Welcome To 2018 Spring ICB Conference Ethical Navigation

Welcome To 2018 Spring ICB Conference Ethical Navigation of Social Media

Patricia R. Diel MSW, LSW, CADC, SAP 444 S. Willow St. Effingham, IL 62401 903 W. Lincoln Ave Charleston, IL 61920 217 -347 -7384 patricia@dielcounseling. com

George K. Rafeedie MPA, CSADC Consultation Assessment & Treatment Services GKR 410@GMAIL. COM

ETHICAL NAVIGATION OF: SOCIAL MEDIA, TEXTING, TWEETS AND SNAP CHATS • Identify threats to privacy and confidentiality involved in the use of social media • Identify boundary and multiple relationship issues involved in the use of social media • Review how privacy and boundary issues that can arise from social media use • Identify social media issues that should be included in the informed consent • Understand record keeping challenges posed by the use of social media sites, texting and tweets • Discuss competence issues involved in the use of social media • Look at the development of a social media policy

ETHICAL NAVIGATIONAL GOALS • Participants will be able to clearly evaluate the use of social media as an aid or detractor related to professional boundaries. • Participants will be able to apply critical thinking related to the use of social media. • Through practice participants will be able to establish baseline policy related to social media. • Understand the expansion of the community related to social media. • Learn to appropriately evaluate the use of social media in therapeutic relationships. • Participants will gain a generalized understanding of the ethical dilemmas that comes with the use of social media in counseling relationships and business.

Training Room Agreements 1. 2. 3. 4. 5. Only One Person Speaking At A Time Be Respectful And Professional No Sidebars Stay On Point Enjoy Academic Freedom A. Free To Ask Anything B. Don’t Talk About Others 6. Participate In Exercises 7. Have Fun

The Big Secret: SOCIAL MEDIA _____________ SOCIAL NETWORKS HAVE RAPIDLY EXPLODED • Facebook 1. 59 billion in 2016 and growing • FB Claims 2 Billion users now • Like all great innovations there are benefits and there are risks

Technology applications include • Email • Texting and chat • Virtual reality environments • Gaming • Videoconferencing • Forums • Social networks • Websites • Blogs • Wikis • Podcasts • Others

Who uses Social Media ? • An estimated 73% of American adults online use a social network of some kind; 42% use more than one (Laranjo, 2015) • 67% of health practitioners use social media professionally. • Counselors mental health ? ? ? • When do you use social media?

Are There Problems? • In clinical practice psychotherapists are now seeing people with “Facebook addiction, ” which researchers correlate with low self-esteem, depression, and decreased life satisfaction (Biachnio, 2016). • There are now diagnostic tools available, such as the Bergen Facebook Addiction Scale and the Facebook Intensity Scale, to assist the clinician in assessing the extent of the person’s involvement with Facebook (Andreassen, 2012). • The world of professional communication is being rapidly swept into the “new normal” medium of social networking. And therein lies another problem

Are There Problems? • Technology creates new ways for us to connect with our patients. . Relationships take new forms. The Geographic barriers fade --We may start and end therapy without ever being together in the same room with the patient… • But the benefits come with costs, risks, and occasional disasters. • Digital technologies take confidential information that was once confined to handwriting in a paper chart kept under lock and key and spreads it over electronic networks.

Social Media - Reality Of Mainstream Life • Has created both new issues for counselors to consider as well as benefits for counselors • Faced with new challenges of establishing effective boundaries with clients • Social media can and does blur the lines between private and public information

Social Media - Reality Of Mainstream Life • The use of social networking technology has become so routine that clinicians might adopt it mindlessly without carefully thinking through the potential consequences in therapy situations. • The results can include unanticipated breeches of confidentiality or the transmission of private information to unintended parties, sometimes leading to severe damage to clients.

The Ethical Use of Social Media The most useful resource is -- • is being well-informed • and using well-reasoned clinical judgment

The Ethical Use of Social Media 2 • As a very simple example, say a client texts you to say she is going to be late for her scheduled session with you. You respond, acknowledging the message. • What has happened here, in the context of this tiresomely routine exchange? • You and your client have just established a digital record of your appointment that will reside forever on some electronic medium somewhere. Is this a problem?

