f. The therapist and/or client must use connection test tools (e.g., bandwidth test) to test the connection before starting their videoconferencing session to ensure the connection has sufficient quality to support the session. 5. Identity Verification of Client a. Therapists must recognize the obligations, responsibilities, and client rights associated with establishing and maintaining a therapeutic relationship. b. The therapist is responsible for assessing and documenting the client’s appropriateness for teletherapy treatment. c. It is the therapist’s responsibility to document appropriate verification of the client’s identity. d. The therapist must take reasonable steps to verify the location and identity of the client(s) at the onset of each session before rendering therapy using teletherapy. e. Therapists must develop written procedures for verifying the identity of clients, their current location, and their appropriateness and readiness to proceed at the beginning of each contact. Examples of verification means include the use of code words, phrases, or inquiries. For example, “is this a good time to proceed?” 6. Informed Consent Availability of Professional to Client a. The therapist must document the provision of informed consent in the record prior to the onset of therapy. b. In addition to the usual and customary protocol of informed consent between therapist and client for in-person therapy the following issues, unique to the use of teletherapy, technology, and/or social media, must be addressed in the informed consent process: 1. Confidentiality and the limits to confidentiality in electronic communication 2. Teletherapy training and/or credentials, physical location of practice, and contact information 3. Licensure qualifications and information on reporting complaints to appropriate licensing bodies 4. Risks and benefits of engaging in the use of teletherapy, technology, and/or social media 5. Possibility of technology failure and alternate methods of service delivery 6. Process by which client information will be documented and stored 7. Anticipated response time and acceptable ways to contact the therapist i. Agreed upon emergency procedures ii. Procedures for coordination of care with other professionals iii. Conditions under which teletherapy services may be terminated and a referral made to in-person care 8. Time zone differences 9. Cultural and/or language differences that may affect delivery of services 10. Possible denial of insurance benefits 11. Social media policy 12. Specific services provided 13. Pertinent legal rights and limitations governing practice across state lines or international boundaries, when appropriate 14. Information collected and any passive tracking mechanisms utilized.
c. The information must be provided in language that can be easily understood by the client. This is particularly important when discussing technical issues like encryption or the potential for technical failure. d. Local, regional, and national laws regarding verbal or written consent must be followed. If written consent is required, electronic signatures may be used if they are allowed in the relevant jurisdiction. e. Therapists may be offering teletherapy to individuals in different states at any one time, the therapists must meet each jurisdiction’s regulations and rules related to informed consent and document that in the respective record(s). The therapist is responsible for knowing the correct informed consent forms for each applicable jurisdiction. f. Therapists must provide clients clear mechanisms to: 1. Access, supplement, and amend client-provided personal health information (PHI) 2. Provide feedback regarding the site and the quality of information and services; and register complaints, including information regarding filing a complaint with the applicable state licensing board(s). Working with Children a. Therapists must determine if a client is a minor and, therefore, in need of parental/guardian consent. Before providing teletherapy services to a minor, the therapist must verify the identity of the parent, guardian, or other person consenting to the minor’s treatment. b. In cases where conservatorship, guardianship, or parental rights of the client have been modified by the court, therapists must obtain and review a written copy of the custody agreement or court order before the onset of treatment. 7. Acknowledgement of Limitations of Teletherapy a. Therapists must: i. Determine that teletherapy is appropriate for clients, considering clinical, relational, cultural, cognitive, intellectual, emotional, and physical needs ii. Inform clients of the potential risks and benefits associated with teletherapy iii. Ensure the security of the therapist’s communication medium iv. Only commence teletherapy after appropriate education, training, or supervised experience using the relevant technology b. Therapists are to advise clients in writing of the risks and of both the therapist’s and clients’ responsibilities for minimizing such risks. c. Therapists must consider nonverbal and verbal communication cues and how these may affect the teletherapy process. Therapists must educate clients on how to prevent and address potential misunderstandings arising from the lack of visual cues and voice intonations when communicating electronically. d. Therapists must recognize the members of the same family system may have different levels of competence and preference using technology. Therapists must acknowledge power dynamics when there are differing levels of technological competence within a family system. e. Before therapists engage in providing teletherapy services, they must conduct an initial assessment to determine the appropriateness of the client(s) for teletherapy service. An assessment should include
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Book Code: PCUS1525
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