Vonnice audrey, LMFT
Therapist in the Sacramento area
March 16, 2020
With recent concerns about the COVID-19 pandemic, many therapists are looking for solutions to provide seamless care to their clients and, well, keep their businesses running. Many therapists turn to online therapy, also known as telemedicine.
The CDC predicts that the COVID-19 virus can spread exponentially and that taking preventive measures can help slow the spread and reduce the burden it can place on the healthcare system. More importantly, these measures help protect the most vulnerable among us.
Because transmission occurs before symptoms appear, the standard "if you're sick, don't come" guidelines are unlikely to be effective in preventing infection. Offering telemedicine offers clinicians and clients the opportunity to do their part to mitigate the impact of COVID-19 on the community and protect themselves and their families.
EUstarted online therapy in 2016when I became a licensed therapist. I have long been fascinated by the use of technology in therapy and excited about the potential benefits that telemedicine can bring to both clients and clinicians. Reactions from my colleagues ranged from sympathetic and curious to skeptical and even critical. Over the years, I've had incredible experiences, made deep and meaningful connections, and helped a wide variety of clients. I am confident that the rapid increase in the use of telemedicine will help reduce stigma and increase the access and reach of telemedicine services in the future.
I know it can be overwhelming to switch your caseloads to telemedicine so suddenly. The learning curve seems steep. It seems like there is A LOT to know, but with just a few steps, you can get your online trading set up in no time. We are all committed to providing our customers with the best possible service, and with the knowledge and resources to do so safely and effectively, we can.
Legal and ethical considerations
California Council on Behavioral Sciences: Standards of Practice for Telemedicine:
For marriage and family therapists, educational psychologists, clinical social workers, and professional counselors, the BBS has adopted theseStandards of Practice for Telemedicine.
BBS statement on COVID-19 and telemedicine:
The BBS has expanded the privileges of performing telemedicine to all levels of physicians. See the statement for policies specific to your occupation and situation:coronavirus statement
Code of ethics
I encourage you to do a Google search for your profession and "telemedicine code of ethics".
I have included the following links:
- CAMFTCode of ethics
- AAMFTBest practices for online therapy
- NASWtechnology standards
- ERAGuidelines for telepsychology.
liability insurance
Call your insurance provider and make sure telemedicine is covered, if not, follow the steps to add it.CPHincludes telemedicine coverage in all policies and recently released this statement:Telemedicine coronavirus.
What happens if my client leaves the state? Practice across state lines
You may be wondering if you can continue to work with an existing client while they are out of the state of California. In CA therapy, it occurs where the client is sitting at the time of the session.
The BBS states:
"A licensee or registrar in this state may provide telehealth services to customers in another jurisdiction only if the California licensee or registrar meets the requirements to lawfully provide services in that jurisdiction and providing services via telemedicine is permitted by that state." jurisdiction".
In practice, this means that, in most cases, you must be licensed in the state where your client is located at the time of the session. There are some states that allow limited interstate practice. In that case, you would have to comply with all regulations set by that state.
There are some states that define that therapy takes place where both the client and the therapist meet. California is NOT one of those states. This means he can be located anywhere in the world and provide therapy for clients in California.
CAMFT: The practice of marriage and family therapy across state borders(2016)
ASWB: Rules affecting the electronic exercise of social service(2017)
There is an app for that!Calledelementary laws of health. And I found that generally timely and would consider it a great place to start.
CAMFT published aVerification listof the Telemedicine Regulation in CA
- The therapist should document the client's address in their notes at the beginning of each session.
- Provide informed consent specifically for telemedicine services. This can be a separate form or added to an updated consent form for your practice. Some EHRs provide a template for this, or you can buy one from several vendors.
- It's also a good idea to have some sort of emergency response worksheet and agreement. This includes emergency contacts,local emergency servicesand a plan for dealing with an emergency should it arise during or outside of the session.
Note on electronic signatures: Under the Electronic Signature Act of 2000, the ESIGN Act is a federal law of 2000 that legally recognizes electronic signatures and records when all contracting parties choose to use electronic documents and electronically sign them. No contract, signature or record will be denied legal force simply because it is in electronic form.
to supply
platforms
There are several safe and free video platforms. Make sure you complete/sign the Business Associate Agreement (BAA) before using any of these platforms. Most, if not all, allow customers to use computers and mobile devices. Note that the rapid adoption of telemedicine can cause disruption or disruption to these services as they become overwhelmed with new users.
- Michigan: Free version. The customer does not need to create an account. Video quality varies more than others based on therapist and client location and connection, but it generally works well enough. I keep this as a quick backup or to use with free video consultations for new clients.
- See: Free for 25 video sessions per month. This requires a download. I think this supports multiple participants from different locations (couples or groups). Personally, I didn't care for the user interface and experience.
- Google MEETwith a gsuite (paid) email. It does not require the customer to have a Gmail account.
- Signalis an app for text, voice and video calls. Both people must have the app, but it's free. Person Centered Tech says it's so secure it doesn't require a BAA. It can be used on your computer and mobile devices. This is a great option for secure phone and text messaging since other commonly used services (personal cell phones or Google Voice) are not HIPAA compliant or secure.
do not useFacetime, Skype, Zoom (free version), WhatsApp or Google Hangouts. They are not HIPAA compliant and not secure even for a non-HIPAA entity.
If you communicate with customers via email or send and receive private health information via email, it is recommended that you use a secure email solution.Prontomailhas a free version.SilenceYG Suitethey are also popular choices. Hushmail and Prontomail (paid version) offer the possibility to send encrypted messages, which offers the best protection and security. Gsuite also supports HIPAA and a Gsuite account, as do many other services including Drive, Meet and more.
