Ethics Final Review
Withholding records for non-payment
APA allows if client has been given opportunity to pay before sending them a collection agency. HIPAA states that under NO circumstance you can withhold records Go with HIPAA
Confidentiality in Group Psychotherapy
Although psychologists are professionally obligated to maintain the confidentiality of most statements made during group therapy sessions, decisions by members of a therapy group to disclose confidential information are neither bound by professional codes nor subject to legal liability. At the outset of group therapy, and each time a new member enters an ongoing group, psychologists must take reasonable steps to clarify that they can request, but not guarantee, that all group members maintain the confidentiality of statements made during sessions. When group therapy is conducted in response to court-ordered counseling, psychologists must also clarify to group members the parties in the justice system who will receive information learned during group therapy & how such information may be used.
Complaints
Anyone can make a complaint (APA member, non-member, legal guardian). Charge letter is sent to individual in question. Given opportunity to comment on allegation. Failure to respond to a committee is an ethical violation in itself. Resignation while under investigation. Do not wish to contest.
Reporting Laws in Florida : Confidentiality
Confidentiality and privileged communications: Chapter 490.0147 Any communication between any person licensed under this chapter and her/his client shall be confidential. This privilege may be waived under the following conditions: 1. When the person licensed under this chapter is a party defendant to a civil, criminal, or disciplinary action arising from a complaint filed by the patient or client, in which case the waiver shall be limited to that action. 2. When the patient or client agrees to the waiver, in writing, or when more than one person in a family is receiving therapy, when each family member agrees to the waiver, in writing. 3. When there is a clear and immediate probability of physical harm to the patient or client, to other individuals, or to society and the person licensed under this chapter communicates the information only to the potential victim, appropriate family member, or law enforcement or other appropriate authorities.
Therapeutic techniques: Client-Therapy Relationships
Conversion Therapy (p. 426-247): Based on evidence, psychologists who offer such therapies to LGBT patients are violating Standard 2.04, Bases for Scientific & Professional Judgement. When psychologists offer "cures" for homosexuality, they falsely imply that there is established knowledge in the profession that LGBT is a mental disorder. When psychologists base their diagnosis & treatment on religious doctrines that view homosexual behavior as "sin" they can be in violation of Standard 9.10, Bases for Assessments, and may be practicing outside the boundaries of their profession.
FL Statute 64 b19
Documentation of informed consent Report of financial transactions Accurate records Current records Consider level of detail Need to maintain adequate records Client's wishes→ may request limited record keeping Psychologist should consider whether services can be provided under these conditions.
Records should exclude
Emotional statements Personal Opinion Statement(s) about Illegal Behavior Sexual Practice Other Sensitive Information
Accuracy in Training
Exams How professors justify extra credit Content should be created at the difficulty level of program o Professors can modify course requirements & content in a timely manner that allows students to fulfill the requirement(s) without undue hardship.
What to disclose to Collection Agencies
HIPAA's "minimum necessary" standard, as well as Standard 4.01 Maintaining Confidentiality in APA Ethics Code, can be interpreted as requiring psychologists to limit the information provided to collection agencies to the minimum necessary to accomplish the intended purpose. Information to such agencies should be limited to: A. The client's name; B. The dollar amount of the fee that is overdue; C. The date of services for which the unpaid fee was billed; AND D. The client's address, telephone number, and other relevant contact information Psychologists should never real a client's diagnosis or reason for seeking services. Psychologists can simply inform the collection agency that the overdue bill is for "services provided."
Boundary Violation
Harmful boundary crossing. True transgression. Creates reasonable risk of harm or exploitation of the client. Accounts for half of the disciplinary actions in ethics committee.
What goes in records?
Identifying data and contact information Type of service, date of service, fees, assessments, treatment plans for interventions, consultations, summary, testing reports, Fees and billing arrangements Guardianship status Informed consent/assent Waivers of confidentiality Mandated reporting Diagnosis and Treatment Plan
HIPAA and its role in collection agencies
Implications of HIPAA Covered entities who want the option of using collection agencies for non-payment for health services must include this information in a notice of Privacy Practices given to the client/patient at the onset of services, and the notice must be separate document from the consent materials. During informed consent, clients/patients should also be informed that under the most recent changes in the HIPAA rules, when individuals pay for health services by cash, they can instruct their providers not to share information about their treatment with your health plan. Collection agencies hired by a psychologists may be considered a "business associate" under HIPAA. A business associate is an entity who acts on behalf of a covered entity but not as an employee of the covered entity.
What is considered a violation?/What is the process in which a violation should be handled?
Malpractice: refers to professional misconduct or an unreasonable lack of skill. Standard of care that needs to be met in the course of our professional duty. Standard of care: degree to which a reasonably prudent person should exercise in the same or similar circumstances.
