Building Ethical Bridges Using Telehealth. Modality or Theory? ACA Code of Ethics (2014) 10/19/2016

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1 Building Ethical Bridges Using Telehealth Sherry R. Rosenblad Brandy Chalmers Hardin-Simmons University Modality or Theory? In general, professional associations and state licensing boards Codes of ethics and regulations for practice Practitioners are held to the same ethical standards It is the responsibility of the professional To date, all states require licensure to practice within that state. Codes and guidelines attempt to direct ethical provision ACA Code of Ethics (2014) Technology in practice Counselors take special measures Follow legal guidelines Counselors only use technology Maintain records Include licensing information File complaints or access information to file the complaint 1

2 ACA Code of Ethics (2014) Informed Consent Inform client Location of practice & contact information Risks/benefits Anticipated response times Established back-up plan Emergency procedures Time zone differences Cultural or language differences Potential denial of third party reimbursement Clearly defined social media policy ACA Code of Ethics (2014) Special Considerations Consider if using technology Awareness of the potential for miscommunication Consider how the use of technology impacts ACA Code of Ethics (2014) Professional Boundaries Awareness Clearly distinguishing Respect clients right Avoid disclosing confidential information 2

3 67 % of states provide some guidance for telemental health 28% reference professional association standards Or a combination of rules, policy statements, or ethical codes 32% of states provide no direction No state board or licensing body Growing trend Counselors may be better equipped 3

4 Telemental health often crosses jurisdictional borders Other health professions have responded to the issue of providing care across jurisdictional boundaries Federation of State Medical Board model act Approved services vary from state to state and include: Mental health assessment Substance abuse treatment Counseling Education Medication management Consultation 4

5 Texas Administrative Code- Chapter 681 defined telemental health as distance counseling Where the client is a resident of or within the State of Texas and the counselor is licensed by the State of Texas Counselors are instructed to adhere to each provision of the rules and statutes of the board when practicing distance counseling Multiple state licenses Temporary work Ethical Guidelines of the American Telemedicine Association Therapist and Patient Identity Verification 28% of therapists deemed it important Patient identity must be verified Licensure information, qualifications, etc. Therapist credentials 5

6 Verify Therapist and Patient Location Licensing laws in residing state Location of client Emergency management protocols Mandatory reporting, duty to warn Third party reimbursement Determining if a Patient is Appropriate for Telemental Health Current research Cognitive abilities and organizational capacity Utilization of technology Distance to services and support Past psychological treatment Informed Consent (IC) and Telemental Health Determine whether or not electronic signatures IC should contain basics When practicing telehealth, the following should be added to IC 6

7 Managing Emergencies An emergency protocol Clients may be in a location where an emergency protocol may already be in place. Managing Emergencies (Continued) The emergency protocol should include: client s family or social support contact law enforcement contact ambulance service contact hospital emergency room mental health crisis response team whether or not services are available client s ability or inability Minimal Technology Requirements appropriate confidentiality and security levels applications that notify a user anytime someone logs on capability to block the therapist s caller identification (ID). up to date antivirus software and firewalls have a backup plan bandwidth of 384 Kbps or higher resolution of 604 X 360 at 30 frames/second 7

8 Mobile Devices phone should have security features phones should have a timeout function should a phone be lost a therapist should document West Texas Rural Mental Health Research What is your profession? 8

9 In your opinion, what are the primary mental health care needs in your community? How often do you encounter a person with mental health needs? When you encounter a mental health concern, what is the typical response? 9

health professional, would you refer people with mental health needs to this service?

10 Do you feel there is a need for more quality mental health (counseling) services in your community? If an online video counseling service was available where people in your community could find help from a mental health professional, would you refer people with mental health needs to this service? Would you be able and willing to provide a confidential and secure location in the community in which you live where an online video counseling service could be offered? 10

11 QUESTIONS? References American Association for Marriage and Family Therapy. (2015). American Association for Marriage and Family Therapy Board code of ethics. Retrieved from American Counseling Association. (2014). American Counseling Association code of ethics. Retrieved from American Distance Counseling Association (2007). ADCA Association Information. Retrieved from: American Psychological Association. (2010). American Psychological Association ethical principles of psychologists and code of conduct. Retrieved from American Psychological Association. (2013). Guidelines for the practice of telepsychology. Retrieved from American Psychological Association Practice Organization. (2010). Telehealth: Legal basics for psychologists. Retrieved from American Telemedicine Association. (2013). Practice guidelines for video-based online mental health services. Retrieved from American Telemedicine Association. (2013). State Medicaid best practice telemental and behavioral health. Retrieved from -telemental-and-behavioral-health.pdf?sfvrsn=10 Amoran, O., Lawoyin, T., & Lasebikan, V. (2007). Prevalence of depression among adults in Oyo State, Nigeria: A comparative study of rural and urban communities. Australian Journal of Rural Health, 15(3), doi: /j x Birgit, W., Horn, A. B., Andreas, M. (2013). Internet-based versus face-to-face cognitive-behavioral intervention for depression: A randomized controlled non-inferiority trial. Journal of Affective Disorders, doi: /j.jad Bledsoe, T. S., Setterlund, K., Adams, C. J., Fok-Trela, A., & Connolly, M. (2013). Addressing pastoral knowledge and attitudes about clergy/mental health practitioner collaboration. Social Work & Christianity, 40(1), References Center for Connected Health Policy. (2014). Office for Advancement of Telehealth. Retrieved from Center for Credentialing & Education (2015). Distance Certified Counselor. Retrieved from Chester, A., & Glass, C. (2006). Online counselling: A descriptive analysis of therapy services on the internet. British Journal of Guidance & Counselling, 34, doi: / Day, S. X., & Schneider, P. L. (2002). Psychotherapy using distance technology: A comparison of face-to-face, video and audio treatment. Journal of Counseling Psychology, 49, doi: // Federal Information Processing Standard. (2011). Retrieved from Finn, J., & Barak, A. (2010). A descriptive study of e-counsellor attitudes, ethics, and practice. Counselling and Psychotherapy Research, 10, doi: / Federation of State Medical Boards. (2015). Rhode Island is 15th state to introduce the interstate compact for medical licensure. Retrieved from Gamm, L. D., Stone, S., & Pittman, S. (2003). Mental health and mental disorders A rural challenge. In L. D. Gamm, L. L. Hutchison, B. J. Dabney, & A. M. Dorsey (Eds.), Rural healthy people 2010: A companion document to Healthy People 2010 (pp ). College Station, TX: The Texas A&M University System Health Science Center, School of Rural Public Health, Southwest Rural Health Research Center. Gilman, M., & Stensland, J. (2013). Telehealth and Medicare: Payment policy, current use, and prospects for growth. Retrieved from 11

