Maheu 15 Critical Issues for Client/Patient Education


Published on

This program is available for 1 CEU or 1 CME, along with transcripts and an audio download of the event. Details are available here:

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

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

See other offerings at
Send questions or comments to us at
Contact Dr. Maheu to speak at your next workshop or conference at:

Published in: Health & Medicine, Technology
1 Like
  • Be the first to comment

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

Maheu 15 Critical Issues for Client/Patient Education

  1. 1. TMH Institute Webinar 15 Crucial Issues for Client/ Patient Education about Telepractice Marlene M. Maheu, Ph. D.
  2. 2. Questions?
  3. 3. 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 Copyright 2012Te| eMenta| Health Institute, Inc. All rights reserved.
  4. 4. Licensu re ° I'm trying to determine the best way to establish if a client/ patient is a resident of my state, and thus within the geographical scope of my license. ° I am wondering: if a client has a home in my state, but often travels, can I do sessions online and still consider this client a legal resident in my state?
  5. 5. About Blog Forms Pdyinent Practice Welcome Dr. Maheu Is your relationship a thom in your side? Are your worries getting the best of you? Eager to get relief from depression or loss? Want to find more happiness in your everyday life? Having trouble getting along with people, even at work? Have your bad Internet habits gotten you into trouble? Worried that your use of drugs, alcohol or nicotine is interfering with your life? Welcome to my online office. I have extensive training and experience in the areas above — and others. This website was designed to help you learn a bit about me, my services, my office, experience, training, and policies. It also is where you can come monthly to pay for my services by credit card, and check your account. Here you can also gain direct access to the website I founded in 1994, called SelfhelpMagazine. From withing the "My Therapy Center" website, you can access the magazine's thousands of free articles, cartoons, community forum posts and other services. As for my private consultation and psychotherapy services, it may interest you to know that while I work with some people remotely, that is, over the Intemet or by telephone, I always require an intial period of face-to—face meetings. Before I agree to work with you remotely, I want to get to know you as a whole person in my office - at least for a little while. Blog Posts How Might You Check out Is Your Therapist Using Online Therap_y, Online Online Avatar—based An Online Thera ist? Sigge and Billing Your Counseling and Web Therapy for war Veterans? Insurance Illegalm? Therapy — 5 Ways to Make You finally found a counselor or 5 Y A S f Many military personnel spend therapist who might just be able Many therapists are already ufiing hours on the battle field playing I10 hell? ‘/ °U °“Il”e- The WIC9 I5 technology to extend their reach anml New-: Vim-'3' games: arld 3'9 3I'9'3d‘/
  6. 6. OCPM Step 3: Patient Education Email / Texting Social Networking File Exchange Computer Repair Clinical Records Insurance & Reports
  7. 7. How to Accept Referrals for Telepractice? 1. Email or telephone? 2. | n—person assessment? 3. Champions?
  8. 8. Online Norm vs. Standard of Care ' Mostly Email & Chat vs. Video ' Anonymity/ llo Patient Records ' Avoid Responsibility w/ Website Disclaimers ' l| o Clear Channels for Mandated Reporting
  9. 9. Online Norm vs. Standard of Care | lo Contact with Other Treating Clinicians | |o Authentication of Consumer/ Professional l| o Emergency Backup Procedures Misunderstanding of Clinical Processes (suicide) Scant Research for Unsupervised Settings
  10. 10. American Psychological Association Telepsychology Guidelines (Open for Comment Until Late October, 2012) ° Assess client fully, and in-person assessment is ~ advbed C Be aware of client's local resources for both , emergency and . discharge planning 0 Receive professional training
  11. 11. How to Test Equipment Vendors / Colleagues / Family
  12. 12. How to Explain Informed Consent ‘ ‘. .
  13. 13. 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. Copyright 2012 Te| eMenta| Health Institute, Inc. All rights reserved.
