COUN 857 Final

B. Procedures in case of emergency

1. A counselor has decided to offer SKYPE counseling sessions in order to increase the number of clients served. During the initial session, what is the most important issue the counselor should discuss? A. Fee management B. Procedures in case of emergency C. What services can or cannot be provided over SKYPE D. How records will be managed

Morality: our own personal views on social issues. How we would personally handle situations. Need to be aware of our own opinions and biases and when to express and not express Ethics: - consensus on a professional level of acceptable behavioral standards. Need to prevail over personal values.

1. What are the differences between morality and ethics?

1. Restrict practice to areas of competence 2. Never sue a client for unpaid fees 3. Utilize a client disclosure statement 4. Never guarantee or imply guarantee of outcomes 5. Follow full professional boundaries 6. Use supervision or peer supervision 7. Stay connected with colleagues, don't isolate 8. Keep self-disclosures to a minimum 9. Keep current with developments in law and ethics I 0. When in doubt, consult: colleagues on ethical questions, lawyers on legal questions II. Monitor effectiveness as counselor 12. Keep foci on taking responsibility for professional actions and on client welfare 13. Keep case notes 14. Maintain an ethic of self-care 15. Protect self legally (professional liability insurance)

30. Provide 3 examples of professional actions you can engage in to avoid legal /ethical problems? On complaints received by boards in the USA handout; under Guidelines for avoiding problems.

- Ethical Considerations: o Don't ask for client testimony o Representation needs to be accurate o Credentials, educational degrees need to be present o Don't imply doctoral level competence if not at doctoral level Have accurate representation. You only use the qualifications you actually have. It must be clear. Separate your various credentials, unless directly relevant. "Expertise" entails extensive training and experience. Communicate exactly how much experience or knowledge you have. Then, it's up to the client.

34. What ethical and legal guidelines should be considered in advertising?

A. Allows practitioners to sift potentially real cases of an elder and dependent abuse from ones that may have been imagined by an elder or a dependent adult B. However, this exception is limited to very specific circumstances

40. What are the exceptions to elder or dependent adult reporting?

Tarasoff CANRA Duty to report Elder abuse

5. Provide examples of laws applicable to counseling.

a. Dimensions of professional identity i. Wellness model- goal: to achieve positive mental health where possible, tailored to the client, so they can achieve independence. SEEING THE PERSON AS A WHOLE ii. Developmental perspective- goal: personal/emotional issues are natural/ normal/ developmental in nature. Looking at client historically and contextually, but knowing that its not the root to all issues. iii. Prevention and early intervention- goal: using education as a way to prevent future problems. iv. Empowerment of clients- goal: to help clients solve problems independently v. Interpersonal perspective- goal: relationship for therapeutic, emancipating purposes

8. What dimensions would you use to explain a counselor's professional identity to other mental health professionals?

a. Multicultural competence guidelines similar to code of ethics bc they are aspirational in nature. b. Multicultural competence and ethical practice are best practices together. We need to be challenging ourselves to be better equipped at helping diverse populations

9. How does cultural competence relate to ethical practice?

If you are accused of a legal issue - seek legal counsel: ● If you receive a notice from a licensure or certification board or from a professional association ethics committee that you have been accused of unprofessional conduct you need immediate legal counsel. ● Report any threatened or completed accusation of professional misconduct to your supervisor if you work in an agency and to your personal professional liability insurance carrier. Generally professional liability insurance companies provide legal counsel to policyholders. ● You must make every effort to fully explain a situation to your legal advisors and educate them, to the extent possible, regarding the counseling process and the counseling profession. ● Review notes, texts, and legal codes, codes of ethics. ● Examine your actions and whether they were incompetent and if so do they constitute malpractice. ● We should also examine whether standards of care of the profession were not upheld by our actions. ● You can then follow the legal advice you have been given without worrying about whether it is correct. ● You should raise questions if you believe you are being given incorrect advice, but you can rely on the advice you have been given. ● Lawyers are required to stand behind the advice they render. ● You can sue your lawyer if you are harmed as a result of relying on their incorrect advice.

9. What should you do if a malpractice lawsuit is filed against you?

prevention

All following are goals of ethical multicultural practice except: self-awareness, knowledge, skills, prevention

- informed consent - confidentiality - monitoring client's safety - assessing for suicidality - consent to collaborate with other professionals

Both legal and ethical standards

The client is not under obligation CPS though if it was a minor is the victim can encourage to contact police

Neighbor across street has a gun tells intent to shoot boss not our client

- processing report with client - managing fees - cultural competence - autonomy, beneficience, nonmaleficence etc... Collaborating with other professionals Consider clients ability to pay fee (in beginning) Managing own counter transference consultation

ethical standards

Standard of Care

is the degree of care that a reasonably prudent person should exercise in the same or similar circumstance. ● A key statement to remember in terms of standard of care is "we don't fail by doing, but by not doing or being neglectful" ● We are consistently compared to our community. ● When our conduct is below the standard of care - we typically call this neglect

- Sex with current and former clients, their romantic partners or family members - Abandonment - Sexual relationship/harassment with supervisees - Sex with research participants

14. What are the counselor behaviors specifically prohibited by the ACA code of ethics? (do we need to know considerations, when to document?)

D. All members of the family (whoever is involved); (need to acknowledge all parties when getting ARI. Not the best answer but it includes all

1. A family of 5 (mom 46, dad 48, oldest son 17, middle son 15, and youngest daughter 9) comes to see the counselor to discuss a recent loss of their maternal grandmother who was very close to the family. In order to assess the impact of this loss on the oldest children, the counselor decides to contact their school and find out their progress. In order to be able to speak with a school representative the counselor should obtain a written release from: (informed consent vs. authorization of release of information) A. The 17 and 15-year-old boys B. The parents C. Any one of the parents since they are still married D. All members of the family

Diffuse: Or enmeshed boundaries fail to provide adequate protection. Rigid: Boundaries lead to isolation, aloofness, disconnect and lack of communication Flexible Boundaries: Promote integrity, professionalism and are conducive, facilitative of thriving. Flexible boundaries are appropriately responsive to changes in the environment. They are helpful in characterizing and maintaining identity

14. Describe the difference between diffuse, rigid and flexible boundaries

a. Self-awareness: counselors need to be aware of their own biases, values, assumptions through self-reflection b. Knowledge: counselors need to constantly be increasing their knowledge of cultural values, biases assumptions of the cultures of their clients c. Skills: counselors need to constantly be developing culturally appropriate intervention strategies for their diverse clients d. Cultural safety: high level of cultural humility and a high level of cultural competence e. Should not expect clients to educate us on their culture, but we should know it all or have preconceived notions

10. What are the goals of multicultural practice?

Compensatory - trying to make a client whole; the function is reparative; this was damage court assesses in monetary value and counselor owes to client or client's family. Trying to punish the therapist = punitive; set a standard; punish counselor for wrong doing and set and example to other counselors; sometimes take away license; publish in ACA journal names recent cases or lose license; fine to advisory board; or community service for face of the profession.

