The 4-hour Emergency Telehealth Best Practices Clinical Training for COVID-19 has been developed to give you the bare essentials of setup, documentation, and informed consent AND a heavy focus on the clinical realities, that is, how to handle the risks of poorly-managed telehealth.
The focus of this 1-day intensive, LIVE, interactive, video-based training is on how to prevent and handle clinical problems that can result from quickly migrating your practice to your home. As a course, this program will briefly cover current events, including recent federal changes, critical ethical, legal, and technical issues for the first hour, with the remaining hours focused on the complex clinical challenges that can arise, how to prevent and handle them. This roll-up-your-sleeves clinical webinar workshop will describe existing, published competencies needed for clinical assessment and care in telepractice, and then focus on specific topics of immediate need for coping with quickly setting up telepractice because of the COVID-19 emergency.
Topics
Evidence-based protocols to minimize later complications
What to say to educate your client/patient about telehealth
Establishing appropriate boundaries and what to do when they fail
Maintaining essential privacy protections in your home and your client/patient’s
Essential informed consent
Cultural Sensitivity
Documentation
What to do when the connection is lost
How to perform essential clinical functions such as gait analyses, hygiene checks, maximizing privacy
Controlling your client or patient’s room
How to handle intruders from either your room as the practitioner
How to handle intruders from your client or patient(s) room
Setting and maintaining the therapeutic frame
Including family members in the session
Anxieties about working with technology
Clinician self-care
Handling requests for clients/patients to stay connected while in other states
Evidence-based models for preventing and handling emergencies
This will be a hands-on, practical, interactive experience to allow you to get a true sense of the power of using video conferencing, but it will be tinged with sobering information to keep you professional, focused and in charge of your telehealth interactions. You will participate in a clear discussion of “dos and donts,” along with their rationales, to allow you to make your own clinical decisions for the people that you serve.
Basic competencies covered include documentation requirements, safety protocols and how to effectively involve family members or friends.
As a community service, TBHI is honored to be offer a FREE informational course to the behavioral community of professionals at this worrisome time.
Resources are being offered by a number of key groups to help you get immediate, accurate and helpful information
Attend this webinar to hear the evidence supporting practice models that can be legitimately offered from your home. You will be delighted to see several viable models that meet all required legal and ethical mandates, are evidence-based, competency-based and are financially successful — not only in the United States but across the globe.
FREE with this coupon code: COVID
Available immediately upon registration
100% online access, 24/7 for 6 months
Available wherever you are with an internet connection
1 CME or CE Hour Available at 50% off if needed ($39.50) after viewing
This document provides information about conducting telehealth sessions. It discusses that telehealth allows providers to interact with clients remotely using video chat technology. It provides guidance on getting started with telehealth including checking licensing and reimbursement rules, setting up technology, preparing the environment, and obtaining client consent. The document offers tips for a successful telehealth session such as dressing professionally, having proper lighting, and maintaining eye contact. It stresses the importance of being in a quiet, private space free from distractions.
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Emergency Telehealth Best Practices Training for COVID-19 has been developed to give you the bare essentials of telehealth setup, documentation, and informed consent. 1 CME or 1 CE is available for free through the Telebehavioral Health Institute, LLC through 2020.
USE THIS CODE in the shopping cart to get this 100% online professional training FOR FREE: "COVID" by reading the description and scrolling to bottom where you can register: :https://telehealth.org/COVID
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As a community service, TBHI is honored to be offer a FREE informational course to the behavioral community of professionals at this worrisome time.
Resources are being offered by a number of key groups to help you get immediate, accurate and helpful information
Attend this webinar to hear the evidence supporting practice models that can be legitimately offered from your home. You will be delighted to see several viable models that meet all required legal and ethical mandates, are evidence-based, competency-based and are financially successful — not only in the United States but across the globe.
FREE with this coupon code: COVID
Available immediately upon registration
100% online access, 24/7 for 6 months
Available wherever you are with an internet connection
1 CME or CE Hour Available at 50% off if needed ($39.50) after viewing
This document provides information about conducting telehealth sessions. It discusses that telehealth allows providers to interact with clients remotely using video chat technology. It provides guidance on getting started with telehealth including checking licensing and reimbursement rules, setting up technology, preparing the environment, and obtaining client consent. The document offers tips for a successful telehealth session such as dressing professionally, having proper lighting, and maintaining eye contact. It stresses the importance of being in a quiet, private space free from distractions.
This document summarizes an episode of "The Entrepreneur's Radio Show" that interviews Dr. Arlen Meyers. Dr. Meyers is a world-renowned physician in ENT medicine and a professor. He is also a successful entrepreneur who commercialized a medical device he invented to detect oral cancer. In the interview, Dr. Meyers discusses his background in bioengineering and how he applied his medical and academic experience to successfully start a business. He also believes both physicians and entrepreneurs use both logical "left-brain" skills and intuitive "right-brain" skills in their work, though they may not recognize both aspects. The interview explores how developing both analytical and creative abilities can help anyone become a
Emergency Telehealth Best Practices Training for COVID-19 has been developed to give you the bare essentials of telehealth setup, documentation, and informed consent. 1 CME or 1 CE is available for free through the Telebehavioral Health Institute, LLC through 2020.
