SUPERVISION, MOBILITY AND TELEPSYCH: THE NEXT FRONTIER TO

PSYCHOLOGICAL PRACTICE

SUPERVISION, MOBILITY AND TELEPSYCH: THE NEXT FRONTIER TO

PSYCHOLOGICAL PRACTICE

ALEX M. SIEGEL, J.D.,PH.D.

ASSOCIATION OF STATE AND PROVINCIAL PSYCHOLOGY BOARDS

NOVEMBER 18, 2011

ALEX M. SIEGEL, J.D.,PH.D.

ASSOCIATION OF STATE AND PROVINCIAL PSYCHOLOGY BOARDS

NOVEMBER 18, 2011

Disclaimer and Acknowledgement

Disclaimer and Acknowledgement

It is PAST October 17, 2011 yet. DPA for ASPPB APA/ASPPB/APAIT JOINT TF I am a reluctant digital immigrant APAIT TRUST Presentation with Eric

Harris and Jeff Younggren, Risk Management in the Electronic Age

It is PAST October 17, 2011 yet. DPA for ASPPB APA/ASPPB/APAIT JOINT TF I am a reluctant digital immigrant APAIT TRUST Presentation with Eric

Harris and Jeff Younggren, Risk Management in the Electronic Age

WHAT IS ASPPBWHAT IS ASPPB Association of State and Provincial Psychology

Boards

64 State/provincial/territorial psychology

regulatory boards/colleges US and Canada

Services to licensing boards, applicants for

licensure/registration, licensed psychologists

Goal is to be the international source of

information and offer model programs on

regulation of psychologists

Association of State and Provincial Psychology

Boards

64 State/provincial/territorial psychology

regulatory boards/colleges US and Canada

Services to licensing boards, applicants for

licensure/registration, licensed psychologists

Goal is to be the international source of

information and offer model programs on

regulation of psychologists

PURPOSE OF PRESENTATIONPURPOSE OF PRESENTATION

Identify benefits and problems with an internet practice of psychology

Compare electronic practice with portability and mobility of your license

What you will need to do as a practitioner for telepsych and or mobility

Discuss the changes in supervision requirements in PA

Identify benefits and problems with an internet practice of psychology

Compare electronic practice with portability and mobility of your license

What you will need to do as a practitioner for telepsych and or mobility

Discuss the changes in supervision requirements in PA

Psychology A Regulated Profession

Psychology A Regulated Profession

Canada - by province/territory 10 Provinces

Northwest Territories

United States - by state/territory 50 States

Virgin Islands, Puerto Rico, Guam

District of Columbia

Canada - by province/territory 10 Provinces

Northwest Territories

United States - by state/territory 50 States

Virgin Islands, Puerto Rico, Guam

District of Columbia

Registration/Licensure Overview of Requirements

Registration/Licensure Overview of Requirements Graduate degree in psychology

Supervised professional experience (SPE)

1500 to 6000 hours of SPE

Examinations

Examination for Professional Practice in

Psychology (EPPP)

Jurisprudence and/or Ethics Exam

Oral Examination

Graduate degree in psychology

Supervised professional experience (SPE)

1500 to 6000 hours of SPE

Examinations

Examination for Professional Practice in

Psychology (EPPP)

Jurisprudence and/or Ethics Exam

Oral Examination

Sequence of Training Leading to

Licensure

Sequence of Training Leading to

LicensureAcademic Program

PracticumDissertation/Thesis…

InternshipGraduation

Postdoctoral ExperienceTesting

Licensure

Academic ProgramPracticumDissertation/Thesis…

InternshipGraduation

Postdoctoral ExperienceTesting

Licensure

Entry to Independent Practice:

United States

Entry to Independent Practice:

United States Most (49) states require a doctoral degree for

licensure as a Psychologist

One (1) state (West Virginia) requires a masters

degree for licensure as a Psychologist

Two (2) jurisdictions also license at masters level

for independent practice, different title:

Oregon: Psychological Associate

Vermont: Psychologist - Master

Most (49) states require a doctoral degree for

licensure as a Psychologist

One (1) state (West Virginia) requires a masters

degree for licensure as a Psychologist

Two (2) jurisdictions also license at masters level

for independent practice, different title:

Oregon: Psychological Associate

Vermont: Psychologist - Master

Entry to Independent Practice

Academic Degree: Canada

Entry to Independent Practice

Academic Degree: Canada Five jurisdictions (BC, MB, ON, NB, QC)

Psychologist: doctoral degree

Psychological Associate: masters degree

Six jurisdictions (AB, SK, NS, PE, NL, NWT)

Psychologist: doctoral or masters degree

Five jurisdictions (BC, MB, ON, NB, QC)

Psychologist: doctoral degree

Psychological Associate: masters degree

Six jurisdictions (AB, SK, NS, PE, NL, NWT)

Psychologist: doctoral or masters degree

PsychologistGraduate Degree

PsychologistGraduate Degree

Must be a recognized psychology

program (accredited/designatated

Specific courses may be required

CPA/APA accredited doctoral program

may meet all degree requirements

Must be a recognized psychology

program (accredited/designatated

Specific courses may be required

CPA/APA accredited doctoral program

may meet all degree requirements

Pennsylvania RequirementsPennsylvania Requirements

41.31(5) First time applicants who were enrolled in

doctoral program prior to March 23, 1991will have their educational credentials evaluated under regulations in effect at that time.

If apply under 41.42(b)[reapplication] will have credentials evaluated under regulations in effect at time of reapplication

41.31(5) First time applicants who were enrolled in

doctoral program prior to March 23, 1991will have their educational credentials evaluated under regulations in effect at that time.

If apply under 41.42(b)[reapplication] will have credentials evaluated under regulations in effect at time of reapplication

Old 41.31(b) prior to June 30, 2008 REQUIREMENTS Education 1) Program Director completes the

Verification of Doctoral Program Approval Status reflecting APA or CPA Accreditation or

2) ASPPB/NR Designation or Within 1 year from the award of Doctoral

Degree

Old 41.31(b) prior to June 30, 2008 REQUIREMENTS Education 1) Program Director completes the

Verification of Doctoral Program Approval Status reflecting APA or CPA Accreditation or

2) ASPPB/NR Designation or Within 1 year from the award of Doctoral

Degree

IF NOT APA OR ASPPBIF NOT APA OR ASPPB

Must demonstrate applicant’s satisfactory completion of core, specialty, practicum and internship:

1)Recognized Sequence within the overall program or department

2) Comprises Integrated, Organized Sequence of Study Ethics Research Design and Methodology Statistics and Psychometrics

Must demonstrate applicant’s satisfactory completion of core, specialty, practicum and internship:

1)Recognized Sequence within the overall program or department

2) Comprises Integrated, Organized Sequence of Study Ethics Research Design and Methodology Statistics and Psychometrics

Competence 4 Substantive Content Areas: Biological Bases of Behavior Cognitive-Affective Bases of Behavior Social Bases of Behavior Individual Differences Specialty Courses, Practicum, Internship At least 60 graduate hours of above

Competence 4 Substantive Content Areas: Biological Bases of Behavior Cognitive-Affective Bases of Behavior Social Bases of Behavior Individual Differences Specialty Courses, Practicum, Internship At least 60 graduate hours of above

RESIDENCYRESIDENCY

Each degree candidate complete a minimum of two consecutive academic semesters as a matriculated student physically present at the institution grating the degree

Each degree candidate complete a minimum of two consecutive academic semesters as a matriculated student physically present at the institution grating the degree

41.31(4)41.31(4)

First time applicants who enrolled in a graduate degree program in psychology or field related to psychology on or after July 1, 2008 will be evaluated under theses regulations.

