rico-that did not submit infomiation in response to our request. Every effort has been mitdc 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 error. Rc.1ders are eriootintged to bring any errors. omissions. or changes to our attention. For any questions or corrections regarding this chart. please contact: American Counseling Associattion Ethics and Professional Standards 5999 Stevenson Avenue Alexandria. VA 22304 Web site: tiwtw. counsellng. og U. S. toll~l'nce: X00/3-17-6647. xll-8 I DC amt: 703/823-9800. x314 Fax: 703/823-3760 E-mil: stlitncemnmdlnnnm For additional informsrtion. or clarifie. -tliori or interpretation of any of the laws and regulations sumntirized in this report. please contact the appropriate state licensing board. Written and edited by Christie Lum. ACA Oflice of Public Policy & Legislation. Howard B. Smith. Ed. D. NCC. CCMHC. LPC (License M920 Louisiana) reviewed and reviurd Appendix D: Aecredit. 'ition. Ccnification and Licensure Defined and (. 'onl'identi; tlity/ l"ri‘ileg. 'td ('unimunii: .itiun. Copyrighu‘Z0|0 by the American Counseling A-ssnciation. Amerlcsn Counseling Assoclatlon 5999 Stevenson Avenue Alcundrtn. VA 12304 (800) 341-6647 . ‘m! .-§lt. ttll8.llIl£&l!
  • 125. ALABAMA AL Board of Examiners in Counseling 950 22nd Street North. Suite 765 Birmingham. AL 35203 800/822-3307 205/458-8716 205/458-8718 (fax) www. abec. alabama. gorv Application packet (if mailed): 325 Application fee: S200 LPC License fee: $300 ALC License fee: S150 Liceuxurt Requlremenlsfar Pr0frs. rinnuI Crmn. elar. r - 2010 Credential Tltle(s) Educational Experiential Exam Requirements Requirements Re - uired Licensed Professional Counselor (LPC) A person licensed to render professional counseling services in private practice for a tee. Associate Licensed Counselor (ALC) A person licensed to render professional counseling services in private practice for a fee while under board approved supervision. Masters degree or higher in counseling lrom a CACREP or CORE accredited program. or the content equivalent. with a minimum of 48 graduate semester hours (or 72 graduate quarter hours) from a regionally accredited academic institution. 3,000 hours of supervised experience in professional counseling with board approved supervision. An applicant may subtract 1.000 hours of the required professional experience tor every 15 graduate semester hours (or 22.5 quarter hours) obtained beyond the masters degree from a regionally accredited academic institution. provided that the coursework is clearly related to the field of professional counseling. This formula may be used for up to 2,000 hours.
  • 126. K‘ ’<, :ll: ’li'i: _rlltih. ‘_-'i’rg‘. v 20/20: A Vision for the Future of Counseling 4) Creating a portability system for licensure will benefit counselors and strengthen the counseling profession.
  • 127. ‘*‘¢'%j; '4{%%‘: {l‘i‘§‘—f; ‘~’; E"‘ -. ,4.q-. -—. -ii. -ll: -.. .-, ..-. ,~. . Inter-jurisdictional Practice Licensing Boards that may assertjurisdiction: ° The one in the professiona| ’s state(s) of Iicensure * The one in the client/ client's state of location at time of call ° Both Safest Practice: * Provide services only where licensed ° Require client to attest to his or her location on every call
  • 128. ‘<, -ll= ’l’u"i= ,r-'Iliil. ‘_-m‘: Inter-jurisdictional Practice (cont. ) Spedalufleheahhandinrnanycases "telemedicine” laws have led the way ° Prescription-writinginitiativesled to devdopnmntoHam5inthe9O% ° Reimbursement practices for Medicare7 Medicaid ° 32 states now mandate in-person assessment prior to distance contact ° Special informed consent laws also rapidly evolving ° Regulatory Case ° Oklahoma case of Dr. Trow ° No in-person assessnwent ° No informed consent v No HIPAA-compliant technology(he used Skype)
  • 129. rm'. isrm. i llf»lTil (( , , ‘ _ telehealthorg Licensure Requirements for Professional Counselors — 2014 What's New for 2014 (page 4) Distance Counseling, Technology, and Social Media Information In response to the increased use of social media and technology within the counseling profession, state Iicensure boards continue to develop rules and regulations regarding distance counseling. It should be noted, however, that these guidelines are in their initial stages of development and are therefore changing rapidly; always check with your specific state for comprehensive guidelines before engaging in any distance counseling activities. 4° Seventeen (17) states (Alaska, Arkansas, Califomia, Colorado, Iowa, Louisiana, Massachusetts, Minnesota, Nebraska, New York, North Carolina, Oregon, South Carolina, Ohio, Texas, Utah, and West Virginia) do regulate electronic communications for counselors, but only within their particular state. The general rule is that to practice distance counseling in these states, the counselor must be licensed and follow the regulations of that state. Colorado makes the recommendation that the first session should be face-to-face and to meet periodically face-to-face with the client. 0 ZEIYA TEIEMEMEI Heart? ! ITISULLIIE, lnl:
  • 130. ((6 ‘‘‘t'? ?,‘l‘ ~‘Jl»n, ‘.‘I3;I5J= l i, ‘-IIiIi"t= .F’lljii{_II'(5} r Licensure Requirements for Professional Counselors — 2014 What's New for 2014 (page4) °. ° Twenty (20) state counseling boards (Alabama. , Arizona, Connecticut, Delaware, , Florida, Georgia, Hawaii, , Kentucky, , Maine, Michigan, , Missouri, New Hampshire, North Dakota, Oklahoma, Pennsylvania, Rhode Island, South Dakota, Vermont, Washington and Wyoming) and the District oI'Columbia report an absence of any law. rule, or regulation addressing the use of the intemet with clients. It is therefore assumed that these states treat electronic messages between counselor and client the same way that they treat face-to-face communication. '4' One (I) state, Arkansas, has an addendum to their Iicensure requirements specifically geared towards technology assisted therapy: The Technology Assisted Counseling Specialization license requires additional education and supervision. ‘a’ Five (5) states (Maryland, New Mexico, Tennessee, Virginia and Indiana) specifically state that they do not support electronic communications under their scope of practice for professional counselors. ‘a One (I) state (Mississippi) will only grant Iicensure to state residents and/ or those who pay state income tax. '5 One (I) state (Kansas) allows distance supervision provided that the supervision is conducted via confidential electronic communications. '2' One ( I) state (Louisiana) allows for 25 of the required I00 clinical supervision hours to be conducted via videoconferencing. -2- One (I) state (Ohio) defined one continuing education hour as I0,000 words with regards to distance leaming courses. ' 13,5 .
  • 131. ( ’’3_5r7,‘‘l5”Ji‘%‘-f-‘3€‘3’‘’ ‘<, =lt= ’l‘o'i= ,i'-'lli'n. ‘_-'iig? Special Telehealth Licenses or Certificates Licenses could allow an out of state provider to render services via technology in a foreign state, or it allows a clinician to provide services via telehealth into a state if certain conditions are met (such as agreeing that they will not open an office in that state. ) http: //www. fsmb. org/ pdf/ grpo| _telemedicine_licen sure. pdf
  • 132. ( ‘l'v''.9'fA_'. *''‘g‘;3g''L'*7‘‘f*‘*’l‘i‘5'‘‘’ ‘K, ’-llilfur-’ll3h. ‘_-1'15?’ States with Laws Mandating Private Insurance Coverage of Telemedicine Telemedxcme Parity Law Proposed Parity Lfgflldtlon No Pamy Legislative Action
  • 133. ( ‘l‘r‘§'. ’‘, '3'f‘!7i‘*_‘-f*‘~’f‘§’‘‘’ i, "-ll= ’li"x= ,rlll3n. ‘_-1’(e‘: ‘- w. 'ir. :w, ': Special Telehealth Licenses or Certificates * Alabama * New Mexico to Louisiana * Ohio * Minnesota * Oregon Montana 4' Tennessee * Nevada * Texas http: //www. fsmb. org/ pdf/ grpo| _telemedicine _licensure. pdf
  • 134. ( i'T'Tf_”}“;17i'%“f*'35L1_"‘l ‘<, =itai. u,r: ILil. .;-m‘. » Innovative Models * National Council of State Boards of Nursing (NCSB) * Federation of State Medical Boards (FSMB) * Association of State and Provincial Psychology Boards (ASPPB)
  • 135. Licensure Portability Legislation I’ I I . ,a‘*- _
  • 136. ms, -mum urum ((( , ‘ T teiehealtnorg l'. ‘—l 2010 Innovatjye Met_h_ods " 1'? " The Regulation of Technology-Assisted Distance Counseling and Supervision in the United States: An Analysis of Current Extent, Trends, and Implications Charles R. Mc/ idams III & Kristi Lee Wyatt Counseling Iicensure boards report emerging needs to regulate technology- assisted distance counseling and supervision. An analysis of published regulations and telephone interviews with board administrators nationwide suggests that boards agree generally on 7 aspects of technology-assisted distance practice that need to be regulated. 0 21114 Teieuemzi Health Insunnei Inc
  • 137. lfl FMF Nlfll HF ‘K TH ((( fl telehea| th. org illl TABLE 1 Current Extent otTechnoIogy-Assisted Distance Counseling (TADC) and Technology-Assisted Distance Supervision (TADS) Regulation (N = 46) TADC TADS Extent of Flegulation No. of States % No. of States % Regulations were in place 14 30 6 13 Regulations were under development 5 11 4 9 Regulations were under discussion 15 33 14 30 TADC and TADS were prohibited as illegitimate activities 10 22 19 41 TADC and TADS had not arisen as issues 2 4 3 7 0 21114 Telemental Health lnsmne, lm:
  • 138. ( ‘l'v''.9'fA_', *''‘. ‘;3.''L'*7‘‘f*‘*’l‘i‘5'‘‘’ i, '—llili‘t= ,l= ’ll3ti. ‘_-1'15? TELEmedicine for MEDicare Act, 2013 1* HR 3077, the ”TELE-MED Act” was introduced Sept. 10 in the House by Reps. Devin Nunes, R—Calif. , and Frank Pallone, D-N. J. Nicknamed the TELE-M ED Act, seeks to update current Iicensure laws for Medicare beneficiaries, the number of whom is expected to rise to 81 million by 2030
  • 139. Vii, -.irNTAl llFiTH ((( Q _ ‘T telehea| th. org l’. ‘ I TELEmedicine for MEDicare Act, 2013 In the case of a Medicare participating physician or practitioner who is licensed or otherwise legally authorized to provide a health care service in a State, such physician or practitioner may provide such a service as a telemedicine service to a Medicare beneficiary who is in a different State, and any requirement that such physician or practitioner obtain a comparable license or other comparable legal authorization from such different State with respect to the provision of such health care service by such physician or practitioner to such beneficiary shall not apply. If passed, the bill will give licensing or authorizing states enforcement powers and require the Secretary of the Department of Health & Human Services to solicit input from ”relevant stakeholders” in order to provide telemedicine guidance for states. 0 21114 Telemental Health lnstmne, lm:
  • 140. X. ‘J lU. S.-CONGRESSMAN MIKE THO _‘REPRESENTl G CAi ifORllli'+ S HFTH DISTRICT E mail | '.liln'i: - lle-'. '.~sletlr_-i Signtlp Reqtie-st a Flat) PRESS RELEASES nee. MIKE THOMPSON mmoouces BILL IMPROVING ACCESS TO MENTAL HEALTH cm: H D 1‘: >3 Washington. DC. Dec 6l 1 comments U S Rep l. lir. e Thompson iCA'«-SN introduced cipamsan legislation ewpanding access to mental health care for Medicare recipients H R 3.2 the Llental Health -‘CC9SS lmprorement -‘-, ct will and thousands of night, qualified Iicenseo mental health counselors and marriage and lanllli therapists il. lFT3l to the nether. Q(pr0u1'39lS eligioie to ser. -:- Llecicare "eneticlanes "Access to quality mental health care shouldri‘t be dependent on how old you are. where you live or how much money you make. ” sai-3 Thompson ‘This legislation will allow thousands of mental health care professionals to provide quality. alloraable care to people on Medicare. and it will save money. Right now. there are more than 600 licensed l. lFTs in my congressional aistnct and more than 31.000 licensed l. lFTs in Calilomia that can provide quality mental health services. Our goal should be to expand access to these prolessionals and the comprehensive and quality care they provide. not limit it. " l. lecii: are currentl. recov; ni: es CSyCl'll3lf| SlS, pshzholo-gists clinical social wcrliers and psichiatric nurses ti: provide coiereo mental health semces How-: -.er mental health counselors anc l. lFTs who hate eouualent education and training to clinical sccial worters and prance taught. 4.’) percent of mental health st-races are not eligible to se reimriursed n. l. l-ecicare H R 3662 would fix this oiscrepanc, 3. ma-mg "ienlal health counselors and l. lFTs eligisle to sene Lleoicare tieneliciai-es aaairig; morethan 15-5.000 licensee practitioners to the Lleoicaie program that are not part of the normal aging process such as depression anriet. mood disorders and suicide Llani ol these mental illnesses can ae diagnosed and propetli treated ilthe appropriate care is at-ailacle sought anc accessed However illefl unheated it can lead to higher ’l‘lel‘JICal costs and negaliie health effects Curr-: -ntlr l. lecii: are ceneficianes who were seeking mental health S9l'y1C§SllDF"I mental health counselors at l. ll-’Ts prior to their ellglflllllv tor Lledicaie oft-: —n stop recei.1ngtreal't‘. c-nt because their eiusting pron-Jet is not under Medical? Thompson 5 legislation will ensure that seniors hate cornpt-: —hensi. ‘e access to qualiliec mental health protiders 3. increasing the pool olrnental health prolessionals that are eligiole to sene Medicare seneliciaries
