CPLEE_Mgt. Issues in Therapy

Question 1

Owner of record

Answer 1

In general, client owns the contents of the records while psych/facility owns the physical document.

Question 2

Maintenance of Records

Answer 2

in ethics code 6.01
psych create, and to the extent when records under their control, maintain, disseminate, store, retain, etc in order to 1) facilitate provision of services, 2)allow for replication of research, 3) meet institutional requirements, 4) ensure accuracy of billing/payments, 5) ensure compliance with the law.
in ethics code 6.02 a/b
requires psych to maintain conf when storing, accessing, transferring and disposing of records under their control, written, and coding or other techqniues to avoid the inclusion of personal identifiers when conf client info is stored in record systems that are available to persons whose access has not been consented.

Question 3

Maintenance of Records cont

Answer 3

6.02c requires psych to have a plan for protecting the conf of records in the ten of their illness/death or withdraw from practice. Possible alternative including having an agreement of mgnt of records with colleague, arrange with prof association, have a prof will.

Question 4

Retention of records

Answer 4

Guidelines for duration of records are provided by CA law and in APA’s record keeping guidelines.

• -For adults: Psych shall keep records for minimum of 7 years from pt’s d/c date.
• -For minors: Psych shall keep records for 7 years from the date the patient reaches 18 (so 25 y/o)
• -For unemancipated minors: Psych keeps records for at least 1 year after person reaches 18, and in any case, not less than 7 years

Question 5

Record Keeping Guideline

Answer 5

psych strives to be aware of applicable laws/regs to retain records for a period required by legal, regulatory, institutional ethical req.

Question 6

Retention of records, absence of state laws (APA)

Answer 6

For adults: psych keeps records for 7 years

For minors: psych keeps records for 3 years from the age of majority (21)

Question 7

Electronic record keeping

Answer 7

provided in HIPAA’s security rule;
Providers of health services…ensure safety and integrity of all electronic media by…..
–offsite backup storage system, image mechanism that is able to copy sig, and making sure it’s unalterable.
–Original hard copies of records may be destroyed once record has been electronically stored.

Question 8

HIPAA denial of access to records

Answer 8

• -HIPAA PREEMPTS CA LAW
• -psych’s may deny a client access to his record if they determined that access is “reasonably likely to endanger the life/safety of a client or another person” and the client is given the right to have denial reviewed.

Question 9

CA law denial of access to records

Answer 9

psych to deny access when they determine there is a substantial risk of significant adverse or detrimental consequences to patients in seeing/receiving their records

Question 10

Access to psychotherapy notes

Answer 10

CA LAW PREEMPTS HIPAA FOR PSYCHOTHERAPY NOTES
–HIPAA allows for an absolute non-reviewable denial of access to psychotherapy notes, but CA law does not; in other words, upon request from the client, psych’s may give client access to complete psychotherapy notes or a summary, or may decline to provide notes if there is a legal reason for doing so.

Question 11

Who has access to record?

Answer 11

Adult client, minor client authorized by law to consent to tx, or clients’ representative are allowed to have access to those records but must present a WRITTEN request for the records and pay any costs.

Question 12

CA law withholding records

Answer 12

CA law prohibits provider from withholding patient records/summaries of patient record b/c of any paid bill for health care services.
–this is not consistent with Ethics code which states psych may not withhold records under their control that are requested for client’s emergency tx solely b/c payment has not been received (implies that there would be a time when you would withhold records for nonpayment)

Question 13

Timeframe for responding to request for client to access records

Answer 13

• -Client to inspect records within 5 working days following written request.
• -Client to receive a copy of the record within 15 days following written request.
• -For client to receive a summary of records within 10 working days from the request.
• -For client with LONG history should receive a summary of the records within 30 days.

Question 14

Multiple Relationships

Answer 14

A psych refrains from entering in a multiple rel if the rel could reasonably be expected to impair objectivity, competence, or effectiveness in performing function of a psych.

• -A multiple rel that would not be expected to cause impairment/risk exploitation or harm are not unethical
• -If psych finds that, due to unforeseen circumstances, a potentially harmful rel has arisen, the psych takes reasonable steps to resolve it with due regard for the best interests of the affected person and maximal compliance with the ethics code.

Question 15

Multiple Relationships cont.

Answer 15

• -not all multiple rel are unethical

- -i.e. rural communities

Question 16

Multiple Relationships in a Forensic Setting

Answer 16

when psych’s are required to serve in more than one role in a forensic setting, they must clarify role expectations and issues related to confidentiality.

