Have you ever done a phone or video session with a client? Most therapists occasionally will, perhaps for clients who are sick or temporarily traveling. We don’t tend to think of this as unusual or as a different framework for therapy. But like many other states, California considers even a single phone session, even with a client normally seen in person, to be telehealth—and requires providers to follow its regulations on the topic.
The California Telemedicine Act
The central state law on the topic is the California Telemedicine Act, which defines telehealth in a dizzyingly long sentence. It boils down to this: if you’re in one place, the client is in another, and you’re using technology to provide a health care service, you’re engaging in telehealth. And if you’re engaging in telehealth, you need to get the client’s specific consent to do telehealth.
Note: The law uses the term “telemedicine,” while the video session feature within SimplePractice is called “Telehealth”—they mean essentially the same thing.
The client’s consent for telehealth doesn’t need to be in writing—verbal consent can suffice, but it does need to be documented. Since it doesn’t need to be an entirely separate document, it may make sense to put a telehealth informed consent into your regular informed consent document that all clients sign, just in case they may have a phone or video session at some point in the future.
California telehealth regulations
For master’s level mental health providers, the California Board of Behavioral Sciences has additional regulations governing telehealth.
At the first instance of telehealth services with a client, the therapist must:
- Get informed consent specific to telehealth, as described above.
- Inform the client of potential risks and limitations involved with telehealth.
- Provide the client with the therapist’s license or registration type and number.
- Document any reasonable efforts made to gather relevant resources, including emergency services, local to the client. (In general, riskier clients require more effort to identify available crisis resources).
In addition to those requirements, at each instance of telehealth services, the therapist must:
- Verbally obtain and document the client’s full name and current location at the beginning of the session.
- Assess whether the client is appropriate for telehealth.
- Use best practices for client confidentiality and security in telehealth.
Each of these steps is reasonable, even if they aren’t all necessarily intuitive. Gathering the client’s full name and current location is a good example. Their full name is critical in knowing that you’re talking with the right person—especially if via phone or online chat. And knowing their present location is helpful both in making sure you’re only practicing where you’re appropriately qualified, and that if the client goes into crisis or has an emergency during session, you know where to send help.
There are other pieces it can help to be aware of too, like how California handles questions related to clients outside of the state, the specific applications of each of the requirements listed above, and how to determine what “best practices” really means in practice. For those additional details, check out our California Telehealth Law CE course (1 hour CE, $19), recorded from a live event I taught this November.
As I say in that course, a few years ago telehealth in mental health care felt like the Wild West. We’ve come a long way. There are now clear, achievable regulations and reliable, secure technology for providing mental health care. It’s not the Wild West any more. For many therapists, doing some sessions via phone or online is now standard practice.