Dr. Gavazzi finishes the third hour with a focus on informed consent, risk management, and interjurisdictional practice. With consent, Dr. Gavazzi, adds to what is essential to telepsychology practice. In terms of risk management, Dr. Gavazzi highlights some important considerations, such as data security, thorough assessment, and patient's ability to use telepsychology services. Finally, Dr. Gavazzi reviews interjurisdictional practice and ASPPB's e.passport program.

1. Introduction to
Telepsychology
Part 3
JOHN D. GAVAZZI, PSYD ABPP
PSYCHOLOGIST
PENNSYLVANIA PSYCHOLOGICAL ASSOCIATION
AUGUST 2016

2. www.ethicalpsychology.com
http://www.slideshare.net/gavazzij

3. Quick Review of Last Session
• Definitions:Telepsychology, Patient, Security, Confidentiality,
Remote, Information Systems, and Jurisdictional Practice
• Competence: Bandwidth, Wi-Fi, Security, HIPAA, Synchronous versus
Asynchronous Communication, Knowing your platform, and Knowing
the location of your patient
• Delivery ofTelepsychology: Assessment, Providing Care, and
Managing Emergencies

4. Learning Objectives
At the end of today’s session, you will be able to:
1. Understand important components of informed consent,
2. List three key features of risk management, and
3. Outline what PSYPACT is and why it may help your practice.

5. Informed Consent
SOME TOPICS TO CONTEMPLATE

6. Informed Consent
• Need to use all the good, regular, face-to-face information related to
informed consent
• Cost
• Benefits to psychological treatment
• Risks of psychological treatment
• Confidentiality and its limitations
• Background, education, and training
• Remember, telepsychology is still considered an innovative practice.

7. Informed Consent with Telepsychology
Psychologist
• Agree to use HIPAA compliant platform. And, if not, you need to
explain the risks of doing so.
• Explain what to do in case of lost transmission (for example, if you
internet connection goes out.)
• Develop a safety plan in advance if the patient cannot get to your
office. More of a risk with greater distance.
• Develop a plan if the patient needs face-to-face sessions. If the
patient lives close, the patient can come to the office. If the patient
lives too far away, do you have a colleague who can see one of your
patient’s within an appropriate time frame.

8. Informed Consent with Telepsychology
Psychologist
• Develop an emergency plan for a patient crisis. Does the patient
have the numbers for crisis intervention in his/her locality? Are you
familiar with hospitalization procedures in that area?What would you
do if an involuntary commitment is needed?
• Agree that you will use similar treatment procedures/interventions as
you would in a face-to-face sessions (for example, you cannot be
browsing the internet or responding to emails during sessions).
• Agree that you will not record the sessions
• Agree that you are the only person in the room/office when
conducting telepsychology services

9. Informed Consent with Telepsychology
Patient
• Agree that the patient will not record the sessions
• Agree that the patient is the only person in the room/office when
conducting telepsychology services.
• Agree that if requested by the psychologist, the patient will move the
camera around the room to insure confidentiality.
• Agree that the patient is in the state/jurisdiction that s/he says she is
in.
• Agree to use only secure networks. If not a secure network, discuss
the drawbacks of these situations. Data security risk is important.

10. Documentation of Informed Consent
• In Pennsylvania, you do not have to have written informed consent.
• However, you need to document that informed consent was
provided.
• Probably a good idea to generate written informed consent
procedures for regular and telepsychology services.
• No. I have yet to develop one.

11. Risk Management
A FEW REMINDERS

12. Risk Management Reminders
• Provide comprehensive informed consent
Remember, informed consent is an ongoing process in
treatment. It is not a once and done activity.
• Develop appropriate documentation of assessment and session
Make sure you put some type of note or assessment as to why
telepsychology is appropriate for the patient.
• Consult knowledgeable others when you have questions.

