Telebehavioral health Information and Counselors in Health Care

The COVID-19 pandemic changed how licensed professional counselors (LPCs) practice, particularly in the early phases of the pandemic as the profession responded to the urgent need for mental health practitioners. Many LPCs received temporary practice privileges from regulatory boards in other states as permitted by state of emergency proclamations or executive orders issued by governors. Professional counselors and other mental health practitioners engaged in professional advocacy by “stepping up” and providing professional services in times of dire need.

As the pandemic has evolved, many executive orders and state of emergency proclamations have been — or are expected to be — ended or rescinded. As a professional counselor, you must be aware of the legal, ethical and risk management implications of these changes. In sum, you must:

  • Be aware of the standards of care and laws that apply where you are practicing.

    Standard I.1.a. of the 2014 ACA Code of Ethics requires you to know and understand the ethical codes, state licensure board regulations and laws that apply where you practice. Lack of knowledge or misunderstanding of ethical, regulatory or legal responsibilities is not a defense against a charge of unethical conduct.

  • Resist the temptation to redefine the counseling relationship.

    When representing yourself to the public as a professional counselor, you must accurately share your credentials, degrees and license to practice (Standard C.4.f.). This includes honestly telling clients if you are validly practicing temporarily in another state during the pandemic. In addition, you should not “redefine” the counseling relationship to another type of relationship (for example, “life coaching”) to circumvent regulations.

  • Regularly review your authorization to practice temporarily in another state based on a state of emergency proclamation or executive order.

    Failure to remain familiar with state laws and regulations is not a justification for illegal or unethical practices (Standard I.1.c.).

  • If needed, appropriately transfer services to a licensed mental health practitioner in the state where the client resides.
    If a state rescinds a state of emergency proclamation or an executive order, you may become ineligible to practice there and need to make an “appropriate transfer” of a client as described in Standard A.11.d. As soon as you become aware of a developing con­cern, it is advisable to begin consulting with other LPCs and/or with an attorney who specializes in mental health law regarding transfer of clients. When consulting, make sure to maintain client confidentiality (Standard B.7.). You should also complete and document an ethical decision-making model (Standard I.1.b.).

    Becoming knowledgeable of community mental health resources now will help you to competently make referrals and appropriately terminate relationships with clients when you need to. Remember to provide your client with the reason for termination and transfer of care to another provider.

The practice of telebehavioral health involves the consideration of:

Frequently Asked Questions and Answers for Telebehavioral Health

Access undated information on how to deliver counseling support using technology, such Telebehavioral Health services.

Licensure and Liability Insurance

Use of telebehavioral health service delivery does not eliminate the licensure requirements. Learn what you need to know.

Ethical Standards

Review how the 2014 ACA Code of Ethics impacts the practice of telebehavioral health during a pandemic.

Insurance Billing Practices and Policies

Learn important information to navigate claims, billing and reimbursement for telebehavioral health services.

Effective Remote Counseling

Skills required to effectively work with a client without in-person interactions

Telebehavioral Health Technology

Using appropriate technological platforms where security standards conform with the recommendations of the Office of the National Coordinator for Health Information Technology (DHHS). 

Resources for Counselors Working in Health Care

We know there are counselors working in health care facilities and directly with those who have been infected. Substance Abuse and Mental Health Services Administration (SAMHSA) has a guide to management stress in crisis response professions

The Centers for Disease Control and Prevention (CDC) also has information about caring for patients with confirmed or possible COVID-19 Infection.

As the coronavirus spreads and healthcare providers are tasked with caring for an influx of patients, the Healthcare Providers Service Organization (HPSO) risk management team has identified four specific risks/tips providers should keep in mind to protect themselves.

Counselors are often reluctant to use technology in counseling, but they don’t have to be. This article discusses how counselors can ethically incorporate technology into their practices and how they can also benefit from it.

Telebehavioral health services allows counselors to work with clients across state lines, but the lack of licensure portability complicates the situation. This article discusses the ethical, legal, and counseling consequences of providing telehealth services to out-of-state clients.
With telebehavioral health services, ethical boundaries aren’t always clear-cut.  

Recommended Resources

  • American Counseling Association. (2014). ACA code of ethics.
  • Barnett, J. E., & Johnson, W. B. (2015). Ethics desk reference for counselors (2nd ed.). American Counseling Association.
  • Wheeler, A. M., & Bertram, B. (2019). The counselor and the law: A guide to legal and ethical practice (8th ed.). American Counseling Association.

Additional Information

Join/Renew NOW!