Ethics 2

Question 1

List the 12 standards under section 3, Human Relations

Answer 1

1. Unfair Discrimination
2. Sexual Harassment
3. Other Harassment
4. Avoiding Harm
5. Multiple Relationships
6. Conflict of Interest
7. Third-Party Requests for Services
8. Exploitative Relationships
9. Cooperation with Other Professionals
10. Informed Consent
11. Psychological Services Delivered to or through Organizations
12. Interruption of Psychological Services

Question 2

What is the standard 3.01 Unfair Discrimination?

Answer 2

In our work, we do not discriminate unfairly based on age, gender, gender identitty, race, ethnicity, culture, national origin, religion, sexual orientation, disability, socioeconomic status, or any basis proscribed by law.

Question 3

What is the standard 3.02 Sexual Harassment?

Answer 3

• We do not engage in sexual harassment.
• Sexual harassment means sexual solicitation, physical advances, or verbal or nonverbal conduct that is sexual in nature, and either
  1) is unwelcome, offensive, or creates a hostile environment and the psychologist knows this or is told, and
  2) is sufficiently severe or intense to be abuse to a reasonable person.
• It can consist of a single incident or multiple.
• We do not discriminate against others solely because they have made charges of sexual harassment.

Question 4

What is the standard 3.03 Other Harassment?

Answer 4

We do not harass or demean others with whom we work.

Question 5

What is the standard 3.04 Avoiding Harm?

Answer 5

We take reasonable steps to avoid harming those with whom we work and to minimize it where it is foreseeable and unavoidable.

Question 6

What are the 3 parts of the standard 3.05 Multiple Relationships?

Answer 6

a) A multiple relationship means a psychologist is in a professional role and/or
1. is in another role with the same person
2. is in a relationship with another person closely associated with the first
3. promises to enter into another relationship with either of the above.
We refrain from entering into multiple relationships if doing so would risk impairing our work. Multiple relationships that would not risk this are not unethical.
b) When we discover ourselves in multiple relationships, we act to resolve it in the best interests of the person and consistently the Code.
c) When we may serve in more than one role in judicial or administrative proceedings, we clarify role expectations and the extent of confidentiality at the outset and update these as changes occur.

Question 7

What is the standard 3.06 Conflict of Interest?

Answer 7

We refrain from taking on roles that could reasonably be expected to

1) impair our objectivity, competence, or effectivness
2) expose those with whom we work to harm or exploitation.

Question 8

What is standard 3.07 Third-Party Requests for Services?

Answer 8

When services are provided at the request of a third party, we clarify at the outset the following:

• our role
• who the client is
• probable (expected?) use of services and/or information obtained
• limits to confidentiality

Question 9

What is standard 3.08 Exploitative Relationships?

Answer 9

We do not exploit relationships with those over whom we have authority.

Question 10

What is standard 3.09 Cooperation with Other Professionals?

Answer 10

We cooperate with other professionals to serve our clients/patients appropriately.

Question 11

What are the 4 parts of standard 3.10 Informed Consent?

Answer 11

a) In conducting research and providing psychological services, whether in person or by other means, we obtain informed consent from those with whom we work, using clear language, except when consent is prohibited by law or otherwise provided in the Code.
b) For persons legally incapable of consent, we take reasonable steps to protect her/his rights and welfare and then
1) explain the services,
2) seek assent,
3) consider the person’s preferences and best interests, and
4) obtain appropriate permission from those authorized.
c) When services are mandated, before proceeding, we inform the person about the nature of the services, including the mandate and limits of confidentiality.
d) We document written or oral consent, permission, assent, etc.

Question 12

What are the 2 parts of standard 3.11 Psychological Services Delivered to or through Organizations?

Answer 12

a) As appropriate, we provide information to clients and those receiving services regarding:
1. nature and objectives of the services
2. intended recipients
3. who the clients are
4. our relationship with each person in the organization
5. probable uses of services and information obtained
6. who has access to information
7. limits of confidentiality
We provide results and conclusions as soon as feasible.
b) We say at the outset what information, if any, we are precluded by law from providing.

