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Dr. Marlene Maheu delivered 6-hours of a professional training workshop to the Cincinnati Academy of Professional Psychology (CAPP) on April 27, 2012. ...

Dr. Marlene Maheu delivered 6-hours of a professional training workshop to the Cincinnati Academy of Professional Psychology (CAPP) on April 27, 2012.

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

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

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

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Maheu CAPP Legal & Ethical Telehealth Issues, Online Therapy & Online Counseling CEUs Presentation Transcript

  • 1. < / l‘ l‘ Success Strategies for Legally & Ethically Expanding Your Practice Online Using 21“ Century Tools April 27, 2012 Marlene M. Maheu, Ph. D.
  • 2. Disclaimer WHO I AM: I am a licensed psychologist, not an attorney, physician, marketing or information technology (IT) professional. The content of my presentations covers a wide range of technical, clinical, risk management, legal and ethical issues from my perspective of a psychologist. These areas are in rapid flux. MY GOAL: My goal is educational only. I will outline the issues and alert you to what's happening in a way to help think through the issues, help you move forward, and protect yourself as well as your clients or patients. No warranty, guarantee, or representation is made as to the accuracy or sufficiency of the information contained in my presentation for your specific circumstance. Therefore, I assume no responsibility in connection therewith. YOUR PART: You are encouraged to seek specific advice from your specific legal, regulatory, ethical and malpractice bodies before offering any online services or programs to consumers. Get all such opinions in writing, and have your informed, trusted, local, legal counsel review them for their full significance with your particular business requirements, and the specific populations you serve. — If you ask questions, please protect the identify of the patients and clients you may mention. Copyright 2012 TeleMenta| Health Institute, Inc. All rights reserved.
  • 3. What are some of your concerns?
  • 4. J _ -. .__ _ ‘ J! /. .34 ail . .. u .4. A. _, A . J I , . u ‘ I , ,. . . V “I xi . (.1./ ..mw. .. I.. . -. lli. ... NI. ... ..Hv«. .. 1 l l I ‘I u . .2.9.. .. l -
  • 5. ‘Q; ;*' Inspire You r What's Happening r Myths vs. Realities r Opportunities for Us and Our Clients
  • 6. Goals 0 ° What's the Problem? ° Definitions ° What's Happening ° Legal/ Ethical: Online Clinical Practice Management (OCPM ° Training ° Referrals - Patient Ed - Legalities - Assessme - Direct Care - Reimbursement - Possible Solutions?
  • 7. Learning Objectives - 1. ETHICS: Describe 3 ethical dilemmas related to Skype, Google and Facebook, blogging and the ethical codes that help practitioners think through those dilemmas. ° 2. LEGAL ISSUES: Discuss the legal issues related to practicing over state lines or international borders, HIPAA and informed consent when practicing online. ° 3. RISK MANAGEMENT: Outline 3 key elements of a risk management plan for working online with clients to deliver care.
  • 8. Benefits of Telehealth Increased client satisfaction Decreased travel time Decreased travel, child & e| der—care costs Increased access to underserved populations Improved accessibility to specialists Reduced emergency care costs Faster decision—making time Increased productivity / decreased lost wages Improved operational efficiency
  • 9. The Is Video Teleconferencing (VTC) Effective? ° Yes — Medicare & Medicaid required to pay ° Client satisfaction very high ° Provider satisfaction is high ° 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 Copyright 2012 TeleMenta| Health Institute, Inc. All rights reserved.
  • 10. With everything we know in the telehealth literature, when is it acceptable to have an ”accident” as a treating professional?
  • 11. Existing Te| eMental 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 Medica/ Association, March 22/29, 283(12), pp. 1600-1606 A I
  • 12. 2010 OPA Telepsychology Guidelines *- 1t"t p :1/iIiIiI. o h psyc li‘l . o itfiy chologis'i: s/fi les/ Z011/06/O Pl’-Telei: '>s/ chologx/ Guideline s4-1710. p df
  • 13. Ohio Board of Psychology Telepsychology Rules 0 l‘l'i: 'i: igf/ iIiIA/ . [LA/ C o I o gv. o hi o . gox/ /p cifs/ Al_l_%20 i| Ei/ %.7_ 0TEi_EPSYCi-l%.7_0RU i_ES%. "/.0 PO R%20i/ E . i: > df
  • 14. . I I’ 2 1’ +: ‘~ I _ , / . / / F f / _ . r’ . / We Are Re—too| ing
  • 15. Accelerating Pace of Developing Tools “ Stone Implements 9 Iron _'. ,: lg f, / V Hunting & Gathering 9 ’ . " 3’ Farming - V “ Scribes 9 Printing Press 9 Typewriters 9 Microsoft “‘ §_/ ft" I [J: «_. f'-in 9’ T ' WORD Horses (100 years ago) 9 Automobiles 9 Jets ‘ I _ I‘ In-person 9 Distance via K’. Information & I ‘ Communication Technology (ICT), mHea| th & Medical Homes
  • 16. Types of Health Care Technology Bioinfonnatics Proteomio “W3” Communltatlons . _ Biosensors ' Biodrips Mmflumc Nanodevites Dmg Delivery Nanosensors Ilanobiotechnology "3"°°l°‘"°“'5 Electrical - Structural - Biomediral Energy & Environment M0166“ With permission from Teri Louden of the Louden Network and Adapted from: Biology, Bioconvergence, Information and Enterprise: Taking the Broad View, May 20, 2004, Alan Barrel
  • 17. Effective Conversations? Terminology is Evolving in Scientific Literature: — Ehealth — Telehealth — Telemedicine , _ ' ( k — Telemental Health . _ f " ‘ll — Telepsychology A‘ » — Behaviora| Te| ehea| th . — Online Counseling I — Online Therapy )
  • 18. Effective Conversations? Email Chat Text Messaging Telephone/ Vo| P Video Chat Smartphone Tablet PC Peripherals t! PN / Cloud Video 9.
  • 19. Effective Conversations? 50 Different State Boards, Each State w/ 3 or 4 Different Regulatory Boards: — Medical Boards * Specialty Boards — Psychology Boards — Boards of Behavioral Sciences ‘ Social Workers ‘ Counselors ‘ MFTs .4? .4 Substance Abuse ~_-«~, .‘: gi.
