California Profesional Psychology School Class Flashcards

Question

Seven Stage Crisis Intervention Model by Roberts

Answer 1

Most frequently cited models and applied to various situational and maturational crises. 1) Crisis assessment: evaluate lethality of SI/HI, immediate medical/psychosocial needs, and risk/protective factors 2) Establish Rapport - convey respect, genuineness and acceptance 3) Identify Major Problems - ID and prioritize problems including precipitating event, nature of clt's reactions, and clt's lethality and previous coping methods 4) Explore Feelings and Emotions - through this process, help clt ID maladaptive beliefs underlying emotions, consider behavior options and restore emotional balance 5) Generate and Explore Alternatives - stage where clt may sign no-suicide/-violece contract, consider hospitalization, etc. 6) Develop and Implement an Action Plan - implementation of interventions and promote cognitive master of crisis (i.e. understanding what led to crisis, meaning of crisis, and replacing maladaptive beliefs with adaptive ones). This stage ends with resolution of crisis. 7) Follow-up - Post crisis evaluation assessing clt's overall functioning and satisfaction w/treatment and determine how clt is handling current stressors. Establish a follow-up plan (i.e. follow-up session once a month, annually, periodical "booster" sessions.

Answer 2

depends on clt's level of mobility/immobility (ability to autonomously change/cope in response to different moods, feelings, emotions, needs, conditions and influences) 1) nondirective - usually when clt can do it themselves and crises are less severe. Provider supports clt to make their own decisions 2) collaborative approach - when non directive doesn't work, but enough mobility to work with provider. Provider's rol is catalyst, facilitator, consultant, and provider of support 3) directive - when clt is too immobile to cope effectively with crisis due to psychiatric symptoms and level of functioning. Provider assumes temporary responsibility and control, defines problems and alternative solutions, and facilitates the clt's ability to take action by providing instruction and explicit guidance.

Answer 3

1) Psychological First Aid (PFA) - mental health services provided to an individual immediately following exposure to a disaster or other traumatic event with primary goal of bolstering sense of safety, well-being and empowerment. This is often 1st phase in intervention process and involves 6 steps (1-immediate intervention - provide immediate contact, address safety needs, and prevent legal bxs, 2-establish rapport, 3- assessment, 4-take action, 5-utilize referral sources, and 6-provide aftercare) 2) Group Interventions (ex. group cognitive processing therapy is effective for female survivors of sexual assault; cognitive behavioral group therapy shows reduction of trauma related sxs in children physically abused; bereavement support groups for couple whose baby died and for children who experienced suicide of parent or sibling) ----Critical Incident Stress Management (CISM) is multimodal approach for individuals who have been exposed to a disaster or other traumatic event and combines grp therapy with indiv counseling and support, family interventions, and follow up services and referrals Group defusing (structured small-group discussions occurring within a few hours after traumatic event allowing members to vent and reflect on feelings in safe, supportive environment) and debriefing (more formal meetings that are held at intervals during first several days to weeks after even are used to provide info to victims and their families, help victims deal with trauma related symptoms, and facilitate post-crisis psychological closure) are components of CISM 3) Individual Interventions (behavior, cognitive-behavior, and solution-focused therapy). Some evidence supporting Trauma-Focused CBT. 4) Family Interventions - Harris's systematic model based on problem-solving approach involving 5 steps: 1)making psychological (therapeutic) contact with the family by building rapport and encouraging family members to express their feelings and tell their personal stories; 2)exploring dimension of emily problem by ID-ing immediate concerns, ID-ing family strengths and weaknesses, and mobilizing social support; 3) exploring possible solutions by helping family ID alternatives and create a "family healing theory"; 4) assisting family in taking concrete action by ID-ing ways to overcome obstacles and urging members to work toward resolving their probs; 5) providing follow-up by continuing to see family, make referrals, and/or check on their progress. 5) Referrals - refer to professionals, services, or agencies depending on clt's need

Answer 4

determine imminent and future risk for SI, get info needed to develop treatment plan, and once treatment beings, monitor its effectiveness

Answer 5

Suicide assessment is done at 1 initial evaluation, 2 during each session of several months following release from psychiatric hospitalization, 3 during each session of a suicide intervention, 4 at onset of new, painful, or disabling medical condition, 5 at onset of a new or intensification of a co-existing psychiatric disorder, 6 at onset of signs of relapse or recurrence of sxs, 7 at occurrence of a major stressor, and 8 on the emergence of other high-risk factors

Answer 6

involves integrating info from a variety of sources including a clinical interview, a mental status exam, clt's family members, clt's physician and other health care providers, and psychological tests 1) risk factors: (for general risk factors = 1 suicidal thoughts/behaviors, gestures, plans, and history of suicide attempts; 2 psychiatric diagnosis; 3 psychiatric symptoms; 4 physical illness; 5 psychosocial factors (recent stressful life event or chronic stress, lack of social support, history of violence or trauma, and family history of suicide or mental illness; and 6 demographic characteristics) (for adolescents, risk factors are aggression and hostility especially when combined with depression, impulsivity, recent interpersonal conflict/loss, substance abuse, history of physical and/or sexual abuse) (for Older adults, risk factors are physical illness, depression/bipolar do, multiple losses associated with aging, access to firearms or other lethal means

Answer 7

high risk is associated with male gender, older age, and White race for males, rates are highest among those ages 75 an older but for women, rates are highest for ages 45-54. Rates for completed suicide are higher for men, while rates for attempted suicide are higher for women RE race/ethnicity, for most age groups, Whites have the highest rates of suicide with exception for American/Indian/Alaskan Native people aged 15-34 which is nearly double the national average for that age group

Answer 8

include good coping and problem-solving skills, intact reality testing, a sense of responsibility toward family, ability to garner social support, cultural or moral/religious values that discourage suicide, fear of suicide, motivation to seek help and access to mental health services, and a positive therapeutic appliance

Answer 9

can't make predictions but in general, the greater the number of risk factors and the fewer the number of protective factors, the higher the level of risk

Answer 10

ask clt direction questions about suicidal thoughts plans, behaviors, and intent. this is a critical aspect of suicide assessment 1) being with questions addressing feelings about living: do you ever feel that life isn't worth living? do you sometimes feel as though you'd like to go to sleep and never wake up? how does the future look o you? 2) follow-up questions with questions that address specific thoughts about death, suicide, and self-harm: have you been thinking about harming yourself lately? have you been thinking about what it would be like to die? 3) for clients who have thoughts about death, suicide, or self-harm, follow-up with more specific questions about those thoughts and about a suicide plan, intent, and lethality: what led up to your thoughts of suicide? do you have a specific plan for how you will kill yourself? 4) for clients who have attempted suicide or engaged in self-harm, follow-up with more specific questions about those incidents: what was happening in your life right before the attempt? 5) As appropriate, follow-up with questions that address the clt's risk for harm to others: are there other people who you would want to die with you?

Answer 11

these instruments are not likely to be useful when clt is in acute crisis state and in need of immediate intervention, they can be helpful for detecting SI in clts who are not overtly suicidal Beck Scale for Suicide Ideation (BSS) - 21 item self-report measure that quantifies the intensity of individual's suicidal ideation over previous week and addresses clt's suicidal wishes, attitudes, and plans. Scores range from 0 to 38 with hither scores indicating greater severity of suicidal ideation. Beck Depression Inventory - 2nd Ed (BDI-II) - 21 items that address cognitive, affective, behavioral, and physical aspects of depression and correspond to the DSM's diagnostic criteria for depressive dos. Each item has four choose that are rated according to severity from 0 to 3. Severe depression = 29-63. Beck hopelessness Scale (BHS) - 20 true/false items that evaluate negative attitudes about the future. Total score ranges 0-20, with higher scores indicating a greater degree of hopelessness Reasons for Living Inventory - 48 item rating scale assessing beliefs and expectations that reduce the likelihood that an individual will act on suicidal ideas. Proivdes total score and 6 sub scales (survival and coping beliefs, responsibility to family, child-related concerns, fear of suicide, fear of social disapproval, and moral objections to suicide. Scores range from 1 to 6, with higher scores indicating more reasons for living Minnesota Multiphasic Personality Inventory (MMPI-2/MMPI-A) - No MMPI "suicide profile" has been found to be an accurate predictor of suicide risk. Elevated score on Scale 2 (depression) raises possibility of suicide, especially when elevation is high to very high on Scales 4 (psychopathic deviant), 7 (Psychasthenia), 8 (Schizophrenia), and/or 9 (Hypomania).

Answer 12

The MMPI has 10 clinical scales that are used to indicate different psychological conditions. Despite the names given to each scale, they are not a pure measure since many conditions have overlapping symptoms. Because of this, most psychologists simply refer to each scale by number. Scale 1 – Hypochondriasis: This scale was designed to asses a neurotic concern over bodily functioning. The 32-items on this scale concern somatic symptoms and physical well being. The scale was originally developed to identify patients displaying the symptoms of hypochondria. Scale 2 – Depression: This scale was originally designed to identify depression, characterized by poor morale, lack of hope in the future, and a general dissatisfaction with one's own life situation. Very high scores may indicate depression, while moderate scores tend to reveal a general dissatisfaction with one’s life. Scale 3 – Hysteria: The third scale was originally designed to identify those who display hysteria in stressful situations. Those who are well educated and of a high social class tend to score higher on this scale. Women also tend to score higher than men on this scale. Scale 4 - Psychopathic Deviate: Originally developed to identify psychopathic patients, this scale measures social deviation, lack of acceptance of authority, and amorality. This scale can be thought of as a measure of disobedience. High scorers tend to be more rebellious, while low scorers are more accepting of authority. Despite the name of this scale, high scorers are usually diagnosed with a personality disorder rather than a psychotic disorder. Scale 5 – Masculinity/Femininity: This scale was designed by the original author’s to identify homosexual tendencies, but was found to be largely ineffective. High scores on this scale are related to factors such as intelligence, socioeconomic status, and education. Women tend to score low on this scale. Scale 6 – Paranoia: This scale was originally developed to identify patients with paranoid symptoms such as suspiciousness, feelings of persecution, grandiose self-concepts, excessive sensitivity, and rigid attitudes. Those who score high on this scale tend to have paranoid symptoms. Scale 7 – Psychasthenia: This diagnostic label is no longer used today and the symptoms described on this scale are more reflective of obsessive-compulsive disorder. This scale was originally used to measure excessive doubts, compulsions, obsessions, and unreasonable fears. Scale 8 – Schizophrenia: This scale was originally developed to identify schizophrenic patients and reflects a wide variety of areas including bizarre thought processes and peculiar perceptions, social alienation, poor familial relationships, difficulties in concentration and impulse control, lack of deep interests, disturbing questions of self-worth and self-identity, and sexual difficulties. This scale is considered difficult to interpret. Scale 9 – Hypomania: This scale was developed to identify characteristics of hypomania such as elevated mood, accelerated speech and motor activity, irritability, flight of ideas, and brief periods of depression. Scale 0 – Social Introversion: This scale was developed later than the other nine scales as is designed to assess a person’s tendency to withdraw from social contacts and responsibilities.

Answer 13

revised Rorschach Suicide Constellation (S-CON) consists of 12 variables intended to ID clts at risk for suicide. S-CON score of 8 or more indicates a very high potential for suicide, while a score of 6 or 7 suggests the need for additional evaluation for suicide potential

Answer 14

Primary and Secondary Goals Primary goals are to: 1 ensure the clt's safety by eliminating or reducing access to common methods of suicide (firearms, meds); 2 establish a therapeutic alliance with trust and rapport; 3 alleviate acute risk symptoms that are amenable to treatment (panic sxs, agitation,insomnia, substance abuse) Secondary goals are to reduce future suicide risk by addressing mania, depression, and other conditions and risk factors

Answer 15

3 types: hospitalization, outpatient crisis intervention, and outpatient psychotherapy. Consider clt's preferences and the potential risks and benefits of each approach No suicide contracts do not guarantee person's safety and should be used only as a component of a comprehensive intervention

Answer 16

appropriate for clt who just attempted suicide or is at imminent risk for suicide as indicated by presence of a specific suicide plan with access to lethal means in conjunction with other risk factors such as impaired judgment, current impulsive behavior, severe mental illness or chemical dependency, and/or a lack of social support. Initial alternative should be to encourage voluntary hospitalization but involuntary hold should be initiate if clt refuses voluntary hosp.

Answer 17

when clt is at moderate risk for suicide as evidenced by suicidal intent with lack of access to lethal means, fair or good judgment, presence of social support, and a willingness to comply with treatment. Crisis intervention for suicide risk could involve 7 stage crisis intervention model by Roberts and Ottens or other crisis intervention model intervention should address: reducing social isolation, removing lethal means of suicide, encouraging clt to express anger in alternative ways, relieving anxiety and sleep loss, and persuading clt to postpone a decision about suicide until after crisis has ended.

Answer 18

appropriate as follow-up to hospitalization and crisis intervention and the treatment for clots who are at low risk for suicide as evidenced by suicidal intent with an absence of a specific suicide plan, the present of social support, and willingness to talk about problems and comply with treatment. Beneficial therapies for suicidal clots include CBT, interpersonal therapy, DBT, and problem-solving therapy

Answer 19

refers to a number of harmful acts including emotions, sexual and physical violence, intimidation and threats, neglect or abuse of dependents, stalking and harassment, property damage, and reckless bx.

Answer 20

issues of concern regarding legal and ethics: maintaining clt's confidentiality vs due to warn/protect clt's intended victim(s) and the need to involuntarily hospitalize clt.

Answer 21

Exception to confidentiality in law and ethical standards is when clt is a serious risk of danger to otters. Tarasoff decision established therapist's duty to protect a readily identifiable victim by warning them, notifying police, and/or taking other reasonably necessary steps. California adopted Civil Code Setion 43.92 as an immunity statute designed to establish "warning as one way, but no the exclusive way, to get immunity and discharge the tidy to warn or protect."... in addition, Standard 4.05 of APA Ethics Code states that psychologists may disclose confidential info without clt's consent as mandated by law or where permitted by law for a valid purpose to protect clt, psychologist, or others from harm"

Answer 22

voluntary hospitalization is usually an option before initiating an involuntary hold; involuntary hold should be considered only when the danger the clt poses is imminent and due to mental disorder or chronic alcoholism, and the clt has refused or unable to comply with recommendation to enter a psychiatric hospital voluntarily

Answer 23

When faced with a violent clt, important to remain calm, encourage communication by asking open-ended questions, and attempt to determine intensity of clt's feelings and lethality of their intent Methods: less intrusive (speaking softly, moving slowly, adequate physical distance from clt, leaving door open, expressing sympathetic concern for clt's well-being, setting limits on bx and suggesting alternatives to violence) vs more intrusive (when less intrusive methods fail and include leaving the room, calling for help, picking up a potential "weapon" and if necessary, fitting back. Calling for help is acceptable only if clt's condition permits violation of confidentiality or clt gives permission for doing so

Answer 24

to determine probably that clt will commit a violent act in the near future, ID factors contributing to clt's dangerous bxs and intent, and obtain additional info that is needed to identify treatment goals and develop a treatment plan

Answer 25

assessment is an ongoing process that should be conducted during the first contact with the client and when there is a change in clt's mental state or legal status, clt experiences major change in life circumstances (job, divorce), or there is a modification in clt's care (discharge from psychiatric hospital, referral to new provider)

Answer 26

assessment of clt with danger to others requires comprehensive approach involving obtaining info on multiple factors (i.e. history of violent bx, access to weapons and potential victims, and other risk factors; mental status and overall level o functioning; current stressors and coping skills; and the clt's willingness and ability to collaborate with treatment.) from multiple sources (family members, friends, informants familiar with clt, medical and mental health records; and police and court records Note: any threat of harm against others should always be taken seriously

Answer 27

Single best predictor of future violence is a past history of violence, with commitment of a serious violent act at an early age and/or commitment of multiple violent acts begging associated with the greatest risk. ----- Demographic, personality, and situational factors associated with high risk for danger to others: 1 Demographic Characteristics (past violent behavior, male gender, younger age (late teens to early twenties), lower SES, low intelligence, history of child abuse or witnessing spouse abuse, father who has a criminal arrest history 2 Psychiatric Diagnosis 3 Psychiatric Symptoms 4 Situational factors: lack of social support, access to weapons, high level of perceived stress, victim specificity and availability, non-compliance with treatment and poor therapeutic alliance

Answer 28

Borum, Swartz, and Swanson recommend a 2-stage approach for asking clt questions related to potential for violent bx initial screening questions are general and less sensitive and are asked of all clients - i.e. what mass you mad? what do ou do when mad? own weapons? second screening questions are more detailed questions asked to obtain information about past incidents of violence and current intent when an elevated risk for violence is suggested by clt's answers to the initial screening questions or by a history of violent behavior, a stated intent to harm someone, or other factor(s)

Answer 29

tests are not likely to be necessary when clt express intent to harm someone or useful when clt is in acute crisis state and in need of immediate intervention. Test are helpful for detecting potential for violence Psychopathy Check List-Revised (PCL-R): measure of psychopathy and often used to predict violent recidivism. 20 items measure traits associated with psychopathy (i.e. pathological lying, poor behavioral controls, grandiose sense of self-worth). Scored on 3 point scale. Score range 0-40, with scores over 30 suggesting presents of psychopathy MMPI-2 and MMIP-A: several MMPI scales are useful for detecting anger and aggression. Very high Scale 4 = clt may be aggressive or assaultive. Elevated scores on 4 and 9 associated with underlying sense of anger, alienation, impulsiveness, and antisocial tendencies with the energy to act on these feelings. Elevated Scores on 6, 4 and 9 = clt is likely to be very dangerous and to have poor judgment and their acting out is likely to be violent and seem justified to them because strong feelings of resentment toward others. High scores on 4 and 2 are associated with personality disorders, especially passive-aggressive and antisocial personality traits, and with hostility that may be expressed either directly or indirectly. Millon Clinical Multiaxial Inventory - III (MCMI-III): used to assess DSM-IV personality disorders and clinical syndromes, and scores on several scales are useful for assessing risk for violent behavior. (Ex. high score on Antisocial scale (6a) is associated with impulsive acting out of antisocial feelings; high score on Aggressive scale (6b) indicates a propensity for aggressive outbursts, often with an absence of shame or guilt; and elevated scores on both scales are associated with expressions of antisocial feelings that are likely to be direct and abusive...High scores on Aggressive and Paranoid (P) scales suggest that person's paranoia may be expressed in a controlling, intimidating, and belligerent way and that they may brood about perceived injustices and develop plans of revenge.

Answer 30

determining risk is always subjective, thus subject to error Low Risk - when clt has few risk factors, does not have a history of impulsive behaviors, and does not have a specific plan or the means to carry out a plan Moderate Risk - when clt has multiple risk factors, expresses low to moderate intent to carry out a plan or does not have the means to carry out a plan, exhibits only minimal cognitive or emotional impairment, and has protective factors (i.e. social support, safety plan) High Risk - when has concrete plan and access to lethal means to carry out that plan, has multiple risk factors (i.e. impulsivity and low frustration tolerance, significant mental health problems, limited social support), and is unwilling or unable to form a therapeutic relationship

Answer 31

initial goals are to build rapport with clt and reduce risk for future violence by bringing violent, aggressive behavior under control. Treatment goals depend on factors such as setting (inpatient vs outpatient), clt's characteristics, and the underlying cause(s) of and contributor(s) to clt's threatening, aggressive, or violent behavior

Answer 32

methods for reducing risk depend on nature, lethality, and immediacy of violence throated by clt but may include having clt agree to adhere to a medication regimen, a safety plan, and/or a no-violence contract

Answer 33

appropriate treatment depends on level of risk and causes of violent behavior. when choosing a treatment, primary guiding principle is to try and keep the clt in the least restrictive environment Hospitalization - if clt poses imminent danger to others as a result of mental disorder, voluntary psychiatric hospitalization is usually the preferred intervention; but if clt refuses voluntary, then involuntary hospitalization may be necessary. follow up with a hospitalized clt until crisis is stabilized and then proceed with treatment if possible. (if clt's imminent danger is not due to mental disorder, it may be necessary to consider alternatives such as referral to substance abuse treatment program or involvement with criminal justice system) Outpatient Management - when clt is sincere in desire to change and risk for future violence is low. Treatment includes teaching communication, problem-solving, stress management, and anger management skills; fostering development of empathy in the clt for potential victims and increasing their understanding of consequences of violence; and working with clt to develop a safety plan that includes reducing environmental triggers for violent behavior and removing access to weapons. (CBT-thought patterns that can be controlled and replaced with pro-social thinking. Strategies incl training in cognitive self-control, anger management, social perspective-taking, social problem-solving, and relapse prevention) (Couple and Family therapy - often useful since most violence occurs within families. Intervention include educating family members about family dynamics leading to violence and early warning signs of violent bx, training in interventions for high-risk situations (i.e using time outs and impulse delay tactics), training in communication and problem-solving skills, and referral to support groups) (Group therapy - often less threatening to clts than individual therapy and provides opportunities to that others struggle similarly, see how others have successfully dealt with situations that normally trigger violence, and learnt to resolve conflicts with other group members in a supportive environment.) Consultation - important adjust when choosing appropriate management strategy for potentially dangerous clt. consultation increases predictive accuracy and facilitates ID of appropriate interventions and can reduce legal liability

Answer 34

the state or condition that is caused by a loss and includes both grief and mourning

Answer 35

Psychological, behavioral, and physical experience of loss

Answer 36

external expression of grief and is affected by a number of factors including gender, culture, relgion/spirituality, and the cause of the loss

Answer 37

loss of family member or friend is probably most common precipitant of grief but may also be triggered by other factors (serious health problem, death of pet, substantial financial loss, change in a familiar social role)

Answer 38

1) Anticipatory Grief - refers to a grief reaction that occurs prior to an expected loss. Similar to normal grief in terms of symptoms but has some unique characteristics (i.e. rehearse actual seat in their mind, spend time thinking about what life will be like when person dies, and vacillate between acceptance and denial). Beneficial effects because provides individual with time to accept the reality of the loss, to prepare for life without the deceased, and to resolve unfinished business by expressing feelings and addressing unresolved issues 2) Normal (Uncomplicated) Grief - a process involving stages or tasks (5 stages: denial, anger, bargaining, depression, and acceptance). Responses often include shock and disbelief, sadness and depression, anxiety, anger, guilt, a sense of emptiness, disturbances in sleep and appetite, dreams about the deceased, and/or sensing the presence of the deceased. Duration varies but most severe symptoms subside within 6-12 months 3) Complicated Grief (also referred to as unresolved or pathological grief and may occur when progression through the stages or tasks of normal grieving is disturbed or blocked.) - may include reactions associated with normal grief that are more intense or prolonged as well as social isolation, impairments in cognitive/motor skills, hostile/violent behavior, severe depression, symptoms of PTSD, phobias and irrational fears, avoiding reminder of the deceased, and/or imitating the deceased. High risk for complicated grief linked to very close, dependent, or conflicted relationship with the deceased, sudden or unanticipated death, multiple losses, lack of social support, past history of mental illness or substance abuse, concurrent circumstances that interfere with grieving such as physical illness or present of other stress, and a lack of cultural traditions or spiritual beliefs. No standard diagnosis for pathological grief reactions. DSM includes Bereavement with "Conditions that may be a Focus of Clinical Attention" when "the focus of clinical attention is a reaction to the death of a loved one. Person with pathological grief may have symptoms that meet other disorders. 4 types of complicated grief Masked Grief - when a person experiences troublesome symptoms but does not recognize them as being related to the loss Delayed Grief - when an intense grief reaction emerges at a later time, often in response to a minor event Distorted or Exaggerated Grief - involves atypical or very intense symptoms (i.e. development of irrational fears, physical or psychiatric symptoms, SI) Chronic Grief - characterized by symptoms that have a prolonged duration and do not subside in severity

Answer 39

Primary goals of assessment are to determine how clt is coping with loss and to distinguish between grief and other conditions or disorders so that an appropriate intervention can be identified. main source of info is from clinical interview to address nature of loss, clt's current symptoms, mental status and level of functioning (including risk for self-destructive bx), psychiatric history, coping style, concurrent stresssors, and support network) BSI-II, BDI-II, Acute Stress Disorder Scale, Impact of Events Scale-Rtevised and DSM's GAF

Answer 40

depends on type of loss, nature and severity of clt's grief, and presence of co-existing problems. Primary goal is to help clt successfully complete the grieving process

Answer 41

variety of interventions aimed at particular types of loss brief interventions based on crisis theory are often beneficial for addressing acute grief reaction. normal grief may require an intervention or not; or may need grief/supportive counseling, referral to a support or self-help group, and/or referral to a physician for short-term medication for insomnia or anxiety may be appropriate. complicated grief may require more intensive, grief-focused therapy

Answer 42

time-limited therapy appropriate for ppl with complicated grief reaction that is prolonged, delayed, exaggerated, or manifested as somatic o behavioral symptoms. Primary goal is to help clt resolve conflicts related to separating from the deceased person that are interfering with completion of the 4 tasks of mourning - 1) accepting the reality of loss, 2) working through the pain and emotional aspects of the loss, 3) adapting to an environment without presence of deceased, and 4) establishing a new rx with deceased person and reengaging in life. Therapy determines which of the four tasks have not been completed and then using interventions that address those tasks. There is a diff between grief therapy and counseling. Counseling is appropriate for normal grief.

Answer 43

for ppl whose depression is related to abnormal (complicated) grief. Primary goal = to facilitate the clt's grieving process and help clt reestablish interests and interpersonal relationships. Strategies include linking onset of depressive symptoms to the loss, reconstructing clt's relationship with deceased person, exploring feeling associated with loss, and identifying ways to connect with others IPT was designed as treatment for depression and explicitly targets abnormal (complicated) grief. IPT targets 3 other areas such as interpersonal role disputes, role transitions and interpersonal deficits.

Answer 44

Shear et al 2005 used a targeted complicated grief treatment combining education about grief, imaginal exposure through listening to a recorded retelling of the each, in vivo exposure to avoided situations, reducing distress through guided "conversations" with the deceased and recalling positive memories involving the deceased, and identifying personal life goals and ways to achieve those goals to be an effective approach for resolving the symptoms of complicated grief.

Answer 45

benefits = reducing social isolation and providing opportunities for chars is and acquiring coping skills. Most common are psychodynamic, interpersonal, and cognitive-behavioral

Answer 46

time-limited approach that emphasizes prevention by providing treatment to families that include a terminally-ill member and are at risk for complicated grief and other negative outcomes following death of that person. Focuses on improving family functioning by enhancing family cohesion, conflict resolution, and communication of thoughts and feelings

Answer 47

denial, anger, bargaining, depression and acceptance (DABDA) Research found that stages do not always occur in this order and stages may be repeated

Answer 48

defined in California's Welfare and Institutions Code (WIC) WIC Sections 5008(h)(1) and (3) define it "as a result of a mental disorder or chronic alcoholism, he/she "is unable to provide for his or her basic personal needs for food, clothing, or shelter" Sections 5008(h)(2) states a person who is mentally retarded cannot be determined to be gravely disabled by reason of being mentally retarded alone (includes epilepsy, other developmental disabilities, alcoholism, other drug abuse, or repeated antisocial bxs, by themselves constitute a mental disorder" Section 5585.25 - minor is gravely disabled when, as a result of a mental disorder, he/sh is unable to use the elements of life which are essential to health, safety, and development, including food, clothing, and shelter, even though provide to the minor by others.

