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 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.

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.”

What is Telepsychology?

Telepsychology is the provision of non-face-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

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 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

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

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 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 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.

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 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:

CompensationBillingPayment 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