TMH Institute APA & ATA Guideline Summary Marlene M. Maheu, Ph.D. & Massimo Agnoletti, Ph.D.

APA & ATA 2013 Guideline Similarities

Both documents recommend:

o Adherence to local, state (licensing laws, interjurisdictional practice, mandatory reporting), federal laws (e.g. HIPAA and HITECH), & ethical codes of profession

o Competency of practitioner (adequate professional and technical knowledge and skills, etc.)

o Competency of client/patient (e.g., appropriateness for telepractice services, technical competencies, cooperation)

o Informed consento Careful and ongoing assessmento Emergency planningo Privacy, security and confidentiality and risk managemento Documentation

Both also do not purport to establish binding legal standards and defer to clinical judgment in any specific circumstance

APA & ATA 2013 Guideline Differences

APA ATA

For Psychologists For Providers

Global Perspective Specific Perspective

Scope: Email, telephone, social networking and video teleconferencing (requires broad principles)

Scope: Real-time, videoconferencing via personal computers and mobile devices allows for specificity (e.g., connectivity, device security, camera angle, PIP)

Theoretically focused, describes ethical concepts more than “how to”

Practical, clinical, administrative and technical “how to”

Focused largely on consumer-protection Focused on both consumer and professional-protection (e.g., availability of emergency contact info at each session, working with uncooperative patients)

Makes strong statement regarding the need to not only know, but keep updated with the evidence-based literature

References a number of studies but does not explicitly direct the provider to adhere to the evidence-base or keep updated

Specific Use of Psychological Test Instruments and Other Assessment Procedures

Broader Use of Term Assessment

Language is Aspirational (e.g., “might,” “could,” etc.)

Language is Mixed (e.g., “should,” “shall,” “may”)

*CAUTION: This draft document has been designed for discussion & training purposes only. Omissions or mis-interpretations may have occurred. Use at your own risk, proceed with caution and defer to your own clinical judgment. Verify original documents referenced & consult with your attorney, state boards and other authorities before implementing any changes to your standard practices.

Copyright 2013 Marlene M. Maheu, Ph.D. & Massimo Agnoletti, Ph.D.

TMH Institute APA & ATA Guideline Summary Marlene M. Maheu, Ph.D. & Massimo Agnoletti, Ph.D.

TMH Institute Telepractice Checklist

TOPICS APA ATA You?** Document considerations and choices regarding the use of telecommunications technologies v

** Document risks and benefits of telepsychology service (e.g., cost savings for client/patient, travel, time off work, parking, baby sitting), improved access to care & specialty care (e.g., emergency or elderly, disabled, reduced stigma and embarrassment)

v

** In testing and assessment documentation, specify that a particular test or assessment procedure has been administered via telepsychology, and describe any accommodations or modifications that have been made.

v

** Document how secure the communicated information is with each technology used, and any technology-related vulnerability to confidentiality and security by creating and storing electronic client/patient data and information

v

Consider client/patient preferences regarding technology, treatment, arrangements v

** Document emergency resources (e.g., telephone numbers, hospital admissions, local clinical resources, local champion or proctor, friend/family member(s)

v

** Provide and discuss clear emergency plan with written instructions (e.g., suicide, homocide, abuse, other) v v

** Document plan for addressing emergencies and other relevant factors re: efficacy and safety of treatment v v

Consider potential benefits: cost/time savings (e.g., saved baby-sitting fees, parking fees, time away from work, travel costs) v v

Consider other “disadvantages” of using telepsychology v v

Adhere to current evidence base, outcomes research, best practices v v

Manage factors that can impact on the efficacy of intervention (e.g., “intrusions” caused by people or events ) v v

Consider multicultural , diversity, socioeconomic & linguistic issues (e.g., is it advisable to test language skills?) v v

Consider other individual characteristics (e.g. , medical status, psychiatric stability, physical/cognitive disability, personal preferences) v v

Consider accessibility of technology & client’s/patient’s and practitioner’s technical competence v v

** Document verbal informed consent prior to treatment (risks/benefits of chosen technology; limits to confidentiality; access, disclosure & storage of data; boundaries; procedures for responding to e-communications)

v v

** Document the method & procedures for data & information storage, which info will be stored, how info will be stored transmission, disposal of malware, cookies, etc.

v v

Adhere to legal/regulatory mandates for all jurisdictions involved (clinician’s & client’s/patient’s location at time of contact) v v

** Document and verify client/patient location v

** Documentation to include date, duration and type of service (med management, therapy, assessment, etc.) v

** Document the treatment plan based upon an assessment of the patient’s needs. The plan should meet the professional’s discipline standards and guidelines and include a description of services to be provided and the goals for services.

v

** Document all communications with the patient (e.g., written, audiovisual, or verbal) v

*CAUTION: This draft document has been designed for discussion & training purposes only. Omissions or mis-interpretations may have occurred. Use at your own risk, proceed with caution and defer to your own clinical judgment. Verify original documents referenced & consult with your attorney, state boards and other authorities before implementing any changes to your standard practices.

