Telehealth and High-Risk Situations

Telehealth and High-Risk Situations


We cannot turn on the news without hearing about challenges teachers are facing with providing remote classrooms, challenges parents are facing with trying to work remotely while their children are participating in remote classrooms, or challenges children, teens, or college students are facing with remote classrooms or transitioning to in-person learning. The way treatment is being provided by Allied Healthcare Professionals has shifted in the wake of COVID-19. Telehealth is more widely used. According to FAIR Health’s Monthly Regional Tracker, which uses a database of 31 billion healthcare records, telehealth claim lines (an individual service or procedure listed on an insurance claim) increased 8,336% nationally, from 0.15% of medical claim lines in April 2019 to 13% in April 2020 with mental health conditions listed as the top diagnoses.[1]

The COVID-19 pandemic has impacted all of us, and those with mental illness and substance use issues are at increased risk. According to a Kaiser Family Foundation poll, nearly half of Americans report that the COVID-19 crisis is harming their mental health. A federal emergency hotline for people in emotional distress through the Substance Abuse and Mental Health Services Administration (SAMHSA) registered a more than 1,000 percent increase in April compared with the same time last year and, in April alone, roughly 20,000 people texted the hotline.[2]

Mental illness and substance use not only effects the person but also those around him/her in the home setting and beyond. Since the pandemic, we have published a number of Allied Healthcare Blogs related to telehealth, risks in using certain platforms, and working with patients who are at increased risk of harm. Some of you may still be providing telehealth for your patients while others may be providing in-person care, or a combination of the two. When engaging in telehealth with patients, there are a number of potential issues to be mindful of. Take this case, for example:

Imagine the horror of seeing a violent incident occur while engaging in a telehealth session. Recently, an incident occurred during a zoom classroom meeting where the child’s mother was shot and killed by her father while the 10-year-old was engaged in a classroom session. There were six children in the home at the time.[3] Although this incident was not specific to telehealth, it highlights issues that could potentially occur when providing telehealth. 

As many people remain confined to their homes, a new hand signal is being used by domestic violence victims to alert those, on the other end of the screen, that they may be in danger.[4] The “Signal for Help” initiative was launched by the Women’s Funding Network during the COVID-19 pandemic and has been circulated on Twitter and Tik Tok. It is important that Allied Health Professionals are aware of this signal and, when used, seek help for the patient. If you are unaware of this signal, the link below will bring you to an article where the video is embedded and demonstrates the signal. Keep in mind, however, that the abuser could be in the background and may be able to overhear the session. It is important to ask questions in a way that the abuser is not alerted. 

There are a number of considerations to keep in mind when engaging in telehealth with patients, particularly those at increased risk. It is important to make sure that you: 

  • Be aware of patients and families who may be at-risk for violence, abuse, neglect, or other high-risk situations. Look for signs and symptoms such as bruising or if you hear issues occur in the background of a session. There could be signs before the situation escalates further.
  • If you visualize issues on the screen that are concerning and impact the patient’s safety or another’s safety in the home, be aware of the steps to take. 
  • Know the patient’s history. This is not always possible, but when able, obtain medical records and collateral information about the patient’s history of violence and abuse and neglect. He/she may be at increased risk during this time. 
  • Remain vigilant regarding issues that may occur. If you have an issue occur, you may need to seek help immediately. Know the patient’s location ahead of time, to be able to quickly seek assistance.
  • If you are providing a group session, you may need to terminate the session to protect other patients from witnessing an incident, such as violence.
  • If indicated, it is important that you know how to terminate the telehealth session.
  • Know when you may need to quickly take action by contacting the relevant authorities. Safety is of the utmost importance.
  • Know if you are a mandated reporter and what the requirements are in your state. 
  • Be aware if you have a duty to warn/protect and steps you may need to take. Specific to mental health, the National Conference of State Legislatures has a complete list of each states’ laws, and it is important you know the rules in your particular state. If you are an Allied Healthcare Professional not providing mental health treatment (a physical therapist, for example), check your board of licensure’s website, your professional organization’s website, and your state website for applicable laws. As regulations change, it is important to be up to date on the laws in your state pertaining to duty to warn/protect.[5]
  • If you have time, i.e., the situation does not put the patient or others at imminent risk, seek advice from a risk management professional or an attorney.

In an earlier Blog: “Patients Who Are At Increased Risk Of Harm During The Coronavirus (COVID-19) Pandemic,” we provided a number of resources including hotline numbers/websites.[6] We encourage you to review the Blog and additional resources. 

[1] Gelburd, R., J.D., Telehealth Continues Rapid Growth Tied to COVID-19, U.S. News & World Report,, July 13, 2020; FAIR Health Monthly Telehealth Regional Tracker,, [last accessed Aug. 21, 2020]

[2] Wan, W. The coronavirus pandemic is pushing America into a mental health crisis, The Washington Post,

[3] Burke, M., Florida child's mother shot and killed during online Zoom class as teacher watches,, Aug. 12, 2020

[4] Daoud, E., Hand signal seen on TikTok being used by domestic violence victims to reach out for help,, June 8, 2020

[5] National Conference of State Legislatures, Mental Health Professionals’ Duty to Warn,;Tarasoff v. Regents of the University of California, 17 Cal. 3d 425, 551 P.2d 334, 131 Cal. Rptr. 14 (Cal. 1976)



Kristen Lambert, JD, MSW, LICSW, CPHRM, FASHRM
Healthcare Practice and Risk Management Innovation Officer
Trust Risk Management Services, Inc.

NOTE: This information is provided as a risk management resource and is not legal advice or an individualized personal consultation. At the time this resource was prepared, all information was as current and accurate as possible; however, regulations, laws, or prevailing professional practice standards may have changed since the posting or recording of this resource. Accordingly, it is your responsibility to confirm whether regulatory or legal issues that are relevant to you have since been updated and/or to consult with your professional advisors or legal counsel for timely guidance specific to your situation. As with all professional use of material, please explicitly cite The Trust as the source if you reproduce or distribute any portion of these resources. Reproduction or distribution of this resource without the express written permission of The Trust Companies is strictly prohibited.