Telemental Health Training & Resources

Georgia Composite Board Rule 135-11-.01 requires a licensee to obtain a minimum of six continuing education hours before delivering clinical TeleMental Health. Those six hours are delivered live and synchronously. This page prepares you for them and remains available afterward as reference.

Reading it does not satisfy the rule. Nobody delivers TMH on the strength of having read a web page.

The board names eight areas the six hours may cover. The live training works through all of them; this page is organised the same way.

HIPAA & FERPA module Disclosures module Collaboration module

Ga. Comp. R. & Regs. r. 135-11-.01.

• TeleMental Health is assessment, diagnosis, treatment, or supervision delivered by technology-assisted media.
• The originating site is where the client is. The distant site is where you are.
• Asynchronous store and forward is transmission of client information from the originating site to a licensee at a distant site without the client present.

• Same scope of practice and same ethics as in person. TMH does not expand what an intern may do. See Chapter 135-7, the Code of Ethics.
• Six CE hours before delivering clinical TMH; nine before delivering TMH supervision.
• Verbal and written consent, in the chart, before the first TMH session. Both. The consent must name third-party vendors — EHR, billing, platform, attorney.
• If TMH is not suitable for a client, see them in person or terminate with referral.
• Failure to comply constitutes unprofessional conduct.

A TMH-ready intake collects things an in-person intake never needed.

Every intake ends with an explicit determination, documented: TMH / hybrid / in-person only / refer out. It is a clinical judgement, it gets revisited, and it is not settled by the client’s preference alone.

• Benefits and limits of TMH, and the limits of confidentiality over a network
• Recording policy
• No-show and billing terms
• Third-party vendors by name — platform, EHR, billing service
• The right to in-person care instead
• What happens if the call drops, and the crisis plan

• HIPAA-capable platform with an executed business associate agreement. Consumer FaceTime, WhatsApp, and Facebook are not practice platforms.
• Encryption in transit, unique logins, screen lock.
• No sessions where anyone can see or hear your screen. A coffee shop is not an office.
• Verify identity and location every session, not just at intake.

• Do not record without the client’s written consent to recording.
• Text and email carry brief logistics only. Clinical content goes in the EHR.
• Disclose the EHR, the billing company, and the platform in the consent.
• TMH notes should show modality, client location, consent on file, and the risk screen.

• Advertising is regulated. No “licensed in all states,” no outcome guarantees. See Chapter 135-10.
• Medicaid carries additional written telehealth-consent language. Private pay still requires the board’s TMH consent.

Same theories, different channel.

• Slower pacing, more check-backs, shorter bursts.
• Name the room. Lighting, sound, who else is there, pets, children.
• Silence on video runs longer than silence in an office. Do not fill it out of your own discomfort.
• Phone only costs you the face. Raise your risk assessment accordingly and document why audio-only was clinically necessary.
• Hybrid is a legitimate plan. Some work is safer in person — a first trauma disclosure, certain couple and family work, significant dissociation.

For clients with ADHD, autism, or auditory processing difference, the screen adds load that the office did not. Adjust deliberately: camera optional where clinically sound, written keywords, extra processing time, one speaker at a time, and an agreed signal — “if I fade out, say yellow.”

Agree the drop protocol before the first session, not during the first emergency.

1. Not an emergency. Wait two minutes, then the counsellor calls the client’s phone. You call them; you do not wait to be called.
2. An emergency. The client calls 911 or goes to the nearest emergency department. The counsellor does not say “call me back.”
3. Client unsafe and unable to call. Use the address you collected this session to direct emergency services.

• Confirm location first. Before anything else, get the address and a working phone number for right now. Everything that follows depends on it.
• Keep them on the line. Do not end the call to make another one. Use a second device, or ask a colleague or supervisor to call for you while you stay present.
• Assess as you would in person — ideation, plan, means, intent, timeframe, protective factors — and remember you cannot see most of the room.
• Means restriction is a conversation. Ask what is accessible and who could hold it. A support person on site, with consent, is worth more than any instruction you can give down a camera.
• Homicidal ideation brings in duty to protect and possible warning obligations. Consult immediately; this is never a supervisee’s independent call.
• Involve the emergency contact collected at intake, within the permission already obtained.
• Supervisor during, not after — and document contemporaneously: observations, questions asked, answers, reasoning, actions, times.

