Recommendations for the Use of Telepsychology in Psychology-Law Practice and Research: A Statement by American Psychology-Law Society (APA Division 41)

Abstract

In response to the COVID-19 pandemic and subsequent impact on psychological work, Division 41 of the American Psychological Association convened a taskforce to provide guidance to its membership regarding the use of technology for practice and research at the intersection of psychology and law. Drawing from existing research in psychology-law and beyond, as well as the first-hand experience of taskforce members, this document outlines foundational guidance to apply technology to forensic and correctional work while acknowledging these settings provide unique challenges to ethical practice. The recommendations provide support for psychologists involved in assessment, treatment, training, and research. However, these recommendations may not exhaustively apply to all areas of psycholegal practice or all forms of technology. Further, these recommendations are intended to be consulted in conjunction with other professional practice guidelines, emerging research, and policy changes that impact the integration of technologies into this work.

The field of psychology has steadily embraced the use of telecommunication technologies to reach clients¹ who may have limited options for local providers, face increased costs and lost wages for travel, or would otherwise go without services altogether (see Guidelines for the Practice of Telepsychology², 2013). Beyond this, remote communication technologies (i.e., those that allow activities or interactions to take place virtually with some physical distance between participants) have become a necessity for sustaining clinical practices and safely engaging with clients following the onset of the COVID-19 pandemic. The use of these technologies within the practice of forensic and correctional psychology has followed a similar trajectory. Given the high demand for forensic services such as pre-trial evaluations (Antonacci, et al., 2008; Deslich et al., 2013), the rural location of many correctional facilities, and increased risk of disease infection in total confinement, the use of remote technologies is increasingly used to assess and treat legally-involved persons. While commentary and research have been emerging (see e.g., Batastini et al., 2016; Luxton & Lexcen, 2018; Manguno-Mire et al., 2007), practitioners, scholars, and policymakers remain in need of guidance for improving the efficiency and quality of telecare.

As emphasized in the Specialty Guidelines for Forensic Psychology (2013), “the practice of forensic psychology differs in important ways from more traditional practice areas” (p. 7; see also Monahan, 1980). Further, courts and in-custody settings (e.g., jails, prisons, forensic hospitals) pose unique considerations regarding privacy, access to technology, and other logistics. Despite the existence of general guidelines for the practice of telepsychology and specialty guidelines for forensic practice, there have been no clear recommendations to address the cross-over between psychology-law issues and the use of remote service provision and/or communication in these contexts. In response, the American Psychology-Law Society (Division 41) convened a taskforce to develop resources for its members by connecting research with practice within and outside the profession of psychology-law. Taskforce members were selected to represent a diverse array of professionals across the career spectrum and areas of expertise. Among other factors, consideration was given to members’ race and ethnicity, gender, career level (from student to late-career), occupational setting (e.g., practice vs. research; criminal vs. civil; hospital vs. corrections; clinical vs. legal), and population of expertise.

Unique to this set of recommendations is the additional emphasis of ethical research practice. These recommendations focus not only on remote clinical and consultation work in psychology-law, but also on empirical investigations of specific outcomes related to these practices. This added attention to research is in response to the fact that, despite the growing use of and support for remote mental healthcare, there is comparatively little empirical evidence that meets a high standard of scientific rigor as it relates to the implementation of telehealth in psychology-law practice. As there are again unique considerations for conducting research in legal and correctional settings as well as research conducted remotely, we address ethical, methodological, and reporting considerations.

The purpose of the Recommendations for the Use of Telepsychology in Psychology-Law Practice and Research is to provide further direction for psychologists³ who use technology-based mechanisms in forensic and correctional practice (including assessment, treatment, and consultation), research, and supervision/training. However, recommendations may not apply to other areas of forensic practice such as investigative interviewing of victims, witnesses, or suspects (interested readers may refer to Brown et al, 2021). This document address considerations that occur at the intersection of psychology-law practice and telecommunication implementation, which may overlap with general psychological practice in some respects. These considerations include, but are not limited to, testing, informed consent, privacy/confidentiality, diversity and equity factors, expert testimony, and legal communications. These recommendations are not intended to replace relevant APA guidelines (e.g., Guidelines for the Practice of Telepsychology, 2013; Specialty Guidelines for Forensic Psychology, 2013), but should be considered as supplementation.

Further, psychologists are responsible for remaining current with updates to these recommendations, as well as relevant guidance available in their specialized area of practice (e.g., child custody, police candidacy), laws governing the practice of telepsychology in their jurisdiction (e.g., county, state, providence, country), and the state of the research literature. Finally, the recommendations outlined in this statement are not exhaustive and may not specifically or fully address myriad nuances that can arise in everyday practice. These recommendations draw on presently existing research, commentary, and experience to help professionals practice more competently within psychology-law contexts when remote technologies are used.

Section 1: Assessment

1.1. Preparation

Prior to conducting virtual forensic mental health evaluation or teleassessment⁴, the psychologist may consider development of a checklist to ensure that they address all relevant tasks and considerations. The checklist would include considerations before and during the evaluation. A general checklist for telepsychological services developed by the American Psychological Association (APA; see Section 6: Resource Links) and may be useful to modify for psycholegal purposes. Issues to address prior to the interview include communicating the space, privacy, and technology needs for the evaluee/examinee (i.e., the individual who is the subject of the forensic evaluation) to relevant parties; methods for protecting confidentiality; ensuring the psychologist has all tools potentially necessary on hand; protocols for assessing and addressing risk issues should they arise; and methods for troubleshooting technology difficulties.

Before the onset of the evaluation, the psychologist should consider assessing the suitability of the case for a virtual evaluation. The psychologist may provide education to the evaluee or their legal representative about the physical space and technology needs for the evaluation. It is recommended the psychologist become reasonably aware of how they will need the evaluee to interact with the technology to complete the evaluation. If, for example, the evaluee will need to use a mouse, keyboard, or particular size of screen for testing, it would be useful to clarify these requirements ahead of time so the evaluee can appropriately prepare. The psychologist may also inquire about internet access, specifically the reliability of it and any cost to the evaluee. Some evaluees may not have reliable access to free Internet and should be encouraged to participate in a physical space where they will not incur significant cost for the evaluation. It is recommended the evaluee be situated in a private space that affords relative freedom from distraction for the duration of the evaluation. Use of headphones can be used as an additional privacy resource. For individuals less familiar with videoconferencing technology, they may need additional instruction and support for downloading and operating the platform. They may also benefit from a test run with the psychologist or their legal representative to reduce the possibility of disruptions and frustration on the date of the evaluation. Psychologists are advised to gain familiarity with and provide support for people with differing abilities, such as the use of language interpreters and close captioning. The psychologist should consider matching the nature of the evaluation to the type of technological devices available to the extent possible. For example, use of a cell phone with video and internet capability may work for a videoconference (i.e., synchronous video and audio communication between one or more parties) of the interview but be too cumbersome for psychological testing. It is recommended evaluees be instructed to close all other applications and programs on their devices to reduce distraction. To assess the privacy of the space, the psychologist can ask the evaluee to move the video camera around the room to “show the room.” Finally, the psychologist is advised to also assess the lighting, positioning of the technology, and other relevant details and make suggestions to the evaluee as needed.

At the onset of the meeting, it is useful to orient the evaluee to the technologies used and how to navigate them. It is advisable to inform the evaluee how to troubleshoot easily anticipated issues and explain alternative procedures (e.g., identifying on-site personnel to contact, gathering alternative contact information for the evaluee, how and who should initiate reconnection to the platform) if problems arise. Additionally, the psychologist should consider using the initial minutes to assess the sound and/or image quality and adjust as necessary. Ongoing assessment of sound and image quality is recommended throughout the provision of services. This may also be an opportunity to assess the evaluee’s capacity to work with the remote technology and determine whether they have the necessary capacity to engage with it.

The psychologist should consider collecting contact information regarding the physical location and phone number for the evaluee. This is relevant for any risk concerns and provides a method of contacting the evaluee in the case of technology difficulties. If conducting the assessment across jurisdictional boundaries, the psychologist is advised to be aware of the relevant laws and practice limitations associated with the location of both the psychologist and evaluee. Because the psychologist will be less aware of the evaluee’s physical space, it may be useful to discuss a plan of action if their privacy becomes compromised. For example, a code word could be established and used to signal pausing communication and then resuming once the evaluee is comfortable doing so.

