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Association of Marital and Family Therapy Regulatory Boards
Teletherapy Guidelines
September 2016
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AMFTRB Teletherapy Guidelines
Table of Contents Overview......................................................................................................................................................4
KeyAssumptionsoftheTeletherapyCommittee........................................................................................4
TheProcess..................................................................................................................................................4
IntroductiontoTeletherapyGuidelines......................................................................................................5
Definitions...................................................................................................................................................7
GuidelinesfortheRegulationofTeletherapyPractice................................................................................9
1. AdheringtoLawsandRulesinEachJurisdiction.............................................................................9
2. Training/EducationalRequirementsofProfessionals......................................................................9
3. IdentityVerificationofClient...........................................................................................................9
4. EstablishingtheTherapist-ClientRelationship..............................................................................10
5. CulturalCompetency.....................................................................................................................10
6. InformedConsent/ClientChoicetoEngageinTeletherapy..........................................................11
AvailabilityofProfessionaltoClient..................................................................................................11
WorkingwithChildren.......................................................................................................................12
7. AcknowledgementofLimitationsofTeletherapy..........................................................................12
8.ConfidentialityofCommunication.................................................................................................13
9.ProfessionalBoundariesRegardingVirtualPresence....................................................................13
10.SocialMediaandVirtualPresence.................................................................................................13
11.SexualIssuesinTeletherapy..........................................................................................................14
12.Documentation/RecordKeeping...................................................................................................14
13.PaymentandBillingProcedures....................................................................................................15
14.EmergencyManagement...............................................................................................................15
15.Synchronousvs.AsynchronousContactwithClient(s)..................................................................16
16.HIPAASecurity,WebMaintenance,andEncryptionRequirements..............................................16
17.Archiving/BackupSystems.............................................................................................................17
18.ElectronicLinks..............................................................................................................................17
19.Testing/Assessment.......................................................................................................................17
20.Telesupervision..............................................................................................................................18
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Contributors..............................................................................................................................................19
MFTTrainingProgramsandFaculty:.................................................................................................19
StateLicensingBoards,ExecutiveDirectors,andBoardMembers:..................................................20
TeletherapyCommitteeMembers:...................................................................................................21
Resources..................................................................................................................................................22
References.................................................................................................................................................24
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Overview TheAMFTRBTeletherapyCommitteewascreatedandtaskedwithdevelopingasetofguidelinesforusebyMemberBoardswhenregulatingthepracticeofteletherapybyLicensedMarriageandFamilyTherapists(LMFTs)acrossthecountry.TheCommitteereviewedcurrentAAMFTCodesofEthicsandotherprofessionalcodesofethics,statelaws,researcharticles,andtelehealthguidelinesofmanydisciplinesincreatingthefollowingguidelinesforLicensedMarriageandFamilyTherapists.
Key Assumptions of the Teletherapy Committee
Thecommitteeagreeduponthefollowingtenetswhichinformedeachoftheguidelinesherein:
I. Publicprotectionmustbetheoverridingprinciplebehindeachguideline.
II. Eachguidelineshallbewrittenwithspecialconsiderationofthoseuniquelysystemicchallenges.
III. Allexistingminimumstandardsforface-to-faceclientinteractionareassumedforteletherapypractice.
IV. Ateletherapystandardshallnotbeunnecessarilymorerestrictivethantherespectiveface-to-facestandardforsafepractice.
V. Eachguidelinemustbearecommendationforaminimumstandardforsafepracticenotabestpracticerecommendation.
VI. TheregulationofteletherapypracticeisintertwinedwiththechallengesofportabilityofLMFTlicensureacrossstatelines.
VII. Eachguidelineshallbewrittenwithconsiderationforthepossibilityofanationalteletherapycredential.
The Process
TheAMFTRBTeletherapyCommitteememberswereidentifiedinfall2015.Thecommitteebeganwithareviewofliteratureandcurrenttelehealthpracticepublicationswithinthefieldofmarriageandfamilytherapyandacrossprofessionaldisciplines.Topicalareasfortelementalhealthguidelineswereidentified,andeachcommitteememberwaschargedwithresearchingthecriticalelementstobeincludedinthefinaldraft.Thecommitteemetandreviewedeachoftheelementsoftheguidelines.Pleasebeadvisedthatthecommitteedidnotdraftspecificregulationsregardingtheappropriatenessoftelementalhealthandworkingwithdomesticviolencevictims,completingchildcustodyevaluations,treatingcyberaddiction,orusingtechnologyforsupervisedsanctionsastheresearchineachoftheseareaswaslimited.WealsoacknowledgethatamethodbywhichculturalcompetencymaybemeasuredisneededandencourageMemberBoardstoadvisetherapiststoseektraininginthisarea.
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Committeemembersidentifiedstakeholderswhoseinputwasdesiredinreviewingthedraftguidelines.Commentswererequestedfrommarriageandfamilytherapygraduateprograms,continuingeducationresources,andstatelicensingboards.Thecommitteereviewedandanalyzedthecommentsfromstakeholders,consultedtheAAMFTCodeofEthics,andGuidelines,andincorporatedthisinformationintothefinaldocument.Thedraftguidelineswerethensubmittedtothe2016AMFTRBdelegateassemblyfordiscussionandadoption.
Introduction to Teletherapy Guidelines
Electronicpracticeinbehavioralhealthhascontinuedtogarnermomentum.WiththecreationofFacebookin2004,theonsetof140charactermessagesthroughTwitterin2006,andtheproliferationofvideoconferencingplatforms,therapistsandclientshavemoreoptionsavailabletointeractwitheachotherthaneverbefore.Telementalhealthisexperiencingan“evidentboom”formanyreasons.Socialmediahassignificantlycontributedtothegrowth.Forexample,asofJuly2016,Facebookreportsover950millionusers,500millionofwhomlogindaily.ThePewResearchCenter(January2014)reported87%ofAmericanadultsusetheinternet,upfrom14%in1995(Pew,2014).TheInternetWorldStatsestimates3,611millionsofusersoftheinternet(Zephoria,2016).