The Ethical Use of Social Media 3 • Maybe not, but even the fact that a therapeutic relationship exists is part of a confidential record. • But the client did it to herself, right? She sent you the text. • Again, maybe, but you gave her your cell phone number and you responded to her text. • Are these forms of electronic communication – like texting, emailing, and social networking – appropriate forms of communication for use in a confidential setting? • Do you have reasonable protections in place? • Are they described and discussed in your informed consent process?

Six Ethical Principles Related to Social Media 1. 2. 3. 4. 5. 6. Privacy & Confidentiality Multiple Relationships Professional Boundaries Competence Informed Consent Documenting and maintaining records Keely Kolmes

Social Media & Privacy Obvious concern-the threat posed to client’s rights, that events will remain private & the expectation that therapeutic communication is confidential S-1

Scenario 1: Privacy and Social Media (Adapted from Hartig et al. , 2011) • A counselor-in-training, Meghan, has a social network website account (e. g. , Facebook, My Space). She maintains this account to stay in contact with new and old friends. She has appropriate, yet personal, pictures on her account (e. g. , her with friends, family, and pets). She has not activated the built-in privacy settings; therefore, her profile and all information contained therein are publicly accessible and viewable to anyone with a Facebook account. She is also an orientation leader on campus and has served in a variety of leadership roles. • Meghan began counseling a sophomore undergraduate student in her individual counseling practicum. After two counseling sessions, she realized the client was listed as a friend on her account. The client requested to be a friend a year ago when she found Meghan’s information on an orientation list. They had minimal interpersonal contact prior to the practicum. The client wanted to demonstrate popularity by having large numbers of friends on her site; Meghan has large numbers of friends on her account, as she has accepted all people who request her as a friend.

Scenario 1: continued • During supervision, Meghan shares this information with her supervisor. She is not sure what to do as she already began a counseling relationship with the client. She understands this is a potential dual relationship, but she is concerned the client will be hurt or confused if she discovers Meghan has “unfriended” her. She doesn’t want to reject the client as a friend even if there is not a real friendship between them. • For your consideration: • What are the ethical and professional issues here? • What are the teaching challenges for the supervisor? • If you were Meghan’s supervisor, what options for ethical solutions would you review with her?

Privacy and Confidentiality The American Psychological Association, in its social media/forum policy, clearly states: • “First and foremost, public social networks are not private. Some may be open only to invited or approved members but even then, users should not expect privacy among the members. If you choose to participate on such Forums, assume that anything you post will be seen, read, and open for comment. Anything you say, post, link to, comment on, upload, etc. , can and may be used against you by your peers, colleagues, employer, potential employers, fellow members, and so on” (APA, 2016).

Agency Policies & Procedures • Provide a written social media policy and consent form that clients must sign • Use privacy settings on social media accounts whenever possible • Check with state licensing board to stay current on rules and regulations • Have separate social media accounts for your professional and private life • Remember… your mom, your clients and next door neighbor see your posts on social media

Privacy & Confidentiality • It should be noted that privacy in a therapeutic setting has two aspects: • Privacy of the client • Privacy of therapist (seldom discussed or tended too) • Both aspects are relevant to therapeutic process. Ethical principles generally address the former, but rarely do they address the latter.

“The monster has gone digital, be careful what you instagoogle and tweetface” Movie Triple 9 Woody Harrelson

Everyone Is Communicating With New Technologies • Our ethical obligation is to be thoughtful about how the code of ethics applies to these communications…. and • Understand how state and agency rules and regulations apply • David Kaplan, ACA -- Counselor should always be asking themselves not “is it okay for me to use social media’’ but rather “is this particular tool the best way to help this specific client with this specific need”

Steps to protect privacy in social media. Barnett (2010) recommends some steps that can be taken to protect clients’ privacy in the course of using social networking services: • Make thoughtful decisions about who you accept on your friends list and thus, grant access to your personal information. • Consider using some form of restrictions to your online profile such as utilizing private or friend-only access or using a pseudonym. • Keep in mind that whatever you share online may be available to numerous individuals and once out there, it can’t be taken back.

