Final for ethics and virtues Cook

Rights Pertaining to Diagnostic Classifying

"because their mental health needs are severe or from fear that they will raise employer insurance premiums" (p. 20). Kress and colleagues advise counselors to provide their clients with the following information about the diagnostic process: whether the client's insurance provider requires a diagnosis; the typical problems associated with a diagnosis; the benefits of receiving a diagnosis; and the options a client can pursue should he or she choose not to receive a diagnosis or not to have an insurance provider involved.

California enacted a law in 2011 allowing mental health practitioners to treat minors

(12 years or older) if the practitioner determines the minors are mature enough to participate intelligently in outpatient treatment or mental health counseling. However, the statute does require parental (or guardian) involvement in the treatment unless the therapist finds, after consulting with the minor, that this involvement would be inappropriate under the circumstances. Therapists have the responsibility for noting in the client's records whether they attempted to contact the minor's parent or guardian, whether this attempt was successful or unsuccessful, or why it was deemed inappropriate to make this contact.

In keeping with the Tarasoff decision, the California Supreme Court held to two things

1. that a therapist has a duty first to exercise a "reasonable degree of skill, knowledge, and care ordinarily possessed and exercised by members [of that professional specialty] under similar circumstances" in making a prediction about the chances of a client's acting dangerously to others; 2. that therapists must "exercise reasonable care to protect the foreseeable victim of that danger."

Informed consent is not a single event

; rather, it is best viewed as a process that continues for the duration of the professional relationship as issues and questions arise (Barnett & Johnson, 2015; Pope & Vasquez, 2016; Wheeler & Bertram, 2015).

Bradley Case

A court ruling stating the responsibility of a therapist to not release a dangerous client from a psychiatric facility. take away: Supreme Court ruled that a physician has a duty to take reasonable care to prevent a potentially dangerous patient from inflicting harm A second case illustrates the duty not to negligently release a dangerous client. In Bradley Center v. Wessner (1982) the patient, Wessner, had been voluntarily admitted to a Georgia facility for psychiatric care. Wessner was upset over his wife's extramarital affair. He had repeatedly threatened to kill her and her lover and had even admitted to a therapist that he was carrying a weapon in his car for that purpose. He was given an unrestricted weekend pass to visit his children, who were living with his wife. He met his wife and her lover in the home and shot and killed them. The children filed a wrongful death suit, alleging that the psychiatric center had breached a duty to exercise control over Wessner. The Georgia Supreme Court ruled that a physician has a duty to take reasonable care to prevent a potentially dangerous patient from inflicting harm

Jablonski Case

A court ruling that underscores the duty of a therapist to commit a dangerous individual. Take away: The essence of Jablonski is a negligent failure to commit (Laughran & Bakken, 1984). A third legal ruling underscores the duty to commit a dangerous individual. The intended victim's knowledge of a threat does not relieve therapists of the duty to protect, as can be seen by the decision in Jablonski v. United States (1983). Meghan Jablonski filed suit for the wrongful death of her mother, Melinda Kimball, who was murdered by Philip Jablonski, the man with whom she had been living. Earlier, Philip Jablonski had agreed to a psychiatric examination at a hospital. The physicians determined that there was no emergency and thus no basis for involuntary commitment. Kimball later again accompanied Jablonski to the hospital and expressed fears for her own safety. She was told by a doctor that "you should consider staying away from him." Again, the doctors concluded that there was no basis for involuntary hospitalization and released him. Shortly thereafter Jablonski killed Kimball. The Ninth U.S. Circuit Court of Appeals found that failure to obtain Jablonski's prior medical history constituted malpractice.

Repressed or False Memory

A memory is considered false if it is arrived at through an untested intervention by the therapist rather than being the client's actual memory. Therapists have been sued and found guilty of such induced memories.

Wyke v. Polk County School Board (1997)

A school could be found negligent for failing to notify a parent of a student's suicide attempts

Interruptions in Therapy

A therapist's absence might appear as abandonment to some clients, especially if the absence is poorly handled. As much as possible, therapists should have a plan for any interruptions in therapy, such as vacations or long-term absences. When practitioners plan vacations, ethical practice entails providing clients with another therapist in case of need. Clients need information about the therapist's method of handling emergencies as part of their orientation to treatment. . It is recommended that therapists include in their informed consent document the name of at least one professional colleague who is willing to assume their professional responsibilities in the event of an emergency, such as the therapist becoming incapacitated through injury or death (McGee, 2003).