MUST BE FROM APA or CPA ACCREDITED OR

ASPPB/NR DESIGNATED PROGRAM

First time applicants who enrolled in a graduate degree program in psychology or field related to psychology on or after July 1, 2008 will be evaluated under theses regulations.

MUST BE FROM APA or CPA ACCREDITED OR

ASPPB/NR DESIGNATED PROGRAM

Psychologist: Supervised Professional Experience

Psychologist: Supervised Professional Experience

Two years (3,000 hours) of supervised experience typically required, usually one of these must be postdoctoral

Two years (3,000 hours) of supervised experience typically required, usually one of these must be postdoctoral

Some states include APPIC most don’t Some include APA/CPA most don’t Advantage of APPIC/APA is program has

been peer reviewed and meets minimal standards

Have some recourse if problems occur

Some states include APPIC most don’t Some include APA/CPA most don’t Advantage of APPIC/APA is program has

been peer reviewed and meets minimal standards

Have some recourse if problems occur

Hours Number of Jurisdictions

•2000 11

•1900 2

•1800 6

•1750 5

•1600 1

•1500 14

Hours Number of Jurisdictions

•2000 11

•1900 2

•1800 6

•1750 5

•1600 1

•1500 14

Pennsylvania RequirementsPennsylvania Requirements Practicum hours NOT Counted (OLD) Predoc Internship

Supervised training for at least 450 hours Learning activities for an average of 2 hours a

week Interact formally and informally with students For 1 year and 1500 hours with 25%(375) in

direct patient contact and no more than 25% in research

Part time for 2 year half time

Practicum hours NOT Counted (OLD) Predoc Internship

Supervised training for at least 450 hours Learning activities for an average of 2 hours a

week Interact formally and informally with students For 1 year and 1500 hours with 25%(375) in

direct patient contact and no more than 25% in research

Part time for 2 year half time

New Regs do not define internship requirements since it is part of the doctoral program requirements

New Regs do not define internship requirements since it is part of the doctoral program requirements

POST DOCPOST DOC

1500 hours is defined as a year (37.5 weeks)At least one half of experience in direct

servicesMust be supervised by psychologist hold

current licenseSupervisor meets individually for an average

of 2 hours a weekMay delegate 1 hour

1500 hours is defined as a year (37.5 weeks)At least one half of experience in direct

servicesMust be supervised by psychologist hold

current licenseSupervisor meets individually for an average

of 2 hours a weekMay delegate 1 hour

Not Acceptable ExperienceNot Acceptable Experience

Independent Private practice as a Qualified member of another recognized profession

Independent practice as a certified school psychologist

Independent Private practice as a Qualified member of another recognized profession

Independent practice as a certified school psychologist

New 41.31New 41.31

Shall complete 1 year of acceptable post doc supervised experience

First time applicants who commence post doc as of December 6, 2010 1 year is calculated as at least 12 months consisting

of 1750 hours No more than 45 hours and no less than 15 hours

may be counted each week At least 50% direct services

Shall complete 1 year of acceptable post doc supervised experience

First time applicants who commence post doc as of December 6, 2010 1 year is calculated as at least 12 months consisting

of 1750 hours No more than 45 hours and no less than 15 hours

may be counted each week At least 50% direct services

EXPERIENCE AT MORE THAN 1 PLACE

EXPERIENCE AT MORE THAN 1 PLACE

Experience is obtained for each entity for a minimum of 6 consecutive months

Experience occurs for a minimum of 15 hours per week at each setting

Total experience for all settings does not exceed 45 hours

Experience is obtained for each entity for a minimum of 6 consecutive months

Experience occurs for a minimum of 15 hours per week at each setting

Total experience for all settings does not exceed 45 hours

Acceptable Experience 1) practice at entity consistent with

psychologist’s education and training 2) No experience may be obtained if

psychology resident acts independently

Acceptable Experience 1) practice at entity consistent with

psychologist’s education and training 2) No experience may be obtained if

psychology resident acts independently

All experience must be obtained under supervision of a primary supervision

Primary – if obtained from more than 1 supervisor, hall have a primary supervisor at each entity.

Delegated- may delegate supervision for up to 1 hour per week

All experience must be obtained under supervision of a primary supervision

Primary – if obtained from more than 1 supervisor, hall have a primary supervisor at each entity.

Delegated- may delegate supervision for up to 1 hour per week

TELEPSYCHTELEPSYCH

Scope of IssueScope of Issue

10% growth in telehealth annually $500 million spent in US annually Federal health care law provides $1billion a

year to study telehealth Insurance plans starting to market to large

employers

10% growth in telehealth annually $500 million spent in US annually Federal health care law provides $1billion a

year to study telehealth Insurance plans starting to market to large

employers

“The technology has improved to the point where the experience of both the doctor and patient are close to the same as in-person visits, and in some cases better,” Dr. Kaveh Safari, head of global health care for Cisco Systems, NY Times, 05/28/10

“The technology has improved to the point where the experience of both the doctor and patient are close to the same as in-person visits, and in some cases better,” Dr. Kaveh Safari, head of global health care for Cisco Systems, NY Times, 05/28/10

Overwhelming research indicates that face to face therapy is no better(or worse) than telepsych as measured by satisfaction of consumers

983 articles since 1993, 2/3 of them since 2008

A Comprehensive Review and a Meta-Analyisis of the Effectiveness of Internet-Based Psychotherapeutic Interventions in J of Technology in Human Services Vol 26, pages 109-160, 2008

Overwhelming research indicates that face to face therapy is no better(or worse) than telepsych as measured by satisfaction of consumers

983 articles since 1993, 2/3 of them since 2008

A Comprehensive Review and a Meta-Analyisis of the Effectiveness of Internet-Based Psychotherapeutic Interventions in J of Technology in Human Services Vol 26, pages 109-160, 2008

China American Analytic Association organized a 2 year program with seminars, supervision and psychoanalysis through Skype.

China American Analytic Association organized a 2 year program with seminars, supervision and psychoanalysis through Skype.

Numbers of usersNumbers of users

73% American adults are internet users (Madden 2006)

5% broadband internet at home (Horrigan, 2008) 85% college students report own computer and

72% check email at least once a day( Jones 2002) 82% of college student use social networks

(Caruso & Salaway 2007)

73% American adults are internet users (Madden 2006)

5% broadband internet at home (Horrigan, 2008) 85% college students report own computer and

72% check email at least once a day( Jones 2002) 82% of college student use social networks

(Caruso & Salaway 2007)

69% of psychologist admit to providing services by phone(Vandenbos & Williams 2000)

75% have offered services to residents of another jurisdiction where they are not licensed or registered

Office of Advancement of Telemedicine(HHS) identified licensure as a major barrier of telemedicine

Both nursing(compact) and medicine have plan to deal with interstate practice issues on a national scope

69% of psychologist admit to providing services by phone(Vandenbos & Williams 2000)

75% have offered services to residents of another jurisdiction where they are not licensed or registered

Office of Advancement of Telemedicine(HHS) identified licensure as a major barrier of telemedicine

Both nursing(compact) and medicine have plan to deal with interstate practice issues on a national scope

WHY NOWWHY NOW

Psychologist are being hit hard by lowering reimbursement rates and increasing restrictions

Electronic Communications are already a part of professional practice of psychology (HIPAA and HITECH). For example in 2012 all billing will have to be electronic. IN 2014 all records will be electronic.