  • 20. 'Future Studies Moore's Law vs. Single Atom Transmitter - The number of transistors that can be placed on a processor will double approximately every 18 months. - The latest Intel chip, the "Sandy Bridge, " uses a manufacturing process to place 2.3 billion transistors 32 nanometers apart. Reprinted with permission from Ray Kurzweil, 2005 O o O. .- V) . _ 0 0. U c o o W U) 5- 0 Q m c 9 .5 3 2 co 0 Moore's Law The Fifth Paradigm HI’. l”r, II'u‘r l: mrrIIr. ' [900 1910 1920 1930 Rrlsru 1940 Lin . -4:1": lrrlw 1950 Year 1960 fr. v:rr. ~.'>lur 1970 Loganrhnnc Pia! lrI'I': " 1 080 '. ":Ilt‘tl L—l'L HI! 1 990 ZOOI’)
  • 21. TELEPHONE- BASED CARE Copyright 2012 TeleMental Health Institute, Inc. All rights reserved. J - : ;"l §¢; rr£‘ ' all‘ :3, I; <_; _'}»_; ‘ _: __. _ , l l .6 . . *': ".f'A‘: ‘ , )2!‘-' I“; -— _______; ___ ___“: ’ e _-_ - g 7:0» . — }
  • 22. Traditional Telemedicine Remote deeter exannnes a nanentvs Patient in rural ER gets benefit of local inner ear from a remote leeanen care plus remote consultatlon w1th spec1al1sts. Copyright 2012 Te| eMenta| Health Institute, Inc. All rights reserved.
  • 23. VIDEO Tl5l. ECONFERENCING (VTC) Copyright 2012 TeleMental Health Institute, Inc. All rights reserved.
  • 24. Copyright 2012 Te| eMenta| Health Institute, Inc. All rights reserved.
  • 25. Wearable Computers (Glasses)
  • 26. Virtual Worlds IFE Random People Vampires Animals Robots Vehicles @ This is how you Will Initially appear In Second Life You can customize your appearance later
  • 27. . of I '6 Personal Robots Group mil media lab {III IIIIJ b: '.'. '.; .' l“4‘r‘lIl-l rrvlmjr: 1. Home Welcome to the Personal Robots Group
  • 28. F Our Primary Focus: What is the service we are delivering?
  • 29. WHAT'S HAPPENl_N§ ONLINE? Coming next. .. M What do ‘k mental health consumers Want online? Copyright 2012 Te| eMenta| Health Institute, Inc. All rights reserved.
  • 30. Keyword ideas Sign in with your AdWords Iogin information to see the full set of ideas for this search. Download v l [j Keyword Competition Global Monthly Searches " online counselor Q - 90,500 = marriage counseling Q - 201,000 — online counseling Q 2 74,000 r‘ online marriage counseling Q - 8,100 = christian marriage counseling Q - 14,800 — online counseling services Q 2 2,900 * online relationship counseling Q - 1,900 = pre marriage counseling Q 2 33,100 — online christian counseling Q - % 5,400 - counseling services Q 2 135,000 = couples counseling Q - 40,500 — online christian marriage counseling Q I 880 - marriage counseling questions Q 2 3,600 Copyright 2012 Te| eMenta| Health Institute, Inc. All rights reserved.
  • 31. PEW: Social networking sites and our lives (June 16, 2011) 0 The number of people using social networking sites has nearly doubled since 2008, and the population of SNS users has gotten older.
  • 32. Psychoeducation Anywhere, anytime Serve more people Part time Practice generator Lower risk Non-therapeutic relationship Clearer legal/ ethical mandates Copyright 2012 Te| eMenta| Health Institute, Inc. All rights reserved.
  • 33. XInternet World Stats Usage and Population Statistics Google AoWords Put your ad online. New Stats Start with $75 free Internet Users in the World Distribution by World Regions - 2011 12.0°r‘a 10.4% I Asia 44.8% I Europe 22.1% I North America 12.0% I Lat Am / Caribb 10.4% I Africa 6.2% I Middle Easi 3.4% I Oceania / Australia 1.1% Source: Internet W0l’ld Stats - wwwinternetworldstats. com/ stats. htm Basis: 2,267,233,742 Internet users on December 31, 2011 Copyright© 2012, Miniwatts Marketing Group 1,695 Facebook ~9 Tweet [’s>
  • 34. Usage and Population Statistics ’-"1 ,4_r‘g_C‘ 1.) I. New Facebook Statistics . «mx. :i- 1:-IL: Amiaflgr-.13 tie As-11:‘ -J 1:-IL: Btu-J-i= ..: l“ - 1:19 303 R: -IL: IVIII-_l‘32eii. .~21}: -lie. Elgar‘ -ull: ‘$.11:-tr 2011 Industg Trends What's in store for 2011? Access predictions. interviews & analyses. 3412.32 am -3 Intelligence Trends study qobal Market Intelligence Trends 2015 - Download free white paper! . ;i: :3i. ~.siiiga- Unified Telecommunications Unlimited Voice. IM. Web Meeting Fax. Email. Presence. Mobility :3-ia~a~er. -.- 5 Ads by Google INTERN ET USAGE STATISTICS The Internet Big Picture Vorld Internet Users and Population Stats VORLD INTERNET USAGE AND POPULATION STATISTICS World Regions I Population Internet Users Internet Users Penetration Growth Users % ( 2010 Est. ) Dec. 31, 2000 Latest Data (% Population) 2000-2010 of Table Q | 1.013.779.o50| 4.514.400 11o,931,700| 10.9 %| 2357.3 % 5.6 % E | 3334.792352] 114304.000 325,094,393] 21.5 %| 321.3 % 42.0 % Europe I 313319.511] 105096.093 475,069,448I 53.4 %| 352.0 % 24.2 % Middle East I 212.336.924I 3.234.300 63,240,946I 29.3 %| 1325.3 % 3.2 % North America 344124.450 108,096,800 266,224,500 774 % 146.3 % 13.5 % Latin America/ Caribbean I 592.556.972I 13,063,919 204,689,836I 34.5 %| 10323 % 10,4 % OceaniaIAustralia | 34.70o.201| 7.620.480 21,2e3,99o| 61.3 %| 179.0 % 1,1 % WORLD TOTAL | e.345.e09.9e0| 330335.492 1,966,514,816 | 23.7 %| 444.3 % 100.0 %
  • 35. F'md keywords Based an are m ‘mzh iahe fdlamng yotIIorp§'aseVIg cnlme o: LrseIr-; £5!/ IHE‘ .1‘! Categones m Comaim sar. Amueu J; M! ’: counseling " ’, cnunsefing mine L‘ ¥ ncmvseing . . ’ nschozi cauusein; ‘i ’, onine chrskm counsetmg ‘E 3/, onlne course’ Wehsle 3 Lceatcvs trnec was Languages: E': ;isr KEYWON “B35 3 ‘ nth yuurkdwords ‘o; r rktrram 1c see me fu| ¥ set of ideas fnnhs seanzh Sorted b, v 3': 7 Kaeywum Covrpamon GkA2a1"c"h>; Searc! oes 7 Q 135.300 ; ‘ 49.5mm ’ F; 22200 ; ‘mo ‘W3 9.900 7 ’ ': »:*': ':-' : :_"£= '; 9301) Q 8150 ‘= ::" : .. ea ; I‘ 8130 7 5;, 5.400 3 ma 9, 5400 7 7', 5.400 , mu 1‘ 3.500 Lcval Mont)’ Sean‘: -es 11 1 C03 5 4433 22233 S 103 8 103 8 103 B 10:! 4,4133‘ 5 4433 Local Search Yrends
  • 36. Practitioner / -c! option? o Over 1/2 million Google search results: — “online counseling” = 210,000 + searches — "online therapy” = 143,000 + searches — "online counselling” = 83,100 + searches — ”on| ine therapy” = 65,900 + searches 502,200 searches
