Lesson 1 of 3_Telepractice Telehealth Law & Ethics Implementation Workshop.pptx
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This document provides an overview of a telehealth law and ethics implementation workshop. It discusses the goals of the workshop, which are to educate participants about telehealth standards, guidelines, competencies and legal/regulatory considerations. The workshop will consist of 3 video trainings and assignments related to documentation standards for different disciplines. It emphasizes that participants should seek advice from their own legal and regulatory authorities before offering telehealth services. The document outlines the learning objectives, structure, and assignments of the workshop.
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Lesson 1 of 3_Telepractice Telehealth Law & Ethics Implementation Workshop.pptx
- 1. Telepractice: Telehealth Law & Ethics Implementation Workshop Lesson 1
- 2. © 1994-2022 Telehealth.org, LLC. All rights reserved. • WHO WE ARE: We are licensed healthcare professionals, attorneys and other consultants. • TELEHEALTH GOAL: Our goal is educational only. No warranty, guarantee, or representation is made as to the accuracy or sufficiency of the information contained in our training for your specific circumstance. • YOUR PART: You are encouraged to seek practice-specific advice from your own legal, regulatory, ethical and liability authorities before offering any telehealth services or programs to consumers/clients/patients. Obtain all such opinions in writing, and have your informed, trusted, local, legal counsel review those written responses for their full significance. Disclaimer 2
- 3. © 1994-2022 Telehealth.org, LLC. All rights reserved. 3 Discuss Intelligently discuss why and when to think about technology-relevant standards published by groups such as JCAHO, URAC, COA, and CARF Describe Describe where to go to quickly and easily get relevant documentation standards and/or guidelines Identify Identify at least two types of documents to use as a source for their specific discipline's relevant documentation requirements Learning Objectives
- 4. © 1994-2022 Telehealth.org, LLC. All rights reserved. 4 Learning Objectives Name Name where to go to learn about relevant federal and state regulations related to telepractice Describe Describe documentation requirements related to team-based approaches to delivering telehealth (i.e., integrated care) that go beyond one's specific disciplinary telehealth requirements Describe Describe the role of other professionals in reviewing documentation requirements and where to find such professionals when needed
- 5. © 1994-2022 Telehealth.org, LLC. All rights reserved. • Syllabus • Quiet Space • Questions • Twitter @Telehealth.org 5
- 6. © 1994-2022 Telehealth.org, LLC. All rights reserved. Course Structure 6 Training Hours 3 Video Trainings (3 hours) 3 eLearning Assignments Related to Your Discipline • Standards • Guidelines • Competencies • Other Oversight Groups
- 7. © 1994-2022 Telehealth.org, LLC. All rights reserved. Documentation & Administration Course Structure: Lessons & Topics 7 Telehealth Standards, Guidelines & Competencies Telehealth Regulatory Guidance Other Telehealth Guidance: Oversight Agencies, Specialty or Population- Specific Guidelines Lesson #1 Lesson #2 Lesson #3
- 8. © 1994-2022 Telehealth.org, LLC. All rights reserved. Orientation to Your Training Materials 8 Lessons: Next Steps: Resources : • Lesson One • Lesson Two • Lesson Three • Assignments • Post-Test • Course Evaluation • Course Certificate • Course Documents • Bibliography • Tools
- 9. © 1994-2022 Telehealth.org, LLC. All rights reserved. Assignments 9 • Lesson I Assignment: Check the Standards, Guidelines and/or Competencies in Your Discipline • Lesson II Assignment: Check the Regulatory Code for Each of Your States of Licensure • Lesson III Assignment: Pulling It All Together
- 10. © 1994-2022 Telehealth.org, LLC. All rights reserved. Assignments 10 • Lesson 1 Assignment: Check the Standards, Guidelines and/or Competencies in Your Discipline • Please look for the "Course Documents" link to the immediate left of this instructional box. Click the link and look in the Teleheath list of documents to find the published ethical standards (code of conduct), guidelines and/competencies for your discipline. If it is absent, please go to your national professional association and ask for them. (Then please forward to us and we will add it to our list of it is publicly available. Our address is contact@telehealth.org. Thank you.)
