Social work practice with digital communication technologies: Ethical issues and policy responses.
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Presentation by Dr Allan Barsky (Florida Atlantic University) to husITa16 in Seoul, Korea on 29th June, 2016.
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Social work practice with digital communication technologies: Ethical issues and policy responses.
- 1. IASSW at Seoul, South Korea June 2016 Allan Barsky, JD, MSW, PhD Professor, School of Social Work Florida Atlantic University Boca Raton, FL 33431 barsky@barsky.org
- 2. Need for Policies re CTs Ethical Issues Framework for Policy Making Sample Class Exercises 7/19/2016 2Barsky - Ethics & DCTs
- 3. Growing Use of DCTs in SW ◦ E-counseling / E-advocacy ◦ E-documentation ◦ Email ◦ Messaging / Smart phones ◦ Social networking ◦ Avatars / Smartphone Apps ◦ Electronic tracking (client, SW, E-health, M-health) NASW Code – gaps Risk-Benefit management 7/19/2016Barsky - Ethics & DCTs 3 If it ain’t broke… ? Pre-empt problems ?
- 4. NASW/Other Code of Ethics Practice Standards Practice Guidelines Evidence-Based Practice 7/19/2016Barsky - Ethics & DCTs 4
- 5. ASWB, NASW, CSWE, and CSWA https://www.aswb.org (link) or http://www.socialworkers.org/practice/naswst andards/TechnologyStandardsInSocialWorkPrac tice/CommentSubmission.aspx 7/19/2016Barsky - Ethics & DCTs 5
- 6. In classroom? In small group work? In field? 7/19/2016Barsky - Ethics & DCTs 6
- 7. Confidentiality Informed consent Client safety (physical and psychological) Documentation Billing Risk management Boundary crossings and violations Unintentional dual relationships Client access/justice/diversity concerns Practice in multiple jurisdictions (“location” of online practice) 7/19/2016Barsky - Ethics & DCTs 7
- 8. Access – remote, disability/special needs, embarrassed clients, specialists Continuity of service Cost-effective Digital natives Enhanced confidentiality, anonymity SW mobility Reaching masses… 7/19/2016Barsky - Ethics & DCTs 8
- 9. 1. Which technology is of concern? 2. What is the nature of the concerns? 3. What do existing laws, ethical codes, or agency policies say about its use? 4. How have other SW programs/agencies dealt with these issues? 5. What does the research say about potential benefits and risks? 6. What are the advantages and disadvantages of having a new policy? If +’s > -’s, then… 7/19/2016Barsky - Ethics & DCTs 9
- 10. Students want to use computers/tablets to take notes, refer to e-textbooks… 7/19/2016Barsky - Ethics & DCTs 10
- 11. Students want to post activities, photos, information, and interesting stories… 7/19/2016Barsky - Ethics & DCTs 11 Great idea. What could possibly go wrong?
- 12. www.carolinashealthcare.org/social-media-guidelines 1. Know and follow other policies… (e.g., confidentiality) 2. Don’t forget your day job… 3. Personal responsibility… 4. Respect your audience and coworkers… 5. Be courteous and respect others’ privacy… 6. Be mindful of the world’s longer memory… 7. Write in first person… 8. Admit errors… 9. Protect agency’s good reputation 10. Use personal email addresses… 11. Coordinate work-related websites.. 12. Avoid candid camera… 13. Report violations… 7/19/2016Barsky - Ethics & DCTs 12
- 13. Students are expected to practice in an ethical manner… Social media sites are public domains and any and all information can be accessed by anyone; once in cyberspace information remains indefinitely…. Clients… and employers… may find information about them… Students should not make disparaging comments about practicum supervisors, colleagues… on social media sites... Posting negative professional/practicum related content on personal social media sites can damage professional credibility… Students should consult with their placement site about existing agency policies and expected practices on social media use… In the event that a student’s social media profile or linkage is considered a poor professional practice or an ethical violation, the student may be subject to an Academic and Professional Standard Review. 7/19/2016Barsky - Ethics & DCTs 13
- 14. Available - http://drkkolmes.com/social- media-policy/ 7/19/2016Barsky - Ethics & DCTs 14
- 15. Student doing home visits, needs to check in with agency; using own cell phone (GIS App) 7/19/2016Barsky - Ethics & DCTs 15
- 16. Student asked to co-facilitate online group. 7/19/2016Barsky - Ethics & DCTs 16
- 17. Finds photos of student engaged in drinking… nonprofessional; nothing illegal. 7/19/2016Barsky - Ethics & DCTs 17
- 18. To assess To confirm (e.g. forensic evidence) To monitor vulnerable client (re crisis) To locate client at risk Ethical concerns? Prohibit? Regulate? 7/19/2016Barsky - Ethics & DCTs 18
