title: Consensus Among International Ethical Guidelines for the Provision of Videoconferencing-Based Mental Health Treatments.
abstract: BACKGROUND
  Online technologies may reduce barriers to evidence-based mental health care, yet they also create numerous ethical challenges. Recently, numerous professional organizations and expert groups have produced best-practice guidelines to assist mental health professionals in delivering online interventions in an ethically and clinically sound manner. However, there has been little critical examination of these international best-practice guidelines regarding appropriate electronic mental health (e-mental health) service delivery via technologies such as videoconferencing (including Skype), particularly for specific, vulnerable populations. Further, the extent to which concordance exists between these guidelines remains unclear. Synthesizing this literature to provide clear guidance to both mental health professionals and researchers is critical to ensure continued progress in the field of e-mental health.
  
  
  OBJECTIVE
  This study aims to review all currently available ethical and best-practice guidelines relating to videoconferencing-delivered mental health treatments in order to ascertain the recommendations for which international consensus could be found. Additionally, this review examines the extent to which each set of guidance addresses several key special populations, including children and young people, and populations living with illness.
  
  
  METHODS
  This systematic review examined guidelines using a two-armed search strategy, examining (1) professional organizations' published guidance; and (2) MEDLINE, PsycINFO, and EMBASE for the past ten years. In order to determine consensus for best-practice, a recommendation was considered "firm" if 50% or more of the reviewed guidelines endorsed it and "tentative" if recommended by fewer guidelines than these. The professional guidelines were also scored by two raters using the Appraisal of Guidelines for Research and Evaluation II (AGREE-II) criteria.
  
  
  RESULTS
  In the study, 19 guidelines were included, yielding 11 specific "firm" and a further 123 "tentative-level" recommendations regarding the appropriateness of e-mental health, competence, legal and regulatory issues, confidentiality, consent, professional boundaries, and crisis management. International consensus yielded firm guidance across almost all areas except professional boundaries and some aspects of determining the appropriateness of e-mental health. Few guidelines specifically addressed special populations. Overall guideline quality varied; however, 42% (8/19) of the guidelines scored at least 5 out of 7.
  
  
  CONCLUSIONS
  This synthesis of guidelines provides a foundation for clinicians and researchers utilizing e-mental health worldwide. The lack of specific guidance relating to special populations is an area warranting further attention in order to strengthen mental health professionals' and researchers' capacity to ethically and effectively tailor e-mental health interventions to these groups.
authors.affiliation: Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Randwick, Australia. ursula@unsw.edu.au.
authors.forename: Ursula M
authors.identifier: http://orcid.org/0000-0003-4200-8900
authors.initials: UM
authors.lastname: Sansom-Daly
authors.forename: Claire E
authors.identifier: http://orcid.org/0000-0001-7704-7067
authors.initials: CE
authors.lastname: Wakefield
authors.forename: Brittany C
authors.identifier: http://orcid.org/0000-0002-2134-2988
authors.initials: BC
authors.lastname: McGill
authors.forename: Helen L
authors.identifier: http://orcid.org/0000-0003-4464-8944
authors.initials: HL
authors.lastname: Wilson
authors.forename: Pandora
authors.identifier: http://orcid.org/0000-0002-1686-3252
authors.initials: P
authors.lastname: Patterson
keywords: Internet; Skype; cognitive therapy; ethics, professional; guidelines as topic; mental health; professional practice; societies; standards; videoconferencing