7 Ways to legally and Ethically Expand Your Services with ......7 Ways to legally and Ethically...
Transcript of 7 Ways to legally and Ethically Expand Your Services with ......7 Ways to legally and Ethically...
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7 Ways to legally and Ethically Expand Your
Services with Evidence-Based Telehealth
Presented by Marlene Maheu, PhD
January 11, 2017
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Thomas Durham, PhD
Director of Training
NAADAC, the Association for Addiction Professionals
www.naadac.org
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Produced By
NAADAC, the Association for Addiction Professionals
www.naadac.org/webinars
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www.naadac.org/webinars
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www.naadac.org/telehealth
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Cost to Watch:Free
CE Hours Available:1.5 CEs
CE Certificate for
NAADAC Members:Free
CE Certificate for Non-members:
$20
To obtain a CE Certificate for the time you spent watching this webinar:
1. Watch and listen to this entire webinar.
2. Pass the online CE quiz, which is posted at
www.naadac.org/telehealth
3. If applicable, submit payment for CE certificate or join NAADAC.
4. A CE certificate will be emailed to you within 21 days of submitting the quiz.
CE Certificate
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Using GoToWebinar – (Live Participants Only)
Control Panel
Asking Questions
Audio (phone
preferred)
Polling Questions
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7 Ways to legally
and Ethically Expand
Your Services with
Evidence-Based
Telehealth
Telebehavioral Health
Institute, Inc.
Marlene M. Maheu, PhD
Executive Director
619-255-2788
NAADAC
Copyright © 2017 Telebehavioral Health Institute All rights reserved.
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Copyright 2012 TeleMental Health Institute, Inc. All rights reserved.
Consulting,
Staffing,
Credentialing
and Professional
Training (CEs)
in Ethically -
Required
Competencies
www.Telehealth.org
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Disclaimer
I am a licensed psychologist and MFT, not an attorney,
physician, information technology specialist or billing
agent. The information I present is my best attempt to
bring you timely and relevant information in a rapidly evolving area. I therefore make no warranty, guarantee,
or representation as to the accuracy or sufficiency of the information contained in any of my training.
My goal is educational only. I seek to outline the issues
and alert you to what's happening, with a keen eye
toward legal, ethical and other risk management issues.
You are encouraged to seek specific advice related to your circumstance from your qualified authorities.
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Optimizing Your Learning
You may want to turn off your cell phone,
close your email & lock your door
I often take questions as I go instead of
only at the end of the webinar. Just type
them into our interface as those questions
occur to you
Copyright © 2017 Telebehavioral Health Institute All rights reserved.
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Learning
Objectives
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Learning Objectives Name two telehealth-related competencies
Compare and contrast definitions of at least three
different terms referring to “telehealth” in the
behavioral disciplines
Name three differences between traditional “online
therapy” and evidence-based telehealth
Name 2 legal issues of importance to telehealth
Name 2 ethical issues of importance to telehealth
Copyright © 2017 Telebehavioral Health Institute All rights reserved.
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① Practice
Evidence-
Based Telehealth
Copyright © 2017 Telebehavioral Health Institute All rights reserved.
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Understand Definitions Behavioral Telehealth
Telehealth
eHealth
Telemedicine/Telepsychiatry
Telemental Health
Telebehavioral Health
Telepsychology
Distance Counseling
Online Therapy
mHealth
E-Therapy
Telehealth vs.
Technology?
Copyright © 2017 Telebehavioral Health Institute All rights reserved.
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Online Therapy vs. Standard of Care
Mostly Email / Chat vs. Video
Anonymity / No Patient Records
Avoid Responsibility w/ Website
Disclaimers
No Clear Channels for Mandated
Reporting
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Online Therapy vs. Standard of Care
No Contact with Other Treating Clinicians
No Authentication of Consumer / Professional
No Emergency Backup Procedures Misunderstanding of
Clinical Processes (suicide)
Operating w/o Needed Research for Unsupervised Settings
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② Follow Your
Ethical Code(s)
All Existing Ethics
Apply
Copyright © 2017 Telebehavioral Health Institute All rights reserved.
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Copyright © 2017 Telebehavioral Health Institute All rights reserved.
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Relevant Professional Association
Standards & Guidelines American Counseling Association (2014)
2014 ACA Code of Ethics
American Psychological Association (2013)Guidelines for the Practice of Telepsychology
American Telemedicine Association (2013)Practice Guidelines For Video-Based Online Mental Health Services
National Association of Social Workers (2017)Predicted publication date will be summer
NAADAC/NCC Code of Ethics (2016)http://www.naadac.org/code-of-ethics
Copyright © 2017 Telebehavioral Health Institute All rights reserved.
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http://www.naadac.org/code-of-ethics
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Copyright © 2017 Telebehavioral Health Institute All rights reserved.
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Copyright © 2016 All rights reserved.
