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. 2023 Feb 1;66(4):244–256. doi: 10.1177/00343552221147216

Ethics of Technology Practice: Beliefs and Behaviors of Certified Rehabilitation Counselors During the COVID-19 Pandemic

Michael T Hartley 1,✉, Paul Bourgeois 2, Brian J Clarke 1
Editors: Trenton J Landon, Julie C Hill, Robert Froehlich, Pamela Shlemon
PMCID: PMC9899674  PMID: 38603434

Abstract

The coronavirus (COVID-19) pandemic represented a critical moment for technology use within rehabilitation counseling. This study explored trends in the beliefs and behaviors of certified rehabilitation counselors (CRCs) regarding the ethical use of technology before and during the pandemic. Specifically, this study compared two groups of CRCs regarding the degree to which they engaged in 59 technology behaviors and whether they viewed each behavior to be ethical. Overall, group comparisons suggested an increased use of telephone, videoconferencing, and email to deliver counseling, assessment, and supervision services during the pandemic. Furthermore, supervision via videoconferencing and email in the pandemic were rated as more ethically appropriate than before the pandemic. As a general trend, synchronous modes of communication such as the telephone and video conferencing were rated as more ethically appropriate than asynchronous modes such as social networking and text messaging. Indicating a high degree of congruence between beliefs and behaviors, the technology practices viewed as most ethical were used the most often. Implications address the revisions to the Code of Professional Ethics for Rehabilitation Counselors regarding the ethical use of technology in rehabilitation counseling.

Keywords: coronavirus, ethical guidelines, rehabilitation counseling, technology

The extreme contagiousness of the coronavirus (COVID-19) pandemic resulted in social distancing mandates and shelter-in-place orders starting in March 2020 (Levine et al., 2022; Pebdani et al., 2022). With an overnight shift to remote work, rehabilitation counselors had to quickly navigate and gain the technological and professional competencies necessary to provide technology-assisted services ethically and effectively (Hartley & Bourgeois, 2020). This was challenging given that less than 40% of counseling professionals had ever provided distance counseling before the pandemic compared with 98% during the pandemic (Glueckauf et al., 2018; Sampaio et al., 2021). Clients, too, were learning to use technology in new ways during the pandemic. McClain and colleagues (2021) reported that 90% of people rated the Internet as essential to their lives during the first year of the pandemic, with 40% using the Internet in new ways, and 80% using videoconferencing on a regular basis. With rehabilitation counselors and their clients using information and communication technology (ICT) in unprecedented ways, it is important to consider how the ethics of technology practice evolved during the pandemic.

Prior to the pandemic, there had been a steady rise in the use of ICT by rehabilitation counselors to communicate with clients. The majority of rehabilitation counselors reported using ICT to communicate with clients (87%) and share employment information (92%; Boeltzig, 2011). Furthermore, clients believed ICT was acceptable because “counselors responded more quickly to email responses than phone messages, it was a quick way to communicate between in-person meetings,” and it provided “documentation they could refer back to for clarification” (Ipsen et al., 2012, p. 177). Today, new generations of transition-age youth with disabilities increasingly prefer text communication with rehabilitation counselors (Anderson et al., 2021). Yet, it was not until the highly contagious COVID-19 virus that rehabilitation counselors were forced, for the first time, to interact with their clients exclusively via ICT applications.

Counseling is an intimate human-to-human interaction, and counselors traditionally have expressed reservations about ICT and distance counseling. Often, this is expressed through overly generalized arguments such as “to do no harm translates to do not use tech” (Phillips, 2019, para. 5). Yet, to avoid technology may be viewed as unethical and culturally insensitive in a culture where that is how people communicate (Hartley et al., 2021). This was especially true during the pandemic when ICT applications were the only way to deliver services safely. At the same time, there are ethical risks whenever technology is used to communicate with clients. While texting may increase counselor and client interactions, there also can be an unrealistic expectation of an immediate response that may harm the working alliance and place a client in danger (Wheeler & Bertram, 2019). What’s more, statistics indicate that almost half of Americans have personal information stolen each year (Elhai & Hall, 2015). Even with privacy protections, it is possible to extract immense amounts of personal data from digital communication. Due to concerns of safety, liability, and competence, counselors were reticent to embrace ICT applications (Glueckauf et al., 2018; Sampaio et al., 2021). The pandemic, thus, represented a critical moment for distance counseling when face-to-face services became unsafe.

Although the social distancing restrictions of COVID-19 continue to evolve and change, the first year of the pandemic represented a critical moment when many rehabilitation counselors were providing distance services for the first time. Distance services are the provision of rehabilitation counseling by means other than face-to-face meetings (Hartley & Bourgeois, 2020). One way to understand distance services is the differentiation between synchronous and asynchronous communication. Synchronous refers to real-time communication between the counselor and client that may include video, audio, text, or chat communication, while asynchronous is characterized by a time delay in communication between the counselor and client (Hartley et al., 2021). Prior to the pandemic, counseling professionals rated synchronous communication via the landline telephone (82.7%), cell phone (57.9%), and videoconferencing (52.6%) as more ethically appropriate than more asynchronous email (34.6%), text messaging (16.7%), and social media (2.6%) (McMinn et al., 2011). In another study, professionals also rated the telephone (74.4%) and videoconferencing (72.3%) as more ethically appropriate than email (38.4%) and text messaging (16.5%; Glueckauf et al., 2018). In both studies, telephone and video conferencing were rated as most ethically appropriate, perhaps because they most closely mirror the dynamics of in-person counseling. Yet, during the first year of the pandemic, almost all counseling professionals used a wide range of ICT applications (Sampaio et al., 2021).

The pandemic represented a critical moment for the ethical practice of rehabilitation counseling. Since 1987, the Commission on Rehabilitation Counselor Certification (CRCC, 2023)Code of Professional Ethics for Rehabilitation Counselors (hereafter referred to as the Code) has required all professionals who hold the certified rehabilitation counselor (CRC) credential to behave in an appropriate professional and ethical manner. However, rather than a static set of universal, impartial rules and standards, the Code is a “living document” that has continually evolved in response to emerging ethical problems (Tarvydas et al., 2010, p. 195). With this in mind, periodic revisions to the Code in 2002, 2010, 2017, and 2023 have provided more refined and expanded guidance on the ethics of technology use. For instance, revisions to the 2010 Code expanded guidelines on the ethics of distance counseling as well as ICT within rehabilitation counselor education and supervision (Barros-Bailey & Saunders, 2010). Revisions to the 2017 Code regulated the use of social media, for the first time, in response to survey research regarding “the indiscriminate use of social media by both rehabilitation counselors and clients” (Hartley & Cartwright, 2016, p. 41). With technology use increasing during the pandemic, systematic research on the evolving beliefs and behaviors of CRCs is an important context for understanding current revisions to the CRCC (2023)Code.

