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Digital Ethics, HIPAA, & TeleMental Health


This resource page is part of the following Online Courses
TeleMental Health: The New Standard ~ Psychology of the Web ~ HIPAA Made Friendly ~ HIPAA Security and Privacy
Electronic Health Records ~ Digital and Social Media Ethics
Digital Ethics, Security & Privacy ~ HIPAA's Patient Access Rights


Table Of Contents

Practice Mgmt, HIPAA, Digital Ethics

Practice Mgmt, HIPAA, Dig. Ethics (cont'd)

TeleMental Health


Practice Management, HIPAA & Digital Ethics

Digital Ethics-General

E-Mails in Traditional Therapy and in TeleMental Health

Hushmail and other secure email services are a good idea, but many, if not most, clients balk at the extra hassle involved in using them to communicate with their therapists, and may choose to use the familiar and free, but unsecured, emails after being informed of the risk by their therapists (via an Informed Consent and e-mail signature.)

Use of Text in Traditional Therapy and in TeleMental Health

Therapists Googling Clients

Clients Googling Therapists

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Yelp: Responding to Negative Postings

Facebook & Psychotherapy and Facebook Privacy Issues

Social Media

Stalking, Harassment & Violations of Privacy

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HIPAA & HITECH Information, Resources, and Guidance


Are Square, Credit Cards, & Banks HIPAA Compliant?

Encryption & Computer Security

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Business Associates

HIPAA & NPI: Registration & Basic Info

Additional NPI Resources

Search the NPI Registry

HIPAA's Patient Access Rights: What Patients & Providers Need to Know

Risk Management & Security


EHR Information

Cloud Based Management Systems

HIPAA Audits

Therapy Tech With Rob and Roy

HIPAA Updates

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Data Security

Paperless Office

Informed Consent to TeleMental Health Services

    Sample Consent Forms to TeleMental Health Services
    (Make sure you comply with copyright laws prior to copying or employing any of the forms below in your practice)
  • Avera Health
  • LA County

Media Psychology

Psychotherapists' Professional Associations

Federal Resources, Laws, and Regulations

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Psychology of the Web & TeleMental Health

Psychology of the Web Bibliographies


Guidelines by Prominent Organizations on TeleMental Health

Additional Resources

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TeleMental Health

Telehealth, e-therapy, online therapy, online counseling, tele-medicine, e-counseling, or TeleMental health: all refer to the use of digital technology to provide clinical services, such as assessment and treatment. Telehealth activities may include providing clinical services by telephone, email, chats, interactive televideo communications technology such as Skype, or via virtual reality (VR) such as Second Life (SL), to individuals in conjunction with face-to-face (f2f) therapy or with no in-person contact. States and organizations vary in their definitions of telehealth.

TeleMental Health Platforms

e-therapyMake sure to verify that the platform you choose to use is HIPAA compliant and complies with your state, federal, and your state and national professional organizations rules, codes of ethics, laws, and/or regulations.

TeleMental Health Technology Comparisons: A useful website that compares different TeleMental Health options by Behavioral Health Innovation


TeleMental Health Across State Lines

State Lines

State TeleHealth Laws & Licensing Boards

Malpractice Insurance for TeleMental Health or Online Therapy

Reviewing online insurance policies and the literature on the topic, it is my general understanding that the following insurance companies will cover telemental health, e-therapy or online therapy if the insured practices legally, within the scope of his/her profession, and within the scope of his/her expertise (call your insurance company to verify your coverage):

