Telepsychology and technology-enhanced psychology practice have greatly increased as a result of the COVID-19 pandemic and will likely continue to be utilized in future psychological practice. In response to the increased need for telepsychological services, the Board is strongly advising licensees to obtain at least three hours of continuing education in the provision of telepsychology services. The Board is recommending that these hours be completed as soon as possible. Further, because of the rapid rate at which technology changes, the Board is recommended that psychologists continue to regularly complete continuing education in this area, rather than on a one time basis.
Prior to COVID-19, many psychologists had not previously engaged in telepsychology with their clients or patients. Then with the onset of the pandemic many psychologists were thrown into this medium with little guidance or training. For this reason, the Board is advising that psychologists complete continuing education in this area on an ongoing basis.
There are legal and ethical considerations that are specific to online sessions, which include among other issues the following:
- A psychologist needs to ensure a confidential setting, data security and the avoidance of unsecure platforms.
- A psychologist needs to ensure that there is informed consent addressing the specific concerns related to telepsychology.
- A psychologist needs the ability to ensure safety over the electronic platform.
- A psychologist needs to meet licensure requirements of different jurisdictions, if practicing across state lines.
- There may be some situations where it is not appropriate for psychological services to be held in a virtual setting – i.e., for some individuals, some diagnoses, or some age groups.
- It is incumbent upon the psychologist to ensure that the client or patient understands how to use the technology and any potential risks associated with its use.
In addition, telepsychology does not just mean videoconferencing, but also includes telephone communications, chats, texts and emails, among other electronic mediums.
Other issues for psychologists to consider are whether telepsychological services can be used for psychological testing and assessment and, if so, how to ensure the integrity of the testing. Another consideration is whether telepsychology can be utilized for group therapy and whether all members of the group are comfortable with this medium and ensuring confidentiality of the sessions.
Therefore, because of the various serious implications of the use of telepsychology, some of which have been set forth above, the Board is recommending continuing education in this area. Please review the Board’s advisory statement on the provision of electronic services, for licensure issues regarding the delivery of telepsychology, found on this page.
For additional information, review the American Psychological Association’s Guidelines for the Practice of Telepsychology, which are found at: https://www.apa.org/practice/guidelines/telepsychology
Updated December 2020
In response to inquiries from licensees and other interested parties, the Board has confirmed that it has no separate view per se with regard to provision of services via electronic means. As long as a licensee is practicing in a manner consistent with his/her training and experience, and is receiving supervision as is appropriate, the medium for doing so is not at issue. However, it is incumbent upon any psychologist to recognize that as he or she moves away from direct contact with clientele, the psychologist incrementally loses much of the richness of interaction which, as any psychologist knows, comes with traditional face-to-face contact in an individual session with a client.
Delivery of clinical services by technology-assisted media such as telephone, use of video, and the internet obligate the psychologist to carefully consider and address a myriad of issues in the areas of structuring the relationship, informed consent, confidentiality, determining the basis for professional judgments, boundaries of competence, computer security, avoiding harm, dealing with fees and financial arrangements, and advertising. Specific challenges include, but are not limited to, verifying the identity of the client, determining if a client is a minor, explaining to clients the procedure for contacting the psychologist when he or she is off-line, discussing the possibility of technology failure and alternative modes of communication if that failure occurs, exploring how to cope with potential misunderstandings when visual cues do not exist, identifying an appropriately trained professional who can provide local assistance (including crisis intervention) if needed, informing internet clients of encryption methods used to help ensure the security of communications, informing clients of the potential hazards of unsecured communication on the internet, telling internet clients whether session data are being preserved (and if so, in what manner and for how long), and determining and communicating procedures regarding the release of client information received through the internet with other electronic sources.
The Board considers that the practice of psychology occurs both where the psychologist who is providing therapeutic services is located and where the individual (patient/client) who is receiving the service is located. In order for an individual to provide psychological services in North Carolina, that individual must be licensed by the Psychology Board or be exempt under the Psychology Practice Act. On this basis, if a North Carolina licensee renders psychological services electronically to an out-of-state client, it is recommended that the licensee contact the psychology licensing board in the state in which the patient/client resides to determine whether or not such practice is permitted in that jurisdiction. Licensees are advised to review the North Carolina Psychology Practice Act, specifically the Code of Conduct, and the APA Ethical Principles of Psychologists and Code of Conduct (Standards 3.10(a), 4.02(c), 5.01(a), and 5.04 specifically address electronic transmissions).
