177 The Professional Counselor™ Volume 13, Issue 3, Pages 177–192 http://tpcjournal.nbcc.org © 2023 NBCC, Inc. and Affiliates doi: 10.15241/ad.13.3.177 Amanda DeDiego, Rakesh K. Maurya, James Rujimora, Lindsay Simineo, Greg Searls Counseling and the Interstate Compact: Navigating Ethical Practice Across State Lines In the wake of COVID-19, health care providers experienced an immense expansion of telehealth usage across fields. Despite the growth of telemental health offerings, issues of licensing portability continue to create barriers to broader access to mental health care. To address portability issues, the Counseling Compact creates an opportunity for counselors to have privileges to practice in states that have passed compact legislation. Considerations of ethical and legal aspects of counseling in multiple states are critical as counselors begin to apply for privileges to practice through the Counseling Compact. This article explores ethical and legal regulations relevant to telemental health practice in multiple states under the proposed compact system. An illustrative case example and flowcharts offer guidance for counselors planning to apply for Counseling Compact privileges and provide telemental health across multiple states. Keywords: telehealth, legislation, Counseling Compact, portability, telemental health Maximizing the use of technology-assisted counseling techniques, telemental health (TMH) is a modality of service delivery that takes the best practices of traditional counseling and adapts practice for delivery via electronic means (National Institute of Mental Health, 2021). There are many terms to describe TMH, which include: distance counseling, technology-assisted services, e-therapy, and tele-counseling (Hilty et al., 2017). Counselors have previously been hesitant in adopting technologysupported counseling practice (Richards & Viganó, 2013). Since the onset of the COVID-19 pandemic, TMH use has grown exponentially in applications across various disciplines (Appleton et al., 2021). Between March and August 2021, out of all telehealth outpatient visits across disciplines, 39% were primarily for a mental health or substance use diagnosis, up from 24% a year earlier, and 11% two years earlier (Lo et al., 2022). During the same period, 55% of clients in rural areas relied on TMH to access outpatient mental health and substance use services compared to 35% of clients in urban areas. Further, TMH has expanded the accessibility of mental health services to underserved populations, including people living in remote areas, and marginalized groups, including sexual minorities, ethnic and racial minorities, and people with disabilities (Hirko et al., 2020). With broader adoption of TMH, existing issues of licensure portability continue to represent barriers to service provision across state lines. Recent state and national legislation that addresses telehealth parity and clarifies language in the provision of telehealth services supports the continued expansion of TMH (Baumann et al., 2020). Thus, to address portability issues, a partnership of professional counseling organizations engaged in a decades-long effort to address barriers to portability, leading to the recent creation of the Counseling Compact. With the Counseling Compact legislation having been successfully passed in far more than the required 10 states, the Counseling Compact Commission has convened to create bylaws and informational systems to manage opening applications for privilege to practice in early 2024 (American Counseling Association [ACA], 2021). As counselors venture into a new era with privileges to practice 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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