3 CE Credit Hour Training on Cross Jurisdictional Teletherapy

Legal-Ethical Cross-Jurisdictional Telemental Health in 2026: Interstate, International, and Complex Practice Considerations

presented by Eric Ström, JD, PhD, LMHC and Liath Dalton

3 legal ethical CE credit hours

Six years into the rapid expansion of telehealth, cross-jurisdictional practice is no longer an occasional exception — it is a routine reality of modern mental health care delivery.

Clients travel, relocate, attend college out of state, temporarily reside elsewhere, move internationally, or access care while physically located in a jurisdiction different from where the clinician is based. Clinicians increasingly maintain hybrid or fully remote practices, pursue licensure in multiple jurisdictions, participate in licensure compacts, or even relocate abroad themselves while continuing to provide care to U.S.-based clients.

Yet many mental health professionals are still navigating these realities using outdated assumptions, oversimplified guidance, incomplete risk analysis, or COVID-era understandings that no longer reflect the current legal and practice landscape.

In reality, cross-jurisdictional telemental health practice involves far more than determining whether practice is technically authorized.

Cross-jurisdictional practice is not simply a licensure issue. It is also a standards-of-care, ethics, risk-management, documentation, privacy, emergency planning, and client-protection issue.

On-demand Self Study

CE Credit Hours

Legal Ethical CE

Real feedback from the live event:

“This was by far one of the best trainings that I have been to in a long time. I am so grateful for all the work you have put in. I am so full of good info I cannot wait to educate my colleagues. thank you.”

“Thank you for an absolutely excellent presentation! The presentation is a home run, and I will recommend it to my colleagues. I have a somewhat unique perspective on teletherapy and licensure mobility from working on these issues at the state, national, and international regulatory levels. The information that you provided is clear, direct, easy to follow, and accurate. I’m grateful for you both and the time and research that you put into providing this continuing education.”

“Best on-line class ever! Will be taking more classes!”

“Amazing presentation with such a breadth and depth of knowledge. Thank you!!”

“Exceptional presenters. Very important information. Well organized. Interesting. 5 stars”

This updated legal-ethical training provides foundational guidance alongside advanced real-world application for navigating contemporary interstate and international telemental health practice.

Participants will learn practical frameworks for evaluating cross-jurisdictional practice questions while remaining grounded in professional ethics, evolving legal requirements, client protection, standards of care, documentation, due diligence, and practical risk management.

Special attention will be given to the nuanced and often ambiguous situations clinicians actually encounter in practice, including conflicts between jurisdictional legal requirements; differing laws related to minors, parental rights, age of majority, and minor consent or assent; emergency planning across state and national borders; continuity-of-care challenges; coaching versus psychotherapy distinctions; international practice ambiguity; and circumstances in which legal permissibility, ethical obligations, and standards of care may not neatly align.

Excellent course! Very well presented and very very useful. I’m recommending it to my colleagues. I think the presenters should approach Boards of Psychology and other boards in states and get them to make this course mandatory for relicensure. I know so many clinicians who practice inter jurisdictionally without any consideration of any of this.

The course will also directly address considerations for U.S.-licensed clinicians who are temporarily or permanently residing abroad while continuing to provide telehealth services to clients located in states where the clinician is licensed or otherwise legally authorized to practice. These scenarios raise important questions about therapist location, client location, foreign jurisdiction rules, professional liability coverage, privacy and security, documentation, emergency response capacity, and the difference between practice being clearly authorized and merely not clearly prohibited.

Participants will explore interstate telehealth laws and temporary practice allowances; PSYPACT, the Counseling Compact, and Social Work Licensure Compact developments; therapist-location versus client-location considerations; documentation of due diligence and jurisdictional verification; records and custodian-of-record obligations; reimbursement and insurance issues; mandatory reporting and confidentiality conflicts; and practical strategies for reducing exposure when providing care across jurisdictional boundaries.

Rather than offering oversimplified or purely licensure-focused “yes/no” answers, this training emphasizes ethical decision-making, jurisdictional analysis, practical implementation, and real-world clinical applicability.

Who is this event for?

This course is designed for counselors, psychologists, clinical social workers, marriage and family therapists, and other behavioral health professionals engaged in hybrid, remote, interstate, or international telemental health practice.

Hybrid Practices

Teletherapy Only Practices

Plus Supportive Handouts including:

Practice Permission Worksheet: U.S. Practice Authority Due Diligence Tool
International Telemental Health Cross-Jurisdictional Due Diligence Worksheet
Law & Regulation Fundamentals Worksheet: U.S. Cross-Jurisdictional Telemental Health Documentation Tool

I’ve been watching several of your CE programs and, while I’ve always been impressed with your services, I just have to say, your programs are excellently done with production and content and simultaneously warm and accessible. I really appreciate what you do!

