Risk Assessment and Crisis Management in Technology Assisted Therapy

1. Risk Assessment and Crisis Management in Technology Assisted Therapy SexTherapy-Online, PLLC Rhiannon Beauregard, MA, LMFT-S, CST Licensed Marriage and Family Therapist AASECT Certified Sex Therapist Specialist-Problematic Sexual Behavior

2. Agenda for Today • 10 am – 10:15 am: Introduction to Presenter and Attendees ✔️ • 10:15 am – 11:15 am: Introduction to Online Therapy ✔️ • 11:15 am – 11:30 pm: BREAK- Ask questions, use restroom, self-care ✔️ • 11:30 pm – 12:30 pm: Laws, Rules, Regulations, and Ethics of Online Therapy, including Out-of-State Practice, Online Apps/Programs, International Online Therapy ✔️ • 12:30 pm – 1 pm LUNCH ✔️ • 1 pm – 2:00 pm: Logistics of Online Therapy: The How To’s including HIPAA Compliance ✔️ • 2:00-2:45 pm: Risk Assessment and Crisis Management when Working Online • 2:45 – 3:00 pm: BREAK- Ask questions, use restroom, self-care • 3:00 pm – 4:00 pm: Advanced Concepts of Online Therapy: Online Therapy as a Model within Itself

3. What's the greater risk? Letting go of what people think - or letting go of how I feel, what I believe, and who I am? Brene Brown

4. Risk Assessment Every professional has a different definition of risk and a different level of tolerance of risk. When assessing for risk, it is important that we understand both within ourselves and within our profession. What do you think the biggest risk factor in doing technology assisted therapy is for you? What is your biggest fear about technology assisted therapy?

5. Risk Assessment • Assess for risk to YOU as the provider (malpractice insurance, licensing laws, ethical codes, guidelines to practice, scope of practice) • Is this the best modality for YOU to be working in? • Is this the best modality for the models you are trained to work in? • Assess for risk to THE CLIENT • Appropriateness for online services • Is this the best modality for the presenting issue? • Have we assessed for suicidal ideation, domestic violence, substance abuse issues, and severe mental health issues? Does that immediately exclude this population from technology assisted treatment? • Verification of identity and age for non-anonymous services • WHAT OTHER RISKS EXISTS?

6. Risk Assessment • Check with your malpractice insurance prior to working online. Mine specifically stated: • “In regards to online counseling, there is no specific exclusion within CPH and Associates policies for this practice, so it is covered under policy as long as the services being provided are authorized or allowable under the scope of the policyholder’s license. However, given the new terrain, regulatory boards and professional ethics codes are just beginning to tackle this issue. Be cautioned that the way this service is being handled varies greatly from state to state.”

7. Crisis Management • Advanced Planning • Recommended to safety plan with each client as soon as possible. • Informed Consent • “Providing therapy at a distance arises some unique challenges in case of an emergency. If an emergency occurs, Rhiannon C. Beauregard may speak to a member of your family or another clinician without your consent. If there is good reason to believe you are at imminent risk of harming yourself, Rhiannon C. Beauregard is legally responsible to inform a crisis center, hot line, emergency room, police, etc. and will contact the appropriate authorities in the area that you are located. “ • Safety Plan should include (and be kept in a file with your access to it): • Closest Emergency Room • Closest Police Station • Local Emergency Numbers (fire, police, ambulance) • Closest/Local Psychiatric Inpatient Facilities • Contact phone number and information for local therapist (if available) • Local, regional, and state Suicide Prevention Hotlines • Local, regional, and state Crisis lines, including Domestic Violence Hotlines and Sexual Assault Hotlines • In Case of Emergency: Who Do I contact that would know what happened?

8. Crisis Management • Coordination of Care • I often request the client have a local contact for therapy that I have a prior Authorization to Release Information signed so that can be a point of contact for more intense care. • If a client is psychiatrically involved, I may not see them unless they have a local contact that is primarily responsible for their psychiatric care and that I am in contact with regularly. • Reassessment of Care After Crisis • Sometimes clients are appropriate for online work but then transition into needing a higher level of care. This is something I discuss with the client and often provide the levels of care as options and discuss with the client what my role will be in their care.

9. Sample of Informed Consent

10. Risky Business • Let’s come up as a group with some risky and/or crisis situations and brainstorm how we would handle them, paying special attention to risk assessment/management and crisis issues as well as: • How would telehealth and online therapy benefit this case? • How would telehealth and online therapy be challenging for this case? • What are the relevant • LEGAL • ETHICAL • RISK MANAGEMENT • BEST PRACTICES, SCOPE OF PRACTICE, AND QUALITY OF CARE issues to consider with this case?

11. Any Questions?

12. Contact Rhiannon C. Beauregard, MA, LMFT-S, CST, S-PSB Licensed Marriage and Family Therapist in Maine, Massachusetts, New Hampshire, New York, & Texas www.SexTherapy-Online.com rhiannon@sextherapy-online.comrhiannon.c.beauregard@gmail.com Phone: 603.770.5099 Phone: 512.765.4741 Fax: 888.288.8495 Follow me on Facebook: @RhiannonBeauregardCSTWatch my YouTube Channel: Rhiannon@SexTherapy-Online.com