Here at Kamato Group we occasionally receive questions about providing psychological or counseling services through new forms of telecommunications technologies. These questions often times do not have clear-cut answers as the legal and ethical spheres have not been able to keep pace with the rapidly developing technological world. As a result, every legal jurisdiction and professional board has different, sometimes vague, and occasionally even non-existent definitive regulations on these types of practices.
If you wish to engage in “Telepsychology” or a like practice, you must always abide by the requirements of your professional board and state laws (and laws of your clients’ states if they live outside of your state). However, because untangling all the requirements and guidance from these various entities is often daunting and unclear, we put together a summary of major ethical issues you should be sure to consider as a starting point. It is based on a publication the APA put out to its members in 2012.
To reiterate, this is merely our broad-based summary of APA guidelines. If you wish or are required to abide by the full guidelines, you can find them here: http://www.apa.org/practice/guidelines/telepsychology.aspx. Depending on the type of therapist you are, where you live, and the types of therapy you practice, these guidelines may not be all-inclusive, or you may not technically be legally bound to all of them. However, they make a fine starting point for issues to consider before engaging in technologically-enabled remote therapy practices. Keep in mind, these are merely additional considerations, and all baseline ethical and legal practices that would apply in a traditional therapy setting must be upheld in a remote one as well.
If you wish for more research specific to your jurisdiction and licensure, email us at kamato@nullhushmail.com.
Summary of the APA’s “Guidelines for the Practice of Telepsychology
Background
- “These guidelines are informed by relevant American Psychological Association (APA) standards and guidelines, including the following:Ethical Principles of Psychologists and Code of Conduct (“APA Ethics Code”) (APA, 2002a, 2010), and the Record Keeping Guidelines (APA, 2007).”
- “The guidelines were developed by the Joint Task Force for the Development of Telepsychology Guidelines for Psychologists (Telepsychology Task Force) established by the following three entities: The American Psychological Association (APA), the Association of State and Provincial Psychology Boards (ASPPB) and the APA Insurance Trust (APAIT).”
- “Funding was provided by each of the respective entities to support in-person meetings and conference calls of Task Force members in 2011 and 2012.”
Main points
- “Psychologists who provide telepsychology services strive to take reasonable steps to ensure their competence with both the technologies used and the potential impact of the technologies on clients/patients, supervisees or other professionals.”
- “Psychologists are encouraged to examine the available evidence to determine whether specific telecommunication technologies are suitable for a client/patient.”
- “Psychologists make reasonable effort to understand the manner in which cultural, linguistic, socioeconomic and other individual characteristics (e.g., medical status, psychiatric stability, physical/cognitive disability, personal preferences), in addition to, organizational cultures may impact effective use of telecommunication technologies in service delivery.”
- “Psychologists make every effort to ensure that ethical and professional standards of care and practice are met at the outset and throughout the duration of the telepsychology services they provide.”
- “As in the provision of traditional services, psychologists endeavor to follow the best practice of service delivery described in the empirical literature and professional standards (including multicultural considerations) that are relevant to the telepsychological service modality being offered. In addition, they consider the client’s/patient’s familiarity with and competency for using the specific technologies involved in providing the particular telepsychology service.”
- “Psychologists are encouraged to assess carefully the remote environment in which services will be provided, to determine what impact, if any, there might be to the efficacy, privacy and/or safety of the proposed intervention offered via telepsychology.”
- “Psychologists are urged to monitor and assess regularly the progress of their client/patient when offering telepsychology services in order to determine if the provision of telepsychology services is still appropriate and beneficial to the client/patient.”
- “Psychologists strive to obtain and document informed consent that specifically addresses the unique concerns related to the telepsychology services they provide. When doing so, psychologists are cognizant of the applicable laws and regulations, as well as organizational requirements that govern informed consent in this area.”
- “Prior to providing telepsychology services, psychologists are aware of the importance of obtaining and documenting written informed consent from their clients/patients that specifically addresses the unique concerns relevant to those services that will be offered.”
- “Psychologists are cognizant of pertinent laws and regulations with respect to informed consent in both the jurisdiction where they offer their services and where their clients/patients reside.”
- “Psychologists are encouraged to discuss with their clients/patients those issues surrounding confidentiality and the security conditions when particular modes of telecommunication technologies are utilized.”
- “As part of informed consent, psychologists are mindful of the need to discuss with their clients/patients what the billing documentation will include prior to the onset of service provision.”
- “Psychologists who provide telepsychology services make reasonable effort to protect and maintain the confidentiality of the data and information relating to their clients/patients and inform them of the potentially increased risks to loss of confidentiality inherent in the use of the telecommunication technologies, if any.”
- “Psychologists both understand and inform their clients/patients of the limits to confidentiality and risks to the possible access or disclosure of confidential data and information that may occur during service delivery, including the risks of access to electronic communications (e.g. telephone, email) between the psychologist and client/patient.”
- “Psychologists who use social networking sites for both professional and personal purposes are encouraged to review and educate themselves about the potential risks to privacy and confidentiality and consider utilizing all available privacy settings to reduce these risks.”
- “Psychologists who provide telepsychology services take reasonable steps to ensure that security measures are in place to protect data and information related to their clients/patients from unintended access or disclosure.”
- “Psychologists are encouraged to conduct an analysis of the risks to their practice setting, telecommunication technologies, and administrative staff, to ensure that client/patient data and information is accessible only to appropriate and authorized individuals.”
- “Psychologists strive to ensure that policies and procedures are in place to secure and control access to client/patient information and data within information systems.”
- “When keeping records of email, online messaging and other work using telecommunication technologies, psychologists are cognizant that preserving the actual communication may be preferable to summarization in some cases depending on the type of technology used.”
- “Psychologists who provide telepsychology services make reasonable efforts to dispose of data and information and the technologies used in a manner that facilitates protection from unauthorized access and accounts for safe and appropriate disposal.”
- ”Psychologists are encouraged to develop policies and procedures for the destruction of data and information related to clients/patients. They also strive to securely dispose of software and hardware used in the provision of telepsychology services in a manner that insures that the confidentiality and security of any patient/client information is not compromised.”
- “Psychologists are encouraged to document the methods and procedures used when disposing of the data and information and the technologies used to create, store, or transmit the data and information, as well as any other technology utilized in the disposal of data and hardware.”
- “Psychologists are encouraged to consider the unique issues that may arise with test instruments and assessment approaches designed for in-person implementation when providing telepsychology services.”
- “When a psychological test or other assessment procedure is conducted via telepsychology, psychologists are encouraged to ensure that the integrity of the psychometric properties of the test or assessment procedure (e.g., reliability and validity) and the conditions of administration indicated in the test manual are preserved when adapted for use with such technologies.”
- “They are encouraged to consider if modifications to the testing environment or conditions are necessary to accomplish this preservation. For example, access to a cell phone, the Internet or other persons during an assessment could interfere with the reliability or validity of the instrument or administration.”
- “Psychologists are encouraged to be familiar with and comply with all relevant laws and regulations when providing telepsychology services to clients/patients across jurisdictional and international borders.”
- “It is important for psychologists to be aware of the relevant laws and regulations that specifically address the delivery of professional services by psychologists via telecommunication technologies within and between jurisdictions.”
- “At the present time, there are a number of jurisdictions without specific laws that govern the provision of psychological services utilizing telecommunication technologies. When providing telepsychology services in these jurisdictions, psychologists are encouraged to be aware of any opinion or declaratory statement issued by the relevant regulatory bodies and/or other practitioner licensing boards that may help inform them of the legal and regulatory requirements involved when delivering telepsychology services within those jurisdictions.”