Updated March 2005
This advisory statement is written to provide a general framework for psychologists to consider when making decisions regarding record keeping upon their death. The Board advises that psychologists give serious consideration to the issue of what provision to make for psychological records upon their death and to have a written plan which documents what will happen with their records upon their death. Further, the Board advises that the best practice may be to have the records transferred to another trained individual who will ensure that they are maintained in a confidential manner. This policy is consistent with the N.C. Psychology Practice Act, which requires that records be maintained confidentially for a period of at least seven years from the date of the last provision of psychological services or three years from the date of the attainment of majority (whichever is longer). [N.C. Gen. Stat. § 90-270.15(a)(18)].
The Board advises that psychologists consider making provisions for their records upon their death in estate planning documents. Psychologists may wish to consult with an estate planning attorney to add this provision to their estate planning documents. However, attorneys may have differing opinions about including this in estate planning documents. The individual to whom you would transfer your records would ideally be another psychologist or licensed mental health professional whom you trust to handle your records with due consideration given to the statutory and ethical requirements regarding record maintenance and confidentiality of psychological records. You may also consider designating a back up person in the event that the first person is unavailable. There may also be businesses that store such records. In addition, it may be helpful to review your plans periodically to ensure that they remain consistent with your wishes for your records.
This advisory statement is based upon several pertinent standards in the Ethical Principles of Psychologists and Code of Conduct (American Psychological Association, 2002). Specifically, Standard 4.01 requires that psychologists take reasonable precautions to protect confidential information. In addition, Standard 6.02 (c) states that psychologists make plans in advance to facilitate the appropriate transfer and to protect the confidentiality of records and data in the event of psychologists’ withdrawal from positions or practice. Further, Standard 3.12 requires that psychologists make reasonable efforts to plan for facilitating services in the event that psychological services are interrupted by illness, death or other limitations. Finally, Standard 10.09 discusses providing for an orderly and appropriate resolution of responsibility for client/patient care.
In addition, in order to be compliant with HIPAA requirements, psychologists may wish to provide consent forms to their current and new patients in which psychologists inform patients of their plans upon death. Therefore, patients are made aware of whom psychologists are transferring their records to, and they are able to provide psychologists with the proper written consent to allow such a transfer.
Finally, psychologists may consider a method for informing patients or former patients that the records have been transferred to another clinician and how they may gain access to their records. A psychologist could make provisions to have such a notice published in the newspaper and/or sent to all patients and former patients, if possible.
This advisory statement is intended to provide psychologists with guidance as they attempt to establish their own record keeping policies and practices for transfer/maintenance of their records upon their death.
Psychologists may also wish to review Record Keeping Guidelines, published in the December 2007 edition of the American Psychologist, and available on the APA website at www.apa.org
Adopted: February, 2008
Amended: December, 2009
In response to inquiries from licensees and other interested parties, the Board is issuing this advisory statement concerning the requirements for the use of the latest version of assessment instruments and the use of the latest norms available for a test. This advisory statement is intended to provide psychologists with guidance to ensure that psychologists use the current version of tests instrument and current norms.
Standard 9.08 of The Ethical Principles of Psychologists and Code of Conduct (APA 2002), states the following:
- Psychologists do not base their assessment or intervention decisions or recommendations on data or test results that are outdated for the current purpose.
- Psychologists do not base such decisions or recommendations on tests and measures that are obsolete and not useful for the current purpose.
The Board advises psychologists to pay particular attention to the section of this standard that prohibits psychologists from using data, test results, or measures that are either obsolete or are not useful for their current purpose. Therefore, in a psychologist’s review of the above standard a psychologist will need to determine whether the norms he/she is using are current for the test he/she is using. When a psychologist decides to use an old version of a test or “outdated” norms, he/she runs the risk of assessing persons by using outdated or obsolete measures. A psychologist should never administer one edition of a test and then score and interpret the test using the norms of another edition. The Board further advises that a psychologist seek the best information available to make sound clinical decisions regarding use of norms, so that a psychologist is certain that he/she is practicing in compliance with the above standard regarding this issue.
Another issue that has arisen before the Board concerns how long a psychologist has before beginning to use a revised test or new norms following publication. The revised tests or new norms should be used within a time period that would be considered “current,” which is within one or two years of the release of the revised test. If, however, a psychologist determines not to use the most recent version of a test, this decision must be based upon valid research data and sound clinical judgment. A decision to use an “old” test or “old” norms, must be clearly clinically supported, in compliance with Standard 9.08, and defensible if called into question. Again, however, a psychologist should never administer one edition of a test and then score and interpret the test using the norms of another edition.
North Carolina Psychology Board
February 2018
The North Carolina Psychology Board has received numerous inquiries about whether a psychologist has a firm legal/ethical ground on which to stand when making medication recommendations either to a provider about his/her patients or directly to the patient himself/herself.