- 19. Off-duty, MSW student sees photos on FaceBook re friend abusing a child 7/19/2016Barsky - Ethics & DCTs 19
- 20. Children with autism Avatar Therapy: Help with Disturbing Voices Disturbing Voices (auditory hallucinations) https://www.youtube.com/watch?v=aYfG53fgwXc&sns=em CTN Brave New World https://www.youtube.com/watch?v=XH13MORUCio 7/19/2016Barsky - Ethics & DCTs 20
- 21. As a BSW class project, Jen creates a website advocating for the rights of dangerous sex offenders Upon graduation, Jen is interviewing for a job and the interviewer asks how she could support such a “vile population” 7/19/2016Barsky - Ethics & DCTs 21
- 22. Ellie: 87-year-old woman; frail condition, significant risk of heart attack or stroke; lives alone To monitor her pulse, blood pressure, mobility, and breathing, she has special monitors that send data to health professionals who monitor her condition Any ethical concerns? How else can bio-monitors be used? (including mobile devices for mHealth) 7/19/2016Barsky - Ethics & DCTs 22
- 23. “Due to the casual communication common in the online environment, students are sometimes tempted to relax their grammar, spelling, and/or professionalism; however, remember you are adult students and professionals—your communication should be appropriate. You are expected to use correct spelling and grammar and write in complete sentences. Also, please note that in the online environment you do not have the advantage of voice inflection or gestures. As a result, sarcasm can come across very negative, so this form of communication should be avoided. When conducting peer reviews or responding to classmates’ posts, remember that you are responding to the ideas of the writer: keep your communication professional and on-topic.” [FAU] 7/19/2016Barsky - Ethics & DCTs 23
- 24. Engage leadership and broad base Consider precedents / alternatives Obtain legal advice / IT advice Start with guidelines… then rules Pilot test Educate Ensure commitment - implementation 7/19/2016Barsky - Ethics & DCTs 24
- 25. American Psychological Association. (n.d.). Guidelines for the practice of telepsychology. Retrieved from http://www.apa.org/practice/guidelines/telepsychology.aspx?item=13 American Telemedicine Association (2009a). Evidence-based practice of telemental health. Retrieved from http://www.americantelemed.org/files/public/standards/EvidenceBasedTelementalHealth_Wi thCover.pdf. American Telemedicine Association (2009b). Practice guidelines for videoconferencing-based telemental health. Available at http://virtualservices.kansasworks.com/About/Documents/Telemental%20Health2.pdf. Belluomini, E. (2014, Winter). Using digital self-advocacy to empower social work populations. New Social Worker. Retrieved from http://www.socialworker.com/feature- articles/technology-articles/using-digital-self-advocacy-to-empower-social-work- populatio/ Cason, J. (2011). Telerehabilitation: An adjunct service delivery model for early intervention services. International Journal of Telerehabilitation, (3)1. Available at http://telerehab.pitt.edu/ojs/index.php/Telerehab/article/view/6071/6301. Deardorff, W. (2014). Internet-based treatment: A comprehensive review [Ethics and risk management] Retrieved from http://www.behavioralhealthce.com/index.php/component/courses/?task=view&cid=69 Gutheil, T. G., & Brodsky, A. (2008). Preventing boundary violations in clinical practice. New York: Guilford. Harris, B., & Birnbaum, R. (2014). Ethical and legal implications on the use of technology in counselling. Clinical Social Work (online). doi:10.1007/s10615-014-0515-0 7/19/2016Barsky - Ethics & DCTs 25
- 26. Hildy, D. M., Ferrer, D.C., Parish, M. B., Johnston, B., Callahan, E. J., & Yellowlees, P. M. (2013). The effectiveness of telemental health: A 2013 review. Telemed Journal and E-Health, 19(6), 444-54. doi: 10.1089/tmj.2013.0075 International Technology Task Force. (2013). Delegate assembly presentation. Association of Social Work Boards. Retrieved from http://www.aswb.org/wp- content/uploads/2013/11/DelegateAssemblyPresentation- InternationalTechnologyTaskForce.pdf Judd, R. G., & Johnston, L. B., (2012). Ethical consequences of using social network sites for students in professional social work programs. Journal of Social Work Values and Ethics, 9(1). Retrieved from http://www.socialworker.com/jswve/content/view/145/75 Lopez, A. (2014). Social work, technology, and ethical practices: A review and evaluation of the National Association of Social Workers’ Technology Standards. Social Work in Health Care, 53(9), 815-833 doi:10.1080/00981389.2014.943454 Marsch, L., Lord, S., & Dallery, J. (2015). Behavioral healthcare and technology: Using science-based innovations to transform practice. New York: Oxford University Press. Morgan, S., & Polowy, C. (2012). Social workers and Skype: Part II—telemental health laws. NASW Legal Defense Fund, Legal Issue of the Month. Available at https://www.socialworkers.org/ldf/legal_issue/2012/Apr2012.asp (password access required). 7/19/2016Barsky - Ethics & DCTs 26
