Ethics Final

Individuals with Disabilities Education Improvement Act (IDEA)

ensures that all children with disabilities are entitled to a free appropriate public education (FAPE) to meet their unique needs. The law requires public schools to provide special education and related services to children from ages 3-21 who meet certain eligibility criteria, and to provide early intervention services to eligible children ages birth to age 3. Key principles in the law include. The Act requires that the school system convene the individualized education program team to plan a functional behavior assessment, arrange for the assessment to be conducted, and develop and implement a plan of appropriate interventions to address the behavior either before or within ten days of making a "change in the placement of a child with a disability" for discipline reasons, including suspensions of ten school days A law ensuring services to children with disabilities throughout the nation. It governs how states and public agencies provide early intervention, special education and related services. o 1. Child is entitled to a free and appropriate public education (FAPE) o 2. An IEP (Individualized Education Plan) o 3. Services are provided in the least restrictive environment (LRE) o 4. Student is entitled to an evaluation in all areas related to the suspected disability o 5. Input of the child's parents must be taken into account in the process o 6. When the parents feel an IEP is inappropriate or their child is not receiving adequate services they have the right to due process.

Keeton v. Anderson-Wiley (2011) & Ward v. Wilbanks (2010)

graduate students of counseling programs were removed when they were unable to put aside their personal beliefs about homosexuality

Title 6, Article 89-4404: Appeal procedures for children with handicapping conditions (2015)

guarantees parents, guardians, the board of education and trustees of the district with a complaint about identification, evaluation, placement, or provisions provided- to a student with a disability an impartial hearing.

Clinical Supervisors

have the position of influence with their supervisees, they have to operate multiple roles. May serve many different functions during a single supervisory session.

Summative assessment

is an end point evaluation typically completed at the end of a professional program or when applying for licensure status.

Bradley Center v. Wessner (1982)

"Duty not to negligently release a dangerous client"

Jablonski v. United States(1983)

"Duty to commit a dangerous individual"

English legal treatise from 1581

"If a madman or a natural fool, or a lunatic in the time of his lunacy" kills someone, they cannot be held accountable.

Psychodiagnosis

)- is a general term covering the process of identifying an emotional or behavioral problem and making a statement about the current status of a client in order to lead to some kind of treatment plan designed to improve the identified problem. - multiple tools are used in this process such as clinical interviews, observation, psychometric tests, and rating scales.

Making Referrals

-You may need to refer a client if the resources are limited in the setting in which you work. You may also need to refer a client if the boundaries of your professional role restrict you from delivering the services your client needs. o Referring a client because of a conflict with your value system is not an ethically acceptable reason for a referral. o Consider a referral as a final intervention after you have exhausted other interventions including consulting.

Boundary Crossing

A departure from commonly accepted practices that could potentially benefit clients. Ex: attending a student's school play or sports event to build a positive relationship with him or her. Depending on how often you attend these events can be dangerous and could potentially be violating the boundary.

Multiple Relationship

A practitioner is in a professional role with a person in addition to another role with the same individual, or with another person who is close to that individual. Occurs when professional assume two or more roles at the same time or sequentially with a client. Also includes providing therapy to a relative or a friend's relative, socializing with clients, etc. Dual relationships and multiple relationships are used interchangeable in various ethic codes and ACA uses the term nonprofessional relationships. Mental health professionals must learn how to effectively and ethically manage multiple relationships, including dealing with the power differential that is a part of most professional relationships, managing boundary issues, and striving to avoid the misuse of power.

Boundary Violation

A serious breach that results in harm to clients and is therefore unethical. Ex: A gradual erosion of boundaries that leads to sexual exploitation of the client. Therapy self-disclosure.

Evidence- Based Therapy Practice

APA Presidential Task Force's Definition 2006: "The integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences" should enhance public health. It remains unclear and controversial whether EBPs perform reliably better than practices not designated as evidence-based

The person giving the consent must be competent

Able to make a decision of an understanding of the issues involved.

10 ways to avoid frequent Pitfalls: 1. Understand what constitutes a multiple relationship

According to the Ethics Code, psychologists should avoid relationships that could reasonably impair their professional performance, or could exploit or harm the other party. Behnke emphasizes, however, that multiple relationships that are not reasonably expected to have such effects are not unethical. That's because sometimes it's impossible for psychologists to completely avoid multiple relationships. Power, duration, and termination. "It's only an ethical problem when there's a reasonable basis to see a foreseeable risk, and the psychologist fails to see it or ignores it and goes forth anyway"

Assessment of Competence

Assessment approaches are most effective when they integrate both formative and summative evaluations. Together these assessments address individual practitioner's strengths and provide useful information for developing remedial education plan, if needed, for the person whose competence is being evaluated. Provide rigor and efficacy, but they note some problems associated with self-assessment. Clinicians often fail to recognize their own problems with competence, and some may be reluctant to address problems of competence in colleagues even when there is evidence that these problems exist.

Gestalt Therapy

Attend to interruptions in the client's here and now awareness and encourage clients to explore to what they are experiencing in the present.

Sexual Attractions in Therapy

Attraction to clients is a prevalent experience among both male and female therapists. Simply experiencing sexual attraction to a client, without acting on it, makes the majority of therapists feel guilty, anxious, and confused. There is a distinction between finding a client sexually attractive and being preoccupied with this attraction. Neglecting to attend to family-of-origin issues can lead to blind spots as being attracted to clients. Try to be objective.

ACA: for Telehealth

B.3.e Transmitting Confidential Information Counselors take precautions to ensure the confidentiality of all information transmitted through the use of any medium. • Section H. Distance Counseling, Technology, and Social Media Introduction Counselors understand that the profession of counseling may no longer be limited to in-person, face-to-face interactions. Counselors actively attempt to understand the evolving nature of the profession with regard to distance counseling, technology, and social media and how such resources may be used to better serve their clients. Counselors strive to become knowledgeable about these resources. Counselors understand the additional concerns related to the use of distance counseling, technology, and social media and make every attempt to protect confidentiality and meet any legal and ethical requirements for the use of such resources. • H.1. Knowledge and Legal Considerations H.1.a. Knowledge and Competency Counselors who engage in the use of distance counseling, technology, and/or social media develop knowledge and skills regarding related technical, ethical, and legal considerations (e.g., special certifications, additional course work). • H.1.b. Laws and Statutes Counselors who engage in the use of distance counseling, technology, and social media within their counseling practice understand that they may be subject to laws and regulations of both the counselor's practicing location and the client's place of residence. Counselors ensure that their clients are aware of pertinent legal rights and limitations governing the practice of counseling across state lines or international boundaries. -H.2.a. Informed Consent and Disclosure Clients have the freedom to choose whether to use distance counseling, social media, and/or technology within the counseling process. In addition to the usual and customary protocol of informed consent between counselor and client for face-to-face counseling, the following issues, unique to the use of distance counseling, technology, and/or social media, are addressed in the informed consent process etc

Cognitive-Behavioral Therapy

Based on getting a sense of the client's pattern of thinking using a collaborative approach. Once self-defeating beliefs have been identified, the treatment process involves challenging specific thought patterns and substituting constructive ones.

The three pillars of EBP

Best available evidence, clinician expertise, and client characteristics

Cassandra C. v. the State of Connecticut (2015)

Cassandra C., as she was identified in court documents, was diagnosed with Hodgkin's Lymphoma and rejected chemotherapy. As she was a minor at the age of 17, the state argued she was not competant enough to make a decision as serious as forgoing chemotherapy. Cassandra C. used the Mature Minor Doctrine to argue her case. The courts ruled in favor of the. State and Cassandra C. was forced to undergo chemotherapy.

Character Witnesses

Character witnesses testify to what they know about the defendant, and try to prove the character of the defendant to the extent of their knowledge of that defendant to the jury/judge. Unlike expert witnesses, character witnesses have more limits: o Cannot use every single aspect of defendant's life as evidence, especially those irrelevant to the case. (Example: Talk about every positive contribution to the community or family the defendant has done.) o Can only limit your testimony to accuracy to defendant's character and their truthfulness/honesty.

Mental hygiene law

Clinical records; confidentiality • ... information about patients or clients ... shall not be a public record and shall not be released ... to any person or agency outside of the offices except as follows: • to an endangered individual and a law enforcement agency when a ... psychologist has determined that a ... client presents a serious and imminent danger to that individual. The reasons for any such disclosures shall be fully documented in the clinical record. Nothing in this paragraph shall be construed to impose an obligation upon a treating psychiatrist or psychologist to release information pursuant to this paragraph.

Role Blending

Combining roles and responsibilities, is quite common in some professions. Ex: counselor educators serve as instructors, but they sometimes act as therapeutic agents for their students' personal development.

Shuffer V. Trustees of California State University and Colleges (1977

Complaint similar to the medical student. The faculty determined that his work in practicum was unsatisfactory , she was required to take a second practicum. The court held that a faculty may require students to complete special requirements as long as requirements are not arbitrary.

