Telepractice in North Dakota

so for the final hour today we’re going to spend some time talking about information specific to North Dakota have a beautiful picture tell a psychology in North Dakota from the Creative Commons okay and we know you haven’t forgotten but for those joining us via webinar my name is dr. Sarah Schmucker barn while I’m a clinical psychologist licensed in the state of Washington and you know my great interest is in telehealth how we can use technology to bring good evidence based care to clients where they need it I’ve had the good fortune of doing this work in a diversity of settings was one of the founders of the promoting access to telemental health group or path service at VA puget sound that uses a diversity of interactive technologies web internet from web an Internet web telephone video conferencing mobile applications and others to deliver care to veterans and now in private practice in my work currently see clients typically through videoconferencing and telephone I’m dr Margot Adams Larson I’m a licensed psychologist here in North Dakota I come into this presentation through my interest in the regulatory side of telepractice and partnering with Sarah and several other fantastic colleagues on tell a psychology task force that was put together from APA asp PB in the trust and i do a little bit of this work in my office setting but i primarily am focused on some of the regulatory aspects so I’m adjunct faculty in the University of North Dakota Department of Psychology and also teaching this semester in the counseling department just a couple things as we’re getting this section started one if you didn’t pick up the handouts for it they are available and we can hand those out I got this one the other thing that I have been asked to let you know about and that is this whole day of workshop counts two words rce credits that are in law jurisprudence and ethics and so we only need three of those in North Dakota each reporting cycle but they wanted me to make that announcement to you so that you know all seven of these hours are actually coming towards that or for those on the webinar the one so our agenda today we’re going to cover broadly some federal statutes and rules that you need to be aware of to inform your practice here in North Dakota we’re going to talk specifically about North Dakota statutes rules and policies and we’re going to look at some of the aspects of occupational and practice law we’re going to look at the psychology statutes and rules and we’re also going to touch a little bit upon some of the mental health law in our state we’ll do a brief review of some integers diction all issues and we’ll talk about some special considerations regarding telepractice within our community and we’ll have some cutting-edge details about the compact announcement so take it away and a few disclaimers you know as we’ve said in a sort of prognosticating way whenever you talk about technology there will be technology problems you know we’re really here to offer our best practice recommendations based on our clinical experience or experiences in regulation our review of the empirical literature and our consultation with colleagues we know this is really intended to be an educational seminar and never a replacement for good legal counsel consulting with your board and generally being aware of the considerations specific to your jurisdiction so we always are asking you you know look at your state regulations consult your own legal counsel consult with your risk manager and you know always we’re always using our best best judgment and our best common sense so BF Skinner the real problem is not whether machines think but whether men do you know this idea of technology doesn’t give us the solutions to sort of our problems as clinicians or rather facilitates how we disseminate our answers to the problems that exist so the legal lingo is talk little bit about some definitions and this actually I have to say was very good for me as a general matter margot helped me a lot thinking about regulation from a legal perspective and making a distinction between law regulation and guidelines law being those statutes created by our legislature legislature our legislatures who are elected and appointed regulations being those rules often found an Administrative Code which often have the force of law but are distinct from law and guidelines these are the

professional conduct or standards of care typically proposed by some of our professional organizations consider the guidelines on telus psychology or our ethical guidelines through providing us aspirational guidance you may see it cited in law and ultimately may be discussed by legislators who may or may not be always well apprised of our professional organizations intense but you know we do want to make the distinction between these three things and various agencies develop these rules based on their authority related to the law so laws can relate to professional titles can relate to practice and practice environments to the requirements of reporting duty to warn how we do civil commission how we think about consent and how we think about the consent of special populations like mine ours so what is jurisdiction anyway we wanted to make the distinction between three types of jurisdiction we have in-person jurisdiction think of a title via a license so for example I’m licensed in the state of Washington and by holding a license that entity my board has jurisdiction over me and over my use over my practice as a psychologist I would distinguish this from subject matter jurisdiction so we many of us here today most of us I believe are psychologists where where I’m from in Washington that’s a term of art you are not a psychologist until you are licensed in psychology and so where I absent a PhD in psychology and absent a license from the state of Washington to go set up my five lemonade stand you know like Lucy van Pelt on the sidewalk