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Thursday, 20 October 2016 09:41

North Carolina

Counseling:

North Carolina Board of Licensed Professional Counselors

Provision of Services via Electronic, Distance Professional Counseling Services, and Supervision

http://www.ncblpc.org/

Effective Date: February 2, 2017

In response to inquiries from licensees, supervisors and other interested parties, the North Carolina Board of Licensed Professional Counselors has confirmed that it has no separate view per se with regard to the provision of services via electronic means as long as a licensee is practicing in a manner consistent with his/her training and experience, is receiving supervision as is appropriate, and the medium for doing so is not an issue. Counselors consider the differences between face-toface and electronic communication (nonverbal and verbal cues) and how these may affect the counseling process. Counselors educate clients on how to prevent and address potential misunderstandings arising from the lack of visual cues and voice intonations when communicating electronically.

The Board considers that the practice of counseling occurs both where the counselor who is providing counseling services is located and where the individuals (clients) who are receiving services are located. In order for an individual to provide counseling services in North Carolina, that individual must be licensed by the North Carolina Board of Licensed Professional Counselors or be exempt under the Licensed Professional Counselors Act. On this basis, if an individual licensed in North Carolina renders services electronically to an out-of-state client, it is the responsibility of the counselor to ensure that the counselor is complying with the laws and rules in the other state. Licensees are advised to review the North Carolina Licensed Professional Counselors Act and Section H of the ACA Code of Ethics (2014).

Delivery of clinical services via technology-assisted media such as telephones, use of video, or the internet requires the counselor to be sensitive to various issues. The counselor must consider and address a multitude of issues in the areas of structuring the relationship to include: informed consent, confidentiality, acquiring required signatures on intake forms (consent to treat, release of information, professional disclosure forms, consent to treat minors, consent to tape, etc.), determining the basis for professional judgments, boundaries of competence, computer security, avoiding harm dealing with fees and financial arrangements, and advertising. Other specific challenges include, but are not limited to verifying the identity of the client, determining if the client is a minor, explaining to the clients the procedures for contacting the counselor when he or she is off-line, discussing the possibility of technology failure and alternate means of communication if technology failure occurs, exploring how to cope with potential misunderstandings when visual cues do not exist, identifying an appropriately trained professional who can provide local assistance (including crisis intervention), if needed. It is imperative that when providing services through electronic methods, the client and counselor be knowledgeable regarding emergency services available in the communities where their clients live.

It is necessary for counselors to use encrypted technology. Because changes in technology are constantly evolving, the Board cannot provide advice regarding the specific technology to use. Clients should be informed of the encryption methods used to help ensure the security of communications and be made aware of the potential hazards of unsecured communication on the internet. Also, counselors should inform clients as to whether session data is being preserved and if so, in what manner and for how long. In addition, clients need to be informed regarding the procedures that will be in place in receiving and releasing client information received through the internet and other electronic sources

Licensees are advised to review the following:
NC General Statutes - Chapter 90 Article 24
American Counseling Association (2014). ACA Code of Ethics. Alexandria, VA: Author. (Specifically Section H: Distance Counseling, Technology, and Social Media and F.2.c.).
North Carolina Administrative Code Chapter 53 - Board of Licensed Professional Counselors

Marriage and Family Therapy:

Take from North Carolina Marriage and Family Therapy Licensing Board
 http://www.nclmft.org/position_statements

Provision of Services via Electronic Means Adopted by North Carolina Marriage and Family Therapy Licensure Board August 30, 2012 In response to inquiries from licensees and other interested parties, the Board has confirmed that it has no separate view per se with regard to provision of services via electronic means. As long as a licensee is practicing in a manner consistent with his/her training and experience, and is receiving supervision as is appropriate, the medium for doing so is not at issue. However, it is incumbent upon any licensed marriage and family therapist (LMFT or LMFTA) to recognize that as he or she moves away from direct contact with clients, the therapist incrementally loses much of the richness of interaction which, as any therapist knows, comes with traditional face-to-face contact in an individual session with a client. Delivery of clinical services by technology-assisted media such as telephone, use of video, and the internet obligate the therapist 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 therapist 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, identifying an appropriately trained professional 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 considers that the practice of marriage and family therapy occurs both where the therapist who is providing therapeutic services is located and where the individual (patient/client) who is receiving the service is located. In order for an individual to provide marriage and family therapy services in North Carolina, that individual must be licensed by the North Carolina Marriage and Family Therapy Licensure Board or be exempt under the North Carolina Marriage and Family Therapy Licensure Act. On this basis, if a North Carolina licensee renders marriage and family therapy services electronically to an out-of-state client, it is recommended that the licensee contact the marriage and family therapy licensing board in the state in which the patient/client resides to determine whether or not such practice is permitted in that jurisdiction. Licensees are advised to review the North Carolina Licensure Act and the AAMFT Ethics Codes (adopted by the North Carolina Marriage and Family Therapy Licensure Board.

