Season 1,
Telemental Health,
61 MIN 22 SEC

Episode 105: Telemental Health

October 26, 2017

This Episode’s Sponsor.
Coupon Code: therapytech


Is telehealth the wave of the future? Can it benefit you, your practice, and your clients? What are the legal and ethics considerations of providing distance counseling services?  And really, what IS telemental health and how many different things can we call it?  Join Rob, Roy and their guest Jay Ostrowski, as they take the scare out of scary!


Show Notes
  • :13

    Scary Telemental Health

  • 2:30

    Taking the Scare Out of Scary – Why Telemental Health?

  • 3:28

    What Is Telemental Health?

  • 5:23

    Get Started Inexpensively – Do Your Cost/Benefit Analysis!

  • 8:43

    New Revenue Stream

  • 9:08

    Client Benefits

  • 10:17

    Is Training Necessary? w/Guest Jay Ostrowski

  • 30:25

    Describe Question – What Is Jay’s Hidden Talent?

  • 34:11

    Survey of Standards

  • 35:09

    Across State Lines

  • 39:56

    Ethics Considerations

  • 48:05

    Insurance Reimbursement

  • 52:20

    Technology Selection

  • 56:49

    Next Steps – Getting Started

  • 59:53


Episode Transcript
Rob: Therapy Tech with Rob and Roy, the most fun therapists can have listening to a podcast about technology. This episode of Therapy Tech with Rob and Roy is brought to you by makes running your practice easy, organized and secure. Try it out risk free,  
Wooo, it's our October episode. It's spooky. I'm Roy.  
Roy: I'm scared Roy.  
Rob: Are you scared Rob?  
Roy: I'm really ... You're scaring me.  
Rob: It's okay, you don't have to be scared of telemental health.  
Roy: Welcome everybody to our telemental health episode. I'm Roy.  
Rob: And I'm Rob.  
Roy: And this is-  
Rob: And together we make ...  
Roy: Therapy Tech with Rob and Roy.  
Rob: Dun, dun, dun.  
Roy: Dun, dun, dun. Great, okay. So telemental health. We can just talk about the whole thing in an hour. Right?  
Rob: Yes, actually we really only have about less than 40 minutes because our guest spot takes up a good 20, so yeah.  
Roy: Yeah.  
Rob: Yeah, so everybody listen because we're going to be talking really, really quickly. We're gonna cover it all.  
Roy: Right. All the whole thing. Yeah. Okay.  
Rob: Yes.  
Roy: Yeah, we should probably start by saying we can't cover it all. That's the first item of covering it all. And the reason I say that is-  
Rob: We could-  
Roy: What's that?  
Rob: We could mention all the things we should talk about.  
Roy: I actually think that's a really good idea because I recently ... You know Michael Jones? He's one of the people who's been teaching telemental health stuff for a while, or distance counseling at least. Right? Because Arkansas is one where counselors have to get special training program before they can even pick up a phone to do with clients, like to do any technology.  
He's been teaching that for a long time, but I saw him at the ACA Conference presenting some research on how well people who are doing telemental health actually understand all the standards.  
Rob: Uh-oh.  
Roy: Yeah, yeah.  
Rob: I bet it didn't go well.  
Roy: It didn't, no. They found a lot of information about people not understanding, especially some of the more ... Like the less tech-oriented stuff like crisis plans, and how you identify clients when you have a session with them and all those kinds of standards.  
People aren't familiar with that because we tend to stick to the basic basics and a lot of the training doesn't get further than those basics of things like choosing the right video software. I think it's a good idea to make sure we cover all of it today.  
Rob: Yep but that's all scary Roy.  
Roy: It is scary. That's okay. It's Halloween episode. It's supposed to be scary.  
Rob: But we'll take the scare out of scary.  
Roy: Yeah, woo-hoo. Oh okay, yeah I don't know. Just roll with it man. Just like-  
Rob: So why are people doing this. I mean if this is so scary, and they don't know what they're doing, why are they doing it?  
Roy: Why are they doing it? Oh, well I think there's a lot of reasons. I'm finding at least at our office hours at Person Centered Tech, a lot of people are doing telemental health because an existing client is moving. Or the existing clients has some reason why they want to be able to see their therapist from home. Maybe for access reasons or something along those lines, and a lot of people are starting to do it.  
Rob: Yeah, I actually run into that. I still do clinical work. You do as well. I still have clients now that maybe they have a child sick at home, or they are running late leaving work. We have some definite traffic issues in our area where I live. Being able to say, "Hey, let's still meet," is nice.  
Roy: Yeah, and it's interesting because we used to talk about the idea of phone sessions, but a phone session is telemental health. That's definitely becoming the standard. We used to just sort of think of it as not much different from meeting in person, but now it's in that category. A lot of people are saying, hey, well why not just do video? Why not do the whole thing instead of just limiting it to the phone.  
Rob: Exactly. Depending on where you are, there's some other mitigating factors. There are things that'll move you toward doing the video like some insurance companies will only reimburse if video is involved. They won't reimburse for telephone.  
Roy: That's right, and luckily, I'm actually starting to have colleagues tell me they're getting reimbursed for the phone by insurance companies as well. So I'm guessing even that might change, but maybe not. Maybe that's just a few of those companies.  
Rob: Well, and if it does change, it would be slow like always.  
Roy: Exactly. Yeah, and the other cool thing that people are doing that's telemental health is they're starting to say, hey, there are these cool apps. There's this tech that helps me do better work that I can't do without telemental health.  
That's especially true with people doing certain kinds of modalities like cognitive behavioral therapy. You know, CBT involves a lot of homework. Right? Well what if the homework is automated? What if there's some system that helps you track homework or helps clients do homework? That's telemental health. Right?  
It's not what we tend to think of when we say online counseling or distance counseling or telepsychology or those kinds of phrases. I mean there's like 40 million different phrases. But it is telemental health when you use an app or something like that to help the client work in between sessions.  
Rob: Absolutely.  
Roy: And you can get to some pretty cool stuff with that. There's some amazing interventions you can do if you start thinking about the tools available and get creative with the tools. A lot of the people who are kind of leaders in tele-health in general talk about that a lot. Just being like, hey, as soon as you get into this, and you understand the basics, then suddenly your imagination can start to run with it and be like, "Wow, I can think of a cool intervention my client could really use." How can I put that together for them? That's telemental health.  
Rob: The great thing about it is so many of those tools and options are really affordable.  
Roy: Exactly, that's the cool thing.  
Rob: You don't have to go out and invest thousands of dollars in this new modality that you want to use. It's actually very low entry cost.  
Roy: Yes, that's right. Yeah. Especially these days, and if you're doing what most people do, and you're starting by wanting to be able to just remotely work with your existing clients. And then you're slowly moving into the bigger stuff, you could even get into it for free. As long as you've got a good computer and a good camera and a good space. Some of the basic software you need can actually be acquired without any monetary cost.  
Rob: And to be clear, you mean free on the technology side because you may need to invest in some training, and we're gonna get into that later.  
Roy: Yeah, yeah for sure.  
Rob: But from the technology side, free is about as low-cost as you can get. Right?  
Roy: It is. Yeah, I can't imagine somebody paying me to use their software. That would be lower than free. Right?  
Rob: It would be awesome.  
Roy: Awesome. It would be amazing. Okay. See that would make it a lot less scary right there. You know, someone paid me to use their software. That would be fantastic.  
Rob: Yes. That's not a hint to you software developers out there at all. Not a hint at all.  
Roy: No.  
Rob: That we would gladly work with your software if you pay us.  
Roy: Right. Yep. I'm sure that's generally true of a lot of situations. There's also potentially cost savings if you really get into it. Yeah, there's reduced travel costs. I find for me, it doesn't reduce my costs, but it can definitely reduce client cost.  
Rob: Well and it depends on especially if you get to a point where you're doing all telemental health. Now you can do this all potentially from your home. You don't have to rent office space. There's a number of different ways that you can reduce costs. Especially if let's say you live remotely, and if you did have an office, you would have to travel 30 minutes each way.  
Roy: Right.  
Rob: So lots of different ways, and it can reduce costs in similar fashion for clients who might have to travel.  
Roy: Yeah, I think the bigger costs savings, I've found are for the clients actually. Especially because my office is in downtown Portland. So depending on where they are, it can actually be kind of travel expensive to come get to me. Unless they're one of my clients who works in downtown, which is the convenience point.  