Recording Therapy Sessions or Live Observations

Many agencies require that interviews be recorded for training or supervision purposes. Clients must consent before a therapist or trainee may audiotape or videotape any session, and this consent must be documented in the clinical record (Nagy, 2011). Therapists sometimes make recordings because they can benefit from listening to them or by having colleagues listen to their interactions with clients and give them feedback. Some agencies allow recordings, but more and more do not support this training method due to HIPPA and confidentiality concerns.

Practicing Beyond the Scope of Competency

Mental health practitioners have been held liable for damages for providing treatment below a standard of care. If the client follows the treatment suggested by a professional and suffers damages as a result, the client can initiate a civil action.

Security requirements.

Minimum requirements are outlined in HIPAA that are designed to safeguard confidential information and prevent unauthorized access to health information of patients. Technological advances, including electronic record keeping, challenge practitioners' abilities to maintain security

Negligent Assessment and Misdiagnosis

Negligent assessment can be the basis for complaints to a state licensing board, an ethics committee, and for malpractice action. Areas of high risk involve assessment in child custody cases and in employment evaluations (Knapp & VandeCreek, 2012). Lacking the ability to demonstrate diagnostic competence can result in making a misdiagnosis or missed diagnosis, which could leave the practitioner vulnerable to an allegation of malpractice

Eisel v. Board of Education (1991)

One of the first cases that addressed school counselor liability for student suicide The school has a duty to protect a student from foreseeable harm and school counselors have a duty to use reasonable means to attempt to prevent suicide when they are aware of a student's intent The reasoning of the court was that an adolescent is more likely to share thoughts of suicide with friends than with a school counselor, teacher, or parent. The court found that reasonable care would have included notifying Nicole's parents that their daughter was at risk for suicide. Although the suicide occurred off the school premises, the court held that legally the school could be held liable for failure to exercise reasonable care to prevent a foreseeable injury.

Informed Consent and Managed Care

Practitioners are ethically bound to offer the best quality of service available, and clients have a right to know that managed care programs, with their focus on cost containment, may influence the quality of care available. Clinicians are expected to provide prospective clients with clear information about the benefits to which they are entitled and the limits of treatment. Informed consent forms should state that the managed care company may request a client's diagnosis, results of any tests given, a wide range of clinical information, treatment plans, and perhaps even the entire clinical record of a client.

Record Keeping for Managed Care Programs

Practitioners working within a managed care setting are required to maintain adequate documentation of treatment services. A managed care program may audit a practitioner's reports at any time. By law, managed care practitioners are required to keep accurate charts and notes and must provide this information to authorized chart reviewers.

Unhealthy Transference Relationships

The importance of understanding how transference and countertransference play out in the therapy relationship is considered in Chapter 2. The mere existence of countertransference feelings is not an ethical or legal issue. However, if a therapist's personal reactions to a client cannot be managed effectively, an abuse of power is likely, and this can have both ethical and legal consequences.

the upper age for a minor is

The upper range is 18 to 21 years of age, although some states authorize 16-year-olds to consent to their own health care in some circumstances.

Background of the Therapist

Therapists can provide clients with a description of their training and education, their credentials, licenses, any specialized skills, their theoretical orientation, and the types of problems that are beyond the scope of their competence. State licensure boards often make giving this information a legal requirement.

Failure to Obtain or Document Informed Consent

Therapists need to recognize that they can be liable for failure to obtain appropriate informed consent even if their subsequent treatment of the client is excellent from a clinical perspective.

The ACA (2014) Code of Ethics also addresses this topic of minors not able to give consent

When counseling minors, incapacitated adults, or other persons unable to give voluntary consent, counselors seek the assent of clients to services, and include them in decision-making as appropriate. Counselors recognize the need to balance the ethical rights of clients to make choices, their capacity to give consent or assent to receive services, and parental or familial legal rights and responsibilities to protect these clients and make decisions on their behalf.

Clients requesting access to their files may be signaling

a deeper concern, and the counselor should explore this further before granting a client's request. The clinician needs to make a professional determination of those times when seeing records could be counterproductive

Privileged communication is

a legal concept that generally bars the disclosure of confidential communications made to a psychotherapist from any judicial proceedings or court of law (Knapp & VandeCreek, 2012). All states have enacted into law some form of psychotherapist-client privilege, but the specifics of this privilege vary from state to state.