Clients have seizures, hypoglycaemic episodes, cardiac events, panic that looks like a cardiac event, and falls, while you watch and cannot reach them.

• Know at intake whether a client has a condition that could become an emergency, and note it where you will see it before the session, not buried in the history.
• If a client becomes unresponsive or is clearly in medical distress, call 911 for their location. This is precisely why the address is confirmed every session.
• Stay on the call. You may be the only witness, and responders will want what you observed and when.
• Contact the emergency contact within existing permission.
• Document exactly what you observed and the times — not an interpretation.

• Duty to warn and protect still applies where there is clear and imminent danger. Distance makes acting on it harder, which is precisely why you collected the address and the emergency contact.
• Mandated reporting of suspected abuse or neglect of a child, elder, or disabled adult is not suspended by the screen. A video session with a client located in Georgia is a Georgia mandated-reporter situation.
• Intimate partner violence has a TMH-specific danger: the session can trap a client in the house with the person harming them. Agree a code word, a camera-off option, and a plan to hang up and call 911.

Orchard’s own model, and the thing that distinguishes how we respond to distress. Learn the sequence; do not improvise one.

Most practices respond to risk at the point of crisis. Orchard responds at the point of distress — earlier, and on purpose. When we see someone struggling, we put resources in their hands straight away rather than waiting to see whether it escalates. The resources are already built, already vetted, and already online, which means the response costs nothing and can happen inside a single session.

That is a deliberate stance. A client given something useful at the moment they are merely struggling is a client who has it at 3am, and who has learned that reaching out produces something concrete.

1. Notice and name the distress. Out loud, without alarm. Distress is the trigger for this protocol — not a stated plan, not a threshold score.
2. Stay with it in the session, and regulate together. Resources do not replace the conversation. Give the distress somewhere to go first, and use a self-regulation strategy with the client — see the next card.
3. Put the resources in their hands, in session. Share your screen, open the pages together, and make sure they leave with a way back to them. Do not describe a resource and hope they find it.
4. Assess. Structured risk assessment where indicated — PHQ-9, GAD-7, C-SSRS — alongside clinical judgement.
5. Safety plan collaboratively where risk is present, using the Orchard form, completed together.
6. Escalate as indicated, and involve your supervisor. For a supervisee, steps 4 through 6 are supervised, not independent.
7. Follow up. Ask at the next session whether they used any of it. That question tells you more than the handing over did.

Crisis support Self-Care Guide Hope

What you actually do at step 2 of the protocol — and what the client keeps after you log off.

Orchard teaches a small set of regulation strategies deliberately. Clients need something they can do without us, at 3am, with no equipment and no app. Every technique below works that way, and each can be taught over video.

Teach them before they are needed. A strategy introduced during a crisis is a strategy the client has never practised, and dysregulated people do not learn new skills well. Introduce one early, practise it in calm sessions, and it will be available later.

One hand rests on the forehead, one over the heart. Attention settles into the heart while the breath slows and lengthens. The contact is gentle and the holding is sustained — long enough for the settling to happen rather than a moment of contact and on.

• Over video: do it with the client, both hands visible, and stay silent together once it is established. Your own regulation is doing much of the work.
• Excellent for children, and for adults who find breath-focused work activating.
• Self-touch is regulating and available anywhere, which is the point.

Two inhalations through the nose, the second a short sharp top-up on an already full breath, followed by a long slow exhale through the mouth. One to three repetitions is usually enough. The extended exhale is what does it: it lengthens the out-breath relative to the in-breath and brings arousal down quickly.

