transcript for covid-19 q&a session

"covid-19: ethical, legal and clinical considerations for social workers"

moderator:shana swain
date:april 21, 2020

dawn hobdy:greetings wonderful social workers. welcome to the covid-19 ethical legal and technical considerations for social workers q and a session. my name is dawn hobdy. i am in the vice president of ethics, diversity and inclusion at the 巴西vs塞尔维亚赔率 and your moderator for today.

nasw is so delighted to have you join us for what we hope will be an informative and helpful session. as professions we are facing some of the most challenging times in our careers.

we are working harder than ever and for many of us we are not necessarily feeling understood, appreciated or protected. this program was developed as a way of nasw saying to you we understand you, we appreciate you and we thank you.

as a thank you, we want to offer for you today some guidance and some resources on telehealth during covid-19 from a legal, technical, ethical and liability perspective. we also want to provide an open forum for you to ask questions about the implications of covid-19 on your practice.

but more importantly or as significantly, we want to provide an opportunity for us to explore together the impact of the pandemic on the profession through shared reflections and experiences. it is our hope that you all feel a level of comfort in sharing your thoughts including your fears and your frustrations as well as the successes you’ve had in navigating this challenging time.

i’d like to begin by introducing the chief executive officer of the 巴西vs塞尔维亚赔率 . we think... we believe that dr. angelo mclean is with us and so we're going to try to connect him so that he can provide some brief remarks. are we able to to connect dr. mclean? okay. we're going to give them some... give some time to see if we can get him connected. and until then i’d like to take some time to introduce today’s presenters.

we are so grateful to be able to pull together the top managers and senior staff members of nasw’s national office. together our presenters have almost 60 years of experience in legal, clinical and ethical social work practice. these are the national staff members who provide of all of the clinical legal and ethical consultations resources and content. they are the experts.

i’d first like to introduce mirean coleman, lscswct. she serves as a clinical manager. mirean will discuss moving to telehealth, clinical and coding issues during covid-19. elizabeth felton, syn and lscw serves as the associate counsel for the legal defense fund hear at nasw and will discuss telehealth - that's right, excuse me, tele-mental health, legal considerations for social workers. and then finally we will hear from andrea murray, lscsw who is the senior ethics association. and andrea will discuss telehealth and covid-19 ethical considerations.

in addition to our esteemed presenters, we have a special guest, ms. lonnie rob with the nasw risk retention group who has accepted the invitation to join us on the call to assist us in answering your liability questions. we want to thank lonnie for joining us as well. i’d like to acknowledge members of our national ethics committee, our national association staff and leaders who are joining us today. we sincerely thank you for your support.

so the order of the events for today’s session will be as follows. we'll begin with brief presentations from mirean, elizabeth and andrea who will discuss the trending social work questions during covid-19 pandemic and then provide some guidance from ethical, legal and technical perspectives.

after that, we will open the q&a portion of the session. this will be the opportunity to ask questions regarding the presentation and any other questions you may have. we'll also spend some time reflecting and sharing our experiences. i’d like to provide a disclaimer that all of the information and materials provided for this presentation are for general information purposes only and are not intended to constitute ethical, technical or legal advice.

also please be advised that this teleconference will include a q&a answer segment and it will be audio recorded. by participating in the q&a portion, you consent to having your questions and comments audio recorded and to nasw making such recordings available to others for any educational, promotional or commercial purpose consistent with nasw’s mission and purpose. further, you release nasw from any liability connected with the use of the recording and waive all rights you may have to compensation related to the recording.

okay so let’s begin. i'd like to try one more opportunity to see if we can connect dr. mclean before we began. okay. so let’s begin. i’d like to introduce mirean coleman. mirean, if you’d like to say a few things and then provide your presentation.

mirean coleman:thank you dawn for the opportunity to participate in this webinar. and the title of my presentation is moving to telehealth clinical and coding issues during the pandemic. the pandemic has affected not only the personal lives of social workers, but also their professional lives.

we have lost our routines and activities as we knew them. and we're now living in a world of unknowns and things are changing daily as we seek to understand this daily disease – this deadly disease. the pandemic has changed the clinical aspect of social work services.

although we continue to provide procedures such as the post-traumatic stress disorder, cognitive behavior therapy, supported therapy and many other treatment modalities, we're now treating the reactions to the disease that has precipitated problems of isolation, loneliness, anxiety and stress. these reactions are increased if the patient has an existing mental illness. and for those living with a substance-use disorder there is an increased risk for relapse.

what has also changed for social workers is how to administrate the services we provide through the telehealth system and the emotional impact the pandemic has had in the community and on the patients we serve including the healthy, the sick and the mentally ill.

most salaried social workers who work in settings such as hospitals, long-term care facilities, medical clinics, protective service agencies and rural health clinics continue to be employed and are considered essential workers. they are supplied with protective health equipment when it is available, thus placing themselves at great risk when it’s not available.

social workers in healthcare settings are experiencing deaths of patients at an alarming rate just as the physicians and nurses, yet we may not hear about them on the national and local news. they’re providing grief counseling to families over the phone and assisting patients with emotional support and end-of-life issues when appropriate.

they're are also doing discharge planning and linking the patients to services in their communities. they're helping to connect patients and families through technology such as texting, facetime and skype. and they’re also contacting patients with families without technology through the postal service mail to provide them with assistance.

clinical social workers in private practice are having a different experience. many of them have closed their practices and are experiencing financial difficulties due to the pandemic. some patients are sheltering in place to stay safe and healthy and are receiving technological interventions.

other patients may have lost their jobs and cannot afford to continue to pay cash or pay for their health insurance due to the loss of their job. private practitioners are sheltering in place and they themselves may not be able to go to an office to provide services. medicare is helping with the problem by expanding its telehealth program and many private health insurance companies are also taking steps to explain their telehealth services.

this change to help patients receive health and mental health services remotely will assist in reducing the risk of a pandemic transmission not only for social workers in private practice who bill independently for their services, but also for social workers in medical settings whose services may be bundled through the medicare participation fee.

so here are some of the medicare changes during this period. medicare services may be provided across state lines if permitted by your state statutes or regulations. the telehealth services can be administered in any setting to new and established patients through popular applications that allow for video chats including apple facetime, facebook messenger video chat, google hangouts studio, zoom or skype.

facebook live, twitch, tiktok and similar video communications are public facing and should not be used. at this time there are no audio-only telehealth services that are being reimbursed. nasw is advocating for audio-only services through cms and congress. although there may not be reimbursement for providing audio-only services, there are social workers who are committed to providing it anyway because they care and they know that their patients are in need of the services.