Informing efforts to refine and expand the ethical standards of the CRCC (2023)Code, this study explored trends in the beliefs and behaviors of CRCs regarding the ethical use of technology before and during the pandemic. Initially meant to explore CRCs opinions in January 2020, the study expanded with the unexpected pandemic to compare the opinions of CRCs in January 2020 versus January 2021, 1 year into the pandemic. Based on two separate, national samples, the research question was the following:

  • Research Question 1 (RQ1): How did the ethical technology practices of CRCs evolve during the first year of the COVID-19 pandemic?

To answer the research question, group comparisons explored the opinions of CRCs regarding the degree to which they engaged in 59 technology behaviors and whether they viewed each behavior to be ethical. Implications address current revisions to the CRCC (2023)Code of Professional Ethics for Rehabilitation Counselors regarding the ethical use of technology in rehabilitation counseling.

Method

Procedures

The present study replicated previous survey procedures to measure the ethics of technology practice among counseling professionals (McMinn et al., 1999, 2011). An online survey was constructed for feasibility, low cost, and benefit of allowing CRCs to respond anonymously (Dillman, 2007). The survey was divided into three main parts. The first part asked CRCs to rate the extent to which they had engaged in 59 different technology behaviors in their practice. The 59 behaviors included verbatim items from the McMinn et al. (2011) questionnaire, with outdated items such as answering machines removed. For each item, CRCs rated the behavior’s occurrence in their practice on a 5-point scale of never, rarely, sometimes, fairly often, or very often. The second part asked CRCs to rate whether they had ethical concerns about the behavior with responses of yes, no, or unsure/it depends. The third part asked CRCs to provide demographic information. Certified rehabilitation counselors were able to skip items in case there were concerns with anonymity.

With approval from an Institutional Review Board, participants were recruited from the CRCC database. Conducted at two points in time, two random samples of 1,000 CRCs each were selected from the entire CRCC database of approximately 15,000 email addresses. Recruitment occurred at two points in time: January 2020 and January 2021. For each sample, recruitment consisted of three separate email mailings inviting CRCs to participate in the study. A total of 1,832 emails were successfully delivered across the two samples. Of the successful transmissions, 189 CRCs completed the survey for an overall response rate of 10.3%. The response rate before (n = 103; 10.5%) and during (n = 86; 9.3%) the pandemic were similar to previous CRCC ethics research (Hartley & Cartwright, 2016). Low response rates are common when there is no compensation for participation (Dillman, 2007).

Participants

With missing data across the demographic variables, 181 of the 189 CRCs identified their gender as either female (n = 143; 78.6%) or male (n = 39; 21.4%). In terms of ethnicity/race, 143 (77.7%) identified as Caucasian or White, 16 (8.7%) as Black or African American, 13 (7.1%) as Hispanic or Latinx, 9 (4.9%) as Asian or Pacific Islander (n = 7; 3.9%), 1 (0.5%) as American Indian, and 2 (1.1%) as of another race/ethnicity. The majority of CRCs were over the age of 40 years old: 43 (23.2%) were between the ages of 40 and 49 years, 45 (24.3%) were between the ages of 50 and 59, and 51 (26.9%) were age 60 or older. Only a quarter of the CRCs were below 40 years old: 14 (7.6%) were 29 or younger and 31 (16.8%) between the ages of 30 and 39. The largest proportion (n = 85; 46.2%) worked in state/federal vocational rehabilitation, followed by private rehabilitation (n = 40; 21.7%), with the rest representing a range of other settings such as mental health centers (n = 59; 32.1%). The CRCs practiced in the Southeast (n = 54; 29.5%), Middle Atlantic (n = 25; 13.7%), New England (n = 31; 16.9%), Midwest (n = 28; 15.3%), Southwest (n = 16; 8.7%), West (n = 20; 10.6%), and Northwest (n = 9; 4.8%). The samples before (n = 103) and during (n = 86) COVID-19 did not differ in practice setting, χ2(8, n = 176) = 5.16, p = .740; geographic region, χ2(6, n = 178) = 4.69, p = .585; gender, χ2(1, n = 181) = 0.24, p = .876; ethnicity/race, χ2(5, n = 179) = 3.95; p = .557; or age, χ2(5, n=179) = 2.63, p = .758.

Data Analysis

SPSS v. 27.0 was used to analyze the data. Based on an a priori decision, the 59 practice behaviors were organized into five categories with Cronbach’s alpha as a measure of internal consistency: (a) professional counseling services (9 items; α = .70), (b) professional assessment services (12 items; α = .80), (c) supervision and consultation (10 items; α = .82), (d) communication and records (15 items; α = .71), and (e) business and advertising (13 items; α = .75). Levene’s test verified the assumption of homogeneity of variance before analysis of variance (ANOVA) compared the practice ratings on the scale of 1 to 5 with responses of never, rarely, sometimes, fairly often, or very often (Heppner et al., 2016). Chi-square tests then compared the percentage of CRCs who responded yes, no, or unsure/it depends to having an ethical concern for each practice behavior. Finally, the practice and ethics ratings during the pandemic were compared across the employment contexts of state/federal vocational rehabilitation (n = 40), private rehabilitation (n = 13), and other settings (n = 27). Multiple comparisons elevated the risk of a Type I error, and the Hochberg procedure adjusted the .05 alpha of significance against progressively more stringent levels of significance for each p-value within each category. Tables 1 and 2 include the statistics for each practice and ethics rating, including partial eta squared and Cramer’s V as measures of effect size.

Table 1.

Practice Rating: How Often Did Certified Rehabilitation Counselors Engage in This Practice or Behavior?