• Over video: demonstrate rather than describe, and breathe along audibly so they can follow the rhythm without watching the clock.
• Works on the phone, which makes it the technique of choice when you have dropped to audio or the client has moved to a car or a walk.
• Fast enough to use mid-sentence when someone is escalating.

A two-part posture from Educational Kinesiology. Seated: ankles crossed, arms extended and crossed at the wrists, fingers interlaced and the hands folded in toward the chest, tongue resting on the roof of the mouth, breathing slowly. Then the second position: legs uncrossed, fingertips lightly touching, breathing continued.

• Over video: this one needs the camera repositioned so you can be seen from the knees up, and the client the same, or they will not get the posture. Worth the thirty seconds it takes.
• Hold each part for a minute or two. Children often settle visibly in the first part.
• Adapt freely for mobility or physical limitation — the crossing matters more than the precise arrangement.

Naming what is present through the senses: five things you can see, four you can hear, three you can touch, two you can smell, one you can taste. Attention returns to the room and to the present, which is exactly what dissociation and panic take away.

• Over video: ask them to name things in their room, not yours. It anchors them where their body actually is — which matters when the screen is pulling their attention somewhere else.
• The first choice for dissociation, flashback, or panic, where breath work can make things worse.
• Works with children as a game, and with adults who find anything that sounds like meditation off-putting.
• Slow it down. Rushing it defeats it.

You cannot drive to a client, walk them to a waiting room, or take something out of their hand. What you have instead is preparation.

In an office, help is down the corridor. Online, the nearest person who can physically reach your client is someone you have never met — and only if you collected them in advance.

• Collect the name, relationship, and phone number at intake, with written permission to contact them and agreement about what may be disclosed. Permission obtained during a crisis is worth much less.
• They must be near the client’s usual location. A devoted sister three states away cannot check on anyone tonight.
• Ask what the client would want said. Many will accept “tell him I need him to come over” while refusing “tell him what we discussed,” and that distinction is worth having in advance.
• Ask whether the emergency contact is safe. Where there is abuse or coercive control, the obvious contact may be the danger. Never assume the person nearest is the person to call.
• Re-check when circumstances change — a move, a separation, a bereavement.
• Record it where you can see it before the session, not buried in the intake history.

One genuine advantage of working online: you can put something useful in a client’s hands inside ten seconds. Orchard maintains an extensive library of client-facing material precisely so you are not improvising.

• Share your screen and walk through it together rather than sending a link and hoping.
• Paste the link into the chat so they still have it after the call.
• Follow up by email only where that is safe — see the caution below.
• Know the library before you need it. Hunting for a resource during a crisis is not the moment.

Crisis support resources Full resource index Self-care guide

Screening is harder on a screen. You lose posture, smell, the state of the room, and much of what you notice without noticing. Compensate deliberately rather than assuming your in-person instincts transfer.

• Use structured measures rather than relying on impression.
• Ask about ideation, plan, means, intent, and timeframe directly. Indirectness costs more online, where you cannot read hesitation as well.
• Ask what is in the room. You cannot see it. Means restriction begins with knowing what is accessible.
• Screening results inform a clinical picture; they do not replace judgement or establish a diagnosis.
• Document what you asked, what was said, what you concluded, and why.

Orchard completes three instruments. Administration and scoring guidance is on the site; know all three before your first intake.

Assessments — PHQ-9, GAD-7, C-SSRS MSE clinician reference

Orchard’s safety planning form was assembled by Dr. Darleen Claire Wodzenski, drawing together current best practice from across her training and adapting it for Orchard’s use. Its six-step structure follows the Stanley-Brown Safety Planning Intervention, reprinted with the authors’ permission and credited on the form itself.

It is completed with the client rather than handed to them, and the collaboration is most of what makes it work — a plan written in the client’s own words, naming their own people, gets used. A plan filled in by the clinician and emailed over does not.

The form closes by asking the one thing most important to the client and worth living for. Do not skip it because it feels sentimental; for many clients it is the line they return to.