To succeed in a malpractice claim, these four elements of malpractice must be present:

a professional relationship between the therapist and the client must have existed; the legal duty based on this relationship must have been breached: the therapist must have acted in a negligent or improper manner, or have deviated from the "standard of care" by not providing services that are considered "standard practice in the community"; the client must have suffered harm or injury, such as emotional distress or physical harm, which must be verified; there must be a legally demonstrated causal relationship between the practitioner's negligence or breach of duty and the damage or injury claimed by the client.

Tarasoff Case/ Duty to warn

a therapist who has reason to believe that a client is dangerous to someone must warn the endangered person or take other steps to prevent harm at least within the state of California they are allowed to do this directly but there are other means of protecting some such as alerting the police ect. which you must do in Texas, you cant notify the other person directly because of the confidentiality Under the Tarasoff decision, the therapist must first accurately diagnose the client's tendency to behave in dangerous ways toward others. This first duty is judged by the standards of professional negligence. In this case the therapist did not fail in this duty. He even took the additional step of requesting that the dangerous person be detained by the campus police. However, the court held that merely notifying the police was not sufficient to protect the identifiable victim. the duty to protect can be discharged in a variety of ways, one of which involves hospitalization, whether voluntary or involuntary. Therapists can protect others through traditional clinical interventions such as reassessment, medication changes, and referral. Other steps therapists may take include warning potential victims, calling the police, or informing the state child protection agency. Negligence lies in the practitioner's failure to conduct an assessment for potential violence, failure to warn a third party of imminent danger, not in failing to predict any violence that may be committed. In Ewing v. Goldstein (2004) the California courts broadened the practitioner's duty to warn by declaring that therapists must break confidentiality if they receive information from a family member about a client's intention to seriously harm another person (Nagy, 2011). This court decision means that licensed therapists in California could be held liable for failure to issue a Tarasoff warning when the information regarding the dangerousness of a client comes from a client's family member rather than from the client. "

Professional need to avoid subtly coercing clients to cooperate with

a therapy program to which they are not freely consenting. It is the responsibility of professionals to assess the client's level of understanding and to promote the client's free choice. In doing so therapists can model a social justice perspective for clients, many of whom may experience oppression and discrimination.

Progress notes

are a means of documenting aspects of a client's treatment and are kept in a client's clinical record. These notes may be used to document significant issues or concerns related to a client's treatment.

Privacy

as a matter of law, refers to the constitutional right of individuals to be left alone and to control their personal information (Wheeler & Bertram, 2015). Privacy is the right to be protected from visibility, access, or intrusion by others (Fisher, 2016). Practitioners should exercise caution with regard to the privacy of their clients. It is easy to invade a client's privacy unintentionally.

Ultimately Tarasoff comes down to two responsibilities:

assessing for violence, and if the assessment reveals the likelihood of violence, discharging the duty to protect" (Jensen, 2012, p. 50).

Process notes

or psychotherapy notes, are not synonymous with progress notes; process notes deal with client reactions such as transference and the therapist's subjective impressions of a client. Other areas that might be included in the process notes are intimate details about the client; details of dreams or fantasies; sensitive information about a client's personal life; and a therapist's own thoughts, feelings, and reactions to clients. Process notes are not meant to be readily or easily shared with others

In his article, "HIPAA Overview," Jensen (2003b) describes the four standards of HIPAA:

privacy requirements, electronic transactions, security requirements, and national identifier requirements.

the law requires clinicians to keep what kind of notes?

progress notes

The HIPAA Privacy Rule was designed to

provide a uniform level of privacy and security on the federal level. This Privacy Rule, which applies to both paper and electronic transmissions of protected health information by covered entities, developed out of the concern that transmission of health care information through electronic means could lead to widespread gaps in the protection of client confidentiality.

Assessment of a Client's Background

questions of clients during the intake session and the assessment process, and clients are more likely to cooperate in providing honest information if they know why they are being questioned. This assessment often includes areas typically influencing the quality of life, such as family of origin, culture, divorce, substance abuse, immigration status, traumatic events, and religious and spiritual background. Such questioning may reveal areas of a client's life that shed light on the presenting problem, identifying areas for potential exploration during the therapy process.

Malpractice is the failure to

render professional services or to exercise the degree of skill that is ordinarily expected of other professionals in a similar situation. Malpractice is a legal concept involving alleged negligence that results in injury or loss to the client.

Privacy requirements.

requires practitioners to take reasonable precautions in safeguarding patient information. Licensed health care providers are expected to have a working knowledge of and guard patients' rights to privacy in disclosure of information, health care operations, limiting the disclosure of protected information, payment matters, protected health information, psychotherapy notes and a patient's medical record, and treatment activities.