and say psychological services five cents a glass you know the board might have something to say about that and in a limited capacity could you know sanction me by saying hey you’re using a term of art they have jurisdiction you know over the subject matter over this practice of psychology and they have a duty to protect it then we’ve also spoken a fair bit throughout the day today regarding geographical jurisdiction so these may be state boundaries you know very often or subject matter boundaries no for example the distinction between North Dakota’s jurisdiction you know existing within those boundaries and for example going outside the state of North Dakota South Dakota in all of these instances we’re talking about Authority Authority by way of license location or what you are doing and this is typically either granted by law or by one of the entities we’ve discussed that create these regulation or guidelines enforced by executive branch state of government licensing boards and other entities okay and you know for me it was helpful to think about what is the mission of the various organizations making these rules you know we have our professional organizations we have American Psychological associations a great example this is a guild organized to support and foster the development of our profession of psychology and at the heart of its mission they have its membership you know they have the members of APA they have the profession of psychology elevating that and continuing its development you know they have a commitment to the protection of the profession the development of guidelines that help us sort of aspire towards the best practices of our profession and really establishing the best standards of care helping us really reach to be the best we can be in the practice of our profession I’d also make the distinction then between insurance providers again they also develop policies to assist us and they really have an eye towards the legal issues for us as professionals and they have the they’re insured at the heart of their mission and very much you know helping manage risk because certainly when it’s bad ad for the insured it’s bad for the insurance company you know they want to be thoughtful about ways that we can practice that will not get us into trouble that will not that will keep us clear of any type of complaints litigation and so forth so really at the heart of a mission they have our risk management and helping protect us as providers and then I would note the licensing boards licensing boards are the extension of the government the promulgation of laws and really at the heart of their mission is the public you know they’re there to prevent the public from harm and really making sure that our best practices are carried out and that there is an account of a mechanism of accountability should that not be the case so let’s talk a little bit about federal statutes and rules and the first one that I’ll mention is HIPAA we talked a lot about HIPAA Health Care Insurance Portability and Accountability Act came into effect in 1996 and has had several

additions since that time frame and we will continue to have additions and growth with that as well hi tech we’ve mentioned a few times and high tech is the health information technology for economic and clinical health act and that was enacted as part of the american recovery and reinvestment act in 2009 and that adds a layer and blends into HIPAA related to a lot of the technology practices that we’ve been talking about today i mentioned earlier coppa the Children’s Online Protection privacy protection act came into effect in two thousand and this is the law that you want to look too if you have any work that you’re doing with kids or your professional website is interesting looking to children and I say that kind of broadly but it’s kind of vague and you need to be aware of what some of those requirements are FTC the Federal Trade Commission Act is a consumer protection act and historically has been one of the founding laws behind some of these other later laws it came into effect in 1914 and continues to have significant influence in terms of business practice and particularly trade which psychologists and other licensed professionals are considered to be one of another federal statute that we want to draw your attention to is the code of federal regulations and in particular where this impacts us in psychology or for those who are doing work with substance or alcohol abuse and treatment and 42 CFR part 2 is what you want to pay particular attention to as there are very specific requirements related to mental health treatment of these specific diagnosis or populations so in North Dakota jurisdictional and I should mention we do we’ve done this talk in several different states and kind of modify this section so it’s very specific to North Dakota for this talk but we’ll talk a little bit in terms of other jurisdictions because you’re going to want to know if you have clients coming from another jurisdiction or traveling to how to get the same information in that jurisdiction so we’ll talk about that in a little bit but in North Dakota you want to go to the government website I kind of took a screenshot here and threw it up here the picture changes so don’t look for the picture they rotate through all sorts of lovely scenes of North Dakota and I noticed they were all spring-like at this time of year I’ve actually pulled a few when I’ve done presentations around the country because they have some nice barren snow ones to show in the winter all that kind of stuff but from the government site you should be able to find some other more particular links for law and regulations so you can find the century code you can find the administrative code and several other things that will be helpful you want to poke around that website it’s kind of cool when I first got licensed here way back a long time ago all this stuff wasn’t really