As people in a helping profession, many counselors know the frustration of something getting in the way of us being there for our clients. At some point in our careers, we all must deal with scheduling conflicts, illnesses, weather delays and other events outside of our control. Typically, these are temporary setbacks, and we find a way to adjust. Other situations, especially those we don’t feel make sense from a client care perspective, can be particularly frustrating, however.
A modern, timely example of this is when trying to help clients from outside of our own state. Many situations can cause this to occur. Among the examples I have personally encountered include:
- Working with an adolescent who later went off to college in another state
- Working with a businessperson whose career required being out of state for weeks at a time
- Working with a military family that was reassigned to a new location in another country
The list of potentially similar circumstances is endless. The good news is that modern technology makes it possible to continue working with these clients through telehealth (i.e., using secure video while complying with the Health Insurance Portability and Accountability Act). In fact, there is mounting evidence that counseling services delivered via telehealth can be as effective as in-person services (see ncbi.nlm.nih.gov/pmc/articles/PMC5723163). Problem solved, right?
The barrier to telehealth
Unfortunately, there continues to be a significant barrier to this interstate solution: the lack of counselor licensure portability/reciprocity between states. Our professional licensure is “state based,” meaning that we have to apply for licensure in each state individually. Even if we are licensed in one state, we start from scratch in applying in another. Currently, our licensure will not transfer. (Note: In October, the American Counseling Association Governing Council approved the initial endorsement and funding of a professional occupation interstate compact for professional counselors that could help to make licensure portability a reality in the future.) This matters for telehealth because we can’t practice counseling in a state in which we are not licensed, at least not without permission. More on that in a bit.
I’ve often come across counselors who have made assumptions such as: “Well, my client is going to be there for only a couple of weeks, so it shouldn’t matter” or “My client’s not going to be an official resident of that state for a while.” Both of these assumptions, as well as other related assumptions, are problematic.
Here’s the simple reason why: State counseling licensure boards exist to protect everyone in that particular state. It ultimately doesn’t matter how long that person is there.
Yes, state counseling licensure boards do things such as process our applications and ensure that we are getting enough continuing education. But they do these things to serve their primary purpose: protecting the public. The laws they enforce won’t allow just anyone to call himself or herself a licensed professional counselor, which helps ensure that the public receives proper, ethical care. Following that logic, to protect people within their borders, these boards won’t allow just anyone to “telehealth in” from another state to provide care.
Yes, we can argue that this sometimes presents a barrier to providing clients needed care. Yes, we can argue that it’s a barrier to quality mental health care in general. Hopefully, we can take it many steps further, arguing vociferously until we have a national counseling licensure or at least reciprocity between states. In the meantime, however, we cannot ignore the legalities and liabilities of the situation. And it doesn’t mean that we are currently without options. Some states will allow counselors to practice there temporarily, but this will require you to do some research and to make some contacts.
Tracking telehealth laws
A good starting point is Epstein Becker Green’s telemental/telebehavioral health survey (see ebglaw.com/telemental-telebehavioral-survey). This survey endeavors to track telehealth laws as they pertain to the provision of mental health care in all 50 states. It breaks down telemental health laws not only by state but also by professional licensure. The survey includes information on whether each individual state allows out-of-state providers to temporarily practice within the state, and it also includes links to governing boards.
It is important to note the following caveat: The original survey was done in 2016 and has been updated with a 2017 appendix that is 316 pages long. Telehealth laws are changing that quickly. Given that fact, it will be important that you:
1) Visit the state board website in question to investigate whether any changes or new information have been added
2) Contact that state board and ask it directly about your situation and the granting of temporary privileges
3) Document everything
It is also important to be aware of your own state’s licensure laws to ensure that they don’t include any restrictions that might affect you. As always, consultations with your attorney and your liability insurance company are also advised. You must also be aware of other ethical, legal and counseling ramifications before providing telehealth services (for more, see tameyourpractice.com/telehealth). With a bit of due diligence, you may be able to continue providing care to clients in many interstate situations.
Rob Reinhardt, a licensed professional counselor supervisor, is a private practice and business consultant who helps counselors create and maintain efficient, successful private practices. Before becoming a professional counselor, he worked as a software developer and director of information technology. Contact him at firstname.lastname@example.org.
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