USE THIS CODE in the shopping cart to get this 100% online professional training FOR FREE: "COVID" by reading the description and scrolling to bottom where you can register: :https://telehealth.org/COVID
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The document provides information on best practices for telehealth during the COVID-19 pandemic. It discusses topics such as obtaining informed consent, updating websites with COVID-19 information, considering the appropriate technology based on a client's diagnosis and environment, and communicating with clients via email or text messaging while maintaining privacy and documenting communications. The document emphasizes applying an ethical risk-benefit analysis and advising clients that some rules have been temporarily relaxed due to the emergency situation.
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This document provides guidance on best practices for telehealth during the COVID-19 pandemic from the Telebehavioral Health Institute. It discusses preventing interruptions during telehealth sessions, making to-do lists, the evidence base for telehealth, fundamentals of telehealth including legal and ethical compliance, demonstrating telehealth competence, technology choices, clinical and technical issues, HIPAA requirements, the impact of technology on the therapeutic relationship, variations in connectivity, temporary relaxing of HIPAA enforcement and licensing requirements during COVID-19, informed consent issues, and implications of COVID-19 for clinical work.
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The document discusses best practices for clinical telehealth, including establishing telepresence to maintain a connection with clients, screening clients for appropriateness for telehealth services, adapting in-person clinical practices and care requirements for telehealth while maintaining quality, and validated methods for conducting assessments over telehealth technologies. It provides guidance on domains such as evaluation and treatment, technology, and legal and ethical considerations.
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2) It outlines various ethical codes that relate to text therapy and discusses ensuring informed consent, adhering to boundaries of competence, and using evidence-based practices.
3) The document also discusses legal issues like HIPAA compliance, using secure platforms, and addressing issues that may arise when accepting employment from online text-based employers.
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Internet counseling allows licensed therapists to provide counseling services to clients remotely through online means such as email, videoconferencing, and chat rooms. Some key advantages are anonymity and increased convenience without needing to travel to an office, which can benefit those with disabilities, time constraints, or phobias. However, therapists have a limited view of clients' expressions and body language online. Ethical considerations of internet counseling include ensuring client confidentiality, verifying client and therapist identities and credentials, addressing technological limitations, and maintaining professional accountability. While some research shows internet counseling can be effective, more studies are still needed, especially in comparing its efficacy to traditional face-to-face counseling.
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The document summarizes key points from a webinar on improving communication between clinical and IT staff. The presenter, an emergency physician and IT consultant, discusses how clinicians and IT professionals have different cultures and languages. He emphasizes the importance of understanding the clinical perspective and priorities, such as saving time, making work easier, and helping patients. The presenter also provides tips for IT staff to effectively engage with clinicians, such as using respected doctors to advocate, providing food at meetings, and communicating messages simply and concisely. He warns that failing to properly communicate and align goals can undermine projects and damage credibility.
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To increase patient engagement, positive outcomes, and patient satisfaction, practices and health systems need to focus on reaching their current patients.
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1) The document discusses 12 risk management considerations for using text messaging in behavioral health practice.
2) It outlines various ethical codes that relate to text therapy and discusses ensuring informed consent, adhering to boundaries of competence, and using evidence-based practices.
3) The document also discusses legal issues like HIPAA compliance, using secure platforms, and addressing issues that may arise when accepting employment from online text-based employers.
201 Telehealth Law and Ethical Issues Finished 6.7.23.pptxMarlene Maheu
This document provides an overview of telehealth law and ethical issues related to practicing telehealth across state lines in accordance with HIPAA, malpractice, billing, and other considerations. The presenter, Marlene Maheu, is the executive director of Telehealth.org and founder of the Journal of Technology in Behavioral Science. She has over 100 hours of training in telebehavioral health clinical, legal, and ethical risk management and has published extensively on telehealth topics. The presentation will discuss informed consent, HIPAA compliance, interstate practice licensure issues, cultural awareness, telesupervision, and reimbursement among other topics over the course of a three hour training.
This webinar provided an opportunity for participants to ask questions about the implementation of Early Intervention Targeted Case Management (EI TCM) in Virginia. The webinar covered several topics related to EI TCM including practitioner requirements, provider requirements, billing and reimbursement, family contacts, documentation requirements, health status indicator questions, and transitioning children currently receiving TCM services. Participants could ask questions about these topics using the chat function. Contact information was provided for the webinar speakers and a website was provided with additional documents related to EI TCM implementation.
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The document provides information on setting up a video-based office for telehealth. It discusses the necessary hardware, including computers, cameras, monitors, speakers and what issues may arise. It also covers software options and how to ensure compliance with HIPAA. Additional topics covered include properly setting up the office environment, professional presentation, working with clients, emerging video technologies and their impact on telehealth, and legal and ethical considerations.