  • 141. SEARCH FOR BILLS CONNECT refit! E-NEWSLETTER SIGN-UP Medicare currentty recognizes psyichiatnsts. psychologists. clinical social workers and psychiatric nurses to provide covered mental health services However, mental health counselors and Ml-‘Ts. who have equivalent education and Stues have shown l . geniors in l e Medicare program are 0 en . i e highest its for mental ea i pro that are not part otihe normal aging process such as depression, anxiety, mood disorders and suicide Many oi these mental illnesses can he diagnosed and property treated it the appropnate care is 3'lr'3l|3DtEi sought and Currentty. Medicare benetidanes who were seelung mental health senrices from mental health counselors or MFTS prior to their eligibility for Medicare. ohen stop receiving treatment oecause their eiiishng provider is not under Medicare Tliompsons legislation will ensure that seniors have comprehensive access to qualified mental health providers by increasing the pool oi mental health proiessionals that are eligible to serve llledicare henelicianes ‘The National Board tor Certified Counselors (NBCC) applauds Representative Thompson tor his commitment to ensuring a robust mental health woridorce ior older krriericans. ‘ said Thomas W. Ctawson. President and CEO oi the National Board for Certified Counselors. ‘Medicare provides healtti care to over 49 rniition people and research r than 40% oi older adults with mental or suoslance use disorders ootain treatment The Seniors ss ImprovementActwiII increase access to needed care or expanding the pool at qualified mental Adding mental health counselors and rnarnaoe and family therapists as eligible providers will , tensed proiessionals immediately available to the Medicare population This addition will expand ~ 55, and reduce oosts o - ovidin care in the commurii _ and aroldin e ensiie in atientselvices. NBCC 'tternoers oi the Calrtomia Association oi Mamaoe and Family Therapists enthusiastically applaud and support Congressman Mike Thompson's bill to provide greater mental health senices to our eldeiiy population. ‘ said Guileiino Alvaiel, Chairman of the Caliiomia Association oi Marriage and firmly Therapists ‘By allowing Licensed tlarnage and Family Therapists to become Medicare providers. many calilomiaiis will oenehitiom their expertise in treating a vanety or mental health issues. ‘ H R, 3662 is oo-authored by Repuolican Congressman Chris Gibson (NY-19), The oilt has been referred to the House Committees on Energy and Commerce and Ways and Means. oi which Thompson is a senior member Congressman Alike Thompson is proud to represent Caiifornias 5th Congressional Dismct wihich include: art or part or Contra Costa Lake Napa So-‘ano and Sonoma Counties He is a senior membero! the House Ways and Means Committee and the House Permanent Select Committee on intelligence Rep Thompson is also a memoerof the fiscally conservahve Blue Dog Coalition and chairs the bipartisan oicerneral Congressional Wine Caucus $33
  • 142. M15-L'i'i; ‘i ii. I I’ II 1:: Iii I (:1v. vic Blll tackles telehealth reimbursement, Iicensure . :L to iVTDl'0vE M-_— mare and Mediraid '9 coverage 01 telehealth This it-Fl I new. tenitor. ‘ for “ rhompson, he mtrodut-Ed some nL}0T -Ealth ' €~i-qis|3ti-: -n as 3 Cahiorrua State Senator In the 19905 = The latest hi" 5 defin tion of ’telehv3a! th" COvE'f5 . arious h-227th s-gm: -as dei . -area remoteh, mclu-ding i‘ < > reniot-2 nC4|'H{O’1|'a and . ideoconfer'ncxnq. both for r home care use. and to -: -nab! -3 sno: -cialists to zvrtuaili practice at hospitals . i.h-: -re they re needed Jonathan L| |'1V. OU5.Ch| €'€! ECUth'E ciflrc-: -r of the ‘ ‘ . '.rneri<an Telemedzzine Associaumn -j. '.T. '.‘i, tc-id i MobiH-2.31: ‘ that en tel‘ ‘aim was WV KS mfanc, , ieg . . tors --vom~: -d about abuse or that it wouidnt be cost-eff-scti. -9 and they hmited Me i and Medicaid ccwersoe to .2" narticutor cases -— only patients in runs? areas could be r-: -inibursed (or am‘ tel-= u Thorr*pson‘s bi", >- r ‘:4. ca‘¥ed Yhe Teleheaith Oromotion Act of 2012, slim mates an» such ‘arb Lrar‘. co. =rage restrict: -:»ns, ‘ amending the Sozial Securm Act to assert that teleheaith must be to. : 0 in any case in i. -/hrch the corresponding in-person treatment mould be COME are Linlrous said It 5 the nah! time for .1 change in t earth palm, due to a combination of the technoiogy ICS-E" irnorounq and becoming cheaper and the tact that teieh-sa’th is a more prowen technologv now. Threats or abuse or wast-: = have not materiahzed, he said. even uwouoh some )0 nii iron people are b-; -in-3 s-; -r. -ed by tel-an . -one todax. Another bio D70-ISIC-V1 c-! the bin stfiat it i. ‘.c-uld 3!‘-3.-. Dh': ‘:’-VCIEUS to pram»: -:~ (‘31v‘: nV-Ed : in. :« across state lines‘ thou! h3.| l'| Q to be hzensed in both states. something . ~.ha: h AYA estimates costs ohm tians about $300 muion a ‘year ‘For Durvoses of remrbursemenn ‘censure. professional IISDVMH‘, and other purposes under this mix; »‘.4lh f>':5E~. CI to the pro. ' ': -ith 5-mic-as, Dhvfiiizxans. Dramti-an-zrs. n<i H tn h: - fiirn. <5* m1 (Hfh : .:r‘ lth s-emits that r-zquired pat: -:~nt-phtsic-an interaction. for insmncvz. «yr-u—-vu . ..| . Jarfzo 20}: cm é. .1. mar‘ im, iP1' , _'L «"1: ‘Li. Fe: 35 ‘Mi: .'. asnirician DC Fe: 23 - 27 2); i.i C)7r1.1ndc’ Fran .13
  • 143. (( tcansrclannu. 3:11: uzu Connect] [Inc ahe v. s. Governnchi-. Pnnuhg ounce] (L1. 6719 lanodaced an Emu: (13)) 112:3 COIIGIISS Z6 suntan H. R. 5715 T9 9:3“ and Ixpuad the Ayplaunon at tchhulca made: Roman and other reaenl. health one program, And to: other aux-pelu. IN ‘BIG HWSZ O! IKIIISEHYAXXVIS mafia: 30. 2011 Xx. Thomlea at Calxlexnza xhuoducld the tonmuhw bun vhxch vu relenea ID the cauuuee on Energy and counezee. and La Adfliilen to the Ccuuceco on II: I and Menu. Ovczswht cad Gavvnncn: luau. Arne Bcrvxcu. Ind Voceunr lttuu. to: I Mrxed to he luhlcflutnclv necexnuaea by the Speaker. 3.: eneh en: 10: cenexneznuea at such pxovxnann 2.2.1 vxthan can junldxcncn at ch: cwnnen ccnccncd 9 protect and expend the hwlxcncaen at tlllhtllbh usdcz flndscln And other federal heuth caxe program, and to: ache: yurpaaea. 3: 3: uuctld by tat Sums: I-A HUBII at Runncntltavcl at the and sun: at inane: In Cohan tabled. zcrzoa 1. $80!? TIYLI: TABLE 0!‘ CONTESTS. In) 3210:: 21:10.--than Act My be sand on the ‘ ‘fnlchculth naocxon An: 9! 20:1". ch) run: at Con: u:: A.~-The uhle at eonaenu a! thin Ac: 1.: u Sec. 1. Shot: tack: eabxe 9: contents. TITLE I--RDNVIIM nun»? COVERABZ RESTRICTIONS ON TIQRILLTH HM! IIIIZRM’. BILL! !! (122 PIIOGIIAHJ sec. 101. Ihuure: ltedxeud: can. See. 102. Federal enoloyees hunch, dental, And vxsxan benefits pxowxu-. |. see. IDS. TIICABZ. sec. 109. Health care pxovxded by the Department at Veeczhns Mints. sec. 105. zltccuvn den. TXTZZ I1--IDDITXOIIBL IHPIOVDEVIS 1'0 HZDICRRI sec. 20:. Pounve xncci-inn to: uedxun I hunxuz. zcouxuaxena ZEQICELOB ~- -
  • 144. i I counscrmo ms HEALTHCARE Q aIe TECHNOLOGY COMMUNITY Home t. lews&Comrnentar_. -‘tumors Slloeshows Video Reports ‘. '.’hl!9 Papers Events tnterop +W: »li. :i. :. ’. -- - ' - '-*-l ‘ SOVFWARE SECURITY CLOUD MOBILE BIC DATA INFRASTRUCTURE GOVERNMENT SMART l I II S HEALTHCARE 1/ POLICY & REGULATION Bill Seeks To Clean Telehealth State mu¢moNA. _,u; som. ¢;s Regulations Mess , , Telehealth regulations differ in each of the 50 states, inhibiting » '8'-t Puressrstems -Hamil; olEvm: -nlnlecratec use of technology to treat patients, say proposed law‘: 3"“°"“ PM E‘”""'5° sponso, -3_ )9 Oracle Enadata and tau Pureoata $_. stem tor Anai, tics Compared The Big Data 200 ~ Taming the Beasts :9 IBM Tetaaata Compared -'«‘I’otaI Costot ken Tm’ Representatives Doris Llatsui t'D4CAl and Bill Ownersmn Study Johnson (R»OHl have introduced a hill in » Opegauona] . »‘n3m, c5 mom Mo 2 Congress that creates a tecteral oetinilion or A telehealth and that provides guidance to wow states on how to regulate this burgeoning a . held Telehealth is a major contributing lactor to lncreased health care quality convenience ‘tr and lower costs “ m§jnm ot the hill h V stated “'r-loivever there currently are :70 f3._ separate sets of rules [in different states] as to . vhat type of care can be provided This otten ‘ t geayeg Dom provlgeyg and panems ln 3 state itweet : i of uncertainty The Telehealth Modernization m sham »3g§_', 'i'iII provide guidance to states as they look to UII|1Z€' telehealth 6 technologies in the satesi most secure manner possible " Move to the cloud 3" he t. latsui-Johnson oill grew out ol legislation that was rgggntty adgptgg in Watch tBI. t Business Pannets asmey-talk accutnoi. -1 Clout} Comourlng has czcugnz about traristo'mat<~nai change tc thew chents cusmesses California Among other things that state law broadens the detinitlon ot telehealth to include store-and-ton-lard technology and home monitoring of patients It also allows the state's htedicaict program to cover doctonpatient communic ations that take place outside 0! hospitals physician offices and killed ntirsirlc tacllities
  • 145. THFMFNTAI HEALTH ((( I , Y K ‘ _ , teleheaIth. org . F. ‘ ‘— i i Legal Suggestions ° Counsel each other & ° Write to your malpractice document those carrier and describe your conversations proposed service before . Communicate Often to investing too much time your local, state and 0’ 5$ national professional ° Check with an informed, associations— let them local attorney who know what you need specializes in telehealth ' Put information in writing '50 verify that 3” aspects of your telepractice are in compliance with state law
  • 146. Other Legal & Ethical Issues for Distance Counseling ~- — ———— — er s"'r'°fi‘ "“‘ V ; fi , /iv 31, “i
  • 147. ( ‘l‘v", ¥'. "“_’~"‘7’_. "§‘%‘-f~‘~’. *i‘£"" z, -.uaa‘x= ,r: ua*. ..‘, -my. » ‘- w. 'lr. :w, ': 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 A _ Professions Code Sections 4989.54 (cont. ) l 1 S
  • 148. ( ‘t'v''.9'ft_'. *''‘. ‘;3.''L'*7‘‘f*‘*’l’i‘5'‘‘’ A1,’-Il= TI"(= ,l= ’llih{_Il'(! ‘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)
  • 149. THFMFNTAI urmm ((( I , Y ‘ _ , teleheaIth. org . n ‘— l . , l I Opening Protoco| * ° Identify yourself and your geographic location ° Ask your client/ patient to do the same 0 Audio/ video check (e. g., Do you hear & see me clearly? ) ° Is there anyone in your room or within ear—shot today? (Agree on safety code words, signals or phrases) 0 Is there anything else I might notice andfind of interest if! were in the same room with you today? ° Has there been an emergency in your environment today? 0 Is there anything else I should know about before we begin ta/ king 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. 0 2014 Telauemal Helm Insmua. In:
  • 150. r(_c Local Collaborators or Champions
  • 151. m FMFNT/ II ummc ((( , teleheaIth. org I? .“3li, Iii Mention Other Safety Issues - Have an addendum to your informed consent document — Include social media policy statements*that fit your client population, such as: — Iwill not ”friend” you on Facebook or other social media sites — Iwill 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 yo consent document. ur informed
  • 152. ( ‘t‘r''.4'. ‘'‘. '~''‘. ‘»! .''; ‘*_‘-f*‘~’I*i‘§’‘‘’ ‘K, ’-II= ’Ii"i= ,r'lllth. ‘_-1'15‘: :- i. 'ir. :ii, ': 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 rt Use of trigger safety lock devices is an option
  • 153. «( TFIFMFNTIUHFALTH . I . -.i »* I ' * teIeheaIth. org 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)
  • 154. «( TFIEMFNTN. HEALTH . I F-. ‘ " ‘ ' teleheaIth. org 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
  • 155. Tfl FMFNT/ II. HEALTH I H (,7 Y I U T I, teIeheaIth. org 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
  • 156. m EMFNT/ II. HEALTH l H K‘ Y I U T F teleheaIth. org 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
  • 157. Safety Issues to Consider ° 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
  • 158. m FMFNTAI IIF '«ITH ((( teIeheaIth. org Iuiltii 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 if 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 I O 2014 Telauemzl Helms Insmna. Im:
  • 159. OCPM: Online Clinical Practice Management Telemental Health: HIPAA, HITECH & Your State Law
  • 160. Three HIPAA Rules: - Transmission - Privacy - Security as‘-', ‘.~rm" '3
  • 161. ( it ‘t, -IIéIu‘i= rilli'n. ',-1'15‘: HIPAA Privacy Rule 4* 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:
  • 162. T'l F-‘.4El‘ITAI IIF um ((( t teIehea| th. org I: i HIPAA Privacy Rule (cont. ) Name Address (all geographic subdivisions smaller than state, including street address, city, county, zip code) 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) Telephone numbers Fax number Email address Social Security number Medical record number Health plan beneficiary number Accountnumber Certificate/ license number Any vehicle or other device serial number Device identifiers or serial numbers Web URL Internet Protocol (IP) address numbers Fingeror voice prints Photographicimages Any other characteristic that could uniquely identify the individual 0 21114 Telauemal Health Instmne, In:
  • 163. m FMFNTAI IIFAITH ((( teIeheaIth. org I? .‘3li, Ili 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 withouttraining? 'Jacobsen, T. & Kohout, J. (2010). 2008 APA Survey of Psychology Health Service Providersflelepsychology. I‘-. I’Iedication and Collaboration. APA Centerfor Workforce Studies. 0 2014 Telemental Heami Insmua. Inc
  • 164. TFIFMFNT/ II IIFAITN ((( _ g Y ' ‘ _ , teIeheaIth. org . F. ‘ ‘V i , ii 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.