Answer 49

Consider whether the person's inability to care for basic personal needs is due to mental disorder and if so, whether that inability threatens the person's survival. primary goal = to determine the extent to which a clt's mental disorder or chronic alcoholism interferes with ability to effectively deal with everyday functioning. Signs of GD is malnutrition/dehydration, inability to maintain a level of personal hygiene needed to prevent infection and illness, and/or be unable to formulate a reasonable plan for obtaining shelter. Info is primarily collected from clinical interview with clt, interviews with family members and others familiar with clt, and a review of clt's medical and legal records. determination of GD by assessment cannot include poverty or other factors that are not a mental disorder or chronic alcoholism. Mental disorder is what's in DSM 1) Mental Status Exam - systematic method for obtaining info on individual's appearance and behavior, communication processes, thought content and processes, cognition (memory, attention, general knowledge), emotional functioning, and orientation. Mini-MSE is a brief version of MSE assessing cognitive functioning 2) Global Assessment of Functioning (GAF) Scale - to record T's judgment of clt's overall level of psychological, social, and occupational functioning at time of evaluation (note: know 0-30 range) 3) MMPI-2/MMPI-A - generally elevated scales on MMPI may indicate functional impairment, especially elevations on 6 (Paranoia), 8 (schizophrenia), and 9 (Hypomania) 4) MCMI-III - generally elevated scores indicate a high level of functional impairment, especially on Severe Personality Pathology Scales (Schizotypal, Borderline, Paranoid) or Severe Syndrome scales (Thought Disorder, Major Depression, Delusional Disorder)

Answer 50

0 to 10 Persistent range of severely hurting self or others (i.e reorient violence) OR persistent inability to maintain minimal personal hygiene or serious suicidal act with clear expectation of death 11 to 20 Some danger of hurting self or others (i.e. suicide attempts without clear expectations of death, frequently violent; manic excitement) OR occasionally fails to maintain minimal personal hygiene (i.e. smears feces) OR gross impairment in communication (i.e largely incoherent or mute) 21 to 30 Behavior is considerably influenced by delusions or hallucinations or serious impairment in communication or judgment (i.e. sometimes incoherent, acts grossly inappropriately, suicidal preoccupation) OR inability to function in almost all areas (i.e. stays in bed all day, no job, home, or friends)

Answer 51

appropriate for GD and disability cannot be managed safely in a less restrictive environment. Voluntary hospitalization is considered first before involuntary hold. Involuntary commitment should be used only when disability is result of a mental disorder or chronic alcoholism and the individual has refused or is unable to comply with a recommendation to enter a psychiatric hospital voluntarily 1) Lanterman-Petris-Short Act (WIC Sections 5000) - regulations for involuntary commitment. Commitment beings with a 72 hour hold (5150) which may be followed by a 14 day hold (5250) and then additional post certification holds. 2) necessary to consider whether there are reliable people who can care for clt when determining GD person for involuntarily hospitalization Psychologist on staff at hospital that accepts involuntary holds may admit for involuntary confinement Psychologist NOT on staff can activate a hold by calling police, mobile crisis tea, or psychiatric emergency response team. Psychologist should also notify hospital that a clt will be arriving for intake and attempt to speak with admitting psychiatrist/psychologist to discuss admitting diagnosis. Psychologist can assist in determining what clinical action is needed too

Answer 52

involves collecting and evaluating information for purpose of determining a diagnosis, identifying an appropriate treatment plan, or evaluating the progress and outcomes of treatment. Info is obtained directly from clt, but because clts are not always able or willing to provide complete or accurate info, it may be necessary to obtain info from other sources (family, physicians, educational/employment records). Thorough assessment might require referral to other professionals for specialized evaluations i.e. pcp adopt a BIOPSYCHOSOCIAL ORIENTATION TO ASSESSMENT - chosing assessment techniques that provide info on biological, psychological, and social factors that are contributing to clt's probs and sxs

Answer 53

requires evidence that symptoms have been intentionally produced for the purpose of obtaining external incentives (ie. financial compensation, avoiding criminal prosecution, gaining access to drugs). Collecting collateral info helps to determine this

Answer 54

Standard 9.03 APA Code - must obtain informed consent for assessments, evaluations, or diagnostic services except when a) testing is mandated by law/governmental regulations, b)informed consent is implied because testing is conducted as a routine educational, institutional, or organizational activity; or c) one purpose of the testing is to evaluate clt's decisional capacity." Also requires to provide individuals who have "questionable capacity to consent" with info about the nature and purpose of the assessment in reasonably understandable language.

Answer 55

Legal EXCEPTIONS TO PRIVILEGE: when appointed by court to examine a defendant to help court make a decision about clt - i.e. competent to stand trial or ascertain defendant's state of mind at time of crime. MUST inform defendant before perming evaluation that his/her communications will not be confidential. Failure to do so leads to evaluation cannot be submitted to court. does NOT apply when court orders evaluation at request of defendant's lawyer in order to provide lawyer with info needed to advise defendant whether to enter or withdraw a plea based on insanity or to present a defense based on his/her emotional condition...since purpose of evaluation is to help lawyer to develop legal strategy Specialty Guidelines for Forensic Psychologists state that forensic psychologists must inform person being evaluated of limits of confidentiality prior to conducting the evaluation but must also "make every effort to maintain confidentiality with regard to any info that does not bear directly upon the legal purpose of the evaluations When eval is NOT court-ordered, person being evaluated is ordinarily the "client," meaning cannot reveal any info in court or other legal proceeding unless clt waives the privilege or court determines that an exception to privilege applies and orders the psychologist to do so. no privilege when psychologist is appointed by Board of Prison Terms to evaluate an inmate to determine need for mental health treatment. no privilege in proceeding brought by or on behalf of an individual to establish his/her competence

Answer 56

RE: release of test data: (according to ethics code) Test data defined as "raw and scaled scores, clt responses to test questions or stimuli, and psychologists' notes and recordings concerning clt statements and behavior during an examination." (According to ethics code) Pursuant to clt release, psychologists provide test data to clt or other persons ID-ed in release. Psychoogists may refrain from releasing test data to protect clt or others from substantial harm or misue/misprepresentation of the dat or the test. Law/HIPAA can take precedence over ethics code.HIPAA says, may deny clt's request for test data if I belief releasing data "is reasonably likely to endanger the life or physical safety" of clt or other person. Moreover, clt has right to request a review of the denial Guidelines for explaining assessments to clients and others: take reasonable steps to ensure that explanations of results are given to individual or designated representative unless nature of rx precludes provision of an explanation of results (i.e. organizational consulting, pre-employent or security screenings, and forensic evaluations), and this fact has been clearly explained to person being assessed in advance in Standards for Educational and Psychological Testing, interpretations of test results "should describe in simple language what the test covers, what scores mean, the precision of scores, common misinterpretations of test scores, and how scores will be used." Includes providing minors with info in language appropriate to their developmental level. In ethics code, "include in written and oral reports and consultations, only info germane to the purpose for which the communication is made, which is consistent with HIPAA's "minimum necessary" requirement (except in certain circumstances, must limit disclosure of PHI (Protected Health Info) to the minimum necessary to accomplish the disclosure's purpose.

Answer 57

HIPAA's Security Rule : related to creation, storage, and transmission of test data and other PHI in any electronic form; lists administrative, physical, and technical safeguards for protecting electronic PHI (ePHI) from unauthorized use. Safeguards categorized as "required implementation specifications" (A covered entity's policies and procedures for ePHI MUST be consistent with required specifications (ex., under technical safeguards, unique user ID is a required specification, which means a covered entity must assign a unique and sufficiently complex password to each employee, which the employee uses to access systems containing ePHI) OR "addressable implementation specifications" (allow a covered entity some leeway when a) it is determined that the specification is not reasonable or appropriate for the covered entity's environment and b) the covered entity documents why the specification is not reasonable or appropriate and implements an equivalent alternative measure as appropriate, i.e., encryption is an addressable specification). {Note: while encryption is included in Security Rule as addressable specification, Centers for Medicare and Medicaid Services recommended that encryption of ePHI be treated as mandatory. California's data breach notification law requires state agencies and private sector businesses that own or licence computerized data to notify any CA resident of unauthorized access to unencrypted personal info, which applies to electronic medical and health insurance info (this law covers only unencrypted personal info so most effective way to avoid liability is to encrypt all ePHI)

Answer 58

RE: USE OF ASSESSMENTS AND ASSESSMENT RESULTS should ordinarily base conclusions on in-person evaluation that provides data that adequately supports those conclusions. when in-person is not feasible, must limit nature of conclusions and as appropriate, inform relevant parties about limitations of evaluation results administer, adapt, score, interpret, or use assessment techniques, interviews, tests, or instruments in a manner and for purposes that are appropriate in light of the research on or evidence of the usefulness and proper application of the techniques use assessment instruments whose validity and reliability have been established for use with members of pupation tested. if no validity and reliability have been established, must describe strengths and limitations of test results and interpretation use assessment methods appropriate to an individual's language preference and competence, unless use of alternative language is relevant to assessment issues deviation from standard admin of attest may be acceptable when doing so is supported by research or other evidence. (ex, providing rest breaks or assistance with marking answer to person with physical disability as long as purpose of test is not to evaluate the nature or severity of examinee's disability) acceptability of modifying standardized test by TRANSLATING TEST ITEMS into another language addressed in Standards for Educational and Psychological Testing...methods used in establishing adequacy of the translation should be described, and empirical and logical evidence should be provided for score reliability and the validity of the translated test scores (i.e., reliability and validity of translated version for members of target population should be established before used with these individuals). Back translation (Two independent translators are involved in this preferred method. Translator one translates the original version into the target language then the second translator translates it back into the original language. The researcher can consult with the translators to determine discrepancies.) is not recommended as a stand-alone procedure. take into account purpose of assessment as well as various test factors, test-taking abilities, and other characteristics of the person being assessed, such as situational, personal, linguistic, and cultural differences that might affect our judgment or reduce accuracy of interpretations. If these exist, include in test report avoid basing assessment and intervention decisions based on obsolete tests or results of currently used tests when those results are outdated which can be due to amount of time passed or to changes in examinee's health or educational status since testing when using automated and other scoring and interpretation services, must select these services based on evidence of validity of info they provide and psychologists retain responsibility for appropriate application, interpretation and use of assessment instruments whether they score anne interpret such tests themselves or use automated or other services.

Answer 59

make reasonable efforts to maintain integrity and security of test materials and other assessment techniques consistent with law and contractual obligations and in a manner that permits adherence to this Ethics Code. Test material refers to manuals, instruments, protocols, and test questions or stimuli but does NOT apply to test data "Test Integrity" aka "psychometric integrity" and refers to test's reliability and validity "Test security" refers to limiting unauthorized access to test items and other test materials.i.e. showing clt test items before admin

Answer 60

Guidelines for Providers of Services to Ethnic, Linguistic, and Culturally Diverse Populations presents aspirational principles be aware of how own cultural background, attitudes, and value may impact their work with clts and make efforts to correct prejudices and biases. cognizant of limits of our training and experience and seek consultation and make referrals as needed consider impact of ethnicity and culture when working with members of various ethnic and cultural groups.consider how cultural values, attitudes, and beliefs of clts may impact diagnosis and intervention. be aware of research and practice issues relevant to populations they serve interact with clts in language requested by client or, if not feasible, make appropriate referral.If these options are not possible, can hire translator with cultural knowledge and appropriate professional background. if professional translator is unavailable, obtain services of a trained paraprofessional from clt's culture. To avoid limiting validity of assessment or effectiveness of intervention, translator must not have a dual role with clt document relevant sociopolitical and cultural factors in their records (i.e. number of years in country, fluency in English, level of stress related to acculturation, familiarity and comfort with the majority culture) ----- Suggestions for improving cultural sensitivity of assessments: 1) conduct a self-assessment of your own biases and prejudices and familiarity with clt's culture 2) determine clt's preferred language and, if ou do not speak that language, refer the clt to a clinician who does or, if a referral is not possible, obtain the services of an interpreter 3) Establish a good therapeutic relationship with the client prior to assessment 4) use a multi-method assessment approach that, when possible, includes culturally sensitive instruments (i.e. instruments that have low cultural loadings and low linguistic demands 5) when interpreting result of an assessment, consider impact that clt's culture may have had on those results. - ---- Should take into account a clt's stage of racial/ethnic identity development (person's sense of collective identity based on perception that he/she share common racial or ethnic heritage with a particular group) and level of acculturation when making assessment and intervention decisions. (most referred to are Atkinson, Morten, and Sue's (1998) Racial/Cultural Identity Development Model

Answer 61

1) Conformity 2) Dissonance and appreciating 3) Resistance and immersion 4) Introspection 5) Integrative awareness

Answer 62

influences psychological help-seeking behavior, compliance with treatments, and treatment outcomes...an important factor to consider when working with Native Americans and immigrants/refugees Berry Acculturation - degree to which a member of culturally diverse (minority) group accepts and adheres to the values, behaviors, customs, etc. of his/her own group and those of the dominant (majority) group.... four groups: assimilation, integration, separation, and marginalization

Answer 63

responses to interview and test questions/items can be impacted by many factors (i.e. current emotional or physical state, response to characteristics of clinician (gender, age, race, skill level), and willingness to talk about sensitive topics Malingering (aka "Faking bad")... concerned about not getting the help they would like. This is suspected when a) inconsistency between behavioral observation of clt and test results; b) results of tests or subtests produce inconsistent results; c) inconsistencies between data obtained directly from clt and info obtained from collateral sources; d) when scores on validity scales of some tests and scores on measure designed to deltic this type of responding (i.e. Structured Interview of Reported Symptoms. Defensiveness (aka "Faking good")...conscious effort to present better than actual. Motivations include seeking release from hospital, obtaining custody, making a favorable impression on therapist. Suspected when: a) provides minimal responsive answer to interview questions and guarded responses to test items that are inconsistent with a documented history of problems; b)overly interested in convincing psychologist of their numerous strengths, capabilities, and accomplishments and these assertions far exceed what is reasonably likely to be true. Can be datected by scores on validity scales and tests designed for this purpose

Answer 64

may operate consciously or unconsciously Preconceived Notions: perceptions and judgments may be influenced by beliefs about people based on demographic data, physical appearance as well as context in which assessment occurs Confirmation Bias: commonly form opinions about a clt early based on info from referral source, data gathered early in assessment, and their preconceived notions which could also affect what additional info they decide to collect and how they interpret that info

Answer 65

To improve validity of clinical judgments and decisions: 1 establish an optimal level of rapport and trust while patting attention to nonverbal bx 2 consider all sources of information and don't overlook inconsistent data. consider strengths/assets and pathology/dysfunction to get balanced view of clt while considering clt's circumstances and environment 3 supplement clt self-report data with info from other sources including family, friends, other professionals, medical evaluations, life records, and behavioral observations 4 be familiar with theories and research relevant to clt which includes empirically validated assessments and interventions and information on impact of racial, ethnic, and cultural factors on diagnosis and treatment 5 use base rate info to estimate utility of assessment procedures, especially for predicting rare phenomena.base rate refers to expected frequency of a characteristic, behavior, or diagnosis in a particular population. even when valid instrument may not improve ability to predict a bx when bx is rare 6 be aware of own expectations and biases and take steps to reduce impact on clinical decisions.

Answer 66

core of most assessments allowing to obtain info directly thru clt's answers to questions and indirectly by observation of non-verbals Types Intake Interview - ID nature of clt's problem; determine whether provider has resources/competencies to help clt; provide info about nature of available services, treatment options, and office policies; and obtain informed consent; opportunity to establish working relationship Case (Psychological) History Interview - purpose is to obtain additional info about clt's background to help formulate a diagnosis and determine how the clt's presenting problem fits into the wider context of their life (i.e. obtain info on developmental history, family-of-origin, education, employment, recreation/leisure, dating and marital hx, sexual hx, physical health, and alcohol and drug use Diagnostic Interview - goal is to obtain info needed to classify clt's symptoms according to DSM or other diagnostic system. Can be structured (explicit directions, standard questions asked in specific oder, and a system for rating clt's responses; ex = Structured Clinical interview for DSM-IV Axis I Disorders - SCID-I, Structured Interview for DSM-IV Axis II Personality Disorders - SCID-II, Diagnostic Interview for Children and Adolescents - DICA, and Diagnostic Interview Schedule for DSM-IV - DIS-IV), unstructured (use clinical judgment to decide what to ask, explore and investigate; formulate hypotheses about clt and sxs & tests these hypotheses by looking for info consistent with them)) and semi-structured (standardized questions designed to elicit specific info in a consistent way but include open-ended questions allowing to follow up on important issues raised by clt's responses; ex = Semistructured Clinical Interview for Children and Adolescents - SCICA; Personality Disorder Interveiew-IV (PDI-IV), and Schedule for Affective Disorders and Schizophrenia (SADS)), and Crisis Interview (goal is to identify nature of clt's crisis, provide immediate support to clt, and identify methods for resolving the crisis as quickly as possible.

Answer 67

Provides info on clt's current level of mental functioning and can be used in conjunction with other data to formulate appropriate psychiatric diagnoses and plans for further assessment and intervention (referral to specialist, admission to hospital, evaluation for med problems affecting psychological functioning includes evaluation of domains of functioning (appearance; activity and behavior; attitude toward examiner; mood and affect; speech and language; thought content; thought process; insight and judgment; and sensorium/cognition

Answer 68

shortened version of MSE for assessing cognitive functioning; useful initial screening device for cognitive impairment and to follow course of illness and monitor response to treatment. Often used as diagnostic tool for dementia but this is not what it was designed for nor suffice on its own Contains 11 questions assessing 6 aspects of cognitive functioning: 1) Orientation to time and place - ask for date, season, name of location; 2) Registration - measure of immediate verbal recall and is evaluated by determining how many trials it takes for person to accurately repeat three words named by examiner; 3) Attention and calculation - assessed by asking person to count backwards from 100 by a specific number of digits; 4) Recall - measure of delayed recall and involves asking person to recall the three words that were previously named by examiner; 5) Language - evaluated with questions including asking person to name familiar objects and to follow a simple three-stage command; 6) Visual Construction - ask person to copy a simple geometric figure. Max score is 30...23 or 24 is the cutoff with scores below indicating cognitive impairment....scores on MMSE are affected by premorbid intelligence, educational experience, and race/ethnicity

Answer 69

Helby and Haynes definition: scientific approach to psychological assessment that emphasizes use of minimally inferential measures, use of measures that have been validated in ways appropriate for assessment context, assessment of functional relations, and derivation of judgments based on measurement in multiple situations, from multiple methods and sources, and across multiple times they assist in deriving diagnoses, determine appropriate interventions for problematic bxs, and assessing progress and outcomes of interventions focus on directly measurable behaviors and view of behavior as situationally specific. usually focuses on overt behavior but may also focus on physiological phenomena (ie. muscle tension, heart rate, blood pressure), cognitions, and social interactions involves obtaining info on environmental events that elicit, maintain, or otherwise affect that bx. Environmental events preceding target bx (verbal instructions, presence of a person, participation in particular activity) are ANTECEDENTS. Events following behavior (desirable events that increase behavior such as praise and tokens) are CONSEQUENCES includes identifying antecedents and consequences which is referee to as a FUNCTIONAL BEHAVIORAL ASSESSMENT because antecedents and consequences help explain the function (purpose or cause) of bx. Results of FBAsessment provide info needed to develop functional behavior plan identifying an alternative bx that serves same function as target bx as well as antecedents and consequences that support the alternative behavior...often used in schools for students and mental health settings for behavioral probs FUNCTIONAL BEHAVIORAL ASSESSMENT is sometimes used interchangeably with FUNCTIONAL ANALYSIS/FUNCTIONAL BEHAVIORAL ANALYSIS but the latter was used to describe process of generating and testing hypotheses about antecedents and consequences of behavior incorporates variety of assessment methods (i.e. interviews (with indiv and peers/loved ones) followed by behavioral observations in natural or analogue [controlled settings providing some elements of natural settings; recordings done by narrative recording-verbal descriptions of bx, event recording - recording frequency, duration, or intensity of bx, interval recording-recording whether or not bx occurred during predefined time intervals, self monitoring-i.e. Beck's cognitive therapy's Daily Record of Dysfunctional Thoughts- record disturbing automatic thoughts, events that preceded the, and their emotional reactions] settings, behavior rating scales, self-report inventories, and measure of physiological events.

Answer 70

tests scores alone are not sufficient for making diagnostic and treatment decisions. must integrated with other sources suh as clinical interview, clinical impressions and observations, and info from collateral sources choice of psych test depends on purpose of testing, certain characteristics of clt (i.e demographics, reading ability, physical limitations), examiner's training and experience, and psychometric properties of test Tests should have appropriate norms and adequate levels of reliability and validity

Answer 71

norm-referenced tests compare examinee's performance to performance of a norm group. meaningful info about examine depends on extent to which examinee's characteristics match those people included in norm (standardization sample). To evaluate test norms, ask: a) is norm sample sample representative of population it is intended to represent - samples ar emore likely representative when sample size is large and was randomly selected from population;;; b) do characteristics of norm group include individuals of same age, race/ethnicity, and SES as examinee?;;; and c) how recent are test norms? Test norms (and content) should be periodically updated to ensure they are not outdated.

Answer 72

refers to consistency, and ability of a test to provide dependable, consistent scores is affected by the degree to which scores are susceptible to measurement error (i.e. to factors that are irrelevant to what is being measured by the test and that have an unpredictable effect on examinees' scores). usually reported in terms of a reliability (correlation) coefficient that ranges in value from 0 to 1.0 with larger values indicating higher levels of reliability. A coefficient of .90 or higher is preferred when test results are used to make important decisions about an examinee To evaluate reliability: 1) test-retest reliability - used to determine reliability of tests designed to measure attributes that are relatively stable over time and are not affected by repeated measurement (i.e. practice effects); appropriate for test of aptitude which is a stable characteristic but not for a test of mood since mood fluctuates over time 2) alternate forms - indicates consistency of responding to different item samples (i.e. different forms of a test) and, when forms are administered at different times, the consistency of responding over time; NOT appropriate when attribute measured is likely to fluctuate over time and the forms will be administered at different times or when scores are likely to be affected by repeated measurement 3) internal consistency reliability - used to evaluate reliability when a test is designed to measure a single characteristic, when the characteristic measured by the test fluctuates over time, or when scores are likely to be affected by repeated explosure to the test; Split-half reliability and coefficient alpha are two methods for evaluating internal consistency reliability 4) Inter-Rater (interscorer) reliability - of interest whenever scores depend on a rater's judgment (ie, behavioral observation scales and projective personality tests should have evidence of adequate inter-rater reliability test are never perfectly reliable so interpret with caution which can be done by constructing a confidence interval around that score, which indicates the range within the examinee's actual (true) score is likely to fall given obtained score. Confidence interval is calculated by using standard error of measurement (SEM), which is a type of standard deviation and is interpreted in terms of areas under the normal curve

Answer 73

refers to accuracy or degree that it accurately measures what it is intended to measure. 1) Content validity - important for tests designed to measure a specific content or behavior domain (i.e. achievement tests, work sample tests); established primarily through judgment of subject matter experts who determine if test items are an adequate and representative sample of the domain assessed by the test 2) Construct validity - critical for test designed to measure a hypothetical trait or construct (i.e. self-esteem, intelligence, neuroticism); established through systematic accumulation of evidence that test is actually measuring the construct it was designed to measure (i.e. through the use of multitrait-multimethod matrix or factor analysis) 3) Criterion-related Validity - important for tests that will be used to predict or estimate an examinee's status or performance on an external criterion (ie. when a measure of job knowledge will be used as a selection test to predict future job performance); 2 types of criterion-related validity (both assessed by correlating scores on the test (predictor) with scores on the criterion obtained by a sample of examinees: Concurrent validity (when test will be used to estimate current status on the criterion) and Predictive validity (when purpose of testing is to predict future performance on the criterion)

Answer 74

highly structured and present examinees with multiple-choice questions or other unambiguous stimuli MMPI-2: self-report measure assessing social and personal maladjustment and is used to assis in diagnosis of mental disorders and treatment planning 567 true/false items and provides scores on 10 clinical scales and 8 validity scales as well as numerous sub scales and supplementary scales including Harris-Lingoes sub scales (e.g., subjective depression, psychomotor retardation, familial discord), social introversion sub scales, and content scales (.e. anxiety depression, health concerns) Age range is for >18 years of age at least 5th grade (Lexile average) or 4.6th grade (Flesch-Kincaid) reading level; other sources cite 6th or 8th grade level MMPI-A is for 14-18 years of age Scoring and Interpretation: raw scores on each scale converted to T-scores that have a mean of 50 and standard deviation of 10. A T-Score of 65 or higher is considered clinically significant; Interpretation begins by determining validity of profile When LFK assume a V-shaped pattern, interpret with caution as it suggest an attempt to present oneself in a favorable light (to fake good) and has been found common for child custody litigants especially those exhibiting "parental alienation syndrome" Extremely elevated F scale score and a high value on the F-K index (F minus K is greater than +9) suggest symptom exaggeration (an attempt to "fake bad"_ and have been linked to malingering If profile is valid, focus on individual clinical scale scores and code-type(s) which consist of 2 or 3 most elevated scores. Three point code of 1-2-3 with scales 1 and 3 having substantially higher scores than Scale 2 is known as the "neurotic triad" or "conversion valley" and is associated with somatization of psychological problems Code of 6-7-8 (with scales 6 and 8 substantially higher scores than 7) is known as the "psychotic valley" and is associated with delusions, hallucinations, disordered thought, and a diagnosis of schizophrenia, especially the paranoid type

Answer 75

MMPI-2 Validity Scales - Validity Scales ? (Cannot Say/Omitted items) - High score = defensiveness, indecisiveness, reading difficulties L (Lie) - High Score = attempt to "fake good," defensiveness, denial; Low Score = frankness, exaggeration of negative characteristics F (infrequency) - High Score = exaggeration of probs, deliberate malingering; Low Score - absence of unusual behavior, social conformity K (correction) - High Score = attempt to "fake good," defensiveness, lack of insight; Low Score = attempt to "fake bad," excessive self-criticism Fb (Back-F) - High Score = deviant responding to items at the end of test Fp (Psychopathology Infrequency) - High score = endorses extremely bizarre content VRIN (Variable Response) - High score = inconsistent responding to similar items TRIN (True Response Inconsistency) - High score = gives "true" or "false" responses indiscriminantly

Answer 76

most recent version of MMPI; an alternative (but not a replacement) for MMPI-2 and designed to be consistent with current models of personality and psychopathology 338 items derived from MMPI-2 item pool and it utilizes the MMPI-2 standardization sample 9 restructured clinical (RC) scales (ie antisocial ehavior, dysfunctional negative emotions, hypomanic activation), 8 validity scales, and several additional scales. RC scales can be used to clarify scores on MMPI-2's clinical scales; ex, when someone gets elevated scores on Scales 6, 8 and 9 of MMPI-2, scores on Scales RC6, RC8, and RC9 of MMPI-2-RF can be used to determine if these elevations are due to psychotic symptoms or to demoralization and general distress appropriate for >18 years or older at least 5th grade (Lexile average) or 4.6th grade (Flesch-Kincaid) reading level

Answer 77

175-item true/false self-report test used to assist in diagnosing DSM Axis I and Axis II disorders. Scores on 14 personality disorder scales, 10 clinical syndrom scales (which represent the more prevalent Axis 1 disorders), and 4 correction scales that are used to detect distortions in examinee's responses appropriate for >18 years of age with at least 8th grade reading level Millon Adolescent Clinical Inventory (MACI) is available for ages 13-19 whose reading ability is at 6th grade or above

Answer 78

differ in terms of content, format, and interpretation but are all based on assumption that examinee's responses to ambiguous stimuli or tasks can elicit meaningful information about personality and underlying motivation and conflicts. Rorschach - 10 inkblot cards (5 achromatic, 5 with color) each containing a bilaterally symmetrical inkblot; primary use is to obtain info about personality structure to assist in diagnosis and treatment planning; administered in 2 phases; During free association phase, present 10 cards in a prescribed order, asks examinee to describe what he/she sees, and keeps a verbatim record of examinee's responses,,,,During subsequent inquiry phase, examiner actively questions the examinee about the features of the inkblot that determined his/her responses to facilitate scoring.; age range is >2 years of age; number of scoring and interpretation systems available; assesses for location, determinants (what in the inkblot determined response), form quality (how similar the perception is to the actual shape of inkblot), content (category the perception falls into- human, animal, or nature), and frequency of occurrence (extent to which perception is original or popular); interpretation inovles considering number and type of resonse in each category - color responses suggests emotionality and impulsivity; use of white spaces suggests oppositional tendencies; and confabulation (overanalyzing a part of the inkblot to the whole) may indicate brain damage, emotional disturbance, or mental retardation Thematic Apperception Test (TAT) - based on Murray's theory of needs; 19 cards containing vague black and white pictures that include one or more human figures and one blank card; make up a store about each picture including info about what is happening in picture, what led to that situation, how the people feel, ad how the story ends; several scoring systems (Murray's system involved ID-ing story's hero and evaluating the intensity, frequency, and duration of needs, environmental press, them, and outcomes expressed in each story; little utility for assigning specific diagnoses but may be useful for gross diagnostic distinctions such as distinguishing between Schizophrenia and neurosis Projective Drawing Tests - House Tree Person, Draw a Person and Kinetic Family Drawings; assumes that in drawing peering persons or object, examinee projects an inner view of self, environment, and things he/she regards as important; used to assess personality and asset in diagnosis of psychopathology but validity for these purposes is questionable.

