"In order to practice marriage and family therapy via telehealth with a client who is physically located in California, the therapist must have a valid and current license or registration issued by the BBS.3 Therefore, LMFTs who are licensed in other states must also hold valid California licenses or registrations in order to provide psychotherapy services, including via telehealth, to clients who are physically located in California.

It is important to note that these regulations do not mention MFT Trainees. Per Business and Professions Code Section 2290.5, MFT Trainees, while under appropriate supervision and working in lawful, exempt settings, may provide psychotherapy services via telehealth. The BBS does not have jurisdiction over any complaints filed against the MFT Trainee as MFT Trainees do not hold a registration or license issued by the BBS. Nevertheless, the BBS and CAMFT strongly encourage MFT Trainees to comply with these regulations as they establish the standard of care for marriage and family therapy services via telehealth in California.

Upon Initiation of Telehealth Services
The regulations require the therapist to engage in four specific one-time actions upon initiation of telehealth services to a client. The four actions are as follows:

1. Obtain Consent: The therapist providing telehealth services must obtain consent from the client as required by the “telehealth statute” (Business and Professions Code Section 2290.5).4 The statute requires the therapist to 1) inform the client about the use of telehealth; 2) obtain from the client verbal or written consent for the use of telehealth as an acceptable mode of delivering psychotherapy services; and 3) document the consent obtained by the client in the client’s treatment record.

2. Disclose Risks/Limitations: The therapist must inform the client of the potential risks and limitations of receiving treatment via telehealth.5 This disclosure may be done verbally or in writing. Either way, documentation of the disclosure in the client’s record is recommended. Potential risks and limitations of telehealth may include: technical failures; interruption by unauthorized persons; unauthorized access to transmitted and/or stored confidential information; and decreased availability of the therapist in the event of a crisis. CAMFT Code of Ethics Section 1.4.2 also requires the therapist who is rendering telehealth services to “inform patients of the potential risks, consequences, and benefits, including but not limited to, issues of confidentiality, clinical limitations, transmission difficulties, and ability to respond to emergencies.”

3. Disclose License/Registration: The therapist must also provide the client with his or her license or registration number and the type of license or registration.6 This disclosure can be done verbally or in writing. Most therapists have this information on their Disclosure Statements or Informed Consent Forms.

4. Provide Contact Information of Relevant Resources: The therapist must document reasonable efforts to ascertain the contact information of relevant resources, including emergency services in the client’s geographic area.7 Section 1.5.3 of the CAMFT Code of Ethics also specifies that when a therapist is not located in the same geographic area as the patient, he or she must provide the client with appropriate resources in the patient’s locale for contact in case of emergency. The therapist may achieve this by sending or emailing the relevant resources to the client or by providing the information verbally and documenting in the client’s record (e.g., the therapist informed the client of the University Hospital, located on Washington Street, which provides emergency services and inpatient psychiatric services, including specialized services for children). The emergency services near the client’s location may include telephone numbers and addresses for nearby emergency rooms, the psychiatric emergency team telephone number; and telephone numbers to local crisis hotlines/centers.

 

For Each Telehealth Session

The regulations provide three actions the therapist must take each and every time he or she performs telehealth with a client. The three actions are as follows:

1. At the beginning of each telehealth session, the therapist must verbally obtain from the client the client’s name and document such name and the address of the client’s present location. According to the BBS, obtaining the client’s full name and present location may lessen the possibility of impersonation of a client. Further, should an emergency situation arise, the therapist would be equipped with information regarding the client’s location, which may change from session to session.

2. The therapist, during each telehealth session, must assess whether the client is appropriate for telehealth, including but not limited to, consideration of the client’s psychosocial situation. The BBS is concerned the client’s mental health could change from session to session, hence the therapist should assess whether the rendering of psychotherapy via telehealth continues to be appropriate for the client. CAMFT Code of Ethics , Section 1.4.2 also provides that when therapists are providing telehealth services to clients, they should take care to evaluate the appropriateness and suitability of this therapeutic modality to the clients’ needs.

3. The necessary documentation of this issue may vary, depending on the client and his or her particular circumstances. For example, in circumstances where the client is in significant distress, or has a chronic history of serious behavioral health problems, a therapist may determine that it is appropriate to document in considerable detail, his or her effort to carefully assess the suitability and appropriateness of telehealth services for the particular patient at that time. In other circumstances, it may be adequate to document that the therapist believes, based upon his or her discussion with the client, that the use of telehealth is appropriate to the client’s needs.

4. For each session, the therapist must utilize industry best practices for telehealth to ensure both client confidentiality and the security of the communication medium. Therapists who are interested in utilizing a videoconferencing platform for telehealth services are encouraged to research the platform’s security and privacy protocols, including the security of the transmission of communication. A key inquiry is whether the voice, video, and file transfers through the platform are secured or encrypted. In addition, consider researching if any video or voice data is stored on the platform’s server(s) and if yes, whether the files on the server(s) are encrypted. Documentation of the therapist’s due diligence in researching and verifying the security of the communication medium is essential. Therapists who utilize a videoconferencing platform for telehealth should take care to protect their computers from viruses that can not only damage the computer, but also collect private stored data by installing antivirus software and firewalls. The computer or mobile device used for videoconferencing should be regularly receiving the most recent security updates. It is recommended to choose strong and unique passwords for both the computer and the platform’s account. Providers who are HIPAA “covered entities” should ensure the technology used for telehealth services is compatible with HIPAA requirements." (CAMFT Website)