Course 203_Lesson 1_Telepractice Telehealth Law & Ethics Implementation Workshop.pptx

At the Telebehavioral Health Institute, you can earn CEs while you learn. Benefit from our webinars, our individual courses or full certificate in telebehavioral health and online therapy.

1. Telepractice: Telehealth Law & Ethics Implementation Workshop Lesson 1

2. WHO WE ARE: We are licensed healthcare professionals, attorneys and other consultants. TELEHEALTH GOAL: Our goal is educational only. No warranty, guarantee, or representation is made as to the accuracy or sufficiency of the information contained in our training for your specific circumstance. YOUR PART: You are encouraged to seek practice-specific advice from your own legal, regulatory, ethical and liability authorities before offering any telehealth services or programs to consumers/clients/patients. Obtain all such opinions in writing , and have your informed, trusted, local, legal counsel review those written responses for their full significance. Disclaimer

3. Discuss Intelligently discuss why and when to think about technology-relevant standards published by groups such as JCAHO, URAC, COA, and CARF Describe Describe where to go to quickly and easily get relevant documentation standards and/or guidelines Identify Identify at least two types of documents to use as a source for their specific discipline's relevant documentation requirements Learning Objectives

4. Learning Objectives Name Name where to go to learn about relevant federal and state regulations related to telepractice Describe Describe documentation requirements related to teambased approaches to delivering telehealth (i.e., integrated care) that go beyond one's specific disciplinary telehealth requirements Describe Describe the role of other professionals in reviewing documentation requirements and where to find such professionals when needed

5. Syllabus Quiet Space Questions Twitter @Telehealth.org

6. Course Structure Training Hours 3 Video Trainings (3 hrs.) 3 eLearning Assignments Related to Your Discipline Standards Guidelines Competencies Other Oversight Groups

7. Telehealth Law & Ethics Implementation Course Structure: Lessons & Topics Telehealth Standards, Guidelines & Competencies Telehealth Regulatory Guidance Other Telehealth Guidance: Oversight Agencies, Specialty or Population-Specific Guidelines Lesson #1 Lesson #2 Lesson #3

8. Orientation to Your Training Materials Lessons: Next Steps: Resources: Lesson One Lesson Two Lesson Three Assignments Post-Test Course Evaluation Course Certificate Course Documents Bibliography Tools

9. Assignments Check the Standards, Guidelines and/or Competencies in Your Discipline Check the Regulatory Code for Each of Your States of Licensure Lesson 1: Lesson 2: Lesson 3: Pulling It All Together

10. Lesson I Assignment Check the Standards, Guidelines and/or Competencies in Your Discipline Please look for the "Course Documents" link to the immediate left of this instructional box. Click the link and look in the Teleheath list of documents to find the published ethical standards (code of conduct), guidelines and/competencies for your discipline. If it is absent, please go to your national professional association and ask for them. (Then please forward to us and we will add it to our list of it is publicly available. Our address is [email protected]. Thank you.)

11. Assignments This training's first assignment involves your reading all relevant documents for your discipline and listing all the documentation requirements or other suggestions made. With a pad in hand (electronic or paper), read all relevant documents, create a bullet-point list of such requirements or suggestions and paste them as a response to this question below. This exercise is designed to motivate you to take the hour(s) needed to accomplish list. The resulting list will be developed for your purposes only. It can then be used in your work setting to document your compliance with ethical standards (code of conduct), guidelines and/competencies in your discipline(s).

12. Existing Telemental & Telebehavioral Health Ethical Statements American Association of Marriage and Family Therapists (2015). Code of Ethics. American Counseling Association. (2014). ACA Code of Ethics. American Mental Health Counselors Association. (2000). Code of Ethics of the American Mental Health Counselors Association, Principle 14, Internet On-Line Counseling.

