Considering Special Education Counseling as a Related Service during COVID-19

1: Are LSSPs allowed to provide counseling via a virtual medium (commonly referred to as “tele-health”)?

• Yes

• Board rules do not prohibit tele-psychology (tele-health, tele-counseling). It is important for LSSPs to understand that this is an “emerging area” of practice and should read the “Guidelines for the Practice of Telepsychology” below.

• https://www.tsbep.texas.gov/files/forms/Guidelines%20for%20the%20Practice%20of%20Telepsychology.pdf

• http://www.tsbep.texas.gov/new-developments-and-requirements

2: If Special Education Counseling as a related service is an agreed upon support in the student’s most recent ARD (and the student has a signed Consent for Placement on file) is another consent for special education counseling with an LSSP (Informed Consent) necessary?

Typical Practice - No

• • 465.38(g) “Informed Consent in a Public School. Informed consent for a Licensed Specialist in School Psychology must be obtained in accordance with the Individuals with Disabilities Education Improvement Act (IDEIA) and the U.S. Department of Education's rules governing parental consent when delivering school psychological services in the public schools, and is considered to meet the requirements for informed consent under Board rules. No additional informed consent, specific to any Board rules, is necessary in this context.” https://www.tsbep.texas.gov/files/agencydocs/Rulebook_2019August.pdf

COVID-19 School Closure – Best Practice

• Office of Civil Rights

1. “The Department encourages parents, educators, and administrators to collaborate creatively to continue to meet the needs of students with disabilities. Consider practices such as distance instruction, teletherapy and tele-intervention, meetings held on digital platforms, online options for data tracking, and documentation.” 3.21.20 Supplemental Fact Sheet Addressing the Risk of COVID-19 in Preschool, Elementary and Secondary Schools While Serving Children with Disabilities https://www2.ed.gov/about/offices/list/ocr/frontpage/faq/rr/policyguidance/Supple%20Fact%20Sheet%203.21.20%20FINAL.pdf

2. A supplemental Informed Consent is evidence that the LSSP and the parent collaborated and fully discussed the benefits and risks of “tele-health”.

• Texas Education Agency

  1. “LEAS should provide proactive and ongoing communication with parents and families of students with disabilities.” 4.9.20 TEA COVID19 and SPED Q&A
     https://tea.texas.gov/sites/default/files/covid19_special_ed_qa_updated_april_9vf.pdf

  2. A supplemental Informed Consent is evidence that the LSSP and the parent collaborated and fully discussed the benefits and risks of “tele-health”.

• There is no legal requirement to add a supplemental “Informed Consent” specific to the provision of counseling through “tele-health”. An LEA may want to consider its use to promote communication and transparency. This is an element of “local control” and will be determined by LEA administration in consultation with legal counsel.

• However, it should be remembered that Informed consent is a process, not a form. Ethically, informed consent requires that those who are consenting to the services are fully informed of the nature of the service, the limits of confidentiality (which is different in tele-health situations) and the opportunity for the consent to be withdrawn.

• NASP has developed a webinar that assists LSSPs in thinking through the ethical issues related to the provision of tele-health services, including matters of informed consent. https://www.nasponline.org/resources-and-publications/resources-and-podcasts/covid-19-resource-center/webinar-series/legal-and-ethical-considerations-for-remote-school-psychological-services

3: If a supplemental tele-health Informed Consent form is used – what might it include?

• Description of the service delivery method being utilized (tele-health counseling).

• Discussion of possible benefits and risks.

• Confidentiality within a tele-health model and when the provider would need to break confidentiality (suspected child abuse, expressed imminent harm to self or others, etc.).

• Students’ rights within a tele-health model (the ability to stop a session if privacy or confidentiality cannot be maintained in the session).

• Assurance to student/family that counseling sessions are not being recorded.

• Parent right to refuse tele-health counseling services. It is recommended that if a parent refuses the tele-health counseling model that other service delivery models be considered to meet the student’s needs.

4: What range of services might be considered when trying to meet a student’s needs during school closure?

• Consultation with parents (indirect service)

• Parent training: developing schedules, expectations and positive supports, de-escalation tools, relaxation tools, etc.

• Packets, workbooks, book study, guided journaling, etc.

• Taped content – general video lessons on emotional regulation, social skills, problem solving, etc.

• Taped content – taped specifically for a student with lessons geared around personalized goals and messages of support.

• Phone calls to student

• Tele-conferencing (live) – no video feed

• Tele-conferencing (live) – with video

• The service delivery options available is an element of “local control” and will be determined by LEA administration in consultation with legal counsel.

5: Points to consider when considering tele-health counseling (and to some extent telephone calls)

Technology

• Does the student and provider have the technology needed to support tele-health counseling?

  • Computer, laptop, iPad, and/or phone that can support a tele-conferencing program or app

  • Does the student have an internet or phone plan that can support the program or app?

  • Be cognizant of the family’s data plan connected to the family/student phone and the impact of tele-health counseling on that.