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Internet counseling allows licensed therapists to provide counseling services to clients remotely through online means such as email, videoconferencing, and chat rooms. Some key advantages are anonymity and increased convenience without needing to travel to an office, which can benefit those with disabilities, time constraints, or phobias. However, therapists have a limited view of clients' expressions and body language online. Ethical considerations of internet counseling include ensuring client confidentiality, verifying client and therapist identities and credentials, addressing technological limitations, and maintaining professional accountability. While some research shows internet counseling can be effective, more studies are still needed, especially in comparing its efficacy to traditional face-to-face counseling.
This document discusses how medical practice managers can optimize their use of technology through cloud computing solutions. It begins by debunking common myths about high costs and IT expertise being required. Specific examples are provided of how the author implemented cloud-based solutions for electronic medical records, telephone systems, payroll, and other services, saving thousands of dollars annually compared to traditional on-premise systems. The document encourages managers to research affordable cloud alternatives before making new technology purchases.
This document summarizes a presentation on developing a telepractice business model during the COVID-19 pandemic. It discusses legal, ethical and financial considerations including: obtaining proper insurance and tax advice; maintaining client privacy and cybersecurity; clearly communicating policies on fees, cancellations and recordings; distinguishing personal and professional device use; and creating best, moderate, and worst case financial scenarios accounting for fixed and variable costs. The presentation advises speech pathologists transitioning services online to carefully prepare for each telepractice session and maintain a professional environment.
The document discusses new ethical dilemmas for mental health professionals regarding the use of technology. It provides guidance on email, texting, and videoconferencing within the requirements of HIPAA and 42 CFR Part II. The presentation reviews the risks of using these technologies, such as lack of security, and outlines best practices for digital communication to maintain client privacy and confidentiality. Recent changes to regulations have provided more flexibility for telehealth during COVID-19 while still requiring reasonable safeguards of protected health information.
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Place-Based Point-of-Care Patient Education Reaching Ultra-Targeted Women, Di...Care Media Holdings
Digital out-of-home advertising like CARE Media TV Networks provide health and wellness content in medical office waiting rooms. CARE Media operates three networks - KidCARE TV in pediatric offices, Women's HealthCARE TV in OB/GYN offices, and PetCARE TV in veterinary offices - that reach over 5,000 screens. Physicians and their staff report that patients are engaged with the educational programming. The document outlines CARE Media's targeting of women audiences and ability to reach consumers in a captive setting without distractions, providing exclusive advertising opportunities for brands.
The document summarizes key points from a webinar on improving communication between clinical and IT staff. The presenter, an emergency physician and IT consultant, discusses how clinicians and IT professionals have different cultures and languages. He emphasizes the importance of understanding the clinical perspective and priorities, such as saving time, making work easier, and helping patients. The presenter also provides tips for IT staff to effectively engage with clinicians, such as using respected doctors to advocate, providing food at meetings, and communicating messages simply and concisely. He warns that failing to properly communicate and align goals can undermine projects and damage credibility.
The document discusses the high costs and inconvenience of the current healthcare system for both individuals and employers. It then introduces CADR+ as a telemedicine program that provides 24/7 access to licensed physicians via phone or video consultations to diagnose common conditions and prescribe medications when needed. This allows people to get healthcare conveniently without taking time off work or paying high costs for urgent care or emergency room visits. The program aims to reduce healthcare costs and increase access and satisfaction for both individuals and employers.
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This document provides guidance on best practices for using telehealth, including different modalities like phone conferencing, video conferencing, and app-based services. It discusses dos and don'ts for each approach, such as finding a private space for video sessions and ensuring technology is set up properly. Engaging clients in telehealth is also addressed, with tips like explaining any security measures and checking in frequently on their experience. A variety of free or low-cost technology options are presented. Overall, the document outlines how telehealth can increase access to care during crises while maintaining standards of privacy and effectiveness.
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The document provides best practices for using various forms of telehealth including phone conferencing, video conferencing, app-based mental health, and communicating with clients. It discusses dos and don'ts for each method, how to engage clients, address barriers to access, and considerations for ensuring privacy and security. Common technologies that can be used for telehealth like Zoom and specific mental health apps are also outlined.
The document discusses a voice-based heart health program called HEARTPartner that provides daily risk assessments, education, and support for patients with chronic heart conditions. It integrates data from electronic medical records and devices to personalize the patient experience. The program qualifies doctors to bill Medicare, with the potential to generate substantial revenue. It has won several awards for its innovation and success in engaging patients. The company seeks partnerships with organizations like Novartis to expand its expertise in digital patient engagement and voice technologies.
To increase patient engagement, positive outcomes, and patient satisfaction, practices and health systems need to focus on reaching their current patients.
