Dr. Maheu offers an introduction to evidence-based apps to be used with smartphones and other portable devices. The above event is sponsored by the TeleMental Health Institute, Inc. We are the premier professional training site for professionals seeking training in telehealth. Our courses are offered in a state-of-the-art, 100% online learning environment that is fully mobile compatible. Professional training is now available from your desktop of mobile device, 24/7, at your home or office. To receive our FREE monthly newsletter related to telemental health, telecounseling, online therapy, telepsychology or telepsychiatry and telenursing, send an email to: tmhinews@aweber.com You will also receive notices of our bonuses and discounts for professional training for CEUs and CMEs. See other offerings at www.telehealth.org Send questions or comments to us at www.support.telehealth.org Contact Dr. Maheu to speak at your next workshop or conference at: www.support.telehealth.org

1. Smartphone and
mHealth Apps:
Evidence-Based
Considerations for
Psychology
August 5, 2012
Marlene M. Maheu, Ph.D.
www.telehealth.org 1

2. Disclaimer
• The content of any TeleMental Health Institute training covers a number of
developing areas where legal and ethical issues are in still solidifying. It
then, is impossible for us to give you definitive advice. We assume you are
licensed or otherwise credentialed are responsible for your own decisions
and actions.
• Our goal is educational only. Our legal advisors insist that we inform you
that “No warranty, guarantee, or representation is made by the TeleMental
Health Institute, its trainers, guests or independent consultants as to the
accuracy or sufficiency of the information contained in our training.
Therefore, the Institute, trainers, guests and consultants assume no
responsibility in connection therewith.”
• Our goal is to outline the issues and alert you to what's happening, including
legal, ethical and other risk management issues, but we cannot and are not
attempting to provide definitive advice for your specific situation. You are
encouraged to seek such specific advice from your specific legal, regulatory,
ethical and malpractice bodies.

3. mHealth
• Mobile phones are the
predominant form of
communication in 3rd
world countries
– landlines are extremely
limited
– broadband lags behind
in development
Copyright 2012 TeleMental Health Institute, Inc. All rights reserved.

5. 49.7% of all Americans have a smartphone (Neilson, Feb. 2012)
Copyright 2012 TeleMental Health Institute, Inc. All rights reserved.

6. Communication
channel of choice
for many people
We are making ourselves
irrelevant to health care!
Nick Cummings, Ph.D.

7. Mobile Subscribers June 2012

8. Mobile Security

10. Barriers to mHealth
• Lack of data security • Cost of solution
• Difficulties for users in finding • Regulation, slowing down
mHealth solutions innovation and development
• Devices do not meet clinical • Patients' discomfort with
requirements in terms of change in their healthcare
hygiene, waterproofing, etc routine
• Lack of standardization in • Technology isn't practical and
terms of hardware and affordable for a large enough
software, slowing down the market yet
market dynamic • Lack of Business Models
• Unknown legitimacy, causing • Resistance from healthcare
distrust with users providers
• Patient information security, • Few members of the target
encryption and authentication group (elderly/chronic disease)
issues own a relevant mobile device

11. 15 Categories of Health Apps*
Mental Health / Behavior Medical & Other Health
• Cardio Fitness
• Diet
• Emergency Care
• Smoking Cessation
• Chronic Condition
• Stress Management
• Sleep • Calculator Apps
• Women’s Health • Strength Training
• Medication Adherence • Physical Therapy
• Mental Health Apps • Allergy
– Anger Management • Professional Office
– PTSD Appointment
Brian Dolan, July, 2012, 13,600 iPhone Health & Fitness Apps

12. App to Prescribe Apps?
http://m.iwhealthcare.com/135368/show/8462525c94292d898b2428c8bca8a665/

14. All
Existing
Legal
and
Ethical
Rules
Apply

15. Duty to Report / Duty to Warn
• (v) Failing to comply with
the child abuse reporting
requirements of Section
11166 of the Penal Code.
• (w) Failing to comply with
the elder and adult
dependent abuse reporting
requirements of Section
15630 of the Welfare and
Institutions Code. CA Business
and Professions Code Sections
4989.54 (cont.)

