Reviewed by: Caitlin Kingston, LCSW
Updated: April 23, 2021
Distance counseling is not a new option for people seeking behavioral health services from a licensed clinician, but this area of practice spiked significantly during the pandemic. Counselors recognize that telemedicine—or telemental health as it is often referred to in the therapy arena—offers flexibility and greater access to services.
When a distance counselor holds the Board-Certified Telemental Health (BC-TMH) credential from the Center for Credentialing & Education (CCE), the thorough training and testing ensures that best practices are in place to deliver the highest quality telemedicine services.
“Credentialing provides training on HIPAA compliance, how to present in front of a camera, crisis planning protocols, ethics, care coordination and how to make clients feel comfortable with counseling virtually,” says Tammi Lee, vice president, Center for Credentialing & Education.
The CCE first rolled out a distance counseling program in 2004, calling it the Distance Counseling Credential (DCC). “We recognized from 2004 forward that there were other professionals aside from counselors in the mental health space that needed this training,” says Winifert Lawson-Graves, director of business development and marketing for the association. “People were looking for ways to deliver their services in a safe environment using technology.”
In 2018, the CCE introduced the Board-Certified TeleMental Health (BC-TMH) credential program. “It grew because there was a market and need for this,” Lawson-Graves says.
In fact, the BC-TMH has grown in a big way during the last year. Currently, 2,600 clinicians hold this credential. Before March 2020 when COVID-19 hit, there were about 1,700 BC-TMH credential holders.
“CCE has been the forerunner with distance counseling for more than 20 years when they first put together standards, and they put a lot of work into establishing competencies and codes of ethics,” says Raymond Barrett, CEO, LMHC, LPC and founder of The Telehealth Certification Institute.
Lawson-Graves adds, “We provide the instruction and products that make for knowledgeable credential holders.”
What Is Distance Counseling?
Before diving into the certification process and what is involved in training, along with the benefits of having a BC-TMH, let’s simply identify what telemental health means. What is distance counseling?
Distance counseling is a form of telemedicine that allows clinicians in the mental health field to provide therapy without being face-to-face with a client in an office. Distance counseling can take on a number of forms, including communicating and delivering services by phone, video call and/or using secure email and electronic medical record (EMR) platforms to share information.
According to the National Board for Certified Counselors (NBCC), which oversees the CCE, distance counseling is referred to as “distance professional services involving the use of electronic or other means (telephones or computers) to provide services such as counseling, supervision, consultation or education.”
When a distance counselor holds the BC-TMH credential, clients know that the clinician is prepared to properly execute a virtual appointment. Dominique Hammonds, LCMHC, BC-TMH, has been offering distance counseling since 2011. “I saw it on the horizon, and when the credential was introduced by CCE, I jumped at the chance to get formally trained,” she says.
Dr. Hammonds is an assistant professor in the Department of Human Development and Psychological Counseling at Appalachian State University in Boone, N.C. Today, her practice is entirely telehealth. “Distance counseling gives more access to potential clients who might not be in your immediate area, which is huge,” she says. “Many of us have niche areas of practice, so we can reach clients from across the state, adn that has been a huge benefit.”
Access, convenience and safety are just a few reasons why clients appreciate distance counseling. Also, counselors are using distance professional services, as NBCC states, to achieve certifications and complete supervisions that are necessary to get licensed.
The Benefits of BC-TMH Credentialing
To create the BC-TMH curriculum and standards, CCE established a board of clinicians from various behavioral health fields, who collaborated on the content and provided recommendations, Barrett explains. “They also conducted a job analysis to determine the competencies that clinicians need to know to be effective in a telemental health position,” he says. “Then, they created an examination and an exam committee that actually tests the exam for quality.”
Before counselors can go through BC-TMH training, they must already be a licensed clinician or have the National Certified Counselor credential from NBCC. “Because you can’t get the credential unless you are a licensed professional, you already have a foundation and what the BC-TMH credential training does is introduce you to all aspects of telemental health,” Lawson-Graves says.
The BC-TMH is a specialty credential.
Dr. Hammonds says the benefits of BC-TMH credential training include fine-tuning one’s practice and putting systems in place to best deliver telemental health services. For example, during the online coursework, she updated her paperwork and re-evaluated her health informed consent processes. “I wanted to make sure everything was being presented in the most ethical way possible,” she says.
“I really sat down and combed through my documents and drafted new documents by taking specific line items and suggestions from the training,” Dr. Hammonds continues. “It allowed me to find gaps in what I was doing, evaluate how to handle emergency procedures and situations, and ask myself questions ahead of time related to the referral and intake process.”
Another benefit of BC-TMH credentialing is really getting to know the technology required to deliver effective, high-quality telehealth services. That includes how to present in front of a video camera, and how to set expectations for clients and help them navigate the technology.
The process of getting the BC-TMH credential thoroughly prepares distance counselors to effectively manage all aspects of a telemental health practice. Barrett adds, “The credential helps the public assess whether or not a provider is likely to be competent.”
Training to Get the BC-TMH Credential
The Telehealth Certification Institute is one of two approved training providers that delivers the BC-TMH curriculum for distance counselors to prepare for the credentialing exam. The other training organization is New College Institute STAR Telehealth.
The CCE outlines required course content to earn the BC-TMH credential, and professionals must get at least nine continuing education clock hours via live, webinar, online or hybrid instruction. Dr. Hammonds says her training took about 15 hours because she dedicated extra time to developing processes and documentation for her counseling practice.
