Best Practices by Natalie Jambazian

Code of Ethics in Telehealth Platform Sites

Like psychotherapy, telehealth, operates using the same ethical and legal guidelines. Lately, a trend has ensued, in which clinicians are using certain telehealth platforms for therapeutic services, yet many question the reliability and security. What are the best practices when a clinician wants to use such platforms to provide services? First of all, one must be a licensed therapist to provide services. The next step is to ensure client confidentiality is maintained at all times. Some platforms I have encountered include: Better Help, Talkspace, and E-counseling. We are all asking the same questions; "Are these options HIPAA compliant? "Am I meeting the standard of care?"

I have conducted research and consulted with CAMFT attorneys who were not able to provide specific answers to my questions. I was told as long as the telecounseling platform says they are HIPAA compliant then it should be fine. However, as I continued my research; exploring FAQ questions on the various websites; it does not appear so black and white. According to HIPAA, "The privacy rule requires a covered entity to obtain patients information prior to disclosure of psychotherapy notes." Healthy privacy laws state health providers/insurance companies place an encryption on the site to limit access to patients information. Forbes reported, therapists using Talkspace have filed a complaint because they were in violation of HIPAA requirements. For example, on Talkspace, the FAQ section indicates they are "fully HIPAA compliant" and the chat between therapist and clients are encrypted. However, there are many conflicting messages. Listed below are some pros and cons I discovered, which may be useful in your consideration for use of such platforms:

Pros

1. Convenient and easily accessible to patient care.
2. Helpful for patients who are disabled, diagnosed with anxiety disorders, or are embarrassed or too nervous for face to face work with a clinician.
3. Families who do not have access to reliable transportation.
4. Reduction of missed visits due to illness.
5. Less stigma being associated with seeking therapy.

Cons

1. Company can read online chats between client and therapist. The business side of Talkspace for example can have access to client's personal information.
2. The therapist must insert a script promoting talkspace and without doing so he or she will not be paid.
3. Confidentiality and security may be compromised. As mental health professionals, we have an ethical and legal duty to protect client's confidentiality. Even though most sites may have security protocol in place, with online therapy, client records and information can be jeopardized due to hackers and other security failures. There is a greater risk of a breach.
4. There can be issues with technology.
5. Someone could hack into the system.

Using telehealth platforms can come with significant risks. However, understanding the risks and benefits can help clinicians make informed decisions about whether he or she will choose to use this new approach for therapy in his or her practice. Remember Knowledge is power.

Natalie Jambazian is a Marriage and Family Therapist Registered Intern working in private practice under the supervision of Anita Avedian, LMFT, CAMS IV. Natalie is currently an Anger Management facilitator through Anger Management Essentials and NAMA facilitating groups in Sherman oaks and Glendale. Anger Management 818 accepts both volunteer and court ordered clients, In addition, Natalie works with children, teens, and adults and her specialty includes but not limited to anger management, ADHD, PTSD, divorce, and grief. Natalie has received training in NLP, CBT, Mindfulness, and Trauma Focused Therapy. She is fluent in Armenian as her second dialect and can be reached at 818.334.8786 or via email at www.therapywithNatalie.org, Please visit her website at www.Angermanagement818.com.