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Table of Contents
List of Illustrations
Guide
Pages
Distance Counseling and Supervision. A Guide for Mental Health Clinicians
DEDICATION
PREFACE
About the Editors
About the Contributors
Appendix Authors
Chapter 1. Ethical, Legal, and Risk Management Considerations: Understanding the Landscape of Telebehavioral Health and Supervision
Competency
Residency
Assessing Appropriateness for Technology-Assisted Services
Access to and Knowledge About Technology
Emotional Stability, Safety, and Emergency Risk Management
Anonymity and Confidentiality
Limits and Risks of Confidentiality
Security
Remember the Two-Lock Rule
Use and Protect Security Settings
Liability Insurance and State Licensure Regulations
Synchronous Videoconferencing
Texting
Social Media
Voice-Assisted Technology, Bluetooth, and Gaming Communication on Devices
Informed Consent
Distance Counseling Credentials
Physical Location of the Practice and Contact Information
Time Zone
Risks and Benefits of the Use of Distance Counseling Technology
Social Media Policy
Emergency Procedures
Anticipated Response Times
Cultural or Language Differences
Insurance Coverage and Billing
Additional Recommendations to Be Included in the Informed Consent. License Number and Licensing Board Information
Notes and Documentation
Distance Supervision
Scenarios for Discussion. The Case of Joe
The Case of Rico
The Case of Boa
Questions to Explore
Conclusion
References
Chapter 2. Certification and Regulation of Distance Counseling and Supervision
The Promise and Peril of Behavioral Telehealth Services
What Is Regulation and Why Is It Important?
Types of Regulation
Registration
Certification
Licensure
Limitations of Registries and Certifications
The Case for Licensure
State Licensing Boards
Regulations and Statutes
Practices
Ensuring Minimal Qualifications for Practice
Interpreting Counseling Practice Acts
Overseeing Disciplinary Cases
Communicating With the Public Regarding the Regulation of Counseling Services
Composition
Single-Focus Board
Composite Board
Limitations of State Licensing Boards
Reduced Employment in Licensed Professions
Reduced Geographic Mobility
Reduced Market Competition and Innovation
The Role of Regulation in Telehealth
Questions to Explore
Best Practices for Practitioners
Scenario for Discussion
Discussion
Conclusion
References
Chapter 3. Bridging the Generational Technology Divide in Counseling Training, Practice, and Supervision
Definition of Terms
Technology in the Counseling Profession
Technology in Training Programs
Technology in Practice
Technology in Supervision
Scenarios for Discussion. The Case of a Generation Xer
The Case of Patrick: A Millennial Perspective
Questions to Explore
Conclusion
References
Chapter 4. Navigating the Regulatory Gauntlet
The Current Landscape of Regulation and Oversight
Important Terminology
The Role of Regulatory Bodies
Protecting the Public
Protecting Privacy
Ensuring the Quality of Services
Providing Access to Care and Services
Professional Associations’ Codes of Ethics and Standards of Practice
American Counseling Association (ACA)
National Board for Certified Counselors (NBCC)
American Association for Marriage and Family Therapy (AAMFT)
American Psychological Association (APA)
National Association of Social Workers (NASW)
HIPAA
ePHI
Safeguards
Physical
Technical
Administrative
HIPAA Under Coronavirus (COVID-19)
HITECH
Business Associates
Neglect and Breaches
FERPA
Implications for Education and Supervision
FERPA Clarifications Under COVID-19
Licensing Boards
Scenarios for Discussion. A Client’s Temporary Relocation
Mom Takes the Lead
Questions to Explore
Conclusion
References
Chapter 5 Distance Supervision
Challenges to Finding Good Supervision
Free Supervision Comes With Its Own Price Tag
Good Supervision Is Often Cost Prohibitive
Supervisors Are Difficult to Find
There Is a Shortage of Supervisors in Rural Areas
The History of Clinical Supervision
Box 5.1 Template Email for Inquiring About Telesupervision Regulations as a Prelicensed Counselor
Box 5.2 Template Email for Inquiring About Telesupervision Regulations as a Clinical Supervisor
Best Practices for Establishing a Telesupervision Practice
Box 5.3 Template Email for Advocating for Telesupervision to the State Board
Questions to Ask a Potential Clinical Supervisor
Box 5.4 Template Email for Inquiring About the Use of Videoconferencing for Peer Consultation and Continuing Education
Scenarios for Discussion. Case Study: Using Telesupervision to Improve Therapist-Supervisor Fit
Case Study: Using Telesupervision for Ongoing Peer Consultation
Conclusion
References
Chapter 6. The Tools of Telebehavioral Health: How to Identify, Vet, and Deploy the Right Technology in Practice
Federal Rules and Regulations: HIPAA and HITECH. HIPAA Compliance and Security
HITECH
HIPAA Administrative Safeguards. Written Policies and Procedures
Family Educational Rights and Privacy Act of 1974 (FERPA)
Security Standards. Network, Equipment, Software, and Security
Networking
Equipment (Computers)
Software
Business Associate Agreements/Contracts
Identifying, Vetting, and Deploying the Right Technology
Types of Telehealth (Synchronous Video) Vendor Solutions. Fixed End Point (Hardware)
VPN
Native Applications (Mobile/Desktop)
Browser-Based Solutions (WebRTC)
Additional Workflow Solutions
Key Trends. Migration to the Cloud
The Integration of Telehealth Into EHR
