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Many of the largest telemedicine services that allow consumers to schedule a video visit with a professional are being forced to deal with sexually inappropriate telehealth patients who present with shady behavior, videos and photos, according to CNBC. The problem is an old one, but now, such behavior has virtual manifestations that can leave a professional off guard. Some virtual patients are sending inappropriate images, innuendo and direct comments. Some engage in secretive behavior that then becomes not-so-secret, veering into the immoral. All this is happening at a time when about 1/3 of healthcare providers are already offering video-based virtual visits, with many more likely to join them, according to a survey by KPMG.
Most large telehealth services, including MDLive and Doctor on Demand, have experienced the problem and are taking steps to curb the inappropriate behavior. But it’s hard to block individuals if they access free services and use false information to do so. When online, there are some relatively easy ways for medical professionals to deal with such shady problems. A telehealth service’s response is typically to cancel the account of known offenders and to refer the individuals to behavioral health support when possible. These companies may also stop marketing campaigns that offer free trials. In the digital world, these companies can also terminate the consumer’s account, turning off their logins. They also can try to prevent the opening of new accounts by verifying these patient’s identity through credit card authorization, making it difficult for the person to re-enter the system with the same credit card. All of this is predicated on the assumption that their initial informed consent and supporting documentation informed the patient of the consequences of any inappropriate behavior.
Managing Sexually Inappropriate Telehealth Patients Involves Referring to a Trained Telebehavioral Health Specialist
While it makes sense to refer sexually inappropriate clients/patients to behavioral health professionals, the professionals accepting such referrals ought not to be the average behavioral clinician or telebehavioral health professional. Rather, they ought to be particularly well trained in not only managing sexually inappropriate behavior by clients/patients, but more specifically, how to anticipate the many ways that suggestive innuendo, topics and activities can feed rather than treat sexual acting out or addiction. Just as technology can be used to augment and expand a wide variety of behaviors, so too can it be used to manipulate and other engage in destructive behavior. It is the task of the treating behavioral professional then, to not only understand the underlying behavior and treatment options, but to also understand how technology can be used to thwart or improve the treatment of this as well as any other type of inappropriate behavior.
Treatment Considerations for Inappropriate Telebehavioral Health Patients
Successful treatment can only be managed by a behavioral professional who is also well trained/experienced in using technology to deliver therapeutic services. For example, a well-considered, telebehavioral informed consent process and supporting document are key. Next, experience in how to anticipate and interrupt symptomatic behavior while maintaining the integrity of the therapeutic relationship s also crucial. For example, a client/patient struggling with voyeurism can easily be recording a session during teletherapy by using a camera that is positioned out of view of the clinician. The clinician’s reactions to evocative or inappropriate language, gestures or activities can then be recorded for later stimulation by the patient. An experienced telepractitioner who also has expertise in treating problematic sexual behavior will know how to discuss the issues without alienating the patient.
But what about the average behavioral health professional who may be unsuspecting and untrained in how to manage such behavior? After all, dealing with sexually inappropriate clients/patients is a specialty, and certainly not “soup du jour” for the average behavioral health professional. In fact, a behavioral professional may be surprised to realize that a client/patient may be actively engaged in a wide variety of sexually inappropriate activity while on camera or afterward, as suggested above. In many ways, dealing with these issues is no different than how professionals have dealt with such problem patients in an office setting, except that can be less visible. Again, developing a clear telebehavioral informed consent process and document are key.
HIPAA for Sexually Inappropriate Telebehavioral Health Patients
Another issue to consider is that when making or accepting referrals through telehealth can involve a good understanding of related HIPAA requirements for the protection of the client/patient’s privacy. Such instances are yet another reason that any behavioral professional working virtually consider the need for thorough training before jumping into this new type of practice.
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This has not been a significant problem in our practice, but it is very good information to have, especially regarding HIPAA rules and regulations.