During COVID (n = 86) Before COVID (n = 103) Comparison
Variable M SD M SD η2 p
Professional counseling services
 Counseling via email 3.83 1.36 2.91 1.53 .099 <.001*
 Counseling via videoconferencing 3.60 1.43 1.69 1.28 .356 <.001*
 Counseling via cell phone 3.29 1.48 2.50 1.38 .062 <.001*
 Counseling via landline phone 3.25 1.57 3.44 1.29 .008 .374
 Counseling via text messaging 1.61 1.03 1.54 1.08 .004 .419
 Counseling via instant messaging 1.31 0.81 1.16 0.57 .008 .174
 Counseling via social networking 1.09 0.43 1.07 0.38 .001 .770
 Maintaining a social media profile related to counseling 1.32 1.29 1.74 1.31 .002 .668
 Maintaining a blog related to counseling 1.17 0.65 1.16 0.66 .015 .830
Professional assessment services
 Discussing results via landline phone 2.52 1.46 2.19 1.23 .015 .111
 Discussing results via videoconferencing 2.46 1.23 1.32 0.98 .205 <.001*
 Discussing results via cell phone 2.17 1.29 1.75 1.12 .031 .020
 Discussing results via text messaging 1.33 0.88 1.14 0.53 .019 .073
 Using computerized administration 1.96 1.31 2.29 1.36 .015 .111
 Using computerized scoring 1.85 1.20 2.13 1.29 .013 .143
 Using computerized interpretation 1.67 1.02 2.17 1.34 .043 .007*
 Relying on computerized software for diagnosis 1.44 0.89 1.38 0.78 .001 .636
 Sending results via email 1.79 1.22 1.81 1.25 .000 .943
 Administering via videoconferencing 1.68 0.89 1.20 0.54 .070 <.001*
 Administering via cell phone 1.26 0.76 1.21 0.66 .001 .638
 Administering via email 1.22 0.68 1.27 0.64 .001 .643
Supervision and consultation services
 Receiving supervision online 2.42 1.44 1.74 1.13 .069 <.001*
 Supervising via videoconferencing 2.64 1.49 1.64 1.17 .129 <.001*
 Supervising via cell phone 2.37 1.41 2.01 1.22 .015 .074
 Supervising via landline phone 2.35 1.44 2.32 1.30 .000 .880
 Supervising via email 2.23 1.30 2.13 1.37 .005 .619
 Supervising via text messaging 1.58 1.04 1.59 1.00 .000 .987
 Supervising via instant messaging 1.58 1.02 1.43 1.03 .010 .334
 Supervising remotely to someone in another state 1.33 0.87 1.45 1.00 .003 .272
 Seeking consultation on professional listserv 1.24 0.66 1.19 0.59 .002 .625
 Supervising via social networking 1.10 0.53 1.12 0.52 .000 .797
Records and communication practices
 Storing client records on a computer password-protected 3.95 1.45 4.06 1.36 .002 .594
 Including emails in client record 3.34 1.44 3.37 1.53 .000 .870
 Faxing confidential information 2.91 1.38 3.04 1.47 .002 .554
 Storing electronic records only (no paper) 2.64 1.55 2.49 1.61 .002 .556
 Emailing confidential information 2.61 1.39 2.78 1.47 .000 .431
 Keeping a schedule with identifying client information on cell phone 1.60 1.20 1.88 1.40 .011 .162
 Including text messages in client record 1.93 1.37 1.99 1.36 .000 .802
 Storing client contact information on a cell phone or external storage 1.83 1.23 2.00 1.45 .004 .423
 Performing an online search to obtain information about a client 1.63 0.94 2.14 1.15 .050 .005*
 Failing to receive client message due to failure hardware/software 1.52 0.71 1.60 0.70 .003 .494
 Deleting digital client records at termination of counseling services 1.46 1.07 1.56 1.11 .002 .536
 Storing client records on a computer, without password protection 1.30 0.83 1.09 0.40 .023 .054
 Contracting with a third-party provider to store digital client records 1.35 1.00 1.52 1.20 .006 .313
 Inadvertently emailing confidential client information to wrong person 1.28 0.67 1.24 0.49 .002 .599
 Losing client records due to a hardware/software failure 1.21 0.49 1.27 0.55 .003 .444
Business and advertising practices
 Scheduling appointments via email 3.40 1.54 3.43 1.43 .005 .896
 Addressing social media as part of informed consent process 1.98 1.48 2.52 1.89 .025 .042*
 Including organizational social media policy as part of informed consent 1.79 1.42 2.21 1.64 .018 .082
 Maintaining a website that describes practice 1.68 1.35 1.84 1.48 .005 .377
 Participating in online public discussions about counseling issues 1.54 0.93 1.48 0.83 .001 .655
 Emailing clients about payment or insurance 1.44 0.98 1.60 1.16 .005 .332
 Submitting electronic claims to insurance 1.39 1.00 1.76 1.39 .023 .047
 Including links to relevant credentialing bodies on website 1.37 1.05 1.46 1.05 .002 .569
 Providing professional advice on a listserv 1.24 0.64 1.18 0.49 .003 .489
 Soliciting testimonials from clients for your professional website 1.22 0.86 1.49 1.09 .021 .050
 Providing informational updates on Twitter 1.17 0.55 1.18 0.67 .000 .915
 Advertising services on the Internet 1.13 0.44 1.33 0.97 .016 .097
 Seeking referrals on professional listserv 1.13 0.57 1.11 0.51 .001 .770
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*

Statistically significant at p ≤ .05 adjusted significance level.

Table 2.

Ethics Rating: Have You Had Concerns About Whether This Practice or Behavior is Ethical?