Question 13

What is standard 3.12 Interruption of Psychological Services?

Answer 13

We make reasonable efforts to plan for “facilitating” services in the event we are unable to continue to provide them. (It is possible for my estate to be sued for malpractice.)

Question 14

What are the 7 standards under section 4, Privacy and Confidentiality?

Answer 14

1. Maintaining Confidentiality
2. Discussing the Limits of Confidentiality
3. Recording
4. Minimizing Intrusions on Privacy
5. Disclosures
6. Consultations
7. Use of Confidential Information for Didactic or Other Purposes

Question 15

What is standard 4.01 Maintaining Confidentiality?

Answer 15

Taking reasonable precautions to protect confidential information is a primary obligation. We also recognize that confidentiality may be limited by law, institutional rules, or professional relationships.

Question 16

What are the 3 parts of standard 4.02 Discussing the Limits of Confidentiality?

Answer 16

a) We discuss with those whom we serve
1) the limits of confidentiality and
2) foreseeable uses of information generated by our services
b) This discussion occurs at the outset of the relationship, whenever possible.
c) When services are provided electronically, risks to privacy and confidentiality inherent to that medium are also discussed.

Note: Limits of confidentiality particular to a practice are also discussed at the outset of treatment, e.g., if a couple’s therapist has a policy not to hold secrets between partners.

Question 17

What is standard 4.03 Recording?

Answer 17

We obtain appropriate permission to record before doing so.

Question 18

What are the 2 parts of standard 4.04 Minimizing Intrusions on Privacy?

Answer 18

a) Only relevant information is included in reports and consultations.
b) We discuss confidential information only with persons concerned and for appropriate professional purposes.

Question 19

What are the 2 parts of standard 4.05 Disclosures?

Answer 19

a) We disclose information only with the consent of the client/patient.
b) We disclose information without consent only as mandated by law, or where permitted in order to
1) provided needed services
2) obtain appropriate consultations
3) protect someone from harm
4) obtain payment for services (minimum disclosure only)

Question 20

What is standard 4.06 Consultations?

Answer 20

When consulting with others,
1) we do not disclose confidential identifying information without consent to do so or it cannot be avoided and
2) information is only disclosed to the extent necessary.
Consultation itself is only sought for appropriate professional purposes.

Question 21

What is standard 4.07 Use of Confidential Information for Didactic or Other Purposes

Answer 21

We do not disclose identifying information in didactic situations unless

1) the person/organization being discussed is reasonably disguised,
2) we have written consent, or
3) there is legal authorization to do so.

Question 22

What is the difference between privacy and confidentiality?

Answer 22

• Privacy is the right of an individual to control what information about themselves to share with others.
• Confidentiality is a standard requiring professionals not to share information about another without that person’s permission.

Question 23

The basic theme of the standards of confidentiality is that all client/patient information is confidential except when:

Answer 23

1. the patient/client has waived that right
2. identifying information is disguised or removed
3. a breach is required by law, usually to protect someone.

Question 24

Is it necessary to get permission from a client/patient to consult with another professional on their case?

Answer 24

Only if you intend to include identifying information about the client/patient.

Question 25

Describe the “quality assurance” dilemma and how to approach it.

Answer 25

When asked by a third party such as an insurance company to provide client/patient information for the purposes of quality of treatment review:

1) find out why it is needed
2) if it is a valid request, release only relevant information
3) limit access of unnecessary others, for example by stating who is authorized to receive it in a cover letter.

Question 26

Describe one way of handling confidentiality in Employee Assistance Programs (EAPs).

Answer 26

Since the company usually pays for the EAP services, it often expects to be informed about the employee’s status and/or progress. A typical compromise between the employer’s reasonable expectations and the employee’s confidentiality, often spelled out in the EAP agreement or other policy statment, is for the service provider to inform the employer only of whether the employee

a) kept the appointment
b) needs treatment, and if so for how long
c) accepted or rejected the treatment offer.

Question 27

Confidentiality may be breached if a client/patient is a danger to him/herself. How should that be handled?

