The following guidance takes account of that written by the College for Child and Adolescent Psychotherapies (CCAP) to support CCAP members who may have occasion to work with infants, children and young people online.

These guidelines are to be used in conjunction with UKCP Guidelines for Working Online/Remotely (2021) and UKCP Code of Ethics and Professional Practice (Code of Ethics), which can be found on the UKCP website, as well as the Au Milieu online social media/digital policy below.

All other UKCP/CCAP and Au Milieu guidance for working therapeutically with infants and their caregivers must also be adhered to alongside these online guidelines.

For the purposes of this document:

• ‘Infant’ refers to children up to around 2 years of age.
• ‘Online’ refers to working face to face on a secure online platform.

 

Au Milieu is a specialist service providing infant-parent psychotherapy that aims to promote early relational health. This involves working with the relationship between the baby and the parent(s), or with the mother (and possibly partner) during pregnancy.  Although this is best achieved face to face there may be certain circumstances when face to face work is not possible (such as during a pandemic or caused by the risk of infection). At such times, online work may be appropriate, although challenging to facilitate. This will involve limited work, most likely in a supportive role, with the caregiver(s). 

 

Deciding whether to work online is a complex process and must include a consideration of:

1) Therapist

1. Therapists should ensure they have a safe and uninterrupted space from which to work and that confidentiality can be maintained.
2. The therapist / trainee must be competent with delivering therapy online and have completed any necessary additional training.
3. Appropriate insurance cover and professional body support for online working should be in place.

2) Context

1. The challenges for the therapist in providing the degree of containment needed for safe therapeutic work means that the therapist may need to draw on the support of others for this process. If this has become an option for a trainee, then it must first be discussed with his or her supervisor and approved by the director of training.
2. Boundary considerations in respect of online working are vastly different, and therapists will need to be able to manage the complexity of this extended therapeutic frame within the bounds of safety, confidentiality, data management and the session’s therapeutic aim. 
3. There are questions to consider, many of which the therapist / trainee may already have information on following previous contact either in the home or a clinic. – For example, does the caregiver have their own room or a space where they can engage without interruption? Will the infant be either visible or in a safe space, monitored by the caregiver or another responsible adult (this should be recorded)? What is the likelihood that others might overhear or disrupt the session? The latter is a particular consideration when there is a risk of domestic violence within a household. What is the overall level of household order or chaos, and how might this impact on online contact?
4. It is Au Milieu’s policy that all therapeutic interventions should, whenever possible, take place during the times when the therapist / trainee has access to the local safeguarding service. If this may not be the case, then whether or not to proceed must be discussed with the director of training.

 

Potential Risks.

1. Cybersecurity – is it possible for local third-party access (for example, are any other individuals able to monitor/hack or record communications)?
2. To what extent does the caregiver have private control of the physical equipment such as a smartphone or laptop? (For example, what is the risk of confiscation or third-party access when domestic violence is suspected?)
3. Evaluating developing safeguarding issues in context can be more complex and difficult to assess accurately.
4. Does the therapist / trainee have ‘live’ support processes in place in the event of needing to escalate safeguarding concerns that might arise during the session? Consideration should also be given to the fact that the therapist / trainee is isolated themselves, that technology may fail and that they may struggle to get into immediate contact with necessary support services.
5. What is the impact of the therapeutic session content remaining in the caregiver’s space by working online, rather than being able to be ‘left’ with the therapist / trainee? It is necessary to keep in mind that online contact within the early relational health field is primarily supportive and that it is complex and it is not appropriate to address complex or conflictual issues. It is recommended that thought has been given for the eventuality that the caregiver raises such issues or becomes distressed.
6. Data security arrangements and confidentiality may need to be reviewed. It is not appropriate for therapists / trainees to record any online session on a personal pc or smartphone.
7. Security of therapist / trainee contact details needs to be considered as this could provide access to personal social media, etc..

This policy will be reviewed every two years or sooner, depending on relevant advances in social media and digital technology.

01/12/2024.