Distance Counseling and Supervision

1 Cover

2 Title Page edited by Jennifer Nivin Williamson Daniel G. Williamson

3 Copyright Page Copyright © 2021 by the American Counseling Association. All rights reserved. Printed in the United States of America. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher. American Counseling Association 6101 Stevenson Avenue, Suite 600 Alexandria, VA 22304 Associate Publisher Carolyn C. Baker Digital and Print Development Editor Nancy Driver Senior Production Manager Bonny E. Gaston Copy Editor Beth Ciha Cover and text design by Bonny E. Gaston Library of Congress Cataloging-in-Publication Data Names: Williamson, Jennifer Nivin, editor. | Williamson, Daniel G., editor. Title: Distance counseling and supervision : a guide for mental health clinicians / editors, Jennifer Nivin Williamson, Daniel G. Williamson. Description: Alexandria, VA : American Counseling Association, [2021] | Includes bibliographical references and index. Identifiers: LCCN 2020041305 | ISBN 9781556203930 (paperback) Subjects: LCSH: Mental health counseling. | Counseling psychology. | Medical telematics. | Counselors—Supervision of. Classification: LCC RC466 .D57 2021 | DDC 362.2/04256—dc23 LC record available at https://lccn.loc.gov/2020041305

4 Dedication Page

5 Preface

6 About the Editors

7 About the Contributors Appendix Authors Appendix Authors Kenda Dalrymple, JD, is an attorney and the managing partner of Dalrymple, Shellhorse, Ellis & Diamond, LLP, in Austin, Texas. She earned her undergraduate degree in communications from Baylor University and her Juris Doctor degree from Baylor University Law School. For the past 26 years, she has represented hundreds of professionals before their licensing boards on complaint and license-related cases. She also presents frequently on ethics, risk management, confidentiality of records, Health Insurance Portability and Accountability Act of 1996 and Health Information Technology for Economic and Clinical Health Act regulations, and other matters related to administrative law and mental health. Although she excels at helping professionals when a problem has arisen in their practices, she much prefers to educate and train them to recognize common pitfalls and avoid trouble, if possible. She is past president of the Austin Bar Association’s Administrative Law Section and the Kappa Alpha Theta Austin Alumnae Association and a past course director for the State Board of Texas Advanced Administrative Law Seminar, an annual 2-day continuing legal education seminar. For the past 10 years, she has been a member of the American Psychological Association (APA) Board of Directors’ Standing Hearing Panel, which hears and decides ethics cases brought by the APA. Amber Hord-Helme, MA, LPCC-S, NCC, has been a licensed counselor for more than 15 years. She has owned her own private group practice in Versailles, Kentucky, for the past 10 years. She is currently a doctoral candidate in the Counselor Education and Supervision program at Lindsey Wilson College in Columbia, Kentucky. She has been an adjunct instructor for Lindsey Wilson College since 2017 and has supervised interns and provisionally licensed postgraduate practitioners since 2012. She is a former secretary of the Kentucky Mental Health Counseling Association and is currently president of the Kentucky Association for Assessment and Research in Counseling. Her current areas of research include counseling for clients with dyslexia, implementing telehealth counseling in private practice, and developing professional counselor identity in early professionals.

8 Chapter 1: Ethical, Legal, and Risk Management Considerations: Understanding the Landscape of Telebehavioral Health and Supervision Competency Competency In many situations, counselors are responsible for identifying and demonstrating competency when determining their scope of practice. There are, however, specific laws or regulations for determining minimum standards. Some state licensure boards have identified minimum training standards through continuing education credits or university training, whereas other boards have not clearly articulated expectations. It has been a challenge for regulatory entities to stay current with the rapid evolution of technology and technological practices. It is clear in all situations that counselors must always function within their areas of competence and be able to provide evidence regarding their competence and adequate training. This is especially challenging as technology is constantly changing, and best practices in technology-assisted mental health services are in their infancy. ACA (2014) notes that “counselors who engage in the use of distance counseling, technology, and/or social media develop knowledge and skills regarding related technical, ethical, and legal considerations (e.g., special certifications, additional course work)” (Standard H.1.a.). In addition, counselors must make clients and supervisees aware of the training, limitations, and protections offered by the counselor or supervisor (American Association for Marriage and Family Therapy, 2015). The Association of Marital and Family Therapy Regulatory Boards (AMFTRB; 2016) identified a minimum of 15 hours of initial training, including the appropriateness of teletherapy, teletherapy theory and practice, modes of delivery, legal/ethical issues, handling online emergencies, best practices, and informed consent. In addition, it requires five continuing education hours every 5 years. NBCC offers a nationally recognized credential, the board certified-telemental health provider (BC-TMH), who might be useful in training and the demonstration of skills. This provides counselors an opportunity to demonstrate formal training or skill attainment as a telemental health provider (Center for Credentialing and Education, 2020). Residency Residency When counselors engage in technology-assisted counseling, they should be aware of the laws and regulations in their state of practice as well as the client’s state of residence. In most situations, counselors must adhere to the laws and regulations of both states (ACA, 2014; AMFTRB, 2016; NBCC, 2016b). When clients or counselors travel out of their state of residency (physically or virtually), counselors should be aware of the state’s definition of residency, as each state defines residency differently. Some states allow a client’s residency to be defined by the client’s home address, whereas others define residency as the physical locations of the counselor and/or client at the time of service delivery (AMFTRB, 2016). Some states allow for travel, but they may define the number of days outside of the home state. In this situation, an attorney and the licensure boards for the states in question should be consulted to fully understand the legal definition of residency. Once counselors have identified the legal regulations for their region, they should document their findings as well as their activities in their counseling records (NBCC, 2016b). When counseling clients who are outside of the United States, it is important to identify the counseling regulations for the counselor’s home state as well as the country and/or region in which the client is living (ACA, 2014). It might be important to identify how mental health services are defined and regulated in the region, as the terms counselor or therapist might have different meanings in different regions. When counselors or clients reside on a military base, the regulations may also be very different. Many U.S. military bases are considered sovereign territory and possess their own regulations regarding licensure. Another factor to consider is where the counseling services are offered, either through a mental health office or through a chaplain’s office. Chaplain or faith-oriented services are sometimes subject to different rules, laws, and regulations, which has implications for confidentiality. Several resources are available to assist counselors providing telebehavioral health services. ACA provides resources regarding client/counselor residency on their website ( https://www.counseling.org ) and specifically in the Government Resources section ( https://www.counseling.org/government-affairs/government-resources-for-counselors ).