  • 165. ( it ‘t, -IIiIu‘i= rilli'n. ',-lie? The HIPAA Compliant Email Companies » 4securemaiI T e I-IeaIthBl l *' Hushmail - offersfree accounts I» Luxsci ~ / :*—. ~_. _ _— s 0 Sendlnc -- offersfree L. / ' accounts
  • 166. ( l‘v", ¥'. :"‘_’~"‘7’_. "§‘%‘-f~‘~’. *i‘£"" ‘I, -.iiaia‘i= ,r: iiai. .‘, -in. » : - I. 'ir. :iI', ': Current Surveys The Professional survey: ttp: [[tinyur| .com[kpnfh75 The Consumer survey: ~. htt : tin ur| .com mb86oav Research team includes: Drs. Marlene Maheu, . Robert Glueckauf, Ken Drude, Eve-Lynn Nelson
  • 167. 0 2014 Telemental Health Insmtta. In:
  • 168. ( t'v''.9'f‘t_'; ''‘7i. ''L'*_‘‘= '‘*’I’i‘5’‘‘’ ‘K, ’-II= ’ifi= ,i= 'lli'ii. ‘_-i’(! ?' | (—. l}. ’I’ Skype’s Most Recent Hacking — November 2012 . ‘1i_: .-». l.a; |i: .'K By Leonas Sendrauskas on Noventber 14, 2012 [UPDATE:14I11I2o12@15:28GM1'] Early this moming we were notified of user concems 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 moming 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. ‘J r 'I'i igj '_n_s
  • 169. ls Skype Reliable? W Skype tiles & 1. pixelates, the audio I gets tinny, echoes I develop, and often calls drop entirely. Sometimes _ consumers can see L you and hear you, « fl without your in awareness.
  • 170. III HIPAA requires an ”audit trai Skype doesn't provide audit trails — and isn't obligated to
  • 171. Psych iatricT1mes DD can make it all feel ovenrvhelming. g. _/g WARNING‘. SUlClDAL 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 Telepsychiatry: The Perils of Using Skype First released in 2003 Skype offers free worldwide wdeo access to an. patient with an Internet onnection either D)‘ mobile device or desktop computer What it does not offer however is a m ns of comrnunication dearly suitable for clinical semces—especiaII_v in mental health WARNING: SUICIDAL THOUGHTS AND BEHAWORS Antidepressants increased the risk of suicidal thoughts and behavior in children. adolescents, and young a ults in short-term studies. These studies did not show an ‘I’ e ' - . . . I ity and Accountability Act Ordinarily neitherfederal nor state law IS designed to regulate specific Df0DlI9t3F_v entities such as Skype and its competitors Video-chat platforms were developed (:0AngI-CS5 -- I for marketing to the general consumer and not for health care The Health Insurance Portability and Accountability Act i, HIP-RA. ) holds professionals SEARCHMEDICA RX responsible for conducting their own internal risk assessments regarding their chosen technologies Before using any equipment, the professional should require documentation that explicrtlv promises 'H| P»'«-'t compliance‘ or ‘HP-LA compaii: iiiity' One could talre further comfon In a designation of Federal Information Processing Standard iFIPS. ‘I Certification a standard that Fltar riieei and exceed HP-Vt standards 3 —— Browse drugs by name HIPAA requires the use of equipment that allows for audit trails According to the A-. merii: an Health Information Management Association, audit trails allow 593'“ '°' °'“95 breaches in be traced ‘ Liice other proprieiar, platforms Slope makes it impcssirile to conduct approved secuiir, audits ma audit trails Stripe itself is not
  • 172. Face1”ime is HIPAA compliant and encrypted, could for V0 U r change the way physicians and patients O communicate 100 A free Sep 26. 2011 by Brittany Chan fl ‘tweet 151 fluke 32 7 EM R ac C0 U nt‘ cuuggnun _ M t '- idiertisement Healthcare communications is rapidly changing — patients now H m ! routinely email their physicians, m ea at a physicians connect with each-other via mobile-based professional I networks, and more. The _ I introduction of Apple's Faoelime The freshest mobile health content video chat sparked excitement and discussion in the healthcare community about its possible use in Smart Pill bottles, medication adherence, and preventing telemedicine, However, many were readmissions wary about associated patient 15 days 890 pnvacy issues and HIPAA compliance. How to cite a Tweet and other social media in a medical journal It seems that this question has now been answered. According to Apple, calls made via 17 days ago FaceTime can be HIPAA-compliant with the appropriate sewrity configuration. The news that this ubiquitous, tree communications platform meets these rigorous standards has potentially F D A Warns of medical device wide implications for how patients. physicians, and others in healthcare communicate. - hacking Juli 20‘ 2013 o be fair, its not quite as simple as just opening FaceTime and calling your patient. : - ‘ficalty, the WPA2 Enterprise configuration provides an extra level of authentication _ Team explores using Google Glass for remote patient diagnosing 2 n establishing a wireless connection. WEP does not provide the appropriate level of 0'‘'l''"‘, ’ and WPA and WPA2 personal settings are questionable. F aceTime calls are fully
  • 173. iri FMFNTAI iir ‘ilTH ((( telehealth. org Iriillii Skype’s Privacy Policy ° Skype may gather and use info about you. .. — 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 l O 2014 Teleuemzl Health Insumte. Iiii:
  • 174. THFMFNTAI HEALTH ((( I , Y K ‘ _ , telehealth. org . F. ‘ ‘— l i 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 HIPAA-compliant 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?
  • 175. ( ‘l‘v", ¥'. "“_’~"‘7’_. "§‘%‘-‘~‘~’. *i‘£"" ‘(; —llil’i"i= ,r§l[i'ii. '_-1'15‘: ~. l| "l, ',l]i'. ": OCPM Step 3 Legal Issues: Which Technologies to Use? No Guesswork Needed '''''' " HIPAA comp). -3,, ‘ il Handoff Sess' E any Device Oveggiszfgzfveonk I‘ ll ‘ SWeeping ” r ll l Be vcdobnevu I v ' ; _A ll. '1' J
  • 176. "_‘—3).5§‘, %"‘I~‘. :“’, *"'; ‘E‘-’-‘_~’fL1”" ‘i, =ttili"t?3lli‘ii. ‘;-’i’(g‘. ~ i. -g, -,i, .«iJ. : | nternet—based, VTC Companies Claiming HIPAA Compliance* ° Access Psychiatry , Ivfldoud) ° Adobe Connect ° ljfesize ( Logitech) ° Behavior Imaging Solutions , MDUVG - (. opeToday , - Consult a Doctor MyTherapyNet ° Revation ' C°""S°"C°m ~ Secure Telehealth - Secui'eVideo. com(FREE) ° Shepell fgi ° EasyShareVC - eCounse| ing - E Mental Health Center 0 ForefrontTelecare ° Smart House Calls ° Soltrite ° GEMS - Via3 ° G°T°M°eti"g - VisHealtli (Visual Telehealth) ° ‘C °"°" - Vsee (FREE) . |meraCtiVe Care 0 VirtualTherapyConnect 0 iTe| - Wecounsel ‘ TMH Institute has partnered with some ofthese companies andi. -.-"ill receive a referralfee if you mention TMHI. You may also get an added discount.
  • 177. ( ‘‘‘r''.4'. ‘'‘; '~''‘7’_. ''; ‘¢_‘-f~‘~’i*i‘§’‘‘’ ‘(, '-ll= ’t‘i"i= ,i'-’ll3li. ‘_-in? ‘- i. 'ir. :ii, ': What makes you a ”covered entity”?
  • 178. _ ‘“"' ‘C-ll£li‘i= ,l'illi'ii. ‘_-i’(! ? HIPAA Policies it Use HIPAA compliant technologies and develop written processes — Document policies * Security & privacy policies — Repairs . _ — Staff training — Breach notification, etc.
  • 179. Tfl FMFNTAI, HEALTH ((( I i Y I ‘ _ , telehealth. org 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.
  • 180. ‘(, '—llili‘i= t='lli'ii. '_ol'(5‘. ’ 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.
  • 181. TEIFMFNT/ ll IIFAITH ((( I I I I _ I telehealth. org . n ‘— l . , I i 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. 0 HHS is stepping up enforcement efforts. ° See Federal Register available online at http: //federaIregister. gov/ a/2013-01073, and on FDsys. gov 0 2014 Teleuemal Health Insmtte. Ini:
  • 182. HIPAA, Business Associates & HITECH Iii, ’ All Business Associates in health ca re must sign an agreement statingtheir adherence to HIPAA standards ° Transactions ° Security ~ Privacy True for any service you hire It is now enforced by the HITECH ACT
  • 183. _ ‘“'‘' ‘C-ll£li‘i= ,l'illi'ii. ‘_-i’(! ? HITECH * If aware of a potential breach of protected if health information: — Conduct risk assessment . _ x . . ‘ — Mitigate breaches " — report them to affected W clients, the federal A‘ government, and in some cases, the media
  • 184. ( i'T'§f_”}“;17i'%“f*'35L1_"‘l ‘<, =iiai. i:, r:itii. .;-in. » HITECH Implement or update privacy and security policies / » and procedures: ‘ Need policies to be I I written (a paragraph is ok) r Staff education , _.- * Breach procedures — Consult your attorney — 500 or more records 9 notify media
  • 185. _ ‘“'‘' ‘C-ll£li‘i= ,l'illi'ii. ‘_-i’(! ? HITECH Do not disclose treatment information to your client's If health insurance carrier for they have paid out—of— __ pocket, unless the disclosure is required by law --. ~
  • 186. ( i'T'§f_”}“;17i'%“f*'35L1_"‘l ‘<, =iiai. i:, r:itii. .;-in. » HITECH * Clients may ask for copies oftheir electronic health ,5 records in electronic form. . * For example, you cannot I 2 . . . c ‘7~ make a unilateral decision i to download and print , _ I ‘“’ electronic records and , send the printed version to a client who requests them.