Behavior Therapy

Comprehensive assessment of the client's present functioning, with questions directed to past learning that is relate to current behavior. Favor diagnostic stance, valuing observation and other objective means of appraising both a client's specific symptoms and the factors that have led up to the client's malfunctioning.

Ethical Issues for Online Supervision

Confidentiality in online supervision is fraught with potential problems such as the possibility of computer-savvy individuals hacking into confidential communications between supervisor and supervisee and the risk of confidential content being sent or forwarded to others in error. Another major consideration is whether online supervision will count toward licensure when the supervisor and supervisee reside in different states.

Multiple Roles & Relationships in the Supervisory Process: Sexual intimacies during training

Core issue is difference in power and status

Training, supervision, and clinical experience

Didactic and experiential methods

Multiple Roles & Relationships in the Supervisory Process: Providing counseling for trainees

Dual relationship standard of ethical conduct should be used

Feminist Therapy

Emphasizes the cultural context of clients' problems, especially the degree to which clients possess power or are oppressed. Diagnosis and assessment requires a cooperative and phenomenological approach.

10 ways to avoid frequent Pitfalls: 7. Practice only when you have expertise

Every psychologist knows they are obligated by the Ethics Code to practice only where they are competent. But sometimes difficulties arise when, for example, they practice in emerging areas where there aren't clear standards. Competence issues also come into a play in child-custody ethics, when psychologists are unfamiliar with the nuances of working with courts. Take the case of a psychologist who is asked to write a letter to a judge about the relationship of a boy in treatment to his parents. If she has little forensic training, the psychologist could land in ethical hot water if, for example, she failed to include the limitations of her opinion, such as that she's never met one of the boy's parents.

Factors to Consider Before Entering Into a Multiple Relationship:

Examine the potential positive and negative consequences that a secondary relationship might have on the primarily counseling relationship. It is suggested that counselors consider forming multiple relationships only when it is clear that such relationships are in the best interests of the client. Applying ethically based, risk-managed, decision-making model when practitioners are analyzing a situation involving the pros and cons of multiple relationship. Practitioners must carefully assess the risk for conflict of interests, loss of objectivity, and implications for the therapeutic relationship. Counselors must discuss with the client the potential problems involved in a multiple relationship, and it's good practice to actively involve the client in the decision-making process.

Expert Witnesses

Expert witnesses testify to facts, using information from within their field that are not of common knowledge to the jury or judge. o Example: A toxicologist would be considered an expert witness in a case involving a DUI or DWI, as they have knowledge on the process of chemical tests and how to find drugs/alcohol in the body.

Psychoanalytic Therapy

Favor Psychodiagnosis. Largely limited to persons trained in medicine.

Special Issues in Supervision for School Counselors

Few school counselors have received formal preparation in supervision. Even in cases where the clinical supervisor is appropriately prepared, he or she may not work in the same site as the counselor being supervised. This situation does not allow for direct observation of the counselor's performance.

Telehealth competence

Follow best practices o In person assessment o Use research based protocols o Informed consent to contact family members if can't locate client

The consent must be voluntary

Free from coercion, secondary gain and pressure from extrinsic sources.

BOE of the Hendrick Hudson Central School District v. Rowley (1982)

Furnace Woods School refused to provide deaf student Amy Rowley with a sign language interpreter. Amy was an excellent lip reading and had minimal residual hearing. School administrators, along with a sign language expert, determined Amy was able to succeed in school without an interpreter. Amy's parents sued the school on her behalf for violation of the Education of All Handicapped Children Act of 1975. The Act requires all schools that accept federal funds to provide a "free appropriate public education" to all handicapped students. The Act also allows schools discretion in deciding what steps to take to accommodate handicapped students.The district court ruled in the Rowleys' favor, holding that while Amy was doing better in school than the average hearing student, she was not achieving to her full potential because she was unable to understand as much as she would with a sign language interpreter. The U.S. Court of Appeals for the Second Circuit affirmed. Did not require that the special instruction and supportive services provided under the law by state governments to disabled students be designed to help them achieve their full potential as learners. First case to reach the supreme court in which the court attempted to define what an "appropriate education" was.

Impartial Hearings

If a child is not receiving the proper special education services, parents have the right to request an impartial hearing. Impartial Hearing: an administrative proceeding, like a trial, to resolve disagreements between a parent or legal guardian and a school about a child's special education services; Impartial Hearing Officer: an administrative law judge certified by the New York State Education Department that runs the hearing and writes a decision in the case explaining why they rule they way they did. Decision based on witness testimony and evidence from documents presented by the parent and the DOE and are final unless the parent or the DOE appeals the decision to the New York State Review Officer

Internet's Ethical Challenges: Googling

In certain circumstances, there may be a good reason to do a search of a client — there may be an issue of safety, for example. In certain kinds of assessments, it might be a matter of confirming information. But again, we always need to think about how this fits into the professional relationship, and what type of informed consent we've obtained. Curiosity about a client is not a clinically appropriate reason to do an Internet search.

Hidden V. Mutual Life Insurance Company C. 1954

In the court case, a man was suing his insurance company because he claimed he suffered from a disabling nervous condition that prevented him from working at times and that he should receiving disability benefits. A clinical psychologist had performed projective testing on him, and when he testified in court he stated that the man did indeed qualify for disability benefits. The defense had objected to the testimony, and the judge had removed it on the basis that the psychologist was just stating opinion. However, later a court of appeals overturned the decision, saying that the psychologist's testimony should have been included and that the psychologist was an expert witness.

Developing a Counseling Style

it is an ongoing and fluid process, you ideally want to pick one theory that you agree with but modify it as you gain more experience and evaluate what seems to be working or not working with your clients. It is important to evaluate what you emphasize in your counseling work and make sure the basis of the theory you picked addresses these points. o Ideally, the theoretical approach you use to guide your practice is an expression of you as a person and is the result of intensive study, reflection, and clinical experience. o Ultimately, your counseling orientation and style must be appropriate for the type of counseling you do and the unique needs of your clients. o Theories of counseling are based on worldviews, each with its own values, biases, and assumptions of how best to bring about change in the therapeutic process. o Many of the assumptions of contemporary theories are inappropriate for evaluating clients from cultures that focus on interdependence, downplay individuality, and emphasize being in harmony with the universe. o Practicing counseling without an explicit theoretical rationale is somewhat like trying to sail a boat without a rudder. o A theoretical orientation is not a rigid structure that prescribes specific steps of what to do in a counseling situation. o Rather, it is a set of general guidelines that counselors can use to make sense of what they are hearing and what needs to change.

Responsibility to research participants

Investigators respect the dignity and protect the welfare of research participants and are aware of federal and state laws and regulations and professional standards governing the conduct of research. Researchers must carefully consider the ethical aspects of any research proposal, making use of informed consent procedures and explaining to participants what is involved in any research project.

Safe Act (New York Secure Ammunition and Firearms Enforcement Act)

Is a gun regulation law in the state of New York. In response of the Sandy Hook Elementary School shooting. Broadened the legal definition of assault weapon to include those semi-automatic rifles, semi-automatic pistols (handguns), and semi-automatic shotguns with one or more "military-style features, such as a telescoping stock, bayonet mount, flash suppressor, grenade launcher and others. Requires ammunition dealers to conduct background checks (similar to those for gun buyers) for purchases, and bans on direct Internet sales of ammunition. mental health professionals currently providing treatment services to an individual must make a report to authorities, "if they conclude, using reasonable professional judgment, that the individual is likely to engage in conduct that would result in serious harm to self or others.

The consent must be informed

Made knowingly, or with the knowledge of the consenter that consent is being given.

CAMFT: Ethics Code

Make continuous efforts to be aware of how cultural/racial/ethic identity, values, and beliefs affect the process of therapy. Font exert undue influence on the choice of treatment or outcomes based on such identities, values, and beliefs. When treating family, marriage and family therapists carefully consider the potential conflict that might arise between each individual. Marriage and family therapists clarify, at the commencement of treatment, which person or persons are clients and the nature of the relationship the therapist will have with each person involved in the treatment.

Cultural Perspective on Boundaries

Many African American clients expect warm, reciprocal, and understanding relationship and perceive therapists' objective detachment as uncaring and uninvolved. Solidarity, rooted in the ties within a society that bind people together, as a culturally congruent way of understanding, defining, and managing boundaries.

Systemic Approaches

Many symptoms stem from problems within the system, rather than originating in the individual. Assist clients in tracing the key events of their family history and identifying issues in their family origin.

Responsibility to clients in family and couples therapy

Marriage and family therapists advance the welfare of families and individuals. They respect the rights of those persons seeking their assistance, and make reasonable efforts to ensure that their services are used appropriately. By agreeing to become involved in family therapy, the members can generally be expected to place higher priority on the goals of the family as a unit than on their personal goals. Balancing the rights and well-being of the individuals with the family as a whole is one of the most challenging aspects of ethical family practice.

American Association for Marriage and Family Therapy

Marriage and family therapists are aware of their influential position with respect to their client, and they avoid exploiting the trust and dependency of such persons. Make every effort to avoid conditions and multiple relationships with clients that could impair professional judgment or increase the risk of exploitation.