telehealth services are paid at the same rate as an in-person visit. in order for this to occur, use the modifier gt in the same place of service codes you would use for an in-person visit. for place of service codes for clinical social workers, include 11 for office, 33 for nursing home, 12 for home and assisted living would use 13.

copayments are waived during this period. the most common type of virtual services that clinical social workers will perform is the medicare telehealth services. to report the telehealth services, use the individual, crisis, family and group psychiatric codes.

e-visits are the second commonly most used service for virtual service for clinical service workers. e-visits take place using an online portal communication and are basically used to assess and manage a patient’s illness. one can only use e-visits for one patient for a total of 21 minutes over a period of seven days.

so how can we help our patients get through the pandemic in addition to using appropriate treatment modalities? well we can encourage them to stay connected to others through phone calls, texting and virtual chats, encourage them to use virtual neighborhoods. and all of this helps to keep them grounded.

recommend that they avoid triggers that create anxiety and stress. recommend that they not overload themselves with information, especially about the pandemic which can sometimes precipitate or increase depression and anxiety, especially when you’re watching television or using the internet for many hours during the day. encourage them to create a daily routine with structure and also encourage them to exercise and get good nutrition when possible.

most of all, social workers should be students of themselves and follow the same tips and document the services performed in order to avoid audit problems in the future and overpayment requests. nasw has also developed a covid-19 web page to assist with the needs of social workers. and i encourage you to visit it for the most updated information.

you may access it at www.socialworker.org. and for information on providing services across state lines i’m referring you to your state board of social work or you may contact the association of social work boards at www.movingsocialwork.org.

for information about coding visit www.cpkalled.com/practice/clinical-social-work/billing-codes. and for additional information you may also contact medicare@cms.gov or the insurance company with whom you are credentialed. so i would like to close by thanking all of the social workers for their commitment to serve and help others to overcome the challenges of the pandemic. dawn?

dawn hobdy:yes, thank you so much mirean. as a reminder we encourage you to gather your questions and as soon as we finish with each of the brief presentations, we'll begin answering your questions either related to the presentations or any other general questions you have. i’d like to now introduce elizabeth felton. elizabeth?

elizabeth felton:yes thank you dawn, thank you mirean. hello everyone. thank you for joining us. as dawn said, my name is elizabeth felton and i'm an attorney and a licensed clinical social worker here at nasw. due to the covid-19 pandemic and all the stay-at-home orders that are in effect, nasw has received a lot of calls about tele-mental health, so today i will discuss some of the legal considerations the social worker who provide tele-mental health services.

tele-mental health is the practice of providing clinical services through technology assisted media between a practitioner and a client who are located in two different locations. there are multiple layers of consideration regarding tele-mental health. social workers must make sure they are practicing legally and ethically, following state licensing regulations and adhering to state and federal practice guidelines as well as payor contracts for reimbursement.

but before providing tele-mental health services, social workers should check the following. number one, their state licensing board, number two, the state licensing board where the client is, number three, professional liability insurance, number four, the payor -- whether it’s commercial, medicare or medicaid -- number five informed consent and number six hipaa if applicable. and i will discuss each of these briefly.

so the first area is licensing. the general rule regarding the provision of tele-mental health services is that social workers must meet licensing requirements in the state where they're licensed and they must meet the licensing requirements of the state where their client is physically located. that is the general rule. that was - just think of that as pre-covid-19.

however during the pandemic, many states are temporarily suspending some of the regulatory provisions of the tele-mental health requirement. so due to the current climate, social workers should be sure to check the appropriate licensing board to find out if any changes have been made. aswb - they also have a resource on this web site of the states that have emergency provisions regarding social work licensure as related to covid-19 pandemic.

so i will definitely suggest that you check with the aswb web site and also a lot of states if you would even do a google search for covid-19 orders in just your state that will also provide you some information on finding out if there are going to be changes in your state for a licensing requirement.

the second issue i wanted to remind social workers to check is the payor, either private payor or government reimbursement. the social workers need to check to make sure that they will be reimbursed for tele-mental health services.

as mirean had stated both private and government payors have modified some of their regulations during the pandemic so you need to make sure that you will be reimbursed for tele-mental health services and that they will allow you to do it and you follow the criteria that they specify in order to be reimbursed.

a third area is informed consent. it’s important to obtain informed consent for tele-mental health to address many issues including the risk and benefits associate with tele-mental health, exceptions to confidentiality, what to do if there are technical difficulties or interruption of service and what to do in cases of emergency.

also in some jurisdictions, it's a requirement either the state licensing board, state regulation or reimbursement. so if it’s a requirement you definitely have to use in your jurisdiction. but even if it’s not, nasw recommends obtaining a tele-mental health informed consent from your clients as a best practice.

professional liability, social workers need to confirm that their malpractice insurance covers the provision of tele-mental health services. for instance nasw insurance services asi professional liability policy provides coverage for tele-mental health as long as it’s an accepted practice conducted according to the social worker state regulation, state licensing board and hipaa privacy and security standards.

so if you halve insurance through nasw and you follow everything that’s accepted, then it's covered. but for others you may need to check because it’s not automatic.

and lastly there’s hipaa. before covid-19 all vendors had to be hipaa compliant and the vendors had to sign a baa. however, that’s a business associated agreement. however, due to covid-19 hipaa has relaxed the enforcement of the hipaa requirement related to the type of platforms used for videoconferencing and they'll need to enter a baa with the vendor.

so even though hipaa is saying that they’re not going to enforce it during this time, mirean did discuss some of the accepted forms, video platforms that would be acceptable but you still can get a business associate agreement if you like.

the only difference during the pandemic is that hipaa will not be enforcing it during this time. but you have to remember that the privacy, security and confidentiality rules still apply to tele-mental health. and that is - those are the major points that i wanted to cover.

i do believe that as social workers on the front line and they’re doing a great job of still trying to maintain but also be there for their clients and it’s commendable. and i am really grateful that we're able to be here to offer you the support that you need so that you can continue caring for the clients that you care for. thank you so much. dawn?

dawn hobdy:thank you for that elizabeth, i really appreciate it. another reminder that this presentation will be available as a recording sometime shortly after today’s presentation. i’d like to now introduce andrea murray. andrea?

andrea murray:thank you dawn and thanks colleagues. my name is andrea murray and i'm senior ethics associate in the office of ethics and professional review. and oh how things have changed over the last month. ethics has always been a hot topic but lately even more so. social workers want to know how to respond to the new realities presented by covid-19.

we do ethics consultations on pretty much daily basis in our office and some of the major themes we're hearing some of the questions we're getting are around what take precedence during this pandemic, self-care or client care? how do social workers service clients who are in crisis remotely? is it okay to take on expanded professional duties to "help out during this crisis?"

