Consumers have forged fake ID cards for decades. Even high school kids know how to use phoney ID cards to gain entrance to clubs with bouncers directly examining those IDs with flashlights. Is it adequate for us as mental health professionals to simply ask a distant client to fax, scan or mail a driver’s license for online therapy when we haven’t met them in-person?
Given that the populations we serve can include people with characterological disorders as well as serious mental illness, most institutional-based telehealth programs such as those now commonplace in the military, the Veteran’s Administration, teaching and private hospitals usually require at least a single in-person identification process to be conducted by a responsible party before telehealth services are rendered.
Most often conducted by an admin or a nurse, close examination is made of the client or patient, as well as one or more forms of identification. Required forms of ID often include a driver’s license and an insurance card. Next of kin are named and contact numbers are requested. Medical records are accessed. Release forms, HIPAA agreements and multiple other documents are signed. Slip-shod and unprofessional procedures exist in some places, but they certainly are not the norm.
If we look beyond our own arena, we can see that other professions also require more reliability in their identification processes, too. For example, in the legal world the signing of legal documents is taken quite seriously. Notaries are trained and licensed to verify ID in person, take a thumb print, and only then sign a document verifying that we are indeed who we say we are. Why should our professional requirements be any more lax?
Given that we most of us don’t know ahead of time when we are working with a potentially lethal or abusive client, I can only recommend that mental health professionals working online proceed with caution. Although some professionals have gotten away with “caution” being the posting a website disclaimer asking such distraught patients to go elsewhere, those disclaimers aren’t likely to release any professional from responsibility if something goes wrong and charges get filed with either a licensing board or a civil court. We are duty-bound to conduct proper screening or assessment everywhere we practice.
On the other hand, if we get a referral from an internist or other reliable professional who has identified the client using standard in-person procedures, that might be defensible. Such professional-to-professional referrals are commonplace in telehealth, but they are quite different from relying solely on an emailed statement from a client naming themselves and faxing a ID card of some type. Even a video impression augmented by an ID card can be arguably inferior to an in-person ID process. Similarly, if the referral comes from an EAP, or directly from an employer, an in-patient treatment facility, a hospital, a church or some other source where the client has been fully identified, that might be considered adequate, too.
Accepting referrals straight off the net raises many red flags and can leave us vulnerable if we get brought up on charges for any reason. I’d encourage everyone to ~not~ take any one’s word on this issue, no matter how informed they seem. Write to your licensing board and ask them if they consider it legal for you to simply ID a new patient or client online using a faxed ID, combined with email correspondence, video interview or whatever system you want to use. Be specific in your inquiry. If you want to use Skype, name it. State boards are the ones who have rules defining legal practice in your state, so I’d encourage you to write and get your answer from your own state board.
(Please post your view on this matter below, or if you have information from your state board, please let us all know what they have said.)