Providing Mental Health During COVID-19

by | Mar 18, 2020 | Front Page, Press Release |

Dear Members,
Mental Health providers are facing unique challenges as we move forward in providing care to clients and self-care to ourselves.  While there have not been any clear guidelines provided to us, I am going to give you some resources as they are found on the Internet and within the AMHCA open forum as you continue to see clients.  PLEASE NOTE: this is not a written policy and RIMHCA is merely providing resources and suggestions for moving forward with providing direct care to your clients during the COVID-19 pandemic.  It is your professional responsibility to contact your insurance providers and liability carriers for specific regulations and guidance moving forward.
Here are some considerations for your practice:

  1. Telemental Health Counseling. Telemental health sessions are an opportunity for concerned clients with adequate internet access to continue with their therapy and minimize exposure possible exposure to the virus.  Anxiety and concerns about the spread of the virus can be heightened for some clients, and if you are able to provide distance counseling you may be able to mitigate additional mental health crises.
    • Telemental Health Platforms
      • When using telemental health, note that you must use a platform that is HIPPA/HITECH compliant.    
        • Doxy (https://doxy.me), provides both a free version or you can pay $35 per month for the “pro” version, which includes the ability to screenshare with clients (if you want to show them something on the screen) and to conduct group sessions.  
        • Zoom also provides a free and paid version, however, the free version is not HIPPA-compliant.  Zoom Healthcare is HIPPA-compliant and costs $200 a month (for up to 10 users)
        • Many electronic practice management systems and counseling website vendors, such as Simple Practice and TherapySites, also have options of adding telehealth platforms, so if you already have a practice management system, you may want to consider adding that feature.
      • Understand that no platform is compliant with the law unless you have signed a business associate agreement (BAA) with the tech company, so make sure you get that document signed and saved as soon as you secure your platform.
    • Telemental health and Ethics
      • Once you have an appropriate platform, your next task is to ensure that you are abiding by good ethical practice and by legal guidelines when using telehealth.  Ethics Rock is providing their $599 training on ethics of telehealth for free until 3/23/20 and might be a good resource to learn more (ethicsrock.com/services).  You should also read up on Ethical Guidelines for your State and Professional Organizations on the use of technology supported counseling and communications.  Client access to the internet, familiarity with technology, privacy concerns, etc. are all issues to be addressed with the client, and appropriate informed consent must be procured.
    • Telemental health and the Law
      • Each state has different laws regarding the practice of telemental health services.  If you and your client are physically in two different states at the time of a telehealth session, you have to ensure that it is legal in both states for you to conduct the session.  The free telemental health app enables you to learn what the laws are state-by-state for counselors conducting telehealth (www.ebglaw.com/telemental-health-laws-app).  
      • Regarding billing for Telemental Health Services: PLEASE CONTACT the insurance companies where you are paneled for direct guidance on if this is covered and how you should bill the sessions.  Some insurance policies may not cover this modality and others have different modifiers that are used to indicate virtual sessions.
      • You may be able to communicate with the client’s insurance company or Board of Health for the state in which your client lives to get a waiver during this time if you are not licensed in the state they are physically located in during the virtual session.
      • Determine if there are special considerations for seeing youth/minors during this time.  You may want to require that a guardian is available throughout the duration of your session.
  2. COVID-19 and the Counseling Office.  Until you receive further notice to stop all in-person sessions from the Department of Health (PLEASE REGISTER your email with the state to receive updates), you may still want to see clients in the office, however, you may want to consider canceling groups.  Please develop and plan and communicate whatever plan you are using with your clients.  Some examples can include:
    • Your plan for disinfecting common areas;
    • Posting reminders on proper hand-washing procedures;
    • Flyers for clients about the precautions being taken and the option for telemental health;
    • Post notices to clients regarding how to proceed if they do not feel well and/or are having flu-like symptoms;
    • Consider waiving late-cancellation fees during this time;
    • Change office furniture to allow for enough distance.
  3. Resources from Professional Organizations:

Please note that we are following the guidance of the Governor on holding events.  We have rescheduled the March 19th seminar to June 5th and are cancelling the Networking Event scheduled for April 1st.  Ashley will be in contact with individuals who were registered for the Networking event.  We are looking into platforms to hold our Monthly Meetings and have them open to members.  We will send out an email about that once we have decided on how to hold it.
Your self care is also important during this time.  Make sure that you are able to communicate with colleagues and peers, and seek supervision, when you have questions.  For example some questions that may come up are: how will you collect copayments during this time, what if you work with minors or couples, how to handle bad connections during the virtual session, how do you ensure confidentiality during the session, how do you manage balancing your own concerns about health and safety with the concerns your clients are bringing up, etc.  
If you work with an Agency, now is a good time to share best-practices with your fellow Mental Health Agency Providers across the state.  We should be working together to support one another and our clients throughout this time.
I hope that you are in good health and are taking the time you need to remain present and well during this time.
Best,
Michelle

Michelle Crossley, Ph.D., LMHC, NCC