Responsibility to students, employees, and supervisees

Marriage and family therapists do not exploit the trust and dependency of students and supervisees. Practitioners are cautioned to avoid multiple relationships.

Advertising

Marriage and family therapists engage in appropriate information activities, including those that enable the public, referral sources, or other to choose professional services on an informed basis.

Confidentiality

Marriage and family therapists have a unique confidentiality concerns because the client in a therapeutic relationship may be more than one person. Therapist's respect and guard confidences of each individual client. Entails that practitioners not disclose what they have learned through the professional relationship except 1. Mandated by law, 2. When it is necessary to protect clients from harming themselves or to prevent a clear and immediate danger to others, 3. When the therapist is a defendant in an action arising from the therapy, or 4. When a waiver has previously been obtained in writing.

Professional competence and integrity

Marriage and family therapists maintain high standards of professional competence and integrity. Continuing education and clinical experiences.

Fees

Marriage and family therapists make financial arrangements with clients, third party payors, and supervisees that are reasonably understandable and conform to accepted professional practices.

Responsibility to the professions

Marriage and family therapists respect the rights and responsibilities of professional colleagues and participate in activities that advance the goals of the profession.

Court-ordered emancipation, Situational emancipation, Type of treatment

Minors are often allowed to consent to treatment for such things as substance abuse, mental health care, and birth control. In several states, such as Vermont and California, this right is granted to minors as young as 12. As these laws vary considerably, it is important that psychiatrists familiarize themselves with their own state's particular laws. When allowing a minor to consent to treatment, it is important to remember that although a minor may meet the legal criteria for granting consent, a psychiatrist should still satisfy him or herself that the minor patient possesses the capacity and maturity to understand to what he or she is consenting. Thoroughly document under what circumstances the minor is being allowed to consent to treatment on his or her own behalf.

1954:Durham v. United States

Monte Durham: 23-year-old man who had been in and out of prison and mental institutions since he was 17. Convicted for housebreaking in 1953, and his attorney appealed Although district court judge had ruled that Durham's attorneys did not succeed to prove he didn't know the difference between right and wrong, the federal appellate judge decided to use the case to reform the McNaughton rule Citing leading psychiatrists and jurists of the time, the appellate judge claimed that the McNaughton rule was based on "an entirely obsolete and misleading conception of the nature of insanity." The judge overturned Durham's conviction and established new rule Durham rule states "that an accused is not criminally responsible if his unlawful act was the product of mental disease or mental defect." Durham rule was eventually rejected by the federal courts, because it cast too broad a net → Alcoholics, compulsive gamblers, and drug addicts were successful using the defense to defeat a wide variety of crimes.

Sexual Relationships with Former Clients

Most professional organizations prohibit their members from engaging in sexual relationships with former clients because of the potential for harm. Some organization specify a time period, and other don't. Psychologists don't engage in sexual intimacies with former clients/patients for at least two years after cessation or termination of therapy. Psychologists don't engage in sexual intimacies with former clients/patients even after a two-year interval expect in the most unusual circumstances. A therapist should seek consultation or personal therapy to explore his or her motivations and the possible ramifications of transforming a professional relationship into a personal one.

Andrea Yates: 2001

Mother killed her 5 children (7 years-6 months old) by drowning them in Texas. She had attempted suicide twice, was diagnosed with psychosis and postpartum depression, and was hospitalized due to a breakdown. She called her husband home from work and called the cops, confessing that she had killed her children because the voices told her it would save their souls. She pleaded not guilty by reason of insanity, but did not meet the definition. The jury found her guilty and sentenced to life in prison. However, in 2005 an appeals court reversed the verdict because the forensic psychiatrist had given false testimony. Yates was found not guilty by reason of insanity in 2006 and sentenced her to a state mental hospital.

Multicultural Issues in Supervision

Multicultural supervision encompasses the full range of cultural factors, including race, ethnicity, socioeconomic status, ability status, privilege, sexual orientation, spirituality and religion, values, gender, family characteristics and dynamics, country of origin, language, and age. Ancis and Marshall (2010) found that discussing and attending to cultural variables in the supervisory relationship results in a higher degree of satisfaction with supervision and an enhanced working alliance between supervisor and supervisee. If supervisors do not assist supervisees in addressing racial and ethnic issues, their clients may be denied the opportunity to explore these issues in their therapy. The supervisor's recognition of racial issues can serve as a model for supervisees in their counseling relationships. Reflecting on racial interactions in supervision offers a cognitive framework for supervisees to be inclusive in their counseling practice. Supervision across cultures requires acknowledging cultural differences in values and learning styles and being willing to make adjustments by including these differences in the supervisory process. Supervisors must be open and willing to address spiritual issues when they are of significance to the supervisee or his or her clients.

Multiple Roles & Relationships in the Supervisory Process

Multiple-role relationships in supervision occur when a supervisor has concurrent or consecutive professional or nonprofessional relationships with a supervisee in addition to the supervisor-supervisee relationship. Multiple relationships with supervisees cannot always be avoided, but it is the responsibility of supervisors to avoid those nonprofessional relationships with supervisees that are likely to impair objectivity or to harm the supervisee. Supervisors need to clarify their roles and to be aware of potential problems that can develop when boundaries become blurred. The core issue of multiple-role relationships in the training and supervisory process is the potential for abuse of power. Like therapy clients, students and supervisees are in a vulnerable position and can be harmed by an educator or supervisor who exploits them, misuses power, or crosses appropriate boundaries. Not only is sexual behavior in the supervisory relationship against the ethics codes, but it also creates a climate in which the supervisee can justify breaches in his or her own actions with clients or future supervisees.

The Division of Responsibility in Therapy

Often beginning mental health practitioners burden themselves with too much responsibility for their client's outcomes. This could make the counselor anxious of failing their client, which is transferred onto the client. clients should be encouraged to assume responsibility for their counseling in the beginning of the therapeutic relationship. o One way to clarify the shared responsibility in a therapeutic relationship is by a contract, which is based on a negotiation between the client and the therapist to define the therapeutic relationship. o A contract encourages client and therapist to specify the goals of therapy and the methods likely to be employed in obtaining these goals. o Therapists who work within a managed care context need to discuss with clients how being involved with managed care will influence division of responsibility between the HMO, the client, and the therapist.

Osheroff v. Chestnut Lodge (1982)

Osheroff sued psychiatric hospital, Chestnut Lodge, because of their failure to follow accepted standards of care in treatment of his psychiatric illness. They misdiagnosed him with narcissistic personality disorder and ordered a treatment that would be expected to take 3 yrs (no drugs). Osheroff was eventually transferred to another hospital where he was treated pharmocologically and completely recovered in ten days, never to be hospitalized again. Malpractice pertaining to misdiagnosis, substandard treatment, and failure to obtain informed consent about method and duration of treatment

Training Issues in Couples and Family Therapy

Personal characteristics of family therapists; Training, supervision, and clinical experience; and Values in couples and family therapy

Managing Multiple Relationships: Small Community

Practitioners who work in small communities often have to blend several professional roles and functions. They have to become an integral part of the community to be accepted as a credible mental health resource. If these practitioners isolate themselves from the surrounding community, they are likely to alienate potential clients and this reduce their effectiveness in the settings where they work. They have a greater challenges in dealing with multiple relationships than those who work in urban areas.

Perspectives on competence

Professional codes of ethics on competence have common themes. Counselors practice only within the boundaries of competence, based on: o Education o Training o Supervised experience o State and national professional credentials o Appropriate professional experience

Telementalhealth

Providing services to clients over the phone, internet or videoconferencing

10 ways to avoid frequent Pitfalls: 2. Protect confidentiality

Psychologists are often asked to provide information about their clients to employers, spouses, school administrators, insurance companies and others. While such requests may be well-intentioned, psychologists need to carefully balance the disclosure with their ethical obligations to protect their patients' confidentiality. APA's 2002 Ethics Code stipulates that psychologists may only disclose the minimum information necessary to provide needed services, obtain appropriate consultations, protect the client, psychologist or others from harm, or obtain payment for services from a client. To help: Discuss limits of confidentiality, ensure the sage storage of confidential records, know federal state and law, and obey mandatory reporting laws

10 ways to avoid frequent Pitfalls: 4. Know your supervisory responsibility

Psychologists may be responsible for the acts of those who perform work under their watch, whether it's interns providing therapy or administrative assistants helping with record-keeping and billing. That means supervising psychologists should continually assess their supervisees' competence and make sure they are managing them appropriately, say experts. Such supervision should cover everything from ensuring that supervisees conduct the informed-consent process correctly to prohibiting them from using the supervisor's signature stamp on any bill or letter that the supervisor hasn't reviewed. Establish timely and specific processes for providing feedback--and provide information about these processes at the beginning of supervision. Outline the nature and structure of the supervisory relationship in writing before supervision begins. Supervisors should include both parties' responsibilities as well as intensity of the supervision and other key aspects of the job. Document their experience with the supervisees, including supervision dates, discussions they've had and other relevant facts. Such information will help if ethical dilemmas arise later. Explain to patients that the therapist is in training and give clients the name of the supervisor. Note that billing may be under a supervisor's name, not the supervisee's, so that clients don't accidentally report billing problems when there are none. Avoid delegating work to people who have multiple relationships with the client that would likely lead to harm or the supervisee's loss of objectivity--for example, avoid using a non-English-speaking person's spouse as a translator.

