This document outlines key aspects of providing telepsychology services discussed in Part 2 of an introduction to telepsychology presentation. It defines important telepsychology terms and highlights that psychologists must understand definitions, technology like bandwidth, and the platform they are using. They must also follow standards of care for assessment, treatment and managing emergencies when providing remote services. The document emphasizes that telepsychology requires ongoing evaluation of a patient's suitability and that services must meet the same standards as in-person care.

1. INTRODUCTION TO
TELEPSYCHOLOGY: PART II
JOHN D. GAVAZZI, PSYD, ABPP
PENNSYLVANIA PSYCHOLOGICAL ASSOCIATION
AUGUST 2016

2. QUICK REVIEW
• Outlined the prevalence of online use
• Myths of telepsychology
• Patient resistance and patient benefits
• Psychologist resistance and benefits
• The Migration Model
• Legislative efforts in Pennsylvania

3. OUTLINE FOR TODAY
• APA Guidelines for the Practice of Telepsychology
• Definitions
• Competence of the Psychologist
• Standards of Care

4. LEARNING OBJECTIVES
At the end of today’s presentation, the participant will be able to:
1.List three important definitions in the
Telepsychology Guidelines,
2.Describe what bandwidth is and why it is
important to providing high quality
telepsychology services,
3.Write two important points related to the
delivery of telepsychology services.

5. DEFINITIONS SECTION:
WHAT ARE THE DEFINITIONS?
WHY IS THIS IMPORTANT?

6. DEFINITIONS OF TELEPSYCHOLOGY
• Telecommunication technologies: are not limited to telephone,
mobile devices, interactive videoconferencing, email, chat, text,
and Internet (e.g., self-help websites, blogs, and social media).
• Client or patient: the recipient of psychological services,
whether psychological services are delivered in the context of
healthcare, corporate, supervision, and/or consulting services.
• Remote: refers to the provision of a service that is received at a
different site from where the psychologist is physically located.

7. DEFINITIONS OF TELEPSYCHOLOGY
• Security or security measures: encompass all of the
administrative, physical, and technical safeguards in an
information system.
• Confidentiality: the principle that data or information is not
made available or disclosed to unauthorized persons or
processes.
• Information System: An interconnected set of information
resources within a system and includes hardware, software,
information, data, applications, communications, and people.
• Jurisdictions or jurisdictional (think interjurisdictional): when
referring to the governing bodies at states, territories, and
provincial governments.

8. WHY DOES THIS MATTER?
• Delineates how telepsychology services are different than face-
to-face
• Addresses synchronous and asynchronous formats
• Very broad-based and non-specific
• Addressing interjurisdictional practices
• Association of State and Provincial Psychology Boards (ASPPB)
has 12 points to differentiate face-to-face from telepsychology

9. COMPETENCE
• Difficult to quantify
• Know APA’s Ethical Principles of Psychologists and Code of
Conduct
• Know this Guideline
• Know basic concepts related to technology (which are coming)
• Know how to use the technology well enough to teach it to your
patient
• Know HIPAA as it applies to telepsychology (such as a BAA from
platform that you are using)
• Pay attention to the rest of today and tomorrow

10. BASIC TECHNOLOGICAL KNOWLEDGE
• Bandwidth
• Wi-Fi
• HIPAA Rules
• Synchronous versus asynchronous communication
• Know the platform that you are using
• Know how to seek assistance from your videoconference
provider
• Know the location of your patient

11. BANDWIDTH
• Bandwidth is the amount of information that can be “pushed
through” your internet services.
• The bigger bandwidth, the better. Rural versus urban areas.
• DSL (Digit Subscriber Line) vs. High Speed Internet access
• Usually measured in kilobytes/sec (Kbps) or megabytes/sec
(Mbps)
• Higher bandwidth allows information to be passed more
quickly, which translates into better image quality/voice
quality. (Download speed 44 Mbps and Upload of 10 Mbps).

12. MORE BANDWIDTH
• Use internet-based video conferencing software programs should
provide such services at a bandwidth of at least 500 Kbps in each of
the downlink and uplink directions. Such services should provide a
minimum of 640 x 480 resolution at 30 frames per second.
• Depending on the service provided, higher bandwidth speeds may be
needed, like MRIs and
• The platform security code makes the software bulkier, meaning your
system may use Skype well, but does not work with doxy.me.
• Most current phones and computer have sufficient resolution and
frames per second

13. EVEN MORE ON BANDWIDTH
• The best, most secure way to
use telepsychology services is
to use your Ethernet cable
and tap directly into the
internet.
• At a minimum, you will need
to know how to plug your
Ethernet cable from your
computer to your modem.