Reporting Laws in Florida: Child Abuse/Neglect/Abandonment
Mandatory Reports of Child Abuse/Abandonment/Neglect: Chapter 39.201 Any person who knows or has reasonable cause to suspect child abuse/abandonment/neglect by a parent/caregiver/person responsible for child's welfare is mandated to report this. Other mandatory report of abuse/neglect (not on this chapter): elderly & disabled individuals
Reporting Laws in Florida: Minors Access to Outpatient Crisis
Minors access to outpatient crisis intervention & treatment: Chapter 394.4784 Minors age 13 years or older experiences emotional crisis that he/she perceives needs professional assistance, he/she can obtain mental health diagnostic & evaluative services provided by a licensed mental health professional. Cannot be more than 2 visits in 1-week period Then needs parental participation/consent Minor is not held liable for payment of these services No mental health professional is obligated to provide these services Provision of these services shall be on a voluntary basis
Multiple relationships
Not All Multiple Relationships are Unethical Incidental encounters with clients/patients at religious services, school events, restaurants, health clubs, or similar places are also NOT unethical as long as psychologists react to these encounters in a professional manner. Nonetheless, psychologists should always consider whether the particular nature of a professional relationship might lead to a client's/patient's misinterpretations regarding an encounter. If so, it is advisable to keep a record of such encounters and discuss them with the client/patient when clinically indicated.
Standard of Care is violated by:
Not rendering services with the degree or skill or care that is commonly applied by average member of the profession. If injury or harm results from failure to meet standard of care, may result in malpractice. Fail to meet standard of care: can be accused of negligence. Negligence: Commission: Doing something that should NOT have been done. Omission: NOT doing something that should have been done. Doesn't matter if act was intentional or not. Sole issue is whether act fell beneath the standard of care.
Assessing Student and Supervisee Performance
Professor must provide timely feedback Students must be informed of when & how often they will be evaluated AND basis for evaluation o Psychologists evaluate students on the basis of their actual performance
Sexual relationships with Students and Supervisors
Prohibition against sex with students & supervisees in department/agency/training centers If other department (e.g. Physics): okay
Standard 5.01: Avoidance of False or Deceptive Statements
Psychologists aspire to promote accuracy, honest, and truthfulness in the science, teaching, and practice of psychology and do not engage in subterfuge or intentional misinterpretation of fact. The terms avoidance and knowingly exclude as violations statements that psychologists would reasonably be expected to believe are true but that they may later learn are false. Definition of Public Statements The definition refers only to statements made in the public domain. It does not apply to statements made during private professional or personal conversations with clients, organizational clients, attorneys, students, colleagues, or others with whom psychologists have a professional or personal relationship.
Group Supervisions
Psychologists engaged in group supervision must develop competencies in creating a safe environment for group discussion and disagreement and for clarifying the roles of supervisors & supervisees. At the beginning of supervision, they need to clarify the purpose of group supervision & how responsibilities and supervisee evaluation differ from those under individual subversion.
Interpreters
Psychologists must ensure that interpreters have adequate translation skills and sufficient understanding of the psychological nature and ethical responsibilities of the duties to be performed. Psychologists should avoid delegating work to individuals who serve as interpreters in close-knit communities and who are known personally when it will create a multiple relationship between the interpreter and the research participant or person receiving services that could reasonably be expected to lead to breaches in confidentiality; exploitation, or loss of objectivity.
Client/Pt. in Concurrent Single and Group Therapy
Psychologists who see clients concurrently in individual & group therapy must take special precautions to ensure that they do not inadvertently reveal during a group session confidential information gained about a client during an individual sessions. Psychologists must also clarify in advance to such clients differences between the goals, processes, and therapist-client relationships in single versus group therapy.
Records
Records are necessary for: 1. Providing good care. 2. Assist collaborating professionals in delivery of care. 3. Ensure continuity of services in the case of a psychologist injury, disability, death, or change of provider. 4. Provide for relevant supervision or training. 5. Provide documentation required for reimbursement or required administratively under contracts or laws. 6. Effectively document any decision making, especially in high risk situations. 7. Allow psychologists to effectively answer a legal or regulatory complaint. 8. Improve work performance 9. Ensure continuity of care 10. Ensure compliance with rules and law 11. Providing documentation of appropriate planning 12. Replication of research 13. Effectively responding to ethics complaints 14. Modification of services/research 15. Helps conceptualize a case 16. Goal: reduce potential vulnerabilities and ethical complaints 17. Have parameters 18. Better definition 19. How to set fees, how to handle debt, third party relationships 20. Justifications of treatment when getting reimbursed. 21. Protect from charge of negligence
Sanctions
Reprimand: violation was not likely to cause harm to a person or to the profession. Censure: violation was likely to cause harm to another person, but not cause substantial harm to another person or profession. Expulsion: violation was likely to cause substantial harm to a person or to the profession. Stipulated Resignation: violation committed of Ethics Code or failed to show good cause why they should not be expelled. Psychologist is forced to resign.