and then on top of the questions we're getting from members, there's the reality that really we're in a unique time where social workers are navigating in real-time the same crisis situations themselves that the clients that they're servicing are simultaneously dealing with.

so here we are as social workers charged with supporting our clients through a crisis -- through this covid crisis -- and yet we haven’t necessarily had a chance to figure our own way out. so that is really a challenging circumstance for social workers to be able to perform in the roles that we are charged to perform, but yet figure it out for ourselves at the same time. and when we're under stress, it can be really difficult to sort through new and complex variables and make sound decisions.

so the good news is that that’s why we are here today. nasw and the nasw code of ethics has not changed. so our ethical obligations are still there and we are still charged to uphold the same standards of the code that we’ve always been charged to uphold even in the face of this pandemic.

and so as we look at the issues and the challenges and the questions facing us, it’s important to take a moment to really look at that code of ethics. and in addition to the code of ethics -- just as my colleagues have suggested -- consult around the various other factors that will come into play in order to make solid decisions around practicing in this covid environment.

and so with that i just wanted to really set the stage for the q&a portion of this call by just reminding you that the code of ethics from an ethical perspective is a guide. okay, so it addresses the ethical issues in a challenge or a question or a dilemma but it doesn’t necessarily address all of the issues. so more often than not the code is just one stop in the journey of coming to a solid decision. and as my colleagues have shared clinical, legal and other variables often come into play when making a sound decision.

during this crisis nasw has responded to the needs of our members by coming – developing great resources so that you can get some real-time information on what to do as you face new challenging situations. and from the office of ethics and professional review, we have two documents under our ethics 8 series which is a tip sheet series of pointers that help social workers navigate prevailing ethical issues.

and so i just want you to remind you that those resources are available online and we'll be providing you a resource list at the end of this call. i’m not going to spend too much reviewing those tips at this juncture, but what i will do is try to weave them into our responses as we take your questions. so i’m going to turn it over to dawn and we look forward to being able to hear from you soon around what your needs are as social workers.

dawn hobdy:thank you andrea and thank you mirean and thank you elizabeth. we really appreciate your giving a brief summary of some of the trending topics and questions that we’ve had. as you all mentioned, this has been an honor and a privilege for us to be able to support the profession in the way we have been able to do and we want to continue to be able to do that. and so at this time we'd like to open up the question and answer portion of this session. and comppartners is going to provide some instructions on how to proceed with asking questions.

operator:thank you ma’am. ladies and gentlemen, if you’d like to ask a question over the phone, please signal by pressing star 1 on your telephone keypad. if using a speakerphone, please make sure your mute function is turned off to allow your signal to reach our equipment. again leads and gentlemen over the phones that is star 1 at this time, star 1. we do have questions in queue at this time.

dawn hobdy:okay and we are ready.

operator:we'll go first to (mark) in wisconsin.

(mark):yes early in the pandemic i received a number of questions from clinical social workers who were serving college students and who then had to obviously leave the state to go back home. and if students still wanted to - needed or wanted these services from the clinical social workers, the clinical social workers were not licensed in the other state and even to this day there are some of our neighboring states have not made any changes to their licensing laws although wisconsin has.

i checked with our state regulatory body. they say that one if a person is licensed and in good standing in our state they don’t at this time have a problem if they're serving people in other states. so this seems to be kind of a sticky kind of ethical legal issue because you don’t want to abandon the clients.

our licensing board says that this – our licensing department says at this point they don’t have a problem with this but i know the general standards that you are supposed to be licensed in the other state. so i’m just kind of curious about some feedback on the situation.

dawn hobdy:okay (mark) thank you for that question. elizabeth would you like to start with a response?

elizabeth felton:yes hi (mark) and that is a common issue. even though wisconsin is saying it’s okay, the state where the college student needs to say that as well. and i think the dilemma is - it’s - a lot of people are experiencing that. it is something that i don’t know if it will be resolved right away. so i would suggest that if that social worker is able to refer the college student to someone in his state that could service him, i guess, locally since they cannot.

because even though it’s a termination, even though they don’t want it to be a termination i think that would be the – she would have to do that so she wouldn’t abandon the client. and if he were in crisis, that would be the main issue but if there was some kind of transition then maybe that social could refer the college student to a provider in his state, his or her state.

(mark):okay.

dawn hobdy:okay. all right did any other colleagues want to add to that response?

andrea murray:yes from an ethical perspective (mark) the code concurs with the guidance that elizabeth just provided. our code in 1.04 competence does require us to ensure that we have the competence or licensure in the jurisdiction we are in where we're physically located as well as the jurisdiction the client is in. and that’s 1.04e. so if this is not the case then as elizabeth suggested we do need to look at referral for services which is addressed in our code in 1.16.

and for those of you who are wondering how to get their hands on the code of ethics, it is available on our web site socialworkers.org. so it would be ethical, you know, to refer that client out if you are not licensed to provide that service across state lines. and as (mark) you suggested we really want to avoid abandoning clients who are still in their - in need of services. that is our ethical obligation but, you know, it is unusual circumstances.

the code does speak to unusual circumstances that may precipitously require, you know, us to refer out or, you know, cease services. so it’s not ideal, but the code does kind of give some provisions for when things cannot be avoided. so just want to give you those ethical references that collaborate with elizabeth's legal guidance.

(mark): yes i hear that on a practical level sometimes people can’t access services in another state. maybe they don’t have insurance there or something. i mean i understand everything you’re saying, but there are also practical considerations as well.

dawn hobdy:indeed.

andrea murray:understood.

mirean coleman:yes this is mirean. i would just like to add to that. you also have to look at the payor. will the payor reimburse services in both states? another thing to look at is the nasw technology standards.

and it does specifically report that if the social worker is going to provide the service in the state where the patient is, they must also be licensed in that state and also in the state in which they are providing the service from.

dawn hobdy:(mark) i do want to add we definitely understand the challenge here. i think that one of the other things is that we as social workers need to continue to advocate for ourselves during this time with the needs, what the unique circumstances are and how we can work with licensing board, et cetera, to make sure that we can serve our clients in the most ethical and legal way during this time.

and so 世界杯入围名单2022 and working with the association of social work board and the licensing board is key. now nasw, aswb and - i’m sorry let me say what those are nasw, you know what that is, the association of social work board and the council on social work education are all working together to try to ensure there we're meeting the needs of the professions.

and they're aware of all of these challenges and are working together to try to help address them as quickly as possible. we just don’t have, you know, all the answers to everything but they are aware and trying to work on that.

(mark): well i can add just one thing on the 世界杯入围名单2022 .

(crosstalk)

dawn hobdy:sure.