  • The Trust generally covers licensed psychologists. Gerry Koocher, Ph.D. a Trustee for The Trust, posted the following on 1/15/13: "The professional liability policy provided by The Trust is a broad-based policy and would cover any policyholder for civil liability or board complaints arising out of provision of telepsychology services in the same way it provides coverage for other claims and complaints. No provider of professional liability coverage, however, will cover claims of criminal liability."
  • American Professional Agency covers psychologists and other mental health professionals. In response to my inquiry regarding their coverage of telemedicne and telemental health in Jan. 2013, I received the following response on on 1/16/13: "Please be advised, that while this activity would be covered under the policy there are some factors you should take into consideration. First, if you do not hold a license in the state where your patient resides and one is required, you may not be covered by the policy. Second, you must be HIPPA compliant, which includes, but is not limited to, using a secure site to avoid any breach of a patient's rights. Being non-compliant, could put you at risk to fines and penalties, as well as having a suit or complaint being brought against you for breach of confidentiality."
  • NASW Assurance Services which covers social workers, posted An Important Caution for Social Workers Practicing Online Therapy, which includes these statements: "The Social Work Professional Liability Insurance policy sponsored by NASW Assurance Services provides coverage worldwide, as long as the claim is made and the suit is brought in the United States, its territories, possessions, Puerto Rico or Canada. Therefore, it's not necessary to purchase another policy for internet, phone/telecommunication practice... There may be different requirements and/or licensure in the various states in which you may be practicing. As stated in VI. EXCLUSIONS under item Q. of the insurance policy, coverage would be excluded for a wrongful act committed while you did not have a license as required by law. You must be practicing legally for the policy to afford coverage."
  • CPH covers CA MFTs and other mental health professionals. CPH states on its web site regarding coverage for E-therapy or Internet Therapy: "Yes - provided such practice is authorized or allowable under the scope of your license in the state where you practice and provided you are performing such services lawfully. Contact your state licensing board if you are unsure."
  • TelMed is affiliated with American Telemedicine Association (ATA).

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Video Conferencing

General Information

Skype, while free, familiar and encrypted, is no longer an acceptable option for videoconferencing as part telemental health as it does not give a BAA and is not considered HIPAA Compliant.

Below is a list of several websites that market videoconferencing services to mental health and other professionals. Some of these sites claim to be HIPAA compliant. You must verify that they are, indeed, HIPAA compliant and request a Business Associate Agreement. Also pay attention to cross state lines laws in regulations.

  • Comprehensive list of telehealth and videoconferencing platforms, by Jay Ostrowski
  • HIPAA Compliant VoIP Services - LI Conversation
  • Free Online Therapy Software Compared: Usefulness, Ease, Security, Support, & HIPAA, by Roy Huggins
  • VSee and HIPAA - LI Conversation
  • Eye Contact in Video Conferencing

    Is Skype HIPAA Compliant?

    Is FaceTime HIPAA Compliant?

    Ethics Codes on TeleMental Health

    TeleMental Health Guidelines

    Insurance, Billing, Reimbursement & CPT Codes in E-Therapy & TeleMental Health

    Insurance and billing for services Second Life

    Second Life & Virtual Realities

    Professional Telehealth Associations

    University Centers for Telemedicine

    Online Telehealth Publications and Journals

    Miscellaneous Resources

    TeleMental Health Updates

    TeleMental Health References

    • American Association of Marriage and Family Therapists. (2015). Code of Ethics. Alexandria, VA: Author.
    • American Counseling Association. (2014). Code of Ethics. Alexandria, VA: Author.
    • American Psychological Association. (2010). American Psychological Association Ethical Principles of Psychologists and Code of Conduct. Washington, DC: Author.
    • American Psychological Association. (2013). Guidelines for the Practice of Telepsychology. Author.
    • American Telemedicine Association. (2009). Practice Guidelines for Videoconferencing-Based Telemental Health. Author.
    • American Telemedicine Association. (2009). Evidence-Based Practice For Telemental Health. Author.
    • American Telemedicine Association. (2013). Practice Guidelines for Video-Based Online Mental Health Services. Author.
    • American Telemedicine Association. (2014). Core Operational Guidelines for Telehealth Services Involving Provider-Patient Interactions. Author.
    • NASW and ASWB. (2005). Standards for Technology and Social Work Practice. Author.
    • National Association of Social Workers. (2008). Code of Ethics. Washington, DC: Author.
    • National Board for Certified Counselors. (2012). Code of Ethics. Greensboro, NC: Author.
    • US Dept. of Health and Human Services. (2006). HIPAA Administrative Simplification. Washington, DC: Author.
    • US Department of Health and Human Services. (2013). HIPAA Omnibus Final Rule. US Federal Register.

