Asynchronous Mental Health and Connecting Now
By Kurt LaRose MSW LCSW CHT CSW Supervisor and LICSW
Thanks to secure and encrypted technology asynchronous mental health and behavioral health services are available to users 24 hours a day. And to help users who prefer to log in and leave notes, files, and journals for the therapist to review and reply to – at wee hours in the morning or during a coffee break at the office, or maybe right after an argument with a loved one – the time is now with TalkifUwant! For DC and FL residents you can now log in 24/7 and post messages (in a number of digital formats, such as shared journals, chat, secure emails and shared files) from you to the therapist – confidentially. Next, you’ll get notified when you have a reply – so you can log in and check out “what the expert suggested.” To learn more about this monthly online plan register today and choose the asynchronous option to get started! Have questions? No problem, feel free to call too! Log in 24 hours a day, click the “asynchronous subscription” option, or if you’re new to the practice begin here! Coming next? You can now schedule a real time chat session right from your cell phone or tablet (how cool is that!).
Photo: Charles on Unsplash
- What is asynchronous therapy and how does 24/7 access work?
Asynchronous therapy means that you communicate with the therapist anytime day or night in a secure encrypted platform, that only you and your therapist can access. You log in anytime, and using different online tools communicate – at times that work for you. Later (usually in 24 hours or less) your therapist will be prompted to review your content and then a reply, comment, questions, suggestions, and the like will be generated. It’s kind of like checking in, placing your “stuff” right over there (in the server) and then the therapist checks in too and “picks up your stuff” and gives it a look! Between the two, an asynchronous “session” occurs (except it takes less time and less money; so the interactions are not real time, they’re not face to face as they would be in video or office sessions).
If you just have a few questions about online services please reach out here (on the site see the “send message” box) or scan our contact us page.
You share information in the server and I review it and reply! Then, you’ll be notified to see what is suggested. Any time … day or night. It’s like having a therapist in the digital world, just for you … where you can leave a message and have a reply often the same day! – K. LaRose on Google Biz and Blogger
- Is asynchronous therapy a good idea for people who might be unsafe?
No and yes. So first, in the immediate crisis no, because delayed replies are not helpful in preventing or stopping impulsive injurious actions. Second, yes it can help AFTER THE CRISIS is resolved. See more about emergency mental health services and contact information for crisis related matters that may need immediate actions and face to face contacts.
- How does it work?
There is a monthly subscription fee which is non-contract (and you can cancel anytime). There are, of course, a few legal things to look over and agree to, to get started. Asynchronous services are still very new in the US and as such both the therapist and the client need to proceed with clear understandings of what can (and cannot) be accomplished with encrypted asynchronous online checkins, sharing of journals, file sharing (with some size limitations too), secure emailing and the like. So the “legal stuff” will be generated after you register in the server to begin!
The month to month fee is charged at the same day each month and you may cancel it at anytime. There are some limitations to this as well. For example at the point the time used to read and reply to messages hits 65 minutes in any given month then, if more attention and time are needed by you a chat session, video session, telephone session or a traditional office session will need to be considered. People needing more than an hour of asynchronous support in a month may want to add other services (real time sessions, either online or in the office). You can cancel the subscription anytime. Fees are not refundable.
Time and space are limited, however, as only so much time can be managed with many online clients. Too, the location that you live in will matter, along with where licensing is regulated. For LaRose anyone in DC and in FL can use the online asynchronous services (all other services as well). For those who come to see LaRose in DC and in FL, you can travel to the office from anywhere and be seen face to face. This limitation is simply due to the fact that still in 2019 national and state standards have not yet found a logistical way to allow online practice across state lines (at least not for small private practitioners; some federal programs are able to do so). LaRose has long argued that online therapy could be licensed in all 50 states, similar to what universities are able to do with online supervision college courses and field students (when a college is in one state and the student is in another). Maybe one day – but for now – online asynchronous services are, for LaRose anyway, limited to all DC and Florida residents (which by the way, reaches millions of people – so that’s pretty cool even so).
Asynchronous support and real time support can be combined as well. Meaning, you can be seen in other session formats and still use the monthly subscription. This is less expensive too!
