Following telemental health best practices

“Adhere to telemental health best practice guidelines” (NBCC, 2027 task 6.4)

Telemental health is now a routine part of counseling, and it comes with its own standards for consent, privacy, licensure, emergencies and clinical judgment. Following best practice guidelines keeps remote services safe and effective. The exam tests the core practices that apply to every telehealth session.

Key points

Be licensed, or otherwise legally authorized, in the state where the client is located during the session.
Verify the client's identity at the first session and the client's location at every session.
Have a session-specific emergency plan: client address, local emergency contacts and resources, and a backup way to reach the client.
Use secure, HIPAA-compliant platforms and devices, and ensure privacy on both ends (closed door, headphones, no unannounced others in the room).
Assess whether telehealth remains clinically appropriate as risk or needs change.
Maintain professional standards: a professional setting, attention to nonverbal cues, and the same documentation as in-person services.
The ACA Code of Ethics Section H addresses distance counseling, and professional guidelines and state rules add detail; follow both.

In practice

At the start of each video session, a counselor confirms the client's location and asks if anyone else is in the room. When a client says she is in her car outside her office, the counselor confirms the address in case of emergency and checks that she can speak privately.

A client receiving video counseling begins to show signs of mania and talks about driving recklessly. The counselor reassesses suitability, uses the emergency plan to involve the client's agreed support person, and moves the next sessions to in person.

Check yourself

Which state's license generally applies to a telehealth session?

The state where the client is located during the session.

What should a counselor confirm at the start of every telehealth session?

The client's current location and that they can speak privately.

Name two components of a telehealth emergency plan.

The client's physical address and a local emergency contact or resource, plus a backup way to reach the client.

NBCC's knowledge and skills for Domain 6

Knowledge of: State laws (state licensure law, supervision requirements, abuse reporting, license renewal, CAQH); Federal laws (e.g., HIPAA, FERPA, immigration policy, HI-TECH, ADA, NPI); Codes of ethics; Third-party reimbursement, insurance and billing (e.g., CPT codes); Counseling Compact; Emerging technologies in Counseling; Crisis policies and procedures; Recording keeping and reporting requirements and procedures; Appropriate logistics for telemental health services; Scope of practice (e.g., letters of support, working with special populations); Alternative medical-assisted/pharmacological interventions; Accessing state licensure board; Executing voluntary and involuntary commitments.

Skill in: Maintaining confidentiality; Discerning reputable training providers and programs; Troubleshooting technological difficulties during telemental health session (e.g., session disconnects, video not working); Billing and third-party reimbursement.

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