10. What is the difference between compensatory and punitive damages?

Step 1- consult legal and ethical knowledge/experience (seek consultation from client and supervisors/colleagues) Step 2- research Step 3- consider multiple angles to approach situation Step 4- consider clients confidentiality. Let them know you are seeking consultation Step5- consider your own emotions and reactions in assessing the situation Step 6- collaboration with the client on decision making to promote follow-through Step 7- consultation is important. Need to have decision made first beforehand. Step 8- prioritize goals Step 9- your actions will be judged. Make them accordingly Step 10- necessity of strength to implement plan Step 11- actions may not go as planned Step 12- Document everything! To keep with legal/ethical standards and to help learn from the situation. Why is it important/things to consider: - Main goal is to prevent harm and protect clients - Need to consider community standards of practice - Consider scope of practice and scope of competence - Protocol is important - Consider code of ethics - Consider consequences - Document!

11. What are the main components of ethical decision-making?

● We all start with unconscious incompetence. ● Then we move into conscious incompetence. ● Then conscious competence. ● Then unconscious competence. ● All of us are at different stages of different themes and topics in the field. Unconscious - not aware of what don't know Conscious - begin to know what you don't know Conscious competence - begin to try on things but still very conscious Unconscious competence - intuitive second nature not even conscious of what doing

11. When conceptualizing incompetence, it is advisable to think in terms of a continuum from what to what?

The range is from least to most incompetent. ● Terms distressed, burned out and impaired should be seen on the continuum from least to most serious in relation to the impact on competent professional performance Distressed: ● Distressed counselors may experience anxious and depressed moods, somatic complaints, lowered self-esteem, feelings of helplessness, but they are not impaired in their prof-al functioning. ● On some level they know something is off, but distress is usually a transitory and temporary condition Burned Out: ● It is significant exhaustion on emotional, physical and mental levels. It could be brought on by exposure to trauma or prolonged involvement with demanding situations and people. ● Burned out counselors have little energy for their clients, thus it begins to make a difference in the quality of work. Impaired: ● Impaired counselor is unable to deliver competent care to the clients. ● Impairment is often associated with compassion fatigue, vicarious traumatization, AOD use, blurring the boundaries, cutting corners with respect to standards of care.

12. What are the warning signs of professional impairment?

- Means that the decisions that promote the most growth and benefit to the client are made by both client and counselor - Strengthens trust on counseling relationship - Increases probability of follow through - EX: pushing rehab on a client vs discussing its benefits and drawbacks and allowing the client to decide for themselves whether or not they want to go - Pushing the inclusion of a significant other in session with client who is having issues vs. discussing with the client the potential benefits and drawbacks of including significant other in therapy and allowing client to decide whether or not they want to move forward to opening up the session - Including clients as a part of the decision making process increases buy in and compliance to follow through w/ treatment plan if they are owning the decision / plan and invested. Also, including their thoughts opinions/ feelings not only increases their investment but also signifies to them the coun values their them and their thoughts, opinions/ feelings, which fosters trust in the coun relationship. For instance, hearing a client out on their level of self-risk, ways they find helpful to cope and emotions associate w/ reaching a low state of mind, then drafting this into a contracted plan for no self-harm until next session or throughout duration of treatment has more of an impact on client compliance. This is b/c they have physically come up w/ and drafted their individual plan unique to come up w/ and drafted their individual plan unique to them and it's tangible and holds them accountable too.

12. What does the following statement mean: "Ethical decisions are best made with the client rather than for the client"? Provide some examples.

● Personal therapy ● Supervision / consultation ● Vacation / break ● Peer support group ● Regular exercise, meditation, hobbies ● Family and friends support ● Self-care ● It is really important that you develop self-awareness and contact with yourself in order to stay emotionally and psychologically healthy in this profession. Grad school is often very stressful and now is a good time to start practicing self-care.

13. Describe a range of possible self-care activities you ought to engage in to prevent impairment

- Uphold professional identity - Advance client welfare - A way for counselors to police themselves

13. What are the main purposes of the ACA code of ethics?

- Discrimination - Sexual harassment

15. The ACA code of ethics singles out two behaviors that are not condone or engaged in by counselors, what are they?

● 2 or more separate and / or distinct relationships between client and counselor. ● Dual relationships can be sexual or non-sexual in nature. At times dual relationships are emancipatory (helpful), but most of the time they are problematic. Dual relationship is problematic because: ● It may impair our judgment. Conflict of interest is created that compromises the objectivity needed for sound professional judgment. ● It is a slippery slope - once it started, it is really difficult to go back. That's is why boundary crossing done sporadically is dangerous. It should be done thoughtfully and carefully. ● It may lead to exploitation because of power differential. As counselors we know client's most sensitive, vulnerable, intimate secrets and that doesn't go away. This makes it difficult to re-enter counseling relationship.

15. What are dual relationships?

- Allowed to accept gifts if: o monetary value is at max the amount for one session. o The length of time working with client is at an appropriate level. o If it does not coincide with recent developments in therapy - Consider motivation, cultural considerations/norms, does it come as a hardship to the client, discuss gift, open in front of them

16. Based on your understanding of the ACA code of ethics and community standards of practice, are you allowed to accept gifts from clients?

Answer from PPT 9 A boundary crossing is a departure from a commonly accepted practice that occurs to benefit a client. The boundary is shifted to meet the needs of a particular client at a particular moment. In considering a boundary crossing we exercise judgment and discuss it ahead of time. Example: attending a client's wedding, bartering A boundary violation is a serious breach that causes harm. Example: Having sex with the client

16. What is the difference between boundary crossing and boundary violation? Provide examples

From PPT 9 slide #14 & 15: •Sharing holidays with clients •Socializing with client at counselor's home •Attending movies with a client •Helping organize a client's wedding •Holding a client's wedding reception at the counselor's condo. club house •Allowing client to cohabitate with counselor •Seeing a client socially too soon after the termination of counseling •Terminating counseling to commence a personal relationship •Babysitting client's children •Involving client in counselor's family gathering •Visiting a client's home for reasons unrelated to counseling •Sending a client clinically inappropriate emails •Dating •Allowing the partner of the client to cohabitate with counselor.

