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Birds-Eye View of 7 Core Start-up Principles for Telepractice

Start-up Principles for TelepracticeYou’ve probably heard that we are having the Telehealth Summit 2012 this next week. In the next six blog posts, we’re going to give you a bird’s eye view of the topics being presented by our 10 speakers. We will condense over 288 pages of well-edited transcript into a few very short articles, but we hope to impart useful information to you here, and let you know where to get the rest if you are serious about practicing online.

In this week’s installment summarizing our Introductory Session, we give a brief overview of key telepractice start-up issues.

  1. Licensure:
    There are no licensure barriers to practicing telehealth wherever you are licensed to practice. It is neither legal nor appropriate to practice across state lines without licensure or registration in the foreign state, technology notwithstanding. Before working with an online client from another state or country, it is necessary to do 2 things:
    1. review the law within your state because some states have rules about your using their license to practice elsewhere, and
    2. review the legal requirements of the state or country where you wish to deliver distance care because most states and countries have laws about your practicing in their domain without their license and comply with both.
  2. Practicing Legally:
    It is important to remember that if you find yourself practicing illegally, it will likely void your malpractice insurance coverage.
  3. State-specific Regulations:
    Along the same lines, many states have additional regulations regarding security and privacy above and beyond the Federal Government’s HIPAA guidelines. It is necessary to be educated about state-specific regulations.
  4. Standards and Guidelines:
    Online practitioners must responsibly follow all of the same guidelines, standards and practices used when providing in-person psychological services. The same standards for informed consent, documentation, billing, mandated reporting, and handling emergencies apply regardless of how services are delivered. The scientific literature needs to be carefully examined to understand how various populations might benefit maximally from each remote service delivery modality available (e.g, email, telephone, video).
  5. Intake Process:
    A revised intake process that incorporates appropriate assessment of distant clients must be established before initiating online practice.
  6. Video-conferencing Platform:
    Clinicians must also give careful consideration to the videoconferencing platform they use for online psychotherapy. Free services like Skype are not built for health care and they will not guarantee HIPAA compliance. There are many other services that are HIPAA compliant. See the TeleMental Health Institute’s listing of over 50 HIPAA-compatible service providers.
  7. Billing:
    It’s also important to understand how to correctly bill for online services. Clinicians must also be sure to practice within their areas of competence and expertise, based in a solid understanding of the telehealth literature for guidance about how to take an in-person practice online. For example, what works for handling abuse reporting and emergencies in an in-office setting rarely will be effective online. The effort required to develop an online practice is certainly worthwhile, given the many benefits to remote service delivery.

Never before has it been so easy or natural to observe clients in their own homes or enlist their aid in tracking and modifying their behaviors. The opportunities for addressing problems like hoarding, phobias or family conflict are unprecedented. Technology presents many innovative opportunities for psychological service delivery, with clients and patients already seeking help online. Several models already exist for how to fill a practice with online service delivery. We at the TeleMental Health Institute are constantly bringing new and exciting ways to get involved with technology in a responsible, practical and affordable ways so as to manage risk, expand services to new populations, and do so from the comfort of your own home or office.

Now, we have distilled the key strategies and solutions for online practice into a 10-hour pre-recorded program with some of the industry’s top thinkers, so you can listen at your convenience, wherever you want to be. All of these start-up issues, and more, are addressed in detail in the Telemental Health Institute’s Telehealth Summit 2012.

Come see what we have prepared for you. You will be amazed at what is possible in the world of professional training today — we guarantee it! Click here to learn more about the Telehealth Summit 2012.

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Jill Squyres, Ph.D.

Clinical psychologist providing office-based services in Colorado’s Vail Valley and internet-based psychotherapy via secure teleconferencing to high functioning individuals with mood disorders, anxiety, stress, relationship concerns and health problems. Also provide counseling, coaching and mentoring services to enhance healthy living, satisfying relationships, career success, and personal growth and effectiveness. Available for media interviews, public speaking and consultation in stress management, healthy lifestyle, organizational effectiveness, enhancing productivity, team building, interpersonal dynamics, work/family balance, personal growth and success, coping skills training, parenting, relationship skills, problem solving, values clarification, career counseling and psychological issues in social media/internet use.


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