The therapist should also include contact information for law enforcement, ambulance services, the nearest hospital and/or emergency department, and local mental health or mobile health crisis teams (Swenson et al., 2016). Client safety is a concern for clinicians regardless of the modality of treatment. Providers who offer therapy through telemental health services have additional considerations to ensure that clients are protected in the case of emergencies. Kramer and Luxton (2016) offer specific recommendations for handling emergencies and protecting clients. ● Clinicians should know the jurisdictional requirements for civil commitment laws and duty to warn where clients are located. Guidelines for reporting and committing vary by jurisdiction. ● Practitioners should know the specific emergency procedures for the site, such as a clinic, school, or corrections facility, where telemental health treatment will be provided. ● The clinician, client, and/or family members should identify a local support person who can be involved in an emergency situation if needed. ● Therapists should know the local jurisdictional requirements for mandatory reporting laws for children, youth, and dependent adults. Ethical Practice Ethical issues related to confidentiality, dual relationships, and boundaries are also important considerations. An additional issue for practitioners to consider is the competency of the online clinician with whom clients might be working. It is important to know their educational background, certifications, and professional experience (Dolgoff et al., 2012). The American Telemedicine Association recommends certain steps to ensure ethical practice among clinicians who use telemental health services (Swenson et al., 2016). These practices include the following. ● Verify the identity (full name and ID) of the client on the video screen. ● Provide the client with the therapist’s license information and qualifications, either on websites and/or in materials sent to the client. ● Verify the client’s location and comply with all jurisdictional licensing requirements. This is important for emergencies, mandatory reporting laws, and duty to warn. As noted previously, these requirements are tied to the client’s location, not the therapist’s location (Swenson et al., 2016). The practitioner should be cognizant of issues that may compromise confidentiality, such as speaker volume, which could allow others to hear the conversation; window location, which could allow others to see the client’s face during a session; and the presence of others, especially when telemental health sessions are home-based (Johnson, 2014; Luxton et al., 2014). Clinicians should ensure they are following applicable state and federal laws required for the safe transmission and release of medical information as well as professional guidelines for ethical practice (Johnson, 2014; Luxton et al., 2014; Telebehavioral Health Institute, 2013). Many professional organizations provide individual guidelines
Clinicians who provide services using telemental health should be just as concerned about client safety protocols as those who provide face-to-face services. They should establish additional precautions to ensure that both the client and clinician have a plan in case an emergency arises. Jurisdictions may have specific requirements set forth by governing bodies, but even if there are no specific guidelines, therapists should have written procedures in place. Self-Assessment Question 2 Which of the following components should be included in a safety plan for telemental health sessions? a. Ensuring the client’s sobriety and appropriate attire during session b. Discussing the presence of firearms or other weapons before beginning clinic based services c. Verifying the privacy of the client, especially in cases of domestic violence d. Having a backup communication plan in case of lost connection for ethical practice, but for telemental health practitioners, competency, such as adequate professional and technical knowledge and skills, is especially important (Johnson, 2014; Telebehavioral Health Institute, 2013). Practitioners must disclose potential risks associated with telemental health practice, such as breaches of privacy, during the informed consent process (Luxton et al., 2014). In addition, they should inform clients about the challenges that may present themselves while using video platforms for therapy services. Various professional organizations have issued technology- specific directives and included guidance with respect to the use of technology and telemental health service provision in their ethics codes. For example, in 2017, the NASW, Association of Social Work Boards (ASWB), Council on Social Work Education (CSWE), and Clinical Social Work Association jointly published the Standards for Technology in Social Work Practice. The standards are intended to work in conjunction with the NASW (2017) Code of Ethics and are divided into four main sections related to the ways in which social workers use technology to “(1) provide information to the public; (2) design and deliver services; (3) gather, manage, store, and access information about clients; and (4) educate and supervise social workers” (NASW, 2017, p. 13). The American Psychological Association (APA) has also created guidelines for the practice of telepsychology. Much of the guidance from professional associations relates to the professional use of technology and social media, rather than telemental health specifically. Table 2 provides summaries of the guidelines for telemental health from the codes of ethics of the APA, NASW, American Mental Health Counselors Association (AMHCA), National Board for Certified Counselors (NBCC), and American Counseling Association (ACA).
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