- 11. © 1994-2022 Telehealth.org, LLC. All rights reserved. Assignments 11 • This training's first assignment involves your reading all relevant documents for your discipline and listing all the documentation requirements or other suggestions made. With a pad in hand (electronic or paper), read all relevant documents, create a bullet-point list of such requirements or suggestions and paste them as a response to this question below. This exercise is designed to motivate you to take the hour(s) needed to accomplish list. The resulting list will be developed for your purposes only. It can then be used in your work setting to document your compliance with ethical standards (code of conduct), guidelines and/competencies in your discipline(s).
- 12. © 1994-2022 Telehealth.org, LLC. All rights reserved. Existing Telemental & Telebehaviora l Health Ethical Statements 12 • American Association of Marriage and Family Therapists (2015). Code of Ethics. • American Counseling Association. (2014). ACA Code of Ethics. • American Mental Health Counselors Association. (2000). Code of Ethics of the American Mental Health Counselors Association, Principle 14, Internet On-Line Counseling.
- 13. © 1994-2022 Telehealth.org, LLC. All rights reserved. Existing Telemental & Telebehaviora l Health Ethical Statements 13 • American Telemedicine Association. (2013). Practice Guidelines for Videoconferencing- Based Telemental Health. • American Psychiatric Association. (2018). Best Practices in Videoconferencing-Based Telemental Health. • Joint Task Force for the Development of Telepsychology Guidelines for Psychologists. (2013). Guidelines for the Practice of Telepsychology.
- 14. © 1994-2022 Telehealth.org, LLC. All rights reserved. Existing Telemental & Telebehaviora l Health Ethical Statements 14 • NAADAC, the Association for Addiction Professionals. (2016). NAADAC/NCC AP Code of Ethics. • National Association of Social Workers. (2018). Code of Ethics. • National Association of Social Workers. (2017). Technology Standards.
- 15. © 1994-2022 Telehealth.org, LLC. All rights reserved. NAADAC Association for Addictions Professionals, 2016 Principle VI: E-Therapy, E- Supervision, and Social Media 15
- 18. © 1994-2022 Telehealth.org, LLC. All rights reserved. American Psychological Association Guidelines for the Practice of Tele- psychology 2013 18
- 20. © 1994-2022 Telehealth.org, LLC. All rights reserved. American Telemedicine Association Practice Guidelines for Video-Based Online Mental Health Services 2013 20
- 21. © 1994-2022 Telehealth.org, LLC. All rights reserved. Scope and Standards of Practice for Professional Telehealth Nursing, 2018 21
- 23. © 1994-2022 Telehealth.org, LLC. All rights reserved. American Psychiatric Association Best Practices in Videoconferencing Based Telemental Health April 2018 23
- 27. © 1994-2022 Telehealth.org, LLC. All rights reserved. American Psychological Association's Ethical Principles of Psychologists and Code of Conduct "Boundaries of Competence" 27
- 28. © 1994-2022 Telehealth.org, LLC. All rights reserved. GUIDELINES FOR THE PRACTICE OF TELEPSYCHOLOGY Competence of the Psychologist • Acquiring competence may require pursuing additional educational experiences and training, including but not limited to, a review of the relevant literature, attendance at existing training programs (e.g., clinical and technical) and continuing education specific to the delivery of services utilizing telecommunication technologies. • Psychologists are encouraged to seek appropriate skilled consultation from colleagues and other resources. 28
- 29. © 1994-2022 Telehealth.org, LLC. All rights reserved. Development of the Guidelines • Therefore, two of the most salient issues that the Tele psychology Task Force members focus on throughout the document are the psychologist's own knowledge of and competence in the provision of telepsychology and the need to ensure that the client/patient has a full understanding of the potentially increased risks to loss of security and confidentiality when using technologies. • An additional key issue discussed by the task force members was interjurisdictional practice. 29
- 30. © 1994-2022 Telehealth.org, LLC. All rights reserved. American Psychological Association's Ethical Principles of Psychologists and Code of Conduct "Boundaries of Competence" 30 • Education • Training • Experience • Consultation Required Ethical Standard Emotional Reasoning vs Competence • Example: Using Skype -- many professionals have used and 'feel good" about using skype for years, without understanding legal complexities
