1. Ethical Issues in Telepsychology
Audrey E. Ellenwood, Ph.D. & Ky Heilen, Ph.D.
November 21, 2008

2. Where It Began…….

3. Based Upon and Extensions of
APA 2002 Code of Ethics and,
The 1997 APA Ethics Committee statement on electronic services
Appendix A

4. 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.

5. Ohio Psychological Association Staff
Michael Ranney, MPA
Bobbie Celeste, PhD
Denise Brenner, BA
Katie Crabtree Thomas, BA

6. 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.

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

8. What does one mean by non face-to-face communications?
TAAPP Think About
What does one mean by non face-to-face communications?

9. So, What is Non Face-to-Face Communication?
Landline telephones
Cell phones
Video conferencing
Instant messaging
Use of internet services via
Internet meetings
Facsimile
Chat rooms
Webpages

10. 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.

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

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

13. 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

14. 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

15. 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

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

17. Telepsychology Guideline One
TAAPP Think About
Telepsychology Guideline One
Appropriate Use of Telepsychology
What are the key points

18. 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

19. Telepsychology Guideline Two
TAAPP Think About
Telepsychology Guideline Two
Legal and Ethical Requirements
What are the key points

20. 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

21. Telepsychology Guideline Three
TAAPP Think About
Telepsychology Guideline Three
Informed Consent and Disclosures
What are the key points

22. 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

23. 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

24. 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

25. 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.

26. Telepsychology Guideline Four
TAAPP Think About
Telepsychology Guideline Four
Secure Communications/Electronic Transfer of Client Information
What are the key points

27. 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

28. 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.

29. 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.

30. Telepsychology Guideline Five
TAAPP Think About
Telepsychology Guideline Five
Access To and Storage of Communications
What are the key points

31. 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

32. Telepsychology Guideline Six
TAAPP Think About
Telepsychology Guideline Six
Fees and Financial Arrangements
What are the key points

33. Agreement reached specifying:
Compensation
Billing
Payment arrangements
Prior to providing telepsychology services

34. Telepsychology Guideline Seven
Guidelines Revised
April 2013

35. 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

36. Where next?? Online Supervision using Telepsychology
Use of Telepsychology with
psychological assessments