Telepsychology Best Practices Workshop, American Psychological Association, 2013

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Telepsychology Best Practices Workshop as presented at the American Psychological Association Annual Convention by Marlene M. Maheu, PhD on July 31, 2013 in Honolulu, Hawaii …

Telepsychology Best Practices Workshop as presented at the American Psychological Association Annual Convention by Marlene M. Maheu, PhD on July 31, 2013 in Honolulu, Hawaii

Topics covered include telepsychology ethical guidelines as promulgated by the American Telemedicine Association and the American Psychological Association in 2013.

To invite Dr. Maheu to speak to your group about these issues, the her a message through http://support.telehealth.org

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  • 1. liI[>§l't’l: ",r. I|ii/ ‘iC, i‘)‘('gi Telepsychology Best Practices AMERICAN PSYCHOLOGICAL ASSOCIATION July 31, 2013 Marlene M. Maheu, PhD, Patrick DeLeon, PhD, JD, MPH, Steve Demers, ED; Reid Hester, PhD, Eve-Lynn Nelson, PhD i”; '35‘-,3“-‘-. ’i5 a-‘I -.
  • 2. O J= ,”'! ."'. L5.N, ";, V"'L: |!fL“‘. ".: " 1-. I[; Ji‘l£r-llii'. '{o‘i¢g Disclaimer/ Disclosure WHO I AM: I am a licensed psychologist, not an attorney, physician, marketing or information technology (IT) professional. My company has strategic partnerships with some video companies mentioned in my video slides. MY GOAL: My goal is educational only. No warranty, guarantee, or representation is made as to the accuracy or sufficiency of the information contained in my presentation for your specific circumstance. YOUR PART: You are encouraged to seek practice—specific advice from your legal, regulatory, ethical and malpractice bodies before offering any online services or programs to consumers. Get all such opinions in writing, and have your informed, local, legal counsel review them for their full significance.
  • 3. (C 7f. lI‘I", FL'WHEM_T" teieneaimorg Learning Objectives 1. Understand current healthcare policy changes that will impact telepsychology in the next 5 -10 years 2. Be aware of 3 specific legal, regulatory or ethical issues related in telepractice. 3. Be able to explain how multi—cu| tural issues are relevant to telepractice. 4. Understand ethical guidelines when using assessment tools online. 5. Comfortably use telepsychology with children and families. 6. Select smartphone or smart device "apps" to use with clients/ patients. 7. Identify billing codes to use for reimbursement of psychological disorders treated through telepsychology and describe how to use them ethically.
  • 4. - T —~+~——— —-—- : —»_~—A. -—4—>—-<‘= _q: g‘&‘ l Guests: Dr. Pat DeLeon Dr. Steve Demers Dr. Reid Hester ; ~_«; I jg. Dr. Eve-Lvnn Nelson I¢L*""”’% , .-if. Nix
  • 5. —J—~— — — ~e-, I I Housekeeping I Schedule _. _ j Restrooms I Questions _ Q, I WiFi ‘it’ I Twitter @te| epsychoIogy v. ‘ iii W i; if ‘a . :l. x 0 mt! ‘. - r-. rem. .I Hmflh imri Inr
  • 6. APA Telepsychology Guidelines Guideline 1: Competence Guideline 2: Standards of Care Guideline 3: Informed Consent Guideline 4: Confidentiality Guideline 5: Security & Transmission Guideline 6: Disposal of Date & Info Guideline 7: Testing & Assessment Guideline 8: lnterjurisdictional Practice
  • 7. .— 7 . '__ . _ j What's going on? it v= Technology 6 Healthcare -9 Psychology -= Telepsychology
  • 8. Our planet is re-tooling - . , «Q» , j./9* I S / .;= ' I . ~ , l/ ,; asis "if"/ o2 X,2-_/ 5v_, k/_v»! I_; g.. V. , _ , I psychology
  • 9. "F‘lf'v‘E$TALHF, m>TH teiehealth. org US Mental Health Workforce US Bureau of Labor Statistics 2011 ° 693,000 Physicians — 35,000 psychiatrists (5% of all physicians) ° 1,020 Mental Health Professionals — 150,000 clinical and counseling psychologists — 140,000 mental health and substance abuse social workers — 110,000 mental health counselors (LCP) — 90,000 substance abuse counselors — 30,000 marriage and family therapists (MFT) — 500,000 social workers work with families in a mental health capacity but do not treat mental illness
  • 10. LE4,’ UNITED STATES DEPARTMENT OF LABOR -"F ‘I i Subscrbeto E-maiUDd6les '30 inluw Us ’ I what's New I Rel: -ase('. aIerirlar | Site Map * BITRF. -1' or I. .~B()R S'I‘. »l‘IS'I‘l(‘S , e,, ,C, ,,, ,s, ,,, , Q Home V Subject Areas V Databases 8 Tools V Publications V Economic Releases V Beta V OOH none | occuvnnou FINDER | oourao I OOHGLOSSARY | A—ZIN[)O( | oousrm-up | ENESPANOL OCCUPATIONAL OUTLOOK HANDBOOK °° ‘I7i. ‘<r: i rm: n fr K’ r. - > Psychologists I l ~, _'r -+ -r_‘, 'L. , 2.1;, -_ ‘Summary’ WhatTheyDo ‘ Work Environment How to Become one Pay Job Outlook Similaroccupations ‘ Contacts for More Info Summan Quick Facts: Psydtologlsts 2010 Median Pay 0 5°8""‘° 9“ Yea’ 533.00 per hour Entryvlevel Education Work Experience in a Related Occupation 9 None 0n-thejob Training Internship/ residency Number of Jobs, 2010 if 174,000 lob Outlook, 2010-20 (5 l 22% (Faster than average) Employment Change, 2010-20 0 37,700 What Psychologists Do Psychologists study mental processes and human behavior by observing, interpreting, and recording psychologisgs diagnose and evaluate mama. and r. . _ _.4 _u___-. .,. . . _i. ._ 1. __ _ . A.| ... __. Ju__ _. .| .-. ..4.. ».
  • 11. Psychologists : i . . ll’-ll ll/ hat? heyEo l7lork7Environrnent How togecome One l>ayV Jobroutlook Similaroccupations Contacts foriore info Summa ry Quid: Facts: Psydioiogiss ’ L‘ . ‘_ $68,640 per year _‘ 2010 Meo“ian Pay _ 53100 W hour . , V . Entry—Levd Education , , swam: ‘ ‘ 1 , « ', ; ‘ work Experience in a Related occupation ‘_ None ' ' “ , .<’$. . On—thejob Training _ Internship/ residency " ‘ Number of Jobs, 2010 _, 174,000 Job outlook. 2010-20 , 22% (Faster than average) Employment Change. 2010-20 ‘_, 37,700 What Psychologists Do _ Psychologists study mental processes and human behavior by observing, interpreting, and recording psychoyogms dlagnose and evamate mental and how people and other animals relate to one another and the environment. emotional disorders Work Environment Some psychologists work independently, doing research or working only with patients or clients. Others work as part of a healthcare team, collaborating with physicians, social workers, and others to treat illness and promote overall wellness. Those in private practice have their own offices and set their own schedules, often working evenings and weekends. How to Become a Psychoiggist Psychologists need a master's, specialist, or doctoral degree in psychology. Practicing psychologists also need a license or certification. E! The median annual wage of psychologists was $68,640 in May 2010. Job Outlook Employment of psychologists is expected to grow 22 percent from 2010 to 2020, faster than the average for all occupations. Job prospects should be best for those who have a doctoral degree in an applied specialty and those with a specialist or doctoral degree in srhnoi psychology,
  • 12. ”. "!, "'. .J5,“_'; _V‘"'L: |'! _‘: “', ",: " 1-. il; li‘lJ; .ilii', ~;. )‘. , 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-“V Frieda“ Gloria Steinman + 1963 book The Feminine * Sought to transform society MJSLQLE * Sought to have women be accepted in existing world
  • 13. Lac Megantic, Quebec . ,a'. I ; ;-z°. r, ‘ , . 3 . - ‘ vu-~_. Z7‘PhotabySI'Inon _ _ "weir: V I
  • 14. (6 : r‘1s‘r. 'n. .r. '«1u; V;xm~ telehealmflrg What if . ..you had a home in this resort town? _ www. sp1Q. cA
  • 15. ( mnv. s.~mu HEALTH . . . . , _ te| ehealth. or 4. _ A ’ “WWW. SP{Q§A C 35-11 ‘o- e| .venm‘ Nu. m Imrvcxr mr
  • 16. FELEMENTALHFALTH : - - '1‘ . teleheaIth. org
  • 17. telehea| th. org TF1 FMFNTA1 HEAL TH
  • 18. ((( rE‘LEMfl_nA_lHE, AL_m te| ehealth. org ‘. -2.. _ ~ ' ' .4 / _ I I : l / I A? 1 " V V C . . _‘: ;- , .' ' . ' ‘ 3?‘ WWW. SPIQ. CA
  • 19. BE] w j NEWS US&CANADA L home Usscanadn L. lZmAmcrIt'. | UK Amca As-.2 [uropc l. I:rH. :s1 BUSIF‘-CS5 Hum: Scuimuonmcm It-ch En[v: l!mnmrn[ v_v, .1eo AUVEVTlSH. lEHT Premier Rewards Gold Card from American Express ‘ ‘mIv'; Hm‘L ' . "r‘“?4 ‘wt, ., . ‘V . , . 10JuI-, ‘ZU1.‘, . ' ~ « 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.
