CA Internet Marketing Law and Ethics Introduction The world of psychotherapy has changed immensely in the last five years. In addition to providing counseling many psychotherapists have begun to market their services on the internet. It is important to understand the relevant law and ethics requirements for this type of advertising. This law course will give you an understanding of the laws and ethics principles that are relevant to marketing therapy services online. Learning Objectives 1. Participant will understand CA laws in relationship to advertising on a website. 2. Participant will understand the CAMFT, NASW, and ACA ethical standards in relationship to advertising on a website. 3. Participant will understand CAMFT, NASW, and ACA, ethical standards regarding therapist's use of using social media. 4. Participant will understand the ethics of being a participant in online clinical and therapy business related forums or groups. 5. Participant will understand the laws and ethics regarding email communication with clients.
Website Advertising Advertising and Credentials There are many Laws and Ethics that are relevant to advertising on a website. They cover the following principles: 1. Definition of advertising 2. Advertising credentials 3. Advertising fees 4. What claims can be made in regards to success in treatment 5. Testimonials 6. HIPPA Privacy Policy Definition of advertising To begin this is how CA Law defines advertising. CA Business and Profession Code 4890.03 (e) "Advertise," as used in this chapter, includes, but is not limited to, any public communication, as defined in subdivision (a) of Section 651, the issuance of any card, sign, or device to any person, or the causing, permitting, or allowing of any sign or marking on, or in, any building or structure, or in any newspaper or magazine or in any directory, or any printed matter whatsoever, with or without any limiting qualification. Signs within religious buildings or notices in church bulletins mailed to a congregation shall not be construed as advertising within the meaning of this chapter." http://law.onecle.com/california/business/4980.03.html
How to Properly Advertise Your Credentials Next there are several laws that govern how MFT's, LCSW's, and LPCC's can advertise in CA. Effective April 1, 2013 California Code of Regulations 1811 requires that on any advertisement you must have: 1. Your full name as filed with the board 2. The license or registration held or an acceptable abbreviation as follows: a. Licensed Marriage and Family Therapist or MFT or LMFT b. Licensed Educational Psychologist or LEP c. Licensed Clinical Social Worker or LCSW d. Licensed Professional Clinical Counselor or LPCC For Interns a. Marriage and Family Therapist Registered Intern or MFT Registered Intern. You cannot use MFTI unless the advertisement also has the title marriage and Family Therapist Intern included. b. Registered Clinical Social Worker or Registered Associate CSW c. Professional Clinical Counselor Registered Intern or PCC Registered Intern 3. Your license or registration number Other requirements 1. If you are a registrant you must include the name of your employer or the name of an entity for which you volunteer. 2. You may use the word psychotherapist or psychotherapy in an advertisement if you follow all of the rules in 1811 that are listed above..
Each license also has a law that provides Title Protection. This means no one can advertise themselves as a MFT, LCSW, OR LPCC unless they have a license to do so. I will quote the full law for Marriage and Family Therapists and cite the law numbers for LCSW's and LPCC's. Marriage and Family Therapists CA Business and Professional Code 4980 (a) "Many California families and many individual Californians are experiencing difficulty and distress, and are in need of wise, competent, caring, compassionate, and effective counseling in order to enable them to improve and maintain healthy family relationships. Healthy individuals and healthy families and healthy relationships are inherently beneficial and crucial to a healthy society, and are our most precious and valuable natural resource. Marriage and family therapists provide a crucial support for the well-being of the people and the State of California. (b) No person may engage in the practice of marriage and family therapy as defined by Section 4980.02, unless he or she holds a valid license as a marriage and family therapist, or unless he or she is specifically exempted from that requirement, nor may any person advertise himself or herself as performing the services of a marriage, family, child, domestic, or marital consultant, or in any way use these or any similar titles, including the letters "M.F.T." or "M.F.C.C.," or other name, word initial, or symbol in connection with or following his or her name to imply that he or she performs these services without a license as provided by this chapter. Persons licensed under Article 4 (commencing with Section 4996) of Chapter 14 of Division 2, or under Chapter 6.6 (commencing with Section 2900) may engage in such practice or advertise that they practice marriage and family therapy but may not advertise that they hold the marriage and family therapist's license." http://law.onecle.com/california/business/4980.html
The law says that you must have a license in order to advertise yourself as a Marriage and Family Therapist. Clinical Social Workers CA Business and Professional Code 4996 http://law.onecle.com/california/business/4996.html Licensed Professional Clinical Counselors CA Business and Professional Code 4999.30 http://www.leginfo.ca.gov/cgi-bin/displaycode?section=bpc&group=04001-05000&file=4999.30-4999.64 The consequence of advertising in a deceptive manner is spelled out in the following law. CA Business and Professional Code 4982 (p) "4982. The board may deny a license or registration or may suspend or revoke the license or registration of a licensee or registrant if he or she has been guilty of unprofessional conduct. Unprofessional conduct includes, but is not limited to, the following: p) Advertising in a manner that is false, fraudulent, misleading, or deceptive, as defined in Section 651." http://www.leginfo.ca.gov/cgi-bin/displaycode?section=bpc&group=04001-05000&file=4982-4982.3 This law states that the Board of Behavioral Sciences may take disciplinary action if the law is violated. Advertising as an Intern There are some specific laws that apply to interns. MFT Interns A MFT intern must state that they are not licensed and must provide their supervisor's information. They must also provide their employer's information and their intern registration number. Social workers and professional clinical counselor interns must state that they are not licensed and provide their supervisor's name and license number.