Variable During COVID (n = 86) Before COVID (n = 103) Comparison
No concern Yes concern Depends/unsure No concern Yes concern Depends/unsure V p
N % N % N % N % N % N %
Professional counseling services
 Counseling via landline phone 45 75.0 9 15.0 6 10.0 44 66.7 11 16.7 11 16.7 .105 .497
 Counseling via cell phone 41 68.3 11 18.3 8 13.3 32 49.2 16 24.6 17 26.2 .202 .051
 Counseling via videoconferencing 36 60.0 14 23.3 10 16.7 36 60.0 13 21.7 11 18.3 .027 .959
 Counseling via email 37 56.1 18 27.3 11 16.7 27 42.2 20 31.3 17 26.6 .150 .232
 Maintaining a blog related to counseling 30 51.7 8 13.8 20 34.5 24 39.3 16 26.2 21 34.3 .166 .194
 Maintaining a social media profile related to counseling 25 43.1 18 31.0 15 25.9 29 42.0 24 34.8 16 23.2 .043 .889
 Counseling via instant messaging 21 36.8 20 35.1 16 28.1 22 37.3 22 37.3 15 25.4 .032 .944
 Counseling via text messaging 17 27.9 26 42.6 18 29.5 19 29.2 35 53.8 11 16.9 .154 .233
 Counseling via social networking 13 22.8 36 63.2 8 14.0 15 25.0 38 63.8 7 11.7 .040 .911
Professional assessment services
 Discussing results via videoconferencing 41 68.3 9 15.0 10 16.7 30 51.7 12 20.7 16 27.6 .172 .175
 Discussing results via landline phone 38 64.4 12 20.3 9 15.3 34 54.0 15 23.8 14 22.2 .111 .469
 Using computerized interpretation 35 62.5 10 17.9 11 19.6 42 63.8 12 18.2 12 18.2 .019 .979
 Using computerized scoring 34 60.7 9 16.1 13 23.2 43 66.2 11 16.9 11 16.9 .079 .686
 Discussing results via cell phone 34 57.6 14 23.7 11 18.6 28 43.8 20 31.3 16 25.0 .139 .306
 Administering via videoconferencing 28 49.1 13 22.8 16 28.1 21 35.6 18 30.5 20 33.9 .138 .330
 Sending results via email 27 48.2 16 28.6 13 23.2 15 24.2 24 38.7 23 37.1 .252 .023*
 Using computerized administration 36 45.6 10 17.5 11 19.3 43 64.2 12 17.9 12 17.9 .018 .981
 Relying on computerized software for diagnosis 24 43.6 17 30.9 14 25.5 25 39.7 22 34.9 15 23.8 .099 .763
 Administering via cell phone 22 37.9 20 34.5 16 27.6 15 25.0 26 43.3 19 31.7 .141 .312
 Administering via email 21 34.4 26 42.6 14 23.0 14 23.3 28 46.7 18 30.0 .127 .374
 Discussing results via text messaging 14 24.1 35 60.3 9 15.5 17 27.4 33 53.2 12 19.4 .073 .724
Supervision and consultation services
 Supervising via videoconferencing 43 74.1 10 17.2 5 8.6 34 58.6 10 17.2 14 24.1 .214 .019*
 Supervising via landline phone 43 74.1 5 8.6 10 17.2 42 71.2 8 13.6 9 15.3 .080 .688
 Supervising via cell phone 42 71.2 5 8.5 12 20.3 35 57.4 12 19.7 14 23.0 .162 .174
 Receiving supervision online 40 69.0 8 13.8 10 17.2 30 50.0 14 23.3 16 26.7 .193 .110
 Supervising via email 38 66.7 10 17.5 9 15.8 24 40.0 19 31.7 17 28.3 .297 .015*
 Supervising via instant messaging 29 52.7 15 27.3 11 20.0 19 33.3 23 40.4 15 26.3 .197 .114
 Supervising remotely to another state 28 51.9 10 18.5 16 29.6 31 52.5 10 16.9 18 30.5 .021 .976
 Seeking supervision on a listserv 26 45.6 12 21.1 19 33.3 18 29.5 21 34.4 22 36.1 .184 .135
 Supervising via text messaging 24 42.1 20 35.1 13 22.8 19 31.1 23 37.7 19 31.1 .123 .410
 Supervising via social networking 13 23.2 33 58.9 10 17.9 16 26.2 38 62.3 7 11.5 .092 .613
Records and communication practices
 Including emails in client record 40 67.8 13 22.0 6 10.2 39 60.9 14 21.9 11 17.2 .104 .517
 Storing client records on a computer, password-protected 39 61.9 17 27.0 7 11.1 38 53.5 20 28.2 13 18.3 .109 .453
 Faxing confidential information 33 54.1 17 27.9 11 18.0 34 55.7 13 21.3 14 23.0 .086 .635
 Storing electronic records only 31 52.5 17 28.3 11 18.6 37 53.6 20 29.0 12 17.4 .017 .983
 Emailing confidential information 29 49.2 19 32.2 11 18.6 24 38.7 17 27.4 21 33.9 .173 .162
 Failing to receive client message due to failure hardware/software 28 48.3 15 25.9 15 25.9 26 40.6 22 34.4 16 25.0 .097 .566
 Performing an online search to obtain client information 24 41.4 19 32.8 15 25.9 26 42.6 23 37.7 12 19.7 .078 .698
 Including texts in client record 25 41.0 19 31.3 17 27.9 23 35.9 24 37.5 17 26.6 .069 .743
 Losing client records due to a hardware/software failure 20 36.4 25 45.5 10 18.2 16 26.2 34 55.7 11 18.0 .116 .459
 Keeping schedule with identifying client information on cell phone 21 36.2 27 46.6 10 17.2 23 37.1 21 33.9 18 29.0 .158 .224
 Contracting with a third-party provider to store client records 18 31.6 23 40.4 16 28.1 19 29.7 23 35.9 22 34.4 .069 .752
 Storing client contact information on a cell phone or external storage 18 29.5 23 37.7 20 32.8 20 32.8 26 42.6 15 24.6 .091 .606
 Deleting digital client records at termination of counseling services 15 25.0 27 45.0 18 30.0 24 38.1 21 33.3 18 28.6 .150 .252
 Inadvertently emailing confidential client information to wrong person 12 20.7 37 63.8 9 15.5 14 23.7 40 67.8 5 8.5 .110 .495
 Storing client records on a computer, without password protection 12 20.3 43 72.9 4 6.8 14 22.6 45 72.6 3 4.8 .047 .875
Business and advertising practices
 Including links to relevant credentialing bodies on website 46 80.7 4 3.4 7 12.3 41 66.1 10 16.1 11 17.7 .173 .170
 Scheduling appointments with clients via email 46 78.0 9 15.3 4 6.8 47 72.3 14 21.5 4 6.2 .081 .667
 Maintaining a website that describes practice 39 69.6 5 8.9 12 21.4 41 66.1 8 12.9 13 21.0 .064 .787
 Submitting electronic claims to insurance 34 63.0 5 9.3 15 27.8 35 55.6 8 12.7 20 31.7 .079 .693
 Including organizational social media policy as part of informed consent 32 55.2 10 17.2 16 27.6 34 50.7 17 25.4 16 23.9 .099 .540
 Advertising services on the Internet 29 50.9 16 28.1 12 21.1 25 41.0 16 26.2 20 32.8 .135 .339
 Emailing clients about payment or insurance 28 50.0 8 14.3 20 35.7 31 51.7 7 11.7 22 36.7 .039 .915
 Participating in online public discussions about counseling 30 50.0 12 20.0 18 30.0 24 35.8 19 28.4 24 35.8 .147 .256
 Addressing social media as part of informed consent process 28 49.1 16 28.1 13 22.8 30 45.5 19 28.8 17 25.8 .041 .904
 Seeking referrals on professional listserv 25 >43.1 15 25.9 18 31.0 18 30.0 18 30.0 24 40.0 .138 .327
 Providing informational updates on Twitter 24 42.1 23 20.4 10 17.5 17 27.9 25 41.0 19 31.1 .183 .139
 Soliciting testimonials from clients for your professional website 22 38.6 21 36.8 14 24.6 25 39.7 19 30.2 18 28.6 .112 .683
 Providing professional advice on an online public listserv 17 29.8 21 36.8 19 33.3 16 25.4 26 41.3 21 33.3 .055 .834
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*

