Digital Therapeutics Efficacy Ethics Application PRESENTED BY LINDY
Digital Therapeutics: Efficacy, Ethics, & Application PRESENTED BY: LINDY LOTZ, PSYD, TEXAS CHRISTIAN UNIVERSITY FELICE MAYES, PHD, LPC-S, THE CHICAGO SCHOOL OF PROFESSIONAL PSYCHOLOGY JAMIE SUNDVALL, PHD, LCSW, CAPELLA UNIVERSITY
Goals 1) To increase awareness and effective use of digital therapeutics (mental health apps) to aid clients in making behavioral changes that improve quality of life and can be as effective as other intervention types (Efficacy) 2) Examine digital therapeutics as a viable alternative to improve outcomes and reduce access to care burdens (Application) 3) To increase awareness of ethical considerations when using digital therapeutics for professionals that adhere to the APA, ACA, and NASW Code of Ethics (Ethics)
Efficacy What does the research say? American Psychological Association. (2018). 2019 Trends Report. Monitor on Psychology. Washington, DC: Author. Firth, J. , Torous, J. , Nicholas, J. , Carney, R. , Rosenbaum, Simon, & Sarris, J. (2017). Can smartphone mental health interventions reduce symptoms of anxiety? A meta-analysis of randomized controlled trials. Journal of Affective Disorders, 218, 15 -22. Gunther, E. (Ed. ). (2016). Mental health smartphone apps: Review and evidence-based recommendation for future developments. JMIR Mental Health, 3(1). Oliveira, C. , Sousa, A. , Vargos, P, & Oliveira, I. (2017). Social anxiety mobile application to enhance university psychological services. Journal of Medical Research & Health Education, 1(1: 5).
Headspace App based on clinically validated research by internal and external parties Mindfulness based Tailored to specific disorders or symptoms Verbal and visual representations Teaching strategies over time to aid clients in understanding how their thoughts are impacted by their thinking style Resilience based in conjunction with other treatments to increase coping Improving sleep Reducing stress Increasing focus
Headspace Demonstration
Application Group Activity
Breathe 2 Relax
Calm
Daylio
Happify
I Am Sober
Moodpath
Operation Reach Out
Pacifica
Sober Grid
Talk. Life
What’s Up?
Worry Watch
Youper
Ethics: The American Psychological Association's (APA) Ethical Principles of Psychologists and Code of Conduct
General Principles
APA Principle A: Beneficence and Nonmaleficence Psychologists strive to benefit those with whom they work and take care to do no harm. In their professional actions, psychologists seek to safeguard the welfare and rights of those with whom they interact professionally and other affected persons. Appropriateness (e. g. , presenting concern(s), accessibility) Efficacy Level of care
APA Principle D: Justice Psychologists recognize that fairness and justice entitle all persons to access to and benefit from the contributions of psychology and to equality in the processes, procedures, and services being conducted by psychologists. Psychologists exercise reasonable judgment and take precautions to ensure that their potential biases, the boundaries of their competence, and the limitations of their expertise do not lead to or condone unjust practices. Accessibility concerns (e. g. , low cost/free app) Clinician’s competency in making a recommendation for an app
APA Principle E: Respect for People's Rights and Dignity Psychologists respect the dignity and worth of all people, and the rights of individuals to privacy, confidentiality, and self-determination. Psychologists are aware of and respect cultural, individual, and role differences, including those based on age, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, and socioeconomic status, and consider these factors when working with members of such groups. Privacy limitations Building autonomy Accessibility concerns (e. g. , ability status, language, SES)
Ethical Standards
Section 2: Competence 2. 01 Boundaries of Competence- Psychologists provide services, teach, and conduct research with populations and in areas only within the boundaries of their competence, based on their education, training, supervised experience, consultation, study, or professional experience, etc. 2. 03 Maintaining Competence- Psychologists undertake ongoing efforts to develop and maintain their competence. 2. 04 Bases for Scientific and Professional Judgments- Psychologists' work is based upon established scientific and professional knowledge of the discipline. Clinician’s competency in making a recommendation for an app Efficacy & appropriateness
Section 3: Human Relations 3. 01 Unfair Discrimination- In their work-related activities, psychologists do not engage in unfair discrimination based on age, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, socioeconomic status, or any basis proscribed by law. 3. 04 Avoiding Harm- Psychologists take reasonable steps to avoid harming their clients/patients, students, supervisees, research participants, organizational clients, and others with whom they work, and to minimize harm where it is foreseeable and unavoidable, etc. Appropriateness (e. g. , presenting concern(s), accessibility)? Efficacy Level of care
Section 4: Privacy and Confidentiality 4. 01 Maintaining Confidentiality- Psychologists have a primary obligation and take reasonable precautions to protect confidential information obtained through or stored in any medium, recognizing that the extent and limits of confidentiality may be regulated by law or established by institutional rules or professional or scientific relationship. 4. 02 Discussing the Limits of Confidentiality- Psychologists discuss with persons (including, to the extent feasible, persons who are legally incapable of giving informed consent and their legal representatives) and organizations with whom they establish a scientific or professional relationship (1) the relevant limits of confidentiality and (2) the foreseeable uses of the information generated through their psychological activities, etc. Privacy limitations
Section 7: Education and Training 7. 01 Design of Education and Training Programs- Psychologists responsible for education and training programs take reasonable steps to ensure that the programs are designed to provide the appropriate knowledge and proper experiences, and to meet the requirements for licensure, certification, or other goals for which claims are made by the program. Supervisee’s competency in making a recommendation for an app
