the fundamentals of telemental health and ethics

The Fundamentals of Telemental Health and Ethics

2/10/2021

Presented by Glendora Dvine, LPC 1

The Fundamentals of TelementalHealth and Ethics

P r e s e n t e d b y : G l e n d o r a D v i n e , L P C B C - T M H

Webinar Facilitator:Samson Teklemariam, LPC, CPTM

• NAADAC, the Association for Addiction Professionals

• www.naadac.org

• [email protected]

www.naadac.org/webinars N A A D A C , t h e A s s o c i a t i o n f o r A d d i c t i o n P r o f e s s i o n a l s

Director of Training and Professional Development for NAADAC

www.naadac.org/fundamentals‐telehealth‐webinar


Cost to Watch:Free

CE Hours Available:1.5 CEs

CE Certificate for NAADAC Members:Free

CE Certificate for Non-members:$20

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Using GoToWebinar(Live participants only)

Control Panel

Asking Questions

Handouts

Audio (phone option)

Polling Questions


DvineSystems GA

Mental & Behavioral Health Practice

Glendora Dvine NCC, BC-TMH

Licensed Professional Counselor

Board Cert i f ied in Telemental Health

Telemental Health Workshop

Schedule

• 3:00pm - 3 :05pm* Opening

Statements

• 3:05pm-3:30pm * Defining

Telemental Health

• 3:30pm-3:45pm * Benefits of

Providing Therapeutic Services via

Technology- Assisted Media

• 3:45pm-4:15pm * Issues Regulated

by State/Federal and Ethical codes

of standard

• 4:15pm-4:25pm * Questions

• 4:25pm-4:30pm * Closing Statements

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DisclaimerThe fol lowing workshop (v ideos, l ive chats, documents) by Dvine

Systems GA dba Glendora Dvine is offered for informational and educational purposes.

During the LIVE presentat ion, we may experience dif f iculties or technology that may fa i l , i f so recommendations are best practice

based on your c l in ical work. By continuing to further develop in areas of personal interest.

Best Pract ices are always state regulat ions and composite board's ethical codes. Consulting with your legal advisor is a lso

recommended for best practices.

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LEARNING OBJECTIVES

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Participants will define “telemental health” and recall three names to which it has been historically referred.

Participants will describe three benefits of providing therapeutic services via technology-assisted media.

Participants will be able to explain two issues regulated by applicable ethical codes and two issues regulated by the state/federal government regarding the use of telemental health.

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POLLING QUESTION 1 Were you using virtual services prior to

COVID-19?

A. Yes

B. Yes, bu t very min imal

C. No

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PART 1DEFINING Telemental Health

What isTelemental Health?

wait what did you call it?

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Tele-psyhotherapy

VideoTherapyOnline

Counseling

Distance Counseling

TeleHealth

Internet Therapy

VirtualTherapy

Tele-Behavioral

therapy

Digital Therapy

Electronic Healthcare

Delivery &

more!

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Telemental Health--means the mode of del ivering services via

technology-assisted media, such as but not

l imited to, a telephone, video, internet, a

smartphone, tablet, PC desktop system, or

other electronic means using appropriate

encryption technology for electronic health

information. (GA Rule 135-11-.01)

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Telemental Health--Facil i tates cl ient self -management and

support for c l ients and includes synchronous

interactions and asynchronous store and

forward. (GA Rule 135-11-.01)

VIDEO

CONFERENCING

TELEMENTAL HEALTH

SMARTPHONES

LANDLINES

EMAIL

STORAGE

COMPUTER

& CLOUD

CHAT

MESSAGES

WEBSITES

/ APPS

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Informed Consent

Key Term

in Telemental Health

Before the delivery

the licensee shall inform the client

shall obtain verbal & written consent

that Telemental Health will be used

Document both consents in a record

Consent must include disclosure of the use of

3rd party vendors

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Client Assessment

Key Term


Use an assessment instrument

referenced in Rule 135.7-.05

in order to determine whether an

individual

may be properly assessed and /or

treated via Telemental Health

services through technology-assisted

media.

Rule 135-7-.05 Assessment Instruments

(1)When using assessment instruments

or techniques, the licensee

shall make every effort to promote

the welfare and best interests of the

client.

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4 WAYS TO DELIVER THE SERVICE

3 Live/ Real-Time1 Store & Forward

2 Remote Monitoring 4 Telephone

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Asynchronous store & forward

Key Term


Means the transmission

of a client's information from an originating site

to a licensee at a distant site without the presence of the client.

