Clinic Processes & Paperwork
The team at CARE has been doing a great job of pulling together the resources and strategies for ongoing telehealth sessions as well as resources for some of our most frequent client populations.
Clinic Processes & Paperwork
The team at CARE has been doing a great job of pulling together the resources and strategies for ongoing telehealth sessions as well as resources for some of our most frequent client populations.
If you believe we should include additional resources please drop us a note using the form below.
How to use Zoom for TelehealthINTAKE TELEHEALTH PROCEDURESTELEHEALTH CONSENTPreparing your Space for TelehealthHelpful Tips Directly from CARE TherapistsBoundaries with TelehealthZoom Waiting RoomsCool Tools on ZoomAdditional Telehealth Content
Creating Telehealth Appointments in Zoom
- Create a Zoom account and log in
- If there is several Zoom accounts created for each clinician select which clinician to create a Zoom appointment for by following these steps: On the left-hand side of the screen select “User Management” > “Users”
- From here you can see all of the Zoom accounts and make the selection for who you would like to schedule for
- After selecting the clinician you are scheduling an appointment for select “Schedule a Meeting”
- Name the meeting with the client’s initials followed by Telehealth Appointment with Clinician Name
- Select the correct date and time of the appointment
- Make sure that both video and audio are on for both host and participant and to check the box that states “Enable join before host”
- Click save and the Zoom appointment has been created
Emailing Clinicians & Clients
- In the administrative email format email below:
To: Clients Email
BCC: Clinician
Subject: Client Initials Telehealth Appointment with Clinician Name
Hello,
You have been scheduled for a telehealth appointment with CLINICIAN on DATE/TIME
Join URL: Zoom Link
Please click on the link above. You may be asked to enter the meeting ID, which is the last 9 digits in the URL above, and you will be allowed to join the meeting.
If you are using a computer, the video conference should open automatically with you only needing to click ‘Join from your Browser. Please click on the ‘allow’ the use of your camera and microphone.
If you are using an Android or Apple Phone or Tablet you can download the app or just click on the URL above.
Feel free to reference the following links when getting set up with Zoom: About Telehealth.
Thank You
Updating Therapy Notes
- Log into Therapy Notes
- Go to the clinician’s calendar you scheduled an appointment for
- Locate the correct client, date, and time
- Under “Appointment Alert note that it is a telehealth appointment and copy and past Zoom URL
ADMIN and SCHEDULING PROCESS
- While on the Phone with the Client: Administrative staff will set up the intake with the client and let them know that due to COVID-19, all intakes at this time will be done over telehealth.
- Demographic Info: Gather typical demographic information in the EHR
- Telehealth: Describe what telehealth means and help ease any anxiety and let them know we will be sending them an email with a link to the secure session and that the instructions are very simple for Zoom.
- Paperwork: Let them know they will be sent a link to the portal on our EHR and through there, they will receive our intake paperwork. Let them know that even if they sign this in advance, the therapist will review all paperwork with them in their first session.
- After the Intake Call:
- Set up the zoom meeting and send the client the following email:
Hello,
You have been scheduled for a telehealth appointment with CLINICIAN NAME on DATE at TIME
Join URL: (enter URL)
Please click on the link above. You may be asked to enter a meeting ID and you will be allowed to join the meeting.
If you are using a computer, the appointment should open automatically with you only needing to click ‘Join from your Browser’. Please click on the ‘allow’ the use of your camera and microphone.
If you are using an Android or Apple Phone or Tablet you can download the app or just click on the URL above.
Thank you
CLINICIAN INTAKE PROCESS
- Be calm and treat the appointment as if it’s a standard, in person DA session.
- FIRST: Do telehealth consent form and get it signed on the portal.
- Discuss privacy, confidentiality, have client show you their surroundings.
- Get the client’s location/address and document in the note.
- Inform client that if connection is lost and there are safety concerns, you will call the police.
- Intake Paperwork Forms: Clients have been provided documents in advanced
- Check the client’s Document tab for signed forms and go through each one describing the content.
- If they are not signed, work with the client and sign as you go.
- Do not start the session until all forms are signed and you have discussed each form.
- Protocol for High Risk Clients with Telehealth: Do the PHQ-9 toward beginning of session; if SI is elevated, move through the Columbia Suicide Screener. Follow CARE’s Safety Protocol.
- Safety plan right away if needed.
- If working from home due to the COVID-19 Pandemic, you can email the admin email address the word HELP and add the telehealth link. The admin team will immediately find a supervisor who can join your session. If you would prefer a call rather than the supervisor joining the session, note that in the HELP email.
