Ethics Quiz 2

What do some managed care policies dictate in terms of info that can be shared w client

Cant share any negative info about managed care policies, including options not covered by the plan. These work against the mental health workers ethical obligation to provide clients with info about risks/costs of interventions

Can case notes be altered after they have been entered into the clients record

Case notes can never be altered or tampered with after being entered into teh clients record. Doing so can cast a shadow on therapists integrity in court.

What is the legal requirement that informed consent entails regarding client understanding

Client must understand the info presented, give consent voluntarily,a Dan is competent to give consent to treatment/knows consequences

Clients rights to access their files

Clients have legal right to inspect and obtain copies of records kept. Clients have ultimate responsibility for decisions about their health care, their condition info, adn care provided.

How to discuss Diagnostic classification as a requirement for third party reimbursement for psychological services with client

Clients should be informed of how they will be classified and it will permanently be on their file, what the classifications are, and that they will be shared with insurance companies for reimbursement. The diagnosis can effect the costs of insurance, long term insurability, and employment. Add this statement to informed consent. Discuss diagnosis/revisions with client as placed in record. Clients do not have control over who receives this information. Many people have access to it.

How much control over confidential info do clinicians have when released to insurance agencies.

Clinicians have no control over confidential information once it leaves their offices to the third party to authorize initial or additional treatment. Many managed care contracts require practitioners to submit all progress notes before payment is issued. Practitioners can not give clients confidential therapy at any level. Some clients want to safeguard their privacy adn confidentiality by seeking treatment that does not involve third party reimbursement

What topics are most appropriate in initial counseling sessions

Concerns, interests, and questions of the client.

Guidelines for record keeping when involving the court process

Consider the possibility that the contents of a clinical record might someday be read in a courtroom with the client present

What to tell the client about costs involved in thearpy

Costs and methods of payment must be provided at beginning of services. Policy for missed appointment or late cancelation should be stated. Inform about insurance reimbursement/limitations of their health plan with fees. If feesa re subject to change, this should be made clearer in the beginning verbally and in writing. It's good to have a range in mind that is accepted in a community. Matters of fees need to be documented.

Documentation code of ethics for american psychological association

Create, control, maintain, spread, store, retain, adn dispose of records/data in order to 1. Facilitate services by other professionals 2. Allow for replication of research design/analyses 3. Meet institutional requirements 4. Ensure accuracy of billing and payments 5. Ensure compliance with law

What to tell the client about the therapeutic process

- it may cause disruptions, turmoil in life, pain, and anxiety. Some clients may choose to settle for a limited knowledge of themselves rather than risk disruption, this should be explored and respected. Frank discussion of how change happens. Procedures and goals of therapy and right to refuse.

What 4 things need to be present to succeed in a malpractice claim

1. A professional relationship between the therapist and client must have existed 2. The legal duty based on this relationship must have been breached; the therapist must have acted in a negligent or improper manner, or deviated from teh standar pracrtice in the community 3. The client must have suffered. Harm or injury such as emotional or physical, which must be verified 4. There must be a legally demonstrated causal relationship between teh practitioners negligence or breach of duty and the damage or injury claimed by the client

Factors to consider when Counseling minors without informed consent

1. Competence of minor 2. Risks/consequences if treatment is denied 3. Chances minor will not seek help/secure permission from parents 4. How serious is the problem 5. Laws pertaining to counseling ithout consent 5. Consult with other professionals

What should the informed consent form include in terms of what the clinician will need access to

1. Diagnosis, results on tests, clinical info, treatment plans, and entire clinical record of a client

Questions to ask about at teh onset of treatment

1. Goals 2. Techniques, procedures, and potential benefits/risks of services, client expectations, practitioners approach to counseling, qualifications of the provider of services, financial considerations, duration of therapy, limitations of confidentiality, mandatory reporting

What are repercussions that should be discussed

1. Limits of confidentiality 2. Potential repercussions of disclosing personal info to insurance providers. Some services may not be covered under their insurance plans and the insurance plan review teh type and length of treatment received, adn that payment for treatment might be terminated before teh client/counselor thinks the goals of therapy have been achieved. Coverage may be denied by managed care company, so considering out of pocket payments, prop bono, reduced fee, or a referral could be helpful

In what 6 situations is malpractice typically found

1. Procedure used by therapist was not within the realm of accepted professional practice 2. Practitioner employed a technique that they were not trained to use 3. Professional could have used a mroe helpful procedure 4. Therapist failed to warn others about an dpretect them from a violent client 5. Informed consent to treatment was not obtained or documented 6. Professional did not explain eh possible consequences of the treatment

what is the best way to ask clients about past sexual abuse related to their current problem

1. be attentive to kinds of questions you ask 2. remain nonjudgemental and demonstrate empathy as you talk to client about possible memories of abuse 3. avoid prejudging the truth of the clients response 4. if a client reports a memory, explore it 5. us standard assessment and treatment techniques 6. avoid pressuring client to believe events that didnt occur 7. do not minimize a clients reported memories 8. do not suggest they terminate the relationship carefully

course of action in a malpractice suit:what are the steps to consulting with professional association/attorney

1. consult professional association 2. attorney

when documenting child abuse what do you need to do

1. document allegations 2. circumstances when memory was revealed 3. techniques used to assess truth of memory 4. treatment options considered 5. consultation/referal

in writing about clients, what are 3 options for presenting case material?