  • 37. Question is No Longer "| f” but ”How” Table of Contents for Psychological Services, Volume: 9 Issue: 2 Regular Articles - Videoconferencing Psychotherapy: A Systematic Review - Acceptability and Cost Effectiveness of Military Telehealth Mental Health Screening - Telehealth for persons with severe functional disabilities and their caregivers: Facilitating self-care management in the home setting - ATe| ehea| th Intervention for Veterans on Antiviral Treatment for the Hepatitis C Virus - Interactive Voice Response for Relapse Prevention Following Cognitive Behavioral Therapy for Alcohol Use Disorders: A Pilot Study - Assessing Daily Fluctuations in Posttraumatic Stress Disorder Symptoms and Substance Use With Interactive Voice Response Technology: Protocol Compliance and Reactions Brief Program Articles - Lessons Learned From Studies of Psychotherapy for Posttraumatic Stress Disorder via Video Teleconferencing - Tele-Pain Management: Use of video-conferencing technology in the delivery of an integrated cognitive-behavioral and physical therapy group intervention - The VA Maryland Health Care System's Telemental Health Program - Uniting Veterans across Distance through a Telephone-Based Reminiscence Group Therapy Intervention - VA Puget Sound Telemental Health Service to Rural Veterans: A Growing Program - Web-based, Psychosocial Treatment for Substance Use Disorders in Community Treatment Settings - The Use of Internet Technology for Psychoeducation and Support With Dementia Caregivers - Telephone-delivered Psychotherapy for Late-life Anxiety - Improving clinical outcomes in psychiatric care with touch-screen technology - Using an Online Viewing System for Parent-Child Interaction Therapy Consulting with Professionals - A Web-Based Intervention for Elementary School Teachers of Students with Attention-Deficit/ Hyperactivity Disorder
  • 38. Online Norm vs. Standard of Care Mostly Email & Chat vs. Video " Anonymity/ No Patient Records " Avoid Responsibility w/ Website Disclaimers No Clear Channels for Mandated Reporting «i- No Contact with Other Treating Clinicians <3 No Authentication of Consumer/ Professional 0 No Emergency Backup Procedures ~: r Misunderstanding of Clinical Processes (suicide)
  • 39. Benefits of Telehealth Increased client satisfaction Decreased travel time Lower travel, child & e| der—care costs Increased access to unserved populations Improved accessibility to specialists Reduced emergency care costs Faster decision—making time Increased productivity / decreased lost wages Improved operational efficiency
  • 40. Is Video Teleconferencing (VTC) Effective? “ Yes — Medicare & Medicaid required to pay <‘ Client satisfaction very high <‘ Provider satisfaction is high ‘ 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 Copyright 2012 TeleMenta| Health Institute, Inc. All rights reserved.
  • 41. THE VIRTUAL OFFICE Get the legal & ethical training you are mandated to get Study the evidence- based models $150 to $30 a month
  • 42. 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 2012 TeleMenta| Health Institute, Inc. All rights reserved.
  • 43. 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 2012 TeleMenta| Health Institute, Inc. All rights reserved.
  • 44. Training - (i) A psychologist shall not practice outside his or her particular field or fields of competence as established by his or her education, training, continuing education, and experience. Cal. Bus. & Prof. Code 2915. u A 'q’. l."c4‘ Copyright 2012 Te| eMenta| Health Institute, Inc. All rights reserved.
  • 45. ft . _. . .r & _c. v I _ * _ .1 . ,. . I I. .1: 8/(‘i . . .1.» .71 . ..+. . I: Aral . ,I . L. I to 4.. . . . C , .7, . vl.1., ,. . .. .. He. .3 . :,g: +r; , 7 .0 7 II? ‘ . l‘. :. 7 A Boundaries of Competence /1'14’ I3 »; as I‘ 4 Copyright 2012 Te| eMenta| Health Institute, Inc. All rights reserved.
  • 46. K-J. -mIT:4i11,1lI)! I"l= ll= Imt= u|t: II: ta= IIiiuIu.1i'iu| (a . mq : IIII’l:4i1u. u:u= uu= r-.
  • 47. 51 Lighting & Other A / V Issues?
  • 48. ACA Code of Ethics (2005) * Discuss time zone differences, local customs, and cultural or language differences that might impact service delivery.
  • 49. American Psychological Association, Ethical Principles & Standards (2002) ° Psychologists must be i aware of multicultural and diversity issues.
  • 50. Linguistic & Cultural Diversity Copyright 2012 TeleMenta| Health Institute, Inc. All rights reserved.
  • 51. O Multicultural/ Multilingual Issues (1) Se| fhe| pMagazine. com Canada Netherlands United Kingdom Australia Japan Germany New Zealand * Singapore * Greece *' South Africa 9 Malaysia * Israel I‘ Belgium ~ Sweden Copyright 2012 TeleMentaI Health Institute, Inc. All rights reserved.
  • 52. Multicultural/ Multilingual Issues (2) Se| fhe| pMagazine. com Malaysia * Ireland Israel * France Belgium ~ Russia Sweden ° Spain Mexico s Brazil Finland * Austria Saudi Arabia ~ Poland
  • 53. Multicultural/ Multilingual Issues (3) Se| fhe| pMagazine. com Denmark * Thailand Argentina * Croatia Turkey ~ Indonesia Philippines ° Norway Portugal 3 Romania Peru * Italy Hong Kong ° United Arab Emirates Pakistan * Cyprus
  • 54. Multicultural/ Multilingual Issues (4) Se| fhe| pMagazine. com Brunei Darussalam * Bulgaria Latvia * Uruguay Ecuador ~ Former USSR Venezuela * Lithuania Mauritius * Kazakhstan Bosnia-Herzegovina ° Ukraine Slovak Republic ° Zimbabwe South Korea 6 Georgia
  • 55. Multicultural/ Multilingual Issues (5) Se| fhe| pMagazine. com 0 Aruba Iran Nicaragua Guatemala Virgin Islands (USA) Macedonia Netherlands Antilles Botswana Oman Qatar El Salvador Jordan Kenya Papua New Guinea Dominica Madagascar Malta Namibia
  • 56. Multicultural/ Multilingual Issues (6) Se| fhe| pMagazine. com Andorra * Iceland Jamaica ° Egypt Maldives ~ China SriLanka 0 Chile Faroe Islands * Czech Republic Zambia °- Luxembourg Estonia * India Trinidad and Tobago “I Colombia Copyright 2D12TeleMenta| Health Institute, Inc. All rights reserved.