Answer 79

assesses scholastic aptitude, educational, and occupational counseling, and diagnosing Mental Retardation, Learning Disorders, and other disorders. Most intelligence test yield one or more IQ scores which are deviation scores that indicate an examinee's performance in relation to the performance of people in the norm (standardization) sample

Answer 80

based on view that intelligence is a global ability comprised of numerous interrelated functions that allow the individual "to act purposefully, to think rationally, and to deal effectively with his (or her) environment. Major difference between WAIS-IV and WAIS-III is that Verbal IQ and Performance IQ are no longer reported. Instead, WAIS-IV provides a Full-Scale IQ (FSIQ), four Index Scores, and scores on 10 core and five supplemental subtests. Working Memory Index (WMI): simultaneous and sequential processing, attention, concentration, learning ability (Core vs supplemental subtests: Digit Span and Arithmetic vs Letter-Number Sequencing) Processing Speed Index (PSI): speed of processing, cognitive flexibility, learning ability, short-term visual memory (Core vs supplemental subtests: Symbol Search and Coding vs Cancellation) Perceptual Reasoning Index (PRI): nonverbal reasoning, visual problem-solving (Core vs supplemental subtests: Block Dsign, Matrix Reasoning, Visual Puzzles vs Figure Weights and Picture Completion Verbal Comprehension Index (VCI): verbal reasoning, learning ability, practical and social judgment, general knowledge (Core vs supplemental subtests: Vocabulary, Similarities, and Information vs Comprehension) Appropriate for aged 16 years through 90 years, 11 months; Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) for 6 - 16 years, 11 months, while the Wechsler Preschool and Primary Scale of Intelligence-Third Edition (WPPSI-III) is for 2 years, 6 months through 6 years, 3 months Scoring and Interpretation: raw scores converted to standard scores using a conversion tables...FSIQ and Index Standard Scores have a mean of 100 and standard deviation of 15, and the subtest scores have a mean of 10 and standard deviation of 3; Interpretation involves multi-level approach that entails first considering FSIQ followed by consideration of index scores and subtest scores. WAIS-IV Technical Manual says if there is a 1.5 standard deviation or more discrepancy between any 2 index scores, the FSIQ should be interpreted with caution and, if there is 1.5 standard deviation or more discrepancy between any two subtests that contribute to an index score, the index score must be interpreted with caution Subtest scores are used to ID relative strengths and weaknesses General Ability Index (GAI) can be derived from VCI and PRI scores and useful when examiner wants a summary score that minimizes the impact of working memory and processing speed to increase clinical utility of WAIS-IV, Technical Manual provides score patterns characteristic of several clinical groups such as Borderline Intellectual functioning, Mild Cognitive Impairment, Alzheimer's dementia, depression, and ADHS

Answer 81

a measure of general cognitive ability and to assist in psychoeducational evaluation, the diagnosis of developmental disabilities and exceptionalities, and forensic, career, neuropsychological, and early childhood assessment; development of SB5 was based on a hierarchical g (general mental ability) model that incorporates 5 cognitive factors that are each measured by subtests and activities that represent verbal and nonverbal domains. Age range is 2 to 85+ Fluid Reasoning (FR) ability to solve novel problems; (Nonverbal domain subtests/activities vs Verbal: Object Series-Matrices vs Early Reasoning, verbal Absurdities, Verbal Analogies) Knowledge (KN): general information, vocabulary, language use; (Nonverbal domain subtests/activities vs Verbal: Procedural Knowledge, Picture Absurdities vs. Vocabulary) Quantitative Reasoning (QR): logical reasoning, mathematical knowledge and conceptualization; (Nonverbal domain subtests/activities vs Verbal: Quantitative Reasoning vs Quantitative Reasoning) Visual-Spatial Processing (VS): visualization, spatial reasoning, understanding of verbal spatial concepts; (Nonverbal domain subtests/activities vs Verbal: Form Board, Form Patterns vs Position and Direction) Working Memory (WM): storing and manipulating information in short-term memory; (Nonverbal domain subtests/activities vs Verbal: Delayed Response, Block Span vs Memory for Sentences, Last Word) Scoring and Interpretation: Subtest scores (M = 10, SD = 3) are combined to obtain the following composite scores (M = 100, SD = 15): five factor index scores, two domain scores (verbal and nonverbal), Abbreviated Battery IQ, and Full Scale IQ. Change Sensitive Scores (CSS) may be calculated as these scores allow criterion-referenced interpretation of an examinee's performance interns of developmental level (age) and complexity of the tasks and are useful for evaluating individuals in extreme levels of ability and for tracking changes in performance over time (i.e., changes that occur following TBI)

Answer 82

reduced cultural content and make use of nonverbal format to overcome cultural loading associated with language; these tests must be used with caution as they may be as culturally loaded as traditional tests and less valid on predictors of academic achievement and job performance Leiter International Performance Scale - Revised (Leiter-R): measure of cognitive abilities for aged 2-21 years; can be administered without verbal instructions and useful for individuals with language problems or hearing impairment...match a set of response cards to corresponding illustrations on an easel; test items emphasize fluid intelligence and evaluation 4 domains of cognitive functioning - visualization, reasoning, memory, and attention Raven's Progressive Matrices: nonverbal measure of general intelligence (g) and is considered a culture-fair test because it is relatively independent of the effects of special education and cultural learning...solve problems involving abstract figures and designs by inciting which of several alternatives compete a given matrix; most commonly used vernon is Standard Progressive Matrices which is appropriate for aged 6-80; Colored Progressive Matrices (CPM) is an easier and shorter version for individuals 5-11 years and older adults; Advanced Progressive Matrices is for individuals 11 years and older who are of above average intelligence (instructions for this test are simple and can be pantomimed thus ok to use with hearing-imparied and non-English speaking individuals and individuals with aphasia or a physical disability Columbia Mental Maturity Scale (CMMS): test of general reasoning ability for children aged 3-10. 92 cards each containing 3, 4, or 5 drawings and for each card, indicate the drawing that does not belong with others. Does not require verbal responses or fine motor skills. originally developed for children with cerebral palsy, it's useful for children with brain damage, mental retardation, speech impairments, hearing loss, or limited English proficient.

Answer 83

used to screen for brain dysfunction and diagnose neurological disorders...evaluate mental processes ranging from simple motor performance to reasoning, problem-solving, and other complex cognitive abilities. Halstead-Reitan Neuropsychological Battery: tests used in this battery were one to accurately differentiate between "normals" and individuals with brain damage; can select types and number of tests to use but administration includes a standard set of subtests designed to assess sensorimotor, perpetual, and language functioning; yields an average Impairment Index ranging from 0.0 to 1.0 which higher scores indicating more severe impairment. Original battery is for adults but downward extension is available for children 5-14 years. Luria-Nebraska Neuropsychological Battery: consists of 11 subtests that each assess a different skill that is likely to be affected by brain damage. Each item is scored as 0 (normal performance),, 1 (borderline performance), or 2 (clearly abnormal performance,) and the battery provides scores on 14 scales (i.e. motor, tactile, visual, reading, arithmetic, memory); high score on three or more scale suggests neuropsych impairment; forms are available for adults and adolescents and one for children. Bender Visual-Motor Gestalt Test - Second Edition (Bender-Gestalt-II): brief measure of visual-motor integration for aged 3 years and older; 16 stimulus cards containing geometric figures and requires the examinee to first copy the figures and then draw them from memory; valid screening device for neuropsychological impairment and is useful for tracking developmental changes in visual-motor skills but does not appear to be accurate for making psychiatric diagnoses; used as a screening test for organic brain dysfunction Wechsler Memory Scale-Fourth Edition (WMS-IV) - comprehensive measure of memory providing scores on 5 Primary Indexes: auditory memory, visual memory, immediate memory, delayed memory, and visual working memory; co-normed with WAIS-IV so permits comparison on examinee's intellect and memory

Answer 84

assist in the detection and diagnosis of a wide range of problems including fears and anxiety, depression, eating disorders, attention deficit disorders, substance abuse, mental retardation, social skills, and marital relationships...useful for treatment planning, monitoring, and outcome assessment. Beck Depression Inventory-II (BDI-II): 21 item self-report measure of depression for ppl aged 13 years and older with at least an 8th grade reading level; assess severity of complaints symptoms, and concerns related to current level of depression and target specific sxs of depression (incl severe depression and depression necessitating hospitalization); item scores range from 0-3 and are summed up for a total score ranging from 0-63; cutoff scores are: minimal depression 0-13, mild depression 14-19, moderate depression 20-28, and severe depression 29-63.... Beck Hopelessness Scale and Beck Scale for Suicidal Ideation are used to assess suicide risk and similar to BDI-II Symptom Checklist-90-Revised (SCL-90-R): useful for evaluating type and severity of symptoms and tracking treatment outcomes for pp aged 13 through adult; 90 items that provide scores on 9 symptom dimensions (somaticization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism) and on 3 global indices (Global Severity Index, Positive Symptom Distress Index, and Positive Symptom Total)...Brief Symptom Inventory (BSI) is shortened version of SCL-90-R and consists of 53 items Child Behavior Checklist for Ages 6-18 Behavior Assessment System for Children, Second Edition (BASC-2) Vineland Adaptive Behavior Scales, Second Edition (Vineland-II) Activities of Daily Living (ADLS)

Answer 85

21 item self-report measure of depression for ppl aged 13 years and older with at least an 8th grade reading level; assess severity of complaints symptoms, and concerns related to current level of depression and target specific sxs of depression (incl severe depression and depression necessitating hospitalization); item scores range from 0-3 and are summed up for a total score ranging from 0-63; cutoff scores are: minimal depression 0-13, mild depression 14-19, moderate depression 20-28, and severe depression 29-63.... Beck Hopelessness Scale and Beck Scale for Suicidal Ideation are used to assess suicide risk and similar to BDI-II

Answer 86

useful for evaluating type and severity of symptoms and tracking treatment outcomes for pp aged 13 through adult; 90 items that provide scores on 9 symptom dimensions (somaticization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism) and on 3 global indices (Global Severity Index, Positive Symptom Distress Index, and Positive Symptom Total)...Brief Symptom Inventory (BSI) is shortened version of SCL-90-R and consists of 53 items

Answer 87

obtains info about behavioral and emotional problems and competencies of a child or adolescent from parent or guardian. 118 items describing specific areas of behavioral or emotional functioning (child's activities, chores, friends, and grades) plus 2 open-ended items for describing other concerns. Separate Scores are provided for externalizing symptoms (Delinquent behavior, aggressive behavior) and internalizing symptoms (anxious/depressed, social problems, attention problems) Teacher's Report Form for Ages 6-18, Youth Self-Report for Ages 11-18, Adult Self-Report, and Semistructured Clinical Interview for Children and Adolescents. These are all part of Achenbach System of Empirically based Assessment (ASEBA)

Answer 88

uses multidimensional approach to assess the emotions and behaviors of individuals 2 years to 21 years, 11 months...includes Teacher Rating Scales, Parent Rating Scales, Self-Report of Personality, Student Observation System, Parenting Relationship Questionnaire, and Structured Developmental History;;; useful for identifying behavior problems under Individuals with Disabilities and Education Act and for assisting in the determination of an appropriate DSM diagnosis.

Answer 89

measure of adaptive functioning, and deficits in adaptive functioning are one of the diagnostic criteria for Mental Retardation; consists of a Survey Interview Form and Parent/Caregiver and Teacher Rating Forms and is used to evaluate the personal and social skills of individuals from birth to age 90; useful for assisting in diagnosis of several disorders including Mental Retardation, Autism Spectrum Disorders, ADHD, Dementia, and brain injury and for developing educational and treatment plans;;; provides an Adaptive Behavior Composite score, 4 domain scores (Communication, Daily Living Skills, Socialization, and Motor Skills), and an optional Maladaptive Behavior Index Score.

Answer 90

routine activities and tasks of everyday life that are necessary for personal self-care and independent living Basic ADLS (BADLS): related to personal care and mobility (eating, dressing, toileting, ambulation) Instrumental ADLS (IADLS): necessary for independent living (shopping, meal preparation, financial management, and treatment compliance) assessment of ADLs is an essential component of the evaluation of a person's legal competence and is also useful for ID-ing appropriate interventions for individuals with Dementia and other disorders and monitoring and evaluating intervention outcomes. Measures of ADL include Nottingham Extended Activities of Daily Living Scale, Laughton Instrumental Activities of Daily Living Scale, and Functional Independence Measure.

Answer 91

See EPPP (Flash) Cards Categorical classification system...polythetic criteria set Multixial assessment system Uncertainty = deferred, provisional, unspecified, NOS Unspecified mental disorder (nonpsychotic) is coded when there is sufficient info to rule out a psychotic disorder but insufficient info to further specify disorder

Answer 92

Mental Retardation, Learning DIsorders, Autistic Disorder, ADHD, Conduct Disorde,r Oppositional Defiant Disorder, Tourette's Disorder, Stuttering, Feeding and Eating Disorders of Infancy and Early Childhood, Separation Anxiety Disorder, and Reactive Attachment Disorder

Answer 93

when a person's achievement on a standardized achievement test is "substantially below" (which is 2 or more standard deviations between achievement and IQ test scores) that expected for their age, schooling, and level of intelligence, AND cannot be fully explained by a sensory deficit Associated features: usually an IQ in average to above-average range but higher than normal rates of other problems and behaviors, incl delays in language development and/or motor coordination, attention and memory deficits, low self-esteem, and poor social skills Most common comorbid disorder is ADHD; others incl Conduct DO, Oppositional Defiant DO, Major Depressive DO, and Dysthymic DO Differential Diagnosis: must be distinguished from academic difficulties caused by a lack of opportunity, substandard teaching, and//or cultural factors (english is not primary language). If there's a visual, auditory, or other sensory deficit, learning probs must exceed those normally associated with that deficit

Answer 94

at least 6 characteristic symptoms with a minimum of 2 symptoms from 1st category and one each from 2nd and 3rd categories with evidence of some symptoms prior to age 3: 1) qualitative impairment in social interaction (impairment in nonverbal bx; absence of developmentally appropriate peer relationships; lack of social/emotional reciprocity) 2) qualitative impairment in communication 3) restricted, repetitive and stereotyped behavior, interests, and activities Associated features: abnormal responses to sensory stimuli; hyperactivity; short attention span, aggression, impulsivity, self-injurious behavior, and abnormalities in eating, sleeping, mood, and affect...up to 70% have IQ scores in mentally retarded range.

Answer 95

assumed to be the direct physiological consequence of a general medical condition (i.e. Delirium, Dementia, and Amnestic Disorder in addition to Psychotic Disorder, Mood DO, Anxiety DO, Sexual Dysfunction, Sleep DO, Catatonic DO, and Personality Change due to a General medical Condition Must be evidence from the history, physical exam, or laboratory results that the symptoms are the result of a general medical condition; Symptoms must not be better explained by another mental disorder; AND Except for Delirium, symptoms must not occur exclusively during an episode of delirium associated with various medical conditions such as head trauma, seizures, cerebrovascular disease, degenerative neurological disorders (Hungtington and Parkinson's disease), infections, endocrine disorders, and metabolic conditions

Answer 96

See page 40 of Clinical Assessment and Evaluation, Diagnosis page. Frontal Lobe Parietal Lobe Temporal Lobe Occiptal Lobe

Answer 97

alcohol; amphetamines; caffeeine; cannabis; cocaine; hallucinogens; inhalants; nicotine; opioids, phencyclidine (PCP); and sedatives, hypnotics, and anxiolytics use of substances except caffeine can result in Substance Dependence, while Persisting Perception Disorder is associated only with hallucinogen use.

Answer 98

see EPPP flashcards at least 3 symptoms any time during same 12 month period: a) tolerance; b) withdrawal; c)substance frequently taken in larger amounts or over longer periods of time than intended; d)persistent desire or unsuccessful attempts to control or cut down substance use; e)great deal of time spent in activities related to obtaining the substance, using the substance, or recovering from its effects; f)important social, occupational or recreational activities reduced or stopped because of substance use; and/or g) continued use of substance despite persistent or recurrent psychological or physical problems caused by exacerbated by its use 4 specifiers: early full remission = when not has met any criteria for at least 1 month but less than 12 months; early partial remission = when individual has not met the full criteria for at least one month but less than 12 months; sustained full remission = when individual has not met any criteria for 12 months or longer; and sustained partial remission - when individual has not met full criteria for 12 months or longer

Answer 99

maladaptive pattern of substance use that involves clinically significant impairment or distress as manifested by the presence of at least one of the following symptoms during a 12 month period: a) recurrent substance use resulting in a failure to fulfill major role obligations at home, school, or work; b)repeated use of substance in situations in which use is known to be physically hazardous; and c) recurrent substance-related legal problems; and/or d) continued use despite having persistent or recurrent social or interpersonal problems that are caused or exacerbated by the substance

Answer 100

reversible, substance-specifid developing soon after ingesting and combo of pal adaptive behavioral or psychological changes and signs of substance effect on nervous system. Associated with all drug classes except nicotine. Alcohol intox: inappropriate sexual or aggressive bxs, impaired judgment, emotional lability, slurred speech, incoordination, unsteady gait, nystagmus, impaired attention or memory (especially angerograde amnesia or "blackouts"), and stupor or coma Amphetamine and Cocaine Intox: euphoria, anxiety, hyperactivity, grandiosity, confusion, anger, paranoid ideation, auditory hallucinations, tachycardia, elevated or lowered blood pressure, dilated puils, perspiration or chills, nausea or vomitting, weight loss, psychomotor agitation, muscular weakness, confusion, and seizures.

Answer 101

almost always have substance dependence and experience a craving for substance; Alcohol Withdrawal: autonomic hyperactivity, nausea or vomitting, insomnia, anxiety, psychomotor agitation, hand tremor, transient illusions or hallucinations, and grand mal seizures Amphetamine and Cocaine Intox: dysphoric mood, fatigue, vivid and unpleasant dreams, insomnia or hypersomnia, increased appetite, and psychomotor agitation or retardation

Answer 102

Intoxication Delirium, Withdrawal Delirium, Dementia, Amnestic Disorder, Psychotic Disorder, Mood Disorder, Anxiety Disorder, Sexual Dysfunction, and Sleep Disorder Alcohol Withdrawal Delirium (delirium tremens) = disturbances in consciousness, other cognitive deficits, autnomic hyperactivity, agitation, vivid hallucinations, and delusions Alcohol-Induced Persisting Amnestic Disorder (Wernicke-Korsakoff syndrom) = retrograde amnesia, anterograde amnesia, and confabulation; often result of chronic alcoholism, and may be due to thiamine deficiency Anabolic Steroid-Induced Mood Disorder = mood swings, irritability, increased aggressiveness ("roid rage"), insomnia, and increased libido.

Answer 103

1 mental disorder is probably not substance-induced if sxs precede onset of substance use or persist after an extended period of abstinence (except in case of a Substance-Induced Persisting Disorder) 2 if individual has a history of substance use and displays features that are atypical of the primary mental disorder under consideration, a Substance-Induced Disorder is more likely 3 a primary mental disorder may be the appropriate diagnosis when symptoms are inconsistent with the type or dose of the drug used

Answer 104

continuous disturbance of 6 months or more that includes at least 1 month of two or more active-phase symptoms - i.e. delusions (common persecutory or referential), hallucinations (often auditory), disorganized speech (i.e., incoherence, loose associations), grossly disorganized or catatonic behavior (i.e. silliness, unpredictable agitation, disheveled appearance), and/or negative symptoms (flat affect, a logia, avolition) requires evidence of impairment in one or more major areas of functioning, such as school, work, interpersonal relations or self-care 5 subtypes: paranoid, disorganized, catatonic, undifferentiated, and residual (see flashcards) Associated features: inappropriate affect (laughing for no reason); anhedonia (loss of interest or pleasure); dysphoric mood; somatic complaints; and an increased risk for suicide...most have poor insight into their illness (anosognosia) which contributes to treatment noncompliance. Comorbid disorders: substance dependence (with rate of Nicotine Dependence being particularly high) and Anxiety DOs, especially Panic DO and OCD....Schizotypal, Schizoid, or Paranoid Personality DO may precede onset of Schizophrenia Differential Diagnosis: distinguished from other Pscyhotic DO including Delusional DO. Delusional disorder delusions are non bizarre, and if functioning is impaired, impairment is directly related to delusions. Schizophrenia must be distinguished from Mood DOs with psychotic features (in which psychotic symptoms occur only during episodes of a mood disturbance) and from Substance-Induced DOs that produce psychotic symptoms Prevalence: among adults, lifetime prevalence is 0.5-1.5%. Prevalence is slightly higher for males than females, modal age of onset is between 18-25 for males and 25-35 for females Review/see schizophreniform, schizoaffective, brief psychotic disorder, and delusional disorder

Answer 105

see flash cards... Associated features: increased risk for suicide, anxiety and irritability, excessive concerns about physical health, difficulties with social relationships and sexual functioning, and impairments in directed attention and short-term (working) memory Differential Diagnosis between dysthymic, adjustment disorder with depressed mood (response to an identifiable stressor), bereavement (response to loss of loved one and are not clearly excessive or more severe than those associated with a normal grief reaction),,, dementia can resemble depression, especially in older adults-in contrast to Major Depressive Disorder, onset of cognitive symptoms in Dementia is usually insidious and the person often denies cognitive impairments or seems unaware of or unconcerned about them Prevalence: lifetime risk for MDD is 10-25% for women and 5 to 12% for men. Prior to puberty, rates of MDD are about equal for males and females; but, beginning in adolescence, rate for females is about twice the rate for males. Culture/Age: in some cultures, depression is manifested as somatic symptoms....latinos complains of "nerves" and headaches are common, while Asians often experience depression as weakness, tiredness, or an "imbalance."... Somatic complains, irritability, and social withdrawal are common in children; while aggressiveness and destructiveness sometimes occur in preadolescents (especially boys). In older adults, memory loss, distractibility, disorientation, and other cognitive symptoms may be present, making it difficult to distinguish depression from Dementia.

Answer 106

Differential: Bipolar I must be distinguished from Bipolar II and Cyclothymic DO (presence of fluctuating hypomanic symptoms and numerous periods of depressive symptoms that are not sufficiently severe to meet the criteria for a manic or a major depressive episode; duration is at least 2 years in adults or one year in children and adolescents; must not be free from hypomanic or depressive episodes for more than 2 months at a time)

Answer 107

progressive type of Dementia due to Head Trauma that may occur as a result of repeated head injury i.e. boxing;;;;not a DSM Diagnosis

Answer 108

caused by cerebrovascular disease and is charactered by a stepwise deterioration in functioning and a fluctuating course.

Answer 109

"involves setting goals and tasks of treatment that into consideration the unique patient, the nature of the patient's problems and concerns, the likely prognosis and expected benefits of treatment, and available resources Generally, includes: developing a case formulation; identifying treatment goals and objectives; selecting appropriate intervention strategies; and identifying methods for monitoring treatment progress

Answer 110

for clots with less complex and severe problems; can be conceptualized as a single phase during which a relatively circumscribed set of problems are addressed. for clots with more complex and severe problems, usually better to view treatment as a series of phases in which a limited number of probs are addressed during each phase

Answer 111

set of hypotheses about the causes, precipitants, and maintaining influences of a person's psychological, interpersonal, and behavioral problems. derived from a thorough clinical assessment and guides the clinician's decision-making throughout the treatment process not only serves as the basis for the treatment plan but also provides the clinician with the info needed to understand and manage treatment noncompliance and difficulties in the therapist-client relationship and determine when treatment termination is appropriate.

Answer 112

affected by clinician's theoretical orientation and other factors usually contains: Identifying info (name, age, gender, ethnicity, marital status, etc.); problem list; psychiatric diagnosis; precipitating and predisposing factors; working hypothesis; strengths; and treatment expectations

Answer 113

requires considering issues related to clt's cultural background DSM-IV-TR's Outline for Cultural Formulation provides a framework for incorporating cultural issues into the assessment and case conceptualization processes; involves a) clt's cultural identity, b) cultural explanations for the clt's illness; c) cultural factors related to the clt's psychosocial environment and level of functioning; d) cultural elements in the therapist-client relationship; and e) overall cultural assessment for diagnosis and care

Answer 114

goals and objectives of treatment are derived from case formulation and represent the desired outcomes of psychotherapy Goals = broad, comprehensive, and long-term; reducing core symptoms and achieving a satisfactory level of functioning are often the major goals of treatment Objectives = specific, short-term, and measurable and specify the specific changes in behavior, affect, or cognition that are needed to achieve a treatment goal (i.e., experiences a decrease in hallucinations; consistently takes medication" Ideally, treatment objectives are accompanied by a timeline that predicts when each objective will be accomplished or achieved.

Answer 115

based on consideration of clt's characteristics and circumstances, treatment options, and other treatment-related factors Clt characteristics = who the "client" is (individual, couple, or family); the clt's psychiatric and medical history; characteristics relevant to treatment (e.g., psychological mindedness, expectations, motivation); environmental circumstances (e.g., social support, financial resources); and issues related to diversity (clt's race/ethnicity, culture, language, gender, sexual orientation, religion, and age). Treatment Factors = clinician's theoretical orientation (provides a systematic framework for treatment planning and implementation) and experience; appropriate level of care, treatment mode and format; and the criteria that will be used to validate the treatment plan, monitor treatment progress, and determine when termination of treatment is appropriate. Empirically Supported Treatments (ESTs) = aka empirically validated and evidence-based treatments; "specific psychological treatments that have been shown to be efficacious is controlled lineal trials" Level of Care and Mode of Treatment = an initial consideration when choosing a treatment approach is the appropriate level of care (inpatient, partial hospitalization/day treatment, intensive outpatient, or outpatient);;; Primary considerations when choosing level of care are the severity of symptoms and the risk for harm to self or others;;; Modes of treatment = psychotherapeutic, psychopharmacological, medical, education, and/or other (i.e. self-help and support groups). For many cls, multimodal approach will be most effective. Format of Treatment = a consideration is if treatment should be delivered via individual therapy, group therapy, and/or marital/family therapy by considering 1) nature of clt's problems and symptoms, 2) way the clt's problems are manifested (i.e. limited to the family context or demonstrated in multiple contexts); 3) clinician's theoretical orientation, 4) goals and objectives of treatment, 5) clt's preferences, 6) efficiency and effectiveness of the treatment format for clt's symptoms/disorder Treatment Monitoring = treatment plan should identify methods that'll be used to monitor treatment progress such as clt self-reports, therapist observations, and structured symptom checklists (such as the SCL-90) that are administered at the onset of therapy to obtain baseline data, regularly during the course of treatment to assess progress and make adjustments in the treatment plan as needed, and at end of treatment to evaluate outcomes. Treatment Termination = treatment plan should also include the criteria that'll be used to determine when treatment termination is appropriate which should be stated in concrete, measurable terms - e.g., has complied with medication regimen for one month; has not experienced hallucination or delusions for 3 weeks; has had a BDI-III score of <13 for 4 weeks

Answer 116

begins once initial treatment plan has been constructed; includes monitoring the effectiveness of treatment, working with other professionals, and preparing for termination

Answer 117

assessing effects of treatment at regular intervals provide data needed to a) validate the initial case conceptualization; b) inform the clinician, client, and relevant third parties about the clt's progress; c) help the clinician determine if the treatment plan should be modified; and d) help the clinician and clt determine when it is appropriate to terminate therapy

Answer 118

Assessment: complex bc coexisting mental and physical problems, symptoms may be atypical, and causes of probs often a combo of physical, psychological, and social factors; requires a interdisciplinary biopsychosocial approach (physical/medical circumstances, medication history, instrumental and basic functioning, mood/affect, support systems, coping skills, cognitive functioning, substance use, marital and family functioning, economic well-being, spiritual/religious beliefs and practices, and experiences with discrimination Elder abuse signs: physical and emotional signs in addition to caregiver's behavior towards elders Decisional capacity: concern when signs of dementia, depression, or psychosis. (Baker, Lichtenberg, and Moye's model for assessing decisional capacity of older adult for purpose of determining legal competency = 1) referral clarification, 2) assessment planning, 3) assessment (incl clinical interview, performance-based measures of cognition and functional or decisional capacity, and measure of mental health), 4) synthesis of data and communication of results, and 5) follow-up evaluation. Depression: factors increasing risk for depression: social isolation, recent loss of loved one, recent major illness or chronic disabling illness, persistent sleep problems, diagnosis of Dementia or Parkinson's disease, and recent placement in long-term care. Incl assess for risk for suicide; distinguish between depression and dementia Suicide Risk: (factors associated with risk is suicidal behavior and ideation, mental illness (especially depression) substance use, certain physical disorders (i.e. seizure disorder, neurological disorder, cancer, moderate to sever pain), negative life events (i.e. isolation, financial loss, housing changes), lack of social support, and functional impairment. (Scale for Suicide Ideation and the Geriatric Hopelessness Scale) Treatment: Sue and Sue: a) determine clt's views of problems and consider impact of educational background, race/ethnicity, and other characteristics; b) presume an older adult is competent unless there's evidence otherwise; c) identify medical conditions and medications that may impact clt's mental state; d) if necessary, slow pace of therapy to accommodate age-related changes in cognition; e) be aware that it may take more time than usual to establish a therapeutic alliance; f) provide info in an understandable form (i.e. form that matches clt's reading or comprehension level); g) involve clt in decision-making as much as possible; h) involve family members and caregivers when appropriate; and i) discuss positive aspects of clt's life to help develop sense of satisfaction and fulfillment Interventions: tailor to specific needs and circumstances; specific for older adults (Reminiscence Therapy uses old photos, mementoes, music, and other cues to help clt recall past in order to stimulate memory, reduce depression, and help clt integrate life experiences; while validation therapy is used to reduce clt's distress and improve communication between clt and others by validating clt's beliefs and feelings, whether or not they are based in reality