1.2. Informed Consent

Informed consent (or notification of rights) procedures while using remote technology covers similar topics to those procedures when used in non-remote settings (e.g., the nature and purpose of the assessment, confidentiality limitations) with some technology-related specific information added. As applicable, the psychologist should consider explaining the benefits and risks of using remote technology for the evaluation and the evaluee’s rights to complete the evaluation using alternative means (e.g., in-person in the same physical space), if they express dissatisfaction or discomfort with the remote technology. This may not apply in some settings for certain types of assessments (e.g., court-ordered evaluations conducted in jails with in-person restrictions, lengthy physical distance between the parties). An explanation about any technology-specific confidentiality limitations may also be offered. If the psychologist wishes to record the session, it is strongly recommended that expressed consent be gathered separately from consent for the evaluation from the evaluee or their legal representative consistent with APA Ethical Standard 4.03 (Recording) and in accordance with relevant statutes as applicable. Additionally, the psychologist is advised to notify and seek permission to record, as needed, from the referral source and any other relevant parties.

During in-person evaluations, the psychologist may ask the evaluee to sign the consent/notification form, creating a written record of the procedure. In a telepsychology context, the psychologist may use software programs that allow the evaluee to digitally sign the form (e.g., DocuSign, KiteWorks). If a paper or digital signature is not possible, the psychologist should consider documenting in their notes that notification was given, the evaluee’s response, and any other relevant observations. Finally, when documenting the notification process and consent/assent in the corresponding assessment report, psychologists are advised to include a description of the telepsychology disclosures given to the evaluee, the type of technology used, the HIPAA-compliance (or lack thereof) of the software and equipment used, the quality of the audio and video, any interruptions or limitations that arose, and any other relevant components of the evaluation related to the technology (Lexcen et al., 2019). An informed consent template with technology components is available on TrustPARMA website (see Resource Links section); however, this template may need to be modified to accommodate unique forensic ethical standards and the particular needs of the setting or evaluation type.

1.3. The Forensic Clinical Interview

It is recommended forensic mental health interviews conducted through a videoconferencing system closely simulate standard, in-person practice. When using video communication platforms, consider using “speaker” view with the psychologist’s image minimized to best simulate the experience of being face-to-face with the examinee and reduce distraction from seeing themselves on screen. When there are multiple participants on the video and it is important to observe everyone, the “gallery” view would be more beneficial. Many correctional facilities do not allow the psychologist the same flexibility/control (e.g., to share a screen, or for the examinee to have access to a keyboard or manipulate the screen, sound, etc.) that might be afforded in other settings. Relatedly, it is also important to be aware of how the chosen videoconferencing system video records videoconferences: some systems default to only capturing video recordings of the active speaker, meaning that video recordings of the evaluee might not be captured for the entirety of the interview.

The typical social communication feedback loop that provides forensic psychologists and examinees with data from body language, facial expression, and tone of voice can be muted and/or interrupted through videoconferencing platforms. Examinees who experience anxiety and/or have intellectual or cognitive limitations may find virtual interactions even more challenging. Additionally, individuals with differing abilities may have multiple barriers to using telehealth video platforms and require additional considerations for effective communication (Valdez et al., 2021). It is important to discuss the evaluee’s accessibility and attitudes towards technology with them at the onset of the interview as well as ways to address relevant issues. Additionally, the psychologist should consider the impact of these issues in their clinical and psycholegal decision-making and specify any relevant limitations or caveats to their opinions. When limitations or difficulties with audio and/or visual communication preclude adequate interviewing and/or testing, it is advised that the evaluation be stopped and barriers be addressed immediately with the retaining party or institutional contact.

Establishment of rapport over virtual platforms may vary by generation or other sociocultural factors. Older adults, individuals from low socioeconomic populations with less experience with technology, and/or those with limited English proficiency, may require reassurance as well as technical assistance as they interact with the psychologist virtually (e.g., see Connolly et al., 2021). This can be even more challenging in a correctional environment where an examinee and/or psychologist may have little to no control over the technology system if it is managed by the facility. Again, it is crucial to discuss the potential for technology difficulties at the onset of the evaluation, and to normalize difficulty with new technology. To the extent possible, it is recommended that “pre-evaluation/interview” technology checks and run-throughs be conducted with the examinee and anyone (e.g., custody staff) assisting in the process. The psychologist should consider building extra time into assessment sessions to discuss and address technology issues or hesitancies.

It is recommended videoconference-based evaluations be conducted by a linguistically and culturally competent psychologist or with the assistance of an interpreter, consistent with APA Ethics Code 2.01 Boundaries of Competence as well as the APA Standards for Educational and Psychological Testing. The psychologist is advised to ensure any interpreter or other person assisting during the evaluation knows how to appropriately interface with the selected technology, how to address any technology-related concerns, and follows the same protocols for protecting the evaluee’s privacy as they would during in-person interviews. Conducting practice runs with interpreters or other third parties in advance of the interview may be useful.

1.3. Test Selection

When conducting a forensic psychological assessment, the psychologist is encouraged to practice with the knowledge of standardized procedures and an awareness of limitations when using specific instruments consistent with general ethical principles previously identified by APA (2017) and those specific to forensic practice as established in the Specialty Guidelines for Forensic Psychology (APA, 2013). Psychologists are advised to use evidence-based guidance in selecting appropriate tests for the specific case needs as well as the telepsychological format. Specifically, several assessment instruments have demonstrated roughly comparable validity for remote administration as in-person administration such as the Minnesota Multiphasic Personality Inventory, 2^nd edition, Restructured Form (MMPI-2-RF; Menton et al., 2022) and the Inventory of Problems-29 (IOP-29; Giromini et al., 2021). As such, it is suggested that practitioners take the necessary time to understand modified standardization procedures, psychometrics, and limitations of using specific tests remotely within a forensic/correctional context and describe these in their written reports. As with in-person evaluations, psychologists should consider how cultural, linguistic, and other diversity identifiers will influence test selection, administration, and interpretation.

Prior to administering remote testing, the evaluee’s capacity to complete testing in this format should be assessed. It is recommended selected instruments only be administered in a manner consistent with established guidelines offered by the test publisher or peer reviewed literature as applicable. It is strongly advised that any justifiable modifications made without specification from the test publisher or literature or that diverges from established guidelines be clearly documented in any evaluation report along with the examiner’s reason(s) for doing so and any potential limits to the validity of the test interpretation. Psychologists are encouraged to ensure evaluees have appropriate devices for viewing and responding to test stimuli (e.g., sufficiently large enough screen, mouse, keyboard).

In the evaluation report, the psychologist should consider including a description of how the testing was conducted, if it occurred in a manner consistent with established practices, any adaptations made for the virtual administration, if any issues (e.g., connection loss during item administration) occurred while conducting testing, and how the virtual administration may have impacted results. Psychologists are advised to be aware, and discuss with referring parties, the possibility that remotely administered test results may be questioned or not accepted by courts and other decision makers.

1.4. Test Security and Data

Established APA ethical principles (2017) identify concerns associated with maintaining psychological test security (see APA Ethical Standards 9.04 and 9.11 for details) and psychologists completing remote testing are expected to practice within this framework. Further, and consistent with APA Guidelines for the Practice of Telepsychology (2013) Guidelines 6, the psychologist is encouraged to develop a plan for storing and disposing of test data, consistent with federal, state, provincial, and territorial laws and other organizational regulations. For measures administered remotely, test security/integrity can be maintained by following administration practices consistent with standardized guidelines (e.g., via test publisher or peer-reviewed literature). To the extent possible, it is recommended the evaluee be monitored during remote test administration by the psychologist via remote video monitoring. Alternatively, a neutral party could monitor the administration of self-reported measures. It is suggested the psychologist provide instructions about when testing materials should be opened and how they can be returned to the psychologist in a confidential manner. Such observation increases the likelihood examinees are completing measures in a typical manner without assistance or outside influence. Further, such observation encourages procedures such that test materials are protected and not inappropriately used or copied. It would be important for any observing party to be unaffiliated with the case and its outcome as the evaluee’s attorney may appear to assert undue influence. Additionally, use of correctional officers to provide observation is not advised due to potential discomfort and concerns regarding confidentiality of the test data. Psychologists can consider using document cameras or secondary video cameras in observing the testing process as needed (Corey & Ben-Porath, 2020; Luxton et al., 2014). Of note, recording the testing process may inevitably record test materials, which psychologists have an ethical obligation to protect. The psychologist should consider instructing the evaluee on the importance of test security and gain their agreement not to video, take photos, or otherwise preserve, copy, or distribute any test content made available during the session.

