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Transcript: What You Need to Know About Teletherapy (Ep.3)

Transcript

Bonnie Rausch:

Hello again, everyone. The NASW Risk Retention Group, NASW Assurance Services, and Western Litigation have teamed up to produce a series of three podcasts to guide behavioral health professionals on the subject of teletherapy during the COVID-19 pandemic, and this is podcast number three. The name of our series is What You Need to Know about Teletherapy during the COVID-19 Pandemic. I am Bonnie Rausch from NASW Assurance Services, and I have joining me today three subject matter experts.

Bonnie Rausch:

From the NASW Risk Retention Group, we have with us both Phil Lawson, the vice president of product development and risk, as well as Lonnie Ropp, the director of product management and underwriting. In addition, from Western Litigation, we have Deana Larsen, the senior risk analyst, and administrative supervisor. The format that we will use for this series of podcasts is going to be completely Q and A, and we are also answering questions that we have received from our policyholders regarding teletherapy and the current pandemic.

Bonnie Rausch:

Again, before starting, please know that we want to tell everyone that our thoughts continue to be with anyone affected by COVID-19. We are extremely thankful for all of the amazing work of all healthcare and behavioral care professionals as well as all and any other essential workers. Thank you for your great work.

Bonnie Rausch:

The first question I would like to address to Deana, please. Deana, given these new national ethics standards, are state NASW chapters working on developing a way to offer transitional status to a provider whose client has moved to another state so that there can be an orderly transfer of services, much like insurance companies offer two to three transitional sessions when the client has a new policy where you aren’t a preferred provider?

Deana Larsen:

Not that I am aware of. The best way to handle this would be for the provider to have the transfer sessions prior to the client leaving the state. It is inappropriate and probably illegal for the therapist to continue to treat a client after that client has left the state unless the therapist happens to be licensed in the state where that client has moved to. Hopefully, you have enough time with the client prior to their departure to have at least one transitional session. But if you don’t, then it’s up to the client to find a new provider in the new state and for them to start from there.

Bonnie Rausch:

Thank you so much, Deana. Lonnie, could you please share with us what is involved in getting licensed in other states?

Lonnie Ropp:

Sure. You’ll note that each state’s requirements are different, and it should not be assumed that another state’s laws are reflective of your laws in your state. So some states could possibly offer reciprocity with your current state. But the big key fact is that you need to find out. And essentially there’s a great wealth of website resources provided by each state governing social work services. And each licensing board will provide that information on their website and be very detailed in doing so. So you just need to patiently approach each and every state separately, and then you would be able to carve out a solution for your situation.

Bonnie Rausch:

Thank you so much, Lonnie. Good advice. Phil, we’re coming around to you please. Do you know do many states have reciprocity?

Phil Lawson:

Yeah. I want to follow up on what Lonnie said when she mentioned it. You have to check the states out very carefully. They are all different. This requires proactive inquiry on your part with respect to those states in which you want to provide professional services. So reach out to each state’s licensing board before your practice. You need a license in that state. Now you know reciprocity is the practice of exchanging things or services with others for a mutual benefit, especially privileges granted from one state organization to another. Now, technically, legally there is no system of reciprocity for social worker licenses across states. However, most states allow license applicants to transfer the ASWB examination scores from one state to another state and apply for a license and get one. This is not portable like a driver’s license in one state being recognized by another state.

Bonnie Rausch:

All right. Thank you so much. Deana, what are the issues with jurisdiction for military personnel who happened to be your clients, then they are deployed, but they want to stay in contact through technology services?

Deana Larsen:

This is a subject that’s a little bit dear to my heart as my son was active duty military. So I have a little bit of knowledge about this. Military personnel are residents of the state where they are stationed in the United States. However, they do have a little bit of a dual residency as their home state is considered to be where they came from. They’re very rarely stationed in the state where they reside. So having said that, I would be concerned about treating someone who is deployed, who might have a crisis situation, might have a breakdown, and you can’t help them or get them help.