Since 75% are providing service, it is the wild west.No guidelines or regulations.

Psychologist are being hit hard by lowering reimbursement rates and increasing restrictions

Electronic Communications are already a part of professional practice of psychology (HIPAA and HITECH). For example in 2012 all billing will have to be electronic. IN 2014 all records will be electronic.

Since 75% are providing service, it is the wild west.No guidelines or regulations.

Psychologist are uniquely positioned to become the leading profession in this area.

Consensus on the need to solve the interjurisdictional issue

Opportunity to offer services to individuals or communities that are under served

Expand practice Digital natives think differently than us

Psychologist are uniquely positioned to become the leading profession in this area.

Consensus on the need to solve the interjurisdictional issue

Opportunity to offer services to individuals or communities that are under served

Expand practice Digital natives think differently than us

Telehealth, Telemedicine, Telemental Health or Telepsych

Telehealth, Telemedicine, Telemental Health or Telepsych

WHAT TO CALL IT. APA ETHICS, PA STATE BOARD OF

PSYCHOLOGY( LAWS AND REGS) WHAT DO YOU NEED TO KNOW OR

BE COMPETENT TO PROVIDE INTERNET SERVICES

RISK MANAGEMENT APA/ASPPB/APAIT JOINT TF

WHAT TO CALL IT. APA ETHICS, PA STATE BOARD OF

PSYCHOLOGY( LAWS AND REGS) WHAT DO YOU NEED TO KNOW OR

BE COMPETENT TO PROVIDE INTERNET SERVICES

RISK MANAGEMENT APA/ASPPB/APAIT JOINT TF

TELEPSYCHTELEPSYCH

Wikipedia: The delivery of health-related services and information via telecommunication technologies.

THE U: The remote provision of health care services and health education, mediated by technology.

Includes: Internet text based Telephone Videoconferencing- education and treatment

Wikipedia: The delivery of health-related services and information via telecommunication technologies.

THE U: The remote provision of health care services and health education, mediated by technology.

Includes: Internet text based Telephone Videoconferencing- education and treatment

APA ETHICSAPA ETHICS Ethics Committee Opinion on Remote Therapy

• The APA has not chosen to address teletherapy directly in its ethics code and by this intentional omission has created no rules prohibiting such services. The APA Ethics Committee has consistently stated a willingness to address complaints regarding such services on a case-by-case basis, while directing clinicians to apply the same standards used in ‘‘emerging areas in which generally recognized standards for preparatory training do not yet exist,’’ by taking ‘‘reasonable steps to ensure the competence of their work and to protect patients, clients, students, research participants, and others from harm’’ (American Psychological Association, 2002, 2.01e). ..

Ethics Committee Opinion on Remote Therapy• The APA has not chosen to address teletherapy directly in

its ethics code and by this intentional omission has created no rules prohibiting such services. The APA Ethics Committee has consistently stated a willingness to address complaints regarding such services on a case-by-case basis, while directing clinicians to apply the same standards used in ‘‘emerging areas in which generally recognized standards for preparatory training do not yet exist,’’ by taking ‘‘reasonable steps to ensure the competence of their work and to protect patients, clients, students, research participants, and others from harm’’ (American Psychological Association, 2002, 2.01e). ..

APA ETHICS CODE 2010APA ETHICS CODE 2010

Beneficence (Principle A) Nonmaleficence (Principle A) Autonomy (Principle E) Justice (Principle D) Fidelity (Principle B) Integrity (Principle C)

Beneficence (Principle A) Nonmaleficence (Principle A) Autonomy (Principle E) Justice (Principle D) Fidelity (Principle B) Integrity (Principle C)

2.01 Boundaries of Competence2.01 Boundaries of Competence (a) psychologists provide services only within the

boundaries of their competence

(c) Psychologists planning to provide services…involving techniques and technologies new to them undertake relevant education, training, supervised experience, consultation or study.

(e) In those emerging areas in which generally recognized standards for preparatory training do not yet exist, psychologists nevertheless take reasonable steps to ensure the competence of their work and to protect clients/patients, students, supervisees, research participants, organizational clients, and others from harm.

(a) psychologists provide services only within the boundaries of their competence

(c) Psychologists planning to provide services…involving techniques and technologies new to them undertake relevant education, training, supervised experience, consultation or study.

(e) In those emerging areas in which generally recognized standards for preparatory training do not yet exist, psychologists nevertheless take reasonable steps to ensure the competence of their work and to protect clients/patients, students, supervisees, research participants, organizational clients, and others from harm.

3.10(a) Informed Consent3.10(a) Informed Consent

When psychologists conduct research or provide assessment, therapy, counseling, or consulting services in person or via electronic transmission or other forms of communication, they obtain the informed consent of the individual or individuals using language that is reasonably understandable to that person or persons except when conducting such activities without consent is mandated by law or governmental regulation or as otherwise provided in this Ethics Code.

When psychologists conduct research or provide assessment, therapy, counseling, or consulting services in person or via electronic transmission or other forms of communication, they obtain the informed consent of the individual or individuals using language that is reasonably understandable to that person or persons except when conducting such activities without consent is mandated by law or governmental regulation or as otherwise provided in this Ethics Code.

4.0 Privacy and Confidentiality4.0 Privacy and Confidentiality

4.01 Psychologists have a primary obligation and take reasonable precautions to protect confidential information obtained through or stored in any medium…

4.02 Psychologists discuss with persons…(1) the relevant limitations to confidentiality

4.01 Psychologists have a primary obligation and take reasonable precautions to protect confidential information obtained through or stored in any medium…

4.02 Psychologists discuss with persons…(1) the relevant limitations to confidentiality

OTHER KEY APA SECTIONSOTHER KEY APA SECTIONS

1.02 Resolving Ethical Conflicts 2.02 Providing Services in Emergencies 3.05 Multiple Relationships 3.12 Interruption of Psychological Services 5.01 Avoidance of False or Deceptive ST’T 6.01 Documentation of Records 9.01 Assessment 10.01 Informed consent to therapy

1.02 Resolving Ethical Conflicts 2.02 Providing Services in Emergencies 3.05 Multiple Relationships 3.12 Interruption of Psychological Services 5.01 Avoidance of False or Deceptive ST’T 6.01 Documentation of Records 9.01 Assessment 10.01 Informed consent to therapy

PA State Board of PsychologyPA State Board of Psychology

LAW Rules and Regulations Within the Commonwealth

LAW Rules and Regulations Within the Commonwealth

Is Remote Therapy Equivalent Is Remote Therapy Equivalent • Intuitively, to most practitioners, in-person

treatment is superior because of the importance of non verbal cues and other non quantifiable relationship superiorities.

• Some research shows that the closer a communication is to in-person, the more efficacious it is, but there is evidence that supports efficacy of voice and text only.

• There is considerable research that establishes equivalency in terms of outcomes and consumer satisfaction

• Intuitively, to most practitioners, in-person treatment is superior because of the importance of non verbal cues and other non quantifiable relationship superiorities.

• Some research shows that the closer a communication is to in-person, the more efficacious it is, but there is evidence that supports efficacy of voice and text only.

