1. The Use of Web Sites in the Practice of Psychology Ky Heinlen, Ph.D., PCC-S Holly Gage, M.Ed.

2. Objectives of presentation   Learn distinctions between web sites   Learn some key elements in developing web sites   Learn results of a recent survey   Learn how the current APA Code of Ethics and the Ohio Telepsychology guidelines can be applied

3. Why have a web site? Over 220 million people in the United States, use the Internet (73% of those surveyed) 2008 Nielson Ratings Over 220 million people in the United States, use the Internet (73% of those surveyed) 2008 Nielson Ratings Approximately 8 million people in Ohio are on the net Approximately 8 million people in Ohio are on the net The Netcraft Web Server Survey found over 108 million distinct websites (as of Feb, 2007) The Netcraft Web Server Survey found over 108 million distinct websites (as of Feb, 2007) In a 2003 study Welfel & Bunce found that nearly half of APA members who responded (n = 146) reported that they had emailed a client In a 2003 study Welfel & Bunce found that nearly half of APA members who responded (n = 146) reported that they had emailed a client

4. Why Have a Website? Jupiter Research Report, 2001 63% of consumers reported they would switch to a physician whose website offered solid content, appointment scheduling or secure communication channels 63% of consumers reported they would switch to a physician whose website offered solid content, appointment scheduling or secure communication channels More than ½ want to make appointment requests More than ½ want to make appointment requests 1/3 of health care consumers with a chronic condition said they would participate in an online disease management program on their physician’s web site 1/3 of health care consumers with a chronic condition said they would participate in an online disease management program on their physician’s web site

5. “Concern for man and his fate must always form the chief interest of all technical endeavors... Never forget this in the midst of your diagrams and equations.” Albert Einstein (Maheu, 2007)

6. Hiring a web developer Get details about what will and will not be included (ie. site maintenance, hosting) Get details about what will and will not be included (ie. site maintenance, hosting) Get a contract Get a contract Make sure you have a noncompete clause Make sure you have a noncompete clause How will revisions be made, who will make them How will revisions be made, who will make them

7. Web sites that offer technical assistance American Telemedicine Association American Telemedicine Association http://http://www.atmeda.org/news/2006 buyersguidedefinitions.htm Association of Telehealth Service Providers Association of Telehealth Service Providershttp://www.atsp.org

8. What is your objective in developing a web site? Specific activities that augment existing practice (simple brochure) Specific activities that augment existing practice (simple brochure) Recruit new clients or referral partners (advertising services) Recruit new clients or referral partners (advertising services) Provide tools for practice management Provide tools for practice management Create new revenue streams Create new revenue streams

9. Key Elements to Consider in Developing a Web Site Content Content Technical Features Technical Features Ethical considerations Ethical considerations

10. Guidelines for Content AMA’s policy for websites Definition of Content: all material and menus/directional icons, bars, indicators, listings, and indexes Definition of Content: all material and menus/directional icons, bars, indicators, listings, and indexes Site Ownership including affiliations should be clearly stated, copyright ownership of specific content should be clearly indicated Site Ownership including affiliations should be clearly stated, copyright ownership of specific content should be clearly indicated Site viewing – provide information about the platform(s) and browser(s) that permit optimal viewing in a location that is easy to find Site viewing – provide information about the platform(s) and browser(s) that permit optimal viewing in a location that is easy to find

11. HONcode Principles http://www.hon.ch/HONcode/Guidelines/guidelines.html 1.Information must be authoritative 2.Purpose of the website 3.Confidentiality 4.Information must be documented: referenced and dated 5.Justification of claims 6.Website contact details 7.Disclosure of funding sources 8.Advertising policy

12. Content – Simple Brochure Focus – Existing Clients Offer maps to the office Offer maps to the office Answer commonly asked questions (FAQs) Answer commonly asked questions (FAQs) Offer articles of interest to the clients served (may consider a blog) Offer articles of interest to the clients served (may consider a blog) Contact information: Email, phone number, address Contact information: Email, phone number, address Helpful links to resources Helpful links to resources

13. Content – Simple Brochure New clients, referrals Describe specialized services or populations treated Describe specialized services or populations treated Detail age groups or populations served and areas of special training Detail age groups or populations served and areas of special training May focus on events, happenings within the community May focus on events, happenings within the community Offering any products you have developed Offering any products you have developed