Steps To Protect Privacy In Social Media 2 • Consider online relationships as similar to in-person ones with clients and former clients. Don’t overlook the potential impact of online relationships on the professional one. • Never access a clients’ personal information without obtaining permission. Ensure they understand the potential impact of online disclosures on the psychotherapy relationship. • Utilize your profession’s ethics code and consultation with colleagues to guide decision making. • Create a policy for the use of social networking sites, share this with clients who ask, and follow it carefully.

Boundaries and Multiple Relationship • The second most obvious concern in a discussion of psychotherapy ethics and social media is the potential threat to the maintenance of therapeutic boundaries within the context of a therapy relationship • Boundaries are instrumental in defining relationships. Clear boundaries are necessary in order for both therapist and client to understand the nature and purpose of their relationship with each other • Closely related issue is the ethical requirement that therapists refrain from engaging in multiple relationships • If a therapist and his/her client are interacting ________________________________________

Scenario 2: Boundaries and Multiple Relationships (Adapted from Shallcross, 2011) • Susan, a counselor in private practice, was flattered upon receiving an evite via her Facebook page to a client’s long awaited graduation. Choosing whether to accept or decline the invitation was no simple decision, however. • Susan was keenly aware that engaging in contact with a client outside of the counseling office could have ethical consequences. But she also knew the ethically “correct” answer could only be reached by weighing the best interests of her client. So, when the client came in for her next session, Susan opened the discussion by addressing the situation. She asked the woman to think about how it might feel to have her counselor present at the graduation.

Scenario 2 continued • The client had been coming to Susan for a year and a half. During that period, the client had been working full time while simultaneously earning a bachelor’s degree. She had sought out counseling mainly for career issues, but she and Susan had also discussed issues surrounding the client’s relationship with her husband. If Susan attended the client’s graduation, the likelihood existed that she would meet the woman’s husband family. Might that lead to questions about the client’s counseling work that the client wouldn’t want to deal with on her graduation day? • For your consideration: • What are the potential consequences of attending? • What are the potential consequences of not attending? • Who should make the decision about whether or not Susan will attend the graduation – the client or therapist?

Boundaries • One of the mainstays of ethical practice and effective therapeutic practice is the maintenance of clinical boundaries in therapy distinguish psychotherapy from other types of relationships. Confusion about therapist-client relationship can only interfere with the goals and process of psychotherapy. • A client who views therapist as friend, lover, or business associate – anything other than the source of professional help – is likely to have difficulty making use of therapeutic alliance. In consideration of the implicit power imbalance that exists between therapist and client, the burden of responsibility for maintaining boundaries always falls upon therapist.

Boundaries • Making the distinction between personal and professional space is both difficult and important. Kolmes (2010) offers the following: “Our personal activities are not subject to the ethics code of our various professions. However, if you use your Facebook profile to establish your professional identity or to attract, connect, or interact with potential or current clients and colleagues, your Facebook presence has become part of your professional space. This means that legal and ethical provisions may now apply to your online activities. Be aware that professional relationships come with legal and ethical responsibilities that do not cease to exist just because you are on a social networking site. ”

Boundaries A further distinction that needs to be made here is the difference between a boundary crossing – which may or may not be harmful to the client – and a boundary violation – which is by definition harmful to the client. This distinction will be important as we examine the impact of various types of social networking interactions.

DEFINING BOUNDARIES • Boundary Violations - occur when therapist (workers) cross the line of decency and violate or exploit their clients • Boundary Crossing - often involves clinical interventions, such as self -disclosure, home visit, non-sexual touch, gifts or bartering

GREY BOUNDARIES • There are the “grey areas” around professional boundaries that require the use of good judgement and careful consideration of the context---for instance: • Hug a client • Terms of endearment • Gifts

NASW codes Social workers should not engage in dual or multiple relationships with clients or former clients in which there is a risk of exploitation or potential harm to the client. When dual or multiple relationships are unavoidable, social workers should take steps to protect clients and are responsible for setting clear, appropriate, and culturally sensitive boundaries (NASW, 2008).

