CONSULTATION &TRAINING INSTITUTE Professional Ethics: Facing some new challenges April 5, 2012 Presented by: Gary R. Schoener, M.Eq., Licensed Psychologist Director of Consultation & Training
Ethical Framework• Beneficence– doing good; helping• Non-maleficence –avoiding harm• Autonomy – client’s input and role• Fidelity– consistent with what promised• Justice-- welfare of client vs. others (e.g. duty to warn); equitable use of resources – having a basis to proportion them
Ethical Decision-Making• It is often not what is ethical vs. unethical, but the comparative ethicality of the options• This involves weighing which principles are best dealt with through one option or another• What are the likely positive vs. negative outcomes of choosing a given course of action?
Decision table or chart Positive Outcomes Negative Outcomes Option A ______________ _________________ ______________ _________________ ______________ _________________ Option B ______________ _________________ ______________ _________________ ______________ _________________
Electronic records• As of 23 January 2012 US major healthcare information privacy breaches are 19 million records in 385 major HIPAA - reported incidents (each affecting 500 or more) since Sept. 2009 (2 ¼ years)• Minn. Attorney General Lori Swanson has announced a lawsuit against Accretive Health Inc., a debt collection agency, or its role in a breach impacting 20,000 patients at North Memorial Health Care & Fairview Health Services. Data was on an un-encrypted laptop stolen from a parked rental car.• It is recommended that all devices be encrypted, even those which are not supposed to be used to transport data, since people get careless
Challenges of private knowledge• CASE 1: You have a case with severe abuse. You visit your sister and notice the family lives next door, and her kids are going over to play in the abuse house. What actions do you take if any?• CASE 2: Your brother brags to you how he fooled child protection into closing a case, by threatening his wife and kids to deny the complaint. What action options are there? What if any should you take?
Traditional Boundaries withregard to Information Access• Clienthas access to information about the professional based on published biography or revelations, news items• Professional only has access to information about client from disclosures or access granted through signed releases
Variability between staff incommunity programs• Role – staff who are in the community with client or who spend more time with client• Client expectations depending on role• Do you transport the client?• Recovery groups• Where do you live?• Other areas of social activity, politics
Realities of a small community• You and client belong to same church, same social club, same athletic club• Client lives in same building as a friend of yours – what are the issues?• Client interacts with a member of your family, possibly without knowing the connection;• Former client interacts with you or a friend or family
Traditional Concepts ofCommunication• Communication by traditional mail (now called “snail mail”);• Communication by phone during limited business hours;• Leave messages on answering machinesfor later response;• Phone calls private, although a message left might be saved;• Quick response not expected or promised
Communication in today’s world• Expectation of being able to connect at all hours, even when professional is away from office, via cell phones, texting, etc.• Same is true for emails;• Emails and text messages create a record;• Emails can be misdirected or examined by others– need to warn people about employer access to work computers
Challenges of Cell Phones&Hand-Held Devices• Do you have separate personal & professional phones/blackberry’s, etc? it’s a challenge to have two, but a growing number of programs are providing them• Do you accept or receive calls? Is your number blocked? Will your call be accepted if you are trying to contact client? Can client get your home #?
Text Messaging• A growing number of people do texting instead of (or in addition to) emailing;• This is an abbreviated type of message with less information;• This the only way to quickly reach people;• Unlike a phone call, it is silent, so people can receive and view a text without the ring of a phone
Text Messaging (continued)• Veterans Crisis Line (800) 273-8255 or text to 838255http://veteranscrisisline.net• Crisis Connection has a program for texting in 7 counties in northeast Minn. – they are receiving more texts from young people in a day than they previously received as phone calls in a month.
Smartphones & Tablets & Apps• The Therapist May See You Anytime, Anywhere (NY Times, 2/13/12)• Cognitive bias modification (CBM)using an app for social anxiety which directs attention away from hostile faces• Nader Amirat San Diego State – 30”/week for anxiety disorder• Daniel Pine at NIMH – 40 children with chronic anxiety
Smartphones & Tablets & Apps• European psychologistshave tried a BMP aimed at heavy drinking – people pushed away images of alcoholic drinks & zoom in on non-alcoholic ones – aids therapy• How to decide an recommending an app• How and when to ask client to use an app• Implications of doing this with an app that the therapist designed or invented or sells
New Hazards• Client messaging about things during session/activity – distracted? In group is there a breach of confidentiality?• Cell phones can film sessions – Staff privacy rights?• 63% under 30 drove while using hand-held phone; 30% texted• 5,500 people in US were killed in distracted driving accidents in 2009
Social Networking Sites• Facebook -- >500 million users• 92% of SNS users are on Facebook;• 50% log in on any given day;• Facebook – “friend” vs. “deferred”?• Posts from you, friend, relative, kid• 29% use MySpace; 18% Linkedin;• 50 million Twitter – 13% of SNS
Personal Exposure• CASE 3:Professional has gone through a divorce – something his/her clients don’t know – they presume he/she is married• Some clients are working on issues of relationship fidelity, etc.• Professional wants to sign up for a social dating site, but is worried that a client will be asked about dating them• What options are there?