  14. 14. Practice Model: Patient Consent Agreement ° Inform the patient of who else might contact the patient on your behalf ° Discuss the purpose of remote contact
  15. 15. What to Document ° Informed consent ° Emergency planning efforts
  16. 16. Documentation ° Clearly discuss and document which types of telecommunication technologies you will use (e. g., fax, email, chat, text messaging, telephone, video teleconferencing), how they will be used, and whether telepractice is the primary method of contact or augments in-person contact. ° Communicate risks and benefits of the telepsychology services to be offered to the client/ patient.
  17. 17. Discuss and document if you will consult with , = specialists, and n how " y ' lit’). . ,1" « . |, . - - e I. M‘ V’ V - . I c K ’K V. “EH I {5 ‘ 5 )r "i H . »" 35 I? ‘ 5'. A‘ i n '. I ' ff
  18. 18. Documentation / HIPAA & HITECH ° Educate and make agreements with your clients/ patients so they can and will assume a role in protecting the data and information you receive from them trim past email content when responding to avoid its subsequent exposure by inquisitive family or friends double check TO: lines before sending email avoid forwarding email messages from you to others explain ”Protected Health Information or PHI” and how related security breaches could harm them what you will do if someone joins a telephone conversion what you will do if someone walks into their room, or yours e Explain your duties re: HIPAA * Document that you did the above
  19. 19. Document regular evaluation of your ’Ii , I‘ progress with clients and patients in telepractice. I . ’F
  20. 20. Relevant Ethics Codes? All Existing Legal & Ethical Rules Apply
  21. 21. Existing Te| eMenta| Health Guidelines ' American Medical Association. (2000). Guidelines for Patient—Physician Electronic Mail ' American Counseling Association. (1999) (2005). ACA Code of Ethics - American Mental Health Counselors Association. (2000). Code of Ethics of the American Mental Health Counselors Association, Principle 14, Internet On—Line Counseling - American Psychological Association. (1997). APA Statement on Services by Telephone, Teleconferencing, and Internet, A statement by the Ethics Committee of the American Psychological Association - American Psychological Association. (2010). Ethical principles of psychologists and code of conduct - American Telemedicine Association. (2009). Evidence—Based Practice for Telemental Health - American Telemedicine Association. (2009). Practice Guidelines for Videoconferencing—Based Telemental Health - Australian Psychological Society. (2004). Guidelines for Providing Psychological Services and Products on the Internet - British Psychological Society. (2009). The Provision of Psychological Services via the Internet and Other Non—direct Means - Canadian Psychological Association. (2006). Ethical Guidelines for Psychologists Providing Psychological Services via Electronic Media - Federation of State Medical Boards of the United States, Inc. , Report of the Special Committee on Professional Conduct and Ethics. (2002) Model guidelines for the appropriate use of the Internet in medical practice - National Association of Social Workers. (1999) (2008). Code of Ethics - National Board for Certified Counselors and Center for Credentialing and Education, (2001). The Practice of Internet Counseling. (2001) ° New Zealand Psychological Psychologists Board (2011). Draft Guidelines: Psychology services delivered via the internet and other electronic media ° Ohio Psychological Association. (2010). Telepsychology Guidelines 0 Winkler, M. , Flanagin, A. , Chi-Lum, B. , White, J. , Andrews, K. , Kennett, R. , DeAnge| is, C. & Musacchio, R. (2000). Guidelines for medical and health information sites on the Internet. Journal ofthe American MedicalAssociation, March 22/29, 283(12), pp. 1600-1606 A I
  22. 22. ; 4 - 1'. ‘-‘V. ‘ L T’ " ‘F I. ‘ ‘l i . 7. . B. _ 4‘ ‘ 4. L —. L -“; P:', ‘ . ; _ ‘A _v ' - T g .2 ml‘ 1' 1" ' . -5 I. v x 2: ‘ [E ‘ , , I’ iv‘ *4.’ . ' ‘-’_'. "e' | . l . 2'. ‘ ,9’ ‘ I "”)' . '— H’ 5 ' .4 *- r 9 . _ . ‘ . 9 . " g I- :35’ '3 1;’ i 4“ I Competence Racial, Linguistic, Gender, Religious & Cultural Diversity Copyright 2012 TeleMenta| Health Institute, Inc. All rights reserved.