13. American Telemedicine Association. (2013). Practice Guidelines for Videoconferencing-Based Telemental Health. American Psychiatric Association. (2018). Best Practices in Videoconferencing-Based Telemental Health. Joint Task Force for the Development of Telepsychology Guidelines for Psychologists. (2013). Guidelines for the Practice of Telepsychology. Existing Telemental & Telebehavioral Health Ethical Statements

14. NAADAC, the Association for Addiction Professionals. (2016). NAADAC/NCC AP Code of Ethics. National Association of Social Workers. (2018). Code of Ethics. National Association of Social Workers. (2017). Technology Standards. Existing Telemental & Telebehavioral Health Ethical Statements

15. NAADAC Association for Addictions Professionals, 2016 Principle VI: E-Therapy, E-Supervision, and Social Media

16. American Counseling Association Code of Ethics, 2013 Section "H"

17. American Psychological Association Guidelines for the Practice of Tele-psychology 2013

18. AAMFT Code of Ethics 2015

19. American Telemedicine Association Practice Guidelines for Video-Based Online Mental Health Services 2013

20. Scope and Standards of Practice for Professional Telehealth Nursing, 2018

21. AACN TelelCU Nursing Consensus Statement 2018

22. American Psychiatric Association Best Practices in Videoconfe-rencing Based Telemental Health April 2018

23. Social Work Technology Standards 2017

24. American Osteopathic Association

25. Social Work Technology Standards, Standard 2.06 Competence

26. American Psychological Association's Ethical Principles of Psychologists and Code of Conduct "Boundaries of Competence"

27. GUIDELINES FOR THE PRACTICE OF TELEPSYCHOLOGY Competence of the Psychologist Acquiring competence may require pursuing additional educational experiences and training, including but not limited to, a review of the relevant literature, attendance at existing training programs (e.g., clinical and technical) and continuing education specific to the delivery of services utilizing telecommunication technologies. Psychologists are encouraged to seek appropriate skilled consultation from colleagues and other resources.

28. Development of the Guidelines Therefore, two of the most salient issues that the Tele psychology Task Force members focus on throughout the document are 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 potentially increased risks to loss of security and confidentiality when using technologies. An additional key issue discussed by the task force members was interjurisdictional practice.

29. American Psychological Association's Ethical Principles of Psychologists and Code of Conduct "Boundaries of Competence" Education Training Experience Consultation Required Ethical Standard Emotional Reasoning vs Competence Example: Using Skype -- many professionals have used and 'feel good" about using skype for years, without understanding legal complexities

30. AOA Code of Ethics (continued)

31. Competencies to Consider Before Working in Telehealth Follow All Applicable State & Federal Laws Competence in Telehealth Competence in Your Regular Treatment Area

32. Look for this document in your Telehealth Training Platform

33. How competencies fit into the picture (building blocks of what you need to know) Professional Service Delivery Training Competencies Guidelines Ethical Standards Regulations Laws

34. CTIBS Inter-professional Telebehavioral Health Competencies

35. CTIBS Inter-professional Framework for Telebehavioral Health Competencies 149 Telebehavioral Practices Across 3 Competency Levels (Novice, Proficient & Authority) 51 Telebehavioral Objectives 5 Subdomains 7 Domains

36. Interprofessional Framework for Telebehavioral Health Competencies CTIBS, 2017 DOMAIN II - Virtual Environment & Telepresence DOMAIN III – Technology DOMAIN I - Clinical Evaluation & Care SUBDOMAIN I.B Cultural Competence & Diversity SUBDOMAIN I.C Documentation & Administrative Procedures SUBDOMAIN I.A Evaluation & Treatment

37. DOMAIN V - Evidence-Based & Ethical Practice DOMAIN VI – Mobile Health Technologies Inclu- ding Applications (Apps) DOMAIN IV – Legal & Regulatory Issues SUBDOMAIN V.A - Standards & Guideline SUBDOMAIN V. B - Social Media and Digital Information Collection DOMAIN VII - Telepractice Development Interprofessional Framework for Telebehavioral Health Competencies CTIBS, 2017

38. Competency Levels Domain and Subdomains are organized according to competency level Novice - advanced students, interns or residents Proficient - licensed professional, teaching faculty, supervisor Authority - advanced practitioner, specialist

