Resources
Training Programs for Telemental Health
This is the CEU Certificate Program in TeleMental Health & Digital Ethics that I took through the Zur Institute. I found it accessible, informative and affordable but some of the videos are dated and the format feels a little patched together. They continue to add to their program offerings and have recently added a COVID-specific course developed by Roy Huggins of Person Centered Tech that is "geared to orient therapists to the recently rapidly changing landscape of telemental health practice during the COVID-19 emergency response."
Person Centered Tech charges for their comprehensive courses and a membership-based access for detailed questions (which I have used in the past, but not currently). Roy Huggins is considered an industry expert in telemental health and he continues to grow his team at Person-Centered Tech and it's continuing education opportunities continue to develop. He has many wonderful free articles on the website to look through as you set up. The Person Centered Tech team has recently posted a detailed landing page here specifically for therapists who are scrambling to get set up with online therapy in a hurry. Definitely check it out! Roy also gives frequent Facebook Live videos and I subscribe to a helpful newsletter that keeps me abreast of relevant changes in the telemedicine landscape.
Collecting Payment:
Here are a few ways to collect payment-some are more HIPAA-compliant than others.
Want to understand more about HIPAA-compliance and payment? Person Centered Tech has several great articles on this topic. Start here.
Just want the links? Keep reading....
Ivy Pay-- Is fully HIPAA-compliant and designed for therapists. It is super user friendly and holds client's card on file. The downside is that it is app-based--i.e.smartphone only. We'd advise you not to use this option if you do not have your phone password protected or are uncomfortable using an app to collect payment. IvyPay also requires a password entry to open the app every time you use it. Please note, this affiliate link to Ivy Pay gets the customary 2.75% fees waived for your first $1000 of charges.
Google Pay--no transaction fee, easy user interface, does not include BAA
Zelle--bank to bank money transfer service with no transaction fees. May not work for deposits to business accounts
Paypal--Great for international transactions and widely used. Does not include BAA
Stripe--this is what Simple Practice uses
Square--this one includes BAA which provides partial protection of client info. Clients can store credit cards on file with square invoices when that option is selected when invoice is drafted.
What have I missed? Email Megan a link to your favorite way to collect payment and the details about how it works and how well it protects client confidentiality.
Platforms
Here is a short list with embedded links of a few HIPAA-compliant videoconferencing platforms. Make sure to inquire about BAA. Keep in mind that all videoconferencing platforms may be taxed in the coming months and even under normal circumstances some perform better than others. It's a good idea to be familiar with a few of them so you have a backup plan.
UPDATE 3/18/20: The US Department of Health and Human Services Office for Civil Rights (OCR) has given permission to use non-HIPAA compliant platforms, when used in good faith until further notice during this public health emergency. It's still best practice to use HIPAA-compliant versions when you can, but when in a pinch, please know that you can move to Facetime, Skype or any other platform that may not offer a BAA. You can read the FAQs on Telehealth and HIPAA during this time of nationwide public health emergency from the department of Health and Human Services here.
Zoom handles large groups well and is generally very stable. Zoom has also been in hot water recently for security issues and I am becoming increasingly uncomfortable endorsing Zoom, but am waiting to see how they respond to the legitimate concerns about encryption and data-sharing vulnerabilities. In order to obtain a copy of the BAA that is included with the Zoom for Healthcare plan you purchase, you need to speak with someone in their sales department. The HIPAA-compliant version of Zoom costs $200/month for up to 10 users on the same plan. Does this mean that private practice therapists can band together to cost-share. Zoom has given conflicting information about this, so make sure to get their response in writing and request a BAA for all users. Alternatively, while we have temporary permission to use non HIPAA-compliant platforms, you can sign up for Zoom Pro
Used to provide a free option but as of 3/18/20, are now charging $49/mo for their basic plan
Doxy has a free and paid version and provides BAA
Google Meet (aka Hangouts Meet)--only covered by BAA G-Suite. In order to use this option ($6/mo) you have to first set up G-Suite and configure it properly for HIPAA-compliance. Read about what is involved here. Google Meet is good for groups of under 4 and individual sessions but it's not the "quick start" option. However, if you already have and use G-Suite, it's a great option.
If you already have Simple Practice, you should consider adding their videoconferencing option to your plan.
I have heard that Theralink can handle groups too and has other integrated practice management features (like Simple Practice)
HIPAA Compliant Text Platform
Signal is an alternative to texting with clients. It’s a free and easy download and it works like WhatsApp but will protect your client’s info if you read this article first. Also please don't begin using it before selecting the Privacy and Notifications settings that protect your client info. And make sure to advise your clients on taking the same precautions.
How is your platform working for you? Shoot me an email and let me know if you are loving or hating your platform and why and it will help me keep this page current.
Insurance Coverage and Billing Codes:
https://blog.therapynotes.com/the-therapists-telehealth-guide-for-covid-19
https://navigatingtheinsurancemaze.com/coronavirus/
When Your Client is Located Outside of Your State or Country
What about practicing in other states within the USA? You have to turn to each state licensing board for the answer. In 2016, Epstein, Becker, & Green published the most comprehensive survey on the topic with a really helpful app that will link you directly to the board rules and regulations for each board within each state. And here is the 2017 Appendix to that survey.
Things are rapidly changing during the pandemic and some states are offering temporary licensure provisions for cross-state practice. An emerging and updated resource: the University of Texas at Austin Mental Health and Counseling Center has shared access to their State-by-state guide to the rules/laws about telehealth services across state lines for mental health professionals. Person Centered Tech has also published a State-by State Guide for Emergency Teletherapy Practice Rules
Unsure of if you can practice in a certain country? You will have to do your own research to determine if you can see a client living in another country and you will have to carefully consider the risks and benefits of doing so. Learning the rules and regulations for the practice of psychotherapy abroad and documenting them can be tricky. You can check here. If that doesn't clarify things, you can network with other international therapists to learn more about how therapy is regulated and what emergency services are available. The International Therapists Directory lists therapists in private practice across the globe.
Facebook Groups
Want to learn with and from other therapists who are running online practices? Facebook groups can be a great resource when you're getting started:
https://www.facebook.com/groups/onlnetherapy/
https://www.facebook.com/groups/2040519046174737/
https://www.facebook.com/groups/138663903332494/