Counselor Ethics in a Wired World: Best Practices Online

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1 Counselor Ethics in a Wired World: Best Practices Online

2 SECTION A:THE COUNSELING RELATIONSHIP A.1. Welfare of Those Served by Rehabilitation Counselors A.2. Respecting Diversity A.3. Client Rights in the Counseling Relationship A.4. Avoiding Harm and Avoiding Value Imposition A.5. Roles and Relationships with Clients SECTION B: CONFIDENTIALITY, PRIVILEGED COMMUNICATION, AND PRIVACY B.1. Respecting Client Rights B.3. Information Shared with Others B.6. Records SECTION D: PROFESSIONAL RESPONSIBILITY D.2. Cultural Competence/Diversity D.5. Responsibility to the Public and Other Professionals SECTION J:TECHNOLOGY AND DISTANCE COUNSELING J.3. Confidentiality, Informed Consent, and Security J.6. Records, Data Storage, and Disposal J.13. Distance Counseling Security and Business Practices CRCC Advisory Opinion #117

3 Pew Research Center's Internet & American Life Project: 47% of US adults participate in at least one online social network (OSN) OSN use is increasing in rehabilitation Continue to evolve as innovations in social networking emerge Common for rehab related service providers to use OSNs to access stakeholders Increase business Build rapport Share information Improve treatment compliance

4 Most popular are: Facebook My Space LinkedIn Twitter More than 500 disability- related groups maintain a presence on Facebook alone

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7 Convenient, interactive way to stay contact with clients in remote locations Or, those who have time and scheduling concerns Research indicates: Health- related professionals increasingly use OSNs to share information with clients; in turn, clients like to receiving health information through OSNs OSNs especially effective in disease prevention, health management, and preventative care

8 Useful for job seekers wishing to connect with employers, and for employers screening prospective employees Online networking can help people reconnect with previous employers and coworkers, or to create new employment contacts. Research suggests that people who engage in online social networking improve their technology skills, creativity, and openness to diversity However, may inadvertently reveal disability- related or other characteristics that influence potential employers Can highlight job- related qualities, interests, and expertise with appropriate professional profile

9 Research indicates: OSNs facilitate helping relationships Decrease social isolation Provide direct therapeutic services that might not otherwise exist due to factors such as distance, time, or expense Ø The CRC Code of Ethics Section J: Technology and Distance Counseling describes standards for services provided at a distance or online

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15 In 2010, 686 breaches of patient privacy were reported at California hospitals and substantiated by California Department of Public Health Last year, 1,407 such breaches were substantiated

16 Most concerns relate to CRC Code: Section A: The Counseling Relationship Section B: Confidentiality, Privileged Communication, and Privacy Section D: Professional Responsibility Section J: Technology and Distance Counseling. Issues of dual relationships and boundaries, as well as confidentiality and privacy especially important

17 Characteristics that make social networks useful may also result in problems with dual relationships and boundaries Section A: The Counseling Relationship guides CRCs to avoid nonprofessional interactions or relationships with clients A.1., Welfare of Those Served by Rehabilitation Counselor A. 5. Roles and Relationships with Clients The informality of OSN communication can cause confusion and misperceptions Significant life blurring, insider or selective communication, flirtations, excessive disclosure, role reversal Online tools such as: Ø Personal profiles Ø Comments Ø Chat Ø Photo sharing Ø Link sharing Are most likely to result in crossing of professional boundaries

18 Near- constant Internet access poses serious risks to client privacy, as does the illusion of privacy in OSN Section B: Confidentiality, Privileged Communication, and Privacy. Online comments about a client s mannerisms, functional limitations, assessment results, or vocational choices could allow them or others to identify them (or believe they do) In a matter of hours more than a thousand people may read a post!

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20 CRC ethical standards remember require informed consent and disclosure of confidentiality policies We also comply with: Section A. 3. Client Rights in the Counseling Relations- Confidentiality and Limits of Confidentiality Section B: Confidentiality, Privileged Communication, and Privacy But OSNs do not comply with these standards! Most monitor, collect, and store data on users, often selling it for solicitation What does Facebook know about us? Health Insurance Portability and Accountability Act (HIPAA) Family Educational Rights and Privacy Act (FERPA)

21 Study in The Proceeding of the National Academy of Sciences (USA): By analyzing Facebook likes, predicted with high accuracy: Race, age, IQ, sexual orientation, political views, and drug use Despite few users explicitly liking things that reveal attributes To download your own Facebook data: Go to the settings icon of your Facebook account In the general section of you account settings, there is an option to download a copy of your Facebook data Hit the Download Archive option and login You will receive an containing a link to a ZIP file of everything photos, info, video, etc. Double click the index.html file.