accessible on the internet so it’s kind of a nice to see how it transforms and how much easier the access is to this nowadays specifically in North Dakota we have two laws that govern our specific practice of psychology the statutes which is the North Dakota century code it’s organized by chapter and there’s a couple different sections that you want to pay attention to the one that you’re most familiar with is going to be 43 52 which is the chapter on psychologists and i put in brackets and apply behavior analysts because a few years ago we adopted them too and so if that happens to be one of your areas of practice you’re going to want to pay attention to that aspect also there is another chapter that’s probably a little less known to you and that’s chapter 43 52 and that’s a general chapter about organization or occupations and professions has some very interesting information we’ll talk about in a bit related to remote practice and telepractice and that’s general to a variety of professions not just psychology from those statutes that were enacted by the legislature they give us authority in chapter 43 52 to promulgate

rules and the licensing board historically has written various rules related to how that law is going to be implemented and that’s found in the North Dakota Administrative Code that code is organized for all sorts of professions and organizations in North Dakota and our specific information for psychologists is in title 66 and it’s titled the board of psychologists examiner’s one of the things that I want to come back to is this chapter that looks at professions and occupations and this is a global chapter that includes several different professions some are excluded and that’s identified at the start of the law but it talks about the remote practice of psychology or any profession as well as foreign providers and license holders practicing within our state again in a variety of professions so one of the things that’s important to note here if you happen to be interested or somebody asks you that they’re interested in coming in to do telepsychic practice here in North Dakota is the location of practice of an occupation or profession is defined in our law and remember we talked about earlier how the trust has a perspective of where practice occurs aspb has a perspective of where practice occurs and in our jurisdiction it’s very specific and documented in 43 5102 about where practice occurs and it states the provision of services to an individual in this state which fall within the standard of practice of a profession or occupation regulated by a board in our state regardless of the means in which that service is provided or the location of the person providing the services constitutes the practice of that profession or occupation in our state and it’s regulated by whatever Board of profession it is involved so that tells us that if you are doing psychological practice no matter where you’re located if it’s occurring and a service recipient is in our state then its constituting a practice in our state so those are things you want to think about there’s discipline related to violating this law and that’s listed in this next section you want to take a look at that but i’m not going to scare you today by reading all the purple train essentially you just want to be aware that for folks coming in they need to have a license and need to be aware of what our jurisdictional requirements are back to psychology specific law chapter 43 32 is the law North Dakota that provides authority for the licensing board to regulate the profession of psychology industrial organizational psychology and applied behavior analysis if you look to these kind of laws in other states you will find it may be specific to psychology it may be specific to apply behavior analysis in a very separate section of law so some states those are two very different laws and not all the time is IO psychology a licensed profession or a regulated profession across jurisdictions our law in North Dakota outlines licensure requirements for practice in North Dakota that includes educational requirements supervised practice requirements the examination requirements in order to become licensed and then our agreement to abide by the APA ethics code of conduct and if you happen to do applied behavior analysis the BAC be ethics requirements important to note here that APA ethics code is not law it’s referred to in our law and so that’s an important distinction you may want to be aware of though this chapter outlines the board structure importantly all of the board members are appointed by a governor this is not the case in all jurisdictions and so that is kind of our connection with the executive branch of government and our authority or the board’s authority is identified with in that chapter and generally looks at licensing continuing education requirements renewal requirements and a disciplinary process that’s fairly standard across different jurisdictions that you will find all of that kind of content with

in the practice act the rules as I mentioned or they’re located in the administrative code here and they’re identified under Title 66 really identify more detailed how it is that the board carries out that mission or that authority so there’s a lot more detailed information in those rules they have the same force in same kinds of effect as the law but there are just a lot more detailed information you’re going to want to be looking at this kind of a caveat here that I didn’t add in at the time we develop this presentation but the law has recently changed with this legislative session and so that there will be a new law in place shortly I think it will come into effect i’m going to rely on dr. fair is it june that it will be in effect august first okay summertime good reading you want to take a look at that law the rules will be obviously quite some time later but the law will be in effect and we’ll have to be abiding by