2. ATA Practice Guidelines for Video- based Online Mental Health Services “The guidelines pertain to telemental health conducted between two parties, and do not address concerns related to multipoint videoconferencing. These guidelines include telemental health services when the initiating, receiving, or both sites are using a personal computer with a webcam or a mobile communications device (e.g., “smart phone”, laptop, or tablet) with two-way camera capability. These guidelines do not address communications between professionals and clients or patients via texting, e-mail, chatting, social network sites, online “coaching” or other non-mental health services.” (ATA, May 2013)

3. Clinical Guidelines Professional and Patient Identity and Location Provider and Patient Identity Verification Provider and Patient Location Documentation Verification of provider and patient location is Critical for 4 reasons: Compliance with relevant licensing laws; emergency management protocol is dependent upon where the patient receives services; mandatory reporting and related ethical requirements; and in some cases provider payment amounts are tied to location.

4. Clinical Guidelines Professional and Patient Identity and Location Contact Information Verification for Professional and Patient Verification of Expectations Regarding Contact Between Sessions

5. Clinical Guidelines: Patient Appropriateness for Videoconferencing-based Telemental Health To date, no studies have identified any patient subgroup that does not benefit from, or is harmed by, mental healthcare provided through remote videoconferencing. (Day, 2002; O’Reilly et al., 2007 & Ruskin et al., 2004)

6. Clinical Guidelines: Patient Appropriateness for Videoconferencing-based Telemental Health Considerations for the appropriateness of Videoconferencing in settings where professional staff are not immediately available Patient expectations & level of comfort Patient takes an active & cooperative role Patient’s organizational & cognitive capacities

7. Clinical Guidelines: Patient Appropriateness for Videoconferencing-based Telemental Health Other considerations: Patient is responsible for equipment set-up, maintenance of computer settings and privacy at his or her site along with technology competency Geographic distance to nearest emergency medical facility, patient’s support system and medical status

8. Clinical Guidelines: Informed Consent Conducted with patient in real-time Follow local, regional and national laws Provider documents consent in medical record Information included is same as in-person Key topics include: confidentiality, emergency plan, how patient information is documented and stored, technical failure, contact between sessions

9. Clinical Guidelines: Physical Environment Aim to provide comparable professional specifications of a standard services room Ensure privacy If other people are present, announce their presence Seating, lighting, camera positioning

10. Clinical Guidelines: Communication & Collaboration with Patient’s Treatment Team Optimal clinical management of patients depends on coordination of care between a multidisciplinary treatment team

11. Clinical Guidelines: Emergency Management 1.Education and Training 2.Jurisdictional Mental Health Involuntary Hospitalization Laws 3.Patient Safety in a Setting with Immediately Available Professionals 4.Patient Safety in a Setting without Immediately Available Professionals 5.Patient Support & Uncooperative Patients 6.Transportation 7.Local Emergency Personnel

12. Technical Guidelines Video Conferencing Application Device Characteristics Connectivity Privacy

13. Administrative Guidelines Qualification and Training of Professionals Documentation and Record Keeping Payment and Billing