March 1st, 2014

Telepsychology guidelines worth examination

The American Psychological Association has begun planning for the future. In July of 2013, the APA approved Guidelines for the Practice of Telepsychology. Rather than repeat the text and history for these guidelines here, those interested may proceed to the Web site www.apa.org/practice/guidelines/telepsychology.aspx

The site reports that the Telepsychology Task Force that put together the guidelines were focused on two issues: the psychologist’s own knowledge of and competence in the provision of telepsychology; and the need to ensure that the client/patient has a full understanding of the potential increased risks to loss of security and confidentiality when using technologies.

In the “application” section under guideline 5 and elsewhere, there’s a listing of some of the possible technologies that are considered: email, telephone, video conferencing, text and I believe there may be others such as faxes and more as technologies evolve.

On the surface, the guidelines appear to merely expand the possible means by which to communicate and interact with clients/patients. But in actuality, that’s not the case. For example, if a psychologist communicates with a client/patient who is in a different state, the psychologist may need to be licensed in both states. The psychologist may also need to ensure that “professional liability” insurance will cover whatever occurs in each state.

Most psychologists are aware of support and emergency services in the area where they practice. Would this be true for services provided by telepsychology? What about providing an Informed Consent Form? These forms will be different in each state and the law is different in each state, by name and number reference of laws as well as actual application differences.

What about providing services to a minor? What about termination or transfer of services? Many of these issues can be difficult in the usual practice. Under telepsychology, these issues can raise risk to a new level.

For a review of telepsychology for all 50 states, visit www.apracticecentral.org/update/2013/10-24/telepsychology-reiew.aspx

That site sets out the following information for each state: Telehealth/Telepsychology Statutes and/or Regulations; Practice of Psychology defined to include specifically telepsychology; Licensing Board Advisory Opinions; Telehealth Coverage Mandate; Temporary/Guest Practice Provisions; and Penalties for Unauthorized practice of psychology without a license

The responses are sufficiently long and different, so you are encouraged to read the responses for the state in which you have an interest.

Please note that at the bottom of each page at this site is a Disclaimer, which states: “This document does not constitute legal advice and should not be relied upon, as it is not routinely updated and was prepared with information from other sources, whose accuracy was not independently verified by APA. APA strongly encourages the reader to independently verify the information contained herein and/or consult with independent legal counsel if the reader intends to use or otherwise rely on such information. Because the law and related information continually change and because APA relied on other sources to compile information contained herein, APA cannot guarantee the completeness, currency, or accuracy of this document.”

This disclaimer is good advice. If a psychologist has a Web site or uses a blog, a similar disclaimer would be essential.

All the above issues should concern any psychologist thinking of using telepsychology in any form. Additional issues include: how to maintain confidentiality in a location that you do not control; how to inform the client/patient about his role in confidentiality; how to avoid hacking of systems, while in “session” or with the maintaining of records; and how to distinguish between new clients and continuing clients.

Other questions raised are: Does there need to be a minimum number of face-to-face contacts over a given period of time? Under what conditions, short-term, long-term, specialty, emergency, etc. situations, can or should telepsychology occur, if ever?

The guidelines should be regarded as such as they are not law.

There are many qualifiers mentioned throughout including this one of interest regarding the competence of the psychologist.

“Psychologists understand the need to consider their competence in utilizing telepsychology as well as their client’s/patient’s ability to engage in and fully understand the risks and benefits of the proposed intervention utilizing specific technologies. Psychologists make reasonable effort to understand the manner in which cultural, linguistic, socioeconomic and other individual characteristics (e.g., medical status, psychiatric stability, physical/cognitive disability, personal preferences) in addition to, organizational cultures may impact effective use of telecommunication technologies in service delivery.”

All these qualifiers and disclaimers should lead to the most important point. If a psychologist is intending to use telepsychology in a major or minor way, the psychologist should seek legal counsel in both the sending and receiving location.

Edward M. Stern, J.D., has a private law practice in Newtonville, Mass., Stern serves as assistant dean for pre-law advising at Boston University and is a visiting lecturer for the University of Massachusetts/Boston Department of Sociology.

By Edward Stern J.D.

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