MFT Interns' have the most extensive regulations They must 1. Indicate their employer and what license their supervisor holds 2. Have their name and supervisor's license designation or abbreviation and the license number of their supervisor 3. They must state that they are an intern-who their employer is- and that they are supervised by a licensed person. The full legal citation is as follows Business and Professional Code 4980.44 (d) (d) (1) Any advertisement by or on behalf of a marriage and family therapist registered intern shall include, at a minimum, all of the following information: (A) That he or she is a marriage and family therapist registered intern. (B) The intern's registration number. (C) The name of his or her employer. (D) That he or she is supervised by a licensed person. (2) The abbreviation "MFTI" shall not be used in an advertisement unless the title "marriage and family therapist registered intern" appears in the advertisement. http://law.onecle.com/california/business/4980.44.html Example Janice Williams Marriage and Family Therapist Registered Intern IMF 0000 Employed by Happy Counseling Supervised by Mark Edgar Licensed Marriage and Family Therapist MFC 55555
Social Work Interns CA Business and Professional Code 4996.18 "(h) A registrant shall inform each client or patient prior to performing any professional services that he or she is unlicensed and is under the supervision of a licensed professional." http://law.onecle.com/california/business/4996.18.html Example George Rogers, MSW Registered Associate Clinical Social Worker Supervised by Annette Felix LCS 12345 PCC Interns CA Business and Professional Code 4999.45 "(a) An intern employed under this chapter shall: (3) Inform each client prior to performing any professional services that he or she is unlicensed and under supervision." http://law.onecle.com/california/business/4999.45.html Jack Davidson Professional Clinical Counselor Intern PCCI 56789 Supervised by Carol Rogers Licensed Clinical Social Worker License No. LCS 54321 Additionally each license has a law related to unprofessional conduct. This law states that you cannot misrepresent your license, advertise deceptively, nor work or advertise you can work beyond your scope of expertise.
Marriage Family Therapists 4982 "(f) Misrepresentation as to the type or status of a license or registration held by the person, or otherwise misrepresenting or permitting misrepresentation of his or her education, professional qualifications, or professional affiliations to any person or entity." "(l) Performing, or holding oneself out as being able to perform, or offering to perform, or permitting any trainee or registered intern under supervision to perform, any professional services beyond the scope of the license authorized by this chapter." "(p) Advertising in a manner that is false, fraudulent, misleading, or deceptive, as defined in Section 651." "(s) Performing or holding oneself out as being able to perform professional services beyond the scope of one's competence, as established by one's education, training, or experience. This subdivision shall not be construed to expand the scope of the license authorized by this chapter." http://law.onecle.com/california/business/4982.html Clinical Social Workers 4992.3 "(g) Misrepresentation as to the type or status of a license or registration held by the person, or otherwise misrepresenting or permitting misrepresentation of his or her education, professional qualifications, or professional affiliations to any person or entity. For purposes of this subdivision, this misrepresentation includes, but is not limited to, misrepresentation of the person's qualifications as an adoption service provider pursuant to Section 8502 of the Family Code." "(m) Performing, or holding one's self out as being able to perform, or offering to perform or permitting, any registered associate clinical social worker or intern under supervision to perform any professional services beyond the scope of one's competence, as established by one's education, training, or experience. This subdivision shall not be construed to expand the scope of the license authorized by this chapter." "(q) Advertising in a manner that is false, fraudulent, misleading, or deceptive, as defined in Section 651." http://law.onecle.com/california/business/4992.3.html
Professional Clinical Counselor 4999.90 "(f) Misrepresentation as to the type or status of a license or registration held by the person, or otherwise misrepresenting or permitting misrepresentation of his or her education, professional qualifications, or professional affiliations to any person or entity." "(l) Performing, or holding oneself out as being able to perform, or offering to perform, or permitting any clinical counselor trainee or intern under supervision to perform, any professional services beyond the scope of the license authorized by this chapter." "(p) Advertising in a manner that is false, fraudulent, misleading, or deceptive, as defined in Section 651." http://statutes.laws.com/california/bpc/4999.80-4999.90 Along with the laws that regulate advertising there are ethical principles that relate to advertising California Association for Marriage and Family Therapists (CAMFT) Ethics for Advertising CAMFT's code of ethics states that advertising must be ethical and accurate. In order to advertise any specialization they will be sure to have any necessary education or training needed to do so. "10. ADVERTISING Marriage and family therapists who advertise do so appropriately. Their advertising enables consumers to choose professional services based upon accurate information. 10.1 ACCURACY AND HONESTY: Marriage and family therapists accurately represent their competence, education, training, and experience relevant to their professional practice to patients and others. 10.4 FALSE, MISLEADING, OR DECEPTIVE: Marriage and family therapists do not use any professional identification, including but not limited to: a business card, office sign, letterhead, telephone, or association directory listing, Internet, or any other media, if it includes a statement or claim that is false, fraudulent, misleading, or deceptive. A statement is false, fraudulent, misleading, or deceptive if it a) contains a material misrepresentation of fact; b) fails to state any material fact necessary to
make the statement, in light of all circumstances, not misleading; or c) is intended to or is likely to create an unjustified expectation. 10.8 SPECIALIZATIONS: Marriage and family therapists may represent themselves as either specializing or having expertise within a limited area of marriage and family therapy, but only if they have the education, training, and experience that meets recognized professional standards to practice in that specialty area." CAMFT's code of ethics states that advertising must be ethical and accurate. In order to advertise any specialization they will be sure to have any necessary education or training needed to do so. National Association for Social Workers (NASW) Ethics for Advertising NASW ethical codes require social workers to represent their competency for only services for which they have be trained. Social workers must also advertise in an honest manner. "1.04 Competence "(a) Social workers should provide services and represent themselves as competent only within the boundaries of their education, training, license, certification, consultation received, supervised experience, or other relevant professional experience." "4.04 Dishonesty, Fraud, and Deception Social workers should not participate in, condone, or be associated with dishonesty, fraud, or deception." American Counseling Association (ACA) Ethics for Advertising "C.4. Professional Qualifications C.4.a. Accurate Representation Counselors claim or imply only professional qualifications actually completed and correct any known misrepresentations of their qualifications by others.