• There is considerable research that establishes equivalency in terms of outcomes and consumer satisfaction

Is Remote Therapy Equivalent ?Is Remote Therapy Equivalent ?Traditional therapy has a great deal of variation.

• Remote therapy has advantages of increased flexibility, access, and administrative convenience.

• There are some treatment situations where remote treatment has clear advantages

Providing there is good informed consent, there is no reason to prohibit or differently regulate remote treatment if both the adequately trained licensed psychologist and his/her client agree and all parties are within the Commonwealth.

Not violating other laws, ie insurance

Traditional therapy has a great deal of variation.• Remote therapy has advantages of increased flexibility,

access, and administrative convenience. • There are some treatment situations where remote treatment

has clear advantages

Providing there is good informed consent, there is no reason to prohibit or differently regulate remote treatment if both the adequately trained licensed psychologist and his/her client agree and all parties are within the Commonwealth.

Not violating other laws, ie insurance

RISK MANAGEMENTRISK MANAGEMENT

Have a good working knowledge of ethics code and legal standards governing practice

Conduct a conservative evaluation of your competence to perform Intellectual competence Technical competence Emotional competence

Keep your knowledge base up to date Avoid professional isolation

Have a good working knowledge of ethics code and legal standards governing practice

Conduct a conservative evaluation of your competence to perform Intellectual competence Technical competence Emotional competence

Keep your knowledge base up to date Avoid professional isolation

Three keys to SuccessThree keys to Success

Provide Comprehensive Informed Consent Seek Appropriate Consultation Develop good record-keeping practices and

strategies DOCUMENT DOCUMENT DOCUMENT

Eric Harris

Provide Comprehensive Informed Consent Seek Appropriate Consultation Develop good record-keeping practices and

strategies DOCUMENT DOCUMENT DOCUMENT

Eric Harris

APA/ASPPB/APAIT TF APA/ASPPB/APAIT TF

1 COMPETENCE 2 MULTIPLE RELATIONSHIPS 3 INFORMED CONSENT 4 CONFIDENTIALITY AND PRIVACY 5 RECORD KEEPING/ BILLING 6 EDUCATION, SUPERVISION AND CE 7 ASSESSMENT AND TESTING 8 ACCESS TO CARE 9 STANDARDS OF CARE

1 COMPETENCE 2 MULTIPLE RELATIONSHIPS 3 INFORMED CONSENT 4 CONFIDENTIALITY AND PRIVACY 5 RECORD KEEPING/ BILLING 6 EDUCATION, SUPERVISION AND CE 7 ASSESSMENT AND TESTING 8 ACCESS TO CARE 9 STANDARDS OF CARE

10 LEGAL ISSUES 11 INTERJURISDICTIONAL 12 INFORMATION COLLECTION,

COMMUNICATION AND STORAGE 13 CONSULTATION AND I/0 14 ADVERTISING

10 LEGAL ISSUES 11 INTERJURISDICTIONAL 12 INFORMATION COLLECTION,

COMMUNICATION AND STORAGE 13 CONSULTATION AND I/0 14 ADVERTISING

WHAT ARE OTHERS DOINGWHAT ARE OTHERS DOING

ACPRO IN CANADA AUSTRALIA ASPPB EU -EUROPSYC Other states

ACPRO IN CANADA AUSTRALIA ASPPB EU -EUROPSYC Other states

INFORMED CONSENTINFORMED CONSENT

Just as you all use an informed consent with all your face to face patients, need one for telepsych:

Limitations of confidentiality, privacy Interjurisdictional and other state laws Duty to report Tarisoff, Emeric or nothing Child Abuse Standards -no immunity Record keeping- what is part of the record, emails How will Emergencies be handled How available will you be to the patient Billing --90806 ? Payment-- paypal, insurance Who is in the room

Just as you all use an informed consent with all your face to face patients, need one for telepsych:

Limitations of confidentiality, privacy Interjurisdictional and other state laws Duty to report Tarisoff, Emeric or nothing Child Abuse Standards -no immunity Record keeping- what is part of the record, emails How will Emergencies be handled How available will you be to the patient Billing --90806 ? Payment-- paypal, insurance Who is in the room

COMPETENCECOMPETENCE

Before engaging in the remote delivery of mental health services via electronic means, practitioners should carefully access their competence to offer the particular services and consider the limitations of efficacy and effectiveness that may be a function of remote delivery.

On Calif. Board’s website(Koocher)

Before engaging in the remote delivery of mental health services via electronic means, practitioners should carefully access their competence to offer the particular services and consider the limitations of efficacy and effectiveness that may be a function of remote delivery.

On Calif. Board’s website(Koocher)

Practical CompetencyPractical Competency

Have you done internet therapy -confidentiality Why in this case- benefits vs. risk Type of Patient-diagnosis,age,condition,resources Patient wants to do it vs you want to do it Is there a difference with a patient who goes away for a

month vs. a new patient vs. patient from website Is patient who they say they are, does it matter Emergencies how do you handle them-- ND position vs

KY position vs. head in sand

Have you done internet therapy -confidentiality Why in this case- benefits vs. risk Type of Patient-diagnosis,age,condition,resources Patient wants to do it vs you want to do it Is there a difference with a patient who goes away for a

month vs. a new patient vs. patient from website Is patient who they say they are, does it matter Emergencies how do you handle them-- ND position vs

KY position vs. head in sand

Entertaining? Is it like TV. boring? Avatars How much do you get from nonverbal cues Conditions which might change the medium Narcissism of psychologist Intervention you are competent to do Therapy vs assessment vs psychoeducational vs

forensic

Entertaining? Is it like TV. boring? Avatars How much do you get from nonverbal cues Conditions which might change the medium Narcissism of psychologist Intervention you are competent to do Therapy vs assessment vs psychoeducational vs

forensic

WEB THERAPYWEB THERAPY

Technological CompetenceTechnological Competence

Do you know how to use the internet, do you know what you don’t know

Broad Band Width, asynchronis vs synchronis Confidentiality is anything confidential? Skype is not HIPAA compliant, sell info? When technical difficulties happen Skype vs. texting vs emailing vs videoconferencing How to secure records --encryption, back ups CLOUD in PC vs MAC?

Do you know how to use the internet, do you know what you don’t know

Broad Band Width, asynchronis vs synchronis Confidentiality is anything confidential? Skype is not HIPAA compliant, sell info? When technical difficulties happen Skype vs. texting vs emailing vs videoconferencing How to secure records --encryption, back ups CLOUD in PC vs MAC?

Inter Jurisdictional Inter Jurisdictional

10th amendment-- state rights Different states adopt different regulations Licensing Boards are conservative by

nature Need to protect the citizens of the

jurisdiction, not concerned with citizens of other states since Board does not have jurisdiction(authority) in other state.

10th amendment-- state rights Different states adopt different regulations Licensing Boards are conservative by

nature Need to protect the citizens of the

jurisdiction, not concerned with citizens of other states since Board does not have jurisdiction(authority) in other state.

ISSUESISSUES

Where does the electronic interstate transaction take place?

a) where the consumer resides--distant

b) where the psychologist is providing the services in the home office of the licensed jurisdiction-- home

c) in cyberspace

Where does the electronic interstate transaction take place?

a) where the consumer resides--distant

b) where the psychologist is providing the services in the home office of the licensed jurisdiction-- home

c) in cyberspace

Where the Practitioner Resides? Is physically located in a state where he/she is

licensed. Reside or domicile? Psychologist has not set foot in the consumer’s

state Psychologist has not attempted to do business

there(traditional manner or internet). Psychologist can be regulated by the state where

they are licensed or on interstate basis.

