Telehealth Disclosure and Consent

This Telehealth Addendum is an addendum to the Client Therapy Contract at Well Minds Counseling and pertains to counseling services provided via the Internet. All clients are required to review this in order to proactively prepare for online sessions. Please read this carefully and let me know if you have any questions as this document will represent an agreement between you and Well Minds Counseling.  

BENEFITS AND RISKS OF TELEHEALTH  

Telehealth refers to providing health services over the internet using videoconferencing. One of the benefits of telehealth is that the client and clinician can engage in services without being in the same physical location. This can be helpful in ensuring continuity of care if the client or clinician is unable to continue to meet in person. It is also more convenient and may take less time. Telehealth, however, requires technical competence on both our parts. Although there are benefits of telehealth, there are some differences between in-person and online services, as well as some risks. For example:  

Risks to confidentially: Because telehealth sessions take place outside of the provider’s private office, there is potential for other people to overhear sessions if you are not in a private place during the session. On my end, I will take reasonable steps to ensure your privacy. It is important for you to make sure you find a private place for our session where you will not be interrupted. It is also important for you to protect the privacy of our session on your cell phone or other device. You should participate in the session only while in a room or area where other people are not present and cannot overhear the conversation. 

Issues related to technology: There are many ways that technology issues might impact telehealth. For example, technology may stop working during a session, other people might be able to get access to our private conversation, or stored data could be accessed by unauthorized people or companies. 

Crisis management and intervention: Usually, I will not engage in telehealth with clients who are currently in a crisis situation requiring high levels of support and intervention. Before engaging in telehealth, I will determine if our meeting is appropriate for telehealth and inform you of any concerns.

Efficacy: Most research shows that telehealth is almost as effective as in-person care. However, some providers believe that something is lost by not being in the same room. For example, there is debate about a provider’s ability to fully understand non-verbal information when working remotely.  

WASHINGTON STATE LAW  

Arizona law allows for the practice of telehealth between a qualified healthcare professional and a client at home or in another private location. The sessions may take place over an audio, video or other electronic media platform.  Also, the healthcare professional must be licensed to practice in Arizona in order to treat a client physically located in Arizona. If you move out of state or are temporarily out-of-state, we will be unable to engage in treatment. Note that the videoconferencing service that I use will log your physical location based on your internet signal, providing evidence you were in Arizona.  

CONFIDENTIALITY  

I have a legal and ethical responsibility to make my best efforts to protect all communications that are a part of our telehealth. However, the nature of electronic communications technologies is such that I cannot guarantee that our communications will be kept confidential or that other people may not gain access to our communications.  You should also take reasonable steps to ensure the security of our communications (for example, only using secure networks for telehealth sessions and having passwords to protect the device you use for telehealth).  

The extent of confidentiality and the exceptions to confidentiality that I outlined in the Client Therapy Contract and Privacy Protection Notice still apply in telehealth. Please let me know if you have any questions about exceptions to confidentiality.  

TECHNOLOGY  

Doxy.me is the videoconferencing service that I use for telehealth sessions. Doxy.me is a secure, encrypted videoconferencing service that allows for secure conversations. It meets HITECH and HIPAA standards.  

You will receive a separate document with instructions and a link for your session.  

If the session is interrupted, we should both disconnect from the session. We will both wait two (2) minutes and then attempt to reconnect. If either of us is absent from the videoconference after those two (2) minutes, please call or text me at 425.588.9280.  

If there is a technological failure and we are unable to resume the connection, you will only be charged the prorated amount of actual session time.  

You are solely responsible for any necessary equipment, accessories, or software needed to take part in telehealth. If you do not have the proper internet access or equipment, please inform me in advance so that we can consider other options. 

TECHNOLOGY SET-UP  

In preparation for your sessions, please make sure:  

• Lighting on your face is adequate enough to minimize shadows so that your facial features are easily seen. 
• Your eyes are seen 1/3 down from the top of the screen and your shoulders are visible. 
• The microphone is close enough to your mouth and the speaker volume is appropriately loud.  

TIPS FOR A SUCCESSFUL TELEHEALTH SESSION  

The effectiveness of telehealth can be greatly impacted by what is happening in your environment. During sessions, it is important that:  

• Background noises are kept to a minimum (the microphone amplifies sound).  
• No one will disturb you – a “do not disturb” sign on your door may be helpful. 
• You abstain from checking email or other multitasking.   
• You are at your house or other quiet place during the session – not driving or walking.  
• If there are other people nearby, you should consider using headphones for privacy (if there are others participating in the session, there should not be others nearby, in order to protect others’ privacy).  
• If the distractions or disturbances cannot be managed, I may end the session early and determine that the telehealth format is not appropriate. 
• If anything in my environment is a distraction or if you cannot hear or see me well, please interrupt whatever is happening and alert me as soon as possible.  

FEES  

In Washington State, telehealth fees are the same as for in-person sessions. It is your responsibility to ensure that your health insurance plan covers telehealth. If your insurance does not cover telehealth, you will be solely responsible for the entire fee of the session. Please contact your insurance company prior to our engaging in telehealth sessions in order to determine whether these sessions will be covered.  

RECORDS  

The telehealth sessions shall not be recorded in any way unless agreed to in writing by mutual consent. I will maintain a record of our session in the same way I maintain records of in-person sessions in accordance with my policies.  

INFORMED CONSENT  

This agreement is intended as a supplement to the Disclosure and Policy Form you signed when first starting services at Well Minds Counseling, LLC. It does not amend any of the terms of that agreement.