Answer 119

Assessment: necessary to determine degree to which clt's culture and language might impact assessment and treatment planning, identify assessment tools that are appropriate for clt, and consider impact of culture and language when administering a test or other assessment technique and interpreting its results. (Grieger - Cultural Assessment Interview Protocol - CAIP - approach/method of data collection including clt's problem conceptualization and attitudes toward helping, cultural identity, acculturation, family structure and expectations, racial-cultural identity development, experiences with bias, immigration issues, existential/spiritual issues, and perceptions of T's characteristics and bx. Additional info on acculturation, racial/cultural attitudes, racial/ethnic identity, and other relevant issues may be obtained using self-report questionnaires (i.e. Abbreviated Multidimensional Acculturation Scale, General Ethnic Discrimination Questionnaire, Multigroup Ethnic Identity Measure

Answer 120

become familiar with historical events that have affected lives and relationships with White Americans. Due to history, may prefer a therapist who helps them reaffirm values of own culture and may be distrustful of T's attempts to provide therapy in a "value-free" environment Focus on building trust and credibility during initial sessions by demonstrating familiarity with and respect for clt's culture and admitting any lack of knowledge; adopting a collaborate, problem-solving, client-centered approach avoiding highly directive or confrontational techniques; and incorporating elders, medicine people, and other traditional healers into treatment process. AI are likely to exhibit a spiritual and holistic orientation to life emphasizing harmony with nature and regards illness as result of disharmony; place greater emphasis on extended family and tribe than on individual and adhere to a consensual collateral form of social organization and decision-making; and perceive time in terms of personal and seasonal rhythms rather than in terse of the clock or calendar and be more present-than future oriented Interventions: family members, friends, and community members participate in healing rituals and other forms of tx so therapies adopting this approach are recommended (LaFromboise et al's Network Therapy - conducted in clt's home, incorporates family and community members into the treatment process and situates an individual's psychological problems within context of family, workplace, community, and other social systems

Answer 121

Assessment: Be aware of: AA worldview emphasizes the interconnectedness of all things while often prioritizing group welfare over individual needs; family is often an extended kinship network that incl both nuclear and extended family members as well as individuals outside the family (incl church); roles within AA families are flexible and non-hierarchical, and relationships between men and women tend to be egalitarian; AA often experienced considerable prejudice and discrimination and may exhibit "healthy cultural paranoia" chick may be manifested as distrust of white therapists and traditional mental health services. Interventions: generally prefer structured time-limited, problem-solving therapies, interventions that foster empowerment by adopting an egalitarian approach, and family approaches that include the extended family system; Multisystems approach combining elements of structural and behavioral family therapy and addresses multiple systems, intervenes at multiple levels, and empowers the family directly by incorporating their strengths into the interventions

Answer 122

Treatment guidelines: greater emphasis on the group (family, community) than on the individual and adhere to a hierarchical family structure and traditional gender roles; shame, humility, and obligation are important in Asian cultures...consequently, restraint of strong emotions that might disrupt harmony or bring shame to the family is valued, and modesty and self-deprecation are not necessarily signs of low self-esteem; tend to somaticize their psychiatric symptoms; believe they should be passive and respectful in therapy and expect formalism in the therapeutic relationship; to establish credibility, authority, and expertise early in therapy, clinicians can disclose info about their educational background and experience, show familiarity with clt's cultural background, and provide clt with an immediate and meaningful benefit (i.e. offer a solution to clt's presenting problem in initial session) Intervention: often expect therapy to focus more on behaviors than on emotions, expect therapists to give concrete advice, and view therapist as knowledgeable expert so often prefer CBT, Solution-Focused Thearpy, and other brief structured, goal-orientd, problem-solving approaches that focus on alleviating specific symptom; keep in mind those from collectivist Asian cultures prioritize respect and concern for needs of others and may not benefit from therapies emphasizing individual well-being; may need to modify treatment so they incorporate a collectivist perspective

Answer 123

Treatment Guidelines: be aware of: generally LA emphasize family welfare over individual welfare and family structure is often patriarchal with relatively inflexible gender roles; LA often adopt a concrete, tangible approach to life and attribute the control of life events to luck, supernatural forces, acts of God, or other external factors; physical and mental health are interdependent and therefore often somaticize their mental health probs; generally inappropriate to go outside immediate or extended family network to discuss family and personal probs; mental illness and seeking help for mental illness are stigmatized; during initial session, usually best to dopt a formal stance and once therapeutic alliance has been established, it's more desirable to emphasize personalismo (personal connection and warmth and physical proximity) Interventions: culturally adapted behavioral and cognitive-behavioral therapies and other active, directive, and solution-focused approaches are generally preferred; including members of immediate and extended family may be treatment-of-choice bc they are consistent with emphasis on familismmo; Aponte's ecostructural family therapy is derived from structural family therapy, was developed specifically for low-income ethnic minorities and is consistent with latino culture-providing intensive family therapy and fostering relationships between family and community agencies/services

Answer 124

Assessment: LGBT come to therapy for the "usual" reasons, but some seek tx for help with unique issues such as acceptance of sexual orientation, "coming out" to others, or coping with stigmatization and internalized homophobia; critical not to assume probs are necessarily related to sexual orientation Treatment: goal and nature of tx depend on clt's presenting issue and issue's relationship to clt's sexual orientation. Affirmative Psychotherapy: refers to indiv, couple, and group therapies that encourage LGB individuals to accept their sexual orientation and are based on assumptions that a) homosexuality is a normal (healthy) vacation of human sexuality; b) homosexuality is not per se the cause of pathology; c) to be effective as practitioners of affirmative psychotherapy, clinicians must be aware of the impact of heterosexism on lives of LGB individuals and be reasonably free from homophobic and heterosexist biases (see APA's Guidelines for Psychotherapy w/LGB Clients) Sexual Identity Therapy (SIT): alternative to affirmative psychotherapy and sexual reorientation therapy for clts who are experiencing conflicts between sexual identity and personal attitudes, beliefs, and values. Goal is the synthesis of a sexual identity that promotes personal well-being and integration with other aspects of personal identity (cultural, ethnic, relational, spiritual, worldview, etc); 4 phases: a) assessment (evaluating clt's motivation for seeking therapy); b) advanced informed consent (obtaining informed consent after providing clt with complete and accurate info about sexual identity and orientation and alternative treatments and identifying treatment goals; c) psychotherapy (providing interventions and referrals that match clt's goals; and d) sexual identity synthesis Phase-Specific Psychotherapy: phase-specific approach addressing developmental needs of LGB individuals: Phase 1: Sensitization: empathize w/ and destigmatize clt's feelings of alienation and isolation; address depression and suicidal ideation; and address impulsivity, anger, and other bx-al problems Phase 2: Identity Confusion: empathize and explor clt's confusion about sexual identity and related fears and anxiety; help clt identify acknowledge same-sex feelings; dispel myths and stereotypes about hoosexuality; reframe being gay or lesbian as positive; empathize with feelings of loss and facilitate the grieving process; expose the clt to positive role models and identify sources of support; and assess for and address substance abuse. Phase 3: Identity Assumption/Tolerance: Validate clt's self-perception of probable identity and provide info on ID development; facilitate decision-making about self-disclosure and rehearse self-disclosure in therapy; provide education on human sexuality; help clt develop a new personal and social identity; reframe rejection by others as an external prob; and refer clt to community resources for LGB individuals Phase 4: Identity Acceptance/Commitment: encourage clt to adopt a temporary sexual identity label and, as appropriate, refer to clt as LGB; support clt's involvement in LG community; continue to discuss clt's self-disclosures; address issues related to intimacy in initial LG relationships; and if requested, provide couple counseling Phase 5: Identity Pride/Synthesis: validate clt's pride in being LG; acknowledge existence and impact of heterosexist oppression and address clt's negative feelings and conflicts related to heterosexism; examine other dimensions of clt's personality and help them develop an integrated sense of self; facilitate clt's reintegration into dominant culture; help clt redefine former relationships; and address normal developmental issues of adult life.

Answer 125

Assessment for initial identification: CA law requires a mandated reporter to file a report with appropriate authorities when, in professional capacity, knows or reasonably suspects that child abuse or neglect has occurred...recognize indicators of abuse and/or disclosure of abuse during interviews Interview Guidelines for Child: when possible, should interview child and each parent separately and interview family together to observe their interactions; provide a safe environment (i.e. acknowledge difficulty talking to a stranger, beginning interview with questions about "safe" topics such as friendships and school, providing emotional support, and avoiding communication of value judgments through language or nonverbal behavior); use language child can understand; reassure child is not responsible for abuse; avoid leading questions and provide opportunities for spontaneous disclosure (i.e. by providing drawing materials to help child describe what's happened); and as appropriate, inform child of any actions that might take place in the future Interview Guidelines for Parent/Caregiver: use open-ended, nonjudgmental questions about parenting and discipline (ex. what do you do when your child misbehaves? are you ever afraid you might hurt your child? have you ever worried someone might hurt your child? Assessment for Treatment Planning: multistage process, often beginning with impressionistic data from reporting and referral sources, and narrowing toward the evaluation of more specific intervention needs; primary purposes = to identify general problems areas (including individual characteristics, antecedents, and consequences associated with abuse); identify parental strengths and problems areas; identify child strengths and problem areas; and evaluate the parent-child relationships. Methods include clinical interviews, self-and other-report measures, and observational methods. Standardized assessment tools useful for evaluating abused children and family include Abusive Behavior Inventory, Child Abuse Potential inventory, Parenting Behavior Rating Scales, and Symptom Checklist 90-Revised

Answer 126

Treatment: incl education about abuse and its effects, parent training, cognitive-behavioral strategies, supportive therapy, skills training, and self-protective strategies Empirically Supported Treatments for Child Abuse: Abuse-Focused Cognitive-Behavioral Therapy (AF-CBT): short-term treatment for children who have been physically abused and their families; targets child and parent characteristics associated with abuse and family context in which abuse occurs (negative perceptions of the child, harsh punishment, high levels of anger and hostility, stressful life events) as well as consequences of the abuse for child (i.e. behavioral probs, poor social skills); therapy = indiv sessions with child and parent and joint parent-child sessions and specific interventions incl teaching parents alternative discipline techniques; enhancing family interactions; identifying and altering parental reactions to abuse-specific triggers; training for child in coping skills, anxiety and anger management, and affective expression management; and as needed, involvement of community and social systems Parent-Child Interaction Therapy (PCIT): based on recognition that a negative coercive relationships between parent and child is a major risk factor for physical abuse. Provides structured parent training program where therapist acts as a coach by giving prompts to parents (through a "bug-in-the-ar" device) from observation room while parents interact with child. Parents are taught specific strategies that are designed to improve parent-child relationship and increase child's compliance. (5 basic relationship-building skills - Praise, reflection, imitation, description, and enthusiasm- these used when coached to use these skills during relationship-enhancing activity); target bxs are coded and recorded on chart by T during each session, and parents are provided w/feedback about mastery of skills Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT): short-term treatment for reducing PTSD symptoms, depression, and behavioral probs in children who have been sexually abused or exposed to other trauma; address needs of child and family through psychoeducation and normalization of reactions, stress management, affective expression and regulation, gradual exposure the verbal, write, or symbolic recounting of abuse (trauma narration), cognitive reprocessing and reframing, personal safety skills training, parent training in behavioral management skills, and joint parent-child therapy sessions

Answer 127

Assessment for ID: often based on recognition of indicators of abuse (unexplained physical injuries, evasiveness when describing injuries, psychopathology, drug/alcohol abuse, SI, submissive bx in presence of abuse, highly conflictual relationship and relationship dissatisfaction) and/or results of routine screening Interview Guidelines: to increase validity and reliability of interview, attend to woman's needs: a) conduct interview in private; b) begin with open-ended questions; c) avoid leading questions; d) convey interest and be nonjudgmental and supportive: e) avoid giving advice or making interpretations; f) avoid rushing the woman (may not be ready to describe abuse at time); g) clarify an unclear words or statements and verify that you and woman agree on description of abuse Screening questions: Validated screening questions are: Have you been hit, kicked, punched, or otherwise hurt by someone within the past year? (If so, by whom?) Do you feel safe in your current relationship? Is there a partner from a previous relationship who is making you feel unsafe now? Risk assessment: after reveal they are victim of partner violence, conduct risk assessment in a private place preferably unless they request presence of a family member or friend. Incl: evaluating risk for further assault or homicide, suicide/self-harm, and had to children; when risk assessment rev leas safety concerns are acute, should discuss immediate options to ensure safety. If safety concerns are ongoing, should develop a safety plan and discuss referral resources, legal options, emergency shelter, 24-hour hotlines. If children are at risk, appropriate action must be taken to protect them.

Answer 128

Assessment for Treatment Planning: domestic abuse assessment involves interviewing both partners, first separately and then together if it is safe to do so. Children should also be interviewed either separately or with parents. Assessment can be done in 2-3 sessions according to Hamel: Session 1: genearl psychosocial assessment including obtaining basic demo info & info about referral source, indiv current living situation, recent significant events, family functioning, previous mental health treatment, current mood and mental status, and type, severity, and mutuality of abuse. Following interview, review collateral sources of info incl legal, medical, and psychological reports Session 2: continue general psychosocial assessment & incl obtaining info on clt's developmental hx, previous rxs, criminal hx, medical hx, parenting practices, and current ares of relationship functioning that are associated with abuse (i.e. anger and stress management, conflict resolution, control) Session 3: obtain additional info to assist in treatment planning and may incl administering MMPI-2 and measures of anger, relationship satisfaction, family functioning, etc. Based on results of assessment, formulate diagnosis, categorize type of violence, and ID appropriate tx goals and interventions

Answer 129

Indiv therapy: incl approaches based on crisis intervention models, feminist theory, Stages of change model, and CBT Survivor Therapy: combines cognitive-behavioral strategies w/trauma theory and feminist therapy and emphasizes woman's strengths; Primary goals = establish safety, re-empower woman, validate womand and her experiences, expand woman's options, restore her cognitive clarity, encourage her to make own decisions, and heal effects of abuse; Secondary goals = meet woman's needs and those of her family, help woman understand oppression, ID relevant intrapsychic factors, and enhance woman's self-confidence Group Therapy: can be provided alone or in conjunction with individual therapy. Abuse-specific grps that incl women only are generally recommended and may be led by abuse survivors or mental health pros. most based on support group model and incl benefits such as reducing woman's feelings of isolation, helping woman deal with feelings of shame and guild, and providing her with feedback on how she relates to others....approaches to grp therapy are avail for male perpetrators incl grps based on traditional (Duluth) model focusing on personal responsibility and acquiring alternative behaviors; cognitive-behavioral approaches emphasizing impulse control and altering distorted cognitions, and electric approaches focusing on communication and rx dynamics Couples Therapy: use of couples therapy is controversial arguing that partners in abusive rx should usually be treated separately, especially in initial stages of tx before woman has had chance to being own recovery. Avoid until following conditions met: a) there've been no incidents of violence for at least 5 months; b) abuse accepted responsibility for his violent behaviors; and c) both partners have been actively involved in treatment groups. Mack proposes appropriateness of couples therapy depends on type of abuse: Instrumental Abuse is brutal, dangerous, and occurs with little provocation so woman's safety is at risk and thus should be physically separated and provided with separate therapy; Expressive Abuse is related more to couple's emotional life and occurs in a context of escalating conflict about specific issues so may be appropriate to have partners sign a no-violence contract and provide couples therapy

Answer 130

psychologists clarify nature of conflict, make known their commitment to Ethics Code, and take reasonable steps to resolve conflict consistent with General Principles and Ethical Standards of Ethics Code. Under no circumstances may this standard be used to justify or defend violating human rights

Answer 131

If Ethics Code establishes a higher standard of conduct than is required by law, must meet the higher ethical standard

Answer 132

determine whether the law or ethical guideline provides higher standard of conduct

Answer 133

enacted by Congress; consists of several titles (sections); Title II (Administrative Simplification - designed to improve efficient and effectiveness of health care system by standardizing health care transactions) is most relevant to professional practice of psychology; Privacy rule, Security Rule, and Transaction Rule

Answer 134

provides regulations for using and disclosing protected health info (PHI); designed to provide clts with increased protection of their PHI. General requirements: 1) inform clts of their privacy policies; 2) grant clts access to their health info; 3) obtain clt authorization before sharing health info for nontoutine purposes; 4) secure clt records; 5) inform business associates of privacy practices; and 6) train employees so that they understand privacy procedures Privacy Rule Trigger: privacy rule is triggered (must be implemented) when a provider transmits PHI electronically in connection with one of several transactions including health care claims, health care payment, health care plan payment, or enrollment or disenrollment in a health plan; once its triggered, it applies to all of the provider's transactions, not just to those that are conducted electronically. APA recommends to comply with HIPAA regulations, even if they don't transmit PHI electronically

Answer 135

describes security safeguards for electronic PHI; describes administrative (address procedures relevant to implementing security requirements such as office policies and procedures), physical (address computers and other electronic info systems and the facilities in which confidential info is electronically stored), and technical security standards (address methods for limiting access to EPHI-passords and encryption software) and implementation specifications that are designed to ensure the confidentiality of electronic protected health info (EPHI). HIPAA's security rule applies to psychologist who electronically transmit and/or maintain health info about a clt. Even if psychologist does not use a computer in practice or bill electronically, it is recommended that psychologist follow HIPAA regulations

Answer 136

requires providers who transmit certain transactions electronically to use the same electronic format, code sets, and identifiers; requires providers who conduct certain business transactions electronically to use the same electronic format, code sets, and identifiers "transactions" refer to the electronic exchange of clt-identifiable health info for the purpose of carrying out financial or administrative activities, "electronic exchanges" include transmissions over the Internet, leased lines, dialup lines, and private networks as well as those that involve conveying CDs, diskettes, etc. from one location to another. Covered electronic transactions incude those related to health care claims and claim status, health care plan eligibility, referral certification and authorization, health care plan enrollment or disenrollment, health care payment, health care premium payments, and coordination of benefits.

Answer 137

compare HIPAA regulations and state law to determine which one preempts, or supersedes, the other. State law preempts a HIPAA regulation only when the state law is more "stringent" than HIPPA...when law provides greater privacy protection to clts or provides clts with greater access to and control over their health info. CA law is more stringen in protecting info related to certain aspects of mental health treatment and to HIV/AIDS testing

Answer 138

apply to Covered Entities (CEs),, which include health care providers, health plans, and health care clearinghouses. Psychotherapists are included in HIPAA's definition of a health care provider (refers to any person or entity that provides, bills for, and/or is paid for health care as a normal part of business)

Answer 139

type of individually identifiable health info that is maintained or transmitted in any medium and that provides info about 1) individual's past, present, or future physical and mental health condition; 2) provision of health care to the individual; 3) past, present, or future payment for health care provided to the individual. Info that doesn't identify, or cannot be used to identify, an individual is considered "de-identified" and is not covered by the same restrictions as is individually identifiable info. PHI does NOT include individually identifiable health info in educational records covered by the Family and Educational Rights and Privacy Act (FERPA) or in employment records maintained by a CE in its role as an employer.

Answer 140

Access to Health Info: HIPAA regulations regarding clt's right to inspect and receive a copy of health info are similar to requirements of CA Law. Important difference is circumstance in which access may be denied; and HIPAA regulations for denying access generally preempt CA law bc HIPAA has more stringent standards 1) HIPAA distinguishes between circumstances in which clt does and does not have right to request a review of denial by a designated health care professional who did not participate in the original decision to deny access. Clt has right to request a review of denial in following circumstances: a) licensed health care pro has decide that disclosure of PHI to clt "is reasonably likely to endanger life or physical safety" of clt or other person; b) PHI refers to another person who is not a health care provider, and the health care provider believes that disclosure will cause substantial harm to that person; c) request was made by the clt's personal representative and the health care pro believes that disclosure to that representative is likely to cause substantial harm to clt or other person (Note: w/latter, CA law preempts privacy rule bc CA law does NOT allow a health care pro to withhold records from a pateitn's personal representative because provider believes that releasing the records are contrary to patient's best interests) 2) In contrast, clt does NOT have right to request a review of a denial in the following circumstances: a) info is exempt from the right to access (i.e. request is for PHI that was compiled for use in criminal, civil, or administrative hearing); b) CE is a correctional institution or is acting under the direction of a correctional institution, the requester is an inmate, and the CE believes that access will threaten the health or safety of the requester, other inmates, or employees of the institution; c) info was obtained as part of an ongoing research study and the requester agreed to denial of access was part of the consent process; d) PHI was obtained from someone other than a health care provider under a promise of confidentiality. 3) HIPAA permits (but does not require) psychologists to maintain 2 sets of records: first is a general set of records that are more readily accessible to clts, insurers, and others; and second set are psychotherapy notes, which are notes recorded in any medium by a mental health pro that document or analyze the contents of conversations during therapy....Psychotherapy notes are used only by psychologist who wrote them and are not part of the documentation required to provide a clt with health care treatment, to obtain payment for health care services, or to conduct health care operations Under HIPAA, clts do not have right to review psychotherapy notes, but CA law preempts the HIPAA regulation...thus, psychologists may, upon request of a clt, provide clt with a copy of the notes or a summary of them. Alternatively, psychologists may decline to provide a clt with psychotherapy notes when they determine that there is a substantial risk of significant adverse or detrimental consequences to clt in viewing or receiving a copy of these notes Note that any info that is essential for tx should be included in the general record than in psychotherapy notes, which includes info related to medication prescription and monitoring, start and stop times of sessions, modalities and frequency of treatment, results of clinical tests, diagnosis, functional status, treatment plan, symptoms, prognosis and progress

Answer 141

Under HIPAA, clts have right to request an amendment of their PHI if they believe is incorrect. Provider may deny this request for amendment if: 1) info was not created by the prouder, unless the person who created is not available to make the amendment; 2) info is not part of the designated record set or is not available for inspection; or 3) provider believes the info is accurate and complete Clt must be provided with a timely, written explanation describing basis for the denial, clt's right to file a statement of disagreement or have the request and denial notice included in future disclosure of the info, and the procures for filing a complaint with the provider or Department of Health and Human services (DHSH)...If provider accepts part or all of a requested amendment, must add the amendment to the clt's record, inform clt that amendment has been made, and, as appropriate, provide amendment to people who have previously received info covered by amendment

Answer 142

HIPAA gives clts right to request an accounting of disclosures to third parties made during the 6 year period prior to the request but this only is applicable to only certain types of disclosures (ie. does NOT apply to uses of PHI for purposes of treatment, payment, or health care operations ("TPO") but does apply to disclosures to public health authorities, health oversight agencies, and researchers.

Answer 143

Aug 2002 mod to privacy rule eliminated need for a health care pro to obtain consent from clt prior to using or disclosing PHI for purposes of TPO (health care operations), which makes obtaining clt consent a voluntary (rather than a required) procedure when using or disclosing PHI for routine purposes. To best protect rights and welfare of clts, psychologists hold ordinarily obtain a written or verbal consent from clts prior to using or disclosing PHI to third parties unless there is a valid reason for not doing so. HIPAA privacy rule states that a written authorization from clt is ordinarily required prior to disclosing individually identifiable PHI for reasons other than TPO and prior to releasing psychotherapy notes to a third party. Authorization must include a description of the info to be disclosed and limitations on the type of info that will be disclosed; indicate the name and function of the person/entity who is authorized to use the info; indicate the expiration date of the authorization; and include a statement informing clt of their right to receive a copy of the authorization and to revoke the authorization. Privacy rule also identifies circumstances in which is is NOT necessary to obtain an authorization (i.e., when it is de-dnetified info or, in some circumstances, to release info included in a "limited data set" that contains only certain identifies (i.e. city and state of residence, birth date and other relevant dates). Unnecessary to obtain an authorization when PHI or psychotherapy notes must be disclosed to avert a serious threat to the health or safety of clt or other person

Answer 144

HIPAA's privacy rule requires psychologists to provide clts with a written Notice of Privacy Practices (NPP) on or before the onset of treatment that indicates how health info mary be used and disclosed and that informs clts of their rights with regard to health info. NPP must be posted in a prominent place in the psychologist's office, and psychologist must make a "good faith effort" to obtain clt's written acknowledgment of receipt of the notice. NPP must be written in clear language and include a description of how the provider protects a clt's health info, when clt's health info may be used or disclosed without authorization, clt's rights with regard to amending health info and revoking an authorization, how clt may access their health info, and procedures for filing a compliant related to privacy issues

Answer 145

requires psychologists to limit the disclosure of PHI to the minimum necessary to accomplish the purpose of the disclosure. also identifies circumstances in which the minimum necessary requirement does NOT apply (i.e. disclosures to health care pros for the purpose of providing treatment to a clt and disclosures made with clt's authorization)

Answer 146

Business Associate (BA) is a person or organization other than a member of a psychologist's staff who receives PHI in order to provide services to the psychologist or on the psychologist's behalf (i.e. answering service, collection agency, lawyer, accountant, billing service, shredding service, transcribing agency). Psychologists must have a HIPAA contract with all BAs; and when psychologist learns that a BA is violating contract, must take reasonable steps to correct the violation, terminate the contract, or report the violation to DHHS.

Answer 147

Aug 2002 mod to privacy rule eliminated need for a health care pro to obtain consent from clt prior to using or disclosing PHI for purposes of TPO (health care operations), which makes obtaining clt consent a voluntary (rather than a required) procedure when using or disclosing PHI for routine purposes. To best protect rights and welfare of clts, psychologists hold ordinarily obtain a written or verbal consent from clts prior to using or disclosing PHI to third parties unless there is a valid reason for not doing so. HIPAA privacy rule states that a written authorization from clt is ordinarily required prior to disclosing individually identifiable PHI for reasons other than TPO and prior to releasing psychotherapy notes to a third party. Authorization must include a description of the info to be disclosed and limitations on the type of info that will be disclosed; indicate the name and function of the person/entity who is authorized to use the info; indicate the expiration date of the authorization; and include a statement informing clt of their right to receive a copy of the authorization and to revoke the authorization. Privacy rule also identifies circumstances in which is is NOT necessary to obtain an authorization (i.e., when it is de-dnetified info or, in some circumstances, to release info included in a "limited data set" that contains only certain identifies (i.e. city and state of residence, birth date and other relevant dates). Unnecessary to obtain an authorization when PHI or psychotherapy notes must be disclosed to avert a serious threat to the health or safety of clt or other person

Answer 148

HIPAA's privacy rule requires psychologists to provide clts with a written Notice of Privacy Practices (NPP) on or before the onset of treatment that indicates how health info mary be used and disclosed and that informs clts of their rights with regard to health info. NPP must be posted in a prominent place in the psychologist's office, and psychologist must make a "good faith effort" to obtain clt's written acknowledgment of receipt of the notice. NPP must be written in clear language and include a description of how the provider protects a clt's health info, when clt's health info may be used or disclosed without authorization, clt's rights with regard to amending health info and revoking an authorization, how clt may access their health info, and procedures for filing a compliant related to privacy issues

Answer 149

requires psychologists to limit the disclosure of PHI to the minimum necessary to accomplish the purpose of the disclosure. also identifies circumstances in which the minimum necessary requirement does NOT apply (i.e. disclosures to health care pros for the purpose of providing treatment to a clt and disclosures made with clt's authorization)

Answer 150

Business Associate (BA) is a person or organization other than a member of a psychologist's staff who receives PHI in order to provide services to the psychologist or on the psychologist's behalf (i.e. answering service, collection agency, lawyer, accountant, billing service, shredding service, transcribing agency). Psychologists must have a HIPAA contract with all BAs; and when psychologist learns that a BA is violating contract, must take reasonable steps to correct the violation, terminate the contract, or report the violation to DHHS.