Risk Managment

s the practice of focusing on the identification, evaluation, and treatment of problems that may injure clients and lead to filing an ethics complaint to a licensing board or a malpractice action. One of the best precautions against malpractice is personal and professional honesty and openness with clients.

Sperry and Pies (2010) discuss the ethical considerations in writing about clients. They identify three options for presenting case material:

seek the client's permission to publish, which some consider ethically questionable because it entails inserting the clinician's professional agenda into the client's treatment; disguise case material for publication, which may or may not release the therapist from needing to secure the client's permission; develop composite case material from two or more clients.

The duty to protect applies to

situations in which the mental health professional has a legal obligation to protect an identified third party who is being threatened; in these cases the therapist generally has other options in addition to warning the person of harm.

A malpractice lawsuit alleges negligence in meeting one's professional responsibilities or duties. The plaintiff may claim that a practitioner's actions (or lack of actions) deviated from the acceptable what kind of care?

standard of care and directly caused harm to the client (Knapp & VandeCreek, 2012). The primary focus of a negligence suit lies in determining what standard of care to apply in deciding whether a breach of duty to a client has taken place

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was passed by Congress to promote

standardization and efficiency in the health care industry and to give patients more rights and control over their health information. HIPAA is a federal law that contains detailed provisions regarding client privacy, informed consent, and transfer of records. HIPAA regulations require practitioners who are covered entities under HIPAA to provide prospective clients with a clear written explanation of how health information is used, disclosed, and kept

The definition of a minor varies from

state to state

In 1999 in the case of Thapar v. Zezulka, the Texas Supreme Court ruled

that mental health workers do not have a duty to warn and protect their clients' known and intended victims. Basing its decision on the Texas statute governing the legal duty of mental health professionals to protect clients' confidentiality, the court found that it was unwise to impose a duty to warn on mental health practitioners.

Emerging Issues in Online Counseling- whats one of the biggest issues here?

the application of the standard regarding the duty to protect when a client discloses threats of harm to self or others via email or another electronic medium is an issue receiving thoughtful attention

Topics selected for discussion during early counseling sessions are best guided by

the concerns, interests, and questions of the client. Although it is essential to review informed consent with clients in the initial sessions, doing so only at this time is not adequate. Clients are often anxious during their first sessions and are likely to miss important details.

Malpractice is typically found in the following kinds of situations:

the procedure used by the practitioner was not within the realm of accepted professional practice; the practitioner employed a technique that he or she was not trained to use; the professional did not follow standard counseling procedures, which resulted in harm to the client; the therapist failed to warn others about and protect them from a violent client; informed consent to treatment was not obtained or not documented; the professional did not explain the possible consequences of the treatment (Wheeler & Bertram, 2015).

Although minor clients have an ethical right to privacy and confidentiality in the counseling relationship, the law still favors

the rights of parents over their children. However, some sensitive information, if revealed or disclosed, may be detrimental to the therapy process.

If complaints are filed, professionals who provide remote services will have to demonstrate competence in both

the services they offer and the technology they are using to render services. Practitioners need to determine what kinds of services they can and cannot appropriately offer, and they need to assess the benefits and risks of delivery of services remotely.

Refusal to Counsel Clients Due to Value Differences

therapists who refuse to work with clients due to value conflicts may be liable for legal action and malpractice suits. The codes of ethics of most professional organizations state that clinicians may not discriminate against specific categories of people. If a counselor refuses to work with a client because of value conflicts, or if the counselor attempts to impose his or her values on a client, the client may have legal and ethical grounds to file a complaint.

Maintaining clinical notes serves a dual purpose:

to provide the best service possible for clients, and to provide evidence of a level of care commensurate with the standards of the profession.

one way to think of process notes:

view them as a form of self-consultation and a way to organize ideas to bring up in supervision. As a general rule, it is best to exclude from process notes matters pertaining to diagnosis, treatment plan, symptoms, prognosis, and progress.

Confidentiality,

which is rooted in a client's right to privacy, is at the core of effective therapy; it "is the counselor's ethical duty to protect private client communication" (Wheeler & Bertram, 2015, p. 104). Mental health professionals have an ethical responsibility, as well as a legal and professional duty, to safeguard clients from unauthorized disclosures of information given in the therapeutic relationship.

