Legally Practicing Across Borders: Interstate and International Mental Health Practice, During and Post-COVID

1.5 CE Credit Hours. Legal-Ethical. Continuing Education Session Replay (Updated)

Developed by: Roy Huggins, LPC NCC; Liath Dalton
Presented By: Roy Huggins, LPC NCC; Liath Dalton

This course is included as a piece of bonus material in our full
Telemental Health Certificate Program

Course Description

Chain link fence with a hole in it

After March of 2020, all of us are probably teletherapists.

The suddenly — and continuously — shifting landscape of COVID-19-era practice has clients and therapists alike scattered across the states and seas. Despite being so far flung, most of us wish to use the power of the Internet to continue or expand our relationships with clients.

There’s a lot of good news around this! Even before March, opportunities for legal, cross-jurisdictional practice were much greater than most therapists realized. State and national declarations of emergency for COVID-19 expanded those opportunities greatly.

Despite this sudden expansion of practice opportunity, however, many questions remain. These include:

  • Which states or nations will allow me to work with clients within their borders? Will my own state allow me to work outside its borders?
  • Can I travel out-of-state and work with clients back home?
  • How do I find out if a state normally allows temporary practice from out-of-state, or if they allow it only on an emergency basis?
  • What will happen to cross-state practice when COVID-19 ends?
  • What risks do I need to manage when working across states — whether I do it legally or illegally?
  • What risks do I need to manage when working with clients in nations that don’t regulate my professional practice?

This updated introductory-level course for counselors, clinical social workers, marriage and family therapists, and clinical and counseling psychologists will discuss the vicissitudes of cross-jurisdictional practice as they relate to the unique regulatory environment present during the COVID-19 emergency. It will also cover how cross-state practice in the US works even during non-emergency times.

Educational Objectives

  • Describe 3 different schemes of temporary practice provision and how they impact the learner’s ability to work with clients who are present in foreign states.
  • Use freely-available lookup tools to discover licensure board rules and COVID-19 emergency rules in foreign states and how they impact work with clients in those states or therapists travelling to those states.
  • Describe 2 methods for discovering the circumstances of legal practice with clients present in nations outside the United States.


  1. Why do we even have to worry about cross-border/interjurisdictional practice?
    • The role of licensing boards in the US.
    • When and how foreign licensing board rules come into play.
    • Concrete risks in illegal cross-border/interjurisdictional practice.
  2. Changes to interstate practice due to COVID-19
    • The cascade of executive orders.
    • Where emergency practice allowance stands now.
    • A survey of a few states’ executive orders which impact out-of-state practice.
  3. Getting answers about practice in foreign jurisdictions
    • The info items a therapist needs to know about practice in a foreign jurisdiction to determine if it is legal to work from there or with clients there — even after COVID-19 ends.
    • A process for getting these answers from US states during and after COVID-19.
    • A process for getting these answers in nations outside the US.
    • PSYPACT and similar efforts to reduce jurisdictional barriers during and after COVID-19.
  4. Legal-ethical issues arising when the COVID-19 emergency ends
    • Taking new clients in jurisdictions where your allowance to practice is only temporary.
    • Changes to the practice landscape after declarations of emergency lapse.
  5. Working with clients in foreign nations
    • The difference between practice being permitted and practice not being forbidden.
    • Some risks and benefits of Roy’s telepractice in Japan.
    • A demonstration of finding potential information sources in nations where government websites are not written in English, or where information about practice licensure/registration is not findable.
  6. Working with clients in US states where one is not licensed
    • Some specific state boards without any temporary practice allowance of any kind, and how we discovered that fact.
    • Some specific state boards with temporary practice allowance rules that goes back to pre-COVID times, and how we discovered that fact.
    • Some specific states with emergency temporary practice allowance as a response to COVID, and how we discovered that fact.
    • Some specific state boards that restrict the ability of therapists to work with clients while the therapist travels out of state.


1.5 CE Credit Hours.

Presented/Developed By

Roy Huggins, LPC NCCRoy Huggins, LPC NCC, is a counselor in private practice who also directs Person-Centered Tech. Roy worked as a professional Web developer for 7 years before changing paths, and makes it his mission to grow clinicians’ understanding of the Internet and other electronic communications mediums for the future of our practices and our professions.

Roy is an adjunct instructor at the Portland State University Counseling program where he teaches Ethics, and is a member of the Zur Institute advisory board. He has acted as a subject matter expert on HIPAA, security and clinical use of technology for Counseling licensure boards and both state and national mental health professional organizations. He has co-authored or authored 2 book chapters, and he routinely consults with mental health colleagues on ethical and practical issues surrounding tech in clinical practice. He served for 5 years on the board of the Oregon Mental Health Counselors Association and then the Oregon Counseling Association as the Technology Committee Chair.

He really likes this stuff.

Course Co-Presenters

Liath Dalton is a Ph.D candidate in Religious Studies. She began her academic career at Reed College and continued her graduate work at the University of Cape Town.

Liath is the Deputy Director for Person Centered Tech and runs our HIPAApropriateness review program. Through her combination of experience evaluating products for their utility and security in regards to how they can meet risk management needs and providing guidance to members around what product options will best meet their specific practice needs, Liath has an intimate knowledge of both what the practice tech needs are for mental health professionals and what it takes for a product to meet those needs.

Program Notices

Accuracy, Utility, and Risks Statement: This presentation may not include information on all applicable state or national laws. Misapplication of the materials, or errors in the materials, could result in non-compliance with applicable laws or ethics codes.

Conflicts of Interest: None.

Commercial Support: None.

This course is subject to our cancellation/refund policy and complaint policy.

1.5 CE Credit Hours.
Chain link fence with a hole in it

1.5 CE Credit Hours. Legal-Ethical. Continuing Education Session Replay (Updated)


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