  • 187. ( i'T'§f_”}“;17i'%“f*'35L1_"‘l ‘<, =iiai. u,r: Im. ;,-ya. » HITECH Email ~* Send PHI in unencrypted e— 4.” mail only if the client is advised of the risk and still I 2 _ Q‘ <‘_ requests use of email as a a means of transmission , _ V '“’
  • 188. What are risks of sending unencrypted email?
  • 189. _ ‘“"' i; -ll£lu‘i= ,r-'Ili’n. ‘_-1‘(! ? HITECH * There are additional new restrictions on marketing and sale of PHI, which should be included in counselors’ HIPAA policies and procedures and Notice of Privacy Practices if relevant.
  • 190. ( i'T'§f_”}“;17i'%“f*'35L1_"‘l ‘<, =iiai. u,r: Im. ;,-ya. » HITECH Update your Notice of Privacy Practices: ,» . _ ~ OCR and the Office of the National Coordinator for ‘ , ‘ Health Information Technology released a Model Notice of Privacy P ‘L Practices, get it here: 2 http: //www. hhs. gov/ ocr/ priv acy/ hipaa/ modelnotices. htm|
  • 191. _ ‘“"' i; -ll£lu‘i= ,r'Ili’n. ‘_-1‘(! ? HITECH NPP * Make available to existing clients on request * Post on your website * Display in a prominent location in your professional premises ~ Provide copy to all new clients
  • 192. _ ‘“"' ‘(, -ll£lu‘i= ,rllli'ii. ‘_-in? HITECH Update Business Association Agreements (BAAs) if * Contractors & subcontractors = — Billing ‘ — Data storage
  • 193. HITECH * Many states have their own privacy laws, which can be more stringent than federal law HIPAA & HITECH. °= * Consider obtaining a legal review of your HIPAA policies, procedures and other documents by your local attorney.
  • 194. a, -.ii: m iaii; -in Where can you get all the needed HIPAA forms? V
  • 195. ( ‘E ‘<, =iisi. u,r: imi; ,-in. » Enforcement The most common types of t t ‘ covered entities required %_ (§. :‘_, /l; to take corrective action: * Private Practices § _ Genera-I HOSP| t.a. I5. I _’ .3; AA i * Outpatient Facilities {. .7? pl 3 ; ,‘, ‘;; ,#. .;, g:; ’ * Health Plans (group health V “J7~*~ Ff plans and health insurance issuers) and * Pharmacies http: //www. hhs. gov/ ocr/ privacy/ hipaa/ enforcement/ highlights/ inde x. htm|
  • 196. http: //www. counseling. org/ docs/ ethics/ aca-hipaa-hitech-9-23-13-compliance-date. pdf? sfvrsn=4 TICK TOCK. . . lll3ED TIlE lllPA; /lllTE(‘ll CLOCK! Anne Marie “. 'ancy" Wheeler. J. D. Counselors should be ovate that 2013 has brought important twvt changes to HIPAA‘ and that Sept; -ntbct 23. 2011 is the eotttplitutcv: deadltnt: for ll| .ln_V‘ ofthcsc new regulatory It. ‘quIl’I2lIlt. ‘!| l Any counselor who I not sure tfshe ts considered a “coen'd entity” under llIPAA should tnuncdtzttcly J4,‘¢4:_ the online dTlIUn-ln. l.b| l"lg tool I ailablc at the L‘b. |lt. ‘ of the (‘enters for Mnltczte and Mctltcaid Services “ All noun»-Ion who are cotcred cnttttn should mote quickly to cum: tnlu i. -otnplttmct: or nsl tcty stiffmunctary ‘¢lLIlKIt. T. Suggtattuns for cuntpltanc-: and tv~otin: t.~ for counselnnt 1Il'L' set forth below. (the rcmatntler nfthts znntcle lIlrl'| L' the counselor is 11 cm cn. -d entity I. Privacy. Security and Breach Nntllleatlon Ftnt. coumclors must educate tltcmu. -Ives and their wurkfmw, tfapplicahlc. on “HITECH” and in breach miiricztium [Itm IluI't. m Although thts hm INIS p.1x'd in 2009 . added ! ~ul7)l: tnlI. tl “twtlt” to the cnfutccnwnl and penalty putt l, I0llS ul’Hll"A/ . l'lI: Il'I uuitsclors and other tnatlal health profcxxmrtalx are still no! aware of the-tr obligations under HITILCII If: counwlttr bt.1‘Mtit: an an: ofit potcnlial breach of prutet: It: tl health tnfunmttun. ll'| ;Il cuumclur ts legally n. -quire. -d kt pcrlhrm a risk : I4.'lD€l'll. and that mitigati: ht't: .tcl3c and report them to : tIT«tcd cltam. the l't: dt-ml governmetit. and in some cases. the iturdta. " A ’1>rc; tch" is kfioi. -1! in the new 21)! ) ntk as the improper "acqutsitton. .toee. ~.s. use or thsclosute 0! pmtoctcd health infornuttion . which DDll'| [l’lWIILL‘ lht: x-eunty or pnvxtey of the protected health tnfonnution “' Furthemmore. the nth: clanftn that then: is lI]lI‘(ul! l[}ll0ll of: breach tinder the ztbt-w tlclinttton unless a rtslt 1I~M', t'n€nl by it prmtdct or bu~! nc awxtatc tletnunxtritin at low pmlvufulm that prtvtt. -ittul health tttfnrrtutmn ha» been cornptuinised. The final breach mvttficatmn pruvmon ntlt: establish four factors to cunxtder tn analyltng and deciding whether In riottfy tndtudualaz llthc nature and extent of ptotected health tnfommtiott (PHIL including type; of ttkttttfien and likelihood of re-tdcnttftcaitton (e. g.. imprttpet acqumttott or low of social . ~‘u: i:urtIy numbers tutd sensitive cltntcal Infomutton ltkely would call for VM1llCC)$ 2) who the unauthonled person was who used or reeened PHI: 3) wlwthcr the PH] VA1< actually acqniral or tit. -tn. -d; and 4| the extent to which the rtak has been mttigzttcd. For cutnplc, Counselor A is : t HIPAA “cm t. 'ri: d L'1ttity" and uses hts cotnputcr to l“l‘‘. ’|lL‘ and More clxvtmnn: counseling rumrds. Hm otlice was burglurintd and and ll“ laptop. whach was left on hrs desk. was stolen. llts laptop was not pauvt mtl-ptmcctixl and his cltttvul files were not encrypted The Cvtmstlqtr Ilsa has some teatum to utq-cet that the spouse of Ins client mu the burglar. since he saw the spouse lllfllglng . -tmuitd the parktng lot the ewe-ntng his laptop was stolen. The counselor is also ll: Itl: that the couple tn going through it contentious sltmrce. In doing : nsk I)¢. SJ! )fiIL Counselor A would likely tealtie that this >I1IlJll0I"l creates a
  • 197. t . ‘ s. What about text messaging? l I l I l l ozou meuentzi mam lnstttme, inc. l
  • 198. Privacy Cross-over Technologies Many people send text messages over Skype. Do they count?
  • 199. ( ‘l‘r‘.4'. ‘'‘, '~''f‘! .'i‘*_‘-f*‘~’i*i‘§’‘‘’ i, ‘-ll= ’l’u"t= ,t'lll3ii. ‘_-1'15?’ ‘- i. ':r. :ii, ': Safety Tips Some large text— messaging system vendors marketing to , health care l“ +-—~ professionals don't bother with HIPAA, and : may leave you at risk. Z Texting with Clients and Patients: Best Practices for . ‘i'. enta| Health Professionals
  • 200. GENERAL ‘int | “3.'l’T i. *~= lr~= e-Net Messenger 9-Net Messenger Mobile Apps for lPhone, iPad 0-Net Messenger and Android available now! Links For a llmlted tlme, General Devlces ls oflerlng - 0-PM M69090? Details a free, no-risk 60-day trial of our new o-Not ' ‘tfl"*‘-”1‘9§“99i‘—"—'9‘1”” Messenger. Click here for more lnfonnatlon e~Net Messenger is a revolutionary new way to network and get M g e r messages where and when they are needed Combining speed easeotuse. security cost etlectiveness and delivery confirmation e-Net Messenger may be used for applications ranging lrom everyday resource snanng and EMS pre-arrrval notification to complex disaster response activities e-Net Messenger uses the any standard networked PC. 0! 3 mobile device SUCH 35 an lPh00e iPad or Android smanphone/ tablet to send or receive um e-Net Messenger replaces time consuming phone calls and vtrtually eliminates the need lor multiple phone calls lltllh e-tier Messenger sending to one or to many is the same quick and easy task Highly cost ettecttve e—Net Messenger does not require the purchase 0! any special equipment and involves only one low annual subscnption tee A vartety ot plans accommodates both large and small systems so you only pay tor what you need Once you consider the savings in lime and me ltnprmiements in efficiency and effectiveness the only question you will have Is now you can allord NOT to have e-Net Messenger‘ What does o-Not Messenger do tor you? Check out these important e-tlel Messenger features and benefits 5°"e'3‘ D‘-“"‘95 "'°5'°'-“" Cu" Basrttoru vrtll chair 3 Networking Mace Easy Send to one or broadcast to many sub-comrnttte to locus on the save Nursing Time Etirninate long waits a. multiple phone calls specal mrteamt needs at EMS Easy To Use Simple graphic controls means no special training Fast Talk type attach & send - that's it‘ Delivery Confirmation Message tracking 8. status alerts lnletoperabte WDl1(S with standard networtted PCs mobile devices, 8. General Devti: es' lamity ol ‘ cormiunicanons solutions ‘ - Affordable Low subscnptton cost & no equipment purtnases - Secure Password ptolected ti encrypted tor HIPAA compliance in January e-ltel Messenger trmn General Devices was 4 instrumental in latilitating _ Wm‘ ,5 PM. ‘ Muunae, us“ ,0,-, comtttunilzabons during a prison erlal Healtfl | n5Illt.1E. Inc
  • 201. THFMFNTAI HFAITN ((( _ _‘ _ Y ' ‘ _ , telehealth. org Global Smart Messaging Suite ° How text messaging was utilized for reminders and an educational tool to ensure adherence to patient se| f—care ’ behavior 0 ° Results of the study showing . ‘ positive outcomes in patients 5. receiving text messages ° How AT&T’s Global Smart Messaging Suite can be applied to similar use cases for highly secure messaging 0 2014 Telemental Health Insmtte. In:
  • 202. m FMFNTAI, HEALTH I H i Y I U T I, teleheaIth. org Other Platforms ° Engaging targeted - Utilizing encryption audiences with text technology in support messaging has become of HIPAA compliance a cost effective tool in allows PHI to be shared health and wellness for maximizing the management. value of information to improve se| f—care behavior.
  • 203. ((¢ ‘fig-; g§{ég: r;g~ffs; L:j'= l ‘x, -it= ’r‘u"x= ,r-iIli'ol. ‘_-my. » 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. l 3 Use an encryption program. '-_; ' Texting with Clients and Patients: Best Practices for ldental Health Professionals
  • 204. K ‘l'v", ¥'. "“_l~"‘7{. "§‘%‘-f~‘~’. *i‘£"" ‘(; .Il£li"x= ,rll[iii. ‘_-1'15‘: ‘- w. 'ir. rw, ': Remedy for Breaches Under HIPAA, when a device used for text messaging is 5.. lost, any text message about ' a clinical, billing or administrative exchange can be considered a breach of privacy, and a violation of Q” that consumer's ll .5’. I .7‘ confidentiality. The compromised individual must be informed in writing. Texting with Clients and Patients: Best Practices for Vental Health Professionals
  • 205. ( 'l: f'',3.‘'’‘, l5‘, ‘{, '‘L'*, ‘-f'l3t’fl§’: l ‘<; .1i£ii"x= ,r§Iti‘n; .ru‘: ~. l| "l_'_l]r"': ' Safety Tips The Australian Psychological Society advises against the use of slang and V~ +- emoticons when lyf communicating with : clients and patients _ in -text rnessages TextingwithC| ientsand Patients: . Best Practices for Vental Health Professionals
  • 206. ( ‘l‘r''.4'. ‘'‘; '~''‘. ‘»! .''; ‘*_‘-f*‘~’t*i‘§’‘‘’ ‘<, '-Il: ’Ii"x= ,r= ’ll3ii. ‘_-1'15? : - w. 'ir. :w, ': Safety Tips Download yourtext messages from your cell phone into your patient files. a . i 5.‘ 3‘ You can find software for l_; _ this function online. -f: * Texting with Clients and Patients: Best Practices for Vental Health Professionals
  • 207. Safety Tips Be aware that you can text the wrong person in your address book with information that fl” 3: shouldn't be shared I with unauthorized '—f: 9, parties. Texting with Clients and Patients: Best Practices for Vental Health Professionals
  • 208. Safety Tips All text messages reside on your SIM card in your phone, even if you erase them from your visible message area. Texting with Clients and Patients: Best Practices for Vental Health Professionals
  • 209. rti FMFNTAI IIFAITN ((( , telehealtnorg I? .“3ll, lii Stolen Phone Safety SAFETY TIPS ° Password protect your phone as soon as you receive the device. ° Change your online and voicemail passwords often. ° Protect your service. Add a security passcode to your online account. 0 Download device protection and privacy apps for your messaging or smartphone. 0 Don't text - just drive! ° Learn how to back up your SIM card contacts. Copyright 2012 Telelvlental Health lnstitule. lnc. All rights reserved. I 0 2014 Telemental Helm: Insmua. In:
  • 210. TELEMENTAL HEALTH ((( l telehealth. org l N S Y l T U Y F Empirical Guidance for Text Messaging? - Where do you find research? — http: [[telehea| th. org[ ° Look at: — funding sources — meta-analyses Copyright 201'. ‘ Te| =.l. l‘; -mal H-: -allh Institute, Inc -‘-. Il rights 1'5-ser-/ ed 02011 Ttlellelnl mam IHSUIIE. llc.
