[Music] welcome to the voice of counseling presented by the american counseling association this program is hosted by dr s kent butler this week's episode is technology telehealth and professional practice and features dr john duggan welcome to the voice of counseling from the american counseling association i'm dr s kent butler and joining us today is dr john duggan john is a practitioner educator and he's aca's staff lead on developing multimedia educational experiences for our profession today we're going to be exploring technology telehealth and professional practice in this conversation we'll learn about practical use of technology and get some helpful tips on the use of telehealth as the landscape changes in the era of the covid pandemic so dr duggan is an ideal practitioner and he's going to share his insight on these particular issues welcome to the conversation how you doing dr duggan dr butler good morning good day it's good to be with you thank you for the opportunity to be with you kent good to be with you as well and look at that that bright smile you have in your face where was that eight minutes ago i'm just kidding i'm just kidding we've been on there waiting to start this podcast so i hope all as well so i mean we got a little bit of rain up here in dc but it's uh it's kind of kind of fall you know so yeah that's what it is that's what it is well that's where you chose to live so i don't know yeah um so how how has uh life been for you as you've been dealing with the last two years of this um colbit pandemic it has been um so i'm good uh i'm grateful to be healthy and um you know doing things to take care um it has been um very difficult also in that um you know there there's just been a lot of hurt and angst i mean we have multiple pandemics that are going on i have uh you know involved in education and working and school counseling and clinical mental health counseling education and working to focus on anti-racism and uh helping practitioners understand uh the xenophobia the the negativity trans negativity there's just been so much you've been exploring in these vodcasts that has been kind of weighing on uh on me and on us my family here um and and also just kind of you know taking it in it's just like um 20 almost 23 months of um staying very close to home um and uh seeing family once over over that period of time it's uh it's been an adjustment but um what it reminds me of and this comes into one of our first questions is the wisdom that has helped me get through uh the first part of the pandemic and we could we can lean into that but you know i'm doing okay given what is how are you how are things going for you i'm leaning in um i'm doing what i can to kind of stay um you know to be honest i've said i said this couple times i am definitely an introvert and so the pandemic hasn't messed with me the way it has messed with individuals who like to be out there out and about i've been able to maintain and stay kind of relatively calm and and and by into what's happening in my life just being close to family here uh facetime and zoom has been helpful it has i'll be honest about that i'm glad we're going to talk a little bit about what this might look like from a telehealth type situation but it's been really a um i've been a long time you know i think i'm ready to get out i would love for this uh pandemic to be over uh and i don't think anybody wishes it more than i do at this point in time but i'm going to make do when i'm out and about though i'm massed up and taken care of my health and so that's kind of where i am right now and so it's been an interesting ride and i'll i'll leave it at that yes so when you talk when you think about telehealth and all the things that are going on in our community as a counselor um what are some of the things that like stand out to you what what do you think off the bat we as counselors need to know about how we can kind of maintain and do the work that we do um in this telehealth environment well i think one of the important things for us to consider and this goes for our students new professionals as well as the advanced practitioners so across the spectrum is that this is a changing landscape and it has not using technology using telehealth in general has has not settled if you will and i personally would recommend using a legal ethical decision-making model to to really think about when it is appropriate to uh engage in telehealth and what types of practices uh that we're doing because it's it's not as easy as just going based on licensure and and those things i think there are other issues that you know we could talk about but the landscape is changing clearly the pandemics that we're experiencing and i'm using that plurally because there are just multiple needs that are going on we're looking at hospitals that have been closing for decades parts of the country where there are no health care practitioners and you know folks are needing the support we're looking at interventions within the school systems and having clinicians that are supporting school counselors and uh finding ways to you know to to help the various needs that are going on and a lot of that is going to i think come from technology and what we've learned through the pandemic is that um there are just so many opportunities that i think folks were holding back on uh in terms of you know the approval process and so um that that's going to i think continue to expand our struggle is as a profession we often come from schools of education and so over the you know the years and soon you'll you know have another interview on um looking at medicare and things like that with some other other folks from aca but we really need to also look at ourselves as healthcare practitioners and with that comes all of the other stuff that applies to you know physicians dentists and so on and so i think it's important for us to kind of take these different variables and bring them together and find a way to make it a meaningful intervention a meaningful use of technology and engage in it ethically and remember that we are also health care practitioners who uh need to you know need to kind of step into it from from that perspective so how do you wrap your head around that though as a health care professional you know that you have a job to do but