  • 57. G Multicultural/ Multilingual Issues (7) Se| fhe| pMagazine. com Taiwan Lebanon Dominican Republic Yugoslavia Bermuda Slovenia Hungary Costa Rica * Moldavia ° Yemen ~ Switzerland ° Bolivia 6 Ethiopia * Burkina Faso ° Bahamas «I Belarus
  • 58. Practitioner Adoption? 4.5, ° Over 1/2 million Google search results: — ”on| ine counseling” = 210,000+ searches — ”on| ine therapy” = 143,000+ searches — "online counselling” = 83,100+ searches — ”on| ine therapy” = 65,900+ searches - = 502,200 searches
  • 59. ACA Code of Ethics (2005) ° A.12.c. Inappropriate Services — When techno| ogy—assisted distance counseling services are deemed inappropriate by the counselor or client, counselors consider delivering services face to face. — How do you decide what's appropriate? Copyright 2012 Te| eMenta| Health Institute, Inc. All rights resen/ ed.
  • 60. Australian Psychological Society (2011 revision of Internet Guidelines) ° Research—based protocols — 1.6 ”Psycho/ ogists using the Internet to provide a psychological service should be aware of the extent to which therapeutic interventions via the Internet are supported by research or may be contra—indicated . ... ” Copyright Z012Te| eMenta| Health Institute, Inc. All rights reserved.
  • 61. J’ L EI9 ‘II I TOOK THE ‘:3 I-' LAST cup ' OF C0FFE, E I TOO MUCH aIII= esI'—5 -< MAKE A I U / 'U95J9q99l9 Kpueu oooz «:5: 6m9 WHITE COLLAR CRIMES
  • 62. OCPM Step 1: Training 1 — ‘ ° Where do you find research? — http: [[te| ehealth. org[ bibliography ° Look at: — funding sources — meta—ana| yses Copyright 2012 Te| eMenta| Health Institute, Inc. All rights reserved.
  • 63. 0 $ 0 Training Choice of Communication Channel (modality) — Responsibility of Professional? Technology specific training/ proficiency for each modality + combination of modalities Confidentiality for each modality Client authentication for each modality Practitioner authentication for each modality Copyright 2012 TeleMenta| Health Institute, Inc. All rights reserved.
  • 64. Copyright 2002 by Randy Glasbergen. www. gIasbergen. com 1 3. "IF AT FIRST YOU DON'T SUCCEED. BLAME YOU? COMPUTER. ’
  • 65. 5 Google Drive "When you upload or otherwise submit content to our Services, you give Google (and those we work with) a worldwide license to use, host, store, reproduce, modify, create derivative works (such as those resulting from translations, adaptations or other changes we make so that your content works better with our Services), communicate, publish, publicly perform, publicly display and distribute such content. The rights you grant in this license are for the limited purpose of operating, promoting, and improving our Services, and to develop new ones. This license continues even if you stop using our Services. .."
  • 66. 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 2D12Te| eMenta| Health Institute, Inc. All rights reserved.
  • 67. OCPM Step 2: Referrals or Internet Marketing (IM) ° Provider lists ° Colleagues with telehealth training ° Professional websites, blogs, apps All IPhone Apps for "mental health" . .,, ... . mp. .. . ... .,. p. ... ,.. . I w7.. .». -m' vv-'~'A-: :u 4.2‘, ' w Kuéwir - 'len: AH*e| V, JL( . .., . . .. ‘L knew - . ... .,. . . I M. ,.. . . . . . .l V. .. . -.i». .-. . . .., .., .. ' ' : v.. .w . . ' ' "~33. M. - Copyright 2012 Te| eMenta| _H§a| th lnstitute, Inc. ‘ll
  • 68. ACES TECHNICAL COMPENTENCIES * TECHNICAL COMPETENCIES FOR COUNSELOR EDUCATION: RECOMMENDED GUIDELINES FOR PROGRAM DEVELOPMENT ° http: [[fi| es. aceson| ine. net[doc[2007 aces tec hnology competenciespdf
  • 69. Social I! e"cworking
  • 70. 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 2012 Te| eMenta| Health Institute, Inc. All rights reserved.
  • 71. Patient Education Email / Texting Social networking File exchange Computer repair Clinical records Insurance Reports Lateness/ Missed sessions Non-compliance/ Avoidance
  • 72. ACA Code of Ethics (2005) * A.12.a. Benefits and Limitations * Counselors inform clients of the benefits and limitations of using information technology applications in the counseling process and in business/ billing procedures. Such technologies include, but are not limited to, computer hardware and software, telephones, the World Wide Web, the Internet, online assessment instruments and other communication devices. Copyright 2D12TeleMenta| Health Institute, Inc. All rights reserved.
  • 73. 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 resen/ ed.
  • 74. English ~ Near (Address. Neighborhood. City, State or. San Francisco, CA y p Search for (e. g. taco, cheap dinner. Max's) Real people. Real reviews. 5 Find Reviews welcome About Me Write a Review fl don't miss TODAY'S deal from Arar Keely Kolmes, PsyD FlndFriends Messaging Talk Events Category: Counseling 8. Mental Health {sun} 20 Montgomery Street {I3 Suite 400 (between Bush St& Pine St) San Francisco, CA 94104 Neighborhood: Financial District . ' . —_—‘. ._. ~ c www. drl<koImes. com Hours: 9! Appointment Only: Yes Mon 1 pm - 7:30 pm Tue-Wed 11 am- 7 pm Thu-Fri 11 am — 5 pm View Larger Mapll Edit Business Info Browse Neamv: Restaurants | Nightl 4 Write I Review Deals Nearby 0 10% on Ayurvedic consunations at Ayurveda for Balance - Debra Riordan CAS fem Ad 575 for 5 . _‘ 6 (€I'l§lYS E Magnoli: ,yelp. com/ map/ keely-lcolms-psyd-San-franclsco lifestyle recommendations and seasonal cleansing with I 33" Fla‘
  • 75. Rating SITES! Yelp (Keely Kolmes, Psy. D.) ~ Your right / Gently discourage for these reasons: 1. The American Psychological Association '5 Ethics Code states that it is unethical for psychologists to solicit testimonials: Principle 5. 05 "Psychologists do not solicit testimonials from current therapy clients/ patients or other persons who because of their particular circumstances are vulnerable to undue influence. " Since you may decide to return to therapy with me at a later date, I do not request testimonials from people who have ended therapy with me. Copyright 2012 TeleMenta| Health Institute, Inc. All rights reserved.
