Psychology Boards (ASPPB) and the American Psychological
Association Insurance Trust.
APA’s Council of Representatives approved the guidelines in
August, and they will be published in American Psychologist within
the next year. In the meantime, here’s an overview of what they
Ensure confidentiality, privacy and informed
The potential risks of treatment are more complicated
with telepsychology than in a traditional practice. With in-person visits, providers can be more confident of a secure
environment. “But when you move into cell phones, land
lines, video conferencing and Internet, these media all allow for
eavesdroppers,” says Palomares.
One way to mitigate these risks is to have detailed discussions
with your clients at the outset of teletherapy so that clients
understand the potential risks to privacy. For example, if a client
is having the telepsychology session from home, family members
may be able to overhear the therapy, posing a confidentiality risk.
Similar breaches can occur if a client is in a public place — at
work, in a coffee shop or even a park. Make sure the client clearly
understands these risks, then have him or her sign an informed
consent form, says Palomares.
But informed consent isn’t always enough, adds Deborah
Baker, JD, director for legal and regulatory policy in APA’s
Practice Directorate. Skype and some other technologies do
not seem to comply with the requirements under the Health
Insurance Portability and Accountability Act (HIPAA), which
is overseen by the U.S. Department of Health and Human
Services’ Office for Civil Rights. And yet health-care providers
are still responsible for protecting their patients’ and clients’
personal health information — and liable should a breach of
confidentiality occur. “Anything that’s electronically created
through a telehealth encounter is subject to HIPAA,” says Baker.
She recommends that psychologists who want to practice
telepsychology think twice about using Skype or other free
Web-based platforms. Instead, psychologists ought to consider
investing in audio-video conferencing programs designed with
HIPAA compliance in mind, she says. Though APA doesn’t
endorse any one software vendor in particular, the American
Telemedicine Association website ( www.americantelemed.org),
which has a section featuring various companies that create the
programs, might be a good place to start in researching secure
Know the licensing requirements
Practicing telepsychology across state lines comes with great
potential — and great confusion. Laws vary from state to state,
with some states having specific statutes or administrative rules
relating to telepsychology and others having none. Some state
psychology licensing boards, says Baker, have issued advisory
opinions on providing psychological services remotely or
practicing across state lines, evidencing how the boards might
apply the licensing laws to telehealth in the event of a licensing
complaint. And others haven’t addressed the subject at all.
“Always check with your state’s psychology licensing board,”
One of the sticky points is that in addition to being licensed
in the state you’re in, a number of states take the perspective that
the provider ought to be licensed in the state where the client is.
One psychologist, for example, licensed in Ohio, planned to spend
six months of the year in Florida and wanted to continue treating
his clients in Ohio remotely while in Florida. The Florida board
opined that his providing psychological services via telehealth to
his Ohio clients constituted the practice of psychology in Florida as
well as Ohio. It required him to be licensed in Florida, too.
Some states allow for temporary practice for a fixed number
of calendar days per year under a temporary or guest practice
provision that might facilitate telehealth practice across state
lines. Before you engage in telepractice, it is recommended that
you contact your state psychology licensing board to understand
what your state’s policies are. If you anticipate telehealth practice
across state lines, it is equally important to understand what the
other state’s policies are regarding telepractice and the practice of
In addition to the telepsychology guidelines, APA’s Joint
Telepsychology Task Force is hoping to create some consistency
across states by drafting model language for how to best regulate
telepsychology. The task force is also supporting the creation of
the e.passport, a mechanism developed by ASPPB that would
facilitate telepsychology across state lines while maintaining the
protection of the public.
“The concept is that if you’re licensed in one state and have an
e.passport, you could then practice in any state that’s also signed
on to it,” says Palomares.
Of course, states have to be signed on first — a process that
may take years, or decades.
Get in touch with your inner techie
Technological glitches are common, and someone practicing
telepsychology has to have a backup plan for all contingencies.
For example, if you’re in the middle of a video session, what do
you do if your Internet service fails? How do you bill if your
patient’s cell phone dies? If you’re using email for communication
of personal information, is it encrypted?
Also, as noted above, confidentiality is critical. “One thing
is that you really have to understand whether the technology
you’re using is secure,” says Baker. “Our guidelines don’t actually
say, ‘This technology is good, and this one’s not good.’” The
Department of Health and Human Services doesn’t do this either,
she says, so the burden is on the practitioner.
Palomares says telepsychology practitioners should know
how to clear their computers’ cookies, which save their browsing
history and log-in information and could potentially compromise
confidentiality. He also endorses carefully reading over the user