1. seek clients permission to publish, which some consider ethically questionable because entails inserting the clinicians professional agenda into clients treatment 2. disguise case material for publication, which may or may not release therapist from needing to secure clients permission or 3. develop composite case material from two or more clients.

confidentiality and privacy in a school setting: balance ethical and legal responsibilities w what 3 groups

1. students 2. parents/guardians 3. school system. if parents provide informed consent then they may need to be involved in the counseling process.

under what circumstances does the APA ethics code state it is okay to disclose confidential information (4)

1.privde needed professional services 2.obtain appropriate professional consultations 3.protect the client/patient, psychologist, or others from harm 4.to obtain payment for services, where disclosure is limited to the minimum necessary to achieve the purpose.

What happens if a practitioner dosnt take due care and act in good faith?

A malpractice lawsuit alleges negligence in meeting one's professional responsibilities or duties. The plaintiff may claim that a practioners actions, or lack of, deveaited from teh acceptable standard of care and directly caused harm to teh client.

Documentation code of ethics for american mental health counselors association

A)create, maintain, store, transfer,and dispose of client records in ways that protect confidentiality B) establish plan for transfer, storage, and disposal of client records in case of withdrawal from practice/death

confidentiality and privacy in a school setting: what does the ASCA state about school counselor's prioritisation in confidentiality with minors

ASCA states that school counselors recognize their primary obligation for confidentiality is to the student but balance that obligation with an understanding of the parents legal and inherent rights to be the guiding voice for their children. must safeguard confidentiality of minors to extent that is possible.

Guidelines for record keeping - what information to include about what

Address client and therapist behavior that is clinically relevant, include interventions used, client responses to treatment strategies, teh evolving treatment plan, and any followup measures taken

Definition of process notes

Also know as psychotherapy notes, they deal with client reactions such as transference and the therapists subjective impressions of a client. May include intimate details; dreams/fantasies, sensitive info on personal life; therapists own thoughts, feelings reactions. Process notes are not meant to be readily or easily shared with others, intended for practitioners who created them. It's a way to organize ideas to bring to supervision. Best to exclude diagnosis, ,treatment plan, symptoms, prognosis, and progress from these notes.

How long to keep records

As long as is reasonably possible. There are state and federal regulations to check. Retain records for 10 years post termination, and 10 years after a minor client has turned 21. Keep brief summary of clients treatment once clients complete records are destroyed.

How to help avoid complaints by communicating WHAT to clients

Ask for regular feedback from clients about the degree to which they are satisfied with the services rendered to them

Definition of malpractice

Bad practice, it is a failure to render professional services or to exercise the degree of skill that is ordinarily expected of other professionals in a similar situation. It is a legal concept involving alleged negligence that results in injury or loss to teh client.

Guidelines for record keeping length

Be throughout, and keep notes as concise as possible

What's the disadvantage to online counseling

Both therapist and Client need training

Definition of informed consent document

Define boundaries and clarify teh nature of the basic counseling relationship between teh counselor and the client.

What to tell teh client about the background of the therapist

Description of their training and education, credentials, Li's ensues, specialized skills, theoretical orientation, and the types of problems that are beyond teh scope of their competence. This is a legal requirement. If the counseling is done by and intern who will be consulting with the supervisor the client needs to know. If the provider will be working with the supervisor teh client should know.

What is the primary focus of a negligence suit?

Determining what standard of care to apply in deciding whether a breach of duty to a client has taken place.

What to tell the client about benefits and risks of treatment

Emphasize the client's responsibility for the outcomes of thearpy. Need to know no promises can be made about outcome success.

What to tell client about interruptions in therapy

Explain the possibilities for both expected adn unexpected interruptions and how they would best be handled. Practitioners will need writtten consent to provide info to their substitutes. May help to name at least one professional in informed consent that is willing to assume their professional responsibilities if an emergency occurs. Who will maintain their files should also be addressed.

What should the therapist inform the client about when obtaining informed consent

Fees, anticipated course and nature of therapy, involvement of third parties, and limits of confidentiality, provide sufficient opportunity for the client/patient to ask questions and receive answers

What to do if a colleague is being unethical

First talk directly with the colleague respectfully and nonthreateningly, and if no resolution is apparent, report the behavior to a supervisor/admin or go to teh professional organization the colleague belongs to. It is also an option to talk to the client directly and say give them advice on how to proceed when they have concerns about a professional's actions. If this is ineffective you must lodge a complaint.

