OPA Communications & Technology Committee

October 28, 2012 Ohio Psychological Association Convention

Ken Drude CTC Co-chair Audrey Ellenwood CTC Co-chair

Mary Mills Paule Steichen Asch Marc Dielman

2:00-2:30 Social Media 2:30-3:00 Implications for Psychologists 3:00-3:15 Change Happens 3:15-3:45 High Tech Considerations 3:45-4:00 Break 4:00-4:30 Revised Telepsychology Guidelines Assessment Distance Supervision 4:30-4:45 What do you think?

4:45-5:00 Wrap up and Questions

1. Participants will reflect upon how social media may impact their own personal life. 2. Participants will become aware of how social media blurs the therapeutic relationship. 3. Participants will become familiar with the risks faced when using social media. 4. Participants will learn ways to apply risk management approaches when using social media. 5. Participants will become familiar with the revised telepsychology guidelines relating to assessment and supervision.

Facebook LinkedIn MySpace Friendster Landline telephones Cell phones Video conferencing Instant messaging Use of internet services via e-mail Internet meetings Facsimile Chat rooms Web pages Twitter

The father of a child you are treating is in the middle of a legal separation process and he wants you to "confirm" everything in e-mails the day after each session with the child. He is being very pushy and feels like he's actually

bullying you about this. As psychologists we focus a lot on clients'

rights, but what are your rights (and obligations) in this situation?

Where does professionalism begin and where does professionalism end?

Blurred Boundaries

What do we discuss with clients?

What do we avoid?

Become an issue of self-disclosure

OOPS!!!!!

Social Intelligence a company based in California hired employees that will monitor Twitter, Facebook, LinkedIn and other social media sites on behalf of major corporate clients to help keep their employees from misbehaving on the Internet or becoming liabilities.

Facebook Texting E-mail

What do we discuss?

What do we avoid?

Client’s perception of the therapist

Therapist’s perception of the client

How does this affect therapeutic outcome?

Never access without client’s permission Recognize that social media information affects

client’s and therapist’s perception Ask yourself – what is in the best interests of

the client? Talk about the issue of social media in the first

session

When appropriate, utilize social media information as part of the therapy

Reexamine your Facebook page in terms of what you want to disclose

Google Yourself!

1. Look at how you personally use telepsychology in your practice

-e-mails, text messages, professional sites 2. Speak to clients about how you integrate technology in

your practice. 3. What is the best way for clients to contact you? 4. When is it appropriate for clients to text or e-mail you? 5. How long will it take you to respond to a text or e-mail

(Clients want immediate gratification) 6. Are clients your friend? What if an e-mail is sent to

everyone in your address book? 7. Do you conduct web searches on your clients? 8. Do you frequently up-date your web sites?

Change Happens

Vendor Ad viewers (millions) (2008)

Google 2,197 Yahoo! 362 MSN (Microsoft) 309 AOL 156 Adbrite 73 Total 3,087

Ease of access to services

Way to reduce dual relationships

Maintain therapeutic relationships when one party has to move

Mary Mills - LinkedIn Columbus, Ohio Area - Psychology Intern at Ohio Reformatory for Women View Mary Mills's professional profile on LinkedIn. LinkedIn is the world's largest business network, ... Single Mothers Independently Living Everyday, Inc ... www.linkedin.com/ pub/ mary-mills/ a/ 15/ 62 - Cached The SMILE Team Single Mothers Independently Living Everyday, Inc ... Mary Mills stepped out on a wing and a prayer, moving from Kansas to Columbus, OH to co-found SMILE ... smileforchildren.com/ The-SMILE-Team.html - Cached Ohio Psychological Association 2010 Convention Brochure Mary Mills stepped out on a wing and a prayer, moving from Kansas to Columbus, to co-found Single Mothers Independently Living Everyday, Inc (SMILE) and ... issuu.com/ opaworkshops2010/ docs/ 2010convention - Cached

Learn about legal and ethical requirements for client privacy and security

HIPPA – Health Insurance Portability & Accountability Act

HITECH – Health Information Technology for Economics and Clinical Act (In effect now!)

APA Ethical Principles of Psychologists and Code of Conduct

APA Record Keeping Guidelines

OPA Telepsychology Guidelines

Psychology Board Telepsychology Rules

Standards to protect privacy and security of “protected health information” (PHI) and establish penalties for violations Privacy rule – applies to any communications,

including oral, of PHI Security rule – relates to PHI in electronic form –

administrative, physical and technical safeguards

Updates HIPAA Expands HIPAA to include “business associates” Increases breach penalties significantly Four categories of violations that reflect increasing levels of

culpability; Four corresponding tiers of penalty amounts that significantly

increase the minimum penalty amount for each violation; and A maximum penalty amount of $1.5 million for all violations of an

identical provision. Empowers State Attorneys General to initiate civil legal action

for breaches Encrypted data are exempt from breach reporting

requirements

Establish good electronic security practices in your professional and personal lives Use strong passwords Maintain updated virus and malware protection Use firewall protection of computers Use authentication of computer users Data encryption

Work with information technology consultants knowledgeable about health care requirements

Be especially careful when using portable electronic devices

Frequently backup all electronic media Regularly maintain and review your security and

privacy plan to assure it is effective

Psychologists need to be cognizant of standards of patient privacy

and confidentiality that must be maintained in all environments, including online, and must refrain from posting identifiable patient information online.

