Archive for July, 2009

The proposed U.S. health care bill would enact a Telehealth Advisory Committee.  While I am not writing to debate the current merits of the health care bill in general, I find this particular component potentially valuable in promoting online therapy. The committee would consist of physicians and non-physician health care professionals so we need someone representing mental health and counselor efforts on that committee! This would also seem the perfect forum to discuss license portability or national licensure.

I have excerpted the information from the bill below which can be found on page 379.

If you want to see the entire 1017 pages go here
http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3200ih.pdf

Happy reading!!

Subtitle F—Medicare Rural Access
9 Protections
10 SEC. 1191. TELEHEALTH EXPANSION AND ENHANCEMENTS.
11 (a) ADDITIONAL TELEHEALTH SITE.—
12 (1) IN GENERAL.—Paragraph (4)(C)(ii) of sec13
tion 1834(m) of the Social Security Act (42 U.S.C.
14 1395m(m)) is amended by adding at the end the fol15
lowing new subclause:
16 ‘‘(IX) A renal dialysis facility.’’
17 (2) EFFECTIVE DATE.—The amendment made
18 by paragraph (1) shall apply to services furnished on
19 or after January 1, 2011.
20 (b) TELEHEALTH ADVISORY COMMITTEE.—
21 (1) ESTABLISHMENT.—Section 1868 of the So22
cial Security Act (42 U.S.C. 1395ee) is amended—
23 (A) in the heading, by adding at the end
24 the following: ‘‘TELEHEALTH ADVISORY COM25
MITTEE’’; and
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1 (B) by adding at the end the following new
2 subsection:
3 ‘‘(c) TELEHEALTH ADVISORY COMMITTEE.—
4 ‘‘(1) IN GENERAL.—The Secretary shall appoint
5 a Telehealth Advisory Committee (in this subsection
6 referred to as the ‘Advisory Committee’) to make
7 recommendations to the Secretary on policies of the
8 Centers for Medicare & Medicaid Services regarding
9 telehealth services as established under section
10 1834(m), including the appropriate addition or dele11
tion of services (and HCPCS codes) to those speci12
fied in paragraphs (4)(F)(i) and (4)(F)(ii) of such
13 section and for authorized payment under paragraph
14 (1) of such section.
15 ‘‘(2) MEMBERSHIP; TERMS.—
16 ‘‘(A) MEMBERSHIP.—
17 ‘‘(i) IN GENERAL.—The Advisory
18 Committee shall be composed of 9 mem19
bers, to be appointed by the Secretary, of
20 whom—
21 ‘‘(I) 5 shall be practicing physi22
cians;
23 ‘‘(II) 2 shall be practicing non24
physician health care practitioners;
25 and
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381
•HR 3200 IH
1 ‘‘(III) 2 shall be administrators
2 of telehealth programs.
3 ‘‘(ii) REQUIREMENTS FOR APPOINT4
ING MEMBERS.—In appointing members of
5 the Advisory Committee, the Secretary
6 shall—
7 ‘‘(I) ensure that each member
8 has prior experience with the practice
9 of telemedicine or telehealth;
10 ‘‘(II) give preference to individ11
uals who are currently providing tele12
medicine or telehealth services or who
13 are involved in telemedicine or tele14
health programs;
15 ‘‘(III) ensure that the member16
ship of the Advisory Committee rep17
resents a balance of specialties and
18 geographic regions; and
19 ‘‘(IV) take into account the rec20
ommendations of stakeholders.
21 ‘‘(B) TERMS.—The members of the Advi22
sory Committee shall serve for such term as the
23 Secretary may specify.
24 ‘‘(C) CONFLICTS OF INTEREST.—An advi25
sory committee member may not participate
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382
•HR 3200 IH
1 with respect to a particular matter considered
2 in an advisory committee meeting if such mem3
ber (or an immediate family member of such
4 member) has a financial interest that could be
5 affected by the advice given to the Secretary
6 with respect to such matter.
7 ‘‘(3) MEETINGS.—The Advisory Committee
8 shall meet twice each calendar year and at such
9 other times as the Secretary may provide.
10 ‘‘(4) PERMANENT COMMITTEE.—Section 14 of
11 the Federal Advisory Committee Act (5 U.S.C.
12 App.) shall not apply to the Advisory Committee.’’
13 (2) FOLLOWING RECOMMENDATIONS.—Section
14 1834(m)(4)(F) of such Act (42 U.S.C.
15 1395m(m)(4)(F)) is amended by adding at the end
16 the following new clause:
17 ‘‘(iii) RECOMMENDATIONS OF THE
18 TELEHEALTH ADVISORY COMMITTEE.—In
19 making determinations under clauses (i)
20 and (ii), the Secretary shall take into ac21
count the recommendations of the Tele22
health Advisory Committee (established
23 under section 1868(c)) when adding or de24
leting services (and HCPCS codes) and in
25 establishing policies of the Centers for
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383
•HR 3200 IH
1 Medicare & Medicaid Services regarding
2 the delivery of telehealth services. If the
3 Secretary does not implement such a rec4
ommendation, the Secretary shall publish
5 in the Federal Register a statement re6
garding the reason such recommendation
7 was not implemented.’’
8 (3) WAIVER OF ADMINISTRATIVE LIMITA9
TION.—The Secretary of Health and Human Serv10
ices shall establish the Telehealth Advisory Com11
mittee under the amendment made by paragraph (1)
12 notwithstanding any limitation that may apply to
13 the number of advisory committees that may be es14
tablished (within the Department of Health and
15 Human Services or otherwise).
16 SEC. 1192. EXTENSION OF OUTPATIENT HOL

Avatar Therapy is not new. The term has been discussed theoretically for nearly ten years. But now that virtualworlds have reached the mainstream and with the advent of gaming, many people understand the provocative power that exists with an avatar identity. People now live part of their lives virtually, sometimes existing in a mixed reality. Since technology and the internet have become such a part of our social fabric, separating time “online” from real world time is sometimes difficult and the lines have become blurred. Beyond standard email, people now chat and instant message, join social networks such as Facebook and MySpace and network professionally on sites such as Linkedin. People engage in consultation, business transactions, coaching and psychotherapy online via email, chat, audio and videoconferencing. The idea of engaging in therapy online within a virtual world environment is now reality. Second Life, a virtual world platform that is free to join already hosts private practitioners and mental health agencies offering psycho-education, consumer information and psychotherapy.