  • 20. ‘ ~ ' 4., ‘ ‘a. ’ r ' D , ‘_ . . -‘ , ‘. _ rs’, J4». - ‘ 4.- . '7 v — : —— ‘'7 -~ "'. ‘ V‘ at‘ "' . . ‘ x 1 ’ (Q_ J. i ‘ n _ ‘Ne, 7 . . » 4 . — ’ _ , rz _ _. “-* " »'t ' _ " V _ ‘ 4 4' s ‘ ' . _ . - . $4 .5’ . . ‘ . . . -1 9 s - { ‘ -. . - ‘J . ‘ 1 . x’ , .u s . a -A Image nrinted in BBC News. US 8: Canada. Julv 10. 2013
  • 21. I , TELEMENTAL HEALIH I ((( I P‘ 5 , ' ' U I E telehealttnorg Photo printed in BBC News, US & Canada, July 10, 2013 O 201) You-Menu! mum Inmtute. In:
  • 22. .'ELElV. E-NTAL HEALTH I (6 teleheaIt. h.org cacnews IMontreal ‘. ,, Q 9 '3 ‘M 88.5?- A . S V ‘ ‘‘: r'ii'L. ‘ll 5 , ‘3«_ 1% Search resumes in Lac-Mégantic for 5 still missing Evacuees 0! 180 homes to be allowed to return ior personal belongings Sgt Benoit Richard of the Sfirete du Quebec said the tankers can t be pushed or dragged because of the presence of oil and also to preserve the possible bodies underneath them On Sunday afternoon mayor Colette Roy—Laroche and members of provincial civil security announced that evacuees of about 180 homes would be able to enter their houses and apartments this week to Collect some personal belonqinqs such as medicines ‘c rnlenia-‘ Healllz | i'i'. t‘l. ‘lP Iri(
  • 23. .'nrrv. n.~m HFMTH ((( I ‘ _ ', , g te| eheaIth. 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. ” ln disasters that directly affect thousands, local and community mental health resources could not conceivably accommodate an increased treatment demand of this magnitude. Disaster response agencies such as the American Red Cross often dispatch mental health volunteers, who are trained in psychological first aid and disaster mental health services, but it is important to note that their interventions are acute, crisis-based services. American Red Cross (2012). Disaster Mental Health Handbook: Disaster Services.
  • 24. I‘-ll. ‘:l'I‘l= ?-I APA Proposed Society for Technology & Psychology COMMUNICATION 8: Practice ‘°", "_, ’E”, .‘j'; ;;§, ,", §'°"‘ Science a‘e. g.. Internet, Blogging. Social media, Cvbemetics {e. g.. Biosensings‘ Fee<lbadj, Social networlxingl COMPUTING IVETHODOLOGIB le. g.. Artificial Intelligence; TELECOMMUI-ICATIOI-is §‘’; ‘'’‘: ‘ ‘-33 5‘ "§°‘“""§* ‘ _ ‘ l‘ _ f“ _ -0 UHCS; $27 . OITpU'Ef u‘e. §.. EIectrunicI»-Iail; '. “'}‘ “""l. °‘ "1"" ‘L’ ‘'45-’ Inter1aces[e, §.. (omputer Telepsychology, Remote _’ . ' ’isionTraciing. Haptic Sensing; Wireless. :‘. Training I’ I [ll til II "912" 3- l"‘€"73_C€5:; (°| T|D. -WEI’ Techno| ogy, Te| ephones[e. g.. 5"“"'3“°"5l9v_€-~V"W3' Mobil Phon. s. mHeaItli. -: ~‘ , . Human Afienw '= }='5’« E B A" v"‘ ” "1" xnvironinentsg l. Iessaging: ,'Video Conferencing; Interactive Voice Response} I-. licrocomputers; 3D Imaging, Software [e. g.. ."ideo Games: . -um I‘ = ‘.i‘nu . -.r i. w.w: .i-5 Education . i'_lVl: “ 19"“: -”'. Public Interest ‘llllg-II‘-Inn‘-Ialttlfliia (4. HEALTH its. ir: ronMAtics :57 ""1 NE ue. g.. Big Data; Contmlled Vocab: [e. g.. ICE‘-10:; Decision '"3l<i"€—~ 5UPP°"iD3'3 OTHERTECHNOLOGIES Mining; Electronic Health and . Personal Health Records; 'e"‘ga‘r": °e': h‘: :I: ';yg" Electronic | ZIataPri an. ‘ . . ' Security and | megr'itv: Health "a"°mEdm"E' Information Exchange, ’ HITEICH; Into rmation Storage 3. Retrieval; Interoperability (opvright (cji 2012 by Marlene M. Maheu, PhD.
  • 25. OCPM: Online Clinical Practice Management What's Happening Pat DeLeon, Ph. D., JD, MPH
  • 26. H teIeheaIth. org Affordable Care Act Repercussions for Psychologists - Referrals to for ACA patients will primarily come from primary care physician's offices ° Locale of treatment will be primary care physician's office ° Small group and private practices likely to be squeezed out of market due to cost controls in the face of rising overhead ° Shorter sessions/ more clients / families - More documentation
  • 27. 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
  • 28. ”. "!, "', .J5,“_'; _V‘"'L: |'! _‘: “', ",: " 1-. ii; Ji‘lJ; .iIii'. ~;. )‘. , Definitions * Behavioral Telehealth Telehealth vs. Technology? * Eheahh * Telehealth I II Telemedicine ‘- ‘.7 I: Telemental Health : Telepsychology : Online Counseling * Online Therapy 4 mHealth ° Telecounseling
  • 29. H telenealtnoig Telehealth vs. Telemedicine Tel Regional Health Health Professions Information Ecltication Sharing Consumer Education Telemedicine Administration Evaluation Research Homeland Security
  • 30. ( ”_"! ,"', _J5,f{"; _“L: "!f: “', ",: ; l‘-I['7}'| ‘l'. ;?. i|ii'a'I’. o‘)‘lg. Real-Time Telemedicine / 7 Remote dwtol. examines a Pat1e11t11111i1'alER gets beneht ot patie11t”s i11ne1'ea1‘ from a 10031 °“‘1‘e. Ph‘S lemote _ . remote location co11sultat1o11w1tl1 spec1al1sts.
