How to Implement the 2013
ATA & APA Telepractice

Guidelines

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Marlene M.  Maheu,  PhD
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Sneak Peek of the Online Mini-Conference: How to Implement the ATA & APA Telepractice Guidelines for Telemental Health, Telepsychology and Online Therapy

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Maheu_Guidelines Mini-Conference FREE Slides

  1. 1. How to Implement the 2013 ATA & APA Telepractice Guidelines Te| eMenta| Health Institute, Inc. Marlene M. Maheu, PhD Executive Director
  2. 2. 3 , Ignamgrm : -:; w_. ~.: :: I. (( " ' ' , (JI: h[: —>. IllI. .-Iv , 5. I , l Disclaimer 6* WHO I AM: I am a licensed psychologist, not an attorney, physician, marketing or information technology (IT) professional. ° MY GOAL: My goal is educational only. 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 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 those written responses for their full significance. 5:13’: I’; -'a. _i": 1;. _‘; .
  3. 3. tttttttttttttt IH ((( I H V I I teleheaIth. org American Telemedicine Association Telepractice Guidelines ° Practice Guidelines for Video—Based Online Mental Health Services, May 2013 American Psychological Association Telepractice Guidelines ° Guidelines for the Practice of Telepsychology, August 2013
  4. 4. ((( "“‘_"‘”K“"‘l*’*"‘; '” teIehea| th. org lII“I: I.; ',o: ‘,; /'/ vIvAvIvAvIvI. :InI; Iflcglniiakaiixacjl.9I15;/ cjkcm, /‘cikahlulir . ~IcIIIIvc: ;y/ ';iiI= ,IIIIc2h. IIv@: L'. plcaxciikc1943!Iickalllnxaa-: wi! cIr—-vmikeac»-iI: Ia; Ic: I4I*InIhnI; » nIaIIiiI= .IL-: ‘u; I=. IIiimarvnczan. .p1ilI’? ‘:iF‘-vIr= IIIu= I=> P k 11cE GUIDELINES Eon VI E0—BASED ONLINE MENTAL H LTIII SERVICES Ma y0B I I I I I IIIIIIIIIIIII IIIII II I I II I I I IIIIIII IIIIIIIII II [I I I II II I I }IIIIiIIIIIIiIIII Iii I I IIIIIIIIIIIIII "“'I”iI‘I'I‘I‘ I I II I _. I.. .a—- I o “A A 1 Amerknn Tolemedlclnu Auochllqn
  5. 5. p_a Id 0-5 u—- u—- 9-D u—- 0-. I—- v—- 0-0 0- ‘O X l O ‘sh -5- U4 IJ F-' @ ‘O 00 l O ‘J1 -[3 U-I GUIDELINES FOR THE PRACTICE OF TELEPSYCHOLOGY Introduction These guidelines are designed to address the developing area of psychological service provision commonly known as telepsychology. Telepsychology is defined. for the purpose of these guidelines. as the provision of psychological services using telecommunication technologies as expounded in the "Definition of Telepsychologyf‘ The expanding role of technology in the provision of psychological services and the continuous development of new technologies that may be useful in the practice of psychology present unique opportunities. considerations and challenges to practice. With the advancement of technology and the increased number of psychologists using technology in their practices. these guidelines have been prepared to educate and guide them These guidelines are informed by relevant American Psychological Association (APA) standards and guidelines. including the follouingz EtIIicaI' Principles of PS_1‘C/ ‘l010giSIS and Code of Conduct ("APA Ethics Code‘) (APA. 20021 2010), and the Record Keeping Guidelines (APA 2007). In addition the assumptions and principles that guide the APA‘s “Guidelines on Multicultural Training. Research. Practice. and Organizational Change for Psychologists“ (APA 1*. _r. U1wr= .:? ,.'I_.
  6. 6. 1 , |55=j, I_3rIy; t_: ~:I; r. I:: ,. ( I A . utdil‘ II: -m l Consider Context Online Norm / Traditional Telehealth Mostly Email & Chat / Video Anonymity / Full Identification No Patient Records/ Prescribed Records Avoid Responsibility w/ Website Disc| aimers/ No Disclaimers No Mandated Reporting / Clear Channels for Mandated Reporting arr»: I‘; -=; ._: -is 2;»,
  7. 7. lELEMENlAl. HELIH ((( _ N ' teIeheaIth. org | I'». l ATA & APA 2013 Guideline Similarities Both documents recommend: - Adherence to local, state (licensing laws, interjurisdictional practice, mandatory reporting), federal laws (e. g. HIPAA and HITECH), & ethical codes of profession ° Competency of practitioner (adequate professional and technical knowledge and skills, etc. ) ° Competency of client/ patient (e. g., appropriateness for telepractice services, technical competencies, cooperation) - Informed consent - Careful and ongoing assessment - Emergency planning ° Privacy, security and confidentiality and risk management - Documentation Both also do not purport to establish binding legal standards and defer to clinical judgment in any specific circumstance