17. Provide 3 examples of non-sexual dual relationships.

Assures trust in counselor client relationship Keeps client's information safe. Maintains trust - Counselors prohibited from disclosing confidential info to a third party - We are civilly or criminally liable if we do not uphold confidentiality

17. What is the purpose of confidentiality?

From PPT 9 slide # 32 ● Showing sexually explicit material to minors without proper consent ● Watching a sexually explicit movie with a client ● Telling a client that counselor loves him or her ● Accepting nude photographs of a client ● Failing to wait at least 2 years from lawful termination

18. Provide 3 examples of sexual dual relationships

Privacy- the person's right to decide what info about themselves will be shared or withheld from others Confidentiality- legal and ethical concept - Refers to counselors obligation to respect client's privacy and promise that info will not be revealed outside of counseling session Privilege- solely legal concept - Affords the client the right to withhold counselor's testimony in a court of law - Privilege arises from special relationship counselors have with clients - For the common good and for the sake of rehabilitation - Doesn't die with the client

18. What are the main differences between privacy, confidentiality and privilege?

➢ CANRA- Child Abuse and Neglect reporting act: - Mandated to report physical abuse, sexual abuse, neglect, cruelty, unjustifiable punishment, unlawful corporal punishment - When there is a tool used ➢ Elder/ Dependent adult Abuse: - Mandated to report physical abuse, neglect (deprivation of necessary goods or services), isolation, financial abuse, abandonment, abduction, other things that cause physical harm or mental suffering ➢ Tarasoff (duty to protect):- counselor's duty to protect others that may be in danger by the client - Assessment to reasonably determine SERIOUS RISK if client is dangerous to another person (reasonably identifiable victims by 1 or 2 phone calls away) by grave bodily injury or loss of life o Victim can be anyone in harms reach - Warn intended victim of danger, notify police etc... Tarasoff the statute: counselors get immunity from liability for client's violence when they make reasonable efforts to communicate threats to identifiable victim or victims and to law enforcement - Immunity means that if your patient actually harms the intended victims, if you've accomplished the assessment and discharge, you cannot be held financially responsible *Even after assessment, if the client does not communicate a serious threat but you determine they pose a serious danger to another person, you can discharge duty to protect * if it is not feasible, beneficial or counterproductive to inform the victim of the serious threat, a counselor may take other protective measures but needs to document clearly (EX: when a student threatens to kill another student who has a gun, it might not be wise to tell the intended victim for possibility of more damage to be caused. *Tarasoff the case: includes hospitalization of client if a serious risk is determined and reasonably identifiable victims are indicated. Will not be immune to liability but you can make the case if you've met standard of care *if the threat comes from a family member or reliable 3rd party, we act accordingly *hedlund extension- when there is a threat to not only atleast 1 identifiable victim, but to other people that might be in harms way - duty of counselor to speak directly to all other individuals that might be potential victims Duty to report: when a client communicates a serious threat of physical violence against reasonably identifiable victim or victims and is in possession of/has access to weapons, counselors have the duty to report - Need to report to law enforcement within 24 hours of the identity of the person - They notify the department of justice and will be prohibited form accessing weapons for 5 years - Can be satisfied with 1 phone call when enacting duty to protect ➢ Counselors actions in these situations: - Do not investigate. Assess situation to come to a reasonable suspicion o Use records, interviews, experiences in session with client, client history of violence, threats, trauma, current mental state - Make a report - Only disclose relevant information

19. Name and briefly describe the mandatory exceptions to confidentiality. How should the counselor's actions be in those situations?

From PPT 9 Slide # 34 & 35 ● Clients are likely to suffer from therapist - patient sex syndrome with reactions similar to those of rape, spouse battering, incest and PTSD. ● Clients often experience deep ambivalence towards the offender. Trapped between fear of separation and desire to escape from his / her power and influence. ● Clients often suffer from guilt thinking that they are to blame for the relationship. They might also be very angry at the counselor, and rage is often suppressed due to counselor's continuing influence, and on some level wanting to protect and cling to counselor. Such feelings of guilt and rage lead to increased risk of suicide. ● Due to demands to keep it a secret clients often feel isolated, alone, cut off from normal world of human experience.

19. What symptoms may be exhibited by a client who was in a sexual dual relationship with their former counselor?

B. Report elder abuse

2. A son comes to counseling with his 69-year old dad. His father is in the late stages of dementia and he is his father's primary caregiver. The son notes how tough it is to have to take care of his dad. "But there are no any other options", he states. He doesn't trust the nurses in a residential facility to take good enough care of his dad if he sends him there. He also notes he is living off his father's savings and social security checks and would not be able to financially survive without them. What should the counselor do first? 69 is elder; between 18-64 dependent adult A. Report dependent adult abuse (not a dependent adult financial abuse happening) B. Report elder abuse C. Assist the son in locating support services for the mom D. Validate his concern of inadequate care in nursing homes

a. Laws: Agreed upon rules of society. DICTATE MINIMUM STANDARDS OF BEHAVIOR THAT SOCIETY WILL TOLERATE b. Ethics: represents IDEAL STANDARDS expected by profession c. Morality: professional ethics weight out personal values if they are discordant d. How they relate to eachother: PROFESSIONALISM/best practices incorporates legal and ethical behavior. Exists on a continuum i. Ethics is in the middle. ii. Ethical standards are enforceable, best practices are aspirational

2. How do the concepts of morality, ethics, and laws relate to each other?

Scope of Practice Is a legal issue; The definition provided in law that delineates what the profession does and places limits upon or confines the breadth of functions persons within a profession may lawfully perform. Scope of Competence Is an ethical issue: - My bad! 1) core knowledge via our degree, CEUs, training, certification; 2) skills from translating knowledge into practice, it is one's ability to select strategies, interventions, techniques. We hone in on our skills through practicum: 3000 hours in order to be licensed. 3) diligence via consistency, prioritizing client welfare, and recognizing limitations. Standard of Care It is the degree of care that a reasonably prudent person should exercise in the same or similar circumstance. A key statement to remember in terms of standard of care is "we don't fail by doing, but by not doing or being neglectful" We are consistently compared to our community. When our conduct is below the standard of care - we typically call this neglect