Answer 151

legally and ethically obligated to practice within scope of competence. California Code of Regulations (CCR): psychologist shall not function outside particular field(s) of competence as established by education, training, and experience Business and Professions Code (B&PC): board may refuse to issue any registration or license, or issue with terms and conditions, or may suspend or revoke if license has been guilty of unprofessional conduct (defined as functioning outside of particular field(s) of competence as established by education, training, and experience According to Ethics Code: Boundaries of Competence is a) when psychologists provide services, teach, and conduct research with populations and in areas only within boundaries of their competence, based on their education, training, supervised experience, consultation, study or professional experience; b) scientific or professional knowledge in discipline of psychology establishes that an understanding of factors associated w/age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, or socioeconomic status is essential for effective implementation of their services or research, psychologists have or obtain training, experience, consultation or supervision necessary to ensure competence of their services or make appropriate referrals; d) when asked to provide services for whom appropriate mental health services are not available and for which psychologists have not obtained the competence necessary, psychologists with closely related prior training or experience may provide such services in order to ensure that services are not denied if they make reasonable effort to obtain competence required by using relevant research, training, consultation, or study; in emerging areas in which generally recognized standards for preparatory training do not yet exist, psychologists take reasonable steps to ensure competence of their work and to protect clts/patient, students, supervises, research participants, organizational clts, and others from harm; requires to obtain training/experience, seek supervision/consultation, or make a referral whenever a needed service falls outside boundaries of competence; when using new or experimental technique, clt must be made aware of that fact and must take special precautions to protect clt from harm; requires to undertake ongoing efforts to develop and maintain competence while minimizing the potential for harm to clts Providing Services in Emergency Situations when services are outside scope of competence: may provide in order to ensure that services are not denied. Services are discontinued as soon as emergency ended or appropriate services are available.

Answer 152

aka "testimonial privilege" and is a LEGAL TERM that refers to a person's right not to have confidential info revealed in a legal proceeding P-clt privilege is established by Evidence Code (EC) and B&PC... Privilege is narrower in scope than confidentiality bc it applies only to confidentiality of clt info in the context of a court proceeding, deposition, or administrative hearing Holder of Privilege: as defined by EC, is the clt when they have no guardian or conservator; guardian/conservator of clt when the clt has a guardian/conservator; personal representative of clt if clt is dead...meaning a P cannot testify or release a clt's records in a legal proceeding unless clt (or other holder of privilege) has waived privilege or the court has determined that an exception to privilege applies...health care provider is never the holder of privilege Confusion if parents of minor clts hold privilege for minors seen in therapy: EC specifies "guardians" and "conservators" as holding the privilege, not "parents." However, case law confirmed minors are considered holders of the privilege in CA, even though they may rely on adults to claim or waive the privilege on their behalf. Note that there's less ambiguity about this issues for dependent children (children who are wards of the court) California Welfare and Institutions Code (WIC) applies to dependency proceedings and states: "either children or counsel for child, with informed consent of child if child is found by court to be of sufficient age and maturity to so consent, which shall be presumed, subject to rebuttal by clear and convincing evidence, if child is over 12 years of age, may invoke the P-clt privilege; and if child invokes privilege, counsel may not waive it, but if counsel invokes privilege, child may waive it. Counsel shall be holder of these privileges if child is found by court not to be of sufficient age and maturity to so consent When 2 or more individuals are joint holder of privilege, waiver of privilege by one clt does not affect another clt's right to claim the privilege (i.e. couples therapy and court proceedings where one waives and other doesn't-very hard to avoid divulging privileged info by non-consenting partner) Although clt is holder of privilege, P may claim privilege on behalf of clt when P is asked to disclose confidential info in a legal proceeding. After claiming privilege, P would then release the info only if ordered to do so by the court or clt consents to the release. (Terms of "Claim, assert, and invoke" are all the same and used interchangeably)

Answer 153

Privilege does not apply in legally defined circumstances which incl: 1) clt authorizes a release of info; 2) P is legally mandated to breach confidentiality (report child, elder abuse); 3) clt has disclosed a significant part of the info to a third person; 4) situation represents a legally defined exception to privilege (Patient-Litigang Exception, Court-Appointed Psychotherapist, Board of Prison Terms-Appointed Psychotherapist, Crime or Tort, Breach of Duty Arising out of Psychothearpist-Patient Relationship; Proceeding to Determine the Sanity of Criminal Defendant; Patient Dangerous to Self or Others; Proceeding to Establish Competence; Patient Under 16 is a Victim of a Crime) In most cases, exception to privilege is not automatic. Instead, judge reviews relevant material to determine whether an exception applies and then issues an order to release the info if judge determines there is a valid exception to privilege

Answer 154

CA Laws portecting confidentiality of menial health incl: Lanterman-Petris-Short Act (LPSA) and Confidentiality of Medical Information Act which created an overriding presumption that clt info is confidential and may not be released without clt consent, except in specific circumstances (i.e. in a medical emergency, when clt is a danger to self or others, to report child or elder abuse) LPSA - applies to confidentiality of mental health info for clts receiving services in public mental health system or who are hospitalized in a psychiatric facility on a voluntary or involuntary basis, while CMIA applies to all mental health pros. When CMIA and LPSA conflict regarding records of clts in public health system or inpatient psychiatric facilities, LPSA applies CA Law identifies when Ps are required to breach clt confidentiality: a) clt communicates a serious threat of physical violence against a reasonably identifiable victim or victims; b) P has reasonable cause to believe clt is danger to self and disclosure of info is necessary to avert the danger; c) within P's pro role, P learns or comes to reasonably suspect that a minor is being abused; d) Within P's pro role, P learns or comes to reasonably suspect that an elder or dependent adult is being abused; e) court orders P to release records or provide testimony that is needed as evidence in a legal proceeding; f) RE Patriot Act of 2001, Ps are required to provide FBI w/certain clt info and states Ps are prohibited from telling clt or anyone else that FBI has requested info under the Act.

Answer 155

no privilege when P has been appointed by court to examine a defendant to help court make a decision about him/her (i.e. competency) In this situation, P must inform defendant before performing the evaluation that communications will not be confidential; and if P fails to do this, evaluation cannot be submitted in court This exception to privilege does not apply when court orders evaluation of defendant at request of defendant's lawyer to provide lawyer with info lawyer needs to advice the defendant whether to enter or withdraw a plea based on insanity or clt's emotional state (i.e. plan a legal strategy). in this situation, information derived from eval IS PRIVILEGED

Answer 156

aka "testimonial privilege" and is a LEGAL TERM that refers to a person's right not to have confidential info revealed in a legal proceeding P-clt privilege is established by Evidence Code (EC) and B&PC... Privilege is narrower in scope than confidentiality bc it applies only to confidentiality of clt info in the context of a court proceeding, deposition, or administrative hearing Holder of Privilege: as defined by EC, is the clt when they have no guardian or conservator; guardian/conservator of clt when the clt has a guardian/conservator; personal representative of clt if clt is dead...meaning a P cannot testify or release a clt's records in a legal proceeding unless clt (or other holder of privilege) has waived privilege or the court has determined that an exception to privilege applies Confusion if parents of minor clts hold privilege for minors seen in therapy: EC specifies "guardians" and "conservators" as holding the privilege, not "parents." However, case law confirmed minors are considered holders of the privilege in CA, even though they may rely on adults to claim or waive the privilege on their behalf. Note that there's less ambiguity about this issues for dependent children (children who are wards of the court) California Welfare and Institutions Code (WIC) applies to dependency proceedings and states: "either children or counsel for child, with informed consent of child if child is found by court to be of sufficient age and maturity to so consent, which shall be presumed, subject to rebuttal by clear and convincing evidence, if child is over 12 years of age, may invoke the P-clt privilege; and if child invokes privilege, counsel may not waive it, but if counsel invokes privilege, child may waive it. Counsel shall be holder of these privileges if child is found by court not to be of sufficient age and maturity to so consent When 2 or more individuals are joint holder of privilege, waiver of privilege by one clt does not affect another clt's right to claim the privilege (i.e. couples therapy and court proceedings where one waives and other doesn't-very hard to avoid divulging privileged info by non-consenting partner) Although clt is holder of privilege, P may claim privilege on behalf of clt when P is asked to disclose confidential info in a legal proceeding. After claiming privilege, P would then release the info only if ordered to do so by the court or clt consents to the release. (Terms of "Claim, assert, and invoke" are all the same and used interchangeably)

Answer 157

Privilege does not apply in legally defined circumstances which incl: 1) clt authorizes a release of info; 2) P is legally mandated to breach confidentiality (report child, elder abuse); 3) clt has disclosed a significant part of the info to a third person; 4) situation represents a legally defined exception to privilege (Patient-Litigang Exception, Court-Appointed Psychotherapist, Board of Prison Terms-Appointed Psychotherapist, Crime or Tort, Breach of Duty Arising out of Psychothearpist-Patient Relationship; Proceeding to Determine the Sanity of Criminal Defendant; Patient Dangerous to Self or Others; Proceeding to Establish Competence; Patient Under 16 is a Victim of a Crime) In most cases, exception to privilege is not automatic. Instead, judge reviews relevant material to determine whether an exception applies and then issues an order to release the info if judge determines there is a valid exception to privilege

Answer 158

no privilege in legal proceeding in which a clt's emotional condition has been raised as an issue by clt or clt's representative (i.e suing for emotional distress)

Answer 159

no privilege when P has been appointed by court to examine a defendant to help court make a decision about him/her (i.e. competency) In this situation, P must inform defendant before performing the evaluation that communications will not be confidential; and if P fails to do this, evaluation cannot be submitted in court

Answer 160

no privilege when a P is appointed by Board of Prison Terms to evaluate an inmate to determine need for mental health treatment (RE: EC). Penal code says, results are not privilege when Board of Prison Terms requests a P evaluate a prison inmate to determine eligibility for mentally disordered offender program

Answer 161

(RE EC): no privilege "if services of P were sought or obtained to enable or aid anyone to commit or plan to commit a crime or a tort or to escape detection or apprehension after the commission of a crime or tort. (ex, P believes a man is faking sxs so P will assign a dx that'll help man obtain insurance settlement related to work-related injury. Therefore, clt's communication to P will not be recognized as privileged in a legs proceeding related to insurance claim

Answer 162

(RE EC): no privilege in a proceeding intiated at request of defendant in a criminal action to determine sanity.

Answer 163

when P has reasonable cause to beleve clt is in such a mental or emotional condition as to be dangerous to self, to others, or to property of others and that disclose of communication is necessary to prevent the threatened danger. It does not designate Ps as mandated reporters or require them to disclose info but that clt's communications aren't privileged (are not protected from disclosure in a legal proceeding) when P deter mend disclosure of confidential info is necessary to prevent the danger...P may contact whomever is necessary to prevent the threatened danger from occurring

Answer 164

no privilege in a proceeding brought by or on behalf of an individual to establish their competence.

Answer 165

when clt is under age of 16 and P has reason to believe that clt has been victim of a crime and that disclosure of confidential info is in best interest of clt.

Answer 166

when conducting research or provide assessment, therapy, counseling, or consulting services in person or via electronic, etc, obtain informed consent using language that is reasonably understandable except when conducting such activities without consent is mandated by law/government regulation; for ppl legally incapable of giving informed consent, P provide an appropriate explanation, seek clt's assent, consider clt's preferences and best interests, and obtain appropriate permission from a legally authorized person if permitted/required by law...when consent by legally authorized person is not permitted/required by law, P take reasonable steps to protect clt's rights and welfare; when psych services are court ordered or mandated, P inform clt of nature of anticipated services, incl whether services are court ordered/mandated and any limits of confidentiality, before proceeding; P appropriately document written or oral consent, permission, and assent. RE: therapy::::P inform clts as early as is feasible in therapeutic rx about nature and anticipated course of therapy, fees, involvement of third parties, and limits of confidentiality and provide sufficient opportunity for clt to ask questions and receive answers; when obtaining informed consent for treatment which gerenally recognized techniques/procedures have not been established, P inform clts of developing nature of treatment, potential risks involved, alternative treatments that may be available, and the voluntary nature of their participation; when therapist is a trainee and the legal responsibility for the treatment provided resides w/supervisor, clt as part of informed procedure, is informed that therapist is in training and is being supervised and is given the name of the supervisor. RE: assessment: obtain informed consent for assessments, evals or diagnostic services...except when a) testing is mandated by law/governmental regulations; b) informed consent is implied bc testing is conducted as a routine educational, institutional, or organizational activity (i.e. when participants voluntarily agree to assessment when applying for a job); or c) one purpose of the testing is to evaluate decisional capacity

Answer 167

Legally, 3 conditions must be met for consent to be truly "informed" 1) Capacity: capacity to make rational decision about therapy meaning cannot be under influence of alcohol or drugs or is experiencing an acute psychotic episode 2) Comprehension: must be given adequate info and understand the info sufficiently to make an informed decision. Ethics Code requires using language that is reasonably understandable, meaning the consent for must be written in a language and at a reading level that is consistent with a ability of clt. In addition, clt should be given opportunity to ask questions and receive answers to those questions 3) Voluntariness: must give consent freely without coercion; even when services are court ordered or mandated, should inform clt nature of services and any limits on confidentiality (ex, in court-ordered therapy, there are limits to confidentiality set by court i.e. court want to know if clt attended therapy and general info about treatment, which should be told at start of therapy

Answer 168

legal requirements are determined primarily by ethical requirements Exception is B&PC that requires health care providers to obtain verbal consent from clts prior to providing tele health services and to document the consent in the clt record.

Answer 169

means the mode of delivering health care services and public health via info and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a clt's health care while clt is at the originating site and health care provider is at a distant site...and includes synchronous interactions and asynchronous store and forward transfers. Note: BOP has a notice on its website stating that, to provide therapy or counseling services over the Internet to CA residents, provider must be licensed in CA.

Answer 170

when conducting research or provide assessment, therapy, counseling, or consulting services in person or via electronic, etc, obtain informed consent using language that is reasonably understandable except when conducting such activities without consent is mandated by law/government regulation; for ppl legally incapable of giving informed consent, P provide an appropriate explanation, seek clt's assent, consider clt's preferences and best interests, and obtain appropriate permission from a legally authorized person if permitted/required by law...when consent by legally authorized person is not permitted/required by law, P take reasonable steps to protect clt's rights and welfare; when psych services are court ordered or mandated, P inform clt of nature of anticipated services, incl whether services are court ordered/mandated and any limits of confidentiality, before proceeding; P appropriately document written or oral consent, permission, and assent. RE: therapy::::P inform clts as early as is feasible in therapeutic rx about nature and anticipated course of therapy, fees, involvement of third parties, and limits of confidentiality and provide sufficient opportunity for clt to ask questions and receive answers

Answer 171

in Ethics Code: discuss w/pesons (including, to the extent feasible, persons who are legally incapable of giving informed consent and their legal representatives) and organizations with whom they establish a scientific or professional relationships the relevant limits of confidentiality and the foreseeable uses of the info generated thru their psychological activities; unless it's not feasible or is contraindicated, discussion of confidentiality occurs at outset f rx and thereafter as new circumstances may warrant; P who offer services, products, or info via electronic transmission inform clts of the risks to privacy and limits of confidentiality.

Answer 172

in Ethics Code: P who provide services at request of a third-party are required to clarify nature of their rx with each involved party at outset of delivery of services (applies to various situations incl conducting court-ordered evaluations and seeing a minor in therapy at request of a parent). P who deliver services to or through organizations to provide info to clts and others directly affected by the services about the nature of the services, who is considered the clt, and any limits of confidentiality. confidentiality may be breached in context of an employee assistance program (EAP) in the same situations that it can be breached in other contexts (i.e. when a clt is believed to be a danger to self or others)...when an employee comes for counseling as result of a referral by supervisor, supervisor may e given limited info: such as if employee kept the appointment, whether employee needs treatment, and whether employee accepted treatment. Supervisor shouldn't be given any other info about employee w/o employee's consent limited info may be provided to an employer when employer has requested a P to conduct a fitness-for-duty evaluation of an employee to determine if psychological or psychiatric factors will interfere w/employee's ability to perform essential job functions. in this situation, employee is ordinarily asked to signs waiver form or an authorization for release of info prior to the evaluation. However, even when employee refuses to do so, employer has a right to limed info about results of eval (i.e. ability to perform essential job functions, whether any functional limitations will affect employee's ability to perform job duties, and whether any accommodations are needed to help employee perform job duties

Answer 173

confidentiality in grp therapy and other multi-clt therapies requires special consideration 1) grp members not legally obligated to maintain one another's confidentiality, group therapist must stress the importance of doing so...according to Ethics Code, P describe at outset the roles and responsibilities of all parties and the limits of confidentiality. Good strategy to remind grp members of need to maintain confidentiality periodically during course of therapy 2) RE couple and family therapy, P must clarify the probable uses of the services provided or the info obtained. for ex, problem of "secrets" may arise in couple or family therapy, esp when T also sees partners or family members in individual therapy, and T should clarify policy with regard to this type of info at outset of therapy

Answer 174

Unless a legal exception applies, parents have a legal right to be informed of info revealed by their minor child during course of treatment. However, full disclosure is likely to undermine effectiveness of treatment; and a good strategy is to obtain an agreement with all parties at beginning of therapy regarding what kinds of info will be disclosed to parents. Note, however, this agreement may not be legally binding

Answer 175

addressed in HIPAA's privacy rule, CA's Patient Access to Health Records Act, CA's Confidentiality of Medical Info Act, and APA's Ethics Code CA Laws are similar to HIPAA's privacy rule or have no analogous provisions in HIPAA. In these circumstances, adhering to CA Law doesn't violate requirements of HIPAA. However, there are circumstances in which HIPAA requirements preempt CA Law For ex, HIPAA's regulation regarding denial of access to records generally preempt CA Law. Under HIPAA, P may deny access to record if determined access is "reasonably likely to endanger the life or physical safety of clt or another person and clt is given the right to have denial reviewed. In contrast, H&SC section permits Ps to deny access when they determine there is a substantial risk of significant adverse or detrimental consequences to a clt in seeing or receiving a copy of records...Bc CA law gives clt less control over their own records, HIPAA's privacy rule preempts CA law and should be considered when determining whether or not to deny a clt's request for access to records other than psychotherapy notes In terms of psychotherapy notes, CA Law preempts HIPAA bc HIPAA allows for an absolute non-reviewable denial of access to psychotherapy notes, but CA law does not. In other words, upon request from a clt, Ps may give clt access to the complete psychotherapy notes or a summary of them or may decline to provide the psychotherapy notes if there is a legal reason for doing so H&SC Section: an adult clt, a minor clt authorized by law to consent to treatment, and a clt representative are entitle to have access to clt's records but must present the leash care provider with a written request for those records... and pay reasonable clerical costs incurred in locating and making the records available... with regard to minor clts, it is consistent with HIPAA's privacy rule and requirement for a written request is consistent with HIPAA as long as provider has informed clt that provider only accepts a written request H&SC Section: prohibits health care providers from withholding clt records or summaries of clt records bc of unpaid bill for health care services. This provision is not consistent with Ethics Code that states Ps may not withhold records under their control that are requested and needed for a clt's emergency treatment solely bc payment has not been received; Ethics Code implies that there would be times when withholding records for nonpayment of fees would be acceptable, but this provision is superseded by requirements of this H&SC section bc it grants clts greater control over their records.

Answer 176

found in Ethics Code, Record Keeping Guidelines by APA, HIPAA, and California Law Ethics Code: RE documentation of Professional and Scientific Work and Maintenance of Records, P create, and to extent records are under their control, maintain, disseminate, store, retain, and dispose of records and data relating to their professional and scientific work in order to 1) facilitate provision of services later by them or by other pros; 2) allow for replication of research design and analyses; 3) meet institutional requirements; 4) ensure accuracy of billing and payments; and 5) ensure compliance with law Ethics Code: RE Confidentiality of Records, P maintain confidentiality in creating, storing, accessing, transferring, and disposing of records under their control, whether these are written, automated, or in any other medium; if confidential info concerning recipients of psychological services is entered into databases or systems of records available to persons whose access has not been consented to by the recipient, P use coding or other techniques to avoid the inclusion of personal identifies; P make plans in advance to facilitate appropriate transfer and to protect the confidentiality of records and data in event of P's withdrawal from positions or practice. Circumstances dictate what measures must be taken to ensure confidentiality of records is preserved, but these typically include ensuring all staff members understand importance of keeping info contained in files confidential, keeping records in a locked filing cabinet/room, and making sure that access to records stored in electronic databases is limited Ethics Code requires Ps to have a plan for protecting the confidentiality of records in event of their death, illness, or withdrawal from practice for other reasons. Possible alternatives include (a) having an agreement about the management of records with a responsible college; b) arranging with a professional association to assist in managing or maintaining the records; or c) having a professional will that designates an executor or other person who will maintain the records, identifies the location of clt records, and provides other crucial info

Answer 177

Provided in CA law and APA's Record Keeping Guidelines Legal Requirements for retention of health records by P after clt's discharge are provided in B&PC stating a P shall retain a clt's health service records for a minimum of 7 years from clt's discharge date. If clt is a minor, clt's health service records shall be retained for a minimum of 7 years from date the patient reaches 18 years of age. H&SC (legal): applies to licensed outpatient health clinics, acute care facilities, adult day health care centers, and home health agencies and states that, if the licensee ceases operation, it has an obligation to preserve records for a minimum of 7 years following discharge of clt, except that records of unemancipated minors shall be kept at least one year after minor has reached age of 18 years, and in any case, not less than 7 years In APA Record Keeping Guidelines: P strives to be aware of applicable laws and regulations and to retain records for the period required by legal, regulatory, institutional, and ethical requirements; in absence of superseding laws or institutional regulations, P may consider retaining full records until 7 years after the last date of service delivery for adults or until 3 years after a minor reaches age of majority, whichever is later. In some circumstances, P may wish to keep records for a longer period, weighing risks associated with obsolete or outdate info, or privacy loss, vs potential benefits associated with preserving records.

Answer 178

Provided in HIPAA's security rule and in CA Law. H&SC: a) providers of health services that utilize electronic record keeping systems only, shall comply with additional requirements of this section. These additional requirements do not apply to clt records if hard copy versions of clt records are retained; b) any use of electronic record keeping to store clt records shall ensure safety and integrity of those records at least to extent of hard copy records. All providers a) shall ensure safety and integrity of all electronic media used to store clt records by employing an offsite backup storage system, an image mechanism that's able to copy signature documents, and a mechanism to ensure that once a record is input, it is unalterable; c) original hard copies of clt records may be destroyed once record has been electronically stored; d) printout of computerized version shall be considered the original for purposes of providing copies to clts, the Division of Licensing and Certification, and for intro into evidence in administrative/court proceedings; e) access to electronically stored clt records shall be made available to Division of Licensing and Certification staff promptly, upon request; f) this section doesn't exempt licensed clinics, health facilities, adult day health care centers, and home health agencies from requirement of maintaining original copies of clt records that cannot be electronically stored; g) any health care provider subject to this section, choosing to utilize an electronic record keeping system, shall develop and implement policies and procedures to include safeguards for confidentiality and unauthorized access to electronically stored clt health records, authentication by electronic signature keys, and systems maintenance; h) nothing contained in this chapter shall affect the existing regulatory requirements for access, use, disclosure, confidentiality, retention of record contents, and maintenance of health info in clt records by health care providers; i) this chapter doesn't prohibit any provider of health care services from maintaining or retaining clt records electronically

Answer 179

addressed in HIPAA's privacy rule, CA's Patient Access to Health Records Act, CA's Confidentiality of Medical Info Act, and APA's Ethics Code CA Laws are similar to HIPAA's privacy rule or have no analogous provisions in HIPAA. In these circumstances, adhering to CA Law doesn't violate requirements of HIPAA. However, there are circumstances in which HIPAA requirements preempt CA Law For ex, HIPAA's regulation regarding denial of access to records generally preempt CA Law. Under HIPAA, P may deny access to record if determined access is "reasonably likely to endanger the life or physical safety of clt or another person and clt is given the right to have denial reviewed. In contrast, H&SC section permits Ps to deny access when they determine there is a substantial risk of significant adverse or detrimental consequences to a clt in seeing or receiving a copy of records...Bc CA law gives clt less control over their own records, HIPAA's privacy rule preempts CA law and should be considered when determining whether or not to deny a clt's request for access to records other than psychotherapy notes In terms of psychotherapy notes, CA Law preempts HIPAA bc HIPAA allows for an absolute non-reviewable denial of access to psychotherapy notes, but CA law does not. In other words, upon request from a clt, Ps may give clt access to the complete psychotherapy notes or a summary of them or may decline to provide the psychotherapy notes if there is a legal reason for doing so H&SC Section: an adult clt, a minor clt authorized by law to consent to treatment, and a clt representative are entitle to have access to clt's records but must present the leash care provider with a written request for those records... and pay reasonable clerical costs incurred in locating and making the records available... with regard to minor clts, it is consistent with HIPAA's privacy rule and requirement for a written request is consistent with HIPAA as long as provider has informed clt that provider only accepts a written request H&SC Section: prohibits health care providers from withholding clt records or summaries of clt records bc of unpaid bill for health care services. This provision is not consistent with Ethics Code that states Ps may not withhold records under their control that are requested and needed for a clt's emergency treatment solely bc payment has not been received; Ethics Code implies that there would be times when withholding records for nonpayment of fees would be acceptable, but this provision is superseded by requirements of this H&SC section bc it grants clts greater control over their records.

Answer 180

Health and Safety Code specifies requirements regarding the time frame for responding to the request of a clt/clt representative for access to clt's records. Section states a health care provider must permit a clt/clt representative to inspect clt's records during business hours within 5 working days following receipt of written request. Section states that a health care provider must ensure that a copy of clt's record is transmitted to clt/clt representative within 15 days after receipt of a written request for the copy Section allows a health care provider to choose to prepare a summary of the record for inspection or copying, but HIPAA permits this only if clt agrees in advance to receiving a summary... Bc HIPAA grants clts greater right of access, it preempts CA law. For clts who request a summary, provider shall make summary of record available to clt within 10 working days from date of clt's request. However, if more time is needed bc record is of extraordinary length or bc clt was discharged from a licensed health facility within the last 10 days, health care pro shall notify clt of this fact and the date that the summary shall notify clt of this fact, and the date that summary will be completed, but in no case shall more than 30 days elapse between the request by clt and delivery of the summary

Answer 181

In Ethics Code, occurs when P is in a professional role with a person and at same time is in another role with the same person, at the same time is in a rx w/ a person closely associated with or related to person with whom P has the professional rx, or promises to enter into another rx in the future with the person or a person closely associated with or related to person. P refrains from entering into multiple rx if multiple rx could reasonably be expected to impair P's objectivity, competence, or effectiveness in performing his/her functions as a P, or otherwise risks exploitation or harm to person with whom the professional rx exists. Multiple rx that would not reasonably be expected to cause impairment or risk exploitation or harm are not unethical (rural community) as long as special precautions are taken If P finds that, due to unforeseen factors, a potentially harmful multiple rx has arisen, P takes reasonable steps to resolve it with due regard for best interests of the affected person and maximal compliance with Ethics Code When Ps are required by law, institutional policy, or extraordinary circumstances to serve in more than one role in judicial or administrative proceedings, at the outset they clarify role expectations and extent of confidentiality and thereafter as changes occur. Post-therapy rxs with clts or relatives of clts are likely to be unethical.

Answer 182

addressed in Ethics Code and APA's Specialty Guidelines for Forensic Psychology in Ethics Code Standard, Ps are required by law, institutional policy, or extraordinary circumstances to serve in more than one role in a forensic setting, they must clarify role expectations and issues related to confidentiality. Ps should accept dual roles in forensic settings only when doing so is unavoidable in APA Specialty Guidelines for Forensic Psychology, "when requested or ordered to provide either concurrent or sequential forensic and therapeutic services, forensic practitioners are encouraged to disclose the potential risk and make reasonable efforts to refer the request to another qualified provider." When referral is not feasible, P must consider risks and benefits for all parties and must "seek to minimize the potential negative effects of this circumstance."

Answer 183

P refrain from taking on a professional role when personal, scientific, professional, legal, financial, or other interests or rxs could reasonably be expected to 1) impair their objectivity, competence, or effectiveness in performing their functions as Ps or 2) expose person or organization with whom the professional rx exists to harm or exploitation. For ex, unethical for P to provide expert testimony on a contingent fee basis or to recommend mental health services provided by a particular company to clts when P is a co-owner of that company

Answer 184

Gottlieb recommends, when Ps are considering acceptability of a multiple rx, they evaluate each relationship in terms of 3 factors: 1) Power differential: How great is the difference in power between the P and the other person? The more influence the P has over the clt, the less likely the rx is ethical; 2) Duration of rx: What is (was) the length of the rx? The longer the duration of either rx, the more dubious the acceptability of the multiple rx; 3) Clarity of termination: What is the likelihood that the individual will desire additional professional services in the future? The greater the chance that either rx will continue (i.e clt will want to return for additional therapy later), the less acceptable the multiple relationship.