Tara Ingram

Legal Perspective

Identify legal, ethical, and regulatory considerations involved in interstate and international telemental health practice.

Analyze how differing jurisdictional laws may impact consent, confidentiality, documentation, mandatory reporting, emergency response obligations, and standards of care.

Cross Jurisdictional Practice Authority

Differentiate between licensure compacts, temporary practice allowances, and other forms of cross-jurisdictional practice authority.

Risk Evaluation

Apply ethical decision-making and risk management frameworks to complex cross-jurisdictional telehealth scenarios.

Considerations Forward

Identify considerations related to minors, parental rights, age of majority, minor consent or assent, continuity of care, emergency planning, and jurisdictional verification in cross-jurisdictional practice.

Describe legal, ethical, and practical considerations for clinicians residing abroad while continuing to provide telehealth services to clients located in jurisdictions where the clinician is authorized to practice.

Course Details

3 CE Credit Hour. Self Study

Title: Legal-Ethical Cross-Jurisdictional Telemental Health in 2026: Interstate, International, and Complex Practice Considerations

Authors/Presenters: Eric Ström, JD, PhD, LMHC and Liath Dalton
CE Length: 3 CE credit hours, legal-ethical
Legal-Ethical CE Hours: 3 legal-ethical CE hours

Educational Objectives:

By the end of this course, participants will be able to:
1. Identify legal, ethical, and regulatory considerations involved in interstate and international telemental health practice.
2. Differentiate between licensure compacts, temporary practice allowances, and other forms of cross-jurisdictional practice authority.
3. Analyze how differing jurisdictional laws may impact consent, confidentiality, documentation, mandatory reporting, emergency response obligations, and standards of care.
4. Apply ethical decision-making and risk management frameworks to complex cross-jurisdictional telehealth scenarios.
5. Identify considerations related to minors, parental rights, age of majority, minor consent or assent, continuity of care, emergency planning, and jurisdictional verification in cross-jurisdictional practice.
6. Describe legal, ethical, and practical considerations for clinicians residing abroad while continuing to provide telehealth services to clients located in jurisdictions where the clinician is authorized to practice.

Syllabus:

Module 1: Setting the Foundation — The Cross-Jurisdictional Landscape

How cross-jurisdictional telemental health practice is regulated
Client location, clinician location, and licensure jurisdiction
State board authority and consumer protection
U.S. state-based regulation and international practice considerations
Common telehealth scenarios that create multi-jurisdictional questions

Module 2: Beyond “Am I Allowed?” — The 2026 Decision Framework

Ethical standards for cross-jurisdictional practice
Practice permission as the threshold rather than the full analysis
Jurisdictions implicated, authority relied upon, conditions, conflicts, and documentation
The decision framework: Permission → Conditions → Conflicts → Capacity → Documentation → Decision
When consultation, modification, referral, transfer, or re-review may be needed

Module 3: Practice Authority and Permission Pathways

Full licensure and local licensure
Temporary practice allowances and temporary permits
Temporary and telehealth registration pathways
Compacts, portability, and other practice-authority mechanisms
Tools and strategies for locating, verifying, and documenting current practice rules
Insurance and malpractice considerations related to cross-jurisdictional care

Module 4: Compacts and Portability — Important Pathways, Incomplete Answers

Interstate compacts as state-law practice authority pathways
PSYPACT, Counseling Compact, and Social Work Licensure Compact updates
MFT portability developments and Access MFTs
Compact eligibility, privilege requirements, state participation, and physical-location limitations
Compact misconceptions and limitations
Issues not fully resolved by compacts, including payer, malpractice, documentation, emergency planning, minors, confidentiality, reporting, and records considerations

Module 5: Ordinary Scenarios, Real Exposure — When Location Changes the Analysis

Client travel, relocation, and temporary physical location changes
Clinician travel, relocation, and remote practice from another jurisdiction
Scenarios where both client and clinician location change
Residence versus physical location
Common assumptions involving coaching labels, pro bono services, certifications, and VPN use
Risks associated with unpermitted practice, including standard-of-care, payer, and malpractice concerns

Module 6: International Practice and the U.S.-Licensed Clinician Abroad

International practice considerations for clients, clinicians, or both outside the United States
Distinguishing “not prohibited” from “authorized”
Researching and documenting international practice rules and professional recognition
Risks and limits of unregulated practice
HIPAA, privacy, security, payer, malpractice, EAP, and contracting considerations
U.S.-licensed clinicians residing abroad while serving U.S.-based clients
Military-base and other complex physical-location scenarios