I gotta say, in terms of costs though, I mean to be sort of like to quibble with the whole cost saving thing that everyone talks about with telemental health, my apartment is a two-bedroom apartment, even though my wife and I don't need one. We don't need an extra bedroom except for the fact that I need a private room in which to do my telemental health sessions.  
So it actually increased our costs. We would have a much lower rent cost, if I wasn't doing telemental health because my office downtown doesn't have a strong enough internet connection to doing telemental health from it.  
Rob: Ah.  
Roy: Yeah, so it's like it can actually ... I was actually talking to people who have that kind of situation, where they're like, "Hmm, actually I need to get a private space and arranging the private space in my home was actually more expensive than sharing office space with somebody." Or others who say, "Yeah, I saved money because now I don't have to travel." I mean that's the other side. If all of my practice was telemental health ... I use mass transit to get to downtown, but I'd be like, yeah, it's about 75 bucks a month in bus fees that I would save if I did it all from home.  
Rob: So what you're suggesting is as with many things we talk about, people should do their homework, do a little research, put some numbers to paper, and kind of figure out what it's gonna look like for them.  
Roy: Yeah. Makes a lot of sense. Right, yeah for sure.  
Rob: So Roy, as part of that cost benefit analysis, the other thing people can look at is what is the potential for increasing their revenue stream? Do they have the possibility of seeing more clients for some reason by doing telemental health, whether that's because they're able to reach clients in rural locations, who don't otherwise have services or grow their group through telemental health. So that's another benefit of going that direction.  
Roy: Yeah, that's definitely true because there are a lot of opportunities out there where people aren't getting served, and telemental health can allow you to serve them. So that's true, that can bring in more revenue.  
Rob: Right. And people in rural locations aren't the only situation where clients can benefit. You have people who maybe deal with anxiety, the stigma of going into a mental health office, maybe you're in a very small town where everybody knows each other. So that can help them, whether it's deal with anxiety or deal with not dealing with social situations or privacy issues that they might want to deal with.  
Roy: Right. That's very true. I think there's an episode of Web Therapy about that. The Lisa Kudrow web series where she's like a terrible psychologist who does everything online. I think there's one where Conan O'Brien is her client, and I think he does it that way because he doesn't want to be seen walking into an office, if I recall the episode correctly.  
Rob: I think you're right, and I think I highly recommend that series as a thing to watch to view on learning how not to do things.  
Roy: Right. It's great for training in the opposite sense. That's Web Therapy folks, with Lisa Kudrow. It's online. The thing is though, if we want training that isn't the opposite way such as watching Web Therapy, there's kind of the question of what's the best way to do it. And a really important question, do you need it? Is it something that without training, you can go do? Or do we really need to get training? I kind of wish I could get some good info about that.  
Rob: Yeah, I wonder who we could talk to who has been around tele-health for a while, knows about training and certification. If we could just find just the right person that would know those kinds of things.  
Roy: I know. Wouldn't that be great? Oh hey, someone's at the door.  
Rob: I'm shocked. Let's see who it is.  
Roy: Who is it Rob?  
Rob: Oh my gosh, it's Jay Ostrowski. We like summoned him.  
Roy: He's great. He's perfect for this exact moment.  
Rob: So our sponsor for this episode is Counsol. Counsol's been around quite a while. They were actually one of the first practice management systems I was aware of that integrated video into the practice management system along with their billing and note-taking and other features.  
Roy: I've always been impressed by how Counsol really covers the things that therapists really want in a private practice. They've always been very attentive to what is the thing you need, and their feature set is fantastic.  
Rob: And they've offered a very special offer for our listeners. You can use the code "THERAPYTECH". I wonder where they came up with that. "THERAPYTECH" is the code.  
Roy: That's a good one.  
Rob: And that'll get you five dollars off your monthly rate for an annual savings of $60.  
Roy: Oh that beats a kick in the pants.  
Rob: And of course, they have a risk-free trial.  
Roy: We are extremely lucky to have telemental health mega-expert Jay Ostrowski here. I was gonna say Jay's letters after his name, but he has ... It like takes up a whole line, so I figure I'm not gonna bother, but he is a professional counselor. In fact, in North Carolina, where you are Rob.  
Rob: Exactly.  
Roy: Yeah. So welcome Jay.  
Jay: Welcome. Thanks for having me.  
Roy: Awesome.  
Rob: Yeah, great to have you Jay.  
Roy: I'm gonna read Jay's bio because it's actually kind of like somebody being super subtle about their qualifications, but listen to this. Okay, so Jay Ostrowski is the CEO of Behavioral Health Innovation and Adaptive Telehealth. Jay's passion is research and development in the telemedicine field. Thus far, Jay has led the development of eight HIPAA secure telemedicine software platforms. Okay y'all hear that, eight different software platforms, created nine peer-reviewed telemental health training courses for national certification and created many innovative niche-treatment programs.  
So he's not even necessarily specifying how interesting those are because that actually, if you learned what those are, that would be really impressive. He also serves as a consultant partner for the Mid-Atlantic Telehealth Resource Center providing telemental health technical assistance, helping organizations start up and scale telemedicine services including telemental health, telebehavioral health and telepsychiatry.  
So basically, this is just a very short way of saying, there's probably no one in the mental health field who knows what's going on with telemental health better than Jay. And I know that Jay is a very humble person who doesn't like to say that sort of thing, so I'll say it for him. Thanks so much for coming here Jay.  
Rob: I think he's like the top five people that know stuff about telemental health.  
Roy: He's all five of them, yes. You mean he's one of the top five? Or he is all five?  
Rob: I think he covers the first five slots.  
Roy: Yeah, I think so as well. I think so as well.  
Jay: If I keep eating, I think I might show that physically as well.  
Roy: There you go.  
Jay: But that's very nice, thank you.  
Roy: Welcome Jay. Okay just a little quick ... just a little intro, what have you been doing lately?  
Jay: Well we've just been part of a team that created a DSM module where people can do like a little checklist to check off clinical criteria and basically auto-document like am I diagnosing properly, and have I documented that I've diagnosed properly. So we just did that in a HIPAA-secure platform, and rolling out some kind of workflow features for different companies to kind of automate a lot of their processes because I'm allergic to paperwork.  
Roy: Yeah, yeah.  
Rob: Yeah, I think that's a requirement for our field.  
Jay: I don't like to type twice. Anything a computer can do for me is what I prefer.  
Roy: Right on. We are of the same heart, I think. Okay, well let me ask you then because we're really interested in having you update us on what is going on these days. So let me just ask you a couple of questions and then get your opinions on that.  
The first one is, so we talked already, a little bit about how private practitioners can try to track clients for telemental health. So that means attracting them in an independent way, but you've been telling me, every time I see you, about stuff that's going on in sort of managed care or just third-party payer facilitated telemental health. Can you tell us where that is right now?  
Jay: Sure. So a lot of the third-party payers are in governments actually, state governments, city governments, county governments, are kind of getting the memo that providing outpatient treatment is much, much cheaper than inpatient treatment. So they are trying to basically divert people towards wellness or early intervention. So they're basically tracking more, what are symptoms, and what are the outcomes of treatment, to see if they can identify these people early and see what treatment is more effective.  
Of course paying people for outpatient is preferable, but there's a shortage of mental health providers across the nation. And that might feel like a little bit of a pinch if you're in private practice, and you're not full. You're like what? There's no shortage. I want more clients. There really is a shortage, and it's not just psychiatry. It's the entire spectrum of mental health care.  
I found that a lot of people are laser focused on psychiatry because it's kind of one of the biggest things that people ... That are expensive. If you have a hospital per se, and you have people waiting for a hospital bed. And you have a whole bunch of mental health patients in your emergency room that are taking up space and resources, and they shouldn't be there, you need a mental health counselor to do an assessment or a psychiatrist to do an assessment to kind of discharge them to the appropriate level treatment.  