- I’ve been hearing about “encryption” for years. What is that anyway?
You’re not alone here. In fact many therapists and insurance companies are not sure what it means either (even as they have been using it for years for claims and credit card processing). Mental health encryption is actually believed to be stronger than that of banking and claims processing sites, to be clear. Read on and you’ll see what I mean …
Encryption means that you receive in a “location” (a file directory) jibberish until you use a highly sensitive password to log in. That is when someone sends you information, it may look like a language on the screen but once it is saved or sent it is placed in the file directory as “#1;lkjd-89uaj?xx///fkjt5002” (for example) which is now encrypted. For it to be un-encrypted the receiving party must have their own user name and highly sensitive password. Once the sender logs in encryption is undone for the sender and until the receiving party logs in the data for the (and anyone else who may try to access it) is jibberish. Mental health records have to be highly protected by state and federal laws. Some secure platforms will not only require highly sensitive passwords (letters, numbers, upper and lower case plus symbols for example) but they will include security certificate verification software that continually checks that the URL (the domain and the sub-directories or sub-files within in the URL) to make sure the the secure socket layering (SSL) is active and working. Going further though, secure platforms will also require users to go through a manual robot verification step to ensure that it is a person sitting behind the screen. Then, and this would be a fourth layer of security protection, some secure platforms will authenticate (or allow for 2-step authentication settings) the device. The secure and encrypted platform used by TalkifUwant includes all of these layers of protection (and the secure server also has non-daisy chained servers) located in different cities and in different states. As of today’s date the secure practice digital portal has not been hacked (even as some insurance companies have been, some school districts and even some federal government sites). With LaRose, even if the Talkifuwant.com site were hacked, the secure digital practice server would not be impacted at all! For more information on encryption, generally speaking, have a look here: https://g.co/kgs/FrjrEt How can I tell what is “talkifuwant.com” and what is the secure server of talkifuwant? Click here for the PUBLIC domain and then click here for the Secure Practice Server! If you’d like to read more about secure and non-secure communications check out the summary on our Contact Us page too.
- Can Anyone Use Asynchronous Services?
Not everyone who wants asynchronous service is an ideal candidate. Here are a few examples and scenarios to consider.
Emergency factors are one limitation. As stated earlier the immediate risks cannot be dealt with in delayed replies and need real time help. If you are in an emergency based situation, or you are unsure if your situation is an emergency and still would like to consider asynchronous services you could take a look at our 911 page. It contains a number of scenarios that are life threatening considerations, where more immediate action may be needed.
Suicidal and homicidal clients should not use asynchronous services at the time of the suicidal and/or homicidal thinking. Asynchronous services may be helpful after the crisis is resolved and it could help in suicide and homicide prevention. Because safety risks in the immediate will require emergency service interventions it is not a good idea to engage outside of real time help (asynchronous is not real time). Delays between shared and read information could lead to wellness checks and EMS contacts when eyes and ears are not able to immediately connect; that is the therapist may read a client comment that seems to suggest safety risks and if the therapist cannot make immediate contact with the reporting party the authorities may be needed to intervene. People who are dealing with immediate or ongoing safety risks should be seen right away. For other 24/7 crisis options consider this contact list for scenarios that may apply to your situation; here, besides the nearest emergency room and 911, you’ll find online chate and texting options, as well as reporting agencies for abuse scenarios and some unique considerations with domestic violence as well (here’s that link again).
Some seeking asynchronous options will benefit more from traditional services. If, as one example, you need more time than say 65 minutes in asynchronous support then other therapy methods and modalities may be indicated. For more lengthy times, more complex cases, more serious and debilitating mental illnesses asynchronous therapy would not be ideal.
Besides safety risk limitations, those who are dealing with active hallucinations, thought disorders and in some cases personality disorders may want to use face to face services before considering asynchronous kinds. Some clients will use talk therapy as the primary service with asynchronous as supplemental.
SOME CLIENTS BENEFIT. Many clients who are too nervous to enter an office or who prefer to tippy toe into mental health (kind of like someone who tests the water in the pool before jumping in) will only do so in an asynchronous, non real time methods. Anxiety and phobic clients, hoarding and PTSD cases, depression and a myriad of other scenarios can benefit from asynchronous services.