(mark): it seems to me that asw needs to contact all the social work boards in the united states to say, "hey you need to asap and get an emergency order so that people can get temporary licenses in your state.

maybe because some of the states - i know minnesota's not done anything. i talked to my colleague there. i believe illinois's done something so there are a number of states that haven’t done anything and then you have a big problem.

dawn hobdy:yes, yes.

(mark): so i don’t know if nasw has talked to aswb, but maybe that would get some of these states to do something…

dawn hobdy:yes.

(mark): …so that there can be services across state line.

dawn hobdy:yes i agree with you. and we will follow-up with some of these comments and if we receive additional information from any of the sister associations we'll be more than happy to provide those updates. so thank you for that (mark).

(mark): thank you.

lonnie robelizabeth felton:and dawn this is lonnie robb. if you deem it appropriate, i can certainly enter in a small piece associated with professional liability insurance.

dawn hobdy:yes please do, please do.

lonnie robelizabeth felton:okay there i want to point out that everything covered as far as licensure in other states where clients are, i guess, temporarily residing until they return to the area that you’re located in, keep in mind professional liability insurance with the nasw risk retention group it covers all 50 states, but with the requirement of checking that regulation and making sure that if you're required to hold licensure in the other states that that would be completed an advance of providing services.

and actually i just want to take an opportunity to point out why that actually is the case. keep in mind the purpose of a professional liability insurance policy is to support the mission to provide a robust legal defense if professional impropriety allegations rise related to that client relationship.

and so essentially the reason that complying with state regulation is helpful is if allegations, even unrelated to those state regulations, would arise it would actually be something that may be admissible in the case as to well the person, you know, the social worker, that it could be brought up by those bringing a suit forward that the social worker is not complying with state regulation. and it just makes that defense that much harder or more difficult to overcome.

so that’s actually a good question that has just come up just overall that you do give me support, but if i fall behind and i’m not working to align myself from a regulatory standpoint, what are you actually giving me? so what we’re doing is just asking just like any other inquiry. social workers are good risk managers to do that due diligence ahead of time and then, you know, consider that option. and we would support you as long as you’re in compliance with those regulations.

dawn hobdy:thank you for that. that’s very helpful -- appreciate it. okay i think we’re ready for another question.

operator: yes ma’am. we’ll go next to (joann) in rhode island.

(joann): hello, good afternoon. i'm realizing as i’m listening it’s great information, but i am not an individual provider. i am in a school social worker in a collaborative setting. and i’m working out of my home in rhode island because school's building closed. and the - my program is a massachusetts. do i have to be concerned about that i’m in rhode island and providing services in massachusetts?

i mean it’s all on a platform that has been set up by, you know, my employer. the students and families understand - they know that i am working from home. you know, i’m not sure if it - if they know i'm exactly in rhode island. they just know i’m home. but is that something that i should look into regarding the telehealth piece in terms of i’m in another state? i’m licensed in both states and i’m licensed with the department of education in massachusetts.

dawn hobdy:okay that’s a great question. who would like to start? you want to start from the legal perspective?

elizabeth felton:yes i just...

(crosstalk)

elizabeth felton:...wanted a better – a clarification. tell me what the legal question was again? i couldn't hear the rest of it.

(joann): oh i’m sorry. i do have insurance and i have the tele, the - we have telehealth or the - distance tele (inaudible) word in the insurance. when i’m working i’m in massachusetts right in…

elizabeth felton:okay.

(joann): …a collaborative building okay? now that the school building is closed and now we just found out for the rest of the school year, i’m providing services like from homes remotely via phone, email contact and sort of and, you know, video platform. when you were talking about, you know, over state lines i thought would that…

elizabeth felton:yes.

(joann): …also apply to me? okay.

elizabeth felton:okay, so you’re physically located in one state and your client's in another?

(joann): yes.

elizabeth felton:is that what you’re saying?

(joann): right now, yes right now…

elizabeth felton:yes, yes.

(joann): ...they are usually yes.

elizabeth felton:so that is correct. so you can tele-mental health can be provided intrastate or interstate so it can be across state lines or it can still you can be in the same state. so if it - if the client is in one state and you’re in the other then that means it’s intrastate and you still follow the criteria. let me make this clear too. the resources we have online, nasw has a number of resources a talk about tele-mental health in some of the things i pointed out. and we also have an…

(joann): yes.

elizabeth felton:…informed consent online. so if you go online and you look at those resources that can help better understand what i was talking about earlier.

but yes in your case since you are physically located in one state and your client is in another then you need to make sure when you talk about the licensing boards in each state, the payor and all those other requirements you need to just make sure that you meet -- reimbursement licensure and state regulations and things such as that.

now look - and when you’re saying with kids you need to be – the videoconferencing platform i noticed certain jurisdictions they are not allowing zoom . so i don’t know which platform you’re using but certain school districts have banned zoom. so make sure you’re in compliance…

(joann): yes.

elizabeth felton:…with whatever your jurisdiction has indicated for you to do.

(joann): okay you know what thank you very much. all those pieces are in place already…

elizabeth felton:okay.

(joann): …through the employer and through clinical supervision that we get. and they’ve upgraded all the video communications to the professional educational platforms that are served by and hipaa compliant okay.

elizabeth felton:okay.

(joann): all right they - those - all those have been covered. thank you so much. when i was thinking of it i thought, oh dear god and then i thought okay thank you very much. i appreciate it. and this is very informative. thank you.

elizabeth felton:you’re welcome.

dawn hobdy:okay thank you so much for that. anyone else like to add to that response?

andrea murray:i'd just like to reiterate from an ethical perspective that the issue of working in - across state lines remotely does still entail some of the same things that we spoke to in the first question. you do have to check with your licensing board to ensure that you are licensed to provide those services across state lines by the licensing board that you are currently located in.

as well as checking with the licensing board that your students are located in to ensure that you are properly licensed to perform those services. and there are some exceptions if you’re not but it’s state by state, board by board and so that from an ethical perspective is addressed in 1.04 competence of the code of ethics on standard e, e as in elephant under 1.04.

dawn hobdy:yes thank you all for that. i think it’s just really important like what we’re trying to get out of that. these are very unique situations and there's no one answer. the most important thing that anyone can do right now is seek consultation. there are so many individual pieces to every scenario.

the best thing you have is the guidance that's available. so having your malpractice insurance and reaching out to them if you’re a member of nasw please take advantage of the clinical, the legal and ethical consultation that are available to members. if you’re not a member i would encourage you to join to make - to ask to take avenge of these opportunities.

but you really want to make sure that whatever decision you make and to social workers in a similar situation might make different decisions. what’s important is that you can show that you’ve taken the correct steps to make those decisions.

so you want to be able to say, "i spoke with a licensing board in my state, i spoke with a licensing board in the state where i’m interested in providing services, i've checked with my liability insurance," document those efforts and make sure that you feel comfortable about the decision you’re going to make because it’s really - we really wish we could say this is what everyone should do in any of these circumstances, but it just it's not working that way.

i also shared about the efforts with nasw and asw b and i want to make sure that everyone was clear that an asw is working with aswb and they’re advocating for state waivers and that’s what out-of-state therapist to practice. so that is an emotion.

of course i’m sure you all probably feel like it’s not happening fast enough but that is something that we are working on. but i think right now just get the consultation, asked the questions that you need for your specific situation and make sure that you feel comfortable when you make those steps okay? thank you for that question. are we ready for the next question?

operator: yes ma’am. we'll go to our next question in queue. we'll go to julia in alabama.

dawn hobdy:hi julia. welcome.