- Go from DA mode to Emergency Mode if SI is high. If you lose connection with a client and are concerned about their safety, or the client cannot contract for safety, call the police and request a wellness check (document in the note).
- Remember: DO NOT KEEP ANY PHI AT HOME
CLINICIAN ONGOING SESSIONS
- Go over telehealth informed consent at the start of every session (especially about safety, location of the client, and privacy of the space).
- Continue to review safety plan if applicable.
TELEHEALTH ADD-ON PARAGRAPH – Add this to each note
The therapist and Ct. began the session by talking about the risks and benefits of telehealth, what to do if there is a break in the connection, reviewed the safety protocol for during and after sessions, and they showed the therapist their space so that the therapist could confirm it was secure and they were alone. The session was both audio and visual on Zoom, a secure system that is HIPAA compliant/certified. The telehealth consent form was signed prior to the session; please see signed form in the ct.’s chart. The client was (specifically name where they were – ie: in their home). The purpose of using telehealth for this session was due to the COVID-19 pandemic and was to reduce the spread of the disease and protect both the clinician and client.
Please email admin or the clinic director regarding any Telehealth/Zoom questions. Thank you for your flexibility, patience, and commitment to keeping you all safe while delivering continued care to our clients.
KEEPING CLIENTS INFORMED
Use the below example as an email to send to all current clients informing them of temporary changes that have been made moving all appointments strictly to telehealth until the foreseeable future:
Good afternoon!
The team at CARE Counseling wanted to communicate a recent update to our procedures in respect to the evolving COVID-19 situation in our community.
Aligned with CARE’s mission, starting on 3/23/2020 CARE is temporarily transitioning all therapy appointments to be conducted via telehealth. The transition is to help limit the transmission of the virus, while also being able to continue to provide services to help support the Mental Health of the community. We know that these are unprecedented times and there is a lot of anxiety and uncertainty that we are all facing. During these times, the best way we can help work through this experience by providing mental health support while also protecting the community from continued exposure is through telehealth. Therefore, unless otherwise approved by CARE, all sessions will be via HIPAA compliant telehealth through Zoom.
Will my appointment be via telehealth? All scheduled appointments (unless otherwise approved) will be scheduled for telehealth.
How will I know how to join the telehealth appointment? Please check your email on file (also connected with the Therapy Notes Portal) for the personalized link to join your HIPAA Compliant therapy session.
What if I need additional support during this challenging time? Please talk with your therapist about increasing the frequency of sessions to support your mental health.
Where can I find further details on how to use telehealth: Please go here: Learn about Telehealth for instructions on how to connect to Zoom and other technical questions.
We thank you for your flexibility as we navigate these challenging times. We will get through this together as a community.
APA’s Telehealth/Telepsychology Informed Consent Checklist: Since the informed consent for telehealth form is used in addition to, not a replacement of your consent to psychotherapy form, make sure items on this checklist are addressed primarily in your telehealth consent form but some items may already be in your consent form.
Sample Telehealth Consent Form: This is the telehealth consent form CARE Counseling uses with telehealth clients. This has been tailored to our clinic based on our other paperwork and the population we serve. This form may not be completely applicable to other clinics nor do we take responsibility for other clinics using this paperwork. We hope this helps give others a sample to work off of for creating their own telehealth consent form.
Setting up for Telehealth in the office is one thing, but now doing therapy from home is whole new thing… but is it?
One of the reasons CARE loves Zoom is that it is HIPAA compliant and also protects the therapist’s privacy by not sharing the therapist’s IP address. This means, clients are protected but so are you because your clients cannot see where you live. We care (pun intended) deeply about our team and help them hold strong professional boundaries. Zoom helps them do this successfully. In these uncertain and very stressful times, professionalism and boundaries continue to be important or even more important than ever as we work from home.
Continue to consider the following:
- Background: What can a client see behind me in session and what am I disclosing about myself with that visual. On zoom, there is a way to add backdrops behind you, which may be a good option if you don’t have a comfortable space with a semi-neutral wall behind you. We are even having pictures of our offices taken so that our backdrops can be our normal office. This sense of normalcy might feel really good to some of your clients.
- Lighting: Lighting should highlight your face to ensure that facial expressions can be seen between client and clinician.
- Attire: I know wearing pjs while working from home is tempting, but keep in mind, it is recommended that what you wear is consistent with what you would normally wear to your sessions with clients. Ideally wear neutral colors that will not present as a distraction during session.
- Audio: At the beginning of each session, ensure that audio quality is high and volume is turned up on your device to a suitable level.
- Eliminate any extra noise or notifications on your screen.
- Camera Angle: Camera should be at eye level to promote a sense of natural gaze point and proximity; the screen should capture a visual from your shoulder level and up.