- 31. © 1994-2022 Telehealth.org, LLC. All rights reserved. AOA Code of Ethics (continued) 31
- 32. © 1994-2022 Telehealth.org, LLC. All rights reserved. Competencies to Consider Before Working in Telehealth 32 Follow All Applicable State & Federal Laws Competence in Telehealth Competence in Your Regular Treatment Area
- 33. © 1994-2022 Telehealth.org, LLC. All rights reserved. Look for this document in your Telehealth Training Platform 33
- 35. © 1994-2022 Telehealth.org, LLC. All rights reserved. How competencies fit into the picture (building blocks of what you need to know) Professional Service Delivery Training Competencies Guidelines Ethical Standards Regulations Laws 35
- 37. © 1994-2022 Telehealth.org, LLC. All rights reserved. CTIBS Inter- professional Framework for Telebehavioral Health Competencies 37 149 Telebehavioral Practices Across 3 Competency Levels (Novice, Proficient & Authority) 51 Telebehavioral Objectives 5 Subdomains 7 Domains
- 38. © 1994-2022 Telehealth.org, LLC. All rights reserved. 38 Interprofessional framework for telebehavioral health competencies CTIBS, 2017 DOMAIN II - Virtual Environment & Telepresence DOMAIN III – Technology DOMAIN I - Clinical Evaluation & Care SUBDOMAIN I.B Cultural Competence & Diversity SUBDOMAIN I.C Documentation & Administrative Procedures SUBDOMAIN I.A Evaluation & Treatment
- 39. © 1994-2022 Telehealth.org, LLC. All rights reserved. 39 Interprofessional framework for telebehavioral health competencies CTIBS, 2017 DOMAIN V - Evidence-Based & Ethical Practice DOMAIN VI – Mobile Health Technologies Inclu- ding Applications (Apps) DOMAIN IV – Legal & Regulatory Issues SUBDOMAIN V.A - Standards & Guideline SUBDOMAIN V. B - Social Media and Digital Information Collection DOMAIN VII - Telepractice Development
- 40. © 1994-2022 Telehealth.org, LLC. All rights reserved. Competency Levels 40 • Domain and Subdomains are organized according to competency level • Novice - advanced students, interns or residents • Proficient - licensed professional, teaching faculty, supervisor • Authority - advanced practitioner, specialist
- 41. © 1994-2022 Telehealth.org, LLC. All rights reserved. Competency Levels 41 • Each competency level is categorized into discrete • Telebehavioral Objectives • Telebehavioral Practices
- 42. © 1994-2022 Telehealth.org, LLC. All rights reserved. CTIBS Telebehavioral Health Competencies Domain I, Clinical Evaluation & Care, Subdomain 1.C. Documentation & Administrative Procedures SUBDOMAIN I.C Documentation & Administrative Procedures: Within his or her competency level then, the professional: 11. Adapts TBH practices 12.Adheres to policies/procedures from in-person care 13.Applies/adapts policies/procedures to TBH 14.Adheres to professional, agency and other organizational policies/procedures (see Legal and Regulatory) 15.Documents TBH practices according to requirements 42
- 43. © 1994-2022 Telehealth.org, LLC. All rights reserved. CTIBS Telebehavioral Health Competencies Domain I, Clinical Evaluation & Care, Subdomain 1.C. Documentation & Administrative Procedures 16.Distinguishes and adapts to non-routine components (for Proficient and Authority) 17.Offers supervision in how to comply with all documentation requirements (for Proficient and Authority) 43
- 44. © 1994-2022 Telehealth.org, LLC. All rights reserved. CTIBS Telebehavioral Health Competencies Domain I, Clinical Evaluation & Care, Subdomain 1.C. Documentation & Administrative Procedures • 1.C.11 Adheres to operational policies/procedures for in-person care and modifications for TBH care. • Can demonstrate compliance with proper documentation requirements to ensure the quality and consistency of TBH care and adherence to relevant oversight agencies and their policies/procedures. • Can demonstrate adherence and adaptation to best practices for both in- person and TBH care, with awareness of differences in requirements e.g., state/provincial laws and professional standards on informed consent, privacy and billing. 44
- 45. © 1994-2022 Telehealth.org, LLC. All rights reserved. H.2.b. Confidentiality Maintained by the Counselor Counselors acknowledge the limitations of maintaining the confidentiality of electronic records and transmissions. They inform clients that individuals might have authorized or unauthorized access to such records or transmissions (e.g., colleagues, supervisors, employees, information technologists). ACA – Code of Ethics 45