That's where a lot of healthcare systems are feeling that pinch. But then when people think of, well how do we prevent those people from going to the ED in the first place? That's where there's a lot of opportunity for, how do we identify people that need help? How do we divert them to tele services? Where are those services?  
And then a lot of the Fortune 500 companies that I talk with, we're talking like IBM, Apple, Facebook, Chase Bank, Johnson & Johnson, these are worldwide companies that have expatriates in other countries, but they are American citizens, and they need expert help. They could be as far away as that really distant country Canada, or Mexico or Roy's favorite place in the world, Japan.  
Roy: Yeah.  
Jay: So it could be they're working for maybe a Fortune 500 company, and they go there. And their family members are struggling. Not just the employee, but usually insurance covers their whole family. So there is obvious needs right there, but I think as you're ... You're a private practitioner. You're thinking, "How do I actually connect with the need?" I think it's to not look at, okay, who's gonna send me clients today kind of thing, but how do I develop relationships with people that are feeling that shortage?  
It could be a group home that's 100 miles from you. It could be a primary care doctor around the corner that can't get his patients to go to therapy. But you really need to be cultivating referral streams. There's also Medicaid. And people, "Oh I don't want Medicaid clients." But there's actually block grant money that each of these states and sometimes even more local governments have. They have to facilitate treatment.  
One of the cool companies I'm working with is actually, they do equestrian care. And they're gonna do part of their equestrian care through telemedicine, and they're county government is paying for those services. So it's about who has this need, who's feeling this shortage, and connecting with those organizations to be their outsource provider.  
Roy: I have an extremely important followup question Jay. How do you get the horse onto the video?  
Jay: It's very easy. My question was, do you have to have the licensed person on their profile or the horse's? And the therapists are very clear that it's the horse that does the therapy.  
Roy: Right. Okay, there you go.  
Jay: So I at least get that answer.  
Roy: Right, right. There's an answer. I was joking, but wow. Okay.  
Jay: [crosstalk 00:18:59] through the internet fibers or anything.  
Roy: Yeah, right. Okay. There you go. Yeah, it's interesting because this is what we're also saying about trying to find general opportunities as a private practitioner. It's like just hanging a shingle or putting up a website saying I do online therapy, really it doesn't work. You need to connect with people who are actually looking for therapists and can facilitate getting the client to you through telemental health. I mean that seems to be the way it works. Right?  
Jay: Yeah, it's supply and demand. So where is the demand? And that's where you go and add your supply. I mean I know it sounds over simplistic, and there's a little bit of hard work there, a little bit of research. But if you do go look, if you start to smile and dial different behavioral health organizations or mental health organizations, you're gonna find they have three and four month waiting lists.  
Roy: Oh wow.  
Jay: You go, and you say to their director, "I can help you relieve some of that pressure." I think another way, if I was gonna be looking for work that way, I would be looking at the want ads. Where are they looking for therapists? If they're looking for therapists in some remote area, which they usually are, usually mountains or deserts, places people don't want to live because there's no night life, or there's no other economy in the area. Right?  
But there's usually a shortage in these rural areas, and if you can contact them and say, "Hey I know you have this ad for therapists, but I can actually do lot of this online for you. Let me give you a little example of how that would work." And then you'd set up a little video interview.  
You know, you might have to give them a little background information on this stuff and connect with one of the telehealth resource centers to help you kind of convince them of that, but there are places that are just like they can't meet their state mandate for services, and you can be the answer to their prayers.  
Roy: Will the telehealth resource centers tend to have any type of guides or directories on who's looking for people?  
Jay: Not at this point, but they are usually in contact with people trying develop services because they have that need. And those are those higher level organizations that have a budget for this. So that would be a good place to tap into who's looking for an online therapist, and can you connect with people in my state.  
Roy: Right nice. Okay great. So telehealth resource centers, and that's a thing I think most people don't know about, and I know you're involved with them. So thanks for mentioning that. We'll definitely put that in the show notes. People who are interested in hanging a shingle, doing online therapy really should know all about those because that's a fantastic resource for people who want to do telemental health.  
Jay: Yeah, it's federally funded. It's funny. I didn't even know there was an office for the advancement of telehealth. It's part of the health and human services. And also SAMHSA and HRSA, there are many organizations under health and human services that are actually in parallel working on telemental health and telebehavioral health services and really promoting that.  
The diction of technology and transfer centers, I think they sometimes focus on different types of technology, and they're just kind of getting into the telemental health part. But those are another good resource to connect to.  
Roy: Okay, and I got one more question and then Rob's got a really important question for you that's gonna just blow everyone's minds.  
Rob: Dun, dun, dun.  
Roy: Right exactly. My other question of course, and of course I have a vested interest in your answer, but you don't have to address that at all Jay, you can just give an honest answer. Which is, do you need to be trained before you can do online therapy, and if so how do you get it? And what do any of these certifications that are out there mean?  
Jay: I would say only if you want to be legal and ethical. So it's-  
Roy: Only then.  
Jay: [crosstalk 00:22:33] answer. Really.  
Roy: Okay. So you're saying it's needed. You're saying you gotta do it.  
Jay: Well, if you don't, and your license board finds out, or your association finds out, you could be sanctioned or fined or lose your license.  
Roy: Okay, well all right.  
Jay: I don't know whether that's incentive enough or not, but also there's this part about, well you could lose your malpractice insurance too because you're basically practicing out of scope. While telemental health is the same thing as mental healthcare, it's just a different mode of how we do the same care. There are some, a few ways where it can be dangerous to your clients. Not like dangerous like an ax murderer's gonna come to your house dangerous, but dangerous in that there are some very clear ways where you can violate laws, state laws or federal laws, for privacy, security.  
Again, outside of the scope, across state lines, and you're really gonna want to know what to do in a crisis, how to be HIPAA secure, HIPAA compliant, how to choose technology, how to onboard people. Basically, like therapy ... I'm a therapist too, and I wanted to know kind of where can I mess up, where are those boundaries, what are the outer boundaries.  
And once you learn the outer boundaries, and then you feel pretty comfortable with everything in between, that's where some of the arts come in of doing therapy. But you want to know that you have covered all the bases, and that you're gonna be sound and do good work that way.  
Also, you're gonna feel more confident and comfortable, and then you're gonna have talking points to give to people that ask you these questions as well. Of course, I'm a big fan of your courses, of course. I think you are someone that does their homework, and some people might go, "Wow, it's a little bit more detailed than I'd want." But at least if you go through these details, you know you've got it covered. And making those checklists and worksheets really kind of help you remember those things.  
So I think it's very important. I've been a part of making courses for a national certification that's coming out soon. We say soon because there's bureaucracy involved. It's a board certification telemental health. You can take three of the courses online at your leisure at  
I get no anything from that. It's a nonprofit organization that provides this training. It's part of ... I think they're closely affiliated with the University of Virginia, which have been doing telehealth for near 20 years, very, very good reputation. And that's eventually gonna be offered through the Center for Credentialing and Education, which is basically a wing or affiliate of the National Board for Certified Counselors.  
The training there, it's meant to be multidisciplinary, so it's for counselors, psychologists, social works, psychiatrists, the whole ... We aggregated all of the laws and ethics and best practices and the research, and put it into here's the essentials. Then we had it peered reviews by about 20 other telemental health professionals, the top people in the field. So very sound and well documented training.  
That's coming down the pike, and ... You know, we just had this debate yesterday. Is it "pike" or "pipe"?  
Roy: It's pike.  
Rob: Pipe.  
Jay: Actually if you-  
Roy: No. What?  
