The Coronavirus COVID-19 and resulting pandemic has changed so many aspects of our lives, that for many of us, life today almost seems surreal. Non-emergency in-office visits are now a thing of the past and telehealth is being pushed on us. We must keep at least a six-foot distance between ourselves and everyone else. For some of us, curfews have been imposed and only essential travel is allowed. And, in Florida, police are present at state lines, screening entrance into the state.
So, for therapists, counselors, psychologists, and all mental health professionals, the only answer is to turn to telehealth, also known as teletherapy, e-therapy, telemental health, telepractice, and telepsychology (among other names), which means a new learning curve. So here are some quick tips to help you get started:
Understand What Is Allowed And What Is Not
At the time of this writing, the HIPAA rules have been relaxed regarding
telehealth. Specifically, the Office of Civil Rights (OCR) of Health and Human Services (HHS), which has authority over HIPAA, states, “A covered health care provider that wants to use audio or video communication technology to provide telehealth to patients during COVID-19 nationwide public health emergency can use any non-public facing remote communication product that is available to communicate with patients.
What that means is that public facing platforms like Facebook Live, Twitch, and Tik-Tok should not be used for providing telehealth. However, platforms like Apple Facetime, Facebook Messenger video chat, Google Hangout video, or Skype can be used.
Important to note that the OCR does not endorse any of these. While greater privacy protection can be obtained by using HIPAA-compliant video communication solutions, the relaxation of the HIPAA policy means that non-public facing platforms – which would normally not be allowed – are now allowed, provided that they are used in connection with the good faith provision of telehealth. This means that to the provider’s knowledge, the platform used is private, and not accessible to the public.
Make Every Effort To Provide A Therapeutic Space
It is a given that when a patient enters an office for therapy, the room will be quiet, inviting, and most important, private and free from distractions. When offering therapy over the internet or phone, however, making the space where therapy will be offered similar to what would be expected in traditional therapy will take some effort.
To begin, be sure that the room you work in is quiet. While some things like your neighbor mowing his lawn may not be avoidable, things like the dog barking, kids screaming or playing in the background should be minimized.
Next ensure that the area you choose is one where you will be free from distractions. This may mean using a door sign for family members that reads, “In Session” so they will know not to interrupt you.
Lastly, choose an area where you feel like you can focus. While this may seem obvious, we do put effort into arranging a traditional office not just to be inviting for our clients, but also to help us feel comfortable, safe, inspired, and focused. So take some time to think about where you will feel most comfortable and if needed, create a space for yourself.
Encourage Your Client To Make His/Her Space Therapeutic
Just like it will take some effort on your end to make your space therapeutic, your clients will also need to think about where in their environment will be most quiet, secure, private, and free from distractions. Perhaps they has a home office that be used, a bedroom that is quiet, or even an outside area like a patio, deck, or backyard.
Again, what is most important is that your clients find a place where they truly feel comfortable and can focus without interruption. This may be somewhat challenging, especially with kids at home, however this is all the more reason to encourage your client to take the time to find the appropriate space, before teletherapy or e-therapy sessions begin.
Know Your Resources
Because telehealth is a new format for many of us, it is always helpful to know where to find more information when it is needed. In response to the emergency, HIPAA Journal has worked with Compliancy Group to set up a free hotline for any questions you may have related to HIPAA compliance during the COVID-19 crisis. That number is (800) 231-4096.
The first place to start is by checking with your professional licensing board website to find guidance specific to your state/profession.
Federal Government Guidance on Telehealth
H.R. 6074, the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020, signed into law on March 6, gives states the ability to request waivers that would allow them to use Medicare and Medicaid funds for telehealth services without the “originating site requirement.” Under normal circumstances, patients are required to have one or more face-to-face appointments at a qualifying health care site before Medicare or Medicaid will pay for telehealth services. Counselors are not covered under Medicare, but Medicaid coverage varies by state. Most states cover Medicaid services provided by counselors, but some restrict the types of providers that can furnish telehealth services. States that have waivers approved by the Centers for Medicare & Medicaid Services may lift some restrictions temporarily and begin covering counseling services via telehealth. Several other federal government agencies have released guidance important to behavioral health providers.
The National Association of Medicaid Directors lists contact information for each state Medicaid agency. If you are unsure of the status of Medicaid coverage for counselors providing telehealth in your state, contact your state Medicaid director’s office or email@example.com.
