• Sara Gilman

Telemedicine & Telehealth:Getting the Help You Need, When and Where You Need It, Can Make a World oF

Updated: Jun 7

A Difference!

What is meant by ‘telemedicine’ or ‘telehealth’? In 1996 California passed legislation regulating the practice of “telemedicine.” This definition was updated in 2012 and the term “telemedicine” was updated with the term “telehealth.”

The primary goal of creating ‘telehealth’ services is to make effective healthcare & counseling assessable to people who are unable to reach a professional due to a variety of reasons, such as, injury, illness, being house bound as a patient or a care giver, living in rural areas, or deployment.

The California Board of Behavioral Sciences, who is the governing body for professional mental health counselors, puts it this way, “Telehealth means the mode of delivering health care services via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health.” All of the same ethical standards and guidelines apply to telehealth services, just as if the client was in the office. Confidentiality and the safe keeping of records is paramount. This includes consent for treatment, and the understanding the risks involved in using certain less secure devices, such as Skype. Clients need to be informed that it is at times difficult to secure online communications. The Centers for Medicare and Medicaid Services (CMS) requires that the telehealth interaction use real-time audio and video communications between the patient and provider. Telephones, facsimile (fax) machines and electronic mail systems do not meet the definition of an interactive telecommunications system.

Counselors can treat clients in their own state where they are licensed, however they may need to obtain further approval for out of state services of new clients. A specific credential has been created called the Interjurisdictional Practice Certificate that facilitates temporary practice in other jurisdictions.


The growing need to provide services to our military, who are in need and do not have accessibility due to deployments, increased the focus of providers and policy makers to look into the issues surrounding telemedicine.

According to an article titled, “Telemedicine — Breaking Barriers to Psychotherapy,

the RAND Center for Military Health Policy Research, says about 20% of veterans who served in Iraq and Afghanistan suffer from PTSD or MDD (Multiple Deployment Disorder), and about 7.1% of veterans meet the criteria for substance abuse disorder. The RAND report has expressed the growing need for confidential, evidence-based psychotherapy. Some recent studies recommend telemedicine as the solution to providing these needed services! EMDR Therapists, serving the military, have been actively involved in implementing this on the front line, with positive results!

This same article goes on to describe some of the known barriers that have kept our service men and women from getting the help they need have included mobility, stigma (“If I get help will they think I’m crazy? Will it affect my job status?), and geographical isolation. Additionally, for the over 5.3 million veterans living in rural communities in the United States with limited access to mental health care, telemedicine can be a cost effective, and a valuable opportunity for improving health and wellbeing. After 30 years of working with veterans, and others suffering from PTSD, I believe early intervention will not only save dollars in future health problem costs, but may also save lives by heading off the debilitating effects of being left untreated. Many veteran mental health care providers join me, when I say, EARLY INTERVENTION WITH EFFECTIVE EMDR TREATMENT IS THE BEST CHOICE!”

(To read more go to: http://www.ruralhealth.va.gov/about/rural-veterans.asp, https://www.memd.me/telemedicine-breaking-barriers-to-psychotherapy)

What are some circumstances when telehealth would be used in psychological counseling?

As mentioned previously, when people live in rural areas where in-person services are inaccessible, Internet video conferencing can be the bridge to healing. Or the client who is house bound due to injury, illness, or is a caregiver and cannot leave their suffering loved one. Caregivers often experience feelings of isolation, fear, and confusion, and need support to negotiate the mental and physical demands. Young parents who do not have access to childcare are another important group to care for. Parenting is a challenging and scary job, and when there is no support available, these moms and dads may develop ineffective coping styles. Individual and family counseling, coping skills building through psycho-education, EMDR Therapy for traumatic stress processing, and ongoing follow-up, can all be effectively accomplished in face-to-face video conference calls. In other cases, when a current client of the counselor’s is traveling, or working somewhere else in the world for a period of time, the counseling process does not have to be disrupted.

Does my insurance pay for it?

Many insurance companies have come on board to pay for telemedicine services. Specific billing codes for certain services have been defined. Your healthcare provider can check on this.

The emerging field of telemedicine is growing rapidly. If you have further questions about telehealth counseling services, please contact us. Getting the help you need, when and where you need it, can make a world of difference!

Sara Gilman, LMFT

PsyD, CEO, Director

Coherence Associates Inc.

www.coherenceassociates.com (760) 942–8663

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