As many of you know, I’ve been working toward developing such guidelines since 1995, largely through repeated efforts at the American Psychological Association. We now have a sound set of “Best Practice Guidelines” as issued by the American Telemedicine Association (ATA). This indeed is a momentous time, because regardless from whence they come, they finally are here!
What do they mean to me? Verification, that is, verification that our Online Consultation Practice Model, (OCPM), originally published in 2001 in a peer reviewed journal (Maheu, 2003) and then expanded and republished in our 2004 professional/academic book (Maheu, Pulier, Wilhelm, McMenamin & Brown-Connolly) is indeed on target. In fact, this easy-to-remember, 7-point legal and ethical model is more relevant than ever for telemental health practitioners, online counselors and online therapists.
The ATA’s Telemental Health Practice Guidelines are on par with my research and thoughts about patient care — and much more. They cover administrative, technical, record-keeping, consultation as well as patient care. They are well-researched, well-considered, and well-articulated.
I’d encourage anyone interested in patient contact online to go download their FREE copy from the ATA website, here: http://www.americantelemed.org/i4a/pages/index.cfm?pageid=3311
Furthermore, the publication and dissemination of these guidelines mean that telemental health has finally come of age.
As a new and emerging field, telemental health, otherwise known as behavioral telehealth, online counseling and online psychotherapy has needed specific events to occur prior to being considered legitimate by important bodies such as other professional associations and third party carriers, as well as mainstream clinicians and patients/clients alike.
Although the ATA document is focused primarily on videoconferencing as the telecommunication vehicle of choice by the scientific community, it also establishes the standard of care for the related procedures that need to be in place and the necessary considerations for working remotely with consumers.
More specifically, the publication of these guidelines means to me that those who practice loosely online without prior focused training and supervision need to sit up and take notice. This document establishes a “standard of care” for licensed professionals working remotely with mental health consumers. The document provides a measuring stick against which to compare other service delivery models for remote care.
What does that mean to me? In my mind, it means that those who practice online counseling and psychotherapy exclusively in email, chat or IM systems without:
- prior training based on a thorough understanding of the scientific literature in this area
- without a face-to-face contact with the client or patient
- without properly authenticating the client or patient (identifying)
- without informed consent discussions and documentation
- without emergency and backup systems
- without cultural competency for the clients they choose to treat
- without knowing if the client has the cognitive ability to understand the technology being used
- without procedures in place for proper screening and intake
- without procedures for proper referral
- without written procedures for security
- without proper training for operating the equipment
- without using proper equipment, workspace and setting, including background
- without the necessary “education, training/orientation and continuing education/professional development to insure they possess the necessary comptencies” (ATA Practice Guidelines for Videoconferencing-based Telemental Health, P. 8)
are taking a very serious risk that if things go wrong. They might be found lacking due to operating outside the standard of care for telemental health, online counseling and psychotherapy.
As such, they are making their patients and clients unduly vulnerable to their lack of knowledge, training and expertise. They are failing to use the wisdom to be found by reading and understanding the scientific literature, training with more experienced colleagues, consulting with experts and/or obtaining appropriate supervision.
I hope everyone appreciates the years of work that has gone into such an effort, and thank the authors of this Best Practices Guideline document for their vision and dedication to the field, in trying to protect not only consumers of mental health care, but also the professionals who have been clamoring for such guidelines for a long, long time.
These are some of my thoughts. What are yours?
Marlene M. Maheu, Ph.D.