raise ethical and legal issues. Although companies providing therapeutic conversations have not been presenting their services as actual therapy, it is unclear that clients understand that this is the case. According to Groshong and Aronson (2019), texting might work as a way of beginning the therapeutic process, which could then move on to therapy conducted through videoconferencing or in person. Legal problems with this form of client engagement might result from privacy and security concerns, and specifically with HIPAA compliance. Furthermore, the commercial nature of the texting being advertised could lead to ethical problems. Using email with clients poses other challenges that need to be addressed with clients. Although convenient for a number of purposes, including completing necessary paperwork before sessions, scheduling, or answering simple questions without playing “phone tag,” email carries inherent confidentiality and boundary risks. The need for informed consent, with its attendant implications and risks, must be taken into consideration. The added protection of an encryption program, as well as the use of a password or code words or an electronic signature system that verifies clients’ identities, could also be considered (Sidell, 2015). Both texting and emailing clients can pose ethical dilemmas and place practitioners at potential risk for favoritism, conflicts of interest, and boundary confusion (NASW, ASWB, CSWE, & CSWA, 2017). Furthermore, it is never possible to ensure that the intended person is receiving an electronic communication. Again, referring to professional guidelines for technology, along with ethical and legal standards, is key to effective and appropriate documentation. The National Association of Social Workers (2020b) presents a list of eight ethical considerations when starting a telehealth practice: 1. In keeping with Standard 1.04(a), Competence, in the NASW Code of Ethics, “Social workers should provide services only within the bounds of their education, training, license, certification, consultation received, supervised
experience, or relevant professional experience.” In the context of telehealth, this means that social workers must receive adequate training and be competent in the work. In accordance with Standard 1.04(d), social workers need to understand the communication challenges of this type of work and be able to implement strategies to address the challenges. 2. In accordance with Standard 1.02, Self-Determination, social workers need to be aware of client preferences and capabilities. In accordance with Standard 1.03,(f)(g), Informed Consent, social workers must be aware of clients’ ability to understand and use such services. Also, Standard 1.05(d), Cultural Awareness and Social Diversity, requires that social workers understand issues such as culture, economic status, mental or physical abilities, and language issues that might influence the effectiveness of such services for clients. 3. In accordance with Standard 1.04(e), Competence, social workers need to be sure that they are appropriately licensed and adequately insured when providing telehealth services. 4. In accordance with Standard 1.07(m), Privacy and Confidentiality, social workers need to select a secure and HIPAA-compliant platform. 5. In accordance with Standard 1.13, Payment for Services, and 3.05, Billing, social workers need to pay attention to payment and billing requirements. Standard 1.07(m), Confidentiality, must also be addressed when third-party billers such as insurance companies, Medicare, or Medicaid are involved. 6. Social workers need to implement technology standards, policy, and procedures, in accordance with Standards involving informed consent, privacy and confidentiality, and conflicts of interest. 7. Because technology can be disrupted, social workers need to develop an emergency backup plant. 8. When necessary, social workers will need to seek consultation from technical experts, attorneys, or professional colleagues with relevant expertise and experience.
SOCIAL WORK IN THE DIGITAL AGE
In 2015, the American Academy of Social Work and Social Welfare, in conjunction with thirteen universities across the country, developed Practice Innovation through Technology in the Digital Age: A Grand Challenge for Social Work Working Paper Number 12 . The Grand Challenges were: Designed to focus a world of thought and action on the most compelling and critical social issues of our day. Each grand challenge is a broad but discrete concept where social work expertise and leadership can be brought to bear on bold new ideas, scientific exploration, and surprising innovations. (Coffey, 2016) The Grand Challenges for Social Work include the following: 1. Ensure healthy development of all youth.` 2. Close the health gap. 3. Stop family violence. 4. Eradicate social isolation. 5. End homelessness. 6. Promote smart decarceration. 7. Reduce extreme economic inequality. 8. Build financial capability of all. 9. Harness technology for social good. 10. Create social responses to a changing environment. Working Paper Number 12 addresses harnessing technology for social good. According to Berzin, Singer, and Chan (2015): Information and Communication Technology (ICT) is transformational in its power to connect, create access to, and embolden new opportunities to rethink social work practice. … As the world becomes increasingly reliant on 11. Achieve equal opportunity and justice. 12. Advance long and productive lives.
technology, a grand challenge for social work is to harness technological advancements and leverage digital advances for social good. Meeting this challenge would result in more accurate, timelier targeted services. Social service recipients would benefit from improved assessment, intervention, and real-time feedback. Social services would be available to people who traditionally have been excluded because of geography, transportation, and scheduling barriers. Enhanced by innovative integration of ICT, social work would have a broader reach to the benefit of society as a whole. Berzin and colleagues have identified three facts that make the challenge of integrating technology and social work practice a compelling priority for the profession and the general public, including important statistics. First, these authors point out that “the professional reach of social workers is unparalleled in human services delivery,” and that the number of social workers providing services is higher than the numbers of all other mental health professionals combined. In 2016, there were more than 680,000 social workers employed in the United States (Torpey, 2018). By contrast, there were about 140,000 mental health counselors (U.S. Bureau of Labor Statistics, 2017). According to the Bureau of Labor Statistics, there were approximately 59,000 marriage and family therapists in 2019, and there were fewer than 182,000 psychologists and 25,630 psychiatrists as of 2018 (U.S. Bureau of Labor Statistics, 2019a,b; 2020b). As of May 2019, there were about 296,000 educational, guidance, and career counselors and advisors (U.S. Bureau of Labor Statistics, 2020a). It is worth noting that the above statistics represent a shortage in mental health professionals in the United States, especially
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