Student Disclosure of Personal Information
Respect privately rights of students Students not required to disclose sexual history; history of abuse; psychological treatment; relationships with peers, spouses, significant others except if: 1. Program has clearly identify disclosure as requirement 2. Info is necessary to evaluate or obtain assistance for student (danger to self or others)
Sexual Relationships/Applicable vs Non-Applicable
Standard 10.05 Sexual Intimacies with Current Therapy Clients/Patients: Psychologists do not engage in sexual intimacies with current therapy clients/patients. The term sexual intimacies is broadly interpreted and includes fondling, intercourse, kissing, masturbation in front of a client, telephone sex, touching of genitals, erotic hugging, verbal invitations to engage in sexual relationships, or communications (in person or via electronic transmission) intended to erotically arouse the patient. The ethical obligation to avoid sexual intimacies with clients/patients lies solely with the therapist, not with the client/patient. Any sexual intimacy between psychologists and clients represents a violation of this standard regardless of whether clients initiated sexual contact or voluntarily or involuntarily responded to therapists' overtures.
Sexual Relationships/Applicable vs Non-Applicable
Standard 7.08 Sexual Relationships with Students & Supervisees: Psychologists do not engage in sexual relationships with students or supervisees who are in their department, agency, or training center or over whom psychologists have or are likely to have evaluative authority. If in another department (e.g. Physics): then it is allowed
Deception in Research: Scientific and Social Justification
Under Standard 8.07a, deception studies are ethically justified only if psychologists demonstrate that: a. Prospective benefits to science or society significantly outweigh violating participants' right to determine whether they want to be involved in the type of experimental procedures for which they are recruited AND b. Nondeceptive alternative procedures do not offer sufficient scientific controls to test the hypothesis under investigation.
Steps for documenting decision making when keeping records:
What you expect your treatment of choice to accomplish? Why you believe it will be effective? Any risks involved? Any alternative options? Why were alternative options rejected? What steps are taken to improve effectiveness of present treatment?
Parole Hearing
"A judge ordered a convicted sex offender to receive therapy as a condition of parole. The psychologist assigned to provide the therapy explained to the parolee that all information revealed during therapy would be provided to the court and might be used to rescind parole."
To what ACTIVITIES does the Ethics Code apply to?
- ACTIVITIES include but are not limited to, clinical, counseling, and school practice; research, teaching and supervision; public service and policy development; program design, implementation and evaluation; construction, administration, and interpretation of assessment instruments; organizational consulting; forensic activities and administration.
Retention of Records
- APA full retention of records for 7 years - HIPAA full retention of records for 6 years - State of Florida: 3 years full records, 4 years summary (7 total) - For retention of records, go with APA -According to the book: The APA Record Keeping Guidelines recommend that, in the absence of specific legal requirement for record retention, complete records are maintained at minimum until 7 years after the last date of service delivery for an adult or until three years after a minor reaches the age of majority, whichever is it later. HIPAA regulations require that policies and procedures used to comply with the Privacy Rule are documented and retained for 6 years from the date of creation or the last date in which it was in effect, whichever is later. - If the state law establishes a longer period of record retention than HIPAA, psychologists who are covered entities must follow the state laws.
Intro/Applicability/Pre-Amble : To WHAT does the Ethics Code Apply?
- All activities, all persons, all settings, and all communication contexts that are conducted, encountered, or used in one's role as a psychologist.
To what COMMUNICATION does the Ethics Code apply to?
- COMMUNICATIONS CONTEXTS include research, consultation, and the delivery of services in person or via post, telephone, fax, internet, mobile phone, television, radio and other electronic transmission.
Why was HIPAA created?
- Designed to protect Americans that lost their job and insurance - Uniform standards for creating, transmitting and storing health care records - Applies to covered entities and health plans - whom privacy rules apply
What is not considered Private Health Information?
- Education records covered by the Family Education Rights and Privacy Act of 1974 - Employment records held by a covered entity in its role as employer - De-identifiable records
Components of HIPAA : 2) Transaction Standards
- For the electronic exchange of health information. - Requires standardizing & formatting of electronic transactions for certain specified financial & administrative purposes.
Components of HIPAA : 1) Privacy Standards
- For the use and disclosure of individuals' identifiable protected health information. - PHI (Protected Health Information). - When & to whom confidential info can be disclosed. - Focuses on application of effective policies, procedures, and business service agreements that control the access and use of client info.
Content of Records Depends Upon:
- Legal requirements (rules of evidence) and regulatory factors (ACA, FERPA, HIPAA). * Certain policy and procedures. - Work settings (schools, independent practice, interpersonal health organizations, disaster relief). * Need to follow organization + agency rules. - Requirements of 3rd parties (Medicare, Medicaid, Managed Care Organizations). - Nature of services provided (Assessment, Psychotherapy). - Emergency/Relief Settings (May not be substantiated due to situational demands, information may be limited, but always document). - Client's wishes - may request limited record keeping, but still need adequate records. * Need to consider if you can provide services under these conditions.
Intro/Applicability/Pre-Amble : To WHOM does the Ethics Code Apply?
- Membership in the APA commits members and student affiliates to comply with the standards of the Ethics Code. Many psych programs adopt the Ethics code into their faculty and student policies & portions of the Ethics Code are integrated into state laws, rules and regulations governing the licensed practice of psychology.
To what PERSONS does the Ethics Code apply to?
- PERSONS include individual clients/patients, research participants, students, children and adults of all ages; individuals with or without mental disorders, individuals with disabilities, persons of diverse cultural and language backgrounds and different sexual orientations, individuals within families, groups, and organizations; medical and social service providers; attorneys and other professionals.
Components of HIPAA : 3) Security Standards
- Protecting creation & maintenance of PHI, address the provider's or organizations physical infrastructure (office files, computers) to ensure info is secured. Info needs to be encrypted.
Advertisements
- Purpose: Trying to attract clients - The field has become business-like due to advertisement * Image: what image are we trying to portray? * Be careful of the language: define roles & functions (people usually can't differentiate a psychologist from a psychiatrist) * Radio-calling in: "there is NO therapeutic relation;" clarify you are just giving advice from research * Federal Trade Commission: * Bureau of Competition: focused on antitrust issue(s) * Bureau of Consumer Protection: investigate false charge & deceptive * Biggest Problem with Advertisements: Inadvertent Deception (#1 issue)
Differences between HIPAA LAW and STATE LAWS VS CODE
- Record retention - Withholding records for non-payment -APA vs Florida law on sex w current clients ----ALWAYS adhere to the highest standard
To what SETTINGS does the Ethics Code apply to?
- SETTINGS include military bases, schools, research laboratories, universities, private or group practice offices, business organizations, hospitals, integrated care systems and patient-centered medical homes, managed care companies, the courts, private and public social services programs, government agencies, and public spaces where research or intervention is carried out.
Parts of the Ethics Code : Introduction and Applicability Section - Pre-amble
- This section states that lack of awareness or misunderstanding of any part of the Ethics Code is not itself a defense to a charge of unethical conduct. - Discusses the intent, organization and procedures.
Ethics Code : Core Value
- Welfare and protection of the individuals/groups with whom psychologists work with
Parameters of Animal Research
09 Humane Care and Use of Animals in Research: (a) Psychologists acquire, care for, use, and dispose of animals in compliance with current federal, state, and local laws and regulations, and with professional standards. (b) Psychologists trained in research methods and experienced in the care of laboratory animals supervise all procedures involving animals and are responsible for ensuring appropriate consideration of their comfort, health, and humane treatment. (c) Psychologists ensure that all individuals under their supervision who are using animals have received instruction in research methods and in the care, maintenance, and handling of the species being used, to the extent appropriate to their role. (d) Psychologists make reasonable efforts to minimize the discomfort, infection, illness, and pain of animal subjects. (e) Psychologists use a procedure subjecting animals to pain, stress, or privation only when an alternative procedure is unavailable and the goal is justified by its prospective scientific, educational, or applied value. (f) Psychologists perform surgical procedures under appropriate anesthesia and follow techniques to avoid infection and minimize pain during and after surgery. (g) When it is appropriate that an animal's life be terminated, psychologists proceed rapidly, with an effort to minimize pain and in accordance with accepted procedures.
Purpose of the Ethics Code: Purpose 1
1) Establishing the integrity of the profession - Adoption of a set of core values that reflect consensus among member of a "community of common purpose" - Establish and maintain the viability of a profession, reflects a collective decision. - Enhance public confidence : showing that psychologists are member of a responsible and substantial profession with high standards and a contract with society to act in the patient's best interest. - Welfare and protection of the individuals and groups with whom psychologists work.
What are the 3 components of HIPAA?
1) Privacy Standards - April 14, 2003 2) Transaction Standards - October 16, 2003 3) Security Standards - April 21, 2003 & became compliant in April 1, 2005
Patients do not have the right to:
1) Psychotherapy/Process Notes 2) Inspect or change info compiled in reasonable anticipation of or for use in civil, criminal or administrative action. 3) Can't amend the records to their benefit
Patients have the right to:
1) Receive notice of use & disclosure of their PHI and how it is being used. 2) Access records for inspection & amend them in any way. 3) Account how their PHI is used and shared.
Ethics Committee may recommend for the psychologist to :
1. Cease & desist - stop what you're doing/an activity. 2. Obtain additional education/training/supervision. 3. Be evaluated for and obtain treatment if appropriate. 4. Agree to probationary monitoring
Two Kinds of Multiple Relationships
1. Concurrent multiple relationships: social or business relationships with patient at the same time that they have a professional relationship. 2. Consecutive multiple relationships: social or business relationship with patient either before or after professional relationship.
Mentorship: 4 stages
1. Initiation: 6 months -1 year; primary contact with mentor & have agreement 2. Cultivation: 2-5 years; meaningful interactions & deeper (emotional) bond developed 3. Separation: mentees autonomy develops 4. Re-defining: mentor & mentee redefine relationship; both are considered equal
Common Multiple Relationships
1. Sexual relationship w/ client, supervisee, or student. 2. Non-sexual, social or professional relationship: happy hour w/ client, hiring a supervisee. 3. Financial: Business relationships can occur in a rural town or small community (ethical in rural settings).