Jay: Yeah. No, it's like ... Come on. That's the weasel way out of things.  
Roy: Right. Uh-huh, sure.  
Jay: My wife is a writer, and we had this big debate yesterday.  
Roy: Okay.  
Jay: [crosstalk 00:26:00]. So Ray Barrett also, his Telehealth Certification Institute, I think it's called.  
Roy: Yeah, that's right.  
Jay: Also, has been a part of reviewing those courses and helping write some of those parts of that, so I think he's also one that would have quite a bit of information on that too.  
Roy: Right. Makes sense.  
Jay: There are many trainings out there on the market. They age quickly. This one is the most up-to-date as of now. By design, we've designed it to keep up, basically refresh it pretty frequently. Hopefully that does come out, but these are ... Again, you want your training from kind of credible sources and very practical. These are meant to be very practical, down-to-earth, and for people that want to do specifically video and be legal and ethically competent.  
Roy: Right. Great. So there's a lot of private organizations that will do certifications including for example, I created most of the coursework for the Zur institute, and they have a certification. So talk to me about the CCE's upcoming certification, and what its concrete value is compared to some of these private ones.  
Jay: I'm no longer with CCE, but I can tell you just in a general sense. CCE is a third party, so they have a set of standards in their ... They work within guidelines for what certification companies, what are best practices in certification. So there's even certification certification people. I don't know who certifies certification certifiers, but that's a different podcast.  
Roy: All right.  
Jay: So a lot of people kind of make their own content, and then certify their own content. It's like, I'm the greatest, and I certified that I'm the greatest.  
Roy: Right.  
Jay: That's not the best practice. The best practice is to have a third party make the content, have it peer reviewed, have kind of standards and apply those standards. So that's more of the CCE style, and what proper certification would look like.  
Roy: Right. Yep, yeah. And I want to say as a person who is developing courses as part of one of those, yeah, I entirely agree. And of course, I know for some people the reason they'll give a certificate is really just to show the learner that you finished it.  
Jay: Yeah. There's a difference between a certificate and certification. But I think even the people that provide these documents, don't always know the difference.  
Roy: Right.  
Jay: Certification's meant to be a third-party inspection, and even a third party inspection of the content of the curriculum.  
Rob: So Jay, you've mentioned a couple of places we can rely on for that, and we'll certainly have them in the show notes. As people are looking around, is there an easy way for them to tell, oh these are people that are just gonna give me a certificate versus this is somebody who's had this peer reviewed and has done their homework. What can people look for?  
Jay: Golly, you're asking the right questions.  
Roy: We're good at that.  
Jay: One more I would mention is that American Telemedicine Association has put out some more third-party documents. They do have quite a bit of industry influence, but they are giving it the college try of also staying independent. They have, I think it's a three-hour course, that's meant more for psychiatrists that is also a fairly good course as well. I've been through it.  
I think it's just asking the questions of who's the third party that certifies your information. And they can just look for are they both the content creator and the certifying body. I think that's the main thing to look for.  
Roy: Right. And I'll say in defense of those, I mean I guess I got to, is just I always do view those certificates as just being the content creator is going to give you some kind of document that says, "You've completed our course set."  
Jay: Yeah. I mean there's nothing wrong with them. They just say, "I attended." Right?  
Roy: Right.  
Jay: And you can attend and sleep through things.  
Roy: That is true, unfortunately. Right.  
Jay: And I will say, there is lacking in the industry, kind of a third-party test, like check out. When I was first making the credential, I was advocating strongly that we'd have a third party say, "Okay, I have seen this person on video, and they presented to me their first session." So [inaudible 00:30:06] go through, but that was shot down because it was logistically difficult.  
Roy: Yeah, that's hard.  
Jay: But you know, that's what it would really look like if we were to do that. It might come some day.  
Roy: Right. It might. Okay, yeah. Well thanks a lot Jay. I think we should probably get to Rob's highly important followup question.  
Rob: Describe comes with over a dozen activities that can be used with clients of all ages. Find out more at  
Jay, each time we have a guest, I don't know if you're familiar with my Describe Deck. I created it for therapists to use with their clients. But we pull a random card out and ask a random question to our guest, so I hope you're ready.  
Jay: We can't see your air quotes when you say random.  
Rob: Exactly. So the word for today is "talented". And your question is, what is a hidden talent that you possess and haven't been able to fully explore?  
Jay: Gosh, probably playing video games. Actually, my terraria in Minecraft has become ... I have two boys, and I've spent many hours bonding over ... Actually you know what? That's not true. It's actually building Lego, I think is probably my hidden-  
Roy: Oh nice.  
Rob: Those both are connected to the young child at home situation. Aren't they?  
Jay: Our living room was constantly full of Lego for the first 10 years of our parenting. Maybe after that, maybe 12, so yeah, I think building crazy Lego structures is probably ... We have four giant bins of Legos. And I mean giant like the kind that don't fit under the bed, they're so big, giant things of Legos because we've for years.  
Rob: This home sounds familiar.  
Roy: Yeah, I was gonna say, you'd be very welcome in Rob's home, by the way Jay. You guys should get together.  
Jay: And even though my boys aren't playing with them actively. They're 14 and 16 now. There's no way in the world, they will let us get rid of those Legos.  
Roy: Right, of course not. No.  
Rob: So if Lego were to hire you to create a brand new Lego set, what would it be?  
Jay: I don't think that's in your random stack.  
Roy: No, I've seen it. I have a copy of Describe. It's totally in there.  
Jay: You know, I'm drawing a blank on that one. But the unfortunate thing is now that you've asked the question, I'm just gonna noodle on it for days coming up with that answer.  
Roy: I think you'd build a full-featured completely broad telemental health platform out of Legos. That's what you'd do. Right?  
Rob: Exactly. Well his first answer is probably Minecraft because of the other things going on in the home, but they're already doing that.  
Roy: Yeah, exactly.  
Jay: I don't know if you can do fall out or, that would be appropriate.  
Roy: That would be a hilarious Lego set.  
Jay: Well thanks for having me on. I really appreciate it and good luck to you in getting the word out. I appreciate you guys doing that and all your support for [inaudible 00:33:13].  
Roy: Yeah. Thanks Jay. Thanks so much for coming on. We know you're extraordinarily busy, so we appreciate you taking the time out to be here.  
Jay: I'm grateful to be a part of it. Thanks.  
Rob: Jay is there anything else you want to point people to? Any resources, anything you're doing, you want to make sure people are aware of?  
Jay: If you're interested a HIPAA-secure platform, you can go to and contact us there. If you need help getting off the ground starting services, we kind of do the wraparound boutique thing where we help companies get everything they need to get going and even coach them through that process.  
And also the Telehealth Resource Centers, just Google that, and you'll get a national directory of the local ones near you. There are actually 14 of them federally funded groups that can help you guys out.  
Roy: Great, and also in the rest of this podcast, we're mentioning a lot of, which is one of Jay's creations. And we'll have a link to that in the show notes as well. All right, see you next time Jay.  
Jay: Thanks guys. Bye-bye.  
Rob: Thank you Jay. All right, Roy, we got pretty lucky again, getting a guest on here who'd talk directly to what we were having questions about. It certainly sounds like we might want to make sure we do some training in this area.  
Roy: Yeah, I guess so. Yeah, it's pretty important, and also definitely considering whether or not you want a proper credential or just training that covers the standards. It's kind of interesting because there are a lot of standards around telemental health that a number of trainers don't really know about. Because like we were talking about earlier, people tend to stop at the technology, so maybe even getting one from someplace that's credentialed could help ensure that you cover everything.  
Rob: Right, exactly. And you know, we talked at the beginning of the episode about this all being scary. I hope most people agree with me that part of tackling fear is educating, finding out the answers, and removing that fear.  
Roy: Absolutely. Absolutely. That's true. Right. Well okay, so speaking of standards, why don't we try to give a survey of those. I'm sure that's a lot of what people are interested in hearing from us. Right?  
Rob: Yeah, sure. So-  
Roy: Besides jokes.  
Rob: Let's start with the legal stuff, insert caveat that we are not attorneys and this does not qualify as legal advice.  