p < .05.

Results

Professional Counseling Services

During the pandemic, there was an increase in the use of videoconferencing, email, and cell phone to deliver professional counseling services. Based on data in Table 1, counseling via videoconferencing had the largest effect size (η2 = .356), increasing from “rarely” (M = 1.69; SD = 1.28) to “fairly often” (M = 3.60; SD = 1.43) during the pandemic. Furthermore, counseling via email in the pandemic increased from “sometimes” (M = 2.91; SD = 1.53) to “fairly often” (M = 3.83; SD = 1.36). Finally, counseling via the cell phone increased in the pandemic from “rarely” (M = 2.50; SD = 1.38) to “sometimes” (M = 3.29; SD = 1.48). Effect sizes for email (η2 = .099) and cell phone (η2 = .062) were smaller because they were more common before the pandemic. In contrast, the practice ratings for counseling via social networking (M = 1.09; SD = 0.43), instant messaging (M = 1.31; SD = 0.81), and text messaging (M = 1.61; SD = 1.03) remained at “never” during the pandemic. Finally, two of the practice ratings differed across employment contexts of state/federal vocational rehabilitation, private rehabilitation, and other settings during the pandemic. First, counseling services via email, F(2, 77) = 5.10, p = .008), had a rating of “fairly often” in state/federal vocational rehabilitation (M = 4.25; SD = 1.12) and private rehabilitation (M = 3.92; SD = 1.18) compared with “sometimes” in other settings (M = 3.22; SD = 1.55). Similarly, counseling via videoconferencing, F(2, 79) = 3.90, p = .024), had a more frequent rating in state/federal vocational rehabilitation (M = 4.05; SD = 1.22) compared with private rehabilitation (M = 3.00; SD = 1.56) and other settings (M = 3.37; SD = 1.50).

Surprisingly, only one of the ethics ratings came close to a statistically significant difference before versus during the pandemic. Based on the percentage of “no” concern, counseling via cell phone was rated as more ethically appropriate during (n = 41; 68.3%) versus before (n = 32; 49.2%) the pandemic. Although the other ethics ratings remained consistent before and during the pandemic, there were patterns in what was considered most and least ethically appropriate. The most ethically appropriate practices in the pandemic, based on the percentage of “no” ethical concern, involved counseling via landline phone (n = 45; 75.0%), cell phone (n = 41; 68.3%), videoconferencing (n = 36; 60.0%), and email (n = 37; 56.6%). In contrast, the least ethically appropriate practice behavior, based on the percentage of “yes” ethical concern, involved counseling via social networking (n = 36; 63.8%) during the pandemic. Across employment contexts, the percentage of “yes” concern for counseling via social networking, χ2(4, n = 55) = 9.18, p = .048, was higher within state/federal vocational rehabilitation (n = 19; 76.0%) and private rehabilitation (n = 7; 70.0%) compared with other settings (n = 8; 40.0%).

Professional Assessment Services

During the pandemic, there was an increase in the use of videoconferencing and cell phone to discuss assessment results with clients. Reflected in Table 1, the use of videoconferencing to discuss assessment results had the largest effect size (η2 = .205), increasing from “never” (M = 1.32; SD = 0.98) to “sometimes” (M = 2.46; SD = 1.23) in the pandemic. In addition, the use of videoconferencing to administering assessments in the pandemic increased (η2=.070) from “never” (M = 1.20; SD = 0.54) to “rarely” (M = 1.68; SD = 0.89). Furthermore, the use of computerized interpretation software in the pandemic decreased from above “rarely” (M = 2.17; SD = 1.34) to below “rarely” (M = 1.67; SD = 1.02). In fact, all of the practices related to computerized assessment software for administration, scoring, and diagnosis had ratings below “rarely” during the pandemic. The practice ratings were similar across state/federal vocational rehabilitation, private rehabilitation, and other settings during the pandemic.

For the ethics ratings, only one assessment practice had a statistically significant difference before versus during the pandemic. Sending assessment results via email had a higher percentage of “no” ethical concern during (n = 27; 48.2%) versus before (n = 15; 24.2%) the pandemic. The other ethics ratings remained similar before and during the pandemic. The practices viewed as most ethically appropriate, based on the percentage of “no” ethical concern, involved discussing assessment results with clients via videoconferencing (n = 41; 68.3%), landline phone (n = 38; 64.4%), and cell phone (n = 34; 57.6%) as well as the use of computerized software for scoring (n = 34; 60.7%) and interpretation (n = 35; 62.5%). In contrast, the least ethically appropriate practice, based on the percentage of “yes” ethical concern, involved discussing assessment results via text messaging (n = 35; 60.3%) during the pandemic. The ethics ratings were similar across employment contexts during the pandemic.