(julia): hi. can you hear me?

dawn hobdy:yes.

(julia): okay great. i have another similar question about college students in different states. i have a unique situation. the student is coming is like living with family in atlanta and that also keeping her apartment near the university. and so she’s kind of back-and-forth between.

i would just say like okay i’ll just meet with you when you’re here, but one of the reason she’s back-and-forth with her family as that there’s a suicide in her family recently. and i just feel like if she's going to be there for three weeks i feel the need to check in with her and i just feel really conflicted about what to do because she’s not - she hasn’t moved there but she’s been spending a lot of time there right now.

dawn hobdy:okay another great question. who would like to start? mirean do you have any perspectives for that question from a clinical perspective?

mirean coleman:okay would you please explain the concern again about the college student?

(julia): yes, so she has an apartment here in alabama and she has family that lives in atlanta. and so she’s back-and-forth between the family in atlanta and her apartment here. but a big reason that she’s with family in atlanta is because there was a reason suicide and her family. and that’s obviously really hard. and so she’s spending like a couple of weeks over there and then coming back when she needs to do something, you know, on campus for whatever reason.

so anyway i just kind of feel like i – she’s going to be there for three or four weeks it feels - i feel like i need to be checking in with her and also and it doesn’t seem like referring her to a provider in atlanta doesn’t necessarily make sense because technically like she’s, you know, going to be back i assume this summer or next fall. so i don’t know i’m just kind of feeling conflicted about what to do.

mirean coleman:okay, and he releases a georgia right? you’re only licensed in georgia right? you're only licensed in alabama? okay.

(julia): yes.

mirean coleman:well i would think that it would be very important for you, you know, considering the circumstances to provide her with a list of emergency resources in georgia in the event that she needs emergency help under the circumstances. because it would be difficult for you to provide those emergency services in georgia.

if she becomes, you know, upset or ill in that case. and after providing her with the emergency services, i would also check with the licensed board the state board of social work in georgia to see what their requirements are regarding providing services when you’re not licensed in their state, but you're licensed in another state. there might be some variability there.

also check with their insurance company to see how they would like for you to build this case and whether or not she’s eligible to receive services in…

(julia)yeah i mean…

(crosstalk)

mirean coleman:… both areas because a lot of insurance companies have their own restrictions about payment when it comes to providing services in different localities.

(julie): yes and like i work on campus and we don’t bill for services on campus. so i think that’s the other thing is like she can – she’s paid for services with us right through her tuition. and so, you know, be like while you can use this right now you’ve got to pay for counseling somewhere else it just seems kind of i don’t know just frustrating.

dawn hobdy:i understand that. and i definitely think that’s frustrating. i’m sorry, mirean, were you finished?

mirean coleman:yes. but i would also check with your college administrator. they may have some policies around this because the college insurance may have some policies around where you can provide services and restrictions. and we want to make sure that your following those procedures.

(julie): thank you.

dawn hobdy:i do want to add i also think that this is another opportunity to reach out to to the licensing board. many licensing boards have exceptions not many but some licensing boards have exceptions.

for example, even outside of an emergency situation like this, there are some licensing boards that have provisions where if you’re on vacation or something and you’re temporarily in a different state from your client or vice versa, that you can provide limited services are check-ins or, you know, some social workers will provide a check-in and not bill it not consider it therapy.

so just kind of talking through with them about what your options are and kind of ask what you can offer the client during those times whether in the different states and explain the situation because some states do have some exceptions understanding where there is a temporary situation.

(julie): thank you. i appreciate that.

dawn hobdy:okay, so great questions. we can take another question.

operator: we’ll go next to jackie in georgia..

dawn hobdy:okay. hi jackie.

operator: jackie, your line is open. please check your mute function. and they have withdrawn their question. we'll go next to (ravina) in north carolina.

(ravina): hi, i’m so glad i got through.

dawn jodby: hi (ravina). thank you for joining us.

(ravina): hi. i just want to say the north carolina under the direction of valerie arndt is doing an exceptional job. we are really, you know, overwhelmed with all these changes and they are putting together webinars with real practical advice. and we don’t have to go figure everything out. they pointed to some good resources.

and what i wanted to say is we have a member of our chapter ethics committee who worked for university. and, dawn, i can forward you this information.

dawn hobdy:okay.

(ravina): she does her university uses a website that tracks the updates for the states and as seems to be when i compare what’s on your with some other places it seems to be the most upbeat quickly updated.

and there are some states that will approve providing services in their state if the client relationship is already established. so then but even when it’s not, you know, they give some direction on what to do. so i think anything that helps us feel like cut through, you know, having to start from the very beginning that…

dawn hobdy:absolutely.

(ravina): … and then one of our webinars talked about there is a place called the mid-atlantic telehealth resource center. and it serves the mid-atlantic states but they just hold your hand through the whole telehealth process.

they answer all questions with billing and set up in platforms and consent forms all those things so i just wanted to say that based on what i’ve heard i can share those two resources. and if i hear about anything else that would be helpful, i can send it to you for your consideration to see if you want to pass it along.

dawn hobdy:thank you so much for always being so supportive. that’s a great segue. i do want to share that we are all in this together and some states are doing better than others. and so if we have a question here today and you think your state or your - you have another resource that is better information please share. we will make sure is up to date. we will put on the website and make sure it’s available.

we're trying to keep up with everything but it’s really difficult so any support that we can get any information you have that is helping you all and then you think can help the rest of our procession please for free to share it with us.

i know we are asking questions but we also want to let you all know that this is an opportunity to share how you’re feeling, your experiences, etcetera. i appreciate i think it was justine sharing the frustration she is feeling. and we're all feeling different things. so in addition to asking questions, we do want you to just feel comfortable using this as an opportunity to just share your experiences where you feel frustrated, where you think we need to work harder to get things in place.

and then even some positive experiences that you’re having. so i just want to open up the question-and-answer purple to those opportunities as well. thanks again (ravina). appreciate that. and please share with us anything that you have. we appreciate it.