how do you come to grips with all of this sure well i think um one of the the important pieces is you know becoming knowledgeable about the technologies that are available paying attention to our standard of care which is the uh 2014 aca code of ethics and and how it is that we would normally protect uh you know client student privacy and confidentiality uh in the the physical setting right and and then think about how we then expand that into uh the settings where we're using technology one of the the things that i think is going to be important for our profession and it's it's evolving is that you know kent there are 30 plus names for the use of telehealth and technology that are out there in the literature 35 or 40 names our code of ethics when it was written was calling it distance counseling and other practitioners and i have you know clearly had the experience where we're having groups and people are using technology to securely send us messages in the group setting in the same physical space and what that means is that there is no distance we've been physically present before the pandemic and people are you know especially you know teens and young adults they're sending that stuff through an encrypted uh telehealth type platform um although it's mostly messaging and what we really need to remember is that it is no longer just about distance it's about the use of technology um and then that's one of the things where i really enjoy the uh the book that we we have from aca is talking about using of technology assisted distance supervision um and so remembering that this is about the use of technology how i wrap my head around it though is that we need to continually be seeking and engaging supervision and training our supervisors need to be trained in the intervention of using technology and telehealth services and and really getting some different types of feedback in terms of what is working and what doesn't and also being attentive to who's appropriate now i understand that in the pandemic right um we don't have much of a choice so i i get that so i don't want folks to kind of hear this and go what the heck is this guy saying but over the years of clinical practice i've worked with folks from different diverse social identities and backgrounds some who did not have uh bank accounts let alone able to have you know technology and internet service um as well as folks who have um you know bipolar spectrum psychotic disorders i became a specialist with dissociative identity disorders and people who had adverse childhood experiences or who actually were you know kind of asylees to the united states and had experienced periods of torture and so for some of those individuals using telehealth services audio and video can be helpful for them to remember who john is as a counselor because someone who has that type of an experience can after a couple of weeks forget who you or i are uh that that sense of identity can can kind of fade away and but we have to make sure that the person is appropriate and is going to be uh well served through the use of technology so my hope is that as we look at the use we just don't have a kind of one-size-fits-all approach right as the pandemic recedes so can you talk a little bit about it from the ethical point of view then because that sounds like it feeds right into how counselors can stay above the grade right and make sure that they are not doing harm especially from an ethical point of view exactly and so we we need to pay attention to really our our use of an assessment um part of it also as you had asked earlier was um you need to also look at your scope of practice and your licensure uh regulation so for example i'm here in maryland there are very specific things that need to happen in order for a counseling relationship to begin and so there needs to be a thorough assessment there needs to be certain things in the documentation and all of that um epically we need to make sure that we're doing that and so there are some uh services or platforms uh that will allow one to initiate a telehealth i call it kind of like a a counselor on retainer type thing where you know a counselor is is into this this service they're getting paid a certain amount they get certain clients and there may not be uh really the ability to do a visual and a thorough assessment to determine well is john experiencing bereavement or is it a depression or is it a thyroid disorder or is it sleep apnea what's going on i mean somebody can can initially say hey i took this assessment online and i think i have depression it's just it's you know this is what it is well okay but we need to engage ethically in a thorough assessment we need to ethically do interdisciplinary care and remember that when we're looking from the clinical side of things the diagnostic process is you do a rule out for any type of substance any type of environmental factor that may be influencing right i've had times where i've worked with clients who um are referred to me for panic disorder and the panic comes when they're putting their head down to sleep on the pillow and so the assumption can be oh my gosh there's panic because of something that's related to um you know where they're sleeping well when you're following the rule out process of first looking at the environment the substance any substances and that could be over-the-counter medication too and then looking at the medical issues getting a full diagnostic from a physician to rule out any organic or metabolic issues then you can start to figure out well okay what else is going on how am i ethically engaging in counseling with this particular person kent in the scenario that i just laid out for you one particular client who maybe is having uh panic when they're kind of going to sleep it actually turns out to an allergy that is a very you know there are still issues that can be worked out in the counseling relationship and those can be addressed in telehealth but the key factor that i want to point out is ethically we need to make sure that we're following all of the steps that are part of the standard of care um [Music] and i'll add not just doing evidence-based interventions for the sake of doing an evidence-based intervention right how do you ensure that you're doing the right thing um for your clients