  8. 8. 3 I§_'_3Ill, =‘| fL‘‘l-1:V_l; l3I , y. ‘ (( ~"‘ -§ . uIa. I~. r.IIII. .-Io APA ATA For Psychologists For Providers Global Perspective Specific Perspective Scope: Email, telephone, social networking and video Scope: Real-time, videoconferencing via personal computers and mobile teleconferencing (requires broad principles) devices allows for specificity (e. g., connectivity, device security, camera angle, PIP) Theoretically focused, describes ethical concepts more than ”how Practical, clinical, administrative and technical ”how to” to” Focused largely on consumer-protection Focused on both consumer and professional-protection (e. g., availability of emergency contact info at each session, working with uncooperative patients) Makes strong statement regarding the need to not only know, but References a number of studies but does not explicitly direct the keep updated with the evidence-based literature provider to adhere to the evidence-base or keep updated Specific Use of Psychological Test Instruments and Other Broader Use of Term Assessment Assessment Procedures n 1: Language is Aspirational (e. g., ”might, could, ” etc. ) Language is Mixed (e. g., ”should, ” ”shall, ” ”may”)
  9. 9. APA/ ATA Telepractice Guidelines What else do I need to know about the actual ATA and APA guidelines?
  10. 10. I. I 7*-. F. I=_'I‘_Jl}. l §_= !l"§IV'l: 'r¥= llli'-‘rj"Ali! ‘} It
  11. 11. meMm1m. nsLm ((( I 5 V I g _ L telehealth. org ATA —— Role of Your Judgment ° If circumstances warrant, a practitioner may responsibly pursue a course of action different from the guidelines when, in the reasonable judgment of the practitioner, such action is indicated by the condition of the patient restrictions or limits on available resources, or advances in information or technology subsequent to publication of the guidelines. ° Nonetheless, a practitioner who uses an approach that is significantly different from these guidelines is strongly advised to provide documentation, in the patient record, that is adequate to explain the approach pursued.
  12. 12. I H telehealth. org ATA —— Scope ° The scope of these guidelines covers the provision of mental health services provided by a licensed healthcare professional when using real-time videoconferencing services transmitted via the Internet. ° The guidelines pertain to telemental health conducted between two parties, and do not address concerns related to mu/ tipoint videoconferencing.
  13. 13. meMm1m. nsLm ((( I ! _ V I g _ L I telehealth. org ATA —— Scope (cont. ) - These guidelines include telemental health services when the initiating, receiving, or both sites are using a personal computer with a webcam or a mobile communications device (e. g., ”smart phone”, laptop, or tablet) with two- way camera capability. These guidelines do not address communications between professionals and clients or patients via texting, e—mai| , chatting, social network sites, online ”coaching” or other non—menta| health services.
  14. 14. TELEMENIAL nsum ((( I II I I I _ II I teIehealth. org ATA —— Scope (cont. ) ° This document contains requirements, recommendations, or actions that are identified by text containing the keywords ”sha| |,” ’’should, ’’ or ”may. ” ”Sha| |” indicates a required action whenever feasible and practical under local conditions. These indications are found in bold throughout the document. ”Shou| d” indicates an optimal recommended action that is particularly suitable, without mentioning or excluding others. ”May” indicates additional points that may be considered to further optimize the telemental healthcare process.
  15. 15. I I, ‘.! ?iitl, :_: |fI; ‘_: ::1;Vj-I3: JIJIIRIII. l T“ 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 2:2»: n-= ;._: -*: : ,1.
  16. 16. I H telehealth. org 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., se/ f—help websites, blogs, and social media). p.3
  17. 17. H te| ehealth. crg Development of the Guidelines Therefore, two of the most salient issues that the Telepsychology Task Force members focus on throughout the document are the psychologist’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.
  18. 18. |; g=, ‘,l_5fn «i: .:i; w_. ~.x: : umu: r.iIli. .-m 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 intended to take precedence over the judgment of psychologists or applicable laws and regulations that guide the profession and practice of psychology. 51,": T’; -'a. _i-‘I ‘V. {(—
  19. 19. What are the differences: guidelines, standards and state laws? A -*— Z V ‘———*‘—”‘—‘_ . j; J. ‘ “ . l. V ’-fir». -r«-2-: v.<~. ~., _, ‘ ,1 . ->: .—‘-, -.: , _ i ‘l i' ‘ .3?‘