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STORE & FORWARDEMAILS, TEXT, CHATS, DMS, SOCIAL MEDIA

THINK POLICIES

FIRST SESSION

Address asynchronous methods in your policies and

procedures when creating your business in mental

health.

Inform the client of the boundaries you have in place

related to contacting their clinician.

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SynchronousKey Term


Means a real-time

interaction

between a client

and a licensee located at

a distant site.

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REAL-TIME - LIVEMake It Therapeutic

Software Provider

Esthetics

Look for bundles in your software provider. How

many services do they offer that is beneficial to your

practice.

How easy is it to use for the client and the clinician?

Maintain a consistent background.

Resemble in an office setting.

Dress appropriately (collard

shirts/blouses/jewelry/kempt hair).

No eating for client or clinician / Keep water, coffee,

or tea.

Set expectations for services- No driving

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REMOTE PATIENT MONITORING

REMOTE PHYSIOLOGIC MONITORING (RPM)

• @ PHE patient-physician

relationship must be est.

• Consent can be obtained

at the time services start

• Auxillary personnel can

provide services using

99453 & 99454 under the

supervision

• RPM service is for acute

& chronic conditions

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Telephone

Check Your State

• Back-up to Video

• Verify the client's location

• Ensure Privacy &

Confidentiality

• Mindful of client's tone,

tempo, hesitation,

pauses, inflection,

inability to focus

Collab Space Central Pitch Deck

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3 PARTS OF TELEMENTAL HEALTH

3 ADMINISTRATIVE

1 CLINICAL

2 TECHNOLOGY

CLINICAL

Who are you serving?

• What service is being provided?

• Where is the person located?

• What is the treatment process?

• What does the research say about tx?

• What does federal/state & ethics say

about the tx process via technology-

assisted media?

• How long is the treatment process?

• Do I need additional training?

• Are there any updates by the

government?

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TECHNOLOGYHow is the service being delivered?

Software

Hardware

• Easy to use for clients & clinicians (refer out for

face to face if needed)

• Able to justify why using such software

• Bundles features to stretch your $$$

• Business Associate Agreement Avialable

• A backup plan (computer, laptop, tablet, phone)

• Wifi vs. Ethernet cable

• White Noise / Earphones / Lighting

• Chairs - footrest, cushion, back support

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ADMINISTRATIVE

How the service is being delivered?

POLICIES & PROCEDURES

• Involve the staff

• Review annually

• Track your updates

• Research articles

• Stick to boundaries

• Mentor, Business Coach, Retainer

• Join organizations and participatedsgeorgia.com

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Distant SiteKey Term


Means a site or location

from which services are

delivered by a licensee via

technology-assisted media.

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Originating Site

Key Term


Means a site where a client is located

at the time

Telemental Health services are provided via

technology-assisted media

or where the

asynchronous store and forward

services originate.

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RESEARCH FOR YOURSELF

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Scientific Literature• Do the literature make sense to

you

• Are you able to process it

• What was the input of the clients

Use the Literature• To establish your policies

Check your discipline• Related to codes and rules for

Telemental Health

T R A I N I N Gn e v e r e n d s

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LACK OF

PROFESSIONALS

• Must be licensed in the

state where they are

treating clients

• No malpractice

coverage

• No payment or low

payment from

insurances

REIMBURSEMENT

RATE

• Federal and State

Policies

• Federal = Medicare

• State = 50 states plus

District of Columbia

• 2 primary payers

(Medicare/Medicaid)

(Private Payer)

LACK OF PUBLIC

TRUST

BARRIERS TOTELEMENTAL HEALTH

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• People just didn't trust

technology with their

personal medical

business

RURAL AREAS

• Lack of high-speed

internet &

Smartphones

• Lack of

professionals in

their areas

• Local professionals

maybe quailifed but

want to consults

Federal Standards

• Lack of standards

until COVID-19

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CLIENTS

• Uncomfortable with

using technology


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MISTRUST OF TECHNOLOGY &

HEALTHCARE

Concern about the security of

information / Data breaches

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PART 2Benef its of Telemental Health

Face to Face vs. Telemental Health

A Comprehensive Review and a Meta-Analysis of the Effectiveness of Internet-Based Psychotherapeutic Interventions

A comparison between face-to-face and Internet intervention as

reported on in 14 of the studies revealed no differences in

ineffectiveness. The findings of this meta-analysis, and review of

additional Internet therapy studies not included in the meta-analysis,

provide strong support for the adoption of online psychological

interventions as a legitimate therapeutic activity and suggest several

insights regarding its application.

