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Digital Ethics, HIPAA, & TeleMental Health


Online Courses:
TeleMental Health: Practical Applications ~ TeleMental Health: The New Standard
Psychology of the Web ~ HIPAA Made Friendly
HIPAA and Technology in Mental Health Practices
Electronic Health Records ~ Digital and Social Media Ethics
HIPAA's Patient Access Rights


Table Of Contents

Digital Ethics


TeleMental Health


Digital Ethics

Digital Ethics-General

E-Mails in Traditional Therapy and in TeleMental Health

Hushmail and other secure email services are a good idea, but many, if not most, clients balk at the extra hassle involved in using them to communicate with their therapists, and may choose to use the familiar and free, but unsecured, emails after being informed of the risk by their therapists (via an Informed Consent and e-mail signature.)

Use of Text in Traditional Therapy and in TeleMental Health

Therapists Googling Clients

Clients Googling Therapists

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Yelp: Responding to Negative Postings

Facebook & Psychotherapy and Facebook Privacy Issues

Social Media

Stalking, Harassment & Violations of Privacy

References: Digital and Social Media Ethics

  • American Association for Marriage and Family Therapy (2015). Code of Ethics. Retrieved from https://www.aamft.org/Legal_Ethics/Code_of_Ethics.aspx 
  • American Counseling Association (2014). ACA Code of Ethics. Retrieved from https://www.counseling.org/resources/aca-code-of-ethics.pdf
  • American Psychological Association. (2017). Ethical Principles of Psychologists and Code of Conduct. Retrieved from https://www.apa.org/ethics/code/
  • Balick, A. (2013). The psychodynamics of social networking: Connected-up instantaneous culture and the self. London: Karnac Books.
  • Barnett, J., (2009). Social Networking Sites, Clients, and Ethics: Dilemmas and Recommendations. [Lecture]. From International Conference on Use of the Internet in Mental Health, Montreal 2009. Retrieved from http://bcooltv.mcgill.ca/Viewer2/?RecordingID=27892
  • Barnett, Jeffrey E. & Kolmes, Keely.(2016). The practice of tele-mental health: Ethical, legal, and clinical issues for practitioners. Practice Innovations, Vol 1(1), 53-66.
  • Behnke, Stephen, Ethics in the age of the Internet. APA Monitor on Psychology, July/August 2008, 74-75.
  • Blue, V. (2014). Chapter 7: People search websites. In The smart girl’s guide to privacy. (pp. 84-96). Digita Publications Privacy
  • Collins, L. H. (2007). Practicing safer Listserv use: Ethical use of an invaluable resource. Professional Psychology: Research and Practice, 38, 690-698.
  • DiLillo, D., & Gale, E. B. (2011). To Google or not to Google: Graduate students' use of the Internet to access personal information about clients. Training and Education in Professional Psychology, Vol 5(3), 160-166.
  • Donner, M., (2007). The Ethical Use of the Listserv: Privacy and Professional Conduct, The California Psychologist, November/December 2007, 22.
  • Kaslow, Florence W.; Patterson, Terence; Gottlieb, Michael. (2011). Ethical dilemmas in psychologists accessing Internet data: Is it justified? Professional Psychology: Research and Practice, Vol 42(2), 105-112.
  • Kolmes, K. (2010). Private practice social media policy. Retrieved from http://www.drkkolmes.com/docs/socmed.pdf
  • Kolmes, K. (2012). Social Media in the Future of Professional Psychology. Professional Psychology: Research and Practice, Vol 43(6), 606-612
  • Kolmes, K. (2016). Digital and Social Media Multiple Relationships on the Internet. In Ofer Zur (Ed.) Multiple Relationships in Psychotherapy and Counseling: Unavoidable, Mandatory, and Common Relations Between Therapists and Clients. Taylor & Francis.
  • Kolmes, K. & Taube, D. O., (2014). Seeking and Finding Our Clients on the Internet: Boundary Considerations in Cyberspace. Professional Psychology: Research and Practice, Vol 45(1), Feb 2014, 3-10. doi: 10.1037/a0029958
  • Kolmes, K., & Taube, D. O. (2016). Client discovery of psychotherapist personal information online. Professional Psychology: Research and Practice, Vol 47(2), 147-154
  • Lannin, D. G., & Scott, N. A. (2013). Social Networking Ethics: Developing Best Practices for the New Small World. Professional Psychology: Research and Practice, Vol 44(3), 135-141
  • Lehavot, K., Barnett, J., & Powers, D. (2010). Psychotherapy, professional relationships, and ethical considerations in the MySpace generation. Professional Psychology: Research and Practice. Vol 41(2), 160-166.
  • National Association of Social Workers (2017). Code o Ethics. Retrieved from https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English
  • Younggren, J. N. (2010). To Tweet or Not to Tweet, That is the Question. The Clinical Psychologist, 63/2, 18-19.
  • Zur O. & Donner, M.B. (2009, January/February). The Google Factor: Therapists’ Transparency in the Era of Google and MySpace. The California Psychologist, 23-24.

