Informed consent for telemental health

“Obtain informed consent for telemental health services” (NBCC, 2027 task 2A.7)

Telemental health, counseling delivered by video, phone or other technology, needs its own informed consent covering risks, privacy, emergencies and technology failures. Counselors also need to judge whether a client is suitable for remote services. The exam tests the added consent elements and the client factors that make telemental health appropriate or not.

Key points

The ACA Code of Ethics Section H covers distance counseling, technology and social media, including informed consent and security.
Consent should cover the benefits and risks of technology, privacy and confidentiality risks, the platform's security, what happens if the connection fails, response times, and whether sessions are recorded.
Confirm and record the client's physical location at each session, both for emergency response and because licensure generally depends on where the client is located.
Set an emergency plan: the client's location, a local emergency contact, nearby crisis resources, and how the counselor will act if the client is at imminent risk.
Assess suitability: risk level, severity of symptoms, cognitive capacity, access to private space and reliable technology, and client preference.
Discuss the client's own privacy: a private room, headphones, and not using shared devices if possible.
Some states and insurers have specific telehealth consent requirements; check the applicable rules.

In practice

Before a first video session, a counselor reviews a telehealth consent form with a new client, agrees on calling her cell phone if video drops, records her address and an emergency contact, and confirms she will be in a private room for each session.

A client with recent suicide attempts and no private space at home asks for video sessions. The counselor discusses the risks, recommends in-person sessions for now, and plans to revisit telehealth as his stability improves.

Check yourself

Why confirm the client's location at the start of each telehealth session?

For emergency response, and because licensure generally depends on the state where the client is located.

Name three elements specific to telemental health consent.

Technology risks and privacy, a plan for connection failures, and an emergency plan, which go beyond standard consent.

Name two factors that may make a client unsuitable for telemental health.

High acute risk and lack of a private, safe space, which can make remote care unsafe or ineffective.

NBCC's knowledge and skills for 2A. Intake

Knowledge of: Barriers to service; Components of informed consent; Client suitability for telemental health services.

Skill in: Discussing informed consent; Explaining policies and procedures; Conducting a clinical/diagnostic interview.

A study guide written by ExamDragon from NBCC's published task; not NBCC material and not part of the exam.