(Barak, A., Hen, L., Boniel-Nissim, M., Shapira, N. (2008))

2008 2012 2014 2016 2020

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Outcomes of 98,609 U.S. Department of Veterans Affairs Patients Enrolled in TelementalHealth Services, 2006–2010

This four-year study, the first large-scale assessment of telemental health

services, found that after the initiation of such services, patients'

hospitalization utilization decreased by an average of approximately 25%.

(Psychiatric Services 63:383–385, 2012; doi: 10.1176/appi.ps.201100206)

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Telehealth: Mapping the Evidence for Patient Outcomes From Systematic Reviews

The most consistent benefit has been reported when telehealth is used for

communication and counseling or remote monitoring in chronic conditions

such as cardiovascular and respiratory disease, with improvements in

outcomes such as mortality, quality of life, and reductions in hospital

admissions.

(Annette M Totten, PhD, Dana M Womack, MS, RN, Karen B Eden,

PhD, Marian S McDonagh, PharmD, Jessica C Griffin, MS, Sara Grusing,

BA, and William R Hersh, MD. (2016))

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BENEFITS

Medicare Improvements in 2021

• Updates to Physician Fee

Schedule

• Group Therapy 90853

• Cognitve Assessment

99347-99348

• Psychological testing

96130-96133

• RPM service are for

acute & chronic

conditions

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"A late April survey by the Sevocity division of Conceptual MindWorksfound that while overall patient volumes are low, 85% of medical practices said they were conducting telehealth visits, versus only 6% before the pandemic. And yesterday Blue Cross and Blue Shield of Massachusetts reported that claims for telehealth visits have skyrocketed 190-fold since the start of the pandemic, from 200 to 38,000 per day."

COVID-19 reveals telehealth barriers, solutions

Mary Van Beusekom | News Writer |

CIDRAP News | May 22, 2020

SINCE COVID-19

State 50 states and Washington, DC provide reimbursement for

some form of live video in Medicaid fee-for-service.

18 states provide reimbursement for store-and-forward.

BENEFITS TOTELEMENTAL HEALTH

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*21 state Medicaid programs provide reimbursement for remote

patient monitoring (RPM).

*32 state Medicaid programs offer a transmission or facility fee

when telehealth is used.


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*16 states limit the type of facility that can serve as an orginating site.

*43 states and DC currently have a law that governs private payer

telehealth reimbursement policy.

*26 states and DC explicitly note that their Medicaid program will

reimburse telehealth delivered services in a school-based setting


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CONVENIENCE

IMPROVES ACCESS TO CARE

Faster access to services

A multidisciplinary team can be in multiple settings

(Improving continuity of care)

Patient Centered - quailty of care - easy access to care

Phyiscian Centered - collaborative care

System Centered - hybrid models of care


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SENIORS &TEENS

An easier way to decrease no show rates

Children Autisum

Social Anxiety

Psychoeducation Groups

Supervision of others

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TRAVEL

& WAIT TIME

No travel for providers- (rural & local)

Flexibility-

(have multiple consults in one day with

PCP, psychiatrist, and psychologist)

POLLING QUESTION 2

Are you currently l icensed/credentialed

in more than one state?

A. Yes

B. No

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Working Out of StateTelemental Health

1 - Rules & Regulations are made for the public

2 - The originating site holds the jurisdiction3 - Some states do allow a temporary licensee

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Practicing in a New Jurisdiction

Check Off the Needs to KNOW

*Are you legal to

practice there?

*What are the legal

conditions of your

discipline?

*Are you aware of tax

laws?

*Is your promotional

materials legal in that

jurisdiction?

*Are your security &

privacy policies legal for

the jurisdiction?

*Does your liability

insurace cover the

state?

*Back up technology

avai lable

*Identify local support

(professional

organizations, local

professionals, &

community connections)

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TeleMental Health Services Across State LinesBy Ofer Zur, Ph.D."A basic thing that a practi t ioner needs to understand is that when a

cl inician is physical ly located in a state dif ferent f rom his/her cl ient,

the jurisdict ion over the therapeutic relat ionship fal ls on both states.

I t is therefore important for mental health professionals to ful ly

understand and comply with the regulat ions of both states."

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Epstein, Becker, Green 50-state Survey.

Download the App NOW

This app is a handy tool to

check what the states are

saying about jurisdiction in

their areas.

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PART 3

Ethics & Regulations

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Keep up to date!