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    Additional References

    • Aguilera, A., & Berridge, C. (2014). Qualitative feedback from a text messaging intervention for depression: Benefits, drawbacks, and cultural differences. JMIR mHealth and uHealth, 2(4), e46. doi:10.2196/mhealth.3660
    • Aguilera, A., & Muñoz, R. F. (2011). Text messaging as an adjunct to CBT in low-income populations: A usability and feasibility pilot study. Professional Psychology: Research and Practice, 42(6), 472-478.
    • Agyapong, V. I. O., Mrklas, K., Suen, V. Y. M., Rose, M. S., Jahn, M., Gladue, I., & Greenshaw, A. (2015). Supportive text messages to reduce mood symptoms and problem drinking in patients with primary depression or alcohol use disorder: protocol for an implementation research study. JMIR research protocols, 4(2), e55. doi: 10.2196/resprot.4371
    • Alfonsson, S., Olsson, E., & Hursti, T. (2015). The effects of therapist support and treatment presentation on the clinical outcomes of an Internet based applied relaxation program. Internet Interventions, 2(3), 289-296.
    • Anderson, K. M., & Cook, J. R. (2015). Challenges and opportunities of using digital storytelling as a trauma narrative intervention for traumatized children. Advances in Social Work, 16(1), 78-89. Retrieved from
    • Anderson, K. M., & Wallace, B. (2015). Digital storytelling as a trauma narrative intervention for children exposed to domestic violence. In J.L. Cohen, J. L. Johnson, & P. Orr (Eds.), Video and filmmaking as psychotherapy: Research and practice (pp. 95-107). New York, NY: Routledge.
    • Andersson, G. (2016). Internet-delivered psychological treatments. Annual Review of Clinical Psychology, 12, 157-179. DOI: 10.1146/annurev-clinpsy-021815-093006
    • Andersson, E., Steneby, S., Karlsson, K., Ljótsson, B., Hedman, E., Enander, J., & Rück, C. (2014). Long-term efficacy of Internet-based cognitive behavior therapy for obsessive–compulsive disorder with or without booster: a randomized controlled trial. Psychological Medicine, 44(13), 2877-2887.
    • Andersson, G., Topooco, N., Havik, O., & Nordgreen, T. (2016). Internet-supported versus face-to-face cognitive behavior therapy for depression. Expert Review of Neurotherapeutics, 16(1), 55-60.
    • Backhaus, A., Agha, Z., Maglione, M. L., Repp, A., Ross, B., Zuest, D., & Thorp, S. R. (2012). Videoconferencing psychotherapy: A systematic review. Psychological Services, 9(2), 111-131.
    • Bashshur, R. L., Shannon, G. W., Bashshur, N., & Yellowlees, P. M. (2016). The empirical evidence for telemedicine interventions in mental disorders. Telemedicine and e-Health, 22(2), 87-113. doi:10.1089/tmj.2015.0206.
    • Ben-Zeev, D., Brenner, C. J., Begale, M., Duffecy, J., Mohr, D. C., & Mueser, K. T. (2014). Feasibility, acceptability, and preliminary efficacy of a smartphone intervention for schizophrenia. Schizophrenia Bulletin,40(6), 1244-1253.
    • Berle, D., Starcevic, V., Milicevic, D., Hannan, A., Dale, E., Brakoulias, V., & Viswasam, K. (2015). Do patients prefer face-to-face or internet-based therapy?. Psychotherapy and Psychosomatics, 84(1), 61-62.
    • Chen, M. (2002, April). Leveraging the asymmetric sensitivity of eye contact for videoconference. In Proceedings of the SIGCHI conference on Human factors in computing systems (pp. 49-56).
    • Chiad, M. O. (2008). Structural and linguistic analysis of SMS text messages. Journal of Kerbala University, 6(4), 15-27.
    • Herbst, N., Voderholzer, U., Thiel, N., Schaub, R., Knaevelsrud, C., Stracke, S., & Külz, A. K. (2014). No talking, just writing! Efficacy of an internet-based cognitive behavioral therapy with exposure and response prevention in obsessive compulsive disorder. Psychotherapy and Psychosomatics, 83(3), 165-175.
    • Holländare, F., Gustafsson, S. A., Berglind, M., Grape, F., Carlbring, P., Andersson, G., & Tillfors, M. (2016). Therapist behaviours in internet-based cognitive behaviour therapy (ICBT) for depressive symptoms. Internet Interventions, 3, 1-7.
