Part 4 - Ethics and Boundaries Tutorial


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Reach Out Pro Module - Connecting Our Worlds
Part 4

As with any therapeutic intervention, the use of technology in clinical practice is not without its ethical and professional difficulties. This part of the education module has been developed to help you understand and address the professional and ethical issues that arise from using technology in your work with young people.

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Part 4 - Ethics and Boundaries Tutorial

  1. 1. Module Part 4 Professional issues & guidelines Part 4 – Using technology in practice with young people: Professional issues, boundaries, privacy and guidelines Connecting Our Worlds Educational Module Part 4 – Professional issues & guidelines
  2. 2. Module Part 4 Professional issues & guidelinesIntroductionAs with any therapeuticintervention, the use of technologyin clinical practice is not withoutits ethical and professionaldifficulties. This part of theeducation module has beendeveloped to help you understandand address the professional andethical issues that arise fromusing technology in your workwith young people. 2
  3. 3. Module Part 4 Professional issues & guidelinesLearning In completing Part 4, you will gain an understanding of:Objectives • How to maintain professional boundaries when using technology;In completing Part 4, please note that the evidence for • The ethical issues including privacy,technology in therapeutic interactions is still emergingand that this part of the module is not exhaustive in its confidentiality, security and use;coverage. We have aimed to address common ethicalissues and professional challenges, but there will beoccasions when issues arise that are not covered. When • How to manage concerns associated withthis does arise, we encourage you to consult the using technology.professional and ethical guidelines of your organisationand professional association for guidance. 3
  4. 4. Module Part 4 Professional issues & guidelines • Using new technology can potentially challenge your understanding of professional boundaries.Maintaining • Due to reduced interpersonal boundaries online, the professional relationship can seem to blur.professional • Professional boundaries need to be just as clearly definedboundaries in the digital world and should mirror that of face-to-face the digital world • Understanding how best to manage professional boundaries is crucial to both the young person’s and the professional’s safety. • These expectations need to be clearly defined early in contact with clients. 4
  5. 5. Module Part 4 Professional issues & guidelinesSetting boundaries• In order to establish and maintain • In addition to these factors that are professional boundaries, expectations shaped by interactions with clients, need to be set with clients about; healthcare professionals also need to consider; – How often clinicians will check electronic communications and – The impact of private online when they will respond; behaviour on professional life – The clinical issues relating to – The safety of online material privacy, confidentiality, security and appropriate use; • These points are discussed throughout this module. – Management of risk behaviour. 5
  6. 6. Module Part 4 Professional issues & guidelinesClinical issues • The following section provides an outline of key issues when using technology to communicate with your clients. Whilst we have attempted to address the key issues, this list is by norelating to privacy, means exhaustive and may not cover all the issues you face within your organisation and practice.confidentiality, • If you are unsure about how best to manage an issue raised when using technology in your consultations, it issecurity and use recommended that you refer back to the ethical guidelines for your appropriate professional organisation [1]. • Key areas discussed are; – Defining appropriate use – Confirming the client’s identity – Privacy – Secure storage of information – Recording contact – Signatures and sign offs 6
  7. 7. Module Part 4 Professional issues & guidelines • If intending to use electronic communications with clients, timeframes around expected responses to client contact need to be clarified. – This is particularly pertinent for clinicians who work part time and who do not or unable to check theirChecking and email/mobile phones outside of work hours.Responding to • Clients need be clearly informedCommunications about availability to contact their clinicians and the timeframe in which the clinician is likely to respond [2]. • A crisis escalation plan also needs to be developed for when the clinician does not respond within the pre- defined time frame for instance who does the client then contact if they are in crisis or need an urgent response? 7
  8. 8. Module Part 4 Professional issues & guidelinesDefining appropriate use• As we have discussed, the reduced personal • Before initiating electronic contact with clients, it is boundaries of cyberspace can mean that the important that both the client and the clinician clarity around contact boundaries can be agree on the boundaries of appropriate use [2]. blurred. • This includes clarity about the types of• Moreover, this can mean that where clients may communication that are appropriate (eg., have been previously reluctant to contact a confirmation of appointments vs. crisis contact), clinician, they may more readily write and email the times when this communication can be used or send a SMS. (eg., during work hours or available 24 hours per day), and the potential outcomes of such contact.• Whilst this is beneficial in terms of reducing access barriers, it has implications for safety • It is beneficial to set expectations and guidelines in and professional responsibility. the first session and to document these where appropriate.• It is important to consider if the young person would benefit from using technology, and if they will do so appropriately. 8
  9. 9. Module Part 4 Professional issues & guidelines • It can be difficult to confirm a client’s identity when communicating electronically. • It is important to raise this with the young person and to reach an understanding that you will assume that the person responding to the communication is the young person you intended.Confirming the • Where possible, it is best to limit the level of detail and sensitive communication when communicatingclient’s identity • electronically to avoid inadvertent disclosure. You may also want to organise some form of identification process with the young person to ensure that you are communicating with the person you assume it to be. – This could include a code word or confirmation of information such as previous appointment time to help validate an identity. It is beneficial to discuss this with the young person prior to commencing communication. 9
  10. 10. Module Part 4 Professional issues & guidelinesPrivacy• If using electronic communications it is • Highlighting this with young people is important important for the client to understand that there early on in the decision to use electronic is potential for other people to see the communication in a therapeutic manner. communication. • For further information about general privacy• It is important to discuss the potential for their guidelines and storage of information see Privacy friends to read their SMS messages from you, Act and Information Privacy principles which can or that if they leave their emails open others be accessed here: may see the communication. heets/view/6541. 10
