Study is Published: Free Access on Proquest

ETHICAL PRACTICE ONLINE: AN EXPLORATION OF PROVIDER LIABILITY RISK AMONG PRACTITIONERS IN THE EMERGING FIELD OF ONLINE THERAPY
by : Kristie Holmes, Ph.D. Union University

Abstract

Little attention has been given to liability issues and practitioner vulnerability in the rapidly emerging modality of online therapy. The purpose of this study was to explore ethical issues and identify potential risks of liability faced by mental health professionals in three areas of online practice: qualifications and training, domain of practice, and delivery of services. A sample of 232 online providers who were members of the International Society for Mental Health Online (International Society for Mental Health Online) completed an online survey containing items asking about their online therapy procedures and ethical practice. Descriptive statistics, including frequencies and percentages, were used to examine the distribution and patterns of item responses. In addition, t tests were used to compare responses of the participants grouped by two key online therapist characteristics, gender, and domicile of practice. Results indicated that participants were well qualified to provide mental health services with respect to educational and credential requirements (licensure). Issues of possible liability were uncovered with respect to domain of practice in the virtual world, with a significant number of therapists delivering online services outside their licensed geographical boundaries. Although most online practices were congruent with those of traditional therapy, the majority of providers did not know if their malpractice insurance covered online therapy, putting them at risk in the case of a practice lawsuit. Comparison by gender revealed no differences, and by domicile few differences suggesting that risk of liability were concerns experienced by online therapists in general. Results of this study will be useful for professional organizations and educational institutions as basis for increasing the level of clarity about ethical practice as well as providing the necessary elements for future trainings, and by regulating bodies to establish consistent standards and develop legal safeguards to guide and protect practitioners in their practice. And finally, information from this study can be used to focus further research on ethical practice in online therapy and provide a baseline for future studies examining the relationship between the ethics and efficacy of online therapy.

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For Permissions: Kristie Holmes, Ph.D. kholmes@uu.edu

CT13 Conference: San Diego June 2008- Ethical Online Therapy

Thank you to all of you who participated in this study. Currently we are sifting through the data and "cleaning" it up. You should have gotten a brief response from me (kholmes@uu.edu) stating that I had received your information and that you were on my list...or even a simple "got it!". If you didn't, I probably still have your information but my response may have gone through your spam filter. So if you are not sure, feel free to email me and check in to make sure you are on my list.

I have received approximately one thousand emails, and am getting close to sorting through each of them and designating them to various lists. I wish I had an exact timeline for you as far as incentive distribution and /or results. However, I do have to graduate at the end of August- so sometime this summer!

I will be speaking on this topic at the CyberPsychology Conference in San Diego (June) if you are going to be there...you will get a sneak peek at the results!

CT13

New Report: Patients Seek Information from Internet Nearly as Much as from Doctors

No surprise here. Often one can get answers more quickly than the waiting list time it takes many to actually get in to see their doctor. I know that with my family and friends, by the time we make it to the doctor's office (a month later?) the issue is often resolved...often from information off of chat boards or sites like WebMd.com. Hey, I didnt say it was the best practice, but that is how it goes. Although the issue of mental health was not addressed in the study, I am sure it also reflects the liklihood of increased number searching out information on Mental Health issues as well.

Ask.com, yesterday released the findings from a 2007 Consumer Medical and
Health Information poll, commissioned by Ask.com and conducted by Harris
Interactive. The study demonstrates that adults now rely on the Internet as a
primary source of health-related information nearly as much as they rely on
their primary doctors. Seventy percent of adults are now turning to the Internet
as one of their primary resources for medical and health information, surpassed
only slightly by their personal physician (72 percent). Results also cited the
Internet as a far more popular resource for health information than traditional
media outlets such as newspapers/magazines (30 percent), television (26 percent)
and books (25 percent) -- even surpassing friends and family (40 percent) as a
source to find the medical information people seek.Additional findings from the
Harris survey include:
Knowledge is Power: It's all about being informed. 73
percent of adults expressed a desire to be more informed about their personal
health, as well as the well-being of friends and family. Even those born well
before the Internet generation (ages 55+) feel the medium has helped them
diagnose and better understand their condition (76 percent).
That's What
Friends are For: Two-thirds of Americans search to help them diagnose or better
understand a condition (71 percent), and more than half of adults reporting
doing the same for friends and family members (55 percent).
For Your Eyes
Only: Adults aged 18-34 are still embarrassed when it comes to sharing personal
health information, and 21 percent noted they turned to the Internet for
privacy, stating that they were just too embarrassed to talk to anyone about
their medical or health issues.
What's the Alternative: Nearly 30 percent of
adults (28 percent) reported leveraging the Internet to find alternative (e.g.,
homeopathic) treatment options.
This survey was conducted online within the
United States between July 5 and July 9, 2007 among 3,389 adults (aged 18 and
over). Figures for region, age within gender, education, household income and
race/ethnicity were weighted where necessary to bring them into line with their
actual proportions in the population. The data was also weighted to be
representative of the online population of U.S. adults on the basis of Internet
usage (hours per week) and connection type.

Baby Educational Videos May Be Harmful, Slow Development

Yahoo News! is reporting that educational videos currently gobbled up by parents in hopes of giving their children a educational head start may be failing. This is not the sort of study a parent wants to read about- especially if they have been in the practice of plopping their baby down in front of the television for some well- endorsed educational time. Every parent hopes to give their child the best developmental start. Some hope for a boost with these types of products.

WASHINGTON (Reuters) - Recordings that claim to stimulate baby brain development may actually slow vocabulary development in infants if they are overused, U.S. researchers reported on Wednesday.

