Ethics in the “i" world: Internet, telehealth, social media, texting, and e-mail

1. Ethics in the “i" world: Internet, telehealth, social media, texting, and e-mail Patrick B. Mcgrath, Ph.D. Moderator

2. 11161 New Hampshire Ave. Suite 307 Silver Spring, MD 20904 301-593-6554 X14 3200 Tower Oaks Blvd. Suite 200 Rockville, MD 20852 301-593-6554 X14 malvord@alvordbaker.com www.alvordbaker.com The i-world:The Media Age and TechnoEthicsMary Karapetian Alvord, Ph.D.President-Elect, APA Division 46, Media PsychologyAlvord, Baker & Associates, LLC April 13, 2012

3. Disclaimer I have no conflicts of interest to disclose. I have not received any funding from any commercial entities that may be mentioned or discussed in this presentation. All information and opinions shared are mine alone.

4. We are living technolgy history • An example – prior to 1973, cell phones were limited to those installed in vehicles. • In 1983, Motorola introduced the 16-ounce "DynaTAC" phone which cost $3,500. • 2012 – there are more cell phone users across the world, than land line users.

6. What is Telehealth?

7. www.alvordbaker.com

8. Encyclopedia Britannica to stop printing booksBy Julianne Pepitone@CNNMoneyTech March 13, 20120:00 / 2:37Britannica stops presses and goes digital NEW YORK (CNNMoney) -- After 244 years, Encyclopedia Britannica will cease production of its iconic multi-volume book sets.Britannica usually prints a new set of the tomes every two years, but 2010's 32-volume set will be its last. Instead, the company will focus solely on its digital encyclopedia and education tools. .

9. HIPAA (Health Insurance Portability and Accountability Act) • Privacy Rule – now standard of care • Business associate agreements!! • Security Rule – • Adminstrative procedures to safeguard confidentiality and access • Physical safeguards • Technical security

10. Telecommunication system Programmable! T-1 lines or VPN . Voice over IP phones, etc.

11. HAPPY 21ST BIRTHDAY

13. Facilitating gamesmanship and generalizing behaviors through real-life play activities

14. Clinical Applications • Exposures - Endless Loops, sounds, DVD’s, you tubehttp://www.youtube.com/watch?v=F5na4nE21-c • Relaxation –MP3’s • Executive function skills (scheduling, timers, phone alerts, alarms)

15. Technology: Clinical applications • Interactive “screen” systems → face recognition, social skills prompts.

16. Technology in the Practice • Sending assignments for group and other therapies via encrypted email • Testing scoring software • Research online – APA research , Google, etc.

17. Tele-health • http://www.youtube.com/watch?v=4DkezwHawXY • Tele = technology • Health = psychological services (tx, testing, etc.) • Internet speed and bandwidth • Encrypted doesn’t mean HIPAA compliant • HIPAA compliant → HIPAAA Certified • Secure Platforms PC’s vs. MAC’s • Computer Memory • HD Cameras

18. Thank you! • References: • HIPAA regulations • DeAngelis, T. (2012) Practicing distance therapy, legally and ethically • Monitor on Psychology; 43(3). • Highmark launches telehealth service. (2012). Health & Beauty Close - Up, , Retrieved from: http://search.proquest.com/docview/957428259?accountid=11243 • Wolper, L. (2011) The E-Healthcare Movement: Virtual Communities, Web Services, and Other Enterprisewide, Interoperable HCITs for US Healthcare Reform . Health Care Administration . Retrieved from: http://www.r2library.com.proxygw.wrlc.org/contents/content_resource_frame.aspx?isbn=0763757918&Offset=2&SectionId=ch0008s0350&ChapterId=ch0008&library=Medicine&Cache=true

19. Disclaimer • I have no conflicts of interest to disclose, and have not received any funding from any commercial entities that may be mentioned or discussed in this presentation. • All information and opinions shared are those of the presenter.