2. How do the concepts of scope of practice, scope of competence and standard of care relate to one another?

A. validate the feelings of grief and loss (this is the FIRST THING you would do before referring to low fee animal hospital)

2. While talking about her history, a client tearfully tells the counselor that she will have to put her cat to sleep because she cannot afford the surgery that is required after a car hit the cat. What should the counselor do first? A. validate the feelings of grief and loss B. refer the client to a low-fee animal hospital C. suggest the client attends a grief group for those who lost their pet D. ask how the client has dealt with losses in the past

When we have knowledge of or reasonably suspect that a child is or is at risk of suffering serious emotional damage - Includes depression, anxiety, aggression When patient is a danger or self or others, or others property If the client is suicidal When there is a 5150 - When there is a mental disorder or are gravely disabled and client is a danger to self or others, - The law enforcement or psychiatric evaluation can be called to assess the situation and may or may not place them in custody for a 72 hour hold. o There needs to be probably cause • Done by assessment of history, alcohol/drug use, stressors, impaired judgement, means, access, plan

20. Besides mandatory exceptions to confidentiality, what is the most significant situation where counselors have the option to disclose confidential information?

- Consider monetary value - Consider length of time working together - Consider recent progress and developments in therapy - Using hourly wage of client not a good measure - Consider motivation, cultural considerations - Consider If gift comes as a hardship to the client - Standard is 1 session worth of monetary value - Open gift in front of client - Engage in discussion about meaning of gift

26. How do we handle gifts?

a) If the client does not want to report that counselor - they do not have to. Do not pressure them to do so. If they decide to go after the perpetrator - you can assist them in doing so. b) However, if victim still a minor it's a report if no longer a minor it's not a report. c) Do not break client's confidentiality and report the counselor or call to talk to the counselor. Certainly do not do so, unless your client wants and is willing to testify. Let them know that there, most likely, will be formal hearings, cross-examining in a hostile and aggressive manner, a process that will be very emotionally taxing. d) Hand them the brochure - "Professional Therapy Never Includes Sex."

20. What are you legally mandated to do in CA if you learn that your current client was sexually involved with his / her former counselor?

- Release needs to be in writing - All person(s) in treatment need to sign release either consenting or assenting) - Legal representative has to sign for minor. If client dies, still need release from legal representative Needs to include: - Uses and limitations on info to be disclosed - Name or functions of provider that may disclose information - Name or functions of entities authorized to receive info - Uses and limitations on use of info by who is receiving it - The date after the provider is no longer authorized to disclose - Right of client to receive copy of authorization

21. Authorization to release information

- Assessing plan, means, availability, specificity, lethality - Level of risk determines type of intervention Mild (no plan, suicidal ideation) - no suicide contract, increased contact Moderate (a plan is beginning to form, suicidal ideation)- mobilize the support system, enlist the help of significant others Severe -(a plan is in place, have the means and availability, suicidal ideation) encourage voluntary hospitalization; may initiate involuntary hospitalization. Suicidal Client

21. How should the client assess for risk of suicide and what actions should the counselor take if the risk is mild? Moderate? High?

You cannot use the client's previous sexual history but they lose privilege to other information once they raise a lawsuit against you.

21. What should you do if your lawyer advises you to use client's consent as part of your defense against the sexual charges he/she has filed against you?

From PPT 9 slide # 31: According to Civil Code § 43.93: "Sexual contact" means touching of an intimate part of another person. " Sexual contact includes sexual intercourse, sodomy, and oral copulation. "Therapeutic deception" means a representation by a psychotherapist that sexual contact with the psychotherapist is consistent with or part of the patient's or former patient's treatment.

22. What does "therapeutic deception" mean in the context of sexual contact in a therapeutic relationship according to the California Civil Code?

- To prevent danger to self or others - When emotional condition becomes a part of a court case - When a counselor is appointed by court to examine client - When counselor is sought to help commit a crime or escape from punishment - If a client sues a counselor - To determine sanity of criminal defendant - If the client is under 16 and there is reasonable cause to believe that they've been a victim of a crime and disclosure is in best interest of client Civil Code §56.10 - It is OK to disclose some information to other health care providers in case of emergency, particularly regarding life threatening things. We are not required, but we should look at the best practice - which is to prepare the other practitioner so they can provide the best treatment. The value of nonmaleficence. Penal code §11166.05 - If we have knowledge of, or reasonably suspect that a child is suffering serious emotional damage, or is at risk of suffering emotional damage, including, but not limited to depression, anxiety, aggression towards self or others - we may make a report. Evidence code §1024 - patient is dangerous to him or herself or others. There is no privilege under this article if the psychotherapist has reasonable cause to believe that the patient is in such a mental and emotional condition as to be dangerous to himself or herself or to the person or property of another and that disclosure of communication is necessary to prevent the threatened danger.

23. What are the permissible exceptions to privilege?

From PPT 10: a) Seek immediate legal counsel b) Report any threatened or completed accusation of professional misconduct to your supervisor if you work in an agency and to your personal professional liability insurance carrier. c) Make every effort to fully explain a situation to your legal advisors and educate them, to the extent possible, regarding the counseling process and the counseling profession. d) Review notes, texts, and legal codes, codes of ethics. e) Examine your actions and whether they were incompetent and if so do they constitute malpractice. f) Examine whether standards of care of the profession were not upheld by our actions.

23. What should you do if you are formally accused of illegal behavior?

- Applied to entities that transmit health care info in electronic form - Counselors must give clients a clear written explanation of how counselors use, keep, disclose healthcare info - Clients must have access to their records and can request to amend their records through a process in writing - Written history of disclosures must be available to clients - Written privacy procedures, includes who has access to info, how it will be used, when it would or wouldn't be disclosed - Clients must be given a means to make inquiries regarding counseling records and make complaints about privacy of records. - Exists to protect client confidentiality

24. What is HIPAA and why does it exist?

From PPT 10: a) Seek consultation with a supervisor or colleagues b) In seeking legal and clinical consultation we should document, document, document and keep in mind confidentiality (although client's confidentiality is waived by their filing legal action against you, we still must only disclose info that is relevant to the client's accusations) c) Communicate closely with your agency - workplace if applicable and remain aware that our agency has issues on the line in addition to our own personal consequences. Inform the insurance carrier if suit is being filed.

24. What should you do if you are formally accused of unethical behavior?

- Looking at case notes help provide clients with best possible services - Help measure progress/growth - Can help reconnect to old clients when they want to come back - Continuity of care when counselor dies - Documentation in critical situations - Unprofessional/ILLEGAL to not keep records

25. What are the main reasons for keeping records when providing counseling services?

The primary goal is resolution. Speak with your colleague and see if they can remedy the issue themselves before going to a supervisor or higher authorities.

25. What should you do if you are concerned about what appears to be unethical behavior on the part of a colleague? What ought to be your goal?

I.2.a. Informal Resolution: When counselors have reason to believe that another counselor is violating or has violated an ethical standard and substantial harm has not occurred, they attempt to first resolve the issue informally with the other counselor if feasible, provided such action does not violate confidentiality rights that may be involved.

26. What does the ACA code of ethics say about informal resolutions of ethical issues?

- Errors need to be corrected according to agency policy - Don't alter it - Cross it out w/ single line. Initial it - Or add another record, date it, initial it

27. How do we correct mistakes in the records?

Speak to colleague first, look out for each other, trying to find out other side perspective of counselor (give chance to speak their part) and remedy situation on own, before reporting to supervisor, clinical supervisor or BBS. Formal ethical complaint on child abuse seek consultation, document, end interaction suspend services don't talk undue pressure perceived by clients supervisor make contact, review own records and behavior and code of ethics applicable here.

27. What does the ACA code of ethics say about reporting ethical violations?

Formal Complaints to Boards (e.g., BBS) or Committees (e.g., ACA ethics committee) I. All investigations are confidential. 2. All complaints must be in writing and NOT anonymous. 3. Jurisdiction? 4. Do they violate the code of ethics? Are allegations true? 5. If yes, then initiate an investigation ranging from asking written questions to the accused to sending investigators to talk to witnesses or the accused. 6. If settlement is appropriate and reached to mutual satisfaction, done. If not, then a hearing. 7. If violations are established, then sanctions. 8. Counselor may appeal, if appeals exhausted, then counselor can sue if the counselor believes the treatment was unfair. 9. Sanctions are published.

28. What are the typical steps followed by committees on professional ethics when they receive a complaint?

When subpoena is issued by a lawyer, counselors will seek to assert privilege - Can't confirm or deny that person in question is our client - Contact client - Clients lawyer has to seek to squash subpoena - Ask for written permission to speak to client's lawyer or have them do it Clients can waive privilege by signing a release - All members of treatment have their own privilege. All need to sign - Counselor can't assert privilege once it has been waived If subpoena is called by judge or court order, we need to show up or give up records We can advocate for not all of the record to be released, or a summary to be released with a letter to the court if we deem it detrimental to the client Need to document all communication

28. What should the counselor do when he/she receives a subpoena?

Violation burden of proof lies on the client up to them to provide proof that the client was damaged somehow; code refers to ethical code; counselor innocent until proven guilty; handout different percentages complaints to the board.

29. According to the ACA code of ethics, the burden of proof in a code violation rests on whom and why?

- Counselor is the owner of the record - Client needs to have signed off on authorization of release of information to the designated person/entity that's asking - Counselor needs to take precautions to make sure the information is transferred appropriately o Delineate confidentiality of records - decide how much of the record should be released- whole, partial, summary - release of records needs to be in the clients best interest! Can deny release of records if it would be detrimental to the treatment of the client o document why its not in the clients best interest - make sure records are released only of the client in question. (pertinent when working with families or couples

29. When asked to share professional records by a third party, what are the main matters you should keep in mind?

B. Call the psychiatrist and request a faxed copy of his release before acknowledging you see the client. Client doesn't need to sign multiple if client has already have sent make sure legit

3. A counselor receives a phone message from a client's psychiatrist who has been providing medication monitoring for the client's bi-polar. The psychiatrist informs the therapist that the client gave him permission to contact you and he would like to discuss concerns about the client's diagnosis and treatment. What should the counselor do first? A. Call the psychiatrist to inform him that you will request the client sign a release in the next session B. Call the psychiatrist and request a faxed copy of his release before acknowledging you see the client. C. Call the client to request permission to speak with the psychiatrist D. Call the psychiatrist to discuss concerns regarding the client's case since he has signed release.

A. Encouraging client to go the ER immediately and file a police report

3. A female client calls a therapist hysterically crying and reports that she was just the victim of a date rape. The therapist should initially focus on: A. Encouraging client to go the ER immediately and file a police report B. Having her assume responsibility for her part of the rape C. Filing a police report on her behalf D. Helping client identify family and friends who can support her in crisis

a. Principle Ethics- asks "what should I do" i. Autonomy- freedom of client to choose direction in therapy/treatment ii. Nonmaleficence- Do no harm iii. Beneficence- obligation to be of benefit to society. Do good. iv. Justice- commitment to fairness in professional relationships v. Fidelity- keeping promises made to clients. Fulfilling responsibility of trust. Informed Consent & confidentiality vi. Veracity- truthfulness. Being honest at all times with client b. Virtuous Ethics- asks "who should I be" i. Focus is on the counselor as the actor. Need cohesive effective characteristics to be the counselor that you want to be ii. Characteristics: integrity, discernment, respectfulness, self-awareness, acceptance of emotion, connectedness with community

3. What are the similarities and differences between principle ethics and virtuous ethics?

General guidelines to work at our standard of care ● Follow the laws, follow professional standards expressed in the code of ethics, follow own practice guidelines.

3. What guidelines should you follow in order to practice at or above the standard of care?

- if client is seeing another counselor for the same reason, we do not see them; discuss with client; If they are working on a completely separate issue with the other counselor then this is different, but overlap is likely to occur, so it's best to terminate with you and refer them to the appropriate services.

30. What do you do if you learn that your new client is seeing another professional counselor?

10: Talking to Clients' Attorneys when they shouldn't 9: Failing to obtain written authorization from a Client before releasing confidential information 8: Using clinical or diagnostic terms when referring to third parties 7: Failing to Properly Respond to a Subpoena 6: Treating Minors Without Appropriate Consent 5: Writing Letters on Client's behalf 4: Treating Multiple Members of a Family in Conflictual Situations 3: Poor Record Keeping 2: Trying to Help Too Much 1: Calling CAMFT After Taking Action

31. Provide 3 examples of professional actions counselors are known to have engaged in and that resulted in legal/ethical problems.

What is informed consent: when a professional gives client as much info as they need to make an informed decision. Delineates risks to treatments - Have the right to consent or refuse treatment. Need info to do so - Helps avoid misunderstandings - Helps counselors develop sound policies/practices - Is both legal and ethical - Best practice= document + dialogue - Need to revisit informed consent as treatment progresses - Not legally obligated to obtain written informed consent with adults. Verbal will suffice - Client just be able to understand and be able to legally provide informed consent - Needs to include: fees and how they are set, status and license number o If counselor is a covered entity under HIPAA, must provide notice of privacy practices o Protocol for working with insurance provider (what info will be disclosed) o Charges for missed sessions, policy around collections, management of fees o Cancellation policy, scheduling, length, frequency of sessions o Counselor availability on weekends, evenings, phone contact between sessions o Termination policy o Potential risks and benefits of treatment o Limits of confidentiality o Scope of practice/ scope of competence o Theoretical orientation o Policy around diagnosis Obtain written informed consent when treatment is unfamiliar to client or experimental in nature

31. What information do prospective clients need to receive to make an informed decision to enter a counseling relationship?

MINORS AND INFORMED CONSENT - Minor has to be 12 or older to sign their own informed consent (need to be of sound and mature mind) o If brought in by parent, parent must sign as well - Minors under 12 can assent - If parents are married or have never been married, only 1 parents needs to consent o Need to see custody agreement if parents are divorced - Family member who cares for minor can give consent if they fill out caregivers authorization affidavit - If consenting to family therapy, there is no need to have consent to treat minor - If parents have joint legal custody 50/50 or 90/10, technically one 1 needs to sign. BEST PRACTICE: parents that have legal custody should sign so as not to put minor in the middle - FOSTER CARE- SHORT TERM: foster parents needs to show court order indicating legal authority to consent. Legal representatives sign consent when there is no court order(e.g., social worker) - FOSTER CARE- LONG TERM: foster parent can consent to treatment, but needs to show additional information that they have legal authority to consent

32. Informed consent with minors. When do the parents / guardians / caregivers / foster parents sign? Which parents sign the consent form? When can a minor consent to services on their own?

Legal- CANRA, informed consent, limits to confidentiality, when to include parents Seeking informed consent- when parents/ guardians/ care givers/ foster parents sign consent form Inability to give consent- seek assent and involve them in decision making Responsibility to clients to protect confidentiality Responsibility to parents and legal guardians- informing parents/legal guardians about role of counselors and confidential nature of counseling Release of confidential information - seeking permission from appropriate 3rd party to disclose information Sex with minors: - If both are 13 and under: don't report - If one is 13 and the other is older: report - If one is 13 and we don't know the age of the partner: assess - If one is 21 the other has to be 16 or older "if they're old enough to drink, they have to be old enough to drive" - Any forced sexual activity with person under 18- report

32. What legal and ethical issues should you consider when counseling minors?

The Child Abuse and Neglect Reporting Act

33. What does CANRA stand for?

- When client is symptom free - Has met goals of therapy - Maxed out on number of sessions - OK to terminate if presenting issues are outside of scope of competence - OK to terminate if you feel unsafe - Need to terminate in appropriate manner: discussion, normalize reaction, spread out sessions before termination - Refer them out if you are incompetent. i. WARM HAND OFF!! ii. Know your referral services. iii. Make contact with the provider first and connect your client to them. - Do everything you possibly can to take care of your things on your end before referring out or terminating.

33. What is a good time to terminate?

Physical abuse, sexual abuse, and neglect Environmental problems - Hazardous conditions, health risks or unsanitary conditions, extreme dirt of filth affecting health Parental or Caregiver Clues - Unable/unwilling to meet child's basic needs, homicidal thoughts/feelings towards child, use of objects for discipline, unable to describe positive characteristics of child, unrealistic expectations, out of control discipline, unduly harsh or rigid, singles out child as bad or beyond control, constantly humiliates, turns to child to have own needs met, impulsive, can't see child realistically, indifferent to child Physical indicators: Physical abuse - Fractures that are improbable in explanation, bruises, burns, facial injuries ALL WITH IMPLAUSIBLE OR NONEXISTANT EXPLANATIONS, subdural hematomas, fractures in different states of healing, pattern of bruising in different stages of discoloration Neglect - Failure to thrive, malnutrition, inappropriate dress for weather, extremely offensive body odor, dirty/unkempt, unattended medical conditions Sexual Abuse - Bruising/swelling in genital area, swelling/discharge from vagina/penis, tearing in genital/rectal area, lesions around mouth or genitals, lower abdominal pain, painful urination/defecation Behavioral indicators: physical abuse - Hostile/aggressive behavior, extreme fear or withdrawal, destructiveness, verbal abusiveness, out of control behavior Sexual Abuse - Sexualized behavior, hostility/aggression, fearfulness/withdrawal, self-destructiveness, pseudo-maturity, eating disorders, alcoholism/drug abuse, running away, promiscuity Neglect - Clingy, self-imposed isolation, depression or passivity Emotional Abuse Lack of self-esteem, seeks approval, unable to be autonomous, hostile, verbally abusive, provocative

34. What constitutes child abuse and neglect?

Taken from the mandated reporter guide book "the primary intent of the reporting law is to protect the child. Protecting the identified child may also provide the opportunity to protect other children in the home. It is equally important to provide help for the suspected abuser. The report of abuse may be a catalyst for bringing about change in the home environment, which in turn may lower the risk of abuse" - It's a legal and ethical obligation

35. If confidentiality is paramount for a counseling relationship to work, why do you have to report child abuse and neglect as a professional counselor?

