Working out-of-state as an unlicensed trainee?

[kittenlady]

Hi all! I am working in a private practice in California as a board-registered Psychological Assistant and am going to be moving out-of-state this summer for internship. Now, I am well aware that there have been long-existing legal and ethical roadblocks for unlicensed clinicians working across state lines, and I would not even be considering doing so under usual circumstances. However, I heard that there have been some recent changes that would allow trainees to do this, but I can't find any information on the California BOP or APA websites.

Has anyone heard anything recently that would make it okay for an unlicensed trainee to practice telehealth across state lines temporarily (~4 weeks)?

Thank you.

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[WisNeuro]

You need to check with the other states. In most circumstances, the services are considered being delivered where the patient is located.

 

[R. Matey]

https://cdn.ymaws.com/www.asppb.net/resource/resmgr/covid19/9.8.2020_temporary_&_telepsy.pdf

 

[kittenlady]

You need to check with the other states. In most circumstances, the services are considered being delivered where the patient is located.

I would be providing services to my clients in California - I think I worded the above in a confusing way!

 

[AcronymAllergy]

I'd suggest calling the boards of the state you're in and the state the client is in, as the exceptions related to COVID-19 are changing all the time.

Edit: I'd also check with your supervisors, which would be my first stop. VA allows for trainees to practice across state lines, but I have no idea how other systems and states are handling things with respect to unlicensed folks. With you being unlicensed, your supervisor will potentially also want to check with their malpractice carrier (who will probably say to call the state boards).

 

[thebalmofhurtminds]

And not all VAs allow that, so there's some nuance as well. Recently, my former postdoc site (a flagship VA) was still requiring trainees to move and be in the state that they were providing services in.

 

[WisNeuro]

Another caveat about the VA that does not apply to non-VA.VAs and VA services are technically conducted on federal property, so the origination requirements are different.

In the OPs case, they will likely have to check with the state that they are residing in, as well as all of the insurers that they plan on billing, as many have different rules when it comes to telehealth. It's a mess that depends on a lot of things, such as which states are still in emergency declaration.

 

[AcronymAllergy]

And not all VAs allow that, so there's some nuance as well. Recently, my former postdoc site (a flagship VA) was still requiring trainees to move and be in the state that they were providing services in.

The policy was just recently changed (within the past month or two maybe). It's national at this point, but some sites may still take some time to adjust their practices.

But yes, I certainly would never generalize anything that happens inside VA to systems outside VA.

In this case, it may be easiest for everyone involved to set the client up with another therapist prior to leaving the state, if possible.

 

[thebalmofhurtminds]

The policy was just recently changed (within the past month or two maybe). It's national at this point, but some sites may still take some time to adjust their practices.

But yes, I certainly would never generalize anything that happens inside VA to systems outside VA.

In this case, it may be easiest for everyone involved to set the client up with another therapist prior to leaving the state, if possible.

Oh, that's interesting! Is it under an emergency order or will it be like that from now on?

 

[AcronymAllergy]

Oh, that's interesting! Is it under an emergency order or will it be like that from now on?

My understanding is that it will extend beyond the emergency order, which is what always had been intended even pre-COVID, but was disallowed essentially due to a technicality.

 

[ClinicalABA]

Here's another resource:

Telehealth guidance by state during COVID-19

State emergency orders relevant to licensed psychologists during the COVID-19 public health crisis.

www.apaservices.org

 

[foreverbull]

Oh, that's interesting! Is it under an emergency order or will it be like that from now on?

Just as a caution, this doesn’t translate to outside of the VA. I keep up with CA state board regulations generally, but haven’t seen anything about practicing across state lines.

With psychologists temporarily practicing in other states or clients moving to other states, it will be dependent on that particular state’s regulations. I’ve been told that I can only ethically offer a certain number of sessions before referring to a local psychologist, but this was a case of a client who traveled out of state.

If you are practicing from a different state, it’s up to that state’s board of psychology to determine if that’s appropriate. I would imagine that they’re likely to be much more conservative about trainees temporarily practicing in their state vs. licensed psychologists, but that would be a guess. That said, four weeks is very short in duration.

Your supervisor should definitely be looking into this for you because it’s under their license, so they’re going to be seen as responsible for making sure you’re practicing ethically.

 

[AcronymAllergy]

Yep, I would definitely reiterate: do not generalize anything from within VA (particularly when it comes to inter-state practice) to work outside VA.