13.4 Special Considerations
While technology is an excellent asset in providing mental health services to a vast population, not all clients qualify for telehealth services. When considering virtual care, counselors must consider the client’s accessibility, knowledge, and other requirements when providing telehealth care.
Legal Considerations
As a state-licensed counselor, ensuring that clients receiving care reside within the state where the counselor holds licensure is essential. For instance, a counselor licensed in Minnesota must confirm that the client is a resident of Minnesota. When providing telehealth services, counselors should verify the client’s identity and residency by requesting a valid photo identification. This step helps ensure that the individual seeking services is not acting on behalf of someone else and confirms that they are who they claim to be.
The NAADAC (2021) Code of Ethics states:
“Addiction professionals who engage in the use of electronic platforms for the delivery of services shall take reasonable steps to verify the client’s/ supervisee’s identity prior to engaging in the e-therapy relationship and throughout the therapeutic relationship. Verification shall include, but shall not be limited to a minimum of one of the following: picture ids, code words, numbers, graphics, or other nondescript identifiers” (Standard VI-5).
The ACA (2014) Code of Ethics states
“Counselors who engage in the use of distance counseling, technology, and social media 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 residence. Counselors ensure that their clients are aware of pertinent legal rights and limitations governing the practice of counseling across state lines or international boundaries” (Standard H.1.b.).
Accessibility
While technology is often assumed to be universally accessible, this is not true for many populations. Individuals from low socioeconomic backgrounds may need access to appropriate devices or reliable internet. For clients experiencing homelessness, access to electronic devices is often nonexistent, making telehealth services inaccessible. In such cases, counselors are ethically responsible for providing in-person services to ensure that care is not denied.
Another significant barrier is inadequate internet connectivity. When clients lack the minimum bandwidth required for telehealth, sessions are frequently disrupted by poor connections, such as unclear video, inaudible audio, or lags. These interruptions waste valuable session time and hinder the development of a strong therapeutic alliance, which is critical for effective treatment.
Counselors must carefully assess these challenges and make informed decisions when determining the appropriateness of telehealth services for individual clients. This may involve consulting with clients about their technological resources and identifying alternative solutions to ensure equitable access to care.
The ACA (2014) Code of Ethics:
“When distance counseling services are deemed ineffective by the counselor or client, counselors consider delivering services face-to-face. If the counselor is not able to provide face-to-face services (e.g., lives in another state), the counselor assists the client in identifying appropriate services” (Standard H.4.d.).
The NAADAC (2021) Code of Ethics:
“Addiction professionals shall determine whether the client/supervisee shall be physically, intellectually, emotionally, linguistically and functionally capable of using e-therapy platforms and whether e-therapy/e-supervision is appropriate for the needs of the client/supervisee. Providers and clients/supervisees shall agree on the means of e-therapy/ e-supervision to be used and the steps to be taken in case of a technology failure. Providers shall verify that clients/supervisees understand the purpose and operation of technology applications and follow up with clients/supervisees to correct potential concerns, discover appropriate use, and assess subsequent steps” (Standard VI-14).
Technological Competence
The ability of clients to effectively use technology is a critical consideration when providing telehealth services. Some populations may need help navigating online platforms and need more knowledge or skills to utilize features such as video conferencing, file sharing, or secure messaging. In these cases, counselors may devote significant time to teaching clients how to use the platform, potentially detracting from the time available for therapeutic interventions.
However, educating clients about technology may be necessary in certain situations, mainly when telehealth is the only viable option. For example, individuals with life-threatening conditions who cannot leave their homes due to health risks may rely on telehealth as their sole means of accessing mental health care. In such instances, counselors can provide guidance and support to help clients effectively use virtual platforms, ensuring access to care while focusing on therapeutic goals.
Counselors must also assess clients’ cognitive capacity, maturity, and ability to engage meaningfully in virtual mental health services. This includes evaluating whether the client can follow instructions, navigate the technology independently, and maintain focus during online sessions. When barriers are identified, counselors may need to adapt their approach, provide additional support, or explore alternative care delivery methods to effectively meet the client’s needs. Ensuring that clients have the necessary skills to engage in telehealth facilitates the therapeutic process and promotes equitable access to mental health services.
The ACA Code of Ethics states:
“Counselors provide information to clients regarding reasonable access to pertinent applications when providing technology-assisted services” (H.4.e.).
The NAADAC (2021) Code of Ethics states:
“Addiction professionals shall assess and document the client/supervisee’s ability to benefit from and engage in e-therapy services. Providers shall consider the client/supervisee’s cognitive capacity and maturity, past and current diagnoses, communications skills, level of competence using technology, and access to the necessary technology. Providers shall consider geographical distance to the nearest emergency medical facility, efficacy of client’s support system, the client’s current medical and behavioral health status, the client’s current or past difficulties with substance abuse, and the client’s history of violence or self-injurious behavior” (Standard VI-9).
Key Takeaways
- Counselors must verify client identity and residency to ensure compliance with licensure regulations when providing telehealth services.
- Accessibility challenges, including lack of internet, devices, or private spaces, necessitate offering alternative in-person services when telehealth is not feasible.
- Counselors are ethically responsible for assessing clients’ technological competence and providing support to ensure equitable access to telehealth services.
- Poor internet connectivity and disrupted sessions can hinder therapeutic alliances, requiring counselors to evaluate the appropriateness of telehealth on a case-by-case basis.
- Counselors must ensure clients understand the purpose and operation of telehealth platforms and address potential barriers to engagement proactively.
- Legal, ethical, and practical considerations outlined by ACA and NAADAC Codes of Ethics guide counselors in delivering technology-assisted mental health services effectively and equitably.