TheStateofTelementalHealthin2016identifiesfivereasonsforthisgrowth.First,telementalhealthdoesnotrequirephysicalcontactwithpatients;therefore,technologybasedservicesarenotthatdifferentfromface-to-facetherapy.Whilethisstatementoverlooksthenuancesofprovidingtelementalhealth,itdoessupportaburgeoningpracticeofclientsreceivingserviceswithoutneedingtostepfootinatherapist’soffice.Second,telementalhealthhasbeenacceptedbyalargenumberofpayers,morethanothertelehealthdisciplines.Asmoreandmorepayerscoverservicesprovidedthroughelectronicpractice,itisanticipatedthatagrowingnumberoftherapistswillprovidecareelectronically.Third,telementalhealthmayreducethestigmaofthoseseekingcare.Oneoftheunspokenbenefitsoftelementalhealthisthatclientsdonotneedtobeseenenteringatherapist’soffice.Therapistsarecognizantoftheconcernclientshaveforconfidentialitywhendeterminingwheretohousetheirbrick-and-mortarpractices.Withtheopportunitytoreceivetelementalhealthelectronically,thestigmaofreceivingcounselingmaybelessened.Notonlyisthepotentialforthestigmaofmentalhealthdiminishing,moreandmoreclientsmayalsohaveanopportunitytoreceivecarethroughtelementalhealth.Fourth,theprevalenceofmentalhealthservicesandtheshortageofmentalhealthcounselorsisincentivizingstakeholderstolookforalternativestoface-to-facecare.Forpsychiatry,theAmericanMedicalAssociationreportedthat60percentofpsychiatristsnationwideareatleast55yearsold,withabout48percentconsideringretiringinthenextfiveyears.“AccordingtoMentalHealthAmerican’slatestreportonmentalhealth,thereisonlyonementalhealthproviderforevery566peopleinthecountry.”Mainehasthehighestnumberofmentalhealthproviderswitha1:250ratioandTexashasthefewest(1:1,100).Finally,thepatientswhohavereceivedtelementalhealthserviceshaveperceivedtheircaretobeeffective(Epstein,Becker,&O’Brien,2016).
Sincetheearlydiscussionsabouttelementalhealth,thetechnologicallandscapehaschanged.Cybercounseling(Hughes,2000),e-counseling,e-therapy(Epstein,Becker,&O’Brien,2016)andthecurrenttermoftelementalhealthserviceshaveevolvedastheshiftingsandsofmodalitiesusedinelectronicpracticehavealteredthemodalitiestherapistsuse.Earlypublicationsabouttelemental
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healthservicesaskedquestionssuchas,“Shouldemailsbeencrypted?”(Mitchell,2000),“Whatfeestructuresshouldbeestablishedforonlineservices?”(Hughes,2000),“Canaclientdeclinetousesecuresystems?”,and“Whatifaclientemergencyisreceived,andthereisnoidentifyinginformation?”(Mitchell,2000).
Discussionsaboutonlinetherapyhaveshiftedastechnologiesavailablefortherapyhaveshifted.Earlydiscussionsinvolvedtelephoniccounselingandemailswhichevolvedintovideocounseling,avatars,chats,blogs,andmore.Socialmediaandsocialnetworkingsiteshavealsoalteredthetherapylandscape.Althoughthetechnologieshavechanged,theconcernsassociatedwiththeprovisionoftelementalhealthserviceshavenot.Theassuranceofconfidentialitycontinuestobeaconcern(Hertlein,Blumer,&Mihaloliakos,2014;Derrig-Palumbo&Eversole,2011),asdoesboundarymanagement((Hertlein,Blumer,&Mihaloliakos,2014;Hertleinetal,2014),andmanagementofcrises(Hertlein,Blumer,&Mihaloliakos,2014;Perleetal.,2013;Chester&Glass,2006).Otherconcernsidentifiedinresearchincludetheimpacttechnologyhasonthetherapeuticrelationship,liabilityandlicensingissues,andtrainingandeducationrequiredtoprovideeffectivetelementalhealthservices(Hertlein,Blumer,&Mihaloliakos,2014).
Asmillennialsenterthecounselingfield,theuseoftechnologyisanticipatedtocontinue.Reith(2005)notedmillennialsaremorecomfortablewithtechnologyandhavebeendubbedthe“digitalnatives”.Digitalnativeswere“borninto”aworldoftechnology,moresothanpreviousgenerationswhohavebeentermed“digitalimmigrants”(Prensky,2001).Furthermore,Blumer,Hertlein,Allen,&Smith(2012)reportedthatmillennialsalsofeeltechnologyisprivateandsafe.Thisperceptioncouldimpactthedecisionsmadeinthecareandsafekeepingofclinicalinformationwhichfuelstheneedfortechnologyspecificregulations.
Theproliferationofcounseling-relatedwebsiteshasalsoimpactedtheneedfortechnology-relatedregulations.InSeptember2008,Haberstroh(2009)identified4millionwebsiteswhensearching“onlinecounseling”.InJuly2016,arecentsearchofthesametermnetted94millionresults.Thisgrowthclearlyindicatesmoreandmorecounselorsareturningtotheinternettoprovideservicesofsometype.Blumer,Hertlein,Allen,&Smith(2012)notedintheirresearchthattherapistsusedtechnologytoaugmenttreatmentandTwist&Hertlein(2015)notedtheuseoftechnologyforonlineprofessionalnetworking.
Whileresearchindicatesagrowinguseoftechnologyinprofessionalcommunications,Maheu&Gordon(2000)discoveredthat78%ofcounselorsacknowledgedtreatingclientsfromotherstatesonline.Furthermore,Shaw&Shaw(2004)andHeinlenetal(2003)“foundmanyonlinecliniciansdidnotregularlyfollowethicalguidelinesintheirpractices”.InastudyofSwedishphysicians,Brynoldetal(2013)notedthatphysiciansweretweetinginamannerdeemed“unprofessional,”andthetweetswereconsideredviolationsofpatientprivacy.Nearly84%offamilytherapistswerenoted,inonestudy,tohavecommunicationwithclientsviaemail(Hertlein,Blumer&Smith,2013).
Therapistsmaybeconfusedabouthowtoethicallyandlegallyprovidetelementalhealthservices.Haberstroh,Barney,Foster,&Duffey(2013)notedwhilenostatelicensingboardsprohibittelementalhealthservices,thelanguageisvague.“Lessthanhalfofstateboardsdirectlyallowedthepracticeofonlineclinicalworkthroughtheirlocalstatelawsorethicalcodes…However,thespecificityoftheguidanceprovidedbylicensureboardsvariedgreatly.”Statesseemtobegrapplingwiththechallengesofwritingeffectiveandsomewhattimelesstechnologyregulations.Therapistsmustcomplywiththe
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relevantlicensinglawsinthejurisdictionwherethetherapistislicensedwhenprovidingthecareandtherelevantlicensinglawswheretheclientislocatedwhenreceivingcare.Manystateswillonlyprocesscomplaintsfromresidentsoftheirstate.Note,intheUnitedStates,thejurisdictionallicensurerequirementisusuallytiedtowheretheclientisphysicallylocatedwhenheorsheisreceivingthecare,notwheretheclientlives;however,therapistsmustensuretheyarealsocompliantwithanyandallstateandfederallaws.
Whilethetechnologiesandopportunitiescontinuetoemerge,fewgraduateprogramsprovidemeaningfulguidanceinhowtoestablishatelementalhealthpractice.Feedbackreceivedfromgraduateprogramsindicatethemajorityofprograms,iftheyareaddressingtelementalhealthpracticeatall,arecoveringtelementalhealthservicestypicallyinoneclassperiod.Manynotedthatthelackofclearregulationsimpactedtheirwillingnesstoprovidemorecomprehensiveeducationabouttelementalhealthpractice.