What do you report: - Report past and present abuse (need to distinguish between child abuse report and historic report) - Abuse happening outside of CA - Call cps for consultation if unsure - When victim is under 18 yrs, report: physical injury inflicted by other than accidental means, sexual abuse (assault and exploitation), willful cruelty/unjustified punishment, unlawful corporal punishment/injury, neglect (either severe or general if perpetrated by one responsible for child's welfare) How: - Report immediately by phone, followed by written report within 36 hours When: - When a mandated reporter has reasonable suspicion that abuse is taking place (reasonable suspicion = when based on facts presented, a reasonable person in the same position would make the same call) To Whom: - Report to a county welfare department or probation department (if designated by county) or police/sheriff's department

36. In the case of child abuse, what do you report, how, when and to whom?

Suicidality is a may but in both don't make report will be in trouble; assess further moment suspect question to verify; not automatically breaking confidentiality. Emotional abuse- may report (need to assess further once you find out there is emotional abuse) Physical/sexual abuse/neglect- must report Why: protecting welfare of client. Promotes beneficence, and nonmaleficence

37. What type of child abuse you must report and what type of child abuse you may report?

a. Dependent Adult Abuse i. Someone between the ages of 18-64 that has a certain mental or physical disabilities that keeps him or her from being able to do normal activities or protect himself or herself B. Elder Abuse 1. Someone 65 years old or older ii. Physical abuse, neglect, financial abuse, abandonment, isolation, abduction (taking the person out of the state against his or her will), behavior that causes physical harm, pain, or mental suffering iii. Deprivation by a caregiver of things or services that the elder or dependent adult needs to avoid physical harm or mental suffering

38. What constitutes elder or dependent adult abuse?

a. Make a phone call immediately or as soon as reasonably possible b. Submit a written report within 2 working days (48 hours) c. Call APS- Adult Protective Services d. If the elder lives in the care facility report to local ombudsman e. Reporting duties are individual f. Supervisor advising not to report is not a good enough reason not to make a report g. As a counselor we are granted immunity from civil liability and criminal prosecution

39. In the case of elder or dependent adult abuse, what do you report, how, when and to whom?

a. Licensee name b. Registration number c. Title or appropriate acronyms of the license or registration d. Intern i. Must include "intern" ii. Interns registered number iii. Name of their employer e. Accurate representation f. Credentials g. Educational Degrees

50. What are the guidelines for proper advertisement?

Consider how long we've been seeing each other, intention, motivation. Have thorough convo about any potential harm, potential benefits, in case of any emergency, what will we do? Will I be paid? What is the meaning? (5-10 pt question). Consider risks and benefits beyond conventional parameters Have a conversation prior to the event. Think about how long you've known client, history of boundaries, client's intentionality, client's intention of invitation. Anticipate difficulties, Discuss in what capacity the counselor will be there as, how are you introduces, who do you sit with, role/capacity of involvement. Have conversation after the event to debrief on how everything went. Document conversation prior to interaction, potential benefit, anticipated consequences, potential harm, what remedy will be with potential harm

4. According to the ACA Code of Ethics what are your ethical responsibilities when Olivia, your 33-year-old client, invites you to her wedding?

Autonomy - We encourage client empowerment and independence, so far as it is culturally appropriate; we remember that autonomy is always tempered and balanced by relatedness. Encourage and support client actualization and growth. Nonmaleficence - Do no harm. Act in client's welfare always. Beneficence - Do good, actively, for client and society. Justice - Treat clients fairly and equally. Fidelity - We are loyal to our clients, don't abandon them, fulfill our promises. Veracity - We are honest and act with integrity. We represent ourselves and share our expertise with colleagues and clients to the best of our knowledge and abilities.

4. What are the moral principles embraced by the counseling profession and what do they mean? (same as question 3)

● Statutes relevant to Unprofessional conduct (basis for malpractice and negligence lawsuits) - Business and professions Code 4982 ● Read (k, m, o, v, w, x) statutes ● Read (s) statute -acting outside the scope of practice could result in a lawsuit. For example prescribing meds as an MFT would be outside of scope of license ● Professionals have a legal obligation not to harm people who come to see them for professional services. If a professional is practicing in a manner that leads to injury to a recipient of their services a civil lawsuit can be filed against them.

4. What is unprofessional conduct and where is it defined?

a. Unexplained signs of injury such as bruises, welts, or scars b. Broken bones, sprains, or dislocations c. Report of drug overdose or apparent failure to take medication regularly d. Broken eyeglasses or frames e. Signs of being restrained, such as rope marks on wrists f. Caregiver's refusal to allow you to see the elder alone g. Sudden change in elder's behavior

41. Offer 4 physical and behavioral indicators of elder abuse.

a. Little or no personal care b. Refusing medication c. Unsafe living conditions d. Hoarding e. Inability to manage finances and property f. Disoriented or incoherent g. Isolation h. Alcohol or drug dependence

42. Offer 4 indicators of possible self-neglect.

a. Who is the client? i. Professionally 1. The family as a whole ii. Legally 1. Each member is recognized as an individual with their own rights and responsibilities iii. Informed consent 1. Parents divorced or married, step-parents, adopted parents 2. Legal guardian (court order) 3. Relatives that cares for the child

43. What legal and ethical issues should you consider when counseling families?

a. We do not report DV b. We make a CPS report if DV impacts the child c. Make APS report if DV is between elders or dependent adults d. May make CPS report if the child is negatively impacted emotionally

44. What legal and ethical issues should you consider when working with domestic violence?

a. Seem afraid or anxious to please their partner b. Go along with everything their partner says and does c. Check in often with their partner to report where they are and what they're doing d. Receive frequent, harassing phone calls from their partner e. Talk about their partner's temper, jealousy, or possessiveness f. Have injuries with excuse of "accidents" g. Miss work, school, or social occasions without explanation h. Dress in clothing designed to hide bruises or scars (long sleeves in the summer or sunglass indoors)

45. Offer 4 signs of someone who is a victim of partner relational violence

a. Jealous, possessive b. Limits access to money, friends, family, phone or car c. Controlling, manipulative d. Has unpredictable temper e. Belittling, humiliating partner f. Criticizing, putting down partner g. Ignore or put down partner's opinions and/or accomplishments h. Have a hard time taking responsibility for their actions i. See their partner as a property or sex object

46. Offer 4 signs of someone who is a perpetrator of partner relational violence.

a. Informed Consent i. Important to do a pre-group preview and screening ii. During this time, talk about informed consent 1. Educate people on what to expect from the group 2. Purpose of group 3. Ground rules 4. Format 5. Procedures 6. Psychological risks involved in-group b. Division of responsibility between leader and participants c. Rights and responsibilities of group members d. Confidentiality and its limits i. Cannot guarantee it, but educate members about it e. In CA, if someone discloses something in the group it is considered privileged information i. If we get a subpoena, we assert privilege f. If mandated clients, have them understand the legal implication of them leaving the group or not abiding by the group rules g. Client Welfare: i. Counselors take reasonable precautions to protect clients from physical, emotional, or psychological harm ii. Ensure the safety of the members iii. Keep abusive members out h. Avoid dual relationships i. Conflict of what was said individually and in group i. Competence i. Counselors need knowledge and training to lead group