1.5. In-Custody and Inpatient Evaluations

Conducting forensic mental health assessments within the criminal legal system, especially with evaluees in locked and controlled settings, is met with inherent accessibility and feasibility challenges. Correctional facilities and psychiatric hospitals have their own set of security parameters that are important to navigate and are often unique to each facility and setting. Prior to conducting a teleassessment in a correctional or hospital setting, it is necessary to gain express permission from the facility to conduct the evaluation in this manner. Depending on the specifics of the setting, special consideration will need to be given to internet connectivity, access, and interaction with the device(s) by the person being evaluated, and the confidentiality of the communication given that some communications are monitored or recorded by the institution. Psychologists are advised to work with these facilities to ensure the privacy of their communications with evaluees is appropriately maintained.

Depending on the facility, availability of HIPAA-compliant videoconferencing technologies may also be limited. While HIPAA compliance may not be necessary for some forensic mental health assessments, to the extent possible, practitioners should take steps to use appropriately secured technologies and may need to seek assistance from local partners (e.g., information technology staff, jail or hospital administrative staff) to ensure compliance within the facility. If a HIPAA-compliant system is required but not feasible, any confidentiality concerns should be shared directly with the evaluee and noted in the corresponding report. If the evaluation cannot be conducted with reasonable safety and integrity, the psychologist should inform the referral source and seek guidance. Additionally, and if applicable, steps should be taken to control the remote environment as much as possible. This might include ensuring the evaluee is in a private area where they will not be overheard (e.g., asking whether computer audio can be heard by staff outside the assessment room). Additional considerations include verifying the evaluee’s identity and location, reducing noise and distractions or note such limitations in the evaluation report, ensuring no one else is in the room, and positioning the camera to best observe the examinee and any test materials (if possible).

1.6. Community-Based Evaluations

If the evaluee is not in a custodial setting, there are several important considerations to determine suitability for telepsychological evaluation. First, the evaluee should have access to a suitable electronic device with internet access. That electronic device should have video and audio capabilities sufficient to use the videoconference platform and the capacity to maintain the device’s power through the duration of the evaluation. Relatedly, the evaluee should have an internet connection that allows for a relatively uninterrupted flow of communication. Given the length of time often needed for forensic mental health assessments, the evaluee’s access to free or low-cost internet should be assessed so the assessment does not place an undue financial burden on the evaluee. For individuals who are involved with the criminal legal system, it is also important to ensure there is no pretrial condition barring access to internet-connected devices, video technologies (e.g., smart phones or computers), or other potential interference associated with completion of an alternative format evaluation is necessary.

Although forensic psychologists lack some control over the evaluee’s setting in in-custody settings, this can be exacerbated when the evaluee is in the community, as settings have the potential to be more variable and unpredictable. Evaluees may have little understanding of the need for privacy and a distraction-free environment, and require education and assistance before initiating the evaluation. Evaluees should be encouraged to find a quiet and private space where they will not be interrupted or overheard by other parties for the expected duration of the evaluation. Individuals with privacy concerns, including those who are unhoused or lack other necessary resources (e.g., internet access), may need assistance in locating the requisite physical space and technology needs. These evaluees can be referred to their legal representatives or others who may be able to secure space (e.g., attorney’s office, a conference room in the courthouse) and/or electronic devices.

Additional safety and integrity considerations may be relevant when conducting evaluations with individuals in the community. The psychologist is encouraged to verify the individual’s physical location and contact information in the rare case a welfare check needs to be initiated. This also allows the psychologist to determine that the physical location of all parties so the psychologist ensures they are licensed to conduct the evaluation where the evaluee is located; psychologists are responsible for adhering to requirements of relevant licensing bodies or other authorities (e.g., PSYPACT). The psychologist may also inquire as to the evaluee’s perception of privacy and safety in their physical space such as whether they are concerned about being monitored and any related safety concerns. Additionally, it is recommended the psychologist monitor for signs of substance use or intoxication and inquire about recent substance use. If the psychologist is concerned about the integrity of the evaluation based on these or related concerns, they should consider rescheduling or conducting the evaluation under different circumstances.

1.7. Child and Family Issues

There are several considerations unique to evaluations with children and families, including parenting plan (formerly referred to as child custody), parenting capacity, and personal injury cases involving youth. One concern is an increased potential for the evaluation to be monitored by a third party, most likely a parent or guardian, and what effect monitoring may have on the data collected from the evaluee. Monitoring of a telepsychology evaluation can be accomplished in many ways, some of which are difficult or impossible for the psychologist to detect. For example, a third party could be listening in off-camera, a recording device could be placed in the vicinity of the evaluation, or the electronic device being used by evaluee could be monitored through software installed on the device or through access to the network being used for communication. There are two primary implications of this type of monitoring: (1) the third party could learn of the contents of the evaluation and (2) the evaluee might present differently if they know or believe they are being monitored. To the extent possible, psychologists should consider assessing the likelihood and implications of monitoring before conducting a remote evaluation, especially when involving a minor child, and the psychologist is advised to remain alert to potential monitoring throughout the course of the evaluation.

If the psychologist determines a videoconferencing evaluation in family legal matters is justified, there are some precautions to mitigate the occurrence of monitoring or its consequences:

1. Inform all parties that monitoring through physical or electronic means is strongly discouraged and that monitoring (even if covert) can have significant impacts on the accuracy of the evaluation. The psychologist may also explain actions they plan to take if monitoring is detected or suspected.

2. Prior to the session, have the evaluee move the camera of the device around the room. This could be done under the pretext of wanting to see the evaluee’s location or tour the child’s room.

3. Ask the evaluee and other family members to turn off other electronic devices such as phones, games, or other computer tabs to help minimize interruptions.

4. Listen for computer feedback, which often creates an echoing sound or other audio distortions/delays.

5. Observe the evaluee for behaviors that may suggest the presence of a third party observer such as frequently looking around the room or in a specific direction of the room before answering questions.

6. Document all steps taken to assess for and minimize monitoring.

Evaluations conducted remotely may also impact the ability to capture a reliable interaction between a parent/guardian and a child or children. In addition to discussing monitoring concerns with the parent before the session, it is suggested that psychologists who elect to conduct a parent-child observation through videoconferencing emphasize the importance of selecting a private and quiet location. The psychologist may also want to ensure the parent has the necessary equipment, is able to set up the equipment in advance of the session, and that the device is positioned to clearly show the interaction. In some cases, however, conducting observations via videoconference may not be appropriate (e.g., if a parent and child would not naturally be in interaction per the custody schedule, the child is expected to be uncooperative, etc.). It is recommended the psychologist be prepared to clearly articulate why an interaction observation was conducted via videoconference in their report and discuss concerns that may have resulted from doing so. Additional ethical and practice considerations are presented in Dale and Smith (2021).

1.8. Neuropsychological Considerations

Issues related to neuropsychological functioning are commonplace in both civil and criminal forensic mental health assessment (e.g., LaDuke et al., in press; Arredondo et al., 2017; Gardner et al., 2018). The provision of remote neuropsychological evaluation requires complex decision making about risks and benefits, which psychologists should consider discussing with the referring party before accepting the evaluation (such as during the initial call from the referring party). This will allow the referral source to decide whether the risks of tele-neuropsychological testing (Tele-NPT; i.e., the use of audiovisual technology to enable remote neuropsychological assessment) are worth taking before engaging in a contract. For instance, potential referral sources may be told about the limitations to validity, admissibility considerations such as the change to standardized administration and interpretation, and about the need to disclose limitations in any report. To the extent possible and given what is known about a case or specific examinee, the psychologist may provide guidance regarding the best option for assessment (in-person, Tele-NPT, and or a hybrid model). Psychologists may be personally uncomfortable recommending and/or conducting Tele-NPT when so much to date is unknown about how or if these data will be accepted by the courts. Psychologists are encouraged to engage in due diligence to determine whether they can ethically conduct Tele-NPT, if they should refer to or consult with a neuropsychologist, or if they even feel comfortable referring an attorney to consider this option. The psychologist may defer to the decision of the referral source as long as it fits within ethical standards of neuropsychological practice and the psychologist is willing to accept the conditions of the arrangement.