Costs Involved in Therapy

All costs involved in counseling or psychological services, including methods of payment, must be provided at the beginning of these services. A therapist's policy on charging for missed appointments or late cancellations should be clearly stated. Most professional codes of ethics have a pro bono guideline that encourages practitioners to share their expertise with those who cannot afford to pay for services.

The responsibility to protect the public from dangerous acts of violent clients entails liability for civil damages when practitioners neglect this duty by

failing to diagnose or predict dangerousness, failing to warn potential victims of violent behavior, failing to commit dangerous individuals, prematurely discharging dangerous clients from a hospital (APA, 1985).

Jaffee applies only in

federal cases, both civil and criminal, governed by the Federal Rules of Evidence.

The Jaffee Case and Privileged Communication

Jaffee v. Redmond (1996), written by Justice John Paul Stevens, states that "effective psychotherapy depends upon an atmosphere of confidence and trust in which the patient is willing to make frank and complete disclosure of facts, emotions, memories, and fears." The 7-2 decision in this case represented a victory for mental health organizations because it extended the confidentiality privilege.

Marked Departures From Established Therapeutic Practices

f counselors employ unusual therapy procedures, they put themselves at risk. They bear the burden of demonstrating a rationale for their techniques. If it can be shown that their procedures are beyond the usual methods employed by most professionals, they are vulnerable to a malpractice action.

The ethics codes of the major professional organizations specify that it is unethical to practice in areas

for which one has not been trained. It is important not to begin counseling with minors without requisite coursework and supervision by a specialist in this area.

To determine that you are a "covered entity," you need to answer affirmatively to all three of these questions:

Are you a health care provider? Do you transmit information electronically? Do you conduct covered transactions?

School counselors do not have a legal obligation to

Basically they dont need parental consent for the kid unless the state requires it in their statues obtain parental consent for counseling unless a state statute requires this. Many schools have a student handbook, a part of which typically describes information about counseling services available to students. This handbook is often sent to parents at the beginning of a school year to provide them with school rules and policies, as well as general information about various services offered by the school. At the end of the handbook, there is typically a page that asks for parents' signatures indicating their consent for their children to use the services provided by the school.

Use of Smartphones

Basically this is making remote therapy possible Increasingly, clinical programs are encouraging or even requiring clients to download apps on their smartphones to record information about their clinical symptoms, moods, and behaviors; to obtain psychoeducation information or automated messages from clinicians

Implications of Duty to Warn and to Protect for School Counselors

Basically, school counselors are not obligated by their codes of ethics but the supreme court has deemed school counselors to be responsible to uphold the peace among students when directly observing behavior that is dangerous or assessed, so no "not obligated" but yes that they must facilitate the right to warn and protect the students. The basic standard of care for school counselors is clear; courts have uniformly held that school personnel have a duty to protect students from foreseeable harm The duty to protect vulnerable children is also a well-articulated standard in the field of psychology. School personnel may need to act on student reports of their peers' plans related to intended violence. Furthermore, school officials may be held accountable if a student's writing assignments contain evidence of premeditated violence. Hermann and Finn (2002) contend that school counselors are legally and ethically obligated to work toward preventing school violence. Moyer and coauthors (2012) suggest that ethics codes "provide no explanation as to what constitutes a potentially disruptive or damaging behavior, and individual school counselors are likely to interpret this differently" Courts have consistently found that school counselors have a duty to exercise reasonable care to protect students from foreseeable harm, but they are only exposed to legal liability if they fail to exercise reasonable care (Hermann & Remley, 2000).

Failure to Assess and Manage a Dangerous Client

California says you can warn the person that your client is planning on harming, Texas that is not allowed you have to call the police Therapists may have a duty to intervene when clients pose a grave danger to themselves or to others. Reporting dangerousness is required by California statute, and there is no privilege in cases involving dangerous patients (Leslie, 2010). Even in states where such a warning is not legally mandated, ethical practice demands a proper course of action on the therapist's part.

Benefits and Risks of Treatment

Clients are largely responsible for the outcomes of therapy, so it is a good policy to emphasize the client's responsibility. Clients need to know that no promises can be made about specific outcomes, which means that ethical practitioners avoid promising success

The Length of Therapy and Termination

Clients should be told that they can choose to terminate therapy at any time, yet it is important for the client to discuss the matter of termination with the therapist. Part of the informed consent process involves providing clients with information about the length of treatment and the termination of treatment. Many agencies have a policy limiting the number of sessions provided to clients. These clients should be informed at the outset that they cannot receive long-term therapy. Under a managed care system, clients are often limited to 6 sessions, or a specified amount for a given year, such as 20 sessions.