10 ways to avoid frequent Pitfalls: 3. Respect people's autonomy

Psychologists need to provide clients with information they need to give their informed consent right at the start. Limits of confidentiality, such as mandatory reporting. Nature and extent of the clinician's record-keeping. The clinician's expertise, experience and training as well as areas where the therapist lacks training. Estimated length of therapy. Alternative treatment or service approaches. The clinician's fees and billing practices. Whom to contact in case of emergency. Client's right to terminate sessions and any financial obligations if that occurs. Not only what services the psychologist will provide, but what they can't or won't do.

Confidentiality for School psychologists

School psychologists have an ethical obligation to maintain confidentiality within a professional relationship with students. Failure to ensure confidentiality would inhibit self-disclosure and cooperation from students. Both the American Psychological Association (APA) and the National Association of School Psychologists (NASP) have stringent rules about maintaining confidentiality with clients. Confidential information is revealed only with appropriate informed consent "except in those situations in which failure to release information would result in clear danger to the child or others" One of the most frequent risky adolescent behaviors involves substance use. Adolescents often experiment with smoking cigarettes, drinking alcohol, and using illegal drugs. For some behaviors, however, respondents found it ethical to break confidentiality at low levels of frequency/duration, and for other behaviors, respondents did not find it ethical to break confidentiality even at high levels of intensity and frequency/duration. Take, for example, the situation where the adolescent was HIV positive and admitted to engaging in sexual activity without using condoms. Under these circumstances, respondents were likely to find it ethical to break confidentiality even at the lowest level of frequency/duration (i.e., once several months ago). We observed a similar pattern with the item describing a suicide attempt. Thus, if the adolescent engages in behaviors perceived as extremely dangerous, school psychologists seem to find it ethical to report such behaviors even when they do not occur very frequently. Conversely, for behaviors such as cigarette smoking, sexual activity with a steady partner, and stealing clothes from a store, respondents did not seem very likely to find it ethical to report these behaviors even when they occurred at high rates of frequency/duration (e.g., nearly daily for the last year, more than once during the last month). School psychologists may prove more likely to address these less severe behaviors through the counseling relationship rather than breaking confidentiality to report the behaviors. School psychologists are more likely to believe it is ethical to break confidentiality to report these behaviors. The gender of the respondent did rank as significant for the alcohol use domain, such that male respondents seemed more likely to find it ethical to break confidentiality than did female respondents. This finding suggests that male school psychologists may feel more protective than female school psychologists. Responses provided by the school psychologists in this study suggest that school psychologists proved somewhat more likely to find it ethical to break confidentiality than the pediatric psychologists surveyed in the Rae et al. (2002) study.

Rule 702. Testimony by Expert Witnesses

o A witness who is qualified as an expert by knowledge, skill, experience, training, or education may testify in the form of an opinion or otherwise if: o (a) the expert's scientific, technical, or other specialized knowledge will help the trier of fact to understand the evidence or to determine a fact in issue; o (b) the testimony is based on sufficient facts or data; o (c) the testimony is the product of reliable principles and methods; and o (d) the expert has reliably applied the principles and methods to the facts of the case.

School Psychology ethically challenging situations Article

School psychology practitioners are likely to encounter two types of ethically challenging situations: ethical dilemmas and transgressions. Dilemmas occur when "there are good but contradictory ethical reasons to take conflicting and incompatible courses of action." The critical incident technique (Flanagan, 1954) is a set of procedures for collecting reports from real-life settings of particular types of problem situations, with the goal of describing the types of problems encountered in "real world" practice settings. Another approach to studying real-world ethical challenges is to use a structured questionnaire to ask practitioners whether they have experienced or witnessed various types of ethical dilemmas and transgressions. Most survey respondents had witnessed at least one type of ethical transgression by a school psychologist within the past year. Assessment-related transgressions were witnessed by the greatest number of respondents. This finding is not surprising because school-based psychologists typically spent a large portion of their time in assessment-related activities. About three fourths of the respondents had witnessed a transgression involving failure to follow-up on an intervention. The ethical concerns that were ranked in the top three by the greatest number of respondents were administrative pressure to act unethically, unsound educational practices in the schools, and assessment-related concerns. Although assessment-related ethical problems may be relatively common, school psychology practitioners are most concerned about pressure from administrators to act unethically and unsound educational practices in the schools. Ethical worries appear to be particularly acute when school-based practitioners must balance the dual roles of student advocate and school employee. Almost three fourths of the survey respondents indicated they had encountered at least one of eight types of ethical dilemmas within the previous year. The four dilemmas experienced by the greatest number of respondents (about one fourth) concerned whether to contact child protective services, whether to disclose a student's risky behavior to his or her parents, how to address unethical conduct by a colleague, and how to balance a parent's request to view his or her child's test protocols with the ethical obligation to maintain test security. These difficult dilemmas also have been the focus of research and multiple commentaries. The question of whether "reasonable suspicion" of child abuse exists is problematic. About one quarter of respondents experienced the dilemma of what information to disclose to the parents of a minor who is engaging in risky behavior. Suggested that mastery of an explicit decision-making model may help psychologists make informed, well-reasoned choices when dilemmas arise in professional practice. Use of a systematic problem-solving procedure also may assist psychologists in anticipating and preventing ethical problems.

Using Tests in Counseling

o Be familiar with tests being used and take tests themselves o Recognize limits of competence to use and interpret tests o Know reasons why a particular test is being used o Make clients aware that tests are merely tools that can provide useful information o Select tests appropriate for client given their unique cultural, social, and cognitive factors o Give test results, not simply test scores o Be sensitive to ways clients respond to results o Assure clients that test results will not be used against them o Assure confidentiality unless consent is given o Know the limitations of tests being used

Legal Sanctions Against Sexual Violators

o Being the target of a lawsuit o Being convicted of a felony o Having license revoked or suspended by state o Being expelled from professional organizations o Losing their insurance coverage o Losing their jobs

19th century British law : M'Naughton Rule

Scottish man killed Prime Minister's secretary while attempting to murder the Prime Minister. He believed Prime Minister was the reason behind his financial problems. 9 witnesses testified he was insane and was acquitted by "not guilty by reason of insanity" Queen Victoria was mad and asked the House of Lords to review the case. They decided to reserve the verdict and declared "a defendant should not be held responsible for his actions if he could not tell that his actions were wrong at the time he committed them." Law kept in America with no modification and provided guidelines for whether a criminal knows right/wrong during crime -Every man is presumed to be sane Unless it can be proven that they did not understand what they did or if they failed to distinguish right from wrong due to a diseased mind Set the standard for insanity cases in both the US and the UK

Personal characteristics of family therapists

Self-knowledge is critical, especially family-of-origin issues.

Ethical standards on Bartering

Should be evaluated within a cultural context. In some cultures, and especially in small communities, bartering is an accepted practice. Before bartering is entered into, both parties need to talk about the arrangement, gain a clear understanding of the exchange, and come to an agreement. It is important that problems that might develop be discussed and that alternatives be examined.

Reality Therapy

Skillful questioning, the therapist helps clients make an assessment of their current behavior. Focus on what they want form life and to determine whether what they are doing is working for them.

Smith v. Seibly (1967)

Smith, an 18 year old from Washington state (where the legal age was 21) discovered he was suffering from a progressive disease, myasthenia gravis, and requested a vasectomy as to not burden his family. The performing doctor, Seibly, informed Smith of the risks and the permanence of the surgery, to which Smith consented, and Seibly performed the operation. After turning 21, Smith sued Seibly and claimed that as a minor at the time of surgery he could not have consented to the operation. The courts ruled in favor of Seibly, stating "...age, intelligence, maturity, training, experience, economic independence or lack thereof, general conduct as an adult and freedom from the control of parents are all factors to be considered in such a case [involving consent to surgery]" ▶ Established precedent known as the Mature Minor Doctrine: unemancipated minor may possess or refuse a particular health treatment, with or without the knowledge of the parents, and should be permitted to do so ▶ legal in Arkansas, Illinois, Maine, Massachusetts, Nevada, Pennsylvania, and Tennessee ▶ Smith v. Seibly. Justia US Law. The Supreme Court of Washington (August 1967)

Postmodern Approaches

Solution-focused brief therapy and narrative therapy. Emphasis is placed on an individual's competence, accomplishments, skills, strengths, and successes. Collaborative conservations with clients.