Answer 27

1) It is only done as necessary to prevent the danger. If there are other means to protect the client that do not involve breaching confidence, take those steps.
2) Only information relevant to protecting the person should be disclosed.

Question 28

Confidentiality may be breached if a client/patient is a danger to others. How should that be handled?

Answer 28

The Tarasoff case established a broad duty to protect potential victims of persons in our care. If a client/patient makes a specific, current, credible threat against an identifiable person, we make reasonable attempts to protect the potential victim. Such efforts can include warning the police and/or the potential victim.

Question 29

What are some situations in which dangers to others that you learn about from client/patient are not grounds for confidentiality breach?

Answer 29

• If an event occurred in the past and there is no indication that it will be repeated now, e.g., a client confesses leaving the scene of an accident in which others died. There is no expectation here that the client will use his car to hurt someone else.
• If the client/patient reports of another’s danger to someone, e.g., a patient states her husband plans to kill her boss. The patient could be encouraged to go to the police herself, or, potentially, less desirably, could grant a release of information to you.

Question 30

How does a patient’s HIV infection affect Duty to Warn?

Answer 30

One approach suggests the following criteria be met before breaching confidentiality:

• risk of infection is significant
• identity of the third party is known
• warning is likely to prevent infection
• reasonable efforts to convince the patient to disclose have failed.

The APA’s guidelines for legislatures also suggests that whether or not the third party has no reason to suspect s/he is at risk should be considered as well. They go on to recommend that providers who disclose a patient’s HIV status under these circumstances be immune from criminal liability.

Question 31

How does knowledge or suspicion of child abuse affect Duty to Warn?

Answer 31

In all states, we are required to report to appropriate state agencies when we suspect child abuse has occurred, if the victim is still a minor. If the victim is an adult and there is reasonable suspicion that the abuser is still active with other children, we are required to report. If there is not reasonable suspicion, the reporting requirement varies by state.

Question 32

How does HIPAA and coordinated care affect disclosure of patient information?

Answer 32

Patients must be notified of a provider’s privacy practices. Once such notification is given, information can be shared among health care providers involved in the patient’s care without further consent.

Question 33

How are psychotherapy notes (process notes) treated under HIPAA?

Answer 33

“Notes recorded in any medium by a mental health professional documenting or analyzing the contents of conversation during a private counseling session” are not part of a patient’s protected health information. So long as they are kept separate from her/his PHI, they are not subject to release to third-party payers or patients.

Question 34

What is a “covered entity” under HIPAA?

Answer 34

Any health plan, health care clearinghouse, or health care provider that transmits health information electronically (via Internet). Receiving PHI from a covered entity via, for example, email makes one a covered entity, even if one did not send PHI via any electronic means.Any covered entity is required to have a written privacy notice that includes staff accessing information, how it will be used, and when it will be disclosed.

Question 35

What is the difference between privilege and confidentiality?

Answer 35

Confidentiality is an ethical obligation. Privilege is a legal term referring to a person’s right not to have information released in a legal setting. Legally competent adults are their own “holders of privilege.” For minors, parents or guardians hold their privilege.

Question 36

What are some exceptions to privilege?

Answer 36

Psychotherapists who evaluate a patient at the appointment of a court are not privileged; they must disclose all information they a have about that patient (the patient would be informed of this beforehand). If a psychologist with privileged information is asked to disclose during testimony or deposition, s/he may assert privilege and decline disclosure pending a court order.If a psychologist receives a court order to disclose privileged information (and all attempts to limit or modify the disclosure have failed), s/he must comply with the court order. Research data is not usually protected by patient-therapist privilege. Researchers should take steps in advance to protect confidentiality, e.g., not collecting identifying information, warning participants of a possible subpoena.

Question 37

How should subpoenas be treated?

Answer 37

1) Determine that the subpoena is valid.
2) If so, contact the client and discuss its implications.
3a) If the client consents and no other reason prevents it, disclose requested information.
3b) If the client does not consent, attempt to negotiate with requester.
4) If requester persists, seek guidance informally from the court (via letter) or file a motion to quash or for a protective order
5) If these fail, and you do not intend to appeal, the requested information must be released.