1. Local educational events:
Mental Health Association of California: http://www.mhac.org/
California Board of Behavioral Science:http://www.bbs.ca.gov/
California Board of Psychology: http://www.cpapsych.org/
California Network of Mental Health Clients: http://www.californiaclients.org/

2. Most common communication tools used in the country:
Landline phone service as well as mobile phone services and text messaging are common for almost all residents.  Email is used in mid to upper level income families, as well as many poor families. 

3. Level of access for the general population:
Many children who may be from poverty level homes and do not have computers in their homes have access at their schools, as they are often funded by the state. For mid to higher- income residents, increasingly multi-task devices such as Blackberry and iPhone where texting, chat and email can all be done in any location. 

4. Level and examples of online mental health
services/research/education/supervision:


5. Legal/regulatory issues:

In the state of California, a provider should not provide mental health services to a resident of the state of California unless they are licensed in the state of California.

A full PDF of Statutes and Regulations for Educational Psychologists, Marriage and Family Therapists and Social Workers can be found here:
http://www.bbs.ca.gov/pdf/publications/lawsregs.pdf

Checking the Validity of a License ONLINE for those licensed in the State of CA (per the Board of Behavioral Science Website).

The following licensees and registrants can be verified through the Board of Behavioral Sciences by clicking this link: http://www.bbs.ca.gov/quick_links/weblookup.shtml

• Marriage and Family Therapists
• Licensed Clinical Social Workers
• Licensed Educational Psychologists
• Marriage and Family Therapist Interns
• Associate Clinical Social Workers
• Continuing Education Providers
• MFT Referral Services
  
  Psychologist License Verification:
  http://www2.dca.ca.gov/pls/wllpub/wllqryna$lcev2.startup?p_qte_code=PSX&p_qte_pgm_code=7300

Disciplinary Terminology

Accusation- a written statement of charges which shall set forth in ordinary and concise language the acts or omissions with which the respondent is charged, to the end that the respondent will be able to prepare his defense.

Citation­- administrative action, usually including a fine, for violations of the statutes and regulations enforced by the Board.

Revocation, or revoked - the license or registration is canceled and the right to practice is ended.

Suspension - the licensee or registrant is prohibited from practicing for a specific period of time.

Stayed - revocation or suspension is postponed, and the licensee or registrant is put on probation.

Probation - The licensee or registrant may continue to practice under specific terms and conditions.

Voluntary Surrender / Surrender of License - the licensee or registrant turns in the license or registration while charges are still pending. The right to practice is ended.

Effective Decision Date - the date the disciplinary action goes into operation.

Public Reprimand - the licensee or registrant is issued a letter of reprimand resulting from a disciplinary action or pursuant to Business and Professions Code Section 495.

Writ of Mandate - the respondent has appealed the Board's Decision to the Superior Court.

Health Insurance Portability and Accountability Act (HIPAA) Requirements

What is HIPAA?

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) enacts sweeping changes in how the healthcare professions handle the administrative details of their practices, and contains a broad and stringent framework for the privacy and confidentiality of personally identifiable health information. This Federal statute was enacted as Public Law 104-191. Further information regarding this act can be found at the Department of Health and Human Services (HHS) website.

What issues are addressed by HIPAA?

The Administrative Simplification provisions of HIPAA (Title II of the Act) require HHS to establish national standards for electronic health care transactions and national identifiers for providers, health plans, and employers. Covered entities must comply with the technical standards and data sets adopted by HHS. HIPAA also addresses the security and privacy of health data, and establishes stringent procedures that covered persons and entities must follow in obtaining and disclosing personally identifiable health information.

Where can I find more information about HIPAA?

Licensing boards do not administer the provisions of HIPAA. Therefore, board staff are not expert in providing guidance to licensees with regard to HIPAA compliance. Licensees with questions regarding HIPAA should seek answers through the following resources:

• HHS's website provides a great deal of information, including frequently asked questions.
• Another good source of information is the HIPAA website maintained by the HHS Centers for Medicare and Medicaid Services (CMS, formerly called the Health Care Financing Administration or HCFA), at www.cms.hhs.gov/hipaa (click on the "Administrative Simplification" link).
• HHS's Office of Civil Rights (OCR) implements the HIPAA privacy regulations. Guidance about the privacy requirements may be found on OCR's website at www.hhs.gov/ocr/hipaa.

Updated: May 29, 2007

6. Insurance/payment options:
Very Infrequently does insurance reimbuse for online services.  This may change in the near future as some psychiatric services performed by MDs are now required by law to be covered by insurance companies.


7. Languages spoken:
Primary:  English and Spanish.  As the state of California is multicultural (especially in urban areas) most languages are spoken in "pockets" of the population.


8. Relevant cultural issues:


9. Resources in the field of online mental health:
Legal Notice to Providers and COnsumers of Online Menatl Health in the State of CA:

Notice to Licensees Regarding Psychotherapy on the Internet

In 1996 California passed legislation regulating the practice of “telemedicine” (SB 1665, c. 864).  As defined in Business and Professions (B&P) Code Section 2290.5, telemedicine means:

“…the practice of health care delivery, diagnosis, consultation, treatment, transfer of medical data, and education using interactive audio, video, or data communications. Neither a telephone conversation nor an electronic mail message between a health care practitioner and patient constitutes "telemedicine" for purposes of this section.”