Roy: Okay, yeah. All right, so I'm in Oregon, and I can go ahead and just hang out a shingle saying I work with clients in North Carolina. I am an Oregon LPC. I am qualified to work with people in Fuquay-Varina, North Carolina, right near Rob. So I can poach all of Rob's potential clients. That's gonna work. Right?  
Rob: That'd be just like you Roy. Just like you.  
Roy: It's just like me.  
Rob: Unfortunately, that's not gonna work. It would be kind of like you hanging out, oh remember, you almost became a psychiatrist. It'd be kind of like if you hung out that shingle as a psychiatrist that time that somebody accidentally listed you as a psychiatrist. Yeah.  
Roy: Yeah. Healthgrades just handed me a whole lot of extra education right there. Yeah, that's a pretty good analogy right there. Right? I mean it's basically an issue of like am I actually that thing? Am I a North Carolina LPC? But here's the question though. I mean Rob, you're a North Carolina LPC. Right?  
Rob: I am.  
Roy: Why am I different from you? Aren't we basically trained the same? Shouldn't I be able to work-  
Rob: I know. It's because you haven't got up off your keister and talked to your legislatures and gotten us some portability in licensure.  
Roy: Oh, portability in licensure. That would be really handy. So you're saying that-  
Rob: That would be awesome.  
Roy: So it's not just an issue of what it's supposed to be. The legalities across state isn't just like, oh it should be that way. It's also a lack of other supports or infrastructure or systems that we're still trying to work on in our modern society. Is that what you're telling me?  
Rob: That's summed up awfully well, Roy.  
Roy: Thanks. I'm good at summing.  
Rob: So any other legalities we need to be concerned about?  
Roy: Well legalities, yeah, I mean with legalities it gets complicated because you want to make sure you know not just what the licensing boards say, but also state legislature. Sometimes there are general telehealth laws in a place that can apply to you. And there's always a big question of like, okay, so let's say I do get a license in North Carolina, and I'm also licensed in Oregon already. What if I want to work with a North Carolina client while I am in Kansas?  
Rob: Well did you move to Kansas, or are you just temporarily in Kansas?  
Roy: I'm just temporarily in Kansas. Maybe I'm at a conference or something. So oh my North Carolina clients needs a session, and can I do it from Kansas? I mean the answer there is I actually have no idea. I don't know what the Kansas or North Carolina laws on that are.  
Rob: Well, and I'm guessing that there probably aren't laws that speak specifically to that situation. It would come down again to case law. Has it been tried in court? Has anybody made a determination about how this would be ruled on.  
Roy: Right, and there can be. I know in Texas there almost was a rule that said that both parties have to be located in Texas. My understanding is that did not pass though.  
Rob: Right. That's the reason you need to check the laws in any state that's involved in what you're doing because some states do have some very specific laws, and others do not.  
Roy: Yeah, exactly. That's the thing. I know it makes it hard if someone's traveling a lot. So what this points to, is something that is kind of frustrating, but is especially frustrating if you or a client is moving through a lot of states. But essentially, you need to be able to discover the legal landscape of the combination of two states, no matter where the client is.  
If the client is currently in Kansas, and I'm currently in Washington, I need to know the legal landscape of the two states. If I'm using my Oregon license, while I'm in Washington, and they're in Kansas, I also need to be aware of what Oregon says about me being out of the state.  
Like Rob said, most of the states won't necessarily have anything at all to say about any of those items, but they might because different states get into it in different ways. And there's not a lot of uniformity about this yet. So generally, your best due-diligence is to discover everything that matters around all of those combinations of things. Doesn't that sound awesome?  
Rob: We're back to being scary Roy.  
Roy: I'm sorry. I'm sorry.  
Rob: Thankfully, and I'm sure you're aware of the same resource, the American Telemedicine Association has some pretty good resources on their site.  
Roy: They do.  
Rob: They track the legal situation for telehealth across the states, so you can keep up-to-date on it.  
Roy: There's also the Epstein-Becker-Green, I want to say, report. We'll link to all these things for you guys. There's a report on the telehealth laws for various different professions in all 50 states, which of course can become outdated. But the nice thing is that it tells you where you start from in order to find out what's going on in a particular state. So yeah, there are a couple of places, and we'll link to them, where you can get some initial information in order to start your research. So you're not totally hanging in the breeze all by yourself.  
Rob: Exactly. Going even beyond legal issues, when you talked earlier about hey people are primarily focused on the technology. I think they tend to miss some of the ethics you talked earlier about. How do we handle crisis situations? And there's a number of ethics issues we need to talk about, to make sure people are aware of also.  
Roy: Right. Well, there's definitely a need for extra informed consent. Right. Often it's described as an additional informed consent. Something that makes it very clear that in addition to the normal stuff, here's the specific informed consent around the fact that we're doing remote work, you know, working through, I guess sort of technology mediated work, through video or something like that.  
Because you want to cover things like the risks involved in doing that, making sure the client understands how to respond to things like technology failure. We can't really go into all the details of it because it gets really detailed. But you certainly want to have that extra paperwork because there are different kinds of risks involved, and the client needs to be informed of them and consent to them.  
Rob: Right, and you know that is a pretty long list, but just to give people a couple of examples. It'll include things like, what new issues come up with privacy, and the aforementioned, how are we gonna handle crisis situations.  
Roy: Yeah, how are we gonna handle crisis? That's an interesting one. That's one that according to the research that Jones showed, a lot of people were not familiar with how to do. Even if they were familiar with the need for it, they weren't quite sure how to go about doing it. Because crises that can come up are ... It can be difficult to contemplate what they are until you really contemplate through the different context in which you might do telemental health.  
For example, if you're working with a care facility, whether it's a clinic or like a rest home or something along those lines, your client is in a space where there are caretakers around to deal with certain crises. And so long as you have figured out how to coordinate, and how that care team should respond to crises, you have a lot of coverage. But if you're doing what a lot of us do, which is delivering services to the client's home, then in terms of making sure you can deal with crises, it's the clients themselves and you. Or if they have any caretakers nearby, perhaps them.  
So you're like, what do you do? What if the client decompensates? What if they become suicidal? And you want to think about things like, what if you're working with clients who have dementia or psychosis? You know, what if the person basically forgets that they are actually working with you through video, and suddenly think they're talking to their television?  
These are the kinds of things you need to make sure you consider. And by the way, none of this says that you can't do that work with those people. There's actually no specific contraindication for telemental health for any particular condition. It's just an issue of making sure you know how to take care of a person who has those conditions, when you're gonna do remote work.  
Rob: Exactly. And the key is recognizing that you have a lot more control over the environment and situation in general when people are coming to your office.  
Roy: Yeah.  
Rob: So you start by looking at hey, where are all the facets of this, where I will not have control anymore. I know how to handle crisis if somebody's in my office. I know where the local resources are, but what if this person is 300 miles away across the state and so forth.  
Roy: Exactly. Yeah, right. Yeah, do you know the response time for emergency services to that person's home? For example. Do you know how long it takes for the police or an ambulance to get there? These are a lot of things, and you know, I made a checklist of this for the courses I make on telemental health.  
So there's some amount of guidance there. But of course, for the level we're doing here at the podcast, the best you can do is say hey, think about it. You know? Imagine the situation. Imagine what you would do in different crises, and just think, kind of roll the tape forward and think about what happens next, and are you prepared to make sure that goes the right way.  
Rob: And speaking of the general environment, you have to think about how that is going to impact the actual work. What interpersonal cues might you be missing when you're working with somebody through video or even moreso through the phone.  
Roy: You usually can't see their pants or their shoes.  
Rob: Right. Right, and who knows what those feet are doing.  
Roy: Yeah. It could matter.  