Counselors truthfully represent the qualifications of their professional colleagues. Counselors clearly distinguish between paid and volunteer work experience and accurately describe their continuing education and specialized training." Fictitious Names There are some additional laws that are specific to the use of Fictitious Names in a private practice. Each law requires the licensee to not use a DBA that is false or misleading. This might include naming a business something that could indicate a degree not received or promising success that cannot be substantiated. Marriage Family Therapists CA Business and Professional Code 4980.46 "Any licensed marriage and family therapist who conducts a private practice under a fictitious business name shall not use any name that is false, misleading, or deceptive, and shall inform the patient, prior to the commencement of treatment, of the name and license designation of the owner or owners of the practice." http://codes.lp.findlaw.com/cacode/bpc/1/d2/13/1/s4980.46 Clinical Social Workers CA Business and Professional Code -4992.10 "A licensed clinical social worker who conducts a private practice under a fictitious business name shall not use a name that is false, misleading, or deceptive, and shall inform the patient, prior to the commencement of treatment, of the name and license designation of the owner or owners of the practice." http://law.onecle.com/california/business/4992.10.html Professional Clinical Counselors CA Business and Professional Code -4999.72 "Any licensed professional clinical counselor who conducts a private practice under a fictitious business name shall not use any
name that is false, misleading, or deceptive, and shall inform the patient, prior to the commencement of treatment, of the name and license designation of the owner or owners of the practice." http://law.onecle.com/california/business/4999.72.html CAMFT also addresses this in their code of ethics. "10.3 FICTITIOUS/OTHER NAMES: Marriage and family therapists do not use a name that could mislead the public concerning the identity, responsibility, source, and status of those practicing under that name, and do not hold themselves out as being partners or associates of a firm if they are not." Advertising Fees If you choose to list your fees on your website there are additional regulations to follow. CA Business and Professions Code 8 (c) "Any price advertisement shall be exact, without the use of phrases, including, but not limited to, "as low as," "and up,""lowest prices," or words or phrases of similar import. Any advertisement that refers to services, or costs for services, and that uses words of comparison shall be based on verifiable data substantiating the comparison. Any person so advertising shall be prepared to provide information sufficient to establish the accuracy of that comparison. Price advertising shall not be fraudulent, deceitful, or misleading, including statements or advertisements of bait, discount, premiums, gifts, or any statements of a similar nature. In connection with price advertising, the price for each product or service shall be clearly identifiable. The price advertised for products shall include charges for any related professional services, including dispensing and fitting services, unless the advertisement specifically and clearly indicates otherwise." http://law.onecle.com/california/business/651.html This law states that your price advertising cannot be in any way be seen as misleading.
In additional each license requires that fees be disclosed prior to treatment along with the basis of the fee. This should be considered when deciding whether or not to advertise your fee and how to advertise if you have a sliding scale. Marriage Family Therapists 4982 "(n) Prior to the commencement of treatment, failing to disclose to the client or prospective client the fee to be charged for the professional services, or the basis upon which that fee will be computed." http://law.onecle.com/california/business/4982.html Clinical Social Workers 4992.3 "(o) Prior to the commencement of treatment, failing to disclose to the client or prospective client the fee to be charged for the professional services, or the basis upon which that fee will be computed." http://law.onecle.com/california/business/4992.3.html Professional Clinical Counselors 4999.90 "(n) Prior to the commencement of treatment, failing to disclose to the client or prospective client the fee to be charged for the professional services, or the basis upon which that fee will be computed." http://statutes.laws.com/california/bpc/4999.80-4999.90 Ethical Standards That Are Relevant to Fees The CAMFT Code of Ethics is the only code of ethics that specifically addresses the disclosure of fees. They say 9.3 DISCLOSURE OF FEES Marriage and family therapists disclose, in advance, their fees and the basis upon which they are computed, including, but not limited to, charges for canceled or missed appointments and any interest to be charged on unpaid balances, at the beginning of treatment and give reasonable notice of any changes in fees or other charges. So you should address these issues on your website in your fees section.