Copyright 2013 Marlene M. Maheu, Ph.D. & Massimo Agnoletti, Ph.D.

TMH Institute APA & ATA Guideline Summary Marlene M. Maheu, Ph.D. & Massimo Agnoletti, Ph.D.

** Starred topics suggest need for documentation.

ReferencesAmerican Psychological Association. (2013). Guidelines for the Practice of Telepsychology, June DraftAmerican Telemedicine Association. (2013). Practice Guidelines for Video-based Online Mental Health

Services. Retrieved from: http://www.americantelemed.org/practice/standards/ata-standards-guidelines/practice-guidelines-for-video-based-online-mental-health-services

References from ATA Practice Guidelines for Video-based Online Mental Health Services

American Telemedicine Association. (2007). Core Standards for Telemedicine Operations. Retrieved from http://www.americantelemed.org/docs/default-source/standards/core-standards-for-telemedicine-

operations.pdf?sfvrsn=4.American Psychological Association. (1997). APA Statement on Services by Telephone, Teleconferencing,

and Internet: A statement by the Ethics Committee of the American Psychological Association. Retrieved from http://www.apa.org/ethics/education/telephone-statement.aspx.

Australian Psychological Society. (2011). Guidelines for providing psychological services and products using the internet and telecommunications technologies. Retrieved from

http://aaswsocialmedia.wikispaces.com/file/view/EG-Internet.pdfBouchard, S., Paquin, B., Payeur, R., Allard, M., Rivard, V., Fournier, T., et al. (2004). Delivering cognitive-

behavior therapy for panic disorder with agoraphobia in videoconference. Telemedicine Journal and E-Health, 10 (1), 13-25

Day, S.X., & Schneider, P.L., (2002). Psychotherapy using distance technology: A comparison of face-to-face, video, and audio treatment. Journal of Counseling Psychology, 49 (4), 499-503.

Dongier, M., Tempier, R., Lalinec-Michaud, M., & Meunier, D. (1986). Telepsychiatry: psychiatric consultation through two-way television. A controlled study. Canadian Journal of Psychiatry, 31 (1), 32-34.

 Grady, B., Myers, K.M., Nelson, E.L., Belz, N., Bennett, L., Carnahan, L., et al. (2011). Evidence-based practice for telemental health. Telemedicine Journal and E-Health, 17 (2), 131-148.

Hyler, S.E., & Gangure, D.P. (2004). Legal and ethical challenges in telepsychiatry. Journal of Psychiatric Practice, 10 (4), 272-276.

Luxton, D.D., O'Brien, K., McCann, R.A., & Mishkind, M.C. (2012). Home-based telemental healthcare safety planning: what you need to know. Telemedicine Journal and E-Health, 18 (8), 629-633.

Luxton, D.D., Sirotin, A.P., & Mishkind, M.C. (2010). Safety of telemental healthcare delivered to clinically unsupervised settings: a systematic review. Telemedicine Journal and E-Health, 16 (6), 705-711.

Ohio Psychological Association. (2010). Telepsychology Guidelines. Retrieved from http://www.ohpsych.org/psychologists/files/2011/06/OPATelepsychologyGuidelines41710.pdf.O'Reilly, R., Bishop, J., Maddox, K., Hutchinson. L., Fisman, M., & Takhar, J. (2007). Is telepsychiatry

equivalent to face-to-face psychiatry? Results from a randomized controlled equivalence trial. Psychiatr Services, 58 (6), 836-843.

National Association of Social Workers. (2005). Standards for Technology and Social Work Practice. Retrived from http://www.socialworkers.org/practice/standards/naswtechnologystandards.pdf

Ruskin, P.E., Silver-Aylaian, M., Kling, M.A., Reed, S.A., Bradham, D.D., Hebel, J.R., et al. (2004). Treatment outcomes in depression: comparison of remote treatment through telepsychiatry to in-person trea-tment. The American Journal of Psychiatry, 161 (8), 1471-1476.

Sharp, I.R., Kobak, K.A., & Osman, D.A. (2011). The use of videoconferencing with patients with psychosis: a review of the literature. Annals of General Psychiatry, 10 (1), 14.

Yellowlees, P., Shore, J., & Roberts, L., (2010). Practice guidelines for videoconferencing-based telemental health - October 2009.Telemedicine Journal and E-Health, 16 (10), 1074-1089.

VA Northwest Health Network Office. (2011). Home-Based Telemental Health (HBTMH) Standard Operating Procedures Manual. Vancouver, WA: Shore, P.

*CAUTION: This draft document has been designed for discussion & training purposes only. Omissions or mis-interpretations may have occurred. Use at your own risk, proceed with caution and defer to your own clinical judgment. Verify original documents referenced & consult with your attorney, state boards and other authorities before implementing any changes to your standard practices.

Copyright 2013 Marlene M. Maheu, Ph.D. & Massimo Agnoletti, Ph.D.