Model Technology Transfer
Activities:
It’s Not About Technology – It’s About
Expanding Access and Enhancing
Treatment Serivces
Mark Disselkoen, MSW, LCSW, LADC
Project Manager
Center for the Application of Substance Abuse
Technology
Presentation Outline
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Use of Technology by General Public
Brief History of Technology in Counseling
Description of SUD Workforce and Digital Types
Ethics and Technology
Social Media Policy
Safe Technology Practices
Reimbursement
Telehealth Capacity Assessment Tool
Proposed Training Activities
Use of Technology by the
General Public
85% of American adults have
cell phones
53% have smart phones
(Pew Report, 2012)
80% send and receive
text messages
(Pew Report, 2012)
Over HALF have gathered health
information on their phone
Almost 20% have a health app
(Pew Report, 2012)
#&%
80% of Americans
use the Internet
(Pew Report, 2012)
http://pewinternet.org/Infographics/2013/Health-and-Internet-2012.aspx
http://pewinternet.org/Infographics/2013/Health-and-Internet-2012.aspx
Source: Pew Research Center, 2012
FB remains
dominant
platform
There was
little room
left for FB
growth
among teen
social media
users
Teens are using cell phones as learning tools
• 42% of AP teachers say their students
use their phones to look up
information in class
• 38% say students take pictures or
record video with their phones for class
assignments
• 18% say students use cell phones to
upload school related content to the
internet
• 11% report students texting in class
with a teacher/other students as a part
of a class assignment
• 2% have students use an online cell
phone platform like CELLY
Customer Demand
Customer Demand
• WellPoint Inc., the nation's second-biggest health
insurer, plans to offer a new service in all of its
employer and individual plans that will allow
people to consult with physicians on-demand,
using laptop webcams or video-enabled tablets
and smartphones.
• Aetna Inc. and UnitedHealth Group Inc., offer
virtual-visit services as an option for certain
employers.
(Wall Street Journal December 31, 2012)
Survey by Mercer found
15% of very large employers use
some form of telemedicine, and
another 39% are considering it
Home Depot Inc., Booz &Co., and
Westinghouse Electric Co.
(Wall Street Journal December 31, 2012)
What do we know about clients?
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Survey of 8 urban drug treatment
clinics in Baltimore (266 patients)
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Client’s access to
- Mobile Phone (91%)
- Text Messaging (79%)
- Internet/Email/Computer (39 - 45%)
(McClure et al., 2012)
History of
Counseling & Technology
Audio Taping Clients Began?
1942 by
Carl Rogers
And then….. advances in fax
machines, word processors,
answering machines, video
taping, and voice mail.
Description of SUD Workforce
and Digital Types
Behavioral Health Workforce
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Clinical/Counseling Psychologists - 152,000
Mental health/substance abuse Social
Workers - 138,700
Mental Health Counselors - 113,300
Substance Abuse Counselors - 86,100
Psychiatrists - 34,400
Marriage and Family Therapists - 27,300
(US Bureau of Labor Statistics, 2011)
Almost one-third of clinical directors
report that they are only somewhat
proficient in web-based technologies
(Ryan, O., Murphy, D., & Krom, L. (2012). Vital Signs: Taking the Pulse of the Addiction Treatment Workforce, A
National Report. Available at http://attcnetwork.org/index.asp)
Average age of Clinical Directors was
52…
60% were over 50
(Ryan, O., Murphy, D., & Krom, L. (2012). Vital Signs: Taking the Pulse of the Addiction Treatment
Workforce, A National Report. Available at http://attcnetwork.org/index.asp)
75% of workforce (substance abuse
treatment) is over the age of 40
Knudsen, 2003
Almost 70% of individuals who
received SUD services were under the
age of 40
(Utah TEDs Data; SAMHSA, 2010)
Digital Immigrants
(Zur, 2012; Prensky, 2001)
USE of TECHNOLOGY
As Digital Immigrants learn – like all
immigrants, some better than others – to
adapt to their environment, they always
retain, to some degree, their "accent," that
is, their foot in the past.