Therapistscurrentlyinthefieldrelyonpost-graduatetraining,typicallyintheformofcontinuingeducationworkshopsandprograms,toexpandtheirprofessionalcompetence.Hertlein,Blumer&Smith(2013)notedthattherapistsshouldbetrainedinprovidingtelementalhealthservices,andyet,atthe2010AAMFTconference,theynote1of220workshops/postersfocusedontelementalhealth.Williamsetal(2013)suggesteda“frameworkthatincludese-professionalism”bedrafted.AlloftheseeventssupporttheneedforAMFTRBtoestablishtelementalhealthguidelines.
Definit ions
Asynchronous–Communicationisnotsynchronizedoroccurringsimultaneously(Reimers,2013)
Competency-Marriageandfamilytherapistsensurethattheyarewelltrainedandcompetentintheuseofallchosentechnology-assistedprofessionalservices.Carefulchoicesofaudio,video,andotheroptionsaremadeinordertooptimizequalityandsecurityofservicesandtoadheretostandardsofbestpracticesfortechnology-assistedservices.Furthermore,suchchoicesoftechnologyaretobesuitablyadvancedandcurrentsoastobestservetheprofessionalneedsofclientsandsupervisees.(AAMFTCodeofEthics,2015)
Electroniccommunication-UsingWebsites,cellphones,e-mail,texting,onlinesocialnetworking,video,orotherdigitalmethodsandtechnologytosendandreceivemessages,ortopostinformationsothatitcanberetrievedbyothersorusedatalatertime.(TechnologyStandardsinSocialWorkPractice,2016)
Encryption–Amathematicalprocessthatconvertstext,video,oraudiostreamsintoascrambled,unreadableformatwhentransmittedovertheinternet.(Trepal,Haberstroh,Duffey,&Evans,2007)
HIPAAcompliant–HIPAA,theHealthInsurancePortabilityandAccountabilityAct,setsthestandardforprotectingsensitivepatientdata.Anycompanythatdealswithprotectedhealthinformation(PHI)mustensurethatalltherequiredphysical,network,andprocesssecuritymeasuresareinplaceandfollowed.Thisincludescoveredentities(CE),anyonewhoprovidestreatment,paymentandoperationsinhealthcare,andbusinessassociates(BA),anyonewithaccesstopatientinformationandprovides
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supportintreatment,paymentoroperations.Subcontractors,orbusinessassociatesofbusinessassociates,mustalsobeincompliance.(WhatisHIPAACompliance?2016)
HITECH-HealthInformationTechnologyforEconomicandClinicalHealth(HITECH)Actof2009addressestheprivacyandsecurityconcernsassociatedwiththeelectronictransmissionofhealthinformation,inpart,throughseveralprovisionsthatstrengthenthecivilandcriminalenforcementoftheHIPAArules(HITECHActEnforcementofInterimFinalRule,2016)
PHI–ProtectedHealthInformation(HIPAA,2016)
Socialmedia/socialnetworking-Socialmediaareweb-basedcommunicationtoolsthatenablepeopletointeractwitheachotherbybothsharingandconsuminginformation(Webtrends,2016)
Synchronous–Communicationwhichoccurssimultaneouslyinrealtime(Reimers,2013)
Telesupervision-referstothepracticeofsupervisionbyalicensed(teletherapy)supervisorthroughsynchronousorasynchronoustwo-wayelectroniccommunicationincludingbutnotlimitedtotelephone,videoconferencing,email,text,instantmessaging,andsocialmediaforthepurposesofdevelopingtraineemaritalandfamilytherapists,evaluatingsuperviseeperformance,ensuringrigorouslegalandethicalstandardswithintheboundsoflicensure,andasameansforimprovingtheprofessionofmaritalandfamilytherapy.
Teletherapy/Technology-assistedservices–referstothescopeofmarriageandfamilytherapypracticeofdiagnosis,evaluation,consultation,interventionandtreatmentofbehavioral,social,interpersonaldisordersthroughsynchronousorasynchronoustwo-wayelectroniccommunicationincludingbutnotlimitedtotelephone,videoconferencing,email,text,instantmessaging,andsocialmedia.
Verification–Measurestoverifybothcounselorandclientidentitiesonline(Haberstroh,2009)
Virtualrelationship-Arelationshipwherepeoplearenotphysicallypresentbutcommunicateusingonline,texting,orotherelectroniccommunicationdevise(UrbanDictionary,2016)
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Guidelines for the Regulation of Teletherapy Practice
1. Adhering to Laws and Rules in Each Jurisdiction
A. Therapistsofonestatewhoareprovidingmarriageandfamilytherapytoclientsinanotherstatemustcomplywiththelawsandrulesofbothjurisdictions.
B. Treatment,consultation,andsupervisionutilizingtechnology-assistedserviceswillbeheldtothesamestandardsofappropriatepracticeasthoseintraditional(inperson)settings.
2. Training/Educational Requirements of Professionals
A. Therapistsmustbeaccountabletostatesofjurisdictioneducationrequirementsforteletherapypriortoinitiatingteletherapy.
B. Therapistsmayonlyadvertiseandperformthoseservicestheyarelicensedandtrainedtoprovide.Theanonymityofelectroniccommunicationmakesmisrepresentationpossibleforboththerapistsandclients.Becauseofthepotentialmisusebyunqualifiedindividuals,itisessentialthatinformationbereadilyverifiabletoensureclientprotection.
C. Therapistsshallreviewtheirdiscipline'sdefinitionsof"competence"priortoinitiatingteletherapyclientcaretoassurethattheymaintainrecommendedtechnicalandclinicalcompetenceforthedeliveryofcareinthismanner.Therapistsshallhavecompletedbasiceducationandtraininginsuicideprevention.Whilethedepthoftrainingandthedefinitionof“basic”aresolelyatthetherapist’sdiscretion,thetherapist’scompetencymaybeevaluatedbythestateboard.
D. Therapistsshallassumeresponsibilitytocontinuallyassessboththeirprofessionalandtechnicalcompetencewhenprovidingteletherapyservices.
E. Minimum15hoursinitialtraining.Mustdemonstratecontinuedcompetenceinavarietyofways(e.g.encryptionofdata,HIPAAcompliantconnections).Areastobecoveredinthetrainingmustinclude,butnotbelimitedto:
a. AppropriatenessofTeletherapyb. TeletherapyTheoryandPracticec. ModesofDeliveryd. Legal/EthicalIssuese. HandlingOnlineEmergenciesf. BestPractices&InformedConsent
F. Minimumof5continuingeducationhoursevery5yearsisrequired.
3. Identity Verif ication of Cl ient A. Therapistsmustrecognizetheobligations,responsibilities,andclientrightsassociatedwith
establishingandmaintainingatherapeuticrelationship.B. Anappropriatetherapeuticrelationshiphasnotbeenestablishedwhentheidentityofthe
therapistmaybeunknowntotheclientortheidentityoftheclient(s)maybeunknowntothetherapist.Aninitialface-to-facemeeting,whichmayutilizeHIPAAcompliantvideo-conferencing,ishighlyrecommendedtoverifytheidentityoftheclient.Ifsuchverification
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isnotpossible,theburdenisonthetherapisttodocumentappropriateverificationoftheclient.