Who is fit for online counseling VS unfit

Fit = career counseling and educational counseling Unfit = severe/deep personal/interpersonal concerns. Any complex variables

When do minors not need parental consent for treatment?

For dangerous drugs or narcotics, for sexually transmitted diseases, pregnancy/birth control, examination following sexual assault of a minor over 12. Years of age

In the case of suicide what two factors determine a practioners liability?

Foreseeability and reasonable care

When is it better to not talk with a college about their ethical misconduct?

Generally it is best to deal directly with the colleague, unless doing so would compromise a client's confidentiality. Additionally, with big offenses like sexual exploitation or general incompetence its not enough to deal with it informally, it must be reported to a professional board or supervisor.

How does documentation work when doing group counseling/family?

Gets more complicated because info disclosure on one client may compromise confidentiality of other clients. Could be useful to create/maintain separate record for each person participating in group therapy.

What does teh APA require be included in record keeping

Identifying data, fees/billing info, documentation of informed concent, waivers of confidentiality, presenting complaint/diagnosis, plan for services, client reactions to professional interventions, risk factors for suicide/homicide, plans for future interventions, assessment/summary info, consultations or referrals to other professionals, relevant cultural and sociopolitical factors

Guidelines for record keeping if a client misses a session

If a client misses a sessions its good to document the reasons

Standard of care

If a reasonably prudent counselor in a similar circumstance would have acted in the same manner.

What do therapists do if the treatment techniques/interventions arent established yet?

If the treatment techniques/interventions are not established yet you must inform client of teh developing nature of treatment, potential risks involved, alternative treatments available,and voluntary nature of their participation

If the state law dosnt require parental consent for treatment but you ask for permission and they decline what can. You do

If you are not required by state law to get parental consent for treatment but you ask for their remission adn they decline, you cannot counsel their children

Guidelines for record keeping when proving something happened

If you did not document it, it didnt happen

What does the counselor say about the diagnosis/tests/payments

Implication of diagnosis, intended use of tests and reports, fees, and billing arrangements

Definition of minor's *assent*to treatment

Implies that counselors involve minors in decisions about their own care, and that they agree to participate in the counseling process

Should one choose online or in person counseling from teh perspective of risk management? List when you would use online

In person, only do online if a) service is provided in context of an existing therapy relationship. B)if in person treatmetn is difficult or impossible due to clients remote location c) if remote services offer practical advantages over in person treatment like a persons busy schedule makes only remote visits convenient d) when client desires remote sessions and therapist has sufficient info to determine if this is a rational/informed service

Guidelines for records with violent or aggressive clients

In situations involving potential danger of harm to oneself others or physical property when use of physical restrain must be recorded a record should b made within 24 hours of its occurance. Include these things in documentation 1. Events leading up to the incident 2. Alternative strategies attempted and any departures from teh plan of care 3. Rational for use of physical interventions and risks involved 4. Methods/duration of each restraint used 5. Difficulties encountered in monitoring clients physical well being and actions taken as result of difficulties 6. How restraint ended

Documentation Code of professional ethics for rehabilitation counselors

Include sufficient and timely documentation to facilitate delivery adn continueity of services. Make records accurately reflect progress/services provided. If errors are made then must take steps to note the correction to agency or institutional policies

Benefit of informed concent

Increases chances that aclient will become actively involved, educated, adn willing participants in the assessment process/therapy

What to tell client about consultation with colleagues

Inform clients they may consult with other professionals on their cases. Routinely let clients know about this, that way they have less reason to feel that trust is violated. Name of client does not have to be disclosed when consulting with professionals.

Define foreseeability

Involves assessing the level of risk. Failing to conduct a comprehensive risk assessment and document it would be a major error on teh therapist's part. If you are not competent to make the assessment a referral is mandatory. Practitioners need to show their judgements were based on data observed, and that the judgments were reasonable.

How should the counselor talk about confidentiality with parent and child

It is a wise policy for practitioners to make it clear to parents of minors that effective counseling requires a sense of trust in the therapist. Information disclosed, or not disclosed will be discussed at the beginning of therapy with child and parent. Should bring up that sensitive information if revealed may result in no longer trusting the therapist. If a minor is in danger of hurting self or others then counselor must inform the minors parents or guardians. Must establish what the parent and child's stance is on reporting to the parent about self harm.

What methods are most effective in counseling children?

It's best not to rely solely on verbal therapies, so play therapy, art thearpy, music therapy, and recreational therapy are good approaches.

How to secure records

Keep in secure place and exercising care when sending records to others by mail or electronic means. Putting things on the cloud is not allowed.

How does documentation work when couseling a couple?

Keeping a single record VS individuals depends on many factors, is the couple the client or each individual separate clients? If couple is the client - single record. Document relational data in client records, not just individual information.

Why is record keeping important from a risk management perspective?