(ravina): i will. thank you.

operator: and again ladies and gentlemen for questions or comments as a sign that is star 1 on your touch-tone phone. we’ll go next to (kiana) in georgia.

(kiana): yes hello everyone. thank you…

dawn hobdy:hi, kiana.

(kiana):… for your time and hi. as another caller mentioned coming more from a leadership administrative background for social work not clinical. i am licensed at the lmsw level with a doctorate in the field. and my question more so is regarding nasw support, really rallying those administrative leaders in social work venues to provide support for the actual social workers who are doing the work on the ground.

particularly as it relates to obviously the pandemic certainly unprecedented as well as helping to really preface this teleworking environment. because often i feel even as a social worker, not in practice but more so administration at this point, is so easy to just do what we know and support our clients and that is what we're supposed to do, but it is so important to make sure we're practicing self-care.

and so it sort of leads into the question i was asked, you know, not so much questions but our own practices how are we feeling? and so i guess it’s dual fold what should be nasw approach if you will to really make sure that guidance and that support is being sent out to those who make decisions for our social workers who are actually in the field or providing direct service.

because i find that even in the past two months it’s been a challenge with the leadership and really understanding teleworking and minimizing the fact that we are in a crisis and that we have to make sure that we're taking care of ourselves in order to support our clients.

and so maybe just gathering thoughts from the group on that, but also any practical guidance that nasw in the other social work entities are providing to help executives administrative leadership. they may not all come from a social work background and so i think that’s where we can really advocate to really make sure we're practicing - that we're actually living in unprecedented times. we're still are expected to do what we're supposed to do, but we have to ensure that we're processing it in this environment.

and so i was just curious about people’s thoughts about that again not so much from a clinical perspective but it is as well due to some of the mental health concerns that can come from what we're currently facing. so thank you.

dawn hobdy:well we really appreciate - that’s a great feedback in question. i do want share -- and i’ll let my colleagues contribute as well -- nasw we did i don’t know if we mentioned specifically that nasw does have a coronavirus webpage.

and it just has a plethora of resources and information from all aspects of this pandemic. and there is a section on self-care that we have available. and it talks about the importance of it, what it might look like avoiding burnout compassion fatigue, etcetera. and we are working to continuously build on that site.

one of the things i think - one of the problems i think we are having is we have so much information and working so hard it’s just making sure that the people who need to get the information. and so try – always working to see creative ways to make sure the people that need the information are receiving it. i would encourage you to start their let us know what you see there and whether you think it’s useful for leaders and administrators and then let us know what else you think we might be able to do.

again we have been quite a bit. we’ve written articles nasw really agrees with you that self-care is so critical right now and really promoting the necessity for us to take care of ourselves the balancing act that we have to do right now in terms of our self-care for ourselves and our families and our clients. they are real things.

and so we're also encouraging members to share their experiences of the resources. so my nasw has an online community and others are sharing their experiences there too. so what they’re trying to do is create resources and opportunities for you all to share your experiences in your resources. and so that’s my quick response. i do want to see if other colleagues have some additional feedback that they’d like to share for (kiana).

(kiana): thank you.

andrea murray:dawn?

dawn hobdy:yes andrea.

andrea murray:i’d like to just bring attention to the standard of the code that are often overlooked. often times when we talk about social work ethics, were always well not always but were often thinking through the lens of our ethical obligation to our clients and, you know, to direct service providers but the code is rich and that it speaks to social workers in all around. so (kiana) as an administrator and a leader 3.07 of our code of ethics administration really holds into some of the ethical obligations that really align with your leadership role.

in the profession speaking to social workers administrators obligation to advocate within and outside of their agencies for adequate resources to meet clients' needs and it also speaks to providing adequate - ensuring that there's adequate super - staff supervision, resources, you know, on many levels.

and so that is an ethical need and i heard (kiana) speak to working in an environment that may not be purely social work, so i know many of our members and social workers across the country may find themselves in what we call host environments.

we heard from a teacher earlier and when you're working in an environment that is not exclusively social work, it is really important for you and it's actually an ethical obligation under commitments to employers to take reasonable steps per the code to ensure that your employers are aware of social workers' ethical obligations as set forth in the nasw code of ethics and the implications of those obligations for social work practice.

and sometimes it's really awkward to take a stand when you may be one of few or the only social worker in an organization, but i often tell our members to think of it as a win-win.

when you inform your agencies, your organizations about your ethical obligations you are preserving and mitigating risk for your organization by educating them about what your licensure entails, what your ethical obligations entail and - so that you're setting them up, you know, not to have any, you know, risk associated with overlooking your ethical obligations.

so it's not a - just about, you know, you as a social worker but it's about your overall organization and supporting them, you know, support you in doing the right thing.

so i just wanted to bring up those two standards in the code 3.07, administration, and 3.09, commitment to employers, you know, from an ethical perspective as a leader that you might want to visit when you get off the call.

(kiana): thank you.

dawn hobdy:yes. any other colleagues want to provide feedback to (kiana)? okay. and i really appreciate that question and again the covid-19 nasw resource page is filled with information and resource that are meant to be helpful and useful.

the other thing we need from you all is to review them and there's quite a bit there. find out your area of interest and then if you feel there's something you're - we're missing or something different you need from us we will try to see if we can assist.

we know that and you - i would like to share none of us can and are expected to do everything, but we're all expected to do something and we got to figure out what it is that we can do and do well.

so any of them - you - as possible trying to figure out what our - what will be the benefit to our profession and to our 世界杯欧洲杯小组赛 in how we help you and in what way so please look at the resources.

let us know if you find them helpful and then let us know if there's something else you might need from us, so thank you again for that question. unless there are any other colleagues that would like to contribute we'll take the next question or reflection.

operator: we'll go next to (sky) in kansas.

(sky): hello.

dawn hobdy:hi (sky). thanks for joining us.

(crosstalk)

(sky): sure. here's my question. with the attention to mental health needs during the pandemic, what is the ethical and best practice guide to conduct a diagnostic assessment and assign a diagnosis for a new - using the tele-mental health environment? thank you.

dawn hobdy:okay. who would like to stop with that question?

(crosstalk)

mirean coleman:well, this is mirean.

dawn hobdy:okay. okay we'll go mirean and then andrea will contribute and then i'll add as well.

mirean coleman:okay. the type of services and treatment modalities that we use in an - in-person visits have not changed and are the same in a telehealth environment, so the diagnostic procedures that you'd use to diagnose or evaluate a patient is the same.

that has not changed. was there something else more specifically you were looking for (sky)?

dawn hobdy:(sky)?