39. Competency Levels Each competency level is categorized into discrete Telebehavioral Objectives Telebehavioral Practices

40. CTIBS Telebehavioral Health Competencies Domain I, Clinical Evaluation & Care, Subdomain 1.C. Documentation & Administrative Procedures SUBDOMAIN I.C Documentation & Administrative Procedures: Within his or her competency level then, the professional: Adapts TBH practices Adheres to policies/procedures from in-person care Applies/adapts policies/procedures to TBH Adheres to professional, agency and other organizational policies/procedures (see Legal and Regulatory) Documents TBH practices according to requirements

41. CTIBS Telebehavioral Health Competencies Domain I, Clinical Evaluation & Care, Subdomain 1.C. Documentation & Administrative Procedures Distinguishes and adapts to non-routine components (for Proficient and Authority) Offers supervision in how to comply with all documentation requirements (for Proficient and Authority)

42. CTIBS Telebehavioral Health Competencies Domain I, Clinical Evaluation & Care, Subdomain 1.C. Documentation & Administrative Procedures 1.C.11 Adheres to operational policies/procedures for in-person care and modifications for TBH care. Can demonstrate compliance with proper documentation requirements to ensure the quality and consistency of TBH care and adherence to relevant oversight agencies and their policies/procedures. Can demonstrate adherence and adaptation to best practices for both in-person and TBH care, with awareness of differences in requirements e.g., state/provincial laws and professional standards on informed consent, privacy and billing.

43. H.2.b. Confidentiality Maintained by the Counselor Counselors acknowledge the limitations of maintaining the confidentiality of electronic records and transmissions. They inform clients that individuals might have authorized or unauthorized access to such records or transmissions (e.g., colleagues, supervisors, employees, information technologists). ACA – Code of Ethics “

44. “ 6.4 Technology and Documentation Therapists and supervisors are to ensure that all documentation containing identifying or otherwise sensitive information which is electronically stored and/or transferred is done using technology that adhere to standards of best practices related to confidentiality and quality of services, and that meet applicable laws. Clients and supervisees are to be made aware in writing of the limitations and protections offered by the therapist's or supervisor's technology. ACA – Code of Ethics

45. AMA - Clinical Documentation of a Telepsychiatry Encounter

46. AMA - Clinical Documentation of a Telepsychiatry Encounter Clinical Documentation of a Telepsychiatry Encounter is as important as with any clinical encounter but there may be some important additional considerations including a special need for Documentation of the time, date, remote site location Documentation of the duration of the encounter and time spent face-to-face with the patient in interview and examination Documentation of the originating site location and personnel

47. Components of a clinical encounter which should be documented include: Chief Complaint or Reason for Encounter Referral Source History of Present Illness Current Treatments including medications and ongoing therapies Mental Status Examination Diagnoses Treatment Plan including AMA - Clinical Documentation of a Telepsychiatry Encounter

48. Inclusion of other items is sometimes needed such as: Past Medical, Family, Social Histories Review of Systems AMA - Clinical Documentation of a Telepsychiatry Encounter

49. CTiBS Telebehavioral Health Competencies Domain I, Clinical Evaluation & Care, Subdomain 1.C. Documentation & Administrative Procedures 1.C.12 Adapts operational policies/procedures for situations in which there is no requirement/ specifications on to develop new ones.

50. Represents a "meeting of the minds" Information is influenced by many factors, including: Client/Patient's capacity for absorbing information Time Limits Clinician's schedule Static vs. Dynamic (needs ongoing documentation) Informed Consent Discussion vs. Document

51. A thorough e-therapy informed consent shall be executed at the start of services. A technology-based informed consent discussion shall include: distance counseling credentials, physical location of practice, and contact information; risks and benefits of engaging in the use of distance counseling, technology, and/or social media; possibility of technology failure and alternate methods of service delivery; anticipated response time; VI-4 Informed Consent

