It can be reasonably assumed that a number of the guidelines addressed in the previous section concerning email can also be applied to e-communications sent via smart phones – whether that transmission is by phone conversations, texting or smart phone based email. Because cell phone conversations can be intercepted by readily accessible (and not excessively expensive) microwave interception equipment, they are not considered secure. Likewise, equipment exists to intercept text messaging and email by smart phone.

There are companies that provide the equipment and software connections to allow for encrypted cell phone communications. However, the major impediment to the adoption of this capacity is that both parties need to be using the equipment that contains the encryption software.

From a practical standpoint, it means that every patient would need to adopt that same technology for secure, encrypted cell phone communication to occur. This is not within the bounds of reasonable feasibility with the state of current technologies.

The practical effect of this reality is that questions related to the use of smart phones within the treatment relationship must be addressed in the context of the informed consent agreement. Clients must be notified that communications via smart phones cannot be considered secure and consideration must be given to what that means in terms of assuring and protecting the client’s right to privacy.

Given that today’s smart phones have a multitude of different capabilities, the informed consent process is going to need to be more thorough in helping clients to think through and understand the various risks to privacy that can occur in the interactions between a clinician and a client.

Smart phones can transmit photos, video clips, texts, and emails, in addition to phone calls. They also store records of communications – often until the client actively deletes them. This makes smart phone information vulnerable should other persons gain access to the smart phone screens, or to the smart phone software using a computer virus that has been designed to target the software systems currently in use.

There are smart phone applications designed to offer virus protection, but they must be downloaded by the phone user and updated on a regular basis. Smart phone manufacturers have recognized the threat that viruses pose for their business models and are engaged in attempts to make suitable anti-virus software available. They also engage in attempts to educate their customers about the risks associated with virus software and place those educational notifications in public view.

Below you will find a link from the Samsung Corporation about how users can protect themselves from smart phone viruses:

http://techlife.samsung.com/protect-smartphone-viruses-1085.html

There is another much less technology driven problem with smart phones. They can be used anytime, anywhere, so that supposedly private communications can be overheard or overseen by people for whom the communications are not intended.

Clinicians who are engaged in conversations with clients via cell phone must not only be concerned as to whether people may be listening in on conversations on the clinician’s end, but also from the client’s end. This suggests the need for some careful consideration about what might be discussed via voice, text or email modes of communication.

The forethought of the clinician in addressing these hi-tech and lo-tech concerns during the informed consent process is very important from an ethical and therapeutic perspective. While it may technically not be the clinician’s responsibility to educate each and every client about all of the aspects of responsible and secure smart phone use, the technology intersects with the clinical and privacy issues in a very powerful way. It is protective of the therapeutic relationship to help the client anticipate and respond to privacy risks and dangers in a proactive way.

The most recent update to the NASW Code of Ethics (2017) addresses this emerging issue directly, in stating the following set of guidelines ins section 1.04 (d): Social Workers who use technology in the provision of social work services should ensure that they have the necessary knowledge and skills to provides such services in a competent manner. This includes an understanding of the special communication challenges when using technology and the ability to implement strategies to address these challenges.

A 2014 update to the ACA code of ethics provides similar guidelines for professional counselors in terms of educating themselves on the special challenges related to the use of e-communication technologies. 

This can be done early in the therapeutic relationship and as an integral part of the process of formalizing the informed consent agreement. However, because there are so many different elements involved in determining how communication might proceed, it may be helpful to create some separation between this aspect of the informed consent and all the other parts of the informed consent agreement.

A conscientious clinician might consider the recommendations noted earlier: to provide the client with a menu of options concerning how e-communication might proceed under a variety of possible circumstances for a variety of different purposes. This could be presented to the client as an addendum to the formal informed consent agreement.

One potential model of this kind of addendum is shown on the following page.

 

Communication Addendum to the Informed Consent Agreement

Secure and private communication cannot be fully assured utilizing cell/smart phone or regular email technologies. It is the client’s right to determine whether communication using non-secure technologies may be permitted and under what circumstances. Use of any non-secure technologies to contact John Q. Clinician will be considered to imply consent to return messages to client via the same non-secure technology, pending further clarification from client. Please check below which modes of communication are permitted and which are not permitted. This consent may be altered at any time should circumstances or preferences change.

In the event that client chooses not to allow non-secure modes of communication, contact will only be made on John Q. Clinician’s secure portal site, via wire to wire phone, wire to wire fax, or mail.

Voice communication to client’s cell/smart phone for:

Scheduling appointments                      ___Permitted    ___Not permitted

Appointment reminders                         ___Permitted    ___Not permitted

Between session contact                     ___Permitted     ___Not permitted

 

Voice communication from John Q. Clinician’s cell/smart phone for:

Scheduling appointments                      ___Permitted    ___Not permitted

Appointment reminders                         ___Permitted    ___Not permitted

Between session contact                      ___Permitted     ___Not permitted

 

Fax communication to client’s non-secure fax or E-fax for:

Scheduling appointments                      ___Permitted    ___Not permitted

Appointment reminders                          ___Permitted    ___Not permitted

Between session contact                       ___Permitted     ___Not permitted

If permitted, list permitted fax number(s):                                             

 

Text communication to client’s cell/smart phone for:

Scheduling appointments                      ___Permitted    ___Not permitted

Appointment reminders                          ___Permitted    ___Not permitted

Between session contact                       ___Permitted    ___Not permitted

 

Text communication from John Q. Clinician’s cell/smart phone

Scheduling appointments                      ___Permitted    ___Not permitted

Appointment reminders                          ___Permitted    ___Not permitted

Between session contact                        ___Permitted    ___Not permitted

 

Contact via the client’s email, including attachments

Scheduling appointments                      ___Permitted    ___Not permitted

Appointment reminders                          ___Permitted    ___Not permitted

Between session contact                       ___Permitted    ___Not permitted

If permitted, list permitted email address(es):                                       

 

Teleconferencing based communication to client’s portal for:

Scheduling appointments                      ___Permitted    ___Not permitted

Appointment reminders                          ___Permitted    ___Not permitted

Between session contact                       ___Permitted    ___Not permitted

If permitted, list permitted portal site(s):                                    

 

Teleconferencing based communication from John Q. Clinician’s portal for:

Scheduling appointments                      ___Permitted    ___Not permitted

Appointment reminders                         ___Permitted    ___Not permitted

Between session contact                      ___Permitted    ___Not permitted

If permitted, list permitted portal site(s):                                    

 

Communication Addendum to the Informed Consent Agreement

 

A copy of this addendum will be maintained in client’s case record. Revisions to this agreement will become effective immediately upon receipt of instructions on the part of the client to alter the agreement and will be formalized with an updated and signed revised addendum;

                                                                                                           

Print client name                      Signature                               Date

 

John Q. Clinician                                                                                 

                                                Signature                                  Date

 

 

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