C. Atherapistshalltakereasonablestepstoverifythelocationandidentifytheclient(s)attheonsetofeachsessionbeforerenderingtherapyusingteletherapy.
D. Therapistsshalldevelopwrittenproceduresforverifyingtheidentityoftherecipient,hisorhercurrentlocation,andreadinesstoproceedatthebeginningofeachcontact.Examplesofverificationmeansincludetheuseofcodewords,phrasesorinquiries.(Forexample,“isthisagoodtimetoproceed?”).
4. Establishing the Therapist-Cl ient Relationship
A. Atherapistwhoengagesintechnology-assistedservicesmustprovidetheclientwithhis/herlicensenumberandinformationonhowtocontacttheboardbytelephone,electroniccommunication,ormail,andmustadheretoallotherrulesandregulationsintherelevantjurisdiction(s).
B. Therelationshipisclearlyestablishedwheninformedconsentdocumentationissigned.C. Therapistsmustcommunicateanyrisksandbenefitsoftheteletherapyservicestobe
offeredtotheclient(s)anddocumentsuchcommunication.D. Screeningforclienttechnologicalcapabilitiesispartoftheinitialintakeprocesses.(Ex.This
typeofscreeningcouldbeaccomplishedbyaskingclientstocompleteabriefquestionnaireabouttheirtechnicalandcognitivecapacities).
E. Teletherapyservicesmusthaveaccurateandtransparentinformationaboutthewebsiteowner/operator,location,andcontactinformation,includingadomainnamethataccuratelyreflectstheidentity.
F. Thetherapistand/orclientshalluseconnectiontesttools(e.g.,bandwidthtest)totesttheconnectionbeforestartingtheirvideoconferencingsessiontoensuretheconnectionhassufficientqualitytosupportthesession.
5. Cultural Competency
A. Therapistsshallbeawareofandsensitivetoclientsfromdifferentculturesandhavebasicclinicalcompetencyskillsprovidingtheseservices.
B. Therapistsshallbeawareofthelimitationsofteletherapyandrecognizeandrespectculturaldifferences(e.g.whentherapistisunabletoseetheclient,non-verbalcues).Therapistsshallremainawareoftheirownpotentialprojections,assumptions,andculturalbiases.
C. Therapistsshallselectanddevelopappropriateonlinemethods,skills,andtechniquesthatareattunedtotheirclients’cultural,bicultural,ormarginalizedexperiencesintheirenvironments.
D. Clientperspectivesoftherapyandservicedeliveryviatechnologymaydiffer.Inaddition,culturallycompetenttherapistsshallknowthestrengthsandlimitationsofcurrentelectronicmodalities,processandpracticemodels,toprovideservicesthatareapplicableandrelevanttotheneedsofculturallyandgeographicallydiverseclientsandmembersofvulnerablepopulations.
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E. Therapistsshallconsiderculturaldifferences,includingclarityofcommunications.F. Sensorydeficits,especiallyvisualandauditory,canaffecttheabilitytointeractovera
videoconferenceconnection.Therapistsshallconsidertheuseoftechnologiesthatcanhelpwithvisualorauditorydeficit.Techniquesshouldbeappropriateforaclientwhomaybecognitivelyimpaired,orfinditdifficulttoadapttothetechnology.
6. Informed Consent/Client Choice to Engage in Teletherapy
Avai labi l i ty of Professional to Cl ient A. Thetherapistmustdocumenttheprovisionofconsentintherecordpriortotheonsetof
therapy.Theconsentshallincludeallinformationcontainedintheconsentprocessforin-personcareincludingdiscussionofthestructureandtimingofservices,recordkeeping,scheduling,privacy,potentialrisks,confidentiality,mandatoryreporting,andbilling.
B. Thisinformationshallbespecifictotheidentifiedservicedeliverytypeandincludeconsiderationsforthatparticularindividual.
C. Theinformationmustbeprovidedinlanguagethatcanbeeasilyunderstoodbytheclient.Thisisparticularlyimportantwhendiscussingtechnicalissueslikeencryptionorthepotentialfortechnicalfailure.
D. Local,regionalandnationallawsregardingverbalorwrittenconsentmustbefollowed.Ifwrittenconsentisrequired,electronicsignaturesmaybeusediftheyareallowedintherelevantjurisdiction.
E. Inadditiontotheusualandcustomaryprotocolofinformedconsentbetweentherapistandclientforface-to-facecounseling,thefollowingissues,uniquetotheuseofteletherapy,technology,and/orsocialmedia,shallbeaddressedintheinformedconsentprocess:
a. confidentialityandthelimitstoconfidentialityinelectroniccommunication;b. teletherapytrainingand/orcredentials,physicallocationofpractice,andcontact
information;c. licensurequalificationsandinformationonreportingcomplaintstoappropriate
licensingbodies;d. risksandbenefitsofengagingintheuseofteletherapy,technology,and/orsocial
media;e. possibilityoftechnologyfailureandalternatemethodsofservicedelivery;f. processbywhichclientinformationwillbedocumentedandstored;g. anticipatedresponsetimeandacceptablewaystocontactthetherapist;
i. agreeduponemergencyprocedures;ii. proceduresforcoordinationofcarewithotherprofessionals;iii. conditionsunderwhichteletherapyservicesmaybeterminatedanda
referralmadetoin-personcare;h. timezonedifferences;i. culturaland/orlanguagedifferencesthatmayaffectdeliveryofservices;j. possibledenialofinsurancebenefits;k. socialmediapolicy;l. specificservicesprovided;m. pertinentlegalrightsandlimitationsgoverningpracticeacrossstatelinesor
internationalboundaries,whenappropriate;andn. Informationcollectedandanypassivetrackingmechanismsutilized.
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F. Giventhattherapistsmaybeofferingteletherapytoindividualsindifferentstatesatanyonetime,thetherapistsshalldocumentallrelevantstateregulationsintherespectiverecord(s).Thetherapistisresponsibleforknowingthecorrectinformedconsentformsforeachapplicablejurisdiction.
G. Therapistsmustprovideclientsclearmechanismsto:
a. access,supplement,andamendclient-providedpersonalhealthinformation;b. providefeedbackregardingthesiteandthequalityofinformationandservices;andc. registercomplaints,includinginformationregardingfilingacomplaintwiththe
applicablestatelicensingboard(s).
Working with Chi ldren A. Therapistsmustdetermineifaclientisaminorand,therefore,inneedofparental/guardian
consent.Beforeprovidingteletherapyservicestoaminor,therapistmustverifytheidentityoftheparent,guardian,orotherpersonconsentingtotheminor’streatment.
B. Incaseswhereconservatorship,guardianshiporparentalrightsoftheclienthavebeenmodifiedbythecourt,therapistsshallobtainandreviewawrittencopyofthecustodyagreementorcourtorderbeforetheonsetoftreatment.