Considerations for Conducting (Tele-NPT) and/or Referring Out

Please note that much of the information below has been replicated and/or modified from already established resources, and most prominently, from the Interorganizational Practice Committee (see Bilder et al., 2020). Neuropsychologists conducting Tele-NPT and other neuropsychological practices remotely (e.g., consultation) are encouraged to adhere to other portions of these Recommendations whenever applicable. The following points clarify and/or emphasize considerations that are unique or particularly salient in Tele-NPT in a forensic context.

• Forensic psychologists are encouraged to continuously check the available resources and literature about Tele-NPT, including sample informed consent language and documents, and make a checklist of important areas to include. The informed consent process, as always, should be documented whether it is conducted verbally or in writing.

• Involvement of a third-party observer in the Tele-NPT meeting (e.g., caregiver, parent, facilitator, correctional staff, legal representative) may add concerns about the impact of observation, as well as interruption, on performance, and test security. In fact, some scholarship has advised against third party observers during neuropsychological testing in medicolegal and other forensic contexts, regardless of the format of the evaluation (Glen et al., 2021). These factors may be discussed at the onset of the evaluation and adequately documented.

• There are multiple opportunities for additional sources of error when Tele-NPT procedures are administered with individuals from culturally, linguistically, and/or socioeconomically diverse populations, when an interpreter is required, and/or when an examinee or the neuropsychologist has limited experience/comfort with the technology being used.

• While some telepsychological services can be conducted by phone, it is recommended neuropsychological testing not be performed over a telephone in most cases, as there would be no video opportunity to confirm the identity of the examinee nor their environment. Conducting testing over a telephone would result in too many unknown variables that would impact validity and is likely to be difficult, if not impossible, to adequately address or justify in court.

• It is suggested reports of neuropsychological assessments based on Tele-NPT include notation of the platform used, if the tests were adapted or modified, and specific administration modifications. Psychologists conducting Tele-NPT are encouraged to remain abreast of each test publisher’s current guidance.

• Among other relevant limitations or caveats, documentation of testing and interpretive limitations may address: the use of interpreters, facility-related factors such as an examinee’s inability to reposition the screen, an individual’s educational history, computer literacy, internet access and connectivity, and other factors that may interact with and further limit the comparability of Tele-NPT with standard assessment practice.

• Tele-NPT test results may not be as readily accepted by courts and/or forensic/legal organizations.

Psychologists should consider consulting relevant resources (e.g., Bilder et al., 2020; Bush et al., 2017) to determine appropriate test selection, procedures, and interpretation. While the psychologist is encouraged to rely on relevant literature as appropriate, certain moderating factors or other test issues may be more or less well adapted to Tele-NPT. Most Tele-NPT research to date is conducted in a different context than the typical forensic clinical evaluation where hardware, staffing support, and other features can be different. Overall, research has not yet provided clear guidance about how to modify most tests for Tele-NPT in psycholegal settings. However, some Tele-NPT studies in other settings describe modifications to specific tests that resulted in outcomes comparable to in-person evaluations (e.g., Barcellos et al., 2021, Galusha-Glasscock et al., 2016). Simply stated, it is ideal to simulate in-person administration as closely as possible, and again, it is recommended that the forensic context and legal parameters be simultaneously considered when determining the appropriateness of administering Tele-NPT.

Section 2: Treatment

2.1. Treatment Preparation and Informed Consent

Prior to a formal informed consent discussion, it is recommended clients be screened for appropriateness for participation in telepsychology services (e.g., clinical and cognitive status, access to technology, safety and health concerns, private physical space available, parental permission; see APA Office and Technology Checklist for Telepsychological Services). Assuming telepsychology services are appropriate, it is advised clients be oriented to the following during the informed consent discussion:

• The hardware and software platforms being used and how to navigate technical difficulties (e.g., through basic instruction guides and/or identified personnel to contact for support).

• Availability of a private space and use of other privacy strategies (e.g., headphones) in the remote environment.

• Risks and benefits of using remote technology for treatment and any alternative (e.g., in-person) options available to the client.

• Back-up contact information and re-initiation processes in case of disconnection. For youth clients or vulnerable adults, obtaining contact information for an available caregiver is strongly advised.

• Safety protocols including under what circumstances emergency services would be deployed to the client’s location in the case of disconnection or emergency.

• Protocols for disclosing treatment progress or nonadherence to legal personnel (e.g., judges, probation/parole officers) and what specific information would need to be shared.

• The need for on-site personnel to be involved in escorting the client to services, setting up videoconferencing sessions, sending and receiving treatment materials, or who otherwise may have knowledge about the client’s participation in services.

Caregivers of youth or vulnerable adults will also need to provide informed consent for the use of technology for service delivery. Tools such as the Privacy and Safety Protocol for Home-Based Telemental Health (Sharma et al., 2021) are useful for clients in community settings.

In secure care environments, there may be additional privacy limitations (e.g., security staff in the room to set up and monitor technology) specific to technology-based services. Psychologists are advised to ensure understanding of privacy and security procedures at any facility in which they operate, as well as limitations in the availability of in-person treatment options. Similarly, the facility’s staff may have different or competing goals, such as ensuring safety and security, rather than the specific goal of the treatment service the forensic professional is attempting to provide. Psychologists are encouraged to be aware of whether facilities are recording sessions and how recordings might be used and stored, and ensure clients are aware of these practices. Whenever possible, it is recommended psychologists initiate telecommunications services using HIPAA-compliant technology that notifies the client if they are being recorded in the moment.

When documenting informed consent procedures, a description of the telepsychology disclosures given to the client and/or caregivers, the type of technology used, the HIPAA-compliance (or lack thereof) of the software and equipment used, the quality of the audio and video, and any interruptions or limitations that arose related to the distance technology should be considered for inclusion. Electronic signatures on treatment consents can be obtained through secure online platforms when clients have the capacity to interact with the technology. In cases where clients or facilities do not have such capacity, documenting consent in the treatment record is essential. Please refer to Section 6 for a link to TrustPARMA where sample informed consent documents can be found.

Finally, throughout the informed consent discussion, and during ongoing service provision, psychologists should consider attending to technology-related considerations and safety, which may impact ability to continue telepsychology services. Psychologists are advised to frequently assess sound and image quality and determine whether in-person services are necessary if telecommunications barriers impact ability to deliver treatment. It is recommended that the client’s current location and back-up contact information be confirmed and documented at the start of each subsequent treatment session.

2.2. In-Custody and Institutional settings

In this section, “in-custody” refers to total or near total confinement facilities including jails, prisons, detention centers, and inpatient hospitals or secure forensic units. It is important to consider the availability of staffing and resources in many institutional settings when determining the feasibility and appropriateness of implementing telepsychological services and the types of technology to be used. Correctional and inpatient facilities, especially those with fewer resources and/or issues with overcrowding, may have limited room available for telepsychological appointments (e.g., there may only be one private space with videoconferencing capabilities that is used for medical appointments, court appearances, attorney meetings, etc.) or limited staff who can oversee the appointment or troubleshoot issues with electronic devices, internet access, or connection stability. Further, psychologists and agencies may need to be mindful of existing procedures to ensure safety and security in these facilities, including who to notify in case of an emergency (e.g., serious concerns about harm to self or others). Certain policies and procedures may preclude incarcerated or hospitalized individuals from touching or physically interacting with technological equipment. Individuals may also be required to be escorted to and from videoconference appointments and monitored or observed during appointments. Thus, it is important for psychologists to coordinate with on-site staff regarding such policies and procedures and consider the potential impact of such policies on privacy and confidentiality.

Clear communication and coordination with on-site staff are also essential to improving the quality and continuity of care. In addition to logistics of room coordination and escorting clients, psychologists may need to work around the individual’s schedule, including designated meal, shower, recreational, and medication distribution times, as well as other appointments and unpredictable lockdowns. Psychologists are encouraged to coordinate with institutional staff to develop recurrent weekly clinic blocks and to encourage setting up and testing technological equipment in advance of the remote appointment. Psychologists may coordinate with staff to allow alternative means of contact (e.g., using a unit or visitation telephone) when videoconferencing is unavailable or in an emergency. On-site staff may also be needed to minimize privacy concerns, such as positioning webcams so they are not pointed toward common ward/unit milieu spaces where other patients or incarcerated persons can be viewed and ensuring the volume is not so high that others outside the room can hear. It might be beneficial to have designated on-site staff whose responsibility is to schedule virtual meetings, to ensure the client is free of other scheduled obligations or appointments, and to start the meeting using the needed equipment and/or software. It is also useful to ensure on-site staff availability following the termination or completion of services to transport the client if necessary and secure the equipment.

