disclosures Flashcards
explain disclosures with client consent
Be sure to have informed consent
-Informed means no surprises for the client
explain HIPAA and release of information
-HIPAA requires that CEs obtain written valid authorization from the individual or personal representative before releasing PHI
-CEs have an obligation to agree to patient’s request unless request is reasonably likely to be associated with harm
-PA licensure regulations requires release only after full disclosure to client
disclosures permitted by law
Standard 4.05 permits disclosure of confidentiality information without consent if the disclosure is permitted by law and the disclosure is a valid purpose
valid reasons for disclosures
-To provide needed professional services
-To obtain appropriate professional consultation
-To protect the client/patient, psychologist or others from harm
-To obtain payment for services
explain pennsylvania psychologist patient privileged communication statue
-No person licensed to practice psychology without consent of client can be examined in any civil or criminal matter on behalf of the client
-Privilege belongs to the patient
-Communications made by an agent of the psychologist are also privileged
-Do not have to testify without consent, but you might be held in contempt
-Subpoena is just a legal request for information
exceptions and waivers to limits on release of information
1) When patient places their mental health into the issue, they have waived their privilege
-They do not have to consent, but best practice would be talking to the client about it first
-E.g. temporary insanity
2) Patients seeking redress for emotional harm by citing the need for psychotherapy have waived privilege
if you put mental health into the equation you have waived privilege, but it is best practice to talk with them about it first
3) Psychologist can refuse if information may harm the patient
4) What if a third party is present during the interaction with the psychologist and patient? At times privilege is waived
-Privilege waived mean they are okay with it being not confidential
-Times it could be waived: with spouse, collateral, groups
what can you be subpoenaed to do
release information, show up at a deposition, show up in court, testify
what matters to subpoenas usually come up
Client is involved in a legal matter
-Child custody/divorce
-Have to have information about this in policies and how you testify in court
-Personal injury
-Worker’s compensation
-Criminal case
-Child welfare investigation
Other reasons for requests
-Client’s personal use
-Education/employment accommodations
steps to do after receiving subpoena
1) Is it valid?
-Contact your lawyer to see, consult with someone and check
2) What is it requesting?
-Does it want records, to show up, whole file, pieces of file?
3) Contact client
-Letting them know that you received a subpoena for their records; tell them who is requesting it
4) Contact requesting attorney
-Who is the attorney for
5) Contact the court
-See what they are looking for
6) Challenge the subpoena
-Say you are unable to follow through with this, it may harm the client
-If it happens when you are a trainee the goal is to get you out of it because they are often wanting a witness to testify about the mental health of a client
7) Comply with subpoena
-You have to respond, but the repercussions are not that intense if you do not respond
fact witness vs. expert witness
Fact witness: says facts related to the case
-PHI
Expert witness: clinical impressions; trainees can probably not function in this realm
explain court order
demand not a request you have to show up, more serious; can be sent for similar reasons; court orders are sent by judges
If someone else’s information is at risk or if it causes substantial harm
They might hold you in contempt if you do not talk, rare that it gets this far, but you have to know what you are able to ethically and legally do
what things impact 4.05 disclosures without consent (permitted by law)
-PA Duty to Report Laws Cheat Sheet
-Mandated Reporting (PA Regulations)
-Discretionarily disclosures (depends on setting
-Tarasoff/ duty to warn/ protect
-PA Code Principle 5
explain what you are required to mandated report
Child Abuse
Intentionally knowingly or recklessly causing physical injury
-Must have occurred within the last two years
Serious physical neglect
-Witnessing domestic abuse counts as a reason to report, counts as neglect
Sexual abuse or exploitation
Mandatory reporting of infants
-Illegal substance abuse by the child’s mother
-Withdrawal symptoms resulting from prenatal drug exposure
-A fetal alcohol system disorder
what is considered child abuse
Child Abuse: Intentionally, knowingly, or recklessly doing…
Causing bodily injury
Fabricating, feigning or intentionally exaggerating or inducing a medical symptom or disease which results in harmful medical evaluation
Causing or substantially contributing to serious mental injury
Creating likelihood of sexual abuse or exploitation of a child
Causing physical neglect of a child
