Massachusetts Board of Registration in Psychology’s current thinking with regard to provision of services via electronic means.
Consumer Affairs and Business Regulation
Provision of Services Via Electronic Means
Originally adopted in March 2005
Updated October 2015
In response to inquiries from licensees and other interested parties, the Board would like to share its current thinking with regard to provision of services via electronic means. The Board recognizes that this is an evolving practice issue, and its policy may be updated from time to time. However, there are some issues and policies that the Board believes are important to share, even as this area evolves. The Board believes that psychologists should recognize that as he or she loses the kind of direct contact with a patient/client that occurs in an in-person, face-to-face office, the psychologist incrementally loses much of the richness of interaction which, as any psychologist knows, comes with traditional face-to-face contact. For this reason, a psychologist should seriously consider conducting the initial evaluation of a client in-person before beginning electronic provision of services, and holding sessions in-person periodically thereafter. A psychologist should also recognize that without such in-person, face-to-face interaction, patients/clients may misinterpret or feel injured by a psychologist’s statements, tone of voice, or other perceived empathic failures, and the psychologist may fail to observe the signs of this in a timely way. This may lead to the patient filing a complaint, prematurely terminating the therapy, or both.
In addition, delivery of clinical services by technology-assisted media such as telephone, use of video, and the internet obligate the psychologist to carefully consider and address a myriad of issues in the areas of structuring the relationship, informed consent, confidentiality, determining the basis for professional judgments, boundaries of competence, computer security, avoiding harm, dealing with fees and financial arrangements, and advertising. Specific challenges include, but are not limited to, verifying the identity of the client, determining if a client is a minor, explaining to clients the procedure for contacting the psychologist when he or she is off-line, discussing the possibility of technology failure and alternative modes of communication if that failure occurs, exploring how to cope with potential misunderstandings when visual cues do not exist or are insufficient, identifying appropriately trained professionals who can provide local assistance (including crisis intervention) if needed, informing internet clients of encryption methods used to help ensure the security of communications, informing clients of the potential hazards of unsecured communication on the internet, telling internet clients whether session data are being preserved (and if so, in what manner and for how long), and determining and communicating procedures regarding the release of client information received through the internet with other electronic sources.
The Board’s current position is that the practice of psychology occurs where the patient/client who is receiving the services is physically located at the time of service. In order for a psychologist to provide psychological services to a patient in Massachusetts, that individual must be licensed by the Massachusetts Board of Registration of Psychologists or be exempt under the provisions of M.G.L. c. 112 §.123. If the patient/client is in Massachusetts at the time of service, and files a complaint against the treating psychologist, that complaint will be heard in Massachusetts.
A Massachusetts psychologist who renders psychological services electronically to a client who is not in Massachusetts is advised to contact the psychology licensing board in the state in which the patient is at time of service, to determine whether or not such practice is permitted in that jurisdiction.
Licensees are advised to review the following:
M.G.L. ch. 112, s. 118-129b
APA Ethical Principles of Psychologists and Code of Conduct (Standards 3.10(a), 4.02(c), 5.01(a), and 5.04 specifically address electronic transmissions).
APA/ASPPB/APAIT Joint Task Force Telepsychology Guidelines
Massachusetts Board of Registration of Social Workers
Practice Advisory regarding social work services by electronic means
Adopted by the Massachusetts Board of Registration of Social Workers on October 22, 2013.
The Board of Registration of Social Workers (“the Board”) voted today to adopt the following practice advisory about providing social worker services by electronic means.
This practice advisory does not have the force of law or regulation, but is intended to provide social workers and the public with a recommended protocol to follow in situations where social work services are not provided in the traditional face-to-face practice setting. The Board will look to this practice advisory in considering matters within its scope.
This Practice Advisory addresses the provision of social worker services by electronic means of communication (“e-practice”), which includes but is not limited to: telephone calls, internet video conferencing , texting, and electronic mail.
In response to inquiries from licensees and other interested parties about providing social work services by e-practice, the Board has reviewed and considered appropriate protocols for providing such services. Social workers must recognize that as he or she moves away from direct contact with clients, the social worker loses the value of interacting with the client which comes with traditional face-to-face practice setting. While e-practice is not encouraged by the Board, the Board recongnizes that in certain circumstances e-practice can be used as a complement to an existing face-to-face therapeutic relationship OR when warranted by extenuating circumstances.
Licensees are reminded that all of the statutes and regulations that govern traditional Social Work are still applicable when treating a client via e-practice. The Board, therefore, recommends that licensees conduct the initial evaluation of a client in person before treating a client via e-practice, and conduct subsequent sessions in person periodically thereafter to best service the needs of their clients.
Treating clients via e-practice obligates licensees to carefully consider and address diverse issues such as structuring the relationship, obtaining informed consent, maintaining confidentiality, determining the basis for professional judgments, determining boundaries of competence, maintaining computer security, avoiding harm, dealing with fees and financial arrangements, and advertising.
In order to provide social work services in Massachusetts, you must be licensed by the Board or be exempt under the provisions of M.G.L. c. 112, §134. In determining whether social work services are being rendered in Massachusetts, the Board considers licensure with the Board necessary when the Patient/Client is located within the Commonwealth. If a Massachusetts licensee renders social work services via e-practice to an out-of-state client, the Board recommends that the licensee contact the social worker licensing board in the state where the client is located to determine whether such practice is permitted in that jurisdiction.
