LOS ANGELES COUNTY
DEPARTMENT OF MENTAL HEALTH
  Policy 401.05 Use of Secure Text Messaging and Video Chat in Practitioner/Client Communications
 
  PROCEDURES
  1. Administrative Safeguards
     
    1. A clinician who is an authorized workforce member may utilize secure text messaging and/or video chat communication with a client under the following conditions:
       
      1. Client has a communication device that is supported by DMH-approved secure text messaging/video chat application.
         
      2. Client has been informed of the authorized workforce member’s work hours and availability to respond to secure text messages as well as how to best contact the authorized workforce member in an emergency.
         
      3. Explicit informed Consent for Secure Text Messaging/Video Chat must be obtained and documented. At a minimum, the consent form must state the following:
         
        1. Client will use DMH-approved secure text messaging/video chat application as the only option for sending texts and video chat with DMH authorized workforce members;
        2. DMH does not assume any liability over the client’s device;
        3. Client may opt out of receiving text messages and the manner in which that is done;
        4. Correct use of secure text messaging and video chat;
        5. Identification of the authorized workforce member (A separate consent must be signed if a client wishes to communicate with an authorized workforce member not identified on the consent form).
           
      4. Once text message communication is initiated, the authorized workforce member must confirm the client contact information is accurate and up-to-date at least on a monthly basis or at the next client contact if the time between contacts is greater than a month.
         
  2. Clinical Safeguards
     
    1. Authorized workforce member shall exercise clinical judgment regarding the appropriateness of utilizing secure text messaging or video chat with clients.
       
    2. Text messaging may be used to prompt, encourage, or coach clients to practice skills developed and learned during face-to-face treatment.
       
    3. Communication that does not require the immediacy of text messaging should be sent via other electronic communication methods (e.g., secure messaging within myHealthPointe) or through face-to-face or telephonic communication, as appropriate.
       
    4. Text message communication should not constitute psychotherapy in-and-of itself. The Video Chat feature should not be used to conduct telepsychiatry (i.e., psychotherapy and/or medication support services).
       
    5. Authorized workforce members should not send mass text messages to large groups of people, especially if any PHI is involved.
       
    6. Text message or video chat contains minimum information necessary, including PHI if applicable, to achieve the intent of the communication.
       
    7. Secure text message/video chat exchange must be documented within a progress note, using non-billable services, and in accordance with the timeliness requirements in DMH Policy 401.03. Documentation of any text message/video chat exchange must clearly state the text message/video chat was received by the clinician, a response was provided to the client, and a brief summary of the purpose of the text message(s)/video chat.
       
    8. If there is no client consent to text message/video chat on file and the client initiates the communication, the workforce member shall respond through another form of communication such as by telephone.
       
    9. If the content of the client’s text message indicates the presence of an urgent or emergency situation, the authorized workforce member shall respond to the client in the most expeditious and appropriate manner available including text message, regardless of whether a signed consent/agreement is on file.
       
  3. Technical Safeguards
     
    1. A DMH staff person performing in a management or supervisory capacity may submit a request to the Chief Information Office for installation of the DMH-approved secure text messaging/video chat application for their subordinates who have been assigned a County-issued smartphone device, a business justification for communicating by text messages or conducting video chats, have signed the Secure Text Messaging and Video Chat Communication Agreement, and have reviewed the Secure Text Messaging and Video Chat Solution User Guide.
       
    2. Only authorized workforce members who have been issued an approved device and authorized by their management to have DMH-approved secure text messaging/video chat application installed on their device may send texts or conduct video chats, including PHI or confidential data.
       
    3. Authorized workforce members are prohibited from using non-DMH devices or install the DMH-approved secure text messaging/video chat application on unapproved devices.
       
    4. Potential counter communication candidates must download the DMH-approved secure text messaging/video chat application at no cost from the application store of their smart mobile device. Once downloaded and configured, text messages and video communications can be exchanged through this application securely and in a compliant manner between devices.
       
    5. All devices utilizing the DMH-approved secure text messaging/video chat application must be password protected in order to prevent unauthorized access and confidential messages sent to or from the device, should the device become lost, misplaced, or stolen.
       
    6. Authorized workforce members must ensure that DMH-approved secure text messaging/video chat application’s secure Personal Identification Number (PIN) is enabled as an additional security safeguard for preventing unauthorized access to the confidential communication within the application.
       
    7. Authorized workforce members are prohibited from using their device’s native SMS, Apple iMessage, or any other third party messaging application for communicating confidential data, including but not limited to, PHI with clients, workforce members, or other individuals unless explicit permission is granted by the DMH Information Security Officer. Standard text messaging discloses the device’s identity and phone number which may also result in future unwanted calls and unsolicited messages. DMH authorized workforce members are encouraged to protect their device’s identity and number to avoid unforeseen circumstances.
       
    8. If an authorized workforce member receives a text or video chat message that includes sensitive or confidential information via an unsecure method such as the device’s native SMS, Apple iMessage, or any other third party messaging application, staff must respond to the sender via other means of communication (e.g., telephone) and delete the unsecure text message or video chat immediately.
       
    9. Saving or sharing text messages, pictures, and audio or video recordings outside of DMH-approved secure text messaging/video chat application is strictly prohibited.
       
    10. When authorized workforce members register within the DMH-approved secure text messaging/video chat application, they must accurately input and/or update their profile information within the Application in order to ensure integrity and verification of parties involved.
       
    11. All text, audio, and video conversations will expire on both sending and receiving devices after fourteen (14) days, and logs will automatically be purged. Workforce members are advised to take notes, and if applicable, ensure the communicated materials are documented in the clinical record in accordance with the timeframes described in DMH Policy 401.02.