Rob: Even moreso, you don't know what's going on necessarily around them. Who else might be in the vicinity or even in the same room with them?  
Roy: Who's standing behind the camera?  
Rob: Right. Are they able to control the level of privacy wherever they're speaking to you from?  
Roy: Right, and so I know that I've actually had that experience. You know, before I started to really learn how to do the protocols correctly. Yeah, I started early, and I should have gotten more training with that. Although it wasn't really available yet at the time.  
But yeah, I've had a couple times when there was someone behind the camera, and it was a person friendly to the client. The client felt safe and okay with that, but it's like it reminded me, it showed me very clearly like, oh okay, this is something I need to check for.  
So now that's part of my protocol with clients is to kind of scan the room, to try to make sure there isn't anybody else there, and to have safe words they can use to try to indicate to me that there's someone else in the room or that the scene isn't safe.  
Speaking of which, you know we've got video, so we can see the person, which raises the question of, what do we need to do to confirm their identity? I know you're pretty good at that stuff Rob. What kind of things do we need to think about when it comes to that?  
Rob: Call the FBI.  
Roy: That's perfect. That's it. You need fingerprints.  
Rob: Yeah, it's an interesting situation because most people I talk to, if someone comes into your office, most people aren't checking driver's licenses and doing other things to verify the identity of this person in their office. So you have to give some thought, and it's kind of a risk analysis thing to, okay, is it more likely that someone via telemental health is going to put themselves forth as someone who they are not.  
Roy: Right.  
Rob: And if so, what am I gonna do to verify, and obviously that risk is much lower if you're doing like you and I do, and you're really only doing telemental health with current clients who typically come into the office.  
Roy: Right. Yes, in that case, that's not the big issue. Right? And if you can see their face and hear their voice, it's less likely to be an imposter, or actually it's very unlikely. Right? But there is that kind of online disinhibition effect thing.  
You know like I always wonder why does the American Telemedicine Association guidelines say you need to confirm their identity, when you can see their face and hear their voice? And I don't ask for driver's licenses when someone comes to my office. But there is that strangely enough, slightly increased likelihood if somebody wants to do something fraudulent like that, they may be more likely to do it through telemental health.  
Rob: Right because they have that buffer of the internet.  
Roy: Right. Here's the other thing though. It's not necessarily just their identity. It's also things like their location. If a client in Washington, for example, wanted to work with me online, they may not think about the fact that I'm in Oregon. They may just think I'm nearby because Portland is really close to the border with Washington. They could literally be like a 20 minute drive away, and be in a different state from me.  
So the person may call up, and just not really talk to me about that. Or they maybe do something like, oh Roy's in Oregon, so I'm gonna give them my uncle's address instead of mine, so that he has an Oregon address. Not knowing that that actually is really dangerous for me. So seeing an ID actually helps me confirm what state they're a resident in or state they're in at that time.  
Another thing that the standards say is you want to actually record the client's location at the time of sessions.  
Rob: Yeah, that's a really great point.  
Roy: So it's a strange situation.  
Rob: Yeah, it's especially strange because that person could get in their car and drive to your office, and there would be no issue.  
Roy: Yeah, that's right. Except that driving across the Columbia River can be a real pain depending on the time. That happens a lot. I have clients who really would rather do online, but they're in Washington, and I'm not licensed there. So it's like, "Sorry, we gotta meet in here. You gotta come to the downtown Portland office, even though it's a pain to get here."  
Rob: You just need to talk to Healthgrades, and have them give you the licensure there.  
Roy: That's true. Healthgrades can just make me a Washington license, apparently, just by changing my profile. That would be great.  
Rob: Awesome.  
Roy: Awesome, thanks Healthgrades. Okay, you're the insurance guy, Rob. Tell us about insurance.  
Rob: Yeah, so another thing that's a factor in deciding whether you want to do telehealth, or what it's gonna look like for you is finding out whether you can get reimbursement for telehealth. And that, much like the laws surrounding telemental health, are varied across states. So insurance is regulated at the state level.  
So when you talk about private insurance especially, you're gonna want to investigate, hey are private insurers reimbursing for this in my state. If so, what are the rules and regulations around that? Will they reimburse for phone calls, or will they only reimburse for video sessions? Are there other ramifications? How do I have to code this in the insurance claim? There's a good bit of research to be done on that end.  
Roy: I have a question because there's something that's come up quite a bit. I'm kind of curious what you think, Rob. I've had colleagues who are either members of my service or just friends around the area, who said that they've done online sessions with clients, and just coded it like a normal session. Like they were not aware that they needed to do any special coding in their insurance billing.  
So they got reimbursed, and it wasn't until after the fact that they realized they'd done like five or six of these, and they'd gotten reimbursement and didn't code it correctly. What might happen as a result of that? What should they do? Should they leave it alone? What do you think?  
Rob: Well I'm not an insurance company, and certainly again, it varies across the country, but I suspect that the insurance company could use that as leverage to say, look this was coded incorrectly, give us our money back. The one thing they could do, they could certainly resubmit the claims amended to show oh hey this is the way it should have been coded. They could also contact the insurance company and say this is what happened. What's the best approach? It's likely they'll say, hey resubmit an amended claim.  
Roy: What if they won't cover it then because it was telemental health, and they aren't covering that?  
Rob: Well I guess they're gonna have to give that money back to the insurance company then.  
Roy: Dun, dun, dun.  
Rob: And collect from the client.  
Roy: Right. This really is a scary episode.  
Rob: Or they can roll the dice and go for the insurance fraud choice.  
Roy: Woo. Right. Yeah, and that's the kind of thing that sucks because you realize, oh man, I just committed insurance fraud. I bring it up because it happens a lot I think.  
Rob: I mean we talk about people often see the insurance companies as big scary entities, but there are human beings working there, so I'm sure if you contact most of them and say, "This is what happened. How can I correct it?" There will be a path for correction.  
Roy: Right. Right. And you just hope that it doesn't involve giving all the money back. That's the thing you hope for. Right. Yeah, and that's a good point. The situation of insurance reimbursement just seems to change so fast. I can barely keep up with it.  
Rob: Yeah, I can say in North Carolina there's an update pretty much every year. Blue Cross is the big insurer here that definitely reimburses for telemental health. There's no regulation or law in North Carolina currently that require it from private insurance companies, but Blue Cross has still voluntarily chosen to reimburse. But each year they have an update on okay, well this is how we want you to code this now, and it's changed a couple of times over the last two years.  
Roy: They actually tell you?  
Rob: Yeah.  
Roy: Yay.  
Rob: Yeah. Well, when I say tell you, I wouldn't say they're going overboard to make sure it's communicated to everybody.  
Roy: Oh I see.  
Rob: But there are resources available on the website, if you know where to look.  
Roy: Right. I'm like, wait, they do what? That's very kind of them. Yeah, that's the thing. Right?  
Rob: Yeah.  
Roy: And you being you, you're usually on top of that. You go and look at that stuff on the website.  
Rob: Right. So yeah. It all brings us back to all the points we've just kind of hit on, is you gotta do your research. It's gonna take a little bit of leg work. But again, there's more and more people doing it, and people are on therapists Facebook groups and Listservs. It's a great question to ask locals, hey have you done this? What information have you found out already? And collaborate.  
Roy: That's a very good point. That's one of the things I've seen Facebook therapists groups, local ones, have a great success at in terms of consulting is being able to say, "Hey, what do I do with this?" And someone being able to say, "Oh I use that insurance. They reimburse to this. You've gotta make sure you code in this way." Very helpful kind of situation for those.  
All right, so okay, I'm gonna do this now Rob. Now I feel ready. I know what I'm doing. I'm gonna go out there, and I'm gonna fire up Skype, and I'm gonna start working with people.  
Rob: I knew that's what you were gonna do.  
Roy: I just use the Skype chatting/texting thing as where I could document my sessions too.  