INSERT
NAADAC
ETHICS CODE
POLLING
QUESTION HERE
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Informed
Consent
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Copyright © 2017 Telebehavioral Health Institute All rights reserved.
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Client/Patient Training
Email /Texting/Telephone/Video
Social networking – social media policy
File exchange
Computer repair
Clinical records
Insurance
Reports
Lateness / Missed sessions
Non-compliance/Avoidance
Safety plan (e.g. firearms, alcohol, drugs, children)
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Multicultural Issues &
Diversity
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③ Follow the Law
All Existing Laws
Apply
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HIPAA
Three Rules:
Transmission
Privacy
Security
Three HIPAA
Rules:
• Transmission
• Privacy
• Security
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HIPAA Privacy Rule
Data are “individually identifiable” if they include
any of the 18 types of identifiers, listed below, for
an individual or for the individual’s employer or
family member, or if the provider or researcher is
aware that the information could be used, either
alone or in combination with other information, to
identify an individual:
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HIPAA Privacy Rule (cont.)1. Name
2. Address (all geographic subdivisions smaller than state, including street address, city, county, zip code)
3. All elements (except years) of dates related to an individual (including birth date, admission date, discharge date, date of death and exact age if over 89)
4. Telephone numbers
5. Fax number
6. Email address
7. Social Security number
8. Medical record number
9. Health plan beneficiary number
10. Account number
11. Certificate/license number
12. Any vehicle or other device serial number
13. Device identifiers or serial numbers
14. Web URL
15. Internet Protocol (IP) address numbers
16. Finger or voice prints
17. Photographic images
18. Any other characteristic that could uniquely identify the individual
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Privacy vs. Confidentiality Privacy is the client
or patient's legal right to express themselves selectively.
Confidentiality is a health care professional's legal duty to protect a client or patient's right to privacy.
Copyright © 2016 All rights reserved.
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Privacy
Increased hacking of Private Healthcare
Information (PHI) and devices
Increased privacy concerns by consumers
as they get more info-engaged
Greater number of audits in 2016 of
professionals and how they deal with PHI
ICD-10 audits
HIPAA audits
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HIPAA Documentation Risk Analysis
Define scope Define your systems – tablet, Gmail, look for vulnerabilities in
equipment, threats can be accidentally disclosing power outages that can happen
Rate risk as low, medium or high Example Risk: High risk is that laptop doesn’t have security, your
practice is to leave your laptop in your car when running errands Solution: Put encryption and firewall on your laptop
Document Risk Examine how all systems are working together Make you more efficient Save money
Should be re-upped every years Validate what’s been done, review any new risks (clients,
technologies) Calendar issues you will address throughout year, document
progress
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Copyright 2012 TeleMental Health Institute, Inc. All rights reserved.
• All Business Associates in
health care must sign an
agreement stating their
adherence to HIPAA
standards
• Transactions
• Security
• Privacy
• True for any service you hire
• It is now enforced by the
HITECH ACT
HIPAA, Business Associates &
HITECH
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Copyright © 2017 All rights reserved.
INSERT SKYPE
POLLING
QUESTION
HERE
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HIPAA requires an “audit trail.” Skype doesn‘t
provide audit trails – and isn’t obligated to ….
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HIPAA requires “breach notification
tools.” Skype doesn‘t provide…
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Email HIPPA Omnibus Act
allows us to have email contact without meeting usual HIPAA standards when risks are fully disclosed in
Be aware of inherent problems with soliciting email contact from websites and directories.
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Where to find HIPAA-
compliant technology?
http://telehealth.org/
directory
Copyright © 2017 All rights reserved.
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Jurisdictional Issues
Consumer Protection
• Training• Licensing (practicing
over state lines)• Privacy & Confidentiality• Interjurisdictional
Practice
• Record Keeping
• Advertising
• Mandated Reporting
• Collaborating with Other
professionals
• Technologies to Be Used
• Fees
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Practicing Over
State Lines
• Get licensed or registered everywhere you wish to practice
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④ Decide Which
Clients
/Supervisees to
Serve
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Choice of Clients / Supervisees
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⑤ Develop Clinical
Skills Related to
the Technology
You Choose
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Which technologies are legal and
ethical to use?
Videoconferencing
Telephones
Biotech test results (genomic testing?)
Apps
Social media
Newer technologies
Text messaging
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NAADAC Code of Ethics
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Videoconferencing
Most video-based practice models have
not changed much in the past 10 years.
They stick to the fundamentals, which
work exceedingly well when delivered
according to evidence-based protocols.
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Telephones
State laws differ regarding the inclusion of
telephones in telehealth definitions and
statutes. (Some states exclude
telephones.)
Many telephone-based practice models
have not changed much in the past 10
years - some things simply get paid, and
will continue to do so.
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Technology Evolution
Consumer devices
Dedicated
hardware
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Copyright © 2017 All rights reserved.
