During the COVID-19 pandemic, many counselors adapted to counseling clients via video while in-person appointments were not possible or severely restricted. Correspondingly, insurance coverage expanded and regulations regarding telebehavioral health were relaxed in many states out of necessity.
Now, as pandemic restrictions are being loosened and some helping professionals return to in-person office settings, many counselors are wondering about the future status of telebehavioral health. Will all the “old” regulations suddenly return, or will changes introduced during the pandemic remain long term?
Lynn Linde, the American Counseling Association’s chief knowledge and learning officer, says that a number of factors point toward telebehavioral health remaining a viable option for counselors in the months and years ahead.
“People have discovered that there’s a tremendous desire on the part of clients to continue telehealth, and that’s what will drive this,” says Linde, who is also a past president of ACA. “I think states aren’t going to be quick to go back to the way things were. … Counselors traditionally have not received a lot of training in telebehavioral health. We all have had to learn how to live a Zoom existence and get work done remotely — and people’s perspectives [about telebehavioral health] have changed.”
Regulation of telebehavioral health for professional counselors varies state to state. Prior to the pandemic, a handful of states had statutes that allowed for the use of telebehavioral health under counselors’ scope of practice. During the pandemic, other states relaxed and expanded the regulations surrounding telebehavioral health via executive orders from governors of regulation boards, Linde explains.
Now, more than a year later, state legislatures in several states are considering omnibus bills that would allow for the use of telehealth permanently, Linde says.
“There has been a lot of push by [state] governments for health insurance companies to cover telehealth. I think now that the efficacy of telehealth is being demonstrated, insurance companies are going to view things differently,” Linde says. “As telehealth expands, they’re going to have to rethink some of their policies around reimbursement. Some of them already are, and some states are also putting pressure on them to change. This is a huge change in the field of medicine and mental health. It’s partly counselors and clients becoming accustomed to doing things differently, and regulators and insurance companies noticing the difference.”
Telebehavioral health is also a major aspect of the interstate counseling compact project that has been gaining momentum this spring. The compact, an initiative that would allow counseling practice across state lines, is finalized and will take effect once 10 states pass legislation to adopt it. In March, Georgia was the first state to pass such legislation, followed by Maryland.
Language in the agreement ensures that any state that adopts the compact will allow counselors to use telebehavioral health permanently, Linde says. Launched in 2019, the compact project is a partnership between ACA and the Council of State Governments’ National Center for Interstate Compacts. Once a 10th state adopts the compact, it will become live and those 10 states will form its governing body.
Leaders involved in the project, including Linde, expect that the compact will reach the 10-state threshold in the summer of 2022. There is a “critical mass” of states — more than 20 — that have shown interest in joining the compact in the coming year, she says.
“It’s not a question of if we will have a compact but when,” Linde says. “We’re really seeing progress, and there is excitement [among those involved].”
Convenience and improved access
The increased use of telebehavioral health among counselors over the past year-plus has shed light on its benefits as well as how it can improve access for clients who face barriers to in-person treatment, Linde notes.
“The pandemic, in many ways, showed the deficits in our mental health delivery system,” she adds.
Telebehavioral health has allowed clients who struggle with transportation and other barriers, as well as those who live in communities or areas without a counselor, to access counseling more easily. It has also benefited college students who had to return home — often to a different state — when many campuses closed in the spring of 2020 and shifted instruction online, Linde notes.
“Necessity is the mother of invention. When everything locked down, everyone was scrambling on how to continue services. One year later, [telebehavioral health] is no longer a one-off. It’s become more of a way of doing things,” Linde says. “Counselors are trained to do face-to-face, in-person counseling. That’s our training. But we’ve seen that it is possible to pick up on some of those cues that we usually depend on seeing in person [during sessions]. It’s not the horrible situation that a lot of counselors thought it would be it. Actually, it can be very positive, and there can be benefits and time savers both for counselors and clients.”
- Read more on this topic in a feature article, “Pandemic telehealth: What have we learned?” in Counseling Today’s May magazine.
- Find out more about the ethical standards for telebehavioral health and other important information on ACA’s COVID-19 resource page here.
- Also see Section H, “Distance Counseling, Technology, and Social Media,” of the 2014 ACA Code of Ethics at counseling.org/ethics.
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Bethany Bray is a senior writer and social media coordinator for Counseling Today. Contact her at bbray@counseling.org.
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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.
Sometimes change is incremental; sometimes it happens like a flash of lightening. What seemed impossible at the beginning of March 2020 became standard operating procedure later that spring and is now what most of my clients prefer – and I do, too. In a sprawling city like Atlanta with epic traffic, it wasn’t unusual to have clients late for sessions. This is a less stressful way for many clients to work. I don’t think there has been a loss of connection or effectiveness.
I couldn’t have imagined working this way before the pandemic. Now it would feel strange not to work this way.
We had to close our office during the shutdown phase with zero notice. It took tremendous effort, planning, equipment purchases, a new website, advertising etc to navigate that devastating change. Not to mention trying to figure out how to keep at least part of our clients. Changed mailing addresses for every insurance company, Created all new forms and paperwork. Upgraded Internet service and ran wire in our home office spaces. We spent over 20 years building a thriving practice and to have it ripped away like that was – well there are no words. Once we got tele therapy set up and we realized it works so well for both clients and us we decided to make it permanent. We paid rent on our office space for 10 months, and never used it once during that time because COVID did NOT go away by April as trump touted. We’ve had such positive feedback. As lives have gotten more scrambled it has become a modality people actually seek out – knowing how much better it will fit into their lives. I feel no deficit in access to patient cues. . Eagerly awaiting the expansion of the Compact.
I am a clinical mental health counselor and I work with clients who have chronic illnesses, pain, and invisible disabilities. To say tele-therapy has been great would be an understatement! If it’s sanctioned use goes away, so will most of my clients, who already have anxiety, stress, and depression related to living with their chronic physical conditions. The use of tele-therapy needs to be considered as essential as in-person sessions.
Update on the Counseling Compact, May 11: https://www.counseling.org/news/updates/2021/05/11/georgia-becomes-first-state-to-sign-interstate-counseling-compact-into-law