- 27. National Association of Social Workers & Association of Social Work Boards (2005). Standards for technology and social work practice. Available at http://www.socialworkers.org/practice/standards/NASWTechnology Standards.pdf. Rudo, P. (2012). How cloud computing affects HIPAA compliance, Enterprise Features. Retrieved from http://enterprisefeatures.com/2011/08/how-cloud-computing- affects-hipaa-compliance Santhiveeran, J. (2009). Compliance of social work E-therapy websites to the NASW Code of Ethics. Social Work in Health Care, 48, 1-13. State of Missouri, Office of the Secretary of State. (2013). Guidelines for creating an agency social media policy. https://www.sos.mo.gov/archives/pubs/SocialMedia.pdf Young, T. B. (2009). Facebook: Ethical and clinical considerations. The New Social Worker, 16(4), 4-5, Retrieved from http://www.socialworker.com/home/Feature_Articles/Ethics/Facebo ok%3A_Ethical_and_Clinical_Considerations Zur Institute (n.d.). Digital ethics: Internet and therapy. Retrieved from http://www.zurinstitute.com/articles.html 7/19/2016Barsky - Ethics & DCTs 27
Editor's Notes
- Mention resource online: http://www.naswwebed.org ***Announcement of Your Presentation Date and Time*** Friday, July 24, 2015 Dear Allan E. Barsky We look forward to your participation at CSWE’s upcoming October 15–October 18, 2015 Annual Program Meeting (APM) in Denver, CO. The 2015 APM meeting activities will be held at the Sheraton Denver Downtown and Crowne Plaza Denver Downtown. Sheraton Denver Downtown Website: www.sheratondenverdowntown.com Crowne Plaza Denver Downtown Website: www.hoteldenver.net The 4-days of 2015 APM operations include more than 650 educational sessions structured into 40+ content tracks scheduled over 3 meetings days: Friday, October 16 through Sunday, October 18—with the 14 preconference workshops held on Thursday, October 15 This e-mail includes important information about your session’s presentation time assignment within those activities. *****YOUR PRESENTATION DATE AND TIME***** Presentation Title: Communication Technologies: Developing Policies to Manage Ethical Issues in Classroom and Field Presentation Type: Interactive Workshop Date: Saturday, October 17, 2015 Time: 3:15 PM Room Assignment: Sheraton Denver Downtown Hotel Governor's Square 11, Plaza Building
- Do we need to codify everything? What needs to be put into policy? What can be left to SW/student discretion? M-Health – mobile health Avatar – Hindu – incarnations… Second Life (e.g., individual and group counseling) Risk-Benefit – not just focusing on risks… as per risk management mHealth – mobile health – see case Example 9 below
- Updates in progress…
- Problems in access, no nonverbal cues, miscommunication risks, emergency response, people not comfortable with technology, when technology goes awry…
- Anonymity – disinhibition; asyncrhonous communication – time to think, respond…
- Need to deal with separate technologies separately… very different issues re use of cell phones for messaging vs. use of FaceBook for social networking…
- What are the concerns? What are the existing laws, policies, codes… Practice classes vs. Policy/Research ? Confidentiality, recording prof/students, posting on web, not paying attention/doing unrelated activities/not professional – parallel process – class/field
- Professionalism, reflection on school, profession, agency Boundary issues – once on the internet… - Risk Management - If you want to have your own personal Facebook account, what are the risks? How can you manage these risks? Facebook settings – privacy, limit friends; talk to friends about what they may post and what they should not post; have a separate Facebook account for professional purposes? Ultimately, what should you do? -- Baylor University - Clients may ask to “friend” you on social media. A polite way to decline the request is to emphasize agency policy and your concern to protect the client’s privacy. You may say “I do not add clients as friends on social networking sites because they are not secure and doing so can compromise your confidentiality”/
- Critique – what are the strengths and limitations of this policy as written? Plain language – clear Provides rationale for policies Acknowledges areas of discretion and personal responsibility Difficult to enforce?