The document discusses the importance of relationship-based care in veterinary medicine. It notes that current models focus too much on efficiency and not enough on communication, which can decrease trust, compliance, and satisfaction for both veterinarians and clients. To provide better care, veterinarians need to slow down visits, engage empathetically with clients, listen to understand their pet's lifestyle and social context, and discover non-medical clues from the home environment. Building relationships through caring interactions leads to increased compliance, better health outcomes, and a more successful practice over the long term. The key is for veterinarians to practice strong communication and engagement skills.
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Need CME(s), CNE(s), or CE(s)?
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For a full-service telehealth training segment associated with this topic, see https://telehealth.org/legally-ethically-marketing-your-telehealth-services/
Need CME(s), CNE(s), or CE(s)?
Register for full CME, CNE, or CE credit(s) for multi-modal, 100% online, on-demand telehealth professional training programs. Registration gives you access to slides, handouts, course materials, and course completion certificates for your licensing board: http://telehealth.org/course-catalog.
Read our 700+ no-cost blog posts at https://blog.telehealth.org, and register for one of our 55+ no-cost telehealth newsletters at https://telehealth.org/signup. If you are seeking telehealth-specific vendors to provide technology, visit https://guide.telehealth.org.
This document discusses legal and ethical considerations for telehealth jobs that can be done from home. It identifies several key issues, including:
1. Legal issues like ensuring proper licensure for the state where clients are located, complying with zoning laws, and addressing questions from insurance companies.
2. Ethical issues like maintaining appropriate boundaries and preventing interruptions, ensuring informed consent addresses the home setting, and protecting privacy and limiting distractions.
3. Technical issues like ensuring adequate bandwidth and connectivity for video sessions and protecting virtual waiting areas from other home occupants.
The document provides guidance on addressing these issues, such as developing clear protocols for sessions, notifying family of appointment times, and checking insurance policies for
International Cancer Survivors Day is celebrated during June, placing the spotlight not only on cancer survivors, but also their caregivers.
CANSA has compiled a list of tips and guidelines of support:
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Physical Benefits: Discusses how exercise aids in weight management, muscle and bone health, cardiovascular health, and flexibility.
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Tips for Staying Active:
Encourages consistency, variety in exercises, setting realistic goals, and finding enjoyable activities to maintain motivation.
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Integrating Nutrition and Exercise: Suggests meal planning and incorporating physical activity into daily routines.
Monitoring Progress: Recommends tracking food intake and exercise, regular health check-ups, and provides tips for achieving balance, such as getting sufficient sleep, managing stress, and staying socially active.
Dr. David Greene R3 stem cell Breakthroughs: Stem Cell Therapy in CardiologyR3 Stem Cell
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KEY Points of Leicester travel clinic In London doc.docx
Telehealth Clinical Best Practices for COVID-19
1. Telehealth Clinical Best
Practices Workshop
MARLENE M.
MAHEU, PHD
EXECUTIVE
DIRECTOR
TELEBEHAVIORAL
HEALTH INSTITUTE
CONTACT@
TELEHEALTH.ORG
619-255-2788
APA WEBINAR
MARCH 20, 1994-
2020
Copyright 1994-2020 Telebehavioral Health Institute, LLC All rights
reserved.
2. Learning
Objectives
Identify at least three basic
definitions used in telehealth.
Outline a validated model for
conducting assessment
through video-conferencing.
Identify at least three
telehealth issues regulated by
state boards.
Identify at least three
telehealth issues regulated by
the ethical codes of
professional associations.
3. Learning
Objectives
Describe how you would know
which of the many technologies
available today meets HIPAA,
HITECH and/pr PIPEDA
requirements
Describe how to manage your
therapeutic relationship in the
face of a failing video
conferencing platform.
Discuss how you would handle
an unwanted intruder if they
entered your room
Discuss how you would handle
an unwanted intruder if they
entered your client/patient’s
room
4. Disclaimer/Disclosure
GOAL: My goal is educational only. No warranty, guarantee,
or representation is made as to the accuracy or sufficiency of
the information contained in our presentation for your specific
circumstance.
YOUR PART: You are encouraged to seek practice-specific
advice from your legal, regulatory, ethical and malpractice
bodies before offering any online services or programs to
consumers. Get all such opinions in writing, and have your
informed, local, legal counsel review them for their full
significance.
I have no conflicts of interest with any groups identified in this
training.
Copyright 1994-2020 Telebehavioral Health Institute, LLC All rights
reserved.
5. Issues involved with COVID-19
are complex, fact-specific and
state-specific. They will require
legal expertise that I cannot
provided in this presentation.
I do not, and cannot, provide legal
advice. The information that I
present does not constitute and
should not be relied upon as legal
or ethical advice and should not
be used as a substitute for
obtaining personal legal advice
and consultation prior to making
decisions about your work.