Claims on Website There are extensive rules as to what you can claim in your advertising. I have included the parts of CA Professional and Business Code 651 relevant to therapists and bolded the parts that are especially relevant. CA Business and Professional Code 651 "(a) It is unlawful for any person licensed under this division or under any initiative act referred to in this division to disseminate or cause to be disseminated any form of public communication containing a false, fraudulent, misleading, or deceptive statement, claim, or image for the purpose of or likely to induce, directly or indirectly, the rendering of professional services or furnishing of products in connection with the professional practice or business for which he or she is licensed. A "public communication" as used in this section includes, but is not limited to, communication by means of mail, television, radio, motion picture, newspaper, book, list or directory of healing arts practitioners, Internet, or other electronic communication. (b) A false, fraudulent, misleading, or deceptive statement, claim, or image includes a statement or claim that does any of the following: (1) Contains a misrepresentation of fact. (2) Is likely to mislead or deceive because of a failure to disclose material facts. (3) (A) Is intended or is likely to create false or unjustified expectations of favorable results, including the use of any photograph or other image that does not accurately depict the results of the procedure being advertised or that has been altered in any manner from the image of the actual subject depicted in the photograph or image. (B) Use of any photograph or other image of a model without clearly stating in a prominent location in easily readable type the fact that the photograph or image is of a model is a violation of subdivision (a). For purposes of this paragraph, a model is anyone other than an actual patient, who has undergone the procedure being advertised, of the licensee who is advertising for his or her services. (C) Use of any photograph or other image of an actual patient that depicts or purports to depict the results of any procedure, or presents "before" and "after" views of a patient, without specifying in a prominent location in easily readable type size what procedures were performed on that patient is a violation of subdivision (a). Any "before" and "after" views (i) shall be comparable in presentation so that the results are not distorted by favorable poses, lighting,
or other features of presentation, and (ii) shall contain a statement that the same "before" and "after" results may not occur for all patients. (4) Relates to fees, other than a standard consultation fee or a range of fees for specific types of services, without fully and specifically disclosing all variables and other material factors. (5) Contains other representations or implications that in reasonable probability will cause an ordinarily prudent person to misunderstand or be deceived. (6) Makes a claim either of professional superiority or of performing services in a superior manner, unless that claim is relevant to the service being performed and can be substantiated with objective scientific evidence. (7) Makes a scientific claim that cannot be substantiated by reliable, peer reviewed, published scientific studies. (8) Includes any statement, endorsement, or testimonial that is likely to mislead or deceive because of a failure to disclose material facts. (c) Any price advertisement shall be exact, without the use of phrases, including, but not limited to, "as low as," "and up," "lowest prices," or words or phrases of similar import. Any advertisement that refers to services, or costs for services, and that uses words of comparison shall be based on verifiable data substantiating the comparison. Any person so advertising shall be prepared to provide information sufficient to establish the accuracy of that comparison. Price advertising shall not be fraudulent, deceitful, or misleading, including statements or advertisements of bait, discount, premiums, gifts, or any statements of a similar nature. In connection with price advertising, the price for each product or service shall be clearly identifiable. The price advertised for products shall include charges for any related professional services, including dispensing and fitting services, unless the advertisement specifically and clearly indicates otherwise. (d) Any person so licensed shall not compensate or give anything of value to a representative of the press, radio, television, or other communication medium in anticipation of, or in return for, professional publicity unless the fact of compensation is made known in that publicity. (e) Any person so licensed may not use any professional card, professional announcement card, office sign, letterhead, telephone directory listing, medical list, medical directory listing, or a similar professional notice or device if it includes a statement or claim that is false, fraudulent, misleading, or deceptive within the
meaning of subdivision (b). (f) Any person so licensed who violates this section is guilty of a misdemeanor. A bona fide mistake of fact shall be a defense to this subdivision, but only to this subdivision. (g) Any violation of this section by a person so licensed shall constitute good cause for revocation or suspension of his or her license or other disciplinary action. (h) Advertising by any person so licensed may include the following: (1) A statement of the name of the practitioner. (2) A statement of addresses and telephone numbers of the offices maintained by the practitioner. (3) A statement of office hours regularly maintained by the practitioner. (4) A statement of languages, other than English, fluently spoken by the practitioner or a person in the practitioner's office. (5) (A) A statement that the practitioner is certified by a private or public board or agency or a statement that the practitioner limits his or her practice to specific fields. (B) A statement of certification by a practitioner licensed under Chapter 7 (commencing with Section 3000) shall only include a statement that he or she is certified or eligible for certification by a private or public board or parent association recognized by that practitioner's licensing board." http://law.onecle.com/california/business/651.html This law limits any claims in advertising to those that can be scientifically validated. It states that advertising in general cannot be deceptive in any way. There are also ethical codes regarding not being deceptive in advertising. CAMFT says "10.4 FALSE, MISLEADING, OR DECEPTIVE: Marriage and family therapists do not use any professional identification, including but not limited to: a business card, office sign, letterhead, telephone, or association directory listing, Internet, or any other media, if it includes a statement or claim that is false, fraudulent, misleading, or deceptive. A statement is false, fraudulent, misleading, or deceptive if it a) contains a material misrepresentation of fact; b) fails to state any material fact necessary to make the statement, in light of all circumstances, not misleading; or c) is intended to or is likely to create an unjustified expectation."