10 ways to avoid frequent Pitfalls: 8. Know the difference between abandonment and termination

Standard 10.10 that psychologists can discontinue treatment when clients: Aren't benefiting from therapy. May be harmed by the treatment. No longer need therapy. Threaten the therapist, themselves or others. Psychologists should provide pretermination counseling and suggest alternative service providers, says the Ethics Code, noting that this may not be possible in all cases, such as if a patient abruptly stops attending therapy. Such pretermination counseling could include explaining the benefits of the new services and why the current treatment is no longer helpful, addressing feelings of separation by emphasizing the transfer is not a personal rejection, and identifying practical issues in transferring the client, such as resolving financial arrangements with the new provider before ending treatment.

Liability

Supervisors can be held accountable for these direct and vicarious

Board of Education v. Rowley

The Court held that an IEP must be reasonably calculated for a child to receive educational benefit, but the school district is not required to provide every service necessary to maximize a child's potential.

Cedar Rapids Community School Dist. v. Garret F. ex rel. Charlene F., 526 U.S. 66 (1999).

The Court held that continuous nursing service is a "related service" that the school district is required to provide under the IDEA. The Court also noted that an IDEA dispute "is about whether meaningful access to the public schools will be assured", thereby repeating the "meaningful access" standard originally articulated in Rowley.

Boynton v. Burglass (1991)

The Florida state appeals court declined to adopt a duty to warn and held that a psychiatrist who knew or should have known that a patient presented a threat of violence did not have a duty to warn the intended victim.

Gatekeeper Role of Faculty in Promoting Competence

The academic faculty in a professional program generally has a gatekeeper's role, protecting consumers by identifying and intervening with graduate students who exhibit problematic behaviors. o The gatekeeper role is addressed in the ethics codes of most professional organizations. When a student has good grades but demonstrates substandard interpersonal behavior, indicating serious unresolved conflicts, action needs to be taken. o Well-designed gatekeeping procedures appear to improve the effectiveness with which deficient students are identified and prevented from progressing unremediated into the counseling profession. Dismissal from a program is a measure of last resort.

Deciding on the Goals of Counseling

o Both therapist and client should clearly understand the goals of their work together and the desired outcomes. o The aims of therapy are specific to a particular culture's definition of psychological health; no single approach is equally effective in working with all client populations. o In a managed care system, the goals will need to be highly specific, limited to reduction of problematic symptoms, and often aimed at teaching coping skills. o In crisis intervention, goals are likely to be short term and functional, and you may be much more directive. o In schools, you may combine educational and therapeutic goals. o In serving older adults residing in an assisted living community, you may stress coping skills and ways of relating to other residents.

Competence of Supervisors

The counselor licensure laws in a number of states now stipulate that licensed professional counselors who practice supervision are required to have relevant training experiences and course work in supervision. When supervisees are working outside the area of competence of the supervisor, it is the responsibility of the supervisor to arrange for competent clinical supervision of the cases in question. o Most psychology and counselor education programs offer a course in supervision at the doctoral level, but training for supervisors at the master's level is lacking o The licensure laws in several states stipulate that LPCs who practice supervision are required to have relevant training experiences and course work in supervision. o Good supervisors demonstrate the four A's: • They tend to be available, accessible, affable, and able.

Cultural Consideration for Socializing

The cultural context can pay a role in evaluating the appropriateness of dual relationship that involve friendships in the therapy context.

Psychological Fitness of Trainees

The emotional or mental stability necessary to practice safely and effectively. Evidenced by the presence of personality adjustment, absence of psychological disorders, and appropriate use of substances.

Evaluating Character of Trainees

The honesty and integrity with which a person deal with others.

Adlerian Therapy

The initial session focuses of developing a relationship based on a deeper understanding of the individual's presenting problem. Examining the client's lifestyle. Seeks to ascertain the faulty, self-defeating beliefs and assumptions about self, others, and life that maintain the problematic behavioral patters the client brings to therapy.

Boundary Crossing and Multiple Relationship

The rationale for abstaining from boundary crossings or multiple relationships involves the potential for therapists to misuse their power to influence and exploit clients for their own benefit and to the clients' detriment.

Board of Curators of The University of Missouri V. Horowitz (1978)

The united Supreme Court considered a case brought by a student who had been dismissed from medical school, in spite of the fact that she had excellent grades. The decision to dismiss the student was based on the faculty's determination that she was deficient in clinical performance and interpersonal relationship skills. The student continued to receive unsatisfactory evaluations on her clinical work. She was evaluated by seven independent physicians in the community, all of whom agreed with the medical school professors that her clinical skills were unsatisfactory. The student filed a lawsuit claiming that her dismissal from medical school violated her constitutional rights. Court considered that the student had been informed of the dissatisfaction her clinical performance, and the student know that unless she made significant improvement in this area, she would be dismissed form the program. The held the decision to remove her from the program.

10 ways to avoid frequent Pitfalls: 10. Be accurate in billing

There's nothing more important than accuracy when it comes to billing patients and insurers for psychological services, say ethics experts. While sloppy bookkeeping can land some psychologists in hot water, others find themselves in predicaments because they've worked the system to get clients more benefits than a third-party payor entitles them to. Bill only for services you have provided. Only list the dates you treated the patient. Call it as you see it. Discuss billing practices up front. Be conscientious about collecting fees. Take caution in pursuing delinquent accounts. Watch your paperwork.

Ethics of Multiple Relationships

These caution professionals against any involvement with clients that might impair their judgment and objectivity, affect their ability to render effective services, or result in harm or exploitation of clients. Nonsexual multiple relationships are not inherently unethical, and most ethics codes acknowledge that some multiple relationships are unavoidable. When multiple relationships exploit clients, or have significant potential to harm clients, they are unethical.

Turning Five Process

Transitioning from preschool special education services to kindergarten when the child turns five. Department of Ed. will hold a "turning 5"/kindergarten IEP meeting in addition to the child's annual preschool IEP meeting. If IEP team finds that the child is eligible for kindergarten special education service,s, the IEP team will complete a new IEP for the child's kindergarten services, including a classification of disability, a program recommendation (types of kindergarten classes), related services, and goals, as well as if the child will attend a "non-specialized District 1-32 school" or a "specialized school". Eligible for services from ages 5 to 21

Existential Therapy

Understand the personal meanings and assumptions clients use in structuring their existence. Understanding client's inner world, not one understand the individual from an external perspective.

Person-Centered Therapy

Understanding another person through his or her subjective world. Assessment and diagnosis is detrimental because they are external ways of understanding the client.

Values in couples and family therapy

Value system of the therapist has crucial influence on formulation and definition of problems.

10 ways to avoid frequent Pitfalls: 5. Identify your client and role

When practicing psychologists work with organizations or groups of individuals, they should understand from the start who they were hired to help and what is expected of them. Dilemmas crop up in a variety of settings. "Knowing who your client is, what your role is and being transparent about what it is that you do and mindful about the professional boundaries that arise are good guideposts to effective practice." That means psychologists should, at the outset, have frank discussions with all parties involved about the relationship they will have with each person or organization.

10 ways to avoid frequent Pitfalls: 9. Stick to the evidence

When you give your expert opinion or conduct an assessment, base your evaluation only on the data available. For example, psychologists in child-custody cases should be sure they aren't being biased in favor of the parent who is more financially secure. Know what the referral question is and choose assessment tools that can validly answer that question. Don't rely on third-party reports to formulate assessments and avoid giving an opinion of any person they haven't directly evaluated. Make sure the assessment is thorough. Discuss the limitations of their work. Ensure that tests were developed for the target population.

Developing or Upgrading Skills

Work with colleagues or professionals who have more experience. Seek consultation before moving outside areas in which you have received education and training. Learn new skills by attending conferences, reading professional articles, taking courses, and participating in workshops.

Formative assessment

a developmentally informed process that provides useful feedback during one's training and throughout one's professional career.

Daniel R.R. v. State BoE (1989)

a handicapped boy and his parents, urge that a local school district failed to comply with the Education of the Handicapped Act. Specifically, they maintain that a school district's refusal to place the child in a class with nonhandicapped students violates the Act. The district court disagreed and, after a careful review of the record, we affirm the district court. Supreme Court noted, many handicapped children suffered under one of two equally ineffective approaches to their educational needs: either they were excluded entirely from public education or they were deposited in regular education classrooms with no assistance, left to fend for themselves in an environment inappropriate for their needs.

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. The decision to warn or not warn a third person creates a dilemma for a clinician between an ethical and legal obligation to maintain a client's confidentiality and an ethical and legal obligation to warn third persons of potential harm to them.

Duty to Warn

arises when a patient has communicated an explicit threat of imminent serious physical harm or death to a clearly identified or identifiable victim or victims, and the patient has the apparent intent and ability to carry out such a threat.

Bartering

arrangement, exchanging goods or services in lieu of a fee.

Contract

based on a negotiation between the counselor and client to define the therapeutic relationship, share the responsibility of counseling, can be an extension of the informed consent, specifies goals of the therapy, and methods likely to be used to obtain these goals.

Competence

both an ethical and legal concept. From an ethical perspective, competence is required of practitioners if they are to protect and serve their clients. Incompetence is often a major contributing factor in causing harm. From a legal standpoint, incompetence practitioners are vulnerable to malpractice suits.