6. Today’s Schedule
Times: 2 – 6:30 PM Eastern
A 15 min. break will be from 3:15-
3:30 PM Eastern
A 15 min. break will be from 5:00-
5:15 PM Eastern
7. CME or
CE
You must complete a course
evaluation and post-test to unlock
and print a Course Completion
Certificate for your licensing board
Your will see one for all the types of
CME and CE offered
Just like in-person training, if you
arrive more than 15 minutes late,
we cannot give you “live” credit
We will need you to type a message
at the end of all breaks so that we
know that you are here
Software keeps track of your ISP
and times that you comment
8. Please
Interact
This was event is designed to
be a workshop –we can
interact
Please contribute to the group
discussion
The chat room is open for
everyone to see
I will read your questions and
as much of the answers as
possible
If you get out of hand, I will
remove you from the room and
refund your fees…
9. Today’s Webinar
The Internet Is Straining
Copyright 1994-2020 Telebehavioral Health Institute, LLC All rights reserved.
PLEASE
UNDERSTAND
. YOU MAY
NOT HEAR OR
SEE
EVERYTHING.
INTOLERAN
T
RESPONSE
S TO
FAILING
TECH
DON’T
HELP
IF YOU
CANNOT
SEE ALL OF
THIS
EVENT, IT
WILL BE
RECORDED
IF THE
RECORDING
IS NOT
PERFECT,
PLZ KNOW
THAT WE ARE
TRYING
10. Make a To-Do List
Optimize Your Learning
1. Mute your phone, turn off texts and
emails, lock your door
2. Organize yourself by
3. making a to-do list as we go
4. Rank order your to-dos by priority
5. Consider meeting with like-minded
colleagues to discuss your
implementation plan
13. Poll
Copyright 1994-2020 Telebehavioral Health Institute, LLC All rights reserved.
My technical
incom-
petence will
show
I will make a
clinical
mistake
I won't get
paid
I can't
control the
other site
14. Attitude
Reflect on what’s happening
Share those views with colleagues
Self-discipline
Stay sober
Get and share the facts to reduce unneeded anxiety
Stay away from main stream TV
Engage in activities that will calm you
Call the older generation
Create a new playlist, experiment with new recipes, go
outdoors for a long walk every day
15. Attitude
Reflect on what’s happening worldwide
Share views with trusted colleagues
Self-discipline
Stay sober
Get and share the facts to reduce unneeded
anxiety
Read “The Story of a Coronavirus,” New York
Magazine
16. Client/Patient Education
Copyright 1994-2020 Telebehavioral Health Institute, LLC All rights reserved.
You need to check in more Technology is unforgiving.
Learning curve is steep.
Can create anxiety
t
17. Cons
Copyright 1994-2020 Telebehavioral Health Institute, LLC All rights
reserved.
MORE MISTAKES
BECAUSE YOU
HAVE LESS
INFORMATION
“REPEAT IF I’M
NOT GETTING IT”
LET’S GO
SLOWLY
EXTRA CAUTION
NEEDED
Client/Patient Education
18. Telehealth Guidelines?
The American Telemedicine Association and
the America Psychological Association
published Telepsychology Guidelines in 2013
NASW and other groups published a
guideline in 2017
American Psychiatric Association in
conjunction with American telemedicine
Association published guidelines in 2019
Reading a guideline does not establish
competence
20. Do we really need special
telehealth training?
Competence in behavioral health is NOT equivalent to
competence as a telebehavioral health professional
All ethical codes require competence in our
professional practices
Competencies have since been published in
telebehavioral health.
It would be in your best interest to download a FREE
copy, and consider whether you can do what is
expected of you as a professional
21. Do we really need special
telehealth training?
Competencies have since been published in
telebehavioral health.
Download a FREE copy, and consider whether you
can do what is expected of you as a professional
24. Fundamentals of Telehealth
The fundamentals of
responsible clinical practice do
not change with telehealth.
Good clinical practice remains
the same regardless of delivery
vehicle.
Adoption is changing
25. Fundamentals of Telehealth
Right now, we are experiencing
forced adoption.
However, whether you use video,
telephone, text, email, apps,
artificial intelligence, remote patient
monitoring or any other tech, you
are responsible through your legal
and ethical codes to maintain the
same quality of care as in-person.
26. With integrity, you have
nothing to fear, since you
have nothing to hide.
― Zig Ziglar
27. Fundamentals of Telehealth
Telehealth is much like
driving a car. It can take
a few months of regular
practice to learn and
remember safe
response sets, develop
reflexes, etc.
28. Fundamentals of Telehealth
Telehealth is similar. However,
right now, in this extraordinary,
worldwide state of emergency, so
many clinicians are untrained that
the rules must be temporarily
relaxed.
Keeping clients/patients safe is
more important than attending to
other safety rules such as privacy
right now.
29. Role of Good
Clinical
Practice &
Work Ethics
Practitioners have
traditionally been free to
practice from their homes,
but cautioned to exercise
good clinical judgment
Same is true today with
COVID-19 as well
Not time to throw out the
rule book
Copyright 1994-2020 Telebehavioral Health Institute, LLC All rights
reserved.
31. Home-Based Ethical Issues
BOUNDARIES:
You may inadvertently violate your own
boundaries
Noises / sounds (spouse yelling at
children)
Children / adults in background,
seen through windows, doors
Personal items visible in background
Copyright 1994-2020 Telebehavioral Health Institute, LLC All rights
reserved.