It is recommended that clients’ symptomatology and presentation (e.g., propensity for anger or agitation, cognitive limitations; Magaletta et al., 2000) be considered when determining the appropriateness of telepsychological services. However, there is currently no known literature to suggest certain symptoms or clinical presentations would inherently disqualify a person from receiving telepsychological services. Further, it is necessary to consider the role of cultural and other individual factors (e.g., age, race or ethnicity, psychiatric history, legal history) that may be relevant to the client’s abilities or concerns regarding the use of technology. Psychologists may need to use assistive technologies or other supports (e.g., interpreters, on-site assistants) to accommodate clients’ abilities when appropriate and without comprising their rights or the provision of services. It may also be necessary to provide clients an opportunity to discuss questions and any hesitancies toward using the technology.

2.3. Community Supervised Settings

Clients being supervised by community corrections departments (e.g., probation, parole) and/or courts (e.g., diversion programs) may have limited availability and access to resources, including smartphones, laptops, private space, and secure and consistent internet. For those who are unhoused, these barriers are more likely. In some cases, clients may be able to use private spaces and equipment at local libraries, community centers, at their reporting site, or the courthouse. Similarly, it is important to coordinate with relevant agencies and parties (e.g., judges, parole/probation officers, caseworkers) to ensure equitable access to appropriate technological equipment and private treatment spaces, if needed.

In many jurisdictions, individuals may be ordered by the court to participate in treatment, most often as a condition of probation or parole. It is important to consider the impact of mandated treatment on clients’ level of motivation or other symptomology (e.g., agitation; Magaletta et al., 2000) when determining the appropriateness of telepsychological services, particularly if low motivation may contribute to low engagement and/or adherence in remote treatment. In the experience of members of this taskforce, clients (particularly those with lower motivation) may approach telepsychological sessions more informally than in-person sessions and, therefore, may test boundaries regarding scheduling and missed appointments. Remote services may also create more opportunities for clients to attribute lack of attendance to external factors such as technological problems or internet failures. We recommend psychologists assess whether client technological issues are associated with genuine lack of access, connectivity, and/or skill in using the technology and help clients minimize the likelihood of problems in the future. Psychologists are advised to be aware of the consequences of treatment nonadherence for their clients and maintain regular contact with the court about issues with engagement; these points may be useful to discuss/reiterate with clients who seem less motivated to engage in services or troubleshoot barriers. Clients who are mandated to treatment, perhaps more so than other clients, may also be reluctant to engage in remote therapeutic services unless all confidentiality and privacy concerns are thoroughly addressed. For example, in virtual group-based treatment, psychologists should consider emphasizing and ensuring all participants adhere to unique privacy and confidentiality protocols such as disabling recording devices, preventing other household members from hearing the session or enter the room, etc. As in any service setting, it is helpful to consider the role of cultural and other factors (e.g., age, race or ethnicity, psychiatric history, legal history) that may contribute to clients’ reluctance to engage in remote treatment.

Section 3: Court Communications

3.1. Forensic Report Preparation

In all communications, forensic psychologists strive to be as transparent as possible about their procedures, data, clinical opinions, and rationale for their findings. When incorporating remote practices, it is recommended psychologists similarly strive to detail the nature of their procedures and any augmentations they made to typical in-person evaluations or other services. Specifically, practitioners may consider including details of the virtual platforms used, any difficulties encountered when using these technologies, and the ways in which the virtual evaluation did or did not impact communication, data gathered, or the clinical findings. To summarize other sections of these recommendations, psychologists are encouraged to document directly in the report their notification of rights/informed consent procedure, the general conditions of the psychologist’s and evaluee’s environments and communication, and any augmentation of testing procedures. The psychologist may include this in a specific section towards the beginning of the evaluation as well as in relevant sections of the report (e.g., mental status examination, test procedures).

3.2. Deposition and Testimony

Before any virtual court appearances or communications, psychologists are encouraged to gain a reasonable understanding of the materials or exhibits that are likely to be referenced by the judge or attorneys and how they will access these during the appearance. Because a lawyer cannot physically hand documents to the virtual witness, the psychologist is advised to gather and organize these materials electronically for easy reference during testimony. Any materials the psychologist uses during a case are considered discoverable and may be made available all parties. Psychologists are encouraged to learn about any previous rulings limiting the use of specific materials during virtual testimony and ensure they are not relying on documents or other materials while testifying that were not previously approved by the court. If the psychologist is expected to release their file to another party before or during courtroom proceedings, the psychologist may want to plan how to efficiently release the file in written or electronic fashion.

To date, there is little scholarship regarding perception, credibility, and influence of remote depositions and testimony. As such, psychologists are encouraged to consider how their normal procedures for court preparation may need to be altered for the virtual format. If the psychologist has never testified using a virtual platform, a test run with the specific platform used by the court before the scheduled appearance is highly recommended. Retaining parties may be able to set up such a session. Additionally, it would be useful to identify a contact person in the courtroom or at whatever location/site is hosting the communication in advance for assistance troubleshooting as well as receiving information about when the psychologist should log in for the appearance. Psychologists are advised to participate in or observe court procedures only when they are allowed to do so, as some proceedings limit or prohibit witnesses from observing the testimony of others or procedural issues between the court and attorneys.

Psychologists are also encouraged to be aware of the environmental background that would be visible to courtroom participants given their camera angle. Professional backgrounds are recommended, as well as exercising caution when determining what supplies, memorabilia, or other objects are displayed. Some items that seem professional and relevant to the forensic context, such as textbooks, may create the possibility for these materials to be referenced or questioned during testimony. It is recommended psychologists also ensure all environmental distractions in their general area are removed or minimized so as not to disrupt the proceedings. Further, psychologists are advised to carefully consider their presentation and ensure adequate attire, lighting, video frame, and audio. We recommend psychologists be prepared for the possibility of appearing on video even if they are only expected to observe. For example, courts may require parties observing online to identify themselves which may include brief audio and visual communication. It is suggested that any such observation be completed in a professional environment that maintains the privacy and integrity of the court.

Virtual testimony will typically not provide the same visual field as live court appearances. Specifically, the psychologist testifying is unlikely to be able to closely observe the judge, jury members, or the attorneys questioning them. Thus, the psychologist may have fewer cues than typical about their presentation and may need to adjust their expectations and communication accordingly. Because camera views and angles vary widely across jurisdictions, a practice run with the retaining party or courtroom personnel may also help psychologists ascertain where cameras will be positioned so they understand who they will be able to see and to what extent the visual cueing will be limited. Additionally, the virtual format may disrupt communication if the audio transmission of the attorney’s question is variable or poor. Therefore, psychologists may need to request clarification and other assistance more frequently than in-court testimony to ensure they understand the questions posed.

Another consideration for deposition and testimony is the use of presentation materials such as written documents, graphs or charts, and slide shows. Prior to the court appearance, psychologists should consider discussing with the retaining party who will be sharing and controlling access to these documents. The psychologist may want to practice with any presentation materials beforehand to ensure smooth transition and execution. When reviewing documents that are virtually shared with the trier of fact by attorneys or other parties, the psychologist may need to respectfully and assertively request changes to the visual field (e.g., scrolling up or down; enlarging text) to ensure they can understand and respond accurately to questions.

Finally, if the psychologist is testifying about a remote evaluation or other matters involving telepsychological practice, it is advised they be prepared to describe their procedures and cite evidence to support their use of such technology. As noted in Section 4 of these recommendations, psychologists are in a unique position to educate triers of fact and legal professionals about the scholarship regarding telepsychology including gaps in knowledge. It is recommended they be prepared to address any limitations and areas of uncertainty while also reviewing the merits of telepsychological practice.

Section 4: Training

4.1. Teaching and Education

For purposes of this statement, teaching refers to didactic instruction (e.g., coursework, training seminars) and experiential learning in health service psychology graduate programs, fellowships, and post-licensure continuing education. Recommendations for disseminating educational content to professionals (e.g., policymakers, attorneys, judges, correctional administrators) in legal settings who are likely to have exposure to telepsychological practices or may make decisions in relation to these practices are also offered.