When was HIPAA enacted?
1996
Purpose of the Ethics Code: Purpose 2
2) Education and Professional Socialization - What psychologists should expect of themselves and one another.
Purpose of the Ethics Code: Purpose 3
3) Public Trust - High standards, acts in consumer's best interest, obligations made by all members in profession, contract/promise between the profession and the society. Also, the public can hold psychologists accountable.
Purpose of the Ethics Code: Purpose 4
4) Enforcement Value - Provides a clear statement of the types of behaviors considered ethical violations to guide psychologists in avoiding such behaviors, to assist consumers in making ethical complaints and to ensure the profession monitors itself. (Helps psychologists defend their decisions to courts, institutions, or government agencies that would encourage them to go agains the values of the profession)
Standard 5.01: Avoidance of False or Deceptive Statements
: A) Public statements include but are not limited to paid or unpaid advertising, product endorsements, grant applications, licensing applications, other credentialing applications, brochures, printed matter, directory listings, personal resumes or curricula vitae, or comments for use in media such as print or electronic transmission, statements in legal proceedings, lectures and public oral presentations, and published materials. Psychologists do not knowingly make public statements that are false, deceptive, or fraudulent concerning their research, practice, or other work activities or those of persons or organizations with which they are affiliated.
Therapy Involving Couples or Families
: If it becomes apparent that psychologists may be called on to perform potentially conflicting roles (such as family therapist and then witness for one party in divorce proceedings), psychologists take reasonable steps to clarify and modify, or withdraw from, roles appropriately. When such situations arise, under 10.02b, psychologists must first take steps to clarify to clients the nature of the two roles and the potential effect on each party involved in the therapy.
Sexual Harassment
: Psychologists do not engage in sexual harassment. Sexual harassment is sexual solicitation, physical advances, or verbal or nonverbal conduct that is sexual in nature, that occurs in connection with the psychologist's activities or roles as a psychologist, and that either: 1. is unwelcome, is offensive, or creates a hostile workplace or educational environment, and the psychologist knows or is told this or 2. is sufficiently severe or intense to be abusive to a reasonable person in the context. Sexual harassment can consist of a single intense or severe act or of multiple persistent or pervasive acts.
Therapy: Informed consent
: b) When obtaining informed consent for treatment for which generally recognized techniques and procedures have not been established, psychologists inform their clients/patients of the developing nature of the treatment, the potential risks involved, alternative treatments that may be available, and the voluntary nature of their participation.
What is a modifier?
A modifier is a word or phrase that qualifies the meaning of an ethical rule. - It is used to eliminate injustice or inequality - Examples of specific language is used in the Ethics Code : "appropriate", "potentially", "to the extent," "as early as feasible", "attempt to"
Multiple Relationships
A multiple relationship occurs when a psychologists is in a professional role with a person and 1. at the same time is in another role with the same person, 2. at the same time is in a relationship with a person closely associated with or related to the person with whom the psychologist has the professional relationship OR 3. promises to enter into another relationship in the future with the person or a person closely associated with or related to the person. A psychologist refrains from entering into a multiple relationship if the multiple relationship could reasonably be expected to impair the psychologist's objectivity, competence, or effectiveness in performing his/her functions as a psychologists, OR, otherwise risks exploitation or harm to the person with whom the professional relationship exists. Multiple relationships that would not reasonably be expected to cause impairment or risk or harm are not unethical.
General Principles: A
A) Beneficence and Non-maleficence - Do good. Avoid harm. Promote the welfare of others.
Role of LANGUAGE in Ethics Code
A) Have clarity necessary to provide the adequate notice of behaviors that would be considered code violations B) To be applicable across many multifaceted roles and responsibilities of psychologists C) To enhance and not impede good scientific and professional practice. * Must be specific to provide guidance yet general enough to allow for critical thinking and professional judgment. * Was crafted to describe the behaviors that are REQUIRED & those that are proscribed in a manner that readers would reasonably understand.
Standard 5.03 Statements by Others
A) Psychologists who engage others to create or place public statements that promote their professional practice, products, or activities retain professional responsibility for such statements. B) Psychologists do not compensate employees of press, radio, television, or other communication media in return for publicity in a news item. C) A paid advertisement relating to psychologists' activities must be identified or clearly recognizable as such.
General Principles: B
B) Fidelity and Responsibility - Faithfulness, keeping promises, discharge and acceptance of fiduciary responsibilities and appropriate maintenance of scientific, professional and teaching relationships. Seek to meet their responsibilities by avoiding conflicts of interest that would jeopardize trust or lead to exploitation of harm.
