Ethics and professionalism in telemental health: next level accountability

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The practice of telemental health is rapidly growing. As its popularity and availability increase, the expectations for its practice grow with it.

Traditional standards of practice were established around the in-person therapy model. Now that telemental health has arrived, adherence to those standards and practices is being challenged and redefined. Regardless of the mode of service delivery, one thing remains constant: adherence to ethical practices and professionalism remain the same.

In some ways, ethical practices and professionalism are even more important in the virtual space because the client is not literally in front of you. Telemental health brings with it a host of benefits, risks and considerations that every clinician must be mindful of and address accordingly.

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Ethical Practice in the Virtual Space

“Ethics is knowing the difference between what you have a right to do and what is right to do.” --Potter Stewart

The fact is that the same technology that makes telemental health possible carries with it a number of areas of risk.¹ Some of these areas are of particular of concern for therapists and their clients. It is up to you as the professional to be mindful of these and to know the best practices for dealing with them.

Know and Follow the Rules

Telemental health is evolving and as it does, various disciplines and regulatory agencies are setting standards and expectations for their members/licensees.² However, there is no current, single set of ethical standards or guidelines for telemental health that encompasses all disciplines. Each entity is defining its own set of standards.

A good rule of thumb is to know and follow your licensing board’s requirements as well as that of any other regulatory agency that has oversight for your practice privilege.

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Understand and Choose Your Technology Carefully

Not all technology is created equal. Just because it requires a log in and is used behind closed doors does not make it secure. Despite the fact that they may “feel” private and secure, regular email, texting, cell phones and online video chat apps are generally not HIPAA-secure.

It is up to you to choose video conferencing platform for telehelath, e.g. telemental health that is HIPAA-secure and poses the least risk for breach. If a client’s data is breached, “I didn’t know” will not protect you from sanctions.

TheraPlatform is a secure and HIPPA compliant platform that you might want to consider for your teletherapy needs: www.theraplatform.com

Confidentiality and Privacy

Of course, confidentiality and privacy are of concern in any therapeutic engagement. When telehealth is added, there is an additional level of awareness and risk management to be exercised.

Any type of electronic interaction carries with it the risk of being breached. As the clinician, it is important that you be aware of the risks posed by any type of technology you use and take steps to manage the security and integrity of your systems. Always strive to use systems, such as video conferencing that are HIPAA-secure and adopt policies and procedures that minimize the risk of data breaches.³

Informed Consent

Just as you would in your in-person practice, you need to obtain informed consent for your telemental health clients. Clients need to know the risks, benefits, process and limitations specific to telemental health so that they can make an informed choice.^2,4

Make sure you obtain and clearly document informed consent.

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Working Within Your Scope of Practice

It might be tempting to jump on the telemental health bandwagon. Don’t. Telemental health requires a specific set of skills and understanding of the technology.

Take the time to get trained and then get comfortable with using your chosen platform and tools. You don’t want your first misstep and possible breach to be with an actual client. Train and practice before you take that next step.

Professionalism in the Virtual Space

“You never get a second change to make a first impression.” – Will Rogers

Never have those words been truer than for therapists working in the virtual space. As flexible and relaxed as online work can be, one thing holds true no matter what: you are a professional. How you present and conduct yourself in front of your client is important. Professionals dress up, show up and come prepared to each and every session.

A good rule of thumb is this: would I do this if I were seeing this client in my office? If you even have to think about it, the answer is no.

Dress Appropriately

As tempting as it may be, pj’s are not appropriate office attire. You might love your jammies with the sheep sleeping on clouds but your client will not. A suit or dress may not be necessary but you want to present yourself in a professional manner and dressed in attire appropriate to the situation. In this situation, business casual is probably a happy medium.

No Snacking Allowed

Eating, crunching and chewing will be picked up quite easily on an open mic. That noise can be distracting and annoying. And you certainly don’t want your client to see and hear you with a mouthful of food on camera. Your client needs to know that you are 100% focused on them and the discussion at hand. Of course, it’s ok to have water nearby and take a quick sip as needed.

Minimize Distractions

If you’re working from home, it’s important to maintain good environmental hygiene. What’s that mean? It means you strive to minimize outside noises, disruptions or worst of all, intrusions into your home office space during a client interaction. (Then you have an ethical issue and a violation of confidentiality to contend with.)

If you have pets, be sure they are elsewhere. Barking dogs or cats strolling across your keyboard in front of the camera is distracting.
If you have kids at home, be sure to arrange for their care while you’re working.
Make sure everyone in the family knows when you’re working online. A sign on your door can let them know you are in session.

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See Through the Eyes of Your Client

Have you ever looked at what your client sees when they are online with you? Do they see a blank wall? Do they see piles of paper or books? You may LOVE your flowers and stripes wallpaper. But how does that look on camera? Turn your webcam on and look at the window with you in it. That’s what your client sees.

The fact is, some things look better on camera than others. You want your client to see a background that is professional and calming. Maybe they see your license. Neutral or soothing colors such as light blue work well. No you don’t have to repaint your space or remove everything but at least consider where you sit.

Before you embark on a telemental health practice, take the time to think it through. Consider the value, benefits and risks for you and for your client. Take the time to research and choose tools that are HIPAA-secure. Invest the time to enhance your skills so that you are ready to deliver competent, ethically-sound and client-friendly services.

References

1. Moghbeli, F., Langarizadeh, M., & Ali, A. (2017). Application of Ethics for Providing Telemedicine Services and Information Technology. Medical Archives, 71(5), 351-355.

2. Telebehavioral Health Institute. (n.d.). Telebehavioral Health Statements.Standards,Guidelines,Best Practices. Retrieved from telehealth.org

3. Torous J, Roberts LW. (2017) The Ethical Use of Mobile Health Technology in Clinical Psychiatry. The Journal of nervous and mental disease, 205(1):4–8.

4. López, C. M., Qanungo, S., Jenkins, C. M., & Acierno, R. (2018). Technology as a means to address disparities in mental health research: A guide to “tele-tailoring” your research methods. Professional Psychology: Research and Practice, 49(1), 57-64.