Rob: You totally, totally forgot at the beginning of the session, when you were rattling all the different things off that it's called telemental health and telehealth and internet therapy. You totally forgot to call it Skype therapy.  
Roy: Oh that's true. It's almost as if I avoid doing that.  
Rob: Why would you do that Roy?  
Roy: Why would I do that? Well because Skype is really not a good choice for a lot of reasons, but one of the biggest ones being just it's not legal to use under HIPAA. I would also argue it's not quite ethical to use because in a sense that Skype doesn't guarantee security in the ways we need it to guarantee them.  
Rob: But there's Skype for Business Roy.  
Roy: Well okay, so Skype for business is a completely different piece of software. Just because they call it Skype, it's not the same. In fact, Skype for Business, used to be a thing called Lync, L-Y-N-C. And Microsoft had been doing business associate agreements, the HIPAA stuff for Lync for a long time. They just changed it to call it Skype for Business.  
So in theory, Skype for Business can be used for telemental health sessions. My company hasn't done our official review process for it, so I can't really speak to the risk management issues besides the business associate agreement, but they do provide that part, which is 90% of your issue there.  
Rob: My understanding is it's pretty expensive though.  
Roy: Yeah, it is. And I'm not entirely sure. I don't really know anyone who uses it. It just doesn't seem like a really good ... The cost benefit analysis for Skype for business, doesn't look good to me.  
Rob: Yeah, that's why I'm still using VC myself. What do you use?  
Roy: I'm using VC as well. And if you go to our article that I'll link in the show notes, you will see instructions for how you can also get a pro-account of VC with the BAA for free by telling them that Person Centered Tech sent you.  
Rob: Awesome.  
Roy: Awesome. And there are other free ones as well, that are also using quality software. You'll see that in the article as well. I think this is a thing. Jay was on here talking about a lot of really good stuff, but I've had a lot of conversations with Jay about the question of is the free software really what you want to use? What do you think about that Rob? I know you have a lot of thoughts on it.  
Rob: You know, I always am skeptical about free. I always wonder what's the catch. You know?  
Roy: Yeah.  
Rob: You know Facebook is free because they are mining your data and selling it to advertisers, essentially. So what is the catch with these free pieces of software? It comes down to the HIPAA risk analysis. Are they gonna sign the business associate agreement? Have you looked through their terms and conditions? Are they doing things that you might not be comfortable with? Like I've talked in the past about my relative lack of comfort with Practice Fusion.  
Roy: Oh God.  
Rob: Selling de-identified protected health information and so forth. So you know, looking into what the risks are.  
Roy: Yeah, I'm with you there, and that's a really important bit, is to be like, so what's the fine print? Certainly, there are those free options that we think are upstanding, you know, that are good free options. But the other thing is not just those risks of what they're doing or are you their product that they're selling like Practice Fusion.  
I am actually happy to say Practice Fusion's terrible. I'll just say it. Don't use Practice Fusion. I'm happy to do that. I tell my own clinicians, please, if you use Practice Fusion, please don't put my information into it. I don't want them having my info.  
So now that I've said that, I'm gonna blow past it and talk about something else. The other reason why free can be something to consider as maybe what you do or don't want is that often free also means doesn't have a lot of features. That's not always true, but it can be.  
For example, a lot of people might want a platform for their telemental health that includes the record keeping and billing and other features that they might want to have in one place. In which case, there's no way those things will be free because that's just way too much service to give for free.  
Rob: Sure, well and even another platform that I hear a lot of people use, and I hear good things about is But even that platform, yes, they have the free version, but they also have a couple other paid tiers where oh if you want certain features like group sessions, you've got to fork over a few dollars.  
Roy: Right, exactly. Yeah, it's the freemium model, which is part of where you'll go, okay, I can see where's ... You know, follow the money. You can see, oh well is starting with free, and you can pay for it if you need to. And you can start to see where their business model is still supportive of our needs.  
Rob: Yeah, so the other two things we were gonna talk about here, with giving a survey of this, was about finding clients and certification. I think Jay did a pretty good job of covering that. So obviously, people might want more detail. Maybe they're jazzed about jumping into telemental health, now that they've listened to us talk about it for a while. What are the next steps?  
Roy: Well, you kind of need to figure out if this is all stuff that you're up for doing? I think that a lot of people think about telemental health because they kind of believe it's the next big thing, and they have to do it. I don't think that's true. I think there's forever going to be room and lots of interest in coming to your office and seeing you in person. I don't think that's going away.  
Rob: Yeah, I agree with you. I agree with you on that for sure.  
Roy: But you know, it's definitely, and I'm sure with the next 10 years, it'll become a part of training programs, to expect that this is gonna be an aspect of how you deliver services is online.  
Rob: Yeah, and I think they'll have to make it part of training because I think there'll be an increased number of jobs available in that realm. So it'll behoove people to at least have training in it, and it'll continue to grow as an adjunct I think, for the reasons we specified earlier for having the convenience and the availability of it, along with office visits.  
Roy: Yeah. And then if you do decide it's a good fit, at whatever level you're doing it for, get some appropriate training. Maybe the level of training you need can be kind of modulated according to what you want to do with telemental health. But certainly, if you really want to be doing it for the long-term, you want to get something that covers all the standards, so you really know the whole thing, the whole deal.  
Rob: Yes, to be clear, even though we've covered a lot of ground in this episode, this does not constitute all of the training you need to jump into telemental health.  
Roy: It does not. No. However, it's a pretty good survey of the things you need to make sure you understand.  
Rob: Yeah, I hope this is a really good jumping off point.  
Roy: Yeah, and I'll tell you right now. I don't know what your experience is with getting your online clients because I know you do online work, but I do have clients that are purely online or start online. And that's entirely through referral networks. It's never from just putting out a website, and the person finds me. Actually that's not true. I had one or two clients that way, but that's not generally how they come.  
Rob: Yeah, there's just not a lot of, in my experience, clients specifically looking for that.  
Roy: Right. Yeah, in my case, the two that did, it's because I work with people in Japan, and they were like I really need somebody, and there wasn't anything in their area. So they went and looked. But that's the kind of thing it usually takes for somebody to be like, "Hey, I want to find an online therapist." The vast majority of clients come because you're working with a local champion or referral network or a community that wants your help, just like Jay talked about, so that's why it's important to do that.  
Rob: Yeah, so that would kind of be the next step after training, is hey, how am I going to build this network? How am I going to get myself out there, find clients, work with [crosstalk 00:59:39] other people.  
Roy: Yep, absolutely. And don't be scared by that part. Of all the things we talked about today, that's the part that you as a therapist are probably a lot better at than you think.  
Rob: And it's something most of us need to be doing anyway, even if you aren't jumping into telemental health.  
Roy: Totally. Absolutely. Well I think that's the whole thing Rob. I mean that's all the telemental health. That's the whole thing.  
Rob: That's all the telemental health information ever.  
Roy: Ever. Woo. Good job us. Go high five team. Bam.  
Rob: So if there were specific things that we talked about, if there were any of the bullet point survey items that we talked about that you'd love to hear more details on, maybe we could do a whole episode on them, or touch on them in a future episode. Let us know. We'd love to hear.  
Roy: Yeah, we would. You could just comment below the show notes, assuming you're looking at a page right now.  
Rob: If you're not looking at a page, if you're on iTunes then instead, leave a review for us.  
Roy: Yeah, that'd be a great idea. That'd be basically the same thing.  
Rob: Unless you're in your car and driving.  
Roy: Oh yeah, don't do that. Oh my God. No, no, stop it. Stop it.  
Rob: Don't do that while you're driving.  
Thank you for tuning in to Therapy Tech with Rob and Roy. This episode has been sponsored by makes running your practice easy, organized, and secure. Try it out risk free. Episode notes and helpful resources can be found at Until next time, may the season bring you more treats than tricks.  