that so we’ll want to pay attention to to some of that in terms of our rules related to psychology here in North Dakota we do have some options that may have significance related to telepractice and that’s limited practice without a license and that’s for folks that don’t live here aren’t licensed here but may be licensed in another state and this comes is informed by the occupations and professions law permitting the practice for someone with a certificate who’s informed themselves to the board they can come in and practice for 30 days if they’ve been approved by the board some practical guidelines that you’re going to want to look too not specifically in tell a psychology but certainly as you’re thinking about all of these new ideas and things that are coming along and terms of Technology in your practice and you want to look at the a paas ppb and the trust guidelines and documentation that they have available on their websites the ATA that we’ve talked about look to that empirical literature if there’s something neat you want to do do a search see what you can find in terms of some of that empirical evidence and use that to help inform how your practice can be and always think about how that regulation can be impacting what you’re doing in practice so a screenshot just to capture for what the licensing board home page looks like here I know when I’ve given this talk in a variety of places some people have trouble finding the board websites and asp PB is kind of the overarching association of all the licensing boards and states and provinces in north america and i also think in puerto rico and they have oh and guam thank you they have a really nice linking page if you’re looking for a website and can’t find it if you check out the asp PB dot org website they’ll have a link to the other jurisdictions and can help you find that more easily the North Dakota licensing board it does have some pages that show related links some of those linked to the laws in North Dakota and information specific to North Dakota and some of those linked to some of those federal laws that I’ve just talked about there’s another layer that isn’t law it’s not got the effective rule but it can be informative to your practice from a licensed and regulatory standpoint and those tend to fall under the caveat of policy what’s been kind of historically happening some of that you can find in meeting minutes sometimes boards will have what they call white papers or position statements in North Dakota the board of psych the psychologists examiner’s board tends to put that out it looks like from frequently asked questions page which is certainly a strategy a number of other boards around the country use so I’ve put a link here for the North Dakota one and there is a specific link to tell a psychology and I don’t want to spend a lot of detail in time specifically on that other than to say this is an ongoing process that’s probably going to be changing so this is a place you’re going to want to visit an update probably every few months so that you can have the most up-to-date

information so as I mentioned talking a little bit about how to find this information in other places sometimes it’s confusing some boards are really hard to get ahold of some boards work on very minimal actually most boards work I’m very minimal funding and you know they don’t have a lot of web access they don’t have a lot of personnel you know that happens to be the case here in North Dakota we have a half-time volunteer secretary in Minnesota they have 10 people in their IT department alone for their psychology board they have a large number of employees it’s just a matter of population and around the country that is quite variable so to help you out find the government website for whatever jurisdiction you’re looking to look for statute for occupations and professions or psychology or counseling depending what you’re looking for search for their rules some of those are not easy to find and this is part of my world on a day to day basis so I understand it can be kind of complex again looking to asp PB to help you navigate some of that is certainly a viable thing to do if you could find the website for the State Board of psychologists examiner’s that can help to just do a google search and put the state or jurisdiction in there that you’re looking for sometimes it pops up that way but you can’t find it because their government doesn’t allow a search engine to be readily available searching telepractice with that jurisdiction can also pull up a lot of really helpful information again just like anything on the web you want to kind of at that through your clinical judgment process is it you know some blog by someone that sort of knows what they’re doing or is it somebody official in the government that you know is a white paper and giving you some good information again the trust has some fantastic resources that are state specific and so that’s another great place to look for some of this information for other jurisdictions a little earlier someone had asked a question regarding First Nation and tribal communities in the state of North Dakota and I hope to make mention of one additional point especially as we start talking about jurisdictional considerations and that is the research of dr. jshore jshore has done a tremendous amount of research looking at you know working in tribal communities using telehealth to do work that is culturally informed an evidence-based so i thought i’d mention mention his work as we sort of start talking about this review of energy restriction or concerns that would actually be with a sovereign nation but any time any time we’re talking about the provision of psychological services using telecommunications technologies across jurisdictional boundaries we’re really talking about an inner jurisdictional telepractice you know we’ve spoken a fair bit about this in the past but we wanted to provide some examples because i