Engaging in any of the following
-Kicking, biting, burning, stabbing, cutting
-Unreasonably restraining a child
-Forcefully shaking a child under one year of age
-Forcefully slapping or otherwise striking a child under one
-Interfering with the breathing of a child
-Leaving a child unsupervised with an individual other than the child’s parent, who the actor knows or should have known has been determined a sexually violent predator
All include act or failure to act
explain corporal punishment and child abuse
if a child has been hit in a way that is leaving marks this counts as abuse
explain where mandated reporting came from and some cultural concerns
Penn State Sandusky helped create the mandated reporting laws : a lot of people knew what was going on but didn’t do anything; came up with this quickly and the law was not incredibly thoughtful and mindful about what they are saying
Laws are not culturally humble, does not account for different cultures and collectivistic societies
Understanding where the corporal punishments come from, they were punished in the way; does not get at the why
-Can have this conversation with families
child sexual abuse in PA
-2 years difference is typically the standard; age of consent is 14
-With fighting, this is typically not a mandated reporter thing
If someone has naked pictures of someone under 18, it is considered child pornography and it is reportable and can be held criminally liable
Mandated by law: duty to protect laws
Tarasoff vs. Regents of the University of California (1978)
-Inform a third party of the prospect of being harmed if the client has plans to harm them
-If your client says someone specific will cause a credible threat, we have a duty to get them to act; but not legally required to report that a client shares with you something bad is going to happen to someone else
-Ethically you should
when are you required to inform a 3rd party of the prospect of being harmed by a client
-There must be a credible threat
-Threat must be toward an identifiable or potential victim
-The threat must be believable
-Threat has to be imminent and you must take action and cannot wait for others to learn of the risk to prevent damage
who do we report it to (duty to warn)?
Call the police and duty to warn the potential victim (do what you can to get in touch with them)
-Get emergency contacts for people in case a situation like this arises
what to do when you decide to warn
-Discuss the warning with the client
-Warn intended victim about the threat and the sources of the threat
-Contacting people who can apprise the potential victim of danger
-Notifying local law enforcement authorities
-Initiating voluntary or involuntary psychiatric commitment
-Taking whatever other steps seem appropriate
-Consult APA code, PA code and state law
-Document all your thoughts and efforts
how to determine risk
-Perform specific case assessment that looks at factors that inhibit and precipitate violence
-Link specific interventions to precipitating and inhibiting variables and continue to assess whether each intervention works
-If alliance is waning and precipitating factors appear to be escalating, consider 302
-List our analysis of the precipitating and inhibiting factors related to the risk of violence in the chart
-Note subsequent actions related to the management plan
-Delineate evidence establishing the diminution of risk
duty to warn or protect with family
Ewing vs. Goldstein
-Communication of serious threat by member of patient’s family, member is not technically a patient
What do you do?
-Breach confidentiality vs. wrongful death suit
-Credibility of the communication not a preclusion to disclosure
Ewing sets therapist up as an investigator
Who is patient? How do you determine in an emergency?
-Previously patient was patient
-Ewing- immediate family is patient
-Why stop immediate family
how might we proceed in duty to warn issues
Identify or scrutinize the problem
-How dangerous is this situation? What about intimate partner violence?
Develop alternatives or hypothesize solutions
-What are my treatment options?
Evaluate or analyze options?
Act or perform
-How can I involve the client? do I need to back up a verbal warning? Police involvement
Look back and evaluate
explain how to handle disclosures of suicidal intent
Good ethical practice in response to indications of suicidal intent requires
-Competence to recognize, manage, and treat suicidality
-Identification of community resources for client/patient emergencies outside the treatment setting
-Development of consultative relationships with other professionals to assist in case management
-Understanding of legal principles and institutional policies regarding voluntary or involuntary commitment
explain duty to protect with suicide vs. self injury
Not a duty to warn because there is no 3rd party
Self injury is usually not covered unless:
-Severe
-Anorexia
-Kids
no harm contracts?
Be careful: an attorney’s field day
No data showing they are useful
Instead consider
-Self care options
-Other options
