Informed Consent for Telepsychology

This Informed Consent for Telepsychology contains important information focusing on doing psychotherapy and evaluation using the phone and/or Internet. Please read this carefully and let us know if you have any questions. When you sign this document, it will represent an agreement between us.

Telepsychology refers to providing psychotherapy services remotely using telecommunications technologies, such as video conferencing or telephone. One of the benefits of telepsychology is that the client and clinician can engage in services without being in the same physical location. This can be helpful in ensuring continuity of care if the client or clinician moves to a different location, takes an extended vacation, or is otherwise unable to continue to meet in person. Telepsychology, however, requires technical competence on both our parts to be helpful. Although there are benefits of telepsychology, there are some differences between in-person psychotherapy and telepsychology, as well as some risks. For example:

Risks to confidentiality. Because telepsychology sessions take place outside of the therapist’s private office, there is potential for other people to overhear sessions if you are not in a private place during the session. On our end we will take reasonable steps to ensure your privacy. But it is important for you to make sure you find a private place for our session where you will not be interrupted. It is also important for you to protect the privacy of our session on your cell phone or other device. You should participate in therapy only while in a room or area where other people are not present and cannot overhear the conversation.

Issues related to technology. There are many ways that technology issues might impact telepsychology. For example, technology may stop working during a session, other people might be able to get access to our private conversation, or stored data could be accessed by unauthorized people or companies.

Crisis management and intervention. Usually, we will not engage in telepsychology with clients who are currently in a crisis situation requiring high levels of support and intervention. Before engaging in telepsychology, we will develop an emergency response plan to address potential crisis situations that may arise during the course of our telepsychology work.

Efficacy. Most research shows that telepsychology is about as effective as in-person psychotherapy. However, some therapists believe that something is lost by not being in the same room. For example, there is debate about a therapist’s ability to fully understand non verbal information when working remotely.

The process of evaluation includes multiple types of data collection, including clinical interviewing with the client, interviewing of parents/caregivers and teachers, administration of online behavior rating scales, and direct administration of standardized tests. The standard administration of these tests involves in-person, face-to-face methods. The impact of applying non-standard administration methods has been evaluated only in part by scientific research.

Test administration methods - Standard test administration will be modified, and this may affect results in ways that are so far unknown. This has the potential to reduce confidence in the diagnostic conclusions and recommendations for treatment.

Involvement of a third-party in the tele-evaluation session (caregiver, guardian, parent, facilitator) may add additional concerns about the impact of observation on performance.

Error may be compounded when tele-evaluation procedures are used with peoplewho come from culturally and linguistically diverse populations, require an interpreter during the tele evaluation, or have limited experience/comfort with the technology being employed.

There will be a loss of some qualitative data usually obtained during an in-person exam, and this loss may reduce the richness of the clinical data and further limit conclusions and recommendations.

Tele-evaluation may pose additional risks to privacy and confidentiality.

Ensuring test security is a critical role of psychologists. Tele-evaluation may require the use of paper-and-pencil protocols that will be mailed to the client’s home in advance of their testing sessions. The client and their parents will be instructed to keep the mailed envelope sealed until a specific time during the video conference session to help ensure test security. Within the envelope, there will be a number of smaller envelopes to be opened at prescribed times in front of the camera for the evaluator to observe. Finally, there will be an empty envelope that completed material will go into throughout the session which will be sealed in front of the camera for the evaluator to observe.

The telepsychology sessions shall not be recorded in any way unless agreed to in writing by mutual consent. We will maintain a record of our session in the same way we maintain records of in-person sessions in accordance with our policies.

We will decide together which kind of telepsychology service to use. You may have to have certain computer or cell phone systems to use telepsychology services. You are solely responsible for any cost to you to obtain any necessary equipment, accessories, or software to take part in telepsychology.

We have a legal and ethical responsibility to make our best efforts to protect all communications that are a part of our telepsychology. However, the nature of electronic communications technologies is such that we cannot guarantee that our communications will be kept confidential or that other people may not gain access to our communications. We will try to use updated encryption methods, firewalls, and back-up systems to help keep your information private, but there is a risk that our electronic communications may be compromised, unsecured, or accessed by others. You should also take reasonable steps to ensure the security of our communications (for example, only using secure networks for telepsychology sessions and having passwords to protect the device you use for telepsychology.

The extent of confidentiality and the exceptions to confidentiality that we outlined in Wolff Child Psychology’s Informed Consent still apply in telepsychology. Please let us know if you have any questions about exceptions to confidentiality.

From time to time, we may schedule in-person sessions to “check-in” with one another. We will let you know if we decide that telepsychology is no longer the most appropriate form of treatment or evaluation for you. We will discuss options of engaging in in-person counseling or referrals to another professional in your location who can provide appropriate services.

Assessing and evaluating threats and other emergencies can be more difficult when conducting telepsychology than in traditional in-person therapy. To address some of these difficulties, we will create an emergency plan before engaging in telepsychology services. We will ask you to identify an emergency contact person who is near your location and who we will contact in the event of a crisis or emergency to assist in addressing the situation. We will ask that you sign a separate authorization form allowing us to contact your emergency contact person as needed during such a crisis or emergency.

If the session is interrupted for any reason, such as the technological connection fails, and you are having an emergency, do not call us back; instead, call 911, or go to your nearest emergency room. Call us back after you have called or obtained emergency services.

If the session is interrupted and you are not having an emergency, disconnect from the session and I will wait two (2) minutes and then re-contact you via the telepsychology platform on which we agreed to conduct therapy. If you do not receive a call back within two (2) minutes, then call us on the phone number we provided you.

If there is a technological failure and we are unable to resume the connection, you will only be charged the prorated amount of actual session time.

The same fee rates will apply for telepsychology as apply for in-person psychotherapy and evaluation. However, insurance or other managed care providers may not cover sessions that are conducted via telecommunication. Please contact your insurance company prior to our engaging in telepsychology sessions in order to determine whether these sessions will be covered.

The telepsychology sessions shall not be recorded in any way unless agreed to in writing by mutual consent. We will maintain a record of our session in the same way we maintain records of in-person sessions in accordance with our policies.

This agreement is intended as a supplement to the general informed consent that we agreed to at the outset of our clinical work together and does not amend any of the terms of that agreement. Your signature below indicates agreement with its terms and conditions.