20. Ethics in the “i" world: Internet, telehealth, social media, texting, and e-mail Telehealth in the Treatment of Anxiety: Effective Technological Interventions for Anxiety Disorders Nikki Godine

21. Disclaimer • I have no conflicts of interest to disclose, and have not received any funding from any commercial entities that may be mentioned or discussed in this presentation • All information and opinions shared are those of the presenter

22. Clinical Technologies Administrative Telephone Computer Fax machine • Telephone • Computer • Cell phone (talking, texting, apps) • IATV • Internet (chat, forums, message boards) • Virtual reality

23. Panic Disorder • Treatment via the Internet: an effective way to reduce panic symptoms (Bergstrom et al., 2009; Wims, Titov, Andrews, & Choi, 2010) • Types of treatment: • Clinician-assisted CBT • Settings in which this type of treatment can be used • Clinical outcomes

24. Post-Traumatic Stress Disorder • Treatment via videoconferencing and the Internet can improve symptoms of PTSD (Germain, Marchand, Bouchard, Drouin, & Guay, 2009; Lange, Rietdjik, Hudcovicova, van de Ven, Schrieken, & Emmelkamp, 2003) • Internet treatment • Cognitive-behavioral writing assignments • Videoconferencing treatment • CBT • Clinical outcomes

25. Generalized Anxiety Disorder • Symptoms of GAD can be successfully treated through the Internet, virtual reality, and the use of biofeedback and mobile phones (Gorini et al., 2010; Pallavicini, Algeri, Repetto, Gorini, & Riva, 2009; Titov et al., 2009). • Types of treatment • Clinician-assisted CBT • Virtual reality with biofeedback • Stress management and relaxation techniques • Settings in which this type of treatment can be used • Clinical outcomes

26. Social Phobia • Internet-based treatment for social phobia reduces symptoms of social phobia and other comorbid disorders (Berger, Hohl, & Caspar, 2009; Titov, Gibson, Andrews, & McEvoy, 2009) • Types of treatment: • Clinician-assisted CBT • CBT without clinician guidance • Clinical outcomes

27. Child and Adolescent Anxiety • Treatment delivered primarily via the Internet can be effective for a number of child and adolescent anxiety disorders (Spence, Holmes, March, & Lipp, 2006) • Type of treatment • Clinician-assisted CBT • Clinical outcomes • How effective is it compared to in-person CBT?

28. References • Andersson, G., Carlbring, P., Holmstrom, A., Sparthan, E., Furmark, T., Nilsson-Ihrfelt, E. … Ekselius, L. (2006). Internet-based self-help with therapist feedback and in vivo group exposure for social phobia: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 74, 677-686. doi:10.1037/0022-006X.74.4.677 • Berger, T., Hohl, E., & Caspar, F. (2009). Internet-based treatment for social phobia: A randomized controlled trial. Journal of Clinical Psychology, 65, 1021-1035. doi:10.1002/jclp.20603 • Bergstrom, J., Andersson, G., Karlsson, A., Andreewitch, S., Ruck, C., … Lindefors, N. (2009). An open study of the effectiveness of Internet treatment for panic disorder delivered in a psychiatric setting. Nordic Journal of Psychiatry, 63, 44-50. doi:10.1080/08039480802191132

29. References cont’d • Botella, C., Gallego, M. J., Garcia-Palacios, A., Banos, R. M., Quero, S., & Alcaniz, M. (2009). The acceptability of an Internet-based self-help treatment for fear of public speaking. British Journal of Guidance and Counseling, 37, 297-311. doi:10.1080/03069880902957023 • Carlbring, P., Nordgren, L. B., Furmark, T., & Andersson, G. (2009). Long-term outcome of Internet-delivered cognitive-behavioral therapy for social phobia: A 30-month follow-up. Behavior Research and Therapy, 47, 848-850. doi:10.1016/j.brat.2009.06.012 • Germain, V., Marchand, A., Bouchard, S., Drouin, M., & Guay, S. (2009). Effectiveness of cognitive-behavioral therapy administered by videoconference for posttraumatic stress disorder. Cognitive Behaviour Therapy, 38, 42-53. doi:10.1080/16506070802473494 • Gorini, A., Pallavicini, F., Algeri, D., Repetto, C., Gaggioli, A., & Riva, G. (2010). Virtual reality in the treatment of generalized anxiety disorders. Studies in Health Technology and Informatics, 154, 39 – 43.