The Board=s consideration of this issue was limited to whether this practice could potentially violate the N.C. Psychology Practice Act or Ethical Principles of Psychologists and Code of Conduct (APA 2002), which is the only authority the Board has with regard to any issues with which it is presented. Any other potential issues that may arise about this practice are outside of the Board=s jurisdiction and were not considered.
The Board recognizes that there is not a simple answer to this inquiry, but rather that it depends upon the specific facts and circumstances with which the psychologist is confronted. However, the Board raises the potential problems that may arise as a result of this practice under the N.C. Psychology Practice Act and Ethical Principles of Psychologist and Code of Conduct.
Before making a medication recommendation to a provider, a psychologist must consider whether he/she is competent to do so. The issue of competence is set forth in N.C. Gen. Stat. ‘ 90-270.15(a)(13), which states that it is a violation of the Psychology Practice Act if a licensee, “Has practiced psychology or conducted research outside the boundaries of demonstrated competence or the limitations of education, training, or supervised experience.” Competence is also addressed in N.C. Gen. Stat. ‘ 90-270.15(a)(14), which states that it is a violation of the Psychology Practice Act if a licensee, “Has failed to use, administer, score, or interpret psychological assessment techniques, including interviewing and observation, in a competent manner, or has provided findings or recommendations which do not accurately reflect the assessment data, or exceed what can reasonably be inferred, predicted, or determined from test, interview, or observational data.”
Whether a psychologist is competent to engage in a certain activity is also addressed in the Ethical Principles of Psychologists and Code of Conduct, Standard 2.01 (a), which states, “Psychologists provide services, teach, and conduct research with populations and in areas only within the boundaries of their competence, based on their education, training, supervised experience, consultation, study, or professional experience.”
The Board consulted with the North Carolina Medical Board regarding whether this would constitute the practice of medicine and the Medical Board provided the information set forth in this paragraph. A psychologist making a specific medication recommendation to a patient, in and of itself, would most likely not constitute the practice of medicine as defined in NC Gen. Stat § 90-1.1(5). However, it would be inadvisable to do so. A specific drug recommendation could interfere with the physician-patient relationship. The Psychology Practice Act, specifically, N.C. Gen. Stat. 90-270.15(a)(19), is instructive on this point as that provision forbids psychologists from engaging in conduct which “substantially impede or impair other psychologists’ or other professionals’ abilities to perform professional duties.” Therefore, a suggestion to a patient that he/she might want to discuss an antidepressant with his/her doctors would generally be acceptable; but a statement that a patient should tell his/her doctor that he/she needs a prescription for Prozac, would generally not be. The Medical Board’s concern was that the specific recommendation could interfere with the physician patient relationship and could negatively impact patient care.
Therefore, it is the Board’s position that a psychologist: 1) should not make a specific medication recommendation to a patient, but rather may consider suggesting a general classification of medications for which a patient may wish to seek consultation with a physician; and 2) should consider his/her own competence when deciding whether to make recommendations regarding medication to providers, or whether to make suggestions to a patient to see a physician about a general classifications of medications, otherwise the psychologist may be in violation of the N.C. Psychology Practice Act and/or the Ethical Principles of Psychologists and Code of Conduct.
There may be other issues that are not within the Board=s jurisdiction that a psychologist should consider in making a decision about engaging in this type of conduct. However, the Board’s position on this matter is limited, as described in this article.
North Carolina Psychology Board
May 2014
Psychologists who use these various classification manuals are advised to begin using the most current and up-to-date versions within one year from the date of publication to learn and begin to utilize the updated manuals for purposes of diagnosis, treatment planning, and professional documentation, consistent with the APA’s Ethical Principles of Psychologists and Code of Conduct and the North Carolina Psychology Practice Act. Psychologists should make every effort to familiarize and use manuals based on sound scientific practice. Psychologists should also use judgment and caution when there is controversy or contradictory evidence documented as it pertains to various diagnoses and classifications in the respective manuals utilized by psychology practitioners.
North Carolina Psychology Board
January 2014
The Board has become increasingly aware of the difficulty for a supervisee to meet in person with a supervisor for Board mandated supervision on a regular basis, especially in rural areas where traveling a great distance may be required in order to meet with a supervisor. As a result, effective immediately, the Board has broadened its interpretation of the term “face‐to-face” for all supervision required under Board rule, to include not only in person face-to-face supervision, where the supervisor and supervisee meet in person in the same physical location, but to also include electronic means of face-to-face interaction, without meeting in person. The face-to-face supervision must be live, interactive and visual. Video or other technology may be used so long as it is synchronous (real time) and involves verbal and visual interaction for the entire session. The face-to-face supervision must take place in such a manner as to maintain the confidentiality of the communication as it relates to the identifying information regarding patients/clients. Due to the fact that changes in technology are constantly evolving, the Board cannot provide advice regarding the specific technology to utilize.