Keeping adequate records is the standard of care. Accurate, relevant, and timely documentation is useful as a risk management

What to tell clients about alternative to traditional therapy

Learn community resources to be able to present alternatives. Can i nclude self help programs, stress management, personal effectiveness training, peer self help groups, indigenous healing practices, bibliotherapy, 12 step programs, support groups, and crisis intervention

What to tell clients about recording therapy sessions

Many agencies requires recorded interviews for training/supervision. Client must consent before audio taping/video taping can occur, and it must be documented. There is a right to decline this. Clients should know why recordings are made, how they will be used, who will have access to them, and how they will be stored.

What type of notes can be legally requested

May include requests for process and progress notes, so consider scrutiny notes may be under

What to tell teh client about the assessment of a client's background

May reveal areas of a clients life that shed light on teh presenting problem, identifying areas for potential exploration during the therapy process.

Definition of progress notes

Means of documenting aspects of a clients treatment and are kept in a client's clinical record. May be used to document sig issues or concerns related to treatment. Brief notes are preferred. Progress notes are behavioral, adn address wh at people say and do. Contain info on diagnosis, functional status, symptoms, treatment plan, prognosis, and client progress

The difference between what minors ethically require and legally in terms of confidentiality

Minors have an ethical right to privacy adn confidentiality, but law still favors the rights of parents over their children.

If informed consent is obtained orally what is the procedure

Must document in clinical record that informed consent was conducted, including the nature and extent of process

Record keeping in managed care programs

Must include: client identifying info, chief complaints, pertinent history, objective findings from recent physical exam, intake sheet, doc of referrals, consultations findings, -diagnostic procedures/tests, informed consent thats signed, diagnosis when determined, prognosis, sig cont problems or conditions, treatment plans, target problems and goals, signed and dated progress notes, types of services provided, times and dates of appointments, termination summary, use and completion of a discharge summary, release of info obtained.

School counselors record keeping

Must keep records on parent contacts and suicidal risks. There's a federal law that requires federally funded schools to provide access to all school records to parents of students under age of 18 and students after they are 18. Records are not to be released to third parties without written consent of parents or adult students.

If a complaint is filed for remote services then what needs to happen

Need to demonstrate competence in services they offer and the technology they are using to render services

Ethical issues in online counseling from a risk management perspective if there is a threat to safety

Need to know the true identity and location of their clients in case of an emergency.

Can you ignore ethical misconduct in a colleague

No it is an ethical violation to do so

Marriage and family therapists concent expectations

Obtain consent adn use language that is reasonably understandable to clients. The informed concent requires that the client a) has capacity to concent b) has been adequately informed c) knows risks and benefits d) has agreed without influence e) consent is well documented

What do you do if a person is not legally capable of giving informed concent??

Obtain infomed persmission from a legally authorized person, if such substitute consent is legally permissible

Define reasonable care

Once an assessment of risk is made for suicide it is important to document that appropriate predications were taken to prevent the suicide.

When in the treatment is it most appropriate to involve parents

Parents/guardians should be in initial meeting when possible to arrive at a clear, mutual agreement regarding the nature and extent of information that will be provided to them. Can also see how child behaves around parents/how parent reacts to child.

Who does telephone counseling make treatmetn available to

People who would not have otherwise received mental health care services. Dosnt require training for client or therapist

What is the benefit of having two sets of notes : progress and process

Progress notes are mroe general, less private, and more accessible to others. Process/psychotherapy notes are more private and for the use of the therapist, these must be kept separately from the individuals clinical record.

Why is record keeping important from a clinical perspective?

Record keeping provides a history that a therapist can use in reviewing the course of treatment. A) evidence of level of care b) provide best service possible.

Why is record keeping important from a ethical perspective?

Records can assist practitioners in providing quality care to their clients

Why is record keeping an important responsiblity?

Records must be current for high quality service and to maintain continuity of care when a client is transferred from one professional to another. It protects counselors because it can show that adequate care was provided, which can be an issue in disciplinary hearings. Counselors are expected to document decisions they have made and actions they have taken.

Definition of professional negligence

Results from unjustified departure from usual practice or failing to exercise proper care in fulfilling one's responsibilities.

What are mental health professionals required to disclose by the ethics codes

Risks, benefits, alternatives to proposed treatment

Ethical questions often raised by psychologists about own practice

Self disclosure, multiple relationships, maintaining confidentiality

Ethical questions raised by clients

Sexual intimacies, maintaining confidentiality, reporting ethical violations, client fees, financial arrangements, and termination process

Common complaints lodged against counselors by the state licensure board involve the vernal category of negligence. What are some examples.

Sexual misconduct, boundary violation, misrepresentation of credentials, failure to clarify matters pertaining to fees, making child custody recommendations when appropriate evaluation of all parties has not been conducted, violating confidentiality, and practicing beyond the scope of the one's competence, dual relationships, incompetence in diagnosis and treatment, premature termination, inadequate supervision, inadequate record keeping, impairment, breach of confidentiality.