Suggestions for Health Service Trainees and Professionals

Health service trainees and professionals (e.g., graduate students, pre-doctoral interns, post-doctoral fellows, licensed professionals needing continuing education credits) are strongly encouraged to routinely seek teaching and training opportunities related to the practice of telepsychology generally and specifically in psycho-legal contexts. This may include, but is not limited to:

• Reviewing and monitoring for updates in relevant policies, regulations, statutes, and legislation (e.g., PSYPACT regulations, laws governing interjurisdictional practice).

• Reviewing relevant scientific literature and monitoring for updated information.

• Attending webinars, workshops, conference symposia, etc.

• Presenting on telepsychology topics to trainees, colleagues, the broader professional community, or those outside the profession (e.g., attorneys, judges, the general public).

• Learning about newly developed technologies and how to safely, effectively, and ethically apply them in psychology-law practice.

To ensure staff and trainees receive the most up-to-date information on changing policies and practices, graduate programs and agencies involved with clinical training may consider forming inter-organizational committees that are responsible for periodically checking for, documenting, and disseminating these changes.

Pre-licensure training and practicum.

Given the proliferation of telepsychology before, during, and likely after the COVID-19 pandemic, supervised direct care experience with remote counseling and assessment is recommended at the pre-doctoral level (i.e., internal and external practicum placements) and, as clinical skills and expectations become more advanced, continuing into internship and postdoctoral training. Although forensic and correctional services require knowledge and skills unique relative to general clinical practice, working remotely with clients who are not legally involved will begin to expose trainees to logistical and ethical considerations that are distinct from in-person practice. If opportunities to provide adequately supervised clinical services to forensic or correctional clients are available for trainees, areas of practice emphasis may include:

• Remote forensic psychological assessment (e.g., navigating jail policies regarding spacing, privacy, exchange of documentation, effective incorporation of third parties such as interpreters or attorneys; ensuring the use of or modifications to assessment tools for remote administration are defensible and minimize risk of legal scrutiny).

• Remote competency restoration services (e.g., modifying patient teaching materials for virtual delivery, consulting with on-site medical staff about psychotropic medication management)

• Community-based services for court-mandated clients, such as individuals on diversion, probation/parole (e.g., helping clients engage with services despite low motivation, limited resources and often chaotic home environments, building effective communication with supervision officers and judges)

• Mock virtual court to practice remote testimony or observations of real-time virtual court proceedings

Post-licensure training and continuing education.

Some licensed practitioners may not have had the opportunity to obtain supervised clinical hours during formal training opportunities. We recommended these providers consult with and/or observe other licensed practitioners who have expertise in telepsychological service provision for legally involved persons before initiating their own practice.

While there is currently no evidence that a certain number of training hours will ensure competency in telepsychology practice in legal and correctional settings, we suggest licensed practitioners who regularly use telepsychology obtain relevant continuing education training each renewal cycle. Given the rapid rate at which technology itself, laws pertaining to telepsychology practice, and recommendations for use evolve, it is essential for licensed practitioners who use telepsychology to remain knowledgeable about current standards of practice. Further, documented evidence of continued education in this area may be beneficial for purposes of demonstrating expert qualification to the court, other retaining parties, or collaborators.

Be advised there is not yet a professional consensus on how much educational exposure is sufficient to practice telepsychological services in psycho-legal contexts. Ultimately, clinicians should consider the extent of training that would be reasonably expected by others in the profession.

Suggestions for Educating Legal and Policy Professionals

Psychologists are encouraged to help educate legal personnel and the court about best practices in telepsychological services, current laws and regulations governing practice, and research on its prevalence, acceptability, and efficacy relevant to specific purposes or populations. Educating legal parties may require discussing these issues with retaining attorneys, opposing counsel, judges, or the court (including jurors) during direct and cross-examination. Educational opportunities may also include presenting more formally to larger organizations (e.g., state bar associations, judicial conferences) or governing bodies that may have the authority to influence policies regulating telepsychological coverage or care. However, it is recommended psychologists only present on topics for which they have sufficient expertise and acknowledge any gaps in knowledge.

4.2. Supervision

For purposes of this statement, supervision primarily refers to clinical oversight of unlicensed trainees, most often those in health service psychology graduate programs and fellowships, by professionally licensed mental health providers with expertise in psychology-law practice. Tasks encompassing supervision may include observation of direct client contact (e.g., live supervision, review of recorded sessions), management and editing of written materials (e.g., clinical notes, evaluation reports), facilitation of regular individual and group supervision meetings, general guidance regarding professional and ethical conduct within a given scope of practice, objective evaluation of trainee performance, and implementation of remediation plans. Although not yet explored in forensic or correctional clinical training settings, synchronous telesupervision has been associated with similar levels of satisfaction among trainees as in-person supervision (Tarlow et al., 2020).

Similar to teaching and education, there is currently no professional consensus dictating the minimum qualifications for supervisors of telepsychological services in general clinical practice or psychology-law settings. Licensed psychologists interested in supervising telepsychological practice are encouraged to review the recommendations in Section 5.1. Chapter 8 (Telesupervision and Training in Telepractice) in Luxton et al. (2016).

Unique Opportunities

The remote environment of supervision (i.e., telesupervision) and/or the supervision of remote services can offer several unique benefits and experiences for psychology-law trainees. These include but are not limited to:

• Trainees can participate in remote role-play simulations with supervisors and/or peers to better prepare for logistical challenges, difficult to treat or manage clients/examinees (e.g., challenging personality traits, psychosis, malingering), or court depositions/appearances.

• Trainees can use remote supervision as an opportunity to develop rapport virtually, observe nonverbal cues and other interpersonal behaviors with their supervisor, and apply these skills to their remote clinical experiences.

• Trainees and supervisors could remotely co-conduct forensic evaluations via three-way videoconference, thereby allowing for live supervision and collaboration through both verbal and messaging modalities (e.g., direct messaging).

• When permitted, trainees could accompany supervisors to virtual meetings or three-way calls with attorneys and other court personnel to observe standard procedures, how supervisors handle legal questions or concerns, or network with potential retaining parties.

• Trainees could receive remote supervision from providers with specialized expertise (e.g., cultural competencies, less common forensic referral questions, low base rate clinical presentations) who would otherwise be inaccessible due to geographical limitations.

• Trainees may be able to gain supervised experience with specialized populations that are not readily accessible near their on-site training location (e.g., clients/examinees in rural communities or from diverse demographic and sociocultural backgrounds).

Unique Considerations and Cautions

Conversely, telesupervision and the supervision of remote psychological services comes with a unique set of considerations and cautions (Luxton et al., 2016). Here, we highlight several points that may be particularly relevant to psychology-law settings.

Supervisors are encouraged to ensure video recorded supervision and training sessions are properly maintained and saved in secure formats compliant with guiding rules, regulations, and laws. This applies to supervisors’ and supervisees’ maintenance of video. Use devices (e.g., personal USB drives) with adequate encryption and security (e.g., AES 256-bit). Supervisors may consult with information technology professionals to determine the security of their devices and software systems.

Supervisors should consider building competencies related to telepsychological practice explicitly into trainee goals and performance evaluations to initiate conversations about strengths and areas for growth. Competencies may include issues such as professional, personal, and environmental appearance on video platforms, virtual transmission of verbal and non-verbal behaviors, knowledge of relevant guidelines and practice recommendations, application of appropriate testing modifications for virtual administration, and perceived credibility and efficacy as a remote expert witness.

Supervisors are also encouraged to monitor and address “Zoom” fatigue (i.e., the physical and mental exhaustion that can result from frequent engagement in videoconferencing communication and socialization) among themselves and trainees. In psychology-law contexts, there is a possibility of compounded burnout: Zoom fatigue coupled with the typical fatigue of providing forensic and correctional services. Correctional psychologists, for example, report higher levels of burnout than psychologists in other settings, including Veterans Affairs hospitals and counseling centers (Senter et al., 2010). Measures of Zoom-related exhaustion and fatigue (e.g., Fauville et al., 2021) could be helpful to initiate and anchor discussions about technological burnout. Some students may be more prone to videoconference burnout than others. One study showed that women and new hires are more likely to become fatigued by videoconferencing (Shockley et al., 2021); however, this research is preliminary and has not been replicated with psychology-law trainees. Supervisors who detect fatigue or burnout among themselves or their supervisees may consider reducing the overall frequency or duration of virtual appointments when feasible, breaking supervision sessions into shorter intervals and/or allowing additional breaks, or disabling the self-view feature within videoconferencing platforms, and integrating in-person sessions if feasible.