  • 31. ' rrIrIv. rvII HFAITH ((( H _ '_ , teIehealth. org 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 & Bl'0-‘-/ I1-CDl‘Il]O"V. (2004). The mental health professional and the new technologies. Erlbaum, New York.
  • 32. "F‘lf'v‘E$TA{HF, m>TH teIehealth. org The Is Video Teleconferencing (VTC) Effective? ° Yes — Medicare & Medicaid required to pay ° Outcomes are relatively comparable, especially for follow-up care (intakes are still a matter of state law) ° Literature for specialty groups is sparser, but positive (pediatrics) — Also effective for supervision — Can improve some ways service is rendered — See www. te| ehea| th. ORG/ bibliography ° BUT, traditional VTC isn't the same as Skype
  • 33. rririvrsmi ll’AlTlI ((( H _’, '_ teleheaithorg 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 U. S. Department of Veterans Affairs patients enrolled in telemental health services, 2006-2010. Psychiatric Servcies, 63(4). 383-385.
  • 34. -'flFlI'FT‘I llz’AlTl ((( M _’, _‘ telehealthorg Recent Supporting Research Backhaus and colleagues (May, 2012) reported in their abstract of a meta-analysis that: 0 821 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. dol: 10.1037la0O27924
  • 35. ' J11 ll’llTll ’ telehealthorg 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
  • 36. Caution — Consider Context Online Norm vs. Standard of Care Mostly Email / Chat vs. Video *1 Anonymity / No Patient Records :5: Avoid Responsibility w/ Website Disclaimers 4: No Clear Channels for Mandated Reporting
  • 37. ( "r'5,"'. _‘5.l‘{’l, "‘; "3.‘f~'. ".“ l: l['7}'| ‘l'. ;r. )|ii'iQo‘ll5. ATA B. 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 - . ‘7"lTI. ~' 1'5 5: 3’-‘ ; I3 :5 ‘I’ - .
  • 38. ii’ I l I I I I All Existing Legal & Ethical Rules Apply I _? ‘{‘ / '
  • 39. -D O O ( ". "5,"'. V‘5.l‘{’l, "‘; "-‘. ‘:~'. ".“ t-. rrV-,4'. *I; ‘;. iiaa'. I.t. ‘I‘. ,. APA Telepsychology Guidelines Pros Legitimizes telepractice Sets policy Sets groundwork for competencies to be identified and taught Cons * Can be used against us in a court of law + Difficult to change — Time/ energy/ good will — Delays progress * Wording includes "any” in several places, rendering compliance a challenge
  • 40. GUIDELINES FOR THE PRACTICE OF TEI. .EPSYCHOI. OGY 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 using 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 u-0-0 I-'©‘O®lO. h&aIl~J 3-‘ —- I9 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. 20023. 2010). and the Record Keeping Guidelines (APA. 2007). In addition. thc assumptions and principles that guide the APA's “Guidelines on Multicultural Training. Research Practice. and Organizational Change for Psychologists" (APA -Io—-n--o-u—-—nn- ©%JO. II&U)
  • 41. Guidelines for the Practice of Telepsychology These guidelines are designed to address the developing area of psychological service provision commonly known as telepsychology. Telepsychology is defined, for the purpose of these guidelines, as the provision of psychological services using telecommunication technologies as expounded in the ”Definition of Telepsychology. ”p1
  • 42. Guidelines for the Practice of Telepsychology Telecommunication technologies include but are not limited to telephone, mobile devices, interactive videoconferencing, email, chat, text, and Internet (e. g., self-help websites, blogs, and social media). p.3
  • 43. Development of the Guidelines Therefore, two of the most salient issues that the Telepsychology Task Force members focus on throughout the document are the psycho| ogist’s own knowledge of and competence in the provision of telepsychology and the need to ensure that the client/ patient has a full understanding of the potentially increased risks to loss of security and confidentiality when using technologies. An additional key issue discussed by the task force members was interjurisdictional practice.
  • 44. "F‘lf'v‘E$TA{HF, m>TH telehealth. org Conclusion It is important to note, that it is not the intent of these guidelines to prescribe specific actions, but rather, to offer the best guidance available at present when incorporating telecommunication technologies in the provision of psychological services. Because technology and its applicability to the profession of psychology is a dynamic area with many changes likely ahead, these guidelines also are not inclusive of all other considerations and are not in tended to take precedence over the judgment of psychologists or applicable laws and regulations that guide the profession and practice of psychology.
  • 45. l‘-ll': l't‘l3!’-llii'i{"I¢! r Telemental Health Standards & Guidelines American Medical Association. (2000). Guidelines for Patient-Physician Electronic Mail American Counseling Association. (1999, 2005, 2013). ACA Code of Ethics American Mental Health Counselors Association. (2000). Code of Ethics of the American Mental Health Counselors Association, Principle 14, Internet On-Line Counseling American Psychological Association. (1997). APA Statement on Services by Telephone, Teleconferencing, and Internet, A statement by the Ethics Committee of the American Psychological Association American Psychological Association. (2010). Ethical principles of psychologists and code of conduct American Telemedicine Association. (2009). Evidence-Based Practice for Telemental Health American Telemedicine Association. (2009). Practice Guidelines for Videoconferencing—Based Telemental Health American Telemedicine. Association. (2013). Practice Guidelines For Video-Based Online Mental Health Services. 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). Psychology services delivered via the Internet and other electronic media Ohio Psychological Association. (2010). Telepsychology Guidelines http: //telehealth. org/ ethical-statements
  • 46. ((( ", L§M", ”", ‘”‘, ’“_‘” te| ehealth. org 'nI, »;a. ,a: -; "A'"A'"A'I5|“I31firI“3:‘: IIII3nII§lI'I>l€! §.. j5j§fi'5{i"I‘f€i'i'I2lE= lII‘I» * 61:} qI, [I’. sTI: ,'IIi>I'I= L-If. ‘I? -vmlu‘ -«‘ar: I.-1:4:-1-J nITIaI; — asum»-: ;.': Ik= :III4Ei‘¢~: ?I: ; y . :.~IivI‘: aIIr, —<$~ |7|'[, ’-, "Il: l‘= .I‘Pr‘, ‘I‘i. '=_f,3.Iifi? #1§vi3”V'([ ». =}: }.3I€| . PRAbncE GUIDELINES FOR VIDEO-BASED ONLIINE MENTAL HEALTH SERVICES Mayima IIIIIIIIIIIII IIIII II’ I I II I I I IIIIIII IIIIIIIII II II I I II II I I ”IVIIIIIliIIIIIIII_! _ III Ii I IIIIIIIIIIIIIIII IIIII I I II II____—I. -—-3-— A"“A 1 Arm-vkan Trlemnfldno Anodallan
  • 47. ”, ”'! ,"', ~J5_N, ";, V"'L: |'! ,‘: “‘, ",: " I-. Il, '7J‘I‘I-‘J, ’-i| ii'. '{o‘I'¢g ATA Guidelines 2013 This practice guidelines document focuses on telemental health services delivered in real—time using ini'ernei' based videoconferencing technologies through personal computers and mobile devices. - 5"1'-'u, ~' 1'5 -31; 7’-‘A. If 4"? ’ - .
