Hello,

As you know the world is being forced to quickly adapt to the pressing health concerns associated with COVID-19.  We found the below reminders for proper etiquette and protocol regarding Telehealth sessions via Zoom have been VERY helpful.

Setting Up the Appointment:
Double Check the Telehealth Consent Form:

• Make sure this is signed and in the chart (you can do this at the beginning of the
  session)
• Make a note on the first page of your client’s EHR information (patient section of TherapyNotes) that this form has been signed so you do not have to check every time.
• If you do not have a telehealth consent form at your practice we would strongly suggest you make one based on the guidelines of your board, the MPA, or the APA –  an example format provided by CARE Counseling Team is available here (Note: this is just a jumping off point for your documentation)

Schedule the Appointment on Telehealth: If it is a same day appointment we would suggest the administrative team at your practice manages the creation and communication of the new appointment type.

Appointment Location: This is critical to some insurance panels – make sure to work with your billing department/company to set the correct location and codes to make this process through insurance quickly and correctly.

Setting Up Your Environment:
Lighting: Lighting should highlight your face to ensure that facial expressions can be
seen between client and clinician.
Attire: Wear professional clothing suitable for the office, and 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.
• Use a sound machine to dampen any 3rd party sounds – click this link to find 3 white noise options we have created by the team at CARE Counseling which include a beep at 50 minutes so you can end sessions on time.

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:

• Turn off mirrored picture or place post-it over the screen to avoid distraction.
• Keep children, pets, and any other person out of the room during session.

During Session:

• Review consent form, additional risks to safety with Telehealth and conducting sessions
  outside of clinic.
• Confirm location of client and make note of address in Therapy Notes.
• Scan the room and have the client show you theirs to ensure privacy and transparency.
• Remain calm, and work through any technical issues together. Use audio via telephone if device is experiencing difficulties.

Writing the Note:

• Telehealth Add-On Paragraph (remember to add something along these lines 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 epidemic and was in an effort to reduce the spread of the disease.

Learn best practices to use while conducting telehealth counseling sessions.

Click here to download the CARE Counseling Telehealth Training: CARE Counseling Telehealth_

There are 3 steps when scheduling a reoccurring telehealth appointment on Zoom, step by step instructions for these are below. If the therapist is scheduling their own Zoom appointments step 3 can be skipped.

1) How To: Telehealth – Recurring appointments on Zoom

Steps for scheduling recurring appointments:

1. Set up the recurring appointment in Zoom (reference “How To: Telehealth-Zoom” for detailed guidance).
2. Insert the zoom link & number of occurrences into the TN appointment note for the 1st appointment in the series. 
   1. Note: there is one link for the series.
3. Email the client using the “client email template” below. BCC the clinician to the email.
4. Send an additional email to the clinician  with instructions about the recurring appointment. Use the “clinician email template.” 

2) Client Email Template:

Subject line: [Ct Initials] – Recurring Appointment with CLINICIAN NAME

Hello, 

You have been scheduled for a series of Telehealth appointments with CLINICIAN NAME at TIME (CST) on DAY OF THE WEEK starting DATE OF FIRST APPT through DATE OF FINAL APPT.  These appointments are scheduled FREQUENCY.

Join URL: INSERT LINK

Please click on the link above to join the session. The link above will be used for every upcoming appointment- please keep this email as a reference.

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. 

3) Clinician Email Template (if your admin are setting up the appointments)

Subject line: Recurring Telehealth Appointment Information: [Ct Initials]

Hi!

We have set up a series of telehealth sessions for you and your client in Zoom. There is ONE link to join these sessions. The link can be found in the following locations: 1) The comments of the appointment in Therapy Notes (same link has been inserted for each app and 2) The email sent to the client.

See below for the specifics of your recurring telehealth appointments:

• Client:

• Day of week, time, frequency: 

• Date of first appt: 

• Date of final appt: 

This series is set up in Zoom to reoccur for 8 dates. The final appointment date is noted in the comments of Therapy Notes. If you would like to extend the recurring appointment with the client, please email admin staff to set up more appointments. If a client misses a telehealth appointment, Zoom will not automatically add an additional appointment.

Let me know if you have any questions!

Thank you!

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

1. Sign into Zoom
2. In the navigation menu, click settings
3. On the Meeting tab, navigate to the Waiting Room option under In-Meeting (Advanced) and verify that the setting is enabled.
4. 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

1. As the meeting host, click “Manage Participants”
2. Click “Admit” to have the participant join the meeting

Sending participants to the waiting room during a meeting

1. As the meeting host, click “Manage Participants”
2. Click “More” next to the participants name
3. Click “Put in Waiting Room”

Tips from the Amazing Therapists at CARE Counseling:

• 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.
• 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. – close all other browsers
• This might be a good time to practice collaborative documentation. Just be transparent and tell the client what you’re doing.
• 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!

How to successfully transition to remote sessions:

9 Steps to a successful transition