Section 10: Therapy 10. 01 Informed Consent to Therapy- When obtaining informed consent for treatment for which generally recognized techniques and procedures have not been established, psychologists inform their clients/patients of the developing nature of the treatment, the potential risks involved, alternative treatments that may be available, and the voluntary nature of their participation. Efficacy
Ethics: The National Association of Social Workers (NASW) Ethical Principles and Revisions Related to Technology
Ethics: American Counseling Association (ACA) Code of Ethics & Texas LPC Code of Ethics
ACA (Principles) Nonmaleficence, or avoiding actions that cause harm; Beneficence, or working for the good of the individual and society by promoting mental health and wellbeing (ACA, 2014)
ACA (Code of Ethics - Standards) Section H: Distance Counseling, Technology, and Social Media H. 1. Knowledge and Legal Considerations H. 1. a. Knowledge and Competency Counselors who engage in the use of distance counseling, technology, and/ or social media develop knowledge and skills regarding related technical, ethical, and legal considerations (e. g. , special certifications, additional course work) (ACA, 2014)
ACA (Code of Ethics - Standards) Section H: Distance Counseling, Technology, and Social Media H. 2. Informed Consent and Security H. 2. a. Informed Consent and Disclosure Clients have the freedom to choose whether to use distance counseling, social media, and/or technology within the counseling process. In addition to the usual and customary protocol of informed consent between counselor and client for face-to-face counseling, the following issues, unique to the use of distance counseling, technology, and/ or social media, are addressed in the informed consent process: risks and benefits of engaging in the use of distance counseling, technology, and/or social media; possibility of technology failure and alternate methods of service delivery; cultural and/or language differences that may affect delivery of services;
ACA (Code of Ethics - Standards) Section H: Distance Counseling, Technology, and Social Media H. 4. Distance Counseling Relationship H. 4. c. Technology-Assisted Services When providing technology-assisted services, counselors make reasonable efforts to determine that clients are intellectually, emotionally, physically, linguistically, and functionally capable of using the application and that the application is appropriate for the needs of the client. Counselors verify that clients understand the purpose and operation of technology applications and follow up with clients to correct possible misconceptions, discover appropriate use, and assess subsequent steps (ACA, 2014)
ACA (Code of Ethics - Standards) Section H: Distance Counseling, Technology, and Social Media. H. 5. Records and Web Maintenance H. 5. d. Multicultural and Disability Considerations Counselors who maintain websites provide accessibility to persons with disabilities. They provide translation capabilities for clients who have a different primary language, when feasible. Counselors acknowledge the imperfect nature of such translations and accessibilities (ACA, 2014)
Texas – LPC Code of Ethics Subchapter C. Code of Ethics. § 681. 41. General Ethical Requirements. (a) A licensee shall not make any false, misleading, deceptive, fraudulent or exaggerated claim or statement about the licensee's services, including, but not limited to: (1) the effectiveness of services;
Texas – LPC Code of Ethics Subchapter C. Code of Ethics. § 681. 49. Advertising and Announcements. (b) False, misleading, or deceptive advertising or advertising that is not readily subject to verification includes advertising that: (2) makes any representation likely to create an unjustified expectation about the results of a health care service or procedure;
Ethics: The National Association of Social Workers (NASW) Ethical Principles and Revisions Related to Technology
Revisions and Standards Revision of the NASW Code of Ethics focus on technology (NASW, 2017): Standard 1. 01 Clinicians must ensure that technology used is accurate and consistent with the code of ethics Standard 2. 01 Services provided electronically must be the same quality of services provided in person Ensuring services, provider competence, and client well-being is the focus
Revisions and Standards Standard 2. 04 and 2. 06 Screening appropriate clients, ethical service delivery, practitioner competence Informed consent Opportunity to refuse of technology Offered alternatives Clearly documented, specific to technology use in treatment Assess benefits versus risks
Revisions and Standards Standard 2. 04 and 2. 06 (continued) Benefits should include: Enhancing services for those suffering from illness, disability, geographical isolation, etc. Addressing client scheduling Cost effective service delivery for the client Reducing travel strain for clients
Revisions and Standards Standard 2. 04 and 2. 06 (continued) Risks considered: Safety and acuity concerns Cost Competency with technology Technology failure risk to treatment Empowerment, compulsive use or dependence on technology Access to internet, technology, language barriers, financial access or burden Culture clashes Impact of disability Lack of familiarity and comfort with technology Emergency situations
References American Psychological Association. (2017). Ethical Principles of Psychologists and Code Conduct. Washington, DC: Author. American Psychological Association. (2018). 2019 Trends Report. Monitor on Psychology. Washington, DC: Author. American Counseling Association. (2014). ACA Code of Ethics. Alexandria, VA: Author Firth, J. , Torous, J. , Nicholas, J. , Carney, R. , Rosenbaum, Simon, & Sarris, J. (2017). Can smartphone mental health interventions reduce symptoms of anxiety? A meta-analysis of randomized controlled trials. Journal of Affective Disorders, 218, 15 -22. Gunther, E. (Ed. ). (2016). Mental health smartphone apps: Review and evidence-based recommendation for future developments. JMIR Mental Health, 3(1). National Association of Social Workers. (2018). Code of ethics of the National Association of Social Workers. Washington, DC. NASW Press. Oliveira, C. , Sousa, A. , Vargos, P, & Oliveira, I. (2017). Social anxiety mobile application to enhance university psychological services. Journal of Medical Research & Health Education, 1(1: 5). of
Thank You! Questions?
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