Technology Assisted Counseling (TAC) Standards for Clinical Mental Health Counselors July 11, 2015 AMHCA Advancement of Clinical Practice Committee and Task Force on Tele-Mental Health ****
Develop New Provisions on Technology- Assisted Counseling (TAC) for Clinical Mental Health Counselors for incorporation of the AMHCA STANDARDS FOR THE PRACTICE OF CLINICAL MENTAL HEALTH COUNSELING. 2
Over the last four months, the Task Force on Tele- Mental Health of the AMHCA Advancement of Clinical Practice Committee (ACPC) met with the goal of developing new standards and provisions on distance counseling to the AMHCA STANDARDS FOR THE PRACTICE OF CLINICAL MENTAL HEALTH COUNSELING. The task force was composed of Judith Harrington (chair of the ACPC and chair of the task force), Gray Otis, Karen Langer, Thom Field and Steve Brady. 3
The ACP Committee believed that tele-mental health is one of the most active telemedicine applications rendered in the United States, and that it was incumbent upon AMHCA to provide guidance and guidelines to members. So the task force members were honored to be called upon to meet and update the AMHCA Standards to include these critically important provisions. 4
Tele-mental health is an intentionally broad term referring to the provision of mental health and substance abuse services from a distance. But the task force thought the phrase Technology Assisted Counseling or TAC was a more appropriate one for our work. 5
The new standards provide further guidance on the clinical, technical knowledge and skills as well as ethical issues (forthcoming), related to electronic communication between professionals and clients using advances in technology-assisted modes and the resulting treatment models. The TAC standards will serve as a companion document to the AMHCA Code of Ethics document. Other professional organizations in the U.S. and abroad have published guidelines for the provision of mental health care utilizing technology-assisted communications. 6
Today, mental health professionals are using inexpensive technologies available through the proliferation of personal computers, the Internet, mobile devices and video-conferencing software to provide MH services. For example, many MH professionals are using widely available, commercial software downloaded from the Internet to provide care directly to a client s home or other non-institutional setting. Internet-based web sites can serve as a conduit or portal for mental health professionals and clients seeking treatment online. Mental health professionals can sign up with one or more webbased companies and provide a professional profile that can be viewed online by prospective patients. Patients find such sites by searching online or through word of mouth. 7
We believe mental health is particularly suited to the use of advanced communication technologies and the Internet for delivery of care. By using advanced communication technologies, mental health professionals like CMHCS are able to widen their reach to patients and clients in a cost-effective manner, ameliorating the mal-distribution of specialty care. Establishing guidelines for tele-mental health improves clinical outcomes and promotes informed and reasonable patient expectations. 8
In this rapidly growing and evolving field, the risks and benefits of tele-mental health services delivered using various technologies are not widely discussed or addressed in formal training of mental health practitioners. Therefore, thoughtful elucidation of the key issues and the potential solutions are needed to better inform those who want to practice responsibly. Thus, the development of the AMHCA TAC provisions. 9
Key TAC Provisions in the New AMHCA Standards Document 10
Possess a strong working knowledge of Technology-Assisted Counseling between Clinical Mental Health Counselors (CMHCs) and clients/patients. Must be technologically competent in the modality of communication being used. Understand that TAC is changing rapidly and anticipate that new modalities of communication with clients/patients will continuously emerge. Understand all state laws governing or relating to TAC. 11
Stay up to date with relevant changes to laws and continuously consult with ethical and legal experts. Have a working knowledge of how TAC adheres to policies within the American for Disabilities Act. Know the need to obtain written informed consent for all TAC modalities utilized. Know provisions for emergency intervention. 12
Demonstrate competence with technological modalities being used such as synchronous modalities. Demonstrate competence and the ability to anticipate and adapt to emerging technologies. Possess the ability to carefully examine the unique benefits of delivering TAC services (e.g., access to care) relative to the unique risks. 13
Demonstrate the ability to communicate any risks and benefits of the TAC services to the client/patient. Demonstrate competence in assessing the appropriateness of the TAC services to be provided for the client/patient. Assessment may include the examination of the potential risks and benefits of TAC services for the client s/patient s particular needs. Demonstrate ability to monitor & engage in the continual assessment of the client progress when offering TAC services. 14
Demonstrate reasonable efforts to identify and learn how to access relevant and appropriate emergency resources in the client s/patients local area. Demonstrate understanding of best practices of service delivery described in the empirical literature and professional standards including multicultural considerations. Have a reasonable skill in accepting and addressing special needs of clients in adhering to appropriate ADA provisions. 15
The following reports have been issued through the sponsorship of the AMHCA Advancement of Clinical Practice Committee (www.amhca.org): How to Become a Medicaid Provider Integration of Mental Health and Primary Care Services Mental Illness Prevention and Public Health Approaches Early Mental Health Screening and Intervention Crossing the Behavioral Health Digital Divide Quality and Performance Measures The Future of the Mental Health Workforce Thriving in the New Era of Neuroscience 16
TRAUMA Techniques for Treatment Military Combat Violence, Domestic Violence Marginalization, Bullying, Unsafe Identity Groups Early Childhood Trauma Trauma from Natural or Human-Formed Disasters Self-care for Clinicians related to Vicarious Trauma, Differences between Compassion Fatigue, Burnout, etc. Other.? 17
PROCESS AND/OR BEHAVIORAL ADDICTIONS Gambling Spending/debting Sex Love Work Treatments Other.? 18
