Ethical Issues in Telepsychology

1. Ethical Issues in Telepsychology Audrey E. Ellenwood, Ph.D. & Ky Heilen, Ph.D. November 21, 2008

2. Where It Began…….

3. Based Upon and Extensions of • APA 2002 Code of Ethics and, • The 1997 APA Ethics Committee statement on electronic services Appendix A

4. Ohio Psychological AssociationCommunication & Technology Committee • Kenneth Drude, Ph.D., Chairman • Audrey E. Ellenwood, Ph.D. • Kathleen (Ky) T. Heinlen, Ph.D Current Chair • Terry Imar, M.A. • Michael Lichstein, Ph.D. • Paule Steichen Asch, Ph.D.

5. Ohio Psychological Association Staff • Michael Ranney, MPA • Bobbie Celeste, PhD • Denise Brenner, BA • Katie Crabtree Thomas, BA

6. Mission Statement “TO PROPOSE A SET OF FLEXIBLE AND WORKABLE GUIDELINES THAT CAN BE APPLIED BY PSYCHOLOGISTS WHEN PROVIDING TELEPSYCHOLOGY SERVICES. . . THEY ARE INTENDED TO BE APPLICABLE TO ANY PSYCHOLOGICAL SERVICES PROVIDED USING COMMUNICATION TECHNOLOGY.”

7. What is Telepsychology? Telepsychology is the provision of non-face-to-face psychological services by distance communication technology.

8. TAAPP Think About What does one mean by non face-to-face communications?

9. So, What is Non Face-to-Face Communication? • Landline telephones • Cell phones • Video conferencing • Instant messaging • Use of internet services via e-mail • Internet meetings • Facsimile • Chat rooms • Webpages

10. Why Telepsychology Guidelines? • Practiced by many psychologists around the world • Psychologists and clients at risk for potential harm -Lack of clear guidelines • Guidelines provide a framework • Recommend specific professional behaviors, endeavors, or conduct for psychologists

11. Categories That Justify Development • LEGAL & REGULATORY ACCOUNTABILITY • APA Code of Ethics - no guidelines for electronic communications • PUBLIC BENEFIT • PROFESSIONAL GUIDANCE

12. TAAPP Think About What is the difference between standards and guidelines? Code of ethics? Standards? Best Practice?

13. Guidelines Vs. Standards Standards Mandatory and may be accompanied by an enforcement mechanism Guidelines • Facilitate the continued systematic development of the profession • Assure a high level of practice • Not mandatory or exhaustive • May not be applicable to all professional and clinical situations • Are not definitive • Do not take precedence over the judgment of psychologists • APA 2002, p. 1050

14. Guideline Assumptions • Voluntary • Do not carry the force of the law, • Represent best practices and, • Evolutionary in nature.

15. Process of Development • Guidelines and standards created by other health agencies (Table 1) • Reviewed the 2002 APA Ethical Standards • Developed guidelines Draft • OPA reviewed • Sent out to OPA members and state, regional and national organizations for input • Changes and suggestions were discussed and adopted • Final version to OPA • Three years start to adoption

16. Technology Guidelines Approved by the OPA Board of Directors April 12, 2008

17. TAAPP Think About Telepsychology Guideline One Appropriate Use of Telepsychology What are the key points

18. The Appropriate Use of Telepsychology • Not appropriate for all problems • Specific process of providing services varies, situations, setting, time • Decisions made case by case basis • Psychologists have specific skills to use technology • Can the clients benefit from technology services • Psychologist determines, not appropriate create alternatives

19. TAAPP Think About Telepsychology Guideline Two Legal and Ethical Requirements What are the key points

20. Legal and Ethical Requirements • Make sure that provision of telepsychology is not legally prohibited by local or state regulations • Need to be aware of and in compliance with the laws and standards CLIENT RESIDES • Know requirements for reporting individuals at risk to themselves or others • Comply section 508 to make telepsycholgy accessible to those with disabilities • Assure all advertisement is not deceptive

21. TAAPP Think About Telepsychology Guideline Three Informed Consent and Disclosures What are the key points

22. Informed Consent and Disclosures • Provide information about use of electronic communication • Level of Experience in Telepsycholgy explained • Use language client will understand • Obtain appropriate consent for minors • Client’s Informed Consent must be secure (Encryption Services) • Limitations of technology and client provides written acknowledgement

23. Informed Consent and Disclosures (Cont.) • Personal risk to confidentiality of information due to technology • Legally required reporting (Suicidal or homicidal) • Written client consent • Psychologists make reasonable attempts to verify identity of clients • Psychologists make reasonable attempts to verify clients are capable of providing informed consent

24. Informed Consent and Disclosures (Cont.) • Alternative means of contacting client or psychologist in emergency situations • Inform clients about potential risk of disruption with telepsychology • Psychologist must clearly state : • policies on use of telepsychology • When they will respond to electronic messages • Alternative communication for emergencies

25. CAUTION************** Given the 24 hour, 7 day a w eek availability of online environment, as well as increased disclosure online, clinical clients may be more likely to disclose suicidal intentions and assume the psychologist will respond quickly.

26. TAAPP Think About Telepsychology Guideline Four Secure Communications/Electronic Transfer of Client Information What are the key points

27. Secure Communications/Electronic Transfer of Client Information • Use secure communication with clients • Encrypted text messages • Secure websites • Obtain consent for use of non-secured communications • Reasonable efforts to ensure the confidentiality of information electronically transmitted to other parties

28. Example of Possible Electronic Confidentiality Statement • Note: This document contains confidential information. This report is intended for the sole use of the person upon which it is supplied via electronic means. This document or any information contained within may not be released to another person without prior written consent from the client. If you received this document in error please contact …….. Immediately.

29. Example of Possible Electronic Confidentiality Statement • Note: This fax contains confidential information. This fax is intended for the sole use of the person upon which it is supplied via electronic means. This If you received this fax in error please contact …….. immediately.

30. TAAPP Think About Telepsychology Guideline Five Access To and Storage of Communications What are the key points

31. Access To and Storage of Communications • Inform client who else has access to communications • How client’s communication can be directed to a certain psychologist • How client information will be stored • Unauthorized persons do not have access to any of the information • Computers and storage devices need to be disposed of when no longer in use • Types of information that will be maintained as part of client’s records

32. TAAPP Think About Telepsychology Guideline Six Fees and Financial Arrangements What are the key points

33. Agreement reached specifying: • Compensation • Billing • Payment arrangements Prior to providing telepsychology services

34. Telepsychology Guideline Seven Guidelines Revised April 2013

35. Be sure to Review: • Ten Interdisciplinary Principles for Professional Practice in Telehealth (Appendix B) • Telehealth and Telepsychology (Figure 1) • Examples of Relevant Terminology (Appendix C) • Standards and Guidelines Relevant to Telepsychology (Appendix D) Handout

36. Where next?? • Online Supervision using Telepsychology • Use of Telepsychology with psychological assessments