● I understand that at any time, I may decide to discontinue teletherapy sessions with my provider. My therapist will refer me to a local mental health provider who can provide face-to-face services. ● I understand that, under the law, my mental health provider may be required to report to the authorities any information suggesting that I have engaged in behaviors that are dangerous to myself or others. ● My therapist/psychiatrist have explained the risks and benefits of receiving teletherapy. I understand that I still may need to see a specialist in person. ● I understand that information from my teletherapy sessions will be protected by HIPPA privacy laws. I may request a copy of my electronic record in writing. ● I understand that as part of receiving teletherapy, some information will be used for research purposes. No identifying information will be revealed to anyone other than those involved in my treatment at ABC Agency. These are the names and phone numbers of my local emergency contacts: ● Therapist: ● Psychiatrist: ● Primary care physician: ● Local hospital emergency room: I voluntarily consent to participate in telemental health services using video-conferencing equipment for the care, treatment, and services deemed necessary and advisable under the terms set forth herein. Signatures Name: Date: Witness: Date: Parent or Legal Guardian: Date:
Patient safety is the cornerstone of behavioral health care. A clinician should consider how to obtain consent (face-to- face vs. telemental health), what should be included in the consent, and how to manage emergencies. The guidelines for treatment must be organized and established prior to service provision. The practitioner should ideally have multiple backup plans in place in case a situation arises where assistance is required but not immediately available, as discussed later in the course. Both the client and clinician will benefit from a well-thought-out plan of action. Certain risks to client safety can occur in both office settings and telemental health settings (Luxton, Nelson, & Maheu, 2016), and elucidating these risks is an important part of thorough informed consent. These risks include suicidal or homicidal ideation, worsening symptoms, and medical emergencies such as cardiac arrest. In home-based treatment settings, access to firearms or other weapons or lethal doses of prescription medications may concern providers. When providers assess clients for telemental health treatment, as with in-person appointments, they need to evaluate the potential for risk along with access to weapons or other lethal means. For example, if a client reveals acute suicide risk and has access to firearms, other weapons, or other lethal means in the home, a clinic-based treatment may be most appropriate depending upon the situation. Because many rural areas have a culture of firearms, owning a firearm would not necessarily rule out home-based telemental health treatment. However, clinician assessment of risk in combination with access to the means by which to carry out threats to others or self is an important clinical consideration and may impact provision of services when it is not possible to have clinical staff with the client when/if they experience active suicidality/homicidality during sessions. Of note, with the necessary transition to virtual modes of treatment during the COVID-19 pandemic, research has shown comparable treatment effectiveness for diagnoses, symptoms, and treatments previously thought too risky to treat virtually such as borderline personality disorder and intensive outpatient programming. This research shows comparable levels of patient satisfaction, symptom reduction, functional improvement, and suicide attempts (Zimmerman et al., 2022). Additional safety precautions should include verifying the privacy of the client, such as asking the client in a domestic
violence situation if the abuser is around the home. If the abuser is around the home, the clinician may want to see the client in a clinic-based setting or adjust the timing of the session. Clients should also be reminded that telemental health sessions are to be completed with the same expectations for sobriety, wearing appropriate clothing, and removing inappropriate paraphernalia from the video view. Nonbehavioral risk factors should also be addressed in the first telemental health session. If a patient were to be receiving services within a clinic and had a cardiac arrest, the provider would likely call a medical provider (if they were within a medical hospital) to come into the session or call 9-1-1. However, in a telemental health session, the patient and provider are not in close proximity, and therefore an emergency plan should be developed so that the patient knows what to expect and the provider knows whom to call. For example, it is possible that there may be a family member in the room next door, and it would be the patient’s preference for the provider to call both the family member and 9-1-1. The proximity of family members likely will change from session to session; therefore, it is imperative to briefly rediscuss the plan at the onset of every session. It is also important to verify the client’s location during each session in case this impacts the emergency plan or other safety factors. Providers should ensure that safety planning is an integral part of a treatment plan. Safety plans are written safety procedures about what defines an emergency situation and what steps should be followed. Luxton, Nelson, and Maheu (2016) recommend several components that should be included in a safety plan. ● If treatment is clinic based, the provider should talk to on-site staff prior to beginning telemental health services. ● The clinician should assess for a client history of violence toward self or others. ● The clinician should discuss the presence of firearms or other weapons before beginning home-based telemental health services. ● The clinician and client should have a backup communication plan, such as a cell phone or landline, in case the connection with each other is lost. ● Identify and document local resources, such as contact information for family members and local emergency departments.
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