Photo by Pavan Trikutam on Unsplash


  1. Thanks so much for this informative (and entertaining!) look at telehealth. Shopping around now for credentialing and this helped navigate the maze of options out there. I’m in Florida and use We Counsel as my platform for existing clients in Florida, but want to document due diligence I’ve taken in paperwork and procedues. Considering Zur Institute’s program. Any suggestions for Florida based programs?

    1. RobReinhardt says:

      Hi Dianne

      Very happy to hear that you found our podcast both informative AND entertaining. Bonus! Roy may want to weigh in, but I’m not familiar with any credentialing programs specific to the state of Florida. Another program that we mentioned in the podcast but may not be in the links above is the Telehealth Certification Institute: You can also find other programs via the last resource link above (Telehalth Resource Centers) Best wishes on your telehealth journey!

  2. Hilary Akman says:

    Thank you for this podcast. It was the first I’ve listened to in your series. I also moved to FL from NJ and converted my office based NJ practice to an online based practice. I am provisionally licensed in FL while I complete their numerous requirements for licensure.

    I only want to see about 4-6 clients per week as I homeschool my children by day and want to work 2 nights per week. I am currently seeing a couple of my existing NJ clients I have completed all of Roy’s telemental health CEUs. I’m using and updated all my paperwork (thank you Roy!). I’m wondering after listening to this podcast if I really need to pursue a special certification in distance counseling for such a tiny practice.
    Also, you boys mentioned that an online practitioner really can’t build a practice online through online marketing. Psychology today use to be sufficient until I went online only. Jay mentioned needing to reach out to agencies with long waiting lists to let them know how I can serve their clients. That seems similar to the passive kind of outreach of hoping that doctors send referrals. I’ve been spending lots of the limited time I have when kids are in bed in increased blogging, vlogging, website facelift, reading all I can about online marketing,etc.and wondering if I’m spinning my wheels after hearing your podcast.
    I appreciate any feedback or insight you have. I wouldn’t think building a teeny tiny practice would be so hard!

    Thank you so much, Rob and Roy!
    I look forward to the catching up on the podcasts.

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