INTERIM ETHICAL GUIDELINES FOR PSYCHOLOGISTS PROVIDING PSYCHOLOGICAL SERVICES VIA ELECTRONIC MEDIA
The following interim guidelines were developed by the CPA Committee on Ethics. They were approved in principle by the CPA Board in June 2006, and distributed for consultation in draft form. The interim guidelines were provided in March of 2020.
Note: A PDF version of the interim guidelines is also availabe by clicking here.
These guidelines apply to the evolving and increasing practice of providing e-services to clients; that is, providing services through electronic media (e.g., telephone, video-conferencing, e-mail, chat rooms). The guidelines apply to services that require a contractual relationship between a psychologist and client; they do not apply to the use of these media to provide general educational or resource information.
The guidelines are derived from the ethical principles and values of the Canadian Code of Ethics for Psychologists (CPA, 2017), which provides an ethical framework and standards for the professional activities of all members of the Canadian Psychological Association, or of members of other bodies that endorse or have adopted this Code. However, the guidelines address issues that are unique to the use of electronic media; they do not duplicate relevant standards in the Code. As such, the guidelines should be used in conjunction with the most recent version of the Code. Each guideline is referenced with one or more Ethical Values used in the Code.
As significant new technology is emerging continuously, the guidelines avoid being technology specific.
Principle I: Respect for Dignity of Persons and Peoples
- When obtaining informed consent for electronic provision of services, psychologists include information about the particular nature, risks (including possible insufficiency, misunderstandings due to lack of visual clues, and technology failure), benefits (including appropriateness and advantages re distance, convenience, comfort), reasonable alternative service options (e.g., in-person services, local services from an available health service provider of another discipline), and privacy limitations (including the possibility of interception of communications) of providing services through the particular electronic medium/media to be used. (Informed Consent)
- Psychologists providing services to clients for whom capacity to consent or freedom of consent may be an issue arrange for an in-person contracting session, either with themselves or with another qualified health care practitioner. (Informed Consent, Freedom of Consent)
- If a substitute decision maker is needed to provide consent (e.g., a parent), the identity of the substitute decision maker is verified in person, either with themselves or with another qualified health practitioner. (Protection for Vulnerable Persons)
- Psychologists educate themselves regarding current practices and security devices for electronic communications, and use those systems and practices that are reasonably available, and that best protect their clients’ privacy. (Privacy, Confidentiality)
- Psychologists inform clients of their security practices, and reach agreements with clients regarding maximization of security for each client, including whether the client will require any special equipment (e.g., special software) to access and transmit information and, if so, whether the psychologist provides the special equipment as part of the services. (Privacy, Confidentiality)
- In situations where it is difficult to verify the identity of the client being served electronically, steps are taken to address impostor concerns (e.g., by use of identity code words or numbers). (Privacy, Confidentiality)
Principle II: Responsible Caring
- Psychologists keep up to date with the e-service literature, including research literature regarding the efficacy and effectiveness of services using electronic media, and take this literature into consideration when deciding what services to provide to which clients, with what methods, and under which circumstances. (Competence, Maximize Benefit)
- Psychologists do not attempt to address a problem using electronic media unless they have demonstrated their competence to do it in in-person services. (Competence)
- Psychologists ensure that prospective clients for e-services receive an adequate assessment of their needs. If the type of service being offered requires in-person assessment, psychologists provide such assessment or arrange for another health care provider to conduct the assessment prior to beginning e-services. (Risk/Benefit Analysis)
- Psychologists develop e-service plans that are consistent with the client’s needs and the limitations of e-services. (Maximize Benefit)
- The client’s record includes hard copies of all online communications of a material nature, and notes regarding contacts of a material nature using other electronic media. (Maximize Benefit)
- Prior to beginning e-service, the psychologist obtains from the client the name and phone number(s) of someone for the psychologist to contact in an emergency. (Maximize Benefit, Minimize Harm)
- Prior to beginning e-services, psychologists discuss with clients the procedures to be followed in an emergency. Psychologists collaborate with clients to identify a qualified health care provider (e.g., the family physician) who can provide local back-up assistance, and to determine the local crisis hotline telephone number and local emergency telephone numbers. (Maximize Benefit, Minimize Harm)
- Psychologists make adequate plans for accessing and responding to messages left by clients in electronic form during times of psychologists’ unavailability, illness, or incapacity. (Maximize Benefit, Minimize Harm)
- Psychologists inform clients of alternative communication procedures if there is a technology failure. (Maximize Benefit, Minimize Harm)
- If a client is receiving only e-services (i.e., not combined with any in-person services), and it becomes evident that the client would receive significantly greater benefit from in-person services, and such services are available, psychologists provide in-person services or refer the client to a qualified professional who can provide such service. (Maximize Benefit, Minimize Harm)
Principle III: Integrity in Relationships
- Psychologists set appropriate boundaries with clients regarding their availability. (Avoidance of Conflict of Interest)
- Psychologists ensure that the possible convenience and financial advantages of providing e-services are never allowed to outweigh the best interests of clients. (Avoidance of Conflict of Interest)
- Psychologists inform themselves of jurisdictional requirements regarding licensure or certification, and are licensed or certified in any jurisdiction that requires licensure or certification of psychologists providing e-services to persons who reside in that jurisdiction. This may include being licensed or certified both in a client’s home jurisdiction, as well as being licensed or certified in the psychologist’s own home jurisdiction. (Reliance on the Discipline)
Principle IV: Responsibility to Society
- To prevent the loss of security of assessment techniques, psychologists do not administer electronically any psychological tests for which such administration would put the security of the assessment techniques at risk or would violate any copyright restrictions. (Beneficial Activities)
- Psychologists obtain, where feasible, liability insurance coverage for their e-services. (Beneficial Activities)
- Psychologists provide to clients relevant contact information (e.g., mailing address, phone number, fax number, Website address, and/or e-mail address) of all appropriate certification/regulatory bodies. (Beneficial Activities)
- Psychologists familiarize themselves with and honour the relevant laws and regulations of all jurisdictions to which they provide e-services. This includes such matters as age of consent or definitions of capacity to consent, and requirements for mandatory reporting. (Respect for Society)
“Canadian Code of Ethics for Psychologists. Fourth Edition.” Canadian Psychological Association, 2017, https://cpa.ca/docs/File/Ethics/CPA_Code_2017_4thEd.pdf.
Examples of Other Relevant Guidelines
“ACPRO Model Standards for Telepsychology Service Delivery.” Association of Canadian Psychology Regulatory Organizations, 2011, http://www.acpro-aocrp.ca/documents/ACPRO%20Model%20Standards%20for%20Telepsychology%20Service%20Delivery.pdf
“eHealth Code of Ethics.” eHealth Ethics Initiative, 2000, http://www.ihealthcoalition.org/wp-content/themes/IHC-theme/code0524.pdf
“Suggested principles for the online provision of mental health services.” International Society for Mental Health Online, 2000, http://ismho.org/resources/archive/suggested-principles-for-the-online-provision-of-mental-health-services/
“Guidelines for the practice of telepsychology.” Joint Task Force for the Development of Telepsychology Guidelines for Psychologists, 2013, https://www.apa.org/practice/guidelines/telepsychology
“Policy regarding the provision of distance professional services.” National Board for Certified Counselors,2016, https://www.nbcc.org/Assets/Ethics/NBCCPolicyRegardingPracticeofDistanceCounselingBoard.pdf
“Draft guidelines: Psychology services delivered via the internet and other electronic media.” Psychologists Board of New Zealand, 2011, http://www.psychologistsboard.org.nz/cms_show_download.php?id=141