NASW says "4.06 Misrepresentation (c) Social workers should ensure that their representations to clients, agencies, and the public of professional qualifications, credentials, education, competence, affiliations, services provided, or results to be achieved are accurate. Social workers should claim only those relevant professional credentials they actually possess and take steps to correct any inaccuracies or misrepresentations of their credentials by others. " ACA says "C.2.a. Boundaries of Competence Counselors practice only within the boundaries of their competence, based on their education, training, supervised experience, state and national professional credentials, and appropriate professional experience. Whereas multicultural counseling competency is required across all counseling specialties, counselors gain knowledge, personal awareness, sensitivity, dispositions, and skills pertinent to being a culturally competent counselor in working with a diverse client population. C.2.b. New Specialty Areas of Practice "Counselors practice in specialty areas new to them only after appropriate education, training, and supervised experience. While developing skills in new specialty areas, counselors take steps to ensure the competence of their work and to protect others from possible harm." "C.3.a. Accurate Advertising When advertising or otherwise representing their services to the public, counselors identify their credentials in an accurate manner that is not false, misleading, deceptive, or fraudulent." Testimonials Testimonials are not ethically permitted in advertising for MFT's LPCC's, or LCSW's in CA CAMFT says the following:
"10.6 SOLICITATION OF TESTIMONIALS: Marriage and family therapists do not solicit testimonials from patients." NASW has similar ethical standards about testimonials. NASW Code of Ethics "4.07 Solicitations (a) Social workers should not engage in uninvited solicitation of potential clients who, because of their circumstances, are vulnerable to undue influence, manipulation, or coercion. (b) Social workers should not engage in solicitation of testimonial endorsements (including solicitation of consent to use a client s prior statement as a testimonial endorsement) from current clients or from other people who, because of their particular circumstances, are vulnerable to undue influence." The ACA does not allow testimonials to be solicited from current or former clients. "C.3.b. Testimonials Counselors who use testimonials do not solicit them from current clients nor former clients nor any other persons who may be vulnerable to undue influence. Counselors discuss with clients the implications of and obtain permission for the use of any testimonial.
HIPAA on website The regulations regarding HIPAA are in regards to businesses that are considered "covered entities". The US Department of Health and Human Services National Institute of Health defines covered entities as follows: "Covered entities are defined in the HIPAA rules as (1) health plans, (2) health care clearinghouses, and (3) health care providers who electronically transmit any health information in connection with transactions for which HHS has adopted standards. Generally, these transactions concern billing and payment for services or insurance coverage. For example, hospitals, academic medical centers, physicians, and other health care providers who electronically transmit claims transaction information directly or through an intermediary to a health plan are covered entities. Covered entities can be institutions, organizations, or persons." http://privacyruleandresearch.nih.gov/pr_06.asp For more information on whether you are a covered entity please see the flow charts linked to below. To be a covered entity you must be a health care provider who electronically transmits information regarding specific covered transactions. These transactions include: Health care claims Verification of health care eligibility Authorization and certification of benefits Claims Status Enrollment or disenrollment in a health care plan Getting payment remittance advice Making payments for healthcare services Coordination of benefits information The covered entity flow chart can be found at the link provide below. http://www.cms.gov/regulations-and-guidance/hipaa-administrative- Simplification/HIPAAGenInfo/downloads/CoveredEntitycharts.pdf
If you are a covered entity you are required to post your privacy policy on your website as indicated in the Federal Regulations below. "See 45 C.F.R. 164.520(c). Code of Federal Regulations 164.52o 3) Specific requirements for electronic notice. (i) A covered entity that maintains a web site that provides information about the covered entity's customer services or benefits must prominently post its notice on the web site and make the notice available electronically through the web site." Professional Listing Lists If you advertise on professional listing sites you are ethically obligated to be sure all the information is accurate. In addition, if you participate in professional groups online there are ethical standards for how you treat colleagues. Ethics regarding 3rd party listings CAMFT says 10.2 THIRD PARTY ACCURACY: Marriage and family therapists take reasonable steps to assure that advertisements and publications, whether in directories, announcement cards, newspapers, radio, television, Internet or any other media, are formulated to accurately convey information to the public. 10.5 CORRECTIONS: Marriage and family therapists correct, wherever possible, false, misleading, or inaccurate information and representations made by others concerning the therapist's qualifications, services, or products. NASW Says "4.06 Misrepresentation (c) Social workers should ensure that their representations to clients, agencies, and the public of professional qualifications, credentials, education, competence, affiliations, services provided, or results to be achieved are accurate. Social workers should claim only those relevant professional credentials they actually possess and take steps to correct any inaccuracies or misrepresentations of their credentials by others. "
ACA says "C.3.c. Statements by Others Counselors make reasonable efforts to ensure that statements made by others about them or the profession of counseling are accurate." "C.4.a. Accurate Representation Counselors claim or imply only professional qualifications actually completed and correct any known misrepresentations of their qualifications by others. Counselors truthfully represent the qualifications of their professional colleagues. Counselors clearly distinguish between paid and volunteer work experience and accurately describe their continuing education and specialized training." Ethics Relating to Professional Online Groups You are responsible for ethical behavior to your colleagues online. Each professional organization has a statement about respect to colleagues. CAMFT says 5. RESPONSIBILITY TO COLLEAGUES Marriage and family therapists treat and communicate with and about colleagues in a respectful manner and with, courtesy, fairness, and good faith, and cooperate with colleagues in order to promote the welfare and best interests of patients. NASW says "2.01 Respect (a) Social workers should treat colleagues with respect and should represent accurately and fairly the qualifications, views, and obligations of colleagues. (b) Social workers should avoid unwarranted negative criticism of colleagues in communications with clients or with other professionals. Unwarranted negative criticism may include demeaning comments that refer to colleagues level of competence or to individuals attributes such as race, ethnicity, national origin, color, sex, sexual orientation, gender identity or expression, age, marital status, political belief, religion, immigration status, and mental or physical disability." ACA says "D.1. Relationships With Colleagues, Employers, and Employees