Following is the CCE-approved training content mental health professionals receive when preparing for the BC-TMH credential exam:
- Introduction to TeleMental Health
- Presentation Skills for TeleMental Health
- HIPAA Compliance for TeleMental Health
- Best Practices in Video TeleMental Health
- Crisis Planning & Protocols in Video TeleMental Health
- Choosing and Using Technology in TeleMental Health
- Orienting Clients/Patients to TeleMental Health
- Direct-to-Consumer TeleMental Health
- TeleMental Health Settings and Care Coordination
The two BC-TMH training partners were carefully vetted by NCBB and CCE. “We require them to report to us so we can see that they are teaching what is required, and we request quarterly and annual reporting so we can ensure that standards are being met,” Lee says. “Our trainers are carefully vetted by our business development team.”
What Do You Need to Do to Become BC-TMH Certified?
First, you must hold a qualifying license or hold a current, active National Certified Counselor (NCC) certification. CCE will ask for a copy of your license or NCC number to apply.
Next, you must enroll in an approved telemental health training course and meet all requirements. After training, you can submit a BC-TMH application.
To earn the BC-TMH credential, you must earn a passing score on the TeleMental Health Exame (TMHE), which is part of the BC-TMH application process. First, CCE will approve your application, then you can take the exam.
Dr. Hammonds offers these pointers for preparing to get certified:
- Block off time to learn. “Really take the time to focus on the training and ask yourself what’s working in your current practice and what’s not working,” she says.
- Fill the gaps. “Look at your current practice and find gaps in what you are doing and identify how you will fill those,” she suggests.
- Get comfortable with technology. “Do you have access to the proper technology? Will your clients have access? How will you deal with connectivity issues?” she relates.
- Be flexible. “Be flexible with your client and with yourself as you engage in this learning process,” she says. “Beyond the training, you’ll also learn from working with your clients.”
What is the BC-TMH Exam?
The exam includes 50 multiple-choice questions and the CCE allows for 90 minutes to complete the test. It must be completed in one sitting. CCE allows you to take the exam up to two times, but you must wait 30 days if you do not pass the first time.
To maintain the credential, BC-TMH holders must earn at least four continuing education hours every year of their five-year credential period. Approved methods to obtain BC-TMH continuing education clock hours include seminars, workshops, webinars, conferences and publishing articles.
Earning the BC-TMH credential is worth it for distance counselors who want to establish high standards for delivering telehealth, and it can set professionals apart in their fields.
“Many clinicians tha do telemental health jump into it because they have to, but if someone wants to verify that a practitioner actually knows what they ought to know to provide telemental health, a credential such as this helps give them some reassurance that they have taken comprehensive training and were vetted by an exam,” Barrett says.
Distance Counseling BC-TMH Resources
The National Board for Certified Counselors
As the main credentialing body for counselors, the (NBCC) set standards for practice and provides education, examination, supervision, field experience and established ethical guidelines.
Telehealth Certification Institute
The Telehealth Certification Institute has trained more than 20,000 providers on telehealth competencies and has created more than 40 specialized courses. One of its most popular is the TeleMental Health Training Certificate program, approved by the Center for Credentialing & Education.
Center for Credentialing & Education
The Center for Credentialing & Education (CCE) offers the Board-Certified TeleMental Health (BC-TMH) credential. The not-for-profit organization provides assessment, business support services and credentialing for practitioners and organizations. It is an affiliate of the National Board for Certified Counselors and credentials about 25,000 across the globe in a range of fields.
New College Institute STAR Telehealth
The New College Institute STAR Telehealth provides training and preparation for the BC-TMH credential exam. Its academic partners include the University of Virginia’s Karen S. Rheuban Center for Telehealth & Center for Credentialing Education.
American Telemedicine Association
The American Telemedicine Association (ATA) is focused on accelerating the adoption of telehealth. Members include technology players that provide telehealth solutions, partner organizations and alliances. ATA advocates for policy and offers educational resources.
The American Association for Marriage and Family Therapy
The AAMFT is the professional association for marriage and family therapy counselors, representing more than 50,000 members. Its continuing education courses are approved clock hours for the BC-TMH.+
The American Counseling Association
The ACA offers professional development for counselors, along with continuing education that is approved for the BC-TMH. It holds an annual conference and expo with educational opportunities, along with a professional development center with content available online, via webinars and podcasts, and in print.
The American Mental Health Counselors Association
The AMHCA is focused on advancing the clinical mental health counseling field by setting standards for collaboration, advocacy, research, ethical practice, education, training and professional development. AMHCA offers continuing education courses that are approved clock hours for renewing a BC-TNH credential.
The American Psychiatric Association
The APA offers a learning center with CE credits, including courses that allow distance counselors to renew their BC-TMH credential. The APA’s members are involved in psychiatric practice, research and academia. It is the leading psychiatric organization in the world with members in more than100 countries.
The American Psychological Association
The APA offers continuing education programs for mental health professionals, including those that qualify for BC-TMH credential renewal. The APA is the “voice of modern psychiatry.”
The National Association for Social Workers
The NASW is the largest membership organization for social workers and offers professional development along with continuing education that complies with the approved clock hours for BC-TMH.
OnlineTherapy.com consulted these experts for their knowledge in distance counseling credentials:
Tammi Lee, vice president, Center for Credentialing & Education
Winifert Lawson-Graves, director of business development and marketing, Center for Credentialing & Education
Raymond Barrett, CEO, LMHC, LPC and founder of The Telehealth Certification Institute
Learn more from the sources used in this article:
- Center for Credentialing & Education: Approved Methods to Obtain BC-TMH Continuing Education Clock Hours
- Center for Credentialing & Education: Board Certified-TeleMental Health Provider
- National Board for Certified Counselors: Policy Regarding the Provision of Distance Professional Services
- Telehealth Certification Institute: Courses