7. Acknowledgement of Limitations of Teletherapy A. Therapistsmust:(a)determinethatteletherapyisappropriateforclients,considering
professional,intellectual,emotional,andphysicalneeds;(b)informclientsofthepotentialrisksandbenefitsassociatedwithteletherapy;(c)ensurethesecurityoftheircommunicationmedium;and(d)onlycommenceteletherapyafterappropriateeducation,training,orsupervisedexperienceusingtherelevanttechnology.
B. Clientsmustbemadeawareoftherisksandresponsibilitiesassociatedwithteletherapy.Therapistsaretoadviseclientsinwritingoftheserisksandofboththetherapist’sandclients’responsibilitiesforminimizingsuchrisks.
C. Therapistsshallconsiderthedifferencesbetweenface-to-faceandelectroniccommunication(nonverbalandverbalcues)andhowthesemayaffectthetherapyprocess.Therapistsshalleducateclientsonhowtopreventandaddresspotentialmisunderstandingsarisingfromthelackofvisualcuesandvoiceintonationswhencommunicatingelectronically.
D. Therapistsshallbeawareofthelimitationsofteletherapyandrecognizeandrespectculturaldifferences(e.g.whentherapistisunabletoseetheclient,non-verbalcues).Therapistsshallremainawareoftheirownpotentialprojections,assumptions,andculturalbiases.
E. Therapistsshallrecognizethemembersofthesamefamilysystemmayhavedifferentlevelsofcompetenceandpreferenceusingtechnology.Therapistsshallacknowledgepowerdynamicswhentherearedifferinglevelsoftechnologicalcompetencewithinafamilysystem.
F. Beforetherapistsengageinprovidingteletherapyservices,theymustconductaninitialassessmenttodeterminetheappropriatenessoftheteletherapyservicetobeprovidedfortheclient(s).Suchanassessmentmayincludetheexaminationofthepotentialrisksandbenefitstoprovideteletherapyservicesfortheclient'sparticularneeds,themulticultural
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andethicalissuesthatmayarise,andareviewofthemostappropriatemedium(e.g.,videoconference,text,email,etc.)orbestoptionsavailablefortheservicedelivery.Itmayalsoincludeconsideringwhethercomparablein-personservicesareavailable,andwhyservicesdeliveredviateletherapyareequivalentorpreferabletosuchservices.Inaddition,itisincumbentonthetherapisttoengageinacontinualassessmentoftheappropriatenessofprovidingteletherapyservicesthroughoutthedurationoftheservicedelivery.
8. Confidential ity of Communication A. Therapistsutilizingteletherapymustmeetorexceedapplicablefederalandstatelegal
requirementsofhealthinformationprivacyincludingHIPAA/HiTECH.B. Therapistsshallassesscarefullytheremoteenvironmentinwhichserviceswillbeprovided,
todeterminewhatimpact,ifany,theremightbetotheefficacy,privacyand/orsafetyoftheproposedinterventionofferedviateletherapy.
C. Therapistsmustunderstandandinformtheirclientsofthelimitstoconfidentialityandriskstothepossibleaccessordisclosureofconfidentialdataandinformationthatmayoccurduringservicedelivery,includingtherisksofaccesstoelectroniccommunications.
9. Professional Boundaries Regarding Virtual Presence
A. Reasonableexpectationsaboutcontactbetweensessionsmustbediscussedandverifiedwiththeclient.Atthestartofthetreatment,theclientandtherapistshalldiscusswhetherornottheproviderwillbeavailableforphoneorelectroniccontactbetweensessionsandtheconditionsunderwhichsuchcontactisappropriate.Thetherapistshallprovideaspecifictimeframeforexpectedresponsebetweensessioncontacts.Thismustalsoincludeadiscussionofemergencymanagementbetweensessions.
B. Tofacilitatethesecureprovisionofinformation,therapistsmustprovideinwritingtheappropriatewaystocontactthem.
C. Therapistsarediscouragedfromknowinglyengaginginapersonalvirtualrelationshipwithclients(e.g.,throughsocialandothermedia).Therapistsshalldocumentanyknownvirtualrelationshipswithclients/associatedwithclients.
D. Therapistsshalldiscussanddocument,andmustestablish,professionalboundarieswithclientsregardingtheappropriateuseand/orapplicationoftechnologyandthelimitationsofitsusewithinthecounselingrelationship(e.g.,lackofconfidentiality,circumstanceswhennotappropriatetouse).
E. Therapistsshallbeawarethatpersonalinformationtheydisclosethroughelectronicmeansmaybebroadlyaccessibleinthepublicdomainandmayaffectthetherapeuticrelationship.
10. Social Media and Virtual Presence
A. Therapistsshalldevelopwrittenproceduresfortheuseofsocialmediaandotherrelateddigitaltechnologywithclients.Thesewrittenprocedures,ataminimum,provideappropriateprotectionsagainstthedisclosureofconfidentialinformationandidentifythatpersonalsocialmediaaccountsaredistinctfromanyusedforprofessionalpurposes.
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B. Incaseswheretherapistswishtomaintainaprofessionalandpersonalpresenceforsocialmediause,separateprofessionalandpersonalwebpagesandprofilesshallbecreatedtoclearlydistinguishbetweenthetwokindsofvirtualpresence.
C. Therapistsmustrespecttheprivacyoftheirclients’presenceonsocialmediaunlessgivenconsenttoviewsuchinformation.
D. Therapistsmustavoidtheuseofpublicsocialmediasources(e.g.,tweets,blogs,etc.)toprovideconfidentialinformation.
E. Therapistsshallrefrainfromreferringtoclientsgenerallyorspecificallyonsocialmedia.F. Therapistswhousesocialnetworkingsitesforbothprofessionalandpersonalpurposesare
encouragedtoreviewandeducatethemselvesaboutthepotentialriskstoprivacyandconfidentialityandconsiderutilizingallavailableprivacysettingstoreducetheserisks.Theyaremindfulofthepossibilitythatanyelectroniccommunicationcanhaveahighriskofpublicdiscovery.
G. Therapistswhoengageinonlinebloggingshallbeawarethattheyarerevealingpersonalinformationaboutthemselvesandshallbeawarethatclientsmayreadthematerial.Therapistsshallconsidertheeffectofaclient'sknowledgeoftheirbloginformationontheprofessionalrelationship,andwhenprovidingmarriageandfamilytherapy,placetheclient'sinterestsasparamount.
11. Sexual Issues in Teletherapy
A. Treatmentand/orconsultationutilizingtechnology-assistedservicesmustbeheldtothesamestandardsofappropriatepracticeasthoseinfacetofacesettings.
B. Therapistsmustbeawareofstatutesandregulationsofrelevantjurisdictionsregardingsexualinteractionswithcurrentorformerclientsorwithknownmembersoftheclient’sfamilysystem.
