Ethics Flashcards
confidentiality
a psychologist’s obligation to protect clients, research participants, students, and others from unauthorized disclosure of information that they reveal in the context of a professional relationship with the psychologist
Tarasoff decisions
duty to protect the victim when a client threatens violence against an identifiable victim; not legal;
only applies when the client makes a specific, foreseeable, and believable threat of violence; when the victim or victims are identifiable; and when therapist intervention is feasible
protected health information (PHI)
individually identifiable health information that is maintained or transmitted in any medium and provides information about:
(1) a person’s past, present, or future physical and mental health condition
(2) the provision of health care to the person
(3) past, present, or future payments for health care provided to the person
covered entities
health plans, health care clearinghouses, and health care providers who transmit health information electronically
health care provider
any person or entity that provides, bills for, and/or is paid for health care as a normal part of business
privilege
a person’s legal right to not have confidential information (e.g., communications to the therapist) revealed in court or a legal proceeding
capitated
way of paying health care providers or organizations in which they receive a predictable, upfront, set amount of money to cover the predicted cost of all or some of the health care services for a specific patient over a certain period of time
privileged communication
a patient’s right to refuse to have information, disclosed in psychotherapy, released in a legal proceeding
utilization review
assess the use of benefits and reduce or eliminate inappropriate or unnecessary use of health care resources;
cost-containment procedure
the primary purpose of licensure is…
to “protect the public by limiting licensure to persons who are qualified to practice psychology as defined by state or provincial law”
The Ethics Code intention
provide guidance for psychologists and standards of professional conduct that can be applied by the APA and by other bodies that choose to adopt them
competence
one’s education, training, supervised experience, consultation, study, or professional experience.
how to choose referral vs. consultation
the client’s welfare is always of paramount concern when making this determination:
-referral: when there is substantial risk that the therapist-client difference or the therapist’s lack of experience is likely to cause the client more harm than good;
knows that a personal problem is impairing his/her effectiveness
-consultation: psychologist suspects that a personal problem might interfere with his/her effectiveness
vicarious liability
or respondeat superior;
legally responsible for the actions of their supervisees and employees; when the supervisor/employer has the right, ability, and responsibility to control the actions of the supervisee/employee and there is a substantial disparity between the knowledge, training, or experience of the supervisor/employer and that of the supervisee/employee
multiple relationship
occurs when a psychologist is in a professional role with a person and:
(1) at the same time is in another role with the same person
(2) at the same time is in a relationship with a person closely associated with or related to the person with whom the psychologist has the professional relationship
(3) promises to enter into another relationship in the future with the person or a person closely associated with or related to the person
According to Standard 4.05, confidentiality is to be maintained except when
(1) the client has waived his or her right to confidentiality
(2) identifying information is adequately disguised or removed
(3) a breach of confidentiality is required or permitted by law (e.g., when a client poses an imminent danger to self or others)
health maintenance organization (HMO)
A type of health insurance plan with its own network of doctors, hospitals, and healthcare providers who have agreed to accept payment at a certain level for any services they provide, keeping costs low but limiting coverage to care from doctors who work for or contract with them. It generally won’t cover out-of-network care except in an emergency.