WHO DECIDES WHAT IS BEST HERE? The decision to move forward with asynchronous services, to use face to face and real time options or to combine the two will be looked at and sorted out once you register in the server and complete the various requested forms. If there are questions or concerns you will be contacted prior to beginning the asynchronous options and you and the therapist can come to some conclusion about how to begin.
- Can I Text as A Part of This Subscription?
No and Yes…. Let me explain …..
Text therapy is still considered a non-secure form of communications, as as such it is not recommended except in very serious matters. Even those who use their own texting platforms, cannot control the data that is exchanged by SMS (text messages) from carrier to carrier. As such it is not HIPAA secure, it would not meet a confidentiality standard, and again, it is not recommended. People talk about family, spouses, children and serious life events with therapists. Texting this kind of information may not only compromise your information (which you may not really care about) but it could compromise other parties about whom you text. If you elect to text a therapist, in a reply you may be asked to acknowledge and agree that your information is being shared in a non-secure format, it is highly compromise-able and likely accessible by cell carriers and their staff and that you still wish to proceed. With your consent (and you also may be asked to sign a release as well to use texting) you and a therapist can exchange information by text. This is not included in the asynchronous subscription, but it could be added for an additional cost. For emergency matters, like all things involving safety, texting is okay and generally seen as necessary.
- I Have Questions About All of This Online Therapy Stuff so How Can I Learn More?
LaRose has been using online services long before it was thing. In 2005 he was using laptops and Microsoft database applications to treat clients in remote communities. In 2008 and 2009 he was posting online Abobe forms to be downloaded and completed by clients. In 2010 he moved to secure log in options via the web. In 2012 he joined and partnered with a nationally growing secure server platform for therapists and now re-sells it. In 2016 LaRose was a lead presenter on online digital practice models for the Florida State conference of the National Association of Social Workers (Florida Chapter) and he’s written about the topic as well. You can see the resources tab here, or see the B2B tab to find out all you need to know about online models. If you prefer a simple overview, take a look at these videos created by RevMedia here on the site …. it’s a good way to get started!
For Clients Using Online Servers Providers Wanting Online Private Option
- How much does this asynchronous stuff cost?
As much as I hate to say it, and as much as you hate to hear it – “it depends” is the answer. You can use the connect now monthly subscription option which is a monthly fee for 3 month commitment. After the three months it’s a use it as you go kind of thing.
The three month commitment is one of the reasons the fee is so much lower than face to face or real time and synchronous sessions. The lower amount for the connect now option can be a 45% savings to you, compared to regular real time sessions. And with real time session you can have those online too … but here we’re looking at the connect now stuff (for those who want to check in at anytime day or night and then see what reply there is from the therapist). For the connect now option you can use a total of 65 minutes in read and reply communications time from the therapist for a month. You send a message in the server, the therapist reads and then replies to your messages in the server; once 65 minutes is consumed (tracked on each reply so you can see how much time it took to get your comments / questions / concerns answered and how much time you still have left).
The are other reasons the connect now fee is lower. Another thing making connect now less expensive, significantly in fact, is because the first 3 months are billed up front. Plus the time is set up as a “use it or lose it” scenario. If you do not use the 65 minutes each month the time does not roll over; once the three months time line passes, if the time is not used it cannot be – due to time constraints and increasing numbers of clients considering and using this option. Lastly, because the therapist has more freedom about when to check in with the client the flexibility of not having to be in the office makes the work a much more spontaneous and mobile friendly task (confidentiality is still ensured so that when the server is used by the therapist others cannot see or access what is being done asynchronously). Asynchronous services do not change the standards or privacy, is the point here – and the other point is the therapist can check in based on daily convenience, making the costs to practice lower – and saving you money.
After the first three month commitment, you are only billed then when you use the service (sending secure emails to the therapist and waiting for a reply from the therapist); here you may check in one month and then not, but each month you do you are billed at the subscription fee for the 65 minutes.