Direct liability

can be incurred when the actions of supervisors are the cause for harm.

10 ways to avoid frequent Pitfalls: 6. Document

can be psychologists' best ally if they ever face ethical charges. Identifying information and first contact. Relevant history and risk factors, medical status and attempts to get prior treatment records. Dates of service and fees. Diagnostic impressions, assessments, treatment plans, consultation, summary and testing reports and supporting data, and progress notes. Include not only the treatments chosen, but treatments considered and rejected. Informed-consent documentation, consent to audiotape or videotape, and release of information documentation. Relevant telephone calls and out-of-office contacts. Follow-up efforts when clients "drop out of sight. Details necessary, including those listed above, so that another psychologist could take over delivery of service, such as in the event of a psychologist's death or retirement.

Assessment

consists of evaluating the relevant factors in a client's life to identify themes for further exploration

Responsibilities of Supervisees

o Come prepared to each supervision session. o Be an active participant. o Take the initiative to ask for what you need from your supervisor. o Do related research and reading between sessions to enhance your clinical work. o Pay attention to your interactions with clients and with your supervisor. o Be willing to address any areas of concern you have. o If you are having trouble with colleagues or fellow supervisees, bring such matters into supervision. o Ask for feedback about your strengths and areas where you need to improve and be open to feedback from supervisors, fellow supervisees, and your clients. o Try to critically evaluate feedback you feel is not constructive. o Establish healthy boundaries for yourself. o Let your supervisor know if you are feeling overwhelmed by your work with clients. o Be open to various forms of supervision, including live supervision and videotaping. o Talk about insecurities and anxieties you have that pertain to your work. o Provide feedback to your supervisor about what you find helpful or unhelpful in your supervisory relationship. o Pay attention to possible sources of countertransference. • In supervision, explore how these reactions are affecting your work with clients

Cultural Issues in Diagnosis

o Cultural sensitivity is essential in making a proper diagnosis, and a range of factors need to be considered in interpreting assessments. o What is considered healthy can vary greatly from one culture to the next. o There is a tendency for some practitioners to overdiagnose, underdiagnose, or misdiagnose clients from marginalized groups. o Accurate assessment and diagnosis involves taking into consideration realities of discrimination, oppression, and racism in society and mental health disciplines. o Consider the ways in which clients' socioeconomic and cultural experiences can influence behavior, including the presentation of symptoms.

Harmful Effects of Sexual Contact with Clients

o Distrust of therapists and the therapeutic process o Guilt, depression, anger, and/or PTSD o Feeling of rejection and low self-esteem o Suicidal ideation

Risk Management Practices for Supervisors

o Don't supervise beyond your competence. o Evaluate and monitor supervisees' competence. o Be available for supervision consistently. o Formulate a sound supervision contract. o Maintain written policies o Document all supervisory activities o Consult with appropriate professionals o Maintain a working knowledge of ethics codes, legal situations, and licensing regulations. 1 o Use multiple methods of supervision. o Have a feedback and evaluation plan. o Verify that your professional liability insurance covers you for supervision. o Evaluate and screen all clients under your supervisee's care. o Establish a policy for ensuring confidentiality. o Incorporate informed consent in practice.

Arguments Against Psychodiagnosis

o Emphasis of DSM is on pathology o Can minimize uniqueness of client o Ignores natural capacities for self-healing o Can lead people to accept self-fulfilling prophecies o Assumes that distress in family is result of individual pathology o Many therapists are not competent to use DSM diagnosis properly. o DSM has been criticized (e.g., reliability and validity questioned, failure to predict treatment outcomes)

Ethical Issues in Training Therapists

o Establish clear selection criteria o Provide exposure to major contemporary counseling theories o Teach students strengths and limitations of theories o Combine academic and personal learning o Screen candidates to protect public from incompetent practitioners o Teach a range of skills to work with diverse clients o Provide training in ethics

Prior to Establishing a Bartering Relationship

o Evaluate whether it puts you at risk of impaired professional judgment. o Determine the value of goods or services in a collaborative fashion. o Determine appropriate length of time for arrangement. o Document arrangement and consult with experienced colleagues or supervisors.

Confidentiality in Couples and Family Therapy

o Exceptions to confidentiality • When mandated by law • When it is necessary to protect clients from harm to self or others • When family therapist is a defendant in a civil, criminal, or disciplinary action arising from therapy • When a waiver has been previously obtained in writing o When working with family- need consent from ALL parties (family members) to release information

Medicare Telehealth Parity Act

o Extends the term "originating site," for telehealth service payment purposes, to additional sites, including any federally qualified health center and any rural health clinic, at which the eligible telehealth individual is located at the time the service is furnished via a telecommunications system. Prohibits application of the originating site facility fee to the additional sites. Authorizes additional telehealth providers, including a certified diabetes educator or licensed respiratory therapist, audiologist, occupational therapist, physical therapist, or speech language pathologist. Authorizes the Department of Health and Human Services (HHS) to develop payment methods to apply in the case of anyone who would be an eligible telehealth individual except that the telehealth services are furnished at a site other than an originating site. Extends Medicare coverage to remote patient management services for certain chronic health conditions. Authorizes home telehealth sites as additional originating sites. Directs HHS, in determining the component of a physician's fee corresponding to practice expense relative value units for diagnostic tests provided remotely, to include in direct costs of supplies and equipment the costs of the diagnostic device, clinical systems (including hardware and software), information transmission, and device delivery and installation. Directs the Government Accountability Office to study the effectiveness of using specified telehealth services between therapy providers and patients, any associated savings, and the potential for greater use of telehealth services for other forms of therapy.

Licensure

o Governs professional practice o Highlights uniqueness of an occupation o Restricts both use of title and practice of occupation.

Special Education Itinerant Teacher

o Implements the child's Individualized Education Program (IEP) o Collaborates with nursery school directors and teachers to meet the child's needs o Coordinates the child's educational goals with other providers and therapists o Participates in Committee on Preschool Special Education (CPSE) meetings o Provides opportunities for parents to partner in their child's education (i.e. parent trainings and collaborations) o Helping children with behavioral, social/emotional, speech, language, or developmental issues integrate successfully into the classroom o Children ages 3-5 years, who are classified by their school district's CPSE (Committee on Preschool Special Education), are assigned SEIT services.

Intimate Partner Violence

o Intimate partner violence occurs in both same-sex and heterosexual relationships and affects people from all ethnic and socioeconomic backgrounds. o Under current law, mental health providers generally are not required to report intimate partner violence. o The therapist's goal is to protect victims from any further harm, including protecting any children the couple may have at home.

Hedlund Case: Hedlund v. Superior Court of Orange County (1983)

o LaNita and Stephen Wilson were receiving psychotherapy from a therapist and a therapist assistant, Bonnie Hedland, when Stephen Wilson disclosed to the therapist that he intended to harm LaNita.The therapists warned LaNita of the threats. "The man ran the woman and her son off the road in her car and then shot her, leading to the loss of a leg." The woman sued the therapists, claiming that they did not warn her of the danger to herself or her son. Duty to warn is extended to a foreseeable, identifiable person who might be near the intended victim when the threat is carried out and might also be in danger. "The Supreme Court of California ultimately held that the therapists owed a duty not only to the woman, but also to her son because the injury to the woman's son was foreseeable since children are not usually far from their parents."A therapist must now also consider the welfare of persons in close relationship to the victim.

Dealing with Sexual Attraction

o Learn to recognize sexual attractions and how to deal with these feelings constructively and therapeutically. o Seek professional support during times of loss or crisis. o Examine and monitor feelings and behaviors toward client continually. o Know the difference between having sexual attraction to clients and acting on this attraction. o Learn about the possible adverse consequences for clients and therapists who engage in sexual activity. o Establish and maintain clear boundaries when a client makes sexual advances toward you. o Terminate the therapeutic relationship when sexual feelings obscure objectivity. o Recognize that direct explicit disclosures of sexual feelings can run the risk of harming clients and may therefore be unethical. o Rather than making an explicit communication of sexual feelings for clients, acknowledge caring and warmth within the therapeutic relationship. o Practice a risk management approach (e.g., be aware of timing and the location of scheduled appointments, non-erotic touch, and general self-disclosure). o Be open to using supervision, consultation, and personal therapy throughout your career.