Module 7: Conflicting Requirements — When Permission Is Not Enough

Jurisdiction-specific obligations that may apply after practice authority is identified
Family and minor-client scenarios across jurisdictions
Minor consent, assent, and age of majority
Parent/guardian authority, custody orders, decision-making, and records access
Record retention and custodian-of-record requirements
Conflicting legal, ethical, clinical, reporting, confidentiality, or records-related requirements
Situations requiring legal, ethics, board, malpractice, payer, or clinical consultation

Module 8: Documenting the Analysis — Due Diligence, Worksheets, and Re-Review

Documentation as part of cross-jurisdictional standard of care
U.S. Practice Authority Due Diligence Worksheet
International Telemental Health Cross-Jurisdictional Due Diligence Worksheet
U.S. Law & Regulation Fundamentals Worksheet
Re-review triggers, including client travel, clinician travel, relocation, legal age changes, custody changes, payer changes, compact changes, board rule updates, and clinical risk changes
Responsible cross-jurisdictional practice as jurisdiction-specific, documented, clinically grounded, ethically reasoned, client-protective, and revisited over time

Meet Our Presenters

Presented by

Eric Strom JD PhD LMHC and Liath Dalton

Eric Ström JD PhD LMHC, is an attorney and Licensed Mental Health Counselor in Seattle, Washington. As an attorney, Eric provides legal counsel, consultation, and guidance to mental health professionals. Eric’s counseling practice is focused on providing counseling services to combat veterans as well as providing supervision and consultation to other clinicians. Eric currently serves on the American Mental Health Counselors Association Ethics Committee, and is the ethics advisor for the Washington Mental Health Counselors Association. Eric has taught a range of courses in counseling and professional ethics at a variety of graduate and undergraduate programs.

Eric earned a PhD in Counselor Education and Supervision at Oregon State University, a Master of Arts Degree in Counseling Psychology from the Northwest School of Professional Psychology at Argosy University Seattle, graduated cum laude from Wayne State University School of Law in Detroit Michigan, attended the Hague Academy of International Law in the Hague Netherlands, and received a Bachelor of Arts degree in Linguistics from the University of Michigan.

Liath Dalton is PCT’s director and a co-owner. Liath is especially passionate about helping therapists be resourced and supported in navigating the security compliance process and identifying the solutions and processes that meet the particular needs of their practices. Liath’s consultation area of expertise is focused on selecting the right combination of services and tech that not only meet the legal-ethical needs of mental health practices, but also the functionality, efficiency, and cost-effectiveness needs as well.

Resources & Citations

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Counseling Compact. (n.d.). Compact map. Retrieved June 3, 2026, from https://counselingcompact.gov/map/
Counseling Compact. (n.d.). FAQ. Retrieved June 3, 2026, from https://counselingcompact.gov/faq-2/
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Psychology Interjurisdictional Compact Commission. (n.d.). FAQs. Retrieved June 3, 2026, from https://psypact.gov/page/FAQs
Psychology Interjurisdictional Compact Commission. (n.d.). Practice related FAQs. Retrieved June 3, 2026, from https://psypact.gov/page/Practice_Related_FAQs
Psychology Interjurisdictional Compact Commission. (n.d.). PSYPACT map. Retrieved June 3, 2026, from https://psypact.gov/page/psypactmap
Social Work Licensure Compact. (2026, June 2). Social Work Licensure Compact FAQs. Retrieved June 3, 2026, from https://swcompact.org/2026/06/02/social-work-licensure-compact-faqs-2/
Social Work Licensure Compact. (n.d.). Compact jurisdictions. Retrieved June 3, 2026, from https://swcompact.org/compact-jurisdictions/
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U.S. Department of Health and Human Services, Office for Civil Rights. (n.d.). Combined regulation text of all rules. Retrieved June 3, 2026, from https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/combined-regulation-text/index.html
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Accuracy, Utility, and Risks Statement:

This training provides a practical framework for navigating the legal and ethical considerations of cross-jurisdictional telemental health practice. Because laws, regulations, licensing board guidance, and professional standards vary by jurisdiction and may change over time, the information presented should be considered educational rather than legal advice.

Clinicians remain responsible for verifying the requirements applicable to their specific circumstances and for consulting appropriate legal, regulatory, and professional resources when making practice decisions.

The goal of this training is not to provide a definitive answer for every situation, but rather to help clinicians identify relevant risks, ask informed questions, and make ethically grounded decisions in complex practice scenarios.

Conflicts of Interest: None stated.

Commercial Support: none.