Bartering
Barter with Clients/Patients: Barter is the acceptance of goods, services, or other nonmonetary remuneration from clients/patients in return for psychological services. Psychologists may barter only if (1) it is not clinically contraindicated, and (2) the resulting arrangement is not exploitative. The issue of bartering often emerges in response to a client's financial limitations or lack of affordable health insurance. Providing services in return for bartered goods is ethically permissible in situations when to not do so would deprive clients of needed services or run a counter to a community's economic or cultural practices. Although barter is not a per se violation of the Ethics Code, psychologists need to be cautious about accepting bartered goods or services from clients in lieu of monetary payments because such arrangements have an inherent potential for client harm, expectations, and unethical multiple relationships. Standards 6.05 specifically prohibits barter with patients when it is clinically contradicted or exploitative.
General Principles: C
C) Integrity - Honest communication. Don't steal, cheat or commit fraud.
Standard 5.01 C
C) Psychologists claim degrees as credentials for their health services only if those degrees (1) were earned from a regionally accredited educational institution or (2) were the basis for psychology licensure by the state in which they practice. - Standard 5.01c applies only to psychologists who are claiming degrees or credentials as evidence of their competence to provide health services. - This standard is not directed at whether a psychologist actually obtained the degree but whether the degree can be claimed as a basis for offering therapy or diagnostic or other type of health services. - Psychologists may refer to only 2 types of degrees as evidence of education & training in the field of psychology that qualify them as a health service provider. 1. The first type is a degree in psychology (PhD, EdD, or PsyD) earned from a regionally accredited educational institution. 2. The second type of degree is from a program in a nonaccredited institution whose curriculum and training experiences have been approved by the state in which the psychologist practices as qualifying him/her for eligibility for licensure in psychology. A psychologist who claims a degree as a credential for health services that does not meet the above criteria would be in violation of this standard.
Boundary Crossing
Can be concurrent or consecutive When a professional deviates from a professional role but is not unethical per se. Behaviors that deviate from standard of care (self-disclosure, gifts, hugging patient). Need to have a therapeutic rationale - justify actions/behavior and document! Don't become violations unless it reflects exploitation of the client.
What can covered entities do?
Covered entities may engage business associates to carry out their health care activities such as billing, web hosting, technology services, accounting, as long as they assure the PHI will not be misused, and will be protected.
General Principles: D
D) Justice - Provide fair, equitable and appropriate access to treatment and benefits of scientific knowledge.
4 D's: 4 Elements to Establish Negligence Claim
Dereliction of Duty Directly causing Damage: 1. Clinician owed duty of care to client. 2. Clinician breached duty of care. 3. Patient suffered injury/harm for and should be compensated. 4. Clinician's conduct directly caused injury.
Graduate School Programs: what information do they need to have?
Descriptions of Education and Training Programs: Psychologists responsible for education and training programs take reasonable steps to ensure that there is a current and accurate description of the program content (including participation in required course- or program-related counseling, psychotherapy, experiential groups, consulting projects, or community service), training goals and objectives, stipends and benefits, and requirements that must be met for satisfactory completion of the program. This information must be made readily available to all interested parties. This standard of the APA Ethics Code requires psychologists responsible for these programs to keep program descriptions up-to-date regarding: a. Required coursework and field experiences b. Educational and career objectives supported by the program c. Current faculty or supervisory staff d. Currently offered courses e. The dollar amount of available student stipends and benefits, the process of applying for these, and the obligations incurred by students, interns, or postdoctoral fellows who receive stipends or benefits
General Principles: E
E) Respect for people's rights and dignity - Respect the dignity and worth of all people and the rights of individuals to privacy, confidentiality and self-determination.
Latest Revision of the Ethics Code
Est. 2010
Ethics Code
First made in 1938 - took around 60 years to make
HIPAA : What does it stand for?
Health Insurance Portability and Accountability Act
When can you and can't you use collection agencies
If the recipient of services does not pay for services as agreed, and if psychologists intend to use collection agencies or legal measures to collect the fees, psychologists first inform the person that such measures will be taken and provide that person an opportunity to make prompt payment. The definition of prompt payment should be reasonable but need not extend beyond a month depending on how long payments have been delinquent. As a rule of thumb, most businesses turn unpaid bills over to a collection agency after 60 to 90 days. Standard 6.04e applies to psychologists providing therapy, assessment, consultation, forensic, and other services when the service recipient is an individual, couple, or family. This standard does not apply when psychologist chooses to use a collection agency or legal measures to collect unpaid fees , attorneys, companies, organizations, or institutions
What makes health information "PHI"?
It must be created by the following COVERED ENTITIES: - Health Plan. - Health Care Clearing house - Health care provider who transmits any health info in electronic form in connection with financial or administrative activities related to health care.
Final draft of the Ethics Code
Made in 1952, published in 1953
Education and Training Teacher Student Relationship
Not fiduciary - Fiduciary : legal - No malpractice, we are not teacher's clients
Standard 5.02b
Psychologists do not make false, deceptive, or fraudulent statements concerning 1. their training, experience, or competence; 2. their academic degrees; 3. their credentials; 4. their institutional or association affiliations; 5. their services; 6. the scientific or clinical basis for, or results or degree of success of, their services; 7. their fees; or 8. their publications or research findings.