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Are Square, Credit Cards, & Banks HIPAA Compliant?

Encryption & Computer Security

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Business Associates

HIPAA & NPI: Registration & Basic Info

HIPAA's Patient Access Rights: What Patients & Providers Need to Know


EHR Information

Cloud Based Management Systems

HIPAA Audits

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TeleMental Health

Telehealth, e-therapy, online therapy, online counseling, tele-medicine, e-counseling, or TeleMental health: all refer to the use of digital technology to provide clinical services, such as assessment and treatment. Telehealth activities may include providing clinical services by telephone, email, chats, interactive televideo communications technology such as Skype, or via virtual reality (VR) such as Second Life (SL), to individuals in conjunction with face-to-face (f2f) therapy or with no in-person contact. States and organizations vary in their definitions of telehealth.

TeleMental Health Platforms

e-therapyMake sure to verify that the platform you choose to use is HIPAA compliant and complies with your state, federal, and your state and national professional organizations rules, codes of ethics, laws, and/or regulations.

TeleMental Health Technology Comparisons: A useful website that compares different TeleMental Health options by Behavioral Health Innovation


TeleMental Health Across State Lines

State Lines

State TeleHealth Laws & Licensing Boards

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Video Conferencing

General Information

Skype, while free, familiar and encrypted, is no longer an acceptable option for videoconferencing as part telemental health as it does not give a BAA and is not considered HIPAA Compliant.

Below is a list of several websites that market videoconferencing services to mental health and other professionals. Some of these sites claim to be HIPAA compliant. You must verify that they are, indeed, HIPAA compliant and request a Business Associate Agreement. Also pay attention to cross state lines laws in regulations.

  • Comprehensive list of telehealth and videoconferencing platforms, by Jay Ostrowski
  • Free Online Therapy Software Compared: Usefulness, Ease, Security, Support, & HIPAA, by Roy Huggins
  • VSee and HIPAA - LI Conversation
  • Eye Contact in Video Conferencing

    Is Skype HIPAA Compliant?

    Is FaceTime HIPAA Compliant?

    Ethics Codes on TeleMental Health

    TeleMental Health Guidelines

    Insurance, Billing, Reimbursement & CPT Codes in E-Therapy & TeleMental Health

    Insurance and billing for services Second Life

    Second Life & Virtual Realities

    Professional Telehealth Associations

    Paperless Office

    Federal Resources, Laws, and Regulations

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    Psychology of the Web & TeleMental Health

