Teletherapy Competencies, the What and How

We’re always eager to talk about telemental health competencies and how important they are to teletherapy training programs, but it can be difficult to determine which educational content areas are most useful for you. Universities considering graduate program competencies in telebehavioral health training for their staff and/or students may be seeking guidance in selecting the most effective program. In this article, we describe the course qualities that are often seen in relevant, well-rounded telemental health programs. Using current teletherapy research studies, you’ll see how similar teletherapy competencies are gaining prominence across numerous clinical professions—and why you could benefit from learning them.

HIPAA and TeleMental Health: Get Compliant!

Is your telemental health practice HIPAA compliant? It’s a question that can cause a knot in the stomach of even the most experienced telemental health professionals. For those just starting out in telehealth, it may even cause a bout of panic. Exactly how does HIPAA impact counselors who are using telehealth? Are the rules different than the rules for in-person therapy?

Even if you’ve taken a continuing education class covering HIPAA, it may not have covered telemental health and you may have questions. 

Let’s start with some basics: 

Telehealth is Expected to Get a Big Boost in the Biden Era

Even before he was confirmed as President Joe Biden’s health secretary on March 18, 2021, Xavier Becerra had signaled his support for expanding telehealth. During his confirmation hearings in February, Becerra said, "I wholeheartedly believe we're going to be doing expansion of telehealth." 

The counseling profession has struggled with barriers to delivering mental health services to clients across state lines since the conception of licensure law. Most states require counselors to be licensed in the state where the client resides. This means clients have to find a new counselor if they move out of state. It also limits telehealth options for many clients.

To address this dilemma the American Counseling Association (ACA) – in collaboration with the National Center for Interstate Compacts (NCIC) – has been working on an interstate licensure compact. This compact would create licensure portability for professional counselors – creating a way for counselors to practice in multiple states.

To explore what the interstate compact would mean for counselors, Raymond Barrett, CEO of the Telehealth Certification Institute (TCI), interviewed Dr. Lynn Linde, chief knowledge and learning officer at ACA.

The jurisdictional structure of the counseling profession has hampered counselors and their clients for decades. Differing state licensure requirements associated with educational coursework, supervision hours, and professional examinations have fragmented the profession since the founding of the American Counseling Association (ACA) in 1952 and continue to impact counselors. An easy, straightforward answer to this dilemma has eluded industry decision-makers for years, but a professional reformation is underway—set in motion by a three-year investigative study, true portability for counselors is possible.

As the COVID-19 pandemic hit, telehealth became a necessity for many communities across the United States as a means of mitigating the risk of virus transmission and accessing healthcare in a timely manner. Telehealth has expanded access to healthcare in many communities across the country which previously lacked access to such healthcare, including Native communities. On April 8, 2020, the Indian Health Service (IHS) announced an expansion of telehealth across all facilities.

In a notoriously digital age, the healthcare industry has been the newest convert to online, virtual, and distance-based telehealth technology. The National Committee for Quality Assurance (NCQA), the Alliance for Connected Care, and the American Telemedicine Association—with enthusiastic support from 22 experts on various points of the healthcare spectrum—have formed a synergistic Taskforce on Telehealth policy (TTP). The group recently launched a forward-thinking campaign that targets three fundamental categories:

1. The cost of telehealth service expansion (programmatic concerns).
2. Protections and safeguards for patients in remote environments (patient concerns).
3. Data flow, care integration, and quality control (system-level concerns).

The healthcare industry is taking a simple and effective step in protecting its nurse workforce: listening to and allying with their needs. Groups like the National Council of State Boards of Nursing (NCSBN) have put pieces in place to enhance the work-life balance of advanced practice registered nurses (APRN). The APRN compact, influenced by a big legislative push from the NCSBN, is restructuring how patients are treated across the U.S. The compact has opened a new channel for multi-state practice for nurses licensed in a state that has signed the agreement.

The terms telehealth and telemedicine are often used interchangeably by the public, even though they describe distinct processes. In the most generic sense, telehealth and telemedicine involve conducting health care services remotely. The difference between the two terms arises when one examines the medical portion of telemedicine. The nuance isn’t just a lexicological typo, it ties a specific clinical component to the provided services. 

Telehealth, on the other hand, is more inclusive. Non-clinical activities related to education, staff training, healthcare administration, professional conferences, or patient-provider clinical services all fall under the telehealth label. Three of the main telehealth modalities are live patient-provider video sessions, the store-and-forward technique—which collects clinical data and sends it to a separate location for evaluation—and off-site patient monitoring that studies clinical data as it elapses in real-time.

History of Telehealth Services

The telehealth revolution found its footing in a 1925 science fiction premise, which questioned the possibility of remote-based medical procedures. Matt Novak of Smithsonian Magazine pointed to entrepreneur and author, Hugo Gernsback, who imagined a world where doctors could interact with patients using radio waves—an insight that has helped clinicians grow their virtual presence and deliver patient-centered care over the internet. 

Helen Oscislawski is the co-founder & frequent author on the Legal Health Information Exchange, a rich resource of blog articles and a compliance resource library. She was elected in 2020 to the "Super Lawyers" issued by Thomson Reuters, for healthcare law in New Jersey.

Helen is known to many as a “go-to” attorney for legal guidance on HIPAA, HITECH, state privacy laws, and electronic Health Information Exchange (HIE) and is well-regarded for her work with the legal aspects of health information exchanges, HIPAA law, and 42 CFR Part Two for privacy and security law around healthcare information regarding substance abuse treatment. A trusted advisor, Helen now represents some of the most cutting edge and sophisticated HIEs, RHIOs and ACOs in the nation.

Helen and Ray Barrett met for one of our "Telehealth Facts Friday" sessions on Facebook Live. Watch the full interview for answers to frequently asked questions about the legal aspects of telehealth care, including: