The Growing Need for a Psychologist’s Technological Competence

The COVID-19 pandemic brought about many dramatic changes to the provision of behavioral healthcare, with few more impactful than the rapid transition from traditional in-person methods to telehealth (e.g., videoconferencing, telephone, email, texting, messaging programs). Upon review of literature, listservs, professional presentations, and online postings, the idea of technology integration with psychological services continues to be referred to as a “novel” or “new wave.” However, this notion is far older than the COVID-19 pandemic, with examples from the Nebraska Psychiatric Institute dating back to the 1960s (Bashshur & Shannon, 2009). As technologies continue to become smaller, cheaper, more readily available, more powerful, and capable of greater interconnectivity, the field of psychology has demonstrated exponential expansion of use in day-to-day operations. Given the variety of settings in which psychologists work, it is no surprise that such integration has occurred in private practices, hospitals, primary care offices, schools, correctional facilities, academic institutions, Veterans Affairs and other governmental agencies, community mental health practices, Federally Qualified Healthcare Centers, research organizations, and industry. Although video and telephone continue to represent a large portion of technologies employed, professional literature has highlighted how psychologists have integrated electronic health records, virtual and augmented reality systems, video games, wearable technologies, artificial intelligence, mobile apps, and web-based self-guided packages into their clinical work. Some residing in medical or research centers have also participated in the use of, or study of, robotics and nanomachines. In short, psychologists have applied a wide variety of technologies to assessment, intervention, consultation, training, supervision, advocacy, data management, and research activities. As a result, while telehealth continues to dominate the focus of discussions for psychological outlets, the true notion of a psychologist’s technology-enhanced practice can be viewed as significantly more diverse than the use of telecommunication technologies alone.

As with any new clinical service or technique, specialized didactic and hands-on training are essential to not only learn how to effectively utilize and problem-solve the technologies, but to also recognize research-informed benefits and limitations of their use as varying by different populations and demographic/cultural characteristics. Proper training is likely to encourage the implementation of evidence-informed services, foster the confidentiality of protected health information (i.e., collected, or transmitted data), and ensure that psychologists are able to secure appropriate informed consent for any novel methods used. This philosophy aligns with the American Psychological Association’s Ethical Codes (2010), which have several items relevant to a technology-enhanced practice, including, but not limited to: (a) 2.01 – Boundaries of Competence, (b) 2.03 – Maintaining Competence, (c) 4.01 – Maintaining Confidentiality, (d) 4.04 – Minimizing Intrusions on Privacy, (e) 6.01 – Documentation of Professional and Scientific Work and Maintenance of Records, (f) 9.02 – Use of Assessments, (g) 9.03 – Informed Consent in Assessments, (h) 9.06 – Interpreting Assessment Results, and (i) 10.01 – Informed Consent to Therapy. Ethical and legal practice becomes even further complicated when one considers differing jurisdictional guidelines and licensure statutes when practicing across states, provinces, territories, or countries (e.g., data security requirement differences between United States, Canada, and Europe).

Ultimately, focused training on the technologies a psychologist wishes to use can be viewed as both an ethical and legal requirement for the provision of the services themselves. While psychologists may be proficient with technology and masterful at psychological methods, this does not automatically make them fully competent to integrate technology into their clinical practice without consideration of the unique aspects of use, or the unique challenges that could arise. For example, a psychologist can employ a smart watch (i.e., wearable technology) that can collect and transmit a patient’s name or other identifying information (e.g., age), location, start time of activity, end time of activity, heart rate, oxygenation, and blood pressure (i.e., protected health information) to track an individual’s adherence to a behavioral activation treatment for depression. While certainly useful, this method also presents novel challenges distinct from in-person communication. More specifically, psychologists should consider: (a) the platform(s) used, (b) how data is hosted, (c) whether the hosting location is HIPAA-compliant, (d) how the data is destroyed when the care is completed, (e) whether data is hosted by a third-party company, (f) whether there is a signed business associates agreement (BAA) in place, (g) potential lag in data transmission from the patient’s device to the psychologist that can impact clinical interpretation or utility, (h) how to effectively manage a crisis, and (i) how to properly bill for the services. These points can become even more complicated when considering the integration of more complex technology into clinical practice. For example, how does a psychologist integrate, provide informed consent for, and control data risks when utilizing artificial intelligence? Or, if a psychologist communicates to a patient through a virtual reality headset, is any sensitive information stored, or are keywords tracked for marketing purposes by the company that owns the technology? Psychologists should be prudent and consider the aforementioned concerns before integrating technology into their clinical practice. However, many psychologists may not even recognize that these questions are potential points of consideration, as most would not be considered inherently experts in the intricacies of new technological advancements. Nevertheless, it is ethically and legally expected that they attempt to gain such knowledge from independent reading and study, consultation, direct training, continuing education, or a combination in order to develop an understanding of the considerations before integrating technology into their clinical practice and using it in clinical services.

What topics should psychologists focus on to gain competency? What strategies can be employed to gain the competency? While there are no universally-accepted answers, and research and best practice guidelines for many technologies are still forthcoming, literature has highlighted several aspects of competency that can be relevant to a psychological technology-enhanced practice. Although many were developed as telehealth-specific competencies (e.g., Galpin et al., 2020; Maheu et al., 2018; McCord et al., 2020; Perle, 2021), they can also be applicable to other technologies. Competency targets can include:

• Ethical considerations for the use of the selected technology.
• Legal considerations for the use of the selected technology both in a singular location and across states, provinces, territories, or countries.
• Data security considerations for the use of the selected technology, including across countries.
• Patient safety considerations for the use of the selected technology.
• Crisis planning considerations for the use of the selected technology.
• Patient evaluation procedures to ensure that the patient has the cognitive and physical abilities to utilize and problem-solve the selected technology.
• Knowledge of how to troubleshoot and address challenges with the use of the selected technology, including at a distance if the patient is not in the same location as the psychologist.
• Knowledge of how to adapt traditional methods (e.g., assessment, intervention, communication strategies, supervision, consultation) for application through the use of the selected technology.
• Knowledge of how the technology can affect the clinical services and relationships.
• Knowledge of how to adapt practices to differing and diverse populations.
• Knowledge of using third-party-hosted technology, including what data is stored, as well as how it could influence confidentiality and HIPAA compliance.
• Knowledge of how to bill for the use of the selected technology.

Although not an exhaustive list, psychologists can utilize the competencies listed as a starting “checklist.” Being able to appropriately indicate that one feels competent based upon training, continuing education, and readings can justify the use of technology in one’s clinical practice. More directly put, if a patient experiences an adverse event in part or wholly due to the use of technology in clinical care, it is vital that the psychologist be able to reasonably justify their technology selection, use, and troubleshooting as based upon their experiences, training, research-base, and continuing education to protect themselves and their practices.

As technologies can significantly vary (e.g., videoconferencing vs. artificial intelligence), psychologists should consider “technology competency” to be a series of competencies rather than a singular competency, which can vary further by the setting in which the technology is used, as well as the target population. Due to this, psychologists interested in the (continued) integration of technology into their practices should strive to stay abreast of field changes and cutting-edge literature. Although the additional readings and training may take time, the use of technology is riddled with unknown “what ifs” that a psychologist may not consider until they arise. Having the specialized knowledge can serve to prevent issues before they occur, benefiting both the psychologist and patient.