And:

“…"interactive" means an audio, video, or data communication involving a real time (synchronous) or near real time (asynchronous) two-way transfer of medical data and information. ”

In 1999 the law was expanded by adding MFTs and LCSWs to the definition of a “health care practitioner” who is required to comply (AB 352, c. 252).

At its November 2006 meeting, the Board approved a proposal to add a violation of the telemedicine statute to the definition of unprofessional conduct for MFTs and LCSWs. This legislation would help to affirm that, even though B&P Code Section 2290.5 is contained in the Medical Practices Act, it should also be treated as part of Board law. This proposal is expected to be introduced by mid-2007 as part of the Board’s omnibus legislation. Should this bill pass, it will take effect January 1, 2008.

Business and Professions Code Section 2290.5

Telemedicine; informed consent procedures; written consent statement; compliance; application of section

(a) (1) For the purposes of this section, "telemedicine" means the practice of health care delivery, diagnosis, consultation, treatment, transfer of medical data, and education using interactive audio, video, or data communications. Neither a telephone conversation nor an electronic mail message between a health care practitioner and patient constitutes "telemedicine" for purposes of this section.

(2) For purposes of this section, "interactive" means an audio, video, or data communication involving a real time (synchronous) or near real time (asynchronous) two-way transfer of medical data and information.

(b) For the purposes of this section, "health care practitioner" has the same meaning as "licentiate" as defined in paragraph (2) of subdivision (a) of Section 805.

(c) Prior to the delivery of health care via telemedicine, the health care practitioner who has ultimate authority over the care or primary diagnosis of the patient shall obtain verbal and written informed consent from the patient or the patient's legal representative. The informed consent procedure shall ensure that at least all of the following information is given to the patient or the patient's legal representative verbally and in writing:

(1) The patient or the patient's legal representative retains the option to withhold or withdraw consent at any time without affecting the right to future care or treatment nor risking the loss or withdrawal of any program benefits to which the patient or the patient's legal representative would otherwise be entitled.

(2) A description of the potential risks, consequences, and benefits of telemedicine.

(3) All existing confidentiality protections apply.

(4) All existing laws regarding patient access to medical information and copies of medical records apply.

(5) Dissemination of any patient identifiable images or information from the telemedicine interaction to researchers or other entities shall not occur without the consent of the patient.

(d) A patient or the patient's legal representative shall sign a written statement prior to the delivery of health care via telemedicine, indicating that the patient or the patient's legal representative understands the written information provided pursuant to subdivision (a), and that this information has been discussed with the health care practitioner, or his or her designee.

(e) The written consent statement signed by the patient or the patient's legal representative shall become part of the patient's medical record.

(f) The failure of a health care practitioner to comply with this section shall constitute unprofessional conduct. Section 2314 shall not apply to this section.

(g) All existing laws regarding surrogate decision-making shall apply. For purposes of this section, "surrogate decision making,” means any decision made in the practice of medicine by a parent or legal representative for a minor or an incapacitated or incompetent individual.

(h) Except as provided in paragraph (3) of subdivision (c), this section shall not apply when the patient is not directly involved in the telemedicine interaction, for example when one health care practitioner consults with another health care practitioner.

(i) This section shall not apply in an emergency situation in which a patient is unable to give informed consent and the representative of that patient is not available in a timely manner.

(j) This section shall not apply to a patient under the jurisdiction of the Department of Corrections or any other correctional facility.

(k) This section shall not be construed to alter the scope of practice of any health care provider or authorize the delivery of health care services in a setting, or in a manner, not otherwise authorized by law.

Updated: May 7, 2007

The Board of Psychology has posted via their website their position on "Telepsychiatry"

Information on Telepsychology

The following information regarding telepsychology has been excerpted with the permission of the primary author from "Regulation of Telepsychology: A Survey of State Attorneys General" by Gerry Koocher & Elisabeth Morray. Professional Psychology: Research and Practice, October, 2000, vol. 31, issue #5, pages 503-508.

In light of the survey data obtained in this research, the authors offer the following regarding telepsychology:

• 1. Before engaging in the remote delivery of mental health services via electronic means, practitioners should carefully assess their competence to offer the particular services and consider the limitations of efficacy and effectiveness that may be a function of remote delivery.
• 2. Practitioners should consult with their professional liability insurance carrier to ascertain whether the planned services will be covered. Ideally, a written confirmation from a representative of the carrier should be obtained.
• 3. Practitioners are advised to seek consultation from colleagues and to provide all clients with clear written guidelines regarding planned emergency practices (e.g., suicide risk situations).
• 4. Because no uniform standards of practice exist at this time, thoughtful written plans that reflect careful consultation with colleagues may suffice to document thoughtful professionalism in the event of an adverse incident.
• 5. A careful statement on limitations of confidentiality should be developed and provided to clients at the start of the professional relationship. The statement should inform clients of the standard limitations (e.g., child abuse reporting mandates), any state-specific requirements, and cautions about privacy problems with broadcast conversations (e.g., overheard wireless phone conversations or captured Internet transmissions).
• 6. Clinicians should thoroughly inform clients of what they can expect in terms of services offered, unavailable services (e.g., emergency or psychopharmacology coverage), access to the practitioner, emergency coverage, and similar issues.
• 7. If third parties are billed for services offered via electronic means, practitioners must clearly indicate that fact on billing forms. If a third-party payer who is unsupportive of electronic service delivery is wrongly led to believe that the services took place in vivo as opposed to on-line, fraud charges may ultimately be filed.