Published in the Union Leader (10/26/2015)
Q: I am licensed psychologist in private practice and I have clients who want to receive therapy through Skype. Is this even allowed, and if so, what issues do I need to consider?
A: Telehealth services, or in this case telepsychology services, are defined as the provision of psychological services using telecommunication technology, including teleconferencing or use of the internet. Telepsychology is permitted in New Hampshire, however the rules are not yet clear. The New Hampshire Board of Psychologists, the agency that governs licensed psychologists, anticipates that such services may be provided but reminds practitioners that the services must comply with Board regulations. At this point, the Board’s regulations have not yet been issued. As the State is beginning to venture into this territory, there are many issues that psychologists are strongly encouraged to take into consideration.
While the New Hampshire Board of Mental Health Practice does not govern psychologists, its position on telehealth services is relevant as many licensing boards in other states have taken similar position. Specifically, that board has opined that a mental health practitioner who provides telehealth services must be licensed in the state in which he is located as well as the state in which the client is situated.
The American Psychological Association (“APA”) adopted extensive guidelines with regard to the practice of telepsychology in July 2013. Any psychologist considering providing telepsychology services should review them carefully. These guidelines have raised two primary issues. First, any practitioner who provides these services should have competence to handle the necessary technology so that the client’s privacy can be protected. The psychologist should use software that is reliable, safe, and uses encryption technology It would be wise to also consider using technology that is endorsed as HIPAA-compliant. With regard to Skype, psychologists should be aware that APA has not been willing to endorse Skype as HIPAA-compliant, and Skype has not been willing to execute a Business Associate Agreement as is required under HIPAA.
The second primary issue raised by the APA guidelines relates to the importance of providing the client a clear understanding about the increased risks of loss of security and confidentiality of their information through telepsychology. Psychologists are already mandated to provide informed consent to clients that includes an explanation about the limits of confidentiality, however providing therapy electronically raises a host of new and potentially complicated risks.
In addition to the issues identified by APA, psychologists should also consider establishing policies in anticipation of issues that can arise. For instance, is the client expected to participate in the first sessions in person? How are emergencies for the client to be handled? Are special considerations necessary for termination? Must the client agree to only participate in sessions in certain settings where the psychologist has assurance that sufficient privacy is in place? What if a session is disrupted due to technical difficulties? These are just a host of the issues that practitioners can anticipate facing.
While this is new territory, it is an exciting opportunity for practitioners to provide services to clients who otherwise may not be able to receive adequate assistance. As the technology improves and the standards become more clear, practitioners will have more assurances about what should be expected. Until then, psychologists should proceed with caution.
Andrea Daly can be reached at firstname.lastname@example.org.
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