• Complete it together on screen, sharing your screen so they watch it being written, then get a copy into their hands the same session.
• Ask where they will keep it. A plan in an email they cannot open at 3am is no plan — a photograph on their phone or a paper copy by the bed works better.
• Step 6 is harder remotely. You cannot help remove anything, so it must be specific: who is holding it, where it is going, by when, and how you will know it happened.
• Revisit it. A safety plan written in month one and never mentioned again is a document, not a plan.

The board’s first content area is internet use and technology-related psychological problems. This tab covers that, plus everything else about the space your client is actually sitting in.

In an office you control the room. You know who is in the building, whether the door locks, what is on the desk, and whether anyone is listening. Online you know none of that unless you ask, and clients rarely volunteer it. Almost every serious TMH incident traces back to something in the client’s environment that the clinician had not asked about.

Technology is not only how you reach the client. For many clients it is also where the harm is happening. Screen for it, and know that a client’s online life is clinical material rather than a side topic.

A point that is easy to miss: by meeting you on video, the client is on the internet. That is an exposure we created.

To attend a session, a client opens a browser or an app on a device, often signs in, and frequently uses a network they do not control. Merely being there carries risk that has nothing to do with what you talk about.

• Phishing. Fake meeting invitations and “your session link has changed” messages are a known attack pattern. Tell clients at intake exactly how you send links and that you will never ask for a password. Then never break that pattern.
• Identity theft. Clients who are unwell, isolated, or cognitively impaired are disproportionately targeted, and a client managing a crisis is not evaluating a suspicious email carefully.
• Targeted exploitation. Time spent online is opportunity. A distressed adolescent in a waiting room tab is reachable.
• Disclosure of their own health information. A shared or family device, a browser that remembers, a calendar entry naming the practice, an auto-saved password. Clients expose their own care without realising, and the consequences are theirs.

The most common version, and the one clients least expect. Someone books a lunchtime session and joins from the laptop their employer gave them, on the employer’s network, from an empty meeting room. Two separate things then go wrong.

• They may be breaking a rule they never read. Acceptable-use policies commonly prohibit personal use, installing applications, and non-work video calls. A client can face discipline for the act of attending therapy, entirely apart from its content.
• They may be disclosing a health condition to their employer. Employers can typically see network traffic, visited domains, installed software, and calendar entries. Many run monitoring that captures screenshots or keystrokes. A device may be remotely inspected or wiped, and an IT administrator may read what is on it. A practice name in a browser history or a calendar can reveal a diagnosis, a treatment relationship, and its timing.
• They lose the protection they assume they have. Information a client volunteers to their employer this way is not shielded by HIPAA, which binds us rather than them. The disclosure is theirs, it may be irreversible, and it can affect employment, clearances, and licensure.
• Privacy is usually worse than it looks. A glass-walled meeting room, a booking system showing who reserved it, a colleague outside, and a call that may be recorded by the platform under company policy.

Composite scenarios drawn from repeated clinical experience at Orchard. Details are changed; the patterns are not rare and you should expect to meet them.

What links all three is that the young people targeted are the ones we are already treating. Emotional difficulty, trauma history, and attachment disruption are not incidental to this — they are what makes a young person reachable. Someone offering to understand, to belong, or to love is offering the thing that is missing. That is the mechanism, and it is why your clients are at elevated risk rather than average risk.

Know these before you need them. Reporting is directed by your supervisor, but you should be able to say what exists.

• Weapons in the home, and access to them. Ask plainly. This matters most for exactly the clients least likely to raise it.
• Who else is in the dwelling, and their relationship to the client and to the material being discussed.
• Violence or instability — an intimate partner who monitors, a volatile household member, active substance use, eviction, no reliable power or connection.
• Medical vulnerability — seizure disorder, diabetes, cardiac conditions, pregnancy, anything that could become an emergency on camera.
• Where they will actually be. Not where they intend to be.