More visibility issues• If you use a family photograph on Facebook, even with the highest privacy settings people see that photo;• Even if you don’t show your family to the world, friends or family may show your photo or a family activity;• 90% of US physicians are on Facebook or Linked in or some social media.
Hazards Never Imagined (for staffor even clients)• Happy slapping– assaulting someone while others film it (usually on cell phone)• Sexting – sending racy photos of yourself or someone else• Filming and/or broadcasting a party, or other event• Live broadcast using cell phone or camera (privacy invasion case – Tyler Clementi suicide at Rutgers – Dharun Ravi, age 19, convicted in Feb. 2012. Awaiting sentencing)
Hazards Never Imagined (cont.)• Fake profiles• Internet harassment – which can lead to great distress the same as any type of bullying (1/3 to 1/2 of adolescents?);• Fake emails & chat screen names– so one can harass secretly;• Massive Defriending– being shut-out by groups of friends or classmates on a social networking site such as Facebook
Undressing your Friends (orenemies)• FalseFlesh.com, billed as “adult image editing software” allows you to paste someone’s face onto a nude body• “Easily make any picture a nude picture in minutes”
Cases to lose sleep over• Draker v. Schreiber(2006, 2008) two students created My Space site with fake photos trashing Asst. Principal – Anna Drakersued them and their parents without success;• Megan Meier, driven to suicide by “Josh,” created by the mother of a girl she was having a dispute with;
Cases (cont.)• Ryan Hallingan, middle school student with a learning disorder was the focus of bullying & suggestions he was gay. He hanged himself after a girl who claimed to be his friend told him publicly he was a “loser” and that she had been pretending to be just like him so she could post their conversations on line and humiliate him.
Cases (cont.)• GhyslainRaza, the “Star Wars Kid,” a Canadian adolescent made a video in 2002 pretending to fight with a light saber as a school project. Another student posted it, adding music, and 900 million saw it on the web. Raza was taunted repeatedly and dropped out of school. After treatment for depression he got support, some from the internet, graduated law school, and heads a foundation for preservation.
Cases (cont.)• Jesse Logan, Ohio teenager, sent nude pictures of herself to her boyfriend. After they broke up he sent them to other girls who circulated them on line. She was called a slut & ridiculed and started skipping school. Jesse went public with her story via a TV interview in May 2008, but two months later hanged herself. A classic example of the dangers of sexting.
Cases (cont.)• 4/21/11 Buffalo, NY.Police invade home with assault rifles; throw man on floor; call him a “pervert” and “pedophile” and confiscate all computers and cell phones in the house including those of his wife and daughter. He did not have a passcode on his wireless router and it was utilized by someone nearby to download pornography. This can be done by neighbor, or from a car.
Other networking issues• Caring Bridge– sites related to illness: therapist’s illness?; posting on client’s bridge?;• Blogs -- posting responses;• Sites focused on special interests: • Client alerts you to site • You encounter client on a site • Former client alerts you to site
Google & Net Research• Should you “Google” a client? • Emergency Situation – identity issue; • Client denies suicide history but has prior attempts; • Reality check on claims by client; • Checking on criminal justice history; • Screening for sex offenders
Google & Net Research (cont.)• What if the client googles you? • Intern entering therapy googles her therapist and then wonders if she’s “blown it” by doing this. • What if they tell you? What if you suspect? • Sites that evaluate professionals – YELP has >25 million hits a month
Google & Net Research (cont.)• What about hiring or credentialing process – do you google candidates?• What about interns or candidates for supervision?• Do you disclose this practice?• If you stumble on information?• By 2010, 78% of US companies do internet searches on applicants; 86% say it influences hiring decisions
Google & Net Research (cont.)• Clients may interact with each other, adding complex dynamics to service delivery;• An angry client may create a website attacking the counselor, or counseling, or the program or therapeutic approach;• “Googlegangers” – people with same name – people can be mistaken about identity;• Anything on the internet could be false
Google & Net Research (cont.)• Facebook refuses to shut rape page run by schoolboy (Sunday Telegraph,10/17/11)• Compromise of psychological tests: • www.mindfithypnosis.com/free-mmpi2- online • www.hypnoticmp.3.com (Dr. Dobson) • Wikipedia entry on the Rorschach which shows 10 blots and reveals common responses
More Internet Research Issues• Clients & others may research medications, treatment methods, etc. on the internet. The impact varies with the accuracy of what they find.• Research has shown that searches about medications produce different results in the US vs. Canada – Canadians are sent to Wikipedia & drug company sites first
Professional Ethics: UnchartedTerritory• In certain circumstances there may be a good reason to do a search of a client. Steve Behnke, APA Monitor, V ol. 41, #7, July 2010• Googling a patient is not necessarily unethical – the key is that if you do it your actions should be in the patient’s best interest. Psychiatric News, Vol. 44, # 9, May 2009• Ethical analysis: Examine beneficence, non- maleficence, autonomy, fidelity, & justice issues before doing it
AMA Policy: Professionalism inthe use of social media• Refrain from posting patient information• Privacy settings; monitor internet presence• Appropriate boundaries with patient interactions on internet• Separate personal & professional content on line;• Confront or report unprofessional conduct on line• Can undermine reputation & public trust
Some thoughts• The internet creates a “small town”or ethnic subgroup for all of us;• With some areas of work such as criminal justice, there may be greater challenges – clientele, role of security;• Health care rating sitesare likely to grow and include more therapists – healthgrades.com, vitals.com
The Battleground• Section 230 of the Communications Decency Act: internet service providers have no accountability for anon. posts;• This area of law is evolving – some suggest having contract with client;• Firms and approaches are evolving for self- defense www.medicaljustice.com• Integrity Defendersworks at burying negative information w/ positive info.