Social Work:

Take from North Carolina Social Work Certification and Licensure Board
http://www.ncswboard.org/files/Position_Stmt_on_Tech_Facil_Services_Amended_2017.2.1.pdf

Position Statement on Technology Facilitate Services 2011.8.5; Amended 2012.2.4 1 N.C. Social Work Certification and Licensure Board POSITION STATEMENT ON TECHNOLOGY FACILITATED SERVICES Purpose: Pursuant to N.C. Gen. Stat. § 90B-2, it is the purpose of the North Carolina Social Work Certification and Licensure Board (hereafter Board) to protect the public by setting standards for qualification, training, and experience for those who seek to represent themselves to the public as certified social workers or licensed clinical social workers and by promoting high standards of professional performance for those engaged in the practice of social work. While the Board strongly encourages in-person interactions, we recognize that advancement in technology has impacted social work practice both in the delivery of services and obtaining information. As the definition of general social work practice and clinical social work practice in North Carolina includes the phrase “by whatever means of communications,” it is the position of the Board that technology facilitated services are one of several means of providing professional services, and as such, remain fully subject to the statutes and rules governing social work practice as outlined in N.C.G.S. § 90B and Title 21, Chapter 63 of the NC Administrative Code. North Carolina practitioners are reminded that pursuant to NCAC 63 .0211, appropriate supervision of provisional licensees providing clinical social work services to satisfy the requirements for LCSW, shall not be acceptable by any means other than in person. The Board does NOT consider delivery of supervision via telemed, webcasting, skype or other similar audio/video broadcast to be acceptable in satisfying the requirement for in person supervision. Technology facilitated services (e.g. technology assisted services between participants in different locations ) are increasingly used in meeting professional social work functions, including clinical and supervisory interactions. The purpose of this position statement is to clearly define the standards of expectation the Board has for social workers with regard to the use of technology facilitated services in professional social work practice, including supervision and the delivery of social work services to consumers. While this applies to more mature technologies (such as telephone and facsimiles) this position statement expands to address the use of recent and emerging technologies, such as telepractice, electronic therapy, distance therapy, electronic supervision, Webconferencing, Video-conferencing, Webcasts, etc. Practitioner Responsibility: A certified or licensed social worker who uses these means to provide services shall abide by the provisions set forth in the Social Worker Certification and Licensure Act [N.C.G.S. § 90B] and Title 21, Chapter 63 of the N.C. Administrative Code. It is the social worker’s responsibility to Position Statement on Technology Facilitate Services 2011.8.5; Amended 2012.2.4 2 ensure that professional and ethical standards are upheld, and the following practice considerations are addressed: 1. Accurate representation of clinician and services offered: a) Credential type and number is identified for each state where credentialed b) Specify nature and extent of services offered c) Location of practice d) Clinician’s contact information for use in case of technology failure e) Emergency contact information for clinician and client f) Contact information for the regulatory boards from which the clinician is credentialed 2. Compliance with regulatory/licensure requirements for the jurisdiction in which the social worker provides services as well as the jurisdiction in which the client receives services. 3. Knowledge of professional liability requirements/limitations. 4. Clinical Competence: a) Safe, ethical, and appropriate use of technology facilitated services for the specific need, to ensure the use of the most appropriate intervention modality, b) Crisis plan c) Provider’s cultural, clinical and technological competence, to include assessment of the client’s needs, willingness and ability to engage in technology facilitated services d) Awareness and assessment of non-verbal/non-written behavior e) Setting and review of goals, intervention modalities and schedules f) Any expectation for face-to-face contact 5. Augmented Informed Consent to address the additional risks associated with services rendered through the use of technology. 6. Confidentiality: a) Clear identification of what is confidential and the limits of confidentiality b) Knowledge of and adherence to HIPAA requirements c) Documentation adequate to meet professional responsibilities d) Security of confidential information transmitted and stored, including security software, potential risks, ethical considerations, data record storage, etc. 7. Administrative Issues: a) Clear business practices, including service-specific billing b) Administrative record keeping c) Technology availability and technical support 8. Practitioner’s maintenance of professional boundaries in public media, such as social networking.