• A moving vehicle. Never. Not stopped at lights, not on hands-free. End the session and reschedule. The risk is to the client, to other road users, and to you.
• A workplace, unless genuinely private and the client understands the employer may monitor the network.
• Public space — a café, a car park, a library. No confidentiality, and often no safety.
• A bathroom or a wardrobe. Common with clients who have no private space, and a signal to reassess suitability rather than to carry on regardless.

Privacy is a condition of the work, not a preference. A client who cannot speak freely is not receiving therapy, however willing they are to try.

• Ask at the start of every session, not just the first: “Are you somewhere you can talk freely? Is anyone else home? Could anyone hear you?”
• Watch for the signs — volume dropping, glancing off camera, one-word answers, headphones removed, a door opening.
• Agree a code word at intake that means someone came in and I cannot say so. Agree what you will do when you hear it.
• Headphones are a minimum expectation, not an accommodation.
• If privacy fails mid-session, stop the clinical content. Move to neutral ground, or end and reschedule. Do not push on quietly hoping it holds.
• Document that privacy was checked, and what you did when it was not there.

Not every privacy failure is accidental. Some clients are being watched, and the watching is the point.

A client without privacy is one problem. A client whose privacy is being taken is a different and more serious one, because it usually means the thing they most need to talk about is the person in the next room.

• Curiosity. A nosy roommate or relative who hovers because they want to know. Irritating, usually harmless, and often solved by a conversation.
• Suspicion. A partner who believes therapy is where the client is being turned against them, and who therefore needs to hear it. Frequently an early sign of controlling behaviour rather than insecurity.
• Illness. A household member with paranoid symptoms who believes the session is about them, and listens because their illness tells them it concerns them. Not malice, and it needs a different response — but the client’s privacy is gone all the same.
• Coercive control. Deliberate, systematic monitoring: staying within earshot, demanding to know what was said, checking the device, installing monitoring software, insisting on being present. This is abuse, and the session is a threat to it.
• Silencing a child. A parent who lurks in the background precisely so the child cannot disclose what is happening at home. The most consequential version, and the hardest to name.

Poverty, overcrowding, thin walls, shift work, a studio flat, children everywhere. This is not the client’s failing and it should never be treated as noncompliance. But it is real, and pretending otherwise serves nobody.

• Headphones or earbuds are a minimum, not a solution. They stop others hearing you. They do nothing to stop others hearing the client. Say that plainly rather than letting the client assume they are protected.
• The car. Parked, engine off, doors locked. For many clients this is the only door that actually closes, and it is a reasonable place to hold a session. It must be stationary — a moving vehicle is never a session.
• A walk outdoors. Away from the house, on the phone, with earbuds. Privacy improves, and for some clients the movement itself helps — harder conversations often come more easily side by side than face to face. Check they are somewhere safe, not crossing roads, and able to stop and sit if the material becomes heavy.
• Move to the phone. The platform generally runs on a phone, and a phone goes where a laptop cannot — the car, the garden, a walk, a locked bathroom. Where safety or privacy is the governing concern, part of a session may be completed by phone: begin on video, move to audio when the sensitive material arrives, and return if it makes sense. Document why audio-only was clinically necessary, and remember you lose the face, so your risk assessment has to work harder.
• Timing. When is the dwelling empty? A session at an odd hour may be the whole intervention.
• A library study room. Free, bookable, quiet, and often the best option nobody thinks of. Many branches have private rooms with a door and reliable wi-fi, and using one draws no attention at all.
• A friend, neighbour, or relative’s house. A spare room at someone trusted, at an agreed time. Worth asking who in the client’s life already knows they are in therapy — that person may be the answer.
• A private room at a coffee house or similar venue. Some have bookable rooms or quiet corners. Check it is genuinely enclosed, and use headphones — a corner table is not privacy.
• A community centre or place of worship, which will often make a room available on request.
• In-person. For some clients the drive is the only privacy they get.

Where a client can be overheard but not seen, typing the most sensitive material into the session chat lets them say what they cannot voice. It is a genuinely useful adaptation and it carries its own risks, so use it deliberately.