APA codes A multiple relationship occurs when a psychologist is in a professional role with a person and: • at the same time is in another role with the same person, or • at the same time is in a relationship with a person closely associated with or related to the person with whom the psychologist has the professional relationship, or • promises to enter into another relationship in the future with the person or a person closely associated with or related to the person.

Boundary Summary • It seems clear that multiple relationships are of interest in the ethics codes of most major professional organizations. • Are they innately hazardous for client and therapist? • _______________ • Are they cause for ethical alertness and introspection? • _____________ • Are concerns about multiple relationships likely to turn up in social media interactions? • _______________

Multiple Relationships “A client making a Friend Request on Facebook is asking therapist to engage in a secondary social or professional relationship in addition to therapeutic one. If therapist accepts the Friend Request and allows the client to be privy to personal information on the profile and to post comments of a personal nature, this constitutes a social multiple relationship. Similarly, if therapist accepts the Friend Request and allows the client to post comments of a collegial or business nature, this also constitutes a professional or business dual relationship. ”

Non-multiple Relationship “If therapist accepts a Friend Request to post on a profile, which is strictly professional or if therapist allows, through the use of privacy controls, clients to view only professional information and postings on the profile, this would likely not constitute a dual relationship. As long as therapist has not established a secondary relationship, such as a social, collegial or professional relationship with the client, the sheer capacity of the client to follow' therapist's profile or Page online does not constitute a multiple relationship because a secondary relationship was not established. The client, in this case, has only one role, that of the client and patient and is neither colleague, nor business partner, nor a friend of therapist. ”

Wrapping Up - - Boundaries and Multiple Relationships in SNS Interactions There are essentially two aspects to managing boundaries and multiple relationships in a social media setting: • The first step is to engage in a process of deciding whether or not to use social networking as part of professional practice. • If the answer is “yes, ” then there remains a daunting process of digging into the can of ethical worms and sorting out the risks and the benefits. Then proceed to step two. If the answer is “no, ” then go directly to step two. • Step two is to develop a social media policy for your practice and incorporate it into your informed consent process.

Competence • Does the world of social networking introduce a new area of cultural understanding and competence? IDK LOL LMFAO • Competence is an ethical requirement demanded of professionals, by which they are expected to carry out professional activities only within the boundaries of their training, expertise, and knowledge. S-3

Scenario 3: Competence • Your new adolescent client, with whom you just started therapy, is immersed in Facebook, which is virtually her only connection with her peers. She is quite awkward in school, and her friends are limited to those she has made on Facebook. She has never met any of them in the “real” world. All of her conversations are peppered with Facebook jargon, and you are having trouble comprehending much of what she says. She is becoming frustrated with having to stop and explain everything to you. For your consideration: • What are the ethical competency issues here? • What are therapeutic relationship issues here? • What course of action do you think you should take at this point (keeping ethical competency issues in mind)?

Competence • A competent practitioner working online will always adhere to at least the following minimum standards and practices in order to be considered to be working in an ethical manner. • Practitioners have a sufficient understanding of their Ethics Codes and Social Media and can integrate how they relate to professional conduct online. Practitioners are mindful that Social Media activity can blur the boundaries between personal and professional lives, and they take great care to consider the potential impact of these activities on their professional relationships.