think it’s relevant i think this is something that maybe comes into our lives more than we know especially now that folks are more mobile than ever you know we no longer are calling landlines where we know where the other person is seated we’re calling mobile devices where we don’t really know where they are when we shoot an email off you know we really don’t know where that other person is going to read it not to mention you know the server that might be facilitating the sending of that email but thankfully we don’t have think too much about that so some examples of some inner jurisdictional telepractice scenarios that could arise example number one you know if I am licensed in one jurisdiction let’s say licensed in North Dakota and I’m providing tella psychological services to someone in another jurisdiction someone located in Idaho now just out of curiosity folks who’ve been paying attention today what’s one way that you could help address this concern if I am licensed one place and delivering services another place well there’s two more chocolates work for the VA oh he gets the fig fennel in almond yes we could work for a federal entity that facilitates licensure mobility we could be licensed in multiple locations both where the person lives as well as where we are located but in this first example let’s just presume we didn’t enact one of those solutions you know this would constitute an integer stick tional practice and potentially be problematic for us a second scenario licensed in one jurisdiction providing Telus psychological services from a

non-licensed jurisdiction to someone in the license jurisdiction so let’s say I’m licensed in North Dakota but I go on a delightful vacation to Sun Valley and you know in the interim while I’m gone although I’ve arranged for coverage there’s something specific to my client that comes up and the person who is covering my cases reaches out to me or let’s say my client somehow you know has a mechanism they got my mobile phone number there’s an email comes through something you know something that maybe wasn’t the way i hope that technology would be used but i am aware of my client being in crisis in that moment if I elect to pick up my phone from my lovely hotel room in Sun Valley I’m very committed to going there now you know when i pick up the phone and I call my client back in North Dakota I’m actually engaged in an integer asst diction I’ll practice even though I am licensed in North Dakota and you know my client is sitting in North Dakota there’s a potential problem there let’s say something about that communication goes awry and the client then has a complaint against me takes it to the Board of North Dakota well in North Dakota we know that they do regard care as occurring in North Dakota you know where where the client was sitting however there is an issue that I was delivering care from somewhere I wasn’t licensed and let’s say just to you know keep going with it let’s say the board took another position the position that Kara kurz where the provider was seated well let’s say then if that client had a complaint against me that care didn’t even occur in North Dakota so to speak so you can imagine how it gets very confusing very quickly we start going across these interjurisdictional boundaries number three a license in one jurisdiction providing tella psychological services from another non-licensed jurisdiction to someone and yet another non-licensed jurisdiction so let’s say I’m licensed in North Dakota I’m taking a lovely vacation to Minneapolis I go on a lot of vacations and my client who lives in North Dakota is taking a lovely vacation to Sun Valley this time while on vacation in Sun Valley something goes terribly wrong wants to speak to their therapist reaches out to me I’m on my lovely vacation but somehow if we ended up being in communication now not only am I not licensed where I’m delivering care I’m not licensed where the care occurs either because again North Dakota defines the care is occurring where the patients it’s you know so in this instance it’s a mess right there just lots of different jurisdictions being crossed number four is my personal favorite and one workaround I suppose I’m just license no we’re just you know licensed my since I’m not worried about it and I’m delivering Telus psychological services everywhere you know this happens a Margo over the years has sent me some doozy of some websites you know where unfortunately right now really it’s part of our mandate to protect the public you know from some of the things going on out there and folks who I’m going to give the best benefit of the doubt and say are well-intentioned and may not be a prized of the manner in which they are not obtaining licenses to deliver services you know may run afoul of this sorry do you mind repeating that yeah number four makes you dr. Phil I think dr. Phil yes number four is potentially very lucrative I guess yes yeah I mean unfortunately there’s I think there’s a real reality that this stuff is going on and that you know certainly I don’t think anyone in this room would be running out to do that but you know to be aware that these are the types of scenarios we’re speaking about this is a beautiful infographic that describes these four scenarios so where’s my pointer here we go all right so provider and recipient are in the same location let’s say the provider is in the jurisdiction where they are licensed but the recipient is a way or the provider is a way the recipients in the location where the providers license everybody’s away nobody’s like so it’s a nice sort of pictorial demonstration of what we’re talking about so these are some of the issues to consider and hopefully to resolve you know we’ve spoken many times about this mandated reporting issue for Texas we’re picking on Texas today if I’m to understand we’re not to mess with it Margo you know but there there is a notable distinction here that some states have this duty to warn Texas does not and it’s a fairly obvious conflict if you’re delivering care into Texas that’s just one example you know being thoughtful particularly about mandated reporting around special populations you know children elderly anyone that the law may treat as a vulnerable population some of the informed consent requirements may differ among jurisdiction the consenting of minors both were engaging in therapy assessment you know also for therapeutic relationships commitment proceedings not only vary by state jurisdictions but sometimes by County you know these things get very very specific prescribing privileges and particularly