employee assistance program (EAP)
voluntary, work-based program that offers free and confidential assessments, short-term counseling, referrals, and follow-up services to employees who have personal and/or work-related problems
client danger to self choices
when a client threatens suicide and the therapist determines that the client does not pose an immediate danger to him/herself, have the client sign a “no-suicide” contract
client danger to self
legally and ethically justified
HIV disclosure
(a) the provider is aware of an identifiable third party who is at risk for infection
(b) the provider has reason to believe that the third party has no reason to suspect that he or she is at risk
(c) the client has been urged to inform the third party and has refused or is considered unreliable in his or her willingness to do so
psychotherapy notes protection
not included in PHI; must be kept separate from the rest of the individual’s record
exception to privilege
when the court appoints a psychologist to evaluate a defendant in a court case
examples of insurance fraud
(1) billing for missed appointments if that practice is not agreed upon by the insurance company in advance
(2) routinely waiving co-payments without the insurance company agreeing to this practice
(3) providing inaccurate information to the insurance company
expert witness
a “person who has special training, knowledge, skill, or experience in an area relevant to the resolution of the legal dispute and is allowed to offer an opinion as testimony in court”
fact witness
a 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; generally not allowed to offer opinions, address issues that they do not have personal knowledge of or respond to hypothetical situations”
subpeona
a legal document that requires the recipient to testify in court or other legal proceeding on a specified date and/or to produce documents
competency to stand trial
a defendant’s mental state at the time of the trial;
defendant’s ability to:
(1) understand the proceedings against them
(2) assist the attorney in their defense
insanity
a legal (not a psychological) term that refers to a defendant’s mental state at the time he/she committed the crime and is used to determine the defendant’s criminal liability;
person does not possess “substantial capacity either to appreciate the criminality of his conduct or to conform his conduct to the requirements of the law”
when psychologist’s personal misconduct may constitute an ethical violation
(1) The psychologist engages in an act that has serious consequences (e.g., rape, attempted murder) and leads to a felony conviction
(2) the psychologist’s inappropriate conduct becomes highly publicized, especially when the person’s identity as a psychologist is highlighted
sexual harrassment
sexual solicitation, physical advances, or verbal or nonverbal conduct that is sexual in nature, that occurs in connection with the psychologist’s activities or roles as a psychologist, and that either
(1) is unwelcome, is offensive, or creates a hostile workplace or educational environment, and the psychologist knows or is told this or
(2) is sufficiently severe or intense to be abusive to a reasonable person in the context
conflict of interest
roles that are likely to impair a psychologist’s objectivity or effectiveness or cause harm or exploitation
informed consent for research
(1) purpose of the research, expected duration, and procedures
(2) their right to decline to participate and to withdraw from the research once participation has begun
(3) foreseeable consequences of declining or withdrawing
(4) reasonably foreseeable factors that may be expected to influence their willingness to participate such as potential risks, discomfort, or adverse effects
(5) any prospective research benefits
(6) limits of confidentiality
(7) incentives for participation
(8) whom to contact for questions about the research and research participants’ rights
For persons who are legally incapable of giving informed consent, psychologists nevertheless
(1) provide an appropriate explanation
(2) seek the individual’s assent
(3) consider such persons’ preferences and best interests
(4) obtain appropriate permission from a legally authorized person, if such substitute consent is permitted or required by law
barter
accepting goods, services, or other nonmonetary remuneration from clients/patients in return for psychological services;
psychologists may barter only if:
(a) It is not clinically risky
(2) the resulting arrangement is not exploitative
Record Keeping Guidelines
retain a client’s full record for 7 years following the last date of services for adults and 3 years after a minor reaches the age of majority, whichever occurs later
cannot withhold records
that are requested and needed for a client’s/patient’s emergency treatment solely because payment has not been received
if someone doesn’t pay for their services
psychologists may use a collection agency or other legal measures to collect the fees if they “first inform the person that such measures will be taken and provide that person an opportunity to make prompt payment”
sliding fee scales
fees for services that are adjusted depending on an individual’s income;
generally considered acceptable as long as they are fair and serve the client’s best interests
pertinent information shared with third-party payors
information on the service provided, fees and other charges, diagnosis, and the provider’s identity
referral fees
any fee paid to another professional must be based on the actual costs of the services provided for making the referral and not on the referral itself;
payment based on the services provided (clinical, consultative, administrative, other) and is not based on the referral itself
sexual relationships with students or supervisees
in their department, agency, or training center or over whom they are likely to have evaluative authority
deception in research is permissible when
(1) the value of the research outweighs the cost of deceiving participants;
(2) there is no other way to accomplish research goals that doesn’t require deception;
(3) participants are not deceived about any aspect of the research that is likely to cause pain or severe emotional distress;