  • 48. msIv. s.~mu HEALTH (( H _ _ _ te| ehealth. org C 35-11 ‘o- e| .Iem. I‘ I4-. lh lrn, rIL. lv~ lr(
  • 49. $ ’: ‘ A y('7I11:s9AM
  • 50. I‘-ll. ‘:I'I‘l= ?-I APA Proposed Society for Technology & Psychology COMMUNICATION SI Practice ‘°'; ';': ,*; tg; Q;'°'*' Science I‘e. g.. Internet, Blogglng. Social media, Cvbemetics {e. g.. Biosensings‘ Fee<Ibadj, Social networltingl COMPUTING IHETHODOLOGIB le. g.. Artificial Intelligence; mscowr-. ' uI. I: nItIoI. s ,5} I. “ _‘u: r‘_ . ;e. . '. ‘ ‘ ‘ '1.“ “(AF ‘I’, 'I'lsI' lnter1aces[e. g., (omputer _’ _ V " VisionTrac_IIng. Haptic [V I [.1 _fiI| | M912" 3. Interfaces, Computer Simulations [e, g.. /irtual a, II _ Human Agents. " 'atars€. 3" v“"” 4:“. Invironinentsfi; I-. IicrocompI. ners; 3D Imaging, Software [e. g.. ."ideo Games: . -I; cI I‘ = ‘.I‘IIII r= I I-'$. ‘1!lI: -I-1‘ Education I I-_w: II I_-I-H‘-MI. Public Interest ‘III]§'II‘-llll‘-Illfilfllla (4. HEALTH Its. II: ronMAtIcs :57 ""1 NE Ie. g.. Big Data; Contmlled Vocab: [e. g.. ICE‘-10:; Decision '"3I<i"€—~ 5UPP°"iD3'3 OTHERTECHNOLOGIES Mining; Electronic Health and . Personal Health Records; 'e"‘ga‘r": °e': h‘: :I: ';yg" Electronic | ZIataPri an. ‘ . . ' Security and ImEgI'IYV: HE3I‘h "a"°mEdm"E' Information Btcliange, ’ HITEICH; Into rmation St arage 3. Retrieval; Interoperability (opvrlght (cl 2012 by Marlene M. Maheu, PhD.
  • 51. VIRTUALLY B THE CLINIC Bringing Interactive Technology to Be avioral Healthcare for Treatment and Training News Avatars May Help ('tiIldren With Social Anxiety I)-ierroriie fears 4 till I . /II1LI. )I reality battles Pl SI) The Daily I Treating tear cit flyiiia I. -/IIII '4 I’) ‘-lIl| lIIdU. )I"- University of Alabama adds VR Exposure to School of Social Work Gama Pro! A‘-m. Tta. Ior Isn t .3 n€-w»': omer to using ‘. ‘R In Social war» and C9I‘l3.‘lOl'EI health 3 e s seen warring . -nth ‘(El colleagues lire PSIIICI" BI: vidriir: b' and former CEO hen Grasp tor IEQIS 30 ‘. ‘BI IS prc-uri to conlirm that we mil be I3-3Il‘. ‘€I| |'ID 3 e. stc-m to 5-. I3D3FT1.3lO(USC‘II'III‘I|3 Schr: -oi of Social ‘-'-‘DIV CIIECF CIUI II'I€ GEIEIIS I‘l£'! E VR based Treatments get "Exposure" on Fox 5 virtualt. Better welcomed lxrista Littleiielc Iror-I -'-Ilanta 5 For 5 news last wee‘-' for .3 feature on VR case»: treatments TITJIWS Ixnstat Atlanta News -. ‘.‘eatner Traffic and Scor1s| FOx : PRODUCTS COMPANY ADHD: Not just a school problem. Dimculties wllh locus O~el3C1I'.1I‘. I'Y'lDIJISIv‘é' '3-: -nan-are EHIIIHCIESSEG EFV1C'IICll'l3I Iéadtiullw are >: cI'~Irnon Sv| 'T'l[JI’. ‘lT1S at ~‘<iIET‘lllOl'l EielicIb“r<l. :>ei3ctim Disorder Ii~DHDi These and other +‘-DHD 5-"IDYOFIIS can usreai riauoc In -school However School -grades and : l>2I'I3I/ IDIS are riottne -uni, areas Imnactec 3l'1dI71>': i3IE‘ often not even the most negati-aet, ettected Cniidreri with lI‘II5 disorder are also "iI: Ire IIVPII to Suller tram sceech
  • 52. squ- Wearable Computers (Google Glasses) - ": ‘V», ;.7L: ‘_“- : «"' > .
  • 53. Reviews News Download CNEI IV How To Deals 1‘ Log In I Join SAMSUNG The Next Big Thing For Business is Here - 3 "l A ‘ @un '", llE'i ll-'_ur. 's L" :3.-; SAMSUNG Confirnted: Google Glass arrives me lJe>_<t Big Thing in 2013, and under $1,500 f; O,; §,F§"‘eSS Google s at; gi~>eriteci—realitj. ~ soecs are ahead of '5C! ‘.8ClLliE: Are _, ‘OU ready ‘ _ f _; a ‘A . ... . 3 to get _. ‘OLll'bEli' littec or a se: r Eiir Ma-: ‘r. i ‘ ’fi KW _:3 fl lollow 9" fl ‘ '" “ 3 ’ l~'lW~" * ' ' ' 3 3=”“““"‘l? 93 Hottest Reviews. ‘ iPhone 5, Finally. everything we ' hoped it would be ¢-—- . ‘“«'~ —x’ ' mi: ~ at 5139 99 7 5 ~: «~x~A«~: r ' r i Microsoft Surface Pro Smart _ almostrlaptop nearly nails it [ l v m. i m, l SSE»-3 99 1r>'(*i ‘ - - Cliroinebook Pixel Bnlliaiit touch Possibly the 'mu5t—have' gaogetlor the 2013 holiday season (Click the image to: a Google Glass slideshowl . ‘ . screen hefty pnce (Credit Gooqle) " 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 Elfin -l for a consumer release when it revealed PFOJSC1 Glass last year,
  • 54. <(( 'rE‘L§MH, nA¥HF, N_TH te| ehealth. org 69% I Personal Robots Group mit media lab i , i Home Welcome to the Personal Robots Group K“) , -
  • 55. “S I M O The Wood 5 Most Advanced Hcmarioid Robot Asimo - PEWS EDUCATDN v TRAVELS PSIMO W U GALLERY DOWNLOADS ASIMO IS DESIGNED TO HELP PEOPLE : i c Q i turnwundofltll) UVE SHOW FEATURING GALLERY '-igri o-may Photos of i‘-SWO T an M DOWNLOADS Off. -3ia1a’a5l1.‘O co. -inlcacs tei your Mac PC oi lNl(‘/ A ‘ I Vllil-1) ms iim ’"‘°"‘”"°”° TRAVELS Now you can see Asllllo See how robots r- Check out rtonda 5 Molly Criecli out a moo history of ye”: C, ‘SRO 5 “Mn Am€_, mn 70“ “pm” K, ms duty at Dsneylanoa oeveloprnerii now can bring prototypes eriioowered wtn Honda‘: robotics resear. -,n : __m_mm! out the best ri us n ttie limire ASl! .!O-denied technoiogy HONDA ‘lIufiwua&Ivn
  • 56. TELEMENTAL HEALTH <(( ‘ . ‘ , ‘ , V § te| eheaItti. org L '”‘ ~l l Fl? .l l ll l’; '’‘ 5-. i l; ’V“e‘% ' / ./. O 201] 71-ievlenul Health lmhtutr. In(
  • 57. Q’ AMERICAN PSYCHOLOGICAL ASSOCIATION About APA Psychology Topics Hom Publications Psychology Help Center News&Evenls Research Ed SEARCHC IN News&Events v E Home » News 8. Events » Press Room » APA Response to Supreme Court Decision » NEWS 8: EVENTS - Psychology Newswire - APA in the News - Press Room Press Releases ~ Policy Statements News Responses Op-Eds Task Force Reports Videos APA Response to Supreme Court Decision on Affordable Care Act The decision of the U. S. Supreme Court to uphold the Affordable Care Act moves our country forward on the path to extending health coverage to tens of millions of uninsured persons, reducing health care costs and ending discriminatory insurance practices. Since the passage of the act two years ago, millions have benefited from health insurance coverage — including children with pre-existing conditions (including mental disorders). young adults who can now stay on their parents‘ health plan until age 26 and older adults via access to prescription drugs at affordable rates. Certain vital preventive services are now covered free of charge by private insurers. as well as by Medicare and a Prevention and Public Health Fund was created. Furthermore, when the state insurance exchanges go into effect in 2014, millions more individuals will have access to health coverage for mental and behavioral health and substance use services as “essential health benefits" and with the same level of access and coverage they enjoy for physical health services. The Affordable Care Act recognizes the importance of care that is focused on the urhnln nnmnn and rlaliuarnrl hu infnrdicninlinanl nnmmnnifI-h: end fsame nf hnalfh
  • 58. Future of Telepsychology, Telehealth, and Various Technologies in Psychological Research and Practice" from "Professional Psychology: Research and Practice, " Vol 43(6), Dec 2012, 613-621. Downloadable copy: www. telehea| th. org/ future Future of Telepsychology, Telehealth, and Various Technologies in Psychological Research and Practice Marlene M. Maheu Myron L. Pulier Joseph P. McMenamin Les Posen
  • 59. 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
  • 60. OCPM: Online Clinical Practice Management APA & ATA Guideline Summary Checklist
  • 61. fl”J! '|"*. ]5'“~"; ~V‘".3:| '!»‘: “—", :; l= ll= I‘r‘ifi, '-llii: J-‘i¢- GUIDELINES FOR THE PRACTICE OF TELEPSYCHOLOGY Competence of the Psychologist Guideline 1: Psychologists who provide telepsychology services strive to take reasonable steps to ensure their competence with both the technologies used and the potential impact of the technologies on clients/ patients, supervisees or other professionals.