because it's this is a a big mixed bag of a whole lot of things that are coming together that we have to sort through in order to ensure that we are doing the right thing so you know you're talking about these assessments can you talk a little bit about how that's different than if you are face to face with a client and and also what what do we need to know as counselors that helped us to kind of take that into consideration and because how does that look different sure i i think so this is anecdotally from my experience it takes uh much more time and it takes patience because sometimes maybe things that folks might have been familiar to do on a you know a paper uh or in an office setting uh while they're waiting um they may forget to do if you have an online assessment so one one type of way of approaching it is um you know a screening instrument where you're tracking not necessarily a diagnostic exam so it's not an advanced appraisal but you're having some sort of a service that's set up and sometimes they can be reimbursable if a counselor is billing health insurance submitting claims and you can track symptoms you can rule out um you know if there is any report and this is self-report of uh something that is related to misuse of a substance or if there are markers for ptsd but i think also at the same time when we're going through these instruments and being patient because it's not as easy as doing it in the the office setting sometimes people are going to need help uh to navigate these these items uh to also then make sure that you have a good physician or three that are uh kind of in your your your field your you know you're on your team and you can make those referrals so that somebody is also getting a good quality medical checkup along the way and you know it's really helpful when the nurse calls or when the physician calls or sends a report over securely and says you know what what you're experiencing is most likely not related to um you know obsessive compulsive disorder what you're seeing is lyme's disease and this is a neurological issue and so we're going to refer them to a neurologist and here are some of the interventions that you can help with so we can make some quick assumptions based on these symptomatology um you know kind of measures and instruments but we need to then collaborate with other disciplines and make sure that they're you know in the person's welfare and interest that we're not stepping outside of our own scope of practice but that they're also culturally appropriate that not every person not every you know intervention is going to be right just because a book says this is the best thing now i'll be i'll be downright honest with you i was trained by uh dr cortland lee for both my masters and my doc studies and i have had the opportunity to engage with folks and and really become familiar in evidence-based practices and then recognize that for some people they don't fit they're not the right size and i'm going to identify myself i'll be very honest to say i'm a humanist i'm a humanistic existentialist and so that is one of the basis but it allows me also to bring in a multicultural social justice advocacy framework because i want to make sure that ethically we're doing those things to make sure that somebody's really getting the best care that they can the challenge is can it takes time it is a lot of work to pull this off a lot of work because we're doing it online or a lot of work because we are doing it because we're counselors it's a lot of work because we're doing it as counselors and that's remember we also ethically need to be monitoring the effectiveness of treatment and this is part of my one of my research areas where you know looking around is like i asked practitioners well how do you check how do you monitor the effectiveness of treatment and most everybody i would say 95 responses were i simply ask is this helping and what we know is that is not a um a really robust way to to get that information to check about the alliance and then to see if those interventions are are actually helping they just you know somebody may be saying this is helpful when actually they're tanking maybe they're experiencing non-suicidal self-injury um and they're not disclosing that to us so i think it's challenging as counselors but it's also perhaps at times it requires a little more technology and work because we're doing it virtually or using technology so when you think about what we're doing virtually and you look at licensure laws and you look at ethical practice you look at lack of education lack of awareness lack of opportunity to do this where like you said during a pandemic this is coming into view for a lot of people who have never ever thought about counseling in this manner uh who went kicking and screaming into technology in the first place so what are some of the things what are some of the things from your perspective that counselors can do to kind of bring themselves up to speed on how to best kind of navigate these new horizons that we're a part of good question i i think constantly being curious and critically curious um you know not just taking the first information that comes across the website on a web search but being critically engaged in your curiosity and learning as a practitioner and you know engaging in those trainings reading articles and literature on where uh distance counseling or telehealth is going i mean i was trained 15 years ago in in telehealth and i look back at that manual and i'm like wow things have really changed but that's because technology's changed though right now was it correct back then and and for the time that it was in or or were we getting it terribly wrong at that point in time too i don't think it was we're getting it terribly wrong i think that the um the technology has changed and has become uh better not everybody has access to it so there's still that issue that we need to be attentive to um but also some of the stuff related to who might be appropriate and how do we go about some of these interventions right um are are problematic and the other piece i think ken is sometimes people in order to to pay the the mortgage if if you're a counselor and you're running your own practice or that type of a thing you've got to have a certain amount of clients available to