(sky): no. i'm just wondering...

dawn hobdy:okay.

(sky): ...how you do a full diagnostic assessment in the telehealth environment. i understand that the modalities and the services are the same as in-person, but the telehealth modality or the, you know, the environment is a lot different than an in-person interview.

and i just wondered if there was any kind of guidance - how to help clinicians do that diagnosis when it's a new client because there is quite a lot of attention to mental health care during the pandemic and people will be getting new clients. and i just wondered, you know, you can't do it the same way that you...

dawn hobdy:right.

(sky): ...that you do it in an in - environment and that's what i'm asking. what is the guidance? thank you.

dawn hobdy:okay i'll let andrea - and then i'll add as well if necessary.

andrea murray:yes so (sky) those are real practical questions and right now we are, you know, mostly all in some level of a shelter-in-place situation. but we do have to remember that when we practice ethically it oftentimes, you know, entails practicing through the lens of what's in the best interest of clients.

and not every client is going to be - you - it's not always going to be in the best interest of a client to receive their services or a specific service via telehealth and, you know, so this is a temporary situation in terms of not necessarily always being able to see clients face-to-face.

but we need to ensure that as we make decisions around the service delivery modality that we're doing it through the lens of what's best based on what the client's presenting with, and our codes speak to this through the lens of 1.01, commitment to clients, and so we really always want to uphold their best interest.

we also want to think about competence. our code in 1.04 letter a says that, "social workers should provide services and represent themselves as competent only in - within the boundaries of their education, training, license, certification, consultation received, supervised experience or relevant - or other relevant professional experience."

so if you've never diagnosed a client, you know, via telehealth you may need to defer to, you know, someone else who's more experienced if this is your first time using telehealth and/or you may need to get training if this is going to be the modality going forward that you use so that you have a level of competence to provide that service if that is the best way to, you know, serve that particular client.

so i would just again defer to just that whole idea of being competent not only in - as social workers in what we do, in - as social workers but also competent using the technology.

and i think there's going to be some nuances to using technology for those venturing that way for the first time. that will require some additional and more specialized training with regards to telehealth going forward.

dawn hobdy:yes. i appreciate that andrea. i wanted to say - if (lonny) has a - perspectives or any feedback in terms of a - liability and then i'll add some thoughts myself. just wanted to check in with (lonny).

(lonny rob): and actually this question is great. it sort of - kind of goes back to the additional training resources i believe andrea referenced. if you feel uncomfortable it's always good - a great risk management strategy to just circle back with the available resources, the technology standards.

i've actually personally read them and i'm an insurance nerd so they actually have a wealth of information but also i believe on the nasw education - continuing education web site there's a very, very healthy webinar on telehealth that was actually produced long before our current experience, and that actually shines a great deal on the resources necessary to consider these efforts.

so, of course, keep in mind - and just like mirean had mentioned if you can morph your tele-mental health services with a new client and you've consulted all the resources and exhausted it and you feel comfortable moving forward and it's in alignment with the state regulation and all of that great research, you're well-positioned to gain coverage support, you know, with our insurance program.

and, of course, if you happen to be insured with another carrier you would want to just check in with them as well separately.

dawn hobdy:yes. thank you for that. i kind of want to echo what others are saying and start off by saying that none of this is easy and some of the answers are not what you want to hear.

i recognize that. these are just very unique times and we would love to be able to tell you to just do what you have to do right now, but my concern from an ethical perspective is your own safety and protection.

i would say to us that we have to - what's happening is we're being thrown with all of these unique situations and all these clients in need, and our natural instinct as social workers is to try to do everything and try to help and try to really help every client that's in need and i get that.

but i would really say take a breath. you have to take a breath. you have to decide whether this is something that you would be able to take on if there wasn't an emergency, what kind of skills and knowledge you have for that and if not, you know, again seek out and get that knowledge before you take on the role or refer it to someone that does.

so i've been asked questions about social workers who work with children who are now being asked to volunteer or either work in a setting where they're helping seniors and different things and i understand that.

again i understand the need to try to do as much as you can. i also have that myself but what is your experience in working with that population? what is your experience to - working with the technology?

and we know that many of us are being forced into this technology without the experience but to the extent that you can take a breath, step back, do your consultation, get the experience that you need to feel comfortable to provide it - it's also okay to say, "i don't feel comfortable.

i don't have the knowledge that i need to do this safely. i don't know if i would be able to protect this person from harm," and made the decision that you are not the best person to provide the service and make the referral.

and as andrea mentioned you also have to decide that this client might not be the best to receive this service this way. i agree there are tons of telehealth resources out there.

we really want you to do some research, look at them, see what kind of online training you can get. the training on telehealth is extremely important. there are so many unique nuances of providing it and i am concerned about us jumping into it because we feel forced without getting the support and the back - the experience that we need to do it effectively.

and so take a breather and find out what you need to do to do it effectively, to protect yourself and to protect those clients. i have a - 3:21 now. we have a couple of more minutes and we're going to do a quick - some closing remarks.

so i think we have one - a chance for one or two more questions or reflections and we really appreciate you all being so open and honest with us. so we want to take another question or comment.

operator: we'll go next to (susan) in maine.

dawn hobdy:okay, thanks (susan).

(susan): hello? can you hear me?

dawn hobdy:yes.

(susan): so my question is if you could review the platforms that are accessible for audio telehealth.

dawn hobdy:you said the platforms that are available for audio?

(susan): that are permissible for audio-visual i should've said telehealth.

dawn hobdy:okay. i'll let elizabeth begin with that. elizabeth?

elizabeth felton:yes. yes i'm here. yes. so although nasw does not endorse any particular vendor, there are some vendors that claim to provide hipaa compliant videoconferencing and they will enter a (baa).

so it was a - skype for business, vsee, v as in victor, s-e-e, doxy.me, google g suite's hangouts and call up a fax. i would suggest that you go online to nasw's telehealth web page and we have an article that talks about the legal considerations.

and if you click on - it has a listing of the videoconferencing platforms that the office of civil rights has also mentioned but they don't endorse either and it's pretty much the same ones, and i think some of them may be free or have a cost affiliated with it.

(susan): thank you very much.

dawn hobdy:you're welcome.

mirean coleman:yes. this is mirean. i just want to add to that if you look at the medicare regulations they have - waive a lot of the videoconference regulations. and some of the software that you could use would be apple's facetime, facebook messenger's video chat and google hangouts video, zoom or skype.

but what you cannot use during this period is facebook live, twitch, tiktok and anything in which the public would have access to if you would be using it.