Telehealth Concerns

o Licensure concerns: Treating patients across state lines o Privacy risks for online therapy o Reimbursement

Guidelines to clarify barter arrangements

o Minimize unique financial arrangements o If bartering is used, it is better to exchange goods rather than services o Both therapist and client should have a written agreement for the compensation by bartering o If a misunderstanding develops, the matter should be dealt with by a mediator, not by you and your client

Issues to Consider in Addressing Multiple Relationships

o Multiple relationship issues affect most mental health practitioners, regardless of their work setting or clientele. o Most professional codes of ethics caution practitioners about the potential exploitation in multiple relationships, and more recent codes acknowledge the complex nature of these relationships. o Not all multiple relationship can be avoided, nor are they necessarily always harmful, and they can be beneficial. o Multiple role relationships challenge us to monitor ourselves and to examine our motivations for our practices. o Whenever you consider becoming involved in a multiple relationship, seek consultation form trusted colleagues, a supervisor, or your professional organization. It is a good idea to document the nature of this consultation. o Few absolute answers exist to neatly resolve multiple relationships dilemmas. o Being cautious about entering into multiple relationships should be for the benefit of our client or others served rather than to protect ourselves form censure. o In determining whether to proceed with a multiple relationship, consider whether the potential benefit outweighs the potential for harm o Supervisors operate in multiple roles as teacher, mentor, consultant, counselor, sounding board, adviser, administrator, evaluator, and documenter. o It is the responsibility of counselor preparation programs to introduce boundary issues and to explore multiple relationship questions. It is important to teach students ways of thinking about alternative courses of action. o Counselor education programs have a responsibility to develop guidelines, policies, and procedures for dealing with multiple roles and role conflicts within the program. o Defining boundaries and relationships must be done in a multicultural context.

Arguments for Psychodiagnosis

o No third-party reimbursement without acceptable diagnosis o Difficult to formulate treatment plan without defining problem o Provides team members with a common frame of reference o Allows therapists to rule out medical conditions o Used to assess whether clients pose danger to self or others o Provides framework for research o May be a minimum standard of care for some licensed professionals o May seldom have a choice about diagnosis o May be critical to determine therapeutic success o Helps to normalize a client's situation

Steps to follow to minimize risk and practice ethically and professionally for small community

o Obtain informed consent o Document thoroughly o Set clear boundaries and expectations, both for yourself and with your clients o Pay attention to matters of confidentiality o Get involved in ongoing consultation.

Dimensions of a good multicultural model

o Pluralistic philosophy o Cultural knowledge o Consciousness raising o Experiential training o Contact with racial and ethnic minorities o Practicum or internship with culturally diverse populations

Techniques in Counseling

o Practitioners need to function with intentionality. • They must have a clear understanding of the techniques they employ and have a sense of the expected outcomes of their interventions. o Some specific techniques appear to be more effective with particular symptoms and disorders, especially for certain behavioral disorders. o The techniques counselors employ, although important, are less crucial to therapy outcomes than are the interpersonal factors operating in the client-counselor relationship. o For ethical reasons, practitioners must have rationale for using a particular technique and have training in the intervention used. o You cannot separate your personality and your relationship with your client. Counselors give mechanical techniques of intervention, and do not respond to the particular individuals they are counseling. To avoid this pitfall: you must pay attention to the ways you use techniques because the purpose of the techniques is to facilitate progress. o Your techniques need to fit your therapeutic style, your level of training, and the specific needs of your client.

Rule 404. Character Evidence

o Prohibited Uses. Evidence of a person's character or character trait is not admissible to prove that on a particular occasion the person acted in accordance with the character or trait. o Exceptions for a Defendant or Victim in a Criminal Case. The following exceptions apply in a criminal case: o A. A defendant may offer evidence of the defendant's pertinent trait, and if the evidence is admitted, the prosecutor may offer evidence to rebut it. o B. A defendant may offer evidence of an alleged victim's pertinent trait, and if the evidence is admitted, the prosecutor may: offer evidence to rebut it; and offer evidence of the defendant's same trait; and in a homicide case, the prosecutor may offer evidence of the alleged victim's trait of peacefulness to rebut evidence that the victim was the first aggressor o 3. Exceptions for a Witness. Evidence of a witness's character may be admitted.

Tarasoff Case: Tarasoff v. Board of Regents of the University of California (1976)

o Prosenjit Poddar was seeing the campus psychologist, Moore, at the University of California, Berkeley, for voluntary outpatient services. He told Moore that he was intending to Kill Tatiana Tarasoff, but she was away on a trip to Brazil. The psychologist assessed him as dangerous and felt he should be committed to a mental hospital for observation. Moore alerted the campus police of the threat he had made. Her parents sued the university for failing to let Tarasoff and her family know that she was threatened. Lower court dismissed the case in 1974, but it was appealed, and the Supreme Court ruled in favor of her parents in 1976. The Supreme Court held that it was not enough to notify the police if there was an identifiable victim. If a therapist determines that his/her patient is a serious danger to another, he/she has an obligation to "use reasonable care to protect the foreseeable victim."

Informed Consent in Couples and Family Therapy

o Purpose of therapy & GOALS (focus on family or couple) o Typical procedures (must all members be present?) o Risks of negative outcomes o Possible benefits of therapy o The fee structure o Limits of confidentiality (including how secrets are handled) o Rights and responsibilities of clients o The option that a family member can withdraw at any time o What can be expected from the therapist

Telehealth Pros

o Reach people in rural areas or shortage of mental health practitioners o Increase access to treatment and potentially more openness to treatment among clients? • Less than ¼ American with mental illness get treatment o Online therapy may be equally as effective as face-to-face • 2008 meta-analysis of 92 studies • Videoconferencing effective treatment for PTSD

Methods of Supervision

o Self-report is one of the most widely used supervisory methods, yet it may be the least useful. • Procedure is limited by the supervisee's conceptual and observational ability. o Process notes build on the self-report by adding a written record explaining the content of the session and the interactional processes. o Verbal exchange and direct observation are the most commonly used forms of supervision. In verbal exchange, the supervisor and supervisee discuss cases, ethical and legal issues, and personal development. Direct observation methods involve a supervisor actually observing a supervisee's practice. Direct observation, even though it demands time and effort, provides a unique reflection of the skills and abilities of the supervisee. o Audio recording is a widely used procedure that yields direct and useful information about the supervisee. o Video recording allows for an assessment of the subtleties of the interaction between the supervisee and the client. o Live supervision, which is conducted by the supervisor during the supervisee's session with a client, provides the most accurate information about the therapy session.

Minimizing Risks in Multiple Relationships

o Set healthy boundaries from the outset. The boundary crossing is consistent with a client's treatment plan. The client's history, culture, values, and diagnosis have been considered. o Secure informed consent of clients. The boundary crossing is discussed with the client in advance to prevent misunderstandings. o Discuss both potential risks and benefits. Full recognition is given to the power differential, and the client's trust is safeguarded. o Consult with other professionals to resolve any dilemmas o Seek supervision when needed. Consultation with colleagues guides the therapist's decisions. o Document in clinical case notes. The rationale for the boundary crossing is documented in the client's record. o Examine your own motivations. The therapist is motivated by what the client needs rather than by his or her own needs. o Refer when necessary

Viewpoints on multiple relationships vary

o Some focus on the problems inherent in multiple relationships o Others view them as common, inevitable, unavoidable, normal, and healthy part of communal life in many settings. o Ex: Getting a referral for your colleague's son or daughter

Ethical and Legal Issues in Diagnosis

o Some practitioners who are opposed to a diagnostic framework take the path of least resistance, giving every client the same diagnosis. o Presenting an "acceptable" but inaccurate diagnosis is both unethical and fraudulent. o It is an ethical (and sometimes legal) obligation of therapists to be mindful that a medical evaluation is many times indicated. o Competence in using the DSM appropriately is an ethical issue.

The Supervision Contract

o Supervisor's background o Methods to be used in supervision o Responsibilities and requirements of supervisors o Supervisee's responsibilities o Policies pertaining to confidentiality and privacy o Documentation of supervision o Risks and benefits o Evaluation of job performance o Complaint procedures and due process o Professional development goals o Duration and termination of the supervision contract

The Supervisor's Roles and Responsibilities

o Supervisors must be competent both in the practice of supervision and in the area of counseling being supervised. o Supervisors should provide supervision only after obtaining the education and training to ensure competence in this role, and only if they can devote the time to provide adequate oversight. o Supervisors are ultimately responsible, both ethically and legally, for the actions of their trainees. o Supervisors have responsibilities to supervisees' current and future clients. o Supervisors must have a clearly developed framework for supervision and a rationale for the methods they employ. o The quality of the supervisory relationship is just as important as the methods a supervisor chooses. o A good portion of the supervisory sessions should focus on the personal stress experienced by the supervisee during client-counselor interactions.

Rights of Supervisees

o Supervisory sessions free from distractions o To be fully informed of supervisor's approach o Confidentiality with regard to supervisee's disclosure o Confidentiality with regard to clients except as mandated by law o Continual access to records maintained during supervision o To provide feedback to supervisors concerning supervision experience o To seek consultation from other professionals as necessary

Making a Decision About Bartering

o The bartering arrangement is in the best interests of your clients o Is reasonable, equitable, and undertaken without undue influence o Doesn't get in the way of providing quality psychological services to your client.

Informed Consent in Supervision

o The standard of practice is to incorporate clear informed consent material for supervisees, both orally and in writing. o It is beneficial to discuss the rights of supervisees from the beginning of the supervisory relationship. o When supervisees learn what they can expect in supervision and what to do to achieve success, they are empowered to express expectations, make decisions, and become active participants in the supervisory process.