• Agree it in advance, so the client is not improvising while frightened.
• Check who can see the screen before relying on it. Typed words are visible from further away than speech carries.
• Chat may be logged by the platform and may persist in the record. Know what your platform does and tell the client.
• Clear the chat before the session ends, and know whether that actually deletes it.
• Consider whether the device itself is monitored. Where there is coercive control, monitoring software on a phone or laptop is common. If the device may be watched, typing is less safe than speaking, not more.
• Keep it for what is genuinely necessary. A session conducted entirely by typing is a signal that this arrangement is not working.

• A code word meaning someone came in and I cannot say so, and an agreed response — you switch to neutral content immediately, without hesitating.
• A camera-off option the client can use without explaining.
• An agreed cover story for the call, decided by the client.
• A plan for hanging up and calling 911, and what you will do if the call ends abruptly.
• Agreement about whether you may call back, and on which number, since a callback can be dangerous where a partner controls the phone.

A genuine conundrum with no clean answer, and one you will meet early.

A child in a session is a child on the internet. Left alone with a device they may wander into material no one intended, and a responsible adult would supervise that. But an adult sitting in earshot means the child has no confidential space — and confidentiality is much of what makes therapy possible.

Both concerns are legitimate. Resolving it well is a clinical skill, and the resolution is explicit and documented rather than left to chance.

1. The adult sets up, then withdraws. A parent joins, confirms the connection works and the child is settled, then leaves the room — remaining in the house and reachable. This is the default at Orchard.
2. Manage the device, not the conversation. Supervision of internet risk belongs to the platform and the device: a session opened by the adult, on a locked-down browser or profile, with nothing else reachable. It does not require a human listening.
3. Nearby but out of earshot. Door ajar, adult in the next room, child in headphones. The adult can respond in seconds without hearing content.
4. Agree the terms with everyone, out loud. Tell the child what the adult can and cannot hear. Tell the parent what will and will not be shared, and why. A child who suspects the adult is listening will manage the session rather than use it.
5. Where an adult must remain present, say so. For a very young child, or one who cannot be left, presence may be unavoidable. Then be honest with the child that this is not a private conversation today, and adjust what you do accordingly.
6. When it cannot be resolved, it is a suitability decision. In-person, hybrid, or referral. Document the reasoning.

• Plan a final session. Provide written aftercare. Give a route back if the platform fails.
• Ghosting is more common online. Have a documented outreach sequence, follow it, then close the file properly.

• Only after the six hours. Only within the internship contract. Only with a supervisor who meets the rule.
• Supervision by video is permitted where the supervisor meets 135-11 and 135-5 — which means the nine hours if supervision itself is remote.
• Keep contemporaneous supervision logs: date, duration, type, brief summary.
• Supervisors must obtain the supervisee’s verbal and written consent to supervision by TMH, just as with clients.

Georgia began issuing Compact privileges on 2 June 2026, becoming the fifth state to go live. As of 1 September 2026 the Compact was operational in nine jurisdictions: Arizona, Arkansas, Georgia, Indiana, Louisiana, Minnesota, Ohio, Tennessee, and Wyoming. Around forty jurisdictions have enacted it, but enacted and operational are different things.

• You need an unencumbered, independent, highest-level licence in a live home state where you also reside. LPCs, not APCs.
• Both states must be operational. A privilege only works between two live states.
• Privileges are state-by-state and the roster changes month to month. Check the Compact Commission before every out-of-state client.
• A privilege may authorise practice without satisfying an insurer, a panel, or a platform. Those are separate questions.

Rule 135-11-.01 tells you what Georgia requires. ACA, NBCC, and APA tell you what the profession expects. You are answerable to all of them.

Professional ethics codes do not replace federal or state law, board rules, payer requirements, malpractice-policy conditions, or agency policy. You must comply with every jurisdiction the encounter touches — above all the one where the client is physically located. Where the authorities differ, use the most protective lawful standard and seek board or legal consultation (ACA, 2014, H.1.b, I.1.c; APA, 2024, Guideline 6; NBCC, 2023, Standards 92–93).

