Section H

Telehealth and Technology

Introduction

Counselors understand that the profession of counseling involves in-person and virtual interactions. Counselors actively attempt to understand the evolving nature of the profession with regard to technology and how such resources may be used to better serve their clients. Counselors strive to become knowledgeable about these resources. Counselors understand the additional concerns related to the use of technology and make every attempt to protect confidentiality and meet any legal and ethical requirements for the use of such resources.

H.1. Knowledge and Legal Considerations

H.1.a. Knowledge and Competency

Counselors develop knowledge and skills related to technical, ethical, and legal considerations (e.g., special certifications, additional course work) for the use of telehealth, digital interventions, and technology platforms.

H.1.b. Laws and Statutes

Counselors who engage in the use of telehealth within their counseling practice understand that they may be subject to laws and regulations of both the counselor’s practicing location and the client’s place of participation (e.g., location). Counselors ensure that their clients are aware of pertinent legal rights and limitations governing the practice of counseling across state lines or international boundaries. Counselors make every effort to understand the applicable laws and statutes across state, national, and international jurisdictions.

H.2. Informed Consent and Security

H.2.a. Informed Consent and Disclosure

Clients have the freedom to choose whether to use telehealth and technology within the counseling process. In addition to the usual and customary protocol of informed consent between counselor and client for in-person counseling, the following issues, unique to the use of telehealth and technology, are addressed in the informed consent process:

• telehealth credentials, physical location of practice, and contact information;
• risks and benefits of engaging in the use of telehealth and technology;
• possibility of technology failure and alternate methods of service delivery;
• anticipated response time;
• emergency procedures to follow when the counselor is not available;
• time zone differences;
• cultural and/or language differences that may affect delivery of services;
• verification of insurance coverage for telehealth;
• verification of safe and secure telehealth environment for client;
• reasonable access to pertinent technology-assisted services and applications;
• policies and implications for recording sessions through telehealth platforms; and
• uses of artificial intelligence, especially when AI settings are active.

H.2.b. Confidentiality Maintained by the Counselor

Counselors acknowledge the limitations of maintaining the confidentiality of electronic records and transmissions. They inform clients that individuals might have authorized or unauthorized access to such records or transmissions (e.g., colleagues, supervisors, employees, information technologists).

H.2.c. Acknowledgment of Limitations

Counselors inform clients about the inherent limits of confidentiality when using technology. Counselors urge clients to be aware of authorized and/or unauthorized access to information disclosed using this medium in the counseling process. Counselors must be aware of the limits of confidentiality and access to crisis resources for clients in their respective locations.

H.2.d. Security

Counselors use current encryption standards within their websites and/or technology-based communications that meet applicable legal requirements. Counselors take reasonable precautions to ensure the confidentiality of information transmitted through any electronic means. Counselors should verify when AI settings are active. Upon client requests, counselors should deactivate AI settings. Counselors should activate appropriate security settings, including a waiting room or lobby, and locking the meeting once the session begins.

H.3. Client Verification

Counselors who engage in the use of technology to interact with clients take steps to verify the client’s identity and location at the beginning and throughout the therapeutic process. Verification can include but is not limited to using code words, numbers, graphics, or other nondescript identifiers.

H.4. Telehealth Relationship

H.4.a. Benefits and Limitations

Counselors inform clients of the benefits and limitations of using technology applications in the provision of counseling services. Such technologies include but are not limited to computer hardware and/or software, telephones, phone applications, Internet-based applications, AI, other audio and/or video communication, and data storage devices or media.

H.4.b. Technology-Assisted Services

When providing technology-assisted services, counselors make reasonable efforts to determine that clients are intellectually, emotionally, physically, linguistically, and functionally capable of using the application and that the application is appropriate for the needs of the client. Counselors verify that clients understand the purpose and operation of technology applications and follow up with clients to correct possible misconceptions, discover appropriate use, and assess subsequent steps.

H.4.c. Effectiveness of Services

When telehealth services are deemed ineffective by the counselor or client, counselors consider delivering services in-person. If the counselor is not able to provide in-person services (e.g., lives in another state), the counselor assists the client in identifying appropriate services.

H.5. Records and Web Maintenance

H.5.a. Records

Counselors maintain electronic records in accordance with relevant laws and statutes. Counselors inform clients on how records are maintained electronically. This includes but is not limited to the type of encryption and security assigned to the records, and if/for how long archival storage of transaction records is maintained.

H.5.b. Client Rights

Counselors who offer distance counseling services and/or maintain a professional website provide electronic links to relevant licensure and professional certification boards to protect consumer and client rights and address ethical concerns.

H.5.c. Electronic Links

Counselors regularly ensure that electronic links are working and are professionally appropriate.

H.5.d. Multicultural and Disability Considerations

Counselors who maintain websites take steps to promote accessibility to clients with disabilities. When working with clients, counselors attempt to provide translation capabilities for clients who have a different primary language, when feasible. Counselors acknowledge the imperfect nature of such translations and forms of accessibility.

H.6. Virtual Presence

H.6.a. Virtual Professional Presence

Counselors maintain a professional presence and boundaries—that do not harm the profession or clients—across all virtual platforms, including personal webpages, social media platforms, and other accounts.

H.6.b. Client Virtual Presence

Counselors respect the privacy of their clients’ presence on virtual platforms unless given consent to view such information for professional purposes.

H.6.c. Use of Social Media

Counselors are prohibited from discussing confidential information through social media. Counselors should be aware of the risks of non-secure platforms on social media.

H.7. Systems-Based Modalities

H.7.a. Establishing Virtual Groups

Counselors assess the appropriate use of technology platforms, including risks to the group counseling format and Health Insurance Portability and Accountability Act (HIPAA) compliance for security purposes. Counselors determine whether a virtual group format would be suitable to clients’ needs and goals. Counselors identify the benefits and risks of a virtual group format in comparison to in-person group formats. Counselors identify a protocol for when group members are inadvertently removed from the virtual group meeting. Counselors refrain from establishing asynchronous platforms (e.g., group texts or chat-based groups/discussion boards) for the purposes of group counseling.

H.7.b. Couple and Relationship Counseling on Telehealth Platforms

Counselors communicate clearly to couples and partners about the benefits and risks of conducting couple and relationship counseling on telehealth platforms. Counselors are responsible for establishing the protocol of couple and relationship counseling on telehealth platforms.

H.8. Technology and Diagnosis

Counselors recognize that technology platforms, including AI applications if used, are solely supplemental tools in the diagnosing of clients. The use of these platforms should not be a substitute for the counselor’s own professional diagnosis or diagnostic impression. Counselors are responsible for verifying the accuracy of any diagnostic information provided by the technology platform.

H.9. Technology Applications in Counseling

H.9.a. Technology Benefits and Risks

Counselors communicate the benefits and risks of technology applications in clients’ participation in counseling. Technology applications should not replace counseling services.

H.9.b. Technology Use Consent

Counselors inform clients when they are using any form of technology, including applications and AI, at any point in the counseling process. Counselors obtain consent to use these technologies. Should clients decline services involving certain technologies, counselors provide alternative options for them.

H.9.c. Technology Use and Documentation

Counselors communicate the use of technology platforms for documentation, including note-taking. Counselors are responsible for verifying the accuracy of documentation provided by the technology platform. If clients do not consent to technology platforms for documentation, counselors cannot terminate services to clients.