Disadvantages of Socializing with Clients

o Therapists may not challenge clients they know socially because of a need to be liked and accepted by the client. o Counselors' own needs may be enmeshed with those of their clients to the point that objectivity is lost. o Counselors are at greater risk of exploiting clients because of the power differential in the therapeutic relationship. o Former clients may need you more as a therapist at some future time than as a friend.

Findings from Psychotherapeutic Research

o Therapy is helpful to the majority of clients. o Most people achieve some change relatively quickly in therapy. o People change more due to "common factors" than to "specific factors" associated with therapies. o In general, therapies achieve similar outcomes. o Most therapists learn more about effective therapy techniques from their experience than from the research. o Approximately 10 percent of clients get worse as a result of therapy. o The relationship between therapist and client is the best predictor of treatment outcome. o Experts showed strong agreement that research does not support the following assertions: • Placebo control groups and waitlist control groups are as effective as psychotherapy. • Therapist experience is a strong predictor of outcome. • Long-term therapy is more effective than brief therapy for the majority of clients.

Supervision four goals

o To promote supervisee growth and development o To protect the welfare of the client o To monitor supervisee performance and to serve as a gatekeeper for the profession o To empower the supervisee to self-supervise and carry out these goals as an independent professional

Certification

o Voluntary attempt by a group to promote professional identity o Attempts to verify qualifications o Sets minimum standards o Does not assure quality practice

Accepting Gifts

o What is the monetary value of the gift? o What are the clinical implications of accepting or rejecting the gift? o When in the therapy process is the offering of a gift occurring? o What are my motivations for accepting or rejecting a gift? o What are the cultural implications of offering a gift?

Contemporary Theory of Counseling

orientated toward individual change and are grounded in values that emphasize choice, uniqueness of the individual, self-assertion, and ego strength. - Many of the assumptions of contemporary theories are inappropriate for evaluating clients from cultures that focus on interdependence, downplay individuality, and emphasize being in harmony with the universe

Internet's Ethical Challenges: Email or text

part of client's record. For example, if you are communicating with your client via e-mail or text messaging, those communications might be considered part of your client's record. Also, you want to consider who else might have access to the communication, something the client him- or herself may not be fully mindful of. When you communicate with clients, the communication may be kept on a server so anyone with access to that server may have access to your communications. Confidentiality should be front and center in your thinking.

Vicarious liability

pertains to the responsibilities supervisors have to oversee the actions of their supervisees

Section 504 of The Rehabilitation Act of 1973

protects students with disabilities against discrimination by requiring public schools to provide eligible students with accommodations so they can participate in school activities with nondisabled peers. Under Section 504, a student with a physical or mental impairment that limits one or more major life activities is eligible to receive accommodations. A comprehensive evaluation by appropriate, qualified personnel must be conducted before any "significant change in placement." A suspension exceeding ten consecutive (or sometimes ten cumulative) school days or an expulsion constitutes a "significant change of placement" under the regulations. The evaluation must also include a determination of whether there is a connection between the behavior for which discipline is to be imposed and the student's disability.

Accountability

requires an arrangement consisting of professional disclosure statements and contracts that outline the model to be used in supervision, the goals and objectives of supervision, and assessment and evaluation methods. By their own behavior, supervisors model for supervisees appropriate ways of talking about clients and keeping information protected and used only in the context of supervision. Supervisors must make sure supervisees and their clients are fully informed about the limits of confidentiality, including those situations in which supervisors have a duty to protect.

Stay put provision

students with disabilities are not exempt from reasonable disciplinary measures, although due process exceeding that provided general education students is required at times, and penalties may be limited in type and duration. sometimes at issue in school discipline cases is the "stay-put" provision" this provision requires that a student remain in his or her current educational placement while school officials examine disciplinary proceedings

Legal Aspects of Supervision

supervisors must see that trainees provide the information to clients that they need to make informed choices. Clients must be fully aware that the counselor they are seeing is a trainee, that he or she is meeting on a regular basis for supervisory sessions, that the client's case may be discussed in group supervision meetings with other trainees, and that sessions may be recorded or observed. Accountability, Informed Consent, Confidentiality and limits, and Liability.

Hoing V. Doe

the Supreme Court held that an indefinite suspension of two students pending the outcome of expulsion proceedings was a prohibited change in placement and violated the stay-put provision of IDEA. It removed a school's unilateral authority to suspend or expel a student with an IEP for more than 10 days unless there is evidence of weapons, drugs, or serious bodily injury. The school must get a ruling from a hearing officer or court. The case centered on two disabled students in the San Francisco Unified School District (SFUSD). One, identified as "John Doe" in court documents, was an emotionally disturbed 17-year-old who had difficulty controlling his impulses and anger. In November 1980 he responded to the taunts of a peer by choking the student and then kicked out a window as he was being taken to the principal's office. Doe was initially suspended for five days, but the SFUSD Student Placement Committee (SPC) subsequently notified his mother that it was recommending his expulsion and that his suspension would continue until the expulsion process was finished.

DSM-5: Diagnostic and Statistical Manual of Mental Disorders, fifth edition

the official guide to a system of classifying psychological disorders. The DSM-4 used a multiaxial system but the DSM-5 has moved to a nonaxial documentation of diagnosis. When revising the DSM, APA focused on improving the developmental issues, gaps in the current system, disability and impairment, neuroscience, and cross-cultural issues.

Impairment

the presence of a chronic illness or severe psychological depletion that is likely to prevent a professional from being able to deliver effective services and results in consistently functioning below acceptable practice standards" (Corey, Corey, & Callanan, 1998). Burnout-"physical, emotional, intellectual, and spiritual depletion. " Difficulty empathizing with clients. Inability to cope with stressful events. Mental health/personal issues Substance abuse issues Preoccupation with money/professional success Family life Social life

Different Diagnosis

the process of distinguishing one form of mental disorder from another by determining which of two (or more) disorders with similar symptoms the person is suffering from. - The DSM-5 is the standard form for distinguishing one form of mental disorder from another.

Therapist Competence

the skills and training required to effectively and appropriately treat clients in a specific area of practice.

Diagnosis

which is sometimes part of the assessment process, consists of possibly identifying a specific mental disorder based on a pattern of symptoms that lead to a specific diagnosis described in the DSM-5.

Internet's Ethical Challenges: Facebook use

• Be sure your account is private • Self disclosure • "Friend" a student? Past student? Psychologists should be mindful that whether teaching, conducting research, providing a clinical service or acting in an administrative capacity, they are in a professional role. Each role comes with its own unique expectations, and these expectations have ethical aspects. I would encourage a psychologist who's considering whether to friend a student to think through how the request fits into the professional relationship, and to weigh the potential benefits and harms that could come from adding that dimension to the teaching relationship. Of course, the professor should also be informed about the school's policy concerning interacting with students on social networking sites.

.Endrew F. v. Douglas County School District

• In fifth grade, Drew's parents pulled him out of the public school district and placed him in a private school that focused on autism. He began getting appropriate behavioral therapy and support in the new school, and he quickly started to learn. Drew's parents argue he was denied FAPE because he only got a minor benefit from his IEP. They claim he had a right to something more meaningful: an equal opportunity to succeed in school like any other child. On the other side, the school district says Drew made some small progress on a few of his goals. It claims that under the law, he got enough of a benefit from his IEP. -Unanimous decision 8-0 for the parents and Drew. Judge ruled that children with IEPs must be given more than the minimum educational benefit. "The IDEA demands more. It requires an educational program reasonably calculated to enable a child to make progress appropriate in light of the child's circumstances." Drew- boy with autism in Douglas county school district in Colorado. Drew had an IEP, yet he made little progress on his academic goals. His parents said it is because the school didn't give him support for his severe behavioral issues. His IEP goals were largely unchanged from fourth to fifth grade.

Internet's Ethical Challenges: Blogging

• Sharing personal values, opinions. Be aware that when you author a blog, you're putting a lot of yourself into it. That's why you're doing it. So again, you need to be mindful of the impact it will have on your clinical work. It also depends on what the blog is about. For example, if you're blogging about religion, politics or movies, in this day and age, some of your clients are going to read the material. If you are sharing your personal views on some important societal issue, be mindful of how that might affect the work you are doing.

Thompson v. County of Alameda (1980)

• Supreme court denied to extend the Tarasoff Doctrine to this case • the chief concern focused on whether the county had a duty to warn the local police, neighborhood parents, or James' mother of his threats. While recognizing the duty of the county to protect its citizens, the California Supreme Court declined to extend the Tarasoff doctrine it had created a few years earlier noting that doing so would prove impractical and negate rehabilitative efforts by giving out general public warnings of nonspecific threats for each person paroled. The court also deemed warning the custodial parent futile because one would not expect her to provide constant supervision

Insanity Defense

○ Allows mentally ill person avoid being imprisoned for a crime often substitutes inpatient psychiatric treatment for jail time. Individual was not capable of determining right from wrong ○ Some mentally ill people cannot be deterred by the threat of punishment ○ Treatment in a psychiatric institute is more likely to protect society than jail time without treatment