The Substance Abuse and Mental Health Services Administration (SAMHSA) and the Drug Enforcement Administration (DEA) have issued guidance on the use of telemedicine for medication-assisted treatment. SAMHSA has also released guidance relating to the prohibitions on use and disclosure of patient identifying information under 442 CFR Part 2.
The Department of Health and Human Services (HHS) Office of Civil Rights has stated it will waive potential penalties for HIPAA violations against health care providers who serve patients through everyday communications technologies during the emergency.
The American Psychological Association (APA) has created Practice Resources in Response to COVID-19 (which includes information on telepsychology and telehealth) available at:
The American Speech-Language-Hearing Association (ASHA) has posted Telepractice Resources During COVID-19 for Speech-Language Pathologists (SLPs) and audiologists:
The National Board for Certified Counselors (NBCC) has developed a COVID-19 Information Page: https://www.nbcc.org/covid-19
The Trust Practice and Risk Management Association (TrustPARMA) also offers a free sample of an informed consent for e-therapy at: https://parma.trustinsurance.com/Workshops-Webinars/Telepsychology.
The Florida House of Representatives has updated their legislation to include standards of practice for telehealth providers in the state of Florida:
The Florida Department of Health states: “Individual licensed health care professionals are required to use independent judgement or seek personal legal counsel as it relates to interpreting the Florida telehealth law and the various executive orders regarding telehealth by any method to ensure that the care provided meets the standards of the established scope of practice for the profession.”
The California Association of Marriage and Family Therapy (CAMFT) has also posted an overview of HIPAA considerations for implementing telehealth, as well as options for HIPAA compliant telehealth platforms at: www.camft.org/Resources/Legal-Articles/Telehealth-HIPAA-and-Compliant-TeleHealth-Platforms.
Lastly, the HIPAA announcement regarding the relaxation of policies during the COVID-19 national emergency can be found at www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html.
Offering telehealth is a wonderful resource, and thanks to the relaxation of HIPAA policies, now much more accessible to health professionals, and clients alike. Thankfully, the COVID-19 national emergency need not interrupt mental health services.
Related Online Continuing Education (CE) Course:
E-Therapy: Ethics & Best Practices is a 3-hour online continuing education (CE) course that examines the advantages, risks, technical issues, legalities, and ethics of providing therapy online.
E-therapy can be used to address age-old problems, such as how to reach out to those who might not otherwise avail themselves of psychotherapy services even though they are in acute need. At the same time, it is clear that many providers have embraced the new technologies without a firm grasp on the new and serious vulnerabilities that are introduced when their patients’ personal health information goes online. Included in this course are sections on video therapy, email, text messaging, smart phone use, social media, cloud storage, Skype, and other telecommunications services.
This course is focused upon the ethical principles that are called into play with the use of e-therapy. Among them the most obvious concern is for privacy and confidentiality. Yet these are not the only ethical principles that will be challenged by the increasing use of e-therapy. The others include interjurisdictional issues (crossing state lines), informed consent, competence and scope of practice, boundaries and multiple relationships, and record keeping.
In addition to outlining potential ethical problems and HIPAA challenges, this course includes recommended resources and sets of specific guidelines and best practices that have been established and published by various professional organizations. Course #31-19 | 2019 | 60 pages | 20 posttest questions
Professional Development Resources is a nonprofit educational corporation 501(c)(3) organized in 1992. We are approved to sponsor continuing education by the American Psychological Association (APA); the National Board of Certified Counselors (NBCC); the Association of Social Work Boards (ASWB); the American Occupational Therapy Association (AOTA); the American Speech-Language-Hearing Association (ASHA); the Commission on Dietetic Registration (CDR); the Alabama State Board of Occupational Therapy; the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy, Psychology & School Psychology, Dietetics & Nutrition, Speech-Language Pathology and Audiology, and Occupational Therapy Practice; the Georgia State Board of Occupational Therapy; the New York State Education Department’s State Board for Mental Health Practitioners as an approved provider of continuing education for licensed mental health counselors (#MHC-0135); the Ohio Counselor, Social Worker & MFT Board and Board of Speech-Language Pathology and Audiology; the South Carolina Board of Professional Counselors & MFTs; the Texas Board of Examiners of Marriage & Family Therapists and State Board of Social Worker Examiners; and are CE Broker compliant (all courses are reported within a few days of completion).
PDR offers over 150 accredited online CE courses for healthcare professionals.
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