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Ethics Committee Resources to Manage the COVID-19 Crisis

To assist members in managing the challenges of the coronavirus crisis, the AASP Ethics Committee has compiled a resource document for you. The document contains important considerations when transferring service delivery to online platforms (i.e., competency, confidentiality, etc), links to ethics codes members may need to consider, tele-mental health guidelines, practice across state/jurisdiction lines, managing HIPAA changes, online platform considerations, and risk management strategies.

Important Issues to Consider

Competency:
Do you know what you are doing regarding use of technology and its potential impact? Are your clients tech-savvy? Are they comfortable accessing the platform? Do you know enough to help them troubleshoot when there are difficulties? Are you aware of the different features available to protect your client’s privacy? Are you aware of and know how to use the different features for document sharing or white boards?

Client/provider relationship:
How do you continue to develop that rapport with your clients? Are you able to read your clients such that you can see that this platform may or may not be the right fit? Are you comfortable with approaching your clients to discuss obstacles that may be occurring due to telehealth sessions?

Confidentiality:
Is the platform you are using HIPAA compliant?  Does it store/record any data? If they do, what is the data security that is in place? Is there a way you can turn this off? Is the meeting room you are in with your client secured? How do you prevent others from accidentally joining? Does the platform’s business level package offer more secure features than their basic?

Informed consent:
What are the laws? Potential privacy risks? Storing, accessing, and protecting information? What happens if the technology fails? Do you have a backup plan? Have you had your clients sign any paperwork acknowledging these potential risks?  Have they formally consented to telehealth sessions?

Testing/assessments:
How valid or reliable are they via an online platform? Is there someone there assisting the client that you cannot see? 

Resources for AASP Members

American Counseling Association. (n.d.). Telebehavioral health information and counselors in health care. Retrieved from https://www.counseling.org/knowledge-center/mental-health-resources/trauma-disaster/telehealth-information-and-counselors-in-health-care

American Psychological Association. (2020). How to do psychological testing via telehealth: New APA guidance offers six principles for conducting tele-assessments while social distancing. Retrieved from https://www.apaservices.org/practice/reimbursement/health-codes/testing/psychological-telehealth

American Psychological Association. (2020). Office and technology checklist for tele-psychological services. Retrieved from https://www.apa.org/practice/programs/dmhi/research-information/telepsychological-services-checklist

American Psychological Association. (2020). COVID-19 and psychological services: How to protect your patients and your practice. Retrieved from https://www.apaservices.org/practice/news/covid19-psychology-services-protection

Association for Applied Sport Psychology. (2011). Ethics Code: Ethical principles and standards. Retrieved from https://appliedsportpsych.org/about/ethics/ethics-code/

DeAngelis, T. (2020). What the COVID-19 telehealth waiver means for psychology practitioners. Retrieved from https://www.apaservices.org/practice/legal/technology/covid-19-telehealth-waiver

Greenbaum, Z. (2020). Ethical guidance for the COVID-19 era: Psychologists offer advice on ethical practice, research, teaching, and applied work as professionals across the field adjust to a sudden shift in working conditions. Retrieved from https://www.apa.org/ethics/covid-19-guidance

Jobes DA, Rudd MD, Overholser JC, & Joiner TE. (2008). Ethical and competent care of suicidal patients: Contemporary challenges, new developments, and considerations for clinical practice. Professional Psychology: Research and Practice, 39, 405–413. doi: 10.1037/a0012896

Kreuze E, Jenkins C, Gregoski M, York J, Mueller M, Lamis DA, & Ruggiero KJ. (2017). Technology-enhanced suicide prevention interventions: A systematic review. Journal of Telemedicine and Telecare, 23, 605–617. doi: 10.1177/1357633X16657928

Luxton, DD, O’Brien, K, Pruitt, LD, Johnson, K, Kramer, G. (2014). Suicide risk management during clinical telepractice. International Journal of Psychiatry and Medicine, 48(1), 19-31. doi: http://dx.doi.org/10.2190/PM.48.1.c

Mehta, S. (2014). Telemedicine’s potential ethical pitfalls. Retrieved from https://journalofethics.ama-assn.org/article/telemedicines-potential-ethical-pitfalls/2014-12

National Association of School Psychologists. (2020). Virtual service delivery in response to COVID-19 disruptions. Retrieved from https://www.nasponline.org/resources-and-publications/resources-and-podcasts/school-climate-safety-and-crisis/health-crisis-resources/virtual-service-delivery-in-response-to-covid-19-disruptions

Schwartz-Mette, R. (2020). Four pieces of ethical advice for practitioners during COVID-19: Turn to APA’s Ethic Code for guidance on shifting your practice during the pandemic. Retrieved from https://www.apaservices.org/practice/news/ethical-advice-practitioners-covid-19

Sitler, B. (2020). Update on the pandemic, opportunity to make an impact. Retrieved from https://www.nata.org/blog/beth-sitzler/update-pandemic-opportunity-make-impact

Stewart RW, Orengo-Aguayo RE, Gilmore AK, & de Arellano M (2017). Addressing Barriers to Care Among Hispanic Youth: Telehealth Delivery of Trauma-Focused Cognitive Behavioral Therapy. The Behavior Therapist, 40(3), 112 (ncbi.nlm.nih.gov/pmc/articles/)

Wangelin, BC, Szafranski, DD, & Gros, DF. (2016). Chapter 5 - Telehealth Technologies in Evidence-Based Psychotherapy in Computer-Assisted and Web-Based Innovations in Psychology, Special Education, and Health (pp. 119-140). https://doi.org/10.1016/B978-0-12-802075-3.00005-X

Zur, O. (n.d.) Professional association codes of ethics and guidelines on telemental health, e-therapy, digital ethic, & social media: Complete comparative list of different Codes of Ethics on a variety of topics. Retrieved from https://www.zurinstitute.com/ethics-of-telehealth/

Distance Services (i.e.,  platforms)*

Prior to beginning distance services, make sure to review the appropriate Ethics Codes related to technology use. 

Counselors:

Psychologists:

Social Workers:

HIPAA-Compliant Platforms

New regulations do not mean people can disregard HIPAA. The regulations are being more lenient on potential technology breaches. The vendors below provide HIPAA-compliant video communication products (you may need a specific subscription):

  • Skype for Business / Microsoft Teams
  • Updox
  • VSee
  • Zoom for Healthcare
  • Doxy.me
  • Google G Suite Hangouts Meet
  • Cisco Webex Meetings / Webex Teams
  • Amazon Chime
  • GoToMeeting
  • TheraLINK

HIPAA Resources

  1. APA Compares Doxy.me, TheraLINK, and Zoom
  2. Reference List: HIPAA Compliance for Telemental Health
  3. February 2020 Bulletin: HIPAA Privacy and Novel Coronavirus

Resources for Teleconsulting: 

  1. Tele-Mental Health Client_Assessment for Fit
  2. Overcoming the Awkwardness of Receiving Telehealth Services for Clients

Risk Management and Telehealth:
Other at-risk issues that may require additional management and ethical awareness during a time when folks are being asked to stay in their homes/communities where resources may be inconsistently available:

  • Safety/Violence/Domestic Abuse
  • Substance Use
  • Food Insecurity
  • Illness (COVID-19 or otherwise)
  • Mania 
  • Acute Stress Disorder
  • Family/Friend Death (COVID-19 related or otherwise)
  • Major Depressive Episode 
  • Schizophrenia 

Resources: