Part 4 - Ethics and Boundaries Tutorial

ReachOutPro.com.auEducational Module Part 4 Professional issues & guidelines

Part 4 – Using technology
in practice with young people:
Professional issues,
boundaries, privacy and
guidelines
Connecting Our Worlds
ReachOutPro.com.au Educational Module

Part 4 – Professional issues & guidelines


Introduction
As with any therapeutic
intervention, the use of technology
in clinical practice is not without
its ethical and professional
difficulties. This part of the
education module has been
developed to help you understand
and address the professional and
ethical issues that arise from
using technology in your work
with young people.
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Learning In completing Part 4, you will gain an understanding of:

Objectives • How to maintain professional boundaries
when using technology;

In completing Part 4, please note that the evidence for • The ethical issues including privacy,
technology in therapeutic interactions is still emerging
and that this part of the module is not exhaustive in its confidentiality, security and use;
coverage. We have aimed to address common ethical
issues and professional challenges, but there will be
occasions when issues arise that are not covered. When • How to manage concerns associated with
this does arise, we encourage you to consult the using technology.
professional and ethical guidelines of your organisation
and professional association for guidance.

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• Using new technology can potentially challenge your
understanding of professional boundaries.

Maintaining • Due to reduced interpersonal boundaries online, the
professional relationship can seem to blur.
professional • Professional boundaries need to be just as clearly defined

boundaries in the digital world and should mirror that of face-to-face
consultations.

in the digital world • Understanding how best to manage professional
boundaries is crucial to both the young person’s and the
professional’s safety.

• These expectations need to be clearly defined early in
contact with clients.

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Setting boundaries
• In order to establish and maintain • In addition to these factors that are
professional boundaries, expectations shaped by interactions with clients,
need to be set with clients about; healthcare professionals also need to
consider;
– How often clinicians will check
electronic communications and – The impact of private online
when they will respond; behaviour on professional life

– The clinical issues relating to – The safety of online material
privacy, confidentiality, security
and appropriate use; • These points are discussed throughout
this module.
– Management of risk behaviour.

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Clinical issues • The following section provides an outline of key issues when
using technology to communicate with your clients. Whilst we
have attempted to address the key issues, this list is by no
relating to privacy, means exhaustive and may not cover all the issues you face
within your organisation and practice.

confidentiality, • If you are unsure about how best to manage an issue raised
when using technology in your consultations, it is
security and use recommended that you refer back to the ethical guidelines for
your appropriate professional organisation [1].

• Key areas discussed are;

– Defining appropriate use
– Confirming the client’s identity
– Privacy
– Secure storage of information
– Recording contact
– Signatures and sign offs

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• If intending to use electronic
communications with clients,
timeframes around expected
responses to client contact need to be
clarified.

– This is particularly pertinent for
clinicians who work part time and
who do not or unable to check their
Checking and email/mobile phones outside of work
hours.
Responding to • Clients need be clearly informed
Communications about availability to contact their
clinicians and the timeframe in which
the clinician is likely to respond [2].

• A crisis escalation plan also needs to
be developed for when the clinician
does not respond within the pre-
defined time frame for instance who
does the client then contact if they are
in crisis or need an urgent response?

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Defining appropriate use
• As we have discussed, the reduced personal • Before initiating electronic contact with clients, it is
boundaries of cyberspace can mean that the important that both the client and the clinician
clarity around contact boundaries can be agree on the boundaries of appropriate use [2].
blurred.
• This includes clarity about the types of
• Moreover, this can mean that where clients may communication that are appropriate (eg.,
have been previously reluctant to contact a confirmation of appointments vs. crisis contact),
clinician, they may more readily write and email the times when this communication can be used
or send a SMS. (eg., during work hours or available 24 hours per
day), and the potential outcomes of such contact.
• Whilst this is beneficial in terms of reducing
access barriers, it has implications for safety • It is beneficial to set expectations and guidelines in
and professional responsibility. the first session and to document these where
appropriate.
• It is important to consider if the young person
would benefit from using technology, and if they
will do so appropriately.

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• It can be difficult to confirm a client’s identity when
communicating electronically.

• It is important to raise this with the young person and
to reach an understanding that you will assume that
the person responding to the communication is the
young person you intended.

Confirming the • Where possible, it is best to limit the level of detail
and sensitive communication when communicating

client’s identity •
electronically to avoid inadvertent disclosure.

You may also want to organise some form of
identification process with the young person to
ensure that you are communicating with the person
you assume it to be.

– This could include a code word or confirmation of information
such as previous appointment time to help validate an identity.
It is beneficial to discuss this with the young person prior to
commencing communication.

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Privacy
• If using electronic communications it is • Highlighting this with young people is important
important for the client to understand that there early on in the decision to use electronic
is potential for other people to see the communication in a therapeutic manner.
communication.
• For further information about general privacy
• It is important to discuss the potential for their guidelines and storage of information see Privacy
friends to read their SMS messages from you, Act and Information Privacy principles which can
or that if they leave their emails open others be accessed here:
may see the communication. http://www.privacy.gov.au/materials/types/infos
heets/view/6541.

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• It is encouraged that clinicians should utilise
encryption services when communicating
sensitive information, and should discuss
limitations with clients [6].

• Despite having firewalls, there is still the
potential to breach confidentiality when
Secure storage communicating with clients electronically.

of information – A 2006 study by Finn, indicated that 1 in 20
social workers reported that a client’s
confidentiality was compromised due to email
use [3].

• Given this, when communicating with clients it
is important to highlight that whilst efforts to
ensure confidentiality with be implemented, it
cannot be guaranteed that confidentiality can
be maintained [2].

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Recording of contact
• All communications • This includes noting
with clients need to be down the time of contact,
documented in the who initiated the contact,
client’s file. and what was the
purpose and outcome of
the contact.

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• Finally, it is important to consider what to
finish your communication with.

• Email signatures are important as they can
provide emergency contact details, which
may be particularly important if the client is
Signatures and unable to contact you.

• It is recommended that all email
sign-offs communication contain a professional
signature which consists of contact
information, and information about
confidentiality, unauthorised access and
intended uses [4].

• In addition to this, emergency contact details
are also recommended.

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Personal issues relating to
privacy and confidentiality
• In addition to clinical practices, clinicians need • It is important to be aware of the privacy policy
to be aware of the implication of their online and settings of each individual site.
personal behaviour and how this may reflect
them professionally. • Be aware that once you upload information or
images to a site, the site may then take over
• Online accounts are not as secure as we are ownership. Given this, it is important to
lead to believe, and even with high privacy consider the implication of the images you are
settings, information can be accessed by uploading.
others.
• Why not try searching for yourself on Google
• Be aware that your status updates may appear and see what comes up?
in searches, your profile photos might be made
available for anyone to see, and your
comments on other people’s pages may also be
visible.

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• When considering a friend request it is
Additional concerns important to consider the professional
associated with using implications.

technology with • Becoming a friend is likely to blur the
therapeutic relationship through self-
young people disclosure of personal information to the
client.

• When having a friendship requested, it is
advised that you follow the code of

Managing conduct for your profession and
organisation about the appropriateness of
this.
Facebook • For further information about declining a

friend requests request, see the supplementary notes for
a suggested conversation that you might
have with a young person (link – page 4).

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• Providing alternative means for
Additional concerns communication can also mean that there
associated with using are alternative ways for a young person
to communicate risk with you.
technology with
• It is important to have risk protocols in
young people place that can be implemented when
risky behaviours are communicated.

• This includes what will happen if the
young person communicates risk, who

Addressing will be contacted, and how confidentiality
will be managed. It is important to have
set these guidelines in the first session
high risk and to have an action plan documented.
See the supplementary notes for a

communications suggested conversation that you might
have with a young person (link – page 5).

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Personal associations and
guidelines on use of technology
• When setting your own • The following organisations have made a direct reference to the
professional boundaries for use or impact of technology on consultations;
practice, we encourage you
to work within the guidelines – The Australian Psychological Society – The internet’s
of your own organisation. ethical challenges for psychologists
http://www.psychology.org.au/publications/inpsych/2
• You may find you need 010/august/symons/?ID=3248
further guidance and it
might be useful to seek – The Australian Counselling Association – Internet
guidelines from other resources for counsellors
organisations or http://www.theaca.net.au/documents/Internet%20Res
professional associations. ources%20for%20Counsellors%202011.pdf

– The Australian Medical Association – Social Media and
the Medical Profession: A guide to online professionalism
for medical practitioners and medical students
http://ama.com.au/socialmedia

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A final word

• One of the difficulties with electronic communication is
the lack of non-verbal cues that can provide context.
Given this, it is recommended that communication be
explicit when it comes to risk, and that if you are unsure
about risk, err on the side of caution. Similarly, if you
are not getting the responses desired from the young
person, do not hesitate to phone them.

Further information is also provided in the supplementary notes section for this part of the module.

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References
1. Manhal-Baugus, M., E-therapy: practical, ethical, and legal issues.
CyberpsycholBehav, 2001. 4(5): p. 551-63.

2. Bradley, L.J. and B. Hendricks, E-mail and Ethical Issues. The
Family Journal, 2009. 17(3): p. 267-271.

3. Finn, J., An exploratory study of e-mail use of direct service social
workers. Journal of Technology in Human Sciences, 2006. 24: p. 1-
20.

4. Zur, O. I Love These E-Mails, or Do I? The Use of E-Mails in
Psychotherapy and Counseling 2008 [cited 2011 April 9th, 2011];
Available from: http://www.zurinstitute.com/e-mail_in_therapy.html.

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Evaluation
Education Module Pilot Webinar Participants
We are conducting a survey to evaluate the newly launched ReachOut Pro If you are completing this module as pre-reading for a
Educational Module - Connecting Our Worlds, currently being piloted on ReachOut Pro Webinar, please use the link below to undertake a
ReachOutPro.com.au. The survey aims to understand more about who separate survey tailored for your training program.
uses the module, what aspects are considered most useful and also how it
might be improved in the future. [Click here to begin the survey for Webinar Participants]

As this module is a pilot, we ask that you take a moment to complete an
online survey, to assist us in assessing the value of these professional
development resources for your practice. Your feedback will contribute to
more valuable and effective resources for other professionals in your
sector.

If you have finished using the Education Module, we would appreciate
your feedback on it’s usefulness for your practice.

[Click here to begin the survey]

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