Internet Speeds
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⑥ Code Correctly
for
Reimbursement
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http://www.americantelemed.org/policy/state-policy-resource-center#tracker
Reimbursement
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Copyright © 2017 Telebehavioral Health Institute All rights reserved.
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⑦ Responsibly Find
Clients /
Employment
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Getting a Job in Telehealth
Develop competencies (certified training)
Consider employers
Review their offerings, both in terms of services offered and compensation
Review their requirements
Carefully read their policies and procedures and look at them from the perspective of a licensing board
Apply and see if they deliver what they promise
Challenge them on asking you to do anything illegal or unethical
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① Nursing
Homes
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.② Employee Assistance Programs (EAPs)
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③ Rural
Hospitals
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④ Schools
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.⑤ Specialty
Schools,
Residential
Treatment,
Hospitals
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⑥ Migration Model
⑥ Migration
Model
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⑦ Private
Companies
Serving
Consumers &
Healthcare
Systems*
• Register for
employment with
these companies
here:
WWW.PROVIDERPANEL.COM
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.⑧ Home
Health
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⑨ Correction
al Facilities
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Migration Model⑩ Military & Veteran’s
Administration
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11. College
Counseling
Centers
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12. Rehabilitation
counselors and
psychologists work
in a variety of state-
funded settings,
such as hospitals,
substance use
settings, transitional
homes, agencies…
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Telephone
services (EAP),
text-messaging
systems, patient
portals, social
media, social
support
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What’s the process for
getting fully trained
and credentialed in
telehealth?
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Certification in Telebehavioral
Health
State requirements – any licensing issues,
complaints?
Ethical requirements – did you complete a
competency-based training program?
Clinical expertise – do you know how to
conduct clinical work?
Malpractice coverage – do you have
proof of coverage for telehealth?
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Competencies
Knowledge attainment is the basic
requirement in all ethical codes
Have you been professionally trained?
Course completion certificate
Additionally, can you demonstrate the
proper attitudes and skills required for a
new area of practice?
CTiBS.org
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Credentialing
Impacts your ability to find legal and
ethical employment
Medical – related to hospitals
Is required for reimbursement
Professional – related to clinical expertise
In telehealth for behavioral disciplines, a
certification requires a minimum of 9-12 hours
minimum / 39 hours for private practitioners
maximum
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Learning Objectives Names two type of required competencies
Compare and contrast definitions of at least three
different terms referring to “telehealth” in the
behavioral disciplines
Name three differences between traditional “online
therapy” and evidence-based telehealth
Name 2 legal issues of importance to telehealth
Name 2 ethical issues of importance to telehealth
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Questions?
Marlene M. Maheu, Ph.D.Telebehavioral Health Institute, Inc.
Phone: 619-928-2627
Email: [email protected]
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www.naadac.org/telehealth
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Cost to Watch:Free
CE Hours Available:1.5 CEs
CE Certificate for
NAADAC Members:Free
CE Certificate for Non-members:
$20
To obtain a CE Certificate for the time you spent watching this webinar:
1. Watch and listen to this entire webinar.
2. Pass the online CE quiz, which is posted at
www.naadac.org/telehealth
3. If applicable, submit payment for CE certificate or join NAADAC.
4. A CE certificate will be emailed to you within
21 days of submitting the quiz.
CE Certificate
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Diathesis Stress Model of
Addiction: Etiology of Substance-
Related and Addictive Disorders
by DarryI Inaba
February 9, 2017 March 8, 2017
February 22, 2017
Improving Retention, Outcomes
and Supervision with PCOMS
By George Braucht
March 22, 2017
Upcoming Webinars
www.naadac.org/webinars
NAADAC Code of Ethics, Part 2
by Mita Johnson
Six Types of Sex Use Disorder
by Douglass Weiss
January 25, 2017
NAADAC Code of Ethics, Part 1
by Mita Johnson
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www.naadac.org/webinars
Free CEs for Members
Levels:Professional AssociateStudent
www.naadac.org/join
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Over 75 CEs of free educational
webinars are available.
Education credits are FREE for
NAADAC members.
WEBINAR SERIES
In each issue of Advances in
Addiction & Recovery,
NAADAC's magazine, one
article is eligible for CEs.
MAGAZINE ARTICLES
NAADAC offers face-to-face
seminars of varying lengths in
the U.S. and abroad.
FACE-TO-FACE SEMINARS
Earn CEs at home and at your
own pace (includes study guide
and online examination).
INDEPENDENT STUDY COURSES
NAADAC Annual Conference,
September 22-26, 2017, Denver, CO
CONFERENCES
Demonstrate advanced
education in diverse topics with
the NAADAC Certificate
Programs.
CERTIFICATE PROGRAMS
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Contact Us!
NAADAC
44 Canal Center Plaza, Suite 301
Alexandria, VA 22314
phone: 703.741.7686 / 800.548.0497
fax: 703.741.7698 / 800.377.1136
www.naadac.org
NAADACorg
Naadac
NAADAC