Read together, the three authorities agree on a consistent minimum. You must be competent in both the clinical service and the technology; verify telehealth suits this particular client; obtain telehealth-specific informed consent; protect privacy and data; practise lawfully across jurisdictional boundaries; document the encounter and the decisions behind it; plan for technology failure and emergencies; and keep reassessing whether remote care remains safe and effective (ACA, 2014, Section H; APA, 2024, Guidelines 1–9; NBCC, 2023, Standards 91–108).

• Practise only within demonstrated competence in the service, the modality, the technology, the population, and the legal requirements (ACA H.1.a; APA G1; NBCC 91).
• Screen every prospective telehealth client and document whether remote work fits their goals, condition, cognitive and functional abilities, language, technology access, privacy, and safety (ACA H.4.a, H.4.c; APA G1, G7; NBCC 99–100).
• Keep monitoring. If telehealth becomes ineffective or unsafe, say so and arrange in-person care, a different modality, or referral (ACA H.4.d; APA G7; NBCC 99–100).
• Account for multicultural, linguistic, socioeconomic, disability, sensory, cognitive, and digital-access factors. Do not assume comfort with technology is evenly distributed (ACA H.4.c, H.5.d; APA G1, G2, G7, G8).

• Document what is unique to remote delivery: modality, locations, consent, appropriateness, disruptions, risk and safety decisions, referrals, consultations (APA G5; NBCC 92, 95, 99–100, 106).
• NBCC sets a minimum five-year retention period for telemental health records unless state law requires longer. Other legal, contractual, and organisational requirements may extend it — keep to the longest that applies (NBCC 108).
• Explain to clients how electronic records are kept, protected, archived, and disposed of (ACA H.5.a; APA G3–G4; NBCC 97, 101).

The area the board rule says least about and where supervisees most often go wrong.

• Set written expectations for which electronic communications are clinically permitted, what content belongs in them, response times, emergencies, and boundaries outside scheduled sessions (ACA H.2.a, H.4.b; APA G2; NBCC 96).
• Keep personal and professional online presences separate. Do not enter personal virtual relationships with current clients — no friending, no following, no direct messages (ACA A.5.e, H.6.a; NBCC 109, 114).
• Adopt a written social-media policy and discuss it during informed consent: what it offers, what it does not, the privacy risks, and the boundaries (ACA H.2.a, H.6.b; NBCC 109).
• Do not search a client’s social media without consent and a legitimate clinical purpose. NBCC also requires the risks and benefits to be discussed and documented (ACA H.6.c; NBCC 107, 113).
• Never disclose confidential information through public social media. Know and use the privacy settings available to you (ACA H.6.d; NBCC 110–112).

Before administering any instrument remotely, determine whether the instrument, its norms, the administration procedure, the environment, the technology, and test security actually support valid use. Document every adaptation and its limitations (APA, 2024, Guideline 8).

• Consider distractions, assistance from others in the room, identity uncertainty, monitoring limits, equipment differences, disability accommodations, unequal technology access, and the absence of remote norms — each can affect validity and interpretation.
• Use particular caution in forensic, neuropsychological, educational, and other high-stakes evaluations, where remote administration may face heightened scrutiny or may not be accepted at all.

• Supervisors must be competent in the clinical service, the telehealth modality, and the telesupervision technology, and must address privacy, recordings, observation, emergency backup, immediate consultation, trainee competence, and jurisdictional rules (APA, 2024, Guideline 10).
• Apply the same ethical, legal, empirical, privacy, safety, and competence analysis to emerging tools — artificial intelligence, virtual and augmented reality, wearables, digital monitoring — as to established telehealth technology (APA, 2024, Guideline 11).

