— Heidi Sfiligoj, News Staff
Evolving technology is changing the way social work professionals do their jobs and sparking many questions, including: Should social workers offer telephone or Internet therapy? Should they embrace social networking sites? And what privacy and security standards should social workers adhere to when using technology?
“Many emerging technologies are becoming part of the day-to-day life of clients, especially young people,” said NASW Web Designer Ebony Jackson. “Social media technology, texting via phone and e-mail messaging are revolutionizing the way people communicate.”
Because technology is advancing at such a fast rate, many agree that practice is ahead of legislation and regulation in the area of electronic therapy services. “Electronics and technology have moved ahead so quickly. Policies and laws just don’t change that fast,” said Dwight Hymans, director of board services at the Association of Social Work Boards (ASWB). “There are some states that have taken a hard look at this issue and are making some changes. However, there is still confusion about how to regulate and what to regulate.”
e-Therapy. “Social Workers and e-Therapy,” an NASW Legal Issue of the Month article from April 2007, states, “Social work leaders may need to consider new regulatory or legislative alternatives to effectively protect consumers, recognizing that telehealth, cybertherapy or telephone counseling may be the only access to mental health treatment for some clients, or that it may serve as an initial linkage for clients who would otherwise never engage in a therapeutic relationship.”
Sherri Morgan, NASW Legal Defense Fund associate counsel and author of “Social Workers and e-Therapy” noted that offering electronic services would benefit certain people, such as those residing in rural areas, who may not have easy access to someone with therapeutic skills, as well as those who are disabled and have an easier time accessing services through electronic. Additionally, she said, although electronic communications may be advantageous to people who are reluctant to access in-person services, the delivery of services electronically requires the exercise of numerous cautions and professional judgment before venturing into the area.
The NASW and ASWB Standards for Technology and Social Work Practice, published in 2005, offer guidance for “the use of technology as an adjunct to practice, as well as practice that is exclusively conducted with technology.” The standards address certain issues, such as compliance with applicable laws and regulations in all states in which the social work services are provided; privacy protection requirements; risk management; and knowledge about appropriateness of different online technologies for specific clients.
The first standard states that “social workers providing services via the telephone or other electronic means shall act ethically, ensure professional competence, protect clients and uphold the values of the profession.”
Maintaining confidentiality. The NASW Code of Ethics conveys standards based on core values and principles of the profession, including concepts of confidentiality and privacy, competent practice, recordkeeping and self-determination.
“The use of new technologies may require social workers to re-think how the profession’s core values and principles can be maintained while integrating the new technologies into various facets of social work practice,” Morgan said.
The Code of Ethics makes reference to specific technologies in Ethical Standard 1.07 Privacy and Confidentiality (m), when exhorting social workers to “take precautions to ensure and maintain the confidentiality of information” transmitted via various electronic means.
“When the use of a new technology is emerging, social workers have an obligation to fully understand the possible risks to confidentiality and privacy and other ethical imperatives before adopting it in social work practice,” Morgan said.
One emerging technology that many people are embracing is social networking Web sites. “These sites, such as Facebook, allow people to connect in new ways, across physical boundaries, 24 hours a day,” said Jackson.
NASW has a presence on various social networking sites, including Facebook, MySpace and LinkedIn, and is also micro-blogging on Twitter.
However, professionals who use social networking sites to get in touch with their clients need to be aware of the risks involved.
“If social workers can maintain either valid consent or good boundaries around confidentiality, then I think it can be an effective way for people to communicate,” said Hymans. “While social networking can be utilized to provide information and make people aware about social work services that are available, I don’t know if it is a good way to provide therapeutic services.” Moreover, Morgan noted that there are a variety of unresolved issues such as authorization for reimbursement and meeting ethical standards regarding electronic or telephonic therapy.