Psychology:

Take from North Carolina Psychology Board 
http://www.ncpsychologyboard.org/office/ElectronicServices.htm

North Carolina Psychology Board

March, 2005

Provision of Services Via Electronic Means

In response to inquiries from licensees and other interested parties, the Board has confirmed that it has no separate view per se with regard to provision of services via electronic means. As long as a licensee is practicing in a manner consistent with his/her training and experience, and is receiving supervision as is appropriate, the medium for doing so is not at issue. However, it is incumbent upon any psychologist to recognize that as he or she moves away from direct contact with clientele, the psychologist incrementally loses much of the richness of interaction which, as any psychologist knows, comes with traditional face-to-face contact in an individual session with a client.

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, identifying an appropriately trained professional 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 considers that the practice of psychology occurs both where the psychologist who is providing therapeutic services is located and where the individual (patient/client) who is receiving the service is located. In order for an individual to provide psychological services in North Carolina, that individual must be licensed by the Psychology Board or be exempt under the Psychology Practice Act. On this basis, if a North Carolina licensee renders psychological services electronically to an out-of-state client, it is recommended that the licensee contact the psychology licensing board in the state in which the patient/client resides to determine whether or not such practice is permitted in that jurisdiction. Licensees are advised to review the North Carolina Psychology Practice Act, specifically the Code of Conduct, and the 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).

Friday, 14 October 2016 14:39

Virginia

Social Work:

The Virginia Social Work Board requires a clinician to be a licensed social worker in the state if the client is located in Virginia.
The board issued "Guidance on Technology-Assisted Therapy and the Use of Social Media": http://www.dhp.virginia.gov/social/guidelines/140-3.pdf

Psychology:

We are not aware of any specific rules and regulations of the practice of telemental health services by Psychologists in Virginia.

Counseling, Marriage and Family Therapists and Licensed Substance Abuse Treatment Practitioners

Counselors

Virginia Board of Counseling

Guidance on Technology-Assisted Counseling and Technology-Assisted Supervision, 2015

https://www.dhp.virginia.gov/counseling/guidelines/115-1.4%20Technology-Assisted.doc

Guidance on Technology-Assisted Counseling and Technology-Assisted Supervision

 

The Board’s regulations for Standards of Practice (18VAC115-20-130) are prefaced by the following:

The protection of the public health, safety, and welfare and the best interest of the public shall be the primary guide in determining the appropriate professional conduct of all persons whose activities are regulated by the board. Regardless of the delivery method, whether in person, by phone or electronically, these standards shall apply to the practice of counseling.

Therefore, the standards of practice set forth in section 130 of the regulations and in the Code of Virginia apply regardless of the method of delivery.  The Board of Counseling recommends the following when a licensee uses technology-assisted counseling as the delivery method:

 

1. Counseling is most commonly offered in a face-to-face relationship. Counseling that from the outset is delivered in a technology-assisted manner may be problematic in that the counseling relationship, client identity and other issues may be compromised.

 

2. The counselor must take steps to protect client confidentiality and security.

 

3. The counselor should seek training or otherwise demonstrate expertise in the use of technology-assisted devices, especially in the matter of protecting confidentiality and security.

 

4. When working with a client who is not in Virginia, counselors are advised to check the regulations of the state board in which the client is located. It is important to be mindful that certain states prohibit counseling by an individual who is unlicensed by that state.

 

5. Counselors must follow the same code of ethics for technology-assisted counseling as they do in a traditional counseling setting.

 

Guidance for Technology-assisted Supervision

 

The Board of Counseling recommends the following when a licensee uses technology-assisted supervision:

 

1. Supervision is most commonly offered in a face-to-face relationship. Supervision that from the outset is delivered in a technology-assisted manner may be problematic in that the supervisory relationship, client identity and other issues may be compromised.