  • 76. Rating Sites: Yelp (Keely Kolmes, Psy. D.) ° 2. Unlike other business owners who may respond to their Yelp reviews, as a psychologist, I must provide confidentiality to my clients. s This means I am restricted from responding in any way that acknowledges whether someone has been in my care. 6 Thus, I do not intend to respond to any reviews. Copyright 2D12TeleMenta| Health Institute, Inc. All rights reserved.
  • 77. Rating SITESZ Yelp (Keely Kolmes, Psy. D.) ° 3. I hope that if we work together, we can discuss your feelings about our work directly and in person. ° This may not always feel comfortable, but the discussion of positive and negative reactions to our process can be an important part of your therapy. ° If it is simply a matter of poor fit, I'm always happy to help you find a therapist who is a better match. Copyright 2012 Te| eMenta| Health Institute, Inc. All rights resen/ ed.
  • 78. Rating SITESZ Yelp (Keely Kolmes, Psy. D.) ° 4. If you still choose to write something about my practice on Yelp, remember that this is a public forum and you may be sharing personally revealing information with a wide range of readers. ° To preserve your privacy, consider using a pseudonym that is not linked to your regular email address or friend networks.
  • 79. HK. R up SanDiego, CA 03 n_J_j_J__J1/180010 Qfirsteoneview Stay awayll No therapist who works for them, no matter how good, worth the Di. 2 of their therapists at2 different stages in my lite. The lirsttime. I canceled an an for the doctor. The receptionist never gave the doc the message and then they ha payment Countless hours wasted on phone calls 8. letters of documentation. The 2nd time (it was years later 8. I'd forgotten that I already hated them - big mist copay. I called my insurance co. and the representative called Psycare with me to 45 minutes 8. 3 transfers later. we finally talked to someone in Billing. By thattimi Ever hear your insurance rep do your yelling for you? Its hysterical! Along the same lines, every time I called, regardess of the reason, I was on hold exaggeration. Wasthisreview ---'-’-(4) -(3) § . Booltmarii — Send to a Friend ‘Link to This Review
  • 80. Internet Ratings: Where are we going? * Expect ratings and quality surveys by healthcare providers to become standard operating procedure by smartphone app users. ° Yelp — Consumers can rate you, but you can't fully defend yourself without violating confidentiality
  • 81. Informed Consent & Social Media Policy Samples ° http: //telehea| th. ORG/ sites/ def ault/ files/ Informed_Consent. pd f * http: //drkkolmes. com/ for- clinicians/ socia| —media—po| icy/
  • 82. OCPM: Online Clinical Practice Management Step 1: Training Step 2: Referrals Step 3: Patient Education Step 4: Legal Issues Step 5: Assessment Step 6: Direct Care Step 7: Reimbursement
  • 83. All Existing Legal and Ethical Rules Apply
  • 84. Skip to Content I Footer I Accessibility DepartmentofCansumerAffairs ‘ -GOV Board of Behavioral Sciences Search BBS Home Board Activity CONSUMER RELATED TOPICS . ... ... ... -_ D D D D V QUICK HITS >) >) >> >) >> D >) >> >) >) us What's New Board Meetings Customer Satisfaction Survey Consumer Complaint Form Department ofconsumer Affairs Frequently Asked Questions Online License Verification Pending Decisions and Opportunities for Public Participation Recommended Links Statutes and Regulations Q. .r. =n; i.. .r i=0 iH>n- Ilrmuru 1-: nru/ Consumers App| icanrJRegistrant LPCC Exams Licensees Forms/ Pubs Contact Us ’. ‘-: -rtal ~93 tr '-l‘<lllal[‘l‘ . ..C<. .>. I.e. !.J. ;11.<. =.! .lrafraifrtarrtirrrt. !§9sers! i!1s.9r!1i9§. ?§x9h9t11srepy . ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. Notice to California Consumers Regarding Psychotherapy on the Intemet The Board of Behavioral Sciences (BBS) would like to make the following recommendations to Califomia consumers who choose to seek therapy or counseling over the Intemet. Individuals who provide psychotherapy or counseling, either in person, by telephone, or over the lntemet, are required by law to be licensed. Licensing requirements vary by state. Individuals who provide psychotherapy or counseling to persons in Califomia are required to be licensed in Califomia. Such licensure permits the consumer to pursue recourse against the licensee should the consumer believe that the licensee engaged in unprofessional conduct. Be a cautious consumer when seeking therapy over the Internet, or by any other means, by doing the following: -->> Verify that the practitioner has a cunent and valid license in the State of Califomia. -~» Be sure you understand the fee that you will be charged for the services to be rendered and that you frilly understand how and to whom the fee is to be paid. -~>> Be sure you are satisfied with the methods used to ensure your communications with and by the therapist will he confidential. -->> Be sure you are aware of the risks and benefits of doing therapy, over the Internet or by any other means, so you can make an informed choice about the therapy or counseling to be provided. ~>> According to Business and Professions Code Section 2290 5, pnor to the delivery of health care via telehealth, the health care provider at the originating site shall verbally inform the patient that telehealth may be used and obtain verbal consent from the patient for this use, The verbal consent shall be documented in the patient’s medical record. All laws regarding the confidentiality of health care information and a patient’s right to his or her medical information shall apply to telehealth interactions. Business and Professions Code Section 2290.5 (a) For purposes ofthis division, the following definitions shall apply: (1) ‘Asynchronous store and forward‘ means the transmission of a patient’s medical information from an originating site to the health care provider at a distant site without the presence of the patient. (2) ‘Distant site’ means a site where a health care provider who provides health care services is located while providing these services via a telecommunications system. (3) ‘Health care provider’ means a person who is licensed under this division. (4) '0nginating site‘ means a site where a patient is located at the time health care services are provided via a telecommunications system or where the asynchronous store and forward service originates. (5) ‘Synchronous interaction‘ means a real-time interaction between a patient and a health care provider located at a distant site. (6) Telehealth’ means the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, out-io. v.. u.o Mr. ..--.05.» 1--urn n. -u. -uumuuro and “ti: III: -In-uvlIrul| O .6 R n'| .inn0'fl In-ilory. .--rm Iuhiln elm n-roimir ; .- -Id ORA . ..; -;. .-roim. .-‘.9. -um um kn-IIOH . --m. .m. ..; A.u in -in -. As. -o-mo pun
  • 85. Duty to Report / Duty to Warn - (v) Failing to comply with ' child abuse reporting . requirements of Section 1 of the Penal Code. 0 (w) Failing to comply wit elder and adult depende abuse reporting require of Section 15630 of the Welfare and Institutions CA Business and Professions Cod Sections 4989.54 (cont. )
  • 86. 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 (, Emergency protocols shall be created with clear explanation of roles & responsibilities in emergencies