• -an implication of this standard is that psych’s should accept dual roles in a forensic settings only when doing so is unavoidable.
• -when requested/ordered to do so, forensic psych’s are encouraged to disclose the potential risk and make reasonable efforts to refer the request to another provide; when referral is not feasible, the psych must consider risks/benefits for all parties and “seek to minimize the potential negative effects of this circumstance”

Question 17

Conflicts of Interest

Answer 17

Psych’s refrain from taking on professional role when personal, prof, legal, financial, or other interests could be expected to:

1) impair objectivity/competence/effectiveness in performing job
2) expose person or organization with whom they real exists to harm or exploitation

Question 18

Decision Guidelines

Answer 18

Gottlieb records that psych’s consider 3 factors when thinking about multiple rel:

1) power differential: how great is the power differential?
2) duration of rel: what is the length of the rel?
3) clarity of termination: what is the likelihood that the rel with continue in the future?

Question 19

Fees

Answer 19

as early as feasible in the rel, psych’s should reach an agreement about fees specifying compensation

Question 20

Sliding fee scales

Answer 20

Psych’s may charge a fixed fee/use a sliding scale; Mot addressed in ethics code but generally acceptable as long as fair and serve the best interest of the clients.

Question 21

Unpaid Fees

Answer 21

If the client does not pay for services as agreed upon, and if the psych intends to use a collection agency, psych first informs the person that such measure will be taken and provide them with opportunity to make prompt payment.

Question 22

Collection Agency

Answer 22

When using, psych must give the agency only essential info such as clients name, address and amount owed

Question 23

Client with financial crisis

Answer 23

When client has financial crisis, psych may temporarily waive or lower the fee, schedule fewer appts, or suspend tx or refer client to lower-cost provider.
In emergency situation, psych has obligation to continue providing tx to a client, regardless of their ability to pay, until emergency is over.

Question 24

Pro Bono Services

Answer 24

No used in ethics code, General Principle B states, “psych strive to contribute a portion of their professional time for little or no compensation or personal advantage; this is recommended BUT NOT required.

Question 25

Barter

Answer 25

Barter is accessions fo goods/services from clients in return for psych services.

• -Psych can barter only if it is not clinically contraindicated, and the resulting arrangement is not exploitative
• -Barter should be avoided when it is likely to impair the psych’s objectivity or otherwise adversely affect therapist-client rel or when it is not possible to determine the extent to which a bartered service is equivalent in value to the psych’s fee.

Question 26

Factors to consider when bartering

Answer 26

consider: theoretical orientation, client’s dx and dependency needs, expected duration of tx, nature of barter agreement.
- -They conclude that exchange of certain services for tx, would clearly be contraindicated b/c of the potential neg consequences if those services are not performed satisfactorily.
- -Also note when evaluating the potential for exploitation, the client and the psych should be considered–while exploitation to client is the most greatest concern, psych may also feel exploited which then adversely impacts services provided.

Question 27

Referral Fees

Answer 27

when psych’s pay, receive payment from, or divide fees with another professional, other than in an employer-employee rel, the payment to each is based on services provided and not based on the referral itself.
–In other words, paying referral fees is not prohibited but, when they are paid to an individual professional, they must be based on actual costs/services provided and not simply on the referral itself

Question 28

APA on referral fees

Answer 28

Ethics Coe does not prohibit an independent contractor from paying a percentage of the fee to a colleague as long as the payment is within a reasonable range of the fair market value of the services provided
–CA law states, paying/offering to pay/accept/compensate etc, whether monetary or otherwise, for the referral of clients is unprofessional conduct and a cause for disciplinary action by the BOP.

Question 29

Insurance Fraud

Answer 29

• -both illegal and unethical
• -committing insurance fraud is considered unprofessional conduct and a cause for disciplinary action.
• -“in their report to payers for services, psych’s take reasonable steps to ensure the accurate reporting of the nature of the services…”

Question 30

Examples of insurance fraud

Answer 30

1. Routinely waiving copays: it is illegal to waive a client’s copay without contacting the insurance company that you are doing so.
2. Billing for missed appts: you must not bill insurance for a client’s missed appt unless agreed upon by the insurance company
3. Assigning an incorrect dx: dx must be accurate

Question 31

Interruption of psychological services

Answer 31

• -Psych’s make reasonable efforts to plan for facilitating services in the event that psych services are interrupted by factors such as the psych’s illness/death/relocation/retirement/or by financial limitations.”
• -When entering into employment/contractual relationships, psych’s make reasonable efforts to provide for orderly and appropriate resolution of responsibility for client care in the event that the employment relationship ends, with paramount consideration given to the welfare of the client.

Question 32

Termination of therapy

Answer 32

• -terminate therapy when it becomes reasonably clear that the client no longer needs services, is not likely to benefit, or is being harmed by continued services.
• -except where precluded by the actions of a client/third party mayors, prior to termination psych’s provide pretermination counseling and suggest alternative service providers as appropriate.
• -to be consistent with ethical requirements, psych’s must terminate therapy with clients no longer benefitting form it.
• -psych’s to terminate therapy with a client when the client, or a person the client has a relationship with , poses a threat to the psych. In this situation, psych’s are not required to provide advanced notification of termination or pretermination counseling. Also prohibitions against breaching client confidentiality do not apply if psych has to contact police.