Clients' Right of Access to Their Files

Clinical records are kept for the benefit of clients. Remley and Herlihy (2016) maintain that clients have a legal right to inspect and obtain copies of records kept on their behalf by professionals. Clients have the ultimate responsibility for decisions about their own health care and, in most circumstances, also have the right of access to complete information with respect to their condition and the care provided. A professional should write about a client in descriptive and nonjudgmental ways with the expectation that the client may see the file someday. A clinician who operates in a professional manner should not have to worry if these notes were to become public information or were read by a client.

The Nature and Purpose of Confidentiality

Confidentiality is a right granted to all clients of mental health counseling services. From the onset of the counseling relationship, mental health counselors inform clients of these rights including legal limitations and exceptions Clients should be aware that managed care contracts may require therapists to reveal sensitive client information to a third party who is in a position to authorize initial or additional treatment.

The Professional's Responsibilities in Record Keeping

From a clinical perspective, record keeping provides a history that a therapist can use in reviewing the course of treatment. From an ethical perspective, records can assist practitioners in providing quality care to their clients. From a legal perspective, state or federal law may require keeping a record, and many practitioners believe that accurate and detailed clinical records can provide an excellent defense against certain malpractice claims. From a risk management perspective, keeping adequate records is the standard of care (Welfel, 2016; Wheeler & Bertram, 2015). Accurate, relevant, and timely documentation is useful as a risk management strategy.

Legal Aspects of Informed Consent

Generally, informed consent requires that the client understands the information presented, gives consent voluntarily, and is competent to give consent to treatment (Wheeler & Bertram, 2015). Therapists must give clients information in a clear way and check to see that they understand it. Disclosures should be given in simple language in a culturally sensitive manner and must be understandable to clients. To give valid consent, it is necessary for clients to have adequate information about both the therapy procedures and the possible consequences.

Electronic transactions.

HIPAA aims at creating one national form of communication, or "language," so that health care providers can communicate with one another electronically in this common language.

Ethical issues in assessing and treating nonsuicidal self injury

If clients are self-injuring its basically overreacting in a way, its more of an anti-coping mechanism, basically you need to monitor them with the upmost importance it is a mistake to assume that most people who self-injure are suicidal. However, counselors who work with clients who self-injure will most likely deal with ethical dilemmas regarding safety and duty to warn/protect. It is important to monitor and continually assess for the risk of serious harm and the potential for suicide, especially when counseling minors.

Dealing With Suspected Unethical Behavior of Colleagues

Ignoring evidence of peer misconduct is an ethical violation in itself professionals also have an onligation to deal with colleagues when they suspect unethical behavior: you can do this by directly confronting the colleague, indirectly condronting the colleague, if it persist you must file a formal complaint to the board Generally, the best way to proceed when you have concerns about the behavior of a colleague is to deal directly with the colleague, unless doing so would compromise a client's confidentiality. In cases of egregious offenses, such as sexual exploitation of clients or general incompetence, informal measures are not enough.

National identifier requirements.

It is essential that covered entities be able to communicate with one another efficiently. Health care providers and health plans are required to have national identification numbers that identify them when they are conducting standard transactions.

Minors are not always able to give informed consent. The APA (2010) code provides guidance on this matter:

For persons who are legally incapable of giving informed consent, psychologists nevertheless (1) provide an appropriate explanation, (2) seek the individual's assent, (3) consider such persons' preferences and best interests, and (4) obtain appropriate permission from a legally authorized person, if such substitute consent is permitted or required by law.

six-step ethical practice model for protecting confidentiality rights

Preparation. To inform your clients about the limits of confidentiality, you must understand the limits yourself. This involves doing your legal homework and engaging in personal soul searching regarding your own moral principles. Clarify your ethical position about confidentiality and its limits, and devise an informed consent document that reflects your policies and intentions. Tell clients the truth. Inform your clients about the limits you intend to impose on confidentiality, and obtain your client's consent to accept these limits as a condition of entering into a professional relationship with you. Obtain "truly informed consent" before disclosing voluntarily. Make disclosures only if legally unavoidable. Obtain and document your client's signed consent before disclosing this information. respond ethically to legal demands for information. Notify your client of a pending legal demand for disclosure without his or her consent. Limit disclosure of confidential information to the extent that is legally possible. Avoid preventable breaches of confidentiality. Avoid making unethical exceptions to the confidentiality rule; establish and maintain policies aimed at protecting confidentiality; monitor your note taking and record keeping practices; Talk about confidentiality. Model ethical behavior and practice; invite a dialogue with clients about confidentiality as needed; teach ethical practices to students and supervisees; and educate attorneys, judges, and consumers.