32. Home-Based Clinical Issues
Maintaining Consistency/Predictability
Help clients/patients focus off your home to
thinking of your office
Post an image of your office waiting room
Post images of your furniture (chair, sofa,
desk)
Include office décor in your background
(picture, vase, etc.)
Keep reins on your starting/ending times
Copyright 1994-2020 Telebehavioral Health Institute, LLC All rights
reserved.
33. Home-Based Clinical Issues
Maintaining Consistency/Predictability
Keeps things quiet at home
Play ambient music very softly
Ask them if it bothers them
Be extra cautious about comments regarding
your home or family
If your doorbell rings, only respond if you
suspect an emergency
Let the sign on your door direct them
Copyright 1994-2020 Telebehavioral Health Institute, LLC All rights
reserved.
34. Home-Based Clinical Issues
Maintaining Consistency/Predictability
Keep the focus on them
Develop a 1-line response to deal with
normal curiosity about your home life
Use the same line repeatedly and
did no diverge
They will get the message
Copyright 1994-2020 Telebehavioral Health Institute, LLC All rights
reserved.
35. Home-Based Clinical Issues
Maintaining Your Therapeutic Frame
Don’t deny someone’s reality by lying
about:
what you just did
what they just saw
Own it and deal with whatever comes
next
Be yourself
Copyright 1994-2020 Telebehavioral Health Institute, LLC All rights
reserved.
36. Boundaries Are Key
You may forget to notify family and
friends of your professional appointment
schedule – they may unknowingly
interrupt your professional time
You may be flustered when dealing with
an emergency because you have not
practiced coping with crisis when using
technology. Best to “practice” with
colleagues and not clients and patients
Copyright 1994-2020 Telebehavioral Health Institute, LLC All rights
reserved.
37. Procedures Are Also Key
Start a session with an opening protocol
That protocol includes formal procedures
to secure both ends of the meeting
Ask your client/patient to identify
themselves if you don’t know thm well
As where they are
Ask them to scan room with camera if
needed
38. Procedures Are Also Key
Develop a non-verbal, fail-proof system to notify family or
friends when you are in session
Lock your home office door
“Do not disturb” note on door
Note on kitchen counter
Text message others
Turn your camera away from the door
39. Video
“Ooopsies”
Cameras may show
your more than you see
on your end
Clean your background
all the way to the
corners of your room
Test with family/friends
Prepare a response if
someone comments on
what they see
41. Clinical Issues &
Production Values
v Avoid:
v “ One-eyeball Effect”
v Showing Your Client the
Inside of Your Nose
v Messy Backgrounds
v Noisy Children, Spouses,
Curious Cats or a Barking
Dog(s)
v Doorbells (put sign on door)
C 1994-2020 Telebehavioral Health Institute, LLC All rights reserved.
42. Home-Based Clinical Issues
Stretching Your Comfort Zone
Stretching is needed, but don’t over-do
Master one thing at a time
Avoid multiple platforms, devices, apps,
etc.
Find a 1-stop shop to deal with several of
your tech needs
Copyright 1994-2020 Telebehavioral Health Institute, LLC All rights
reserved.
45. Results: From a total of 4,712 potential
references, 453 were eligible for full
text review and 77 papers directly
related to the concepts.
From papers’ references and a review
of books and popular literature, 12
other sources of information about TPr
and VR were found. Though few
studies literally discuss the
therapeutic relationship, the impact
of technology on clinical
engagement and communication is
growing, from clinical (e.g.,
psychotherapy) and non-clinical (e.g.,
communication, TPr) literature.
Impact of
technology on
therapeutic
relationship
46. Avoid
Distractions
The historical evolution of TPr and VR
shows that definitions, foci of studies
… and assessments vary widely. TP
and TBH care can be improved by
concepts of TPr, avoiding
distractions, understanding the
technology-human interface,
measures of TPR for clinical use and
the use of simulation for training.
Reference: Hilty DM, Randhawa K, Maheu
MM, McKean AJS, Pantera R. Therapeutic
relationship of telepsychiatry and
telebehavioral health: Ideas from research on
telepresence, virtual reality and augmented
reality Psychol Cogn Sci Open J. 1994-2020;
5(1): 14-29. doi: 10.17140/PCSOJ-5-145
49. Variations in Connectivity
When at Home
Commercial vs. residential connectivity
Differences in bandwidth
Bandwidth speed can also differ by time of
day. After school is often a high traffic time
and Internet speed can be significantly
slower.
53. Some people are uncomfortable
with technology
Different technologies are better for
specific tasks
54. Difficult to stay focused
with the telephone for
long meetings. Easy to
get bored or distracted.
Video is better to keep
parties engaged.
C 1994-2020 Telebehavioral Health Institute, LLC All rights reserved.
55. Can’t blame the technology company, the Internet,
or the fact that you didn’t know better.