Licensees are advised to review M.G.L. c. 112, s. 130-137, 258 CMR s. 22.00 (Confidentiality of Client Communications and Records), and the NASW Code of Ethics (Ethical Standards 1.07(i) and (m) addressing assuring confidentiality of communications with clients). The NASW Code of Ethics can be found here: http://www.socialworkers.org/pubs/code/code.asp.
Counselors and Marriage and Family Therapists
Policy on Distance, Online, and Other Electronic-Assisted Counseling
The Board of Registration of Allied Mental Health and Human Services Professionals ("the Board") voted at its meeting on November 16, 2007 to adopt the following Policy Guideline. This policy guideline is intended as a recommended protocol for the profession to follow. The guideline set forth below does not have the full force and effect of law, as would a Massachusetts General Law or a Board rule or regulation. However, the Board uses policy guidelines as an internal management tool in formulating decisions that relate to issues in the practice of allied mental health and human services.
Policy No. 07-03
The Board acknowledges that therapy and counseling are increasingly being provided at a distance, making use of the internet, telephone and other electronic means of communication. The emergence of new clinical procedures is necessarily accompanied by uncertainty about legal and ethical obligations. The purpose of this policy statement is to offer guidance to Licensees regarding the ethical obligations and standards of conduct in the use of distance, on-line, and other electronic assisted counseling.
The Board's policy with regard to all distance or electronic-assisted provision of clinical services is as follows:
1. The services offered by licensees of this Board across a distance by electronic means, fall within the jurisdiction of the Board just as traditional, face-to-face services do. Therefore all Board policies and regulations will apply to these services.
2. Distance delivery of counseling and therapy is considered to occur in two locations: where the client is located and where the clinician is located.
3. Therefore, the provision of counseling and/or therapy to individuals located within Massachusetts at the time services are occurring, are considered to fall under the jurisdiction of the Board, regardless of the location of the provider.
4. Mental health professionals licensed by any jurisdiction other than Massachusetts, and not licensed by any Massachusetts Board or not eligible for an exception to Massachusetts licensure, are considered unlicensed by this Board for practice in Massachusetts.
5. Mental health professionals licensed by other jurisdictions who wish to provide services to clients within Massachusetts, are encouraged to apply for Massachusetts licensure. Some, licensees may find the following helpful:
a. Mental Health Counselors: 262CMR 2.03, (1) Licensure for CCMHC's in good standing with NBCC
b. MFT's: 262 CMR 3.04 Licensure by Reciprocity for MFT's.
6. Board licensees who wish to provide services via electronic means to clients located outside of Massachusetts are urged to ensure that they meet the requirements for practice within the jurisdiction where the client is located.
7. Licensees are encouraged to carefully review the way in which the structure of their relationships with clients will be impacted by distance-therapy or counseling to ensure compliance with Board regulations and standards of practice.
8. The following are some areas of practice that licensees should carefully consider:
a. Informed consent
c. Basis for making clinical judgments
d. Areas of competence
e. Avoiding harm
f. Fees and financial arrangements
h. Abandonment of clients
i. Handling requests for obtaining clinical records
9. The Board expects licensees to understand and overcome the significant challenges inherent in providing counseling and therapy without face-to-face contact with the client.
10. Some of the challenges that licensees are expected to manage include, but are not limited to:
a. Full disclosure with regard to potential risks to confidentiality, including computer hacking and/or archiving of communications.
b. Full disclosure of the limits to confidentiality in the jurisdictions where the client, and where the clinician are located.
c. Full disclosure of mandated reporting requirements in the jurisdictions where the client, and where the clinician are located.
d. Full disclosure with regard to the potential disadvantages or limitations of electronic-assisted clinical services.
e. Redirection and/or referral of clients for whom electronic services will not be adequate or appropriate.
f. Full disclosure with regard to fees and billing practices.
g. Full disclosure with regard to licensing, credentials and areas of expertise.
h. Screening and local referral for critical and urgent problems.
i. Verification of the identity and age of the client.
j. Obtaining consent to provide services by a guardian for minors or other vulnerable clients.
k. Management of any misunderstanding or compensation for any missing information, resulting from the lack of visual or auditory cues.
l. Managing the problem of incomplete or inaccurate diagnoses that may result from electronic-assisted services.
m. Managing the potential for technology failure
n. Procedures for contacting the clinician when he/she is offline
11. The Board expects that licensees providing any form of distance counseling will comply with all of the guidelines of ethical practice that apply to traditional, face-to-face counseling.
12. The Board expects that licensees will practice distance counseling in a manner that is consistent with any existing guidelines provided by their professional associations.
13. The Board expects that licensees providing any form of distance counseling will ensure that they are properly trained to manage the specific challenges of this form of counseling and will regularly participate in sufficient continuing education activities that maintain and update the required skills.
14. Unlicensed providers of electronic-assisted counseling will be treated by the Board in the same manner as providers of unlicensed counseling in traditional settings.
M.G.L. Chapter 13, Section 90; and 262 CMR 8.00 et seq.