Sexual Intimacies with Former Therapy Clients/Patients
Sexual Intimacies with Former Therapy Clients/Patients: Psychologists do not engage in sexual intimacies with former clients/patients for at least two years after cessation or termination of therapy. Two Year Moratorium Under Standard 10.08a, any sexual intimacies with a former client within 2 years following the last professional contact are in ethical violation. However, as discussed below under Standard 10.08b, such behavior is not unconditionally acceptable after 2 years.
Sexual Intimacies with Relatives or Significant Others of Current Therapy Clients/Patients:
Sexual Intimacies with Relatives or Significant Others of Current Therapy Clients/Patients: Psychologists do not engage in sexual intimacies with individuals they know to be close relatives, guardians, or significant others of current clients/patients. Psychologists do not terminate therapy to circumvent this standard. Sexual intimacies with such persons harm the client by impairing the psychologist's treatment objectivity, blurring the therapist-client roles & relationships, and risking exploitation of the client to attain or maintain a sexual relationship with a third party. This standard applies to a client's patient's parents, siblings, children, legal guardians, and significant others. It may also apply to other relatives if they are emotionally or otherwise close to the client.
Consultation
Should always be documented
Testimonials
Testimonials: Psychologists do not solicit testimonials from current therapy clients/patients or other persons who because of their particular circumstances are vulnerable to undue influence Standard 5.05 specifically prohibits solicitation of testimonials from clients/patients currently in therapy with the psychologists. The standard does not prohibit unsolicited testimonials or the solicitation of testimonials from former clients/patients who are not vulnerable. Vulnerable clients include: substance abuse; clients with major health illness (e.g. schizophrenia); clients with high probability of readmission; clients who are not compliant with treatment; clients who are suicidal
Therapy with Former Sexual Partners
Therapy with Former Sexual Partners: Psychologists do not accept as therapy clients/patients persons with whom they have engaged in sexual intimacies. Conducting therapy with individuals with whom psychologists have had a previous sexual relationship risks compromising the effectiveness of professional services.
How many standards are part of the Ethics Code?
There are 151 ENFORCEABLE STANDARDS - They describe the required, prohibited and permitted behaviors. - They do not apply to the PRIVATE CONDUCT of psychologists. - Lack of awareness or misunderstanding of ANY PART of the Ethics Code is NOT itself a DEFENSE to a charge of unethical conduct.
Therapy: Informed Consent
When obtaining informed consent to therapy as required in Standard 3.10, Informed Consent, psychologists inform clients/patients as early as is feasible in the therapeutic relationship about the nature and anticipated course of therapy, fees, involvement of third parties, and limits of confidentiality and provide sufficient opportunity for the client/patient to ask questions and receive answers. Informed Consent should include discussion of the duration of each sessions, appointment schedule, and the general objectives of treatment.
Therapy Involving Couples or Families
When psychologists agree to provide services to several persons who have a relationship (such as spouses, significant others, or parents and children), they take reasonable steps to clarify at the outset (1) which of the individuals are clients/patients and (2) the relationship the psychologist will have with each person. This clarification includes the psychologist's role and the probable uses of the services provided or the information obtained. In some couples or family treatment modalities, the client is the multiperson unit, and the primary obligation of the psychologist is to the parties as a whole. Under 10.02, psychologists must identify & explain which members of the couple or family are the primary client. They should also discuss issues related to termination, including whether treatment will continue if a member of the couple or family decides to discontinue. During informed consent, psychologists also need to ensure that all family members understand the nature of psychotherapy and are voluntarily agreeing to participate. If a family member joins the process at a later time, the informed consent process should be repeated.
Standard 5.04: Media Presentations
When psychologists provide public advice or comment via print, Internet, or other electronic transmission, they take precautions to ensure that statements: 1. are based on their professional knowledge, training, or experience in accord with appropriate psychological literature and practice; 2. are otherwise consistent with this Ethics Code; AND 3. do not indicate that a professional relationship has been established with the recipient
Group Psychotherapy
When psychologists provide services to several persons in a group setting, they describe at the outset the roles and responsibilities of all parties and the limits of confidentiality. In addition to responsibilities described in Standards 3.10 Informed Consent & 10.01 Informed Consent to Therapy, psychologists conducting group therapy must describe at the outset of treatment the unique roles & responsibilities of both therapist & clients in multi-person therapies. As in couple and family therapy, informed consent regarding terminating policies is critical. Group members need to know they have the right to voluntarily withdraw from the group as well as the consequences of member dropouts for the continuation of the group as a whole.