D.1.a. Different Approaches Counselors are respectful of approaches that are grounded in theory and/or have an empirical or scientific foundation but may differ from their own. Counselors acknowledge the expertise of other professional groups and are respectful of their practices. Ethics of Email If you use unsecured email to communicate with clients you should have a statement spelling out the possible risks to confidentiality in your Informed Consent. In the ACA s most recent ethics review they also name the protection of privacy and confidentiality for potential clients. This is seen in B.1.c. Respect for Confidentiality, which is spelled out below. An example of a statement for in your consent CONFIDENTIALITY OF E-MAIL, CELL PHONE AND FAXES COMMUNICATION It is very important to be aware that e-mail and cell phone (also cordless phones) communication can be accessed by unauthorized people and hence, the privacy and confidentiality of such communication can be compromised. E-mails, in particular, are vulnerable to such unauthorized access due to the fact that servers have unlimited and direct access to all e-mails that go through them. Faxes can be sent erroneously to the wrong address. Please notify Jane Doe, LCSW at the beginning of treatment if you decide to avoid or limit in any way the use of any or all of the above-mentioned communication devices. Please do not use e-mail in an emergency situations. If you are exchanging confidential information you should be using an encrypted account. Other best practices include: A password protected computer A firewall on your computer An anti viral program on your computer You should also change email password often It is advisable to have a statement at the end of your email to comply with HIPAA regulations such as the one below. CAUTION: This email/fax message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and
privileged information. Any unauthorized review, use, disclosure or distribution is strictly prohibited. If you are not the intended recipient, please contact the server by reply email/fax and destroy all copies of the original message. Ethical Standards For Email CAMFT code of ethics "2.3 ELECTRONIC MEDIA: Marriage and family therapists are aware of the possible adverse effects of technological changes with respect to the dissemination of patient information, and take care when disclosing such information. Marriage and family therapists are also aware of the limitations regarding confidential transmission by Internet or electronic media and take care when transmitting or receiving such information via these mediums." NASW ethics says "(m) Social workers should take precautions to ensure and maintain the confidentiality of information transmitted to other parties through the use of computers, electronic mail, facsimile machines, telephones and telephone answering machines, and other electronic or computer technology. Disclosure of identifying information should be avoided whenever possible." The ACA recently updated their code of ethics and now has an extensive section on Distance Counseling, Technology, and Social Media. It is worth reading in its entirety because the ACA is far more advanced in regards to electronic issues in relationship to counseling. Section H Distance Counseling, Technology, and Social Media Introduction Counselors understand that the profession of counseling may no longer be limited to in-person, face-to-face interactions. Counselors actively attempt to understand the evolving nature of the profession with regard to distance counseling, technology, and social media and how such resources may be used to better serve their clients. Counselors strive to become knowledgeable about these resources. Counselors understand the additional concerns related to the use of distance counseling, technology, and social media and make every attempt to protect confidentiality and meet any legal and ethical requirements for the use of such resources. H.1. Knowledge and Legal Considerations H.1.a. Knowledge and Competency Counselors who engage in the use of distance counseling, technology, and/
or social media develop knowledge and skills regarding related technical, ethical, and legal considerations (e.g., special certifications, additional course work). H.1.b. Laws and Statutes Counselors who engage in the use of distance counseling, technology, and social media within their counseling practice understand that they may be subject to laws and regulations of both the counselor s practicing location and the client s place of residence. Counselors ensure that their clients are aware of pertinent legal rights and limitations governing the practice of counseling across state lines or international boundaries. H.2. Informed Consent and Security H.2.a. Informed Consent and Disclosure Clients have the freedom to choose whether to use distance counseling, social media, and/or technology within the counseling process. In addition to the usual and customary protocol of informed consent between counselor and client for face-to-face counseling, the following issues, unique to the use of distance counseling, technology, and/or social media, are addressed in the informed consent process: distance counseling credentials, physical location of practice, and contact information; risks and benefits of engaging in the use of distance counseling, technology, and/or social media; possibility of technology failure and alternate methods of service delivery; anticipated response time; emergency procedures to follow when the counselor is not available; time zone differences; cultural and/or language differences that may affect delivery of services; possible denial of insurance benefits; and social media policy. H.2.b. Confidentiality Maintained by the Counselor Counselors acknowledge the limitations of maintaining the confidentiality of electronic records and transmissions. They inform clients that individuals might have authorized or unauthorized access to such records or transmissions (e.g., colleagues, supervisors, employees, information technologists). H.2.c. Acknowledgment of Limitations Counselors inform clients about the inherent limits of confidentiality when