 

2.  The counselor must take steps to protect supervisee confidentiality and security.

 

3. The counselor should seek training or otherwise demonstrate expertise in the use of technology-assisted devices, especially in the matter of protecting supervisee confidentiality and security.

 

4. Counselors must follow the same code of ethics for technology assisted supervision as they do in a traditional counseling/supervision setting.

 

5. The Board of Counseling governs the practice of counseling in Virginia.  Counselors who are working with a client who is not in Virginia are advised to check the regulations of the state board in which a supervisee is located. It is important to be mindful that certain states may regulate or prohibit supervision by an individual who is unlicensed by that state. 

Sunday, 09 October 2016 16:49

New Hampshire

The New Hampshire Board of Mental Health Practice notes the following:

If you are located in New Hampshire and are providing mental health services to a consumer located in another jurisdiction, you are considered to be practicing in New Hampshire and need to be licensed in this State. If you are located in another state and are providing mental health services to a consumer located in New Hampshire, you are considered to be practicing in New Hampshire and need to be licensed in this State.

www.oplc.nh.gov/mental-health/index.htm

Sunday, 09 October 2016 16:48

Nevada

Social workers

Bd. of Exam’rs for Social Workers’ regulations.

CHAPTER 641B - SOCIAL WORKERS

GENERAL PROVISIONS

https://www.leg.state.nv.us/NAC/NAC-641B.html

   NAC 641B.124  Practice by electronic, telephonic or other means. (NRS 641B.160)  The provision of social work services to a client within this State through any means, including, without limitation, electronic means or by telephone, regardless of the location of the social worker, constitutes the practice of social work and is subject to the provisions of chapter 641B of NRS and any regulations adopted pursuant to that chapter.

     (Added to NAC by Bd. of Exam’rs for Social Workers by R113-98, eff. 1-13-99)

Sunday, 09 October 2016 16:47

Nebraska

We are not aware of any specific rules and regulations of the practice of telemental health services, but the state Telehealth Act is provided in the following link:

http://dhhs.ne.gov/publichealth/Licensure/Documents/NebraskaTelehealthAct.pdf

Sunday, 09 October 2016 16:47

Montana

Psychologists

Board of Psychologists

Definition of professional relationship.

http://www.mtrules.org/gateway/RuleNo.asp?RN=24%2E189%2E301

Rule: 24.189.301    DEFINITIONS

(1) "Defined professional relationship" means a relationship in which a licensee or license applicant provides diagnostic, assessment and/or therapeutic services to a client. A defined professional relationship shall be initially established in a context where services are provided:

(a) in person and face-to-face; or

(b) transmitted via electronic or related methods. If provided under this subsection, the context must also be:

(i) two-way;

(ii) interactive;

(iii) real-time;

(iv) simultaneous;

(v) continuous; and

(vi) providing for both audio and visual interaction.

Sunday, 09 October 2016 16:46

Missouri

We are not aware of any specific rules and regulations of the practice of telemental health services.
Sunday, 09 October 2016 16:45

Mississippi

Counselors:

https://www.lpc.ms.gov/secure/pdf/Part%202201%20Rules%20and%20Regulations%20Revised%2002.14.2018.pdf

Mississippi Reg Page 42

Rules and Regulations Mississippi State Board of Examiners for Licensed Professional Counselors

Rule 7.5: Practice of Distance Professional Services Any person that provides counseling or supervision services through the means of Distance Professional Services must hold a license in good standing in both the location where services are provided by the professional as well as in the location of the recipient of the services and must also hold the Distance Credentialed Counselor credential or its equivalent as recognized by the Center for Credentialing and Education, Inc. (CCE) or the National Board of Certified Counselors. Distance Professional Services must be performed in accordance with these Rules and Regulations, the current American Counseling Association’s Code of Ethics, the current National Board for Certified Counselors Policy Regarding the Provision of Distance Profession Services, and Mississippi and Federal law.

Sunday, 09 October 2016 16:45

Minnesota

We are not aware of any specific rules and regulations of the practice of telemental health services.
Sunday, 09 October 2016 16:44

Michigan

We are not aware of any specific rules and regulations of the practice of telemental health services.
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TRUDY POST SPRUNK, LMFT-S LPC CPCS RPT-S CPT-S EMD
Clinical Supervisor and Play Therapist / Georgia Association for Play Therapy