Answer 185

In Ethics Code, a) as early as is feasible in a professional or scientific rx, Ps and recipients of psychological services reach an agreement specifying compensation and billing arrangements; b) Ps' fee practices are consistent with law; c) Ps do not misrepresent their fees; d) if limitations to services can be anticipated because of limitations in financing, this is discussed with the recipient of services as early as is feasible; e) if recipient of services does not pay for services as agreed, and if Ps intend to use collection agencies or legal measures to collect the fees, Ps first inform person that such measures will be taken and provide that person an opportunity to make prompt payment Standard: Ps work out agreements about fees and other financial matters with clts as early as feasible (i.e. missed appointments, arrangements with insurance company or other third party payor, and procedures for collecting unpaid bills) Ps may charged a feed fee(which may be reduced in certain situations) or use a sliding fee scale, which are generally considered acceptable as long as they are fair and serve the best interests of clts bc not addressed in Ethics Code When Clt is experiencing temporary financial crisis, P may temporarily waive or lower fee, schedule fewer appointments, or suspend therapy for an agreed upon period. Unacceptable to abandon clt; and abruptly referring a clt to a lower-cost provider may constitute abandonment if therapeutic rx has been established and treatment is underway. In an emergency situation, P has obligation to continue providing treatment to clt, regardless of ability to pay, until crisis has been resolved. When clt has unpaid fees, P should first discuss matter with clt to attempt to reach agreement accommodating clt's financial situation. If mutually acceptable agreement cannot be reached, P may use a collection agency, but only after notifying clt of intention to do so and giving clt an opportunity to pay fees that are owed within a specified period of time. When collection agency is used, P must give agency only essential info, such as clt's name and address and amount owed Ps may also initiate legal proceedings to collect outstanding fees. Exception to privilege that exists when there has been a breach of duty in therapist-clt rx allows Ps to disclose necessary info during these proceedings Ps are NOT obligated to continue treating a clt who does not pay for services in manner agreed upon but may terminate treatment in an appropriate manner

Answer 186

professional services provided without charge; in aspirational General Principle B (Fidelity and Responsibility) in Ethics Code, P strive to contribute a portion of their professional time for little or no compensation or personal advantage." Pro Bono is recommended but not required by Ethics Code. Note: free sessions should never be used as an enticement to draw new clts into P's practice

Answer 187

in Ethics Code: Ps make reasonable efforts to plan for facilitating services in event that psych services are interrupted by factors such as P's illness, death, unavailability, relocation, or retirement or by clt's relocation or financial limitations...when entering into employment or contractual rxs, Ps make reasonable efforts to provide for orderly and appropriate resolution of responsibility for clt care in the event that employment or contractual rx ends, with paramount consideration given to the welfare of the clt.

Answer 188

Covered by Ethics Code: When Ps pay, receive payment from, or divide fees with another professional, other than in an employer-employee rx, the payment to each is based on the services provided (clinical, consultative, administrative, or other) and is not based on the referral itself. In other words, paying referral fees is not prohibited but, when they are paid to an individual professional (as opposed to a referral service), they must be based on the actual costs and services provided and not simply on the referral itself APA said Ethics Codes doesn't prohibit paying a percentage of a fee to a colleague as the payment is within a reasonable range of the fair market value of the services provided. Referral fees are prohibited by B&PC, which identifies "paying or offering to pay, accepting, or soliciting any consideration, compensation, or remuneration, whether monetary or otherwise, for the referral of clts" as unprofessional conduct and a cause for disciplinary action by BOP

Answer 189

illegal and unethical In CA Insurance Code (legal); and committing fraudulent acts (incl insurance fraud) is in B&PC that calls it unprofessional conduct and a cause for disciplinary action. In Ethics Code: in P's reports to payers for services or sources of research funding, Ps take reasonable steps to ensure the accurate reporting of the nature of the service provided or research conducted, the fees, charges, or payments, and where applicable, the ID of the provider, the findings, and the diagnosis Ex: Routinely waiving copayments is illegal without notifying insurance company; Billing for Missed Appointments is illegal unless arrangement has been agreed to by insurance company; Assigning an Incorrect Diagnosis (must provide insurance company w/accurate diagnosis and accurate info about type of therapy provided)

Answer 190

Ps should notify a clt about the kind and extend of info required by insurance company during informed consent process as well as about any limitations to treatment resulting from company's requirements. If insurance company refuses payment for services a P believes are necessary, best first course of action is to file an appeal on clt's behalf. If appeal is denied, P should discuss the situation with clt to identify options regarding alternative treatment and payment.

Answer 191

in Ethics Code: Ps make reasonable efforts to p

Answer 192

In Ethics Code, a) Ps terminate therapy when it becomes reasonably clear that clt no longer needs the services, is not likely to benefit, or is being harmed by continued service; b) Ps may terminate therapy when threatened or otherwise endangered by clt or another person with whom clt has a rx; c) Except where precluded by the actions of clts or third-party payors, prior to termination Ps provide pretermination counseling and suggest alternative service providers as appropriate In Ethics Code: Ps must terminate therapy with clts who are no longer benefitting from it...Ps terminate therapy when clt or a person clt has a relationship with poses a threat to the P.

Answer 193

in Ethics Code: requires Ps to cooperate with other pros in order to serve their clts effectively and appropriately. Includes obtaining consultation (in ethics code): when consulting with colleagues, 1) Ps do not disclose confidential info that reasonably could lead to identification of a clt, research participant, or other person/organization with whom they have a confidential rx unless they have obtained prior consent of the person or organization or disclose cannot be avoided, and 2) they disclose info only to extent necessary to achieve the purposes of consultation

Answer 194

In Ethics Code: if clt or prospective clt is receiving services from another mental health professional, P must carefully consider the tx issues and the potential clt's welfare. P should discuss these issues with clt, consult with other pro when appropriate, and proceed with caution and sensitivity to the therapeutic issues. When clt is seeking another mental health pro for a different problem, it is likely to be acceptable for a P to continue seeing the clt in therapy. When clt is seeing another mental health pro for same problem a P is treating, best course of action would be for P to discuss ethical obligations w/clt and determine why clt is seeking same services from 2 mental health pros. If P determines that there is no benefit for clt in seeing both pros, the P will want to inform clt that it is inappropriate for him/her to continue treating clt.

Answer 195

Minors can't consent to their own treatment except in legally defined situations CA Family Code states that an EMANCIPATED MINOR shall be considered an adult for purpose of "consent to medical, dental, or psychiatric care, without parental consent, knowledge, or liability." (Legal) Considered emancipated when they meet ANY of the following: a) minor has entered into a valid marriage, whether or not the marriage has been dissolved; b) minor is on active duty with armed forces of USA; c) minor has received a declaration of emancipation from the court. Court may emancipate a minor when it finds emancipating wouldn't be contrary to minor's best interests and when ALL of the following conditions are met: Minor is at least 14 years of age; is living separate and apart from parents/guardian with consent or acquiescence of the parents/guardian; is managing their own financial affairs; and does not obtain income from criminal activity. In addition to giving consent for own medical care, emancipated minors may live where they want to live, can apply for a work permit, and can sign up for school or college. Emancipation doesn't change the driving, drinking, or voting age. Statutory rape laws apply to emancipated minors except when minor is legally married and sexual activity was with spouse

Answer 196

addressed in CA Law and Ethics Code in CCR: permits licensed Ps to advertise pro services authorized to be provided by such license within P's field of competence in a manner authorized under Section 651...so long as such advertising does not promote the excessive or unnecessary use of such services... in B&PC, unlawful for any person doing business in CA and advertising to consumers in CA to make any false or misleading advertising claim, including claims that 1) purport to be based on factual, objective, or clinical evidence, 2) compare the product's effectiveness or safety to that of other brands or products, or that 3) purport to be based on any fact. in Ethics Code regarding ethical guidelines for advertising and other public statements, Ps 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) heir services; 6) scientific or clinical basis for, or results or degree of success of, their services; 7) their fees; or 8) their publications or research findings--- Ps who engage others to create/place public statements that promote their professional practice, products, or activities retain professional responsibility for such statements; Ps do not compensate employees of press, radio, TV, or other communication media in return for publicity in a news item; paid advertisement related to Ps' activities must be identified or clearly recognizable as such Guidelines for descriptions of educational workshops and programs: to degree to which they exercise control,, Ps responsible for announcements, catalogs, brochures, or advertisements describing workshops, seminars, or other non-degree-granting educational programs ensure that they accurately describe the audience for which the program is intended, the educational objectives, the presenters, and the fees involved. Solicitation of Testimonials to include in advertisements or other public statements: Ps do not solicit testimonials from current therapy clts or other persons who bc of their particular circumstances are vulnerable to undue influence. Prohibition against soliciting testimonials is not absolute but applies to testimonials that are solicited "from current therapy clts or other persons who bc of their particular circumstances are vulnerable to undue influence. Clt vulnerability can result from a number of factors incl insecurities, emotional problems, naiveté, lack of info, or even awe of the professional.

Answer 197

Ps do not engage, directly or through agents, in uninvited in-person solicitation of business from actual or potential therapy clts or other persons who bc of their particular circumstances are vulnerable to undue influence. This prohibition does NOT preclude 1) attempting to implement appropriate collateral contacts for purpose of benefitting an already engaged therapy clt or 2) providing disaster or community outreach services.

Answer 198

When Ps 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.

Answer 199

CA's Confdientiality of Medical Info Act and HIPAA's privacy rule require that, except in legally defined situations, a clt's written authorization be obtained before disclosing confidential medical info. When authorization is required for disclosure of the record of a minor, authorization must be signed by minor when the record pertains to services that the minor could lawfully have consented to

Answer 200

H&SC: permits a minor who is at least 12 years of age to consent to outpatient mental health treatment or counseling services if the attending professional person believes the minor "is mature enough to participate intelligently in the tx or services" Professional person includes licensed Ps and credentialed school psychologists Treatment authorized under this section "shall include involvement of minor's parent or guardian, unless the professional person who is treating or counseling the minor, after consulting w/minor, determines that involvement would be inappropriate. Minor's parent or guardian is not liable for payment for mental health treatment or counseling services provided pursuant to this section unless parent/guardian participates in mental health treatment or counseling, and then only for services rendered with participation of parent/guardian Does NOT apply to minors who are receiving benefits under the MediCal program and it does NOT permit minors to consent to inpatient mental health treatment or to receive psychotropic drugs, convulsive therapy, or psychosurgery w/o consent of a parent/legal guardian FC sections: permits a minor who is at least 12 years of age to consent to outpatient mental health services or counseling provided by a professional person, a runaway house or crisis resolution center, or a government agency or agency contracting w/a government agency or receiving community united funds. This is more restrictive than H&SC Section and not only requires minor to be able to "participate intelligently" but also that minor "would present serious physical or mental harm to self or others without the services or... is the alleged victim of incest or child abuse. Like H&SC, this section requires that the treatment involve minor's parent or legal guardian when appropriate and does not permit minors to consent to inpatient mental health treatment or receive psychotropic drugs, convulsive therapy, or psychosurgery without consent of a parent/legal guardian... regarding counseling (not medical care), minor who is 12 years of age or older may consent to medical care and counseling relating to the diagnosis and treatment of a drug- or alcohol-related problem. Does NOT authorize minors to receive replacement narcotic abuse treatment without the consent of a parent/guardian

Answer 201

minors are legally and ethically entitled to a confidential rx w/therapists. this is complicated because in most circumstances, parent/legal guardian of an unemancipated minor has a legal right to access info shared by a minor during treatment P must balance parents' cancers about content and progress in child's therapy against child's need to trust that disclosures will be kept confidential. Balance best achieved through discussion of confidentiality with all parties at onset of treatment but if agreement can't be reached, P can choose not to treat the minor and make an appropriate referral Can break confidentiality when permitted or required to do so by law.

Answer 202

H&SC: minors have right to inspect or obtain a copy of their own records when they pertain to health care for which the minor has consented or could have consented as permitted by law. Ordinarily, provider should not share records or other confidential info with minor's parents or legal guardians without minor's authorization When records do NOT pertain to health care for which minor has legally consented or could have consented, parents or legal guardians of a minor ordinarily have the right to have access to minor's records. Exception to this general rule is provider may rufse to provide parents or legal guardians access to a minor's records when provider "determines hat access to the patient records requested by the representative (parent or legal guardian) would have a detrimental effect on provider's professional relationship with the minor patient or the minor's physical safety of psychological well being. If doing so, provider must include a written description of the reasons for denial of access in minor's record and "permit inspection by, or provide copies of mental health records to, a licensed physician and surgeon, licensed psychologist, licensed marriage and family therapist, or licensed clinical social worker, designated by request of the patient...these requirements are consistent with HIPAA's privacy rule H&SC applies to denial of access to the PARENTS OF MINOR CLTS who are not legally permitted to consent to their own treatment, while other regulations apply to the denial of access to CLIENTS THEMSELVES, which include adult clts and minor clts who are legally allowed to consent to treatment FC: notwithstanding any other provision of law, access to records and info pertaining to a minor child, incl but not limited to, medical, dental, and school records, shall not be denied to a parent bc such a parent is not child's custodial parent (custodial refers to physical custody in this section)

Answer 203

CA's Confdientiality of Medical Info Act and HIPAA's privacy rule require that, except in legally defined situations, a clt's written authorization be obtained before disclosing confidential medical info. When authorization is required for disclosure of the record of a minor, authorization must be signed by minor when the record pertains to services that the minor could lawfully have consented to

Answer 204

Tarasoff v. Board of Regents of the University of California: established a psychotherapist's "duty to warn" the intended victim of a clt; in rehearing, changed to "duty to protect" the intended victim by warning him/her, notifying the police, and/or taking other reasonably necessary steps. CA adopted a Section as an immunity statute designed to protect Ts from monetary liability when a clt communicates a "serious threat of physical violence against a reasonably identifiable victim or victims" and the T discharges the duty to protect by making a reasonable effort to communicate the threat to the victim(s) and to a law enforcement agency. To determine whether a situation warrants a duty to protect, P must determine that there's a "reasonably identifiable victim" and that there's a "serious threat of physical violence." Unless a P can identify a specific victim(s), there is no duty to protect. If a clt's dangerousness is attributable to a mental disorder and no victim is readily identifiable, hospitalization is an option "serious threat of physical violence" where "serious" is open to interpretation. To determine if a clt's threat is serious, P would want to consider clt's past history of violence and the context in which they made the threat...when meaning of clt's threat is unclear, consultation is a good strategy When discharging duty to protect, Ps should disclose only info needed to protect the intended victim - P's name, name of clt, name ov victim, and content of threat

Answer 205

expanded meaning of a clt's communication to include communications from clt's "immediate family members." Ex, court concluded communication from a clt's family member may trigger a T's duty to protect....concluded that "serious" and "physical violence" to include "grave bodily injury...which is short of murder, but akin to 'mayhem' or 'serious body injury' as defined by statute

Answer 206

EC Section: exception to T-Clt privilege when clt poses danger to self, others, or the property of others;;; medical info may be disclosed, consistent with applicable law and standards of ethical conduct, by a psychotherapist...if T, in good faith, believes the disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a reasonably foreseeable victim(s), and the disclosure is made to a person(s) reasonably able to prevent or lessen the threat, including the target of the threat

Answer 207

WIF Section 5150: conditions for a 72-Hour Hold: when any person, as a result of a mental disorder, is a danger to others, or to self, or gravely disabled, a peace officer, a member of the attending staff of an evaluation facility designated by the county, designated members of a mobile crisis team, or other professional person designated by a county, may upon probable cause, take, cause to be taken, the person into custody and place him or her in a facility designated by the county and approved by the State Department of Mental Health as a facility for 72 hour treatment and evaluation. 5230 is similar to 5150 but applies to individuals who are impaired as result of alcohol or drug use. "If, upon evaluation, the person is found to be in need of treatment because he is, as a result of impairment by chronic alcoholism or the use of narcotics or restricted dangerous drugs, a danger to others, or to himself, or is gravely disabled, he may be detained for treatment in a facility for 72-hour treatment and evaluation." Gravely Disabled: means either of the following: a) a condition in which a person, as a result of a mental disorder, is unable to provide for basic personal needs for food, clothing, or shelter; b) a condition in which a person has been found mentally incompetent and all of the following facts exist: i) the indictment or info pending against the defendant at the time of commitment charges a felony involving death, great bodily harm, or a serious threat to the physical well-being of another person; ii) the indictment/info has not been dismissed; iii) as a result of mental disorder, person is unable to understand nature and purpose of the proceedings taken against him/her and to assist counsel in the conduct of his/her defense in a rational manner. ; also means "a condition in which a person, as a result of impairment by chronic alcoholism, is unable to provide for basic personal needs for food, clothing, or shelter. It does not include "mentally retarded persons by reason of being mentally retarded alone." CA courts have interpreted "mental disorder" to include any significant mental disorder in current edition of DSM P or any person over 18 may initiate/activate an involuntary hold but only certain individuals may INSTITUTE an involuntary hold - i.e. police officers, members of attending staff of an evaluation facility designated by county, etc. WIC Section 5152 requires each person admitted to a facility for 72-hour treatment and evaluation shall receive an evaluation as soon after he/she is admitted as possible and shall receive whatever treatment and care his/her condition requires for the full period that he/she is held. Person will be released before 72 hrs if psychiatrist directly responsible believes as a result of personal observations, that person no longer requires evaluation/treatment. If any other professional person authorized to release person, believes person should be released before 72 hrs and psychiatrist objects, medical director of facility makes final decision At end of 72 hr period, facility must release individual, refer individual for voluntary treatment, certify individual for additional involuntary treatment, or begin process of appointing a conservator

Answer 208

duty to protect when a clt who is HIV positive reveals that they are sharing needles or engaging in unprotected sex with an identifiable partner remains a grey area CA Law protects physicians and surgeons from criminal and civil liability when they notify the spouse, sexual partners, or needle-sharing partners of a clt who has tested positive for HIV; but there is no legislation for Ts. Unclear whether transmitting a potentially life-threatening disease meets criterion of "physical violence" When clt who is HIV positive says they are planning to share needles or have unprotected sex with an identifiable partner, you're options are: 1) initial course of action would ordinarily be to maintain clt's confidentiality and encourage clt to engage in safe practices or notify sexual and needle-sharing partners about their HIV serostatus; P may offer to help clt make the disclosure; T should also discuss possible legal consequences of engaging in unsafe sex and needle-sharing. P who fails to do so may be liable for negligence 2) If P believes clt's danger to others (threat to infect another person with HIV) is due to a mental disorder, P may involuntarily hospitalize the clt. 3) P may decide to breach clt's confidentiality in order to protect the intended victim; but before doing so, P should explain the decision to clt and attempt to get clt's consent. If clt does NOT consent and P breaches confidentiality, P may be charged with profession misconduct and face legal action by the clt (this situation has not been legally tested). Consulting with a colleague and/or attorney is always a good strategy to help determine the best course of action. To reduce risk of liability, consultations, discussions w/clt, and the rationale for any decision and actions should be documented in clt's file.

Answer 209

When clt's behavior warrants hospitalization, voluntary hospitalization is always preferable, and involuntary commitment should be considered only when following conditions are met: 1) danger that clt poses to self or others is imminent or clt is gravely disabled; 2) the danger or grave disability is the result of a mental disorder or chronic alcoholism; and 3) clt has refused or is unable to comply w/a recommendation to enter a psychiatric hospital voluntarily

Answer 210

Lanterman-Petris-Short Act provide regulations related to involuntary commitment. Commitment begins w/72 hour hold (a "5150"), which may be followed by a 14-day hold (a "5250) and then additional post certification holds

Answer 211

authorization from a parent/guardian is ordinarily required before a minor can be hospitalized; however, Children's Civil Commitment and Mental health Treatment Act provides an exception to this general rule: "when any minor, as result of mental disorder, is a danger to others, or to self, or gravely disabled and authorization for voluntary treatment is not available, a peace officer, member of attending staff of an evaluation facility designated by county, designated members of a mobile crisis team, or other professional person designated by county may, upon probably cause, take, or cause to be taken, the minor into custody and place him/her in a facility designated by county and approved by State Department of Mental Health as a facility for 72 hr treatment and evaluation of minors. Facility makes every effort to notify minor's parent/legal guardian as soon as possible after minor is detained (5585) gravely disabled minor = minor who, as a result of mental disorder, is unable to use elements of life which are essential to health, safety, and development, including food, clothing, and shelter, even though provided to minor by others. Mental retardation, epilepsy, or other developmental disabilities, alcoholism, other drug abuse, or repeated antisocial behavior do not, by themselves, constitute a mental disorder require that a clinical evaluation be conducted and that, as indicated by the evaluation, a treatment plan written that provides for "the least restrictive placement alternative in which minor can receive the necessary treatment...family, legal guardian, or caretake and minor shall be consulted and informed as basic recommendations for further treatment and placement requirements. Every effort shall be made to obtain consent of minor's legal guardian prior to treatment and placement....inability to obtain consent of legal guardian shall not preclude involuntary treatment of a minor who is danger to self, others, or gravely disabled

Answer 212

WIC Section 5250: permits a person who has been detained for 72 hours and received an evaluation to be certified for up to 14 additional days for intensive treatment related to a mental disorder or chronic alcoholism when following conditions have been met: a) as result of mental disorder or chronic alcoholism, person is a danger to self or others or is gravely disabled and b) person has been advised that treatment is required but has not voluntarily consented to it Section 5251 and 5253 require a notice of certification be signed by two people (the professional person or their designee in charge of the facility or agency providing evaluation services and a physician/psychologist who participated in the evaluation) and that a copy of the notice be personally deliver to the person certified, person's attorney, or other attorney or advocate designated in the certificate. Also, individual delivering the certification notice must inform person they are entitle to a certification review hearing to determine if there is sufficient reason to detain him/her (5254) or to a judicial review by writ of habeas corpus to ask for a release from the certification (5254.1) Section 5256 requires that, unless person has requested a judicial review, certification review hearing (which is also referred to as "probable cause hearing" and is conducted by court-appointed commissioner or referee or by a certification review hearing officer) must be held within 4 days of the date on which the person is certified unless person or their attorney or advocate requests a postponement which can be for up to 48 hrs (or in small counties, next scheduled hearing date). Person may waive right to a certification review hearing or right to be present at hearing. Section 5276 (Judicial Review by writ of habeas corpus): judicial review shall be in the superior court for the county in which facility providing intensive treatment is located or in the county in which the 72-hour evaluation was conducted if clt or a person acting on their behalf informs professional staff of the evaluation facility (in writing) that judicial review will be sought. No patient shall be transferred from county providing evaluation services to a different county for intensive treatment if staff of evaluation facility has been informed in writing that a judicial review will be sought, until completion of the judicial review. Person requesting to be released shall be informed of right to counsel by member of treatment staff and by the court; and, if clt elects, court shall immediately appoint public defender or other attorney to assist clt in preparation of a petition for the writ of habeas corups and, if clt so elects, to represent clt in proceedings. At end of 14 day hold, facility must release clt, refer clt for voluntary treatment, certify clt for additional involuntary treatment (initiate a post certification hold), or begin process of appointing a conservator

Answer 213

Types of Child Abuse and Neglect: Physical abuse: physical injury or death inflicted by other than accidental means on child by another person...does NOT include "mutual affray between minors" or "reasonable and necessary force used by peace officer acting within course and scope of employment as peace officer." Sexual Abuse: sexual assault (incl rape, statutory rape, rape in concert, incest, sodomy, lewd/lascivious acts oral copulation, sexual penetration, and child molestation) and sexual exploitation (preparing, selling, or distributing porno materials involving a minor; employing a minor to perform obscene acts; and employing or coercing a child to engage in prostitution; note: must report sexual intercourse of other sexual activity with a minor under 18 when reasonabile suspicion that activity was not consensual, even when minor claims it was consensual regardless of partner's age....lewd and lascivious acts involving a minor must always be reported regardless of consent when a) minor is under 14 years and partner/perpetrator is 14 years or older; b) minor is 14 years of age and partner/perpetrator is 24 years or older; or c) minor is 15 years and partner/perpetrator is 25 years or older...in other words, consensual sexual intercourse is NOT reportable when both minors are under age 14 and are similar in age or when a minor is 14 or 15 and partner is over 14 but under 21. Willful harm or injury: when person willfully causes or permits any child to suffer, or inflicts thereon, unjustifiable physical pain or mental suffering, or having the care or custody of any child, willfully causes or permits the person or health of the child to be placed in a situation in which his/her person or health is endangered (fetal abuse is NOT reportable child abuse in CA and consequently, Ts must consider other options for protecting an unborn child) Unlawful corporal punishment or injury: when any person willfully inflicts upon any child any cruel or inhuman corporal punishment or injury resulting in a traumatic condition" (does NOT include "force that is reasonable and necessary for person employed by or engaged in a public school to quell a disturbance threatening physical injury to a person or damage to property, for purposes of self-defense, or to obtain possession of weapons or other dangerous objects within control of the pupil. Not included is reasonable and age-appropriate spanking to buttocks where there's no evidence of serious physical injury. Neglect: negligent treatment or maltreatment of a child by a person responsible for child's welfare under circumstances indicating harm or threatened harm to child's health/welfare...and includes both acts and omissions on part of reasonable person Severe neglect: negligent failure of person having care or custody of a child to protect child from severe malnutrition or medically diagnosed nonorganic failure to thrive General neglect: negligent failure of a person have care/custody of a child to provide adequate food, clothing, shelter, medical care, or supervision where no physical injury to child has occurred. Receiving treatment only by spiritual means or not receiving treatment for religious reasons does not in itself constitute neglect. MAY but not required to report "serious emotional damage" evidenced by states of being or behavior, including, but not limited to, severe anxiety, depression, withdrawal, or untoward aggressive bx toward self or others, may make a report

Answer 214

conservator may be appointed by the court for any person who is gravely disabled as result of a mental disorder or impairment by chronic alcoholism (5350). Conservatorship may be temporary (30-days) or long-term (for renewable one-year periods) Sections 5350(e)(1) and (2): Gravely disabled = a person is not gravely disabled if that person can survive safely without involuntary detention with help of responsible family, friends, or others who are both willing and able to help provide for person's basic personal needs for food, clothing, or shelter...and unless they specifically indicate in writing their wiliness and ability to help, family, fiends, or others shall not be considered willing or able to provide this help.; Section 5352: within 10 days after conservatorship of person has been established, there shall be individualized treatment plan unless treatment is specifically found not to be appropriate by the kurt...when progress review determines that goals (of tx) have been reached and person is no loner gravely disabled, person designated by county shall so report to court and conservatorship shall be terminated by court

Answer 215

authorization from a parent/guardian is ordinarily required before a minor can be hospitalized; however, Children's Civil Commitment and Mental health Treatment Act provides an exception to this general rule: "when any minor, as result of mental disorder, is a danger to others, or to self, or gravely disabled and authorization for voluntary treatment is not available, a peace officer, member of attending staff of an evaluation facility designated by county, designated members of a mobile crisis team, or other professional person designated by county may, upon probably cause, take, or cause to be taken, the minor into custody and place him/her in a facility designated by county and approved by State Department of Mental Health as a facility for 72 hr treatment and evaluation of minors. Facility makes every effort to notify minor's parent/legal guardian as soon as possible after minor is detained (5585) gravely disabled minor = minor who, as a result of mental disorder, is unable to use elements of life which are essential to health, safety, and development, including food, clothing, and shelter, even though provided to minor by others. Mental retardation, epilepsy, or other developmental disabilities, alcoholism, other drug abuse, or repeated antisocial behavior do not, by themselves, constitute a mental disorder require that a clinical evaluation be conducted and that, as indicated by the evaluation, a treatment plan written that provides for "the least restrictive placement alternative in which minor can receive the necessary treatment...family, legal guardian, or caretake and minor shall be consulted and informed as basic recommendations for further treatment and placement requirements. Every effort shall be made to obtain consent of minor's legal guardian prior to treatment and placement....inability to obtain consent of legal guardian shall not preclude involuntary treatment of a minor who is danger to self, others, or gravely disabled

Answer 216

as legally mated reporters, Ps, in professional capacity or within scope of employment, must report known or suspected cases of abuse and neglect of children and adolescents under 18, including minors who are emancipated, regardless if perpetrator is an adult or child. CAj Child Abuse and Neglect Reporting Act: report to agency immediately or as soon as is practicably possible by telephone and mandated reported shall prepare and send, fax, or electronically transmit a written followup report thereof within 36 hours of receiving the information concerning the incident. may inccl with report any nonprivilged documentary evidence the mandated reporter possesses related to incident. "Reasonable suspicion" means that it is objectively reasonable for a person to entertain a suspicion, based upon facts that could cause a reasonable person in a like position, drawing, when appropriate, on training and experience, to suspect child abuse or neglect....pregnancy in a minor does not, in and of itself, constitute a basis for a reasonable suspicion of sexual abuse. Reports of child abuse/neglect is made to any police department or sheriff's department, not including a school district police or security department, county probation department, if designated by county to receive mandated reports, or the county welfare department (also referred to as County Welfare Service (CWS) agency and Childe Protective Services (CPS)) When two or more persons who are required to report, jointly have knowledge of a known/suspected child abuse/neglect, when there is agreement among them, telephone report may be made by a member of the team selected by mutual agreement and a single report may be made and signed by the selected member of the reporting team. Any member who has knowledge that member designated to report has failed to do so shall thereafter make the report.