SEXUAL HEALTH Psycho-sexual Dynamics Transgender Identity Dysfunctions and Treatment/response Demythologizing BDSM Intimacy Treatments Models for Sex Education 19
ANXIETY Social anxiety Phobias OCD Trauma as an Anxiety Disorder Generalized Anxiety Panic Treatments Hoarding Other? 20
Major changes to the AMHCA Code of Ethics document undertaken by the AMHCA Ethics Committee are: 1) New tele-mental health section; 2) The insertion of working with disabilities language throughout the document; 3) Expanded clinical supervision section. 21
Recognizing that technology can be helpful in client s mental health care management due to availability, expediency, and cost effectiveness, counselors engage in technology assisted, and or distance counseling. a) Counselors only engage in distance counseling when they are licensed in the state of the client. b) Counselors only provide distance counseling when they have had training, experience, and supervision to do so. c) Written policies concerning the use of tele-health in a counseling relationship should include informed consent that is clearly set forth, understandable, and addresses the use of phone, online face to face counseling, electronic billing, text, and email contact with a client. 22
i.) Disclosure should include a statement that if the email transmission from both the counselor and/or the client are not encrypted that the transmission is not confidential. Ii.) Text messages are not a secure form of communication therefore texting of personal information should be discouraged. Iii.) Any online scheduling software should be encrypted and secure. iv.) Counselors should not include chat rooms. 23
d) Counselors follow carefully designed security and safety guidelines when conducting online face-to-face distance counseling. i) Counselors endeavor to protect clients from unwanted interruptions during online face-toface sessions. ii) Counselors are strongly urged to employ the use of local resources in the community of the distance client should emergency care be needed. 24
e) The counselor will evaluate the client to determine that the client is appropriate for distance counseling services. f) Counselors will conduct themselves in a professional manner during distance, online counseling sessions as if the client were in the counselor s office. g) Counselors will disclose to clients all procedures for documenting and storing of records of distance, online counseling sessions. i.) Counselors will safeguard and protect all records of distance counseling sessions. ii.) Counselors should have a written policy that prohibits both the therapist and the client from recording a treatment session without the written consent of the other. 25
h) Counselors do not engage in virtual relationships with clients as to do so could potentially be a violation of confidentiality. i.) If clients follow a professional blog, the counselor will not follow them back. Ii.) Twitter, Facebook, LinkedIn, Google Plus and other social media should be professional profiles that are kept separate from personal profiles. Iii.) Counselors shall not solicit professional reviews by clients, nor respond to reviews posted, as to do so might violate client confidentiality. iv.) Counselors will only seek information about their clients through internet searches for the purpose of determining their own or their clients health and safety. i) Counselors endeavor to provide sensitivity to the cultural make up of all clients, as well as sensitivity to disabilities or physical condition in distance counseling as they would in a physical office. 26
A clinical supervision contract signed by both supervisor and supervisee, should be prepared, which provides for the fees for both individual and group supervision sessions. The contract should also specify the records that will be maintained by both the supervisor and supervisee regarding issues discussed in supervision. In addition, the contract should specify the agreement of supervisor and supervisee regarding how often the supervision sessions will be scheduled. The frequency of supervision sessions shall comply with state regulations. In addition : 27
A.) Insurance. The supervisee will maintain a professional liability insurance policy during the clinical supervision process, and provide a copy of a certificate of insurance to the supervisor. B.) Compliance with the AMHCA Code of Ethics. The supervisor should provide a copy of the Code of Ethics to the supervisee, or ensure that the supervisee has obtained a copy of the Code. The supervisee must agree to comply with the Code of Ethics in all treatment provided. C.) State Licensing Board Rules. The supervisee needs to obtain a copy of the appropriate State Licensing Board Rules, & agree to comply. D.) Compliance with State Laws. The supervisor should inform the supervisee of state laws contained in the Practice Act for counselors, and other legal provisions which apply to treatment, etc. 28
E.) Duty of the Clinical Supervisor. The contract should specify that the duty of the clinical supervisor will be to direct the treatment process, and to assist the supervisee in complying with all legal and ethical standards for treatment. F.) Billing for Treatment. Supervisee should agree that all bills submitted for treatment will accurately reflect the amount of time spent in counseling session, and will also identify the professional who provided services to the client. G.)Treatment Records and Bills. As part of the supervision process, the supervisee will agree to provide treatment records and billing statements to the clinical supervisor upon request. 29
H.) Informed Consent. The supervisee will agree to obtain informed consent in writing from the counseling client in compliance with state law. I.) Dual Relationships. Supervisors will avoid all dual relationships that may interfere with the supervisor s professional judgment or exploit the supervisee. J.) Termination of Supervision. When a supervisee discontinues supervision, a written notice that the supervision process has terminated should be provided by the supervisor, along with an appropriate referral for supervision. K.) Consultation for the Supervisor. Whenever a clinical supervisor needs to discuss questions regarding the clinical services being provided, ethical issues, or legal matters, the supervisor should obtain a consultation in order to resolve the issue. 30
L.) Credentials for Supervisors. A supervisor should have the level of clinical experience required by state regulations, which is required for supervision of other professionals. M.) Credentials for Supervisees. Supervisors must ensure that supervisees have the requisite credentials under state law to provide counseling to clients. 31
Thank You and Questions 32