13. Risk Management Reminders
• Are you competent to provide services? How do you know?
• As mentioned previously, you need to know your hardware and
software comprehensively.
• Obtain more intensive training to engage in services

14. Risk Management Reminders: CIA
• Confidentiality: Are you protecting information from unauthorized
disclosure?
• Integrity: Are you preventing third parties from altering your clinical
record? (This applies more to electronic records.)
• Availability: Are you making data to authorized parties in a timely
fashion? Faxing versus emailing versus mailing versus EHR

15. Risk Management Reminders
• There is a correlation between the distance between you and your
patient with risk level
• There is a correlation between patient complexity and risk level
• There is a correlation between your knowledge of community
support and quickly accessing support and risk level
• Bill insurance companies accurately

16. Interjurisdictional
Practice
QUESTIONS, RISKS, AND PSYPACT

17. Intrajurisdictional Practice
• There is nothing in the State Board regulations that prevents
psychologists in Pennsylvania from providing telepsychology services
within the boundaries of the Commonwealth of Pennsylvania.
• You are at greater risk for greater distances.
• What about neighboring states?
• What if you move to Pennsylvania from another state?

18. What are some concerns about
interjurisdictional practice?
• Are you licensed in the state that the patient is in? If not, why not?
• If a patient presents with child abuse concerns, which state’s law
comes into play? Do you know that state’s law?
• If a patient becomes imminently suicidal or homicidal, which state’s
law comes into play? Do you know that state’s law? Practically, do
you know what to do?
• What about record keeping guidelines?

19. Some Interesting Questions
• What if your patient travels to another state for business?
• What if your patient lives in another state, but works in PA?
• What if a psychologist temporarily travels to another state to take care of
sick relative. Can she/he still practice telepsychology to patients in
Pennsylvania?
• What if a psychologist plans to spend an extended period in another state
for any reason? What are the concerns about continuing practice?

20. Association of State
Psychological and Provincial
Boards (ASPPB) is working on
this.
THANK YOU TO ALEX SIEGEL, JD, PHD FOR PROVIDING SOME OF
THIS CONTENT

21. • Effective means of addressing common problems. In
this case, expanding access to psychology professionals.
• Creates economies of scale; thereby saving money.
• Retains collective state sovereignty over issues
belonging to the states
• Not a new idea: Compacts have been around a long time
What is a Compact?

22. More on Compacts
• Compacts are essentially treaties between two or more states
• There are a variety of ways that compacts come into existence.
Psychologists will likely be looking at legislative efforts to make this
happen.
• Legislators understand compacts.
• Flexible, enforceable means of cooperation.
• More than 200 compacts already exist in the US (NY-NJ Port
Authority)

23. Other Health Professionals Developing
Interstate Compacts
Medicine
Nursing
PhysicalTherapy

24. PSYPACT: ASPPB’s solution
• In February 2015, the Board of Directors of ASPPB
introduced the Psychology Interjurisdictional Compact
(PSYPACT) to address concerns by member jurisdictions
about the increasing availability of unregulated services
provided via telecommunication technologies
• Goal is to protect public through the regulation of
interjurisdictional practice through verification of
education, training and experience to ensure accountability
for professional practice.

25. More on PSYPACT
• Compromise between psychologists and licensing boards
• Will allow great access to care and greater flexibility for psychologists
• Allow psychologists to practice interjurisdictionally with one license
from a PSYPACT state
• Protect public through verification of education, training and
experience to ensure accountability for professional practice

26. How Does PSYPACT work?
Psychologists who wish to practice under PSYPACT obtain:
E.Passport (certificate for telepsychology)
Interjurisdictional Practice Certificate (IPC) for temporary in-person, face-to-face
practice
• PSYPACT states communicate and exchange information including
verification of licensure and disciplinary sanctions.
• The Commission is the governing body of PSYPACT and is responsible
for its oversight and the creation of its Rules and Bylaws.

27. E.Passport Requirements
•Meet educational standards (doctoral
degree)
•Graduate degree (education, experience,
residency)
•Possess a current, full and unrestricted
license to practice psychology in a Home
State which is a Compact State
•No history of adverse action

28. E.Passport Requirements
•No criminal record history
•Provide attestations in regard to areas of
intended practice and work experience
and provide a release of information to
allow for primary source verification and
•Meet other criteria as defined by the
Rules of the Commission.

29. www.psypact.org
Resources include: Compact legislation, legislative
resource kit, FAQs, Up-to-date information about the
status of PSYPACT in each state
In Pennsylvania, we will need to work through PPA
and PennPsyPAC to pass legislation.

30. Summary
• Broadened the scope of what informed consent means in terms of
telepsychology practice
• We reviewed some risk management features
• We reviewed an overview of PSYPACT and why this may be
advantageous to psychologists who live on the borders of
Pennsylvania, psychologists who move into Pennsylvania, or move
out of Pennsylvania.