As the first step in considering the use of telehealth, a determination must be made about the legality and ethics of providing remote services to a client in a location different from that of the therapist (interjurisdictional practice). Providers must strive to be knowledgeable, and to remain abreast of relevant laws, mandates, and regulations governing telehealth service delivery both within the jurisdictions in which they are situated and the jurisdictions where their patients or clients are located.

The emphasis here is on the client’s location, since this is the legal locus of service, regardless of the therapist’s location. Unfortunately, telehealth rules and regulations vary from state to state. The issue of providing telehealth services to a client in another state is the difference in regulations that can impact practice. These include:

• Mandatory reporting of suspected abuse or neglect of a child, older adult, or person with a disability.
• Sexual misconduct by the clinician.
• Clinician impairment (drugs, alcohol).
• Improper or fraudulent billing.
• Other laws governing mental health, addictions, duty to protect clients and third parties, and clinician–client privilege.

Interjurisdictional practice poses ethical and legal challenges that professional organizations are addressing through interstate compacts. Compacts reduce the barriers for healthcare providers to offer services in multiple states, improving access to care for patients, especially in underserved areas.

The National Center for Interstate Compacts (NCIC), established in 2004, helps states collaborate on policy issues for the creation of interstate compacts. The Multi-Discipline Licensure Resource Project provides a licensure compact resource hub @ https://licensureproject.org/.

Psychologists

PSYPACT is a resource that helps to resolve state-by-state issues. PSYPACT is the Psychology Interjurisdictional Compact, designed to facilitate the practice of telepsychology and the temporary in-person, face-to-face practice of psychology across state boundaries. Psychologists with a doctoral degree and a current, active psychology license in at least one PSYPACT state can apply to practice in other PSYPACT states under this agreement.

PSYPACT is unique in that it allows psychologists in the compact to provide only two limited and specific services: telepsychology and/or temporary in-person face-to-face services. Separate application processes, and a separate annual renewal, are required to provide these services. Learn more @ https://psypact.gov/.

School Psychologists

The Council of State Governments (CSG) is partnering with the Department of War (DoW) and the National Association of School Psychologists (NASP) to support the mobility of school psychologists through the development of the Interstate Compact for School Psychologists (ICSP). This compact is still in the early stages. Learn more @ https://schoolpsychcompact.org/.

Counselors

Since 2019, ACA has been working with the National Center for Interstate Compacts to create and operationalize a compact for counselors — and now the Counseling Compact is operational. To participate in the Counseling Compact, states must adhere to a variety of requirements, including that licensees pass a nationally recognized exam and have completed a master’s in counseling and supervised postgraduate professional experience. Counselors who are licensed and living in a compact member state will be allowed to practice telehealth and in-person counseling in other member states through the compact’s equivalent to a license, called the “privilege to practice.” Learn more @ https://www.counseling.org/advocacy/counseling-compact.

Social Workers

In 2024, the Council of State Governments (CSG) partnered with the Department of War (DoW) and the Association of Social Work Boards (ASWB) to establish the Social Work Licensure Compact to support the mobility of licensed social workers. This compact is in the early stages of development. To join the compact, states must license and regulate social work, require that licensees pass a national qualifying exam, and require that licensees graduate from an accredited social work program corresponding to the category of licensure sought. Learn more @ https://swcompact.org/.

Marriage and Family Therapists (MFTs)

The AAMFT has decided against establishing a state-level licensure compact and has chosen to concentrate on formulating model licensure portability laws within each state. The model licensure portability laws proposed by AAMFT are designed to offer complete endorsement for MFTs, allowing an individual’s qualifications for an MFT license in one state to be utilized for licensure in another participating state (WWAMI, 2025).

Speech-Language Pathologists (SLPs) and Audiologists

The Audiology & Speech-Language Pathology Interstate Compact (ASLP-IC) facilitates the interstate practice of audiology and speech-language pathology while maintaining public protection. Learn more @ https://aslpcompact.com/.

Occupational Therapists (OTs)

The Occupational Therapy Licensure Compact (OT Compact) is an interstate compact, or formal agreement among states, that facilitates interstate practice of occupational therapy. Learn more @ https://otcompact.gov/.

Registered Dietitians (RDs)

The Council of State Governments (CSG) is partnering with the Department of Defense (DoD) and The Academy of Nutrition and Dietetics (AND) to support the mobility of licensed dietitians through the development of a new interstate compact. Learn more @ https://compacts.csg.org/compact-updates/the-interstate-compact-for-dietitians/.

States

A few states have licenses or telehealth specific exceptions that allow an out-of-state provider to render services in a state where they are not located. For example, Florida has established a comprehensive framework for telehealth services, allowing both in-state and out-of-state practitioners to provide care under specific regulations. Learn more @ https://flhealthsource.gov/telehealth/.