What to tell client about the length of therapy and termination

Should be told they can terminate therapy at any time, but it is important to discuss the matter with the therapist. Need to tell length adn termination of treatment in informed concent. Termination should be addressed at beginning and revisited, especially if anticipated. Helps with securing trust in therapy process and minimizing return of symptoms/feelings of exploitation. Thereapiatss should help clients plan for it, prepare it, and process it. Many agencies have a limit for # of sessions, this should be told to the client more than once. They have a right to a referral to continue treatment with different therapist.

Why is record keeping important from a legal perspective?

State or federal law may require keeping a record, adn practitioners believe that accurate and detailed clinical records can provide an excellent defense against certain malpractice claims

What do counselors tell their clients about the nature of services provided?

Tell nature of all services provided, inform clients about issues like the purposes, goals, techniques, procedures, limitations, potential risks, and benefit of services; the counselors qualifications, credentials, adn relevant experience; continuation of services upon incapacitation or death of counselor.

what did the US supreme court rule about client therapist communications in forced disclosure cases under federal law? whats the reasoning?

The US supreme court ruled that communications between licensed psychotherapists and their clients in the course of diagnosis or treatment are privileged and protected from forced disclosure in cases arising under federal law. court ruling in Jaffee VS Redmond states that effective psychotherapy depends on confidence and trust, which will encourage frank and complete discourse of facts, emotions, memories, and fears. extends confidentiality.

How rehabilitation counselors talk about the clients rights

The client can leave or enter rehab counseling relationship at any time. Involve clients in planning..making decisions, while informing clients of consequences of their actions. Professional disclosure is required for informed concent. Should document discussions of disclosure and informed consent throughout the relationship

What do counselors say about teh clients provider

The client is given info to make an informed choice when selecting a provider. Includes but is not limited to counselor credentials, issues of confidentiality, the use of tests and inventories, diagnosis, reports, billing,a Dan therapeutic process. Restrictions that limit clients autonomy are fully explained

What does the law say on keeping progress VS process notes

The law requires clinicians to keep clinical record progress notes on all clients, but does not require them to keep process, psychotherapy, notes. The HIPAA rule allows clinicians to keep two sets of records, but does not mandate it.

what does the legal concept of privileged communication NOT apply to.

The legal concept of privileged communication generally does not apply to group counseling, couples counseling, family therapy, or child and adolescent therapy, but therapist is still bound by confidentiality with respect to circumstances not involving a court proceeding. statements made in presence of third party may not be protected in a court proceeding.

Definition of informed consent

The right of the clients to be informed about their therapy and to make autonomous decisions pertaining to it. It is a shared decision making process in which a practitioner provides adequate info so that a potential client can make an informed decision about their participating in the professional relationship. It is a legal and ethical obligation prior to participation in assessment or treatment.

How are confidentiality and its limits addressed

They have ka right to confidentiality, and to be provided with an explanation of its limitations, how treatment team is involved, obtain records, participation, and to be able to refuse any service

In residential addictions treatment programs what do they require? What is the client's role?

They require that patients accept the existence of a power higher than themselves. This higher power is defined by the patient

Guidelines for record keeping language in progress notes

Use clear, behavioral language in progress notes. Focus on describing specific and concrete behavior and avoid jargon

How to write about the client to make it appropriate for them to read

Write in descriptive and nonjudgmental ways. If access to the record would harm the client the therapist could explain their condition/treatment verbally. The clinician should be present when the client reads teh file.

In what form should information be shared w client for maximum understanding

Writing and in person verbally

definition of privileged communication. state to state application. court application. what happens if a client waives this privilege for the therapist? what happens if teh client asks them to disclose certain information?

a legal concept that generally bars the disclosure of confidential communications made to a psychotherapist from any judicial proceedings or court of law. the specifics of these laws vary state to state. When a client-therapist relationship is covered as privileged communication by state, clinicians may not disclose confidential information. Therapists can then refuse to answer questions in court or refuse to produce a client's records in court. These laws protect personal client info from exposure in legal proceedings. Designed for client's protection. If a client knowingly and rationally waives this privilege, the profession has no grounds to withhold info, but can make a clinical decision to withhold all or some information. Professionals are required to disclose information that is necessary and sufficient when the client requests it, but only the info that is specifically requested and only to individuals or agencies that are specified by the client.

what is a false memory, what is the legal consequence of them, how does the therapist end up creating this problem

a memory that is arrived at through an untested intervention by the therapist rather than clients actual memory. therapists get sued for it. the style a therapist questions a client with can influence memories, especially for young children. repeating questioning can lead a person to believe in a memory that did not occur. suggestion of past abuse as cause of symptoms can greatly influence client.

what happens if a counselor accepts a case beyond their competence

accepting a case beyond the scope of a counselor's education and training is not only a breach of ethics but also can result in a malpractice suit.

can any ambiguity in confidentiality exist when counseling couples or families?

