Law and Ethics in your country or state

[DeeAnna Merz Nagel]

Do you know what the guidelines or restrictions are for online therapy or telehealth in your country or state? If you do, please share!! We want to add the information to the OTI Wiki!

[Art Matthews, MA LPC DCC]

I had heard California and Iowa have laws preventing those professionals not licensed in the state to provide counseling to their residents. I'm writing their respective state boards to get the exact verbiage and citations.

[DeeAnna Merz Nagel]

Hi Art-
CA law is already on the wiki at www.onlinetherapy.wikispaces.com !!
Let me know what you hear from Iowa!

DA
Art Matthews, MA LPC said:

I had heard California and Iowa have laws preventing those professionals not licensed in the state to provide counseling to their residents. I'm writing their respective state boards to get the exact verbiage and citations.

[Art Matthews, MA LPC DCC]

Here's what I got so far... I tried to get exact documents and wording...

States with Laws Limiting Distance Counseling

Inquired to contacts listed on the ACA PDF Publication Licensure Requirements for Professional Counselors 2009 http://www.counseling.org/Files/FD.ashx?guid=9869dbfe-082f-41ce-886...

Legend: No – No law specifically addressing limitations of distance counseling
“Yes” – received a response saying there were limitations but no specific wording addressing distance counseling was provided.
Yes – Laws specifically addressing distance counseling and limitations
Draft – Legislation is in draft form now

Colorado No
Indiana No
Wash., D.C. No
Delaware No
Idaho No (Met in May 2009- Considering developing)
Wyoming No
Missouri No
Florida No April 30-May 1, 2009 board meeting minutes about the subject follow.

TOPIC DISCUSSIONS

Distance Counseling

Stephen Giunta, PhD, LMHC, vice president elect for the Florida Mental Health Counselors Association and Jim Akin, Executive Director of the Florida Chapter of the National Association of Social Work (NASW) spoke to the issue. Both stated that one must be licensed in Florida to counsel a Florida client and raised issues of confidentiality, identity and setting guidelines.
The board members, FMHCA, and the Florida Chapter of NASW will forward comments about the issue to board counsel by the end of May for compilation and review for future guidelines for distance counseling.

North Dakota “Yes”
Referred to http://www.legis.nd.gov/assembly/55-1997/bill-text/HQSE0400.pdf Page 2, Section 4.1 (not specific to telehealth or distance counseling – will bring up in May 2009 meeting)

43-47-06. Licenses - Qualifications - Reciprocity.

1. Except as otherwise provided in this chapter, no person may engage in counseling in this state unless that person is a licensed professional counselor or licensed associate professional counselor.

Michigan “Yes”

Does not address distance counseling specifically.

New York Yes
Guideline 9: Engaging in Telepractice (Document or publication not identified)

"Telepractice" is providing service that is not "in person" and is facilitated through the use of technology. Such technology may include, but is not limited to, telephone, telefax, e-mail, internet, or videoconference.

Practice as a licensed professional in New York State, even through telepractice, requires the practitioner to be licensed or otherwise authorized to practice in New York. Telepractice, when used as a form of mental health practice, is subject to all practice and ethical considerations discussed in this document and in the law, rules and regulations governing licensed practice in New York State. If you are licensed in New York State and wish to provide services in another jurisdiction, you should determine the qualifications for practice and any requirements for licensure imposed by that jurisdiction.

You should consider the particular impact of telepractice on dimensions of mental health practice, including, but not limited to:
• awareness and assessment of non-verbal behavior by the patient;
• ensuring the privacy of patients and protection of confidential information through the transmission of information;
• relational and transferential issues;
• access issues such as distribution of computers and familiarity with technology;
• temporal factors such as simultaneous communication, time between responses, and formalized "sessions";
• provisions for emergencies; and
• development of technological proficiencies and on-line culture/language.”

Iowa Yes
IDPH Contact Name: Lappe, Paulette
IDPH Response: 645---31.18(154D) Marital and family therapy and mental health counselor services subject to regulation. Marital and family therapy and mental health counselor services provided to an individual in this state through telephonic, electronic or other means, regardless of the location of the marital and family therapist and mental health counselor, shall constitute the practice of marital and family therapy and mental health counseling and shall be suibject to regulation in Iowa.