Where the Practitioner Resides? Is physically located in a state where he/she is

licensed. Reside or domicile? Psychologist has not set foot in the consumer’s

state Psychologist has not attempted to do business

there(traditional manner or internet). Psychologist can be regulated by the state where

they are licensed or on interstate basis.

• Federal Government Policy: Health Licensing Board Report to Congress, HRSA, HHS, 2011 (HSRA)

Federal government has recognized the importance of use of electronic technology and provision of telehealth services. Federal Agencies Efforts to promote telehealth Fed benefits for remote services Medicaid, Medicare Interstate practice is essential for full benefits Best way to accomplish this is by voluntary compact between

state licensing boards

• Federal Government Policy: Health Licensing Board Report to Congress, HRSA, HHS, 2011 (HSRA)

Federal government has recognized the importance of use of electronic technology and provision of telehealth services. Federal Agencies Efforts to promote telehealth Fed benefits for remote services Medicaid, Medicare Interstate practice is essential for full benefits Best way to accomplish this is by voluntary compact between

state licensing boards

Health Licensing Board Report to Congress HRSA, HHS 2011 Health Licensing Board Report to Congress HRSA, HHS 2011

“ if collaboration between states is unable to develop effective licensure policies to reduce barriers to electronic practice across state lines within the next 18 months, then Congress should intervene to ensure Medicare and Medicaid beneficiaries are not denied the benefits of e-care.”

“ if collaboration between states is unable to develop effective licensure policies to reduce barriers to electronic practice across state lines within the next 18 months, then Congress should intervene to ensure Medicare and Medicaid beneficiaries are not denied the benefits of e-care.”

HRSA 2011HRSA 2011

“ In the absence of specific agreements…states may not discipline healthcare providers not licensed in their state if patient harm occurs as the result of the provision of health care services by an out of state practitioner.”

“ In the absence of specific agreements…states may not discipline healthcare providers not licensed in their state if patient harm occurs as the result of the provision of health care services by an out of state practitioner.”

State licensing authority cannot interfere with the regulatory authority of the federal government such as interstate commerce or an effective military. Military or VA Psychologists Health Care is interstate commerce

Anti Trust CasesErisa v. state mandatesCurrent dispute over health care

State licensing authority cannot interfere with the regulatory authority of the federal government such as interstate commerce or an effective military. Military or VA Psychologists Health Care is interstate commerce

Anti Trust CasesErisa v. state mandatesCurrent dispute over health care

State Licensing BoardsState Licensing Boards

States have taken the position that the transaction takes place in forum state no matter where the patient resides. California Massachusetts Wisconsin Kentucky North Dakota Minnesota Florida Pennsylvania- temp 14 days

States have taken the position that the transaction takes place in forum state no matter where the patient resides. California Massachusetts Wisconsin Kentucky North Dakota Minnesota Florida Pennsylvania- temp 14 days

Minimal Contact RuleMinimal Contact Rule

The state where the patient resides (the forum state) can assert jurisdiction over an out-of-state provider, only when that provider has made a purposeful attempt to promote or provide services in the forum state or has otherwise availed him/herself of the laws of the forum state to his/her advantage.

Wright vs. Yackley (1972), 459 F. 2nd (United States Court of Appeals, Ninth Circuit, 1971).

The state where the patient resides (the forum state) can assert jurisdiction over an out-of-state provider, only when that provider has made a purposeful attempt to promote or provide services in the forum state or has otherwise availed him/herself of the laws of the forum state to his/her advantage.

Wright vs. Yackley (1972), 459 F. 2nd (United States Court of Appeals, Ninth Circuit, 1971).

Prince v. UrbanPrince v. Urban

Three principles of decision Was the doctor-patient relationship created because

of a continuing effort of the doctors to provide services in California or was the location of the client incidental to the services?

Were the doctors services “grounded” in any relationship [they had] in California”?

Even if the above tests are met, the court needed to balance the state’s interest in securing good medical care for its citizens against the potential and severity of the anticipated harm.

Prince v. Urban (1996) 49 Cal.App.4th 1056 [57 Cal.Rptr.2d 181]

Three principles of decision Was the doctor-patient relationship created because

of a continuing effort of the doctors to provide services in California or was the location of the client incidental to the services?

Were the doctors services “grounded” in any relationship [they had] in California”?

Even if the above tests are met, the court needed to balance the state’s interest in securing good medical care for its citizens against the potential and severity of the anticipated harm.

Prince v. Urban (1996) 49 Cal.App.4th 1056 [57 Cal.Rptr.2d 181]

The essence of the relationship was that the California patient sought out the Illinois doctors in Illinois. [The plaintiff’s] residence was irrelevant and incidental to the services rendered by her physicians. If anything [the plaintiff’s] residence hampered the doctor-patient relationship which existed despite the half continent of separation between the parties.

A state’s dominant interest on behalf of its citizens in such a case as this is not that they should be free from injury by out-of-state doctors, but rather that they should be able to secure adequate medical services to meet their needs wherever they may go. In the case of personal services, focus must be on the place where the services are rendered, since this is the place of the patient’s need. They are directed to no place but to the needy person herself.

The essence of the relationship was that the California patient sought out the Illinois doctors in Illinois. [The plaintiff’s] residence was irrelevant and incidental to the services rendered by her physicians. If anything [the plaintiff’s] residence hampered the doctor-patient relationship which existed despite the half continent of separation between the parties.

A state’s dominant interest on behalf of its citizens in such a case as this is not that they should be free from injury by out-of-state doctors, but rather that they should be able to secure adequate medical services to meet their needs wherever they may go. In the case of personal services, focus must be on the place where the services are rendered, since this is the place of the patient’s need. They are directed to no place but to the needy person herself.

Tentative Conclusions by APAITTentative Conclusions by APAIT

Unless a psychologist actively promotes services in an interstate manner, forum ( pt resides) state licensing boards will be unable to gain jurisdiction.

What level of marketing is required to give a forum state jurisdiction is not yet clear.

Websites are unlikely to be seen as promotional. Psychologists who actively market themselves on

an interstate basis are taking risk. Extradition is very unlikely.

Unless a psychologist actively promotes services in an interstate manner, forum ( pt resides) state licensing boards will be unable to gain jurisdiction.

What level of marketing is required to give a forum state jurisdiction is not yet clear.

Websites are unlikely to be seen as promotional. Psychologists who actively market themselves on

an interstate basis are taking risk. Extradition is very unlikely.

Other ViewOther View

Licensing Board could issue a cease and desist order and due to laws of comity have it enforced in another jurisdiction

How lucky do you feel? Do you want to be the test case?

Licensing Board could issue a cease and desist order and due to laws of comity have it enforced in another jurisdiction

How lucky do you feel? Do you want to be the test case?