22 Concerns about the relative permanence of online information also exist CRC Code Section J. 6. Records, Data Storages, and Disposal Requires counselors to be aware electronic messages are part of client records Code implies no exceptions for OSNs YOURS? AGENCIES? CLIENTS?

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24 Consider clearly separating personal and professional content Configure privacy settings, ensuring personal information is protected and limiting visibility Consider using an alternative such as a LinkedIn, a Facebook Fan Page, or a Facebook Group Page to connect without comingling any personal content Even with privacy settings, online behavior and social content may still be locatable (i.e. photos) Monitor your online presence by regularly searching for yourself and/or your business using at least two major search engines (such as Bing and Google), since search engine results vary Encourage clients to do same

25 Considered a request for advisory opinion on ethical implications of CRCs using sites such as Facebook, Twitter, Skype, and other OSNs to communicate with clients Response presumed communications would be professional interactions in client- counselor relationship Not non- professional interactions

26 First, the Committee responded CRCs have the same behavioral and competency expectations regardless of technology used CRCs must understand precautions need needed for confidentiality or if confidentiality can even be maintained

27 Disclosure and informed consent must be also be considered and a distinction between counseling and communicating in noted For example, it is common to simply confirm or change the time of an appointment using electronic communication. However, distance counseling and other rehabilitation services require precautions to ensure the confidentiality, such as proper encryption

28 Final consideration: Will OSN allow the appropriate level of control of personal information so professional boundaries are maintained? Throughout the client- counselor relationship Related Standards (A.3.a, A.3.b, A.5.d, and the majority of Section J) Professional Disclosure Statement Informed Consent Nonprofessional Interaction or Relationship Other than Sexual or Romantic Interactions

29 Examine whether such contact would violate CRC Code Section A 5. Roles and Relationships with Clients Guides contact with clients and their family members outside the professional milieu States such contact is best avoided Consider organizational policies on the use of social networks and client- counselor relationships Including any applicable HIPAA and/or FERPA rules Think about who is in your network now Prohibits extended freestanding friendships

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31 Consider whether you will need to accept all friend requests from clients or none at all Avoid any appearance of selective dual relationships, favoritism, bias, or other impropriety Consider viewing a client s profile before accepting a friend request Discuss any content of concern, and the decision to accept or not, and on what basis, can be disclosed to the client As a related issue, consider whether typical or only unusual communications will need documentation

32 Develop a practical management plan for online activity Develop unfriending guidelines, personal and professional, and apply consistently For example, if other s comments become sexually or racially inappropriate, unfriending is warranted Exercise appropriate discretion in all social network communications Posts should adhere to standard ethical practices, such as respect for all people and appreciation of human diversity Keep comments, photos, and online associations appropriate for a broader audience Average Facebook user has 130 friends and spends 700 minutes per month on Facebook! Know that clients and colleagues may use your behavior as a model

33 Never post official communications to clients on a networking site Official case- related communications should use official online tools, such as a work account Always engage security features Consider disclosing your network s information data retention methods Interactions should remain with the acceptable boundaries of the counselor- client relationship, just as they would in face- to- face or telephonic interactions. May need permission to observe a client s online profile if it for therapeutic or service provision purposes

34 KEEP A CLEAN MACHINE Keep security software current Automate software updates Protect all devices that connect to the Internet Plug & scan USBs and other external devices CONNECT WITH CARE When in doubt, throw it out! Delete suspicious items, and don t click! Get savvy about Wi- Fi hotspots; limit the type of business you conduct through open Wi- Fi

35 A strong password: At least 8 characters long Not your user, real, or company name PHRASE BASED: To err is human, to forgive divine + year of Alexander Pope s death= TEHtfd#1744 No complete words Significantly different from prior passwords Has lower, upper, numerical, special characters My son's birthday is 12 December, 2004 = Msbi12/Dec,4 Substitute numbers or symbols for letters or words = Mi$un's Brthd8iz x 4 Rule (Eight By Four Rule): 8 characters minimum length 1 lower case + 1 upper case + 1 number + 1 special character FAVORITE BASED: I love to play badminton = ILuv2PlayB@dm1nt()n.

36 We can track your location, and we may access your contacts Phones can contain tremendous amounts of personal information Lost or stolen devices can be used to gather information about you and others. Protect your phone like your computer Secure your phone: Use a strong password or code to lock your phone Protect Your Personal Information- Think Before You App: Review the privacy policy and understand what data (location, access to your social networks) the app can access on your device before you download.

37 Learn how to disable geotags on your phone at

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