30. References cont’d • Klein, B., Austin, D., Pier, C., Kiropoulos, L., Shandley, K., Mitchell, J., … Ciechomski, L. (2009). Internet-based treatment for panic disorder: Does frequency of therapist contact make a difference? Cognitive Behavior Therapy, 38, 100-113. doi:10.1080/16506070802561132 • Klein, B., Mitchell, J., Abbott, J., Shandley, K., Austin, D., Gilson, K., … Redman, T. (2010). A therapist-assisted cognitive behavior therapy Internet intervention for posttraumatic stress disorder: Pre-, post- and 3-month follow-up results from an open trial. Journal of Anxiety Disorders, 24, 635-644. doi:10.1016/j.janxdis.2010.04.005 • Klein, B., & Richards, J. C. (2001). A brief Internet-based treatment for panic disorder. Behavioural and Cognitive Psychotherapy, 29, 113-117.

31. References cont’d • Knaevelsrud, C., & Maercker, A. (2007). Internet-based treatment for PTSD reduces distress and facilitates the development of a strong therapeutic alliance: A randomized controlled clinical trial. BioMed Central Psychiatry. Retrieved from http://www.biomedcentral.com/1471-244X/7/13 • Knaevelsrud, C., & Maercker, A. (2010). Long-term effects of an Internet-based treatment for posttraumatic stress. Cognitive Behavior Therapy, 39, 72-77. doi:10.1080/16506070902999935 • Lange, A., Rietdijk, D., Hudcovicova, M., van de Ven, J., Schrieken, B., & Emmelkamp, P. M. G. (2003). Interapy: A controlled randomized trial of the standardized treatment of posttraumatic stress through the Internet. Journal of Consulting and Clinical Psychology, 71, 901-909. doi:10.1037/0022-006X.71.5.901 • Pallavicini, F., Algeri, D., Gorini, A., & Riva, G. (2009). Biofeedback, virtual reality and mobile phones in the treatment of generalized anxiety disorder (GAD): A phase-2 controlled clinical trial. Journal of Cybertherapy and Rehabilitation, 2, 315 – 327.

32. References cont’d • Ruwaard, J., Broeksteeg, J., Schrieken, B., Emmelkamp, P., & Lange, A. (2010). Web-based therapist-assisted cognitive behavioral treatment of panic symptoms: A randomized controlled trial with a 3-year follow-up. Journal of Anxiety Disorders, 24, 387-396. doi:10.1016/j.janxdis.2010.01.010 • Spence, S. H., Donovan, C. L., March, S., Gamble, A., Anderson, R., Prosser, S., … Kenardy, J. (2008). Online CBT in the treatment of child and adolescent anxiety disorders: Issues in the development of BRAVE-ONLINE and two case illustrations. Behavioral and Cognitive Psychotherapy, 36, 411-430. doi:10.1017/S135246580800444X • Spence, S. H., Holmes, J. M., March, S., & Lipp, O. V. (2006). The feasibility and outcome of clinic plus Internet delivery of cognitive-behavioral therapy for childhood anxiety. Journal of Consulting and Clinical Psychology, 74, 614-621. doi:10.1037/0022-006X.74.3.614

33. References cont’d • Titov, N., Andrews, G., Choi, I., Schwenke, G., & Johnston, L. (2009). Randomized controlled trial of web-based treatment of social phobia without clinician guidance. Australian and New Zealand Journal of Psychiatry, 43, 913-919. doi:10.1080/00048670903179160 • Titov, N., Andrews, G., Robinson, E., Schwenke, G., Johnson, L., Solley, K., & Choi, I. (2009). Clinician-assisted Internet-based treatment is effective for generalized anxiety disorder: Randomized controlled trial. Australian and New Zealand Journal of Psychiatry, 43, 905-912. doi:10.1080/00048670903179269

34. References cont’d • Titov, N., Gibson, M., Andrews, G., & McEvoy, P. (2009). Internet treatment for social phobia reduces comorbidity. Australian and New Zealand Journal of Psychiatry, 43, 754-759. doi:10.1080/00048670903001992 • Villani, D., Riva, F., & Riva, G. (2007). New technologies for relaxation: The role of presence. International Journal of Stress Management, 14, 260 – 274. doi: 10.1037/1072-5245.14.3.260 • Wims, E., Titov, N., Andrews, G., & Choi, I. (2010). Clinical-assisted Internet-based treatment is effective for panic: A randomized controlled trial. Australian and New Zealand Journal of Psychiatry, 44, 599-607. doi:10.3109/00048671003614171

35. Thank you!

36. Ethics in the “i” World: Social Media Ethics ADAA April, 13, 2012 Keely Kolmes, Psy.D., Private Practice, SF, CA http://drkkolmes.com drkkolmes@gmail.com

37. I have no conflicts of interest to disclose. • I have not received any funding from any commercial entities that may be mentioned or discussed in this presentation.

