As outlined in a 2021 report by Inside Higher Ed, during the global pandemic, many student counseling centers contracted with third-party vendors to provide teletherapy services for students. The American Council of Education released a 2023 report detailing the potential benefits of teletherapy while outlining considerations for colleges in choosing a teletherapy vendor. Given the rapid expansion of teletherapy, this list of considerations can be expanded to include indemnification of liability, custody of records, the ability to communicate with specific tele-counselors, and justification of expenses.
Indemnification
As described by Cornell Law School, indemnification occurs when one party compensates another party for damages or losses that have occurred related to specific events. It’s common among insurance policies, and there’s a need for schools to consider if teletherapy vendors will completely indemnify the institution in the event of liability concerns. In many cases, the use of teletherapy vendors results in campus counseling centers referring students to therapists who have not been vetted by the university. Furthermore, most schools promote teletherapy vendors as an extension of their campus counseling centers. Thus, if there’s any action that results in a lawsuit, it’s reasonable to assume that the institution will be named in that lawsuit.
Custody of Records
Another consideration with teletherapy vendors is the custody of the counseling records. Students (and their families) might assume that colleges completely control the counseling file, but this is not necessarily the case with outside vendors. If a teletherapy vendor is the sole custodian of counseling records, then there are important questions to consider. For example, if there’s a lawsuit, will the vendor continue to grant the school access to the file? How does the school ensure that the vendor will destroy the records after the required time to maintain records has expired? Furthermore, in 2023, the Federal Trade Commission reported that a teletherapy provider broke its privacy promises. Thus, what guarantees are given by the teletherapy vendor about how student records are stored, shared, and maintained?
Communication With Specific Tele-Counselors
The ACE’s report discussed the importance of collaboration between telehealth vendors and colleges, especially with campus counseling centers. A key part of this collaboration is the ability for schools to communicate directly with specific tele-counselors. If there’s concern about a student who is engaged in telehealth, it will likely be helpful for the counseling center to consult with the student’s online counselor. Thus, an important consideration for schools is if the telehealth vendor allows direct consultations with specific tele-counselors, or if schools are limited to communicating with a clinical team supervisor.
Justification of Expenses
A 2024 report by The Chronicle of Higher Education indicates that contracts with teletherapy vendors can cost hundreds of thousands of dollars each year. It’s important for schools to be certain that this is the best investment. For example, the Center of Collegiate Mental Health found that counseling centers gave 56% of all appointments to 20% of clients. If many students have mental health needs that are beyond the scope of care for a teletherapy vendor to treat, it might be better to invest in high-level services, and/or to contract with a different teletherapy vendor with a high-level specialty, such as treating complex trauma.
Teletherapy is an emerging aspect of college mental health, but not all teletherapy vendors are the same. For schools with campus counseling centers, directors of counseling centers are valuable resources to consult about the specific needs on campus and which teletherapy vendor might be the best fit. Deciding to contract with a teletherapy vendor is a significant investment, and this decision warrants full attention to an expanding list of considerations.