teletherapy delivery is defined in
paragraph (GG) of rule
4757-3-01 of the
Administrative Code. Licensees are reminded that standards of ethical practice
and professional conduct rules
4757-5-01
to
4757-5-12
of the Administrative Code apply to teletherapy.
(A)
These
standards govern the use of electronic or digital services in the provision of
services to include when the counselor, social worker or marriage and family
therapist and the client are not located in the same place during delivery of
services or when electronic systems or digitally-assisted systems are used to
support in-person face to face therapy.
Teletherapy means the use of real-time audio or audiovisual
communications that permit accurate and meaningful interaction between at least
two persons, one of whom is a licensee or registrant ("licensee") as defined in
Chapter 4757 of the Revised Code. For the purposes of this rule, modalities,
including but not limited to phone, video, text, email, instant messaging/chat,
are considered teletherapy.
(1)
All practitioners providing counseling, social work
or marriage and family therapy via teletherapy to persons physically present in
Ohio shall be licensed in Ohio.
All licensees
providing counseling, social work or marriage and family therapy via
teletherapy to persons physically present in Ohio shall be licensed in
Ohio.
(2)
All licensees of this board providing services to
clients outside the state of Ohio shall comply with the laws and rules of that
jurisdiction.
All licensees of this board
providing services to client(s)s outside the state of Ohio shall comply with
the laws and rules of the jurisdiction where the client is located at the time
services are rendered.
(3) Licensees shall consider their
education, training, and experience before providing teletherapy services and
provide only services for which they are competent. Licensees shall assume
responsibility to continually assess both their professional and technical
competence when providing teletherapy. This includes ensuring that all methods
of delivering services are compliant with commonly accepted standards of
technology safety and security at the time at which services are
rendered.
(4) Licensees shall screen potential
distance service clients for appropriateness to receive services via distance
methods, which includes considering their current mental and emotional status.
Licensee shall screen the client's technological capabilities as part of the
intake process. Therapists shall acknowledge power dynamics when working with a
family or group with differing levels of technological competence. These
considerations shall be documented in the records.
(5) Licensees shall be aware of
cultural differences and how they can affect nonverbal cues. Teletherapy
methods should be appropriate to the client's cultural experiences and
environment, and shall also be sensitive to audio/visual impairment and
cognitive impairment.
(6) Licensee shall regularly review
whether teletherapy is meeting the goals of therapy.
(7) Teletherapy shall require an
initial face-to-face meeting, which may be via video/audio electronically, to
verify the identity of the teletherapy client. At that meeting steps shall be
taken to address impostor concerns, such as by establishing passwords or
phrases to identify the client in future electronic contacts.
(8) Licensees shall identify an
appropriately trained professional who can provide local assistance, including
crisis intervention, if needed. Licensees shall provide teletherapy clients the
local crisis hotline telephone number and the local emergency mental health
telephone number.
(9) Licensees shall retain copies of
all written therapeutically relevant communication with clients, to include
emails, texts, instant messages, and chat history. Records. Such records should
be maintained for a minimum of seven years.
(10) Licensees must maintain records
in accordance with rule
4757-5-09
of the Administrative Code.
(B)
Prior to
providing services, licensees must establish informed consent. Informed consent
shall include information defining teletherapy delivery as practiced by the
licensee and the potential risks and ethical considerations per paragraph (B)
of rule
4757-5-02
of the Administrative Code.
Licensees shall
consider their education, training, and experience before providing teletherapy
services and provide only services for which they are competent. Licensees
shall assume responsibility to continually assess both their professional and
technical competence when providing teletherapy.
(1) Clients shall be given
sufficient opportunity to ask questions and receive answers about teletherapy.
These discussions should be documented in the client record.
(2) Informed consent should include
the risks of entering private information when using a public access computer,
or one that is on a shared network, and caution against using auto-fill user
names and passwords. Clients should be advised to consider employer policies
related to use of work computers for personal communication.
(3) Informed consent shall include
the associated needs of delivery method, for example owning a computer with the
correct capabilities or internet access, possibility of technology failure and
what the procedure is in the event that services are disrupted, anticipated
response time to electronic communication, alternative service deliveries, and
electronic communication between scheduled appointments and after normal
working hours.
(4) Informed consent should include
a discussion of how teletherapy may affect billing and access to insurance
benefits.
(5) Licensees shall obtain written
permission prior to recording any part of the teletherapy session. If licensees
are storing audiovisual data from sessions, these cannot be released to clients
unless the client authorization specifically states they are to be
released.
(6) Licensees shall obtain client
consent when using electronic search engines to gather information about the
client, except in circumstances when such searches may provide information to
help protect the client or other parties who may be at risk. The licensee must
document the rationale for conducting any electronic search and why it is not
harmful to the client.
(7) Licensees shall provide links to
websites for all of their certification bodies and licensure boards to
facilitate consumer protection. Licensees shall provide a link to the board
online license verification site on their web page.
(8) Licensees shall not provide
services without client signed informed consent.
(C)
Confidentiality in teletherapy service delivery and records
maintainence shall be maintained by the licensee.
No initial in person or face to face audiovisual visit is
necessary to initiate services using teletherapy modalities.
