all professional services delivered anywhere within the state of Texas, regardless of how they are delivered. Complaints received by the Council regarding technology-assisted services will be evaluated by the Council on a case-by-case basis, and the following general principles will be applied to any such complaints. However, these guidelines are not intended to conflict with, nor should they be construed to alter requirements for the delivery of technology-assisted services that have been established by exempt facilities such as the Veterans Administration. An individual, who is physically located in another state, shall be considered as practicing in Texas and therefore, subject to the Act, if a recipient of services provided by the individual is physically located in the state of Texas. Licensees should also be aware that services they offer to consumers in other states may similarly be regulated by the laws of the state in which the consumers are located. The Covid-19 pandemic increased the demand for counseling services delivered through technology since traditional face-to-face sessions were no longer viable. The pandemic also increased the need for mental health services as people dealt with the impact of the disease worldwide. It soon became apparent that there was a need to address training, licensing, and guidelines to structure, deliver, and regulate technology in therapy practice. The Association of Marital and Family Therapy Regulatory Boards (AMFTRB) Teletherapy Committee took up the challenge, and member boards began a review of state regulations, training and supervision components, complaints to state boards, and current research publications on telebehavioral health practice among other sources. The Teletherapy and Telesupervision Guidelines II (AMFTRB, 2021) were developed to address the need for a comprehensive set of standards with specific strategies for promoting the ethical implementation of technology- assisted counseling and therapy. Though it was developed by the AMFTRB, it is applicable to counseling practice and aligns with state law and national association standards and ethics codes. The commission presented the following clarification on certain types and conditions of therapy that were not addressed in the teletherapy guidelines as follows (AMFTRB, 2021): Please be advised that the committee did not draft specific guidelines regarding the appropriateness of telemental health and working with domestic violence victims, completing child custody evaluations, treating cyber addiction, or using technology for supervised sanctions as the research in each of these areas was limited. As well, the question remains to be addressed of state board’s established rules for a limited number of teletherapy experience hours and of telesupervison hours that are accepted to attain licensure. The teletherapy guidelines are quite extensive and cover and address areas of potential ethical dilemma covered in the course from the perspective of teletherapy. Due to
appropriate to the needs of the client. In emerging areas in which generally recognized standards for preparatory training do not exist, licensees must take reasonable steps to ensure the competence of their work and to protect clients, research participants, and other affected individuals from the potential for harm.” This rule requires that licensees, who provide services in new areas or involving new techniques, do so only after undertaking appropriate study, training, supervision, and/or consultation from persons who are competent in those areas or techniques. It is important for licensees considering such services to review the characteristics of the services, the service delivery method, and the provisions for confidentiality to ensure compliance with the Council rules, as well as federal and state law. Licensees should review all Council rules, particularly 22 TAC §801.58 Technology- Assisted Services, for enforceable minimum standards of practice. Licensees are also encouraged to review the Teletherapy & Telesupervision Guidelines II (August the length of the document, only the key concepts are highlighted here in abbreviated form. It is strongly advised to review these guidelines in their entirety because teletherapy, or technology-assisted therapy, is now widely used throughout counseling disciplines. This document is highly informative and applicable to all counseling and therapy practices considering or implementing a technology-assisted practice. It was formulated with cross-disciplinary input and references from mental health providers, social work, and HIPAA. Teletherapy and Telesupervision Glossary (AMFTRB, 2021). ● Asynchronous: Communication is not synchronized or occurring simultaneously. ● Electronic communication: Using websites, cell phones, email, texting, online social networking, video, or other digital methods and technology to send and receive messages, or to post information so that it can be retrieved by others or used later. (National Association of Social Workers, 2017). ● HIPAA compliant: The Health Insurance Portability and Accountability Act (HIPAA), sets the standard for protecting sensitive patient data. Any company that deals with protected health information (PHI) must ensure that all the required physical, network, and process security measures are in place and followed. This includes covered entities (CEs), anyone who provides treatment, payment and operations in healthcare, and business associates (BAs), and anyone with access to patient information who provides support in treatment, payment, or operations. Subcontractors, or business associates of business associates, must also comply. ● HITECH: The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 addresses the privacy and security concerns associated with the electronic transmission of health information, in part, through several provisions that strengthen the civil and criminal enforcement of the HIPAA rules (HITECH Act Enforcement of Interim Final Rule, 2016).
The Council currently considers the use of technology- assisted services as an “emerging area” per Council rule 22 TAC §801.44(p): “A licensee may not offer services that are beyond the licensee’s professional competency, and the services provided must be within accepted professional standards of practice and 2021) published by the Association of Marital and Family Therapy Regulatory Boards (AMFTRB), and incorporate those best practices where congruent with federal and state law. Association of Marital and Family Therapy Regulatory Boards Teletherapy and Telesupervision Guidelines II
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