10 Things to Consider:
Before Adding Online-‐Based Therapy
Services to Your Clinical Practice
By Takiya Paicely, MSW, LCSW, DCC
Copyright © 2014 Paicely Consulting & Therapy Services, LLC All rights reserved.
The original reader is authorized to make printed copies for personal use. *********************************************************************************************** Contact Information: Web: www.onlinecounselingindiana.com Email: [email protected] Phone: (317) 427-‐5521
Office: 7002 N. Graham Rd., Suite 211 Indianapolis, IN 46220
Table of Contents
Introduction………4
10 Things to Consider………….……….5
Conclusion ... 8
Resources ... 9
A Little About Me ... 11
Introduction
Technology has grown significantly over the last 30 years. The internet turned 25 years old in 2014. We are more connected, and even a little disconnected, due to technology. We are able to communicate with other people thousands of miles away. The technology age has automated many tasks that we once performed individually. We carry smartphones, tablets, computers, and other technology devices with us daily. Technology is a mainstay in our culture and in our society.
As people’s lives become busier and more stressful, they need services that can adapt and adjust to their lifestyles. It is important that as therapists, counselors, social workers, psychologists, and other behavioral health industry professionals are mindful and aware of the ethical and legal implications of adding online-‐based therapy services to our practices.
Here are 10 things you want to consider before adding online-‐based
therapy services to your clinical practice:
10. Ask yourself why you want to add online–based
therapy services to your current practice.
Adding online-‐based therapy services to your practice may sound exciting and have you thinking that you can quickly increase your client load. If increasing your client load is the main reason for adding online-‐based therapy services to your practice, then you will be in for a shock to learn that it requires much work to add online clients to your practice. Depending on your location, online-‐based therapy is new and many potential clients are not aware of what it entails. Education will be key in discussing online-‐based services to your current and potential clients.
9. Think about transitioning to electronic health records.
Electronic health records (EHR) can seem scary and unfamiliar to some therapists. We have been used to keeping paper charts or managing client files through some word processing program. EHR can potentially save you time and money, make it easier for you to manage your client files, and allow clients to schedule
appointments and receive appointment reminders. There are many EHR programs that are specifically designed for the behavioral health profession. They can include things such as treatment plans, progress notes, billing, invoices, and processing insurance claims.
8. Research and try out different HIPAA compliant
software to administer online services.
Try out different software and services. Many companies offer a 30-‐day free trial. This can be a great way to determine ease of use and if it fits your practice needs, without a financial commitment. It is important that you find a service that fits your practice. You want the software to be user friendly, easy to use, and easy to manage. If there is a huge learning curve or it requires a lot of work on your part, you will be less likely to use online-‐based in your practice and it will affect the quality of
services being provided to your clients.
7. Identify your ideal client.
Identifying your ideal client is essential to your practice in general. You want to consider if your ideal clients and current clients are appropriate for online-‐based services. For example, if your ideal clients are very young children, then online-‐ based services may not be the most appropriate. Know whom you want to serve and determine if online-‐based services would be an added benefit for them.
6. Get trained and/or certified in online-‐based therapy
services.
Training is essential before implementing online-‐based therapy services to your current practice. Providing therapy through an online medium requires developing a new set of skills. Research if there is a provider offering trainings or consultation services on online-‐based therapy services in your state. There are a few
organizations that offer certification and training in online-‐based services such as the Center for Credentialing and Education (CCE) www.cce-‐global.org; the Telemental
Health Institute www.telehealth.org; or the Online Therapy Institute
www.onlinetherapyinstitute.com.
5. Be mindful of the theoretical framework that guides
your practice.
Not all frameworks are translatable for the online setting and may require that treatment be provided in person. According to the National Institute of Mental Health (2007), cognitive behavioral therapy currently is the best practice standard for online-‐based therapy services. For example, if you provide eye movement desensitization and reprocessing (EMDR) for your clients, then online-‐based therapy services may not be best suited for your practice.
4. Familiarize yourself with your association’s
technology standards of practice.
Many counseling organizations such as the American Counseling Association (ACA), National Association of Social Workers (NASW), and the American Psychological Association (APA,) have created guidelines for technology and online-‐based services in clinical practice.
3. Know your state licensing laws.
Become familiar with your state licensing laws, regulations, and guidelines
regarding online-‐based therapy services in your state. Contact your local licensing agency to obtain their stance on online-‐based therapy. Questions to keep in mind when researching your state licensing laws:
• Does your state have current regulations and guidelines regarding online-‐ based therapy services?
• If so, what type of online-‐based services do they regulate (video conferencing, telephone, email, instant messaging, virtual reality) • Are there any licensing requirements? Do you have to receive specific
training? Do you have to be independently licensed? • What is the state’s stance on practicing cross state lines?
2. Consider your liability insurance coverage.
If you do not have liability insurance coverage, this is the first thing you want to obtain for your practice. Liability insurance is there to protect not only your clients, but also you and your practice. Some questions you want consider are:
• Does my current policy include online-‐based therapy services?
• If so, what type of services will they cover (video conferencing, telephone, instant messaging, email, and virtual reality)?
• Will they cover practicing cross state lines? • Does it include tail coverage?
And now the #1 thing you need to consider before adding
online-‐based therapy services to your clinical practice.
1. Your comfort level with technology and
willingness to learn!