Arizona, Delaware, Georgia, and West Virginia have also passed permanent legislation allowing certain healthcare providers to provide telehealth services to in-state patients. New Hampshire has expanded their provider types eligible to use telehealth to include psychologists and mental health practitioners (WWAMI, 2025).

Healthcare providers must remain vigilant about the evolving telehealth regulations, particularly regarding licensure and billing practices across state lines. Staying informed and prepared will be crucial for successfully navigating the complexities of providing telehealth services in a multi-state environment. An online resource for telehealth regulations state-by-state can be found here: https://www.ebglaw.com/telemental-health-laws-app/

Telehealth policies are changing rapidly. The CCHP provides federal and state specific telehealth policies @ https://www.cchpca.org/topic/cross-state-licensing-professional-requirements/.

According to the CCHP, the physical location of the patient – which should be verified at the start of each telehealth session – determines which state regulations to apply to avoid practicing without a license or jeopardizing malpractice insurance.

The objectives of interstate occupational licensure agreements are to enhance the efficiency of licensing procedures and to facilitate access to services, all while ensuring public safety. Various mechanisms have been implemented by states and professional advocacy groups to ease the process of licensure across state lines. The most prevalent of these mechanisms are interstate compacts.

Interstate licensure compacts could potentially mitigate workforce shortages in regions with high demand, allowing practitioners to practice more conveniently across state borders. Nevertheless, while these approaches reduce regulatory barriers and streamline the licensure process between states, they do not enhance the overall national supply of providers, and the extent to which these measures enhance access to health services remains to be seen.

Telehealth: Ethics and Best Practices

Telehealth, also known as teletherapy, telepractice, telepsychology, telerehabilitation (and a variety of other names), involves participating in therapeutic services through a digital platform. Patients can consult with their healthcare provider via computer, tablet, or smartphone without needing to visit their office. Telehealth is particularly beneficial for individuals in remote areas or those who have difficulty accessing traditional medical facilities. It encompasses a range of services, including virtual visits, health education, and remote patient monitoring.

The primary and most obvious difference between telehealth and in-person treatment is the fact that the patient is not in the same room as the clinician. This lack of physical presence can limit the range of information available or how accurately it is observed. Communication can be influenced by camera angle, screen size, room characteristics, and other technical factors like bandwidth that may result in poor-quality video and/or audio and prohibit the observation of all behaviors.

Telehealth: Ethics and Best Practices is a 3-hour online continuing education (CE/CEU) course that examines ethical principles and best practices in remote online therapy.

This course will provide an introduction to telehealth, discuss the pros and cons, address ethical considerations (such as competence, informed consent, HIPAA, etc.), how to get started with telehealth (including when to use, not use, or when to combine services), offer practice tips (including camera positioning and cultivating trust), and discuss evidence-based uses for mental health, nutrition, speech, and occupational therapy.

A final section will offer best practices for telehealth in mental health, nutrition therapy, speech therapy, and occupational therapy. Self-efficacy, and how to enhance it, is also discussed.

Professional Development Resources, a small Florida nonprofit educational corporation 501(c)(3) organized in 1992, is approved by the American Psychological Association (APA) to sponsor continuing education for psychologists. Professional Development Resources maintains responsibility for all programs and content. Professional Development Resources is also approved by the National Board of Certified Counselors (NBCC ACEP #5590); the Association of Social Work Boards (ASWB #1046, ACE Program); the Continuing Education Board of the American Speech-Language-Hearing Association (ASHA #AAUM); the American Occupational Therapy Association (AOTA #3159); the Commission on Dietetic Registration (CDR Prior Approval Program); the Florida Board of Clinical Social Work, Marriage & Family Therapy, and Mental Health Counseling, Board of Psychology, Office of School Psychology, Board of Speech-Language Pathology & Audiology, Board of Occupational Therapy, and Dietetics and Nutrition Practice Council; the New York State Education Department’s State Board for Psychology as an approved provider of continuing education for licensed psychologists (#PSY-0145), State Board for Mental Health Practitioners as an approved provider of continuing education for licensed mental health counselors (#MHC-0135) and marriage and family therapists (#MFT-0100), and the State Board for Social Workers as an approved provider of continuing education for licensed social workers (#SW-0664); the South Carolina Board of Professional Counselors and Marriage & Family Therapists (#193); the Texas Board of Examiners of Marriage and Family Therapists (#114) and State Board of Social Worker Examiners (#5678); and is CE Broker compliant (#50-1635 – completions are reported next business day, currently reporting for 50+ boards). Learn more about us.

Target Audience: Psychologists, School Psychologists, Counselors, Social Workers, Marriage & Family Therapists (MFTs), Speech-Language Pathologists (SLPs), Occupational Therapists (OTs), Registered Dietitian Nutritionists (RDNs), and Teachers

Enjoy 20% off all online continuing education (CE/CEU) courses @pdresources.org! Click here for details.