using technology. Counselors urge clients to be aware of authorized and/ or unauthorized access to information disclosed using this medium in the counseling process. H.2.d. Security Counselors use current encryption standards within their websites and/or technology-based communications that meet applicable legal requirements. Counselors take reasonable precautions to ensure the confidentiality of information transmitted through any electronic means. H.3. Client Verification Counselors who engage in the use of distance counseling, technology, and/ or social media to interact with clients take steps to verify the client s identity at the beginning and throughout the therapeutic process. Verification can include, but is not limited to, using code words, numbers, graphics, or other nondescript identifiers. H.4. Distance Counseling Relationship H.4.a. Benefits and Limitations Counselors inform clients of the benefits and limitations of using technology applications in the provision of counseling services. Such technologies include, but are not limited to, computer hardware and/or software, telephones and applications, social media and Internet-based applications and other audio and/or video communication, or data storage devices or media. H.4.b. Professional Boundaries in Distance Counseling Counselors understand the necessity of maintaining a professional relationship with their clients. Counselors discuss and establish professional boundaries with clients regarding the appropriate use and/or application of technology and the limitations of its use within the counseling relationship (e.g., lack of confidentiality, times when not appropriate to use). H.4.c. Technology-Assisted Services When providing technology-assisted services, counselors make reasonable efforts to determine that clients are intellectually, emotionally, physically, linguistically, and functionally capable of using the application and that the application is appropriate for the needs of the client. Counselors verify that clients understand the purpose and operation of technology applications and follow up with clients to correct possible misconceptions, discover appropriate use, and assess subsequent steps. H.4.d. Effectiveness of Services When distance counseling services are deemed ineffective by the counselor or client, counselors consider delivering services face-to-face. If the counselor is not able to provide face-to-face services (e.g., lives in another state), the counselor assists the client in identifying appropriate services. H.4.e. Access Counselors provide information to clients regarding reasonable access to pertinent applications when providing technology-assisted services.
H.4.f. Communication Differences in Electronic Media Counselors consider the differences between face-to-face and electronic communication (nonverbal and verbal cues) and how these may affect the counseling process. Counselors educate clients on how to prevent and address potential misunderstandings arising from the lack of visual cues and voice intonations when communicating electronically. H.5. Records and Web Maintenance H.5.a. Records Counselors maintain electronic records in accordance with relevant laws and statutes. Counselors inform clients on how records are maintained electronically. This includes, but is not limited to, the type of encryption and security assigned to the records, and if/for how long archival storage of transaction records is maintained. H.5.b. Client Rights Counselors who offer distance counseling services and/or maintain a professional website provide electronic links to relevant licensure and professional certification boards to protect consumer and client rights and address ethical concerns. H.5.c. Electronic Links Counselors regularly ensure that electronic links are working and are professionally appropriate. H.5.d. Multicultural and Disability Considerations Counselors who maintain websites provide accessibility to persons with disabilities. They provide translation capabilities for clients who have a different primary language, when feasible. Counselors acknowledge the imperfect nature of such translations and accessibilities. H.6. Social Media H.6.a. Virtual Professional Presence In cases where counselors wish to maintain a professional and personal presence for social media use, separate professional and personal web pages and profiles are created to clearly distinguish between the two kinds of virtual presence. H.6.b. Social Media as Part of Informed Consent Counselors clearly explain to their clients, as part of the informed consent procedure, the benefits, limitations, and boundaries of the use of social media. H.6.c. Client Virtual Presence Counselors respect the privacy of their clients presence on social media unless given consent to view such information. H.6.d. Use of Public Social Media Counselors take precautions to avoid disclosing confidential information through public social media.
Social Media Ethical Principles If you use social media as a professional there are three ethical principles to consider: Informed Consent Confidentiality Dual Relationships Informed Consent If you use social media as a professional it is considered good practice to have a statement regarding the risks of social media in your Informed Consent. An example Jane Doe LLCSW does not engage with clients in any way on social media sites. She discourages clients from posting in any way about their therapeutic process in order to best protect the client's confidentiality. The ethics of Informed Consent are as follows: CAMFT says "1.5 PATIENT DISCLOSURES: Marriage and family therapists provide adequate information to patients in clear and understandable language so that patients can make meaningful decisions about their therapy." "1.5.1 RISKS AND BENEFITS: Marriage and family therapists inform patients of the potential risks and benefits of therapy when utilizing novel or experimental techniques or when there is a risk of physical harm that could result from the utilization of any technique." NASW says "1.03 Informed Consent (a) Social workers should provide services to clients only in the context of a professional relationship based, when appropriate, on valid informed
consent. Social workers should use clear and understandable language to inform clients of the purpose of the services, risks related to the services, limits to services because of the requirements of a third-party payer, relevant costs, reasonable alternatives, clients right to refuse or withdraw consent, and the time frame covered by the consent. Social workers should provide clients with an opportunity to ask questions." "(e) Social workers who provide services via electronic media (such as computer, telephone, radio, and television) should inform recipients of the limitations and risks associated with such services." ACA says A.2. Informed Consent in the Counseling Relationship A.2.a. Informed Consent Clients have the freedom to choose whether to enter into or remain in a counseling relationship and need adequate information about the counseling process and the counselor. Counselors have an obligation to review in writing and verbally with clients the rights and responsibilities of both the counselor and the client. Informed consent is an ongoing part of the counseling process, and counselors appropriately document discussions of informed consent throughout the counseling relations They also specifically address the need for social media information to be part of informed consent in H.6.b. Social Media as Part of Informed Consent which was cited above. One of the reasons for the informed consent statement is the possible risks to confidentiality that engaging on social media may cause. The ethics of confidentiality are as follows. Confidentiality A primary reason for the informed consent statement is the possible risk to confidentiality that engaging on social media may cause. The ethics of confidentiality are as follows. CAMFT says "CONFIDENTIALITY Marriage and family therapists have unique confidentiality responsibilities because the "patient" in a therapeutic relationship may be more than one person. The overriding principle is that marriage and family therapists respect the confidences of their patient(s)."