(4) participants are debriefed no later than after data collection (preferably at the conclusion of their participation)
use of animals in research
(1) use procedures that cause animals pain, stress, and privation only when to do so is justified by the study’s value and no alternative procedures are available;
(2) reasonable efforts must be made to minimize the discomfort, illness, and pain of animals
(3) if an animal must be killed, it must done as rapidly and painlessly as possible;
(4) animals must be cared for, used, and disposed of under law, regulations, and professional standards;
(5) psychologists experienced with animal research must supervise all procedures involving animals and are responsible for their humane treatment, including their treatment by those under the psychologist’s supervision
Psychologists obtain informed consent for assessments except when
(1) testing is mandated by law or governmental regulations;
(2) informed consent is implied because testing is conducted as a routine educational, institutional, or organizational activity (e.g., when participants voluntarily agree to assessment when applying for a job);
(3) one purpose of the testing is to evaluate their capacity to make decisions - obligated to inform the examinee about the nature and purpose of the proposed assessment
time limit for sexual engagement with previous clients
2 years
majority of sexual dual relationships (Pope et al)
male therapist, in his 40’s to 50’s, unstable marriage, professionally “burned out,” suffering from depression, sleep disturbances, and/or alcohol or drug abuse;
significantly older than the clients they became involved with - average therapist age: 42 and 44, w/ average client age: 30 and 33;
nothing on therapist orientation, education, professional achievement, or participation in therapy themselves or between sexual exploitation and any client characteristics
most common reasons for newly opened cases by the APA’s Ethics Committee from 2000 through 2008
loss of licensure in another jurisdiction, sexual misconduct with an adult (45 to 50%), inappropriate practice involving child custody, and involvement in a nonsexual dual relationship
Legally Relevant Factors
examinees’ functional abilities, capacities, knowledge, and beliefs, and address their opinions and recommendations to the identified psycholegal issues
steps for responding to a subpoena
(1) Determine if subpoena is a legally valid demand for the disclosure of client info
(2) If valid, contact the client and discuss the implications of providing the requested information
(3) If client consents and there are no other reasons for withholding the information, provide the information as requested. Alternatively, if the client does not consent, attempt to negotiate with the requester.
(4) If the requesting party continues to demand that the information be provided, seek guidance from the court informally through a letter or have an attorney file a motion to quash the subpoena or a motion for a protective order
managed care organizations do this to reduce liability risk
require all their providers to be credentialed - ensures that their providers are competent and, consequently, reduces their risk of liability
soliciting testimonials from past patients
“vulnerable due to undue influence” language would ban you from soliciting testimonials from former patients in many if not most cases;
not an absolute ban from seeking testimonials from former patients
litigation
process of taking legal action
best key defense in cases of malpractice
good record-keeping
in the context of an EAP, when the employee/client comes to therapy as the result of a referral by his or her supervisor, the supervisor can be given certain limited information:
told if the employee/client kept the appointment;
whether the employee/client needs treatment;
whether the employee/client accepted treatment
malpractice claim against a psychologist
1) psychologist must have had a professional relationship with (and, therefore a duty of care to) the client
2) psychologist must have been negligent or failed to live up to that duty
3) harm to the patient must have resulted
subpoena duces tecum
requires a person to appear at a designated time and place with a copy of records;
doesn’t necessarily require the person to release those records - that is for the court to decide, following a hearing on privilege, if the issue of privilege is being contested
legal basis of the Tarasoff decision
the protective privilege ends when the public peril begins
best single predictor of sexual exploitation in therapy
therapist who has exploited a patient in the past
records should minimally include
identifying data, dates and types of service, fees, any release of information obtained, any assessment, plan for intervention, consultation, summary reports, and/or testing reports
Introduction section
“discusses the intent, organization, procedural considerations, and scope of application of the Ethics Code”
purpose of both the Preamble and General Principles
provide “aspirational goals to guide psychologists toward the highest ideals of psychology”
Wickline v. California
a treating professional who “complies without protest with the limitations imposed by a third-party payor, when his [professional] judgment dictates otherwise, cannot avoid his ultimate responsibility for the patient’s care”;
it’s the health professional’s obligation to protest in these situations and advocacy for the patient’s needs in such situations is an ethical obligation
informed consent for therapy
psychologists inform clients/patients as early as is feasible in the therapeutic relationship about the nature and anticipated course of therapy, fees, involvement of third parties, and limits of confidentiality and provide sufficient opportunity for the client/patient to ask questions and receive answers;
when therapist is a trainee, client must be informed of this fact and given the supervisor’s name
test materials
manuals, instruments, protocols, and test questions or stimuli
test data
raw and scaled scores, client/patient responses to test questions or stimuli, and psychologists’ notes and recordings concerning client/patient statements and behavior during an examination
malpractice
refers to the injurious or unprofessional treatment of a client by a health or mental health care professional