Therefore, any real time video technology where the supervisor and supervisee can actually see each other face-to-face and verbally communicate with each other, but are not in the same room, also meets the requirements of face-to-face, as set forth in Board rules regarding supervision, so long it takes place in a confidential manner.
Please note that the Board has not changed its interpretation of the plain meaning of any other language in its rules other than broadening its interpretation of “face‐to‐face” in its rules regarding supervision. Supervision is still required to be individual and for the requisite hours per week or per month as set forth in rule.
When a supervisor and supervisee are deciding whether to meet in person or through electronic medium, some factors to consider are whether reports or evaluations will be reviewed and whether that can be done through use of electronic medium; whether the supervisory relationship is newly established; and/or whether there are concerns that are better addressed in person.
North Carolina Psychology Board
January 24, 2014
LICENSURE FOR INDIVIDUALS WITH MILITARY TRAINING AND EXPERIENCE AND FOR MILITARY SPOUSES
Since the military requires licensure as a psychologist in any jurisdiction, the following requirements are based upon the military requirements. A member of the military who is seeking to become licensed as a psychologist in North Carolina shall meet the following criteria:
- (A1) Has been awarded a military occupational specialty in psychology and has done all of the following at a level that is substantially equivalent to or exceeds the requirements for licensure in North Carolina: completed a military program of training, completed testing or equivalent training and experience, and performed in the practice of psychology.
- (A2) Has engaged in the active practice of psychology for at least two of the five years preceding the date of the application.
- (A3) Has not committed any act in any jurisdiction that would have constituted grounds for refusal, suspension, or revocation of a license to practice psychology in North Carolina at the time the act was committed and has no pending complaints;
OR:
- (B1) Presents official, notarized documentation, such as a U.S. Department of Defense Form 214 (DD‑214), or similar substantiation, attesting to the applicant’s military occupational specialty certification and experience in psychology; and
- (B2) Passes a proficiency examination in lieu of satisfying the conditions set forth in subsection A1 – A3 of this section; however, if an applicant fails the proficiency examination, then the applicant may be required by the board to satisfy those conditions.
A military spouse who is seeking to become licensed as a psychologist in North Carolina shall meet the following criteria:
- Holds a current license from another jurisdiction and that jurisdiction’s requirements for licensure are substantially equivalent to or exceed the requirements for licensure in North Carolina.
- Can demonstrate competency in psychology through methods as determined by the Board, such as having completed continuing education units or having had recent experience for at least two of the five years preceding the date of the application under this section.
- Has not committed any act in any jurisdiction that would have constituted grounds for refusal, suspension, or revocation of a license to practice psychology in North Carolina at the time the act was committed.
- Is in good standing; has not been disciplined by the agency that had jurisdiction to issue the license; and has no pending complaints.
An occupational licensing board shall not charge a military‑trained applicant or a military spouse an initial application fee for a license issued pursuant to G.S. 93B-15.1. Nothing in G.S. 93B-15.1(k) shall be construed to prohibit an occupational licensing board from charging its ordinary fee for a renewal application or prohibit a third party from charging actual costs for a service such as a background check.
Any worker who is defined as an employee by N.C. Gen. Stat. §§ 95-25.2(4)(NC Department of Labor), 143-762(a)(3)(Employee Fair Classification Act), 96-1(b)(10)(Employment Security Act), 97(2)(Worker’s Compensation Act), or 105-163.1(4)(Withholding; Estimated Income Tax for Individuals) shall be treated as an employee unless the individual is an independent contractor. Any employee who believes that the employee has been misclassified as an independent contractor by the employee’s employer may report the suspected misclassification to the Employee Classification Section within the North Carolina Industrial Commission.
Employee Classification Section
North Carolina Industrial Commission
1233 Mail Service Center
Raleigh, NC 27699-1233
Telephone: (919) 807-2582
Fax: (919)715-0282
Email: ernp.classification@ic.nc.gov
Employee misclassification is defined as avoiding tax liabilities and other obligations imposed by Chapter 95, 96, 97, 105, or 143 of the North Carolina General Statutes by misclassifying an employee as an independent contractor. [N.C. Gen. Stat. § 143-762(5)]
Required by N.C. Gen. Stat. § 143-764(a)(5), effective December 31, 2017