Telemental Health

Under Governor Wolf’s  March 19, 2020 mandate, Inspiring Change, LLC is defined as a Life Sustaining Business. In order to protect the people that we serve and ourselves,  most therapists will be connecting for therapy sessions via Telemental Health. We use HIPAA compliant software to ensure a secure communication.  We will continue to schedule new clients.

Navigating this unprecedented pandemic, we understand the unimaginable stressors it is adding to  some of our already challenging life circumstances. Please know that the emotional and psychological well-being of the people that we serve, and our staff remain our top priority. That is why we are doing Telemental Health.

Create A Confidential Space: Things to Consider

Is the space private? Can you lock the door? If not, will others who have access to the space respect your request for privacy and not enter the room?

Can you/have you had a conversation with them about your need for privacy? Were they receptive? Can others outside the room hear you talking? If so, can you create white noise with a fan or other form of background noise? (Preferably placed outside the doorway of the room you’re in)

Consider using headphones or earbuds so that your provider’s voice is kept private and can only be heard by you. 

If you have a hard time finding confidential space, here are some examples that others have used. 

Laundry Room - Walk-In-Closet -Basement -Attic


These are not ideal but should be considered secondary choices if an ideal setup is not available. If you use any of these, please make sure that the space is comfortable to you. 

Last resort: your car parked in a safe, private spot. (We want to emphasize that private does not mean secluded. Please do make sure you are in a safe location.)


Technical Setup:

A laptop or desktop computer are ideal — preferably the biggest screen size that you have available to you (that you can also have in a comfortable, confidential space)


Whatever device you’re using, please make sure that the camera is about level with your eyes. It may require propping up your device or monitor on other items, such as books.

Please make sure that you’re well-lit and don’t have a bright light source directly behind you.


Clear Your Internet

  1. Quit out of all other non-therapy programs before the session. Some important examples of programs to quit are:
    • Skype. This is a big offender. Even when you’re not making a call with it, Skype may be using your Internet connection for its own needs. Make sure you’ve quit Skype — not just closed its window.
    • Dropbox, Google Drive, and other file synchronization/sharing services. These use the Internet in the background all the time. It’s part of their job.
    • Cloud backup software. These programs are usually pretty mindful about not clogging your Internet pipe, but it’s probably best to shut them down for the duration of sessions. Remember to start them back up when you’re done, though!
    • Close web browser tabs or windows that you don’t need. Remember that many websites and web applications do a lot of Internet back-and-forth while you have them open.
    • Anything else you can find that’s open!
  2. Either connect your computer to the Wi-Fi router with a cable or move very close to the Wi-Fi router. You know that little icon on your computer that tells you how many bars you have for your Wi-Fi connection? That’s telling you how big the Wi-Fi pipe is, and whether it’s watertight or leaky. Your computer can work with leaky Internet pipes — it’s smart like that. The problem is that your video software is trying its darndest to keep your call going in real time. A Wi-Fi pipe that keeps leaking, or that is really narrow, will make its job much harder. So, either move close to the router so the signal is stronger or connect to it with a cable.
  3. Make sure your antivirus program and system software updates aren’t scheduled to run during the session. This isn’t so much a “just before the session” point as an overall planning point.  antivirus software can hog all the Internet and processor speed. Don’t regret a system update to running during a session and then an automatic restart!


Informed Consent for Telemental Health Services

This information is provided for individuals who choose to use Telemental Health Services at Inspiring Change, LLC (ICLLC). This Consent allows your authorization, explains your rights, the risks and benefits and our Social Media Policy and Procedure. 


What are Telemental Health Services?

We are offering remote delivery of counseling services via technology-assisted media. The technology includes video, internet, a smartphone, table, PC or laptop. Secure video chat is secured by two-way encryption between client and therapist. The two-way encrypted communication between ICLLC and the people we serve meets compliance regulations to be considered HIPAA compliant. 