  • 62. ( ", ~'5,"'. .‘5,“', ’3,"~‘; "-‘, ‘}', ","’ . -.irun-: ;.iiaa'. v;. ‘i‘. . GUIDELINES FOR THE PRACTICE OF TELEPSYCHOLOGY Competence of the Psychologist * Acquiring competence may require pursuing additional educational experiences and training, including but not limited to, a review of the relevant literature, attendance at existing training programs (e. g., clinical and technical) and continuing education specific to the delivery of services utilizing telecommunication technologies. * Psychologists are encouraged to seek appropriate skilled consultation from colleagues and other resources.
  • 63. «zit-. I‘u= ‘,. r-Iliir; -‘lug Multicultural Issues & Diversity _ ' .3 . . », , i~’ ‘H . ‘w. ‘PT , ". ' 'I. I”‘. _ _ ‘#5’ ‘. ~ 2. . "‘"’*‘ ; §"“~_, -.»'£. . - 1 ‘ . w‘;1,‘'( 1". .. °9.4._. lf, .'. ".I. .. . _ ‘J . ,_ . ._. E£ I I- 5‘ . .—" I’ _«, ~ I v’ ‘
  • 64. Hll UIDELINES FOR THE PRACTICE or TE LE PSYCHOLOGY Multicultural Issues Assessment Process Research—based Work Professional Standards Informed Consent Emergencies
  • 65. F_”'! ,"'. .J5,“, ':_V‘"'L: |'! _‘: “', ",: " (= ll; li‘i-‘J; .llii', ~;. )‘. , Multicultural / Multlingual Issues Issue How to measure? * Global nature of the * Search online for various | nternet— worldwide instruments that might be audiences valid for your population ° Multicultural issues are + Look for English proficiency quite visible in the tests document, but English as a — Free second language issue are - Easyto take 9 not mentioned — Get to know the norms * Spoken English is different from written English Rarely mentioned anywhere
  • 66. F_”'! ,"'. .J5,“, ':_V‘"'L: |'! _‘: “', ",: " (= ll; li‘i-‘J; .llii', ~;. ‘;‘. , GUIDELINES FOR THE PRACTICE OF TELEPSYCHOLOGY Standards of Care in the Delivery of Telepsychology Services Guideline 2: Psychologists make every effort to ensure that ethical and professional standards of care are met at the outset and throughout the duration of the telepsychology services they provide.
  • 67. ((6’¥%"'l€“1’%; "-tel“ . .i-_. I.e. :s. ,.. .-. .»_. ..-. , ln—Person Contact APA Telepsychology Guidelines: r 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
  • 68. Do you see well enough? -slmage Resolution -° ATA Guidelines Are you conducting an intake orfo| low—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?
  • 69. 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
  • 70. Step 1: Training Step 2: Referrals Ste 3: Client Education Step 4: Legal Issues Step 5: Assessment Step 6: Direct Care Step 7: Reimbursement ‘——x ; Vz ; u__ ' — . -,-V; V — _o o_ r, -2;.
  • 71. Client/ Patient Training Email / Texting/ Telephone/ Video 4 Social networking— social media policy 6 ill 6 0 6 415? ‘R3 File exchange Computer repair Clinical records Insurance Reports Lateness/ Missed sessions Non—comp| ianCe/ Avoidance
  • 72. aw I I -—— we tug Step 1: Training Step 2: Referrals Step 3: Client Education Step 4: Legal Issues Step 5: Assessment Step 6: Direct Care . .I. Ste, pV7.: Reimbursement- V
  • 73. TH telehealth. org GUIDELINES FOR THE PRACTICE OF TELEPSYCHOLOGY Informed Consent Guideline 3: Psychologists make reasonable effort to obtain and document written informed consent that specifically addresses the unique concerns related to the telepsychology services they provide. When doing so, psychologists are cognizant of the applicable laws and regulations, as well as organizational requirements that govern informed consent in this area.
  • 74. TVlf'v‘E$TA{HFVm_TH telehealth. 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
  • 75. ( ", ~'5,"'. V‘5,°', ’t"‘; "-‘, ‘:~', ",“ . -.irV-V4'. *ie‘; .iiaa'. v.t. :i‘. ,. Informed Consent: Function of State Law * Specific statutes govern informed consent in telehealth *9 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 - 5"'l'-'I. ~' 1'5 -31; 7’-‘A. I? 4"? ’ - .
  • 76. ( ", ~'5,"'. V‘5,l‘{’t"‘; "3,‘: ~', ",“ . -.irV-V4'. *ie‘; .iiaa'. v.t. :i‘. ,. Informed Consent Documentation Basics ° Diagnosis ° Outline of intervention ° Risks and benefits of each technology used ° Risks and benefits of competing approaches — Including no service * Emergency Plan including names and Contact information for local, trusted person(s) to be contacted at the discretion of the clinician ° Date - 5"'l'-'I. ~' 1'5 -31; 7’-‘A. I? 4"? ’ - .
  • 77. ( "r'5,"'. V‘5,l'{’3,"‘; "-‘, ‘:~', ",“ . -.irV-V4'. n;. iiaa'. v.t. :i‘. ,. Informed Consent Documentation Basics Q Signature of Witnesses if available A Confidentiality and limits thereof as related to mandated reporting (suicide, homicide, abuse) “II Fees, ifany Statements similar to: * My questions have been answered to my satisfaction in languagel understand * As of the time ofmy signing, all blanks have been filled in - . ‘7"l'-'I. ~' 1'5 v'’IL; 3’? ; I5 4%’ - .
  • 78. 'vEVlf'V‘VE$TA{“FVmVm telehealth. org Informed Consent Documentation Basics - Err on side of listing infrequent and minor risks — Might discourage some who would benefit ° Some risks may not yet be unknown - No physical exam - Identify both the clinician's & client's/ patient’s physical location ° Must rely on information provided by the client/ patient and by any on—site practitioners or other sources ° Potential problems could arise with electronic transmission in telepractice: — distortion, delays, interceptions, interruptions
  • 79. Safety Issues to Consider *: Is there access to firearms in home-based care? ° Discuss firearm ownership, safety, and the culture of firearms ° Be prepared to negotiate firearm disposition with patients and consider involvement of family members when appropriate * Use of trigger safety lock devices is an option - 5"'l'-'I. ~' 1'5 -31; 7’-‘A. I? 4"? ’ - .