Supervision and Consultation Services

During the pandemic, there was an increase in the use of technology-based supervision. Providing supervision via videoconferencing had the largest effect size (η2=.129), increasing from “rarely” (M = 1.64; SD = 1.17) to “sometimes” (M = 2.64; SD = 1.49) during the pandemic. Similarly, receiving supervision via videoconferencing increased in the pandemic from “rarely” (M = 1.74; SD = 1.13) to “sometimes” (M = 2.42; SD = 1.44). The other practice ratings were similar before and during the pandemic. In addition to videoconferencing, the other most common practices in the pandemic involved providing supervision via cell phone (M = 2.37; SD = 1.41), landline phone (M = 2.35; SD = 1.44), and email (M = 2.23; SD = 1.30). In contrast, the least common practices were supervising via instant messaging (M = 1.58; SD = 1.02) and social networking (M = 1.10; SD = 0.53) during the pandemic. The practice ratings were similar across the employment contexts during the pandemic.

For the ethics ratings, a higher percentage of CRCs in the pandemic rated supervision via email and videoconferencing as ethically appropriate. Based on Table 2, supervising via email had the largest effect size (η2 = .297), with a higher percentage of “no” ethical concern during (n = 38; 66.7%) versus before (n = 24; 40.0%) the pandemic. Supervising via videoconferencing also had a higher percentage of “no” concern during (n = 43; 74.1%) versus before (n = 34; 58.6%) the pandemic. Other practice ratings remained similar before and during the pandemic. The most ethically appropriate practice, based on the percentage of “no” ethical concern, involved supervision via landline phone (n = 43; 74.1%) and cell phone (n = 42; 71.2%) during the pandemic. In contrast, the least ethically appropriate practice, based on the percentage of “yes” ethical concern involved supervision via social networking (n = 33; 58.9%). The ethics ratings for supervision practices were similar across the employment contexts of state/federal vocational rehabilitation, private rehabilitation, and other settings.

Records and Communication Practices

The practice ratings for records and communication practices were similar before and during the pandemic with one exception. With a small effect size (η2 = .050), the practice of searching online for client information decreased from above “rarely” before (M = 2.14; SD = 1.15) versus below “rarely” during (M = 1.63; SD = 0.94) the pandemic. The other practice ratings were similar before and during the pandemic. The most common practice behaviors in the pandemic involved storing client records on a computer with password protection (M = 3.95; SD = 1.45) and including emails in client records (M = 3.34; SD = 1.44). In contrast, the least common practice behaviors in the pandemic involved inadvertently emailing confidential client information to an incorrect recipient (M = 1.28; SD = 0.67), losing records due to a computer failure (M = 1.21; SD = 0.49), and failing to receive client messages due to a computer failure (M = 1.52; SD = 0.71). Practice ratings during the pandemic were similar across state/federal vocational rehabilitation, private rehabilitation, and other settings.

The ethics ratings for the records and communication practice behaviors were similar before and during the pandemic. Based on the percentage of “no” ethical concern, the practices viewed as most ethically appropriate were including emails in the client record (n = 40; 67.8%), storing client records on a password-protected computer (n = 39; 61.9%), storing electronic records only (n = 31; 52.5%), and faxing confidential information (n = 33; 54.1%). In contrast, the practices rated as the least ethically appropriate, based on the percentage of “yes” concern, involved storing client records on a non-password-protected computer (n = 43; 72.9%) and inadvertently emailing confidential information to the wrong recipient (n = 37; 63.8%). Finally, there was a statistically significant difference for two ethics ratings across employment settings. Based on the percentage of “yes” concern, there was more ethical concern for storing client records on a computer without password protection,, χ2(4, n = 57) = 12.11, p = .009, in state/federal vocational rehabilitation (n = 20; 87.0%) and private rehabilitation (n = 9; 90.0%) compared with other settings (n = 12; 50.0%). In addition, storing client contact information on a cell phone or external storage device,, χ2(4, n = 55) = 10.08, p = .018, had a higher percentage of “yes” ethical concern in state/federal vocational rehabilitation (n = 15; 60.0%) and private rehabilitation (n = 5; 62.5%) compared with other settings (n = 6; 25.3%).

Business and Advertising Practices

Only one business and advertising practice had a statistically significant difference before versus during the pandemic. Based on Table 1, addressing social media as part of informed consent decreased from “sometimes” (M = 2.52; SD = 1.89) to “rarely” (M = 1.98; SD = 1.48) during the pandemic. The other practice ratings remained similar before versus during the pandemic. The most common practice in the pandemic involved scheduling appointments via email (M = 3.40; SD = 1.54). In contrast, the least common practices involved “never” seeking referrals on professional listservs (M = 1.13; SD = 0.57), advertising services on the Internet (M = 1.13; SD = 0.44), providing informational updates on Twitter (M = 1.17; SD = 0.55), or providing advice on a professional listserv (M = 1.24; SD = 0.64). Furthermore, practice ratings of “never” included soliciting client testimonials for a website (M = 1.22; SD = 0.86) and submitting electronic claims to insurance (M = 1.39; SD = 1.00). The practice ratings were similar across employment contexts during the pandemic.

The ethics ratings for the business and advertising practices remained consistent before versus during the pandemic. Based on the percentage of “no” ethical concern, practice behaviors rated as most ethically appropriate in the pandemic consisted of linking relevant credentialing bodies on websites (n = 46; 80.7%), scheduling appointments with clients via email (n = 46; 78.0%) and submitting electronic claims to insurance (n = 34; 63%). In contrast, the practice behaviors viewed as the least ethically appropriate, based on the percentage of “yes” concern, included offering professional advice on a professional listserv (n = 21; 36.8%) and soliciting testimonials from clients for a website (n = 21; 36.8%) during the pandemic. Across employment contexts, the ethics ratings for addressing social media as part of the informed consent process differed during the pandemic, χ2(4, n = 55) = 12.04, p = .007. Specifically, there was a higher percentage of “yes” ethical concern within state/federal vocational rehabilitation (n = 11; 44.0%), compared with private rehabilitation (n = 1; 12.5%) and other settings (n = 3; 13.6%).