What is Your
Digital Accent
(Prensky, 2001)
(Zur, 2012; Prensky, 2001)
Digital Natives
“native speakers” of the digital language of
computers, cell phones, video games and
the Internet
‘Single biggest problem facing
education today is that our Digital
Immigrant instructors, speak an
outdated language (that of the predigital age) and are struggling to teach
a population that speaks an entirely
new language.’
(Prensky, 2001)
Ethics and Technology
The Web, Cell Phones, and Social
Network Sites have impacted
the practice of
counseling/psychotherapy
Ethics
Use of technology
by counselors
• is increasing
• presents unique
ethical dilemmas
(NBCC Policy, 2013)
Some Professionals Are….
ethically astute, but struggle to
keep up with the technology…..
comfortable with technology but
less familiar with ethical codes….
Professional and ethical challenges as the
distinctions between private and public
information blurs
(Behnke, 2008)
Practitioners are vulnerable to being
blindsided by NEW ethical dilemmas
“Why did I not see this coming?
(Crowley & Gottlieb, 2012)
“Technology will continue to
evolve, but the ethical principles
remain constant”
(Koocher and Keith-Speigel, 2008, p 212)
Ethical Points
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Prevalence rates of technology used by general
public is exploding
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Health Care Customers use technology to improve
access and efficiency of health care services
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Historically, the Counseling Field tried to keep up
with new technologies AND are concerned about
their impact on clinical practice
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Given the workforce data most counselors are
digital immigrants
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More counselors are using technology and ethical
codes have not caught-up
POLICIES
Social Media Policy
Social Media Policy
For Clients and Staff
Does your staff
EMAIL or TEXT
clients?
“electronic exchanges”
“Clients should know that electronic
communications are generally NOT secure
methods of communication and there is a
risk that one's privacy/confidentiality could
be compromised with their use"
. Neace (2011)
Wheeler and Bertram pointed out that counselors have had
complaints lodged against them "based on e-mail being sent
to the wrong person, voice mail being inappropriately
overheard and computerized records landing in the wrong
place" (p. 76). We are also aware of a case where the Ohio
Counselor, Social Worker, Marriage & Family Therapists Board
sanctioned a licensee for activities related to her Facebook
account (Kelly, Hoffman, Adamson, & Bradley, 2010). As such,
it is prudent for professional counselors to keep legal and
regulatory issues in mind when interacting with clients
through social media.
How do you deal with
Email communications?
Security of Email
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Emails are stored at multiple locations: on the
sender's computer, your Internet Service Provider's
(ISP) server, and on the receiver's computer
Deleting an email from your inbox doesn't mean
there aren't multiple other copies still out there
Emails are also vastly easier for employers and law
enforcement to access than phone records.
Finally, due to their digital nature, they can be
stored for very long periods of time
Frequency of Checking Email
• The important issue is what policy has the
counselor communicated to the client regarding
how frequently they check email.
The counselor must then abide
by this policy
Whether SMS, instant messaging, or
messaging through social network
sites such as Linkedln or Facebook
can be used to interact with the
counselor
© Keely Kolmes, Psy.D. – Social Media Policy – 4/26/10
(Kaplan, Wade, Conteh, & Martz, 2011)
TEXTING
“Traditional Short Message Service (SMS)
text messaging is non-secure and noncompliant with safety and privacy
regulations under HIPAA. Messages
containing ePHI can be read by anyone,
forwarded to anyone, remain
unencrypted on telecommunication
providers’ servers, and stay forever on
sender’s and receiver’s phones.”
(Brooks, 2013)
More than one-third of cell phone users
• have sent a text message
to the wrong person
(38%)
• report that a text they sent
was misunderstood by the
reader (37%)
http://www.saurageresearch.com/key-findings-novemberdecember-2009/
“It is not acceptable for physicians or licensed
independent practitioners to text orders for
patients to the hospital or other healthcare
setting. This method provides no ability to
verify the identity of the person sending the
text and there is no way to keep the original
message as validation of what is entered into
the medical record.”
The Joint Commission November 10, 2011
http://www.jointcommission.org/standards_information/jcfaqdetails.aspx?