provide services to and so there's this you know there's this business side of things and one of my fears is that we've looked at wellness through aca one of my fears is that people are burning out because when you go from one telehealth session to the next to the next it is a little different than actually having it can be a little different than having somebody who's sitting in a waiting room or is then coming into your office speak to that um what's that in what ways do you see that as being different and what what ways do you take care of yourself in in regards to that yeah i i think physically there is a break that one experiences after a session and you know you close the door you get a couple of minutes you get that glass of water and then you go greet somebody i think the temptation can be for um folks to go from one zoom session or you know i'm using zoom as a this is an acronym i guess but one one telehealth visit to the next to the next to the next and what happens i think is that without actually scheduling in and being aware self-aware and saying wait a minute i have to do things that are going to take care of myself in this process right and if you're in an agency setting i don't know that you know that's advocacy from a supervisor's level um that's really the intervention to say wait a minute we have got to um measure this out in such a way that folks are going to be able to get that break and and slow down so i was going to ask you a little bit about accountability not just um from a supervisor's point of view in this case where you just spoke to but accountability in general you know in some regard this seems safer to go into a location and receive counseling services there's a little bit of an unknown when you're online right so how do we hold counselors accountable for doing the right thing and not causing harm to their to their clients it's a good question i think that it is about um [Music] consultation groups and um supervision you know i i think that one of the challenges is a lot of times after uh an individual becomes licensed it's like i've i've arrived you know look i've i'm finally licensed i have finished the master's degree i've gone through uh you know all of these different steps and um you know let's face it getting licensed is not an easy process and it takes a lot of it takes a lot of work and i think it's challenging for a new professional who finishes up and goes okay now it's like i got to do another master's degree too i'm trying to read through the lines what you're talking about are you saying that when they get their license or they are licensed at that particular point in time then maybe the imposter syndrome goes away and they feel like they're um you know they do all things is that kind of where you're going with that well no what i think where i'm going is is that there is this sense of oh my gosh i don't need to really consult and to work the imposter syndrome may go away but i think it's more about the the the sense of i don't need to check in with somebody who's going to be a supervisor or some folks may call a master practitioner clinician a consultant to have those ways to check in and get feedback because i may actually have a blind spot so do you feel that most counselor education programs lead um new counselors to that kind of uh end because i mean do you think that there's some kind of conversation in the teaching or in the programs curriculums that we that we have that help people understand that there's a need for added consultation and supervision throughout the lifespan of a counselor i i i hope so you know some of my experiences in teaching have included uh that and i i see some programs but i can't speak universally my hope is that yes um but but i would say that you know it's kind of going to get a little a little over the top with the cognitive bias uh type codex but uh one of the things is called the dunning-kruger effect and what it means is that at any point in our professional lifespan we're going to have gaps in knowledge and then make assumptions about others even at the same point or at other points and so we need to constantly have feedback from other practitioners who can help us engage in good practice right and that's what i think i love about the multicultural social justice counseling competencies in that it's about becoming a lifelong learner understanding that things are going to always uh have an impact on not just ourselves but on our clients and that we need to be aware self-aware enough to be able to do that and so when you think about it from the perspective of someone coming in and saying okay i have arrived i am what you know when you look at some of these racial identity models you say someone who has kind of kind of self-actualized right and has come to this particular point but in a very real sense we should never get there right it should always be an aspirational goal that we should always be lifelong learners as we are moving forward exactly i i would frame it as i'm arriving and so it's always a an ing it's a gerund it's i'm arriving i'm becoming i am continuing to grow and to learn and for me um kind of a quick sidebar i had the chance years ago when i was in my master's of theology program i i got to meet uh dr jerry may uh who was the younger half sibling of rolo may the american existentialist and jerry focused on the stuff of will willingness the openness the willingness to understand the willingness to be understood uh as opposed to being willful and saying you know this is the way it's got to be and i that moved me so much from my early career to to have that encounter and to be uh really just to experience it and the sense of genuineness um to to be willing to to say gosh i have got to learn more about this trained 15 years ago gosh the research has changed the models have changed the technology has changed but the need is still present and and more so so how is it that we can move it forward wow that looks like a great spot for us to take a break real quick and um come back and talk with you some more about what telemental health is and what us as counselors especially american counseling associations affiliated counselors can be doing to move the needle on on what we're doing as counselors for our clients and so i'm dr s ken butler and this