Sunday, November 18, 2012

Therapists and Licensing Issues

States exhibit a number of differences in licensing requirements and laws that mental health professionals currently face when practicing distance medicine such as telehealth in another state. As mental health therapy via telehealth is becoming more common, many questions are being directed to individual states.

Issues involved in providing telehealth services are confusing. The different state policies that exist could possibly be clarified by incorporating national guidelines from national associations or draft regulations could be used to clarify an individual state’s policy on using telehealth services.

In California, currently, a licensee in another state may not counsel an individual in the State of California unless they hold a California license. If the client is not located in California, the client’s state has jurisdiction. The California Board of Psychology under the Department of Consumer Affairs wants to have guidelines issued that are in line with the policies of other states.

Other states have other rules. For example, the Massachusetts Office of Consumer Affairs and Business Regulation licenses mental health professionals in the state. However, currently there is no language in statute or regulations that specifically discusses therapy performed via telehealth.

However, the state licensing board has adopted a policy guideline to address questions about the practice of telehealth. The policy states that therapy via electronic means is considered to occur in both the location of the client and location of the therapist.

Therapy for clients located in Massachusetts falls under the jurisdiction of the licensing board regardless of the location of the therapist.  This means that if the therapist is not licensed in Massachusetts and the client is located there, then this would be an unlicensed practice.

The policy encourages Massachusetts licensees who would like to perform telehealth services to a client in another jurisdiction then check the practice requirements in the jurisdiction where the client is located.

The Washington State Department of Health licenses mental health counselors, marriage and family therapists, and social workers. Currently, the department does not have specific clarifying regulations, but is looking at the regulations in other states as a possible model.

The state requires providers to be credentialed in the state in where they provide services, and if the client is located in another jurisdiction, they advise the licensee to contact that jurisdiction for guidance. At this time, when a licensee inquires about telehealth they are told that they must meet all disclosure and confidentiality requirements. They would also recommend the licensee use an encrypted computer program for online therapy.

Mental health practitioners in Ohio are regulated by the Ohio Counselor, Social Worker, and Marriage and Family Therapist Board. The Ohio Administrative Code (OAC) requires practitioners providing services in Ohio to be licensed in the state. They also require an Ohio licensee who is providing services to a client outside of Ohio to comply with the laws and rules of that jurisdiction.

The OAC specifies that the licensees providing telehealth service must use encrypted methods of service delivery, must have an initial face-to-face meeting with the client which may be via electronic communications, licensees must identify an appropriately trained local professional to provide crisis intervention for the client if needed, and the client needs to be given the telephone numbers of the local crisis hotline and local emergency mental health hotline.

The Arizona Board of Behavioral Health Examiners licenses mental health professionals in the state where mental health services are assumed to take place in the jurisdiction where the client lives. The state does have some exemptions to licensure that a behavioral health professional from another state who wants to perform services in Arizona may want to use.

A non-resident is exempt from licensure if the person performs the services for no more than 90 days in any year, licensed to perform those services in the state or country where they reside, and they must inform the client of the limited nature of the services and that they are not licensed in Arizona.

The Arkansas Board of Examiners in Counseling requires a counselor or a marriage and family therapist licensed in the state who wishes to perform counseling via electronic or technology-assisted mediums to obtain a “Technology-Assisted Distance Counseling or Marriage and Family Therapy Specialization License.” This specialization requires specific training approved by the board.

Any telehealth counseling that occurs in Arkansas whether by an Arkansas counselor or an out of state counselor is considered to occur in Arkansas and the practitioner must hold a valid specialized license.

The Arkansas Board of Examiners has adopted the National board of Certified Counselors document “The Practice of Internet Counseling” as part of the rules to clarify standards related to counseling via telehealth. This document defines various types of counseling and outlines standards for the ethical practice of internet counseling.