STRESSSAFETY has prepared the following brief guide to assist new practitioners with the fundamentals and best practices for tele-Counseling. Here are the key considerations:

Understand applicable regulations and laws to establish the ground rules for tele-psychiatry

The same standards of care existing for face-to-face patient care are operable for tele-Counseling.

Establish whether:

An initial or periodic face-to-face meeting is required

Referral from or coordination with the patient’s primary care or other treating physician is required

Additional requirements or restrictions exist for services delivered to a patient’s home or non-healthcare setting

Follow best practices for managing prescriptions

Verify your state’s requirements for prescribing via telemedicine.

Prescribe medications only after establishment of a doctor-patient relationship and adequate examination and assessment.

If controlled substances will be prescribed, restrict prescribing to patients seen at an organized healthcare setting with active DEA registration.

Make sure the physician’s DEA registration is active and valid for the location from which the physician is prescribing.

Consider having controlled substances prescribed by the client’s primary care physician with consultation from the tele-psychiatrist.

Where uncertainty exists about a client’s prescription history or risk for abuse, check the client’s prescription patterns using the state’s Prescription Drug Monitoring Program (PDMP).

Prepare your practice for tele-Counseling

The doctor’s telemedicine office must provide:

Adequate soundproofing
Freedom from interruption or disturbance by others
Secured access to files or electronic medical records
Password-protected computers with up-to-date anti-virus protection
Secure e-health communication (STRESSSAFETY’s messaging systems are secure)

Obtain consent and engage with client

Authenticate patient identity (example, faxed copy of driver’s license)
Provide patient with a ‘HIPAA Notice of Privacy Practices’
Obtain a signed ‘Consent for Treatment’ that describes delivery of services via telemedicine (STRESSSAFETY provides a Consent for Treatment form)
Establish doctor/patient relationship: examination, medical history, referral as necessary
Link wherever possible to primary care (referral, care coordination, management of medications)
Clearly define how the patient will schedule appointments and the preferred means of contact/communication (secure email or messaging, phone, etc.)
Determine and advise patient of procedure for managing emergencies, including availability of emergency services in the community (nearby Emergency Department, Crisis Stabilization Services)

Suggested patient orientation

“Have you ever talked to a doctor on camera before? We will be talking today just like we were in the same office together. Please let me know if you have any problems seeing or hearing me. If you have any trouble hearing or understanding me, please let me know, and I’ll be happy to repeat myself. I will ask you to repeat if I have any trouble understanding you. I’ve taken steps to make sure that our visit is private and confidential. Our visit will not be recorded. Please make sure as we continue to visit that you are in a place where you can expect privacy and be free of interruptions or distractions.”

Fine-tune the tele-Counseling environment

Optimize lighting and background
Adjust cameras to establish natural eye contact for both parties
Obtain a signed ‘Consent for Treatment’ that describes delivery of services via telemedicine (STRESSSAFETY provides Consent for Treatment form)
Schedule a Customer Support visit on video to verify adequate audio and video quality and to adjust the office environment as necessary (STRESSSAFETY provides a thorough technical and clinical orientation to new providers)
‘Check in’ at the start of each session to make sure that picture and audio quality are good
Ask client or tele-presenter to make necessary adjustments to far side computer/camera to maximize call quality

Improve treatment planning and risk management via assessment and re-assessment

Routinely use structured on-line patient assessments for initial and subsequent care(STRESSSAFETY integrates a well-validated clinical assessment tool, available at the start of each session).
Monitor patient progress via on-line assessments and watch for markers of progress or emergency.
Evidence of severe distress, suicidal ideation, or continuing substance abuse from the self-report tool may assist the clinician in treatment planning and care coordination.
Consider practice setting for high-risk patients
Reserve care of high-risk patients to organized healthcare settings where a tele-presenter can assist
Identify crisis plan and location of emergency services in case of emergency
Refer a patient to STRESSSAFETY