Policy No. 07-03
The Board acknowledges that therapy and counseling are increasingly being provided at a distance, making use of the internet, telephone and other electronic means of communication. The emergence of new clinical procedures is necessarily accompanied by uncertainty about legal and ethical obligations. The purpose of this policy statement is to offer guidance to Licensees regarding the ethical obligations and standards of conduct in the use of distance, on-line, and other electronic assisted counseling.
The Board's policy with regard to all distance or electronic-assisted provision of clinical services is as follows:
1. The services offered by licensees of this Board across a distance by electronic means, fall within the jurisdiction of the Board just as traditional, face-to-face services do. Therefore all Board policies and regulations will apply to these services.
2. Distance delivery of counseling and therapy is considered to occur in two locations: where the client is located and where the clinician is located.
3. Therefore, the provision of counseling and/or therapy to individuals located within Massachusetts at the time services are occurring, are considered to fall under the jurisdiction of the Board, regardless of the location of the provider.
4. Mental health professionals licensed by any jurisdiction other than Massachusetts, and not licensed by any Massachusetts Board or not eligible for an exception to Massachusetts licensure, are considered unlicensed by this Board for practice in Massachusetts.
5. Mental health professionals licensed by other jurisdictions who wish to provide services to clients within Massachusetts, are encouraged to apply for Massachusetts licensure. Some, licensees may find the following helpful:
a. Mental Health Counselors: 262CMR 2.03, (1) Licensure for CCMHC's in good standing with NBCC
b. MFT's: 262 CMR 3.04 Licensure by Reciprocity for MFT's.
6. Board licensees who wish to provide services via electronic means to clients located outside of Massachusetts are urged to ensure that they meet the requirements for practice within the jurisdiction where the client is located.
7. Licensees are encouraged to carefully review the way in which the structure of their relationships with clients will be impacted by distance-therapy or counseling to ensure compliance with Board regulations and standards of practice.
8. The following are some areas of practice that licensees should carefully consider:
a. Informed consent
c. Basis for making clinical judgments
d. Areas of competence
e. Avoiding harm
f. Fees and financial arrangements
h. Abandonment of clients
i. Handling requests for obtaining clinical records
9. The Board expects licensees to understand and overcome the significant challenges inherent in providing counseling and therapy without face-to-face contact with the client.
10. Some of the challenges that licensees are expected to manage include, but are not limited to:
a. Full disclosure with regard to potential risks to confidentiality, including computer hacking and/or archiving of communications.
b. Full disclosure of the limits to confidentiality in the jurisdictions where the client, and where the clinician are located.
c. Full disclosure of mandated reporting requirements in the jurisdictions where the client, and where the clinician are located.
d. Full disclosure with regard to the potential disadvantages or limitations of electronic-assisted clinical services.
e. Redirection and/or referral of clients for whom electronic services will not be adequate or appropriate.
f. Full disclosure with regard to fees and billing practices.
g. Full disclosure with regard to licensing, credentials and areas of expertise.
h. Screening and local referral for critical and urgent problems.
i. Verification of the identity and age of the client.
j. Obtaining consent to provide services by a guardian for minors or other vulnerable clients.
k. Management of any misunderstanding or compensation for any missing information, resulting from the lack of visual or auditory cues.
l. Managing the problem of incomplete or inaccurate diagnoses that may result from electronic-assisted services.
m. Managing the potential for technology failure
n. Procedures for contacting the clinician when he/she is offline
11. The Board expects that licensees providing any form of distance counseling will comply with all of the guidelines of ethical practice that apply to traditional, face-to-face counseling.
12. The Board expects that licensees will practice distance counseling in a manner that is consistent with any existing guidelines provided by their professional associations.
13. The Board expects that licensees providing any form of distance counseling will ensure that they are properly trained to manage the specific challenges of this form of counseling and will regularly participate in sufficient continuing education activities that maintain and update the required skills.
14. Unlicensed providers of electronic-assisted counseling will be treated by the Board in the same manner as providers of unlicensed counseling in traditional settings.
M.G.L. Chapter 13, Section 90; and 262 CMR 8.00 et seq.