VisitG Suiteand use code TAYVF9YFJKGP4WE for 20% off G Suite Basic plan or code 9C49PDJRFGM6V7E for 20% off G Suite Enterprise plan.
Many EHRs have telemedicine options: simple practiceand Theranest are two EHRs I'm aware of that offer a telemedicine video platform, and many others as well. If you're considering an EHR, this might be the right time to take the plunge. The great thing about using an EHR is that you can get all your paperwork, payment processing, and paperless video sessions all in one place.
Use this link to get your first month free and a $50 credit:https://www.simplepractice.com/?p=9bfee6081c
pay
If you don't have an EHR, you must collect payment through a payment processing program. Squareup, IvyPay and Stripe are companies commonly used for this purpose. They all offer a BAA, which you don't have to automatically offer to be HIPAA.
Venmo and PayPal are not HIPAA compliant.
"I'm not a HIPAA company, do I need all this stuff?"
The most certain answer is yes. While you may not be a HIPAA covered entity, if there is a security breach you will be required to follow the standard that MOST therapists follow and most are covered by HIPAA. So why not if it costs nothing?
Safe
- Check with your clients' plan to see if they are eligible for telemedicine and which encryption to use. Most plans refund at the same rate. Unfortunately, some don't.
- Many insurance companies are, or will be, expanding telemedicine coverage for a period of time.
- Ort = 02
- Modifier = 95 or GT
- FB group for insurance and telemedicine for therapists:Telehealth insurance billing.
- If your customer is unable to use your insurance and needs to bill you directly, they will need to complete a cancellation form. You can find an option for the templateHERE.
Office equipment and tips
There are a few things you can do to improve the online therapy experience for you and your client.
- The simpler your background is, the better your video quality will be. This also applies to your clothes. Bright colors and vivid patterns are harder for computer processors to handle.
- Sit away from the computer so that your chest, shoulders and head are clearly visible. And look at your customer. Placing the window directly below the camera will provide the best angle.
- Several diffused light sources (lamps) and/or an inexpensive ring light help to achieve good lighting. I love my umbrella light. A small light ring produces a lot of light. An inexpensive one will work if you need additional lighting, and it's available on Amazon. Make sure there are no light sources behind you, such as windows or lamps.
- A wired connection to your router is faster. Although WiFi works great, I notice a difference when connecting directly.
- Restarting your computer early in the day reduces crashes and interruptions. Encourage clients to reset theirs before the session as well. If you encounter issues, restarting your browser will usually resolve this.
- Close all other browser tabs and programs. And turn off notifications.
- Using headphones reduces feedback and provides a better audio experience for both participants.
- I encourage my clients to use a computer whenever possible. But if you use a phone/tablet, I urge you to use a stand or stand to reduce movement.
Help your customer make the most of their online sessions
Being at home during sessions has advantages and disadvantages. Customers generally feel more comfortable and find it easier to open up. Alternatively, some may find it difficult to find a space conducive to therapeutic work, particularly when children are home due to school closures.
Clients want to find a private space and keep distractions to a reasonable level to get the most out of their sessions. You may also need to restart your computer or close your browser tabs to reduce interference.
resources and training
training courses
Several companies already offer training in telemedicine. Some links are highly recommended. There are other options too, so choose the one that best suits your needs.
- in the direction: This is a 26 CEU certification and includes 12 CA Law and Ethics Units and is very competitively priced.
- person-centered technique: certification program with 17 CEUs and is highly respected and updated regularly. Currently discounted! They offer free 1 CE HIPAA training and free form downloads.
- simple practicenow offers a free 1 CE training course. It's fantastic and accessible to everyone.
- telemedicine traininghas several free offerings and a paid certificate program.
more resources
- Amber Lyda and The Online Therapist Group - LOTS of great information is available for free, with new videos recently released to get you started quickly. It also offers a checklist to get started and paid features on its website.
Site web:https://www.amberlyda.com/
book page:https://www.facebook.com/watch/Dr.AmberLydaONLINEtherapy/
Group:https://www.facebook.com/groups/138663903332494/ - conecte tmh
- person-centered techniqueit has many great resources for individual and group practice.
- You can read another excellent and comprehensive article on the telemedicine transitionHERE.
Do you feel overwhelmed!?
Here is a breakdown of the steps to follow.
- Get a quick overview of your legal and ethical requirements.
- Forms – Update your consent form to include telemedicine and create an emergency service contract. Many EHRs provide templates.
- Check your telemedicine liability insurance, if you have CPH you are good to go!
- Choose a Video Platform – If your EHR has one, try it out. Having everything in one place makes it easy for doctors and clients alike. Take a quick quiz with a friend or colleague.
- Payment processing: If you don't have an EHR to accept payments, set up a payment gateway.
- Consult your customers' insurance coverage.
- Discuss the change with clients, including recommendations on how to get the most out of online therapy and updates to the informed consent form and emergency service agreement.
- Compose an email to customers that includes clear instructions on how to access sessions and what to do when the technology fails. Ask clients to "start" the first session a few minutes early, if they encounter technical difficulties there will be time to resolve them.
disclaimer
I'm not a lawyer. While I have included as much information as possible, this should not be considered a complete overview of all techniques and therapies. Ultimately, you own your license and must make the best decisions for yourself, your clients, and your practice.
About the author
Audrey Schoen is a CA licensed marriage and family therapist. Her online private practice allows him to serve clients across California. As the wife and daughter of law enforcement, she has a special interest in working with first responder partners and couples.