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
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
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
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
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
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
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 9-1-1 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
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
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
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
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