HypotheticalsHypotheticals

Psychologist in PA, patient in PA Psych in NJ, patient in PA Psych in PA, patient in New Orleans, LA. Psych’s PA pt. on trip in Texas, call emergency Psych’s PA pt. now attending college at Michigan Psych’s PA pt. in winter in Florida Psych’s pt. on sabbatical in New Zealand Psych’s pt. in PA, psych in Florida or Psych’s pt is in Florida

and psych is at meeting in Florida. Psych’s pt. at Michigan goes to Calif during break. Psych in

PA. then psych goes to Mexico

Psychologist in PA, patient in PA Psych in NJ, patient in PA Psych in PA, patient in New Orleans, LA. Psych’s PA pt. on trip in Texas, call emergency Psych’s PA pt. now attending college at Michigan Psych’s PA pt. in winter in Florida Psych’s pt. on sabbatical in New Zealand Psych’s pt. in PA, psych in Florida or Psych’s pt is in Florida

and psych is at meeting in Florida. Psych’s pt. at Michigan goes to Calif during break. Psych in

PA. then psych goes to Mexico

Even though the distant( pt resides) jurisdiction might not have jurisdiction, home jurisdiction(where psych is licensed) could always bring action against your license

Even though the distant( pt resides) jurisdiction might not have jurisdiction, home jurisdiction(where psych is licensed) could always bring action against your license

My FantasyMy Fantasy

Registry for all who want to practice telepsych inter jurisdictionally. Benefit:

One license Like military and VA Lets states know who is practicing in the state Protects the citizens of the distant state Moving toward a similar standard across jurisdictions Psych to provide services where they are needed

Registry for all who want to practice telepsych inter jurisdictionally. Benefit:

One license Like military and VA Lets states know who is practicing in the state Protects the citizens of the distant state Moving toward a similar standard across jurisdictions Psych to provide services where they are needed

Problems

1) need to know distant laws, PA v.TX

2) need to abide by stricter standards, records

3) emergencies

4) conflicts of law, child abuse

Problems

1) need to know distant laws, PA v.TX

2) need to abide by stricter standards, records

3) emergencies

4) conflicts of law, child abuse

Confidentiality: CommunicationsConfidentiality: Communications Voicemail

Websites Email Text Messaging Social Networking

Facebook MySpace Blogging

Virtual worlds- 2nd Life Synchronous v Asynchronous

Voicemail Websites Email Text Messaging Social Networking

Facebook MySpace Blogging

Virtual worlds- 2nd Life Synchronous v Asynchronous

Clinical CommunicationClinical Communication

Direct Care Telepsych Coaching Assessment I/O Consultation Forensic

Direct Care Telepsych Coaching Assessment I/O Consultation Forensic

Administrative Administrative

Billing; Insurance, credit or otherwise Scheduling Record Keeping and other documentation Information Storage and Transmission

Billing; Insurance, credit or otherwise Scheduling Record Keeping and other documentation Information Storage and Transmission

Points to ConsiderPoints to Consider

Resolution and Picture Quality Real time Audio Reliability of technology Ease of Use Cost Differences from In Person Communication Privacy

Resolution and Picture Quality Real time Audio Reliability of technology Ease of Use Cost Differences from In Person Communication Privacy

SKYPESKYPE

It is not HIPAA Compliant Sells information to others- confidentiality Public part of profile can be seen by others May respond to subpoenas NETSIS (web video conferencing) better

than Skype but $$

It is not HIPAA Compliant Sells information to others- confidentiality Public part of profile can be seen by others May respond to subpoenas NETSIS (web video conferencing) better

than Skype but $$

Public parts of your Skype profile can be seen by everyone else on Skype. Do not put details in your profile that you do not want to be publicly available.

Except as provided below, Skype shall not sell, rent, trade or otherwise transfer any personal and/or traffic data or communications content to any third party without your explicit permission, unless it is obliged to do so under applicable laws or by order of the competent authorities.

Public parts of your Skype profile can be seen by everyone else on Skype. Do not put details in your profile that you do not want to be publicly available.

Except as provided below, Skype shall not sell, rent, trade or otherwise transfer any personal and/or traffic data or communications content to any third party without your explicit permission, unless it is obliged to do so under applicable laws or by order of the competent authorities.

Skype may disclose personal information to respond to legal requirements, to protect Skype’s interests, to enforce our policies or to protect anyone's rights, property, or safety.

In order to provide you with Skype products you have requested, Skype may sometimes, if necessary, share your personal and traffic data with Skype’s group companies.

Skype may disclose personal information to respond to legal requirements, to protect Skype’s interests, to enforce our policies or to protect anyone's rights, property, or safety.

In order to provide you with Skype products you have requested, Skype may sometimes, if necessary, share your personal and traffic data with Skype’s group companies.

Voice Mail, Email, TextingVoice Mail, Email, Texting

Convenience and efficiency Duty to Care Alternative Backups

WHAT ARE YOU RESPONSIBLE FOR?

Convenience and efficiency Duty to Care Alternative Backups

WHAT ARE YOU RESPONSIBLE FOR?

Holmes v. PetrovichHolmes v. Petrovich

Gina Holmes sued her employer based on allegations of pregnancy disability discriminations.

Holmes forwarded e-mails from her employer to her lawyer, and sent documents through the company’s fax machine.

Gina Holmes sued her employer based on allegations of pregnancy disability discriminations.

Holmes forwarded e-mails from her employer to her lawyer, and sent documents through the company’s fax machine.

The Court reasoned that the e-mails sent through her company computer were “akin to consulting her lawyer in her employer's conference room, in a loud voice, with the door open, yet unreasonably expecting that the conversation . . . would be privileged

The Court reasoned that the e-mails sent through her company computer were “akin to consulting her lawyer in her employer's conference room, in a loud voice, with the door open, yet unreasonably expecting that the conversation . . . would be privileged

The Court emphasized that an email communication does not lose its privileged character solely because it is communicated by electronic means, or because persons involved in the delivery, facilitation, or storage of the electronic communication may have access to its content.

While Holmes decision was largely impacted by the employer’s policies and employee’s awareness of those policies, a practitioner should assume that any communication through such devises may find itself in litigation.

The Court emphasized that an email communication does not lose its privileged character solely because it is communicated by electronic means, or because persons involved in the delivery, facilitation, or storage of the electronic communication may have access to its content.

While Holmes decision was largely impacted by the employer’s policies and employee’s awareness of those policies, a practitioner should assume that any communication through such devises may find itself in litigation.

Informed Consent with PatientInformed Consent with Patient

Do not SMS or use social network site No Wall postings, @replies or other on line

Not secure,may have to be part of the record You, patient and server, ie AOL and State of Virginia All texting in Library of Congress If need to contact me between sessions, call DO NOT PUT ANYTHING IN AN

EMAIL/TEXT/TWEET THAT YOU WOULD NOT PUT ON A POST CARD

Hush mail is may be a better choice

Do not SMS or use social network site No Wall postings, @replies or other on line

Not secure,may have to be part of the record You, patient and server, ie AOL and State of Virginia All texting in Library of Congress If need to contact me between sessions, call DO NOT PUT ANYTHING IN AN

EMAIL/TEXT/TWEET THAT YOU WOULD NOT PUT ON A POST CARD

Hush mail is may be a better choice

FACEBOOKFACEBOOK

Is constantly changing, hard to keep up with all the changes.

Business page now can be post on a page. mashable.com/2011/09/28/newfacebook/

Is constantly changing, hard to keep up with all the changes.

Business page now can be post on a page. mashable.com/2011/09/28/newfacebook/

Is friending a patient a multiple relationship? If you friend someone are friending all of their

friends as well Avoid social networks with patients. No friending Relationship with patient and internet- pregnancy

group therapy Limit emails to administrative,ie appointments Exchange clinical info only in secure manner.