  • 80. TVlf'v‘E$TA{HFVm_TH telehealth. 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)
  • 81. TVlf'v‘E$TA{HFVm_TH telehealth. org Safety Issues to Consider ° Identify and use of a local collaborator such as a family member or close friend of a patient — Enter name and Contact information into informed consent document — Stipulate under which conditions these people will be contacted — Outline emergency procedures and when collaborator will be notified — Clearly define expected roles and responsibilities of local collaborators — Consider discussing these issues with family members directly
  • 82. TVlf'v‘E$TA{HFVm_TH telehealth. 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
  • 83. 'vEVlf'V‘VE$TA{“FVmVm telehealth. 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
  • 84. 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
  • 85. -'flFlv'FT‘l iirimi ((( VV _’V V_‘ teleheaIth. org 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
  • 86. OCPM: Online Clinical Practice Management Step 1: Training Step 2: Referrals Step 3: Patient Education Ste 4: Lealities Step 5: Assessment Step 6: Direct Care Step 7: Reimbursement
  • 87. ( ", ~'5,"'. V‘5,°{’t"‘; "3,‘: ~', ",“ . -.irV-V4'. *ie‘; .iiaa'. v.t. :i‘. ,. Duty to Report / Duty to Warn + (v) Failing to comply with the child abuse reporting requirements of V VVV 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 V V Professions Code Sections 4989.54 (cont. ) I ‘V S - 5"'l'-'I. ~' 1'5 -31; 7’-‘A. I? 4"? ’ - .
  • 88. F_”'! ,"'. VJ5,“, ";_V‘"'L: |'! _‘: “', ",: " 1-. ll; l‘i‘i-‘J; .tlii', ~;. )‘. , GUIDELINES FOR THE PRACTICE OF TELEPSYCHOLOGY interjurisdictional Practice Guideline 8: Psychologists are encouraged to be familiar with and comply with all relevant laws and regulations when providing telepsychology services to clients/ patients across jurisdictional and international borders.
  • 89. S e u 5 kn. i. .Ia n . m Ll. _ . m d .5 r u . U e . .I. m II’ Stephen Demers, Ed. D. l l l I I I l I D Jan ‘. - e-. ieni. i-' Heotii In riuio lvur
  • 90. all-¢l‘i‘t-‘J; .tlii', ~;. ‘;‘. , GUIDELINES FOR THE PRACTICE OF TELEPSYCHOLOGY Confidentiality of Data and Information Guideline 4: Psychologists who provide telepsychology services make reasonable effort to protect and maintain the confidentiality of the data and information relating to their clients/ patients and inform them of the potentially increased risks to loss of confidentiality inherent in the use of the telecommunication technologies, If any.
  • 91. OCPM: Online Clinical Practice Management Telemental Health: HIPAA, HITECH & Your State Law
  • 92. H telehealth. org GUIDELINES FOR THE PRACTICE OF TELEPSYCHOLOGY Security and Transmission of Data and Information Guideline 5: Psychologists who provide telepsychology services take reasonable steps to ensure that security measures are in place to protect data and information related to their clients/ patients from unintended access or disclosure.
  • 93. Three HIPAA Rules: - Transmission - Privacy - Security z‘-3‘{! m’“ '3
  • 94. :r1rrvn; rmwmi ((( M _’, _‘ telehealthorg 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 Providers: Telepsychology. Medication and Collaboration. APA Centerfor Workforce Studies.
  • 95. ((c —"_~'5_"'_‘; ',“E'9;’~': "-’_*f~'_a’s“ (= ll; Ji‘l: }.llii: ;-its The HIPAA Compliant Email Companies * zlsecuremail T « l-lea| thBl l ° Hushmail - offersfree accounts Q V‘ / i—«”_- : .—*~7—<— . ‘ ° Sendlnc -- offers free L*/ accounts —— ‘ F'‘7-'‘}‘: '4’r'': ‘'», -§'7h7;i‘? 4% -.
  • 96. l/ (= "ea, -'; L=, *‘: "4;‘-; ='-4:: ~': ar= : . m~. e.: ;.». aa’. ,:. »,‘. , Current Surveys The Professional survey: ttp: [[tinyurl. com[kpnfh75 The Consumer survey: ~. htt : tin ur| .com mb86oav Research team includes: Drs. Marlene Maheu, . Robert Glueckauf, Ken Drude, Eve-Lynn Nelson
  • 97. I i‘l~ llll ». ls r~ . 1 E , ' C Bfiairrascfifi 3?Ffifl&fifi§fl ? lBi7ifi8Ex*s'. 'C6 KS Hz: -mzfir, Q o V 1-. . 7. g %T. ‘f': vfr. h._, i F‘ ‘"t‘-T: -%_fi ,1a»— L ‘ I I § ' - . * . aasnnfifil l‘ C . T * : E—i E havsssasu l ' “ . . T raj lfififi» T ’ ; z T, grg’-'~tr:1sG » G _ . .. A I: Q@§.4, ‘‘ 1,3 I " z-_. :$~“~. <. A_y _: -£1 "
  • 98. Psych iatricT1mes DD can make it all feel ovenivhelming. ‘. _/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 otters tree worldwide video access to an. patient with an Internet onnection either or mobile device or desktop computer What it does not otter however is a m ns ot communication clearly suitable tor clinical sennces—especiall_r in mental health WARNING: SUICIDAL THOUGHTS AND BEHAWORS Antidepressants increased the risk at suicidal thoughts and behavior in children. adolescents, and young a ults in short-term studies. These studies did not show an T e ' - . . . i ity and Accountability Act Ordinarily neithertederal nor state law is designed to regulate specitic Df0Dll9l3F_r entities such as Skype and its competitors Video-chat plattorrns were developed (:0AngI-CS5 --~ for marketing to the general consumer and not for health care The Health Insurance Portaoiiity and Accountability Act i, HIP-RA. ) holds professionals SEARCHMEDICA RX responsible tor C0l| 'JUC1lng their own internal risk assessments regarding their chosen technologies Belore using any equipment, the I3'IDlESS| Ol"l3| should require documentation that explicrtlr promises 'H| P»'«-' compliance‘ or ‘HP-EA compatioitity' One could talre further comlort In a designation or Federal Information Processing Standard rFtPS? i Certification a standard that mar riieet and exceed HPAA standards 3 —— Browse drugs by name HIPAA requires the use of equipment that allows for audit trails According to the A-. merii: an Health lntormation Management Association, audit trails allow 593'“ '°' °'“95 oreacnes to oe traced ‘ Like other proprietar, piattorrris Slr: ,pe makes it irripcssiole to conduct approved securir, audits ma audit trails Sltrpe itseir is not
  • 99. III HIPAA requires an ”audit trai Skype doesn't provide audit trails — and isn't obligated to
  • 100. ls Skype Reliable? W Skype tiles & ‘ pixe| ates, the audio = gets tinny, echoes ' develop, and often calls drop entirely. ‘ Sometimes , consumers can see A you and hear you, « fi without your " awareness.
  • 101. (zit-7li‘i£g'-lliiii-‘iugi ' s/ <6 Skype’s Most Recent Hacking — November 2012 . ‘1i_: .-». i.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 sale and secure communications experience to our users and we apologize for the inconvenience. ‘J i’ “'1 i; _‘ '3;
  • 102. 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 '- ivvenisement 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 Faoefime 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, free 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 Jun 20‘ 2013 o be fair, its not quite as simple as just opening FaceTime and calling your patient. : - ‘fically, 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"'! "i", ’ and WPA and WPA2 personal settings are questionable. F aceTime calls are fully
  • 103. ( "r'5,"'. .‘5.“{’3,""; "3,‘: ~'. ".“ l: llf'7}'| ‘li, r.l| ii'i. '.o’llg, No Guesswork Needed '1’ OCPM Step 3 Legal Issues: Which Technologies to Use? - V - H Q I V If lftjw ll HIPAA Compliant il Handoff Sessions ‘ . b 1 l ' any Device over any i: ‘;'; veor1rk I - Sweeping ” '| l 'l Be wdobnevu “ v _ ’ lg
  • 104. (Cf "¥'T3i. L»l’—'5‘flf"’i5‘—’, “ iaiaiie-iiaai; ii<g= | nternet—based, VTC Companies Claiming HIPAA Compliance* ° AccessPsychiatry , Ivndoud) ° Adobe Come“ ° Lifesize ( Logitech} - Behavior Imaging Solutions , MDUVQ - CopeToday , - Consult a Doctor MyTherapyNet ° Revation ° C°""5°"c°m ~ Secure Telehealth ° SecureVideo. com(FREE) ° Shepell fgi - EasyShareVC - eliounseling - E Mental Health Center 0 ForefrontTelecare ~ Smart House Calls ° Soltrite ° GEMS - Via3 ° G°T°M°eti"g - VisHealth (Visu al Telehealth) ’ ‘C °"°" - Vsee (FREE) . Interactive Care 0 VirtualTherapyConnect ° iTe| - Wecounsel ' TMH institute has partnered with some ofthese companies and»-. -"ill receive a referralfee if you mention TMHI. You may also get an added discount.