ambiguity in confidentiality may exist regarding who the client is and the specific nature of the therapy goals when counseling couples or families.

course of action in a malpractice suit: what will happen to your clinical records

an expert case reviewer will evaluate your clinical records to determine the standard of care. the manner you document treatment will determine the outcome of your case. case reviewer will look for deviations in reasoning/application of knowledge. need reasonable approach to presenting problem. self reflection on what you do and why is helpful.

ethics code of confidentiality: american counseling association. how to communicate limits of confidentiality

at initiation and throughout process, counselors inform clients of the limitations of confidentiality and identify forseeable situations in which confidentiality must be breached

what is a central concern with termination? how does it need to be handled with clinical records? what needs to be documented?

avoiding abandonment of a client. clinical records should evidence that they were not terminated inappropriately. document nature of client's termination, including who inititated the termination, how it was handled, the degree to which initial goals were met, and referrals provided when appropriate

course of action in a malpractice suit: what to know about your insurance policy

become familiar with liability policy, limits of coverage, and contact insurance company immediatly

how to risk manage with multiple relationship

before engaging in any multiple relationship, seek consultation and talk with client about possible repercussions. can lead to problems for both of you

what are high risk areas for complaints of negligence?

child custody cases and employment evaluations

what is the clients role in termination. how does this help?

clients need to be informed about termination, and should be involved in making decsions about when to end their treatment as much as possible. when client and therapist agree goals of therapy have been achieved and therapy is no longer required, there is a very low risk of teh client filing a malpractice complaint.

what is wise for therapists to require a prospective client to do at the doctor prior to treatment

complete a physical examination to get results that would help with the clients diagnosis and affect their treatment

what have courts ruled as constituting abandonment

consistently not being reachable between apointments; failure to respond to a request for emergency treatment; failure to provide for a substitute thearpist during vacation times; terminating w a client who clearly needs continuing care; therapist one sided termination ending in harm;

risk management strategy for working with suicidal clients

consult when working with suicidal client. document consultation, including topics discussed

what happens if a thearpist's personal reactions to a client cannot be managed effectively

counter transference, an abuse of power, legal and ethical consequences.

are couples and family therapy subject to privileged communication statues in many states? is child and adolescent clients confidential information always private?

couples and family therapy are not subject to privileged communication statues in many states. in the case of child and adolescent clients, there are restrictions on the confidential character of disclosers in counseling relationship.

if a crime is committed by a parent does it (always) have to be reported? if it does have to be reported, what is important to focus on? what should be avoided?

crimes (done by the parent) that do not threaten the safety of a child do not have to be reported. if a report is necessary, it is important to simultaneously work to keep the minor client engaged and focus on the clinical need and safety of the minor client, not be a detective/investigator

course of action in a malpractice suit: how to utilize the professional associations you belong to

determine nature of support available to you from professional associations you belong to

how to deal with client records during treatment and after termination

develop clear and consistent policies and procedures for creating, maintaining, transferring, and destroying client records

course of action in a malpractice suit: is it practical to consult with client directly to resolve matter

do not attempt to resolve matter with client directly because could be used against you in the litigation

course of action in a malpractice suit: do you continue the professional relationship with the client

do not continue a professional relationship with a client who is bringing a suit against you

course of action in a malpractice suit: who to discuss the case with and what to avoid

do not discuss the case with anyone other than your attorney. avoid self incriminating statements to client, their attorney, or the press

risk management in professional sexual relationships

do not engage in sexual relationships with current or former clients, or current supervisees or students

how to risk manage with decisions to do or not to do something

document what you do and why, as well as what you decided not to do

what does the informed consent process include legally

entertains clients ability to act freely in making rational decisions. providing information about nature of therapy, and rights/responsibilities of client/therapist.

how to risk manage with boundaries

evaluate how well you keep boundaries in personal life. this will transfer to professional life

ethics code of confidentiality: canadian counseling and psychotherapy association. what are the 3 exceptions to confidentiality agreements

exceptions to confidentiality include 1. prevent clear and imminent danger to client/others 2. legal requirements demand the reveal of info 3. if a child is in need of protection

How to risk manage with communicating diagnostic info

explain diagnosis, treatment plan, risks and benefits in detail, make sure client understands it, document it well

two options on how to best assess clients who pose danger to self/others

get training in assessing clients who pose a danger to themselves/others, or have an experienced and competent referral

risk management with theoretical orientation

have a theoretical orientation that justifies the techniques you employ

what do duty-to-warn or duty-to-protect statuses do to help mental health professional?

help protect them when need to breach confidentiality to report danger to others/self.