Answer 217

Types of Child Abuse and Neglect: Physical abuse: physical injury or death inflicted by other than accidental means on child by another person...does NOT include "mutual affray between minors" or "reasonable and necessary force used by peace officer acting within course and scope of employment as peace officer." Sexual Abuse: sexual assault (incl rape, statutory rape, rape in concert, incest, sodomy, lewd/lascivious acts oral copulation, sexual penetration, and child molestation) and sexual exploitation (preparing, selling, or distributing porno materials involving a minor; employing a minor to perform obscene acts; and employing or coercing a child to engage in prostitution; note: must report sexual interocourse of other sexual activity with a minor under 18 when reaonsabile suspicion that activity was not consensual, even when minor claims it was consensual regardless of partner's age....lewd and lascivious acts involving a minor must always be reported regardless of consent when a) minor is under 14 years and partner/perpetrator is 14 years or older; b) minor is 14 years of age and partner/perpetrator is 24 years or older; or c) minor is 15 years and partner/perpetrator is 25 years or older Willful harm or injury: when person willfully causes or permits any child to suffer, or inflicts thereon, unjustifiable physical pain or mental suffering, or having the care or custody of any child, willfully causes or permits the person or health of the child to be placed in a situation in which his/her person or health is endangered (fetal abuse is NOT reportable child abuse in CA and consequently, Ts must consider other options for protecting an unborn child) Unlawful corporal punishment or injury: when any person willfully inflicts upon any child any cruel or inhuman corporal punishment or injury resulting in a traumatic condition" (does NOT include "force that is reasonable and necessary for person employed by or engaged in a public school to quell a disturbance threatening physical injury to a person or damage to property, for purposes of self-defense, or to obtain possession of weapons or other dangerous objects within control of the pupil. Not included is reasonable and age-appropriate spanking to buttocks where there's no evidence of serious physical injury. Neglect: negligent treatment or maltreatment of a child by a person responsible for child's welfare under circumstances indicating harm or threatened harm to child's health/welfare...and includes both acts and omissions on part of reasonable person Severe neglect: negligent failure of person having care or custody of a child to protect child from severe malnutrition or medically diagnosed nonorganic failure to thrive General neglect: negligent failure of a person have care/custody of a child to provide adequate food, clothing, shelter, medical care, or supervision where no physical injury to child has occurred. Receiving treatment only by spiritual means or not receiving treatment for religious reasons does not in itself constitute neglect. MAY but not reuiqred to report "serious emotional damage" evidenced by states of being or behavior, including, but not limited to, severe anxiety, depression, withdrawal, or untoward aggressive bx toward self or others, may make a report

Answer 218

WIC Section: members of a multidisciplinary personnel team engaged in the prevention, identification, management, or treatment of child abuse/neglect may disclose and exchange info and writings to and with one another related to any incidents of child abuse that may also be a part of a juvenile court record or otherwise designated as confidential under state law if member of the team having that info or writing reasonably believes it is generally relevant to the prevention, identification, management, or treatment of child abuse, or the provision of child welfare services. All related discussions are confidential and testimony concerning any such discussion is not admissible in any court proceedings

Answer 219

must be sensitive to clt's cultural or religious values/beliefs when evaluating whether clt's behavior constitutes child abuse/neglect and should take into account legitimate differences in childrearing practices. At same time, must abide by requirements of Child Abuse and Neglect Reporting Act.

Answer 220

Failure to report may also lead to criminal penalties such as to civil liability as well as disciplinary action by licensing board. Section: failure to report = guilty of a misdemeanor punishable by up to 6 months confinement in a county jail or by a fine of 1000 or by both. If someone tries to conceal a failed mandated report, it is a continuing offense until discovered Section: any mandated reporter willfully fails, impedes or inhibits a report of abuse/neglect where abuse/neglect results in death or great bodily injury, shall be punished not more than one year in a county jail, by a fine of not more than $5k, or both

Answer 221

as mandated reporters, Ps aren't legally required to tell involved individuals. However, if P foresees a future therapeutic relationship with an involved individual, usually best to advice clt of intent to make a report unless doing so is contraindicated a way to notify clts of legal mandate is to include it in confidentiality forms or NPP when therapy begins; P can remind clt during therapy process

Answer 222

unless the victim of abuse is still under 18, mandated reporter is not required to report regarding abuse of that person. However, Ps should consider possibility that an adult clt's abuser may be currently victimizing other children and thus, must file a report if a reasonable suspicion arises...if in doubt, call CPS anonymously to ask for guidance...P may advise clt to file assault charges or initiate civil action for damages and this process can be therapeutic for clt to experience in taking control of situation and confronting it. Important to inform clt of potential negative consequences of such actions and allow clt to make decision

Answer 223

must be sensitive to clt's cultural or religious values/beliefs when evaluating whether clt's behavior constitutes child abuse/neglect and should take into account legitimate differences in childrearing practices

Answer 224

When Ps learn about child abuse from a third party, they must make a report if info is revealed to them in their professional capacity...meaning they do not have to hear directly from perpetrator or victim

Answer 225

in Elder Abuse and Dependent Adult Civil Protection Act Elder is any person residing in California who is 65 years of age or older Dependent adult is any person between 18-64 years who resides in CA and "has physical or mental limitations that restrict ability to carry out normal activities or to protect his/her rights, including, but not limited, to persons who have physical or developmental disabilities, or whose physical/mental abilities have diminished because of age...or who is admitted as an inpatient to a 24 hour health facility Section: mandated reporter who, in professional capacity or scope of employment, has observed, has knowledge of an incident, or has been told by an elder or dependent adult that the elder or dependent adult "has experienced bx, including an act or omission, constituting physical abuse..., abandonment, abduction, isolation, financial abuse, or neglect, or reasonably suspects that abuse, shall report the known or suspected instance of abuse by telephone or through a confidential Internet reporting tool immediately or as soon as practicably possible. If reported by telephone, written report shall be sent, or an internet report shall be made through confidential Internet reporting tool within TWO working days Agency/individual authorized to receive a report of elder/dependent adult abuse depends on where abuse occurred and type of abuse. Mandated reporter is NOT required to file a report when told by elder/dependent adult that clt has experienced an act that constitutes reportable abuse but ALL of the following apply: 1) mandated reporter does not have any independent corroborating evidence that abuse occurred; 2) adult has diagnosis of dementia or a mental illness or is subject of a court-ordered conservatorship because of dementia or a mental illness; and, 3) based on P's clinical judgment, mandated reporter reasonably believe abuse has not occurred Ps are mandated to report cases of spousal/partner abuse that they learn in course of practice only when partner being abused is an elder/dependent adult or is under age 18.

Answer 226

CA Law determines/defines these differently but all of these MUST be reported by mandated reporters: Physical Abuse: assault, battery, assault with a deadly weapon or force likely to produce great bodily injury, unreasonable physical constraint or prolonged or continual deprivation of food or water, sexual assault (which includes rape, spousal rape, incest, sodomy, oral copulation, sexual penetration, and lewd or lascivious acts), and use of a physical or chemical restraint or psychotropic medication for punishment for a period beyond that for which the medication was ordered by physician providing medical care of for any purpose not authorized by physician. Abandonment: desertion or willful forsaking of an elder or a dependent adult by anyone having care or custody of that person under circumstances in which a reasonable person would continue to provide care and custody. Abduction: removing an elder or dependent adult from CA or restraining person from returning to CA when elder/dependent adult doesn't have capacity to consent to removal or restraint or when conservator or the court has not consented to the the removal or restraint Isolation: deliberately preventing an elder/dependent adult from receiving mail or phone calls; telling a caller/visitor that an elder or dependent adult is not present or does not want to talk to them when statement is contrary to elder/dependent adult's wishes and/or is made for purpose of preventing the elder/dependent adult from having contact with family members, friends, or other concerned individuals, false imprisonment of the elder/dependent adult; and physical restraint of an elder or dependent adult for purpose of preventing clt from meeting w/visitors. These are acts of isolation unless instructed by licensed physician or in response to threat of danger to a person's physical safety or property Financial Abuse: when a person/entity "takes, secretes, appropriates, or retains real or personal property of an elder/dependent adult to a wrongful use or with intent to defraud or assists in doing so Neglect: negligent failure of any person having the care or custody of an elder or dependent adult to exercise the degree of care that a reasonable person in a similar position would provide. Includes a failing a) to assist in personal hygiene; b) to provide food, clothing, shelter, or necessary physical or mental health care; or c) to protect the adult from health or safety hazards or from malnutrition or dehydration. Includes self-neglect that is a result of impaired cognitive functioning, mental limitation, substance abuse, or chronic health problems Law provides mandated reporter MAY make a report when has knowledge of, or reasonably suspects, that types of elder or dependent adult abuse for which reports are not mandated have been inflicted

Answer 227

Reports of suspected abuse of an elder/dependent adult and info contained therein may be disclosed only to the following: 1) persons/agencies to whom disclosure of info or the identity of the reporting party is permitted; 2) persons who are trained and qualified to serve on multidisciplinary personnel teams may disclose to one another info and records that are relevant to the prevention, identification, or treatment of abuse of elderly or dependent persons. Multidisciplinary personnel members are bound by same confidentiality

Answer 228

not civilly or criminally liable for making a report authorized by law, unless it can be proven they knew the report was false

Answer 229

criminal pentalies may be imposed if mandated reporter fails to report... a misdemeanor, punishable by not more than 6 months in county jail, by a fine of not more than $1k or both. Failure to report that results in death or great bodily injury shall be punished by not more than one year in a county jail, by a fine of not more than $5k or both

Answer 230

may be held criminally and civilly liable for engaging in sexual relations w/clts and may lead to disciplinary action by licensing board

Answer 231

stabled by B&PC Section: P who engages in an act of sexual intercourse, sodomy, oral copulation, or sexual contact with a clt, or with former clt when rx was terminated primarily for purpose of engaging in those acts...is guilty of sexual exploitation. No instance shall consent of clt be a defense. Penalties for sexual exploitation: a) imprisonment in county jail for no more than 6 months or fine of $1k or both b) multiple violating acts with single victim, when offender has no prior conviction for sexual exploitation, imprisonment in a county jail for a period of not more than 6 months, or a fine not exceeding $1k, or both c) violating acts (a) with 2 or more victims shall be punishable by imprisonment in the state prison for a period of 16 months, two years, or three years, and a fine not exceeding $10k; or act(s) shall be punishable by imprisonment in a county jail for a period of not more than 1 year, or a fine not exceeding $1k, or both d) 2 or more acts in violation w/a single victim, when offender has at least one prior conviction for seal exploitation, shall be punishable by imprisonment in the state prison for a period of 16 months, two years, or three years, and a fine not exceeding $10k; or act(s) shall be punishable by imprisonment in a county jail for a period of not more than 1 year, or a fine not exceeding $1k, or both e) act(s) in violation with 2 or more victims, and offender has at least 1 prior conviction for sexual exploitation, imprisonment in the state prison for a period of 16 months, 2 year, or 3 years, and a fine not exceeding $10k

Answer 232

California Civil Code (CC): current or former clt can claim injury caused by sexual contact w/P if sexual contact ("touching of an intimate part of another person and includes sexual intercourse, sodomy, and oral copulation) occurred under any of the following: 1) during period clt was receiving therapy from P; 2) within 2 years following termination of therapy; 3) by means of therapeutic deception ("a representation by a P that sexual contact with P is consistent with or part of clt's or former clt's treatment") in B&PC: defines unprofessional conduct by Ps: any act of sexual abuse, or sexual relations with a clt or former clt within 2 years following termination of therapy, or sexual misconduct that is substantially related to qualifications, functions, or duties of a P or psych assistant or registered P. Disciplinary Action by BOP for sexual relations with clt is specified in B&PC section: any finding of fact that licensee or registrant engaged in any act of sexual contact when that act is w/clt, or with a former clt within 2 years following termination of therapy, shall contain an order of revocation which shall not be stayed by the administrative law judge.

Answer 233

in Ethics Code: Sexual Intimacies with Current Therapy Clts: prohibited. "sexual intimacies" are generally interpreted as incl intercourse, fondling, erotic hugging, and communications intended to elicit sexual arousal. Sexual Intimacies with Former Therapy Clts: prohibited (a) for at least 2 years after cessation or termination of therapy; (b) to have sexual intimacies with former clts even after 2 year interval except in most unusual circumstances where P must bear the burden of demonstrating that there has been no exploitation, in light of all relevant factors, incl 1) amount of time that has passed since therapy terminated; 2) nature, duration, and intensity of therapy; 3) circumstances of termination; 4) clt's personal history; 5) clt's current mental status; 6) likelihood of adverse impact on clt; and 7) any statements or actions made by T during course of therapy suggesting or inviting the possibility of a post termination sexual or romantic relationship with clt Sexual Intimacies with Relatives or Significant Others of Current Therapy Clts: prohibited and do not terminate therapy to circumvent this standard Therapy with former Sexual Partners: prohibited Sexual Relationships with Students and Supervisees: P do not engage in sexual rxs w/students or supervisees who are in their department, agency, or training center or whom Ps have or are likely to have evaluative authority

Answer 234

When P learns that a college has had sexual relations w/therapy clt, P is ethically and legally obligated to take steps to protect welfare of clt. 1) when clt reports having sex w/another therapist, P is legally required to give clt the brochure Professional Therapy Never Includes Sex and discuss contents of brochure with clt. P must also file a child abuse report when clt is a minor or when clt is an adult but was a minor when sexual contact occurred and the P has reasonable suspicion that T is still abusing minor clts. However, if clt was an adult when sexual contact occurred, P should not reveal any info without clt's consent. When college discloses to a P that they had, or is having, a sexual rx with an adult clt, P should carefully weigh the ethical and legal implications of taking action. Consider Informal Resolution of Ethical Violations and Reporting Ethical Violations standards of the Ethics Code. Although it may be possible to resolve the situation informally, sexual relationship w/clt may not be appropriate for informal resolution. NOTE: P would NOT be able to file a complaint with licensing board or the APA against colleague if doing so violates clt's confidentiality, which takes precedence over the responsibility to report the colleague for misconduct.

Answer 235

defined in APA's Specialty Guidelines for Forensic Psychology Forensic Psychology refers to professional practice by any psychologist working within any sub-discipline of psychology (i.e., clinical, developmental, social, cognitive) when applying the scientific, technical, or specialized knowledge of psychology to the law to assist in addressing legal, contractual, and administrative matters. Guidelines notes that professional practice is not necessarily forensic simply bc it occurs in a forensic setting. For ex, offering expert opinion in a legal proceeding represents practice of forensic psych but providing "psych testimony that is solely based on the provision of psychotherapy and does not include psycholegal opinions is not ordinarily considered forensic practice.

Answer 236

Expert witness: person who has special training, knowledge, skill, or experience in an area relevant to resolution of the legal dispute and who is allowed to offer an opinion as testimony in court Fact witness: person who testifies as to what he/she has seen, heard, or otherwise observed regarding a circumstance, event, or occurrence as it actually took place...fact witnesses are generally not allowed to offer opinion, address issues that they do not have personal knowledge of or respond to hypothetical situations. Fact witness may provide info about clt in a legal proceeding only w/consent of clt or a court order.

Answer 237

testimonial privilege may be waived by clt and does not apply in certain legally defined situations. EC Section: no therapist-clt privilege in a proceeding in which clt's emotional condition has been raised as an issue by clt or clt's representative...also specifies, in some circumstances, there's no privilege when P has been appointed by court to evaluate a clt to help court determine if defendant is competent to stand trial or ascertain defendant's state of mine ("sanity") at time of crime. Specialty Guidelines for Forensic Psych: requires forensic Ps to recognize their ethical obligations to maintain confidentiality of info relating to a clt or retaining party, except insofar as disclosure is consented to by the clt or retaining party, or required or permitted by law. W/limitations on privilege and confidentiality, forensic P informs service recipient of nature and purpose of treatment and limitations on confidentiality and privilege when goals of treatment are determined by a legal authority Forensic Ps using case materials for purposes of teaching, training, or research strive to present such info in a fair, balanced, and respectful manner while attempting to protect the privacy of persons by disguising confidential, personally identifiable info of all persons/entities who could reasonably claim a privacy interest; using only those aspects of the case avail in the public domain; or obtaining consent from relevant clts, parties, participants, and organizations to use materials for such purposes Ethical requirements related to confidentiality: court ordered or otherwise mandated psych services, Ps inform individual of nature of anticipated services, including whether services are court-ordered or mandated and any limits of confidentiality, before proceeding. Ps ordinarily asked to inform court about attendance of therapy sessions and to provide court with progress reports. In most circumstances, clt must have signed a release before P may do so.

Answer 238

Specialty Guidelines for Forensic Psych requires Ps to strive to inform service recipients about nature and parameters of services to be provided and to do so as soon as is feasible. Unless court ordered, Ps obtain informed consent of examinee before proceeding w/forensic examination. If examinee is unwilling, P may consider postponing exam, advise examinee to contact attorney, and notifying the retaining party about examinee's unwillingness to proceed. When person is ordered/mandated to participate in an examination/treatment, P can conduct exam over the objection and without the consent, of examinee...If examinee is unwilling, P may consider postponing exam, advise examinee to contact attorney, and notifying the retaining party about examinee's unwillingness to proceed. When person is lacking the capacity to give informed consent, P provides an appropriate explanation, seeks examinee's assent, and obtains appropriate permission from a legally authorized prson, as permitted or required by law

Answer 239

Insanity is a legal concept, and most legal definitions reflect the rule set forth by the American Law Institute, which states that a person is not guilty by reason of insanity (i.e., is not responsible for alleged act) when, because of a mental disease or defect, "that person lacks substantial capacity to appreciate the wrongfulness of the act or lacks substantial capacity to behave according to requirements of law. In any criminal proceeding in CA, including juvenile court proceeding, in which a plea of not guilty be reasons of insanity is entered, this defense shall be found by the trier of fact only when the accused person proves by a preponderance of the evidence that he/she was incapable of knowing or understanding the nature and quality of his/her act and of distinguishing right from wrong at the time of the commission of the offense-and it cannot be solely on basis of a personality or adjustment disorder, seizure disorder, or an addiction to, or abuse of, intoxicating substances

Answer 240

Definition: court document requiring a person to appear to give testimony at a deposition or in court, while a subpoena duces mecum requires a person to personally bring to the court proceeding a specified document/property in his/her posession or under his/her control...individuals issuing subpoena include judge, county clerk, and attorney for plaintiff or defendant.

Answer 241

APA's Committee on Legal Issues published guidelines for RESPONDING TO A SUBPOENA requesting disclosure of clt records, test data, or other confidential info. Recommendations: 1st step = determine if it is a legally valid demand (ex, may not be valid bc court does not have jurisdiction over P or bc subpoena was improperly served)...If subpoena is valid, a formal response will be required, but the P should first contact clt to discuss implications of providing the requested info. If clt consents to disclosure, no reasons for withholding the info (i.e. protect clt's welfare or test security), P should provide requested info. If clt does not consent, P or his/her attorney can attempt to negotiate with the party who issued subpoena. If requesting party continues to demand info to be provided, P can seek guidance from court informally through a letter or have his/her attorney file a motion to quash the subpoena or a motion for a protective order. 2nd step = When request for confidential info arises for first time during court testimony or at a deposition, P should claim privilege on clt's behalf and refuse to provide the info until ordered by the court to do so. This is consistent with requirements of EC Section (P who received or made a communication subject to the privilege under this article shall claim privilege whenever he is present when the communication is sought to be disclosed and is authorized to claim privilege) 3rd step = When court issues an order to provide testimony or produce documents and attempts to have the order modified or vacated have been unsuccessful, P must comply with order to avoid being held in contempt of court. To be consistent with ethical guidelines, P should release to the court only info that is relevant to the case and present the subpoenaed records to the court in a sealed envelope marked "confidential." It is illegal to destroy or tamper with records for purpose of avoiding disclosure

Answer 242

Definition: malpractices cases are civil suits that require the plaintiff (clt) to prove his/her claim by a "preponderance of the evidence," which means that plaintiff must establish that there is a standard of care that the P deviated from it. Often involves testimony from expert witnesses, but in some cases, standard of care is derived from legal stattues, articles in professional journals, or third-party payers such as private, state, and federal insurance companies.

Answer 243

4 conditions must be met: 1) P must have had a professional relationship w/person, which established a legal duty of care; 2) there must be a demonstrable standard of care that P has breached; 3) person suffered harm/injury; 4) P's breach of duty within context of standard of care was the proximate cause of person's harm or injury

Answer 244

damages awarded to plaintiff in malpractice suits are of 3 types: 1) award of compensatory damages is based on assumption that plaintiff should be restored to his/her pre-harm condition, which incl payments for past and future work losses, medical care, and physical and mental pain and suffering; 2) Nominal damage are awarded when harm has technically occurred but cannot be translated into monetary terms; 3) Punitive damages are awarded to penalize P and are usually awarded only when P has clearly acted in a reckless, malicious, or willful manner.

Answer 245

most important is being familiar with all relevant legal and ethical standards and maintaining detailed, well-organized records. W/regard to the latter, experts generally agree that the beset defense in cases of litigation is adequate records

Answer 246

CA BOP was established in 1958 as one of 30 regulatory agencies in the Dept of Consumer Affairs Purpose (in B&PC) is for ensuring that those private businesses and professions deemed to engage in activities which have potential impact upon public health, safety, and welfare are adequately regulated in order to protect ppl of CA. Establish minimum qualifications and levels of competency and license persons desiring to engage in occupations they regulate upon determining that such persons possess the requisite skills and qualifications necessary to provide safe and effective services to the public, or register or otherwise certify persons in order to identify practitions and ensure performance according to set and accepted professional standards. Provide a means for redress of grievances by investigating allegations of unprofessional conduct, incompetence, fraudulent action, or unlawful activity brought to their attention by members of public and institute disciplinary action against persons licensed or registered when such action is warranted. BOP conducts periodic checks of licensees, registrants, or otherwise certified persons in order to ensure compliance with relevant sections of this code.

Answer 247

have a doctorate degree 1) in psychology, 2) in educational psychology, or 3) in education with field of specialization in counseling or educational psychology...and except as provided in subdivision g, this degree or training shall be obtained from an accredited university, college, or professional school Candidates must have 1) completed at least 2 years of supervised professional experience; 2) passed required exams; and 3) completed coursework or training in human sexuality, child abuse assessment and reporting, alcoholism and chemical dependency detection and treatment, spousal or partner abuse assessment, detection and intervention strategies, and aging and long-term care. in B&PC, no person may engage in practice of psychology, or represent self to be a psychologist, without a license granted under this chapter individuals licensed as psychologists in another state/province and specifies that these individual may offer psych services in this state for a period not to exceed 30 days in any calendar year. Section: BOP shall grant a license to any person who passes board's supplemental licensing exam and, at time of application, has been license for at least 5 years by a psychology licensing authority in another state or Canadian province if requirements for obtaining a certificate or license in that state/province were substantially equivalent to requirements of this chapter. Psychologist certified or licensed in another state or provide and who has made application to board for a license in this state may perform activities and services of a psychological nature without a valid license for a period not to exceed 180 calendar days from time of submitting application or from commencement of residency in this state, whichever first occurs. Board at its discretion may waive exams, when in judgment of board, the applicant has already demonstrated competence in areas covered by exams. Board at its discretion may waive exams for diplomates of the American Board of Professional Psychology

Answer 248

Qualifications for a psych assistant: "person other than a licensed psychologist may be employed by a licensed psychologist, by a licensed physician and surgeon who is board certified in psychiatry by the American Board of Psychiatry and Nueorlogy, by a clinic which provides mental health services under contract (WIC) by a psychological corporation, by a licensed psychology clinic defined in H&SC, or by a medical corporation to perform limited psychological functions provided that all of the following apply: a)person is termed a "psychological assistant"; b) person (1) has completed a master's degree in psychology or education with field of specialization in psychology or counseling psychology, or (2) has been admitted to candidacy for a doctoral degree in psychology or education with field of specialization in psychology or counseling psychology, after having satisfactorily completed 3 or more years of postgraduate education in psychology and having passed preliminary doctoral exams, or (3) has completed a doctoral degree which qualifies for licensure in an accredited or approved university, college, or professional school located in USA or Canada; c) person is at all times under immediate supervision of a licensed psychologist, or board certified psychiatrist; d) licensed P, board certified psychiatrist, contract clinic, psychological corporation, or medical corporation, has registered the psych assistant w/board. Registration shall be renewed annually in accordance: licensed P may register, employ, or supervise no more than 3 psych assistants at any given time, while a board certified psychiatrist may register, employ, or supervise no more than 1 psych assistant at any given time; no psych assistant may provide psychological services to the public for a fee, monetary or otherwise, except as an employee of a licensed psychologist, licensed physician, contract clinic, psychological corporation, or medical corporation

Answer 249

B&PC Section: Like psych interns, psych assistants, and exempt setting employees, registered Ps may accrue supervised professional experience (SPE) required for psychology licensure. To become a registered P, an individual must have a doctoral degree that qualifies for licensure, have completed at least 1500 hours of SPE, be employed at a nonprofit community agency that receives a minimum of 25% funding from a government source, and be supervised by a licensed psychologist

Answer 250

Regulations for SPE in California Code of Regulations (CCR) Section SPE is defined as an organized program consisting of a planned, structured and administered sequence of professional supervised comprehensive clinical training experiences. SPE shall have a logical training sequence that builds upon skills and competencies of trainees to prepare them for independent practice of psychology once they become licensed...SPE shall include only time spent by trainee engaged in psychological activities that directly serve to prepare the trainee for the independent practice of psychology once licensed. SPE shall not include custodial tasks such as filing, transcribing or other clerical duties. 2 years of qualifying SPE must be completed prior to licensure, with 1 year being defined as 1500 hours. At least one year must be completed postdoctorally; each year must be completed within 30 consecutive month period; and if both years of SPE are completed postdoctorally, they must be completed within a 60 month period Predoc SPE ways at: 1) formal placement at APA, AAPIC (Association of Psychology Postdoctoral and Internship Centers) or the California Psychology Internship Council (CAPIC); 2) employee of an exempt setting; 3) as a psych assistant with registration with board; or 4) pursuant to a Department of Mental Health Waiver Postdoc SPE ways at: 1) formal postdoc training program(APA or APPIC); 2) registered psychologist with registration with board; 3) as employee of an exempt setting; 4) as psychological assistant with registration with board; or 5) pursuant to a Dept of Mental Health Waiver Requirements for SPE: Must be provided with supervision for at least 10% of total time worked each week, with at least one hour per week being direct, individual, face-to-face sup with primary supervisor (Max is 44hrs credited); primary sup must be employed by same work as trainee and be avail 100% of time (incl in-person, by phone, pager, etc) while SPE is being accrued; primary sup must have a plan to protect clt in event clt experiences an emergency/crisis when sup is not physically present at site; SPE accrued while trainee is functioning under another mental health license cannot be credited toward requirements for licensure; SPE shall not be obtained from sups who have received payment from trainee for purpose of providing sup; trainees must have no proprietary interest in business of primary or delegated sup and must not serve in any capacity what would give them influence over primary or delegated supervisor; Prior to start of SPE, primary sup and trainee must sign a supervision agreement that incl: 1) name and signature of primary sup; 2) name and signature of trainee; 3) statutory authority under which trainee will function; 4) start date and anticipated completion date; 5) duties to be performed; 6) address of locations at which duties will be performed; and 6) goals and objectives for SPE supervises are responsible for maintaing a written weepy log of all hours of SPE earned and includes: 1)work setting; 2) specific dates; 3) number of hours worked during week; 4) number of hours of supervision received during the week; 5) type of supervision received (direct, individual, face-to-face, group or other); 6) an indication of whether the SPE performed that week was satisfactory; 7) supervises legibly printed name, signature, and date signed; 8) primary sup's legibly printed name, signature, license type and number, and date signed; 9) any delegated supervisor's name, license type and number, and date signed; 10) description of duties performed during SPE; and 11) statement signed by primary supervisor attesting to info's accuracy

Answer 251

in Section: all primary supervisors shall be licensed psychologists, except that board certified psychiatrists may be primary supervisors of their own registered psych assistants. In this regard, a maximum of 750 hours of experience out of the required 3000, can be supervised by a board certified psychiatrist and can be supervised by a board certified psychiatrist and can be counted toward meeting SPE licensing requirements. Primary Sups: must possess a valid license that is free from any formal disciplinary action and must immediately notify supervise of any disciplinary action or change in licensure status that affects supervisor's ability or qualifications to supervise; ensure they have education, training, and experience relevant to areas of psych practice they supervise; must complete a minimum of 6 hours of supervision coursework every two years; responsible for ensuring trainee complies w/provision of Psych Licensing Law and regulations related to it and that all SPE and record keeping complies with requirements set for in APA's Ethics Code; responsible for monitoring welfare of trainee's clts; responsible for monitoring the performance and professional development of trainees they supervise; ensure that each clt is informed prior to receiving services from trainee that a) trainee is unlicensed and is being supervised by supervisor; b) primary supervisor will have full access to clt's records in order to perform supervisory duties; and c) any fees paid for the trainee's services must be paid directly to primary sup/employer; do not have family, intimate, business, or other relationships with a trainee that compromise their effectiveness or violate the requirements of the Ethics Code; cannot supervise a trainee that is or has been a therapy clt of the supervisor; must not exploit trainees or engage in sexual relationships or other sexual contact with them; require trainees to review the pamphlet titled Professional Therapy Never Includes Sex; monitor the supervision performance of all delegated supervisors

Answer 252

may delegate to other qualified Ps or other qualified mental health professionals incl licensed MFTs, licensed educational Ps, licensed clinical social workers and board certified psychiatrists." Primary sup can as long as meets for 1-hr individual weekly sup. Above does not apply to supervision of psych assistants or registered Ps Registered psych assistant may receive delegated supervision from qualified psychologist or board certified psychiatrist other than the supervisor to whom he/she is registered if delegated supervisor is also employed within same organization; Registered P shall at all times be under the primary sup of a qualified licensed P who is employed by same agency

Answer 253

WHen BOP determines that a consumer complaint is valid, it may take one of several actions: 1) nondisciplinary actions are usually confidential (not avail to public) and may be imposed for minor violations such as a failure to communicate a clear treatment plan or a misunderstanding regarding billing. Confidential nondisciplinary actions include a letter of warning and educational review. Citations and fines are also nondisciplinary but are avail to the public. 2) for more serious violations, Board may take disciplinary action, which is always a matter of public info that is provided to consumers upon request. Incl a letter of reprimand, probation, and suspension, surrender, or revocation of license. Ps who surrender license or have it revoked must wait 3 years before petitioning for instatement of licensure.