StandardsFaqId=401&ProgramId=1
Whether the counselor accepts friend
requests from social networking sites
© Keely Kolmes, Psy.D. – Social Media Policy – 4/26/10
(Kaplan, Wade, Conteh, & Martz, 2011)
If a client friends you and you accept them
they have access to your pictures
Our opinion is that engaging in
friending and following
those whom we serve, supervise, teach, or
collect research data from crosses
appropriate boundary lines because it implies
a personal relationship:
(Kaplan, Wade, Conteh, & Martz, 2011)
The conditions under which Google,
Facebook, or other search engines
may be used to find out information
about a client
Kaplan, Wade, Conteh, & Martz, 2011
© Keely Kolmes, Psy.D. – Social Media Policy – 4/26/10
Prevalence of Googling
• 22% of 193 clinical psychology graduate
students had Googled their psychotherapy
clients (Martin, 2010)
• A survey of 227 multidisciplinary
psychotherapists, found that 28%
accidentally found information about clients
online whereas 48% intentionally sought this
information Kolmes and Taube (2010)
.
Three Things to Consider Before
Conducting Patient Targeted Googling
1. consider the intention of the search
2. evaluate the potential risk to the
patient
3. anticipate the effect of gaining
previously unknown information
Would it be okay for a counselor to
drive by a clients’ house?
How the counselor may or may
not respond to comments or
ratings posted on internet sites
© Keely Kolmes, Psy.D. – Social Media Policy – 4/26/10
(Kaplan, Wade, Conteh, & Martz,2011)
Clinical Supervisors….
Do you talk with your supervisee
about their technology and social
media practices
Counselors may avoid seeking guidance
on Social Network/internet/technology
issues because of a perceived lack of
supervisor knowledge
Example of Social Media Policy
• Dr. Keely Kolmes
http://www.drkkolmes.com/docs/socmed.pdf
Safe Technology Practices
Safe
Practices
maintain physical control
of your mobile
device/computer
(http://www.HealthIT.gov/mobiledevices)
unsecured
networks
unintentional disclosure
password protect EVERYTHING
check out what is
downloaded on your
mobile device/computer
and keep the security
software updated
(http://www.HealthIT.gov/mobiledevices)
activate wiping and/or remote
disabling
Implement policies & procedures to
restrict access to,
protect the integrity of, and
guard against unauthorized
access to e-PHI
(HHS Office for Civil Rights)
Who Pays for
Services
Delivered Using
Telehealth
Technologies
?
Medicare Reimbursement
Requirements
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Type of service (real-time)
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Facility Type
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Practitioner Requirements
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Geography
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Allowable Codes
Originating Site
must be located in a
Rural-Health Provider Shortage Area
or
Non-Metropolitan Statistical Area county
or
Federal telemedicine demonstration
project (Alaska and Hawaii)
Medicare Telehealth Reimbursement
Basics
• Services delivered through telehealth
technologies are billed at the same rate
• Originating site of service may bill separately
• Real time communication through audio or
video technology is required
• Patient must be present at originating site
Medicaid’s Three-Legged Stool
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Person covered by Medicaid
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Service (the use of interactive audio and video
AND the actual service provided) is covered by
Medicaid
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Provider is Medicaid registered and practicing
within the State’s scope of practice
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But States still has option to include in coverage
Private Insurance
• Either mandated in state law or left up
to carrier to decide
• No consistent standards
• 19 states require coverage
• 26 pending legislation
• Successful implementation of a telehealth
program requires attention to the interplay
among many critical factors
• Need to assess organizational readiness to
adopt telehealth technologies
Purpose of TCAT
1) measure organizational readiness (capacity)
in accordance with these factors
2) identify capacity building needs and plan for
development in strategic areas
3) monitor and evaluate the impact of capacity
building efforts
Proposed Training Activities
I am a digital
immigrant….
Digital Accent….
Summarily rejecting technology advances
seems as equally inappropriate as an
enthusiastic and uncritical embrace of all
technology
(Van Allen & Scott, 2011)