12. Documentation/Record Keeping A. Alldirectclient-relatedelectroniccommunications,shallbestoredandfiledintheclient’s
medicalrecord,consistentwithtraditionalrecord-keepingpoliciesandprocedures.B. Writtenpoliciesandproceduresmustbemaintainedatthesamestandardasface-to-face
servicesfordocumentation,maintenance,andtransmissionoftherecordsoftheservicesusingteletherapytechnologies.
C. Servicesmustbeaccuratelydocumentedasremoteservicesandincludedates,placeofboththerapistandclient(s)location,duration,andtypeofservice(s)provided.
D. Requestsforaccesstorecordsrequirewrittenauthorizationfromtheclientwithaclearindicationofwhattypesofdataandwhichinformationistobereleased.Iftherapistsarestoringtheaudiovisualdatafromthesessions,thesecannotbereleasedunlesstheclientauthorizationindicatesspecificallythatthisistobereleased.
E. Therapistsmustcreatepoliciesandproceduresforthesecuredestructionofdataandinformationandthetechnologiesusedtocreate,store,andtransmitdataandinformation.
F. Therapistsmustinformclientsonhowrecordsaremaintainedelectronically.Thisincludes,butisnotlimitedto,thetypeofencryptionandsecurityassignedtotherecords,andif/forhowlongarchivalstorageoftransactionrecordsismaintained.
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G. Clientsmustbeinformedinwritingofthelimitationsandprotectionsofferedbythetherapist’stechnology.
H. Thetherapistmustobtainwrittenpermissionpriorrecordingany/orpartoftheteletherapysession.Thetherapistshallrequestthattheclient(s)obtainwrittenpermissionfromthetherapistpriortorecordingtheteletherapysession.
13. Payment and Bi l l ing Procedures A. Priortothecommencementofinitialservices,theclientshallbeinformedofanyandall
financialchargesthatmayarisefromtheservicestobeprovided.Arrangementforpaymentshallbecompletedpriortothecommencementofservices.
B. Allbillingandadministrativedatarelatedtotheclientmustbesecuredtoprotectconfidentiality.OnlyrelevantinformationmaybereleasedforreimbursementpurposesasoutlinedbyHIPAA.
C. Therapistshalldocumentwhoispresentanduseappropriatebillingcodes.D. Therapistmustensureonlinepaymentmethodsbyclientsaresecure.
14. Emergency Management A. Eachjurisdictionhasitsowninvoluntaryhospitalizationandduty-to-notifylawsoutlining
criteriaanddetainmentconditions.Professionalsmustknowandabidebytherulesandlawsinthejurisdictionwherethetherapistislocatedandwheretheclientisreceivingservices.
B. Attheonsetofthedeliveryofteletherapyservices,therapistsshallmakereasonableefforttoidentifyandlearnhowtoaccessrelevantandappropriateemergencyresourcesintheclient'slocalarea,suchasemergencyresponsecontacts(e.g.,emergencytelephonenumbers,hospitaladmissions,localreferralresources,asupportpersonintheclient'slifewhenavailableandappropriateconsenthasbeenauthorized).
C. Therapistsmusthaveclearlydelineatedemergencyproceduresandaccesstocurrentresourcesineachoftheirclient’srespectivelocations;simplyoffering911maynotbesufficient.
D. Ifaclientrecurrentlyexperiencescrises/emergenciessuggestivethatin-personservicesmaybeappropriate,therapistsshalltakereasonablestepstoreferaclienttoalocalmentalhealthresourceorbeginprovidingin-personservices.
E. Therapistsshallprepareaplantoaddressanylackofappropriateresources,particularlythosenecessaryinanemergency,andotherrelevantfactorswhichmayimpacttheefficacyandsafetyofsaidservice.Therapistsshallmakereasonableefforttodiscusswithandprovideallclientswithclearwritteninstructionsastowhattodoinanemergency(e.g.,wherethereisasuiciderisk).Aspartofemergencyplanning,therapistsmustbeknowledgeableofthelawsandrulesofthejurisdictioninwhichtheclientresidesandthedifferencesfromthoseinthetherapist’sjurisdiction,aswellasdocumentalltheiremergencyplanningefforts.
F. Intheeventofatechnologybreakdown,causingdisruptionofthesession,thetherapistmusthaveabackupplaninplace.Theplanmustbecommunicatedtotheclientpriorto
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commencementofthetreatmentandmayalsobeincludedinthegeneralemergencymanagementprotocol.
15. Synchronous vs. Asynchronous Contact with Cl ient(s) A. Communicationsmaybesynchronouswithmultiplepartiescommunicatinginrealtime
(e.g.,interactivevideoconferencing,telephone)orasynchronous(e.g.email,onlinebulletinboards,storingandforwardinginformation).Technologiesmayaugmenttraditionalin-personservices(e.g.,psychoeducationalmaterialsonlineafteranin-persontherapysession),orbeusedasstand-aloneservices(e.g.,therapyprovidedovervideoconferencing).Differenttechnologiesmaybeusedinvariouscombinationsandfordifferentpurposesduringtheprovisionofteletherapyservices.Thesamemediummaybeusedfordirectandnon-directservices.Forexample,videoconferencingandtelephone,email,andtextmayalsobeutilizedfordirectservicewhiletelephone,email,andtextmaybeusedfornon-directservices(e.g.scheduling).Regardlessofthepurpose,therapistsshallbeawareofthepotentialbenefitsandlimitationsintheirchoicesoftechnologiesforparticularclientsinparticularsituations.
16. HIPAA Security, Web Maintenance, and Encryption Requirements
A. Videoconferencingapplicationsmusthaveappropriateverification,confidentiality,and
securityparametersnecessarytobeproperlyutilizedforthispurpose.B. Videosoftwareplatformsmustnotbeusedwhentheyincludesocialmediafunctionsthat
notifyuserswhenanyoneincontactlistlogson(skype,g-chat).C. Capabilitytocreateavideochatroommustbedisabledsootherscannotenteratwill.D. Personalcomputersusedmusthaveup-to-dateantivirussoftwareandapersonalfirewall
installed.E. Alleffortsmustbetakentomakeaudioandvideotransmissionsecurebyusingpoint-to-
pointencryptionthatmeetsrecognizedstandards.F. Videoconferencingsoftwareshallnotallowmultipleconcurrentsessionstobeopenedbya
singleuser.G. Sessionlogsstoredby3rdpartylocationsmustbesecure.H. Therapistsmustconductanalysisoftheriskstotheirpracticesetting,telecommunication
technologies,andadministrativestaff,toensurethatclientdataandinformationisaccessibleonlytoappropriateandauthorizedindividuals.
I. Therapistsmustencryptconfidentialclientinformationforstorageortransmission,andutilizesuchothersecuremethodsassafehardwareandsoftwareandrobustpasswordstoprotectelectronicallystoredortransmitteddataandinformation.
J. Whendocumentingthesecuritymeasuresutilized,therapistsshallclearlyaddresswhattypesoftelecommunicationtechnologiesareused(e.g.,email,telephone,videoconferencing,text),howtheyareused,whetherteletherapyservicesusedaretheprimarymethodofcontactoraugmentsin-personcontact.
