Transcript Ethical Issues in Telepsychology

Ethical Issues in
Telepsychology
Audrey E. Ellenwood, Ph.D. & Ky Heilen, Ph.D.
November 21, 2008
Where It Began…….
Based Upon and Extensions of
 APA 2002 Code of Ethics and,
 The 1997 APA Ethics Committee
statement on electronic services
Appendix A
Ohio Psychological Association
Communication & Technology Committee
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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.
Ohio Psychological Association Staff
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Michael Ranney, MPA
Bobbie Celeste, PhD
Denise Brenner, BA
Katie Crabtree Thomas, BA
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.”
What is Telepsychology?
Telepsychology is the provision of nonface-to-face psychological services by
distance communication technology.
TAAPP Think About
What does one mean by
non face-to-face
communications?
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
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
Categories That Justify Development
• LEGAL & REGULATORY ACCOUNTABILITY
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APA Code of Ethics - no guidelines for
electronic communications
• PUBLIC BENEFIT
• PROFESSIONAL GUIDANCE
TAAPP Think About
What is the difference between
standards and guidelines?
Code of ethics? Standards? Best Practice?
Guidelines Vs. Standards
Standards
Mandatory and may be accompanied by an
enforcement mechanism
Guidelines
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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
Guideline Assumptions
 Voluntary
 Do not carry the force of the law,
 Represent best practices and,
 Evolutionary in nature.
Process of Development
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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
Technology Guidelines
Approved by the
OPA Board of Directors
April 12, 2008
TAAPP Think About
Telepsychology Guideline One
Appropriate Use of Telepsychology
What are the key points
The Appropriate Use of Telepsychology
 Not appropriate for all problems
 Specific process of providing services
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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
TAAPP Think About
Telepsychology Guideline Two
Legal and Ethical Requirements
What are the key points
Legal and Ethical Requirements
 Make sure that provision of telepsychology is
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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
TAAPP Think About
Telepsychology Guideline Three
Informed Consent and Disclosures
What are the key points
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
Informed Consent and Disclosures (Cont.)
 Personal risk to confidentiality of information
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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
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 :
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policies on use of telepsychology
 When
they will respond to electronic
messages
 Alternative communication for emergencies
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.
TAAPP Think About
Telepsychology Guideline Four
Secure Communications/Electronic Transfer of Client Information
What are the key points
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
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.
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.
TAAPP Think About
Telepsychology Guideline Five
Access To and Storage of Communications
What are the key points
Access To and Storage of Communications
 Inform client who else has access to
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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
TAAPP Think About
Telepsychology Guideline Six
Fees and Financial Arrangements
What are the key points
 Agreement reached specifying:
 Compensation
 Billing
 Payment
arrangements
Prior to providing telepsychology services
Telepsychology Guideline Seven
Guidelines Revised
April 2013
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
Where next??
 Online Supervision using
Telepsychology
 Use of Telepsychology with
psychological assessments