we’re talking about prescribing prescribing privileges for sessions conducted over telehealth the Ryan hate online pharmacy Consumer Protection Act has very specific guidance regarding you know how we think about different classes of drugs that may may not be prescribed over online services and then tax orting so you know if I start going into Idaho and let’s say I do the right thing I get licensed in both places or I’m participating inside pact once it’s up and running and I am making money and Idaho hand over fist you know they’ll they’ll want to know about that i will have income reporting that needs to be done and i want to be sure that i’m really thoughtful about those laws or to tennessee and any documentation requirements notation requirements may differ place the place and just so we’re aware of those and making efforts to reconcile them so some specific considerations that we want to think about related to telepractice now we’re a very rural low population state probably earn some some awards for this from time to time and you see those kind of posts around Facebook and USA today we’re the 19th most rural state with kind of the largest area of all of the states so it’s interesting to me how spread out we are yet how much in terms of our providers we are located in city / large town areas there are 250 licensed psychologist and applied behavior analysis analysts in North Dakota for the estimated seven hundred and thirty-nine thousand of us North Dakotans so technology really is something that could be quite a cool thing for us as a profession we have some amazing training models that are up and coming in our university graduate programs in North Dakota and I think that’s helpful in thinking ahead and to the future in terms of our practice professionals that are going to be coming into our profession in a few years because they’re learning this in grad school are there any graduate students here yay I’m so glad they’re learning how to do this from best practice model and that’s huge we talked about earlier that collegial consultation that we showed our hangout for but some of our early career psychologists are going to have way more information about this than we do and we need to have some open-mindedness in that regard and not be scared off by this new technology that’s kind of invading our practice especially in North Dakota it can bring us and services to communities and partner with professionals in those communities that we’ve not been able to do historically I love the idea of driving a bus around or a Motorhome that’s pretty cool I think und actually has a medical program where they do that but how neat it would be for us to add a mental health component I see the faculty nodding in the back yay certainly we have been cutting edge with some of the professionals that we have in our community i’m thinking of NRI specifically that has done a lot of work with devices and technology and telepractice for quite some time that’s been presented here at NDP a several years ago so it’s not new for us but it’s new and how we’re thinking about it and its new and how we’re thinking about integrating it into our practice world and in North Dakota we do have some flexible state regulations that actually in the world of regulation are quite forward-thinking compared to some of our counterparts around the country who say no you can’t do this even within your state Wow okay just kind of means there’s a lot more change that needs to happen in those jurisdictions before we can even do telepractice within the boundaries of that jurisdiction things we want to think about for our providers and that really is that competency of practice not just in terms of what you’re doing in your psychological aspect of practice in the clinical work that you do but also as you’re integrating that technol and you’re here today gaining that competence and start to know what do I need more information on how can I kind of go home and take the stuff with me and figure out what my task list is how

i can do that risk assessment so i know what i need to focus on we want to think about continuing educational implications a lot of continuing ad is online these days that’s pretty cool really some of that through coursework through universities some of that’s webinars like we’re taping today very cool but continuing education requirements in various jurisdictions mean you have to pay attention to what counts for that in North Dakota you have 20 hours of online webinar kind of education that you’re allowed to count towards that renewal in Minnesota all 40 of your renewal CES can be done online so it’s just an example of how that changes jurisdiction to jurisdiction as I mentioned the individual earlier who had a numerous amount of licenses this is why he needed to have an administrative assistant dedicated to understanding all the CES he needed to gain and how what category they needed to be in in order for him to be compliant with his license renewals there are a lot of administration considerations that we want to think about if we’re entering into telepractice and some of those are the fundamental things we’ve talked about earlier today some of those are also just how do we keep track and let folks know when we’re entering a different jurisdiction what do we need to be aware of in