  20. 20. TELEMENIAL nsum ((( I I_ I I I _ II I te| ehealth. crg Guidelines, Standards, Laws - Professional Association Guidelines: aspirational - Standards: mandatory, required by professional associations — Penalties include probation, additional training, being ousted from the association, reported to authorities - Laws — mandatory — penalties can include fines, community service, loss of license, prison terms - State Law may adopt standards set by a discipline (as is California for psychologists)
  21. 21. APA/ ATA Telepractice Guidelines Do I need to document my rationales for choosing to treat a client/ patient via technology?
  22. 22. uiahizr-Illi. ,-iv Document Rational for Treatment? ° Required by APA but not ATA '* Safer to do so — Your rationales will be needed if yourjudgment is ever questioned '' Insurance companies usually require treatment plan and rationales for authorization (plus much more) 2:2»: r; -=; ._: ~: : ,1.
  23. 23. APA/ ATA Telepractice Guidelines Why would I want to document the location of my client/ patient as well as my own location at the time of any contact?
  24. 24. TELEMENIAL nsum ((( I II I I I _ II I teIehealth. org Document Identity and Location - Who you are (name, license, training) - Your location (billing purposes; emergencies) - Who client/ patient is (for security, confidentiality, privacy) - Client/ patient location at the time of the call (relevant for your licensure to be in effect; reimbursement: to use with billing code for ’’place of service” on HCFA form; to document your knowledge of relevant emergency resources & support)
  25. 25. APA/ ATA Telepractice Guidelines How specific do I need to be in my documentation about any adaptations I've made to psychological testing?
  26. 26. |; g=, ‘,I_5I: n «_ : .:i; wIr-1:: umu~. .». iIli. .-m Psychological or Other Testing ° Document accommodations or modifications that have been made — Location of testing? (e. g., home, work, friend's house) — Intruders? (e. g., interruptions, emotional reactions) — Language barriers? (e. g., written vs. spoken English) — Timing of test completion? (e. g., Did it take 2 weeks from start to finish for MMPI? ) — Other? 51": I’; -'a. _i-‘I ‘V. {(—
  27. 27. APA/ ATA Telepractice Guidelines Should my client/ patient see or sign the emergency plan?
  28. 28. 3 , ngg= ,*,13nr; «_: .:; w;. x:: , ( I g _ (Jl: hI: r.I| lI. .-Iv Need a Signed Emergency Plan? Yes 32' 7 _: -*" 2:1.
  29. 29. APA/ ATA Telepractice Guidelines What factors might need to be included in my emergency planning for every client/ patient?
  30. 30. «( l(-L€-MENl/ l HE: LlH temheakh-org l! .,l‘l, I Emergency Planning Introduction ° What are the typical emergencies of the population you treat? — Suicide or Homicide - What is suicide plan? ° Are firearms accessible? — Abuse - What are the imminent dangers? — Are children or elderly people in environment? — If substance abuse is an issue, is substance in the home? — Is abduction a flight risk if child abuse reporting is discussed? — Medication reactions — Physical emergencies — Is client/ patient alone? — Is social support available? ° What repercussions might ensue if you pull in a friend or family? — Other?
  31. 31. 3 , |gn: §,I_: m;I : -:; I_. ~.x: : , , (( " ' ' , (JI: hI: r.IllI. .-Iv , !I . , , l Emergency Planning Introduction ° Include the emergency plan in your informed consent (IC) document, where your client/ patient will sign that they agree to it 6' Review the specifics of your telehealth informed consent verbally, then ask for signed IC document 51,": I’; -'a. _i-‘I ‘I‘. {(—
  32. 32. TELEMENIAL nsum ((( I H V I b _ H I teIeheaIth. org Emergency Planning Introduction ° Collect & Document Local Emergency Resources — These can be dependent on your client/ patient population (e. g., autistic children and their families, depressed adults, unwed teen mothers, elderly men with anger management issues and subtance abuse) — Document telephone numbers, hospital admissions, local clinical resources, local champion or proctor, friend/ family member(s)
  33. 33. IrmIwIm HE»‘LI'H ((( W I _L , “ teIeheaIth. org If you'd like more content, go to www. te| ehea| th. or mini—conference Course Includes: ° Video Recording of Live Event ° Full Presentation Slides - Mini—Conference Handout ° Assignment Resources ° 6 APA—Approved CEUs
  34. 34. ll-LEMENI/ ll HE»‘LI'H ((( W I _L , “ teIeheaIth. org If you'd like more content, go to www. te| ehea| th. or mini—conference Course Includes: ° Video Recording of Live Event ° Full Presentation Slides - Mini—Conference Handout ° Assignment Resources ° 6 APA—Approved CEUs
  35. 35. 3 ' , I5I= I‘I, =‘IrIII I-1;V_iIl3I , , (C ' ’ '‘'K ' _ (Jl: m~. r.IliIIIIIl' , I I I, , Marlene M. Maheu, PhD Te| eMenta| Health Institute, Inc. Email: support. te| ehea| th. org Training Center: www. te| ehea| th. org[training jrI= .rrI: In-= ; -~41.

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