  23. 23. American Psychological Association, Ethical Principles & Standards (2002) m c «B Psychologists must be aware of multicultural and diversity issues.
  24. 24. Australian Psychological Society (2011 revision of Internet Guidelines) * Research—based protocols — 1.6 ”Psychologists using the internet to provide a psychological service should be aware of the extent to which therapeutic interventions via the internet are supported by research or may be contra—indicated . ... ” Copyright 2012 Te| eMenta| Health Institute, Inc. All rights reserved.
  25. 25. 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
  26. 26. Duty to Report/ Duty to Warn California State Law fi (v) Failing to comply with the child abuse reporting requirements of Section 11166 of the Penal Code. (w) Failing to comply with the elder and adult dependent abuse reporting requirements of Section 15630 of the Welfare and Institutions Code. CA Business and Professions Code Sections 4989.54 (cont. )
  27. 27. ATA Guidelines - Emergencies ° A patient site assessment shall be undertaken, including obtaining information on local regulations & emergency resources, and identification of potential local collaborators to help with emergencies. Copyright 2012 Telemental Health Institute, Inc. 27
  28. 28. ATA Guidelines —— Emergency ° Emergency protocols shall be created with clear - explanation of roles & responsibilities in emergencies ° Beginning protocols — Scan room —— Alone? — Is there a gun? — Alcohol or drugs? ° Name of family or friend and local health provider
  29. 29. 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. It Such technologies include, but are not limited to, computer hardware and software, telephones, the World Wide Web, the Internet, online assessment instruments and other communication devices.
  30. 30. Patient Consent Agreement I Risks and Benefits — 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.
  31. 31. Patient Consent Agreement - Allow patients to prohibit use of identifiable images or information by researchers or other, unidentified entities. ° Allow patients the opportunity to prohibit identifiable medical information or images from appearing in any electronic medium.
  32. 32. ,1-_. -4 Interruptlionysgz Wh, atifp_Tyhey. ,_see Top of I
  33. 33. What if someone enters the patient’s room, or is lurking?
  34. 34. Local Community Emergency Backup Q Risk can be mitigated buy having another licensed professional or trained “champion” in the room to follow specific instructions by the cialist.
  35. 35. Nursing Homes
  36. 36. 1.’ I’ / ' _ .9 ‘- I ,4‘, I P‘ I I. -_o- . _.t : ( ' ‘I 2?; . , .
  37. 37. Rural Hospitals
  38. 38. Hospitals
  39. 39. Home Health .
  40. 40. Correctiona Facilities
  41. 41. Military & Veteran's Administration I l ‘ 7 Y . .4 sf’ I. I r ' , / -, / . I I I . I X , I ' I .
  42. 42. Noncompliance & Avoidance Think ahead: 1. Choose your population wisely 2. Agreements with contacts you will call or email 3. Regular in-person meetings 4. Consequences — 1. Up front payment '= - 2. Termination letter . I I u I : '—-‘CI "—> 1
  43. 43. Charge for Missed Appointments? Informed consent agreement Up front payment Check with 3'0‘ party carrier . ‘ . .
  44. 44. Plan for Emergencies - Informed Consent - Names of family or friend and local healthcare provider ° Local champion - Local Resources
  45. 45. Initial Protocol * Has there been an emergency in your environment today?
  46. 46. How to Deal with Information Breaches Copyright 2012 TeIeMenta| Health Institute, Inc. All rights reserved.
  47. 47. Boundaries & Other Safety Tips Your computer setting is your office ° Never work after drinking / surgery/ mood altering medication - Maintain regular work hours: e. g., do not send out email in wee hours of morning - Do not text with emoticons and abbreviations: LOL, IMHO, etc. ° Practice same boundaries as in office: no spouses, children, barking dogs, etc.
  48. 48. Telehealth Summit 2012 How to Get Started * 3 FREE video training sessions delivered to your desktop — October 15 / / K — Ask your questions ‘ — Get immediate answers Register here: http: //summit. te| ehea| th. org
  49. 49. TMH Institute Certificate Program 30% Discount until 9/19/12 midnight Coupon Code: CERT30 Shopping Cart: http: //store. te| ehealth. org/ cata| og. php? category=3
  50. 50. Discussion?