Limitation of Telemental Health Services

Telemental health offers convenience and flexibility for many individuals and their unique circumstances. There are disadvantages and limitations. There may be a disruption to the service, video and audio quality may not be superb, internet difficulties beyond our control may disrupt communications. These limitations often contribute to frustration about interrupting the normal flow of our interactions. There is a risk of misunderstanding one another, various details of facial expression may not be evident, differences in tone may not be picked up. 


The likelihood of interruptions during sessions in the office are small. The likelihood of interruptions during Telemental health sessions is greater. Therapists at ICLLC take every precaution to ensure a technologically secure and environmentally private counseling session. You are responsible for finding a private location, having an adequate wi-fi connection and asserting the ability to minimize interruptions.


In Case of Technology Failure

Difficulties with hardware, software, equipment and/or services provided by a third party are variables that may contribute to technological failures. A technical complication may prevent or disrupt any scheduled appointment so that online video conferencing cannot be completed. In advance of your prescheduled session, your therapist will give you a phone number to use so that session may be completed via phone call. Sessions may be rescheduled. 


Structure and Cost of Sessions

We continue to offer traditional face-to-face psychotherapy when appropriate and available. We will discuss how to meet your unique needs, through face-to-face or Telemental Health. The structure and cost of Telemental health sessions are exactly the same as face-to-face session as outlined in the Consent for Treatment that you reviewed and signed at intake. 

If you are using private insurance, we are both responsible for understanding your mental health benefits. You may contact your insurance provider to verify coverage for Telemental health services. Most private pay insurances cover this service. In the rare instance that insurance does not cover your session, you will be responsible for payment. 


Electronic Transfer of Private Health Information (PHI) and Credit Card Transactions: Your therapist will require credit card information ahead of your prescheduled session for ease of billing. Click here to make a payment. Clicking here will take you to your tele-therapy waiting room. You can head to our Telemental Health page, or our payment page. Or, your therapist may run your card after you have signed a Credit Card Payment Form. This gives us your permission to charge your card without you being physically present. Your credit card will be charged by your therapist at the conclusion of each Telemental health session unless other arrangements are made with your therapist. 

Therapists may use PayPal to process your credit card information. You will receive an email receipt indicating that you used credit card for services, the date of service and the amount that was changed. This transaction will appear on your credit card bill. Please know that your confidentiality may be compromised if anyone other than yourself has access to your email or your credit card statement. 

If for any reason your PHI needs to be transferred, after you sign a Release of Confidential Information, encrypted HIPAA email will be used to transfer your PHI. 



Therapists at ICLLC use secure email that meets requirements for HIPAA compliance. Secure email will be used to confirm appointments. Please communicate with us through email with a device that you know is safe and technologically secure. Technologically secure means that you may have a firewall, anti-virus software installed, password protection and that you are not accessing the internet through a public wireless network. Please refer to our E­MAILS, CELL PHONES, COMPUTERS AND FAXES ARE NOT PRIVATE disclosure at the end of this document. 


Cancellation Policy

If you are unable to keep a Telemental health prescheduled appointment, please notify your therapist at least 24-hours in advance. If 24-hour advance notice is not received, you will be financially responsible for the missed session. Please note that insurance companies do not reimburse for missed appointments. 


Emergency Management Plan

In order to participate in Telemental health you will need to identify an emergency contact and keep ready documentation of the phone number for Mental Health Crisis Service for your county. 