If you are not comfortable with technology or willing to learn, then it will NOT be an effective tool for your practice. Learning your online communication style and identifying what type of medium (written, verbal, and face-‐to-‐face) you are most comfortable with are essential. If you are comfortable, excited, curious, and feel that online-‐based therapy services can be helpful to your clients, then your clients will be more willing to try this medium as a part of their treatment. Just as in traditional, face-‐to-‐face therapy, it starts with you. When your clients feel comfortable and connection with you, then they are more likely to return and continue therapy with you.
Conclusion
Online-‐based therapy services allow us to be flexible and reach many clients who may have not otherwise met with us in person. Technology will continue to be a main part of our society. Online-‐based services will continue to grow and will be one of the ways many people will visit their healthcare professionals. Learning how to ethically and legally provide online-‐based therapy services is important to the longevity of the counseling professions.
Next Steps
Are you ready to get started with adding online-‐based therapy services in your practice? Do you want help planning your next steps? Have more questions?
I welcome the opportunity to help you get started. Contact me at
[email protected] to schedule a free 15-‐minute telephone or video consultation.
Resources
American Counseling Association. www.counseling.org
American Psychological Association. www.apa.org
American Telemedicine Association. www.americantelemed.org
American Telemedicine Association. 2013. Practice guidelines for video-‐based online mental health services. Retrieved from
http://www.americantelemed.org/home/2013/05/28/practice-‐guidelines for-‐video-‐based-‐online-‐mental-‐health-‐services.
American Telemedicine Association. 2009. Evidence-‐based practice for telemental health. Retrieved from
http://www.americantelemed.org/resources/standards/ata-‐standards guidelines.
Center for Credentialing and Education. www.cce-‐global.org
Counsol. (EHR and video conferencing software) www.counsol.com
Godleski, L., Darkins, A., & Peters, J. 2012. Outcomes of 98,609 US department of veterans affairs patients enrolled in telemental health services, 2006-‐2010.
Psychiatric Services, 63(4), pp. 383-‐385.
Green, D. 2013. The history of online psychotherapy. Retrieved from
http://www.psychom.com/Onlinehistory_en.html.
HITECH Answers. 2014. HIPAA security and compliance. Retrieved from
http://www.hitechanswers.net/ehr-‐incentive-‐program/hipaa-‐and-‐security compliance/.
Kessler, D., Lewis, G., Kaur, S., King, M., Weich, S., Sharp, D. J., Araya, R., Hollinghurst, S., & Peters, T. J. 2009. Therapist-‐delivered internet psychotherapy for depression in primary care: A randomised controlled trial. Lancet, 374, pp 628-‐634.
National Association of Social Workers. www.nasw.org
National Association of Social Workers. 2005. NASW & ASWB standards for technology and social work practice. Retrieved from
http://www.socialworkers.org/practice/standards/naswtechnologystanda ds.pdf.
National Institute of Mental Health. 2007. Internet-‐based PTSD therapy may help overcome barriers to care. Retrieved from
http://www.nimh.nih.gov/news/science-‐news/2007/internet-‐based-‐ptsd therapy-‐may-‐help-‐overcome-‐barriers-‐to-‐care.shtml.
O’Reilly, R., Bishop, J., Maddox, K., Hutchinson, L., Fisman, M., & Takhar, J. 2007. Is telepsychiatry equivalent to face-‐to-‐face psychiatry? Results from a
randomized controlled equivalence trial. Psychiatric Services, 58(6), pp. 836 843.
Online Therapy Institute. www.onlinetherapyinstitute.com
SecureVideo. (HIPAA compliant video conferencing software) www.securevideo.com
SimplePractice. (EHR) www.simplepractice.com
Tame Your Practice. Ron Reinhardt, LPCS, M.Ed, NCC. www.tameyourpractice.com
Telemental Health Institute. www.telehealth.org
Telemental Health Comparisons. www.telementalhealthcomparions.com
Therabill. (EHR) www.therabill.com
Thera-‐LINK. (HIPAA compliant video conferencing software) www.thera-‐link.com
Therapy Appointment. (EHR) www.therapyappointment.com
Therapy Charts. (EHR) www.therapycharts.com
Therapy Note. (EHR) www.therapynotes.com
Valant. (EHR) www.valant.com
VSee. (HIPAA compliant video conferencing software) www.vsee.com
Zoom. (HIPAA compliant video conferencing software) www.zoom.us
A Little About Me
In undergraduate school, I was going through a few issues and I needed professional help. I did not have a car, so driving to a therapist was out of the question. I also did not want to see someone face-‐to-‐face because my schedule was hectic and I remember feeling ashamed and embarrassed. I called around and there was no one who would work with me unless I came in person. I finally found a therapist who was willing to ‘meet’ with me over the phone. She emailed me her paperwork and I sent it back in the mail. We scheduled an appointment and I had sessions over the telephone. The flexibility she was willing to provide me, I will never forget. The help I received was wonderful and it allowed me to address some issues that had been affecting my performance in school and my interactions with others. This is why I am so very passionate about online-‐based services in clinical practice. There are many people who are hurting and struggling in silence. They are looking for therapy that is flexible and meets them right where they are.
I am a licensed clinical social worker (LCSW) and a distance credentialed counselor (DCC). I received my Bachelor of Arts in Psychology from University of Southern Indiana and my Masters of Social Work from Indiana University School of Social Work. I provide anxiety therapy services to adults in Indiana and use online-‐based therapy and various technology services in my practice. I love technology and firmly believe that it can be an effective tool in therapy. I enjoy helping those of us in the behavioral health industry find ethical and effective tools to improve the quality of services provided to those we serve. I have been an online adjunct faculty for over 4 years with University of Phoenix. I am also an associate faculty for Indiana
University School of Social Work’s online MSW Direct program.
