Informed Consent
1. If you are scheduling a telehealth appointment & need to send informed consent prior to the appointment, you would have to use email (since I would not be seeing them face-to-face. Am I exposed by sending this email before I've gotten consent from the client to send the email?
2. As part of my informed consent for teletherapy I require clients to give an address they will be located at.
3. So can you not EVER provide services over a phone call? For example, I have clients who've had car trouble or caught in traffic and called in.
HIPAA-Compliant Video/Text/Call
1. Is FaceTime a safe way to communicate with clients?
2. I’ve heard that Signal is a HIPAA-compliant means of texting.
3. If one uses a cell phone for business and personal but treats every contact as business and confidential, what are the risks? (for a solo practitioner and no one else has access to any devices)
4. So, using a regular phone is not sufficiently secure? Are there secure phone systems you recommend?
5. Is there a list of HIPAA compliant data storage systems?
6. Doesn’t HIPAA require separate forms for telehealth services?
7. Doesn’t the social worker also have to keep a breach log?
8. Is it okay to use unencrypted email for things such as setting up appointments and receiving insurance membership numbers?
9. What about utilizing email for a follow up after a session? (e.g., a referral for another agency's support). Does client consent for utilizing email cover me in terms of the risk of others reading this information?
10. Is Skype secure for telemedicine?
11. Is there a site where acts or standards beyond HIPAA are listed which we can review?
12. What are the limitations to doing clinical supervision via a confidential video services? i.e. BlueJeans, Zoom, etc.
Licensing, Practicing Across States, Outside the Country
1. Given these new national ethics standards, are state NASW chapters working on developing a way to offer transitional status to a provider whose client has moved to another state, so there can be an orderly transfer of services - much like insurance companies offer 2-3 transitional sessions when the client has a new policy where you aren't a preferred provider?
2. Regarding out of state treatment, I had a request for service from a man in the next state, a few miles from my state- to provide telemedicine. My state's Board of Social Work representative said it was no problem to do this. This disputes what you're saying. Comment? My state of licensure is Maryland. This client, when told this, suggested he could drive a few miles and sit in his car, then be in Maryland.
3. What is involved in getting licensed in other states?
4. Do many states have reciprocity?
5. My understanding about current questions (of clients traveling to other states) is that you use the client's RESIDENCE. So if they travel to another state for vacation, I could still see them. Could you clarify if this is correct?
6. With regard to the example of the client that relocated and practicing without a license: If the social worker leaves the state (maybe on vacation?) but is licensed in the same state as the client is located, is this acceptable?
7. There are a number of mental health professionals providing services across state lines, and they have licenses in multiple states. If you provide services to a client in another state and you're licensed in that state, do you have to report your income in the other state?
8. What about treating clients who are traveling internationally?
9. What if I as the clinician am traveling on vacation outside the state I’m licensed in. A client calls me while I am on vacation and needs clinical support. Can I give it to them if they are in the state I see them and am licensed in even though I am out of state?
10. Some states give emergency or short term provisional licenses.
11. Doesn't our code say we have to be licensed in both locations?
12. So if my client goes on vacation out-of-state and feels they have an emergency and needs to talk to me to get settled, I cannot talk with her over the phone because she is temporarily in another state?
13. Also, if I am on vacation can I provide services to my client back home in their emergency or am I providing services in a state where I am not licensed?
14. Is there a process for obtaining licensure in multiple states or must one do so for each state?
15. Can NASW work on having all states recognize LCSW in one state to be recognized in another automatically?
16. Since you cannot know where someone is at the time of service (i.e. cell phone); it appears you can never provide services online or cell. True?
Access to Records
1. If providing electronic service to a client who wants access to their records, must that be provided in the electronic format, or can the clinician print what is appropriate and send it to the client?
2. Are there any mandates for all records to become electronic?
Teletherapy: The New Norm in Client Care
1. What are the many ways non-traditional communication can be described?
2. I have always seen my clients in person prior to the pandemic. I am aware that many of my colleagues are using technology to provide telehealth services for their clients for several years. How do I begin online sessions? What are the guidelines I need to be aware of to assure ethical practice?
3. Can I just choose any form of electronic communication available, especially free options?
4. Can I provide tele mental health services to ALL of my clients?
5. Once I have cleared other efforts to connect remotely with my clients, should I consider steps to make things clear to them about this change in communication?
6. My client will only see me in-person and refuses any other communication option, what should I do?
7. What are the best resources to consider further?
Miscellaneous
1. I am trying to put together a professional will and want to know how long I would need to ask my executor to be able to provide records to clients. Would it be for 7 years?
