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Presented By: Kathryn Benson, LADAC, NCAC II, SAP, QCS Pleiades Clinical Consulting Services 45A Rutledge Street Nashville, TN 615.476.2931 Lightbeing@aol.com

What are they?

How do they serve the counseling relationship?

Autonomy: To allow others the freedom to choose their own destiny Obedience: The responsibility to observe and obey legal and ethical directives

Beneficence: To help others Gratitude: To pass along the good that we receive to others Competence: To possess the necessary skills and knowledge to treat clients and to remain current with treatment modalities, theories and techniques

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Conscientious Refusal: The responsibility to refuse to carry out directives that are illegal and/or unethical

Justice: Fair and equal treatment, to treat others in a just manner Stewardship: To use available resources in a judicious and conscientious manner, to give back Honesty and Candor: Tell the truth in all dealing with clients, colleagues, business associates and the community

Fidelity: To be true to your word, keeping promises and commitments Loyalty: The responsibility to not abandon those with whom you work Diligence: To work hard in the chosen profession, to be mindful, careful and thorough in the services delivered

Discretion: Use of good judgment, honoring confidentiality and the privacy of others Self-improvement: To work on professional and personal growth to be the best you can be Non-malfeasance: Do no harm to the interests of the client

Restitution: When necessary, make amends to those who have been harmed or injured Self-interest: To protect yourself and your personal interests

Health Insurance Portability Accountability Act

Confidentiality Federal Regulations For Substance Abuse Services

All communication from first contact requires a written release to specific parties for specific information to be disclosed for specific purposes.
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Must be signed by adult patient Must be signed by guardian if patient under 16 years of age Must be signed by professional Must be dated Must indicate expiration date of release Must indicate sign without duress and fully informed Must include statement prohibiting re-disclosure of information
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Signed Release Medical Emergencies threats of harm to self, others Child Abuse, neglect, elder abuse Court Order Crimes on Premises, Crimes toward Staff Person Qualified Service Organization Agreement

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Email Texting Internet-supported Intervention Web-based therapy E-interventions Computer-mediated interventions Online therapy Online counseling Technology assisted distance counseling (TADC) E-therapy/e-counseling Cybertherapy/cybercounseling Psycho-technology Tele-Health Internet counseling

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E-therapy chat (live) Moderated forum Web-based psychoeducation Self-guided Web-based interventions with automated feedback (e.g., anxiety, phobia, self-esteem, anger, weight loss)
! Human support ! No human support

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Emotionally safe (e.g., shy, anxious client) Semi-anonymity regarding self-disclosure Convenience Absence of geographical barrier
! Rural areas ! Clients with disabilities

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Video conferencing Internet/Telephone therapy Email exchanges Text messages Client Blogs Client Twitter

! Immediacy ! Flexible scheduling ! Cost effective

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Loss of human factor, nonverbal cues Misunderstandings Compromised privacy and confidentiality Boundary issues (ambiguous access, self-disclosure) Difficulty addressing long-term, complex problems Delayed response Feeling rushed to respond to emails, texts Emergencies Identity fraud Interstate practice without a license Technological failure

Suffering from psychological /psychiatric disorders needing immediate attention Significantly depressed A danger to themselves or others Struggling with serious substance abuse issues Highly reactive and potentially dangerous Struggling with certain personality disorders such as those with borderline personality disorder, paranoia or dissociative disorders

Friending on Facebook
o Boundaries issues o Rejection issues o Privacy issues (e.g., acquaintances in common)

What is on the Facebook profile? o Facebook Page: professional use, one-way o Facebook Profile: personal content, photos, etc. What is the context of therapy? (e.g., client age, culture, clinical setting, therapeutic approach, size of community) Who is the client? (e.g., clinical issues, boundary instincts) Why did the client post the request? Will this set a challenging precedent for other clients? What are the 42 CFR, Part 2 and documentation implications? Will Friending a client create complex boundary issues?

Electronic interactions (Facebook, email)

! Privacy issues ! Documentation issues

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To Google or not to Google

o Curiosity searches o Crisis searches

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Is the email communication for administrative or therapeutic purposes?

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Ethical dilemmas Ethical decision-making Ethics risk management

How often must I check my email messages? (provide clients with written and verbal information about your policy) Does email communication fall under 42 CFR, Part 2? What are the confidentiality and privacy issues? Do I need to document emails in the clinical record?

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Ethical mistakes Deliberate ethical decisions Ethical misconduct

Client rights Confidentiality and privacy Informed consent Service delivery Boundary issues Documentation Client records Supervision Consultation Client referral Fraud Termination of services and client abandonment

http://www.apa.org/ethics/education/telephonestatement.aspx https://ismho.org/suggestions.asp http://www.acto-uk.org/professionalconduct.htm

Kathryn Benson, LADAC, NCAC II, QCS lightbeing@aol.com NAADAC NAADAC.org