Encryption or landline phone not VOI

Is friending a patient a multiple relationship? If you friend someone are friending all of their

friends as well Avoid social networks with patients. No friending Relationship with patient and internet- pregnancy

group therapy Limit emails to administrative,ie appointments Exchange clinical info only in secure manner.

Encryption or landline phone not VOI

Privacy Privacy

“This Ethics Code applies only to psychologists' activities that are part of their scientific, educational, or professional roles as psychologists .... These activities shall be distinguished from the purely private conduct of psychologists, which is not within the purview of the Ethics Code.”

Ie, San Fran politics or student applying to grad school

“This Ethics Code applies only to psychologists' activities that are part of their scientific, educational, or professional roles as psychologists .... These activities shall be distinguished from the purely private conduct of psychologists, which is not within the purview of the Ethics Code.”

Ie, San Fran politics or student applying to grad school

In the age of Google, the concept of privacy has changed.

We all practice in small communities and need to figure out a strategy the maximizes protection of appropriate boundaries.

A psychologist has a right to make his/her feelings about invasions of privacy known to his/her clients and this is an appropriate part of the professional conversation.

In the age of Google, the concept of privacy has changed.

We all practice in small communities and need to figure out a strategy the maximizes protection of appropriate boundaries.

A psychologist has a right to make his/her feelings about invasions of privacy known to his/her clients and this is an appropriate part of the professional conversation.

GOOGLED OR YELPED?GOOGLED OR YELPED?

How many of you think you patients have googled you?

Patients will review sites and other means of electronic criticism, up to cyber attacks

Do you respond?

How many of you think you patients have googled you?

Patients will review sites and other means of electronic criticism, up to cyber attacks

Do you respond?

How many of you have googled a patient?

Informed consent Do you have to let them know Difference in forensic cases BUT slippery slope … duty to warn

How many of you have googled a patient?

Informed consent Do you have to let them know Difference in forensic cases BUT slippery slope … duty to warn

Security,Record Keeping and Storage

Security,Record Keeping and Storage

Same applicability trigger: electronic transmission in covered transaction

Applies only to electronically transmitted and stored PHI

Provides a number of steps that each psychologist must take.

Scalability for smaller practices More complicated for practitioners with

employees

Same applicability trigger: electronic transmission in covered transaction

Applies only to electronically transmitted and stored PHI

Provides a number of steps that each psychologist must take.

Scalability for smaller practices More complicated for practitioners with

employees

Conduct a documented risk analysis which must be kept with other HIPAA compliance records.

Modify your policies and procedures in order to achieve appropriate compliance.

If scaled, document how it has complied with the requirements of the Security Rule.

Periodically review risk analysis, policies and procedures and modify as necessary.

Appoint someone who is responsible for security (Usually you).

Conduct a documented risk analysis which must be kept with other HIPAA compliance records.

Modify your policies and procedures in order to achieve appropriate compliance.

If scaled, document how it has complied with the requirements of the Security Rule.

Periodically review risk analysis, policies and procedures and modify as necessary.

Appoint someone who is responsible for security (Usually you).

Develop specific policies for data access to all electronic devices that store data. (Scalable Issues) Includes not only computers, but PDAs, cell phones

and any other wireless device that stores data. Require passwords that are unique & robust. Fire walls and virus protection: up to date Procedure for assigning/changing passwords for those

entering practice and changing them when they leave. Data separation capacity so individuals only have

access to the information that is necessary for their responsibilities.

Develop specific policies for data access to all electronic devices that store data. (Scalable Issues) Includes not only computers, but PDAs, cell phones

and any other wireless device that stores data. Require passwords that are unique & robust. Fire walls and virus protection: up to date Procedure for assigning/changing passwords for those

entering practice and changing them when they leave. Data separation capacity so individuals only have

access to the information that is necessary for their responsibilities.

Train all employees in the Security Rule. Have policies for dealing with security

breaches including specific sanctions in personnel policies for employee/IC breaches.

Written plan for dealing with emergencies

Train all employees in the Security Rule. Have policies for dealing with security

breaches including specific sanctions in personnel policies for employee/IC breaches.

Written plan for dealing with emergencies

Have appropriate facility access controls Only staff should be able to reach place where

EPHI is stored. Specific rules about removing EPHI from the

premises and be conservative.

Proof of Client Identity

Have appropriate facility access controls Only staff should be able to reach place where

EPHI is stored. Specific rules about removing EPHI from the

premises and be conservative.

Proof of Client Identity

2007 APA Recording Keeping Guidelines

2007 APA Recording Keeping Guidelines

Electronic records, like paper records, should be created and maintained in a way that is designed to protect their security, integrity, confidentiality, and appropriate access, as well as their compliance with applicable legal and ethical requirements

Electronic records, like paper records, should be created and maintained in a way that is designed to protect their security, integrity, confidentiality, and appropriate access, as well as their compliance with applicable legal and ethical requirements

PA PSYCH REGULATIONS Section 41.57(c)

PA PSYCH REGULATIONS Section 41.57(c)

A psychologist shall store and dispose of written, electronic and other records in a manner which insures their confidentiality.

41.57(e) A psychologist shall provide for the

confidential disposition of records in the event of the psychologist’s withdrawal from practice, incapacity or death.

A psychologist shall store and dispose of written, electronic and other records in a manner which insures their confidentiality.

41.57(e) A psychologist shall provide for the

confidential disposition of records in the event of the psychologist’s withdrawal from practice, incapacity or death.

Onsite Back UpOnsite Back Up

External Hard Drive Flash Drives

Back up Drives Tape Flash Memory

Paper

External Hard Drive Flash Drives

Back up Drives Tape Flash Memory

Paper

Off Site StorageOff Site Storage

http://www.carbonite.com/ http://www.mozy.com/ http://www.backblaze.com/ http://www.crashplan.com/ http://go.iomega.com/en-us/?partner=4760 http://www.ironmountain.com/

http://www.carbonite.com/ http://www.mozy.com/ http://www.backblaze.com/ http://www.crashplan.com/ http://go.iomega.com/en-us/?partner=4760 http://www.ironmountain.com/

ENCRYPTIONENCRYPTION

Stanford Hospital $20M Class Action Law for data breach involving 20,000 patients(San Jose Mercury News)

4.9M Tricare Patients Data Breach: name, Diagnosis, SS#, Address, treatment Info, ect.(San Antonio Express)

14,000 Patient Data Breach: Unencrypted Names, Diagnosis, DOB, Addresses, SS# ect (Minneapolis Pioneer Press)

These just in last three weeks

Stanford Hospital $20M Class Action Law for data breach involving 20,000 patients(San Jose Mercury News)

4.9M Tricare Patients Data Breach: name, Diagnosis, SS#, Address, treatment Info, ect.(San Antonio Express)

14,000 Patient Data Breach: Unencrypted Names, Diagnosis, DOB, Addresses, SS# ect (Minneapolis Pioneer Press)

These just in last three weeks

What is EncryptionWhat is Encryption

Definition: Encryption is the conversion of data into a form, called a hypertext that cannot be easily understood by unauthorized people.

A cipher, often incorrectly called a code, can be employed to keep others from obtaining the contents of transmissions.

In order to easily recover the contents of an encrypted signal, the correct decryption key required.

Definition: Encryption is the conversion of data into a form, called a hypertext that cannot be easily understood by unauthorized people.

A cipher, often incorrectly called a code, can be employed to keep others from obtaining the contents of transmissions.

In order to easily recover the contents of an encrypted signal, the correct decryption key required.