Nebraska Draft (Fall 2009)
Draft Regulation Language:
Technology Assisted Services: Clients in Nebraska receiving technology assisted services, such as internet or phone services, must be provided by a Nebraska credential holder.
Arkansas Yes

ARKANSAS CODE ANNOTATED § 17-27-101 et seq Pgs 6-7, 11-12, 45-51 relate to distance counseling.

“Technology-Assisted Distance Counseling” (Electronic Counseling, Cyber Counseling) for Counseling or Marriage and Family Therapy means any form of services offered or rendered by electronic or technology-assisted approaches when the Counselor or Marriage and Family Therapist and the client are not located in the same place. Technology-Assisted Distance Counseling may be synchronous or asynchronous. Only Counselors and Marriage and Family Therapists, licensed by the Arkansas Board of Examiners in Counseling, who also hold the Technology-assisted Distance Counseling or Marriage and Family Therapy Specialization License, may provide Technology Assisted Distance Counseling or Marriage and Family services.”

[DeeAnna Merz Nagel]

Thanks for all of this!!


Art Matthews, MA LPC said:

Here's what I got so far... I tried to get exact documents and wording...

States with Laws Limiting Distance Counseling

Inquired to contacts listed on the ACA PDF Publication Licensure Requirements for Professional Counselors 2009 http://www.counseling.org/Files/FD.ashx?guid=9869dbfe-082f-41ce-886...

Legend: No – No law specifically addressing limitations of distance counseling
“Yes” – received a response saying there were limitations but no specific wording addressing distance counseling was provided.
Yes – Laws specifically addressing distance counseling and limitations
Draft – Legislation is in draft form now

Colorado No
Indiana No
Wash., D.C. No
Delaware No
Idaho No (Met in May 2009- Considering developing)
Wyoming No
Missouri No
Florida No April 30-May 1, 2009 board meeting minutes about the subject follow.

TOPIC DISCUSSIONS

Distance Counseling

Stephen Giunta, PhD, LMHC, vice president elect for the Florida Mental Health Counselors Association and Jim Akin, Executive Director of the Florida Chapter of the National Association of Social Work (NASW) spoke to the issue. Both stated that one must be licensed in Florida to counsel a Florida client and raised issues of confidentiality, identity and setting guidelines.
The board members, FMHCA, and the Florida Chapter of NASW will forward comments about the issue to board counsel by the end of May for compilation and review for future guidelines for distance counseling.

North Dakota “Yes”
Referred to http://www.legis.nd.gov/assembly/55-1997/bill-text/HQSE0400.pdf Page 2, Section 4.1 (not specific to telehealth or distance counseling – will bring up in May 2009 meeting)

43-47-06. Licenses - Qualifications - Reciprocity.

1. Except as otherwise provided in this chapter, no person may engage in counseling in this state unless that person is a licensed professional counselor or licensed associate professional counselor.

Michigan “Yes”

Does not address distance counseling specifically.

New York Yes
Guideline 9: Engaging in Telepractice (Document or publication not identified)

"Telepractice" is providing service that is not "in person" and is facilitated through the use of technology. Such technology may include, but is not limited to, telephone, telefax, e-mail, internet, or videoconference.

Practice as a licensed professional in New York State, even through telepractice, requires the practitioner to be licensed or otherwise authorized to practice in New York. Telepractice, when used as a form of mental health practice, is subject to all practice and ethical considerations discussed in this document and in the law, rules and regulations governing licensed practice in New York State. If you are licensed in New York State and wish to provide services in another jurisdiction, you should determine the qualifications for practice and any requirements for licensure imposed by that jurisdiction.

You should consider the particular impact of telepractice on dimensions of mental health practice, including, but not limited to:
• awareness and assessment of non-verbal behavior by the patient;
• ensuring the privacy of patients and protection of confidential information through the transmission of information;
• relational and transferential issues;
• access issues such as distribution of computers and familiarity with technology;
• temporal factors such as simultaneous communication, time between responses, and formalized "sessions";
• provisions for emergencies; and
• development of technological proficiencies and on-line culture/language.”

Iowa Yes
IDPH Contact Name: Lappe, Paulette
IDPH Response: 645---31.18(154D) Marital and family therapy and mental health counselor services subject to regulation. Marital and family therapy and mental health counselor services provided to an individual in this state through telephonic, electronic or other means, regardless of the location of the marital and family therapist and mental health counselor, shall constitute the practice of marital and family therapy and mental health counseling and shall be suibject to regulation in Iowa.

