Here at Online Therapy Institute we are frequently asked about legal issues (particularly in the United States) pertaining to crossing jurisdictional (state) lines, how coaching lines up with counseling, whether Skype is HIPAA compliant, and we receive many questions about HIPAA in general.
This blog post is an attempt to offer additional resources and to clarify our mission at Online Therapy Institute.
With regard to licensed mental health professionals conducting coach services, I generally state that a licensed therapist who practices coaching will be held to the standard of care, rules and ethics of any healthcare license one holds. This is speculative because we have no case law- but we do have states who have created precedent by including this in the written rules of the law. See this example from the state of TN: http://health.state.tn.us/…/PDFs/Life_Coach_Policy.pdf
When I practiced therapy and/or coaching I practiced coaching as a sub-specialty of my mental heatlh license and simply followed the rules and expectations of my license. There is much debate about this approach- but it worked for me. Kate and I wrote an article about this delineating our take on this hotly debated issue: Strictly speaking…Coaching and Counseling…is there a merge of the disciplines on the horizon? This article also touches on crossing state lines as a therapist-coach.
The issue as a licensed mental health professional crossing state lines is a much bigger quagmire than OTI could begin to untangle. This needs to be addressed by our professional organizations and government efforts within the realm of telehealth. This issue relates to portability of various licenses, 3rd party payment from insurance- (private and medicaid/medicare), establishing uniform CPT codes for tech delivery, defining what a face-to-face session is (does that mean video?) dissecting HIPAA so that healthcare professionals understand the responsibiity to the law and finally, educating state licensing boards who are still in the dark about the use of tech and mental health intervention. With 1/2 dozen mental health disciplines in each state, and several licensing boards overseeing each state’s efforts, and multiplying this by 50 states, adding international jurisdictions and determining different levels of education and qualification, a single source for answers simply does not exist.
Our teachings at OTI focus on clinical, coaching and theoretical applications of technology with much broader ethical discussions that are global in nature. While we address the basics of HIPAA and we give a brief overview of basic legal considerations, our larger remit teaches therapists, coaches and healers about cyberculture and how the culture of cyberspace and working within cyberspace to deliver services impacts the coach/therapeutic relationship. We also wrote an article about this: Cyberspace as Culture: A New Paradigm for Therapists and Coaches. Our Ethical Frameworks are global in nature, providing an ethical frame to place overarching themes in delivering services via technology. We integrate theory, ethics, cybercultuer and application into our Certified Cyber Facilitator credential, offering tracks for therapists, coaches, clinical supervisors and alternative healers.
For licensed professionals who want to cross state lines (as a coach or therapist) I always recommend the following steps:
- Call your state licensing board and ask (look up the rules online too if you can)
- Call the state board where your client resides (permanent domicile)
- Call your liability insurance. Don’t just ask whether you are covered for online therapy/coaching- ask specifics like, “I am licensed in X state and my client resides in Y state. If I conduct online therapy;coaching via [method of delivery- email, chat, phone, video] will I be covered if my client files a complaint against my license or takes me to court?”
For additional resources regarding legalities and HIPAA we recommend the following resources:
Behavioral Health Innovations– technology comparisons
Law for Doctors.net