… [They need to] keep all records, paper and electronic, secured, i.e., [with] locked file cabinets and password and/or encrypted computers … [and] develop Authorization and Revocation of Authorization Forms to allow release of protected health information. Like other covered entities, social workers and other practitioners must develop and implement reasonable and appropriate security measures through policies and procedures to protect the security of electronic PHI (ePHI) they create, receive, maintain, or transmit (Centers for Medicare and Medicaid Services [CMS], 2021). Each entity must analyze the risks to ePHI in its environment and create solutions appropriate for its own situation. What is reasonable and appropriate depends on the nature of the entity’s practice as well as its size, complexity, and resources. Specifically, practitioners must: ● Ensure the confidentiality, integrity, and availability of all ePHI they create, receive, maintain, or transmit; ● Identify and protect against reasonably anticipated threats to the security of the ePHI; protect against reasonably anticipated, impermissible uses or disclosures; and ● Rnsure compliance by supervisees, staff, associates, and anyone who receives the ePHI. (CMS, 2021) The Centers for Medicare and Medicaid Services defines confidentiality as not making available or disclosing ePHI to unauthorized persons or processes. Integrity means that the ePHI is not altered or destroyed in an unauthorized manner. Availability means that the ePHI is accessible and usable on demand by authorized persons (CMS, 2021). Social workers’ licenses cover practice only in Florida, so it is worth noting that the use of electronic platforms across state lines may be a liability issue and could affect the malpractice insurance coverage such practitioners carry. During the COVID-19 pandemic, some states instituted temporary licensure waivers (American Psychological Association [APA], 2021), but it is vitally important to follow the latest developments and to know which states are involved. Florida temporarily relaxed its rules concerning out-of-state providers (APA, 2020), but it is important for Florida providers to be aware of which other states have similarly relaxed standards. In 2022, the Florida Legislature enacted HB 1521, Professional Counselors Licensure Compact, which created a new statute, 491.017, relating to a multi-state compact allowing mental health practitioners to work across state lines. A purpose of the legislation is to “facilitate interstate practice of licensed professional counseling to increase public access to professional counseling services by providing for the mutual recognition of other member state licenses.” Another is to “enhance the member states’ ability to protect the public’s health and safety” (Florida House of Representatives, 2022). This bill becomes effective when enacted into law by 10 states. HB 1523 provides certain exemptions from public records of practitioner information and meetings related to the Compact (Florida Board of Clinical Social Work, Marriage & Family Therapy and Mental Health Counseling, 2022).
The NASW notes that the COVID-19 pandemic has brought about the temporary relaxation of some HIPAA rules. According to the NASW: The HIPAA rule relaxations specifically address the enforcement of HIPAA requirements related to the types of platforms used for video-conferencing and the need to enter a Business Associate Agreement (BAA) with the platform provider. The rule relaxations of HIPAA enforcement apply to all HIPAA-covered entities, even if they are not Medicare/Medicaid providers (NASW, 2020b). On a temporary basis, HIPAA was allowing the use of platforms such as FaceTime and Skype, in addition to HIPAA-compliant platforms such as GoToMeeting and Zoom (APA, 2020). During the early stages of the COVID-19 pandemic, the APA found that three-quarters of the psychologists who answered a survey were providing services solely through remote services, “primarily via phone, a designated telehealth platform—like Doxy.me and Thera-Link—or through videoconferencing software.” Many of those who were still seeing patients were also seeing patients remotely (APA, 2020). There are many liability issues to consider when using electronic technology in the practice of long-distance social work and supervision. These include: ● Missing critical clinical information : The client may provide important information through facial expression, body language, gesture, and other nonverbal cues that may be missed through email, telephone, or other electronic communication between client and social worker. ● Handling crisis situation s: The therapist may miss danger signals and is so far away that distance may interfere with the client relationship. Clients may not turn to the social worker for immediate concerns or in a crisis because they believe they are too far away. ● Misrepresentations or misunderstandings : Clients may disguise, alter, misrepresent, or attempt to deceive the social worker using email, phone, or communication through technology that is easier to do without face- to-face contact. Both the client and social worker may miss information because of technology glitches or transmission breaks. ● Out-of-state concerns : The client may not be in the same state where the social worker is licensed, which may be prohibited by law when delivering services across state or country borders. If a client is in Florida but the social worker is not, Florida statutes may not be applied or followed. Furthermore, a legal conundrum could arise over which state would handle a malpractice case alleged against the Florida social worker practicing with an out-of-state client. ● Too many clients : Technology may add speed and availability for service but may lead to caseloads too large to manage effectively. ● All laws, standards, and practice guidelines from the NASW Code of Ethics and Florida Statutes must be followed as if the social worker is meeting face-to- face with the client. If that level of quality service cannot occur using distance technology, then distance technology should be avoided.
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