52. emergency procedures to follow; when the counselor is not available; time zone differences: cultural and/or language differences that may affect delivery of services, and possible denial of insurance benefits; and social media policy VI-4 Informed Consent

53. Addiction Professionals shall maintain electronic records in accordance with relevant state and federal laws and statutes. Providers shall inform clients on how records will be maintained electronically and/or physically. This includes, but is not limited to, the type of encryption and security used to store the records and the length of time storage of records is maintained. VI-17 Records

54. What are typical emergencies experienced by the population(s) that you serve? Suicide or Homicide What is suicide plan? Are firearms accessible? Abuse What are the imminent dangers? Are children or elderly people in environment? lf substance abuse is an issue, is substance in the home? ls abduction a flight risk if child abuse reporting is discussed? Emergency Planning Introduction

55. What are typical emergencies experienced by the population(s) that you serve? Medication reactions Physical emergencies ls client/patient alone? Is social support available? What repercussions might ensue if you pull in a friend or family? Other? Emergency Planning Introduction

56. Review the specifics of your telehealth informed consent verbally, then ask for signed IC document Include the emergency plan in your informed consent (IC) document, where your client/patient will sign that they agree to your policies Emergency Planning Introduction

57. Collect & Document Local Emergency Resources These can be dependent on your client/patient population (e.g., autistic children and their families, depressed adults, unwed teen mothers, elderly men with anger management issues and subtance abuse) Document telephone numbers, hospital admissions, local clinical resources, local champion or proctor, friend/family member(s) Emergency Planning Introduction

58. Intake form - compare your existing form to your state statutes to make sure you have covered all the required bases Mental status exam Preferences for technology Risks/benefits (See ATA/APA comparison checklist) Diversity needs Gait analysis Hygiene check Alcohol? Intake Form

59. Document, document, document Opening protocol verification of identity, location, and privacy (at a minimum) Clinical protocols followed (evidence-based research articles in your specialty niche or population served) Time in, time out Progress Note

60. Dropped connections Intrusions / interruptions Lighting Adaptive Equipment Progress toward established goals How technology helped/hindered Peer consultation using telehealth systems (e-consults) Progress Note

61. Use your general form, but comment on: Success/pros/cons of telehealth Problems encountered and resolutions if any If telehealth is suggested for future Termination Note

62. Use wording from informed consent agreements about "no-shows/termination" if termination letter is needed Social media policy about "friending" (e.g. Facebook) or giving ratings (e.g. Yelp) and alternative ways to comment after meetings come to a close Termination Note

63. Opening Protocol Identify yourself and your geographic location Ask your client/patient to do the same (as needed) Audio/video check (e.g. Do you hear & see me clearly?) Is there anyone in your room or within ear-shot today? (Agree on safety code words, signals or phrases) Is there anything else I might notice and find of interest if I were in the same room with you today?

64. Intake form - compare your existing form to your state statutes to make sure you have covered all the required bases Mental status exam Preferences for technology Risks/benefits (See ATA/APA comparison checklist) Diversity needs Gait analysis Hygiene check Alcohol? Intake Form

65. Conduct a quick audio and visual assessment and make adjustments as necessary (e.g., are window blinds causing a glare? Is there something interfering with the microphone? Is someone vacuuming in the next room?) Intake Form

66. Telehealth Sample of Initial Evaluation (Intake) Form

67. Telehealth Sample of Telehealth Informed Consent Addendum

68. Telehealth Sample of Progress Note

69. Telehealth Sample of Risk Assessment Form

70. Opening Protocol To be administered by you or your staff Conduct a quick audio and visual assessment and make adjustments as necessary(e.g., are window blinds causing a glare? Is there something interfering with the microphone? Is someone vacuuming in the next room?)

71. Opening Protocol Ask if anyone is in the room, and state if anyone is in the room with you If you hear noises, stop and ask, Has someone entered your room? More times than not, patients won't tell you if someone has entered the room Mention that the session is or is not being recorded and verify whether they are recording it in any way

72. Telehealth.org [email protected] 619-255-2788 Keep in touch! ☺