Please support Telehealth.org’s ability to deliver helpful news, opinions, and analyses by turning off your ad blocker.
A reporter from the New York Times called last week to ask whether or not licensed mental health practitioners can legitimately work over state lines if they practice “coaching” instead of mental health. This is a question I often address, so I didn’t think much of it, until the reporter mentioned that the new telemental health service involved Lantern. I was conflicted about explaining the details because I’ve been more than impressed with Lantern and its predecessor, ThriveOn.
The NYT reporter wanted to discuss the ramifications of coaching services being delivered over state lines by Lantern’s licensed mental health professionals. While I’m personally unaware of Lantern’s activities in this regard, I do have clear opinions about practicing over state lines as a coach when holding a mental health license. The reporter especially wanted to know if what consumers should be told about coaches vs. licensed professionals, so I gave her the information below.
Not All Coaching Training Programs Are Alike
The confusion of coaching and inter-jurisdictional practice is prevalent because unfortunately, many licensed professionals have been led to believe that they can legitimately practice as coaches when working over state lines. Such coaches often serve clients in multiple states and foreign countries by telephone, email or video. Some conduct family or group sessions with clients across state and national borders. Most have not been given the facts about practicing over jurisdictional lines or how such practice can be both illegal and unethical.
These professionals probably came by this belief the same way I did years ago when I went through my own training to be a coach. Licensing requirements were frankly, glossed over. We were however, carefully instructed in how to develop separate practices and promotional websites for our mental health clients/patients in our state(s) of licensure vs. for our worldwide coaching practices. We were given very clear details about which services could be offered in mental health versus coaching, how to draft our intake forms, keep different types of notes, etc. We were taught to open separate bank accounts for the two businesses. We were taught telephone coaching skills and how to run groups anywhere, including over state lines.
It then, comes as no surprise to me that today, many of our colleagues still hold the belief that their license-related mandates don’t apply over state lines. It pains me to be the harbinger of bad news for my colleagues, but the fact is, once we are licensed, the mandates of licensure trump our attempts to call ourselves “coaches” if our services resemble the scope of mental health service as defined not by us, but by our respective licensing boards.
Coaching: More Worrisome Facts
Whether or regulatory board actions apply to your coaching practice can be immediately verified by going to your licensing board’s website and looking for the definition of practice for your discipline. For example, the definitions of practice for California psychologists and marriage, family and child therapists, social workers, licensed professional counselors and educational psychologists are all clearly stated. Delivering a service over state lines that resembles your mental health services as per your state definitions of professional practice can be problematic. You also have to be aware of the laws of the state(s) you are entering, and whether or not those states consider your services professional services as per their definitions. For instance, some states have laws against entering their state to deliver specific services without appropriate licensure. Last I checked, states such as Vermont and Utah can levy rather harsh penalties when such infractions are discovered ($5000 and/or 1 year in jail for psychologists). Other states have laws saying that if licensed, we can’t go out of our state of licensure without written permission from the foreign state or country.
Many other requirements can also come into play. This blog post is already too long, so I’ll only mention a few more examples. In more complicated instances, malpractice coverage can be revoked if the clinician is found by the court to have practiced “criminally” or “with criminal intent” when investigated. What can lead to an investigation? Many things. In my experience as a consultant, I’ve had to calm a number of very distraught clinicians who were dealing with fairly large investments in large cross-border practices, but never considered the possibility that they were engaged in illegal or unethical activity. Then again, the ever-present problem of how to handle clients already engaged in illegal service delivery is also particularly distressing. Breaking the law can also lead to a host of ethical violations, which I won’t discuss here.
Out-Dated, Contradictory Licensing Laws
The truth is that current US and many other countries have licensing laws that are not reflective of current practitioner’s services as delivered via 21st Century technology. Many state regulators and legislators are working diligently to solve this problem, but neighboring states or provinces can have diametrically opposed laws and rules. Different disciplines also have different boards within states and provinces in foreign countries. Those of you who have attended one of my professional association presentations, webinars or taken courses here at the Telebehavioral Health Institute have a sense of the complications involved and where various disciplines are in their respective battles for change. You also know that one of the secrets to thriving in telepractice is to avoid the peering gaze of regulators by following all state and federal laws quite carefully.
(This article is Part I of The New York Times and Lantern. Click here to read Part II)
Introduction to Telehealth Theory & Practice
Enjoy a fast-moving overview of telebehavioral and telemental health. Understand the key points related to telehealth clinical, legal, ethical, technology, reimbursement, social media and other pivotal issues.
Thank you for your question, Marty. If your license is surrendered, they may not have much recourse over you, but my suggestion is to make no assumptions until you see your circumstance outlined in writing by your own board. (Don’t trust me, your professional association or anyone. Contact your board directly when you have questions related to actions of your board.) I’ve seen too many professionals get misguided information why they rely on others.
Because state differ so widely in their requirements, and are in such rapid flux right now, I’d suggest you therefore write a brief note to your licensing board and ask them. Send your letter with a return-receipt, so you will have proof of having sent it, and keep a copy for yourself. Even if they do not respond, you will have proof that you sought their guidance before engaging in any activities that could be objectionable. If they do respond, please send me a copy!
Thanks for this very informative article. There are so many exciting opportunities to reach more people with telemental health, and I was also quite impressed with Lantern’s site when I saw it recently. I am, however, a bit confused, as you seem to indicate that what Lantern is doing may be putting its “coaches” in an unethical (perhaps even illegal) situation, yet you recommend that readers to consider their job opportunities. Can you please explain this further? Thanks.
I don’t know where Lantern was asking their coaches to practice. The NYT reporter had her assertion, but I can’t say if Lantern’s licensed mental health practitioners are practicing over state lines as coaches. Meanwhile, the rest of what they are doing is quite impressive, so if this problem does exist, I trust that they will find an immediate remedy. And yes, I do support this company despite this issue. Many start-ups have done far worse.
The issue is more about the individual licensee, and what you know you can and cannot do online. If you are licensed, it is your responsibility to be practicing in compliance with all the needed legal, ethical and clinical competencies as defined by your state and professional associations. If I were looking for an online job with Lantern or any other company, I’d get the independent training I need to know what I’m doing online, tell Lantern where I’d want to practice and then, and see what they have to offer.
Working online isn’t rocket science, but it isn’t intuitive, either. I hope this helps.
I was pretty pleased to find this page. I need to to thank you.
This article is indeed informative. But what if the “coach” is a former licensed professional that has voluntarily surrendered their license(not in the wake of alleged or adjudicated malpractice) or simply allowed it to expire? Are these individuals violating any laws? One would think that should be outside the reach of the various licensing boards….