For all behavioral health professionals
PROFESSIONS, VOCATIONS, AND BUSINESSES, CHAPTER 57, IDAHO TELEHEALTH ACCESS ACT
54-5704. SCOPE OF PRACTICE. A provider offering telehealth services must at all times act within the scope of the provider's license and according to all applicable laws and rules, including, but not limited to, this chapter and the community standard of care.
54-5705. PROVIDER-PATIENT RELATIONSHIP. (1) If a provider offering telehealth services in his or her practice does not have an established provider-patient relationship with a person seeking such services, the provider shall take appropriate steps to establish a provider-patient relationship by use of two-way audio and visual interaction; provided however, that the applicable Idaho community standard of care must be satisfied. Nothing in this section shall prohibit electronic communications:
- Between a provider and a patient with a preexisting provider-patient relationship;
- Between a provider and another provider concerning a patient with whom the other provider has a provider-patient relationship;
- Between a provider and a patient where the provider is taking call on behalf of another provider in the same community who has a provider-patient relationship with the patient; or
- In an emergency.
(2) As used in this section, "emergency" means a situation in which there is an occurrence that poses an imminent threat of a life-threatening condition or severe bodily harm.
History: [(54-5705) 54-5605, added 2015, ch. 121, sec. 1, p. 308; am. and redesig. 2016, ch. 47, sec. 30, p. 122.]
Telehealth guidelines from IDAHO LICENSING BOARD OF PROFESSIONAL COUNSELORS AND MARRIAGE AND FAMILY THERAPISTS
Telehealth Guidelines for Professional Counselors and Marriage and Family Therapists
All Idaho licensed counselors and therapists, and those practicing under supervision are required to be knowledgeable and comply with Idaho statutes and rules governing their profession, including the 2015 Telehealth Access Act and their profession’s Code of Ethics. These guidelines do not supersede and are subordinate to those laws and rules and Codes of Ethics. They are intended to provide information and clarification and do not take the place of education or training necessary to engage in telehealth practice. They may be periodically reviewed and modified by the Board.
Reviewed and approved by the Board of Professional Counselors and Marriage and Family Therapists on May 6, 2016.
- Competency and Training
Counselors and therapists provide telehealth services only after they take reasonable steps to ensure their competence with the issues pertaining to this method of service delivery. Specifically counselors and therapists need to obtain education, training and supervision in the unique clinical, technical and administrative challenges which arise in telehealth service delivery. Telehealth services include any written, video or audio transmission of client information for clinical or supervisory purposes using any form or format of electronic technology. These include, but are not limited to, telephones, smartphones and applications, telephone answering machines, faxes, email, social media and internet-based applications, and data storage devices or media. Counselors and therapists keep current with emerging knowledge, technology, and research in telehealth and insure their competency in the delivery of telehealth services through continuing education, consultation, or supervision.
- Competency and Training - Supervisors
The use of technology for providing supervision falls into three categories:
- Distance supervision of non-telehealth services.
- Distant supervision of telehealth services.
- Traditional supervision of telehealth services.
These three categories create different issues that need to be addressed in the supervisor/supervisee agreement. The responsibility to be competent in the delivery of telehealth lies with the supervisor when working with supervisees who are employing telehealth services. Similar to other emerging services and methods of treatment, if the supervisor chooses not to provide technology assisted services they are ethically bound to refer their supervisee or recommend they receive additional supervision for that area of their work.
Those providing supervision of telehealth services review the types of telehealth services being provided to ensure appropriateness for client care. The supervisor should review the supervisee’s policies to ensure that telehealth delivery risks and benefits are adequately addressed and there are adequate safety plans for both client emergencies and technology failures.
- Informed Consent and Disclosure
Prior to commencing telehealth treatment, counselors and therapists provide clients with a professional disclosure statement and obtain verbal and written informed consent from the individuals seeking their services. In addition to following informed consent laws and rules currently in place, telehealth providers inform clients of their level of competency, experience and training in telehealth, and the specific benefits and risks associated with technology-assisted services. They review their policies regarding the use of e-mail, internet messaging, phone texting and social media. They verify the identity of the client/s and attempt to obtain information about alternative means to contact them in case of emergency situations. They clearly state their policies regarding response time to routine electronic messages and to emergencies.
- Confidentiality and Security of Client Information
Counselors and therapists inform clients about their responsibilities regarding maintaining confidentiality, including legally required reporting situations, and the potential risks to confidentiality when using technology. They use secure electronic transmissions in all telehealth communications and make reasonable efforts to secure the confidentiality of information transmitted to other parties. Counselors and therapists notify clients as soon as possible of any breach of confidentiality as a result of electronic transmission of confidential information, and document it in the client file.