- Also of related significance are these items in the NASW Code of Ethics: Section 1.03: Informed Consent Section 1.06: Conflict of Interest and Dual Relationships Section 1.07: Privacy and Confidentiality Section 4.06: Misrepresentation U.Texas SSW: POLICY ON SOCIAL MEDIA AND PROFESSIONAL COMMUNICATION. Public social networks are not private. Even when open only to approved or invited members, users cannot be certain that privacy will exist among the general membership of sites. If social work students choose to participate in such forums, please assume that anything posted can be seen, read, and critiqued. What is said, posted, linked to, commented on, uploaded, subscribed to, etc., can be accessed and archived, posing potential harm to professional reputations and prospective careers. Social work students who use social media (e.g., Facebook, Twitter, etc.) and other forms of electronic communication (e.g., blogs, etc.) must be mindful of how their communication may be perceived by clients, colleagues, faculty, and others. Social work students are expected to make every effort to minimize material that could be considered inappropriate for a professional social worker in training. Because of this, social work students are advised to manage security settings at their most private levels and avoid posting information/photos or using any language that could jeopardize their professional image. Students are asked to consider the amount of personal information posted on these sites and are obliged to block any client access to involvement in the students’ social networks. Client material should not be referred to in any form of electronic media, including any information that might lead to the identification of a client or compromise client confidentiality in any way. Additionally, students must critically evaluate any material that is posted regarding community agencies and professional relationships, as certain material could violate the standards set by the School of Social Work, the Texas Code of Conduct for Social Workers, and/or the NASW Code of Ethics. Social work students should consider that they will be representing professional social work practice as well as the University of Texas at Austin School of Social Work program while in the classroom, the university community, and the broader area communities.
- Could use in class… policy and podcast discussion of issues Suggestions from Students from a BPD Task Force: “Google” yourself to see what information is available on you Review and delete inappropriate posts, tweets, blogs, pictures (or un-tag), videos etc. Be cautious in using online dating services Be very select about whom you friend, follow etc. Be very select about what you “like,” as this may be viewed as a reflection of you Use the highest privacy settings available for all social media sites Do not “look up” present or past clients on social media, unless there is a compelling reason Do not friend, follow etc. current or past clients Be cautious in revealing personal information such as DOB, phone number, address, family members, place of employment etc. Consider developing a professional social media site like LinkedIn Do not share client information via email or via text Be very cautious about what you share (any format) about faculty, field agencies/instructors, peers, co-workers, employers etc.
- Safety issues, boundary issues, professionalism, imposition on student… costs? Can agency and student decide, or does BSW program have a say? Liability? Confidentiality? Civil liberties – “big brother/sister is watching… Informed consent?
- Due diligence by agency? Go through concerns identified by International Technology Task Force: Confidentiality (is video secure/HIPAA compliant? E.g., Skype – you get what you pay for? Do you know what/how you are paying? ) Informed consent Client safety (physical and psychological) Documentation Billing Risk management Boundary crossings and violations Unintentional dual relationships Client access/justice/diversity concerns Practice in multiple jurisdictions (“location” of online practice) --- What if the group were for undocumented immigrants, survivors of domestic violence, or children with autism?
- Does it matter if it’s a drug treatment program? SW joins a social networking site for libertarians Prospective employer searches Internet and discovers the SW is a member of this group Is the employer allowed to reject SW’s job application? On what basis? Would it be ethical for employer to ask SW to provide access to SW’s private Facebook account? What if the social networking site was for: swingers, people with schizophrenia, or devil worshippers
- How do we apply the values of “respect,” “safety,” “consent,” and “trust” in such situations? Does it matter whether the client is a child, youth, adult with mental capacity, or an adult with impaired mental capacity? What if you don’t use all means available? What about a BSW programs responsibility if a student might be at risk of suicide?
- Do students need to be told their duties in BSW program policies? In class discussions? Should know the law and what to do without being told?
- What types of policies would be needed? – informed consent/assent; confidentiality; saving/storing the session?
- Has her professor unwittingly set up Jen for problem? What is if Jen complains that the BSW program has ruined her career? What should students be advised when they go public (and online) with their views/advocacy? Or should students simply “know”?
- Monitors may also be used for clients with addictions, anxiety, and diet/exercise plans/weight control; people at risk of suicide, cigarette smokers; virtual companions, electronic reminders/medication compliance, electronic reinforcers (can have access to a new game if…) Marsch, L., Lord, S., & Dallery, J. (2015). Behavioral healthcare and technology: Using science-based innovations to transform practice. New York: Oxford University Press. Consider issues re confidentiality, billing, self-determination, managing risk, documentation, effectiveness/competence, effectiveness…
- Special model syllabi for online courses…some issues cut across courses
- Top down / Bottom up – include digital natives and digital immigrants