Competence • Competence is not an either/or concept • Competence is always growing and changing • Staying current with literature & knowledge • Acquiring appropriate skills (CEUs, supervision, consultation, etc. ) • Understanding when referral is necessary due to inability to gain competence required

APA Code of Ethics - Competence • 1. 02 of the APA Code of Ethics describes the ethical functioning of psychologists in the realm of competence. • (a) 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. • (b) Where scientific or professional knowledge in the discipline of psychology establishes that an understanding of factors associated with age, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, or socioeconomic status is essential for effective implementation of their services or research, psychologists have or obtain the training, experience, consultation, or supervision

Achieving and Maintaining Competence in SNS Interactions • If you are using – or considering using – Facebook or other social networking systems in conjunction with your professional activities, you will need to go farther with your education than simply reading the ideas discussed today. You may need to consider hiring a consultant, one with extensive training and experience, or ask advice from a digital native. • At least for those of us socialized and acculturated in the physical world of the 20 th century, cyberspace and its planets Facebook and Twitter are indeed alien environments. We are confronted with different language, different cultural norms, strange denizens, and unfamiliar forms of social interaction. Fumbling though it all untutored, we are likely to encounter unexpected and unpleasant results.

Friending • A complex challenge facing therapists –how to respond when receiving a friend request from a client • That one little button creates a cascade of questions concerning a broad spectrum of ethical issues. • Kolmes offered this view “Inviting clients to your personal profile can also be perceived as inviting them into your personal life. If you would never think of inviting a client to a cocktail party at your home with your friends and family present, then you may want to think twice about inviting them to be your friend on Facebook (or approving their friend requests). S-4

Scenario 4: Friending • Your new client is 20 -something and a highly socialized digital native. As a digital immigrant, you acknowledge limited comprehension of social networking systems and have not considered using them in any way in conjunction with your therapy. A couple of years ago, you reluctantly established a Facebook page and profile at the urging of your son, but you have done nothing with it since. • Your client is very enthusiastic about Facebook and tells you that you and she could save a great deal of therapy time if you would just visit her Facebook page. There, you could read all about the issues she plans to discuss with you in therapy. She states that she is going to send you a friending request so you can get started right away. For your consideration: • What are the boundary issues here? • What are therapeutic relationship issues here? • Do you have policies that address Facebook friending?

Friending Policies • Iaura Hahn, a counselor in private practice, suggests that therapists refrain from friending clients on Facebook. “Make it a policy by adding a statement to your informed consent documentation and inform your clients up front. For your Consideration • Do you have this type of information in your consents? • Does your personnel policy address SNS use? • Who’s your BFF ? ?

Handling Friending “Some clinicians believe that friend requests from clients should be evaluated on a case-by-case basis, stating that particular treatment issues may make it reasonable to accept some requests. Some feel that declining requests from clients can be perceived as a rejection. Choices on how to manage this may also be influenced strongly by theoretical orientation, age, and cultural contexts. My belief has always been that adding clients as contacts is a big enough threat to both confidentiality and the boundaries of therapeutic relationship to justify a blanket policy of not accepting such requests. ” Keely Kolmes (2010)

American Counseling Association (ACA) The American Counseling Association (ACA) Code of Ethics recognizes that there are ways to maintain your professionalism while using social media. However, the Code of Ethics specifically prohibits personal “virtual” relationships with current counseling clients. This includes friending or following clients on social networking sites via your personal account or profile.

Informed Consent • The discussion between therapist and client that takes place early in therapy, ideally in the first session or two, in which all of the aspects of therapy are discussed so that the client knows – up front – what to expect at each juncture. This is not a time for generalities. It is a time for details and what-ifs. The discussion takes as long as necessary and therapist’s policies should also be given to the client in writing. The informed consent process is described in a number of professional ethics codes. ) S-5

Scenario 5: Informed Consent • Bill a counselor in private practice, was flattered upon receiving an evite via his Facebook page to a client’s long awaited graduation. Choosing whether to accept or decline the invitation was no simple decision. He hears from his spouse that she knows – by way of a friend on Facebook – the client with whom you are working. She knows that the client has entered therapy with you, and why. Actually, your wife seems to know quite a bit more about your client than you do. You learn that the client is aware of the connection between your wife and you, and that she (the client) has been posting comments about her therapy sessions. For your consideration: • Do you have established practice policies that address issues like these? • Where and how do you publish your procedures and convey them to your clients? • How can the informed consent process help you with situations like these? • How can the informed consent process help your clients with situations like these?