  • 211. TFIFMFNTAI HEALTH ((( I , Y K ‘ _ , telehealtnorg . F. ‘ ‘— I I Security Suggestions ° Don't Download Any Clinical Data ° Authenticate — Passwordsto lock; passwords to access networks — Biometric authentication is on the rise - Use Antiviral and Malware programs — ” CounterACT is a security control platform that automatically identifies what devices and users are on a network, controls access to the network, blocks threats, remediates security violations at endpoints, and measures compliance to an organization's security policies. O 2014 Teleuemil Helm Insmua. Inc
  • 212. OCPM: Online Clinical Practice Management Step 1: Training Step 2: Referrals Step 3: Patient Education Step 4: Legalities Ste 5: Assessment Step 6: Direct Care Step 7: Reimbursement
  • 213. http: //www. c0unseling. org/ docs/ vistas/ multlple-assessment—meth ods—and—sources-in-counselIng-ethical—consideratlons. pdf? sfvrsn=4 . i. m-r-in! ll’. nu Viflifll r -~. r.-mum . in Iv Immiliil Aur / /.. ».- . .~. u-.1‘: -W -xx/ hIurnA'nI, :r—ir-tlrv/ 1-Au» Ariit-Iu I7 Multiple Assessment Methods Ind Siillrrts In Counseling: Ethk-ll Consklerntlonn Monica Lcppma and Karyn Dayle Jones Ltwmm. Monltui. IS an Auisunt i-rnrmm ml xvm v. r,. .nu Uniirnity Site I‘ .1 Honda Ltccrued Mental Mum. Counselor (l. Mll(‘) and has hecn m the counmcltng field am I: yvan llcr rcu: .irvli uitcrcstn include mcnul h¢. ilIh uniruclilig. .. »r. ..oi coun, «: IuIg. and counsiclur dc'c| opnii: nI Joncs. K. Dayle. I! an Aauitunc Pniluxsxn tal urmcmry uffcntral numii. She I: (lit cuxdiiiutoi of the Mmul Mtzilih Counseling ltrugmiii at L'(‘F. I! a I~lund. i LICI. 'n. 0:lI Mitnul Hczillh Cuumiclur (LMHC), rind Inn butt: in the counseling l'ii: |d for 22 ymn. Slic Ius published tvnu lcIbtIuL‘ lniroducimii to the Prufcuiun of (‘miiiscltng lxligcltl 5; Jones. 2()(I5I and A~£l| i‘fll Prnccduirs fut CtVl| l|¢| (K§ and Helping Pmfmsionals lnnrnimiirid & Jones. 2010) Abstrutl 1xcs-rncnt in a fund. -inx-niul cuiilponcnl both of the couii-cling process and cllucal clu. -nt care. Allliough ilic asscnittcnt l’L'>I. ‘.l! ':h titanium plLIf! I0lL‘ the use or nlulllplc dim: cullcciiun mclhoih rind oun. ‘(’. I. ‘I1lL‘ltl ‘I(l){L‘l0fIJi ! il.1]| dill'd In I)»: couiucliiig field iiicua. prirrurrly on si. irid. irdm: d initmmcnts_ with little attcntiun gum in quallhlllvr ; iuc~. -snumt nicthmh of the inc of mulllplc nscthiiita and suulccx. Tim amclc pnnidci . in mcnicw 0rA, ~lt>lh(‘1|I Lmng muluplie data ‘lIC‘ll01‘l itictliuds and . 0Ilf‘€. a rvucvt of ctirmnt ctliiml coda related to aucxsirn. -nt. .imI iiirplicuiiic-m and fIV. ‘0l‘lIIl'I. ‘l|4.L‘llIlI| for cuunsclr-nu tcyanling the impnnzinci: or thing mulllplc niflhod. muliiplc source ; Icn‘El'Il It‘. -nmnli: ~‘I¢lYk‘I| I_ multiplc Ill¢lhlI! , t. '|| luIVf| |l pm! ’-. -mun. iI. CI'| |' A. &Ehl“ElII has long hI. ‘. ‘ll rcgardcd a El fundzimcnt-. i| cutnpmicnt of all helping prufcssitins and the I:0rm. 'r, lonc of the counseling pniccxx. Simply put. zisscsstncnl is the process of gzitlicnng infonniition tiboiit ti client. Thmugh nut-xsmcnl. counselors ; Il’C nblc In -. L~ct: rL: iiri import. -mi int’-intuition about clients. such :5 IIIL‘ nature of lhcit problem: lhc magnitude and impact of lhc problem; the: interplay ht. -tvmcn family. |’I: l;IlI0nshIp. and past eitpcricncc-s with respect lo the problem; the client’: strengths and | ’‘i| dll! L‘§ for counseling; Lind wlit-thcr counu-ling can be bcncficia! It) this client (Dninimoiid J: Juno. 2010). Ir: n1<nl is also critical for cflilbllihlng counseling gunk and objectives and for dflflflflifllflg the most effective iiili: rvcntioiis. . A_, <rx. »mL-nl can he dcfiricd us the §y. li? fl|£IIIE fl| 'DCL‘, of gathering information about ; in lfldl'| dU. I' in order to rri: iItc daxi ions or il'Ir¢fl. ‘lIC¢ about that pa. -non [Anicrmin I‘ l: dut. ‘:mon. iI Research Asaoclzilion [AERA]. Anwncan Ps_-chologictil / tssocinlion [APA]. ‘I . alitimil Council on Measurement in Education [I IE]. I999: H. 'l_T| t.‘< & O'Brien.
  • 214. Web pageant was 11.32:? LLe_~z§‘ ~ Smemlg §_am -. | _sum r V Go iglc -" Everything i" Books ' More V Show Search tools -“ i 2 Clll‘llC3l interviews intelligence tests cognitive tests personality inventories rating scales P/5_Y°",9'_‘? S_! _l°a_i' ‘P535, About 7.890.000 results (0153 seconds) Online Psychological Tests_ Free Online Psychological Tests ~ ‘ Online psychological tests center with numerous free psychological tests Online psychological tests include depression test. tests for bipolar disorder, . ~.w. -. health-yolai: e comfpsychological-tests“ -'2 l " vii " u ' * Psych Central « Psychological Tests and Quiues -. ‘ Test your depression. mania. and attention deficit feelings. today and track it over time with our instant quizzes payciir, —i‘itraT cor" iiiiizzea‘ » '2 - ~ i American Psychological Association (APA) T ‘ l} The American Psychological Association (APA) is a scientific and professional organization New questions on test bias August 2. 2010. Inside Higher Ed spa mi’; i l—i' - ', —i Psychological Testing | Psychological Assessment A description of the types of Psychological Tests. the justification for their uses‘ and client nghts ijiuidetopsychology CCi’1“[e5llllg him C « in v. ‘E Psychologlcal testing - Wikigedia. the free encyclogedia Psychological testing is a field characterized by the use of samples of behavior in order to assess psychological construct(s). such as cognitive and -: -n x. .’—ip»: r.ii3 org »-. :'~'irP5ychological_testing C "'- 4 ‘Z " Queendom com Tests‘ Tests Tests and more Tests The biggest J‘ Personality tests Our wide range of personality assessments will facilitate the exploration of your psychological landscape and perhaps even unearth a few , —.-J i; M l, rzueendom ccrwtests‘ '7 '~*"= A . l Test Yourself_1_Esycholqgy_Today C‘ If you purchased one of our Psych Tests and were interrupted you can resume your session at any time. Use the transaction number which was provided via A psychologytoday CD"l‘wI£'SlS ‘i l‘ , l:- i: 7, Home - Psychtestscom: Psychological Testing for Human Resources ~. ' Online psychological tests. assessments and data management system for human resource departments. employee screening and training. counseling or therapy. ‘. '.". 'r. -. ; T3‘, ‘Chl9SlS Com‘ i‘ii'li-' .1 9 *"‘: r ‘Quincy's Online Psgycuhological and Personalityjests‘ ‘~ ‘ Free online Psychological , Personality ‘ and Psychology tests and quizes I quizzes Search
  • 215. (/1 VI i": a'e vi‘. .5 @355 F 3? : "’T: ". f: ‘t. ,i: : :3 ‘[1 icrazy - Psychology Tests L Description F‘? ’ e, .‘ ‘ ‘A. , iy Ever wonder it you're aazfl Now you can find out icrazy is a collection of psychologytests. many oi which are used by actual doctors and therapists to determine the mental health oi an ll'ldl‘ifIdU3|. You will find tests ranging from 51-99 BUY APP ' - Schizophrenia - Bipolar Category Heathcare 8 Frness ’H°°h°"5m Update‘, "3, 03‘ 2010 ~ OCD assessments Current Version 1 2 ’ Pam Macks 1 2 - Eating Disorders 48 . _.5 - Domestic Abuse Language English ‘ De°'955i°"’ Se'er Fishngtori Stiicos ’ '”tem§”‘dd'd'°” 2010 Fishington siiio-cs ' G3”‘5"“9 "‘¢°'°"°" - Stress indications - Sex Addiction Rated «to And more to come in the future R°‘l""°"‘°“‘3‘C°”‘°°“"° W“ And now weve iusl added our latest addition" The Rorschach Ink Blots. View all ten inkolots in their original color and texture. Phone, iPod touch. and Pad Reamres Phone 05 312 or Lam record what you see In the IHKCIOL and VIEW common IDTGTDTEIBUOHS Of each one.
