TPC Journal-V6, Issue 4- FULL ISSUE

The Professional Counselor /Volume 6, Issue 4 388 mental health care providers can easily connect with clients without requiring in-office meetings (Baker & Bufka, 2011). Some individuals will not or cannot seek mental health services when in- person services are needed; therefore, the in-person treatment process becomes a treatment barrier (Bensink, Hailey, & Wootton, 2006). According to Brown (1998), some individuals fail to seek mental health services due to geographical restrictions. Other individuals may struggle with physical health restrictions, preventing them from seeking traditional, in-office services. Mental health conditions such as panic disorder (Klein, Richards, & Austin, 2006), agoraphobia and eating disorders (Zabinski, Celio, Wilfley, & Taylor, 2003) may restrict individuals from receiving traditional services. Using Internet-based services, mental health practitioners can reach clients who are in rural locations, who are seriously ill or who do not seek traditional counseling. While the use of technology increases access to care, the technology itself creates new, unique challenges and potential risks for mental health providers (Baker & Bufka, 2011). Fifteen years ago, Riemer-Reiss (2000) discussed utilizing distance technology in mental health practice, listing foreseeable concerns for practitioners. More recent publications (Barnett & Kolmes, 2016a, 2016b) present similar concerns and questions for mental health providers. Counselors must attain competency in working with special populations or in specific practice areas, including the use of telemental health services (Baker & Bufka, 2011; Barnett & Kolmes, 2016a, 2016b). Yet, counselors are faced with a lack of clear guidance on ethical, legal and regulatory requirements for telemental health services, including security, assessments and best practices (Ostrowski, 2014). A Brief History of Telemental Health In September 1997, the National Board for Certified Counselors (NBCC) became the first organization to adopt standards for telemental health (Shaw & Shaw, 2006). At that time, NBCC called telemental health WebCounseling , defined as “the practice of professional counseling and information delivery that occurs when client(s) and counselor are in separate or remote locations and utilize electronic means to communicate over the Internet” (NBCC, 1997, p. 3). In October 1999, the American Counseling Association (ACA) released the Ethics Standards for Internet Online Counseling in order to “establish appropriate standards for the use of electronic communications over the Internet to provide online counseling services, [which] should be used only in conjunction with the ACA Code of Ethics and Standards of Practice” (p. 1). For psychologists, the American Psychological Association (APA) released a statement in 1997 regarding the use of services by telephone, teleconferencing and the Internet, urging psychologists to use the existing APA Ethics Code and the appropriate licensure board rules for services provided (Shaw & Shaw, 2006). The Clinical Social Work Federation (CSWF) issued a position paper in 2001 on Internet text-based therapy, stressing that practitioners must follow their CSWF code of ethics and all state licensing laws (Lonner, 2001; Shaw & Shaw, 2006). Nearly 20 years have passed since NBCC broke ground by providing initial guidance for Web- based counseling. The ethical guidance for mental health professionals has continued to evolve as the body of research is growing and telemental health services are becoming more prominent. Several studies have discussed the ethical codes for mental health practice for counselors, psychologists, social workers, and marriage and family therapists (Alleman, 2002; Barnett & Scheetz, 2003; International Society for Mental Health Online, 2000; Mallen, Vogel, & Rochlen, 2005; Manhal- Baugus, 2001; Midkiff & Wyatt, 2008; Recupero & Rainey, 2005). However, while most major mental health organizations have released ethical guidelines for telemental health practice, counselors also must seek guidance from state mental health licensing boards to comply with state licensure laws. Competency requires more than familiarity with state licensure laws; counselors must understand