    • Klein, J. P., Berger, T., Schröder, J., Späth, C., Meyer, B., Caspar, F., & Hautzinger, M. (2016). Effects of a psychological internet intervention in the treatment of mild to moderate depressive symptoms: results of the EVIDENT study, a randomized controlled trial. Psychotherapy and Psychosomatics, 85(4), 218-228.
    • Karyotaki, E., Kleiboer, A., Smit, F., Turner, D. T., Pastor, A. M., Andersson, G., & Christensen, H. (2015). Predictors of treatment dropout in self-guided web-based interventions for depression: An ‘individual patient data’ meta-analysis. Psychological Medicine, 45(13), 2717-2726.
    • Nordgren, L. B., Hedman, E., Etienne, J., Bodin, J., Kadowaki, Å., Eriksson, S., & Carlbring, P. (2014). Effectiveness and cost-effectiveness of individually tailored Internet-delivered cognitive behavior therapy for anxiety disorders in a primary care population: A randomized controlled trial. Behaviour Research and Therapy, 59, 1-11.
    • Reese, R. J., & Chapman, N. (2017). Promoting and evaluating evidence-based telepsychology interventions: Lessons learned from the university of Kentucky telepsychology lab. In M. M. Maheu, K. P. Drude, & S. D. Wright. Career paths in telemental health (pp. 255-261). New York, NY: Springer International Publishing.
    • Rozental, A., Forsell, E., Svensson, A., Andersson, G., & Carlbring, P. (2015). Internet-based cognitive—behavior therapy for procrastination: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 83(4), 808-824.
    • Russo, J. V., Bruce, M. A., & Scull, R. (2017). Click here for mental health support: Extending mental health services to the isolated learner. Recruiting & Retaining Adult Learners, 19(4), 1-7. DOI:10.1002/nsr.30211
    • Soucy, J. N., Owens, V. A., Hadjistavropoulos, H. D., Dirkse, D. A., & Dear, B. F. (2016). Educating patients about Internet-delivered cognitive behaviour therapy: Perceptions among treatment seekers and non-treatment seekers before and after viewing an educational video. Internet Interventions, 6, 57-63.
    • Suler, J. R. (2000). Psychotherapy in cyberspace: A 5-dimensional model of online and computer-mediated psychotherapy. CyberPsychology and Behavior, 3(2), 151-159. doi:10.1089/109493100315996
    • Titov, N., Fogliati, V. J., Staples, L. G., Gandy, M., Johnston, L., Wootton, B., & Dear, B. F. (2016). Treating anxiety and depression in older adults: Randomized controlled trial comparing guided v. self-guided internet-delivered cognitive–behavioural therapy. British Journal of Psychiatry Open, 2(1), 50-58. doi:10.1192/bjpo.bp.115.002139
    • Vander Stoep, A., McCarty, C. A., Zhou, C., Rockhill, C. M., Schoenfelder, E. N., & Myers, K. (2017). The children’s attention-deficit hyperactivity disorder telemental health treatment study: Caregiver outcomes. Journal of Abnormal Child Psychology, 45(1), 27-43. doi:10.1007/s10802-016-0155-7
    • Whealin, J. M., King, L., Shore, P., & Spira, J. L. (2017). Diverse veterans’ pre-and post-intervention perceptions of home telemental health for posttraumatic stress disorder delivered via tablet. The International Journal of Psychiatry in Medicine, 52(1), 3-20.
    • Wootton, B. M., Dear, B. F., Johnston, L., Terides, M. D., & Titov, N. (2014). Self-guided internet administered treatment for obsessive-compulsive disorder: Results from two open trials. Journal of Obsessive-Compulsive and Related Disorders, 3(2), 102-108.
    • Yeung, W. F., Chung, K. F., Ho, F. Y. Y., & Ho, L. M. (2015). Predictors of dropout from internet-based self-help cognitive behavioral therapy for insomnia. Behaviour Research and Therapy, 73, 19-24.
    • Zhou, E. S., Partridge, A. H., Blackmon, J. E., Morgan, E., & Recklitis, C. J. (2016). A pilot videoconference group stress management program in cancer survivors: Lessons learned. Rural and Remote Health, 16, 3863. Retrieved from

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