that administrative capacity we want to think about investing in compliant office technologies you know just because skype is available just because the client knows how to use it just because they’re agreeable and the risks don’t seem all that bad doesn’t mean we should do that right we want to be mindful and really consider and document well what our reasoning is clinically for King that leap to something that might not seem like maybe the best practice strategy it might be the best practice strategy in that particular situation but the next client it might not be the best practice strategy we want to think about what the market opportunities are and we want to think about our professional collaborative partnerships because those are important we don’t want to lose that in fact technology can help us build that even more strongly you know I find it much easier to make referrals to folks now because I have connection with them via email or an instant messaging where I can get their phone number right away okay well here it is I can my client that I need to make a referral to can leave the office with that information today so there’s lots of ways that our partnerships can build through technology a little earlier today we spoke about sigh pacts I packed having been announced by a spp be only just two months ago and it’s really very very exciting you know you’ll note peppered throughout our talk today are the message supports I pack you know and I think that both Margo and I really hold we’re really excited about this announcement and really I’m excited for this as a model for how to think about interjurisdictional work sigh packed as we mentioned earlier essentially is this interstate compact that would facilitate temporary interjurisdictional practice between clients and providers who where the state where the client provider are affiliated with our members of the pact so for example if I am on North Dakotan licensed in North Dakota on my glamorous vacation to Sun Valley and Idaho and I did want to get back in touch you know or see an my client is on a vacation to Idaho and has that terrible thing happened while they’re on vacation and I wanted to be in touch with them while they’re on the vacation well if Idaho and North Dakota are members of the side pack that would facilitate a brief you know episode of care that occurs over a distance I mean for me one of the most exciting things about this and Margot I’ll look to you if you have anything you want to add is that this is a very compelling and interesting model and we’ve never had anything like this before some sort of interstate licensing model to facilitate how to handle these issues and I really think we’ll look to this as you know bellwether for how to think about these things and i really encourage folks to get behind this and support this because you know when we do this well I think there’s the opportunity for this to be a template to think about these issues on a larger scale you even larger scale so this is pretty large scale I think I would just add to that that this is coming right on the cusp of the Federation of medical boards announcing a compact process for

fast-tracking medical licensure in all a mobile jurisdiction so this is really a federal kind of process that both the medical world as well as the psychological world from professional standpoint is starting to engage in and I think for that reason there’s likely a lot faster track to adopting this it’s not going to be an overnight process by any stretch of imagination but if the medical boards are going around the country asking legislators and state’s attorneys to review this stuff now we’re kind of coming on the coattails and this isn’t a new we don’t have to pave the way for something hugely new the medical boards just been there so we have a nice way of kind of said segwaying into this kind of a side step from that psychology from the asp PB organization received a grant and only medicine and psychology received this grant from the government to look at professional professional survey how many licensed psychologists are there in the country we don’t know the answer to this question we don’t know how many licensed doctors there are in this country we have some estimates but from both a standpoint of we’re in a lot of need mental health care and we’re an underserved professional group trying to provide it the government is paying really close attention to psychology as a profession and so with that in mind having mobility and portability of licensure is a gigantic important factor that we want to consider and help promote within our profession Fargo and I used to always speak about how both of us had sort of heard this urban legend you know that you could practice anywhere for 30 days and I think it’s really smart that we’re starting off with a 30 day to interstate compact as lots of us thought it was true already so right i mean we have to get behind it it will just confirms that confirmation bias all right anyway I think it’s a really great thing I encourage you to visit this site here take a look at the specific language think a little bit about how this could apply to you I mean personally I feel like this is applied to me many times the clients gone on vacation something’s happened they’ve traveled visited family you know there’s been an instance where I would really like to reach out to them and I’m put in a bind you know ethically I think it is the right thing for me to be in touch with them but you know logistically I’m concerned you know am I practicing outside my license your jurisdiction and this I think is a nice way for us to be doing the ethical thing in a way that is governed correctly so the future the future is wide open you know I think let’s this is a really exciting time and it’s an exciting time to be thinking about how technology informs our practice North Dakota is an exciting place to be doing it you know I think the the environment