  • 105. ", ~'*, "', .L', “', "'; ‘~‘; "-’_‘f~', "," 1-. !r; Ji‘lfi, '-lliii'. ‘.o)'¢5 HIPAA Policies * Use HIPAA compliant technologies and develop written processes — Document policies * Security & privacy policies — Repairs o _ — Staff training —— Breach notification, etc.
  • 106. "F‘lf'v‘E$TA{HF, mTH telehealth. org HIPAA ’’Final Rule” January 17, 2013 ° Department of Health and Human Services (HHS) final modifications are effective March 26, 2013 ° Compliance deadline: September 23, 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). ° Raisesthe maximum penalty for data breaches from a previous cap of $250,000 to a maximum penalty is $1.5 million per violation.
  • 107. ((¢ —"_~'5,"'l; ‘,“E': ‘~‘; "-‘5!~', P'. " 1-. ll'¢J‘v‘l: }.)lii'. ';o‘)'¢5 HIPAA ’’Final Rule’’ ° Individuals have the right to a copy oftheir electronic health records. * When treatment is paid for completely out of pocket, patients now have the right to request that their health care providers restrict disclosing that treatment to their health insurance companies. * 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.
  • 108. ((¢ —"_~'5,"'l; ‘,“E': ‘~‘; "-‘5!~', P'. " 1-. ll'¢J‘v‘l: }.llii'. ';o‘)'¢5 HIPAA ’’Final Rule’’ * When HIPAA was first passed in 1996, most health care practitioners, hospitals and insurance companies scurried to bring themselves into compliance with the new standards. In the face of these final rules, business associates will have to engage in the same process. + HHS is stepping up enforcement efforts. ° See Federal Register available online at http: //federaIregister. gov/ a/2013-01073, and on FDsys. gov ‘ F"7-'‘}‘: '4’r'': l'», -§'7"7;if 4% -.
  • 109. ' rrirnemrai mama ((( H _ '_ , telehealtnorg 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’ 35 national professional ° Check with an informed, associations— let them local attorney who know what you need specializes in telehealth ° Put information in writing t0 Vellt)’ that 3” aspects of your telepractice are in compliance with state law
  • 110. F'"'! v"'r. L=ri'~'it~i"'lt"t‘t*': '.: '" r-ll= J‘v‘Ifi, '-llii'. '.'-‘in GUIDELINES FOR THE PRACTICE OF TELEPSYCHOLOGY Disposal of Data and Information and Technologies Guideline 6: Psychologists who provide telepsychology services make reasonable efforts to dispose of data and information and the technologies used in a manner that facilitates protection from unauthorized access and accounts for safe and appropriate disposal.
  • 111. 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
  • 112. TH telehealthprg GUIDELINES FOR THE PRACTICE OF TELEPSYCHOLOGY Testing and Assessment Guideline 7: Psychologists are encouraged to consider the unique issues that may arise with test instruments and assessment approaches designed for in—person implementation when providing telepsychology services.
  • 113. Assessment i I Reid Hester, Ph. D. I l I . i I . . . L . D 201) ‘. - r‘. Ienru<' warm In Nun lvur
  • 114. Eve-Lynn Nelson, Ph. D. Pediatric Telepsychology Wil. ll-li- I ill: I. D mu ‘m r‘aIeN>I<' Nea‘Ih In Nun lnr
  • 115. 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
  • 116. 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
  • 117. I H". telehealthorg Where to Get Reimbursement for Telemental Health? Private Pa Fee for Service General Niche (smoking, drug/ alcohol etc. ) Boutique (high-end services, rich & famous) Self-help IlAppSII Private Insurance These 16 states now mandate payment: California, Colorado, Georgia, Hawaii, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, New Hampshire, Oklahoma, Oregon, Texas & Vermont -> 13 more states are pending since Jan.1, 2013 CPT code approval
  • 118. 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‘')): . - O . ... _.. .._. ... _ ? °.‘”. “.°5-""“. -'. “- . ‘°°°“9‘. -"‘>‘-"°- Maine Oregon California Colorado Georgia (complications) Hawaii Kansas Kentucky Louisiana Texas (Medicaid) Oklahoma Virginia New Hampshire Maryland Michigan Massachusetts Arizona Montana New Mexico MISSISSIQQI Idaho Kentucky (Medicaid) http: //telehea| th. org/ mandated-states Keep informed by getting our newsletter: http: //telehea| th. org/ newsletter-signup
  • 119. OCPM Step 7: Reimbursement Medicare & Medicaid Reimbursement — Psychiatrists, Psychologists and Social Workers
  • 120. TH telehealth. 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
  • 121. ((( TI-I Fl‘/ Fr‘: -Ibitl Milli 7|: 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
  • 122. tel»: -i'i-. :u? i‘~r_h . i:. -i C 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 7 I 9 I3 Survey Some Providers 00 . Nnlnonal re-ie-on-am: 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 offers DOIICYTIIBI-(E. ‘IS_ health advocates, health care professionals and others wiili an interest in ié, ‘I(: “I'IGdIiI’I a Summary guide oi the most recent iriloimoliori available about how each oi the 50 states (and the DISIIICI oi COILHTiI)Id) (I£! FlII(; “$, goveiris, and i(; ‘(_IUldIC‘S the use of “lelehealth" or “telemedicine" technologies in the delivery of health care services Most remarkable about this report is that every state has its own iinitiiie seal of ieleiiealilw policies Some states have iI'i. ’(7lI3nldIP('I nnliciin-: into law while oitiiarv. have aririiesseri issiieu siirh as fI. F'I5F‘II. ID. Vl , , , ,,,
  • 123. OCPM: Online Clinical Practice Management - _ . ‘ I“. , — 1' r . _ ; _ ' . - .2- ‘,2- , , , . i . ., V ______ , ___ 7 .1 ' ——_ / I 1
  • 124. /(£1 L; ,'. «.“. l,’/1.31:. ’ Lfibuul . './ J:/ Iilil/ l1‘_ll .1 «J . i.I. mi; ;. J . > “Q t . _r- ThisSit£V ‘ Search l fiigii‘. -iii) ‘Q. ’ Federal mHeaIin - Updates 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 ang Health Inlormation Pnvacy and Secung r, oosied12i‘19i'2012i [cc ag_q[e§§es mHe, ‘gii[i Tgsg Forge recommendations (posted 12/18/2012) Video Report: What is mHea| th? Feedback Reguesleg! Healthy Aging White Papgr #2 (posted 12/13.i‘2012i &| .Q1.e. iI_q| .ita_iLQt1_QLi! i;_I. €2rJ: £Qam mobile health prggram 1? (PDF - 224 KB}iposled12/11/2012) TXT4Tots Library TXT4'iots is a Iibrar. oi srion‘ evidence-based messages in English and Spanish Messages are iaigeiedlo parents and caregwers or children Federal mHealth Coordination oemeen 1 and 5 was om am yo. ‘-Us on nutrition and DhyS| C3l 3C1WlYy l. lgre= = Text4Health Task Force
  • 125. ”, ”'! ,"', ~l5_N, ";, V"'L: l!f: “‘, ",: l 1-. lt, ;l‘i‘i-‘J; -llii'. '{o’i¢g Today's teens use media an average of: * 10 hours and 45 minutes it every day s 7 days per week* *Kaiser Family Foundation, 2010
  • 126. "i'eli2l’ii: ;u: ili'ti*ii, ir1iii'i. ;i Selecting Smartphone Apps - Empirical support for theory - Empirical support app - Utility — User ratings — Peer review — Blogs — Ease of Use — Confidentialityl Security
  • 127. OCPM: Online Clinical Practice Management r - i‘ l _ ’_, ' I‘ . « 1 * - vj< ‘J. , , , . i . .) f V . ... ... . s. .. — .25 ___ |
  • 128. lEVlfhl“E$TAlllF: ‘lLTll telehealth. org Health & Behavioral Care in 20 Years ° Mobile devices and peripherals will deliver most health and mental health care —Sensor-based information gathering ° Mirrors, scales, vests, chairs, mattresses, steering wheels, exercise equipment, etc. —Se| f—report
  • 129. lEVlfhl“E$TAlllF: ‘lLTll telehealth. 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
  • 130. ”T'! ."'. ~l5.lll, ";j"L: l!f: “‘. ".: l 1-. lt, ;l‘i‘i-‘J; -llii'. '{o‘i¢g Health & Behavioral Care in 20 Years rt 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. - 5"'l'-'i. ~' 1'5 -31,; 7’-‘A. if trli - .
