A potential barrier to providing online counseling, psychotherapy, or other professional behavioral health services to someone in a different state or country is the licensure issue in telehealth.
Why is licensure required?
Generally, licensure was established for consumer protection, so consumers can be protected and know where to file a complaint. There are other administrative purposes such as who will enforce legal proceedings in case of an infraction, but for the most part, consumer protection is at the heart of the most state and national licensing issues.
Several scenarios are possible:
- You are off in Ohio (at a meeting, on vacation, fleeing reality, or others), where you are not licensed and are using the internet to continue to treat your clients back home in Indiana.
- Your patient is at MIT majoring in sonic paramagnetic resonance, and you are in Connecticut, the only state where you are licensed, have regular telephone chats with her about her impulsivity and her inexplicable aversion to the Pre-Raphaelite movement of the mid-1800s.
- Someone in Tucson (and you’re not even sure what state that city is in or whether it exists) responds to the offer on your website for three introductory psychotherapy sessions at 50 percent off.
In each of these situations, are you at risk of violating something and getting into trouble? Well, it depends on the state (or country). Some states require you to be licensed if you work with their residents. Other states require you to be licensed to practice from where you reside. Many states require both.
Check the Local Jurisdiction of the Patient
To be perfectly correct, if you are from the United States or Canada, you can probably only practice where you are currently licensed with specific exceptions, depending on the state(s) or province(s) involved. At any rate and in any state or province, the location of where you are practicing needs to be the same as where the patient is. In other words, most states want you to be licensed where their citizens are located. Knowing how to find you helps them ensure the safety of their citizens.
Of course, some states have exceptions to this rule. For instance, the Kentucky Board of Examiners of Psychology has taken the stance that if their citizen goes to a state other than Kentucky for psychological care, they will not intervene to resolve a complaint against the professional in that other state. Please see the letter “Kentucky Board of Psychology Letter,” which is reprinted with permission from Dr. Richard Sears, PsyD, ABPP. While this is not the case with most licensing boards across healthcare professions, this is how things work in Kentucky.
For a quick scan of licensing issues in psychology, see this webpage from the American Psychological Association. For Counselors, the document to check is published by the American Counseling Association called the “Licensure Requirements for Professional Counselors in 2012.” On the other hand, if you practice in a discipline other than psychology or counseling, you might contact your professional association to ask if they have a comparable document.
The latest twist concerning licensure is that you probably need to be licensed in the state or country of all your clients or patients at the time of your contact and not just where they reside. Most disciplines and licensing boards will make allowances for you to extend services over state lines if there is an emergency, but planning to offer services to a patient who has gone to Florida for the winter holiday or in Australia for an extended business trip could be controversial if you are caught.
Technically, you could be found guilty of practicing in that jurisdiction without a license. In general, then, it is advised that you contact the licensing board of the state, province, or country where your intended client or patient resides to ask about the legality of serving their citizen.
For more information about other telebehavioral health and telemental health legal and ethical issues, see the Telebehavioral Health Institute’s professional training and consultation. Need specific information about legally practicing over state lines and licensure portability? Join TBHI’s “How to Legally Practice Over State Lines with Telebehavioral and Telemental Health” online training that will outline the scope of distance therapy and detail telemental health licensure portability.