  • 216. Tfl F'. ‘lT NT! ‘-I llF: l TH telehealthprg APA Ethics Standard 9: Assessment - 9.02 Use of Assessments — research based, valid, reliable ”for populations tested” ° 9.03 Informed Consent in Assessments ° 9.05 Test Construction — use proper procedures ° 9.06 Interpreting Assessment Results - 9.07 Assessment by Unqualified Persons ° 9.09 Test Scoring and Interpretation Services ° 9.10 Explaining Assessment Results ° 9.11 Maintaining Test Security
  • 217. ( ‘i'v''.9'fA_'. *''‘. ‘;3.''L'*7‘‘f*‘*’i’i‘5'‘‘’ ‘K, ’-Il: ’li‘i= .l'lll3li; _-iii: OCPI/ I Step 5: Clinical Assessment Be aware of language limitations across W, ‘ (E: +- -W-9;? ‘ distance % — Use English proficiency ~-I ‘4'~‘~“'{- (9 teststo measure / /f: .""‘» " ' I language Q _ comprehension , -, , . ° Written language ' Spoken language
  • 218. ‘(, '-‘llilfisr-"ll_iil. "ol'(5: Pros & Cons? Hclpouts v i -. . r'<l)(unl-; '.; ',«)<ii1 (,1 Noalrli -v_ ‘I-'>>‘r* . 1 . . _ _ , I , . . _ . g I rice ~ *' ‘ an 7 rag »-, i.. ..-. i V
  • 219. ( j3_5.4'; ‘'‘A_'; '‘‘‘’_s''L‘*_‘f‘*’i’i‘5’‘‘’ i, =ll= ’I‘i'i= filli'ii. ‘_-’ii5‘: . i.. i,. r5.: Private Pay *8» 0 6 Google’s He/ pouts Set your own rate by-the-minute Google takes 20% / You keep 80% 2. Offer your services for a flat-rate 45 minutes for $75 10 minutes for $20 Self-pay models will become more prevalent / Risk will increase B/ og discussion: http: //te/ ehealth. org/ biog/ go ogle-steps-into-telementa/ - hea/ th/
  • 220. 0 LIV E P E R s o N TECHNO! OGV COU Sfl ING EDUCATION MFAL TH BUSIN SPIRIYUAI ITY Professional Counseling Pr nl ii Meet our Prolesslonal Counseling expens Sort by Highest rank V on-gu qrnenla compassionate professional read. to listen and help‘ Ask about mpnomerapi sessronsl Change your lils‘ Now cenzrtleu in Sports P5Y 1.: Q5» YEARS Experience Feel Bettertiow Caring C I . Compassionate Healing Energ, ‘Got instant help and ‘g‘‘’'''‘‘‘‘' encouragement mall needed ‘ ‘Hers one oltne Do you feel stuck: trapped in the same pattems that repeat mar & paler’? Do -ou leer depressed anxious angri oraIone°lcan help you Gelsolutions Results Novuseiiualily T I ‘ "". I-mret, OCD womens Issues R¢l3lI0r1S'1Ip5,F'0"I Addiction -°3—"L“ iiiaris Psychology. Daring Coach is a FEE. day‘ Prolessional Compassionate and Iron- . _.. .. iucgemental counselor Greallistener tastrrpist Contact rnel . !J. m.'. lxi 4 latte £1219: p‘On. a.—i Online 52 85Imtnute B S! 20/minute
  • 221. 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
  • 222. ' TELEMENTALHFALTH ((( F ltelehealthprg lN‘5lllUT Where to Get Reimbursement for Telemental Health? Contractual & Grants Direct Services Governmentservices US Department of Education Medicare Departmentof 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
  • 223. ((( TflF‘. lfPdTfil llFitTti telehealthlorg Where to Get Reimbursement for Telemental Health? Private Pa Fee for Service Private Insurance General These 16 states now mandate payment: California, CoIorado, Georgia, Hawaii, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, New Hampshire, Oklahoma, Oregon, Texas & Vermont -> 13 more states are pending since Jan.1, 2013 Niche (smoking, drug/ alcohol etc. ) CPT code approval Boutique (high-end services, rich & famous) Self-help IlAppSII
  • 224. States Requiring Insurance Reimbursement For Telehealth 8 - Telemedicine Below are the individual states in the US. that require some form of reimbursement for services provided by telehealth (usually for serices delivered via video teleconferencing or 'VTC")). - 6 . ... _.. _.. ... ..__ T°9°>‘. °5"P'! -'. -- ? °°°“9!-"9‘-‘”- Maine Oregon California Colorado Georgia (complications) Hawaii Kansas Kentucky Louisiana Texas (Medicaid) Oklahoma Virginia New Hampshire Maryland Michigan Massachusetts Arizona Montana New Mexico Mississiggi Idaho Kentucky (Medicaid) http: //telehea| th. org/ mandated-states Keep informed by getting our newsletter: http: //telehea| th. org/ newsletter-signup
  • 225. ( ‘l'v''.9'fA_', *''‘, ‘;3,''L'*7‘‘f*‘*’i’i‘5'‘‘’ ‘K, ’-! l=’l’i"i= ,r= ’ll3ti. ‘_-1'15? OCPM Step 7: Reimbursement Medicare & Medicaid Reimbursement — Psychiatrists, Psychologists and Social Workers but not counselors yet * Action item for counselor advocates: work with Mike Thompson's office, located in CA)
  • 226. THFMFNTAI HEALTH ((( I , Y K ‘ _ , teleheaIth. org . F. ‘ ‘— l i 2014 Reimbursement Bill - 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. - httgs: [[www. govtrack. us[congress[bil| s[113[hr 1960[text (see section 704)
  • 227. Tfl FMFNT/ ll. HEALTH I H i Y I U T I, teleheaIth. org 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
  • 228. ((( TFHMFNTAI llF: ‘«lTtl I l 7 9 l'. ‘—l To download, go to this webpage: Telehea| th. org / CPA2013 American Telemedicine Association PAYING FOR TELEMEDICINE IN THE UNITED STATES A Concise Review from ATA CEO, Jonathan Linkous
  • 229. ll Center for CCHP PROJECTS National Telehealth Resource Center —- Policy Specialty Care Safety Net Initiative Telehealth Model Statute Tele-Dcnnatolog in Medi-Cal Tele-ICU CA Assessment Project 719 l3 i$urvieVy' Some Providers 00 toalehealthorq . Nnuonal re-ie-ou-nm- Polnty Rt-sooner Cnnrv About CCHP What is Telehealth? CA Telehealth Policy State Telehealth Laws and Reimbursement Policies Report in Feb. 2013 CCHP released a 50-state scan of telehealth laws, regulations and reimbursement policies. This otters policymakers, health advocates, health care professionals and others wrili an interest in ii, -leiiedlih a Summary guide ol the most recent information available about how each oi the 50 states (and the District of Coiurnbla) (iefrrres, governs, élntl riggiildl-J5 the use of “ielehealth" or “telemedrcine" technologies in the delivery of health care services Most remarkable about this report is that every state has its own tiriitriie set of teieireaiili policies Snme states have inrnrnnraieri D()ltFlP< into law while nihprv. have flFl(liP"~‘. P(l lSSll0‘s' such as rl_el4ri! l1Dl1-. ., ,, 0 331-1 Talellertal "lean? ! IHSUILVE. Int:
  • 230. ._‘, § How and when are new services added to the growing list of reimbursable services? r i , i __, .3 ii 54¢ 5 — — - - — — — - . — - g ‘ oyojj. ‘ _ -3. ——_j_. — --+- — . ... .. . n— . _- . . , r r. ‘;
  • 231. Adding New CPT Codes CPT codes originate in the Office for Medicare and Medicaid Services (CMS) Annual call for data to support new codes Large professional associations such as the American Telemedicine Association help organize and submit data for new codes to CMS Decisions are published in the National Register every November
  • 232. V When is credentialing required for reimbursement and how is that best accomplished? i i , i __, ,3 i 54¢ 5 — — - - — — — - . — - i ‘ eyejj. ‘ _ -3. ——_j_ — --~a- — . ... .. . n— . _- _ I‘ it ‘;
  • 233. m FMFNT/ ll, HEALTH I H i Y I U T I, teieheaIth. org Credentialing ° Needed for payment by Medicare, Medicaid and 3'” party carriers — Similarto being credentialed when we sign onto managed care companies ° The credentialing body examines and documents: — Licensure — Malpractice coverage — History — Specialty areas/ required training — Other areas as needed
  • 234. Which 3rd party ‘ insurers are paying, and where? “Q? l i , i __, ,3 i 54-k 5 — — - - — — — - — — 4_- - - ‘ gig _— ‘ __. '_: _.'. ._’: '__. '._. ._‘. _ -3. T — aw-~a— — . ... .. . n— . _- _ It i, ‘ ;
  • 235. ( ‘l‘r‘§'. ’‘l3'f‘!7i‘%‘-f~‘~’f‘§’‘l ‘(, -il= ’ti"i= ,i'lll3ii. ‘,-1‘(5? ‘- w. 'ir. :w, ': 3"’ Party Carriers it Largest barrier is practitioner reluctance to Most large groups are paying * State—dependent No consistent data (Study by ATAjust now in publication for sample across disciplines 9 inconsistent patterns) — Difficult to make predictions
  • 236. ValueOptions and American Well Partner to Deploy the First National Behavioral Telehealth Network am---, am am NORFOLK. Va. and BOSTON. June 27. 2012 / PRNewswireI — Valueoptionso. a health improvement company that specializes in emotional wellbelng and recovery. and American Well‘''‘ 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 transform 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. Vaiueoptions 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 telebehaviorai 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. " "Online 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 for the system of care.
  • 237. V Are rates for telemental health different from in- person care? ; ..'jr_. '.. _': ' __. ._. . .1‘.
  • 238. THFMFNT/ ii liFAlTli ((( I _‘ W V _ , teleheaIth. org Rates ° Traditionaltelehealthz — About the same as in-person care ° Private Pay — Whatever the market will bear
  • 239. ‘“"‘? Which CPT codes need to be used? ~.
  • 240. THFMFNT/ ii liFAlTli ((( I I I I _ , teleheaIth. org . r. ‘ ‘— i . , l i CPT Codes ° Medicare, Medicaid, and 3rd 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
  • 241. CPT Codes for TMH ° Individual psychiatric interview ° Individual psychotherapy ° Individual & group health & behavior assessment & intervention ° Neurobehavioral status examination ° Pharmacologic management ° Smoking cessation
  • 242. Til FMFNT/ ii llFAlTli (G , teieheaIth. org I? .“3li, iir 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 60436 (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 0 mu Telemental Health lnsmtle. lru:
  • 243. ' Tn. rrrrrr L r TTTT TH ((( _ ( teleheaIth. org I N '. ~ l - i U T F Centers for Medicare and Medicaid Services (CMS) ° GO396 and G0397 -— 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 ° G0443 -- Brief face-to-face behavioral counselingfor alcohol misuse, 15 minutes
  • 244. ' Tn. rrrrrr L r TTTT TH ((( _ ( teleheaIth. org I N '. ~ l - i U T F Centers for Medicare and Medicaid Services (CMS) - G0444 —- 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 ° G0447 -- Face-to-face behavioral counseling for obesity, 15 minutes
  • 245. ( ‘l‘r''.4'. ‘'‘. '~''‘. ‘»! .''; ‘*_‘-f-‘~’-*i‘§’‘‘’ ‘K, ’-il= ’li"i= ,r'lll3ii. ‘_-1'15‘: 4- ‘I'l"-'i"»': Distant vs. Originating Sites it Distant Site — where you are to Originating Site — where your client/ patient is
  • 246. ( ll ‘<, =iiai. u,r: ilii. .;-nae‘. - TMH CPT Code Modifiers -4 -GT *4 Most insurance carriers will only reimburse ”GT” coded services for telemental health — Some don't require modifiers ° A/ ways Contact carrier to know rather than assume that you or your billing agent know how to proceed
  • 247. THFMFNT/ ii llFAlTli ((( I I I I _ , teleheaIth. org . r. ‘ ‘— i . , l i CMS Eligible Providers ° Physicians ° Nurse practitioners (NP) ° Physician assistants (PA) ° Nurse midwives 0 Clinical nurse specialists (CNS) 0 Clinical psychologists (CP) ° Clinical social workers (CSW) — (CPS and CSWs cannot bill for psychotherapy services that include medical evaluation and management services under Medicare. 0 Registered dietitians or nutrition professionals 0 (notice that counselors are not included) 0 mu Telemental Health lnsmtle. lru:
  • 248. States Requiring Insurance Reimbursement For W Telehealth 8 Telemedicine Below are the individual states in the U S that require some form of reimbursement for services provided by telehealth (usually for services delivered via video teleconferencing or 'VTC‘) avomsiouvt-um leleheaitrmorq -Wu T*l Maine Oregon California Colorado Georgia (complications) Hawaii Kansas Kentucky Louisiana Texas (Medicaid) Oklahoma telehealth .0: g L HEALTH HOME, /l5l(, )U| US l, il, ()(j (IOIJSUI TIii(2 (‘(_)lJR‘: il, ‘,il§vl’R()(, LR/ M‘§ | 'li, l/‘US Ri, ‘5()UR('i, ‘,S ‘SUM-’l IL‘; http: //telehealth. org/ mandated-states Register for webinars. mini-conferences and future alerts using the form on this month‘; event NAME- EMAIL
  • 249. ._‘, §‘ Which ''location of service" category gets reimbursed most frequently? ; ..'jr_. '.. _': ' __. ._. . .1‘.
  • 250. ( ‘‘‘r‘§'. ’‘, '3'f‘!7i‘%‘-f*‘~’f‘§’‘‘’ i, "-ll= ’li"i= ,i'lll3n. ‘_-lie‘: ‘- w. 'ir. :w, ': Location of Service it Speak with payer before billing to 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 it Indicating service was in your office may or may not lead to payment
  • 251. What's a reasonable fee to request for telemental health?
  • 252. m EMFNT/ ll, HEALTH l H K‘ Y I U T F teleheaIth. org Reasonable Fees ° Typically, fees for TMH are the same as in- person ° For CMS, can add $24 per session for "facility fees” ° Whatever the market will bear — New Internet models such as Google’s ”Helpouts”
  • 253. V A Are reimbursement rates discipline- 1 specific in telemental health? 1
  • 254. m FMFNTAI, HEALTH I H i Y I U T I, teleheaIth. org Fees Across Disciplines ° Disparities exist across disciplines with Medicare, Medicaid and 3”‘ Party Payers — Psychiatry — Psychology — Counseling — not yet covered — Social work — Behavior analysis — not yet covered
  • 255. V 1 Are reimbursement models relevant if I have a se| f—pay practice? 1
  • 256. m FMFNTAI, HEALTH I H i Y I U T I, teleheaIth. org Self Pay ° Reimbursement Models are irrelevant ° Concierge services springing up — ”Se| f pay practitioners are the most likely group to success in health care reform” (Robert McGrath, TMH Summit: Health Care Reform: How to Get Paid)
  • 257. V Which telemental health practice models get paid the most? I I , I __, ,3 I ft 5 — — - - — — - - . — - V L . S_7#j. :. ‘ _ -3. ——_j_ — ---a- - . ... .. . n— . _- I. It I‘ ‘V
  • 258. ( ‘E ‘<, =itsr. u,r:1m. ;,-ru‘. » TMH Practice Models ** Traditional hub-and-spoke models ts Servicing Health Care Shortage Areas (HPSAs)
  • 259. ._V, §V ls telephone work reimbursable under new telemental heaflh opportunities?