is the voice of counseling from the american counseling association our conversation continues in a moment counselors help positively impact lives by providing support wellness treatment we're working to change lives we are creating a world where every person has access to the quality professional counseling and mental health services needed to thrive so welcome back i'm dr s kent butler and we're continuing our conversation with dr john dugan and so it is phenomenal that we've gotten to this point we talked a little bit about telemental health and and how it has really impacted our lives here during this pandemic can you give us some recommendations uh what do counselors need to start looking into those who have not necessarily navigated this pathway yet what are some things that you would share with them that would help them in their journey sure um first one i have kent is just because you can doesn't mean you should now i i understand that we are in a global healthcare pandemic and the need the i mean the script has been flipped the table has been turned we need to come up with new and creative ways to be helpful but i also want to give that just because you can doesn't mean you should what does that mean in clinical practice just because i'm working with a student at uh let's say the university of maryland just down the road for me maybe they're you know starting bipolar medications or something for seizure disorder or something like that they're local they're close i know the resources i'm licensed in maryland it's this it's 20 minutes away if that i i'm able to provide ethical and appropriate services within my scope of practice i'm licensed to do that collaborate with their caregivers now let's imagine that that same student chooses to move to the eastern shore or western maryland i know nothing about that community i don't know the physicians i don't know the practitioners there they're starting a whole new school program there could be a lot more psychosocial stressors and environmental issues just because i can work with them i'm licensed to doesn't necessarily mean i should maybe maybe there's the need to actually transfer the care or to get greater supportive services from somebody who's in the local community which goes back to what we talked about earlier where the reason why you need supervision in consultation with the others so that because a lot of times i would think that you don't want to give up that practice or that client because it means something to you in terms of maybe your your cash flow the money that you're getting from having that as a person as a client and also just a lot of times people just don't want to give up on someone that they've been working with so how do you get through those types of things and how do you move forward in that regards consul consultation working with others being honest i mean one of the the the foundations of our code of ethics is veracity we've got to be truthful we've got to speak truthfully um you know appropriately to one another and be truthful with our clients and and all the others whom we may serve our students so you have to be you've got to be truthful we've got to be truthful in you know what maybe it's not about me maybe i need to step back and say i need to be able to make sure that this client gets the best type of care that they can so that also means that the person has to really go through their program and the remaining of their career being able to take critical feedback and listening and understanding and having some discernment when it comes to how they move forward with each and every client that they have and you know a lot of times people think that they can like you just said and don't really have the skill set to do so and then what that does is cause really maybe irrevocable harm to a client absolutely and you know there can be times where it's not the right skill set uh and i can go and and seek you know more supervision and training and move into it and there may be other times where the interventions aren't being helpful and maybe actually you know hanging on and saying this this is the client that i've worked with for for five or ten years and so therefore i'm going to continue it because we've always had this wonderful relationship well part of the counseling experience if i want to borrow some stuff from dr irv yalum is being able to engage in a transition being able to say uh in a healthy good way goodbye so you said something that you said something that was really interesting just now you said sometimes you've been with a client for five plus years uh is there a it's a time limit is there a time when you maybe feel as though i mean understand that there's maintenance right that's where somebody's coming and they're just staying with you so they they can maintain and things along those lines but is there a certain point in time when you're working with a client whether it's telementally or whether it is um you know in person where you have to say you know what maybe i've reached breaking point with what i can do with this particular client perhaps i need to either refer them on to someone else or maybe the person is is needing to really step away from counseling experiences for a while so they can see what life is like for them on the other side of that absolutely and that's where consultation and uh we're kind of moving for the telehealth but it's where consultation and monitoring the effectiveness of treatment come together and i view it kent as part of informed consent i'm always already bringing that back in how are things going what is our relationship looking like how are you experiencing this beyond these 45 minutes that we have that insurance maybe you know if somebody's working with managed care these 45 minutes that we have to work on something maybe it's 60 minutes what is life like after we move apart what does it look like when we take breaks and i i just want to clarify that when i say five years or longer i'm talking about um usually though and i was a specialist in working with dissociative identity disorder those those are kind of a complex experience where folks maybe are coming for two times a week three times a week and it may be over the course of many years and then they transition from one specialist to another and you know