Mental health professionals can ensure HIPAA compliance in text-based therapy with adolescents by using secure, HIPAA compliant communication platforms, obtaining informed consent, implementing strong access controls, and encrypting all communications. They should also regularly review and update security policies, conduct routine risk assessments, and maintain secure record-keeping practices.
Understanding HIPAA in text-based therapy
HIPAA sets the national standards for protecting patients' protected health information (PHI). The HHS defines PHI as "all "individually identifiable health information" held or transmitted by a covered entity or its business associate, in any form or media, whether electronic, paper, or oral. ". In text-based therapy, PHI includes any information shared between the therapist and adolescent client.
Choosing HIPAA compliant communication platforms
Mental health professionals should use HIPAA compliant text messaging apps or encrypted email services for healthcare that comply with HIPAA, like Paubox. These platforms must provide encryption, secure login credentials, and other safeguards to protect PHI.
Related: Features to look for in a HIPAA compliant email service provider
Securing a business associate agreement (BAA)
If you use a third-party service to facilitate text-based therapy, obtain a business associate agreement (BAA) from the service provider. A BAA guarantees that the service provider also adheres to HIPAA standards in handling PHI. The agreement must include provisions for safeguarding PHI, reporting breaches, and outlining the responsibilities of both parties.
Read more: FAQs: Business associate agreements (BAAs)
Obtaining informed consent
Mental health professionals should obtain informed consent from the adolescent and their legal guardian before initiating text-based therapy. The consent should cover the nature of text-based therapy, the potential risks involved, and how the information will be protected. Document all consent and store it securely with the other patient records.
Related: How does HIPAA apply to minor patients?
Implementing strong access controls
Access controls can help protect PHI in text-based therapy. Secure the devices used for communication with strong, unique passwords and limit access to authorized individuals only. Mental health practices can use multi-factor authentication (MFA) as an extra layer of security. Any devices used for therapy sessions must be dedicated to professional use and not shared with others.
Encrypting communications and data
All text-based communication must be encrypted both in transit (when being sent) and at rest (when stored on servers). That prevents unauthorized individuals from accessing PHI if the message is blocked or a device is lost or stolen.
Adhering to the minimum necessary rule
"The Privacy Rule generally requires covered entities to take reasonable steps to limit the use or disclosure of, and requests for, protected health information to the minimum necessary to accomplish the intended purpose. ". In text-based therapy, this means limiting information in messages to what is required for the therapy session. For example, therapists should avoid including unnecessary personal details or using identifiable information in message subject lines.
FAQs
Can adolescents independently consent to text-based therapy under HIPAA?
Adolescents can consent to therapy without parental involvement in some states, depending on state laws, but HIPAA compliance still requires safeguarding their PHI regardless of who provides consent.
How should therapists handle accidental breaches of PHI in text-based therapy?
If a breach occurs, therapists must promptly notify the affected individual, assess the scope of the breach, mitigate harm, and report it according to HIPAA’s breach notification rules.
Read more: Navigating HIPAA’s Breach Notification Rule
Can group texts be used in text-based therapy sessions?
Group texts should be avoided in therapy due to the high risk of exposing PHI to unintended recipients, which would violate HIPAA’s privacy standards.
Liyanda Tembani