Discussion

Due to the small sample size, it would be inappropriate to generalize the findings of the present study to the entire population of 15,000 professionals who hold the CRC credential. This is especially true given that rehabilitation counselors have a diverse scope of practice (Hartley & Tarvydas, 2023). Rather than one job or work setting, rehabilitation counselors perform diverse tasks and functions across a wide range of settings. Without a more substantial and robust sample, there is an elevated risk of not detecting a statistically significant difference, if an actual difference existed. Despite these limitations, the results of the present study offer a context to understand and apply recent revisions to the current CRCC (2023)Code regarding the ethical use of technology in rehabilitation counseling. In particular, the findings point to the need to differentiate between and better understand the ethics of technology practice when using asynchronous versus synchronous modes of communication.

Technology-Based Counseling and Assessment

The findings from the present study add evidence that when providing counseling and assessment services, synchronous modalities such as the telephone and videoconferencing were most used in the pandemic (Sampaio et al., 2021). This fits with previous research that the use of videoconferencing via platforms such as Zoom, Skype, and Microsoft Teams surged during the pandemic (McClain et al., 2021). In fact, it is somewhat surprising that the CRCs reported using telephone and videoconferencing to provide counseling only “fairly often” as opposed to “very often.” The pandemic was a unique moment in time when government restrictions and penalties for violations to privacy and confidentiality were waived (Adolph et al., 2022; Oesterle et al., 2020). However, these changes were not uniform but differed across states, settings, and agencies. In addition, distance counseling is not appropriate for all client situations. With this in mind, the new CRCC (2023)Code has mandated more flexibility, stating “although some clients may find technology-based services to be a convenient and preferred method of service delivery . . . electronic modalities may not be well suited for all clients and all situations” (K.1.a., p. 35). Beyond the clinical and technological competence of the counselor, it is important to consider the client and their situation.

In addition to the practice ratings, this study looked at trends in the ethical opinions or beliefs about technology use in rehabilitation counseling. Results revealed the most ethically appropriate practices included counseling via telephone and videoconferencing. This may be because real-time conversations on the telephone and videoconferencing most closely resemble the dynamics of in-person, face-to-face services (Glueckauf et al., 2018; McMinn et al., 2011). Perhaps for this reason, there was a high degree of congruence between beliefs and behaviors, with the CRCs engaging in the technology practices they rated as the most ethically appropriate. Similarly, the ethics ratings in the present study suggested that the CRCs adapted to providing technology-based assessments (Pebdani et al., 2022). However, with more guidance in the new CRCC (2023)Code regarding digital assessment administration (H.6.b), it will be important to monitor trends in assessment practices such as computerized software used only “rarely” in the pandemic. Another trend to monitor was that the CRCs emailed assessment results to clients more frequently during the pandemic. The Code specifically cautions about transmitting confidential information via email and text messaging (K.3.a., p. 35).

When it came to social networking, instant messaging, and text messaging, the CRCs reported “never” using these technologies to provide counseling and assessment services before or during the pandemic. This fits with pre-pandemic research that counseling professionals hold ethical reservations about the use of non-verbal, asynchronous technologies to provide counseling and assessment (Glueckauf et al., 2018; McMinn et al., 2011). In addition to never using these technologies, there was a high percentage of concern about the ethics of social networking in rehabilitation counseling (Hartley et al., 2015). In other words, the high degree of ethical concern suggested congruence between the beliefs and behaviors of CRCs with a general reticence toward using social networking, instant messaging, and text messaging to deliver counseling and assessment services. Recent revisions to the CRCC (2023)Code have expanded the social media guidance with respect to personal virtual relationships with clients (A.4.f.) and unique but varied ethical concerns related to privacy, confidentiality, and informed consent (K.4.). If social networking and text messaging continue to become preferred modes of communication by future generations of clients, it will be important to distinguish these modalities from more traditional processes of counseling (Nitzburg & Farber, 2019).

Technology-Based Supervision and Consultation

Findings demonstrated an increase in the use of technology-based supervision during the pandemic. Supervision was most often provided via the telephone and videoconferencing, and least often provided via text messaging and social networking during the pandemic. Although the present study did not measure satisfaction with supervision, other researchers have reported that rehabilitation counselors were generally satisfied with supervision during the pandemic (Levine et al., 2022). Hopefully the use of technology-based supervision continues beyond the pandemic given the advantages of increased access to supervisors in different locations.

Across the ethics ratings, the technology-based supervision practices were generally viewed as ethically appropriate. Most of the practice behaviors included a majority of the CRCs reporting “no” ethical concern. One exception was the use of social networking to provide supervision. Although the CRCC (2023)Code does not differentiate between synchronous and asynchronous communication, there is a clear requirement that “supervisors are competent in the use of those technologies” and take “necessary precautions to protect the confidentiality of all information transmitted through any electronic means” (I.2.c., p. 27). Moving forward, it will be critical to reflect and expand on best practices for distance supervision that emerged from the pandemic to address ethical issues such as competency, informed consent, and evidence-based practices (Lund & Schultz, 2015). Consistent with the current preamble for Section H: Supervision, Training, and Teaching, it is vital to continue recognizing and supporting the notion that ethical and effective supervision can occur in face-to-face, online, and hybrid formats.

Digital Records and Business Practices

The practice ratings remained relatively similar for records and communication as well as business and advertising before and during the pandemic. For instance, storing client records on a computer with password protection was one of the most common practices before and during the pandemic. In contrast, the least common practices were problematic behaviors, such as losing records due to a hardware/software failure and inadvertently emailing confidential client information to the wrong person. For record and communication practices, the one rating that changed during the pandemic was a decrease in searching online for client information during the pandemic. This is positive ethical trend given the CRCC (2023)Code mandates that CRCs “respect the privacy of their client’s presence on social media and avoid searching a client’s virtual presence unless relevant to the rehabilitation counseling process” (J.4.d., p. 32). In other words, it is unethical for rehabilitation counselors to google their clients, although there may be exceptions, such as a suicidal client who is not responding to phone calls (Hartley et al., 2021). Although some have argued online information is public and therefore not private, Harris and Kurpius (2014) counter by pointing out it is important to consider the intent and intentionality. For instance, there is a significant difference between searching online for client’s personal information versus their employment information as part of vocational counseling.

