3 TPC Digest 3 TPC Digest Amanda DeDiego, Rakesh K. Maurya, James Rujimora, Lindsay Simineo, Greg Searls Counseling and the Interstate Compact: Navigating Ethical Practice Across State Lines T he Counseling Compact serves a need for broader options of license portability for professional counselors, especially considering the rapid expansion of telemental health to address a dire need for counseling services across the nation. With the Counseling Compact soon taking applications for privileges, this article offers considerations of ethical and legal aspects of counseling under the compact. An illustrative case example and flowcharts offer guidance for counselors planning to apply for Counseling Compact privileges and use telemental health across multiple states. The most common scenario for counselors using privilege to practice under the Counseling Compact would be provision of telehealth services for clients in multiple states. As part of responsible practice, counselors who engage in telemental health practice need to consider ethical considerations and risks. In addition to considerations of ethical practice, mental health professionals must adhere to federal and state laws regarding privacy and security of information stored and exchanged electronically. For example, counselors need to select HIPAA-compliant software and technologies to maintain the security, privacy, and confidentiality of electronic client information. This article outlines encryption requirements and suggestions of workflow in documentation and protocols to adhere to both ethical and legal requirements of conducting mental health counseling via telehealth. Basic considerations for ethical telehealth practice include: (a) confidentiality and limits of modality; (b) emergency plans, documentation, and storage of information; (c) plans for technological failures; (d) policy for contact between sessions; and (e) termination and referrals. The Counseling Compact is a privilege-to-practice model of interstate compacts. This type of compact establishes an agreement between member states to grant legal authorization that permits counselors to practice. This means counseling licensure is still maintained by a single state, or “home state,” but member states allow privileges to practice with clients located in other states as part of the compact agreement. Under the compact, counselors may choose which states to apply for privileges to practice in and pay the associated fees per state. Under the Counseling Compact, counselors would need to apply for privileges in individual states where they wish to practice if these states have passed legislation to join the compact group. This process may involve passing jurisprudence exams for some states. However, licensing renewal and continuing education would only be required in accordance with the home state standards and process. Ethical practice in multiple states entails more than just applying for privileges through the Compact Commission. This article includes an illustrative case example of Sam, a licensed professional counselor, who requests privileges to practice online with a client in another state through the Counseling Compact. Discussion of this case includes illustrating each step of applying for compact privileges, including examining their own process for telehealth to ensure adherence to ethical and legal expectations. The article includes a visual flowchart for counselors hoping to apply for privileges through the Counseling Compact. This article also includes a visual example of a step-by-step workflow to ethically and legally implement telehealth in multiple states under the compact. Amanda DeDiego, PhD, NCC, BC-TMH, LPC, is an associate professor at the University of Wyoming. Rakesh K. Maurya, PhD, is an assistant professor at the University of North Florida. James Rujimora, MEd, EdS, is a doctoral student at the University of Central Florida. Lindsay Simineo, MA, NCC, LPC, is Legislative Advocate for the Wyoming Counseling Association. Greg Searls is Executive Director of Professional Licensing Boards for the Wyoming Department of Administration & Information. Correspondence may be addressed to Amanda DeDiego, 125 College Dr, UU 431, Casper, WY 82601, adediego@uwyo.edu.
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