Ethical Issues Surrounding the Use of Technology in Clincial Supervision

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This is a copy of a ppt developed for a presentation at the NJCA conference in April 2012. We discuss different types of technology used in supervision and the ethical implications of using them in supervision.

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  • Questions? VERY good idea!Using the internet for clinical supervision permits the supervisor to have more supervisees because it saves time on travel?Engaging in clinical supervision with people from other parts of the country is recommended because it increases the cultural diversity in the supervisor –supervissee relationship, which encourages the learning of different perspectives?Using skype in clinical supervision is just as effective as face-to-face supervision?
  • There are cases of counselors-in-training living in remote areas without close (50mi) supervisors. If there is a client emergency, might be important to use technology to connect with superviseeVaccaro, N. & Lambie, G. W. (2007). - might be best as an adjunct – rather than as primary supervision (in between sessions or illness, traveling, etc.)There are many online counseling programs that utilize a variety of technology in the supervision
  • NCC and ACA : Do not specify ethical guidelines surrounding the use of technology in supervisionSupervisors expected to adhere to guidelines provided for use of technology in counseling relationshipACES – specific guidelines related to technology and supervisionISMHO: International Society for Mental Health Online ISMHO has no specific guidelines for the use of technology in clinical supervisionNew Jersey State Law has no specific information pertaining to the use of technology in in clinical supervisionThere is a continuous reference to “face-to-face” hours when referring to licensure13:34 – 8.2 – information pertaining to the requirements of wrie-protected programs that are necessary for personal pcs which are used to store client information (specific to counselors/not supervisors)
  • Notes for presentation: Ethical guidelines pulled out/State licensure – NJ: Within state, and computer/file Slide for each technology
  • 13:32-4.3
  • Counselor be licensed in the state in which the client lives and receives services
  • ISMHO does have a “Case Study Group” in which is a research and training group that focuses on various applications of mental health services online, including online supervision professional consultations that occurred via the Internet, including, for example, giving advice and/or information to people who contact an online professional and supervision via the Internet (e.g., via e-mail or message boards). The group operates as an email-list and participants are expected to present a case each “round”. There are 21 members in the group.ISMHO - their research suggests that there is great benefit to the quick sharing of references and resources for students and supervisees – is any of this published in peer review journals? ISMHO - chat has been successfully utilized in supervision and provides for “real -time” supervision
  • Landline – cordless – can be picked up by baby monitors, etc. Recording – can be recorded by answering machines easilyCorded phones your best choice – can also buy secure phones that encrypt the phone callsCan buy plug-in encryption device for phone and computer linesCell- lets assume you are not using your cell phone in a public area….malware – easy access to phones through apps – someone can take control of your phone, record conversations, download your contacts list etc. – many phones come with security (droids do) but may not be updated to the newest malware – Downloaded code – you could download a wiretapping code and not know it, deleted messages easily retrieved, Recording phone conversations – because wireless – conversations can be accidently recorded by answering machines, can be picked up on baby monitors, other head sets, etc. , many environmental microphones, Call interception- link between the phone and the cell – can use encrypted links - at the cell site – no defense at the telephone switch – no defense – should have court order interception at leased lines – connect base stations to the telephone switches can be monitored, whether physical lines, fiber optic, cable, Microwave link or virtual circuitsCan buy encrypted phones and secure phone, or download encryption apps – but still not completely secure
  • When using a fax machine to transmit confidential information, it is necessary to have a coversheet that includes information pertaining to the confidential nature of the transmissionIT’s still a phone line, but more secure than e-mail
  • Research indicates that the use of email is a valuable supplement to traditional supervisionThere is an acknowledgement that the use of email may be limiting to those who struggle with typing and the use of technologyThe use of email in supervision can create a document/log of personal reflection and experiences during one’s growth as a practitioner (Wright and Griffith)Boundary setting has the potential for issues and needs to be outlined clearly in the initial contract for any mode of long-distance supervision (Wright and Griffith)Can be subpoenadA message on the e-mail that it is private does not protect you, the supervisor or the client if the e-mail in intercepted.Deleting and e-mail doesn’t actually delete it, there are copies everywhereThere are HIPPA compliant email services – like Jumbleme
  • Can still be hacked – if you keep client files on a computer – the computer should have no access to the internet.Encryption devices that plug into internet, encryption programs – but an experienced hacker can get through them, or design programs to read encryptions pretty easily.Backups – there are HIPPA compliant backup services, and clouds, but many are expensive
  • Cybervision (Cummings article): The Cybervision setting consisted of chatrooms where synchronous texts can be sent between people who are online. Pros: the communication style was advantageous since it lends itself to a direct, clear, and focused form of relating; disinhibition, promoted by the style of communication and lack of face-to-face communication, allowed for freer expression.  Cons: the communication among participant was compromised by misunderstanding at times, but generally seen as “clear enough;” Summary: . In summation, this study claims that Cybervision is indeed effective; however, the researchers do no suggest Cybervision as a substitute for face-to-face supervision, but instead as an adjunct to it
  • Computer Based Supervision: the primary disadvantage of computer-based supervision is that it limits contextual clues, thus, deemphasizing the supervisee-supervisor relationship; Pro:Makes supervision possible for those who are limited by geographical location (McAdams & Wyatt)Advantages of real-time supervision (Wright) Potential Con:The therapeutic alliance is central to the counseling relationship and questions exist around the ability to form an effective therapeutic alliance via the computer. (Me) It follows that the same concerns would be relevant to the supervisor- supervisee relationship (McAdams & Wyatt).Lose “space” created by “going to supervision” (Wright)Possibility for loss of emotional connection (Wright)Security issues – signal can be intercepted at many pointsUse a HIPPA compliant site like – securevideoconference.com or nefsis
  • There are a few cloud sharing sites that are hipaa compliant so could upload audio or video files
  • Does provide voice and chat, have an avatar representation of yourself and superviseeNot really close to f2f, Can make a “cone” of silence around you
  • Should you friend your supervisee? Should you send messages through FB?Dropbox for written documentation?
  • Need to add online or technology use for supervision in informed consentNeed to be cognizant that many of our clients may not be technologically savvy. Don’t use jargon when explaining potential risks and steps taken to make online supervision confidential and effective.
  • Ethical Issues Surrounding the Use of Technology in Clincial Supervision