also checking in with neurology and stuff so um when you think about uh the the work that we're doing as counselors especially when we are kind of looking at somebody on the screen right are there ways that you would want counselors to kind of position themselves or position their the client so that they can you know when you're in a room with a client you can see their full body and you can see what they're doing and you can pay attention to maybe some things that may be seen a little out of out of order with regards to that is there something in your mind that we can do as counselors when we're looking at them on the screen um would it be wise to watch them from a full body experience or is that just too far away it could be i think for me the most important thing is remembering i'm talking to a human being i'm not talking to you see my humanism coming through yards i'm not talking to a screen this is a living breathing loving human being what can i do if we're going to focus on our code of ethics to promote their wellness and dignity and and so that you know that is i mean if you have to put that up on a sticky note on your screen to remind you that you know by the way this is not just another meeting it is these are a group of people who have thoughts and feelings and they're coming to you for a reason right then do it do what you need to do to remind yourself but again so i get that but also like i said there are some things that like so when i'm working with a client and i watch them twitching and i see them having um some things that are going on when we talk about a certain subject and i can visually see that are there some cues that we should be on the lookout for on the screen when we're just seeing somebody who is you know having showed us well yes you you i mean you we're certainly going to become more cognizant or more aware of you know twitches or body movements or behavior but also it's important to check in um as appropriate we don't want to make i don't want to make somebody feel like they're under a microscope you know it's like one client used to say i really enjoy being with you because i don't feel like the client you know the counselor or the practitioner has the high means on me they're they're constantly scrutinizing everything right but i think that yes we can check what might that look like what kind of questions might we ask to check in with someone well how you know how is it how does it look like i've noticed that you know one of the things that i may do is i may have a certain uh move or the way that is everything okay you know what talk to me about what's going on but even before i would do those typical things that we would outline in our skills class i want to make sure that i have training and understand what it's like to be in the client's home environment which is different from having them show up in our professional practice we need to be it's so they're a whole other issue set of issues that'll that'll come into play i mean i used to do home visits and so uh you know the program that i uh oversaw for a county was uh one where we actually went into the home setting you've got to have a sense of that you've got to have a sense of the cultural and the family experience and also if we're working with technology we need to make sure that somebody is actually uh in a secure safe environment right you have a way to check that this is somebody there's a code word so that somebody can say to you i'm safe or i'm actually in harm's way exactly exactly i like that and so there's so many different things so many questions are coming up for me and maybe i'm going to pop some questions at you and maybe you can come back with some quick responses uh you're working with somebody who has weak techno technological skills um the internet goes out while you're in the middle of session what do you do have it have a backup plan always have a backup plan i always make sure that i've got somebody's phone number or some other way to kind of follow up if at all possible if there is a weather outage or something like that i want to have a contingency plan um you know they can text me or something i usually will not do text because it's not safe and secure but i want to know that somebody's okay and that we'll have a a way to check back in right so a counselor is working with somebody and there are people in the background and maybe not a person with a headphones what what what what what's your first response to your client my my so this is one of the things is you always want to check the background right so what i'll do is i will show where i am i'm not moving my camera now but my office space or wherever i'm usually wearing earbuds and i will let them know that i am and i want them to do the same thing i want to know tell me where are you if there are other people in the background let's tell me what you can do to go to a private safe space and if that means that you've got to sit on the edge of the bathtub then you know what i want for you to have a quiet safe space for a little bit where you can actually uh talk to me and we can have a sense of privacy and confidentiality they insist that they're okay where they are what do you do um usually they're again it's going to depend on cultural uh and geographical factors there may be some areas where it's culturally and geographically uh considered appropriate or that's all that they have um then you know what i'm going to do is ask them and make sure that i follow up in a private secure conversation is that really what is going to work for you or do you feel as though you are um being threatened or intimidated is your privacy being um jeopardized and as our ability to be effective lessen because you have other distractions for people around you if the answer is yes then i want to brainstorm with them on how it is that they can change the game up uh and do it so it's confidential and securely but when your client doesn't come online when you're when they're supposed to um in terms of the timing that you have set up um what are some of the things or approaches that counselors can do to ensure that everything's either okay or that the person is not just missing their appointment right um and sometimes it could be over multiple weeks or multiple times if they're supposed to get together