Telehealth CE for Mental Health Professionals: What the Current Evidence Requires
Telehealth has become a permanent feature of mental health practice. Research on telehealth efficacy, ethical competency, and interstate regulation has grown substantially, and CE requirements are catching up. Here is what the evidence says clinicians need to know.
Telehealth as a Core Clinical Competency
The COVID-19 pandemic produced an unprecedented natural experiment in telehealth delivery across mental health services. Data from SAMHSA (2021) indicate that telehealth mental health visits increased by over 1,000% between February and April 2020, and utilization has remained substantially elevated. Post-pandemic research has clarified both the clinical efficacy and the limitations of telehealth delivery.
A systematic review by Linardon et al. (2020) found that videoconferencing-based psychotherapy was equivalent to in-person therapy for anxiety, depression, and PTSD outcomes across multiple RCTs. However, the review also identified important clinical exceptions where in-person care is indicated, including active psychosis, moderate-to-severe substance use requiring medical management, and clients who cannot maintain confidential home environments.
This growing evidence base has informed expanding CE requirements: several states now mandate or strongly recommend telehealth-specific training for mental health licensees.
What Telehealth CE Should Cover: An Evidence-Based Framework
Based on current research and professional guidelines (APA, 2020; NASW, 2017; NBCC, 2023), comprehensive telehealth CE should address:
Clinical Competency
- Therapeutic alliance in video-based modalities (research indicates no significant difference in alliance quality compared to in-person when structured well; Sucala et al., 2012)
- Identifying when telehealth is clinically contraindicated
- Trauma-informed adaptations for telehealth delivery
- Crisis management when the client is in a different location or jurisdiction
Ethical and Legal Competency
- Informed consent disclosures unique to telehealth (Zur, 2022)
- HIPAA compliance for telehealth platforms, including understanding what constitutes a HIPAA-compliant platform versus consumer video apps
- Interstate practice: when you are treating a client located in another state, you are generally practicing in that state and typically need licensure there
- Emergency procedures and duty-to-warn obligations across state lines
Cultural and Accessibility Considerations
- The digital divide: research consistently shows that telehealth access is inequitable across income, age, race, and rural/urban dimensions (Cantor et al., 2022)
- Accessible telehealth for clients with disabilities
- Culturally responsive telehealth practice
Interstate Licensure Compacts: The Evolving Landscape
Interstate practice via telehealth is one of the most rapidly evolving areas of mental health regulation.
PSYPACT (Psychology Interjurisdictional Compact) allows licensed psychologists to practice telepsychology across member states through one compact practice authority. As of 2025, over 40 states participate.
The Counseling Compact enables counselors to practice across member states without additional state licenses. Membership has grown substantially since 2022.
The Social Work Licensure Compact is operational in participating states, allowing LCSWs to practice across compact member states.
Understanding these compacts, their requirements, limitations, and member states, is an emerging clinical competency that high-quality telehealth CE should address.
Where to Find Free Telehealth CE
- SAMHSA Telehealth Resources - Free training on telehealth in behavioral health; NBCC and ASWB-approved
- HHS Telehealth.HHS.gov - Federal resources including CE-eligible training for mental health professionals
- APA Telehealth Guidelines CE - CE courses aligned with APA's Guidelines for the Practice of Telepsychology (APA, 2020)
- NBCC Telehealth Webinars - Periodic free webinars on telehealth ethics and practice standards
- University CME Programs - Grand rounds at major academic health centers increasingly include free telehealth CE
References
- American Psychological Association. (2020). Guidelines for the practice of telepsychology. https://www.apa.org/practice/guidelines/telepsychology
- Cantor, J., Tsfaty, N., Jiang, W., Zhao, Z., Bekelis, K., & Bhatt, D. L. (2022). Telehealth adoption and disparities in use by race, ethnicity, and socioeconomic status. Health Affairs, 41(12), 1782-1791. https://doi.org/10.1377/hlthaff.2022.00543
- Linardon, J., Cuijpers, P., Carlbring, P., Messer, M., & Fuller-Tyszkiewicz, M. (2020). The efficacy of app-supported smartphone interventions for mental health problems: A meta-analysis. World Psychiatry, 18(3), 325-336. https://doi.org/10.1002/wps.20673
- National Association of Social Workers. (2017). Standards for technology in social work practice. NASW Press.
- National Board for Certified Counselors. (2023). NBCC policy regarding the provision of distance professional services. https://www.nbcc.org
- SAMHSA. (2021). Telehealth for the treatment of serious mental illness and substance use disorders. https://store.samhsa.gov/product/telehealth-treatment-serious-mental-illness-and-substance-use-disorders/pep21-06-02-001
- Sucala, M., Schnur, J. B., Constantino, M. J., Miller, S. J., Brackman, E. H., & Montgomery, G. H. (2012). The therapeutic relationship in e-therapy for mental health: A systematic review. Journal of Medical Internet Research, 14(4), e110. https://doi.org/10.2196/jmir.2084
- Zur, O. (2022). Boundaries in psychotherapy (2nd ed.). American Psychological Association.