    1. 1. Dr. Edina Renfro–Michel, LPC, ACS Meghan R. Lehembre Montclair State University
    2. 2.  What do you think?
    3. 3.  Ethical Codes Specific Technologies • Uses • Cautions • Possible Fixes
    4. 4.  Rural Areas Emergencies An Adjunct to Traditional Supervision Online Programs
    5. 5.  ACA ACES NCC New Jersey State Law ISMHO
    6. 6.  A.12. Technology Applications • A.12.a Counselors inform clients of the benefits and limitations of using information technology applications in the counseling process and in business/ billing procedures. Such technologies include but are not limited to computer hardware and software, telephones, the World Wide Web, the Internet, online assessment instruments and other communication devices.
    7. 7.  The supervisor employs technology in ways that enhance the supervisory process and the development of the supervisee. In using technology for distance supervision, the supervisor clearly approximates…
    8. 8.  ….face-to-face synchronous contact (e.g., formats that allow supervisors and supervisees to attend to non-verbal as well as verbal behavior). The supervisor ensures that client and supervisee confidentiality are protected when using technology in supervision (e.g., takes precautions such as password protection and encryption) that are compliant with HIPPA guidelines..
    9. 9.  The supervisor ensures that any technology employed in supervision is in compliance with ethical guidelines and regulations promulgated by accreditation, certification, and licensure bodies. The supervisor is competent in the use of the technology employed in supervision.
    10. 10.  Marriage and family therapy supervision” or “supervised experience” means the ongoing process performed by a qualified marriage and family therapy supervisor who monitors the performance of intern or permit holder and provides regular, documented, face-to-face consultation…
    11. 11.  …guidance and instruction with the intern or permit holder with respect to the marriage and family therapy with individuals, couples and families and monitors the competencies of the intern or permit holder” For client contact – NJ State Law requires that the counselor be licensed in the state in which the client lives and receives services
    12. 12.  No Guidelines Case Study Group Chat
    13. 13.  Landline • Cordless phones • Recording Phone Conversations Cell • Malware • Recording Phone Conversations • Environmental Microphones • Call Interception
    14. 14.  How do you ensure your fax is reaching the intended recipient? Cover Page Still a Phone Line
    15. 15.  Safety of Server Encryption List-Serves
    16. 16.  Desktop computers, Lab top computers and tablets Physical safety of computer Safety of Server Firewalls Backups
    17. 17.  Intentional Recording Physical Safety of device Disposal of recordings Awareness of environment when listening to recorded sessions
    18. 18.  Chat – rooms Medium to upload recorded sessions Course Management Systems
    19. 19.  Skype Video Chat Face - time
    20. 20.  HIPAA Compliance Audio Video
    21. 21.  Provides Interaction Privacy Face-to-Face?
    22. 22.  Facebook Social Blogs Twitter Dropbox
    23. 23.  Do you currently address technology? Doyou currently address long-distance supervision? Do you have an emergency procedure?
    24. 24.  Advise Client of any online supervision Informed Consent Language

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