16. Existing TeleMental Health Guidelines
• American Medical Association. (2000). Guidelines for Patient-Physician Electronic Mail
• American Counseling Association. (1999) (2005). ACA Code of Ethics
• American Mental Health Counselors Association. (2000). Code of Ethics of the American Mental Health Counselors
Association, Principle 14, Internet On-Line Counseling
• American Psychological Association. (1997). APA Statement on Services by Telephone, Teleconferencing, and Internet, A
statement by the Ethics Committee of the American Psychological Association
• American Psychological Association. (2010). Ethical principles of psychologists and code of conduct
• American Telemedicine Association. (2009). Evidence-Based Practice for Telemental Health
• American Telemedicine Association. (2009). Practice Guidelines for Videoconferencing-Based Telemental Health
• Australian Psychological Society. (2004). Guidelines for Providing Psychological Services and Products on the Internet
• British Psychological Society. (2009). The Provision of Psychological Services via the Internet and Other Non-direct Means
• Canadian Psychological Association. (2006). Ethical Guidelines for Psychologists Providing Psychological Services via
Electronic Media
• Federation of State Medical Boards of the United States, Inc., Report of the Special Committee on Professional Conduct and
Ethics. (2002) Model guidelines for the appropriate use of the Internet in medical practice
• National Association of Social Workers. (1999) (2008). Code of Ethics
• National Board for Certified Counselors and Center for Credentialing and Education, (2001). The Practice of Internet
Counseling. (2001)
• New Zealand Psychological Psychologists Board (2011). Draft Guidelines: Psychology services delivered via the internet and
other electronic media
• Ohio Psychological Association. (2010). Telepsychology Guidelines
• Winkler, M., Flanagin, A., Chi-Lum, B., White, J., Andrews, K., Kennett, R., DeAngelis, C. & Musacchio, R. (2000). Guidelines for
medical and health information sites on the Internet. Journal of the American Medical Association, March 22/29, 283(12), pp.
1600-1606

17. Mobile Security

18. HIPAA Privacy Rule
• Data are “individually identifiable” if they include any of the 18 types of identifiers, listed below, for an individual
or for the individual’s employer or family member, or if the provider or researcher is aware that the information
could be used, either alone or in combination with other information, to identify an individual:
• * Name
* Address (all geographic subdivisions smaller than state, including street address, city, county, zip code)
* All elements (except years) of dates related to an individual (including birth date, admission date, discharge
date, date of death and exact age if over 89)
* Telephone numbers
* Fax number
* Email address
* Social Security number
* Medical record number
* Health plan beneficiary number
* Account number
* Certificate/license number
* Any vehicle or other device serial number
* Device identifiers or serial numbers
* Web URL
* Internet Protocol (IP) address numbers
* Finger or voice prints
* Photographic images
* Any other characteristic that could uniquely identify the individual

19. Which Technologies to Use?
• No Guesswork Needed
– HIPAA “compliant” or
“compatible”
– Practitioners need to be
compliant, not
technology
– Look for documentation
of compatibility with
HIPAA standards

20. Privacy
Cross-over
technologies
Many people use
Skype’s app on their
cell phones to speak
or send text messages.
Do they count?
Copyright 2012 TeleMental Health Institute, Inc. All rights reserved .

21. Is Skype a
video
platform or a
social media
platform?
Copyright 2012 TeleMental Health Institute, Inc. All rights reserved .

22. Security Suggestions
• Don’t Download Any Clinical Data
• Authenticate
– Passwords to lock; passwords to access networks
– Biometric authentication is on the rise
• Use Antiviral and Malware programs
– ” CounterACT is a security control platform that
automatically identifies what devices and users are on a
network, controls access to the network, blocks threats,
remediates security violations at endpoints, and measures
compliance to an organization's security policies.

23. Stolen Phone Safety
SAFETY TIPS
• Password protect your phone as
soon as you receive the device.
• Change your online and
voicemail passwords often.
• Protect your service. Add a
security passcode to your online
account.
• Download device protection
and privacy apps for your
messaging or smartphone.
• Don't use your smartphone &
drive - just drive!
• Learn how to back up your SIM
card contacts.
Copyright 2012 TeleMental Health Institute, Inc. All rights reserved.

24. Empirical Guidance for Text Messaging?
• Limited
• Research for underlying
theory
• Research for app itself?
Copyright 2012 TeleMental Health Institute, Inc. All rights reserved.

25. "It would be strange, and embarrassing, if clinical
psychologists, supposedly sophisticated methodologically
and quantitatively trained, were to lag behind internal
medicine, investment analysis, and factory operations
control in accepting the computer revolution."
- Paul Meehl, 1987
Please sign our petition:
www.stp-apa.net/

26. Questions?
Marlene M. Maheu, Ph.D.
TeleMental Health Institute, Inc.
Phone: 619-255-2788
Email: mmaheu@telehealth.ORG
Copyright 2012 TeleMental Health Institute, Inc. All rights reserved.