Some relevant excerpts for MA-licensed LMHCs seeing patients IN Massachusetts:
This policy guideline is intended as a recommended protocol for the profession to follow. The guideline set forth below does not have the full force and effect of law
The Board's policy with regard to all distance or electronic-assisted provision of clinical services is as follows:
1. The services offered by licensees of this Board across a distance by electronic means, fall within the jurisdiction of the Board just as traditional, face-to-face services do. Therefore all Board policies and regulations will apply to these services.
7. Licensees are encouraged to carefully review the way in which the structure of their relationships with clients will be impacted by distance-therapy or counseling to ensure compliance with Board regulations and standards of practice.
8. The following are some areas of practice that licensees should carefully consider:
a. Informed consent
c. Basis for making clinical judgments
d. Areas of competence
e. Avoiding harm
h. Abandonment of clients
9. The Board expects licensees to understand and overcome the significant challenges inherent in providing counseling and therapy without face-to-face contact with the client.
10. Some of the challenges that licensees are expected to manage include, but are not limited to:
a. Full disclosure with regard to potential risks to confidentiality, including computer hacking and/or archiving of communications.
d. Full disclosure with regard to the potential disadvantages or limitations of electronic-assisted clinical services.
e. Redirection and/or referral of clients for whom electronic services will not be adequate or appropriate.
f. Full disclosure with regard to fees and billing practices.
h.Screening and local referral for critical and urgent problems
k. Management of any misunderstanding or compensation for any missing information, resulting from the lack of visual or auditory cues.
l. Managing the problem of incomplete or inaccurate diagnoses that may result from electronic-assisted services.
m. Managing the potential for technology failure
n. Procedures for contacting the clinician when he/she is offline
The primarily relevant section is B.6. “The Use of Technology Supported Counseling and Communications (TSCC)”, which starts on page 12.
Some particularly relevant excerpts:
CMHCs recognize that technology has become culturally normative worldwide and may employ modern technology communications judiciously, attentive to both the benefits and risks to clients and to the therapeutic process of using technologies to arrange, deliver, or support counseling.
b.CMHCs recognize that federal, state, and local laws prevail and that the standard of care for TSCC is expected in the same manner as face-to-face and in-office counseling. Continuity of care is crucial and, at times, may conflict with local laws and regulations. CMHCs should employ a solid ethical decision-making model to secure continuity of care.
d.CMHCs only provide telehealth or distance counseling when they have had sufficient training which can be gained through education, supervision, or other appropriate activities (see the TSCC section of AMHCA Standards for the Practice of Clinical Mental Health Counseling in Appendix B of the “Essentials of the Clinical Mental Health Counseling Profession” text or online atwww.amhca.org/publications/standards)
f.At the beginning of a course of distance counseling, CMHCs acquire the contact information for emergency services in the location of the client and develop a procedure to follow in the event of a psychiatric or health emergency.
g.In states where there is a legal requirement that CMHCs must include in the client record client communications through TSCC, CMHCs inform the client of that fact.
Also note, in the Preamble to the CoE, it states:
In their professional duties, CMHCs may encounter conflicts between the AMHCACode of Ethicsand the law, or between local regulatory statute and state law. CMHCs attempt to resolve these conflicts when they occur. When dealing with such conflicts, CMHCs always consider the client’s best interest, including continuity of care. When conflicts are unresolvable, CMHCs may adhere to the requirements of the law.