  • 87. ATA Guidelines — Emergencies Determine outside emergency coverage Establish guidelines for determining at what point other staff and resources should be recruited to help manage emergencies (, Be familiar with local civil commitment regulations and have arrangements where possible to work with local staff to initiate/ assist with civil commitments
  • 88. ATA Guidelines - Emergencies ° Be aware of the impact ° Be aware of safety issues of remote care on with patients displaying provider's perception of strong affective or control (or lack thereof) behavioral states upon over the clinical conclusion of a interaction, and how session, and how this might impact patients may then provider's management. interact with remote site inhabitants
  • 89. Er L‘-'l2II2II2I Flondy Gloeborgon. irrr'i-r-irr. g|: iel: iori; oIr. i:on1 "Information security is becoming a big problem here. Do you still have my Captain tlruneh decoder ring, hie? "
  • 90. Sources of HIPAA Risks * 79% of breaches caused by employees at 18% by a third—party partner “I the increasing use of mobile devises 2012 HIMSS Analytics Report is http: //www. krollcybersecurity. com/ white- papers/ himss-2012-report. aspx
  • 91. HIPAA Risks Increasing * interconnectedness and information sharing a ‘must have’ competency ° EHR mandated by 2013 or penalties will start being applied in terms of reductions ° Security and privacy risks are increasing proportionally
  • 92. 17 HIPAA Risk Solutions 1. Encrypt e If data is encrypted, there is no duty under the Notification Rule to notify clients if a breach occurs (”safe harbor” clause). ° While HIPAA requires data is encrypted at 178 bits, your software provider may offer 256-bit encryption which is considerably more secure
  • 93. 17 HIPAA Risk Solutions 2. Authentication — Change passwords / symbols & characters/ biometrics / access controls (need—to—know access) 3. Have ”best practices” policies and procedures — Include sanctions for employees in violation — Monitor 3'0‘ party partners — Incident response and planning 4. Create awareness of risk of human error — No laptops in trunks of cars or cybercafés — No passwords on post—it notes
  • 94. 17 17 HIPAA Risk Solutions . Create failed log-in’s after a certain number of attempts Vulnerability testing of your system Use firewalls Digital signatures . Perform yearly logical penetration test, . Provide free credit monitoring to clients . Perform risk assessments on a regular basis . Review and update audit trails regularly . Install tools to shut down the system if hacking is detected . Establish building and computer room security . Learn how to repair and dispose of your old hardware . Screen third parties carefully
  • 95. A m . H M m a Wq. _u. m Hnm %. .mm Vpm bnmv. 5 ex. SO lC. . .IiI ‘J _ o t e V a In ; ..L n S e . m no _B ea Cn no . .M. $ Mvcmsic mo or CD: Difficult for us to know Unless a company makes a statement for which they are liable ° Changing quickly Microsoft Copyright 2012 TeleMenta| Health Institute, Inc. All rights reserved.
  • 96. Which Technologies to Use? * No Guesswork Needed —— wvvniirgrjy ' — HIPAA ”comp| iant” or ”comI0atib| e” mp“ c°"""“‘“‘ . . H ~ — Practitioners need to be an3ll>del: l:: 'ZSf; ?'; f‘; >vxw. ».‘n compliant, not "‘“’°ePinz: ’ “work technology 3:‘ “'4O§Dll. :-N — Look for documentation of compatibility with HIPAA standards
  • 97. Business Asscoaites and HITECH All Business Associates in health care must sign an agreement stating their adherence to HIPAA standards - Transactions - Security - Privacy True for any service you hire - Bi| |ing, janitoria| , computer repair, e—mail, or video conferencing, etc. Not a matter of opinion 9 it is now enforced by the HITECH ACT, ‘
  • 98. What else do healthcare professionals need to know to be compliant with HIPAA regulations today? ° We are mandated to use HIPAA compliant technologies and processes — Document policies ° Security & privacy policies — Repairs — Staff training — Breaches, etc. Copyright 2012 Te| eMenta| Health Institute, Inc. All rights resen/ ed.
  • 99. - l_”€, C'lLl. Cl. lI. g C Wei: (_ Copyright 2012 TeleMenta| Health LT. T.i. (3C . _,‘i; f«I, ‘i'; C% Institute, Inc. All rights reserved.
  • 100. L7’. Licensu re Requirements - We need to be licensed in our state(s) to practice ° Common: We need to be licensed in the state of residency of the patient (e. g., Florida, Texas, Utah, Vermont) ° Also Possible: Both laws may exist
  • 101. American Psychological Associati on Practice Directorate, Legal & Regulatory Affairs Telehealth 50-State Rev] CW March 2010 Slate Psychologist General Telehealth other Notable Temporary I Guest Penalties for Vlolatlon Telehealth Provision Provision Activities License Availability although no specilic statutory fromthe time the application is rules exst onthis issue) approrred - Requires a laceto-face - Licensed out-of-state consultation between a patiert practitioner must be supemsed and physician whenthe physician by a licensed Texas has notseen the patient following psychologist an initial lelemedicine senrice - Texas has created pilot telehealth prograrrs for other health professions (Tex. Gou‘t Code §531021T1) UTAH No Yes (U. A.C. R432-100-32) ”* Establshes rules Yes (Utah Code Ann. §58-1» 3"‘ Degree Felony (Utah Code Ann. governing reimbursemert 307) §58-61-501) - Grants hospitals the right to policies when lelemedicine engage in telemedicine practi; s heath care sen/ ices are - Licensed out-of-state - Possible line up to $5C00 dollars - It a hospital choosesto use proyidedto patients (Utah practitioners may practice inthe AND/ OR lelemedicine, the hospital itsell Code Ann. §28-18-13) state onw it called tor a - Possible imprisonment up to 5 must develop and implement consultation by an indnridual years governance pr’ - licensed in Utah . » Services pertormed must be limited to the consultation Penalty for both Utah and Vermont ihnme l’E. "'°‘l '3 ”°l "3 mead , e duration olthe consultation IS harshl event - No specific language requiring advanced notification to the board VERMONT Yes (26 i. S.A §3018) No « - Yes (CVR04-030-270) General Misdemeanor (3V. S.A. Psychological Examiners §127, 26 VS A. §3002) - Psychologists who provide webste for disclosure - Licensed out-of-state sen/ ices via electronic requirements (per Rule practitioner may practice lor no - Possible line up to $5600 dollars means are deemed to be 3.10) for psychologists who more than 10 days or80 hours AND/ OR enggging in telepractice provide senrices via the in any 12-month period - Possible imprisonment up tol Disclaimer. This document does not constitute legal advice and should not in e relied upon, as it is not routinely updated and was prepared with information Rom other sources, whose accuracy was not independently verified by APA APA strongly encourages the reader to independently verify the infomiation contained herein andfor consult with independent legal counsel if the reader intends to use or otherwise rely on such infinrmation. Because the lawand related infomiation continually change and because APA relied on other sources to compile information contained herein, APA txannot guarantee the completeness, currency or accuracy of this document.