Answer 254

B&PC section: Board may order denial of an application for licensure, issue a license with terms and conditions, or suspend or revoke the registration or license of any registrant or license who has been guilty of unprofessional conduct. Unprofessional Conduct incl: 1) Conviction of a crime substantially related to qualifications or duties of a P or psych assistant 2) Use of a controlled substance or alcoholic beverage to the extent that doing so causes a danger to P or others or impair P's ability safely perform his/her work 3) Fraudulently or neglectfully misrepresenting the type or status of the license or registration actually held 4) Impersonating another person holding a license or allowing another person to use one's license 5) Using fraud or deception in applying for a license or registration or in passing the exam required for licesnure 6) Paying, offering to pay, accepting, or soliciting monetary or non monetary compensation for the referral of clts 7) Making false or misleading statements about one's professional services 8) Willful, unauthorized communication of confidential info 9) Being grossly negligent in one's professional practice 10) Aiding or abetting anyone in engaging in the unlawful practice of psychology 11) Suspension, revocation, or imposition of probationary status by another state or country of a license or certificate to practice psychology or as a psych assistant issues in that state/county for an act that constitutes a violation described in this section. 12) commission of any dishonest, corrupt, or fraudulent act 13) Any act of sexual abuse, sexual relations w/clt or former clt within 2 years after termination of therapy, or sexual misconduct substantially related to the qualifications or duties of a P, psych assistant, or registered P. 14) Functioning outside one's area(s) of competence as established by one's education, training, and experience 15) Willful failure to provide verification of an applicant's supervised experience to the board 16) Repeated acts of negligence in B&PC Section: P's license shall be suspended automatically during any time holder of license is incarcerated after conviction of a felony, regardless of whether conviction has been appealed; order of revocation if licensee or registrant engaged in sexual contact with clt or former clt within 2 years following termination...additionally, BOP is required to deny an application for licensure or suspend a license of any applicant or licensee who has outstanding tax obligations due to Franchise Tax Board (FTB) or State Board of Equalization (BOE) and appears on the FTB or BOE's certified lists of top 500 tax delinquencies over $100k. Applicant/licensee has 90 days from issuance of a preliminary notice of suspension to pay his/her outstanding taxes in full or arrange a payment installment plan with FTB or BOE. If applicant/licensee does not do so, Board must deny or suspend license until it receives a release from the FTB or BOE.

Answer 255

Acceptable Courses: accepts continuing education courses that are approved by MCEP Accrediting Agency or are provided by APA approved sponsors; continuing medical education courses (CME) that are relevant to practice of psych and accredited by CA Medical Association or Accreditation Council for Continuing Medical Education; and courses that are sponsored by the Academies of Specialty board of the American Board of Profession Psychology. CE Credits: CCR Section, licensees will earn 1 hour continuing education credit for each hour of approved instruction. one 3 unit academic quarter = 10 hours of continuing ed credit. one 3-unit academic semester is equal to 15 hours of continuing ed credit; an approved instructor of a CE course "may claim course for his/her own credit only one time that he/she teaches the approved course during a renewal cycle, receiving the same credit hours at the participant." Initial Renewal: CCR Section, licensee who renews license for first time after initial issuance of license is only required to accrue CE for number of months that the license was in effect, including the month the license was issued, at the rate of 1.5 hours of approved continuing education per month Continued ed earned via independent learning (organized and directed learning experiences that occur when instructor and student are not in direct visual or auditory contact and includes instruction delivered via Internet, Cd-rom, and correspondence courses) shall be accrued at no more than 75% of the continuing ed required for the first time renewal. Required hours of continuing ed may not be accrued prior to the effective date of initial issuance of the license Subsequent Renewals: in B&PC, only to those applicants who have completed 36 hours of approved continuing education in the preceding 2 years...except for qualified individuals w/a disability who apply to and are approved by the board, independent learning can be used to meet no more than 75% (27 hours) of the continuing ed require in each renewal cycle. Renewal after Inactive/Delinquent Status: P whose license has been placed on inactive status is exempt from CE requirements: a) to activate licenses which have been placed on inactive status, licensee must submit evidence of completion of the requisite 36 hours of qualifying of qualifying continuing ed courses for 2 year period prior to establishing the license as active; b) for renewal of a delinquent P license within 3 years of the date of expiration, applicant shall provide documentation of completion of the required hours of continuing education. After a license has been delinquent for 3 years, license is automatically cancelled and applicant must submit a complete licensing application, meet all current licensing requirements, and successfully pass licensing exam just as for initial licensing application unless board grants a waiver of exam

Answer 256

CCR section: person renewing or reactivating license must have completed a course in law and ethics as they apply to the practice of psych in CA...through 1) formal coursework in laws and ethics taken from an accredited educational institution; 2) approved continuing ed course in laws and ethics; 3) workshops in laws and ethics; 4) other experience which provide direction and education in laws and ethics including, but not limited to, grand rounds of professional association presentational." Law and ethics requirement applies to each renewal but THERE IS NO SPECIFIC HOUR REQ Section: licensees who began graduate training prior to 2004, prior to first license renewal after 1/1/5, shall take continuing education instruction in spousal or partner abuse assessment, detection, and intervention strategies. This course must be at least on hour in length and it is a one-time only requirement Section: licensees who began graduate training prior to 2005, prior to first license renewal after 1/1/5, shall take continuing ed instruction in biological, social, and psychological aspects of aging and long-term care. Course must be at least 3 hours in length, and it is a one-time only requirement Exemption: may be granted by Board if P verifies in writing that, during 2 year period immediately prior to expiration date of license, P: 1)has been residing in another country or state for at least 1 year reasonably preventing completion of continuing ed requirements; or 2) has been engaged in active military service; or 3) has been prevented from completing continuing ed requirements for reasons of health or other good cause incl: a)total physical and/or mental disability of the P for at least 1 year; or b) total physical and/or mental disability of an immediate family member for at least on year where P has total responsibility for care of that family member Noncompletion of Mandatory CE: If P does not complete required CD, license will become invalid on its expiration date. If CE is not completed within 6 months, P will be subject to a citation and fine and/or other disciplinary action by Board.

Answer 257

comprise of 4 sections: Introduction and Applicability, Preamble, General Principles, and Ethical Standards Preamble and General Principles are aspirational and nonenforceable which means they are general guidelines for ethical decision making but will not serve as basis for disciplinary action against a P. Ethical Standards or mandatory, enforceable provisions. Ordinarily, it will be one or more Ethical Standards cited in a charge of ethical misconduct Introduction and Applicability Section: membership in the APA commits members and student affiliates to comply with Ethics Code and to rules and procedure used to enforce them. Lack of awareness or misunderstanding of Ethical Standard is not itself a defense to a charge of unethical conduct Intro also states: Ethics Code applies only to Ps' activities that are part of their scientific, educational, or professional roles as Ps but that APA may take action against a member after conviction of felony, even when felony is not directly related to P's professional activities.

Answer 258

Ethics Code Standard requires Ps to cooperate with Ethics Committee in ethics investigations, proceedings, and resulting requirements of the APA or any affiliated state psychological association to which they belong. IN doing son, they address any confidentiality issues. Failure to cooperate is itself an ethics violation but that making a request for deferment of adjudication of an ethics complaint pending the outcome of litigation does not alone constitute noncooperation ethical violations by members of the APA can be handled by Ethics Committeee or other entities such as state licensing board or the courts; nonmembers not in jurisdiction of APA and must be handled by other entities Ethics Committee's proceeds related to complains are in APA's Rules and Procedures... when complaint against an APA member is received by Committee, it is first evaluated by Committee's Chair and Director of Ethics Office to determine whether a breach of ethics may have occurred that warrants further consideration. Compaint will ordinarily be considered only if it has been filed by an APA member within 3 years after alleged conduct occurred or was discovered or by a nonmember or student affiliate within 5 years. Committee will not act on an anonymous complaint but may act on its own initiative (sue sponte) in certain circumstances Upon conclusion of investigation of complaint, Ethics Committee wil dismiss case or recommend one of the following actions: a) reprimand is the appropriate sanction if there has been an ethics violation but the violation was not of a kind likely to cause harm to another person or to cause substantial harm to the profession and was not otherwise of sufficient gravity as to warrant a more severe sanction; b) censure is the appropriate sanction if there's been an ethics violation and violation was of a kind likely to cause harm to another person, but violation was not of a kind likely to cause substantial harm to another person or to the profession and was not otherwise of sufficient gravity as to warrant a more severe sanction; c) expulsion from membership is appropriate sanction if there's been an ethics violation and violation was of a kind likely to cause sufficient gravity as to warrant such action; d) stipulated resignation may be offered by Committee following a Committee finding that respondent has committed a violation of Ethics Code or failed to show good cause why he/she should not be expelled, contingent on execution of an acceptable affidavit and approval by the Board of Directors. Reprimand or censure may include one or more of the following directives: cease and desist activity, obtain supervision or additional training or education; be evaluated for and, if appropriate, receive treatment; agree to probationary monitoring; or take a corrective action (i.e. make a monetary payment to the injured person) Committee may also issue an educative letter whether it dismisses the charge or recommends a sanction, which is shared only with respondent Remember code about improper complaints, unfair discrimination against complaints and respondents-Ps do not deny persons employment, advancement, admissions to academic or other programs, tenure, or promotion based solely upon their having made or their being the subject of an ethics complaint. This does not preclude taking action based upon the outcome of such proceedings or considering other appropriate info

Answer 259

Ethics Code standards: informal resolution to ethical violations; reporting ethical violations - formal report to Ethics Committee, state licensing board, or other appropriate authority when prob involves "substantial harm" and is not appropriate for informal resolution or has not been resoled satisfactorily by an attempt at an informal resolution both standards above require Ps consider issue of clt confidentiality before taking any action, which always takes precedence over the need to educate or penalize an offending P. clearly require Ps to take action when they believe a college has acted unethically (as long as clt confidnetilay has been considered) but allow Ps to determine what action is most appropriate. It is up to P to decide what constitutes substantial harm.

Answer 260

Assessment: stadardized IQ test and measure of adaptive functioning (Vineland Adaptive Behavior Scales - II; AAMD Adaptive Behavior Scale)...can use semistructured interviews and bx checklists to assess bx-al and affective sxs and educational tests to evaluate academic skills Treatment: same tx modalities w/ or w/o MR except for some mods. Necessary mods incl: a) matching tx to individual's developmental level; b) using a comprehensive interdisciplinary approach; c) involving the family; d) using directive tactics that maintain the focus on therapeutic interactions on relevant issues; and e) adopting an approach that recognizes individual's capacity for growth and facilitates, to the extent possible, clt's independent fx-ing Education and Training: used to increase skills clt needs to live productively and independently. community based instruction teaches functional skills and adaptive bxs in environments they naturally occur Bx Interventions: stimulus control, chaining, extinction, response costuseful for improving communication skills, self-control, and adaptive functioning and for reducing aggressive, self-stimulating, and self-injurious bxs. Choice of intervention is based on results of a functional assessment which indicates environmental antecedents and consequences that are maintaining undesirable bxs Psychotherapy: benefit from indiv, grp, and family tx as long as they have necessary communication and cognitive skills and therapy is tailored to their needs Family interventions: used to help family members accept and adapt to indiv's limitations, develop realistic expectations, and allow individual appropriate independence. Incl: parent education, parent/family counseling gnu support groups, and referral to community resources and services Tx for Adults: depends on level of disability; incl day-treatment program, behavioral interventions, and caregiver training and support.

Answer 261

Assessment: consider clt's performance on intelligence and achievement tests. Additional incl: neuropsychological, psychoeducational, and socio-emotional assessments to evaluate other areas of concern (i.e., memory and attention, academic achievement, social skills) Treatment: involves adopting a multidisciplinary approach incorporating various pros (psychologist, speech pathologist, occupational therapist, school personnel) Instructional INterventions: designed to remediate underlying processing deficits, improve cognitive skills (memory, comprehension) and teach skills that can help compensate for learning problems and related difficulties (ex: phonological awareness training, cognitive strategy training, and direct instruction) Behavioral Interventions: used to alleviate co-existing bx-al prrobs and may incl setting up bx modification programs to be used at home and school. Bx-al contracting might be used to reduce disruptive or oppositional bx and increase on-task bx Family Interventions: useful for modifying parents' expectations of and responses to child/adolescent w/learning do. (ex help parents structure household and recreational activities so they enable indiv to succeed more often)

Answer 262

Assessment: evaluation and monitoring clt requires multidisciplinary approach incorporating psychologist, pediatrician, neurologist, speech-language pathologist, child psychiatrist, occupational therapist, physical therapist, and school personnel. Incl Parent Interview for Autism, Autism Diagnostic Interview-Revised, Childhood Autism Rating Scale, and BRIGANCE Screens. Administration incl intelligence test, psychoeducational tests, and a measure of adaptive skills Treatment Educational and Vocational Interventions: focus on cognitive, language, social, and functional skills. TEACCH (Treatment and Education of Autistic and Related Communication Handicapped Children) is a structured individualized teaching approach that targets communication, social, and coping skills and focuses on adapting materials and environment to characteristics of child. For adolescents and adults, vocational training and placement through sheltered workshops and supported employment are beneficial Behavioral Interventions: used to reduce undesirable bxs and improve social, communication, and daily living skills (ex. shaping and discrimination training are behavioral techniques useful for improving communication skills). Applied behavior analysis is a comprehensive method for reducing self-injurious, ritualistic, disruptive, and other undesirable bxs and utilizes bx-al techniques to measure bx, teach or promote desirable bxs, and evaluate progress. This often begins w/functional assessment, which is used to identify antecedents and consequences that are maintaining the bx. Sensory Integration Therapy: type of occupational therapy sometimes used as adjunctive tx for indiv w/movement disorders or severe under- or oversensitivity to sensory input, incl clts w/autism, learning disabilities, language do, and ADHD. Based on assumption that certain undesirable bxs are due to a neurological impairment reducing ability to integrate sensory info, and its goal is to improve indiv's ability to process sensory info that clt is better able to perform academic and other tasks. when using this approach, individualized intervention plan developed including education for parents, teachers, and older children, a "sensory diet consisting of daily sensory activities, and alterations to child's environment. Empirical research on this therapy is limited and thus, controversial. Psychotherapy: psychodynamic and other insight-oriented therapies aren't viable txs. Rather, highly structured, directive psychotherapy may be useful for older and higher functioning indivs for treating comorbid conditions (depression, obsessive compulsive sxs), and for teaching social skills Parent/Family interventions: incl parent training, parent-sibling support grps, family therapy, and referral to community services and advocacy grps Pharmacothearpy: generally not considered effective tx for core sxs but may be useful for treating depression, anxiety, and other sxs that are a source of impairment or distress

Answer 263

Assessment: ADHD questionnaires and rating scales completed by clt (when appropriate) and ct.'s parents and teachers used to help confirm diagnosis and quantify clt's behavioral characteristics (ADHD Rating Scale - IV, Conner's Rating Scale-Rev, Child Behavior Checklist). Psychosocial and psychoeducational tests may be administered to evaluate cognitive abilities, emotional adjustment, social skills, and academic achievement Treatment: Pharmacotherapy: (Methylphenidate-Ritalin) and other central nervous stimulants have beneficial effects on core sxs of ADHS in about 75% of cases but are generally MOST effective when combined w/bx-al interventions. Side effects incl: dysphoria (sadness, anxiety, irritability, euphoria), decreased appetite, insomnia, and increased heart rate and blood pressure. Higher doses may produce growth suppression (although adult weigh and hight are usually unaffected), therefore, "drug holidays" can help minimize growth suppression and other side effects and confirm that drug is still needed Bx-al Interventions: used to improve academic performance and social functioning and reduce behavioral problems. Classroom Bx-al management incorporates contingency management, time-out, response cost, and other that have been found to have positive effects on core sxs of ADHD as well as on academic achievement. Other commonly used interventions incl self-instruction, self-evaluation, self-reinforcemet, and other self-control techniques Neurofeedback: aka EEG biofeedback, effective approach for treating core sxs of ADHD....studies show beneficial effects for 70-80% of clts which are similar to stimulate medication effects Parent Education/Training: most effective when parents actively participate and provide child w/consistent rules, a structured environment, and predictable routines. At outset of tx, parents should be educated about causes of ADHD and its effects on bx, learning, self-esteem, and social rxs, encouraged to develop realistic expectations for child, and connected to support grps and community resources. Parent training in bx management is useful for improving parent-child interactions and reducing child's noncompliance

Answer 264

Assessment: rating scales used to help confirm diagnosis and clarify nature and extent of individual's problem bxs (ex., Adolescent Anger Rating System, Child Behavior Checklist, Behavior Assessment System for Children). Incl evaluating clt's potential for danger to self and others, identifying family factors that contribute to clt's sxs (i.e. neglect, abuse, family psychopahtology), evaluating effete of disorder on indiv's academic/vocational functioning, and obtaining info about family functioning (i.e. coping style, resources, stressors). Info should be collected not only from indiv and parents but also from teachers, court, and other. Treatment: Family Interventions: essential component of tx and incl Parent Management Training and Functional Family Therapy. Parent Management Training targets inconsistent discipline and negative, coercive interactions. Parents are taught to set rules, negotiate compromises, develop tx contracts, reward positive bxs, and replace physical punishment w/time-out, response cost, and similar tech. Functional Family Therapy focuses on improving interactions beta parents and child and consists of 3 phases: engagement and motivation, behavior change, and generalization Cognitive Problem-Solving Skills Training (CPSST): incorporates cognitive and behavioral strategies to teach child or adolescent new skills for approaching situations that have previously elicited problematic bxs. Techn incl ID-ing and replacing maladaptive interpretations of situations, modeling of more positive bxs by T, and providing reinforcement for engaging in appropriate bxs. Multisystemic Therapy: comprehensive tx targeting factors within indiv, family, school, peer group, and community that are maintaining conduct probs. Especially useful for youth in mid- to late-adolescence who exhibited more serious sxs of disorder and are at-risk for out-of-home placement. Interventions incl academic support, social skills training, parent management training, indiv psychotherapy, family therapy, peer and school interventions and pharmacotherapy. Pharmacotherapy: although medication is generally NOT recommended as a means of managing bx of these clts, drugs may be used (usually for limited time) when indiv's bx-al problems are escalating and/or pose a high risk for danger; indiv sincerely wants to change but hasn't been able to do so despite adequate prior tx; and/or indiv has ADHD, MDD, or other co-existing do. Out-of-Home Placement: residential tx should be considered for clt who exhibits marked noncompliance or persistent involvement w/deviant peers or whose family has severe dysfunction; while hospitalization may be indicated for those who are at risk for suicidal or homicidal bx or whose functioning is severely impaired by substance abuse or a bx, thought, or mood do.

Answer 265

Assessment: clinician-, self-, and parent-rating scales used to help confirm diagnosis, clarify nature and severity of sxs, and identify associated probs (i.e. Conner's Rating Scale, Child Behavior Checklist). Incl evaluation of effects of disorder on indiv's academic/vocational and social functioning and of environmental factors contributing to sxs (parent-child dynamics, stressors) Treatment Pharmacotherapy: antipsychotic drugs (haloperidol, pimozide) are effective in 80% of cases. Side effects may be intolerable. Bc psychostimulants may increase tics, the inattention and hyperactivity sometimes associated with Tourette's are usually treated with clonidine (drug for hypertension) or Desipramine (antidepressant). Behavioral Interventions: incl self-monitoring, relaxation training, and Habit Reversal Training, which consists of 3 components: a) awareness training (increase awareness of the habit bx and feelings/bxs that immediately precede it); b) competing response training (teach indiv a competing response that disrupts the bx-al chain of the habit); and c) social support (teach parent or other support person to praise indiv for correctly implementing the competing response and provide reminders to use the competing response

Answer 266

Assessment: obtain complete enuresis-specific hx which incl exploring precipitation and complicating factors (i.e. emotional stress), clarifying nature of sxs (i.e. onset, frequency, course), identifying what parents have already done to manage prob, and evaluating parents' attitudes toward prob and wiliness and ability to follow through on tx recommendations. Child Bx Checklist, Conners Parent Rating Scale, and other may be administered to detect associated depression, anxiety, or other probs. Diagnosis CANNOT be assigned until medical condition is RULED OUT as etiological factor Treatment: Night Alarm: most common tx. aka bell-and-pad or moisture alarm), causing bell to ring when sleeping child begins to urinate. Effective in up to 80% of cases. About 1/3 experience relapse within 6 months of initial tx. Efectiveness can be improved in combo w/other behavioral techniques such as behavior rehearsal or overcorrection Pharmacotherapy: imipramine reduces wetting requency in 85% cases and suppresses wetting entirely in 30% cases, most children relapse within 3 months after discontinuing drug. Desmopressing (synthetic antidiuretic hormone) has good short term effects but poor long term effects.

Answer 267

Assessment: State-Trait Anxiety Inventory for Children, Self-Report for Childhood Anxiety Related Disorders, Revised Children's Manifest Anxiety Scale) Treatment: bx-al interventions, incl in vivo (live) exposure, systematic desensitization, contingency management, and modeling. cogntive tehrapy for more mature children; parent support and guidance may be provided to help parents better manage child's emotional and bx-al sxs.

Answer 268

Assessment: Folstein Mini-Mental State Exam, Delirium Rating Scale, and Confusion Assessment Method. Treatment: two primary targets: underlying cause of disorder and reduction of agitated behaviors (combo of environmental manipulation-providing environment that minimizes disorientation) and psychosocial interventions (i.e having a calm, friendly family or staff member stay with clt). Haloperiol or other antipsychotic drug may help reduce agitation, delusions, and hallucinations. Other than benzodiazepine for alcohol withdrawal delirium, sedatives are contraindicated bc of side effects and may mask indiv's sxs.

Answer 269

Assessment: screening instrument is used initially to identify Dementia (Dementia Rating Scale, Alzheimer's Disease Assessment Scale). After confirmation, comprehensive assessment incl evaluating intelligence, memory, and o there cognitive skills; functional status; and associated bx-al, psychosocial, and psychiatric probs. Since progressive disorder and often co-extis w/other conditions, assessment is ongoing process evaluating changes in cognitive, behavioral, and psychical functioning and functional abilities Treatment: Psychosocial interventions incl emotion-oriented therapies (i.e. reminiscence therapy, validation therapy, supportive psychotherapy; stimulation-oriented therapies (i.e. exercise and art, recreational, and animal-assisted therapy); and behavioral-oriented treatments to reduce disruptive, agitated, and other undesirable bxs and improve functional skills. Reality orientation and other cognitive-oriented approaches are generally NOT considered useful (except, perhaps, in early stages of disorder) because they tend to frustrate individual. Environmental Manipulation: appropriate for moderate to severe cognitive impairment and used to enhance memory and increase safety. incl providing daily routine, installing safety measures to prevent accidents, and maintaining a familiar and calming environment (providing familiar objects, adequate lighting, minimizing noise and other distractions) Pharmacotherapy: antipsychotic to reduce agitationg; SSRI or other antidepressant to reduce associated depression, and a cholinesterase inhibitor (e.g. tacrine donepezil, rivastigmine) to slow rate of cognitive impairment. Family/Caregiver Interventions: linked to delayed out-of-home home placement for clt and better quality of life and emotional well-being for caregivers. Incl psychoeducaitonal programs, support groups, family therapy, and adult daycare and other respite services for clt

Answer 270

Assessment: brief screening test (i.e. CAGE, Drug Abuse Screening Test, Alcohol Use Disorders Identification Test)...after Id-ing disorder, questionnaires, diagnostic interviews, and other measures clarify severity and consequences of substance use and determine appropriate level of tx (i.e. Substance Dependence Severity Scale, Addiction Severity Index, Maudley Addiction Profile). Treatment: multimodal and multidisciplinary; long-term process; Institute of Medicine describes 3 stages of tx for alcohol dependence: acute intervention consists of emergency treatment, detoxification,and screening; rehabilitation consists of evaluation/assessment, primary care (brief and intensive interventions), and extended care and stabilization; and maintenance incl aftercare, relapse prevention, and when necessary, domiciliary care. For severe coexisting mental disorder, treat disorder first and stabilize clt before beginning treatment for substance dependence; for non-severe coexisting mental disorder, use a sequential approach in which clt receives tx for addiction first and then for other mental disorder; c) when sxs of coexisting mental disorder make it difficult for clt to participate in addiction treatment, use parallel treatment in which both treated simultaneously. Psychosocial Interventions: c-b interventions; behavioral interventions( assumption: excessive use is a learned bx acquired thru experience (ie thru drug's reinforcing effects on mood); and goal of these interventions is to alter environmental stimuli that trigger and maintain substance use) = bx-al techniques incl behavioral contracting, stimulus control, and aversion therapy; Community Reinforcement Approach is a broad-based behavioral intervention utilizing social, recreational, familial, and vocational reinforces to aid clts in recovery process that begins w/functional assessment and incorporates use of naturally occurring reinforcers w/training in refusing alcohol or drugs, communication, and social skills. MI: specifically developed for substance; 4 general principles guide selection of strategies used: a)express empathy; b) develop discrepancies between current bx and personal goals and values; c) roll with (rather than oppose) resistance; and d) support self-efficacy. Relapse prevention: focus on helping recognize internal and external cues that increase risk for substance use and teach them alternative ways for responding to those cues; Self-Help Grps: AA, SMART Recovery based on cognitive behavioral principles; and Secular Organization for Sobriety (SOS) is similar to AA but focuses on individual responsibility and doesn't invoke a "higher power" Grp therapy helps reduce feelings o shame and guilt associated with use Family therapy: inadequate by itself when serious but rather an important adjunctive tx. Pharmacotherapy: Antabuse; opioid antagonist naltraxone blocks "the "high" produced by alcohol and narcotic drugs.

California Profesional Psychology School Class Flashcards

(294 cards)