• Risk Management

• Improving Competence

&

build your confidence with competence

Follow the code of ethics for your

discipl ine

Standards ARE required for

professionals to fol low

All the discipl ines have some form of

ethics to fol low

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Psychologists & Code of Conduct

Ethical Principles of2.03 Maintaining Competence

Psychologists undertake ongoing efforts to develop and maintain their competence.

A P A . O R G / E T H I C S E F F E C T I V E D A T E J U N E 1 , 2 0 0 3 W I T H A M E N D M E N T S E F F E C T I V E J U N E 1 , 2 0 1 0 A N D

J A N U A R Y 1 , 2 0 1 7 / C O D E /

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Counselor SupervisionCompetence

Ethical Principles ofCounselors

who offer supervision services regularlypursue continuing education activities,

including both counseling and supervision topics and skills.

A C A C O D E O F E T H I C S 2 0 1 4

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Social WorkersforCompetence

Code of Ethics According to the, standard 1.04(a), Competence, “social workers should provide

services only within the bounds of their education, training, license, certification,

consultation received, supervised experience, or relevant professional experience.”

S O C I A L W O R K E R S . O R G / A B O U T / E T H I C S / C O D E - O F -

E T H I C S / C O D E - O F - E T H I C S - E N G L I S H

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Question?

If I am a supervisor and do not provide any TeleMental Health counseling myself, but supervise someone who does, do I need to get the training?

Yes

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SupervisionKey Term


the delivery of supervision

via technology-assisted media

by a supervisor at one site

while the supervisee

is located at a distant site.

**must also include

3 additional hours of training

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Risk Management

Key Term


Understanding the privacy & security

standards

of applicable laws such as

HIPAA ensuring high-quality practices

& procedures that are legally sound

& ethically protect clients and safeguard

against litigation,

including the protection of electronic

information.

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Federal law that is for the purpose of making it easier to public information of health insurance, protect the confidentiality and security of healthcare information, and help the healthcare industry control administrative cost.

HIPAAHealth Information Portability & AccountablilityAct

Public Law 104-191, 100 Stat. 1936, enacted

August 21, 1996

HITECH ACT OF 2009

The Health Information

Technology for Economic and

Clinical Health (HITECH) Act,

enacted as part of the

American Recovery and

Reinvestment Act of 2009

Created to motivate the

implementation of electronic

health records (EHR) and

supporting technology in the

United States.

OMNIBUS RULE OF 2013

Published in the Federal

Register, which created the

final modifications to the

HIPAA privacy and security

rule.

• Business associates’

liability & requirement

changes

• Marketing and protected

health information

• Sale of protected health

information

• 10 MORE AREAS

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Protected Health Information

• Names

• Ful l - face photographic images

• Device serial numbers

• Account numbers

• Insurance pol icy numbers

• Health plan benef iciary numbers

• Electronic mai l ing address

• Social Securi ty Numbers

• Web Universal Resource Locators (URL)

• Al l Dates (death, discharge, bir th)

• Vehicle ident if iers and ser ial numbers

• Biometric identi f iers ( f ingerpr ints or

voiceprints)

• Cert i f icate l icense numbers

• Phone / Fax numbers

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BAABusiness Associated Agreement

Must have from every vendor!

Contract between a professional (entity)

and vendor (business associate) that is

used to protect personal health information

(PHI) in accordance with HIPAA guidelines.

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Collab Space Central Pitch Deck

Questions to Ask?When shopping for products?

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2

Which of the identifiers of Protected Health

Information (PHI) would your company be capable of

assessing?

May I view the results of your last HIPAA compliance

audit?

Questions to Ask?Still Shopping Keep Asking

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4

What administrative, physical, and technical

safeguards do you have in place?

Would you provide a BAA?

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THE COST $$$ OF HIPAA 2020

3A violation suffered as a direct

result of “willful neglect” of HIPAA

Rules, in cases where an attempt

has been made to correct the

violation (corrected in 30 days)

1 A violation that the covered entity

was unaware of and could not have

realistically avoided had a

reasonable amount of care had been

taken to abide by HIPAA Rules

4 A violation of HIPAA Rules

constituting willful neglect, where

no attempt has been made to

correct the violation (not

corrected in 30 days)

2A violation that the covered entity

should have been aware of but

could not have avoided even with

a reasonable amount of care. (but

falling short of willful neglect of

HIPAA Rules)

minimum $119 per violation up to $59,552 minimum $11,904 per violation up to $59,552

minimum $1,191 per violation up to $59,552 minimum $59,552 per violation

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PRIVACY RULE

Who can know

information, who can't,

when, where, etc.

any form (paper,

electronic, etc)

SECURITY RULE

How electronic information

is secured?