APA Code of Ethics • Standard 3. 10 Informed Consent (a) When psychologists conduct research or provide assessment, therapy, counseling or consulting services in person or via electronic transmission or other forms of communication, they obtain the informed consent of the individual or individuals using language that is reasonably understandable to that person or persons… • 10. 01 Informed Consent to Therapy (a) When obtaining informed consent to therapy as required in Standard 3. 10, Informed Consent, psychologists inform clients/patients as early as is feasible in therapeutic relationship about the nature and anticipated course of therapy, fees, involvement of third parties, and limits of confidentiality and provide sufficient opportunity for the client/patient to ask questions and receive answers…

NASW Code of Ethics • 1. 03 Informed Consent (e) Social workers who provide services via electronic media (such as computer, telephone, radio, and television) should inform recipients of the limitations and risks associated with such services. • NASW discourages social workers from scoping out a client's social media profiles if they don't want to share. __________________

Informed Consent & The Use Of Social Media • Again…the purpose of the informed consent at the onset of therapy is to anticipate issues that are likely to come up and assure that the client understands and agrees to the parameters and limitations of therapy. Foremost among these are privacy and boundaries

Questions – Self Evaluation • By what means are therapist and client to communicate outside of therapy session? Cell phones? Email? Texting? • What are the privacy concerns posed by electronic communication? • What safeguards are to be put in place to guard against inadvertent privacy leaks? • During what hours are these communications to take place? (i. e. , handling of after-hours emergency calls/texts/emails) • What are the expectations of the client regarding Facebook friending? • What are the policies of therapist regarding Facebook friending?

Expecting the Unexpected - Informed Consent • One of the purposes of informed consent is to anticipate and plan for issues and events that may take place during the term of therapy. • However, no matter how thorough the planning, unanticipated issues inevitably come up and require further discussion. • Chance encounters on the Internet, Friends of Friends on Facebook, unintentional (or intentional) Google search results, misdirected text messages, cell phone calls or emails – sooner or later, one or more of these are likely to occur if therapy lasts long enough.

Advice for counselors/organizations Informed Consent • Provide written social media policy and consent forms that clients must sign • Use privacy settings on social media accounts whenever possible • Stay current with all rules and regulations with state licensing and certification boards

Developing Informed Consent Policy for SNS Interactions • The informed consent lays the groundwork, so that when an unexpected boundary issue pops up, therapist can refer back to the initial discussion: “Remember when we talked about…. ? ” Specific resources and suggestions for therapist policy statements and client handouts will be offered in the final section of this course.

Documenting and Maintaining Records Why is there a section on record-keeping in a course on ethics and social media? • There at least four reasons: v. Clinical v Ethical v Legal v Risk Management • For all four of these reasons, counselors/therapists are required to maintain confidential and secure records of therapy sessions, including all clinical contacts with the client. S-6

Scenario 6: Record Keeping • Your client, who is in crisis over a variety of distressing issues surrounding an impending divorce, has sent you a flurry of texts and tweets. They are arriving at all hours, expressing what he terms “urgent” issues. You have an appointment scheduled with him for the next morning, but you wonder about the clinical aspects of if/how/when to respond, confidentiality issues, and questions about how to chart the rapid-fire digital communications. For your consideration (aside from the clinical judgments, which are beyond the scope here): • Do the texts and tweets constitute “clinical contacts”? • What are the confidentiality issues here? • How do you decide whether and how to enter the contacts into the clinical record? • From a HIPAA standpoint, would you consider these to be routine notes or psychotherapy notes? • How would a risk management perspective influence your documentation?

Documenting Virtual Contacts • When communication leaves the physical world and enters the virtual world, the idea of what constitutes a “clinical contact” needs to be reevaluated. • Is a text or a tweet or a Facebook posting a contact. If so how is it noted in the treatment or clients records. • Most codes do not yet directly address this question • Zur (2015) basically states that phone messages, emails, texts etc. that have clinical or other significance should be considered part of the patients records ---- Note type of contact in the notes.