2. I work with deaf people using American Sign Language. I’m considering using telehealth, as I live in a very large, rural state. Many individuals have asked for this service but I’m not sure which training I need to take and how to start. I’m fluent in ASL.
3. Hospitals are not allowed to store any patient records in the cloud. How are social workers and private practices getting around this or are they not under the same confidentiality standards?
4. What are the recommendations for how to erase/dispose of old electronic devices like laptops, desktops?
5. Are social work clinicians required to keep electronic records as opposed to paper?
6. Aren't all telephone calls through a cell phone at risk for interception? Or a voicemail overheard? Should we require people to use landlines? So maybe I need to write in the informed consent that I can't take responsibility for info they allow someone else to read, hear or read.
7. There is an app you can buy that allows for a separate phone number that rings on your personal phone. Is that adequate separation per the standard?
8. Does the use of technology create challenges to obtain fees?
9. So the standard confidentiality notice on the e-mail isn't good enough?
10. What about those of us in private practice who still keep paper records? Any guidance related to this in this new landscape?
11. It would be good to define technology services. People think if they are not doing distance therapy they are not using technology, yet they are doing email, texting, electronic record storage, billing, etc.
12. Can you reinforce to attendees that even if the client is ok, we as the social workers need to do everything possible to protect confidentiality.
13. I assist a psychotherapist with her billing. What kinds of safeguards do I the assistant and the psychotherapist need to have in place? Business Associates Agreement?
14. What if you get info about a client that is not yours from a health care provider?
15. You mentioned that a client may not be able to see a therapist due to inability to physically attend a session. What if the client can physically see a therapist face to face and has done so in the past, but due to a request they would like to use technology for future sessions?
16. If I inform my client that Facetime is not secure and they still desire to talk over Facetime, can I provide the service?
17. Is telehealth covered by Medicare and other major health insurance companies?
18. Is it appropriate to see a client privately if they were a previous online client?
19. I received a deposition notice from a previous client and my former school system. Does the school have to give me access to my electronic records stored on their record-keeping systems?
20. What do you do if you work for an organization and have very limited control over maintaining many standards discussed? An example would be not being able to control who has access to information within the agency.
21. What were the names of the Acts (laws)?
22. Does NASW offer cyber liability insurance?
23. I password protect my phone, is that enough separation of personal and professional?
24. A college mental health counselor's professional e-mail is a Gmail account. This therapist has other personal Gmail accounts. On her cell phone the Gmail icon can be clicked and there is access to all of her Gmail accounts without the need to first put in a password. Should this therapist put her e-mail on "vacation/away" mode at the end of each work day and also include a message that states that work e-mail is Gmail and there are risks with e-mailing?
25. Can a therapist e-mail links to helpful resources to clients? Like links to online guided relaxation app. if the client has already said it is okay to communicate about resources and appointments via e-mail?
26. What advice or comments would you have about the organizations that are out there that do "text" therapy?
27. To clarify: if a personal cellphone is used with a line dedicated for patients' ability to text provider, it is ok to use and only should be used for appointments questions?
28. What happens when you send info about a breach to Health & Human Services?
29. Where can one learn about how to be sure that one is using technology for client communication through email, text messaging, and appointment setting software that is HIPAA compliant?
30. If an emergency do you need releases of information?
31. Is there a specific video technology platform that you would recommend to utilize for telehealth services?
32. Since you can't send emails without encryption, is direct phone contact the only HIPAA compliant way to communicate with clients? How does one begin to encrypt emails?
33. If you have a specific landline number for your private practice that doesn't allow texts, how do you forward that number to a private personal cell that allows texts?
34. Can you have phone sessions on a regular office line?
35. If client is a child and parents are in middle of custody dispute (unhealthy dynamics with father are ever present and child does not want father to have her records), can the father have copies of records?
36. Are all insurance panels accepting sessions billed via technology? Does that need to be documented other than on billing?
37. When is it appropriate to use texts with clients?
38. HHS Notification for a breach? Never heard of this! Please provide web link.
39. Are phone sessions considered confidential?
40. How do you secure a folder on your computer with client information?
41. What's your sense of how health insurance is covering teletherapy? With BCBSIL is seems that they will now only cover treatment provided by MDLive providers.
42. When doing a video conference meeting with someone who may not be local and is homebound; how do we do informed consent?
43. What if the agreed upon phone session begins and the provider realizes the client is driving?
44. Are there simplified versions of complicated documents, like HIPAA or informed consent forms? It should be possible to give clients documents they actually understand, especially if they have cognitive challenges or developmental disabilities.
45. How do we deal with liability & damage control, when the web host fails to protect the client's confidentiality?
46. If the wrong person accesses the client's email, they can follow instructions to open the encrypted message. Are we liable, if the client gives their secret password to someone else?