Ubiquity
Industry Consolidation
Questions to Explore When Choosing Telehealth Tools
What to Look for in a Vendor. Breadth of Functionality (Prove the Workflow)
Depth of Functionality (Prove the Workflow)
Ease of Use
Flexibility in Solutions
Integration With Existing Tools
Training and Support Resources
An Active User Community
Willingness to Offer User References
Scalability (the Ability for the Service to Grow With the Agency)
Telehealth Vendor Versus Technology Vendor
Willingness to Sign a Business Associate Agreement
Questions to Ask Vendors
Conclusion
References
Chapter 7. Counseling Training, Practice, and Supervision Using Avatars
History
Virtual Presence
Avatar Platforms
The Palace
Paltalk
Active Worlds
Second Life
VRChat
Facebook Spaces/Facebook Horizon
Timeline of Avatar Platforms
Qualities of Avatars
Qualities of the Environment
Application to Counseling and Counseling Preparation
Training Examples
Counseling Skill Class
Internship Class
Simulated Play Therapy Room
Virtual Conference on Counseling
Continuing Education
Theory Instruction
Practice
Supervision
Ethical Practice Concerns
Efficacy
HIPAA Compliance, Privacy, and HITECH Rules
Encryption
Emergency Access
Payment
Considerations for Supervision
Cultural Responsiveness
Guidelines for Establishing Avatar-Based Practice
Counselor Technology Skills
Counselor Practice Skills
Reading Client Cues Through the Avatar
Developing a Virtual Presence
Client Appropriateness
Client Technology Skills
Client Virtual Presence
Legal Limitations of Practice
State Laws and Client Consent
Emergency Procedures
Terrestrial Backup
Records
Conclusion
References
Chapter 8. Incorporating Online Therapy Into a Private Practice
Clinical Considerations
Informed Consent
Getting Started
Clinical Strategies
Incorporating Online Therapy Into a Private Practice
Online Therapy as the Primary Treatment Format
Hybrid Service Delivery
Online Therapy Sessions as a Backup Option
Marketing
Scenarios for Discussion. The Case of Carlos
The Case of Candace
The Case of Joanne
Conclusion
References
Appendix A. Readiness for Online Counseling: Client Checklist
Getting Started and Netiquette
Technical Requirements/Suggestions
Emergency Risk
Notes
Appendix B. Video Call Etiquette
Before the Session
During the Session
Most Important
Note
Appendix C. Clinical Supervision Agreement
Purpose of Agreement
Terms of Supervision
Consent and Confidentiality
Liability Insurance
Client Emergencies
Use of Technology-Assisted Services in Supervision
Structure of Supervision
Identification of Goals
Supervisor Information
Note
Appendix D. Information, Authorization, and Consent to Technology-Assisted Services
Information, Authorization, and Consent to Technology-Assisted Services
The Different Forms of Technology-Assisted Media Explained. Telephone via Landline
Cell Phones
Text Messaging
Social Media: Facebook, Twitter, LinkedIn, Instagram, Pinterest, etc
Google, Bing, or Other Online Search Engines
Videoconferencing (VC)
Faxing Medical Records
Recommendations of Websites or Applications (Apps)
Electronic Record Storage
ElectronicTransfer of PHI for Billing Purposes
Electronic Transfer of PHI for Certain Credit Card Transactions
Your Responsibilities for Confidentiality and Technology-Assisted Services
In Case of Technology Failure
Cost of Sessions
Cancellation Policy
Limitations of Technology-Assisted Services Therapy Services
Communication Response Time
In Case of an Emergency
Emergency Procedures Specific to Technology-Assisted Services
Consent to Technology-Assisted Services
Notes
Index
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
R
S
T
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V
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WILEY END USER LICENSE AGREEMENT
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Social media is a ubiquitous part of modern life, and it becomes complicated when combined with HIPAA and Health Information Technology for Economic and Clinical Health Act regulations and counselor ethics. Counselors often use social media in their personal lives, to promote their practices, or to network with other mental health professionals in their area. It is imperative that they be mindful of the risks and maintain appropriate boundaries and confidentiality. It is a counselor’s ethical responsibility to understand the risks involved in using social media and take appropriate precautions. Counselors should construct and share with clients a clear policy regarding the use, limitations, and risks of social media with current and former clients. This policy should be included in the informed consent (ACA, 2014; AMFTRB, 2016; NBCC, 2016a, 2016b).
The first step in setting appropriate boundaries is to maintain separation between personal and professional social media use. It is recommended that separate accounts be created if a counselor plans to use social media for professional purposes. Just as one would maintain separate personal and professional lives, one’s virtual life should include similar boundaries (ACA, 2014; AMFTRB, 2016). Counselors should become aware of the security settings available on their various social media platforms and use them to protect the public accessibility of information. These boundaries should be clearly articulated in their social media policy included in the informed consent.
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