For every hour per day spent watching baby DVDs and videos, infants aged 8 to 16 months understood an average of six to eight fewer words than babies who did not watch them, Frederick Zimmerman of the University of Washington and colleagues found.

Older toddlers were not harmed or helped by the videos, the researchers reported in the Journal of Pediatrics.

"The most important fact to come from this study is there is no clear evidence of a benefit coming from baby DVDs and videos, and there is some suggestion of harm," Zimmerman said in a statement.

"The bottom line is the more a child watches baby DVDs and videos, the bigger the effect. The amount of viewing does matter."

Zimmerman and colleagues conducted random telephone interviews with more than 1,000 families in Minnesota and Washington with babies and asked detailed questions about television and video viewing.

Parents of the 8- to 16-month-olds were asked how many words like "choo-choo," "mommy" and "nose" their child understood. Parents of the toddlers were asked how many words like "truck," "cookie" and "balloon" their children knew.

"The results surprised us, but they make sense. There are only a fixed number of hours that young babies are awake and alert," said Andrew Meltzoff, a psychologist who worked on the study.

"If the 'alert time' is spent in front of DVDs and TV, instead of with people speaking in 'parentese'-- that melodic speech we use with little ones -- the babies are not getting the same linguistic experience," Meltzoff added.

"Parents and caretakers are the baby's first and best teachers. They instinctively adjust their speech, eye gaze and social signals to support language acquisition. Watching attention-getting DVDs and TV may not be an even swap for warm social human interaction at this age. Old kids may be different, but the youngest babies seem to learn language best from people."

Dr. Dimitri Christakis, a pediatrician at Seattle Children's Hospital Research Institute who worked on the study, said parents frequently asked him about the value of such videos.

"The evidence is mounting that they are of no value and may in fact be harmful," Christakis said.

Projected Top 5 Breakout Technologies for 2012

Telemedicine ranks 4th in the top five of the projected technologies to come into their own in the next handful of years. IBM brought 150,000 people from 104 countries together to pitch their prognostications. They narrowed the list down to five innovations that were the "most impactful, and probably the most likely to be successful" by 2012, said George Pohle, IBM's vice president for business consulting services (Source).

1. 
   

   "The 3-D Internet: Pohle said this technology is "about translating the user
   experience on the Internet from being almost a replication of a piece of paper -
   a Web 'page' - to almost a three-dimensional experience on the Internet."
   Basically, a virtual world a la Second Life, with open borders."

2. 
   

   "Mind-reading cell phones: In the next five years, cell phones may well have a
   mind of their own - integrating location information with a database of your
   surroundings. If you're on the road at dinnertime, your phone could let you know
   where the nearest pizza place is, and what's on special...You could also point
   your camera phone at a nearby landmark, snap a picture, and have the network
   tell you everything it knows about what you're seeing.

3. Nanotechnology for energy and the environment: "Over 2 billion people live
   without reliable water sources," Pohle said. "More people die from issues
   related to the lack of water than from any other cause." As a spin-off of its
   work with carbon nanotubes for electronics, IBM is looking into developing filters woven from nanotubes that could remove the salt and
   impurities out of salt water, at a lower cost than current desalination
   technologies.

4. Telemedicine: I am inferring that telemedicine as an umbrella term will continue to be
more and more inclusive of mental health. Once MDs use internet as mainstream
practice, mental health should be barking at their heels, especially since
insurance companies have to cover both types of health care visits (Halsey). " "Because many people now have Internet or even broadband connections, you can
start using those communication platforms, free or very cheaply, to connect
to
your doctor's office," Pohle said. Imagine having a setup at home that
can beam your vital
signs directly to the doctor's office, or alert a health-care provider if
something goes wrong. Patient information could be contained on an
RFID-equipped
bracelet - in fact, such bracelets have been in use for years already. Meanwhile, care providers in
remote areas could use a "Doc in a Box" to transmit medical images and data to
specialists thousands of miles away for instant review."
The scenario may
sound like something from George Orwell's "1984" rather than IBM's 2010 - but
Pohle said technological shortcuts could actually create "a higher quality of
interaction between the doctor and the patient."

5. Real Time Speech Translation: This technology too will be able to pave the way for more accurate, timely and convenient mental health services via the internet (Halsey).

"This field is already a hot one, and over the next five years,
IBM predicts
that translators will be popping up in mobile phones, handheld
devices and
automobiles. "These services will pervade every part of business
and
society,
eliminating the language barrier in the global economy and
social
interaction,"
the company said."

For More Info Link to Cosmic Blog MSNBC

Absent Military Parents Result in Higher Child Maltreatment Statistics

This news story came as no surprise. An absent parent generally increases stress and anxiety on the lone parent attemting to rear the household. The study was funded by the US Army and reported at Forbes.

""The practical implication is that child maltreatment incidents are much more likely to occur during soldier deployments than during other times, and this really underlines the necessity of formal and informal support for parents who are going through this," said Deborah A. Gibbs, lead author of the study and a senior analyst with the Children and Families Program at RTI International in Research Triangle Park, N.C. "Our findings really put a number on the extent of the problem and suggest the areas in which supports are most necessary.

Although there is not a long history of research in this field, previous studies have found that children of parents in the U.S. military serving in Iraq and elsewhere have higher blood pressure, heart rates and stress levels than other youngsters, and that children from military families are twice as likely to die from severe abuse as other children are.
Gibbs and her colleagues looked at confirmed incidents of child maltreatment by a parent in 1,771 families of enlisted U.S. Army soldiers who had been deployed to combat at least once between September 2001 and December 2004."