Nebraska Draft (Fall 2009)
Draft Regulation Language:
Technology Assisted Services: Clients in Nebraska receiving technology assisted services, such as internet or phone services, must be provided by a Nebraska credential holder.
Arkansas Yes

ARKANSAS CODE ANNOTATED § 17-27-101 et seq Pgs 6-7, 11-12, 45-51 relate to distance counseling.

“Technology-Assisted Distance Counseling” (Electronic Counseling, Cyber Counseling) for Counseling or Marriage and Family Therapy means any form of services offered or rendered by electronic or technology-assisted approaches when the Counselor or Marriage and Family Therapist and the client are not located in the same place. Technology-Assisted Distance Counseling may be synchronous or asynchronous. Only Counselors and Marriage and Family Therapists, licensed by the Arkansas Board of Examiners in Counseling, who also hold the Technology-assisted Distance Counseling or Marriage and Family Therapy Specialization License, may provide Technology Assisted Distance Counseling or Marriage and Family services.”

[Lynne]

I contacted all 50 states for information on their distance counseling. I have the information in an Excel document. (I didn't hear back from all states.)

If anyone is interested I can forward the document to you.

Lynne Coon, M.S.
http://www.dontworry-behappy.com

[DeeAnna Merz Nagel]

oh absolutely Lynne! If you send it to me I will post the info on the wiki!!!

In fact, if you are ok with it, I could just upload your excel doc to the wiki.

My email is [e-mail]

Lynne said:

I contacted all 50 states for information on their distance counseling. I have the information in an Excel document. (I didn't hear back from all states.)

If anyone is interested I can forward the document to you.

Lynne Coon, M.S.
http://www.dontworry-behappy.com

[Art Matthews, MA LPC DCC]

I clicked the link for the wiki and didn't get there. Is it operational? Or is there an error in the address?

[Catherine Drennan]

How is it going to be possible to keep up to the minute status of each state's laws; some new drafting taking place even as we discuss this topic. Does anyone envision a national organization, with state affiliates. Otherwise, clinicians will have no time to see patients. Another question that I think will come up is what will happen to clients who are engaged in therapy and suddenly the laws change. How could that ever be a good way to terminate? I know I am pretty green, and my questions may have been addressed many times, so thanks for you patience, and your information.

[Trinka Polite]

Hi Catherine!
You are not alone in "being green." :-) I have been reading and researching, and I'm still not sure. I've been following this discussion. However, I'm still asking soooo can online counseling be provided in this state or that state?? I actually expected ISMHO to have addressed this on their website already or to already have a "committee" to cover state laws. It may be there, and I haven't ran across it yet. It seems that this would be a priority.
Yes termination of therapy is a concern. Considering with most online therapy platforms, clients pre-pay and then you get info which is the only time you can determine whether you can legally provide services. If I am wrong here, please provide guidance. Any feedback from the "veterans" of the network? Have you ever encountered someone you could not provide services to due to their state laws?

Catherine Drennan said:

How is it going to be possible to keep up to the minute status of each state's laws; some new drafting taking place even as we discuss this topic. Does anyone envision a national organization, with state affiliates. Otherwise, clinicians will have no time to see patients. Another question that I think will come up is what will happen to clients who are engaged in therapy and suddenly the laws change. How could that ever be a good way to terminate? I know I am pretty green, and my questions may have been addressed many times, so thanks for you patience, and your information.

[DeeAnna Merz Nagel]

Hi Art- I just checked the link and it works- I have not had a chance to upload anything to the wiki yet...
www.onlinetherapy.wikispaces.com

Art Matthews, MA LPC said:

I clicked the link for the wiki and didn't get there. Is it operational? Or is there an error in the address?

[Dr. Gina M.-S.]

Question for anyone:

I have been seeing distasteful comments about mental health services in the UK and I do not understand why? I have heard many counselors in the US online are strongly sought out. Is there any truth to that? Does the UK have a "NAMI" or "SAMHSA" or "MHA" type structure?

I apologized if this is the wrong space.

Dr. G-

[DeeAnna Merz Nagel]

I updated your information to the wiki this past weekend.
http://onlinetherapy.wikispaces.com/Law
DeeAnna Merz Nagel said:

Hi Art- I just checked the link and it works- I have not had a chance to upload anything to the wiki yet...
www.onlinetherapy.wikispaces.com

Art Matthews, MA LPC said:

I clicked the link for the wiki and didn't get there. Is it operational? Or is there an error in the address?