• Is the tele-health counseling platform HIPPA compliant?

  • The U.S. Department of Health and Human Services issued a Notification of Enforcement that states that “OCR is exercising its enforcement discretion to not impose penalties for noncompliance with the HIPPA Rules in connection with the good faith provision of telehealth using such non-public facing audio or video communication products during the COVID-19 nationwide public health emergency.”

  • “Under this Notice, however, Facebook Live, Twitch, Tik Tok, and similar video communication applications are public facing, and should not be used in the provision of telehealth by covered health care providers.”https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html

Confidentiality/Privacy

• Individual Counseling – who can see and who can hear the counseling session? How will this impact privacy/confidentiality and the student’s comfort level in self-disclosure. Is the family able to provide a private space for the student?

• Group counseling – it is recommended the LEA carefully consider any implications related to privacy and the Family Educational Rights and Privacy Act (FERPA) when considering a group delivery model.

• For more information about Privacy and FERPA Considerations for Virtual Instruction please review the TEA Guidance Document below released 4.2.20.
  https://tea.texas.gov/sites/default/files/covid-19_privacy_and_ferpa_considerations_for_virtual_instruction_april_2.pdf

Developmental Level – appropriate fit for student

• What has previous counseling looked like? If it was play-therapy or used gross motor activities to facilitate sessions – tele-health may not be the best fit for the student.

• Does the student have the attention span/executive functioning skills to work independently with a remote provider?

Benefit vs. Risk

• For students with strong pre-existing therapeutic relationships not providing some sort of service, even if it is only touching base via telephone (or sending a personalized taped message to the student), might feel like abandonment.

• Self-isolating/physical distancing at home may create undue stress on tenuous family relationships. Some sort of “check in” (phone, tele-health counseling) would benefit students who may be at risk. Weigh need for support and risks such as confidentiality and privacy.

6: Points to consider when providing tele-health counseling

• Create tele-health expectations

  1. Student/family will not record any portion of the counseling session.

  2. Service provider will not record any portion of the counseling session.

  3. Student will have a private area in order to engage in tele-health counseling. The use of headphones/microphone may be explored to increase attention and lessen distraction (increase privacy).

  4. The student will disclose the address of their location at the beginning of each session (in the event of a crisis the service provider knows where to send help).

  5. An emergency contact number will be provided in the event of a crisis.

• The service provider and family/student should discuss what will be in the “line of sight” of the counselor. Typically a student will be in a private room in the house, but in some homes this may not be possible. It might be helpful to have the student face towards the room so the camera faces the wall. It is also possible that virtual backgrounds could be utilized. The same considerations should be made for the service provider.

• Communicate with the student’s family and other service providers to better understand the student’s needs – similar to the consultation utilized during face to face/school based counseling.

• Consider the best counseling techniques for the virtual medium.

  1. If privacy might be a concern – would a change in topic from introspection to “skills-based”, social skill, and/or SEL instruction be an option?

7: Data Collection and Progress Monitoring

• Document skills prior to school closure

• Document current functioning during school closure and progress towards IEP goals.

• It is possible that the student may show new behaviors due to the stress of school closure or regress on goals already mastered. Document these changes in behavior and skills.

• For some students with school anxiety or refusal - progress or reduction of anxiety/behavior may be observed/reported.

• Collection of data will help with school re-entry planning, as well as future conversations regarding compensatory services.

8: Developing Competency in tele-health counseling for COVID-19 service provision

• Do you understand your technology? If not, you can find “how to videos” on the basics of setting up your system and how to use your system creatively (such as sharing your screen, using a white board, etc.). There are many short “how to” videos available to help a provider set up their sessions.

• NASP has developed webinars to assist in thinking through the issues related to the practice of counseling utilizing distance technology. https://www.nasponline.org/resources-and-publications/resources-and-podcasts/covid-19-resource-center/webinar-series/when-one-door-closes-and-another-opens-school-psychologists-providing-telehealth-services

• NASP has amassed a large collection of resources that are updated daily related to the practice of school psychology during this time of crisis. https://www.nasponline.org/resources-and-publications/resources-and-podcasts/covid-19-resource-center

• APA is offering a series of free webinars (non-members included) titled “Telepsychology Best Practice 101 Series”. While some elements of this series will not apply (reimbursement) there is information regarding selecting and using technology for tele-health counseling. https://apa.content.online/catalog/product.xhtml?eid=15132

• PESI is also offering free or reduced COVID-19 webinar supports. https://catalog.pesi.com/Search?displaytype=1&pagesize=10&sortby=51&sst=&search=coronavirus&utm_source=featuredad&utm_medium=banner&utm_campaign=BH_COVID_webcast

TEA Guidance Document

COVID-19: Providing Counseling as a Related Service April 14, 2020 https://tea.texas.gov/sites/default/files/covid_19_providing_counseling_as_a_related_service_april_14.pdf