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 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 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.” Our intention was to aide psychologists in thinking through the issues of providing services through electronic means. As illustrated by the recent court decision involving a telemedicine case sometimes we think with our hearts in our efforts to help people and forget the importance of using our heads and making sound ethical and legal decisions regarding practice. This area is ripe with opportunities for that.

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

What does one mean by non face-to-face communications? 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 It is conceivable that should a case come up in Ohio that the Ohio Board of Psychology will utilize any available guidelines or standards available to protect the rights of the clients. Guideline assumptions: voluntary, represent best practices and evolutionary in nature.

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

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

Guidelines Vs. 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 Code of ethics—REQUIRED standards adopted by a profession Standards are MANDATORY Expectations and closely adhered to comply with professional practice expectations Best Practices subset of guidelines that address behavior and treatment to be applied in the best interest of the client

Guideline Assumptions Voluntary Do not carry the force of the law, Represent best practices and, Evolutionary in nature. Guidelines are only for those practicing in Ohio Many states and Canada are modeling after these guideleines Voluntary recommended practices used to assist psychologists in applying 2002 APA Code of ethics Considered best practice and reflect current professional experience and knowledge Evolutionary –revisited 5 years validity, utility, applicability and relevance

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

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

Telepsychology Guideline One 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 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

Telepsychology Guideline Two 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 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

Telepsychology Guideline Three 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 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 : 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.

Telepsychology Guideline Four 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 Avoid using personal info with non-secured means reason

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.

Telepsychology Guideline Five 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 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

Telepsychology Guideline Six 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