14. Content – Simple Brochure Tools for practice management Intake and assessment documents Intake and assessment documents Online appointment scheduling Online appointment scheduling Disclaimer Disclaimer Homework assignments Homework assignments Assessment Assessment

15. Content – Generating New Revenue Streams Providing services online: Email Email Chat Chat Group chat Group chat Assessment Assessment

16. Technical Features Domain Names Domain Names Table of contents w/rollover and links back to the top of the page Table of contents w/rollover and links back to the top of the page Privacy policy Privacy policy Site visitor counter Site visitor counter Cookies Cookies

17. Technical Features - Continued (Psychotherapy Finances, Oct, 2007) Home Page Home Page Buy several domain names (not just your name) Buy several domain names (not just your name) Limit the number of links – don’t overwhelm Limit the number of links – don’t overwhelm Keep your introduction brief Keep your introduction brief Test your site on friends Test your site on friends

18. Technical Features Continued Secured site v. non-secured site Secured site v. non-secured site Email links Email links Password protection for “members” Password protection for “members” Last revised date Last revised date Spelling errors Spelling errors Flash and music Flash and music Videos and podcasts Videos and podcasts Pictures (office and personal) Pictures (office and personal)

19. Previous Studies of Online Psychology Web Sites Previous studies of online psychology providers revealed the need to follow a stricter standard for ethical practice on the Internet. Providers surveyed did not consistently comply with standards of the American Psychological Association and the American Association of Marriage and Family Therapy (Heinlen, 2003 and Gage 2007) (Heinlen, 2003 and Gage 2007)

20. Previous Studies of Online Psychology Web Sites (continued) In terms of web site compliance, the studies focused on: A. SITE CONTENT: Name of site, web address, provider’s name B. TECHNICAL FEATURES: Site sponsors, developers, revision dates, guest book, visitor counters

21. Previous Studies of Online Psychology Web Sites (continued) C. STANDARDS OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION: procedures for contacting provider offline, links to appropriate certification bodies, provide encryption methods, discuss confidentiality, intent to harm, provider’s scope of practice

22. Methods The instrument used in the study was a slightly modified version of the measure developed by Heinlen (2000), The Internet Therapy Website Evaluation Form (ITWEF). The instrument was used to review the following components: 1. Technical aspects of the site 2. Content of the site 3. Ethical aspects of web site information provided by Ohio psychologists

23. Current Study Sample There were 128 psychology providers identified on the OPA web site. There were 128 psychology providers identified on the OPA web site. Of the 128 providers, there were 94 different web sites Of the 128 providers, there were 94 different web sites Only 2 of the 94 sites provided online therapy to clients, the other 92 sites were informational. Only 2 of the 94 sites provided online therapy to clients, the other 92 sites were informational.

24. Results of the Current Survey Technical Aspects  Less than 10% of the sites included a visitor counter  14% of sites listed a last revised date  Less than 5% identified any site sponsors  Less than 10% of the web sites used music or flash

25. Results of the Current Survey (continued) Content of the Web Site  57% of sites provided education information  65% indicated the degree of the psychologist.  75% of sites provided either a CV or indicated experience.

26. Results of the Current Survey (continued)  12% of sites 1indicated fees for services  25% provide forms to download (HIPPA, informed consent, intake forms, notice of privacy practices, financial agreement) 0% of web sites provided a list of “FAQs” for potential clients 0% of web sites provided a list of “FAQs” for potential clients 33% of sites included a picture of the psychologist 33% of sites included a picture of the psychologist

27. Results of the Current Survey (continued) Ethical Aspects of Sites  57% of psychologists indicated that they are licensed  2% of the sites provided a link to the licensing board.  57% of sites included psychologist’s email addresses  Less than 10% of sites provided testimonials from former/current clients

28. Results of the Current Survey Ethical Aspects (continued)  96% of sites listed areas of competence  34% of sites listed 1-5 areas  23% listed 6-10 areas of competence.  13% indicated they were competent in 11-15 areas  21% indicated competence in more than 15 areas

29. Ethical Considerations APA Ethics Codes & Ohio Telepsychology Guidelines Identify Professional Licensure w/link to license board Identify Professional Licensure w/link to license board Identify areas of competency Identify areas of competency Information about risks and benefits of therapy Information about risks and benefits of therapy Informed Consent Informed Consent

30. Ethical Considerations - Continued Confidentiality – yours and the clients Confidentiality – yours and the clients Notice about emergency services Notice about emergency services Advertising – testimonials Advertising – testimonials Compliance with Section 508 Compliance with Section 508