legitimate reasons to terminate

if no progress is happening; if clients are not cooperating with treatment; when treatment goals are lost > terminate or could put thearpist at risk

risk management strategy for working with clients considered to be dangerous

if you make a professional determination that a client is dangerous, take steps to protect the client or others from harm

risk management with receiving gifts

in deciding whether or not to accept a gift/engage in bartering, consider the relevant cultural and clinical issues

how to risk manage with termination

inform clients have right to terminate any time they choose. document reasons for termination and any referrals/recommendations given

ethics code of confidentiality:american school counselor association. what do students need to be informed of? what is required of the student for informed consent. will the student make all of the decisions

inform individuals students of the purposes, goals, techniques, and rules of procedure for counseling. disclosures include limits of confidentiality. informed consent requires competence of student to understand limits of confidentiality which is difficult to obtain from younger students. When needed will make decisions on students behalf

the mentality behind risk managing effectively

involves more than following minimal legal reqirements. should be motivated by values and a want to serve others, not by fear.

what leads to a misdiagnosis or no diagnosis

lacking the ability to demonstrate diagnostic competence

Do laws regarding confidentiality in school counseling differ? what do private practices have to do in some states with minors under what age when speaking with parents? what about counselors in schools that receive federal funding? what should counselors be careful about when talking to the parents?

laws regarding confidentiality in school counseling differ. in some states thearpists in private practice are required to demonstrate that attempts have been made to contact the parents of the children who are younger than 16, whereas school counselors are not required to do so. schools that receive federal funding are generally found by the provisions of the family educational rights and privacy act. it is essential that school counselors exercise discretion in the kind and extent of info they reveal to parents.

how to risk manage by keeping what two types of records

maintain financial and clinical records, preserve confidentiality of them

what happens if a therapist stops practicing established therapeutic practices and tries something unestablished?

malpractice, need evidence based > departure from teh standard of care

can members of a counseling group be asked to testify in court concerning certain information revealed in the course of a group session? are there exceptions? in states where no law exists to cover confidentiality in group therapy, what do certain courts use to enforce confidentiality? what may therapists need to do to prove they made attempts to

members of a counseling group can assume they could be asked to testify in court concerning certain information revealed in the course of a group session, unless there is a statutory exception. in states where no law exists to cover confidentiality in group therapy, courts may use the ethics codes of the professions regarding confidentiality. if a situation arises, therapists may need to demonstrate the means they used to create safety for the group members. A written group contract defining members responsibility for maintaining confidentiality of whatever takes place in a group can be used for this purpose.

course of action in a malpractice suit: how to handle client records

never destroy or alter files or reports pertinent to the client's case

have clear judicial trend emerged for communications that are made in the presence of a third person?

no clear judicial trend has emerged for communications that are made in the presence of a third person.

can a court question the therapists diagnosis? when does this change?

no they can not, but if records show that a diagnosis made by the therapist was clearly unfounded and below the standard of care, a case of malpractice might be successful. an expert witness is questioned to determine whether the therapist used appropriate assessment procedures and an accurate diagnosis.

risk management in not being able to keep your appointment/covering emergencies

not keeping your appointments may feel like abandonment to a client. if you have to miss a session, call the client. provide coverage for emergencies when you are not available.

ethics code of confidentiality: american mental health counselors association. when is info obtained? what has to be obtained for it to be communicated? what is disclosed

obligation to safeguard info about individuals during course of practice, teaching, or research. communicate personal info only with consent, preferably written. disclose only what is necesarry, relevant, and verifiable

what happened in Jaffee VS Redmond case?

on duty police officer shot and killed suspect while attempting arrest. victims family sued in federal court, saying constitutional rights had been violated. court ordered a liscenced clinical social worker to turn over notes she made durign counseling sessions with redmond the police officer after the shooting. the social worker refused, saying convo was protected against involuntary disclosure by client-therapist privilege. court rejected her claim of privilege, and jury awarded family 545,000. the court of appeals for the seventh circuit revers this decision and concluded that the trail court had erred by refusing to afford protection to the confidential communications. The supreme court upheld the appellate court's decision,clarifying for all federal court cases, both civil and criminal, the existence of the privilege. this case is not constitutionally based. only applies to federal cases.

how to risk manage with competence

only practice what you are qualified for in education, training, and experience. refer people out of your scope

what is one of the best precautions against malpractice

personal and professional honesty adn openness with clients, as well as quality professional services. talking through misunderstandings can strengthen therapeutic relationship.

definition of risk management

practice of focusing on teh identification, evaluation, and treatment of problems that may injure clients and lead to filing an ethics complaint or malpractice action.

how to risk manage with informed consent

present clients with written info on confidentiality, why clients are contacted at home, fee structures/payment plans, termination policy, and suicide provisions. review with client and document informed consent with signature.

how to risk manage with language used

present info in clear language, be sure they understand

what is an issue for practitioners also teach courses, offer workshops, write books, and journal articles/give lectures.? what is important about with examples they give?

privacy is an issue when practitioners also teach courses, offer workshops, write books, and journal articles/give lectures. if these practitioners use examples from their clinical practice, it is of the utmost importance that they take measures to adequately disguise clients identities

ethics code of confidentiality: national association of social workers. what info is protected, when is it not - in these circumstances what info should be shared

protect confidenciality of all info, except for professional reasons. exception is for prevention of serious forseeable and imminent harm to a client/other > disclose necesary info for purpose. only info directly relevant to purpose should be revealed.