Do You Need Encryption?Do You Need Encryption?

If you don’t encrypt and there is a breach, you must inform your clients.

Unencrypted data breach is more likely to damage relationship with your clients

Clients may then want identity theft protection and may want you to pay for it.

If clients are harmed, they can probably sue or file licensing boards complaints.

If your computer has more than 500 files, you have to inform the media.

If you don’t encrypt and there is a breach, you must inform your clients.

Unencrypted data breach is more likely to damage relationship with your clients

Clients may then want identity theft protection and may want you to pay for it.

If clients are harmed, they can probably sue or file licensing boards complaints.

If your computer has more than 500 files, you have to inform the media.

TrueCrypt (http://www.truecrypt.org/) BestCrypt Enterprise (

http://www.jetico.com/data-protection-encryption-bestcrypt-enterprise/)

PGP Whole Disk Encryption (http://www.symantec.com/index.jsp)

TrueCrypt (http://www.truecrypt.org/) BestCrypt Enterprise (

http://www.jetico.com/data-protection-encryption-bestcrypt-enterprise/)

PGP Whole Disk Encryption (http://www.symantec.com/index.jsp)

MOBILITY AND PORTIBILITY

MOBILITY AND PORTIBILITY

PASS RATE ON EPPPPASS RATE ON EPPP

Doctoral degree first-time takers: 83% APA/CPA accredited graduates: 78% NON APA/CPA graduates: 53% APA/CPA/APPIC internship: 80% No APA/CPA accredited/APPIC: 54%

My impression for the last 12 years in PA are similar to the national numbers

Doctoral degree first-time takers: 83% APA/CPA accredited graduates: 78% NON APA/CPA graduates: 53% APA/CPA/APPIC internship: 80% No APA/CPA accredited/APPIC: 54%

My impression for the last 12 years in PA are similar to the national numbers

For those already licensed/registered with no

disciplinary sanctions

Mechanisms to facilitate mobility:

Certificate of Professional Qualification

Reciprocity Agreement

Mutual Recognition Agreement

Interview and jurisprudence exam may be

required

For those already licensed/registered with no

disciplinary sanctions

Mechanisms to facilitate mobility:

Certificate of Professional Qualification

Reciprocity Agreement

Mutual Recognition Agreement

Interview and jurisprudence exam may be

required

Most new practitioners will relocate at least once in

their career Slight variations in registration and licensure

requirements can become huge obstacles later Documenting supervised experience, course content,

etc. becomes more difficult over time Licensing/registration boards can not accept personal

copies of documents because of possible fraud Training programs, internship sites close, supervisors

and their records disappear

Most new practitioners will relocate at least once in

their career Slight variations in registration and licensure

requirements can become huge obstacles later Documenting supervised experience, course content,

etc. becomes more difficult over time Licensing/registration boards can not accept personal

copies of documents because of possible fraud Training programs, internship sites close, supervisors

and their records disappear

Certificate of professional Qualification (CPQ)

Certificate of professional Qualification (CPQ)

Program of ASPPB

Individual must meet requirements

for CPQ

Includes credentials bank feature

Low cost to obtain & maintain

Program of ASPPB

Individual must meet requirements

for CPQ

Includes credentials bank feature

Low cost to obtain & maintain

Accepted by 44 jurisdictions in Canada &

United States

3 more jurisdictions in the process of

accepting the CPQ for licensure

8 more jurisdictions recognize the CPQ for

licensure

Accepted by 44 jurisdictions in Canada &

United States

3 more jurisdictions in the process of

accepting the CPQ for licensure

8 more jurisdictions recognize the CPQ for

licensure

Accepting CPQAccepting CPQ

Jurisdictions in Canada:

all 10 provinces

Jurisdictions in the United States:

AZ, AR, CA, CO, CT, DE, DC, GA, HI, ID,

KY, LA, ME, MI, MS, MO, ND, NV, NE, NH,

NM, NC, OH, OK, OR, PA, RI, SC, UT, VT,

VA, WV, WI, WY

Jurisdictions in Canada:

all 10 provinces

Jurisdictions in the United States:

AZ, AR, CA, CO, CT, DE, DC, GA, HI, ID,

KY, LA, ME, MI, MS, MO, ND, NV, NE, NH,

NM, NC, OH, OK, OR, PA, RI, SC, UT, VT,

VA, WV, WI, WY

These jurisdictions have “voted” to accept CPQ, and are in process of making legislative or administrative changes for implementation.

US AK, MN, SD,

Canada

These jurisdictions have “voted” to accept CPQ, and are in process of making legislative or administrative changes for implementation.

US AK, MN, SD,

Canada

Recognize CPQRecognize CPQ

These jurisdictions may waive at least one requirement for applications who hold a CPQ.

US IA, MD, MA, MT, NJ, TN, WA

These jurisdictions may waive at least one requirement for applications who hold a CPQ.

US IA, MD, MA, MT, NJ, TN, WA

Not Accepting CPQNot Accepting CPQ

US NY, FL, AL, IN, IL, KS, PR, VI, GU

US NY, FL, AL, IN, IL, KS, PR, VI, GU

ASPPB Agreement of Reciprocity

ASPPB Agreement of Reciprocity

11 jurisdictions (2 provinces, 9 states)

Jurisdiction must meet requirements of

Agreement to participate

Psychologist licensed with no

disciplinary sanctions in one

participating jurisdiction may seek

registration/licensure in another

participating jurisdiction

11 jurisdictions (2 provinces, 9 states)

Jurisdiction must meet requirements of

Agreement to participate

Psychologist licensed with no

disciplinary sanctions in one

participating jurisdiction may seek

registration/licensure in another

participating jurisdiction

Jurisdictions in Canada

MB, ON

Jurisdictions in the United States

AR, KY, MO, MS, NV, NH, OK, TX, WI

Jurisdictions in Canada

MB, ON

Jurisdictions in the United States

AR, KY, MO, MS, NV, NH, OK, TX, WI

Interjurisdictional Practice Certificate (IPC)

Interjurisdictional Practice Certificate (IPC)

Accept IPC Idaho Georgia South Carolina Kentucky Ohio

Accept IPC Idaho Georgia South Carolina Kentucky Ohio

National RegisterNational Register

The National Register credential is approved or in process of approval in 46 jurisdictions in the US and Canada. The National Register has helped more than 1,300 of our credentialed psychologists easily and quickly apply for licensure in another jurisdiction.

BUT must look at each jurisdiction to see what is waived

The National Register credential is approved or in process of approval in 46 jurisdictions in the US and Canada. The National Register has helped more than 1,300 of our credentialed psychologists easily and quickly apply for licensure in another jurisdiction.

BUT must look at each jurisdiction to see what is waived

ABPPABPP

THANK YOU.THANK YOU.

ASIEGEL@ASPPB.ORG 610 668 4240 in Narberth, PA Pa Licensing Board

ST-PSYCHOLOGY@PA.GOV 717 783 7155(P) 717 787 7769(F) STATE BOARD OF PSYCHOLOGY PO BOX 2649 HARRISBURG, PA 17105-2649

ASIEGEL@ASPPB.ORG 610 668 4240 in Narberth, PA Pa Licensing Board

ST-PSYCHOLOGY@PA.GOV 717 783 7155(P) 717 787 7769(F) STATE BOARD OF PSYCHOLOGY PO BOX 2649 HARRISBURG, PA 17105-2649