First Things First

 

Get Your Brain And Body in a State to Tackle a New and Important Project!  

 

If adding telehealth sessions to your therapy practice is new to you, this is a big step. Between figuring it all out and being inundated with all the new and rapidly changing information, adapting your practice can be a huge source of pressure.  

You are doing important work in this world and it’s vital for you to put your own oxygen mask on first. Use your existing coping strategies and resources to take care of yourself so that you can have a solid foundation from which to serve others.  

You will be in much better shape to take on this new venture if your body is grounded and your brain is relaxed. 

 

Basic How To’s – Getting Started with Tech

 

Choose a Telehealth Platform  

Many electronic health records (EHR) systems have a built in option. Rob Reinhardt of Tame Your Practice does an awesome job of reviewing them. (See below for link.)  

Other video platforms include VSee, Doxy and Zoom. They all have the option for being in compliance with HIPAA guidelines through a Business Associate Agreement (BAA) and appropriate security protocols.  

Security and privacy are important considerations and many commonly used video options do not meet HIPAA requirements.  

 

Managing Tech Issues  

Test your platform before you have sessions! Check out the settings, do a trial run, get as familiar with the system as you can. See if your system has how-to materials for you and your clients to read or watch.  

You will have tech problems. You just will. No platform is perfect. Your internet connection; your client’s internet connection; web traffic; computer, phone, and tablet functioning; user comfort and know-how and even the weather can all have an impact. This is ok; you just have to be prepared to manage it and any stress it creates.  

Note that as of this writing (mid-March 2020) some platform servers are getting saturated and this is affecting quality of video.    

 

Communicate & Create Back-up Plans  

Have a clear plan for communication and back-up plans in the event that you encounter tech problems getting connected and for issues that crop up during sessions. Will you email, call the client, have them call you?    

 

Practice and Legal Issues  

 

Informed Consent  

In some states it’s a legal mandate, but it’s certainly recommended that you have a signed consent for telehealth. Clearly cover all the issues that are unique to telehealth and make sure your clients have a reasonable understanding of how this form of therapy works.  

 

Client Insurance Coverage  

Insurance coverage for telemental health varies widely. In this time of health crisis, it appears there is movement to allow for telehealth by insurance companies, but it is important to check with the insurance companies.  

 

Professional Liability Coverage  

Check with your professional liability insurance carrier to see if you are covered for delivery of telemental health with your plan or how to add this coverage.  

 

Telehealth Laws & Regulations  

Generally, telemental health is considered to be taking place in both the location of the therapist and the client. As of now, for most mental health professionals, most states require that you be licensed in the state in which you are practicing and the state in which the client is located at the time of the session.  

The regulations about interstate therapy are evolving, and it may be that this worldwide health crisis leads to the development of modifications, but it is important for you to be aware of the regulations in your state and any states where clients may be located for sessions.

This is a particular concern if clients in your practice reside in a state other than where your practice is located.  

Some states have additional regulations that govern telemental health services.    

 

Clinical Considerations  

 

Confidentiality, Privacy & Environment Set-up  

In your office, you control the environment. In telehelath, the client does. It is important to create guidelines for clients so they understand what their responsibilities are (privacy, limiting distractions, not doing dishes, no others present, etc.) You will also need to assess the situation when doing sessions.  

If your client can’t create an ideal set-up for virtual therapy, you have to decide how to manage and work the situation.  

 

Crisis Management Issues  

In situations of crisis, especially if your client is not in the same geographic area where you practice, it’s important to make sure that your client knows what the crisis resources and procedures might be if needed. You might also need to develop additional crisis evaluation practices.  

 

Adapting to a Virtual World  

Video is not the same as in person connection, but you can still do really good therapy using it. Take the time to familiarize yourself and help your clients with the online experience.  

Some people are adept at talking or meeting online already, but for others it’s unfamiliar and potentially downright unsettling. Be willing to experiment and see what works for you and your clients to make it better. Make sure to practice self-compassion if this is uncomfortable or daunting for you!    

Getting set-up, poor connectivity and other challenges are as much a part of the session as similar challenges might be in your office (construction, power outages, loud children in the waiting room for example). Help your clients “get settled” in the virtual world much the same way as you would in your office. Check in about what it’s like to be meeting online.  

Paying closer attention to non-verbal signals is important, and tricky – especially if the connection is not ideal. You may also need to ask your clients to let you know more about what’s going on for them than you would in the office.  

Eye contact is funny online. If you can, practice looking into your camera – that will give the client the most sense of connection. But don’t ask them to try to do this too – that’s usually too much to add to the mix.  

 

Sometimes Phone Might be Better than Video  

On the one hand, video connection allows for more elements of human interaction to be present than talking by phone. On the other, the nature of video connection might feel harder to manage.  

Sometimes phone (or audio only on a video conference) might actually create a sense of better connection, particularly for clients who are less comfortable with video. Audio instead of video can also reduce the anxiety about being observed in a new way or seeing oneself on screen.  

Note that some insurance companies or practice guidelines view phone as telehealth while others do not.    

 

A Note for Somatic, Creative and Experiential Therapists  

This post is about getting started with telehelath. There are so many ways we can work within virtual sessions to support deep and meaningful work using both verbal and non-verbal interventions. As a therapist who works outside the box, telehealth is not only doable, I think it can be wonderful. I think it likely that I’ll come back to this topic so stay on the look out if you’re interested. In the meantime, I encourage you to be as creative and innovative as you can in moving your work to the virtual world.  

 

Additional Resources

 

Manage Your Own Stress

If it is proving challenging to manage your own stress, take a look at this post: Why You Need a Hammock in Your Office    Please keep in mind this post wasn’t written in the midst of a worldwide health crisis, but I actually think it is MORE important, not less, that we take really good care of ourselves right now, including setting boundaries and taking breaks.

 

Join me at Fire Within  

This global crisis offers an opportunity for therapists to rise as leaders in keeping us all sane! I am committed to playing a part in supporting the therapist community as we all take unexpected new paths in our work and lives.

I don’t really know what this means. It means that even though I’m not an expert in telehealth, I have some experience with it and I can create a post that might help some others get through it with a bit more clarity.

It means I plan to write more, post and interact on facebook, be curious about how to be creative and innovative while remaining calm, and remain open to ways I can be of service.

Wishing you well and calm!

Annabelle  

 

Other Information/Training    

Person Centered Tech (Roy Higgins)    

Tame Your Practice EHR reviews (Rob Reinhardt)  

Zur Institute

I’d love to hear anything you’d like to share, so if you’d like, please get in touch.


This article is intended for informational purposes only. It is not to be considered as legal, ethical, clinical, treatment planning, treatment recommendations, or any other business or clinical practice advice related to your work as a therapist, or business advice on how you choose to use this material.


 

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© 2020 Annabelle Coote & Fire Within

You may freely reprint or share this article/exercise. Simply include the following attribution, and if you print online, make the link at the end live:

Article ©2020 Annabelle Coote, Fire Within, all rights reserved. Used with permission. This article and other resources are available at https://firewithinconsulting.com/

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