Record Keeping for School Counselors

Problem is to many students to keep detailed notes on Keeping records is particularly important in cases involving moderate to severe social or emotional problems or when students may be at risk of suicide (Remley, 2009). Maintaining records on parent contacts is also essential. School counselors are cautioned about the importance of safeguarding the confidentiality of any records they keep. Many schools maintain a computer-based note system where the school counselor can easily log contacts without much detail Student records are not to be released to third parties without the written consent of parents of minors, or the written consent of adult students

Progress notes are what in their nature?

Progress notes are behavioral in nature and address what people say and do. They contain information on diagnosis, functional status, symptoms, treatment plan, prognosis, and client progress.

Sexual Misconduct With a Client

Related to the topic of unhealthy transference relationships is the area of sexual boundary violations, one of the most common grounds for malpractice suits. It is never appropriate for therapists to engage in sexual contact with clients.

School Counselor Liability for Student Suicide

School counselors are expected to be aware of the warning signs of suicidal behavior and need to have the skills necessary to assess a student's risk for suicide Although school counselors are not expected to predict all suicide gestures or attempts, they are expected to use sound judgment in making clinical decisions, and their reasoning should be documented in their notes In cases where school counselors make an assessment that a student is at risk for suicide, it is imperative that the student's parents or guardians be notified that such an assessment took place. Parents or guardians have a legal right to know when their child may be in danger.

Alternatives to Traditional Therapy

Some alternatives to psychotherapy include self-help programs, stress management, personal-effectiveness training, peer self-help groups, indigenous healing practices, bibliotherapy, 12-step programs, support groups, and crisis intervention.

Ethics Codes and Technology

The Code of Ethics of the American Mental Health Counselors Association (AMHCA, 2015) includes guidelines for online counseling that address issues pertaining to confidentiality, client and counselor identification, client waiver, establishing the online counseling relationship, competence, and legal considerations. The APA (2010) ethics code states that psychologists who offer online services inform clients of the risks to privacy and the limits of confidentiality. The ACA (2014) ethics code states that counselors are expected to inform clients of the benefits and limitations of using technology in the counseling process. The AAMFT (2015) ethics code has the following guideline for electronic therapy: Prior to commencing therapy services through electronic means (including but not limited to phone and Internet), marriage and family therapists ensure that they are compliant with all relevant laws for the delivery of such services. Additionally, marriage and family therapists must: (a) determine that electronic therapy is appropriate for clients, considering professional, intellectual, emotional, and physical needs; (b) inform clients or supervisees of the potential risks and benefits associated with technologically-assisted services; (c) ensure the security of their communication medium; and (d) only commence electronic therapy or services after appropriate education, training, or supervised experience using the relevant technology.

issues of power and control

can be central in the therapy process, especially in the case of clients who have been victimized. The informed consent process can help to minimize the power differential.

Professional negligence

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

The duty to warn applies to those

circumstances where case law or statute requires the mental health professional to make a reasonable effort to contact the identified victim of a client's serious threats of harm, or to notify law enforcement of the threat.

Sexual abuse

consists of nonconsensual sexual contact of any kind with an older adult.

Informed consent of parents or guardians may not be legally required when a minor is seeking

counseling for addictions to dangerous drugs or narcotics, for sexually transmitted diseases, for pregnancy and birth control, or for an examination following alleged sexual assault of a minor over 12 years of age

Client Abandonment and Premature Termination

define termination as "the ethically and clinically appropriate process by which a professional relationship is ended" (p. 500). They define abandonment as "the failure of the psychologist to take the clinically indicated and ethically appropriate steps to terminate a professional relationship" (p. 500). Clients need to be informed about termination and, as much as possible, should be involved in making decisions about when to end their treatment. When both client and therapist agree that the goals of therapy have been achieved and that therapy is no longer required, there is a very low risk that the client will file a malpractice complaint. Practitioners who work on a fee-for-service basis can usually terminate treatment when they are not receiving payment for their services because the original remuneration contract is not being honored. Therapists have no legal duty to provide free psychological services and can stop treatment when the client stops paying for the services (Younggren et al., 2011). Courts have determined that the following acts may constitute abandonment: failure to follow up on the outcomes with a client who has been hospitalized; consistently not being able to be reached between appointments; failure to respond to a request for emergency treatment; or failure to provide for a substitute therapist during vacation times. Terminating a client who clearly needs continuing care may be sufficient grounds for a malpractice suit