"2.1 DISCLOSURES OF CONFIDENTIAL INFORMATION: Marriage and family therapists do not disclose patient confidences, including the names or identities of their patients, to anyone except a) as mandated by law b) as permitted by law c) when the marriage and family therapist is a defendant in a civil, criminal, or disciplinary action arising from the therapy (in which case patient confidences may only be disclosed in the course of that action), or d) if there is an authorization previously obtained in writing, and then such information may only be revealed in accordance with the terms of the authorization." NASW says "(c) Social workers should protect the confidentiality of all information obtained in the course of professional service, except for compelling professional reasons. The general expectation that social workers will keep information confidential does not apply when disclosure is necessary to prevent serious, foreseeable, and imminent harm to a client or other identifiable person. In all instances, social workers should disclose the least amount of confidential information necessary to achieve the desired purpose; only information that is directly relevant to the purpose for which the disclosure is made should be revealed." "(i) Social workers should not discuss confidential information in any setting unless privacy can be ensured. Social workers should not discuss confidential information in public or semipublic areas such as hallways, waiting rooms, elevators, and restaurants." "2.02 Confidentiality Social workers should respect confidential information shared by colleagues in the course of their professional relationships and transactions. Social workers should ensure that such colleagues understand social workers obligation to respect confidentiality and any exceptions related to it." ACA says B.1.c. Respect for Confidentiality Counselors protect the confidential information of prospective and current clients. Counselors disclose information only with appropriate consent or with sound legal or ethical justification
Dual Relationships If you engage with a client on social media it can possibly create a dual relationship. The Ethics of this are as follows: CAMFT says 1.2.1 UNETHICAL DUAL RELATIONSHIPS: Other acts that would result in unethical dual relationships include, but are not limited to, borrowing money from a patient, hiring a patient, engaging in a business venture with a patient, or engaging in a close personal relationship with a patient. Such acts with a patient's spouse, partner or family member may also be considered unethical dual relationships." NASW says "1.06 Conflicts of Interest (c) Social workers should not engage in dual or multiple relationships with clients or former clients in which there is a risk of exploitation or potential harm to the client. In instances when dual or multiple relationships are unavoidable, social workers should take steps to protect clients and are responsible for setting clear, appropriate, and culturally sensitive boundaries. (Dual or multiple relationships occur when social workers relate to clients in more than one relationship, whether professional, social, or business. Dual or multiple relationships can occur simultaneously or consecutively.) ACA actually address personal virtual relationships in their code of ethics. A.5.c. Sexual and/or Romantic Relationships With Former Clients Sexual and/or romantic counselor client interactions or relationships with former clients, their romantic partners, or their family members are prohibited for a period of 5 years following the last professional contact. This prohibition applies to both in-person and electronic interactions or relationships. Counselors, before engaging in sexual and/or romantic interactions or relationships with former clients, their romantic partners, or their family members, demonstrate forethought and document (in written form) whether the interaction or relationship can be viewed as exploitive in any way and/or whether there is still potential to harm the former client; in cases of potential exploitation and/or harm, the counselor avoids entering into such an interaction or relationship
A.5.e. Personal Virtual Relationships With Current Clients Counselors are prohibited from engaging in a personal virtual relationship with individuals with whom they have a current counseling relationship (e.g., through social and other media).
Bibliography "Advertising mistakes made by Therapists" by Ann Tran-Lien, JD Staff attorney CA CAMFT The Therapist March/April 2012 pgs 22-25. "An Ethical Framework for the Use of Social Media by Mental Health Professionals", Keely Kolmes, DeeAnna Merz Nagel, and Kate Anthony" Tilt Magazine-January 2011, pages 21-29. http://onlinetherapyinstitute.com/ethical-framework-for-the-use-of-socialmedia-by-mental-health-professionals/ "Emailing your client legal and ethical implications" by Ann Tran-Lien JD The Therapist May/June 2012, Pgs 20-22. Statutes and Regulations Relating to the Practice of: Professional Clinical Counseling Marriage and Family Therapy Educational Psychology Clinical Social Work Issues by the Board of Behavioral Sciences January 2012. http://www.bbs.ca.gov/pdf/publications/lawsregs.pdf