Therapy: Informed Consent
When the therapist is a trainee and the legal responsibility for the treatment provided resides with the supervisor, the client/patient, as part of the informed consent procedure, is informed that the therapist is in training and is being supervised and is given the name of the supervisor. Both the trainee and the supervisor would be in potential violation of this standard of the supervisee failed to include this information during informed consent. This standard does not apply to therapy conducted by licensed psychologists obtaining postdoctoral training & supervision because, in such contexts, the legal responsibility most often resides with the psychologist.
When making a decision
You need to justify reasoning
Feedback in Assessments
a) In academic and supervisory relationships, psychologists establish a timely and specific process for providing feedback to students and supervisees. Information regarding the process is provided to the student at the beginning of supervision. Under Standard 7.06a, psychologists must inform students & supervisees: a. When and how often they will be evaluated b. The basis for evaluation c. The timing and manner in which feedback will be provided
Roles of Covered Entities - They must :
a) Provide information to patients about their privacy rights and the covered entities privacy practices, called a notice of privacy practices. b) Allow patients to access records and upon patient request provide an accounting of disclosures of PHI made to others over the past 6 years. c) Obtain patient authorization for use and disclosures to others in a manner and for purposes specified in the regulations. d) Implement clear privacy procedures for electronic transmission and storage of PHI. e) Designate a privacy officer. f) Implement security procedures that prevent unauthorized access to health records. g) Train and ensure that employees comply with privacy, transaction, and security procedures. h) Reasonably ensure that business associates, individual contractors, consultants, collection agencies, third-party payers, and researchers with whom PHI is shared comply with privacy and transaction rules. i) Attempt to correct violations by these other entities if they occur or cease the relationship.
Deception in Research
a) Psychologists do not conduct a study involving deception unless they have determined that the use of deceptive techniques is justified by the study's significant prospective scientific, educational, or applied value and that effective nondeceptive alternative procedures are not feasible. The "Consent Paradox" By its very nature, informed consent for participation in a deception study creates a moral paradox by compromising an individual's ability to make a fully informed decision about research participation. This is why Standard 8.07 requires that deception research meet more stringent criteria for implantation than is required for nondeceptive studies.
Sexual Intimacies with Former Therapy Clients/Patients
b) Psychologists do not engage in sexual intimacies with former clients/patients even after a two-year interval except in the most unusual circumstances. Psychologists who engage in such activity after the two years following cessation or termination of therapy and of having no sexual contact with the former client/patient bear the burden of demonstrating that there has been no exploitation, in light of all relevant factors, including (1) the amount of time that has passed since therapy terminated; (2) the nature, duration, and intensity of the therapy; (3) the circumstances of termination; (4) the client's/patient's personal history; (5) the client's/patient's current mental status; (6) the likelihood of adverse impact on the client/patient; and (7) any statements or actions made by the therapist during the course of therapy suggesting or inviting the possibility of a posttermination sexual or romantic relationship with the client/patient. If an ethics complaint is made against the psychologist regarding a 2-year posttermination sexual relationship, Standard 10.08b places the ethical burden on the psychologist to demonstrate that the sexual relationship is not exploitative. The standard describes 7 relevant factors that could be applied to determine such exploitation: 1. The amount of time that has passed since therapy terminated 2. The nature, duration, and intensity of the therapy 3. The circumstances of termination 4. The client's personal history 5. The client's current mental status 6. The likelihood of adverse impact on the client 7. Any statements or actions made by the therapist during the course of therapy suggesting or inviting the possibility of a posstermination sexual or romantic relationship with the client However, the State of Florida says that you can NEVER have sexual relationships with a former client. Go with Florida
Feedback in Assessments
b) Psychologists evaluate students and supervisees on the basis of their actual performance on relevant and established program requirements. Fairness & justice require that academic and supervisory evaluations should never be based on student personal characteristics that have not been observed to affect their performance or that are outside the established bounds of program requirements
Faculty must:
ensure students are competent Help students with problem-solving skills Help develop technical skills & judgement Find balance between academics & empathy/compassion of clients Develop emotional competence & technical skills
Role of teachers
is to empower us, help us learn material, but main obligation/role is to protect the public from incompetence Students are constantly being watched/supervised Students have responsibility to report unethical behaviors in practicum: Tell supervisor: puts responsibility on supervisor Must always try to protect client
Info on HIPAA and Informed Consent
o HIPAA Implications: Archival research that was PHI: need to be careful with HIPAA regulations Information of participant should be de-identified (could skew results) o IRB: Institutional Review Board o Informed Consent in Research need to include: Purpose of Research How long it will take Procedures used Participants have right to decline/withdraw at anytime Foreseeable consequences: potential harm Notate any reasonable factors that may lead to harm Any incentives for participation: inducement can't be so big it coerces Who client need to contact when they have questions Give opportunity to ask any questions & answer questions Their rights Research benefits o Informed Consent: Make sure they understand Language: comprehensible; don't use jargon
Regulations that HIPAA applies :
to protected health information (PHI), defined as oral, written, or electronic pertaining to individuals identifiable information related to: a) Patient's past, present, future physical or mental health. b) Provision of health care to the person. c) Past, present, future payment for health care.