  • 102. Know laws in relevant states Decline patients where not licensed Require prospective patient to legally represent he's a citizen of a state — Use authentication services — Use traditional proof of residency El Cl
  • 103. Cross—Border Practice r Licensing Boards that may assert jurisdiction: — The one in your state — The one in the patient’s state — Both <* Safest: — Provide services only where licensed — Require pt to attest to his or her citizenship there Copyright 2012 TeleMenta| Health Institute, Inc. All rights reserved.
  • 104. Question <* What can we do to move licensing forward with the authorities? — Contact them — Volunteer if they need help — Get their newsletters — Follow the literature — Get trained so you know which questions to ask Copyright 2012 Te| eMenta| Health Institute, Inc. All rights reserved.
  • 105. Question <* I'm ok if my malpractice carrier says they cover me online, right? Copyright 2012 Te| eMenta| Health Institute, Inc. All rights reserved.
  • 106. APA Ethical Principles of Psychologists <“ Principle B: Fidelity and Responsibility — Psychologists establish relationships of trust with those with whom they work. They are aware of their professional and scientific responsibilities to society and to the specific communities in which they work. - "Cardiologists fined $100,000 for Internet privacy vio| ations” (Arizona Republic, April 17, 2012) — Online calendar, no written policies & procedures, no documented staff training, no risk analysis, no security official C New York State Social Worker Copyright 2012 TeleMental Health Institute, Inc. All rights reserved.
  • 107. Legal Suggestions (TMH Institute) Study & understand the scientific literature Get broad-based and specific telehealth training ° Save all proof of training or consultation Document, document, docu ment Don't refer to peers who you suspect are practicing illegally or unethically online Communicate often to your local, state and national professional associations Write to your malpractice carrier and ask them to clearly tell you what will happen if you get in trouble Consider that a lawsuit can involve a year or two of your life, without pay Copyright 2012 Te| eMenta| Health Institute, Inc. All rights reserved.
  • 108. 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
  • 109. psychological tests About 3,230,000 results (0.14 seconds) > Psych Central Lgsychological Tests and Quizzes Q Test your depression, mania, and attention deficit feelings, today and track it overtime with our instant quizzes. Bipolar Quiz — OCD Screening Quiz ~ Personality Patterns — Anxiety Screening Quiz psychcentral com. i'quizzes. i' - Cached - Similar 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, Mood Disorder Questionnaire - MDQ ~ Borderline Personality Disorder Test www healthyplace comi‘psychologica| ~tests. /' — Cached — Similar TestYourself by PsychTests: Tests and guizzes on personaliy, IQ PsychTests —professional quality psychological tests and quizzes. Want Big 5 personality test, intelligence quiz, career test, love calculator. testyourself, psychtestscom. -' — Cached - Similar Psychological testing - Wikipedia, the free encyclopedia Psychological testing is a field characterized by the use of samples of behavior in order to assess psychological construct(s). such as cognitive and en wikipedia org‘-‘viil<ii'Psychological_testing — Cached — Similar Tests: IQ tests, _persona| itLtests__| ove tests___career tests Personality tests. Our wide range of personality assessments will facilitate the exploration of your psychological landscape and perhaps even unearth a few www queendom com. v"tests. i' — Cached — Similar Test Yourself | Psychology Today 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 www psychologytoday comftests - Cached » Similar Co| orQuizcom - The free five minute personalig test! ColorQuiz is a free five minute personality test based on decades of research by color psychologists around the world. There are no complicated questions to vm-w colorquiz com” — Cached — Similar
  • 110. 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
  • 111. ACA Code of Ethics (2005) ° A.1.b. Records ° Counselors maintain records necessary for rendering professional services to their clients and as required by laws, regulations, or agency or institution procedures. ° Counselors include sufficient and timely documentation in their client records to facilitate the delivery and continuity of needed services. Counselors take reasonable steps to ensure that documentation in records accurately reflects client progress and services provided. Copyright 2012 Te| eMenta| Health Institute, Inc. All rights reserved.
  • 112. What's the Problem? - Differences, Confusion & Disagreement - Institutional vs. Independents - No IT staff, nurses, admins - No time for it all ° Costs — free video chat - Technology - Unreliable systems ° HIPAA? - Practical - Clarify Roles -Legal/ Regulatory (what's what? ) - Ethical — associations - Reimbursement - Deception — loss of trust - Technical - Anonymity / duty to report - Malpractice carriers
  • 113. Solutions: Anxiety Reduction 9 Education . -Professionals - Blueprint (legal/ ethical) - Licensing - Malpractice - Reimbursement ° Practical (work flow) ° Control / Authority ° Predictable - Peaceful - Patients - Authentication - Reliability - Payment/ Reimbursement Models - Negotiate with Employers - Creative Marketing 9 Positive
  • 114. OCPM Step 6: Direct Clinical Care 9 Explain & sign informed consent document 9 Conduct a formal intake — no shortcuts 0 Meet in—person or video, take full history, medications, illnesses, abuse, stressors, support system, use of other technology, drug/ alcohol use, suicide/ homicide intent, mental status 9 Decide if then which technology is appropriate 0 Obtain names of all other key providers, get all appropriate releases and send reports as usual Contract for short, protocol-driven tx Authenticate & set ground rules at every session Enforce boundaries (privacy, family, social media) Have backup emergency plan Evaluate at regular intervals 00009
  • 115. ls Skype Reliable? I Its free, but then again, so is a park bench K is a park bench adequate for your work? - “ E p _ Skype tiles & pixelates, the audio gets ' ' “ tinny, echoes develop, and often calls drop entirely. Sometimes consumers can see you and hear you, without your . "/"'1; "' awareness. / / 3 ' . _ (r/1:“ "‘-d'? ‘-_ ‘D - How will the most dysfunctional of your ‘~'~" ' l ’ ' ‘ clients and patients react to a dropped ‘ ' . call? _ ’; _.'_. _~, _~, ’fl‘. " A * Do you have a back—up emergency _‘ : :‘-L/ ,’. ."'——-""-. v ‘ plan, and full knowledge of local " ' resources in case you need to act . ___. ‘.'. '—'~v-. -;-, /" .4 immediately? -. . ‘ _ , , --.4-r ‘ Most of the literature has a ”champion” in the local community of the patient. Copyright 2012 TeleMenta| Health Institute, Inc. All rights reserved .
  • 116. Do you see well enough? “Image Resolution V ATA Guidelines Are you conducting an intake or fo| |ow-up? “ Most of the scientific literature described VTC as being used for follow—up care after a primary physician or other licensed professional does an intake. “ Can you properly assess glassy eyes, tremors, gait disturbance, sweaty palms, body odor, other signs of poor hygiene? Copyright 2012 TeleMenta| Health Institute, Inc. All rights reserved .