She recommended, however, that those who do offer therapeutic services online provide them to a client with whom there is an established relationship in order to avoid the issues addressed in Standard 6 of the Standards for Technology and Social Work Practice: “Social workers who use electronic means to provide services shall represent themselves to the public with accuracy and make efforts to verify client identity and contact information.”
Privacy concerns. Social workers should never assume that information they share online is private.
“One of the things that people are probably least aware of is how e-mail can be pretty public. Every e-mail goes through some service and each server it goes through is somehow archiving that information. If nothing else, we need to be fully aware that when we send an e-mail, it is not private. Even with a fully encrypted Web site, you get into the issue of storing whatever services you provide. Electronic information exchanged in a chat room that is fully encrypted and protected with firewalls is still stored,” said Hymans.
In the NASW Code of Ethics, Ethical Standard 3.04, Client Records, requires appropriate recordkeeping to “reflect the services provided” and to “facilitate the delivery of services and to ensure the continuity of services provided to clients in the future.” It also requires that documentation “should protect clients’ privacy to the extent that it is possible and appropriate.” According to Morgan, requiring written client authorization for the disclosure of confidential client information is a key mechanism for assuring client privacy.
“It provides a documentary record of the client’s exercise of their decision-making autonomy that is available for review should questions about privacy and confidentiality arise later,” she said. “Some technologies may significantly increase the ease with which confidential information is disclosed or delivered to others, so requiring client authorization assures that the convenience of new technologies does not override the professional values of client self-determination, informed consent and confidentiality. Only when clients are informed about how their information may be used or disclosed to others are they in a position to affirmatively provide or withhold consent to such activities.”
Standard 7 in the Standards for Technology and Social Work Practice also emphasizes the need for privacy. “Social workers shall protect client privacy when using technology in their practice and document all services, taking special safeguards to protect client information in the electronic record.” The standard further states that “social workers should adhere to the privacy and security standards of applicable laws such as the Health Insurance Portability and Accountability Act (HIPAA) and other jurisdictional laws when performing services electronically. These laws address electronic transactions, patient rights, and allowable disclosure and include requirements regarding data protection, firewalls, password protection, and audit trails.”
The economic stimulus package (H.R. 1), signed by President Barack Obama on Feb. 17, includes a section known as the, “Health Information Technology for Economic and Clinical Health (HITECH) Act,” which authorizes important new health records privacy and security provisions, which NASW strongly supported. The expanded requirements and protections will affect clinical social work practice, social work clients, health professionals and providers, health plans and people who handle personal health records. The majority of the new requirements are expected to be implemented on Feb. 17, 2010, and additional information will be provided about those changes in the future.
Professional Benefits. As long as the right precautions are taken, technology can aid the social work profession, said NASW Special Practice Sections Manager Yvette Mulkey. For example, online continuing education is growing in popularity and can be advantageous to social workers.
“The benefit of quality online continuing education is that it is accessible to many people without them having to travel long distances to get it,” Mulkey said. ASWB’s Approved Continuing Education program reviews providers of continuing education for social workers according to stringent standards.
It is also crucial for professionals to verify that online resources used for research are credible. Anonymous Web sites should be avoided and brochures on how to evaluate Web pages can be downloaded from a number of university Web sites.
According to standard 4 in the Standards for Technology and Social Work Practice, social workers have a responsibility to become “proficient in the technological skills and tools required for competent and ethical practice and for seeking appropriate training and consultation to stay current with emerging technologies.”
NASW’s Jackson agreed. “Not only is proficiency important for working with clients who are tapped into technology, but it’s also important from a standpoint of enhancing the way social workers do their jobs,” she said.
NASW uses online technology to help members communicate with their elected officials. Through the CapWiz e-mail program, NASW members can write letters to their members of Congress and state legislators on issues important to the social work profession. Members are notified of action needed through the Advocacy Listserv. When asking members to act on a specific piece of legislation, NASW provides letter templates or talking points.
“These are great tools we use to mobilize our members at key points in the legislative calendar,” said Dina Kastner, senior field organizer at NASW.