Copyright 1994-2020 Telebehavioral Health Institute, LLC All rights
reserved.
The
responsibility
is on your
shoulders
56. Ignorance is not a defense
in the face of the law
Copyright 1994-2020 Telebehavioral Health Institute, LLC All rights
reserved.
The
responsibility
is on your
shoulders
57. Legal Issues of
Relevance when
Working from Home
C 1994-2020 Telebehavioral Health Institute, LLC All rights reserved.
58. Temporary
Relaxing of
HIPAA vs
Privacy
Requirements
Copyright 1994-2020 Telebehavioral Health Institute, LLC All rights
reserved.
We are in a state of
international emergency
Laws are getting
relaxed, just as they
would be in a hurricane
HIPAA is being relaxed
in some very specific
ways
59. How do you establish
competence?
Education/Training
Supervision
Experience / Self-instruction
Documentation
Informed Consent
Intake forms
Progress notes
Termination notes
Risk assessments
Referrals
60. Basic Telehealth Legal Errors
Billing inaccurately (insurance fraud)
Wrong licensure (practicing without a
license)
Practicing anonymously (precludes
mandated reporting)
No continuity of care
Wrong technology (privacy, security,
data integrity) HIPAA and HITECH)
Copyright 1994-2020 Telebehavioral Health Institute, LLC All rights
reserved.
61. Temporary
Relaxing of
HIPAA versus
Legal and
Ethical
Privacy
Requirements
Copyright 1994-2020 Telebehavioral Health Institute, LLC All rights
reserved.
It is our job to know the laws,
and only relax the ones that we
MUST relax
State laws and ethical principles
related to privacy (and other
areas) are not going out the
window
They will hopefully change, but
we must assume that they were
put into place to protect citizens
and most of them will go back
into effect post-COVID-19
64. HIPAA Rules
HIPAA rules are being relaxed by
the Department of Health &
Human Services
Ok to speak with other
professionals without explicit
release form
Traditional HIPAA discussions
with clients/patients have
included this basic permission
for decades anyway.
HIPAA basics
should be in
place
65. HIPAA COVID-19 Update
Copyright 1994-2020 Telebehavioral Health Institute, LLC All rights reserved.
Not impose penalties
for noncompliance
under good faith
provision of telehealth
Can use any non-
public facing remote
communication
product during during
COVID-19 emergency
66. HIPAA COVID-19 Update
Copyright 1994-2020 Telebehavioral Health Institute, LLC All rights reserved.
Can use audio or
video and applies
to telehealth
provided for any
reason
Assess or treat any
other medical
condition, even if
not related to
COVID-19
67. HIPAA COVID-19 Update
Copyright 1994-2020 Telebehavioral Health Institute, LLC All rights reserved.
Notify patients that
these third-party
applications
potentially introduce
privacy risks
Use all available
encryption and
privacy modes when
using such
applications
68. HIPAA COVID-19 Update
Copyright 1994-2020 Telebehavioral Health Institute, LLC All rights reserved.
•For added protections,
these are some options
of HIPAA-Compliant
services
Skype for Business,
Updox, Vsee, Zoom
for Healthcare,
Doxy.me, Google G
Suite Hangouts Meet
69. HIPAA COVID-19 Update
Copyright 1994-2020 Telebehavioral Health Institute, LLC All rights reserved.
•Some public-facing
video technologies
should not be used
Facebook Live, Twitch,
TikTok, and similar
video communication
applications are public
facing, and
should not be used
70. HIPAA COVID-19 Update
Copyright 1994-2020 Telebehavioral Health Institute, LLC All rights reserved.
Applies to
telehealth provided
for any reason –
does not have to
be COVID-related
Assess or treat any
other medical
condition, even if
not related to
COVID-19
72. What does COVID-19
mean for your work?
The clinical ramifications of giving increased access to you
through technology must be weighed with a risk
assessment of the person in question.
1. What is their diagnosis?
2. What does that diagnosis tell you about their ability to
push any boundaries that you wish to put into place with
technology after the current situation subsides?
3. Can you expect compliance?
73. What does COVID-19
mean for your work?
Consider video conferencing
You may also want to consider any communication
channel that you determine to be necessary to keep
people safe
If you choose to proceed, advise your clients and
patients that rules have been lifted temporarily, much
as they would be in a flood zone or other natural
disaster experiencing an emergency
74. What does COVID-19
mean for your work?
Options Beyond Video Conferencing
Send emails to keep everyone informed? If yes, email the
message to yourself, and BCC your intended recipients so
they won’t see each other on the TO: line of your email
Communicate with your clients and patients in unsecured
text messaging already built into your devices? If yes, think
about what you write, how it might be mis-interpreted, and
document your communications.
75. What does COVID-19
mean for your work?
Options Beyond Video Conferencing
Unencrypted text messages either reside on your SIM
card or in the circuitry of the mobile phone. Messages
then, can be discovered later and given from one party to
another through the hardware of the phone.
Point: be judicious about what you say
Avoid LOL, emoticon, memes, etc.
