Editor’s Note: Nicole Stargell is an associate professor in the Department of Counseling at the University of North Carolina at Pembroke. Nicole earned her master’s degree in clinical mental health counseling and school counseling from Youngstown State University, and her doctoral degree in counseling and counselor education from the University of North Carolina at Greensboro. She is an LPC-A and licensed school counselor in both Ohio and North Carolina, and she is a National Certified Counselor (NCC). We spoke with Nicole about her Board Certified-TeleMental Health Provider (BC-TMH) credential.
How do you use telemental health in your practice?
It’s very timely to start talking about telemental health because the use of technology has become inherent in most things. Whether you are offering it like I am, strictly meeting online, building up a caseload, or sending intermittent emails that include anything other than scheduling and clerical information, then you are engaging in telemental health counseling.
Some counselors will meet with clients in person and then offer telemental health sessions as a supplement in between sessions. This presents its own unique challenges such as ensuring you are legally allowed to practice in the client’s location. I never meet my clients in person, which can require an extra layer of caution—making sure clients understand the limits to distance counseling and ensuring they are in a safe location.
I am able to connect with all clients in North Carolina, but I have professional networks in Greensboro; the Pembroke area, which really connects with the rural population; and Charlotte.
Currently all my clients are permanently located in North Carolina, even though I’m licensed in North Carolina and Ohio. Branching out and trying to reach clients in Ohio would be a manageable next step, but I’ve been doing this for about a year and recently reached my goal of five long-term telemental health clients. While a year may seem like a long time and five clients may seem like very little, I was keeping in mind the time I spend in my role as a full-time associate professor.
What are some benefits of telemental health for your clients?
It’s important to talk about the accessibility of telemental health. I am able to provide services to clients living in rural areas or with schedules as busy as mine. When we talk about rural access to treatment and physical access to treatment, telemental health is a great option for clients who have mobility and transportation limitations. The access to technology, especially in older clients, can be a potential barrier, but if you have access to very simple technology—a webcam and data access—you can participate in telemental health counseling. Telemental health is great for clients without flexibility in their jobs, those who work from home, stay-at-home parents, people who experience emotional discomfort when leaving their homes, people who physically cannot [leave their homes], and those who would rather be in their home during sessions because they stay so busy throughout the day. Most of my clients I see after 5 pm or on Saturday. It’s great for clients. We are in need of more outcome research in telemental health counseling, but the prospect is promising.
What are some benefits to counselors who offer this modality of service?
It’s comfortable and convenient for the client as well as the counselor providing it. I literally walk upstairs and begin my sessions. And they can do that, too. It’s beneficial for the counselor because I’m never in a situation where I have to worry about my safety. Additionally, counselors have an insider look into a client’s personal space, and counselors can ensure client safety using real-life information. Counselors can offer evidence-based therapy to clients across an entire state.
What challenges do you face as a distance counseling provider?
A lot of the challenges faced by telemental health [providers] often circle back around to licensure portability. If our licenses were valid across multiples states, telemental health counseling would have a broader reach.
All my clients are in North Carolina because I’m licensed here. The way our laws work here is that I’m able to provide services to people whose primary residence is in North Carolina and who are located in North Carolina. Some practitioners would like to offer telemental health as a way of maintaining contact and relationships when their clients are out of town, but every state has different laws, and so it depends on the laws for distance counseling in the state where the counselor is licensed and the state where the client travels.
It can be scary with the legal and ethical nuances that aren’t fully established and explored. There are a lot of gray areas. An example would be if a regular client based in North Carolina were to vacation in Vegas for a week. North Carolina law states that counseling takes place where the client is located. So, we need to find out what Nevada law says about counselors seeing clients in their state. It’s different in every state. At this point, nine states do allow for counselors to temporarily counsel a traveling client in their state. Ultimately, we have to ask what is the best clinical care for our clients? Many would argue that a major benefit of telemental health is to be able to provide continuity of care when your clients are living their daily lives. There is a huge advocacy piece that plays into this.
Telemental health counseling is subject to all state laws and national ethics, and HIPAA can be a bit more challenging to protect. However, with proper encryption and business associate agreements, telemental health counseling is quite secure. Counselors must ensure safety for their clients because they are not [right] in front of you. Before every session I always verify their identity and also their physical location. I have an emergency contact for each client, but I could always call the police if assistance was needed. Telemental health is best for people above the age of 18 and who are not in crisis.
What is some advice you would offer to counselors regarding telemental health?
On one hand, I believe that telemental health is the wave of the future and we need to dig into it with training and research programs. On the other hand, it is really new with a lot of considerations for counselors to keep in mind. It’s not something that should be done without intentionality and consultation. I have a distance-based supervisor, also a BC-TMH, through The Center for Credentialing & Education. It’s so important to keep researching and refining this important aspect of professional counseling
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