There are many advantages to developing the capacity to deliver trauma-focused 

telemental health (TMH) services to children’s advocacy center (CAC) clients. First,

TMH extends the reach of the CAC program. Families may be challenged to access 

in-office therapy due to the distances they need to travel each week. In rural and 

frontier communities, families may live an hour or more from the center, and in 

more populated areas, limited transportation options make it hard for families to 

come to a CAC office on a regular basis. In addition, work and school schedules, 

childcare issues and weather can all prevent consistent, in-person participation. 

Second, TMH can address workforce issues. For example, when a CAC does not 

have access to a local therapist trained and experienced in delivery of evidencebased trauma treatments, it must rely on therapists who may live too far from the 

center to provide services routinely on-site. 

Finally, the current COVID-19 pandemic limits face-to-face contact and requires 

social distancing. This new work context has prompted many CACs to quickly 

transition to TMH service delivery in order to provide necessary services. 

As CACs make the transition to TMH services, there are many things to consider, 

and we offer answers to commonly asked questions below.

WRCAC Issue Brief: Moving to Telemental Health in a Child Advocacy Center Environment 1
Is telemental health effective?

The short answer is yes, it is effective for children and adults and is supported by 

numerous research studies. In fact, TMH is not new. The Veteran’s Administration

began delivering trauma treatment to veterans via TMH in the 1990s and now uses 

it widely. All indications are that tele-mode of treatment is as effective as in-office 

therapy, with acceptance and dropout rates largely similar to those of in-office 

therapy. Research on children and youth is growing and current indications are 

that, at least with adolescents and school-age children, TMH is effective across a 

variety of diagnoses (see the WRCAC Telemental Health Resource Center).

Does telemental health meet the National Children’s Alliance standards for 

accreditation?

Yes, if the therapist and modality used are otherwise in compliance with the 

standards (e.g., if the therapist has the required number of hours of training, and 

the modality selected is an approved, evidence-based treatment program for 

children who have experienced trauma).

What equipment does our CAC need?

TMH platforms have gotten more accessible in 

recent years. Basically, the therapist and the 

client need internet access and video and audio 

capability. Many families already have 

appropriate devices in their homes that they use 

daily for personal communications, such as 

tablets or laptops. The therapist will need a 

computer with a camera, speakers, and 

microphone, or use their telephone for the audio 

while on the computer. The client (child or 

parent) will need a computer with speakers and a 

microphone; an IPad or tablet may also be used. A

smartphone is not recommended, due to the small 

screen size, but can be used if there are no other 

options.

Can we use Facetime or Skype?

Under normal circumstances, no, Facetime and the typical personal version of 

Skype cannot be used for TMH, and the selected telecommunication method must

meet Health Insurance Portability and Accountability Act (HIPAA) requirements.

However in March 2020, the U.S. Department of Health and Human Services 

released a Notification of Enforcement Discretion for Telehealth Remote 

For a general introduction 

to the technological 

aspects of TMH, view an 

archived copy of the 

WRCAC TMH Webinar: 

Technology and Licensure. 

For additional information 

and resources, see our setup guides and toolkits.

WRCAC Issue Brief: Moving to Telemental Health in a Child Advocacy Center Environment 2
Communications During the COVID-19 Nationwide Public Health Emergency that 

temporarily allows for the use of popular applications that allow for vide chats. 

There are, however, many accessible and inexpensive options that meet HIPAA 

requirements, such as Zoom for Healthcare (the HIPAA-compliant version of Zoom), 

Doxy.Me, and VSee. For more on video platforms, visit WRCAC’s TMH Resource 

Center. 

What clinical adjustments must be made to therapy?

A change in the clinical setting from in-person to a digital environment requires

some forethought. For example, the Medical University of South Carolina (MUSC) 

has been successfully delivering TF-CBT via a TMH environment for several years 

and has modified in-person activities and materials for virtual delivery. See a brief 

introductory webinar from MUSC and a WRCAC TMH Webinar: The Clinician’s 

Perspective. In the ideal world, therapists would receive additional training and 

guidance on the delivery of mental health services, such as TF-CBT, via TMH. 

Unfortunately, due to the COVID-19 pandemic, CACs are finding they must move 

their services into the TMH environment quickly. The shortened timeline means

that a planned systematic rollout with extensive face-to-face training is not 

feasible. For resources on delivering TF-CBT via a TMH environment, visit the TFCBT National Certification Program website. We can still ensure that quality 

services are delivered, however, by thoughtfully modifying in-person practices to 

fit telehealth delivery. Guidance for therapists on transitioning to TMH can be 

found in our WRCAC webinar: Delivering TF-CBT via Telemental Health or in our 

clinical guidelines at the Telemental Health Resource Center.