Question 33

Relationships with other professionals

Consultation

Answer 33

Consultation: when consulting 1) psych’s do not disclose confidential info that could identify the client unless they have an ROI or if disclosure cannot be avoided, 2) they disclose info only to the extent necessary to achieve the purposes of the consultation (ex. psych works with PCP prescribing meds, cooperate with attorney who is representing client in legal action, seek consultation when encountering difficulties in tx or dx

Question 34

When client is receiving services from another mental health professional

Answer 34

• -the psych must carefully consider the tx issues and the potential clients welfare
• -approp course of action will depend on the circumstances; when a client is seeing another mh professional for diff problem, it is likely acceptable for a psych to cont seeing the client in therapy. Psych should consult with other professional after obtaining client’s consent to do so and “proceed with caution and sensitivity to the therapeutic issues”
• -when a client is seeing another mh professional for the same problem, th best course of action is to discuss the ethical obligations with the client and determine why the client is seeking tx from 2 mh professionals. If psych determines there is no benefit to see both mh professionals, the psych should inform client that it is inappropriate to continue.

Question 35

Advertising, Soliciting of Business, Media and Publication Credit

Answer 35

In CA code of regulations, psych must state that they are licensed psych and include license number in all advertising, soliciting, etc. This does not apply to psych’s practicing in gov’t organizations/nonprofit orgs/reserach education, etc.

• -cannot misrepresent; psych should site only degrees completed and are relevant to their practice (ex deceptive to identify self as PH.D. candidate; also can list APA membership but not make it look like APA sponsors/endorses psych
• -Consequences for misrepresenting: the board may refuse to issue any registration/license or may issue license with terms/conditions, or may suspend/revoke license if they have been found guilty of unprofessional conduct (fraudulently/neglectfully misrepresenting the type of license or status)

Question 36

1. Advertising

Answer 36

guidelines for advertising: permits psych’s to advertise professional services “authorized to be provided by such license within the psych’s field of competence…so long as such advertising does not promote the excessive or unnecessary use of such services.
–in addition, a) unlawful for any person doing business in CA to advertise to consumers in CA to amen any false/misleading claims, inducing claims hat purport to be factual, objective, clinical evidence, compare the products effectiveness/safety to that of other brands/products, or that purport to be based on any facts

Question 37

1. Advertising cont.

Answer 37

Standard Avoidance of False/Deceptive States: psych do not make false, deceptive, fraudulent statements concerning their training/experience/competence, their academic degrees, their credentials, their institution, their services, scientific/clinical basis for results/effectiveness of services, their fees, or their publications/findings
–A psych who engage others to create/place public statements that promote their professional practice, products or activities retain responsibility for such statements; psych’s do not compensate employees of press/radio/tv/other communication in return for publicity; paid advertisement related to psych’s activities must be identified or clearly reasonable as such.

Question 38

2. Descriptions of Educational Programs

Answer 38

“to the degree to which they exercise control control, psych’s responsible for announcements/catalogs/brochures/or advertisements…ensure that they accurately describe the audience for which the program is intended, educational objectives, presenters and the fees involved. Ex. if psych advertises a program she offers as interactive workshop, she should not spend the entire time lecturing.

Question 39

3. Solicitation of testimonials

Answer 39

Psych’s do not solicit testimonials from current therapy clients or other person who because of their particular circumstances are vulnerable to undue influence.
–Prohibition against soliciting testimonials is not absolute but applies to testminatials that are solicited ‘from current therapy clients or other persons who because of their particular circumstances are vulnerable to undue influence. Also includes supervisees writing testimonials for supervisors.

Question 40

4. Solicitation of Business

Answer 40

Psych’s do not engage, directly, in uninvited in-person solicitation of business from actual or potential therapy clients who b/c of their cicurmastatnes are vulnerable to undue influence.
–this prohibition does not preclude 1) attempting to implement collateral contacts for the purpose of benefiting an already engaged client, 2)providing disaster/community outreach services. Ex. following police to a crime scene and handing out business cards to victims is unacceptable uninvited in-person solicitation; in contrast it’s ok for psych’s to give business card to someone who asks for it or send brochures.

Question 41

5. Media Presentations

Answer 41

Such advise must be based on the psych’s professional experience and knowledge, must be provided in a manner consistent with the provisions of Ethics Code, and must not imply that prof relationship has been established.
–Note–this standard does not apply to services that are provided to a client in the context of an established prof relationship.

Question 42

6. Publication Credit

Answer 42

Standard 8.11 prohibits plagiarism and notes that it is unacceptable to take credit for someone else’s work “even if the work/date sours is cited occasionally.”
Standard 8.12 states psych take responsibility/credit, including authorship credit, only for work they have actually performed or to which they have substantially contributed
Standard 8.12b notes that principle authorship or coauthorship reflect the relative contributions of the involved individuals and that minor contributors are acknowledged in an introductory statement.
Standard 8.12c notes except under exceptional circumstances, a student is listed as principal author on any multiple authored article that is substantially based on student’s dissertation