is exactly right for doing this type of technology enabled outreach you know in in other parts of our lives Margo and I both sort of wear different hats where we are working with entities that develop new types of therapies using technology virtual reality exposure therapies you know interactive mobile applications that help advance psychoeducation outside the treatment room you know I think that really this is an incredibly exciting time to be a psychologist a little bit scary but also an incredibly unprecedented opportunity about how we can be bringing these tools into our practice and I think North Dakota you know more than many places is very ripe place to be doing that work and just as we can be bringing that into our practice and there are some fantastic tools and applications to do that equally important is our current abilities and I’ll speak from a Department of Defense example where they are sending holographic therapists out into the front lines to help provide services and mental health needs on the front line you know this is amazing combination of disney and department of defense that has come together to provide a service that’s much needed but really no therapist is necessarily wanting to traverse so there’s lots of ways we can move our services from our office setting out to community of people in great need I find the therapy avatar is all too comforting it’s concerning for job security so so you know we’ve had a long day together today so we’re hoping to create some space to talk about any questions you may have idiosyncratic to your practice or perhaps just clarifying something we’ve spoken about already since we’re close to Canada and other

states I was wondering about I’m assuming this isn’t a problem yet but you don’t know when you’re online which server is being used I mean you know you could send something or go to a website and it’s being bounced off of something in Timbuktu is that going to be is that a problem also when you’re closer to the border you don’t know when your cell calls are utilizing a canadian cell tower and other things is that a problem I can speak to the candidate question for whatever reason the Canadian government has had a very large determination over Internet domain in Canada and so it would surprise me that those transmissions across state lines aren’t being monitored and or deferred elsewhere there’s a lot of concern of Canadian government in terms of what’s accessible by US government who monitors everything on the internet and if we go back far enough to think about how the world wide web was developed it was developed by the American government so they could monitor information so that’s not paranoia that really is part of how that’s developed in terms of cell towers it’s generally you can have some information on your cell phone when it’s being bounced to a tower outside you’re roaming area but you do have to have that enabled so you’re aware of that and you end up with a large fancy charge if you don’t from the cell towers outside of your area and or the US so you do want to be very careful about that but how you have knowledge of that varies depending on what the what the carriers are and i would add and please Margo correct me if you know otherwise I know of no precedent in which someone’s gotten in trouble for this I mean I sort of feel like by my way of thinking if a complaint came to a board if there was some sort of legal thing that was pursued always the question is you know did we do what was reasonable you know it was within your control it’s truly outside your control I mean the idea that I well I shouldn’t call that patient I might be close to the Canadian border I have a hard time believing we’d be held culpable for that I mean I’m not the law obviously but I’m aware of no one ever having an issue of that nature that I think it’s a great question is in your view is North Dakota likely to become one of the states to participate in sy packed and how could we as licensed psychologists then join that network it’s a fantastic question I would say yes there was probably a high likelihood that we could be one of those first adopting States for a number of reasons we’re small we’ve got great connections with our legislative counterparts and we’re kind of forward-thinking folk with that said I think what the committee is going to be looking at when they’re rolling this out is communities of connected jurisdictions that have a lot of interconnections so they’re probably going to look to the northeast because that’s a much larger issue for them than it is for us however you know or small we have a comparatively large voice in government and so we you know where a good candidate for that how can we advocate for that letting the board know in North Dakota letting a spp be no that’s something you can have connection with even though you’re a licensee and not a regulatory board member and how do you get involved with that read the document you’ll find out what some of the requirements are in terms of what you need to do is a licensee and what that process is going to be this probably is going to be a two to five year process it’s not an overnight thing and from a telus psychology standpoint there are going to be some requirements regarding what you need to demonstrate you need some education about telepsychic practices you need some CES and you’re going to need some documentation regarding that competency so great question and you’ve just attended a seminar tell a psychology so well then another question we filled your brains with all we know awesome was this worth your time great

if you do have questions in our materials consistently you’ve got our email contact we’re happy to visit with you that’s probably the easiest way to reach us but leave us your number and we can always give you a call in person we really really are thrilled to be here today and thank you all for participating and helping us put this on thank you so much