The Duty to Warn and to Protect

dual professional responsibility: to protect other people from potentially dangerous clients and to protect clients from themselves. Balancing client confidentiality and protecting the public is a major ethical challenge that mental health professionals must assess in considering these competing interests. American Psychiatric Association (2013b) provides this standard: "When, in the clinical judgment of the treating psychiatrist, the risk of danger is deemed to be significant, the psychiatrist may reveal confidential information disclosed by the patient." (4.8.).

Hedlund Case

extends duty to warn to anyone who might be near the intended victim and who might also be in danger A fourth legal ruling, Hedlund v. Superior Court (1983), extends the duty to warn in California to a foreseeable, identifiable person who might be near the intended victim when the threat is carried out and thus might also be in danger.

Even if clients argue that they can do what they want with their own lives, including taking them, therapists must....?

have a legal duty to protect suicidal clients. The crux of the issue is knowing when to take a client's hints seriously enough to report the condition. If a counselor makes a determination that a client is at risk for suicide, the counselor should take the least intrusive steps necessary to prevent the harm (Remley & Herlihy, 2016). Consult with experienced colleagues when you are faced with clients who are at risk for self-harm, and be sure to document the nature of your discussions with colleagues. very important below: basically not in trouble if the client kills themself and there was a thorough assessment and actions where taken but in trouble if client was in danger to self and was then ignored by the therapist If a client dies by suicide, the risk of a malpractice action is greatly reduced if the therapist can demonstrate that a reasonable assessment and intervention process took place; professional consultation was sought; clinical referrals were made when appropriate; and thorough and current documentation was done (Jobes & O'Connor, 2009). Counselors can be accused of malpractice for neglecting to take action to prevent harm when a client is likely to take the step of suicide, yet they are also liable if they overreact by taking actions that violate a client's privacy when there is not a justifiable basis for doing so

The smart phone for remote counseling is an example of what?

he smartphone is just one example of a widely available technology that can individualize the nature of client care and can tailor assessment and treatment strategies to the needs and preferences of each client.

three types of covered entities:

health plans, health care clearinghouses, and health care providers who transmit health information by electronic means.

reportable abuse

involves the legal responsibility of a mental health professional to report suspected abuse or neglect of children, the elderly, and other dependent adults

Informed consent

involves the right of clients to be informed about their therapy and to make autonomous decisions pertaining to it. Informed consent is a shared decision-making process in which a practitioner provides adequate information so that a potential client can make an informed decision about participating in the professional relationship (Barnett, Wise, Johnson-Greene, & Bucky, 2007). Informed consent is both an ethical and a legal obligation of the clinician, and providing information to clients is also a good quality enhancement strategy. Attending to informed consent not only meets legal and ethical standards but represents excellent clinical care as well (Knapp et al., 2015). Informed consent for treatment is a powerful clinical, legal, and ethical tool (Wheeler & Bertram, 2015).

Physical abuse

involves the use of physical force that often results in bodily injury, physical pain, or impairment.

mandatory reporting

is designed to encourage reporting of any suspected cases of child, elder, or dependent adult abuse; and therapists are advised to err on the side of reporting in uncertain circumstances (Benitez, 2004). The goal of reporting is to protect the child or older person who is being abused. The professional has an obligation to protect those who cannot advocate for themselves.

informed consent document

is to define boundaries and clarify the nature of the basic counseling relationship between the counselor and the client. One benefit of informed consent is that it increases the chances that clients will become actively involved, educated, and willing participants in the assessment process and in their therapy. When clients understand what is expected of them to get positive results from therapy, the therapeutic alliance is enhanced. It may not be possible or clinically appropriate to discuss informed consent in great detail at the first session due to the emotional state of a client.

malpractice

means "bad practice."

Professionals are obligated to disclose information that is

necessary and sufficient when the client requests it, but only the information that is specifically requested and only to the individuals or agencies that are specified by the client.

The idea and benefit of keeping two sets of records is

one set (progress notes) is more general, less private, and more readily accessible to insurers and clients. The other set (process or psychotherapy notes) is more private and for the use of the therapist. Psychotherapy notes may contain the therapist's clinical hunches, matters to raise for supervision, personal reactions to the client, or hypotheses for further exploration.