  • 131. M‘ “V " ' ls. .. . l “ask l Evidence-based Models lie; l is Traditional telehealth _, 2 it . . ” i" 1 ° (Organizations) ill i ii To-the-home . _, ,. E lll‘ ”"’§£, k . _ _'. _.__. , ___, _______. ,__. .:. _A F’. ""'*= ?:= =~: ,__; fi’ ’ ’ ‘*'~*. t’? ?*“”2» *= ‘:is: .~s. , , , is N. ‘ii i 0 mt) ‘. - mieniu-' uuwii lrishl lvir
  • 132. 1: «/
  • 133. I ' . Children's ' Hospitals
  • 134. ./ (= ". ~'! ,"; L'. *‘£"4;‘—-; "-*: !~'. a'. “ 4-. li. ':l‘i‘iir-llii‘. '.‘. -‘icy. Specialty Schools & Services ii Specia| Needs * Autism ° Residential Treatment Centers — Drug & Alcohol — Other
  • 135. Rural Hospitals -at " . 3. O’ . p: f ’ . ‘i. ’
  • 136. Corrections Facilities
  • 137. TELEMENTAL HEALTH ' ((( telehealth. org . I N S Y I 1 U l E Nursing Homes
  • 138. Home Health
  • 139. Employers . :.. ... / .
  • 140. Military & Veteran's Administration
  • 141. Va1ueOptions 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 WelI'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 vvlll develop a first-of-its-kind. national network of telehealth-enabled providers. Through Online Care. Valueoptlons members will have secure and private access to skilled behavioral specialists from home. work or any location where they have lntemet 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 Hayward Donlgan. 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. " "Onllne 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. " Valueoptlons will harness telehealth to reduce the rate of missed appointments and Increase compliance. Moreover. with Online Care. Valueoptlons will build a more efficient. more convenient model for care delivery that vvlll 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.
  • 142. F3e't‘te: r Tl1itt.1id; ii1g for Better Health Home Pharmacies ill Telemedicine Role Models *3 Mayo, Mission Health offer lessons on effective teleiiiediciiie 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'ldIllOl'lS, 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 thromboiytic 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%
  • 143. ° CopeToday ° MDLive ° Securevideo ° Virtua| TherapyConnect ° WeCounse| ((( : rIz: i.'rs. r.'«ir<; ixi's- telehealmflrg Private Companies Serving Consumers On| ine* ' TMH Institute has partnered with some ofthese companies and will receive a referraifee if you mentionTM HI. You may also get an added discount.
  • 144. ( ‘I’ «stair; -ilaa: :ii<g= Migration Model ° Start with your current clients I -_r ° Select those who are reliable, Q Q 5 ‘tr? ’ have good support systems V "r"'. ‘-. and with whom you have a ‘<—~W‘; "‘, > good working relationship * Consider their diagnosis * Take the time to prepare them * ‘ , ' Plan in-person sessions at , regular intervals " ° Do not work through their i . x secretaries or others
  • 145. A l ill its 3” I V _~t*~‘. "’« ¥‘ 2:“. t“ l l l -fax
  • 146. -': =*_-a. ~;L= =‘; r;~_. .=l. zl~_-«; :r target‘; -llii7;ii<g: What if you were the 3 year-old child in this disaster? ‘J’! W ‘1‘I. :'JP_'. '). Cr' r
  • 147. ( "¥'j. 'f’_’f'_”_"i‘-‘; "3,‘f~‘s’, “ 1il[; lii£; r.l| li°i. fii)’(g. r What if you were a grade school child in this disaster?
  • 148. TllFlVFiA mm? » ((( H _ V ‘ telehealthprg What if you were a teen in this disaster? ’ . :A’e~‘& “V P = - = aw-. ~.: .~2;s. ‘.' , — . - ‘ " . _-_‘ - . ' . / S. , a _ ~’-’ T/ vww. s,r5IQ. —cA'g
  • 149. .. ,4‘. ga‘. ; V’ l’I7"l"—"’ '; m*‘= .g‘= lit: ‘ ((( n‘L§M‘H, ”AFHF, N_TH telehealth. org virlfi"‘: WWW. SPIQ. CA
  • 150. (<1 "¥’: .'? },"’_"i‘-‘; "-’_‘}'f’, “ (il[: ,l'vi£; r.]| li/ ‘i. :i)’(‘g: What if you were an elderly person in a nursing home in this disaster? ~'J'}Bv‘1yl€1:)%? £l£I}1
  • 151. ow . .4u 5.4 . What if you were waiting for fire fighters to find your missing loved one?
  • 152. isaster? ire fighter in this d a u , "J= ’_-avert“ What if you were a f
  • 153. rrlwnm wmn (G V. _‘l V_‘ telehealthprg Learning Objectives ° Understand current healthcare policy changes that will impact telepsychology in the next 5 -10 years ° Be aware of 3 specific legal, regulatory or ethical issues related in telepractice. ° Be able to explain how multi—cu| tural issues are relevant to telepractice. ' Follow ethical guidelines when using assessment tools online. ° Comfortably use telepsychology with children and families. ° Select smartphone or smart device "apps" to use with clients/ patients. ' identify billing codes to use for reimbursement of psychological disorders treated through telepsychology and describe how to use them ethically.
  • 154. ”, ”'! ,"', J5_N, ";j"L: l!f: “‘, ",: " 1-. ll, '7J‘v‘l-‘J, ’-llii'. '{o’l'¢g "It would be strange, and embarrassing, if clinical psychologists, supposedly sophisticated methodologically and quantitatively trained, were to lag behind internal medicine, investment analysis, and factory operations control in accepting the computer revolution. " - Paul Meehl, 1987 Please sign our petition: www. stp-apa. netg SOCIETY FOR U r TECHNOLOGY AND {J I PSYCHOLOGY - . ?"'l'-"J 1'5 -"L; 7’-‘A. if 4"? ’ - .
  • 155. F_”'! ,"'. .l5,l', ':_V‘"'L: l'! _‘: “', ",: " 1-. ll; li‘l-‘J; .llii'. ~;. ‘;‘. , Questions? ll Marlene M. Maheu, Ph. D. Te| eMenta| Health Institute, Inc. Phone: 619-255-2788 Email: mmaheu@te| ehea| th. ORG