EAPs and New Technology

EAPs and New Technology

Dale Masi, PhD, LCSW-C

 

The field of Employee Assistance has begun to embrace many new models of service delivery.  The following methodologies that some EAPs are utilizing include telephone counseling (which is not telephone intake), video counseling, e-counseling, and EAP apps.   For any of these methods, it is important to remember that licensed Social Workers must practice in the same state as the client is located.  Counselors cannot cross state lines in providing service.  This may not apply to counselors at federal agencies, such as the Veterans Administration.   Licensing regulations in the United States do not address the issue of counselors in the U.S. servicing EAP clients abroad.  Countries outside the United States do not have such licensing requirements.

Before engaging in any of these techniques Social Workers should check with their malpractice insurer to make sure that video and telecounseling are covered.  It is important to remember that the most widely-used video service, Skype, is not HIPAA compliant, and should not be used for the delivery of video counseling.  Practitioners who want to deliver video counseling services may find a list of HIPAA-compliant companies at the TeleMental Health Institutes website, http://telehealth.org.  A full list is located there under the “Resources” tab on the home page.  TeleMental Health Institute is a good resource.

In delivering counseling services through any of these new methodologies, it is important to remind clients that if they use their employer’s telephone or computer for these types of services, there is no confidentiality guaranteed (because the employer owns the equipment and has access to all its contents).

A useful model for telecommunications policy can be found in guidelines published by the Journal of American Medical Informatics Association.  It covers such issues as the need for password-protected screen savers, encryption, backups, turnaround time, subject headers, acknowledgement of messages, and forwarding.  The practitioner should use the most advanced encryption equipment available.  It can guarantee the message’s authenticity and integrity.  Without such software, there is no way to know whether the person on the other end of the transmission is who he/she claims to be.

E-counseling (or e-mail counseling) offers confidential counseling directly through an EAP’s website.  It is a short-term service to address personal issues through written exchanges with an e-counselor, and clients can post messages at any time.  It is the only methodology that may be delivered using asynchronous (not in real-time) communication.  However, the client should always be informed of the expected turnaround time for e-mail responses.

Clinical Issues

Clients should agree to a Statement of Understanding for the terms of the service (number of sessions, fees, etc.) and a confidentiality agreement (including exceptions).  It is best to have this in written form, rather than verbally.  California is the first state to require providers to obtain informed consent both verbal and written before delivering non-emergency care by telemedicine. Importantly, the counselor also has a right to his/her privacy, and may wish to restrict the use of any copies or recordings that the client may make of their communications.

Emergency contact information should be obtained at the beginning of the service.  It is also important to identify the client’s identity and client’s eligibility (receiving a faxed or emailed copy of the employee’s work-ID would be the best method).

The following kinds of cases should not be treated via video, phone, or email:  addiction, violence, suicide ideation, potential homicide, and clinical depression.  Anyone under 18 years old should also not be treated with these methods.  Even with other types of cases, counselors should have a Clinical Supervisor with whom they can consult.

In addition to the new video and telecounseling initiatives, many EAPs are now offering apps for employees to load onto their cell phones and other mobile devices.  These apps are a handy guide to EAP services, with links to articles about a variety of work/life and mental health issues, and are a great quick reference for employees.

It is important for Social Workers to keep abreast of the various innovations in technology and the relevant regulations related to these services. An excellent reference on this topic is “Telehealth: Implications for Social Work Practice” in Social Work vol. 47, no. 2, April 2002.