(susan): thank you again.

mirean coleman:you're welcome.

dawn hobdy:thank you for that. unfortunately - gosh i wish we had more time. we are - we're going to have to begin to wrap up but again we want to thank you all for taking this time.

this is just the beginning. nasw will continue to provide opportunities for us to gather and to ask questions, share resources and share our thoughts and feelings. i think at this time i'd like to be able to provide some brief closing remarks from our ceo, dr. angelo mcclain, and we also want to make sure that you're aware of the resources that are available. angelo are you available to do closing remarks at this time?

angelo mcclain: i am available.

dawn hobdy:dr. mcclain?

angelo mcclain: ...hear me?

dawn hobdy:yes. thank you dr. mcclain and welcome.

angelo mcclain: hello everyone. it's my pleasure to join you and i'm - we're thankful to dawn, to mirean, to elizabeth and (lonny) and to com partners for bringing this important sort of ethics q&a session to our members.

and it was good for me to listen to the questions because that will inform the work i do at a macro level. we've been working - nasw's been working with the cswe and aswb, the council of social work education and the association of social work boards, to address some of the macro issues.

and we meet on a weekly basis and we actually do a letter to the profession updating folks in terms of things we're working on whether it's a - telehealth. we're working with regulations at medicaid and medicare and cms and then encouraging employers and our licensing boards to - as we think about the next wave of - generation of social workers entering the field that - during this pandemic that there's some flexibility around licensure.

i'm actually meeting with that group today at 4:00. one thing i did want to - i think it was mentioned earlier but i do want to bring it up - the nasw ce institute. i would encourage you to go there.

we've got many offerings, sort of on-demand recorded training sessions that you could - you can listen to at your convenience. one of them is called technology in social work practice, standards of practice.

and as it was already mentioned this was produced before covid hit but it's very applicable and it - this is a free recording that you could listen to. and we have many offerings that are - that we've made available for free during the pandemic.

and then there are others where there is a cost and you can also get continuing education credits there as well. i do want you to know that the staff at nasw have transitioned very well to working remotely, and we are working i want to say 24/7 and we do stop to sleep.

but we've been working around the clock to advocate for the profession, to bring you resources like this and other resources and i would encourage you to check our web site because there's a lot posted there.

we - our conference them - our national conference theme for this year is social workers make a difference, and that's a really timely theme because you guys are out there making a difference.

and i've had the pleasure of being on the radio. i do - i've been doing a radio tour as a part of my response to the pandemic. i've probably been on a couple of dozen radio shows across the country talking about the difference that social workers are making.

i was - did an interview that aired in - on baltimore abc over the weekend and that interview was aired on 30 different stations across the country. associated press and other things really just getting the word out there about the things that social workers are doing to make a difference and that social workers are essential.

many social workers are first responders and that - we're advocating as much as we can with congress. and many of - we - i think we got four things included in the cares act that we'd been advocating for the profession, and we're doing additional 世界杯入围名单2022 for that fourth relief package trying to get things that benefit the profession into law.

i'll just kind of continue my remarks, dawn, by just saying at no time did - do we want to relax our ethics when it comes to being ethical, to practicing ethically and we know that during a crisis like this we might be tempted to relax our ethics.

but we want to practice ethically, we want to practice competently and we don't want to short-change the clients and communities that we work with. and then my last thought is, you know, dawn talked about self-care and the - self-care is on each of us as an individual social worker.

but that self-care is also on our employers and the organizations you work with, and we've put information out so they can understand that they do have an obligation to pay attention to self-care and pay attention to social worker safety. with that i'll turn it back to you dawn.

dawn hobdy:thank you for those closing remarks. that was wonderful. we are at 3:30. we want to recognize that. we do want to take a few minutes just to close out and see if there are any other closing remarks from our panelists or our guests.

if you have to hang up we understand but if you'd like to just hang on for a few more minutes we'll just share some closing remarks. again the covid-19 page is available for you.

we are available for you. if you are a member of nasw we want to say thank you. we appreciate you and we need you. if you are not a member but you appreciated this session we'd like to encourage you to join.

we have again a plethora of resources and information available and we could use your support, so thank you all for joining. i want to just give the panelists an opportunity to see if they have any closing remarks before we sign off.

(crosstalk)

andrea murray:thank you for taking the time to join us. this is andrea in ethics and again we will be following up with an email with a list - a resource list that will support some of the documents that we've referenced during this call.

and we always welcome your feedback and have provided you an email address to give us your feedback around your experience with this and any other needs that you may have going forward. thanks again for joining.

dawn hobdy:oh thank you.

(lonny rob):this is (lonny). i just wanted to - (lonny rob) with the nasw risk retention group - wanted to briefly share that there is a resource page for policyholders of any of our member benefit programs.

it's - the web address is httpsnaswassurance.org/covid19resources. it's being updated on a daily basis to update our policyholders and even folks just interested in the topic of insurance and professional liability or even any other program. anything you need is outlined on that resource page, even tips on teletherapy.

dawn hobdy:okay. and thank you again for joining us and for your feedback. we really appreciate it. any other remarks?

elizabeth felton:so this is elizabeth.

dawn hobdy:sure.

elizabeth felton:oh i'm sorry. hi dawn. yes, this is elizabeth and i just wanted to remind everyone even if you have been providing tele-mental health services and some of the information wasn't there, just make sure you go back and you check all the layers of consideration because you don't want to have a misstep.

and for those of you who haven't it's - we have the resources available. we have some sample informed consent forms that are online and all the other information that i discussed so that you can review it just to make yourself more familiar with the regulations that you need to follow regarding tele-mental health services.

dawn hobdy:okay.

mirean coleman:...mirean.

dawn hobdy:thank you. yes, mirean.

mirean coleman:yes. i would just like to thank everybody for joining today. there was a school social worker on the case - on the call earlier who had a question. nasw is expanding its resources in school social workers during the pandemic, and this is a big change for our school social workers.

so if there are any school social workers who would like to share their experiences, would you please send me an email at mcoleman.nasw@socialworkers.org? all right, thank you.

dawn hobdy:all right, thank you all again. and just as andrea stated we will be sending out a follow-up email and in that email you will receive the list of resources, some of which we've referenced today.

we also request your feedback. please share with us your experience with this call, what you'd like to see us do in the future and any other way that we might support you.

thank you all again for your work, your efforts. just continue, again slow down, ask questions, take care of yourself and know that we're all in this together and we'll get through this. we want to thank you very, very much. you all have a good afternoon. bye.

operator:ladies and gentlemen this does conclude today's call. we thank you for your participation. you may now disconnect.