  11. 11. Module Part 4 Professional issues & guidelines • It is encouraged that clinicians should utilise encryption services when communicating sensitive information, and should discuss limitations with clients [6]. • Despite having firewalls, there is still the potential to breach confidentiality whenSecure storage communicating with clients electronically.of information – A 2006 study by Finn, indicated that 1 in 20 social workers reported that a client’s confidentiality was compromised due to email use [3]. • Given this, when communicating with clients it is important to highlight that whilst efforts to ensure confidentiality with be implemented, it cannot be guaranteed that confidentiality can be maintained [2]. 11
  12. 12. Module Part 4 Professional issues & guidelinesRecording of contact• All communications • This includes noting with clients need to be down the time of contact, documented in the who initiated the contact, client’s file. and what was the purpose and outcome of the contact. 12
  13. 13. Module Part 4 Professional issues & guidelines • Finally, it is important to consider what to finish your communication with. • Email signatures are important as they can provide emergency contact details, which may be particularly important if the client isSignatures and unable to contact you. • It is recommended that all emailsign-offs communication contain a professional signature which consists of contact information, and information about confidentiality, unauthorised access and intended uses [4]. • In addition to this, emergency contact details are also recommended. 13
  14. 14. Module Part 4 Professional issues & guidelinesPersonal issues relating toprivacy and confidentiality• In addition to clinical practices, clinicians need • It is important to be aware of the privacy policy to be aware of the implication of their online and settings of each individual site. personal behaviour and how this may reflect them professionally. • Be aware that once you upload information or images to a site, the site may then take over• Online accounts are not as secure as we are ownership. Given this, it is important to lead to believe, and even with high privacy consider the implication of the images you are settings, information can be accessed by uploading. others. • Why not try searching for yourself on Google• Be aware that your status updates may appear and see what comes up? in searches, your profile photos might be made available for anyone to see, and your comments on other people’s pages may also be visible. 14
  15. 15. Module Part 4 Professional issues & guidelines • When considering a friend request it is Additional concerns important to consider the professional associated with using implications. technology with • Becoming a friend is likely to blur the therapeutic relationship through self- young people disclosure of personal information to the client. • When having a friendship requested, it is advised that you follow the code of Managing conduct for your profession and organisation about the appropriateness of this. Facebook • For further information about declining a friend requests request, see the supplementary notes for a suggested conversation that you might have with a young person (link – page 4). 15
  16. 16. Module Part 4 Professional issues & guidelines • Providing alternative means for Additional concerns communication can also mean that there associated with using are alternative ways for a young person to communicate risk with you. technology with • It is important to have risk protocols in young people place that can be implemented when risky behaviours are communicated. • This includes what will happen if the young person communicates risk, who Addressing will be contacted, and how confidentiality will be managed. It is important to have set these guidelines in the first session high risk and to have an action plan documented. See the supplementary notes for a communications suggested conversation that you might have with a young person (link – page 5). 16
  17. 17. Module Part 4 Professional issues & guidelinesPersonal associations andguidelines on use of technology• When setting your own • The following organisations have made a direct reference to the professional boundaries for use or impact of technology on consultations; practice, we encourage you to work within the guidelines – The Australian Psychological Society – The internet’s of your own organisation. ethical challenges for psychologists• You may find you need 010/august/symons/?ID=3248 further guidance and it might be useful to seek – The Australian Counselling Association – Internet guidelines from other resources for counsellors organisations or professional associations. ources%20for%20Counsellors%202011.pdf – The Australian Medical Association – Social Media and the Medical Profession: A guide to online professionalism for medical practitioners and medical students 17
  18. 18. Module Part 4 Professional issues & guidelinesA final word• One of the difficulties with electronic communication is the lack of non-verbal cues that can provide context. Given this, it is recommended that communication be explicit when it comes to risk, and that if you are unsure about risk, err on the side of caution. Similarly, if you are not getting the responses desired from the young person, do not hesitate to phone them.Further information is also provided in the supplementary notes section for this part of the module. 18
  19. 19. Module Part 4 Professional issues & guidelinesReferences1. Manhal-Baugus, M., E-therapy: practical, ethical, and legal issues. CyberpsycholBehav, 2001. 4(5): p. 551-63.2. Bradley, L.J. and B. Hendricks, E-mail and Ethical Issues. The Family Journal, 2009. 17(3): p. 267-271.3. Finn, J., An exploratory study of e-mail use of direct service social workers. Journal of Technology in Human Sciences, 2006. 24: p. 1- 20.4. Zur, O. I Love These E-Mails, or Do I? The Use of E-Mails in Psychotherapy and Counseling 2008 [cited 2011 April 9th, 2011]; Available from: 19
  20. 20. Module Part 4 Professional issues & guidelinesEvaluationEducation Module Pilot Webinar ParticipantsWe are conducting a survey to evaluate the newly launched ReachOut Pro If you are completing this module as pre-reading for aEducational Module - Connecting Our Worlds, currently being piloted on ReachOut Pro Webinar, please use the link below to undertake The survey aims to understand more about who separate survey tailored for your training program.uses the module, what aspects are considered most useful and also how itmight be improved in the future. [Click here to begin the survey for Webinar Participants]As this module is a pilot, we ask that you take a moment to complete anonline survey, to assist us in assessing the value of these professionaldevelopment resources for your practice. Your feedback will contribute tomore valuable and effective resources for other professionals in yoursector.If you have finished using the Education Module, we would appreciateyour feedback on it’s usefulness for your practice.[Click here to begin the survey] 20