RECORD KEEPING According to the Record Keeping Guidelines of the American Psychological Association: • Records benefit both the client and the psychologist through documentation of treatment plans, services provided, and client progress. • Record keeping documents the psychologist’s planning and implementation of an appropriate course of services, allowing the psychologist to monitor his or her work. • Records may be especially important when there are significant periods of time between contacts or when the client seeks services from another professional. • Appropriate records can also help protect both the client and the psychologist in the event of legal or ethical proceedings. • Adequate records are generally a requirement for third-party reimbursement for psychological services.

Record Keeping Two Legal Considerations in the area of clinical documentation • First, HIPAA privacy legislation • Second, state laws regarding record-keeping by licensed mental health professionals

Documenting Social Networking Interactions • Zur’s 5 - step approach to saving text messages deemed to be relevant clinical communications: 1) Therapists can forward text messages to their own email address. 2) A service such as Google Voice can record and save phone text messages. Therapists can simply set it up and give that number to clients and then will have a record of all texts. Again, security concerns are worth taking into account with all such services. 3) The service Missing Sync connects therapists' phones to their computers and backs up (archives) the text messages. 4) Another option is to use an online for-fee service, such as Treasure My Text. This service stores the text messages online by allowing for simple uploads of messages via text. 5) Lastly, some cell phones, such as i. Phones, allow therapists to take screen-shots of their text messages and then send to their email address as an attachment. • Note: 2, 3, and 4 involve online services with the inherent vulnerabilities that such services provide. Verify issues of security, privacy and confidentiality before you use these products and employ Informed Consent as necessary.

Record Keeping • Privacy and security issues associated with online communications are still/always being integrated into ethical standards. • Ensuring protecting identities of therapist and clients and guarding against unauthorized access to sensitive data. • ACA actually has a code “The use of technology in mental health: applications, ethics and practice” which provides guidance on matters as informed consent.

Two Sets Of Rules When Implementing Technology 1. HIPAA rules for maintaining privacy and data security 2. Professional Codes of Ethics

Is Texting a Pandora’s Box of HIPAA Violations? • According to the Zur Institute, texting may be the easiest way to contact young and adolescent clients, but it’s not without risks. • Traditional SMS messaging platforms are typically not secure enough to transmit e-PHI. • Be read by people other than the intended recipient. • Be forwarded to others. • Remain unencrypted on telecommunication providers’ servers. • Remain on the phones of both the sender and recipient. • Having said that, there are services that offer encrypted text messaging for healthcare practitioners. If you work primarily with young clients, this may be worth exploring

Tips for Using Social Media To avoid losing your social worker license and facing malpractice lawsuits, be sure to follow these tips for using social media: • Assume that all your social media activity is public. Even if you delete a post or tweet, it only takes one screenshot to ensure it lives on forever in Google’s endless memory. • Don’t post about your clients. This is especially true if you’re tempted to write something negative about them or about their specific case. Confidentiality is one of the pillars of social work, and you can harm your clients’ trust. • Posting inflammatory comments and suggestive photographs online may harm your credibility in the field. • Keep your professional and personal social media accounts separate. You might even use a pseudonym for your personal account so you can post with more anonymity. • Don’t add clients to your social media networks. It opens the doors for a personal relationship, which is a conflict of interest. • Don’t use location check-ins when you’re in the field. It may inadvertently jeopardize your client’s privacy.

Privacy and Confidentiality 1. Educate yourself about the privacy settings on social media sites 2. Educate yourself about the privacy risks on each site 3. Decide whether to participate in social networking services or not 4. Be realistic: the nature of social networking is to publicly propagate information Privacy and Confidentiality 5. Think carefully before you make any personal information online 6. Remember that whatever you share online may be available to numerous individuals 7. Remember that whatever you share online can’t be taken back 8. If you do choose to participate, use all available privacy restrictions 9. Expect to encounter unexpected permutations of privacy issues online 10. Develop well-considered social media privacy policies for your practice 11. Incorporate your privacy policies into your informed consent process 12. Google yourself now and then; you need to know what is out there about you