Three-dimensional virtual world settings offer another level of sensory experience that could enhance the therapeutic process. People can create an avatar that is a literal or metaphorical representation of self. Avatars can also represent a part of the self- perhaps the inner child or the shadow. With advances in technology and artificial intelligence, the ability to simulate various scenarios with therapy clients is not far off. Artificial intelligent avatars can be used in the therapeutic process to help a client heal from trauma, create a new ending to a dilemma, or work out unfinished business with a deceased loved one. These are but a few examples of how avatar therapy, with the aid of artificial intelligence and facilitation from a trained avatar psychotherapist can benefit people.

Properly trained avatar therapists would have a clear understanding of more traditional approaches to therapy online such as those mentioned above and understand the ethical issues related to online therapy and the delivery of mental health services through technological means. In addition, avatar therapists would have adequate knowledge of the online disinhibition effect as well as trauma related theories so that clients could be adequately prepared for avatar work. Avatar therapists would need to understand the importance of titrating emotions and properly grounding the client using containment techniques. Keeping the client emotionally safe would be paramount in a virtual environment because issues that would typically surface over several months or years could potentially surface much quicker in virtual world setting.

Avatar therapy of the future moves far beyond the therapist and client’s avatar representations engaging in an online form of traditional talk therapy. This futuristic and innovative therapy combines artificial intelligence with elements of traditional psychotherapeutic techniques used in grief work, and with trauma survivors as examples. Training therapists for this futuristic work can begin now in counseling education programs across the globe as we prepare practitioners to incorporate technology into the art of psychotherapy.

~ DeeAnna

Yesterday I completed facilitation of a two-day Distance Credentialed Counselor training in Springfield, IL.  Every time I do a training I meet great people and I learn.  In this training there was much concern expressed about therapists being able to cross state lines; how to know what each state’s law says, and whether there is a “clearinghouse’ for such information.

Well, OTI has an Ethics and Law wiki and we do our best to keep it updated as we receive information about the legal and ethical aspects of practicing online counselling across the globe.  But still, this method relies on all of us to make sure the updates are received in a timely manner and that Kate and I can upload the information that is sent to us if a person does not enter the information to the wiki him/herself.

So in this training I heard of two more states that may have implemented restrictive language into their law regarding online counseling- not allowing a licensed practitioner in that state to offer online therapy services to anyone outside the state (MA and NE).  I am hoping I can get more clarification and actually see a copy of their language.

And so on my drive back the hotel it occurred to me that one way we can effect change as professionals in our various states and countries is to become active in our professional organizations.  If you are in the states and you are member of APA, ACA, NASW, get involved. Join taskforce committees.  To have influence in your state, join a state chapter.  Volunteer to be on the board. Be part of a government relations or ethics committee.  Become the ethics chair of your state chapter.  That is how we can begin to educate our colleagues about the value of online counseling.  I do not think we should be legislating WHERE online counseling can occur.  I think we should be legislating competency.

It is obvious to me that state licensing boards are way behind the curve when it comes to understanding the global community – and global e-commerce.  Placing practice restrictions on licensed professionals does not allow consumers choice in treatment, and seems to be a rather paternalistic stance.  And clearly, state licensing boards have no clue about the online culture.  Most states require practitioners to have taken a class on multiculturalism to obtain a license to practice, yes? Yet the boards do not understand that we have an entirely new culture of people who live within a mixed reality, choosing to receive professional services online through their global community.  So if we look at the online community as a culture, then we could make the claim that in this instance, our state boards are not being very culturally sensitive, could we not?

While this issue of “crossing state lines” is rather U.S.-centric, my point in this post is to encourage professionals to become involved in their local professional organizations no matter what country, so that we can all make a difference.  We want online therapy to be a viable option within the global community!!

Have a great summer day!

DeeAnna

Check out our latest members of the Online Therapy Institute!

Audrey Jung, Sue Whitlock, Jodi Underhill and Chris Wood are all practicing online therapists!

All members are offered a listing in the Online Therapy Institute’s Web Directory so be sure to check out their profiles!

• Audrey B. Jung, LPC NCC DAPA

  
  

• Coconut Counselling

  
  

• Jodi Underhill MH & Counseling Services

  
  

• www.e-psychotherapy.co.uk

  
  

Kate and DeeAnna have both contributed separately to a project called The Future of Innovation – where “over 350 leading thinkers from business, government, consulting and academia from around the globe share their thoughts, experiences, dreams, visions, hopes, concerns, and passions around The Future of Innovation, providing you with insights into tomorrow’s innovation agenda…”

Kate’s contribution is “The Future of Innovation in Training Innovative Therapists” and discusses training therapists to use technologies such as SMS texting, VR, Social Networking sites, and finally Hologrammatic Therapy (you heard it here first!).

DeeAnna’s contribution is “The Future of Innovation: The Use of Avatars in Psychotherapy” introduces Innovative Avatar Therapy Simulation and discusses what Avatar Therapy looks like, how it can enhance the therapeutic process, and the importance of training in using this new method when combining AI with elements of traditional psychotherapeutic techniques.

See more on the project at : http://thefutureofinnovation.org/