  • 117. Skype does not provide an audit trail, which is a foundational HIPAA requirement
  • 118. What if you just ask consumer to sign a disclaimer? You can ask, but most courts will not support your having asked a vulnerable patient to sign away their basic U. S. rights —— such as the right to privacy.
  • 119. What ifl claim Beneficence vs. Malfeasance? < Are you in an emergency situation? “ Did you document your rationale adequately to defend yourself if something goes wrong? r Did you run your rationale by your own local attorney? i‘ Did you describe your rationale in writing to your licensing board, ethics boards and other colleagues? r Are you sure your malpractice carrier will cover your civil as well as regulatory risk? Get it in writing.
  • 120. What's Microsoft Doing to Improve Skype’s Functionality? “ For developers, the . NE T Framework provides a comprehensive and consistent programming model for building applications that have visually stunning user experiences and seamless and secure communication. htt 2 www. microsoft. com net
  • 121. Implications of Microsoft's actions for Skype in mental health? <* Ve ry positive — Future of bringing mental health care to the hip pocket is more and more of a reality Copyright 2012 TeleMenta| Health Institute, Inc. All rights reserved.
  • 122. #1. VTC is moving to the smart device
  • 123. Nursing Homes
  • 124. x . " -. .
  • 125. Rural Hospitals
  • 126. . l . _ Li. .. . i » lb, ixul. . . V| rr _ : l. w_ ‘ Ill 55 V . )f I‘ I 1 I 4 I. 1/ . /1 .2 / .v ‘. .ru. ..i . . 95.! . . .. . 4. /1. / .. .. t t . I. .. ..I . , . . . L . ; u s . . I I . . . J
  • 127. Home Health ,
  • 128. Military & Veteran's Administration
  • 129. Correctiona Facilities
  • 130. R. ’I= Ifl‘, v Cil. 'i‘: .l)£‘I'i]-; ‘ii ' “In lieu of a raise or promotion, I will agree to friend you on Facebook. ”
  • 131. “I can see my zit on Google Earth! ”
  • 132. mHea| th ° Mobile phones are the predominant form of communication in 3”‘ world countries — landlines are extremely limited — broadband lags behind in development Copyright 2012 Te| eMenta| Health Institute, Inc. All rights reserved.
  • 133. Randy Glxasbc’-rrrnr-n r; l.a-sburgs, -n. com T. GMSBEFEEN “You should turn off your cell phone on a date. .. especially if it’s smarter and cooler than you are. ”
  • 134. 49.7% of all Americans have a smartphone (Neilson, Feb. 2012) U4 " 9 .9 ‘IT 5 K r. . 9,3. ’ What does that mean for psychotherapy? Insurance reimbursement is right around the corner. .. patients and clients will choose between you and someone else who is trained, skilled and available via technology Copyright 2012 TeleMental Health Institute, Inc. All rights reserved.
  • 135. 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
  • 136. Reimbursement? 0 Medicare & Medicaid already pay for VTC. Many 3rd party carriers do, too. C Require HIPAA compliance s Designated sites 0 Ruralareas 6 Not to the home yet, but such reimbursement is coming C Get Telemedicine Reimbursement Handbook or TMI Institute course Copyright 2012 TeleMenta| Health Institute, Inc. All rights reserved.
  • 137. Which features do mental health professionals need to deliver effective care with VTC? ° Depends on population served — General adult — Pediatrics (room, table top — Gerontology (adaptive devices) — Correctional facilities (videophones) - White boards, show desktop & access Internet Copyright 2D12Te| eMenta| Health Institute, Inc. All rights reserved.
  • 138. Special Mental Health Features Depend on services delivered . ',_: ,;, §,l; ,, «: White board ‘ «J Access desktop or web " g Neuropsych testing ""* — Supervision ,5.’ — Might also want secured . F _-}‘: ..~, . I’ = ~'" email, instant . ‘_ ‘.1 _, " I messaging, cloud ‘+-rill" .0 9’ I‘ ‘a storage, etc. .__~; j. ‘ i. 1 — Virtual reality goggles I ‘-'f.7"U—‘_ _: )5. — Apps Copyright 2D12Te1eMenta| Health Institute, Inc. All rights reserved.
  • 139. Internet-based, VTC Companies* Claiming HIPAA Compliance Access Psychiatry _ Interactive Care Adobe Connect _ i-rel Behavior Imaging Solutions , IVE (cloud) Breakthrough - Lifesize (Logitech) Brighter Day Health Ca| iforniaLiveVisit - MyTherapyNet - Pass Copemday - Revation Consult a Doctor - Secure Telehealth Counsol. com EasyShare VC eCounseling E Mental Health Center - Secure Video Conference - Shepell fgi - Smart House Calls - Soltrite Forefront Teleca re _ W33 GEMS - VisHealth (Visual Telehealth) GoToMeeting _ Vsee iCouch * TMH Institute has partnered with some of these companies and will receive a referral fee if you mention TMHI. You may also get an added discount. Copyright 2012 TeleMenta| Health Institute, Inc. All rights reserved.
  • 140. Some 3”‘ party carriers insist that remote care must be "medically necessary. ” Should the delivery system be medically necessary —— or should we focus on the service?
  • 141. Copyright 2007 by Randy Glasbergen. www. g|asbergen. com / e¢A66EF-6 - ‘‘I decided to have the surgery because I need the extra thumb for text messaging. ”
  • 142. Resources * www. te| ehea| th. ORG[bib| iography
  • 143. Learning Objectives ° 1. ETHICS: Skype, Google, Facebook, Assessment, Records, Testimonia ls, use established treatment protocols ° 2. LEGAL ISSUES: — practicing over state lines, HIPAA, informed consent ° 3. RISK MANAGEMENT: — Abide by your ethical code, know your state law, hire a local attorney
  • 144. We can do this if we
  • 145. Wish List of Next Steps ° Recognize Essential Differences: — Traditional telepsychiatry vs. how most psychologists are using telehealth — Outline clear statements of needed techno| ogy—based competencies — Develop psychology protocols for treatment in ”unsupervised settings” ° Find malpractice carriers who will carry our entire risk (both civil & regulatory) - Expand training options for responsible techno| ogy—based practice - Advocate for our regulatory boards to — Post clear statements about, & enforce existing laws — Require techno| ogy—competencies be demonstrated as a condition for licensure - Focus on other areas in addition to direct—care ° Start developing online group practices & our own online ACOs - Join us in forming a Division at the APA devoted exclusively to advancing the use of technology —— and thereby growing the APA
  • 146. Questions? Thonlzl uou Marlene M. Maheu, Ph. D. TeleMenta| Health Institute, Inc. Phone: 619-255-2788 Email: mmaheu@te| ehealth. ORG Copyright 2D12Te| eMenta| Health Institute, Inc. All rights reserved.