how do you account for someone who is kind of being tardy and or maybe not necessarily um showing up for their sessions yeah um that that's in your informed consent you really need to have a communications plan and a backup plan and that's inform consent is not a one-time process where you just you do a forum you sign off on it and the way it goes into an electronic chart or a filing cabinet you no you continually talk about it and if somebody has uh you know a missed session or something like that um i'm calling them up or i'm probably gonna send them i'll have a secure portal uh rather than an email which can uh you know be hacked and things like that so i'm gonna try to reach out to them on that uh if if in the informed consent in the communications policy i have something that talks about um you know the uh innocuous texts so you know if like you're waiting at the door or if something has happened and your you know some sort of happenstance has come along and it's not personal information all i want is an initial and so i i just know who's sending this text because i'm not keeping your phone number in my phone and what i may do is just say in those instances i may reach out to you by text and say is everything okay but i have to keep in mind that the individual that i am that is my client may not be responding to that text especially if you work with folks who have interpersonal violence um you have to take all of these other variables into consideration right i'm definitely reaching out on them two weeks now i i want to find out what's going on i want to have a conversation before you terminate a client oh yeah you would just find out that there's something that's going on in terms of that okay so how do you help someone who's doing telemental health and billing in insurance things is there any feedback or recommendations for those who are now venturing into telehealth and need to kind of look at how they are compensated for their for the services sure uh you want to make sure that you are billing uh so so tracking those claims uh usually if you're using telehealth services you're going to be engaging with um some sort of a a vendor that uh hopefully is engaging with you know secure and encrypted practices you want to make sure that you your billing is clean so they call it a clean claim uh that you're submitting them regularly so you know this is not the area to procrastinate where you know it's like gee i think i want to wait to write this next chapter or something no no no no you've gotta you've gotta get these claims out regularly you're gonna have a system in place uh and then you wanna check the electronic remittance if someone has two insurance plans and they're doing telehealth and one is primary one is secondary you've got to do verifications and check all of that on the front end so you've got to make those phone calls or have somebody who is a business associate agreement is what we call so business associate and you've got to remember that if you're submitting these claims and you're using types of technology to transmit this information congratulations you are part of the hipaa club and there is no way to talk your way out of this it's so um one other question there is uh licensure and um legislative actions that are in play especially when it comes to telemental health are there any things that you would suggest the counselors that they can do to strengthen um the resolve of counselors in the eyes of licensure boards when it comes to telemental health and to legislators especially when we think about the interstate compact and in the fact that people are going to be counseling across borders reach out advocate go to licensure board meetings if you can or join them virtually uh remember that the board is actually the professional members when they gather and they you know the gavel drops and they have their meeting it's not the regulators the regulators are the ones who take what the board is deciding or through the department of health and then enacting it i would say if for those that are doing advocacy um and maybe they're using a temporary license uh in another state because of the pandemic the governor may rescind that and so if that's the case you need to be checking we all need to be checking board websites i have my students doing it every 60 days because regulations can change and it is not a defense ethically i'm not a lawyer so i can't speak legally but it's not simply not a defense to say gosh i didn't know and the other thing ken i would add is do not change the name of the game so if you've been doing professional counseling with somebody and all you know it's in a different jurisdiction um and you're you're doing something to kind of help them out and you're working on a temporary license and then the governor resends that don't change the name and simply say oh we're doing professional coaching now it is most likely is not going to fly it's going to get you into hot water so so you know stay truthful stay honest about it and do what needs to be done do the good work and do it well stay true to who you are in your professional identity that sounds like a phenomenal place to end our conversation today john thank you so much uh it's been great talking with you especially when we have to expand our horizons about what we're thinking about and talking about when it comes to telemental health and i think you've provided us with great ideas and great opportunities to move and explore how we can even make our profession that much even better so appreciate you thank you for taking time out today to be a part of the podcast this is the voice of counseling um coming from the american counselors association dr s ken butler telling you to have a great day and enjoy the view enjoy all those things that are going on in the world and we'll be back with another episode next week thank you have a great day aca provides these podcasts solely for informational and educational purposes opinions expressed in these podcasts do not necessarily reflect the view of aca aca is not responsible for the consequences of any decisions or actions taken in reliance upon or as a result of the information and resources provided in this program this program is copyright 2021 by the american counseling association all rights reserved
2021-10-18