  • 260. m FMFNTAI, HEALTH ((( I V, V _ , teleheaIth. org Te| ephone—based Models ° Dependent on state definitions of telehealth ° Contact your payer and ask how to bill for telephone — Why bill accurately? ° Insurance fraud is considered a very serious offense ° In some states, insurance fraud is considered a ’’criminal activity” ° Being found guilty of insurance fraud can lead to the forfeiture of malpractice coverage
  • 261. ._V, fl SS _— ' __. .'j. ‘j. '.. _': '__I. —_. :‘¢ . __j_ — aw--. - . ... .. . ..— . _-~ “‘; ‘/F ‘ I‘ a-wuss, g V V How is inter-state practice relevant to reimbursement?
  • 262. ( j'v''.9'f”_', *''‘: ‘;3:''L'*7‘‘f*‘*’I’i‘5'‘‘’ ‘K, ’-IIiIi‘i= ,rlll3h. ‘_-1'15? Inter-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
  • 263. How is Health Care Reform changing the playing field for , reimbursement in general? ‘“""Q 1
  • 264. ( j'v''.9'f”_', *''‘: ‘;3:''L'*7‘‘f*‘*’I’i‘5'‘‘’ ‘K, ’-IIiIi‘i= ,rlll3h. ‘_-1'15? Health Care Reform *4: Most significant upheaval and reorganization of US healthcare system we are likely to see in our lifetimes * 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
  • 265. V How is private industry and consumer demand impacting telemental health? 1
  • 266. TEL EMENTAL. HEALTH ((( l H V V I U V V V teIeheaIth. org Private Industry & Consumer Demand ° Non-healthcare companies coming into the market with "disru ptive technologies” — Disruptive technology is a term coined by Harvard Business School professor Clayton M. Christensen to describe a new technology that unexpectedly displaces an established technology ° Can expect many more companies to jump in
  • 267. TELEMENTAL HEALTH ((( V V V V _ V teleheaIth. org . r. ‘ ‘— I . , I I Disruptive Technology Betti! Frieda" Gloria Steinman 0 1963 book The Feminine - Sought to transform society Mystique ° Sought to have women be accepted in existing world
  • 268. «( TFIFMFNTALHFAITH . I , -.L E L ' * teleheaIth. org Private Industry & Consumer Demand ° Non-healthcare companies coming into the market with "disruptive technologies” — Google’s ”He| pouts” — Phone companies ° mHea| th — 5.6 billion people have cell phones — 2 billion have Internet connections
  • 269. _: _, _ . _ (%é":4I ll” Kt‘-g Evidence-based Models “fit A Where might you earn a _. ._ 3 j legitimate income? ll I II I VV. ,Lifi"'_ V5.-V l LL 2? ’”%“"’“3~LL I t~f’“"'"‘= :-2-it ’ Z3 ~‘ : i*-: - . ._V ozou meuemzi mam inmuhe. Inc; I
  • 270. 1: «/
  • 271. I ' , Children's ' Hospitals
  • 272. ( ‘l‘v", -'. "“_’~"‘7{: "§‘%‘-f~‘~’. *i‘£"" ‘L, -.iraia“L= ,r: iLa*. ..‘, -my : - ‘I'l"-'I"»': Specialty Schools & Services * Specia| Needs ~° Autism * Residential Treatment Centers — Drug & Alcohol — Other
  • 273. Rural Hospitals -at " . 3. O’ . p* f V . ‘L. V
  • 274. Corrections Facilities
  • 275. ((( TELEMENTAL HEALTH V teieheanh-org I N S T I Y U T E Nursing Homes
  • 276. Home Health
  • 277. Employers . :.. ... / .
  • 278. Military & Veteran's Administration
  • 279. ValueOptions and American Well Partner to Deploy the First National Behavioral Telehealth Network am---, am am NORFOLK. Va. and BOSTON. June 27, 2012 / PRNewswireI — Valueoptionso. a health improvement company that specializes in emotional wellbelng and recovery. and American Well‘''‘ today announced a partnership to bring critically-needed behavioral healthcare to patients wherever they are. whenever they need it. Using American Well's industry-leading Online Care telehealth solution. ValueOptions will transform 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. " "Online Care telehealth allows us to bring behavioral health directly to our members. " adds Dr. Hal Levine. chief medical officer of Valueoptlons. "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 for the system of care.
  • 280. F3e'ft‘te: ir Tt1iit. l<iZ11g for Better Health Home Pharmacies Ill Telemedicine Role Models *3 Mayo, Mission Health offer lessons on effective teleniediciiie progmms March 5 2013 Two years into its telemedicine efforts, the desired shift shows in Mission's patient data “We've seen a 40% increase in our case mix index, " which measures the acuity and complexity of patients’ C0l'dIltOnS, Bailey says "We would not have anticipated that big a Jump " Corresponding changes have been measured at small hospitals in the region Their admissions of stroke patients and use of thrombolytic drugs have increased since telestroke consultations became available. And like Memorial and St Joseph, community hospitals have regained capacity that they were losing to inefficient care A psychiatnc patient used to spend up to a week in a local emergency department waiting for assessments and treatment plans Bailey says tele—mental health consults have reduced that time by 60-70%
  • 281. ° CopeToday ° MDLive ° Securevideo ° Virtua| TherapyConnect ° WeCounse| T'lF'. 'l. ‘NTi"-I llFi‘i Tl (G I Vt‘ ’ telehealtlmorg l'. ‘l: I Private Companies Serving Consumers On| ine* ' TMH Institute has partnered with some ofthese companies and will receive a referralfee if you mentionTM HI. You may also get an added discount.
  • 282. T'lFMFNTi'tl llF‘ilTH ((( Q _ ‘T telehealth. org l’. ‘ l 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 ° Consider their diagnosis : 4 . Take the time to prepare them ‘ i, ' Plan in-person sessions at ________ ‘’1 regular intervals «"~, 0 ° Do not work through their - s ‘ , / / «-2 secretaries or others 0 2014 Telemental Health lnstmnel Inc
  • 283. Tfl FMFNTAI llf 'ilTH ((( telehealtnorg Iuillii Professional Training ° Clinical Competencies - Department of Defense (DOD) — Ohio Psychology Board — Professional Associations ° Society for Technology & Behavioral Health — Te| eMental Health Institute '- / g ‘ V ' Technical Competencies 1 — Association for Counselor Education and Supervision .1 (ACES) fig’ O 2014 Telauemzl Health lnsumta. lm:
  • 284. ( ‘‘‘r‘§7‘l3¢!7i‘%‘-f*‘3f‘§’‘‘ ‘(, -!l= ’ru"x: ,r= ’ll“n. ‘,-nu‘: ‘- w. ':r. :w, ': ACES Technical Competencies lb ¢ Technical Competencies For Counselor Education: Recommended Guidelines For Program Development (2007) htt : fi| es. aceson| ine. n et[doc[2007 aces tech nology comgetenciesg Q‘
  • 285. ((( TELEMENTAI. HEALTH telehealmorg | r.“1l| .JTp 0 20M Telellemal mam: lnsmma. Inc ‘
  • 286. OCPM: Online Clinical Practice Management - _ . ‘ I“. , — 1' l . _ ; _ ' . - .2- ‘,2- , , , . l . ., V ______ , ___ 7 .1 ' ——_ / I 1
  • 287. J (‘airfi- . “;. ‘ - A . " _~ r. ‘ -M. ;!‘ l . w - ', ‘CD . 3 L. FBl Drags Google Glass man From Theater on Piracy Fears Googln Gun is up: -cwd to tvanxlcrm {ho way that pv. -apt: Interact with em and (ommuniulionx but '0! one unlucky um : pmnoid Indian to the device ended up becen-ng a huge lune w. ::te1,ARM weaving : tumcd off and pruuiption lcnx-equipped mcdelto the theater. 1 man hzd 12 mm «mm his rm on Iuipizien her wax ung: gin; in movin piuty. Several how: hue the FBI concems they'd mzde a big mizuko. film! ___’. A prlvateinternelaccess "‘ in aci : : Luis Aways Lw ; vc= ¢»: V an 'ilfh:4l, olf. .' gel; l'[B
  • 288. /(£1 L; ,'. «.“. l,’/1.31:. ’ Lfibuul . 'Ji: l ilu/1r'_u .1 «J . i.i. mi; ;. J . > “Q s . _r- ThisSit£V ‘ Search ‘ filgii‘. -iii) ‘Q. ’ Federal mHeaIth - upoaias U mHeaIth is the use of mobile and wireless devices to improve health outcomes, healthcare services and health research. "wealth in the News ~ This definition was developed by a NIH Consensus group, Your MQQIIG Device and Health Inlormatiori Pnvacy and Secung r, oosied12i‘19i'2012i [cg ag_q[e§§es mlleggiigi Tgsg Foigg recommendations (posted 12/18/2012) Video Report: What is mHea| th? Feedback Reguesleg! Healthy Aging White Papgr #2 (posted 12/13.i‘2012l &| .Q1.e. v_e| .ILa_ILQt1_QLlli; _I. €2rJ: £Qam mobile health piggram 1? iPDF - 224 KB; iposieo 12/11i2012i TXT4Tots Library TXT4Tots is a | Ib!3l’. oi shon‘ evidence-based messages in English and Spanish Messages are taigeledlo parents and caregwers or children Federal mHealth Coordination oemeen 1 and 5 was old am yo. ‘-Us on nutrition and DhyS| C3l 3C1lVlYy l. lgre= = Text4Health Task Force
  • 289. ( ‘‘‘r‘§'. ’‘, '~''f‘!7i‘*_‘-f*‘~’if‘§’‘‘’ i, ‘-ll= ’l’i"i= ,rlll3il. ‘_-1'15? ‘- i. ':r. :i«, ': Today's teens use media an average of: ° 10 hours and 45 minutes la every day so 7 days per week* *Kaiser Family Foundation, 2010
  • 290. Selecting Smartphone Apps - Empirical support for theory - Empirical support app - Utility — User ratings — Peer review — Blogs — Ease of Use — Confidentialityl Security
  • 291. OCPM: Online Clinical Practice Management l - i‘ l _ ’_, ' I‘ . « 1 * - vj< ‘J. , , , . i . .) f V . ... ... . s. .. — .25 ___ |
  • 292. Tfl EMFNT/ ll. HFAlTH ((( l H K‘ Y I U T F ‘ teIeheaIth. org Health & Behavioral Care in 20 Years ° Mobile devices and peripherals will deliver most health and mental health care —Sensor-based information gathering ° Mirrors, scales, vests, chairs, mattresses, steering wheels, exercise equipment, etc. —Se| f-report
  • 293. m EMFNT/ ll, HEALTH l H K‘ Y I U T F teleheaIth. org Health & Behavioral Care in 20 Years ° Mobile devices will be networked into central database that will correlate all real-time data with your genetic profile: — as reported by you, family members, friends and neighbors who share your environment; and — demographics of people who share your habits, lifestyle, and personal preferences for food, drink, exercise; — medical conditions and medication; — combined with latest empirical evidence about each source
  • 294. ( ‘l‘r‘§7‘l3l!7i‘%‘-f*‘3f‘§’‘l i, ‘-ll= ’l‘i‘i= ,i= ’ll3il. ‘_-i‘(5? : - i. ':r. :i«, ': Health & Behavioral Care in 20 Years it Data will be complied into recommendations that will deliver medications, foods other ingestible substances and behavioral prescriptions in ways that will help remedy diseases and problems before they can even be noticed now.
  • 295. m EMFNT/ ll, HEALTH l H K‘ Y I U T F teleheaIth. org Remote Monitoring Technologies ° Over the next 25 years, remote monitoring technologies are projected to save nearly $200 billion in the US, particularly by managing chronic diseases: — reduce costs for caring for the elderly in rural areas by 25 percent ° 62.7 % of polled hospital personnel reported increased productivity for mobile clinicians and staff ° 38% reported productivity gains of 5% to 20%, and ° 10% reported productivity gains of 45 to 60 % htt : www. brookin s. edu “‘ media research files a ers 2012 5 22% 20mobile%20hea | th%20west[22%20mobi le%20hea lth%20west. pdf.
  • 296. OCPM: Online Clinical Practice Management Step 1: Training Step 2: Referrals Step 3: Patient Education Step 4: Legalities Step 5: Assessment Step 6: Direct Care Step 7: Reimbursement
  • 297. Tfl FMFNTAL HEALTH I II I I I II I I teleheaIth. org Learning Objectives ° 1. Describe 3 ethical dilemmas related to Skype, Google and Facebook, blogging and the ethical codes that help practitioners think through those dilemmas. ° 2. Discuss the legal issues related to practicing over state lines or international borders, HIPAA and informed consent when practicing online. ° 3. Outline 3 key elements of a risk management plan for working online with clients to deliver care.
  • 298. OCPM: Online Clinical Practice Management Exercise: If we have time. ..
  • 299. THFMFNTAI umm ((( _ _ , Y , ‘ _ teleheaIth. org Disasters & Mental Health The American Red Cross reports that on average, "30 — 40 percent of people who are direct victims ofthe disaster experience one or more mental health disorders after the event, such as PTSD, depression and anxiety. ” In disasters that directly affect thousands, local and community mental health resources could not conceivably accommodate an increased treatment demand of this magnitude. American Red Cross (2012). Disaster Mental Health Handbook: Disaster Services.