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17. Archiving/Backup Systems A. Therapistsshallretaincopiesofallwrittencommunicationswithclients.Examplesofwritten
communicationsincludeemail/textmessages,instantmessages,andhistoriesofchatbaseddiscussionseveniftheyarerelatedtohousekeepingissuessuchaschangeofcontactinformationorschedulingappointments.
B. PHIandotherconfidentialdatamustbebackeduptoorstoredonsecuredatastoragelocation.
C. Therapistsmusthaveaplanfortheprofessionalretentionofrecordsandavailabilitytoclientsintheeventofthetherapist’sincapacitationordeath.
18. Electronic Links A. Therapistsshallregularlyensurethatelectroniclinksareworkingandareprofessionally
appropriate.
19. Testing/Assessment A. Whenemployingassessmentproceduresinteletherapy,therapistsshallfamiliarize
themselveswiththetests’psychometricproperties,construction,andnormsinaccordancewithcurrentresearch.Potentiallimitationsofconclusionsandrecommendationsthatcanbemadefromonlineassessmentproceduresshouldbeclarifiedwiththeclientpriortoadministeringonlineassessments.
B. Therapistsshallconsidertheuniqueissuesthatmayarisewithtestinstrumentsandassessmentapproachesdesignedforin-personimplementationwhenprovidingservices.
C. Therapistsshallmaintaintheintegrityoftheapplicationofthetestingandassessmentprocessandprocedureswhenusingtelecommunicationtechnologies.Whenatestisconductedviateletherapy,therapistsshallensurethattheintegrityofthepsychometricpropertiesofthetestorassessmentprocedure(e.g.,reliabilityandvalidity)andtheconditionsofadministrationindicatedinthetestmanualarepreservedwhenadaptedforusewithsuchtechnologies.
D. Therapistsshallbecognizantofthespecificissuesthatmayarisewithdiversepopulationswhenprovidingteletherapyandmakeappropriatearrangementstoaddressthoseconcerns(e.g.,languageorculturalissues;cognitive,physicalorsensoryskillsorimpairments;oragemayimpactassessment).Inaddition,therapistsshallconsidertheuseofatrainedassistant(e.g.,proctor)tobeonpremiseattheremotelocationinanefforttohelpverifytheidentityoftheclient(s),provideneededon-sitesupporttoadministercertaintestsorsubtests,andprotectthesecurityofthetestingand/orassessmentprocess.
E. Therapistsshallusetestnormsderivedfromtelecommunicationtechnologiesadministrationifsuchareavailable.Therapistsshallrecognizethepotentiallimitationsofallassessmentprocessesconductedviateletherapy,andbereadytoaddressthelimitationsandpotentialimpactofthoseprocedures.
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F. Therapistsshallbeawareofthepotentialforunsupervisedonlinetestingwhichmaycompromisethestandardizationofadministrationproceduresandtakestepstominimizetheassociatedrisks.Whendataarecollectedonline,securityshouldbeprotectedbytheprovisionofusernamesandpasswords.Therapistsshallinformtheirclientsofhowtestdatawillbestored(e.g.,electronicdatabasethatisbackedup).Regardingdatastorage,ideallysecuretestenvironmentsuseathree-tierservermodelconsistingofaninternetserver,atestapplicationserver,andadatabaseserver.Therapistsshouldconfirmwiththetestpublisherthatthetestingsiteissecureandthatitcannotbeenteredwithoutauthorization.
G. Therapistsshallbeawareofthelimitationsof“blind”testinterpretation,thatis,interpretationoftestsinisolationwithoutsupportingassessmentdataandthebenefitofobservingthetesttaker.Theselimitationsincludenothavingtheopportunitytomakeclinicalobservationsofthetesttaker(e.g.,testanxiety,distractibility,orpotentiallylimitingfactorssuchaslanguage,disabilityetc.)ortoconductotherassessmentsthatmayberequiredtosupportthetestresults(e.g.,interview).
20. Telesupervision A. Therapistsmustholdsupervisiontothesamestandardsasallothertechnology-assisted
services.Telesupervisionshallbeheldtothesamestandardsofappropriatepracticeasthoseinin-personsettings.
B. Beforeusingtechnologyinsupervision,supervisorsshallbecompetentintheuseofthosetechnologies.Supervisorsmusttakethenecessaryprecautionstoprotecttheconfidentialityofallinformationtransmittedthroughanyelectronicmeansandmaintaincompetence.
C. Thetypeofcommunicationsusedfortelesupervisionshallbeappropriateforthetypesofservicesbeingsupervised,clientsandsuperviseeneeds.Telesupervisionisprovidedincompliancewiththesupervisionrequirementsoftherelevantjurisdiction(s).Therapistsmustreviewstateboardrequirementsspecificallyregardingface-to-facecontactwithsuperviseeaswellastheneedforhavingdirectknowledgeofallclientsservedbyhisorhersupervisee.
D. Supervisorsshall:(a)determinethattelesupervisionisappropriateforsupervisees,consideringprofessional,intellectual,emotional,andphysicalneeds;(b)informsuperviseesofthepotentialrisksandbenefitsassociatedwithtelesupervision,respectively;(c)ensurethesecurityoftheircommunicationmedium;and(d)onlycommencetelesupervisionafterappropriateeducation,training,orsupervisedexperienceusingtherelevanttechnology.
E. Superviseesshallbemadeawareoftherisksandresponsibilitiesassociatedwithtelesupervision.Supervisorsaretoadvisesuperviseesinwritingoftheserisks,andofboththesupervisor’sandsupervisees'responsibilitiesforminimizingsuchrisks.
F. Supervisorsmustbeawareofstatutesandregulationsofrelevantjurisdictionsregardingsexualinteractionswithcurrentorformersupervisees.
G. Communicationsmaybesynchronousorasynchronous.Technologiesmayaugmenttraditionalin-personsupervision,orbeusedasstand-alonesupervision.Supervisorsshallbeawareofthepotentialbenefitsandlimitationsintheirchoicesoftechnologiesforparticularsuperviseesinparticularsituations.
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Contributors
AMFTRBwantstoacknowledgeandthankthefollowingstakeholderswhocontributedtheirresponsestothesurveysanddocumentsthattheTeletherapyCommitteehasdeveloped.Inaddition,aspecialappreciationtothethreeresearchassistantswhoworkedwiththecommittee:fromAlaska,RyanBergerson,B.S.andLaurenMitchell,M.S.andfromColorado,CodyEden,B.A.