Maintain your professional boundary at all times
76. What does COVID-19
mean for your work?
I’m not a lawyer, but given the circumstance, a
reasonable way to proceed could be:
1. Consider diagnosis, risk analysis, history, living
situation, physical health and make your
determination for each person individually
2. Give your patients or client dynamic informed
consent about risks and benefits
3. Document rationale and time/day of IC
4. Carry on
77. Join Your National, State,
Provincial or County
Psychological Associations
It is time to connect with both
our national and local
professional communities
Get on their mailing lists
Give them a hand if you have
time
79. Licensing
Boards
Licensing laws are in flux
Usually, you have to be
licensed where you client
or patient is at the time of
the contact
NOW - Check with your
state board’s website
Get on any mailing lists
Check the Center for
Connected Health Policy
Copyright 1994-2020 Telebehavioral Health Institute, LLC All rights
reserved.
83. CALIFORNIA Department of Managed
Health Care (DMHC) is requiring all
[insurance health] plans to reimburse for
telehealth at the same level they
reimburse for face-to-face visits.
84. What are
traditional
telehealth
jurisdictional
limitations?
Licensing laws are in flux.
To comply with licensing
law, you must traditionally
be licensed in the state (or
province) where your
client/patient is at the time
of the contact, regardless of
where you live or work.
Much telehealth is
conducted by practitioners
in their home offices.
Copyright 1994-2020 Telebehavioral Health Institute, LLC All rights
reserved.
86. How to handle?
Realize that employer,
insurance company and
other forms are legal
declarations
Always tell the truth
Always inform your
malpractice carrier
88. Telebehavioral Health
Standards & Guidelines
American Medical Association
American Counseling Association
American Mental Health Counselors Association
American Psychological Association
American Telemedicine Association
Australian Psychological Society
British Psychological Society
Canadian Psychological Association
Copyright 1994-2020 Telebehavioral Health Institute, LLC All rights
reserved.
89. Telebehavioral Health
Standards & Guidelines
Federation of State Medical Boards
National Association of Social Workers
New Zealand Psychological Psychologists Board
Ohio Psychological Association
For specific documents, see:
http://telehealth.org/ethical-statements
Copyright 1994-2020 Telebehavioral Health Institute, LLC All rights
reserved.
91. Informed Consent Issues
IC is Not Directly Relevant in Home-Based
Telehealth Delivery
IC is a legal as well as ethical issue
Most state laws and ethical codes do
not ask you to describe where you are
at any given time when using
telehealth
If you mention it however, you will
need to deal with consequences as a
therapeutic boundary issue
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reserved.
94. COVID-19 Funding
Changes affect Medicare, Medicaid and in some states,
the 3rd party payors.
See handout by the Center for Medicare and Medicaid
Services (CMS)
So far, communication equipment must provide 2-way,
live interactive video. Telephone is not yet covered,
although APA is advocating for telephone to be
approved
Copyright 1994-2020 Telebehavioral Health Institute, LLC All rights
reserved.
95. Coronavirus Preparedness and
Response Supplemental
Appropriations Act 1994-2020
The new law limits telehealth services to patients for
whom the provider had filed a Medicare claim for
within the previous three years. However, CMS
guidance states that the Department of Health and
Human Services (HHS) will not conduct audits to
check whether a clinician’session was a new or a
returning patient.
96. Coronavirus Preparedness and
Response Supplemental
Appropriations Act 1994-2020
Medicare patients are no longer required to be in
an originating site and can now receive telehealth
services in their own homes as well as in any
health-care facility.
Telehealth is now available to Medicare
beneficiaries in all parts of the country, not just in
rural areas.
97. Coronavirus Preparedness and
Response Supplemental
Appropriations Act 1994-2020
Telehealth services are reimbursed for the
same dollar amount as in-person visits.
Providers may reduce or waive cost-sharing
for telehealth visits during this emergency
period. This does not apply to brief
communication e-Visits (described below).
98. Reimbursement
Copyright 1994-2020 Telebehavioral Health Institute, LLC All rights reserved.
Medicare
Bill Medicare for
telehealth services the
same way you bill for an
office visit by using the
appropriate CPT® code
for the service provided.
99. CPT Codes
Interactive complexity (90785)
Psychiatric diagnostic interview (90791)
Psychotherapy including individual (90832, -34, -37), family
(90846, -47), and
Psychotherapy for crisis (90839, -40)
Psychoanalysis (90845)
Health behavior assessment and intervention services,
individual and group (96158, -59, -64, -65, -67, -68, -70, –71)
Neurobehavioral status examination (96116, 96121)
100. Telehealth Modifier Codes
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“95” IS NEW
STANDARD CPT
CODE
“02” IS USED FOR
PLACE OF SERVICE
(POS)
101. E-visits
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Medicare co-insurance
and deductible amounts
cannot be waived for e-
Visits.
Brief communication,
typically initiated by the
patient, and can be
furnished in any location
or geographic area.