Relatedly, it is recommended supervisors be mindful—for themselves and their trainees—that telepsychology practice increases the number of potential distractors during clinical work. Accessing an internet-connected device increases the likelihood that a trainee may become distracted by email, messaging, or web-based content, particularly as attention begins to wane. Supervisors are encouraged to set clear expectations about closing out or turning off other computer programs during clinical work and meetings, model such behavior for their trainees, and be alert to signs that trainees are distracted during their work.

Finally, it is suggested supervisors be aware of any guidelines or policies dictating the number of remote supervision hours or direct clinical contact hours that can be “counted” on pre-doctoral internship applications or toward licensure. While the Association of Psychology Postdoctoral and Internship Centers (2020) notes that telepsychological assessment and counseling can be counted as direct hours, they also advise applicants to check whether specific entities or sites have designated requirements. Further, some regulatory bodies place limits on the number of telesupervision hours (e.g., no more than 50% of supervision time can be remote). These regulations are often state-specific and may change at the discretion of the body.

Section 5: Research

5.1. Privacy and Confidentiality

Before conducting research remotely with participants involved in the legal system, researchers are strongly encouraged to consult with their organization’s institutional review board (IRB) for specific guidance on how to properly safeguard research participants and their data, particularly those who are considered part of a protected population such as “prisoners,” juveniles, or those with intellectual or developmental disabilities. Of note, the standard definition of “prisoner” refers to any individual (adult or juvenile) involuntarily confined or detained in a penal institution under civil or criminal statute. This includes individuals in forensic psychiatric hospitals or mandated alcohol and drug treatment facilities. It also applies to individuals in work-release and house arrest programs, but does not extend to individuals on community supervision (see hhs.gov for further information).

Prior sections have noted the importance of and challenges associated with ensuring privacy and confidentiality in secure forensic and correctional settings. These issues (e.g., limiting other people or distractors in the room, making sure audio cannot be heard outside the room) certainly extend to research. It is recommended that unique threats to privacy and confidentiality be clearly communicated with prospective research participants and may include:

• A correctional officer or unit staff finding out they participated or refused to participate in the study

• A correctional officer or unit staff overhearing their responses to survey items or study tasks

• The extent to which their use of technological devices may be monitored by staff

• The likelihood staff or administrators could be exposed to electronic or remotely transmitted information

• The need for staff to be involved in sending or receiving study materials, survey responses, or file review data to the research team

Researchers are also encouraged to take reasonable steps to protect participants’ privacy and confidentiality in remote or online research environments. This could include requesting staff not be present during consent or study procedures, asking an administrative assistant with no involvement in the research to pull records or liaison with researchers, and providing participants tips for maintaining privacy and confidentiality in their remote locations.

5.2. Informed Consent

Specific to remote or online research, researchers should consider providing participants with information about how their electronic or virtual data will be stored, maintained, accessed, and shared. For participants in secure settings (e.g., prisons, hospitals, detention centers), it is recommended consent forms also describe whether the agency or department will know if the person participated vs. declined, what level of access they may have to participants’ research data, what specific procedures will be in place to ensure privacy and confidentiality given institutional barriers, and how compensation (if available) will be distributed. For example, if the research is in collaboration with a state department of corrections, how can participants be assured prison staff or administrators will not know about their decision to participate or be able to listen in on or track information transmitted via their computer network? When feasible, using external devices (e.g., tablet computers) or hyperlinks to collect data, and ensuring electronic materials are encrypted and disconnected from cloud-based storage systems should be considered (see section 4.3).

In remote or online research, another important consideration is how informed consent will be obtained and documented. If a study is low enough risk, participants may be able to offer consent verbally (e.g., over the phone, via videoconferencing) or by clicking a response choice in an online survey that acknowledges their consent (e.g., “By choosing to continue with this survey, you are providing your informed consent to participate. You may still withdraw at any time.”). For studies that are higher risk or are being conducted with protected “prisoner” populations, obtaining signed informed consent may be required. REDCap (Research Electronic Data Capture) or Docusign may be useful in these cases. HIPAA-compliant versions of these programs are recommended, even when consent forms do not include protected health information and are maintained separately from identifiable participant data. For a discussion of e-consenting procedures in research see Skelton et al. (2020). Conducting consent procedures in-person or mailing consent forms may be necessary so participants without internet or email are not excluded (unless having such access is an explicit inclusionary criteria). However, in institutional settings, mail may be screened or even electronically scanned (e.g., federal bureau of prisons) by security staff, which may compromise participants’ privacy and confidentiality. For participants who are in-custody, researchers may be able to negotiate with the facility to allow mail clearly designated from the researchers to be privately exchanged. These special considerations for informed consent when conducting remote/virtual research would also apply to parents, legal guardians, or appointed advocates who would need to provide consent on behalf of justice-involved youth participating in research.

Finally, psychologists are encouraged to develop remote procedures for assessing the capacity to consent as a human subjects participant. Compared to the general population, forensic patients and people who are incarcerated have a higher prevalence of serious mental illness, cognitive impairment, lack of education, and other disorders or circumstances that may render them incompetent to consent to research (Ahalt et al., 2018; Al-Rousens et al., 2017; Prins, 2014). Unlike forensic evaluations or mandated treatment, participants are typically expected to have the capacity to consent or assent as a research subject. Ensuring competency may be more challenging with completely asynchronous methods of data collection (e.g., anonymous online survey). One option is to include a brief multiple-choice quiz regarding important aspects of consent (e.g., “Are you able to withdraw from this study at any time without penalty?” “Will your probation officer know how you specifically responded to these items?”) and setting the program to automatically remove participants who respond to consent items incorrectly (or perhaps a certain number of incorrect responses to account for human error); however, it is suggested this possibility be detailed in the informed consent form.

5.3. Data Collection, Security, Storage, and Access

Remote or online data collection can be an efficient, safe, and more inclusive way to conduct research. However, several considerations may be especially relevant when recruiting human subject participants who are involved in the legal or correctional systems. In designing an online or remote study, psychologists are encouraged to consider factors that may challenge data collection such as access to the internet, email, or videoconferencing platforms; participants’ comfort and familiarity with virtual technologies (especially if they have been incarcerated or institutionalized for a long period of time); physical and mental capabilities to engage with technology (e.g., executive functioning, language comprehension, motor skills); risk of harm (to self, others, or the technological equipment); or other constraints associated with the environment (e.g., policies or regulations regarding the use of certain devices or web-based data collection software in prisons or other secure settings).

Determining what skills and infrastructure are necessary to engage in specific remote research tasks and developing brief screening tools for study inclusion may be helpful. Embedding audio and closed captioning into online study stimuli might overcome barriers related to reading level, attention, or visual or hearing impairment. Similarly, it may be necessary to consider the level of motivation to participate and/or the potential for dishonest responding when conducting research among justice-involved populations, particularly if tasks are completed without oversight by research personnel and compensation is available. Shields et al. (2021) provides examples used in research with children that may have applicability. Psychologists may consider the following steps:

• Including manipulation and comprehension checks to ensure participants are attentive and understand the research tasks

• Blocking participants from skipping study material by setting timers (within a reasonable time and only after informing participants about the timer)

• Including shorter, engaging research tasks

• If response anonymity is not required, video moderating research sessions, recording participants during research tasks, or taking periodic video captures of participants throughout research sessions

• Including honesty reminders (“please answer honestly”)

• Excluding stimuli (particularly copyrighted material) that may be easily copied and/or recorded

Psychologists are encouraged to remain mindful of potential threats to the safety and security of data. This may involve taking reasonable steps to protect the integrity and security of data within an information system, such as:

• Considering the appropriateness and feasibility of methods for data collection, including telecommunication technologies and online survey systems

• Encrypting confidential data for storage and transmission

• Encrypting electronic communications and maintained data

• Using robust passwords to protect electronically stored and transmitted data

• Destructing or disposing of data when appropriate and in accordance with all relevant regulations and guidelines

Psychologists are advised that different IRB’s may also have different expectations or interpretations of ethical practice using remote data collection tools, what types of information can be collected remotely (e.g., whether they allow IP addresses to verify geographical location), and how it should be secured or destroyed.

5.4. Reporting and Dissemination

As with any research, it is important to consider what information will be relevant to communicate to the consumers of the research before the project is initiated. Batastini et al. (2021) provide a general list of variables that may be considered when conducting, and subsequently reporting, research on telepsychological services. Here, we summarize and modify key variables/descriptors that may be especially relevant to psychology-law settings. This is not an exhaustive list of and the relevance of these variables, as well as the necessity of others, will be study dependent.

