BFFs with smartphoneAt Person Centered Tech, we get a lot of questions about telemental health (as you can probably guess.) Since launching our Telemental Health Certificate Program, we’ve been getting tons more.

As these questions have come in, we’ve been realizing how valuable they can be to all our colleagues — both those interested in our certificate program and those who are just interested in telemental health.

So I present the 6 most useful questions people have been asking about telemental health and our certificate training program:

1) What’s the point of working on telemental health competence if I can only do it in states where I’m licensed?

As an Oregon-licensed Counselor, I was initially confused by this question — until I saw that it came from someone in tiny Marlyand! We can all understand why that asker would find jurisdictional licensing issues especially frustrating.

In the past few years, I’ve noticed a trend that I see as “good news and bad news.” The good news is that therapists in the US are getting the message that licensure/permission to practice issues arise when a client is in another state.

The bad news is that the message going around reads, “you can only work with clients in states where you’re licensed.” That’s not terribly far off, but it’s more accurate to say, “you can only work with clients in states where you’re legally permitted to practice.”

Quite a few state boards have rules that allow outside therapists a limited amount of temporary practice. This is usually to avoid abandoning clients who move their homes temporarily or permanently. That isn’t universal good news, however — there are also quite a few state boards who don’t allow this at all.

The real good news is that all of our professions have at least one professional association working on improving easy licensure portability. And even without those initiatives, quite a few clinicians have managed to grow their online practices through obtaining licensure in multiple states.

In other words: with some diligence, expansion of telemental health services beyond one’s own state is in the realm of real possibility. In fact, it is likely that most of us will find ourselves incentivized to do so more and more as time goes on.

2) What areas of telemental health competence does a licensed therapist really need other than choosing and using the right tech?

I’ve counted literally hundreds of posts in therapist Facebook groups where someone asks the group to recommend their favorite telemental health video software. While there’s nothing inherently wrong with this approach, the implication is that the asker intends to fire up whatever software they choose and jump right into online practice.

In most cases, very few negative consequences arise from this approach (for reasons that I don’t have the word count allotment to discuss here.) However, these professionals are often taking risks because they “don’t know what they don’t know.”

There are rather well-developed standards out there for performing services via telemental health. In fact, the counselor educator and long-time distance counseling instructor, Michael Jones LPC-S NCC DCC, performed a survey a couple years ago to discover self-reported levels of perceived competence among distance counselors who have received formal training in distance counseling/telemental health.

Jones found that perceived competence was quite low in some rather vital areas, including assessing goodness of client-clinician fit for telemental health, managing crises remotely, selecting technology, and several other areas, as well.

In other words, there is a large demonstrated need for training on telemental health competencies that go well beyond simply picking HIPAA-appropriate software. Here are examples of such standards that are covered in Person Centered Tech’s certificate program:

  • Safety and Crisis Planning
  • Checking safety and confidentiality at each session
  • Assessing goodness of fit for telemental health
  • Backup communicatoin methods
  • Video Presentation Skills
  • Client Orientation Needs
  • Informed Consent Needs

You can find course brochures with syllabus details here at the Telemental Health Certificate Program page.

That’s not an exhaustive list, but it is rather representative of what is missing from many telemental health competency tool belts.

3) Do I have to be a Person Centered Tech member to take the telemental health certificate program?

Nope! It’s just the most economical way of doing it.

9 of the CE hours required for our program certificate come from our core HIPAA & technology course titled, “Engaging in HIPAA Security and Digital Confidentiality as a Mental Health Professional.”

That course normally costs $219, but it is included in membership at no extra cost. So instead of outright buying the two courses that make up the Telemental Health Certificate Program, it makes far more sense to register for the telemental health course series and also sign up as a Person Centered Tech member in order to get the HIPAA course. Doing so is not required, however, for those who wish to complete our training courses on telemental health standards.

4) Do I need a program certificate (any program certificate) for insurance companies to cover my online sessions?

Short answer: no. Long answer: still no, but you’ll find some telemental health education useful for getting paid.

What we have learned from our members is that many private insurers are explicitly adding telemental health programs to their service rosters — or at least they are now requiring special applications from paneled clinicians who wish to be paid for services delivered by telemental health. (If you’ve been billing for online sessions but haven’t gone through any kind of approval process for doing telemental health, you may want to look into that to be sure you haven’t missed anything.)

Generally, the applications that we’ve seen require clinicians to make some kind of attestation. Sometimes the attestations are about the software you use for service delivery. Sometimes they’re about compliance issues. Sometimes it’s both.

The conclusion we came to was that being able to affirmatively respond to these attestation requests usually required an understanding of telemental health standards. So we think that while certificates or credentials don’t (yet) seem to be required, they can still end up being essential to getting paid.

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5) Will my licensing board accept the CE hours from Person Centered Tech’s Telemental Health Certificate Program?

There’s a good chance of it.

Any licensing board that accepts CE hours from APA-approved or NBCC-approved education providers will accept our CE hours. That includes the counseling, marriage and family therapy, social work, and psychology boards in WA, OR, and CA (among many others!) We also have special state approvals in Texas and Ohio.

6) Can I work with people outside the United States via telemental health?

It’s certainly possible!

Most nations regulate psychotherapy in a different manner than the US does, and many do not regulate it at all. With some due diligence, you can discover what the regulation situation is for any given nation and go from there. But proceed with an appropriate amount of caution.

Lack of regulation for mental health professionals in a particular nation often means that practicing with people located there would be legal, but only by virtue of the fact that it’s not illegal. You would also do well to check with your own licensing board to be sure they don’t restrict practice with people located outside the state.

That said, the proper diligence and risk management measures can certainly be taken in order to allow international practice. Here are some examples of risks to address when seeking to work abroad via online therapy.

  • How do you manage your professional responsibilities in a foreign culture with different laws and mores and possibly a language you do not speak?
  • How many assumptions do you make about civil and emergency services that are based on the way those services are provided where you live? How are those services different in the nation where the client is?
  • How do you manage Internet connection failures when you can’t just call your client on the standard telephone?
  • Will your liability insurance cover work in the nation where your client is located?


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