The Ethics of Twittering, Friending,
and Blogging in Rehabilitation
Andrew M. Byrne, MS, CRC
Clinical Instructor, Division of Rehabilitation & Psychology
University of North Carolina at Chapel Hill School of Medicine
3004 Bondurant Hall, Campus Box 7205
Chapel Hill, NC 27599
Martha H. Chapin, Ph.D, CRC
Professor, Department of Rehabilitation Studies
East Carolina University School of Allied Health
4425 Allied Health Sciences Bldg, Mail stop 668
Greenville, NC 27834
This handout and further resources are available at http://www.byrnejournal.com
Ethical Principles Cheat Sheet
Autonomy: Respect the rights of clients to be self-governing within their social and cultural framework.
Beneficence: Promote the well-being of clients.
Fidelity: Keep promises and honor the trust placed in rehabilitation counselors.
Justice: Fair treatment of all clients; to provide appropriate services to all.
Nonmaleficence: Do no harm.
Veracity: Be honest. (CRCC Code of Ethics, pg. 2)
Roles and Relationships with Consumers (A.5.d.) mandate avoidance of nonprofessional relationships with consumers and former consumers, except when the interactions are potentially beneficial, although these should be time limited or context specific.
Section B: Confidentiality, Privileged Communication, and Privacy addresses how rehabilitation counselors handle information obtained about a consumer, including how this information will be shared, when it will be shared, and with whom the information will be shared (B.1.a.).
Rehabilitation counselors are to only access the private information on consumers needed to effectively perform their job (B.1.b.).
Confidentiality, Informed Consent, and Security (J.3.c.) requires the rehabilitation counselor to consider all avenues in which client confidentiality could be breached as well as making sure the consumer understands how technology interfaces with confidentiality.
Consultation Groups (J.5.) which reinforces the need for counselors to follow ethical standards and limit disclosure of confidential information.
Establish boundaries (J.12.c.) with consumers regarding the appropriate use and application of technology and its limits within the counseling relationship.
Nonprofessional relationships are not to occur with current supervisees or trainees (H.3.a.; H.3.f.) or former students (H.3.e.) unless the relationship is initiated with the student’s consent and are time limited or context specific.
Direct quotes from CRCC Code
Ethical Principles
Autonomy: To respect the rights of clients to be self-governing within their social and cultural framework.
Beneficence: To do good to others; to promote the well-being of clients.
Fidelity: To be faithful; to keep promises and honor the trust placed in rehabilitation counselors.
Justice: To be fair in the treatment of all clients; to provide appropriate services to all.
Nonmaleficence: To do no harm to others.
Veracity: To be honest. (CRCC Code of Ethics, pg. 2)
CRCC Code of Ethics
B.1. RESPECTING CLIENT RIGHTS
a. CULTURAL DIVERSITY CONSIDERATIONS. “Rehabilitation counselors maintain beliefs, attitudes, knowledge, and skills regarding cultural meanings of confidentiality and privacy. Rehabilitation counselors hold ongoing discussions with clients as to how, when, and with whom information is to be shared.
b. RESPECT FOR PRIVACY. “Rehabilitation counselors respect privacy rights of clients.
Rehabilitation counselors solicit private information from clients only when it is beneficial to the counseling process”.
J.3. CONFIDENTIALITY, INFORMED CONSENT, AND SECURITY
c. SECURITY. Rehabilitation counselors: (1) use encrypted and/or password-protected Internet sites and/or email communications to help ensure confidentiality when possible and take other reasonable precautions to ensure the confidentiality of information transmitted through the use of computers, email, facsimiles, telephones, voicemail, answering machines, or other technology; (2) notify clients of the inability to use encryption or password protection, the hazards of not using these security measures; and, (3) limit transmissions to general communications that are not specific to clients, and/or use non-descript identifiers.
J.5. CONSULTATION GROUPS
When participating in electronic professional consultation or consultation groups (e.g., social networks, listservs, blogs, online courses, supervision, interdisciplinary teams), rehabilitation counselors: (1) establish and/or adhere to the group’s norms promoting behavior that is consistent with ethical standards, and (2) limit disclosure of confidential information.
J.12. DISTANCE COUNSELING RELATIONSHIPS
c. BOUNDARIES. Rehabilitation counselors discuss and establish boundaries with clients, family members, service providers, and/or team members regarding the appropriate use and/or application of technology and the limits of its use within the counseling relationship.
H.3. ROLES AND RELATIONSHIPS WITH SUPERVISEES OR TRAINEES
a. RELATIONSHIP BOUNDARIES WITH SUPERVISEES OR TRAINEES. Rehabilitation counselor supervisors or educators clearly define and maintain ethical professional, personal, and social relationships with their supervisees or trainees. Rehabilitation counselor supervisors or educators avoid nonprofessional relationships with current supervisees or trainees. If rehabilitation counselor supervisors or educators must assume other professional roles (e.g., clinical and/or administrative supervisors, instructors) with supervisees or trainees, they work to minimize potential conflicts and explain to supervisees or trainees the expectations and responsibilities associated with each role.
e. RELATIONSHIPS WITH FORMER SUPERVISEES OR TRAINEES. Rehabilitation counselor supervisors or educators are aware of the power differential in their relationships with supervisees or trainees. Rehabilitation counselor supervisors or educators foster open discussions with former supervisees or trainees when considering engaging in a social, sexual, or other intimate relationships. Rehabilitation counselor supervisors or educators discuss with the former supervisees or trainees how their former relationship may affect the change in relationship.
f. NONPROFESSIONAL RELATIONSHIPS. Rehabilitation counselor supervisors or educators avoid nonprofessional or ongoing professional relationships with supervisees or trainees in which there is a risk of potential harm to supervisees or trainees or that may compromise the training experience or grades assigned. In addition, rehabilitation counselor supervisors or educators do not accept any form of professional services, fees, commissions, reimbursement, or remuneration from a site for supervisee or trainee placements.
Commission on Rehabilitation Counselor Certification. (2010).
Code of professional ethics for rehabilitation counselors.
Schaumburg, IL: Author.
Advantages and Disadvantages to Internet Presence
Advantages
Positive feedback about the services consumers have received.
Information on jobs obtained by consumers.
Cloud-based communication among the support system of a rehabilitation counseling consumer.
Employers can know exactly where you are located.
Innovation and dissemination of new and evidence based practice can take place through social networking.
Disadvantages
Create potential for HIPAA violations.
Risk to the rehabilitation counselor if private info is available to consumers.
Makes it easy to cross boundaries.
May prevent closure to the counseling relationship.
Privacy settings constantly changing.
Consumers and employers can know exactly where you are located.
Social media can be exploited.
Posted info can never be completely removed from the web.
Recommendations
Use pseudonyms.
Set privacy settings to the highest level allowed.
Search Google to learn what info exists.
Talk with consumers if they research you online.
Be vigilant about the social media you use and what it portrays.
Stay aware of new revisions to the Code of Ethics.
Ethical Decision-Making Model
1. Establish there is a choice between 2 actions.
2. List factually based reasons for supporting each course of action.
3. List ethical principles supporting each course of action.
4. List factually based reasons against each course of action.
5. List ethical principles against each course of action.
6. Justify your decision for choosing a course of action.
Rubin, S. E., Millard, R. P., Wong, H. D., & Wilson, C. A. (1990).
Ethical case management practices (2nd ed.). Carbondale, IL: Southern Illinois University, Rehabilitation Institute.
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