• Process of ensuring and obtaining informed consent remotely.

• Use of any technology screening procedures or preparational procedures to establish proficiency.

• Protocols in place for ensuring safety and risk management (e.g., identifying an on-site emergency contact such as jail personnel, unit staff, in-home caregiver).

• Participant characteristics, sample size, and attrition (including rates and reasons) for the total sample and by condition (e.g., in-person vs. remote videoconferencing), including any statistically significant between-group differences when relevant.

• Location of all clients/participants. Were they seen at home, in jail, prison, at a courthouse, attorney’s office, secure forensic unit? Are there differences in client location? For example, in-person competency restoration services conducted in a state forensic hospital that are compared to jail-based restoration services conducted via secure videoconferencing.

• Location of the providers or researchers. And are they housed within the same agency or facility as the client. For example, an incarcerated client in administrative segregation may use a computer system on their unit while the provider is in their office located elsewhere in the facility.

• Technology set-up at all locations and for all relevant parties (e.g., researcher, provider, participant, 3^rd party observers)

  • The software program used (e.g., Zoom, Polycom, Cisco WebEx) and whether it was HIPAA-compliant.

  • The types of technologies (e.g., videoconferencing, telephone, mobile app) or equipment used (e.g., desktop computers, tablets, webcams, smartphones). Images or diagrams depicting the equipment set-up may be useful to include as appendices or supplemental material.

  • Whether equipment was supplied by the researchers or participants/sites used their own devices.

  • Whether clients/participants required staff escort or observation while using technological equipment. If so, what was the process or policy of the facility and were there any limits to confidentiality?

  • Other institutional policies governing the use of technology (e.g., installment of plexiglass to protect screens, not allowing incarcerated people to physically touch the equipment, requiring shackles).

  • Type of connection (e.g., hardline internet cable, secure Wi-Fi) and quality (e.g., connection speed, video resolution and size).

  • Frequency and type of any technological problems such as connection loss, audio-visual delay, picture distortion, destruction of equipment (intentional or unintentional). And how were these issues resolved or handled?

  • Client/participant perceptions of the technology (e.g., usability, acceptance, overall satisfaction; see Hajesmaeel-Gohari & Bahaadinbeigy, 2021).

• Method of service delivery. Were services provided entirely remotely? Was technology used to implement certain services but not others (e.g., in-person therapy with remote medication management)? Were any modifications (with proper justification) made to intervention or assessment protocols to fit the virtual environment? And did this create differences across study conditions?

• Assignment of providers. For example, if comparing across delivery modalities, were certain providers always assigned to the in-person condition and other providers were assigned to the remote condition?

• Unique training in telepsychology. Did providers have any training requirements or expectations related to the use of remote technologies? If so, what did this training include (e.g., number of hours, whether it was general or specific to psychology-law applications)?

• Provider and participant perceptions of the technology (e.g., usability, acceptance, overall satisfaction, impact on reliability of opinions).

We strongly encourage dissemination of research findings not only through traditional academic journals (e.g., Law & Human Behavior, Psychology Public Policy, and Law, Criminal Justice and Behavior, Psychological Services) and conferences (e.g., annual AP-LS conference), but also mainstream correctional and legal publications (e.g., American Jails, Corrections Today, Journal for Evidence-based Practices in Correctional Health, Journal of Correctional Health Care, The Prison Journal), state judicial or attorney conferences, local trainings for community providers, social media platforms, or other outlets likely to reach a relevant audience.

5.5. Areas of Future Research

Although research on telepsychology in psycho-legal practice was available before the COVID-19 crisis (see Batastini et al., 2016 meta-analysis), and research has continued to emerge since then (e.g., Daffern et al., 2021; Trupp et al. 2021) including technology-focused special issues in Law & Human Behavior and Psychology, Public Policy & the Law, the empirical knowledge base remains relatively sparse compared to other areas within psychology (e.g., Veteran’s services, neuropsychological assessment). Much of the available published work, particularly post-COVID-19 (e.g., Batastini et al., 2020; Bernhard et al., 2021; Brown et al., 2021; Kois et al., 2021; Daffern et al., 2021), appears to be commentary, descriptive, or review. While these scholarly contributions are important, the field is generally lacking scientifically rigorous (e.g., using larger sample sizes, between-subjects designs/random assignment; see also Kois et al., 2021).

The normative nature of telecommunications coupled with continued health concerns across the globe would suggest that remote services, including in psychology-law contexts, are here to stay. As Kois et al. emphasize, “it is imperative that researchers do not assume that nonforensic e-mental health research will generalize and, instead, consider the application of technology to this specific subdiscipline” (2021, p. 4–5). Thus, we encourage both academics and practitioners to keep technological advancements at the forefront of research innovation and program evaluation.

Here, we provide suggested topics for future research that are likely worth expanding and exploring. Again, this does not represent an exhaustive list of possibilities. Readers are also encouraged to review the recommendations discussed in Kois et al. (2021).

Survey or Descriptive Research

• Whether the use of telepsychology changes after the pandemic (frequency, types of referral questions, client characteristics, legal/adjudicative outcomes)

• Perceptions and experiences using telepsychology in different psycho-legal contexts. For example, perceived credibility of experts who use teleassessment or testify remotely; validity of assessment outcomes; quality, acceptability, or effectiveness of services, admissibility in court, etc. Perceptions may include those of clients, providers, and legal personnel (see Batastini et al., 2019).

• Whether the use of telepsychology is associated with stated improvements such as reduced wait times for evaluations or services and cost-effectiveness.

• Differences in practice standards (e.g., consent form, virtual modifications, types of technology platforms use, report elements).

• How practitioners assess and address cultural and diversity factors (e.g., working with older adults, disparities in Internet access, use of closed captioning, role of interpreters).

• Agreement within the field regarding existing guidance and practice recommendations.

• Telepsychology training and educational trends in psychology-law programs (e.g., practicum, internship, post-doctoral fellowships).

Experimental or Quasi-Experimental Research

• Differences in perceptions of expert credibility or efficacy across modalities (e.g., in-person vs. videoconferencing vs. phone).

• Whether services delivered remotely are associated with desired outcomes (e.g., recidivism reduction, psychiatric stability, restoration success, improved social skills, less frequent and serious disciplinary infractions) using baseline and follow-up time-point comparisons.

• Whether services delivered remotely lead to differential outcomes (e.g., triage/treatment planning, diagnostic decisions, risk prediction, psycho-legal opinions, court-decisions) compared to in-person or other comparison conditions (e.g., waitlist control).

• Whether the introduction or inclusion of certain technological aids (e.g., videorecording vs. no recording) has differential impacts (e.g., on examinee response style, attendance/attrition, comprehension, willingness to offer a confession, requests for attorney presence).

Good quality and consistent research on telepsychology in forensic and correctional practice will not only offer scientific support and guidance to frontline practitioners, but it also has the potential to improve systems, close racial and socioeconomic disparities, and influence policy.

Section 6: Resource Links

American Telemedicine Association (ATA) Website

https://www.americantelemed.org/

APA Division 12 Assessment Psychology COVID-19 Resource Website

https://apadiv12secix.com/covid-19/

APA Guidelines for the Practice of Telepsychology (2013)

https://www.apa.org/practice/guidelines/telepsychology

APA Guidance on Teleassessment during COVID-19

https://www.apaservices.org/practice/reimbursement/health-codes/testing/tele-assessment-covid-19

AP-LS Telepsychology Resource and Reference Website

https://ap-ls.org/telepsychology

Association of Psychology Postdoctoral and Internship Centers COVID-19 Information

https://www.appic.org/News-Articles/ArtMID/1931/ArticleID/4/COVID-19-Information

Interorganizational Practice Committee Teleneuropsychology Guidelines

https://iopc.online/teleneuropsychology-guidelines

PSYPACT Website

https://psypact.site-ym.com/

Trust PARMA Covid-19 Resources

https://parma.trustinsurance.com/Resource-Center/COVID-19-Resources

Office and Technology Checklist for Telepsychological Services

https://www.apa.org/practice/programs/dmhi/research-information/telepsychological-services-checklist

U.S. Department of Health and Human Services Office for Human Research Protections Prisoner Research FAQs

https://www.hhs.gov/ohrp/regulations-and-policy/guidance/faq/prisoner-research/index.html