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Guidance on Standards for VA Employees Utilizing Biofeedback/Neurofeedback

Recommended Standards for VA Employees Utilizing Biofeedback/Neurofeedback as part of their VA employment 

VA Employees who utilize Biofeedback/Neurofeedback are ready to do so by meeting 4 standards:

1. The healthcare professional maintains their license in their appropriate field.
2. The healthcare professional is using biofeedback/neurofeedback within their scope of practice/privileges—as defined by state license rules and statutes, VA guidelines, and any local facility rules. Local facilities sometimes choose to have stricter standards than our guidance. Providers are expected to meet their local standards for scope of practice/privileging in the provision of  biofeedback, just as with other aspects of their job. This means that if a registered nurse performs biofeedback, it must be in a manner which fits their scope of practice. Whether or not a professional’s scope of practice/privileges needs to be modified to include biofeedback is highly variable from profession to profession, and facility to facility.  Please check with your local facility to determine if this is needed.
3. Since biofeedback is defined as training in physiological self-regulation, it is within the scope of practice/privileges of many different VA professionals. These include (but are not necessarily limited to): medical providers (medical doctors, doctors of osteopathy, physician assistants, and advanced practice nurses), mental health providers (psychologists, social workers, licensed professional counselors, licensed marriage and family therapists), physical and occupational therapists, and registered nurses.
4. The healthcare professional has adequately passed requirements for basic or advanced training. Basic biofeedback training standards vary depending modality, and recommendations are clarified below:

Feedback Driven Self-Regulation Training must meet the following:

1. Completion of manufacturer’s training recommendations or>
2. Completion of 4 hours education in HRV Biofeedback as approved by a Professional Certifying body or
3. Completion of 20 hours education in Biofeedback as approved by a Professional Certifying body which includes a minimum 3 hours specific HRV education

Heart Rate Variability (HRV) must meet one of the following:

1. Certified in HRV by a Professional Certifying body or>
2. Completion of 8 hours education in HRV Biofeedback as approved by a Professional Certifying body or
3. Completion of 20 hours education in Biofeedback as approved by a Professional Certifying body which includes a minimum 3 hours specific HRV education

General Biofeedback must meet one of the following:

1. Certified in biofeedback by a Professional Certifying body or
2. >Completion of 20 hours education in General Biofeedback as approved by a Professional Certifying body or
3. >Completion of a 3 semester-hour course in biofeedback and/or applied psychophysiology

Neurofeedback must meet one of the following:

1. Certified in Neurofeedback by a Professional Certifying body&nbspor
2. Completion of 20 hours education in Neurofeedback as approved by a Professional Certifying body or
3. Completion of a 3 semester-hour course in neurofeedback and/or applied psychophysiology/neurophysiology

Pelvic Muscle Dysfunction Biofeedback  must meet one of the following:

1. Certified in Pelvic Muscle Dysfunction Biofeedback by a Professional Certifying body or
2. Completion of 22 hours of education in Pelvic Muscle Dysfunction Biofeedback by a Professional Certifying body or
3. Completion of a 3 semester hour modalities course with biofeedback training and a clinical practicum or residency rotation with pelvic health specialty which included training in application of pelvic muscle biofeedback.

A person is ready to practice in the VA upon completion of this Basic training. Certification is not necessary before beginning to practice in the VA.

VA healthcare professionals (including mental health and physical medicine and rehabilitation professionals) do NOT need certification before providing biofeedback to VA patients, as long as they have met the education/training requirements listed elsewhere in this document. Additionally, if the VA healthcare professional also is allowed to provide psychotherapy (such as Psychologists and Social Workers), the facility does not need to follow more stringent rules than those guiding their use of psychotherapy: they generally do not need certification to provide any specific type of psychotherapy, as long as they can demonstrate the appropriate education and training.

Although we support VA healthcare professionals who seek an exterior certification, we recognize that this is a significant achievement beyond the basics required to practice—it is a sign of them going above and beyond, not a sign of basic competency. 

This is with the caveat that anyone practicing biofeedback in the VA is doing so within their existing scope of practice/privileges and is practicing under review for their other clinical activities by normal clinical and or administrative processes such as supervision, peer supervision, or normal administrative review as part of their existing duties.

The VA does NOT require additional or specific supervision or monitoring of biofeedback above and beyond that which is provided for other general therapeutic or medical interventions in that provider’s scope of practice/privileges.

The guideline for deciding whether a clinical healthcare professional needs to have credentialing by local facilities is based on their current level of credentialing. Not all licensed healthcare professionals are credentialed by all facilities and thus not all licensed healthcare professionals will need credentialing for biofeedback.

Biofeedback does NOT require credentialing by the facility unless that profession already goes through credentialing. If a profession currently provides independent clinical activity (such as Clinical Social Workers and Licensed Counselors providing psychotherapy or Occupational and Physical Therapists providing therapeutic exercises or activities that may incorporate biofeedback) under scope of practice/privileges, then biofeedback can also be provided within scope of practice/privileges.

The intent of this document is to provide guidance on the minimum requirements for licensed healthcare professionals to provide biofeedback training. This is to be distinguished from the use of a biofeedback modality within the scope of one's clinical practice (such as the use of a simple finger thermometer to gauge a general relaxation response or surface EMG to aid neuromuscular reeducation).

1. If a profession currently requires credentialing to provide clinical services (either medical, rehabilitative, psychiatric, or psychotherapeutic), then biofeedback will require credentialing for that profession.
2. If a profession currently only requires scope of practice to provide clinical services, then biofeedback will only require scope of practice inclusion for that profession. For example, Clinical Social Workers often provide psychotherapy under a scope of practice rather than under the credentialing process.
3. An addendum is not necessarily required to scope of practice if licensing in that state allows biofeedback as a basic skill or intervention for that profession, and/or the therapeutic activity is covered already in the scope of practice under a more general definition.

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