14. WHY AM I MAKING SUCH A BIG DEAL
ABOUT BANDWIDTH?
• Higher amounts of bandwidth make the telepsychology session
more fluid and real.
• Lower amount of bandwidth can lead to poor quality sound and
video which can decrease the flow of the session and create
multiple clarifications.
• Your patient’s bandwidth is as important as your bandwidth.

15. WHY AM I MAKING SUCH A BIG DEAL
ABOUT BANDWIDTH?
• What is coming: Google fiber, clocking in at 1,000 Mbps/sec
• Using cell phones for telepsychology can be more effective than
computer-based videoconferencing
• Cell phones typically use less bandwidth. However, cannot plug
directly into the internet with a cell phone. Therefore, you
must use Wi-Fi.

16. WI-FI, SECURITY AND YOU
• Wi-Fi is a technology that uses radio waves to
connect you to the internet.
• When information become airborne
(transmitted with radio waves), there is a
higher probability to intercepting or stealing
that information.
• Please advise patients to not use unsecured
Wi-Fi settings. Secure systems typically have
a “lock” icon and they have to provide a
password to log onto the Wi-Fi.

17. WI-FI, SECURITY AND YOU
• Your hardware does not have
to match your patient’s
hardware. So, you can be on
your computer, hardwired
into the internet via your
Ethernet cable, and your
patient can be using a secure
Wi-Fi network on his/her
phone.
• If you use a cell phone, you
may want to invest in a cell

18. WI-FI, SECURITY AND YOU
• Phone to phone typically uses the least bandwidth.
• Computer to computer uses the most bandwidth

19. HIPAA HAS THREE RULES: THEY ALL APPLY
Privacy: National standards for the protection of patient’s privacy
(Guideline 4).
Transmission: Includes transmission of patient information for
billing as well as treatment (Guideline 5)
Security: National set of security standards for protecting certain
health information that is held or transferred in electronic
form. (Guideline 5)

20. SYNCHRONOUS VERSUS ASYNCHRONOUS
Basically, synchronous is live and
interactive.
Asynchronous is stored and forwarded.

21. KNOW THE PLATFORM THAT YOU ARE
USING
• I recommend practicing with it multiple times.
• Use it to talk with friends in state and out of state.
• Folks who live in urban and rural areas to get a sense
of bandwidth.
• Practice so much that you can teach it to someone
easily, including set up, connecting, and using.

22. REACH OUT FOR HELP FROM YOUR
PLATFORM PROVIDER
• By using the tool, you may have questions. My suggestion is to
reach out the help desk to determine if they respond quickly
and resolve your issues.
• Most platforms are pretty good at this.
• Part of your competence is selecting a good videoconferencing
platform that can fulfill your clinical, ethical and legal
responsibilities.

23. KNOW THE LOCATION OF YOUR PATIENT
• Important to somehow verify the location of your patient, to
make sure that you are not practicing outside of your licensed
jurisdiction.
• Preference for the Migration Model
• Insurance coverage helps with assessing patient location

24. STANDARDS OF DELIVERY OF CARE
ASSESSMENT
PROVIDING CARE
MANAGING CRISES
IT MAY ALSO INCLUDE CONSIDERING WHETHER COMPARABLE IN-PERSON SERVICES ARE
AVAILABLE, AND WHY SERVICES DELIVERED VIA TELEPSYCHOLOGY ARE EQUIVALENT OR
PREFERABLE TO SUCH SERVICES. IN ADDITION, IT IS INCUMBENT ON THE
PSYCHOLOGIST TO ENGAGE IN A CONTINUAL ASSESSMENT OF THE APPROPRIATENESS
OF PROVIDING TELEPSYCHOLOGY SERVICES THROUGHOUT THE DURATION OF THE
SERVICE DELIVERY.

25. ASSESSMENT
• Is the patient requesting or are you pushing telepsychology?
• Have you done a face-to-face assessment?
• Can this person be helped with telepsychology services?
• What patient factors support using telepsychology?
• What patient factors suggest not using telepsychology?
• Are you using a Migration Model? If not, why not?
• Does their insurance reimburse for telepsychology?

26. PROVIDING CARE
• Needs to meet same standard of care for face-to-face patients
• Ongoing assessment is appropriate for telepsychology patients
• Is your patient making progress? How to assess?
• If not making progress, what are your choices?
• Miscommunications and misunderstanding
• Maintaining boundaries between sessions

27. MANAGING EMERGENCIES
• How will you manage patient crises and emergencies?
• What happens if you lose your connection?
• What happens if your internet goes out?

28. WRAP UP PART 2
DEFINITIONS
COMPETENCE: BANDWIDTH, TECHNOLOGY, PLATFORM, ETC.
STANDARDS OF SERVICE DELIVERY