ethics code of confidentiality: american psychological association. what types of docs should be protected? what are extends/limits of confidentiality regulated by?

protect confidential information obtained through or stored in any medium, recognizing that the extent and limits of confidentiality may be regulated by lawyer est. by institutional rules

ethics code of confidentiality: american psychiatric association. what to keep in mind when storing client records in technological terms

psychiatric records must be protected with care. computers, duplication equipment, and data banks role in lesser security must be considered.

risk management strategy for being the source of transference from clients

recognize that a mental health professional is a protential target for clients anger or transference. be attentive to your reactions and countertransferrence

definition of privacy. application with clients in general, in public.

refers to the constitutional right of individuals to be left alone and to control their personal information. therapists need to exercise caution w client's privacy, although it can be invaded unintentionally. If see client in public dont violate their privacy > talk with client and discuss how may interact in possible meetings. (employers access to applicant/employee psychological tests, parents access to childs school/health records, third party access to clients diagnosis and prognosis)

definition of confidentiality

rooted in client's right to privacy. it is the counselor's ethical duty to protect private client communication. psychotherapists are prohibited from disclosing confidential communications to any third part unless mandated or permitted by law to do so.

what are school admin's perspective on the counselor protecting children's confidentiality

school administrators may view school counselors protecting the confidentiality of students as insubordination, especially with high risk children

who should counselors ask for permission prior to releasing information?what should the counselor inform the client of about confidentiality. what are the parents told by the counselor?

school counselors have an ethical responsiblity to ask for client permission to release information and they should clearly inform students of the limitations of confidentiality, and how/when confidential information may be shared. must inform parents/guardiens of the counselors role to include the confidential nature of the relationship between student and counselor.

when school counselors need to provide certain info to parents and school, how should they do it? 2 parts

school counselors may be required to provide cerian info to parents and school personnel, but should do so in a manner that will minimize intrusion of the child's privacy and in a way that demonstrates respect for the client

how to do risk manage in terms of laws, agencies, changes in laws, involvement, and continued ed

should be aware of local/state laws pertaining to practice, and your organization's policies. keep up to date with legal and ethical changes by becoming involved in professional organizations and risk management workshops.

in managed care what is termination like? what is abandonment in this circumstance? what is the therapists job in termination

termination is not the result of a collaborative process typically, but of company policy. therapists are accused of abandonment when they terminate a client based on the allocated number of sessions rather than on therpetic needs of the client. it is the therapists job to say additional sessions will not be covered by provider and work on alternatives options with the client

whats the first and second priority to protect against malpractice

the best protection against malpractice is to be concerned first with providing quality care and secondly to reduce risk

define termination

the ethically adn clinically appropriate process by which a professional relationship is ended

define abandonment

the failure of the psychologist to take the clinically indicated and ethically appropriate steps to terminate a professional relationship

what are therapists liable for in terms of informed consent

therapists are liable for failure to obtain appropriate informed consent even if their treatment is ideal.

when should therapists inform clients about confidentiality and its exceptions?

therapists should inform clients about confidentiality and its exceptions from the beginning of the contact and remain open to discussing it as warrented later in relationship. clients have a right to be informed about any limitations on confidentiality in all types of therapy.

how should therapists working with couples or families should address their policy about secrets disclosed by one of the individuals in advance of starting counseling

therapists working with couples or families should clearly communicate their policy about keeping, or not keeping, secrets disclosed by one of the partners or family members in advance of starting counseling.

what happens if a counselor refuses a client treatment due to value differences?

they are liable for legal action and malpractice suits. clinicians may not discriminate against specific categories of people. if a counselor refuses to work with a client due to value conflicts or if a counselor tries to impose his or her values on a client then there are legal and ethical grounds to file a complaint

if practitioners who work on a fee for service basis stop getting paid for their service what can they do?

they can terminate treatmetn because the original remuneration contract is not being honored. there is no legal duty to provide free psychological services and can stop treatment whenever payment stops. still should give referal options

how should mental health professionals work with physicians?

they have an obligation to work closely with physicians to ensure that a medical condition or side effects from a medication are not causing the psychological symptoms.

course of action in a malpractice suit: if a client tries to punish or control you with a suit how do you treat it

treat the lawsuit seriously, even if its an attempt to punish/control you

what should a counselor do if they start having personal feelings about a client?

when a client cannot be served in a professional manner due to a practitioners personal feelings it is the therapists responsiblity to seek consultation, personal therapy, adn if necesarry, refer the client to another counselor.

risk management with consultation, what are the pros of it

when in doubt, consult with colleagues and document the discussions. get consent from client for release of info prior to consulting with others about a specific client. consultation shows commitment to practice and willingness to learn from others for your clients best interest. develope network of consultants