38. Search Engines & Social Media: Who is looking for you? • Clients • Colleagues • Students/Supervisees & Professors/Supervisors • Training programs& employers

39. Setting Up a Google Alert • http://www.google.com/alerts

40. Clinical & Ethical Issues for Clinicians

41. Clients seeking psychotherapist information on the Internet (Kolmes & Taube, 2011) • In a survey of 332 clients, 70% reported finding personal information about their therapist on the Internet. • 87% of these individuals found it intentionally while 13% found it accidentally. • 78% found the information via Google, 42% found it via Facebook, 17% found information on LinkedIn. 10% found it on a blog.

42. Clinical & Ethical Issues for Clinicians

43. Tips for Taking Control of Your Web Visibility • Carefully choose which email address you use to join sites. • Understand the privacy settings on your own (and family members’) profiles. • Correct misinformation. • Google’s URL Removal Tool for URLs that urgently need to be removed. (URLs that accidentally expose confidential data) https://www.google.com/webmasters/tools/removals

44. Social Media And Your Practice • Consider your intent when you join a social networking site: personal or professional? • Implement a Social Media Policy • http://www.drkkolmes.com/docs/socmed.pdf

45. Digital Ethics? • Applying existing Ethical Standards to online activity. • Ethical Standards offer a guide for ethical behavior. • Development of standards is ongoing. • Ethical dilemmas on the Internet mirror ethical dilemmas that also occur offline. • Ethics Codes refer only to our professional activities, not personal ones. • Distinction between professional and personal is getting blurred online. Clinical & Ethical Issues for Clinicians

46. Relevant Ethical Standards • Ethical Standard 3.10 Informed Consent • Ethical Standard 3.05 Multiple Relationships • Ethical Standard 4.01 Maintaining Confidentiality • Ethical Standard: 4.04 (b): Psychologists discuss confidential information obtained in their work only for appropriate scientific or professional purposes and only with persons clearly concerned with such matters.

47. Relevant Ethical Standards (cont.) • Ethical Principle 5.05: Psychologists do not solicit testimonials from current therapy clients/patients or other persons who because of their particular circumstances are vulnerable to undue influence. • Ethical Principle 4.06 Consultations: When consulting with colleagues, (1) psychologists…. disclose information only to the extent necessary to achieve the purposes of the consultation. (See also Standard 4.01, Maintaining Confidentiality.) Clinical & Ethical Issues for Clinicians

48. Beware Online Pseudonyms • Invitations from people you do not know. • Caution when replying to “strangers” in public. • Online impersonation is fairly easy.

49. Closing Remarks • Know what's out there about you. • Take responsibility for your web presence. • Be proactive about cleaning it up or correcting inaccuracies. • Consider whether access to posted information could damage a client, another professional relationship, or you. • Distinguish between personal and professional use on social networking sites. • Understand and use privacy settings. • Be prepared to manage it clinically when internet activity comes into the room. • Develop a social media policy for your practice. • Include it as a part of informed consent and discuss it. Clinical & Ethical Issues for Clinicians

50. References • American Psychological Association. (2010). Ethical principles of psychologists and code of conduct. Retrieved from: http://www.apa.org/ethics. • Donner, M., The Ethical Use of the Listserv: Privacy and Professional Conduct, The California Psychologist, November/December 2007, 22. Retrieved from http://bit.ly/vsKFAW • , Florence W.; Patterson, Terence; Gottlieb, Michael. Ethical dilemmas in psychologists accessing Internet data: Is it justified? Professional Psychology: Research and Practice, Vol 42(2), Apr 2011, 105-112. • Kolmes, K. (2010, April). Private practice social media policy. [PDF file]. Retrieved May, 2010, from http://www.drkkolmes.com/docs/socmed.pdf