• ACA gives the most detailed counsellor duties across competence, consent, security, client verification, accessibility, records, boundaries, and social media.
• NBCC is the most operationally prescriptive, and therefore the most useful when writing policy: encrypted communications, written communication boundaries, written client security information, documented screening, written emergency procedures, verification of identity and location and readiness at each contact, documentation of relevant state requirements, and five-year retention (NBCC, 2023, Standards 92–108).
• APA distinguishes aspirational guidelines from mandatory standards, and goes furthest on data management and disposal, remote assessment, emergencies, telesupervision, equity and access, vendor risk, and emerging technology (APA, 2024).

Drawn from all three sources. Work down it before your first remote session with any client.

• Confirm you are qualified for this service, modality, technology, and population
• Verify authority to practise where both you and the client are physically located, and document the analysis
• Screen and document telehealth appropriateness, access, accommodations, privacy, and safety
• Obtain and document telehealth-specific informed consent; guardian consent and assent where applicable
• At every contact, verify identity, current physical location, readiness and privacy, and a callback number
• Use legally compliant encrypted systems; evaluate vendors, devices, access controls, backups, and breach procedures
• Keep a client-specific local emergency plan and a technology-failure backup plan
• Define communication channels, response times, social-media boundaries, fees, and insurance limitations
• Document modality, locations, contacts, disruptions, risk decisions, consent updates, referrals, and consultations
• Reassess effectiveness and safety; transition or refer when remote care no longer serves the client
• Retain and securely dispose of records under the longest applicable requirement

Distributed at the live training. Keep them where you can reach them during a session, not filed away.

• Rule 135-11-.01 one-pager
• TMH informed-consent addendum — verbal and written, vendors listed
• Session-start checklist — identity, city and state and address today, emergency contact, privacy, weapons and risk
• Drop and crisis flowchart — 911, 988, 1-800-715-4225
• Suitability rubric — TMH / hybrid / in-person / refer
• Platform and BAA checklist
• Compact and out-of-state decision tree

• Ga. Comp. R. & Regs. r. 135-11-.01 (TeleMental Health). Authority: O.C.G.A. §§ 43-1-19, 43-1-24, 43-1-25, 43-10A-2, 43-10A-5, 43-10A-16, 43-10A-17.
• Ga. Comp. R. & Regs. ch. 135-5 (Requirements for Licensure, including supervisor and supervision requirements).
• Ga. Comp. R. & Regs. ch. 135-7 (Code of Ethics).
• Ga. Comp. R. & Regs. ch. 135-9 (Continuing Education).
• Ga. Comp. R. & Regs. ch. 135-10 (Advertising).
• O.C.G.A. § 19-7-5 (mandated reporting of suspected child abuse).
• O.C.G.A. § 30-5-1 et seq. (Disabled Adults and Elder Persons Protection Act).
• O.C.G.A. § 24-5-501 (privileged communications).

• 45 C.F.R. pts. 160 and 164 (HIPAA Privacy, Security, and Breach Notification Rules).
• U.S. Department of Health and Human Services, Office for Civil Rights. Telehealth and HIPAA. hhs.gov
• Fla. Stat. § 456.47 (out-of-state telehealth provider registration).

• Counseling Compact Commission. Privilege to practice and current operational state roster. counselingcompact.gov
• Georgia Secretary of State, Professional Licensing Boards Division. Counseling Compact. sos.ga.gov
• American Counseling Association. (n.d.). Ethical & professional standards. counseling.org
• American Counseling Association. (2014). 2014 ACA code of ethics (see Section H, Distance Counseling, Technology, and Social Media). Revision pending adoption, autumn 2026.
• American Psychological Association. (2017). Ethical principles of psychologists and code of conduct (2002, amended effective June 1, 2010, and January 1, 2017).
• American Psychological Association. (2024). APA guidelines for the practice of telepsychology.
• National Board for Certified Counselors. (2023). NBCC code of ethics (Standards 91–108, telemental health; 109–114, social media and technology).
• National Center for Missing & Exploited Children. CyberTipline. missingkids.org
• National Center for Missing & Exploited Children. Take It Down. takeitdown.ncmec.org
• National Center for Missing & Exploited Children. Sextortion. ncmec.org