47. What legal and ethical issues should you consider when providing group counseling?

Clinical ● Monitors the services provided by the counselor in training and ensures that that are serving the clients appropriately ● Client welfare is the most important ● Supervisors have multiple competing and conflicting responsibilities ○ An employee of an agency ○ An advisor ○ A mentor ○ An evaluator ● Counselor's credentials ○ Counselor in training needs to convey the status of trainee or an intern to the client as part of the informed consent ● Supervisor's Competence ○ Being a good counselor does not mean being a good supervisor ● In CA, there are requirements for supervisors: trainings plus continuing education ● Need to be familiar with legal and ethical regulations, with agency procedures as well as licensing requirements ● Important to maintain appropriate boundaries ○ No romantic relationship ● Have trust ● Informed Consent ○ Need to provide this to supervisees ● Respondent Superior ○ Individuals who have control and authority over others will be held accountable for their negligence ● Document everything in case of lawsuit ● Evaluation ● Consultation

48. What legal and ethical considerations are involved with supervision

a. Phone: i. Counselors must only discuss private information only in settings in which they can reasonably ensure client privacy ii. When we talk on the phone, leave messages to protect the privacy of the clients iii. Do not give out info to unknown callers iv. Keep in mind conversation might be recorded or monitored by unauthorized person v. Do not say anything off the record vi. Notes handled during the conversations should be handled carefully vii. Password for voicemail should not be lying around b. Faxes i. Moment we send the fax, we lose control over the information ii. Use cover sheet to state confidential nature of message should be read by recipient only iii. Prearrange it so person can get it right away, have them give confirmation via phone or email c. Computer i. Cannot be locked so important to use passwords, do not leave passwords on sticky notes d. Email i. Can be deceptive ii. Every message has a record on the computer iii. Even though email is protected by password, individuals who operate it can get through the systems e. Social Media i. If using information for professional purposes, make sure all the information is accurate ii. List all professional licenses and certifications held iii. Do not accept clients as friends iv. If using social media for personal use, set privacy setting to the highest level f. Skype i. Greater possibility for misunderstanding without visual or auditory cues ii. Lacking human presence iii. Cannot help client if threat occurs iv. Make sure to use Internet based counseling make sure to seek legal advice when state boundaries are crossed v. Informed Consent

49. What legal and ethical issues should you consider when using technology?

● Failure to maintain confidentiality, except as otherwise required or permitted by law, of all information that has been received from a client in confidence during the course of treatment and all information about the client that is obtained from tests or other means. ● Engaging in sexual relations with a client, or a former client within two years following termination of therapy, soliciting sexual relations with a client, or committing an act of sexual abuse, or sexual misconduct with a client, or committing an act punishable as a sexually related crime, if that act or solicitation is substantially related to the qualifications, functions, or duties of a marriage and family therapist. ● Paying, accepting, or soliciting any consideration, compensation, or remuneration, whether monetary or otherwise, for the referral of professional clients. All consideration, compensation, or remuneration shall be in relation to professional counseling services actually provided by the licensee. Nothing in this subdivision shall prevent collaboration among two or more licensees in a case or cases. However, no fee shall be charged for that collaboration, except when disclosure of the fee has been made in compliance with subdivision ● Failure to keep records consistent with sound clinical judgment, the standards of the profession, and the nature of the services being rendered.

5. Provide 4 examples of unprofessional conduct.

1. Validate his feelings and share care/concern for client. 2. Always explain WHY it is not good for him → it could confuse the understanding of relationship (ie counselor vs friend relationship). Ie can compare role as counselor as the role of a parent to be supportive. Ask how it might affect future counseling sessions. 3. Address his feelings of loneliness and brainstorm together to get the support he is looking for. Against ethical standards to have dual relationship with client. Explain that I am there to help him make friends. Would be in clients best interest that relationship stay in office. Need to address loneliness No legal precedent

5. Xavier, a 13-year-old skateboarder, comes to the session with his head down. He tells you that he has no friends and is very lonely. He asks if you wouldn't mind coming to the skate park with him next Sunday so you two can "hang out". What legal and ethical issues should you consider when responding to his request?

Could be prohibited behaviors Not seeking consultation Not documenting Not talking about the process of a cps report with client before making it Not seeking assent of clients incapable of giving consent

6. Provide examples of counselor behaviors considered unethical as established by the ACA code of ethics.

● When the professional fails to deliver professional standard of care - it results in malpractice. The professional must exercise the average degree of skill, care and diligence exercised by members of the same profession practicing in the same or similar locality ● The standards we are going to be judged upon are laws, ethics, and community standards of practice.

6. What is malpractice?

In order for client plaintiff to win a lawsuit, client must prove the following 5 elements: ● The counselor had a duty to the client to use reasonable care in providing counseling services ● The counselor failed to conform to the required duty of care ● The client was injured ● There was reasonably close causal connection between counselor's conduct and injury (what is known as proximate cause) ● The client suffered an actual loss or was damaged

7. In a malpractice lawsuit the client plaintiff will need to prove what for the lawsuit to prosper?

Keeping records Treatment plans made with client Informed consent Cultural competence Avoiding nonprofessional relationships with clients when potentially harmful

7. Provide examples of counselor behaviors considered ethical as established by the ACA code of ethics.

● Mental health professionals continue to be sued most often because of the sexual relationship with their clients. ● However, the next leading cause of malpractice lawsuits revolves around situations in which clients attempt or complete suicide. ● Even though it is impossible to predict or prevent suicide, professionals will be held accountable in courts if they fail to follow procedures endorsed by the profession when a client is at risk. There are 2 sources of malpractice suit that parallel beneficence and maleficence: ● The first type of malpractice is by omission - not having done what somebody who is reasonably trained would have done (community standards of practice) ● Second type is by commission - what the professional did was harmful. Ex.: breaching confidentiality.

8. What are the typical professional situations that may result in a malpractice lawsuit?

can't release info w/o signed release form contact wife to discuss her wishes know what husband wants to do need to find out what wife wants to do

Subpoena by lawyer in divorce case one signed release coming in couple sessions

Confident and privilege legal and ethical; privilege is client's right to keep coun testimony out of court; privacy - ability to decide what to reveal, to whom and how

What are the main diff. between privacy, confident, and privilege?

A choice between two mutually exclusive choices of action

What is ethical dilemma?

Child abuse Elder abuse Tarasoff Disclosing fees Records Authorization of release of information

legal standard