Despite restrictions being eased, advice from the UK government is still to work from home wherever possible. As schools fully open to all pupils across the UK, practitioners may opt to continue to work remotely, return to face to face provision, or adopt a more blended approach.
We know that counsellors are concerned that their services are needed now more than ever as young people’s mental health issues are soaring as a result of COVID-19. Many educational settings have expressed they are supportive of counsellors continuing to meet with students in appropriately safe rooms, following stringent safe working practice guidelines and risk assessments.
We're aware that practitioners continue to have concerns about their safety, and may not feel ready to return to face to face sessions, some of these fears are linked to the counselling spaces available in schools. Where room size is under two metres and there are worries about ventilation we encourage practitioners to talk to their senior leadership team or the school business manager to look at carrying out a risk assessment following Government advice.
With the above in mind, practitioners may be more hesitant about offering face to face contact sessions and may wish to return to a more blended approach or only offer remote sessions.
When this is the case, we recommend that CYP practitioners continue to refer to our adult Online and phone therapy competence framework and undertake appropriate training, linking this with the additional social, neurodevelopmental, psychological and legal knowledge required for working with this age group.
Data processing and working with children and young people online
(This information refers to consent for data processing, not consent for counselling.)
Children can be treated the same way as adults, from a data protection perspective, when providing a counselling service (whether online, by phone or face to face). This is because the GDPR and Data Protection Act 2018 contain exemptions relating to counselling services.
There should therefore be no change in the way data is processed, whether providing an online or phone service or face to face counselling. It needs to be in line with current guidance and law with reference to working competently and safely within the online environment.
The ICO interactive toolkit provides tailored guidance on which lawful basis is likely to be most appropriate for your processing activities.
We advise reading the full ICO guidance relating to children and young people giving consent to share their personal data which clearly states that you do not need parental consent when offering an online or phone counselling service directly to a child in the UK.
If you opt to seek parental consent, clear accountability includes checking with the child or young person beforehand to see whether the parent or guardian can be contacted. Ethical considerations arise if the child or young person refuses. It's important to accurately document any decisions made, and the justification for these, in case they are later challenged for ethical or legal reasons.
Data protection impact assessments
Schools and voluntary sector agencies will usually have a data protection impact assessment (DPIA) in place for how they manage data. If not, it's recommended one is carried out before therapy is provided to children and young people online.
This DPIA could consider a variety of risks including:
- whether the therapist is using a device provided by their employer or school solely for work use
- whether there is a secure platform which can be used for contacting clients by email or for online therapy sessions, and if the platform has any age related restrictions
- whether the school or agency is subject to any guidance regarding contact with pupils at home
- whether devices used could unknowingly collect client data
- the impact of providing or not providing therapy if the child or young person refuses to seek parental consent. Would this leave them more vulnerable?
- if accepting informed consent from the child or young person, how to explain and document how this was established
This list is not exhaustive and we advise all therapists new to working with children and young people online to seek guidance from experienced online CYP practitioners, supervisors or specialists in the field of GDPR relating to therapy, via relevant guidelines, training and CPD.
Security and privacy considerations if schools close
For those children and young people who, for whatever reason, are unable to attend school, our learning throughout a series of lockdowns was that it was often difficult for them to find a space that was private, safe, and free from distractions.
When this is the case, young clients may find regular check-ins supportive, providing a way of holding them emotionally between sessions or over lengthy breaks from therapy.
We recommended you plan check-ins thoughtfully and use a secure platform. Private and secure communication cannot be guaranteed when communicating using text via a mobile phone. The most secure form of asynchronous communication is via a secure email platform. You need to consider this in any initial assessment of what is in the best interests of the client.
It's also likely that texting could easily move into therapeutic ‘chat’ – a therapist could be drawn into providing a therapeutic response when the medium cannot be guaranteed as secure and private.
If you do not have appropriate training and experience in providing chat or instant messaging (IM) therapy, we recommend that therapy is provided via video. Video enables the therapist to engage directly with the child or young person, offering the closest medium to working face to face. It becomes more complex to ensure an appropriate assessment of the client when more physical and verbal cues are absent.
If possible, we recommend encouraging a child or young person to make eye contact with the therapist by the end of a session. This helps to ensure or assess an appropriate and safe ending to the session is achieved.
Some young people might feel they can’t engage safely or privately using video. In this case, and if assessed as appropriate, you can communicate via audio function or phone. Some young people may prefer to speak by audio or phone as they may feel video platforms invite therapists directly into their private spaces.
Further aspects to consider, as part of broader risk and cyber security measures related to offering support via phone calls or text chat, include:
- potential safeguarding issues and related management
- ability to make an accurate assessment
- therapist competence in the use of different mediums - the knowledge and experience required to ensure safety of the young client along with the ability to ensure there are no misunderstandings
- understanding of disinhibition online and on the phone, transference and countertransference specific to the digital relationship
- ensuring use of end to end encrypted platforms
Chat and instant messaging sessions are different to texting via a mobile phone. They can be secure and private if set up via a platform offering appropriate security and privacy. If you do not have appropriate training, experience and supervision, we recommend you consider the use of chat or instant messaging carefully. Therapists working using chat or instant messaging within organisations will be supported by appropriate guidelines, protocols and clinical supervision.
Remote safeguarding considerations
A therapist needs to have appropriate knowledge, experience and supervisory support, and the ability to meet particular levels of competence, to ensure a young person is not left in a more vulnerable situation if they share an issue that requires a safeguarding response while working remotely.
- establishing a safety boundary checklist before the start of each session as part of the therapeutic agreement process. This includes checking the exact location of the young person at the beginning of each session, who else might be in the room or area and what they can do if interrupted. It's important to remain aware of any risks, explicit or not, checking out concerns in the moment they arise
- scheduling sessions within normal working hours (where possible) to ensure access to appropriate support services. When offering sessions outside of these times, follow emergency service protocols.
- ensuring a designated safeguarding lead is contactable at any time that remote therapy is taking place
- agreeing clear protocols between all responsible parties
Working with under 10s online or by phone
Working with younger children adds further dimensions to assessment and therapeutic contracting and can be considered a specialist area.
Therapists working within an organisation will be supported by appropriate guidelines, protocols and clinical supervision. However, therapists in private practice or within school settings who do not have appropriate training and experience are likely to find that working online or by phone with younger children poses further challenges and complexities for both themselves and the young client.
For instance, the family dynamic and possible presence of family members will bring additional therapeutic needs and considerations compared to therapy provided within a school setting. The possibility of online or phone disinhibition is also likely to pose further unexpected challenges.
There are additional considerations for consent and confidentiality, including:
- what are the differences between agreeing consent within a school environment and seeking consent with a parent, guardian or carer to work therapeutically online with a young child within their home?
- how can or should a three-way agreement be formatted between the school, therapist and parent, guardian or carer?
- is the therapist likely to be providing therapy with an adult present?
- does the child have a competent level of understanding of the agreed platform and are they able to interact with their therapist online?