12 References Godleski, L. D., Darkins, A., & Peters, J. (2012). Outcomes of 98,609 U.S. department of veterans affairs clients enrolled in telemental health services, Psychiatric Services, 63(4), doi.org/ /appi.ps Haberstroh, S., Barney, L., Foster, N., & Duffey, T. (2014). The ethical and legal practice of online counseling and psychotherapy: a review of mental health professions. Journal of Technology in Human Services, 32(2), doi: / Harris S., & Robinson Kurpius, S. (2014). Social networking and professional ethics: client searches, informed consent, and disclosure. Professional Psychology: Research and Practice, 45(1), doi: /a Health Information Technology for Economic and Clinical Health. (2009). Retrieved from Health Insurance Portability and Accountability Act. (1996). Retrieved from Heinlein, K. T., Welfel, E. R., Richmond, E. N., & Rak, C. F. (2003). The scope of WebCounseling: A survey of services and compliance with NBCC Standards for ethical practice of WebCounseling. Journal of Counseling and Development, 81, International Society for Mental Health Online (2015). About ISMHO. Retrieved from: Kanani, K., & Regehr, C. (2003). Clinical, ethical, and legal issues in e-therapy. Families in Society, 84(2), Lehavot, K., Barnett, J.E., & Powers, D. (2010). Psychotherapy, professional relationships, and ethical considerations in the Myspace generation. Professional Psychology: Research and Practice, 41, doi: /a References Manhal-Baugus, M. (2001). E-therapy: Practical, ethical, and legal issues. CyberPsychology & Behavior, 4, doi: / McCord, C. E., Elliott, T. R., Wendel, M. L., Brossart, D. F., Cano, M. A., Gonzalez, G. E., & Burdine, J. N. (2011). Community capacity and teleconference counseling in rural Texas. Professional Psychology: Research and Practice, 11, 1-7. doi: /a Midkiff, D., & Wyatt, W. (2008). Ethical issues in the provision of online mental health services (Etherapy). Journal of Technology in Human Services, 26, doi: / National Association of Social Workers & Association of Social Work Boards (2005). NASW & ASWB standards for technology and social work practice. Retrieved from O Reilly, R., Bishop, J., Maddox, K., Hutchinson, L., Fisman, M., & Takhar, J. (2007). Is telepsychiatry equivalent to face-to-face psychiatry? Results from a randomized controlled equivalence trial. Psychiatric Services, 58, doi: /ps Rummell, C. M. & Joyce, N. R. (2010). So wat do u want to wrk on 2day? : The ethical implications of online counseling. Ethics & Behavior, 20, doi: / Ruskin, P. E., Silver-Aylaian, M., Kling, M. A., Reed, S. A., Bradham, D. D., Hebel, J. R., & Hauser, P. (2004). Treatment outcomes in depression: Comparison of remote treatment through telepsychiatry to inperson treatment. The American Journal of Psychiatry, 161, doi: /appi.ajp Sharp, I. R., Kobak, K. A., & Osman, D. A. (2011). The use of videoconferencing with clients with psychosis: A review of the literature. Annals of General Psychiatry. Retrieved from Shaw, H. E. & Shaw, S. F. (2006). Critical ethical issues in online counseling: Assessing current practices with an ethical intent checklist. Journal of Counseling & Development, 84, References Stingley, S. & Schultz, H. (2014). Helmsley trust support for telehealth improves access to care in rural and frontier areas. Health Affairs, 33(2), doi: Stubbings, D.R., Rees, C. S., Roberts, L. D., & Kane, R. T. (2013). Comparing in-person to videoconference-based cognitive behavioral therapy for mood and anxiety disorders: Randomized controlled trial. Journal of Medical Internet Research, 15(11), e258. doi: /jmir.2564 Telehealth Counseling Clinic at Texas A & M University. (2015). Retrieved from Telemental Health Institute. (2015). Retrieved from U.S. Department of Health and Human Services, Healthy People (2000). Healthy people Retrieved from up;seq=3 12

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