I recently set up an acct with SKYPE to participate in an upcoming meeting. I’ve had past requests to use SKYPE in counseling people unable to come to the Philadelphia area. While I’m open to doing this (at least for brief consultations), there are a number of issues to resolve. I’m interested in hearing from readers having used it for counseling (feel free to remain anonymous). What was it like? How were confidentiality and informed consent handled? Was any mention of jurisdiction mentioned? Not sure what I mean, read on to consider these issues:
- Confidentiality & Privacy. Are SKYPE video conferences really private? What is the likelihood that someone can tap in?
- Informed Consent. Read any good Telehealth informed consent forms lately? Seems that you have to consider how to deal with crises that might be happening in another state. Insurances cannot be used. What about what files are maintained? I believe it is possible to record SKYPE calls.
- Jurisdiction. It is clear that licensed mental health practitioners must not practice in another jurisdiction (i.e., state) without getting licensed or approved for that jurisdiction. But what about consultations? What about Internet based interactions? Which state has jurisdiction? Some seem to think that the state of the “caller” is going to want to maintain control of the care of its citizens. Others think that informing “callers” that the point of service resides with the Counselor will be enough. Check out what they say at eCounseling.com.
This is what is known as a “Point-of-Service” issue. In our terms of service which both clients and counselors agree to upon eCounseling.com sign up, it states the following in section 5.8: 5.8 POINT-OF-SERVICE. For a client who resides outside their eCounselor’s state of residence and professional licensure, there is an important issue that should be understood by clients before counseling begins: By utilizing these counseling services, the client agrees that he or she is soliciting the services of a professional outside of his or her state of residence. By doing this, the client agrees that the “point-of-service” of counseling is to occur in the counselor’s state of residence and licensure, not the client’s. In essence, the client is using the telephone or the Internet (the “information highway”) to virtually travel to the counselor (the counselor’s state of professional practice). Hence, counselors are accountable to and agree to abide by the ethical and legal guidelines prescribed by their state of licensure and residence. By agreeing to solicit the counselor’s services, the client agrees to these terms. If you do not understand, or have any questions regarding this issue, please feel free to ask the counselor about this issue, or contact eCounseling.com support at support@ecounseling.com DISCLAIMER: The above should not be construed as legal advice. If you have questions about legality or liability, please contact a qualified legal professional.
What do you make of these issues?
Musings on Faith and Psychology 
More information…
Is Skype a Secure Site for Therapy via Teleconferencing: March/2010 —
Practicing Across State Lines: Hageseth v. Superior Court, May/07: —
Recent Guidelines: —
found at…..
http://www.zurinstitute.com/telehealth_update.html
http://www.zurinstitute.com/hipaa_updates.html
2010: Confidentiality and Skype: Therapists must be aware that unlike cell phones or encrypted email, communication via Skype between psychotherapists and clients is considered neither secure nor confidential.
The NBCC has developed some guidelines for distance counseling, using electronic communications means:
Click to access internetcounseling.pdf
There is also a certification as a Distance Credentialed Counselor offered by the NBCC:
http://www.google.com/url?sa=t&source=web&cd=5&ved=0CDIQFjAE&url=http%3A%2F%2Fwww.cce-global.org%2Fextras%2Fcce-global%2Fpdfs%2Fdccapplication.pdf&rct=j&q=nbcc%20internet%20certification%20counseling&ei=8wq5TNDcDpCjnQfRr8DADQ&usg=AFQjCNH0AwX2RXzNgLqnAD00sCMhGuzCrw&cad=rja
At one time, our agency was considering extending distance counseling to former clients in residential treatment, via the use of Skype and the webcam…and I had offered to pursue this credential the lead the charge. It fell by the wayside, for some reason.
One more thing to add…Distance Credentialed Counselor certifications require that the applicant have a “counseling” degree from an accredited university, have state licensure in the state he/she is going to practice in, and receive 15 hours of training from the following provider:
http://www.readyminds.com/training/dcc_cert.asp
This 2-day, 15 hour workshop costs $595, and I believe the application fee of $25 for the DCC credential is collected at the end of the training. Maintenance fees are $35/year.
Or….take the DCC training online, same fee…
http://www.readyminds.com/training/dcc_online.html
I just spoke with my liability insurance company about doing counseling via Skype and was warned to check each state’s licensure requirements first. They indicated that the client’s state was the one that mattered not the counselor’s state. I am not sure there is legal precedent to know who’s right my insurance rep or ecounseling.com. Either way, the concern for privacy is real when using Skype.