1. What are the American telemedicine Association’s recommended elements for informed consent (in absence of specific law or regulation)?
2. Full disclosure of policies and procedures for clinical emergencies is necessary and can include…
3. What is a procedure for risk associated with client ownership of firearms?
4. There is currently no legal mechanism that would permit a psychologist to engage in tele-practice in another state where he or she is not licensed (other than the temporary practice statutes). What is the legal stance on Psychologists engaging in interstate tele-practice?
5. What are common ethical considerations that occurs in an attempt to balance benefits and non-malfeasance?
6. It is important to have both ongoing conversations as well as legal documentation of informed consent when treating patients through tele-mental health. What can be included as Potential risks for tele-mental health in the informed consent form?
7. It is important for TMH practitioners to be familiar with best practices when working with vulnerable populations. Who are the vulnerable populations?
8. When considering the use of email or other forms of electronic communication with patients, establish written policies addressing not only the specific uses of email and social media that will be acceptable (E. G., Scheduling, therapeutic issues), but what else should be considered?
9. Issues to consider for liability risk management center around an understanding of the legal definition of what constitutes malpractice. What are the generally accepted elements of negligence as to what courts consider in malpractice actions?
10. What are some questions to consider regarding “friending” a client?
11. When working with people struggling with personality disorders or substance abuse, for example, it often is optimal to involve a team of local community professionals in the care plan, even when practicing in one’s own professional community. What are the three benefits of creating this support network for yourself?
12. What do Fidelity (truthfulness) and responsibility refer to as they relate to TMH?

Answers:

A. Informing patients that they have an option to refuse TMH care emergency plans may also include
Descriptions of when remote emergency resources will be accessed,. For example, “a client patients emergency contact person (family member, friend, and/or physician) will be contacted immediately if there is reason to believe that there is eminent danger to the client/patient or any other individuals in their environment.”
B. -Limitations to confidentiality when using electronic communications
-Emergency plan and contact information for local resources
-Process for documentation and storage of information
-Potential for technical failure and procedure for coordination of care with other professionals
-Protocol for contact between sessions and
-Conditions under which the TMH services are terminated and a referral for face-to-face care made
C. This action indicates a not lawfully practicing psychology and is thus risking some disciplinary consequences.
D. Access to firearms is another potential safety issue that tele-providers should consider, learning the social norms of the local community. TMH guidelines state that clinician should discuss firearm ownership, safety, and the culture of firearms in the clients community. the need for this discussion can be determined by the client’s history of self-directed and/or other-directed violent behavior.
E. Limitations of technology, which would be considered a “disruption in care,” for example, decreased resolution of the visual image or interruption in auditory signal.
F. --Establishing a procedure related to clients presenting in crisis
--Practicing within the scope of clinical competence
--Assess need for emergency referral
--Non-malfeasance risk-benefit ratio of their practice and conduct only those treatments that clearly benefit the client.
G. When using emails and other forms of electronic communication also to be considered is the following how specific risk will be managed and explained to patients to ensure informed consent, such as the accessibility of emails to unintended parties, the ability of deleted files to be recovered, the consequences of unencrypted exchanges, the expectation to be instantly available and responsive, and the role of the patient in protecting privacy and confidentiality.
H. Veteran populations find the additional control and anonymity afforded by the TMH setting appealing, as reported by others who have experienced trauma.
--Adolescence have been reported to quickly accommodate to the technology setting and often like the additional “personal space” offered by TMH.
--Caucasian clients may find decreased direct eye contact to be a challenge.
--Asian and Native American clients have been reported to prefer the decreased direct eye contact.
Best Practice: Use regular verbal “check-ins” with clients to ask about their current experience of the technology.
I. -How will it affect the patient and the therapeutic relationship if the request is denied?
-How should a provider address this issue as it arises with clients?
-Is it appropriate to accept “friend” request from a family member of the patient, the mother of a pediatric patient for example?
-Is it ethical to accept “friend” request from some patients but not others?
J. If harm to self or others is in question
courts may consider your
a. Duty to warn
b. Breach of that duty to warn
c. Injury as a result of breach of duty
d. Proximity occurring between the breach of duty to warn and the injury.
K.1. Establishing the trust of the clients, colleagues,and the public at large in the practice of tele-mental health.
2. Confidentiality is a key concern with TMH due to the loss of direct control over the clinical environment and the ability to ensure confidential therapeutic encounters.
L.This well considered network of local care providers
--not only improves care by enhancing care coordination,
--but also minimizes risk and
--minimizes the practitioner’s own anxiety when working with difficult patients.