How should the equipment and therapist room be set up?

The therapist must have internet access and 

audio and video capability as described 

previously. A headset and dual monitors are 

helpful for charting during the session or 

managing activities, but not required. The 

therapist needs a private space to deliver the 

session to ensure confidentiality. You should 

also consider issues such as lighting (e.g., is 

the therapist’s face clearly visible on the 

screen without shadowing?) and background 

(e.g., is there anything distracting behind the 

therapist in the video, such as a mirror or 

artwork?). For more information, visit the 

Northwest Regional Telehealth Resource 

Center. 

WRCAC Issue Brief: Moving to Telemental Health in a Child Advocacy Center Environment 3
What considerations need to be made for client confidentiality during the 

session? 

Client confidentiality is an important consideration, as the therapist has less 

control of what is occurring in the remote location than in their own office. The 

therapist should work with the child/youth and caregiver to secure a site in which 

the client can have confidential sessions without the risk that their session is 

overheard by others in the location. This consideration is especially important 

when the child or youth will participate from home. In addition to confidentiality,

such a location helps minimize distractions from others coming and going, from a 

TV playing or from other noises that could interfere with clear communication 

between the client and therapist. 

What considerations need to be made for client safety? 

During trauma therapy, clinical emergencies may arise, such as an expression of 

suicidal intent, an angry outburst, or the throwing of objects (like an iPad) that 

require immediate intervention by the therapist. In traditional office therapy, the 

therapist can physically intervene, but TMH work precludes immediate physical 

intervention. Arrangements should be made to have a responsible adult available 

at the site where the child/youth is located during the TMH session. The therapist 

should have the telephone number for that adult and be able to contact him/her 

immediately in the event of a clinical emergency. The adult could be a school 

counselor or, in when THM occurs from home, a parent, foster parent, or other 

trusted adult. The therapist should coordinate with that person before the 

beginning of therapy to be sure they will always be present and explain their role 

and the type of issues that may arise that would necessitate an intervention, as 

well as the process the therapist suggests for intervention. The therapist should 

have information on crisis resources in the community where the child/youth is 

located.

How can the therapist be prepared for the different structure?

It is fair to assume that the first few

sessions of TMH will look very 

different from traditional office 

therapy. Some children might be 

excited to show the therapist their 

room and their house or introduce 

them to their pet. Others might not 

want to show themselves on video or 

be hesitant to share their home and 

room. The first session or two will be a

transition. Rather than viewing these 

WRCAC Issue Brief: Moving to Telemental Health in a Child Advocacy Center Environment 4
sessions as a departure from the therapeutic process, therapists are encouraged to 

think about this time as another way to build engagement and rapport with the 

client.

Can the CAC be reimbursed for TMH?

While the rules and requirements vary by 

funding source and state, most payers will 

reimburse for TMH therapy at the same rate 

as in-office therapy. See WRCAC’s guidelines 

around telemental health reimbursement for 

more information, and contact your funder 

for details on how to bill for TMH services.

What are the licensing and legal 

implications of delivering TMH?

Again, the legal and licensing implications are 

not much different than for in-office therapy 

with one significant caveat. While TMH offers the technical capacity to access a

therapist anywhere, as of now, the therapist must be licensed in the state where 

the client is receiving therapy. In other words, for a therapist in Sacramento, 

California to provide therapy to a child living on the Fort Peck Reservation in 

Montana, the Sacramento therapist would need to be licensed in Montana. 

Conversely, a licensed therapist in Billings, Montana can serve a child four hours 

away on the Fort Peck Reservation since both the client and therapist are in the 

same state. While we are seeing an increase in cross-state licensing agreements and 

reciprocal licensing in health care in general, these are less common in the mental 

health professions. See WRCAC’s resources about cross-state issues for more 

information.

Do we need special malpractice insurance? 

The agency providing the insurance or the individual therapist, should clarify with 

their insurance provider what their specific policy covers before delivering TMH 

services but, as a general rule, coverage extends to TMH. For more, see WRCAC’s 

insurance resources.

Western Regional Children’s Advocacy Center

A program of Rady Children’s Hospital - San Diego, 

Chadwick Center for Children and Families

www.westernregionalcac.org

wrcac@rchsd.org

WRCAC is funded through the U.S. Department of Justice, Office of Juvenile Justice and Delinquency Prevention, 

Grant #2019-CI-FX-K002

WRCAC Issue Brief: Moving to Telemental Health in a Child Advocacy Center Environment 5