Technology, social media, records and HIPAA

AI-narrated overview made with Google NotebookLM. The written lesson below is by Dr. Andrew Wichterman.

The 2014 Code added a full section on distance counseling, technology and social media, and the exam has followed. This lesson covers Section H, record keeping under Section B, and the federal rules that sit alongside the Code.

Distance counseling and telehealth

Section H of the ACA Code governs distance counseling, technology and social media. Counselors who offer services electronically must be competent in the technology, must know the laws of both the state where they sit and the state where the client sits, and must verify the client's identity and location at the start of each session so they know which jurisdiction's rules and emergency resources apply. Informed consent for distance work adds elements: the limits of confidentiality online, the risk of technology failure, response time for messages, an emergency plan with a local contact, and time-zone differences. The counselor must be licensed where the client is located, which is the main practical barrier to practicing across state lines; the Counseling Compact is the interstate answer.

Social media and electronic boundaries

The Code asks counselors to keep professional and personal web presences separate and to explain a social media policy as part of informed consent. Counselors do not view a client's social media without consent, do not friend or follow clients from a personal account, and do not disclose confidential information on any platform. A client's follow request is declined and discussed, not ignored and not accepted with conditions. Searching a client online without a clinical reason and consent is a boundary violation. Email and text between sessions are covered by the same confidentiality rules as speech, and the counselor uses encryption and secure platforms where the standard of care requires it.

Records: what to keep and for how long

Section B.6 requires counselors to keep records necessary for rendering professional services, to store them securely, and to obtain permission before recording or observing sessions. Clients have a right to reasonable access to their records and to competent assistance in interpreting them; access can be limited only when it would cause harm, and the limitation is documented. When several clients are seen together, one client's record is released only for that client's portion. Records are kept after termination according to state law, agency policy and the Code, and disposed of in a way that protects confidentiality. A counselor who dies, retires or becomes incapacitated must have a plan for transferring records; that is the records custodian requirement.

HIPAA and FERPA

HIPAA is the federal privacy rule for covered entities that transmit health information electronically, which includes most counseling practices that bill insurance. It requires a notice of privacy practices, limits disclosure to the minimum necessary, and gives clients the right to access and amend their records. Psychotherapy notes, the counselor's process notes kept separate from the medical record, receive extra protection and need a specific authorization for release. FERPA governs education records in schools and gives parents, and students over eighteen, access to those records; a school counselor's personal notes kept for their own use are not part of the education record. When state law is stricter than HIPAA, state law controls. Subpoenas do not automatically override privilege; the counselor asserts privilege on the client's behalf and waits for a court order or client consent.

Documentation practice

Good documentation is contemporaneous, factual, and written as though the client will read it. It records what was observed, what was done and why, risk assessments and the response to them, consultations, and any decision to deviate from the plan. It does not record speculation or another person's confidential information. SOAP notes, subjective, objective, assessment and plan, and DAP notes, data, assessment and plan, are the formats the exam names. Altering a record after the fact is falsification; a late entry is dated as such. The standard the exam applies is that undocumented care is presumed not to have happened.