Administrative

Technical & Physical

safeguards

BREACH

NOTIFICATION

RULE

How do you respond to

that?

3 HIPAA RULES

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$10K1st HIPAA Penalty for 2020

Dr. Porter ’s practice in UT provides

gastroenterological services to more than

3,000 patients. OCR launched an

investigation fol lowing a report of a data

breach on November 13, 2013. The breach

concerned a business associate of Dr.

Porter ’s electronic medical record (EHR)

company which was al legedly impermissibly

using patients’ electronic medical records by

blocking the practice’s access to ePHI unti l

Dr. Porter paid the company $50,000.dsgeorgia.com

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HOW TO ABIDE BY HIPAA

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2

3

4

NPPNotice of Private Policy on every

website

RISK ANALYSISPerform them annually

POLICIES & PROCEDURESReview them annually

Risk Management PlanCreate them involving staff

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7 BEST PRACTICIESFOR RISK MANAGEMENT

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2

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4

Informed ConsentThink about social media, email, and

texting - Emergency contact number

Emergency PlansIdentify the nearest mental hospital

Identify 3 professionals for referrals

Set BoundariesCreate clear policies and procedures

Products for HealthcareBAA - a must have

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7 BEST PRACTICIES FOR RISK MANAGEMENT

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Know your jurisdictionBefore crossing, state lines do your

research.

Assess for FitUse a tool and document in the

record.

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5 NetworkJoin Associations

Local Groups

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The IPC facilitates the process for licensed psychologists to

provide temporary psychological services across state lines, in

states that participate in PSYPACT, without obtaining

additional licenses. Temporary psychological services can be

provided up to 30 days per calendar year.

ASPPB

Interjurisdictional Practice Certificate

(IPC)

https://www.telehealthresourcecenter.org

https://www.cchpca.org dsgeorgia.com

AASCB.ORG

American Association of

State Counseling Boards

SOCIALWORKERS.ORG

National Association of

Social Workers (NASW)

AMERICANTELEMED.ORG/

American Telemedicine

Association (ATA)

AAMFT.ORG

American Association for

Marriage and Family

Therapist

AMHCA.ORG

American Mental Health

Counselors Association

NBCC.ORG

National Board Certified

Counselors

ASSOCIATIONS & LICENSING BOARDS COUNSELING.ORG

American Counseling

Association

NAADAC.ORG

National Association for

Addiction Professionals

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• www.dsgeorgia.com

• [email protected]

• 678-212-5146

Stay Connected

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www.naadac.org/fundamentals‐telehealth‐webinar


Cost to Watch:Free

CE Hours Available:1.5 CEs

CE Certificate for NAADAC Members:Free

CE Certificate for Non-members:$20

UPCOMING WEBINARS

Part Two: NAADAC/NCC AP Code of Ethics, Principle II -Confidentiality and Privileged Communication

By: Cynthia Moreno Tuohy, BSW, NCAC II, CDC III, SAP and Mita M. Johnson, EdD, LAC, MAC, SAP, CTHP-II

February 12th, 2021

Wellness and Recovery in the Addiction Profession Part Two: Food as Medicine

By: Mukta Kaur Khalsa, PhD

February 17th, 2021

Rehabilitating Addiction Treatment: An Anti-Racist Recovery Approach

By: Sarah Buino, LCSW, RDDP, CADC, CDWF and Sarah Suzuki, LCSW, CADC

February 24th, 2021


Wellness and Recovery in the Addiction Profession

NAADAC is proud to present the specialty online training series

Wellness and Recovery in the Addiction Profession. Upon

completion of the six-part training series, participants may apply

for the Certificate of Achievement for Wellness and Recovery in

the Addiction Profession.

Specialty Online Training Series

www.naadac.org/certificate‐for‐wellness‐and‐recovery‐online‐training‐series

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Ethics in Practice Specialty Online Training Series

The Ethics In Practice Specialty Online Training Series will provide

a thorough dive into the NAADAC/NCC AP Code of Ethics,

bringing to life how the code plays out in the work of addiction

professionals and ways to handle and avoid ethical dilemmas.

This series is designed to accompany the NAADAC/NCC AP Code of Ethics

www.naadac.org/certificate‐for‐ethics‐in‐practice‐online‐training‐series

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Join NAADAC!

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is eligible for CEs.

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Conferences and Events

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the fundamentals of telemental health and ethics

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