When using the Internet for social networking, psychologists need

to use privacy settings to safeguard personal information and content to the extent possible, but should realize that privacy settings are not absolute and that once on the Internet, content is likely there permanently.

Psychologists need to routinely monitor their own Internet presence to ensure that the personal and professional information on their own sites and, to the extent possible, content posted about them by others, is accurate and appropriate.

To maintain appropriate professional boundaries psychologist should

consider separating personal and professional content online.

When psychologists see content posted by colleagues that appears unprofessional they have a responsibility to bring that content to the attention of the individual, so that he or she can remove it and/or take other appropriate actions. If the behavior significantly violates professional norms and the individual does not take appropriate action to resolve the situation, the psychologist needs to report the matter to appropriate authorities (State Licensing Board).

Psychologists must recognize that actions online and content posted may

negatively affect their reputations among patients and colleagues, may have consequences for their medical careers and can undermine public trust in the psychological profession.

If you interact with clients on the Internet, you must maintain appropriate

boundaries in relation to the client-physician relationship in accordance with professional ethical guidelines just, as they would in any other context (OPA Telepsychology Guidelines).

“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.”

31 © Copyright by OPA, CTC - 2010

Guidelines Revised

April 2013

32 © Copyright by OPA, CTC - 2010

Rapid ease of adminstration

Collection of data Communication of

findings to client More cost efficient

process

More disclosure Reaching individuals

with disabilities Reaching rural areas

1. Test Psychometric Properties 2. Test Administration and Interpretation 3. Examinee Identity 4. Technical Problems and Environment

Providing clinical supervision through technology based, non-face-to-face means including the following: Landline and cell phones Email, chat (real time online) Text messages to cell phone & Instant messages Video teleconferencing Web pages

Interaction between supervisee and supervisor: Discuss cases in-depth Supervisor becomes knowledgeable of critical information

about a client Instructs or models how to deal with issues Assists in developing interventions Monitors students’ and clients’ progress

Practice Facility

Clinical Supervisor

•Secure two way interactive technology

• Internet based e-mail

•Chat rooms for interaction

•WEB based TV staffing sessions

•Electronic bulletin Boards for scheduling

•Encrypted services

Web based case review/electronic medical records

Chat room for discussion of case studies

Supervision via ITV (Group or Individual)

Individual face-to-face supervision with onsite supervision

Supervisee At A Distance

Flow Chart Of Supervision At A Distance

Adapted from Miller et. al. 2008

38

©

Consultation Consultee responsible

for treatment and client Collegial relationship Consultant may have

limited information

Supervisor responsible for treatment and client

Superior-subordinate relationship

Supervisor needs to have access to all available client information

Competence is a standardized requirement for an individual to properly perform a specific job. It encompasses a combination of knowledge, skills, and behavior utilized to improve performance. More generally, competence is the state or quality of being adequately or well qualified, having the ability and a core set of values to perform a specific role.

Habitual and Judicious Involves: Use of communication, Knowledge, Technical skills, Clinical reasoning, Emotions and, Values “Reflection in daily practice for the benefit of the individual and

community being served.” Epstein & Hundert (2002)

Telepsychology supervision may limit a supervisees level of personal contact with supervisor

Supervisees may not get time they need to grow in supervision

Problems with technology access can interfere with supervision

Confidentiality is an issue Requires the supervisee to be more self-

directed

Evaluate the following “Click here” buttons found on these fictional psychologist’s web sites and answer these questions: 1. Is it Ethical? Why or why not? 2. If you were a client, would

these services offered appeal to you? Why or why not?

3. Are the website items “Hot”…ethically sound and commercially appealing, or Not?

Suzy Spring, PhD In Clinical Psychology

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Billing

Compensation

Payment Arrangements

Agreement should be reached prior to providing telepsychology services

The following People contributed to the development of the OPA Telepscyhology Guidelines and portions of this presentation:

Kenneth Drude, Current CTC Chair

Ky Heinlen Audrey Ellenwood Terry Imar Michael Lichstein Paula Steichen Marc Dielman Mary Mills

OPA Staff Michael Ranney Bobbie Celeste Denise Brenner Katie Crabtree

http://www.ohpsych.org/professionalissues.aspx

http://www.ohpsych.org/resources/1/files/Comm%20Tech%20Committee/TelepsychologyGuidelinesApproved041208.pdf