If you use other online services, such as video, chat, telephone, shared journaling your fee is the same as the hourly fees. These rates vary if you are using clinical counseling (mental illness and medically necessary services, options centered and geared to diagnosis and evidenced based care related to disorders), coaching (non-medical customized goal oriented and advice based services), onsite services (on location at a facility or in the community) etc. For more information please see the prices and fees section.
- Can Written Replies from a Licensed Expert be Used as Expert Information
This really a question more suited to an attorney, a licensing board regulating board possibly and certainly it would be determined (who is and what is an “expert”) by a court. For LaRose all asynchronous communications are identified as very limited due to scenarios where a client has not been physically seen or observed and therefore first person observation assessments have not been completed. As such, even if someone were to try and use a written reply, to a written request of a client, as some form of diagnosis or legal interpretation, LaRose would state very clearly this is not recommended. Why? First, LaRose will not make a diagnosis by writing back and fourth. To date, the DSM does not have online diagnostic criteria and clinical assessments that are not done with some face to face interactions are extremely limited. If you were to have an apparent diagnosis online, you would be referred to face to face sessions, either with LaRose or an alternative provider.
- Would this be a good option to get a second opinion?
No, it would not. If you have concerns about your current treatment and diagnosis with your existing provider, the first thing you might consider is talking with them to address concerns and ask them to make changes in something. If you do not like how things are going tell the provider and you can ask that they make notes of your concerns in your records (this is one if your medical rights as well). Finally let them know you are considering a second opinion. If you do get a second opinion, which cannot be completed asynchronously, a complete assessment and a treatment recommendation with diagnoses’ criteria and rule outs would be included. Second opinions really would not be done without first obtaining and reading the original provider records (which requires your consent).
- How are Mental Health Records Requests Handled with Asynchronous Online Services?
If you ask that the documents shared between LaRose and you in the server be shared to another medical provider, this will be done, as a matter of medical records releases. Along with that, a link to this page as a matter of disclosure, would be included and or this content will be incorporated into your signed documentation upon subscribing. Such information would be considered “informed consent” (particularly if you sign – and in the set up you will be asked to do so) and it will help the receiving provider know the context in which services were provided.
With the practice of LaRose medical records requests are made via digital releases and signatures in the encrypted server. And because of the server technology the entire file can be generated with the click of a button in PDF form encrypted and protected (to be sent electronically) or via traditional means, such as mail and fax. Records requests from the asynchronous model would include all records in your file: secure emails, shared journals, digital forms completed by you, etc. Shared files from LaRose to you are not included in sent records; these titles are referenced in the notes such that a receiving party would know that materials commonly called “psychoeducational information” was a part of the communications.
For persons wishing to have expert summaries these are available for a fee (see prices and fees under the resources tab). Again, these would generally NOT be done for clients who were only be supported via asynchronous services.
- How can I get Started?
First be sure to read this whole page. You’ll be sent the link to it if in the secure server you email asking for the connect now option (and if you’re a new client you can choose this option AFTER your initial consultation). Why after an initial consultation? Partly because licensing boards still do not have a way for therapists to practice online, outside of client residency and therapist licenses. This was discussed a bit earlier but worth repeating here. Plus the server technology is something to talk about too as you begin (it’s not confidentially compliant to use skype or face time for mental health services, nor texting either). As ridiculous as the licensing stuff is (I mean, if 48 states have worked out online university credentialing for students without degrees yet not for clients and therapists it just seems a bit ridiculous as far as helping people) it makes a first time meeting more needed. In other words new clients cannot just begin with connect now without some contact first with the therapist (and if needed remote sessions can be done by video if office sessions are not possible). Making sure asynchronous services are “legal” by your residency and my license adds to the rationale of an interactive, real time, initial consult necessary.
Plus since LaRose is licensed in both DC and Florida, with office, onsite and online options in both jurisdictions, technically millions of potential clients can access a therapist both in real time and asynchronously 24/7!
Click the Schedule Now buttons here on every page of the site, follow the prompts and you’ll be in the server – your own digital entry way to my practice! If you have general questions feel free to text the cell phone listed on the contact screen or send a message now through the site!
Rev. 6/6/19, 10/1/19; 9/5/2020