In contrast, there was a decrease in addressing social media as part of informed consent during the pandemic. This is problematic given the CRCC (2023)Code required “rehabilitation counselors clearly explain to their clients, as part of the informed consent procedure, the benefits, limitations, and boundaries of the use of social media in the provision of services” (J.4.c, p. 32). Given the low practice ratings for social networking, it is possible that the CRCs did not believe they needed to address social media as part of informed consent. Yet, not addressing it could lead to miscommunication with clients, and thus the best practice is to have a statement to the effect that the rehabilitation counselor does not use social media in their practice. Informed consent is essential to clients making informed and autonomous decisions. Revisions to the CRCC (2023)Code have clarified informed consent considerations for use of digital technology in addition to the usual and customary protocol (K.3.c.; K.5.a).

Implications

The findings of the present study add evidence that the first year of the COVID-19 pandemic and community lockdown had a significant impact on the delivery of rehabilitation counseling services (Levine et al., 2022; Pebdani et al., 2022). Although vaccines and other mitigation efforts have since reduced the severity of symptoms as well as rates of transmission, hospitalization, and death, individuals with disabilities continue to be differentially impacted by the pandemic. This has included an elevated risk of severe health outcomes due to co-morbidities and poor social determinants of health such as unsafe housing and limited transportation (Shakespeare et al., 2021; Wong et al., 2022). With this in mind, a return to pre-pandemic technology practice may not be ethically possible or desirable (Saia et al., 2021). With clients and counselors becoming comfortable with distance services, many government policies put in place during the first year of the pandemic have remained (Adolph et al., 2022; Oesterle et al., 2020). It is, thus, important for rehabilitation counselors to reflect on the evolution of the ethical use of technology within the practice of rehabilitation counseling (Hartley & Tarvydas, 2023).

A critical moment for distance counseling, the pandemic brought about dramatic changes in the use of technology in counseling, and the ever-growing pace of technology in our society indicates further change seems inevitable. As technology and its uses in counseling evolve, ongoing attention to its application is required to maintain and promote ethical practice. As we extend our practices beyond our offices and physical locations, technological applications are changing the reliance on traditional face-to-face services. Indeed, clients and counselors may continue to prefer technology-based services. If so, it may no longer be viable to be averse to using technology in counseling. This means it is more important than ever before to develop ethical guidance on technology use within rehabilitation counseling. Since technology use will continue to evolve within rehabilitation counseling, the new preamble for Section K: Technology, Social Media, and Virtual Counseling provides an aspirational mandate that (p. 35):

CRCs/CCRCs recognize that service provision is not limited to in-person, face-to-face interactions. CRCs/CCRCs actively attempt to understand the evolving nature of technology-based services, social media, and virtual counseling and how such resources may be used to better serve clients. CRCs/CCRCs appreciate the implications for legal and ethical practice when using technology, social media, or virtual counseling and are particularly mindful of issues related to confidentiality, accessibility, and online behavior. When providing virtual counseling, CRCs/CCRCs are mindful of their professional behavior and disposition, and the background.

One of the major limitations of an ethical code is that standards must be broad enough to address general practice, yet specific enough to guide individual practitioners to make good ethical decisions (Tarvydas et al., 2010). The revisions to the CRCC (2023)Code must, thus, be understood and carefully applied to various technologies. With the potential for emerging technology to reshape face-to-face services, it is essential that rehabilitation counselors behave as e-professionals, defined as the “attitudes and behaviors (some of which may occur in private settings) reflecting traditional professionalism paradigms that are manifested through digital media” (Cain & Romanelli, 2009, p. 66). Rather than a false dichotomy of fully competent to incompetent with respect to technology use, ethical practice in the digital age requires competence to be on a continuum of constant improvement with clear guidance and oversight.

As a complement to the ethical standards of the CRCC (2023)Code, there is a need for accompanying best practice guidelines. Such best practice guidelines must focus on different types of technologies, such as asynchronous versus synchronous as well as unique employment contexts and client populations. Since CRCs used videoconferencing so much more frequently during the pandemic, examples of best practice guidelines could address the use of passwords and wait rooms, legal requirements, and recommendations for security on the most frequently used software platforms such as Zoom and Skype (Elhai & Frueh, 2016). Rehabilitation counselors are likely already engaging in these best practices, and it is just a matter of codifying good ethical practices in ways that can help train future generations of professionals.

Finally, it is not enough for CRCs to know ethical standards. Rather, CRCs must have the clinical competence to deliver distance services ethically and effectively, including emergency and safety planning for client welfare (Lin et al., 2021; Maier et al., 2021). Clinical guidance on how to provide distance services needs to address the broader context of technology use in our society, including the necessary clinical competence and infrastructure necessary to ensure client safety (Bourgeois et al., 2022). Moving forward, it is incumbent that training programs focus on teaching the ethical use of technology as part of rehabilitation counseling practice (Bernacchio & Wilson, 2018). This requires that clinical supervisors are competent to engage in the effective and ethical use of both traditional and online supervision with a focus on ensuring supervisees have both the clinical and technological competence necessary for distancing counseling practice (Lund & Schultz, 2015). Given that the therapeutic skills of in-person counseling may not automatically translate to counseling via technology, it is critical that the professional practice of rehabilitation counseling continues to evolve in the digital age.

Limitations

Although the CRCs were generally representative of the overall CRCC population, all of them self-selected into the research study. This process relied heavily on respondents’ truthfulness, accuracy of self-perceptions, and willingness to report potentially sensitive work behaviors and/or opinions. As such, there was potential response bias as well as limitations in the survey items themselves given there was no context for the practice behaviors. Instead, participants responded based on their own understanding, which may have created difficulties and decreased the generalizability of the responses. Furthermore, the two samples consisted of different CRCs who completed the survey at two different points in time with potential history confounds beyond the pandemic not controlled for. Caution is, thus, warranted in generalizing the findings. Despite these limitations, the results do provide a glimpse into the ethical beliefs and behaviors of technology use among CRCs before and during the COVID-19 pandemic.

Conclusion

The COVID-19 pandemic and community lockdown represented a critical moment for technology use within rehabilitation counseling. Similar to other healthcare fields, the pandemic forced rehabilitation counselors to extend their professional practice beyond the confines of offices and physical locations. With many rehabilitation counselors engaging in distance services for the first time, the results of the present study revealed that rehabilitation counselors were engaging in the technology practice they believed to be most ethical at the time. An entire professional field becoming competent to provide distance services is no small feat, and there is a need for continued research to monitor and promote best ethical practices for technology use within rehabilitation counseling.

Footnotes

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.

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