April 1st, 2013

Telepsychology guidelines anticipated

When patients initiate text messaging with Leslie A. Feil, Ph.D., she won’t text back on clinical issues but responds with a phone call instead. The Rhode Island Psychological Association (RIPA) past president also won’t Skype patients, considering it insecure communication. She added consent for text and email messaging to her patient information-HIPAA form.

“I sometimes use text messaging to initiate changes in appointments with younger patients, who as a group appear to not listen to their voicemail messages,” Feil writes in an email, explaining how she incorporates telepsychology into her practice.

It’s a subject of great interest to Feil, chair of RIPA’s Ethics Committee and many others watching the development of new guidelines to address emerging legal, ethical and practice issues surrounding the provision of psychological services using telecommunication technologies.

A Telepsychology Task Force formed in July 2011 released a draft report in late July 2012 that drew nearly 600 comments. The task force is comprised of four members representing the American Psychological Association (APA), four representing the Association of State Provincial Psychology Boards (ASPPB) and two from the American Psychological Association Insurance Trust (APAIT).

A February APA legal review found no need for a second public comment period. The report was submitted to APA’s Board of Professional Affairs which was expected to forward it to the Board of Directors for approval this June. The guidelines could be ready for a vote by APA’s Council of Representatives during the annual convention July 31-Aug. 4 in Honolulu, says Assistant Executive Director for Governance Operations Ronald S. Palomares, Ph.D., who provided support to the task force.

The task force’s only New England member was Eric A. Harris, Ed.D., J.D., legal counsel to the Massachusetts Psychological Association and consultant to APA Insurance Trust. Harris says feedback given during the public comment period was overwhelmingly supportive for the guidelines.

“I think that within 10 years, 80 to 90 percent of all therapy will be done remotely,” Harris says. “There’s been a lot of research done and there’s not one piece of research that suggests that in-person treatment is superior to remote treatment.”

But because telepsychology crosses state lines, there are regulatory concerns. Licensing boards typically consider the location of the consumer receiving services as the presiding jurisdiction. Says Harris, “If you have to be licensed in every state where you have clients, there’s no way that telepsychology can reach its full potential.”

The report gives no specific way to regulate the delivery of psychological services across state and international borders. But it expresses hope that the profession would have such a means for regulation in the future “given the rapidity by which technology is evolving” and its increasing use by psychologists working for the federal government.

APA guidelines typically take three to five years to establish but the Telepsychology Task Force will probably have guidelines done in just two. “This task force seems to be fast-tracked,” Harris says, noting the guidelines are just the first step of the APA political process. “I expect they’ll be passed in August but this is the easy part.”

The task force report makes clear the new guidelines are different from standards, which would mean they are mandatory and have some means of enforcement. “Guidelines are aspirational. They basically say here are the basic operating principles that you have to be aware of and alert to,” Harris explains.

The task force has already started work developing standards and Harris thinks a draft might be ready by next year. After standards, work can begin on drafting regulations, he says.

“It would be inappropriate for each state to establish their own regulatory or ethics guidelines that might conflict with other states,” Feil says. “We need a top-down approach in developing standards of practice, to which each state can then sign on.”

The need to expand ways in which clinicians can treat their patients has been widely recognized. Mental health professionals in the U.S. are concentrated in highly populated, affluent urban areas and in cities with major universities, limiting the treatment options for people in need living in small towns and rural areas, says Yale University Professor of Psychology & Child Psychiatry Alan E. Kazdin, Ph.D.

“About 70 percent of the people in the U.S. right now who need mental health services receive nothing. Absolutely nothing. That’s a disaster,” Kazdin says. “We know that one-to-one therapy can’t even make a dent in that at all. What is needed is multiple ways to get people treatment.”

By Janine Weisman

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