- Appropriate Use of Telehealth and Client Assessment
Counselors and therapists recognize that telehealth services are not appropriate for every client. They establish a relationship with new clients by use of two-way audio and visual interaction. They assess whether potential clients have the capacity to benefit from online and remote services, including intellectual, emotional, and physical ability to use electronic technology. They consider the potential benefits from treatment via telehealth services and the potential risks to the individual, couple, family or group. If they determine a client/s cannot be provided appropriate treatment through technology assisted services, and the client/s cannot be seen in person, they provide appropriate referrals.
- Referral to Other Services
Counselors and therapists are responsible for monitoring the effectiveness of telehealth services throughout the treatment, and evaluate the client/s need for in person services or an appropriate referral. They are responsible for ensuring and documenting that the quality of the telehealth services meet the appropriate standard of care. Counselors and therapists providing telehealth services shall be familiar with and have appropriate contact information for available medical resources, including emergency resources near the client's location, in order to make appropriate client referrals when medically indicated. “911” may not provide direct access to emergency services in the client’s location.
- Records and Documentation
Counselors and therapists providing telehealth services maintain records in compliance with any applicable state and federal laws, rules and regulations, including the health insurance portability and accountability act (HIPAA). Such records shall be accessible to other providers and to the client in accordance with applicable laws, rules and regulations. Counselors and therapists inform clients that digital and non-digital communications will be included in the clients’ record (including email messages, text messages, instant messages). Clients are informed of the type of security assigned to the records and the length of time records will be stored. Counselors and therapists take steps to ensure that confidential information stored electronically cannot be recovered or accessed by unauthorized persons when they dispose of or destroy computers and other information storage devices. They have documentation that such disposal has occurred.
- Jurisdiction/State Boundaries
Idaho licensees who want to offer telehealth services outside the state of Idaho are advised to research the legal and regulatory requirements of the state or country in which the potential client resides. Telehealth service is deemed to occur where the client is located at the time of service, the originating site. The provider’s location (distant site) is not considered the location where the services occur.
Guidelines adapted from: Idaho Board of Psychologist Examiners Guidelines for Electronic Transmission and Telepsychology in the State of Idaho (2012), Georgia Composite Board of Professional Counselors, Social Workers and Marriage and Family Therapists Rule 135-11-.01 TeleMental Health (2015), 2014 ACA Code of Ethics, 2015 AAMFT Code of Ethics, Model Regulatory Standards for Technology and Social Work Practice, 2013-2014,
It is the Board's opinion that any licensed counselor or therapist who wishes to engage in telehealth services needs to do his/her research to understand the clinical benefits and risks, best practices, and logistical requirements. The Board has developed this list as a way to assist counselors and therapists in this endeavor. Listing by the Board does not mean endorsement and exclusion from this list does not mean rejection.
Idaho Telehealth Access Act at http://www.legislature.idaho.gov/idstat/Title54/T54CH57.htm
National Board for Certified Counselors (NBCC) Policy Regarding the Provision of Distance Professional Services
American Counseling Association (ACA) 2014 Code of Ethics, Section H, Distance Counseling, Technology and Social Media
American Mental Health Counselors Association (AMHCA), (2000). Code of Ethics of the American Mental Health Counselors Association, Principle 14, Internet On-Line Counseling
American Association of Marriage and Family Therapists (AAMFT) Code of Ethics 2014, Principle II Confidentiality and Principle III Professional Competence and Integrity
American Psychological Association (APA) (July/2013). Guidelines For The Practice of Telepsychology
Guidelines for Electronic Transmission and Telepsychology in the State of Idaho at http://ibol.idaho.gov/IBOL/PSY/Documents/Telepsychology%20Guidelines%2007_12_2012.pdf
ZUR Institute (http://www.zurinstitute.com/telehealthresources.html#profassoc2)
American Telemedicine Association. (ATA)
Practice Guidelines for Video-Based Online Mental Health Services (May/2013)
Quick Guide to Store-Forward and Live-Interactive Teledermatology for Referring Providers (April/2012)
Telemental and Behavioral Health (August 2013)
Canadian Psychological Association (2006). Ethical Guidelines for Psychologists Providing Psychological Services via Electronic Media
National Board for Certified Counselors and Center for Credentialing and Education (2012). The NBCC Policy Regarding the Provision of Distance Professional Services
Ohio Psychological Association (2010). Telepsychology Guidelines
New Zealand Psychological Association (2011). Draft Guidelines: Psychology services delivered via the Internet and other electronic media
Renewed Vision Counseling Services www.renewedvisiontraining.com
Zur Institute www.zurinstitute.com/
Telehealth Certification Institute at https://telementalhealthtraining.com/