(1) Licensees shall use encryption
methods that are Health Insurance Portability and Accountability Act of 1996
compliant for teletherapy, except for treatment reminders, scheduling contacts
or other information provided outside of a therapeutic context.
Clients may waive encryption via
informed consent. Licensees must ensure clients understand the risk of
non-encrypted communications.
(2) Licensees shall develop and
disclose policies for notifying clients as soon as possible of any breach of
confidential information.
(3) Licensees shall create a policy
for the secure storage, recovery, and destruction of data, as well as the
technologies used to store, maintain, and transmit data.
(D)
Licensees shall screen client(s) for appropriateness to
receive services via teletherapy throughout the course of treatment, which
includes considering their current mental and emotional status, conducive
treatment modalities, and ongoing effectiveness of the service. The licensee
shall screen the client(s)'s technological capabilities as part of the intake
process and document any assistance provided to facilitate access.
During the COVID-19 state of emergency as declared
by the governor, licensees may:
Provide services without completing an initial face to face
video or in-person session;
Licensee shall
regularly review whether use of teletherapy is meeting the clinical needs of
the client(s).
(2) Obtain and record verbal
acknowledgement of informed consent when it cannot be obtained in writing;
and
(3) Follow guidance issued by the
United States department of health and human services regarding compliance with
HIPAA requirements.
(E)
A licensee is
under no obligation to provide services via teletherapy if their clinical
judgement indicates teletherapy is not an appropriate modality for delivering
services to the client(s).
(F)
No licensee shall
engage in teletherapy while operating a motor vehicle or similar equipment, nor
shall any licensee engage in activities during teletherapy that do not allow
the licensee to focus on the client(s) or prepare to document session. The
licensee should terminate a session if it is determined while in a session the
client is engaged in activities that could endanger themselves or
others.
(G)
A licensee shall not provide teletherapy when either
the client or licensee is in a setting where the confidentiality of the session
could reasonably be expected to be compromised.
(H)
Licensees shall
be aware of cultural and developmental differences and how they can affect
non-verbal cues. Licensees shall also be aware of audio, visual, and cognitive
impairment and the impact of these on the use of teletherapy services.
Teletherapy methods should be appropriate to the client and their
environment.
(I)
Licensees must maintain records in accordance with rule
4757-5-09
of the Administrative Code. Such records must clearly indicate when services
are provided through teletherapy.
(J)
Licensees shall
document all therapeutically relevant communication with client(s)s, to include
emails, texts, instant messages, and chat history.
(K)
The licensee
should ensure that practice or agency staff who are assisting a client(s) with
teletherapy services or providing teletherapy services are adequately trained
in the usage of relevant software or equipment.
(L)
Licensees are not
responsible for client(s) misuse of teletherapy devices during the provision of
services.
(M)
During the initial session, licensees must establish
informed consent in accordance with paragraph (B) of rule 4757-5-02 of the
Administrative Code. Informed consent shall include information defining
teletherapy delivery as practiced by the licensee, as well as potential risks,
security issues, and confidentiality issue when receiving teletherapy. In the
case of a minor client, the licensee must address any potential issues
specifically associated with treating minors.
(1)
Client(s) shall
be given sufficient opportunity to ask questions and receive answers about
teletherapy. These discussions should be documented in the client(s)
record.
(2)
Informed consent should include a discussion of how
teletherapy may affect billing and access to insurance
benefits.
(3)
Licensees shall document permission prior to recording
any part of the teletherapy session. If licensees are storing audiovisual
records from sessions, these cannot be released to client(s) unless
authorization from the client(s) is obtained specifically stating the records
are to be released.
(4)
Licensees shall not provide services without client(s)
informed consent which can be documented through verbal acknowledgement, online
signature, or by signing a hard copy form. Licensees must make available to the
client a copy of the consent documents regardless of the form of consent by the
client.
(5)
Licensees shall make available to clients links to
websites for all certification bodies and licensure boards to facilitate
consumer protection. Licensees shall provide a link to the board online license
verification site on their web page.
(6)
Licensees shall
obtain client(s) consent when conducting web searches to gather information
about the client(s), except when searches are of public criminal records/public
safety databases prior to an initial session with a client or when such
searches may provide information to help protect the licensee, client(s) or
other parties who may be at risk.
(7)
The licensee
shall provide the client(s) information on how to access assistance in a crisis
and outside of established business hours.
(N)
Licensees shall
have a contingency plan for providing services to client(s) when technical
problems occur during a teletherapy session, or when technical problems prevent
a session from occurring. This plan may include information on other qualified
therapists who can provide services if needed.
(O)
Licensees shall
confirm the client(s) location at the time services are
rendered.
(P)
Licensees shall comply with all requirements under
state and federal law regarding the protection of client confidentiality while
providing services. Each provider shall ensure that any username or password
information and any electronic communications between the provider, client, or
third parties are securely transmitted and stored.
Notes
Ohio Admin. Code
4757-5-13
Effective:
6/27/2022
Five Year Review (FYR) Dates:
7/3/2023
Promulgated Under:
119.03
Statutory Authority:
4757.10,
4757.11,
4757.50, 4743.09
Rule Amplifies:
4757.11,
4757.50, 4743.09
Prior Effective Dates: 10/18/2009, 07/01/2016,
09/03/2018, 09/02/2019, 04/06/2020 (Emer.),
10/12/2020