Boundaries and Multiple Relationships 1. Understand how social network interactions can threaten therapeutic boundaries 2. Be aware of the distinction between a boundary crossing and a boundary violation 3. Stay alert for the blurring of roles that occurs in social media relationships 4. Stay alert for the online disinhibition effect; you are not immune 5. Be watchful for boundary issues that arise through no direct action of your own; e. g. , connections through a Friend of a Friend 6. Become expert on the difference between multiple relationships and non-multiple relationships 7. Remember that multiple relationships extend to relationships your family and close friends have with others 8. Expect to encounter unexpected permutations of boundary issues online 9. Develop and publish well-considered social media boundary polices for your practice 10. Incorporate your policies into your informed consent process

Friending 1. Be aware of the many complex issues that are precipitated by friending requests 2. Learn about the “upsides” and “downsides” of using social media in psychotherapy 3. Decide whether or not to maintain a Facebook presence at all 4. Remember that the whole issue of whether to friend can be a minefield 5. Be prepared to discuss friending issues in therapy sessions 6. If you use Facebook, segment your list of friends into limited profile contacts 7. Be aware of transference and countertransference issues 8. Refer back to issues of privacy, multiple relationships, and competency 9. Expect to encounter unexpected friending issues 10. Develop and publish well-considered friending polices for your practice 11. Incorporate your policies into your informed consent process

Competence 1. Study the competence section of your professions’ code of ethics 2. Assess your own digital competence: are you a digital native or a digital immigrant? 3. Prior to entering each social media portal, assess your level of competence 4. Consider using a consultant 5. After learning the competencies you think you need, proceed with caution 6. Expect to encounter unexpected operational changes on social media websites

Informed Consent 1. Become familiar with your profession’s informed consent ethical standards 2. Anticipate social networking issues that may come up in the course of therapy 3. Study model psychotherapy practice policies, including social media policies 4. Write a comprehensive policy for your practice and follow it carefully 5. Publish your practice policies in whatever media you use in your practice 6. Make your published policies the outline for your informed consent process 7. Incorporate your informed consent into the first session or two with each new client 8. Document the details of the informed consent discussion in your case notes

Record Keeping 1. Become familiar with your profession’s ethical standards on record keeping 2. Become familiar with your state’s licensure laws and rules on record keeping 3. Become familiar with HIPAA privacy laws regarding patient health information 4. Take a risk management approach to record keeping 5. Develop a method for deciding which social media interactions are clinical contacts 6. Decide which clinical contacts are “Routine Notes” vs. “Psychotherapy Notes” 7. Carefully consider what to record and how to record it

SNS Technology Take Home • Technology is always evolving, and with it, so are your risks. That’s why if you take away anything from this guide, it should be this: stay up to date on regulations. • When you aren’t sure what the best course of action is, consult the endless resources offered by your industry’s professional associations. • When you comply with what your industry states is the accepted standard of care and conduct, you reduce the likelihood of professional negligence lawsuits and other repercussions. • Lastly, be sure to stay informed about the latest technological developments that your practice may implement. HIPAA places the responsibility on you to create reasonable security practices, which means new technology may signal that it’s time to revisit your risk management policies and revise accordingly

ETHICAL NAVIGATION OF: SOCIAL MEDIA, TEXTING, TWEETS AND SNAP CHATS • Identify threats to privacy and confidentiality involved in the use of social media • Identify boundary and multiple relationship issues involved in the use of social media • Identify social media issues that should be included in the informed consent • Understand record keeping challenges posed by the use of social media sites, texting and tweets • Review how privacy and boundary issues that can arise from social media use • Discuss competence issues involved in the use of social media • Look at the development of a social media policy

ETHICAL NAVIGATIONAL GOALS • Participants will be able to clearly evaluate the use of social media as an aid or detractor related to professional boundaries. • Participants will be able to apply critical thinking related to the use of social media. • Through practice participants will be able to establish baseline policy related to social media. • Understand the expansion of the community related to social media. • Learn to appropriately evaluate the use of social media in therapeutic relationships. • Participants will gain a generalized understanding of the ethical dilemmas that comes with the use of social media in counseling relationships and business.

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