Deana Larsen:

Certainly, you want to continue to treat the person, but if they get into a crisis, you can’t call 911 and direct them to a war zone. You want to make sure that any person who is deploying knows what the resources are at the base where they are deployed so that they can get the assistance that they need if they are in crisis. You may also if you’re a social worker who routinely treats military people, you may want to reach out to the local post and find out a number where you can contact, for example, like the Red Cross or something where they can get a message to that person’s base and alert someone that this person is having a crisis and they need some assistance. So you can do it, but please be cautious and make sure that the person has resources on the other end.

Bonnie Rausch:

Fantastic. Thank you so much. Lonnie, to you please. With regard to the example of a client that relocated and practicing without a license, if a social worker leaves the state, maybe on vacation for example, but is licensed in the same state as the client is located, is this acceptable?

Lonnie Ropp:

Well in this example, if you have a social worker who’s licensed in Georgia and Florida and happens to be in Florida on vacation, that social worker could treat a client who is physically in Florida, so they can help out there.

Bonnie Rausch:

All right. Thank you very much. That’s nice and succinct and appreciate that very much. Phil, to you, please. What about treating clients who may be traveling internationally?

Phil Lawson:

Yes, that’s a great question. With clients who either live or are traveling internationally, don’t do any treatment. Do your best to find resources for your clients wherever they happen to be. But do not treat them yourself while they’re out of your venue where you’re licensed or out of the country.

Bonnie Rausch:

Thank you, Phil. It absolutely makes sense. Deana, back to you please. What if I, as the clinician, happened to be traveling on vacation outside the state that I’m licensed in? While on vacation, a client calls me and needs clinical support. Can I give it to them if they are in the state that I normally see them and I’m licensed in that state even though I physically am out of the state?

Deana Larsen:

The key here is location. As they say in the real estate game, location, location, location. Where are the phones that you are speaking on physically located? If your telephone is located in a state where you are not licensed, you cannot practice. It doesn’t matter that your client is still in their home state. You’re not there. You cannot practice across state lines. You need to be aware of where you are and what the requirements are. Some states are extremely limiting about this. California is one that comes to mind. If you are not licensed in California, you cannot practice there, and that includes reaching in by telephone. So where the phone is located is what dictates whether you can give care.

Bonnie Rausch:

Fair enough. Thank you very much. Lonnie, to you please. Do some states give emergency or short term provisional licenses?

Lonnie Ropp:

Well, every state is actually different and probably licensure is not something that can be granted through a phone call. So don’t assume that this is something that can happen quickly, easily. It’s actually better to ask in advance. You may be pleasantly surprised with some of the current environment changes that have been made to regulation, but the thing is you have to ask the question in order to pursue it with that state licensing board. So the only bad question is the one left unasked.

Bonnie Rausch:

Absolutely makes sense on that one. Thank you so much, Lonnie. And Phil, to you please for our last question. Since you personally cannot know where someone is at the time of service, in other words, they’re on their cell phone calling you, it appears you can never provide services online or across a cell phone. Is that true?

Phil Lawson:

Well, I’d have to say yes, with a limited constraint you’ve given me, but the base here is you have to trust your client to tell the truth. And when the client represents something, you want to document the client’s representation and your notes with the time and date of that statement and the discussion, which becomes evidence if a claim arises that out-of-state services were provided. Now, these records will be eventually subpoenaed as evidence by a plaintiff’s lawyer during the discovery process in a lawsuit formulation litigation. So your defense will also rely on this as evidence as well to defend you. So you want to set the rules of therapy engagement. Set those up when you take on a new client and also do not allow people to overhear your conversations with clients because that’s a records breach.

Bonnie Rausch:

All very good points to consider. Well, this brings us to the end of podcast three. If you didn’t have the opportunity to listen to either podcast one or podcast two, please know that they are available on our COVID-19 page at our www.naswassurance.org website. Phil, Lonnie, and Deana, you folks have provided us all with so much valuable information. Thank you for sharing your knowledge and expertise. Thank you also to our listeners. Please, everyone, be safe. Keep your distance and don’t forget to wash your hands. Have a great day.

Podcast – Podcast 3: What You Need to Know About Teletherapy
Related – Visit our website dedicated to COVID-19 Resources