- 46. © 1994-2022 Telehealth.org, LLC. All rights reserved. 6.4 Technology and Documentation Therapists and supervisors are to ensure that all documentation containing identifying or otherwise sensitive information which is electronically stored and/or transferred is done using technology that adhere to standards of best practices related to confidentiality and quality of services, and that meet applicable laws. Clients and supervisees are to be made aware in writing of the limitations and protections offered by the therapist's or supervisor's technology. ACA – Code of Ethics 46
- 47. © 1994-2022 Telehealth.org, LLC. All rights reserved. AMA - Clinical Documentation of a Telepsychiatry Encounter 47
- 48. © 1994-2022 Telehealth.org, LLC. All rights reserved. AMA - Clinical Documentation of a Telepsychiatry Encounter Clinical Documentation of a Telepsychiatry Encounter is as important as with any clinical encounter but there may be some important additional considerations including a special need for • Documentation of the time, date, remote site location • Documentation of the duration of the encounter and time spent face-to- face with the patient in interview and examination • Documentation of the originating site location and personnel 48
- 49. © 1994-2022 Telehealth.org, LLC. All rights reserved. AMA - Clinical Documentation of a Telepsychiatry Encounter Components of a clinical encounter which should be documented include: • Chief Complaint or Reason for Encounter • Referral Source • History of Present Illness • Current Treatments including medications and ongoing therapies • Mental Status Examination • Diagnoses Treatment Plan including 49
- 50. © 1994-2022 Telehealth.org, LLC. All rights reserved. AMA - Clinical Documentation of a Telepsychiatry Encounter Inclusion of other items is sometimes needed such as: • Past Medical, Family, Social Histories • Review of Systems 50
- 51. © 1994-2022 Telehealth.org, LLC. All rights reserved. CTiBS Telebehavioral Health Competencies Domain I, Clinical Evaluation & Care, Subdomain 1.C. Documentation & Administrative Procedures 51 • 1.C.12 Adapts operational policies/procedures for situations in which there is no requirement/ specifications on to develop new ones.
- 52. © 1994-2022 Telehealth.org, LLC. All rights reserved. • Represents a "meeting of the minds" • Information is influenced by many factors, including: • Client/Patient's capacity for absorbing information • Time Limits Clinician's schedule • Static vs. Dynamic (needs ongoing documentation) Informed Consent Discussion vs. Document 52
- 53. © 1994-2022 Telehealth.org, LLC. All rights reserved. A thorough e-therapy informed consent shall be executed at the start of services. A technology-based informed consent discussion shall include: • distance counseling credentials, physical location of practice, and contact information; • risks and benefits of engaging in the use of distance counseling, technology, and/or social media; • possibility of technology failure and alternate methods of service delivery; • anticipated response time; 53 VI-4 Informed Consent
- 54. © 1994-2022 Telehealth.org, LLC. All rights reserved. • emergency procedures to follow; • when the counselor is not available; • time zone differences: • cultural and/or language differences that may affect delivery of services, and • possible denial of insurance benefits; and social media policy 54 VI-4 Informed Consent
- 55. © 1994-2022 Telehealth.org, LLC. All rights reserved. Addiction Professionals shall maintain electronic records in accordance with relevant state and federal laws and statutes. Providers shall inform clients on how records will be maintained electronically and/or physically. This includes, but is not limited to, the type of encryption and security used to store the records and the length of time storage of records is maintained. VI-17 Records 55
- 56. © 1994-2022 Telehealth.org, LLC. All rights reserved. • What are typical emergencies experienced by the population(s) that you serve? • Suicide or Homicide • What is suicide plan? • Are firearms accessible? • Abuse • What are the imminent dangers? • Are children or elderly people in environment? • lf substance abuse is an issue, is substance in the home? • ls abduction a flight risk if child abuse reporting is discussed? Emergency Planning Introduction 56
