Telehealth and technology: what the exam asks now.
Distance counseling, records, social media and the ethics standards that cover them. A short area that is growing.
By Dr. Andrew Wichterman · September 15, 2026 · 6 min read · Updated October 4, 2026
Section H of the ACA Code of Ethics covers distance counseling, technology and social media, and both NBCC exams draw from it. The 2027 exam specifications add attention to technology including AI and electronic records. The items are ethics items with a technical setting, and the principles are familiar.
What Section H requires
- Competence. Counselors who offer distance services must have the knowledge and skills to do so, and must be aware of the laws where both they and the client are located.
- Informed consent, expanded. Beyond the usual elements: the risks and benefits of technology, the limits of confidentiality online, response times, emergency procedures when the counselor is far away, time zone differences, and how to proceed if technology fails.
- Verification. Verify the client's identity at the start and throughout.
- Security. Use encryption and secure platforms that meet legal standards; know that ordinary email and text are not secure.
- Records. Electronic records must be secured, backed up and disposed of properly; clients are told how their records are stored.
- Social media. Keep professional and personal presences separate; do not view a client's social media without consent; do not disclose confidential information in any public forum.
- Web maintenance. Professional websites carry accurate information, accessible formats and links to licensing boards.
A telehealth consent, element by element
A distance counseling consent adds to the ordinary one. The platform, and that it meets the security standard the law requires; the client's responsibility for privacy at their end, a closed door and no one listening; verification of identity and of the client's physical location at the start of each session; local emergency contacts and the plan if the client is in crisis, including that the counselor will contact emergency services in the client's location; a backup plan if the connection fails, usually a phone number and an agreement about who calls whom; expected response times to messages between sessions, and that messages are not for emergencies.
Also: the counselor's licensure and the jurisdictions in which the counselor may practice, so the client understands what happens if they travel; the policy on recording, which requires consent from both parties and is prohibited by the client as well without agreement; fees and insurance for telehealth specifically; and the counselor's judgment that telehealth is appropriate for this client, with a stated plan to move to in-person care or to refer if it stops being so. An item that describes a telehealth intake missing one of these is asking you to name the missing element, and the location and emergency items are the ones most often missing.
Who is appropriate for telehealth
Section H expects the counselor to assess whether distance services fit the client, and the exam tests that as a screening judgment. Poor fits: a client with active suicidal intent, where distance limits the counselor's ability to respond; a client in acute psychosis or severe substance withdrawal; a minor whose guardian has not consented and is not available; a client with no private space, who would be overheard by the person they need to talk about; a client whose technology access or skills make the sessions unreliable. In each case the keyed answer is in-person care or a referral, with telehealth as a bridge at most.
Good fits are most everyone else, and the exam expects you not to over-exclude: anxiety, depression without acute risk, adjustment, relationship concerns and maintenance work all have evidence behind telehealth delivery. The judgment is revisited, which is why the consent names the conditions under which the modality would change. A client who was appropriate in January and is now drinking heavily and talking about dying is no longer appropriate, and the counselor's move is to say so and arrange the higher level of care.
Licensure across state lines
A counselor must be licensed, or otherwise authorized, in the state where the client is located at the time of service. The Counseling Compact addresses this for fully licensed counselors in operational states through a privilege to practice; outside the compact, providing telehealth to a client in another state without authorization is practicing without a license. When an item includes a client who has moved or is traveling, this is what it is testing.
Emergencies at a distance
Before the first session, obtain the client's physical location for each session, local emergency contacts and a plan for crisis. When a remote client presents imminent risk, the counselor contacts local emergency services in the client's location. An item that has the counselor try to manage the crisis alone by video is wrong.
Artificial intelligence and clinical tools
Expect items on informed consent for AI-assisted documentation or scheduling tools, on not entering identifiable client information into non-secure systems, and on the counselor remaining responsible for clinical judgment regardless of what a tool suggests. The principle is unchanged: technology does not transfer responsibility.
Three items, worked
A client who has been seeing a counselor by video from her home in the counselor's state calls to say she is spending the summer at her parents' house in a neighboring state and would like to continue. The counselor is not licensed there and the states are not both operational in the compact. The keyed answer: explain the licensure limit, refer to a provider in that state for the summer, or confirm whether that state offers a temporary-practice provision, and document. Continuing the sessions is practicing without a license where the client is. The distractor that says "continue since the client consents" misreads consent as authority.
A client sends a friend request from a personal social media account. The keyed answer: decline, and discuss it at the next session as a boundary and a confidentiality matter, with reference to the social media policy in the consent. Accepting, or ignoring it without discussion, are the distractors. A counselor begins using an AI tool that records sessions and drafts progress notes. The keyed answer: the client must be informed and consent, the tool must meet the security standard for protected health information, and the counselor reviews and is responsible for every note. Using the tool because it saves time, with no consent and no review, fails on three elements at once.
Practice this. The flashcards and practice tests on this site are sorted by content area, so you can drill this one until it holds.
Same ethics, new setting. Know Section H and the location rule and these items become straightforward.