ALLEGHENY: 1-888-796-8226


BEAVER: 724-775-5208      OR 1-800-400-6180

BUTLER: 800-292-3866

CLARION: 814-226-7223      OR 1-800-756-5953

ERIE: 716-834-3131

FAYETTE: 724-437-1003

GREENE: 724-627-8156


WASHINGTON: 724-225-6940

WESTMORELAND: 1-800-836-6010


E­MAILS, CELL PHONES, COMPUTERS AND FAXES ARE NOT PRIVATE:  No form of client communication is 100 percent guaranteed to be private. Conversations can be overheard; e-mails can be sent to the wrong recipients and phone conversations can be listened to by others. But in today’s age of e-mail, Facebook, Twitter and other social media, psychotherapists have to be more aware than ever of the ethical pitfalls they can fall into by using these types of communication. Although they add convenience and expedite communication, it is preferred to use e-mail to arrange or modify appointments only. If you e-mail a staff person content related to your therapy sessions, please note that e-mail is not completely secure or confidential. If e-mail communication outside of therapy requires more than 5 minutes to read and respond to, you may be charged for that professional services rendered in 15-minute increments. Please indicate if you intend to pay these charges, or it will be saved for review during your appointment time. Please do not send forwarded messages regardless of how inspirational they may seem to the agency’s professional e-mail address. This is used for work related issues and do not want to risk viruses spread by forwarded e-mails. If you choose to communicate with staff by e-mail, be aware that all e-mails are retained in the logs of your and the recipient's Internet service providers. While it is unlikely that someone will be looking at these logs, they are, in theory, available to be read by the system administrator(s) of the Internet service provider. You should also know that any e-mails received from you and any responses that are sent to you could become a part of your legal record and may be revealed in cases where your records are summoned by a legal entity. 

information private and do not share it with others unless there is reason to believe that the patient or another individual is at risk. It is easy to forget that when we type names into a search engine or a field on a social network, we are also sharing information with others. If you have questions about this, please bring them up during the session so that it can be discussed.   

refer those you feel would benefit from the services. The clinician will not confirm nor deny any professional relationship between clients on any social network site. This social media policy was constructed to inform you of the risks involved with associating on a social network. American Psychological Association Ethics Code states clinicians do not use their professional relationships with clients to further their own interests. Clinicians will not ask you to “like” the page or endorse them on other business pages. Please note that you should be able to subscribe to the page via RSS without becoming a Fan and without creating a visible, public link to our Page. You are more than welcome to do this. 


To enter Susan Roop’s Telemental Health waiting room, go to this address at your scheduled appointment time:




I, the client/guardian____________________________, have read, or have had read to me, and fully understand my rights and responsibilities detailed in the Telemental Health Informed Consent. My signature below indicates that I have discussed those points that I did not understand and have had my questions answered. It is my understanding that if at any time during the treatment I have questions about any part of this Telemental Health Informed Consent, I can talk with my clinician about them, and questions will be answered.  I acknowledge that I am signing this Informed Consent for Telemental heath freely and voluntarily.  I have read and understand the Informed Consent for Telemental health.


  • I have read, received and signed a Professional Disclosure Statement for face-to-face therapy and acknowledge that it is filed in my confidential mental health record at ICLLC.


I agree to abide by and act in accordance with the points covered in this Telemental Health Informed Consent. I understand that after Telemental health or other counseling services begin, I have the right to withdraw my consent at any time, for any reason. However, I will make every effort to discuss my concerns about my progress with my clinician or the Practice Manager before ending therapy/counseling services.


______________________ hereby agrees to enter into Telemental health therapy with Inspiring Change LLC and to cooperate fully and to the best of my ability as shown by my signature. I understand that no specific promises have been made to me by any representative of Inspiring Change, LLC about the results of treatment, the effectiveness of procedures used by clinicians or the number of sessions necessary for therapy to be effective.



Printed Name Signature Date Time


I, ____________________have met with this client/guardian for a suitable period of time and have informed him or her of the issues and points raised in this Telemental Health Informed Consent. To the best of my knowledge, I have responded to all of his or her questions. I believe that the person fully understands each of the points in this Telemental Health Informed Consent and I find no reason to believe that this person is not fully competent and legally authorized to give informed consent to treatment at this time. I agree to enter into therapy with this client, as shown by my signature here. 



Signature of Therapist         Date Time

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