Client-Clinician Agreement: Telepsychology
This Informed Consent for Telepsychology contains important information focusing on doing psychotherapy using the Internet. It is an addendum to the Client-Clinician Agreement in place between existing clients of CPA and their CPA clinician, when telepsychology services are requested. All rights, responsibilities and privileges discussed in the Client-Clinician Agreement remain in force for services conducted using telepsychology. Please read this carefully and let your therapist know if you have any questions. When you and your therapist sign this document, it will represent an agreement between each of you.
In order to meet the needs of our existing clients, we can regularly schedule telepsychology sessions using video chat software called Doxy.me that works automatically in commonly used browsers (e.g., Chrome, Explorer, Firefox) so there is no need to download additional software or plugins on the client’s device of choice. This option is offered as a courtesy to our clients in order to improve their access to services in situations where they might otherwise not be able to attend a session in the office.
Doxy.me is a telepsychology platform that meets or exceeds security requirements set forth by HIPAA and is therefore appropriate for conducting telepsychology services. This platform uses end-to-end encryption and no identifying information is ever recorded. We cannot use other media such as Skype or FaceTime to conduct telepsychology services, as these platforms do not meet security requirements. You can learn more about Doxy.me at https://doxy.me/patients. You will access your scheduled sessions by clicking on the personalized URL emailed to you by your therapist. Once you have clicked the link, you will check into the waiting room by typing your name, and your therapist will initiate the session when they are available. The client is responsible for providing and maintaining all equipment required for using Doxy.me and connecting to the internet from their location. If you are having technical difficulty, or need to contact your therapist for any reason, please email them directly or call CPA’s office at (336) 272-0855.
Benefits and Risks of Telepsychology
Telepsychology refers to providing psychotherapy services remotely using telecommunications technologies, such as video conferencing or telephone. One of the benefits of telepsychology is that the client and clinician can engage in services without being in the same physical location. This can be helpful in ensuring continuity of care if the client or clinician moves to a different location within North Carolina, takes an extended vacation, or is otherwise unable to continue to meet in person. It is also more convenient and takes less time. Telepsychology, however, requires technical competence by both the client and the therapist to be helpful. Although there are benefits of telepsychology, there are some differences between in-person psychotherapy and telepsychology, as well as some risks. For example:
Risks to confidentiality. Because telepsychology sessions take place outside of the therapist’s private office, there is potential for other people to overhear sessions if you are not in a private place during the session. Your therapist will take reasonable steps to ensure your privacy on their end. But it is important for you to make sure you find a private place for the session where you will not be interrupted. It is also important for you to protect the privacy of the session on your cell phone or other device. You should participate in therapy only while in a room or area where other people are not present and cannot overhear the conversation.
Issues related to technology. There are many ways that technology issues might impact telepsychology. For example, technology may stop working during a session, other people might be able to get access to the private conversation, or stored data could be accessed by unauthorized people or companies.
Crisis management and intervention. Usually, CPA clinicians will not engage in telepsychology with clients who are currently in a crisis situation requiring high levels of support and intervention. Before engaging in telepsychology, you and your therapist will develop an emergency response plan to address potential crisis situations that may arise during the course of your telepsychology work.
Efficacy. Most research shows that telepsychology is about as effective as in-person psychotherapy. However, some therapists believe that something is lost by not being in the same room. For example, there is debate about a therapist’s ability to fully understand non-verbal information when working remotely.
CPA clinicians have a legal and ethical responsibility to make best efforts to protect all communications that are a part of telepsychology. However, the nature of electronic communications technologies is such that we cannot guarantee that communications will be kept confidential or that other people may not gain access to our communications. CPA clinicians will try to use updated encryption methods, firewalls, and back-up systems to help keep your information private, but there is a risk that our electronic communications may be compromised, unsecured, or accessed by others. You should also take reasonable steps to ensure the security of our communications (for example, only using secure networks for telepsychology sessions and having passwords to protect the device you use for telepsychology).
The extent of confidentiality and the exceptions to confidentiality that were outlined in the Client-Clinician Agreement still apply in telepsychology. Please ask if you have any questions about exceptions to confidentiality.
Appropriateness of Telepsychology
From time to time, you and your therapist may schedule in-person sessions to “check-in” with one another. Your therapist will let you know if they decide that telepsychology is no longer the most appropriate form of treatment for you. Your therapist will discuss options of engaging in in-person counseling or referrals to another professional in your location who can provide appropriate services.
Emergencies and Technology
Assessing and evaluating threats and other emergencies can be more difficult when conducting telepsychology than in traditional in-person therapy. To address some of these difficulties, you and your therapist will create an emergency plan before engaging in telepsychology services. They will ask you to identify an emergency contact person who is near your location and who they will contact in the event of a crisis or emergency to assist in addressing the situation. Your therapist will ask that you sign a separate authorization form allowing them to contact your emergency contact person as needed during such a crisis or emergency.
If the session is interrupted for any reason, such as the technological connection fails, and you are having an emergency, do not call your therapist back; instead, call 911, or go to your nearest emergency room. Contact your therapist after you have called or obtained emergency services.
If the session is interrupted and you are not having an emergency, disconnect from the session and your therapist will wait two (2) minutes and then re-contact you via the telepsychology platform used to conduct therapy. If you do not receive a call back within two (2) minutes, then call your therapist at (336) 272-0855.
If there is a technological failure and you and your therapist are unable to resume the connection, you will only be charged the prorated amount of actual session time.
Fees and Insurance Coverage
For the purposes of this agreement, telepsychology is defined as psychotherapy services provided remotely using audio AND visual equipment. Psychotherapy services conducted using audio only (i.e., over the phone only) are NOT considered telepsychology, and are NOT covered by insurance. To our knowledge, telepsychology is covered by BCBS, Cigna, and Tricare, and as such, these services can be billed at the same rates and co-pay amounts as in-office sessions. The same fee rates will apply for telepsychology as apply for in-person psychotherapy. However, insurance or other managed care providers may not cover sessions that are conducted via telecommunication. If your insurance, HMO, third-party payor, or other managed care provider does not cover electronic psychotherapy sessions, you will be solely responsible for the entire fee of the session ($140 for 45-minute session; $150 for 60-minute session). Please contact your insurance company prior to engaging in telepsychology sessions in order to determine whether these sessions will be covered.
Missed Appointments/Brief Telepsychology Sessions
As noted in the Client-Clinician Agreement, late cancel/missed appointment fees are charged for sessions not cancelled with 24 hours advanced notice. A client who has an in-office session scheduled but will be unable to attend the session in person, may request a telepsychology session (minimum 30 minutes) in lieu of canceling the appointment if their therapist is registered with Doxy.me. This telepsychology session may or may not be covered by your insurance, as outlined above. You must notify your therapist of your intent to conduct the session remotely (your therapist will not assume that you wish to have your session using telepsychology unless you make a specific request on each occasion). Please keep in mind that telepsychology sessions may not be an appropriate method of treatment for all clients or presenting concerns. The authorization to conduct a telepsychology session in place of a scheduled in-office session is solely at the discretion of your therapist. If you have questions about whether your specific situation is appropriate for teletherapy services, please contact your therapist.
The telepsychology sessions shall not be recorded in any way unless agreed to in writing by mutual consent. Your therapist will maintain a record of the session in the same way they maintain records of in-person sessions in accordance with CPA policies.
This agreement is intended as a supplement to the general informed consent that we agreed to at the outset of our clinical work together and does not amend any of the terms of that agreement. Your signature below indicates agreement with its terms and conditions.