- 57. © 1994-2022 Telehealth.org, LLC. All rights reserved. • What are typical emergencies experienced by the population(s) that you serve? • Medication reactions • Physical emergencies • ls client/patient alone? • Is social support available? • What repercussions might ensue if you pull in a friend or family? • Other? Emergency Planning Introduction 57
- 58. © 1994-2022 Telehealth.org, LLC. All rights reserved. • Review the specifics of your telehealth informed consent verbally, then ask for signed IC document • Include the emergency plan in your informed consent (IC) document, where your client/patient will sign that they agree to your policies Emergency Planning Introduction 58
- 59. © 1994-2022 Telehealth.org, LLC. All rights reserved. Collect & Document Local Emergency Resources • These can be dependent on your client/patient population (e.g., autistic children and their families, depressed adults, unwed teen mothers, elderly men with anger management issues and subtance abuse) • Document telephone numbers, hospital admissions, local clinical resources, local champion or proctor, friend/family member(s) Emergency Planning Introduction 59
- 60. © 1994-2022 Telehealth.org, LLC. All rights reserved. Intake form - compare your existing form to your state statutes to make sure you have covered all the required bases • Mental status exam • Preferences for technology • Risks/benefits (See ATA/APA comparison checklist) • Diversity needs • Gait analysis • Hygiene check • Alcohol? Intake Form 60
- 61. © 1994-2022 Telehealth.org, LLC. All rights reserved. • Document, document, document • Opening protocol verification of identity, location, and privacy (at a minimum) • Clinical protocols followed (evidence- based research articles in your specialty niche or population served) • Time in, time out Progress Note 61
- 62. © 1994-2022 Telehealth.org, LLC. All rights reserved. • Dropped connections • Intrusions / interruptions • Lighting • Adaptive Equipment • Progress toward established goals • How technology helped/hindered • Peer consultation using telehealth systems (e-consults) Progress Note 62
- 63. © 1994-2022 Telehealth.org, LLC. All rights reserved. • Use your general form, but comment on: • Success/pros/cons of telehealth • Problems encountered and resolutions if any • If telehealth is suggested for future Termination Note 63
- 64. © 1994-2022 Telehealth.org, LLC. All rights reserved. • Use wording from informed consent agreements about "no-shows/termination" if termination letter is needed • Social media policy about "friending" (e.g. Facebook) or giving ratings (e.g. Yelp) and alternative ways to comment after meetings come to a close Termination Note 64
- 65. © 1994-2022 Telehealth.org, LLC. All rights reserved. Opening Protocol 65 • Identify yourself and your geographic location • Ask your client/patient to do the same (as needed) • Audio/video check (e.g. Do you hear & see me clearly?) • Is there anyone in your room or within ear-shot today? (Agree on safety code words, signals or phrases) • Is there anything else I might notice and find of interest if I were in the same room with you today?
- 66. © 1994-2022 Telehealth.org, LLC. All rights reserved. Intake form - compare your existing form to your state statutes to make sure you have covered all the required bases • Mental status exam • Preferences for technology • Risks/benefits (See ATA/APA comparison checklist) • Diversity needs • Gait analysis • Hygiene check • Alcohol? Intake Form 66
- 67. © 1994-2022 Telehealth.org, LLC. All rights reserved. Conduct a quick audio and visual assessment and make adjustments as necessary (e.g., are window blinds causing a glare? Is there something interfering with the microphone? Is someone vacuuming in the next room?) Intake Form 67
- 71. © 1994-2022 Telehealth.org, LLC. All rights reserved. Telehealth Sample of Risk Assessment Form 71
- 72. © 1994-2022 Telehealth.org, LLC. All rights reserved. Opening Protocol 72 • To be administered by you or your staff • Conduct a quick audio and visual assessment and make adjustments as necessary (e.g., are window blinds causing a glare? Is there something interfering with the microphone? Is someone vacuuming in the next room?)
- 73. © 1994-2022 Telehealth.org, LLC. All rights reserved. Opening Protocol 73 • Ask if anyone is in the room, and state if anyone is in the room with you • If you hear noises, stop and ask, Has someone entered your room? More times than not, patients won't tell you if someone has entered the room • Mention that the session is or is not being recorded and verify whether they are recording it in any way