An Examination of the APA’s “Guidelines for the Practice of Telepsychology” Part I

Examination of the APA's GuidelinesAs we reported in August, a draft version of American Psychological Association’s Guidelines for the Practice of Telepsychology has been developed by a joint Task Force comprised of members representing the American Psychological Association (APA), the Association of State and Provincial Psychological Boards (ASPPB), and the APA Insurance Trust (APAIT).

The members of the task force completed and summarized a comprehensive review of the relevant empirical literature, which established a strong foundation for the guidelines. The task force is now requesting APA member and public comments on this draft. As we suggested, now is the time for those who currently practice telepsychology or who aspire to practice telepsychology in the near future to make their voices heard. The best guidelines will come about from a careful integration of input from the scientific literature, legal experts and those providing telemental health care who are practicing on the “front lines.”

The draft incorporates 8 guidelines, an introduction, conclusion and reference list. The entire draft is 17 pages in length. The guidelines cover an operational definition of telepsychology, competence, standards of care, informed consent, and the confidentiality, security, transmission and disposal of data and information, as well as testing and assessment and interjurisdictional practice. A complete version of the guidelines can be found and downloaded here from the APA website.

As opposed to required standards such as present in the APA’s Ethical Principles of Psychologists and Code of Conduct, the guidelines are considered to be aspirational in intent. They nonetheless will legitimately serve as a basis for what is expected of psychologists in the practice of telemental health. Therefore, it is imperative that practitioners carefully review these guidelines in light of their work and experience. It is essential to take this single opportunity to voice concerns about standards and guidelines that could be unduly onerous, impractical or even harmful if instituted. (Also acknowledging a job well done is appropriate when that is true!)

Why are Your Comments about these Guidelines Important?

It is no coincidence that the APA has been relatively quiet about guidelines to date, especially since the American Counseling Association, the American Medical Association and the American Telemedicine Association have long since published documents that give rather explicit guidelines for their memberships to consider when using various uses of technology. In fact, over a dozen mental health specific standards and guidelines by different large professional associations have already been published across the English-speaking countries of the world. The fact that the APA has now offered guidelines for comment signals that telepsychology finally has come of age and is viable for routine practice.

However, the nature of telepsychology is still being shaped, and voices of the practitioner community need to be heard if a balanced set of directives will soon be operative. All our views need to be represented, especially those of practitioners who DO their work online.

While ethical competent practice and protection of consumers are paramount, members of any professional association want to insure that accepted guidelines don’t inadvertently limit a profession’s adoption of, and participation in, any growing area of their work, especially one as powerful and potentially expansive as telemental health care. The adoption of guidelines that might potentially curtail psychologists’ ability to transition to and engage in telemental health practice is a concern. We also need to have the guidelines examined in light of where all our mental health professions are going in the overall marketplace. Professionals informed in large, sweeping change in the healthcare policy arena also are needed for full review and comment.

For example, overly restrictive requirements could fuel anxiety-based hesitation regarding telemental health practice, and could be detrimental to not only psychologists, but also to consumers. While consumers and their family members may benefit from more easily accessible, affordable mental health care, many now readily get answers from the Internet. Many concerns experienced by families of patients are also being met by resources available through the Internet. Secondly, some psychologists are mindful of the other forces impinging on their viability in the marketplace. If professionals avoid delivering telepsychology services because of guideline-based concerns, this may unfortunately serve to facilitate the emergence of untrained parties as “experts” and leaders in the field. Another issue is the potential impediment of any guideline in how it can be used against a group in court, where they are most vulnerable.

For these and other reasons that have been elaborated in one of the current author’s text, The Mental Health Professional and the New Technologies, it is our position at the TeleMental Health Institute that it would be wise for psychologists and other professional membership groups to to consider the development of minimalistic guidelines.

We therefore urge you to read and give your perspective, regardless of your discipline. At the very least, you’ll get exposed to a thorough review of the literature, which this document represents exceedingly well. The deadline for comment submission is OCTOBER 26, 2012. The web page for submitting your comments about this draft proposal.

Next week’s newsletter will provide a more detailed review of APA’s Telepsychology Guidelines and discuss some of the concerns we’ve identified in our own review of the guideline draft. Stay tuned!

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