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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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http://www.onlinetech.com/resources/references/what-is-hipaa-compliance

AdoptedSeptember13,2016byAMFTRBAnnualMeetingDelegates.