1. Digital Ethics: There’s No App for That (Yet!) Fred Provenzano, Ph.D., NCSP Private Practice, Seattle, WA Teaching Associate, University of Washington

2. Workshop Objectives 1.Recognize the importance of sound professional judgment. 2.Become familiar with a comprehensive ethical decision- making model.

3. Workshop Objectives, continued 3.Increase knowledge of ethical considerations related to electronic storage & transmission of confidential data. 4.Appreciate benefits and risks related to digital communications.

4. Professional Ethics, v….. Employer Codes of Conduct Licensing and Certification Law State and Federal Case and Statute Law

5. Laws v. Ethical Codes Law: Typically specifies clearly what you can and cannot do. That which it does not specifically prohibit or require, it does not restrict. Innocent until proven guilty.

6. Laws v. Ethical Codes, continued Ethical Standards: Often more general, vague. Typically expect/require professional judgment. Often burden of proof on professionals, to show that their behavior was appropriate.

7. Ethical & Legal Decision Making Model 1.Describe the parameters of the situation. 2. Define the potential ethical-legal issues involved. 3. Consult ethical and legal guidelines and district policies that might apply to the resolution of each issue. Consider broad ethical principles as well as specific mandates involved. 4. Evaluate the rights, responsibilities, and welfare of all affected parties (e.g., child, service providers, other children, other staff, parents, siblings). Consider cultural characteristics of affected parties that might be salient to the decision.

8. Ethical & Legal Decision Making Model, continued 5.Generate a list of alternative decisions possible for each issue. 6.Enumerate the consequences of making each decision. Evaluate the short-term, ongoing, and long-term consequences of each possible decision, considering the possible psychological, social, and economic costs to affected parties. Consider how each possible course of action would affect the dignity of and responsible caring for all of the people involved. Consultation with colleagues may be helpful. 7.Consider any evidence that the various consequences or benefits resulting from each decision will actually occur (i.e., a risk-benefit analysis). 8.Make the decision.

9. Online Communication Email Facebook/Twitter Texting/Skype Apps Online test administration/scoring Websites

10. Evolution of Digital Communication 1890: Keypunch cards 1942: First modern computer 1946: Dick Tracy 2-Way Wrist Radio 1973: Bill Gates graduates high school 1973: First Hand-held Mobile Phone

11. Predicting the Future “There’s no reason for any individual to have a computer in their home.” “640K ought to be enough for anybody.” Get your feet off my desk, get out of here, you stink, and we’re not going to buy your product.” * Quoted from The Experts Speak by Christopher Cerf & Victor Navatsky. Random House, 1998.

12. Privacy & Privileged Communication Are communications by e-mail, Facebook, Twitter considered protected by privacy & practitioner-client privilege? When is privilege invalidated?

13. Email Benefits Quick Easy Immediate Dissemination Ease in Disseminating to Group Ease in Garnering Response

14. Email Risks Casual nature of communication Speed of communication Risk of primary dissemination Risk of others’ dissemination Security

15. Skype Advantage of direct interaction with other (e.g. parent diagnostic interview/feedback) Disadvantages of – not knowing where the data from communication is stored. – Diminished quality of social interaction & non- verbal communication

16. Facebook Benefits Half a BILLION users (National Public Radio, 12/1/10) Ease of connection with others Casual Offers specific, limited connections for groups such as classes of students

17. Facebook Problems Requires sign-up Too casual? Restricts how you can present yourself Little control re what’s posted about you Little control re who can access

18. Cell Phones & Texting Can you hear me now? v. Who can hear me now? Just how secure are those calls & texts?

19. Electronic Storage Forecast: Cloudy, with a chance of violations of confidentiality

20. Healthcare Insurance Portability & Accountability Act (HIPAA) Standardizing privacy protections for Protected Health Information (PHI). HIPAA includes: – The Privacy Rule – The Transaction Rule – The Security Rule

21. HIPAA: Privacy Rule Triggered once any PHI is transmitted electronically regarding any patient/client. Applies to all electronic communication, including faxes. Once triggered, it applies to all communication regarding all clients. Provide PHI only with specific authorization Only provide PHI needed for specific requested purpose.

22. HIPAA: Security Rule Availability: The PHI can be accessed as needed by authorized persons. Confidentiality: The PHI cannot be accessed by unauthorized persons, intentionally or unintentionally. Encompasses administrative, physical and technical safeguards.

23. HIPAA Transmission Rule Intended to set standards relative to submitting electronic claims. Requires compliance with Privacy Rule: – PHI is only transmitted to those meant to receive it. – PHI is transmitted in a manner that protects or at least reduces the risk of it being forwarded in a manner that violates confidentiality.

25. Sensible Digital Rules Send pdf files of you don’t want work altered. Encrypt sensitive files that you email. Use flash drives with passwords or encrypt everything on them. Password-protect smart phones, iPads, etc. if they hold sensitive information. Password-protect your home network.

26. More Sensible Digital Rules Logout and delete originals with digital copiers. Be cautious about sensitive data on cloud services such as Dropbox. Assume IT folks don’t fully appreciate professional standards in mental health. Help your agency be compliant but don’t put your job on the line. Be sensible but not paranoid.

27. References American Psychological Association (2010). Ethical principles of psychologists and code of conduct. Available at www.apa.org.www.apa.org American Psychological Association (2007). Record keeping guidelines. American Psychologist, 62, 993- 1004. Available at www.apa.org.www.apa.org Canadian Psychological Association (2000). Canadian code of ethics for psychologists 3 rd ed.). Available at http://www.cpa.ca. http://www.cpa.ca Family Educational Rights and Privacy Act of 1974, 20 U.S.C.A. Regulations appear at 34 C.F.R. Part 99. Available at http://ecfr.gpoaccess.gov.http://ecfr.gpoaccess.gov

28. References, continued Jacob, S., Decker, D. & Hartshorne, T. (2011). Ethics and law for school psychologists, 6 th ed. Hoboken, NJ: John Wiley & Sons. Health Insurance Portability & Accountability Act of 1996 (Pub. L. No. 104-191), 26 U.S.C. -294, 42 U.S.C.-201, 1395b-5. Koocher, G. P. & Keith-Speigel, P. (2008) Ethics in psychology and the mental health professions: Standards and cases. New York: Oxford University Press. National Association of School Psychologists. (rev. 2010). Principles for professional ethics. Available at www.nasponline.org. www.nasponline.org

29. References, continued Schwab, N.C. & Gelfman, M.H. (2005). Legal issues in in school health services: A resource for school administrators, school attorneys, school nurses. New York: Authors Choice Press. U.S. Dept. of Health & Human Services and U.S. Dept. of Education (November 2008). Joint guidance on the application of the Family Educational Rights and Privacy Act (FERPA) and the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to student health records. Available at http://www.ed.gov/policy/gen/guid/fpco/doc/ferpa- hipaa-guidance.pdf. http://www.ed.gov/policy/gen/guid/fpco/doc/ferpa- hipaa-guidance.pdf

30. Contact Information Presenter: Fred Provenzano, Ph.D., NCSP 5506 33 rd Ave. NE, Suite D Seattle, WA 98105 Office: 206/361-2343 e-mail: fredipro@comcast.netfredipro@comcast.net Dr. Provenzano is the Western Regional Representative to the NASP Ethics & Professional Practices Committee.