    Psychology of the Web

    Guidelines by Prominent Organizations on TeleMental Health

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    Miscellaneous Resources


    • Aguilera, A., & Berridge, C. (2014). Qualitative feedback from a text messaging intervention for depression: Benefits, drawbacks, and cultural differences. JMIR mHealth and uHealth, 2(4), e46. doi:10.2196/mhealth.3660
    • Aguilera, A., & Muñoz, R. F. (2011). Text messaging as an adjunct to CBT in low-income populations: A usability and feasibility pilot study. Professional Psychology: Research and Practice, 42(6), 472-478. http://dx.doi.org/10.1037/a0025499
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    • Anderson, K. M., & Wallace, B. (2015). Digital storytelling as a trauma narrative intervention for children exposed to domestic violence. In J.L. Cohen, J. L. Johnson, & P. Orr (Eds.), Video and filmmaking as psychotherapy: Research and practice (pp. 95-107). New York, NY: Routledge.
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    • Backhaus, A., Agha, Z., Maglione, M. L., Repp, A., Ross, B., Zuest, D., & Thorp, S. R. (2012). Videoconferencing psychotherapy: A systematic review. Psychological Services, 9(2), 111-131. http://dx.doi.org/10.1037/a0027924
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    • Berle, D., Starcevic, V., Milicevic, D., Hannan, A., Dale, E., Brakoulias, V., & Viswasam, K. (2015). Do patients prefer face-to-face or internet-based therapy?. Psychotherapy and Psychosomatics, 84(1), 61-62. https://doi.org/10.1159/000367944
    • Campbell, L.F., et al. (Eds.) (2017). A Telepsychology Casebook: Using Technology Ethically and Effectively in Your Professional Practice. Washington, DC APA Books.
    • Chang, Jessica et. al (2016). Videoconference grief group counseling in rural Texas: Outcomes, Challenges, and Lessons Learned, The Journal for Specialists in Group Work 41 (2), 140-160.
    • Chen, M. (2002, April). Leveraging the asymmetric sensitivity of eye contact for videoconference. In Proceedings of the SIGCHI conference on Human factors in computing systems (pp. 49-56).
    • Chiad, M. O. (2008). Structural and linguistic analysis of SMS text messages. Journal of Kerbala University, 6(4), 15-27.
    • Cook, J. E., & Doyle, C. (2002). Working alliance in online therapy as compared to face-to-face therapy: Preliminary results. CyberPsychology & Behavior, 5(2), 95–105.
    • Dowling, Mitchell, et al. (2013). Online counseling and therapy for mental health problems: a systematic review of individual synchronous interventions using chat, Journal of Technology in Human Services, 31 (1) , 1-21
    • Dulin, Patrick et al (2014). Results of a pilot test of a self-administered smartphone-based treatment system for alcohol use disorders: Usability and Early Outcomes, Substance Abuse 35 (2), 165-175
    • Duncan, Angela (2014). Using videoconferencing to provide psychological services to rural children and adolescents: a review and case example, Journal of Clinical Child & Adolescent Psychology 43 (1), 115-127.
    • Goodyear, Roger et. al (2016) A global portrait of counselling psychologists' characteristics, perspectives, and professional behaviors, Counselling Psychology Quarterly 29 (2), 115-138.
    • Herbst, N., Voderholzer, U., Thiel, N., Schaub, R., Knaevelsrud, C., Stracke, S., & Külz, A. K. (2014). No talking, just writing! Efficacy of an internet-based cognitive behavioral therapy with exposure and response prevention in obsessive compulsive disorder. Psychotherapy and Psychosomatics, 83(3), 165-175. https://doi.org/10.1159/000357570
    • Holländare, F., Gustafsson, S. A., Berglind, M., Grape, F., Carlbring, P., Andersson, G., & Tillfors, M. (2016). Therapist behaviours in internet-based cognitive behaviour therapy (ICBT) for depressive symptoms. Internet Interventions, 3, 1-7. https://doi.org/10.1016/j.invent.2015.11.002
    • Johnson, Kaprea & Kalkbrenner, Michael (2017) The utilization of technological innovations to support college student mental health: mobile health communication, Journal of Technology in Human Services, 35:4, 314-339, DOI: 10.1080/15228835.2017.1368428
    • Kelson Joshua, Lam Mary, Keep Melanie & Campbell Andrew (2017) Development and evaluation of an online acceptance and commitment therapy program for anxiety: phase I iterative design, Journal of Technology in Human Services, 35:2, 135-151, DOI: 10.1080/15228835.2017.1309311
    • Klein, J. P., Berger, T., Schröder, J., Späth, C., Meyer, B., Caspar, F., & Hautzinger, M. (2016). Effects of a psychological internet intervention in the treatment of mild to moderate depressive symptoms: results of the EVIDENT study, a randomized controlled trial. Psychotherapy and Psychosomatics, 85(4), 218-228. https://doi.org/10.1159/000445355
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    • Luxton, D.D., et al. (2016). A Practitioner's Guide to Telemental Health: How to Conduct Legal, Ethical, and Evidence-Based Telepractice. Washington, DC APA Books.
    • McTavish, FM (2012). How patients recovering from alcoholism use a smartphone intervention, Journal of Dual Diagnosis 8 (4), 294-304.
    • Nicholas, David & Chahauver, Anu (2017). Examining computer use by hospitalized children and youth, Journal of Technology in Human Services 35:4, 277-291, DOI: 10.1080/15228835.2017.1366886
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    • Overholser, James C (2015). Training the scientist–practitioner in the twenty-first century: A risk–benefit analysis, Counselling Psychology Quarterly 28 (3), 220-234
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    • Zhou, E. S., Partridge, A. H., Blackmon, J. E., Morgan, E., & Recklitis, C. J. (2016). A pilot videoconference group stress management program in cancer survivors: Lessons learned. Rural and Remote Health, 16, 3863. Retrieved from http://www.rrh.org.au/articles/subviewnew.asp?ArticleID=3863

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