  • 300. TELEMENTAL HEALTH teleheanh-org I N S T I Y U T E Distance Counseling Summary Exercise WWW. SPIQ. CA
  • 301. Lac Megantic, Quebec . ,a'. I l; -z°. r, . , . 3 . - . vi-~_. Z7‘PhotabySI'Inon _ _ "weir: V I
  • 302. ‘V Wm M (€l€h88l[l1.0lg Me 'i WMAPZEDIA File: Lac megantic burning. jpg ju| y6, 2013 Th: I>m~ Fnn-rlopcdu From Wxkipedia me i. -ee encycbpedaa M3." mg: ‘[12 F fie h-stow '~ :32 usage Gvooa’ tile usage Ct: -merits Feaured content Current 9'. Er‘£§ Random . v1ir, |e Donne lo ‘. ‘JIkx)<‘<3&3 '. '»’llL-fhedéa Shop v lnlrfld ‘mm NFC About ‘. ’»'nmcdv. Comm! -tv ports Recent changes Contact page D Tools
  • 303. BE] w j NEWS US&CANADA L hunic Usscanadn L. l!l!7f«Y77CKI(J UK Alillla As-.2 [uropc l. IrrH. :st Business Health Scrimuorwmcm tech Enrv, -rmrnmrnr i_v, .1eo AUVEl‘ilSH. lEliT Premier Rewards Gold Card from American Express ‘ ‘mIv'; Hm‘L ' . "r‘“?4 . vI, .. . iv . , . 1(rJuI-, ‘ZU1.‘r . ' ~ « Aerial images: Destruction at Lac-Megantic Explore the scene of the devastating fire in Lac-Megantic. which swept through the town on Saturday after an oil train derailed.
  • 304. (G TELEMENT/ ll. HEALTH I . -r L: l l. JT r teIeheaIth. or 4. _ A ’ “WWW. SP{Q, §A 0 20M Telellemal HERIIII Insmme. Inc. 3
  • 305. TELEMENTAL HEALTH ((( l N K Y I U 7 E l: eIehea| t;h. org R, . w av. //n . W 1. . L. .. ._. ., .2 . . . 1. as _, .1 . _ Y‘ . ,,. 1%
  • 306. ((( TELEMENTAL HEALTH telehealth-org | F». "'~l Yul!
  • 307. ((( TELEMENTAL HEALTH telehealth-org | h"~l Ttlif ‘. -2.. _ ~ ' ' .4 / . _ I I l‘- , I A? 1 " V V C . . _‘: ;- , .' ' . ' ‘ 3?‘ WWW. SPIQ. CA
  • 308. ‘ ~ ' 4., ‘a. ’ r T D , ‘_ . . -‘ , ‘. _ rs’, J4». - ‘ 4.- . '7 v — : —— ‘'7 -~ "'. T V‘ q. ‘ "' . . ‘ x 1 ’ (Q_ J. r ‘ I _ ‘Ne, 7 . . » 4 . — ’ _ , rz ~ _ _. “-* " »'t ' _ W V _ ‘ 4 4' s ‘ ' . _ . - . $4 .5’ . . ‘ . . . -1 9 s - { ‘ -. . - ‘J . ‘ 1 . x’ , .u s . a -A Image printed in BBC News. US 8: Canada. Julv 10. 2013
  • 309. TELEMENTAL HEALTH i((( I N S T I I U T E telehealthmrg Photo printed in BBC News, US & Canada, July 10, 2013 O HIM ‘ltlllufl IIIM lnslfl. ll:
  • 310. ‘i, =IliliT? :lliil§§'llg': What if you were the 3 year-old child witnessing this disaster? ‘J’! W ‘1‘I. :'JP_'. '). Cr' r
  • 311. T'l F-‘.4Fl‘JTAI Hr um ((( t telehea| th. org l*. ‘l: i What if . ..you were a five year old in this resort village? ‘ - l www. sp1Q. cA
  • 312. j-3>.5.3.. ""_l7:: “i""_‘L“fl3f'1;"’; ‘! ‘i;1t£li"t?3lliil. ‘;-’i’(g‘. ~ lg‘. -.r, .7r; .: What if you were a grade school child in this disaster? ‘1‘l': ‘l‘1'l. :'1r'-'_'Q. C;
  • 313. m FMENTAI HEALTH ((( _ teleheaIth. org lmil Iii: What if you were a teen in this disaster? - . . —‘ . / - . S ~’-’ TIVWW. $'I? IQ. CA'j
  • 314. telehea| th. org TELEMENTAL HEALTH l -T ' . rl l‘li- / ‘ WWW. SPIQ. CA
  • 315. ‘i, =it£li't?3lliiT. f-’ilg‘. ~ What if you were an elderly person in a nursing home in this disaster? . 'e'. a'; 'rv, *'1;-3.-233.9.-r.
  • 316. 1‘. f; ‘l: ‘:°fj'i‘é‘-f[3f‘; "’‘’ ‘i;1tili"t: .tilLiil-‘L-‘i’eg': What if you were wai ing for fire fighters to find your missing loved one?
  • 317. isaster? you were a fire fighter in this d . u. . .( M. M _+~. (Th M. .. 4., .1 .
  • 318. Resources
  • 319. TFLFMFNTAI HEALTH ((( I , Y K ‘ _ , teleheaIth. org . F. ‘ ‘— l r Get Expert Advice ° Consultation from topic experts in telehealth ' Professional Training - Also seek the aid of an experienced billing professional and/ or accountant if you have any financial questions
  • 320. . ' Telehealth .5 0 Resource Centers . Licensure and Scope of Practice . . Table of contents 02011 Tllellemil Health Insnfle. Inc, nu. .. : _ H. _. ._. _._. n
  • 321. Center for Connected Health Policy Telehealth is the use of digital technologies to deliver health services by connecting multiple users in separate locations. I earn More » VILEIIIALTOI IPOTLICIT CCHP Awarded $253,540 for Telehealth Study The Blue Shield or Callloima Foundation (BSCF] awarded the Center for Connected Health Policy (CCHP) a $253540 grant to examine telehealths capacity to improve health care delivery. quality and efficiency over an eighteen month period, Partnering with select California- based federally-qualified health centers (FOHCS). CCHP will assess telehealth cost data before. - v 1"'LF About CCHP What is Telehealth? A? ‘III! Cllfll Telehealth Experts Join Forces for Training Module Series The National Telehealth Policy Resource Center and South (Jenna: lelenealtlw Resource Center - known for their exceptional training and educational resources - are collaborating on a series or comprehensive telehealth policy training modules beginning in early 2014, Read the full press release neie CA Telehealth Policy CCHP Projects l INIALTIIIAY 121713 New York State Creates online Database of Hospital charges > 12.17 13 Firms Tan Data Mining Tools To Aid Clinical Trial Reczultment Process » I2 1713 ONC Releases Findings From Patient Data Matchlng Study s 12 W13 Report Global Telehealth Market To Grow ny18.5% Through 2018 .
  • 322. t‘ S’ J Home About Expertise Events Publications Membership Contact The Senate Finance Committee approved important telehealth legislation during the Committee's consideratron of the Sustainable Growth Rate (SGR) repeal and replace bill. the SGR and Medicare Beneficiary Access Improvement Act, Senator john Thune (R-SD) offered two amendments during Finance Committee consideration of the bill. The first amendment accepted by the Committee is the Fostering Independence Through Telemedtcme Act (PITT) . I . .O( art‘: Insmme. In:
  • 323. telehealth .0: q H03.“ ABOUI l€l (X. H! l(V| (,l S ll(AlNlN(. |'}": ()Ul1'([‘; Register for the Telemental Health News Register Now for Your Weekly Copy of the TeIeMental Health News Nor only wull you re-zelve news about the week's most nmportanl developments. but you'll also. .. J Receive our analyses ol current events and Imluto other key ulemerrul health alelepsydnolry relepsycholog-y dmance counselmg and onlrnethelapyl rescurcel J Recewe news about our bonuses and span»! ducounu fol TMH lnsmure running and (onsultmg servrces To make It even better, you will also. .. ~/ Rouwo your ownlllflt copy olrlw Ielemodldne Reimbunemml Handbook wulhm nanowcanda of ml)-. <nl>rnq Ir conurns pwoul rnlormarron about who can be mmbuned lor r-l-hnlrl: -. -rvu: -a me! which wrvnzw. and pro(rduro mm {CPT} are r-lmbunalslr {CFT Kode‘. h. w«- not yet bun updalrd m (hn docurnenr for 101 3, but the H. -mdbaok wrll u-II you rnlormulon that wrll help youwnth blllmq nnrm-dual-ly nonrllwlrs-. _n We will protect your priva<y and never share your address with anyone. Join us today!
  • 324. m FMFNTAI, HEALTH I H i Y I U T I, telehealtnorg To Keep Up To Date ° TMHI faculty blog about these issues from a mental health perspective as the news breaks ° Options: — Visit Blog at www. telehea| th. org[blog ° Receive RSS feed — You can also receive free weekly newsletter that gets sent to your in-box: http: //telehea| th. org/ sign~up/
  • 325. T'lFMFNTAl llF‘«lTH ((( Q _ ‘T telehea| th. org l’. ‘ l References ° Biba, E. (2005, February 17). Lost your cell phone? Call a cab! PC World. Retrieved June 26, 2010 from htt : www. cwor| d.com rintable article id 119702 rintab| e.htm| ° Borland, John. Breaking GSM with a $15 Phone Plus Smarts. Wired, December 28, 2010. www. wired. com[threat| eve| [20l0[12[breaking—gsm- with—a—l5—phone-plus-smarts. ° Cellular Telecommunications and Internet Association (CTIA). (2010). US wireless quick facts. Retrieved June 26, 2010 from htt : www. ctia. or advocac research index. cfm AID 10323 ° comScore. comScore Reports October 2011 U. S. Mobile Subscriber Market Share. Press release. December 2,2011. www. c0mscore. com[Press Events[Press Re| eases/ 2011/12. 0 21114 Telemental Health lnsmne. lni:
  • 326. K ‘l'v", ¥'. "“_’~"‘7{. "§‘%‘-f~‘~’. *i‘£"" ‘(; .ll£li‘i= ,l= 'l[i‘ri. ‘,-i’(5‘: ‘- i. 'ir. :w, ': References ° Connell, M. , Drogin, E. , Foote, W. , & Sturm, C. (2010). The American Psychological Association's Revised “Record Keeping Guidelines”: Implications for the Practitioner. Professional Psychology: Research and Practice, 41(3), 236-243. * Dolan, RL. (2010, February 22). Data security breaches often triggered by carelessness. American Medical News. Retrieved June 26, 2010 from htt : www. ama—assn. or amednews 2010 02 22 bi|20222.htm * Greene, Adam H. HIPAA Compliance for Clinician Texting. Journa/ of AHIMA 83, no.4 (April 2012): 34-36. ° Gross, B. (2009, August 18). Mobile liability. Annals ofthe American PsychotherapyAssociation. Retrieved June 24, 2010 from htt : www. anna| sof s chothera . com articles news 30 15 Mobile- Liabilit. .. ' HIPAA, Public Law 104-191, 45 CFR §§ 164.524, 164.526.
  • 327. K ‘l'v", ¥'. "‘T_’~"‘7{. "§‘%‘-f~‘~’. *i‘£"" ‘(; .!l£l’i‘i= ,l= 'l[i‘ri. ‘,-i’(5‘: ‘- i. 'ir. :w, ': References ‘ HIPAA, 45 CFR § 164.501. * Ponemon, L. (2009). Fourth annual US cost of data breach study: Benchmark study of companies. Traverse City, MI: Ponemon Institute. Retrieved June 26, 2010 from htt : www. onemon. or local u load fck'ai| eneralcontent 18 file Cos t%. * Office for Civil Rights. Guidance on Risk Analysis. ' Office for Civil Rights. Are the following entities considered ‘business associates‘ under the HIPAA Privacy Rule: US Postal Service, United Parcel Service, delivery truck line employees and/ or their management. March 14,2006. www. hhs. ov ocr rivac hi aa fa business associates 245.htm| .
  • 328. r'ir, -.irimii llF‘«lTH ((( T _ ‘T telehea| th. org l’. ‘ I References ° Office for Civil Rights, US Department of Health and Human Services. Guidance on Risk Analysis. July 14,2010. www. hhs. govlocrlprivacylhipaaladministrativelsecurityrulelrafinalguidan cepdfgdf ° SMS. Wikipedia. htt : en. wiki edia. or wiki SMS#Vu| nerabi| ities. ° TigerText. "Physician and Hospital Texting Is on the Rise. " Press release. October 12, 2011. www. tigertext. comlphysician—texting-on—rise. 0 21114 Teleuemal Health lnsmne, lni:
  • 329. ( ‘E ‘<, =irsi. i:, r:itii. .;-nae‘. - ' 9 Questions. W3” Marlene M. Maheu, Ph. D. Te| eMenta| Health Institute, Inc. Phone: 619-255-2788 Email: mmaheu@te| ehea| th. ORG

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