The Battle Over Criticismon the Web• Second year law student Rockstar05 founded blog Thomas M. Cooley Law School Scam• School sought identity of Rockstar05 to sue for defamation – issue is privacy rights of internet commentators vs. plaintiffs• This case was complicated because company that hosts blog slipped up and revealed his email address
Self protection• Be aware of your web-presence • “Google” yourself • If there is false information, contact site administrator to get things changed• Should you control on-line presence by expanding it? Should you post your own www.google/com/profile?• Collegial discussion – develop standards
On line reviews• It’s hard to know what they mean – they are not systematic;• The data about your work or practice may be in error or outdates;• Many times there are only a few who do a review so there can be a heavy influence of just a few ratings• Consumers focus on manner – civility, perceived warmth, etc.
Accountability vs. Defamation• David McKee, Duluth, MN, neurologist sued the son of a former patient for defamation for statements made on websites alleging bad bedside manner in the treatment of his father.• Dr. McKee was called a “real tool” and alleged a callous attitude. This is not the only such case. It was dismissed although the Minnesota Supreme Court is currently hearing it.
Consent and Disclosure• What ground rules will you have for a given unit, program, or practice as far as googling?• If you do “Google” someone, will you disclose this to them?• What rules if any will you ask clients to follow as regards the internet?• Will you ask them to maintain any privacy or respect any boundaries?
Communications & SocialMedia Policy• Email: Email only to arrange or modify appointments. Do not email content or important things we should discuss face to face…..• Rating or review sites: Info. on them is questionable; I cannot respond to them and do not need positive ratings; ask me about any concerns you have about my services.
Communications & SocialMedia Policy (continued)• Text messaging: please do not use to contact me – leave phone message for time changes, etc.; email not as good but at ….• Internet interaction: do not use wall postings or other means of communication on the internet – none are private• Blog or Twitter: I do not follow you on either – if there are things you want to share, bring them to a session
Communications & SocialMedia Policy (continued)• Friending: It is my practice to not accept contact or “friend” requests from clients on social networking sites such as Facebook or Linkedin. They can compromise privacy and also complicate our helping relationship.• Website or Facebook Page: If you have questions, bring them in a session. Please don’t interact on the internet.
Communications & SocialMedia Policy (continued)• Search Engines:I do not research my clients on Google or other search engines. There may be occasions where you will direct me to look up something related to your life or experience, and if so we can discuss it at a future meeting. If you choose to check me out on the web I would note that not all information is accurate, and would suggest that we discuss anything which you find troubling.
Communications & SocialMedia Policy (continued)• Recording:Unless we have specifically discussed it, there will be no recording of our meetings or any phone conversation. All of our discussions are private.• Records: I will maintain the records of our work together as confidential although some billing-related information may be communicated securely. Please remember that any notes you make can compromise your privacy if not carefully protected.
Challenges for Licensure Boards• Internet services -- How will these new areas of knowledge and skills be assessed for licensing purposes?• Will Boards in any way regulate the creation of internet – based services?• In New Zealand there is an elaborate website to combat depression in young people: http://www.thelowdown.co.nz
Helping Clients or Staff who areVictims of Cyber bullying• Clarify what victim wants/needs• Reinforce that they are not at fault• Avoid victim-blaming by saying things like “you just need to be assertive”• Assist them in taking any action• Help with any underlying problems• Assist in improving healthy relationships
CONSULTATION &TRAINING INSTITUTEGary R. Schoener, Licensed Psychologist, M.Eq.Director of Consultation and Training2421 Chicago Avenue SouthMinneapolis, MN 55404(612) 870-0565 Ext. email@example.com.WalkIn.org