- Be mindful of what can be seen behind your during the session.
- Eliminate Distractions: Is your space quiet right meow? Make sure pet, children, and other distracting noises are absent during your sessions. It can help to turn off mirrored picture of yourself or place post-it over the screen to avoid distraction.
The APA created a checklist for preparing your office for telehealth.
Click here for APA’s checklist: https://www.apa.org/practice/programs/dmhi/research-information/telepsychological-services-checklist
Our entire mission is to build a community to strengthen the community. We have absolutely the most incredible team of professionals. We created all these resources to support our team/community, to help us know what to do and to feel supported and confident. Now comes the next part, to strengthen the community. We know our clinicians are providing exceptional services to our community and making it stronger. Our final step, you, other providers in the community. We want to share with all of you so that our collective mental health community is strong and united as we face tough times. We can get through this because we’re doing it together.
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- Be kind and patient with yourself. This requires a whole new set of skills and it feels tiring and awkward at first. Your presence and relationship is what matters most to our clients right now, even if the logistics feel confusing.
- Remember to check your lighting and background.
- Hide the box that shows your face on the screen so you don’t get distracted.
- Make your Zoom session full screen so you don’t get distracted by email, etc.
- Try to look toward the top of the screen/your camera. Check in with your clients to see that eye contact feels natural-ish for them.
- You may notice yourself less comfortable with pauses or silence over telehealth. Try to take a deep breath and allow some space into the conversation.
- Some clinicians have noticed that it takes 10-15 minutes into the session to settle into the rhythm with clients over telehealth. It may be helpful to name this with clients.
- Clients may need to contain more during these sessions than in the clinic (if they are discussing a family member in the other room, thin walls, etc). Be ready to focus more on self-care, skills, or practical tools if the client is not in an environment where they can do deeper processing yet.
- Having multiple telehealth sessions back to back, especially with the focus on the pandemic, can be taxing. Be sure you are practicing self-care, grounding, and other ways to “fill your cup” between sessions, during breaks, or before/after work. And remember, this will pass!
- Discussing the Email Policy and Having Firm Boundaries: Since clients may see our email addresses on your zoom account, please review CARE’s email policy and how clinicians do not use email to communicate with clients about therapy, scheduling, or to provide resources. If a client emails you, you can write back: Hello, Due to CARE’s email policy, I cannot respond to your email but would be open to talking on the phone. Please call me and we can talk OR It sounds like you are interested in setting up an appointment. You can use our portal on the website to do this or call our admin team.
- What are you Unintentionally Disclosing in your Telehealth Sessions: What can a client see behind me in session and what am I disclosing about myself with that visual. On zoom, there is a way to add backdrops behind you, which may be a good option if you don’t have a comfortable space with a semi-neutral wall behind you. We are even having pictures of our offices taken so that our backdrops can be our normal office. This sense of normalcy might feel really good to some of your clients.
- Blocking Your Phone Number: *67 OR Another option for the iPhone: By opening the Settings app on your iPhone, and going to Phone > Show My Caller ID, you can toggle off a button that will make your phone number private, at least until you turn the toggle back on.
- The Waiting Room feature allows the host to control when a participant joins the meeting. As the meeting host, you can admit attendees one by one or hold all attendees in the waiting room and admit them all at once.
**you must be logged into your Zoom account to do this**
Enabling Zoom Waiting Room
- Sign into Zoom
- In the navigation menu, click settings
- On the Meeting tab, navigate to the Waiting Room option under In-Meeting (Advanced) and verify that the setting is enabled.
- Select who you want to admit to the waiting room.
All participants: All participants joining your meeting will be admitted to the waiting room.
Admitting Participants during a meeting
- As the meeting host, click “Manage Participants”
- Click “Admit” to have the participant join the meeting
Sending participants to the waiting room during a meeting
- As the meeting host, click “Manage Participants”
- Click “More” next to the participants name
- Click “Put in Waiting Room”
- How to use cool tools on Zoom:
- Sharing Screens: Click the “Share” icon at the bottom of your zoom screen. You can then select “Share Screen” and choose your web browser screen. Make sure you do not have Therapy Notes or other PHI visible before sharing your screen with a client. When finished, select the red “Stop Sharing” button at the top of your screen.
- YouTube Videos (guided meditations, psychoeducational videos, etc.): Pull up a YouTube video on your web browser. Once it’s all queued up, share your screen with the client and play the video. You and your client will be able to watch this video together.
- Use the Whiteboard tool on Zoom to make drawings and genograms. To open the Whiteboard, select “Share Screen” and click “Whiteboard.”
First time using Zoom and still have more questions?
Visit our telehealth page here to find additional Zoom content
