First, assess your agency readiness to employ and support a therapist (remote or otherwise).

The first order of business for a CAC contemplating direct mental health service is to review relevant standards and requirements and become familiar with resources related to the provision of mental health services within a CAC environment such as the following:

• NCA’s National Standards of Accreditation for Children’s Advocacy Centers (See the Mental Health Standard)
• CAC Directors’ Guide to Mental Health Services For Abused Children
• State licensing requirements for social workers, marriage and family therapists, and other mental health professionals (these will depend on your state)
• National Child Traumatic Stress Network website
• California Evidence-Based Clearinghouse for Child Welfare, section on trauma treatment of children

Before recruiting a remote therapist, consider the following:

• Determine what salary you can afford for a highly qualified candidate, what resources you have to support the cost of a therapist (including salary, fringe benefits, travel, and professional development), and the stability of your financial resources (e.g., donations, grants, contracts, or fees for service). Review your budget to determine both the market rate for therapists that may be recruited and how that compares to the funds you have available.
• Discuss your insurance policy and needs with an insurance broker. Does the insurance policy of your CAC cover staff liability including mental health staff and delivery of tele-services?
• To what extent do your CAC clients have the capacity to access telemental health services? States vary significantly in terms of broadband availability. If clients do not have high-speed internet in their area, is there private space at the CAC or a school where clients could use a computer to connect with a therapist virtually?

Consider what your telemental health program will look like.

The CAC will need to develop basic policies for the new treatment program and remote delivery of services. It may help to enlist the support of other CACs with longstanding clinical programs and experience with tele-delivery of mental health services to articulate formal and informal policies. Policies should include, for example:

• How will the CAC determine which children will be referred for trauma-focused telemental health services?
• How will the therapist conduct an assessment while delivering services remotely?
• Will therapists be expected to use specific standardized assessment measures and how will the scores be reported?
• What are expectations around caseload sizes?
• How will productivity be measured?
• Will the CAC need the therapist to participate in case review? If so, how will they be compensated for participation?
• How will the CAC handle subpoenas, other requests for records and information, and possible court testimony for therapists? Will the court allow for remote testimony if needed?
• What type of documentation will be used and how will records be stored?