MFT Training Programs and Faculty: AbileneChristianUniversity(MMFT) DaleBertram
AntiochUniversitySeattle(MA) PaulDavid,KirkHonda
ArgosyUniversity-SaltLake(MA) AnthonyAlonzo
ArgosyUniversity-TwinCities(MA) JodyNelson
CentralConnecticutStateUniversity(MS) RalphCohen
ConverseCollege-(MMFT) KellyKennedy
CouncilforRelationships(PDI) MicheleSouthworth
EastCarolinaUniversity(MS) DamonRappleyea
EastCarolinaUniversity(PhD) JenniferHodgson
EdgewoodCollege(MS) WillHutter,PeterFabian
EvangelicalTheologicalSeminary(MA) JoyCorby
KansasStateUniversity(MS)(PhD) SandraStith
LewisandClarkCollege(MCFT) CarmenKnudson-Martin
LouisvillePresby.Theol.Sem.(MA) LorenTownsend
Minnesota,Universityof(PhD) StevenHarris
MountMercyUniversity RandyLyle
NorthcentralUniversity(MA) LisaKelledy
NorthcentralUniversity(PhD) JamesBillings,MarkWhite
NovaSoutheasternUniversity(MS) AnneRambo
OurLadyoftheLakeUniversity-Houston(MS) LeonardBohanon
PfeifferUniversity(MA) LauraBryan,SusanWilkie
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PhiladelphiaChild&FamilyCtr(PDI) MarionLindblad-Goldberg
PurdueUniversity-Calumet(MS) MeganMurphy
ReformedTheologicalSeminary(MA) JimHurley
Rochester,Universityof(MS) JennySpeice
SeattleUniversity(MA) ChristieEppler
SouthernMississippi,Universityof(MS) PamRollins
St.CloudStateUniversity(MS)(PDC) JenniferConnor
St.Mary'sUniversity(MA)(PhD) JasonNorthrup
St.Mary'sUniversityofMinnesota-(MA)(PDI) SamanthaZaid
TexasTechUniversity(PhD) DougSmith
VirginiaTechUniversity-Blacksburg(PhD) ScottJohnson
VirginiaTechUniversity-FallsChurch(MS) EricMcCollum
WisconsinStout,Universityof(MS) DaleHawley
State L icensing Boards, Executive Directors, and Board Members: Alabama AlanSwindall
Alaska LauraCarrillo
Arizona TobiZavala
Arkansas MichaelLoos
Delaware BillNorthey
Guam VincentPereda,MamieBalajadia
Hawaii LynnBhanot
Idaho PiperField
Illinois DavidNorton
Kentucky JaneProuty
Louisiana PennyMillhollon
Maryland TraceyDeShields
Massachusetts JacquelineGagliardi
Massachusetts ErinLeBel
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Minnesota JenniferMohlenhoff
Missouri LoreeKessler
Montana CyndiReichenbach
NewMexico EvelynTapia-Barnhart
NewYork DavidHamilton
Ohio BrianCarnahan
Oregon CharlesHill,LaReeFelton
Pennsylvania JoyCorby
RhodeIsland ArleneHartwell
SouthCarolina DannyGarnett
SouthDakota MaryGuth
Texas RickBruhn
Washington BradBurnham
WestVirginia RoxanneClay
Wisconsin PeterFabian
Wyoming KellyHeenan
Teletherapy Committee Members: Mostimportantly,AMFTRBwantstorecognizetheexceptionalanddedicatedworkoftheTeletherapyCommittee.
MaryAliceOlsan,CommitteeChair(Louisiana)
JenniferSmothermon(Texas)
LeonWebber(Alaska)
JeremyBlair(Alabama)
SusanMeyerle(Nebraska)
LoisPaffBergen,AMFTRBExecutiveDirector
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Resources AlaskaBoardofMarital&FamilyTherapy,ProfessionalLicensing,DivisionofCommerce,Community,andEconomicDevelopment,Corporations,Business,&ProfessionalLicensing,BoardofMaritalandFamilyTherapy
www.commerce.alaska.gov/web/cbpl/ProfessionalLicensing/BoardofMaritalFamilyTherapy
AmericanAssociationforMarriageandFamilyTherapy(AAMFT)
www.aamft.org
AmericanCounselingAssociation(ACA)
www.counseling.org
AssociationofSocialWorkBoards(ASWB)
www.aswb.org
AmericanPsychologicalAssociation(APA)
www.apa.org
AmericanTelemedicineAssociation(ATA)
www.americantelemed.org
AustralianPsychologicalSociety(APS)
www.psychology.org.au
FederationofStateMedicalBoards
www.fsmb.org
InternationalSocietyforMentalHealthOnline
www.ismho.org
NationalAssociationofSocialWorkers(NASW)
www.socialworkers.org
NationalBoardforCertifiedCounselors(NBCC)
www.nbcc.org
OhioPsychologicalAssociation
www.ohpsych.org
OnlineTherapyInstitute
www.Onlinetherapyinstitute.com
RenewedVisionCounselingServices
www.renewedvisioncounseling.com
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TexasStateBoardofExaminersofMarriageandFamilyTherapists
www.dshs.texas.gov/mft/mft_rules.shtm
TeleMentalHealthInstitute
www.telehealth.org
U.S.DepartmentofHealthandHumanServices
www.hhs.gov/hipaa/for-professionals/special-topics/mental-health
ZurInstitute
www.zurinstitute.com/telehealthresources.html
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References
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Blumer,M.L.,Hertlein,K.M.,Smith,J.M.,&Allen,H.(2013).HowManyBytesDoesItTake?AContent
AnalysisofCyberIssuesinCoupleandFamilyTherapyJournals.JMaritalFamTherJournalof
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Brew,L.,Cervantes,J.M.,&Shepard,D.(2013).MillennialCounselorsandtheEthicalUseofFacebook.
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EpsteinBeckerGreen.(2016,May).SurveyofTelemental/TelebehavioralHealth.Chicago,IL.
Haberstroh,S.,Barney,L.,Foster,N.,&Duffey,T.(2014).TheEthicalandLegalPracticeofOnline
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Hughes,R.S.(2000).Ethicsandregulationsofcybercounseling.Greensboro,NC:ERICClearinghouseon
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Reamer,F.G.(2013).SocialWorkinaDigitalAge:EthicalandRiskManagementChallenges.SocialWork,
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Secretary,H.O.(n.d.).HITECHActEnforcementInterimFinalRule.RetrievedJuly07,2016,from
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final-rule/index.html
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Trepal,H.,Haberstroh,S.,Duffey,T.,&Evans,M.(2007).ConsiderationsandStrategiesforTeaching
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Twist,M.L.,&Hertlein,K.M.(2015).E-mailMe,TweetMe,FollowMe,FriendMe:OnlineProfessional
NetworkingBetweenFamilyTherapists.JournalofFeministFamilyTherapy,27(3-4),116-133.
doi:10.1080/08952833.2015.1065651
Virtualrelationship.(n.d.).RetrievedJuly07,2016,from
http://www.urbandictionary.com/define.php?term=Virtualrelationship
WhatisHIPAACompliance?(n.d.).RetrievedJuly07,2016,from
http://www.onlinetech.com/resources/references/what-is-hipaa-compliance
AdoptedSeptember13,2016byAMFTRBAnnualMeetingDelegates.
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