Ethics Flashcards
Are the APA Ethics Code’s preamble and general principles enforceable?
No. They’re aspirational, and will provide general guidelines for practice. They cannot be used for disciplinary action against you.
Is the APA Ethics Code’s standards subsection enforceable?
Yes. The ethical standards are mandatory and enforceable provisions. It is typically one or more of these ethical standards that are used as grounds for misconduct.
“Reasonable”
The prevailing professional judgement of psychologists engaged in similar activities in similar circumstances, given the knowledge the psychologist had or should have had at the time
Five general principles of the APA Ethics Code
Beneficence and Nonmaleficence (do no harm)
Fidelity and Responsibility (be professional and responsible)
Integrity (uphold science, don’t be a douche)
Justice (fairness, being aware of your limitations)
Respect for Rights and Dignity (privacy, confidentiality, self-determination)
Pro bono services
Professional services rendered without charge.
Such services are noted in the APA Ethics Code’s general principles, and thus are recommended but not mandatory.
Client Welfare
Maintaining the welfare and protections of pros s is rye primary goal of the APA Ethics Code.
This encompasses protecting vulnerable populations and research subjects, respecting client autonomy, and committing to doing no harm.
Ethical Standard 1
Resolving Ethical Issues
Misuse of other psychologists work, ethical violations by colleagues, cooperation with the ethics committee, dealing with complaints
1.01 Misuse of Psychologists’ Work
If psychologists learn of misuse or misrepresentation of their work, they take reasonable steps to correct or minimize the misuse or misrepresentation
1.02 Conflicts Between Ethics And Law, Regulations, or Other Governing Legal Authority
If there’s conflict, psychologists must clarify the nature of the conflict, make commitment to the Ethics Code known, and take reasonable steps to resolve in accordance with the general principles and ethical standards
1.03 Conflicts Between Ethics And Organizational Demands
If an organization’s demands conflict with that of the APA Ethics Code, the psychologist must clarify the nature of the conflict, make commitment to code known, and take reasonable steps to resolve the issue in accordance with the general principles and ethical standards
1.04 Informal Resolution of Ethical Violations
When psychologists believe that there may have been an ethical violation by another psychologist, they attempt to resolve the issue by first bringing it to the attention of that individual
1.05 Reporting Ethical Violations
If a violation has substantially harmed, or is likely to substantially harm, or isn’t resolved informally, psychologists must take further action.
Any include referral to state or local licensing boards, or institutional authorities.
Exception to 1.05 Reporting Ethical Violations
1.05 does not apply when you are retained legally to review the work of another psychologist whose professional conduct is in question
1.06 Cooperating with Ethics Committees
Cooperate and address any confidentially issues that come up.
Failing to cooperate is in and of itself an ethical violation.
1.07 Improper Complaints
Do not file ethics complaints that are made with reckless disregard or willful ignorance of facts
1.08 Unfair Discrimination Against Complainants or Respondents
Psychologists cannot discriminate simply on the basis of someone being the subject of an ethics complaint
How to resolve ethical violations by colleagues
Resolve informally (1.04) and then formally if needed (1.05)
Consider client confidentiality (always takes precedence)
“Substantial harm”
Sexual misconduct, insurance fraud, plagiarism
Ethical Standard 2
Competence
Boundaries of competence, providing services in emergencies, maintaining competence, delegation of work to others, personal problems and conflicts
2.01 Boundaries of Competence
Practice within your competence (as supported by relevant training, education, supervision, consultation, study, and professional experience)
Undertake steps to receive education and supervision in new areas
In forensic work, take steps to become familiar with judicial and administrative rules governing their work
2.02 Providing Services in Emergencies
You can practice outside your competence to prevent that services are not being denied who need it…however, discontinue immediately when the emergency has ended or appropriate services are available
2.03
Undertake ongoing efforts to maintain and develop your competence
2.04 Bases for Scientific and Professional Judgments
Base your work on the established scientific and professional knowledge of the discipline
2.05 Delegation of Work to Others
Don’t delegate work to those who will have a dual-role (or poor objectivity), give them work that is only in like with their training and experiences and supervision, see that the delegate services are performed competently
2.06 Personal Problems and Conflicts
Do not engage in work where there is a substantial likelihood where personal opinions or bias will taint your work
When you become aware of a potential problem or bias that interferes with their work, they take appropriate measures (supervision, consultation, etc) and determine whether they should limit or suspend their practice
“Competence”
Skill within an area based on prior training, education, supervised practice, and study, and or professional activities
When should you examine your competence to practice
Incorporating a new technique into one’s practice
Working with a new population that one has not previously served
A critical element of delegating work to others (supervisees)…
Providing them with regular performance feedback
Does provision 2.05 regarding delegating work to inappropriate others include translators?
Yes. Should you has a family member to translate for a client, it places them in a dual-role that is inappropriate and unethical
Vicarious Liability
Being responsible for the actions of supervisees or employees
Often seen in situations with a disparity in training and education between the two parties. You have a responsibility to control the actions of those who work under you (who have less training and experience)
Ethical Standard 3
Human Relations
Discrimination, harassment, multiple relationships, conflict of interest, informant consent, request for services by third party, exploitation
3.01 Unfair Discrimination
In work-related activities, do not engage in discrimination on any basis (age, gender identity, sex, disability, SES, race…)
3.02 Sexual Harassment
Do not engage in sexual harassment (verbal, physical, advances…that is unwelcome/offensive, or severe enough to be abusive)
Can be a single event or multiple events
3.03 Other Harassment
Do not knowingly engage in harassment that is demeaning or harassing based on protected class (and other) factors
3.04 Avoiding Harm
Take reasonable steps to avoid harming those they work with (clients, supervisees, students, research subjects, etc.)
3.05 Multiple Relationships
A multiple relationship occurs when you are in a professional role with a person (and a personal role with them or someone who knows them)
Avoid this, but not unethical if you can’t reasonably expect it to cause harm or risk of exploitation
If a multiple role occurs, take steps to remedy it
3.06 Conflict of Interest
Refrain from taking on roles when personal interests can impair their objectivity or create harm/exploitation
3.07 Third Party Requests for Services
When requested by a third party to deliver services, make all attempts to clarify the nature of the service (who is the client), probable uses of this service to the third party, and any limitations to confidentiality
3.08 Exploitative Relationships
Don’t supervise people you have power over
Fees, bartering, sexual relations with supervisees, former therapy provisions, etc.
3.09 Cooperation With Other Professionals
You’re permitted to work with other professionals to serve your patients appropriately and effectively
3.10 Informed Consent
Always get it (exceptions apply)
Use language that is reasonably understandable
Obtain assent from persons who cannot provide consent (also turn to their legal guardian)
Document it!
3.11 Psychological Services Delivered To or Through Organizations
Provide information about the nature of the services, who the recipients of the information are, the relationship of the psychologist to the organization, probable uses of obtained information, and limits to confidentiality
3.12 Interruptions of Psychological Services
Make efforts to facilitate interruptions in services (illness, vacation, death, relocation, financial limitations, etc.).
Three factors to consider when determining the acceptability of a multiple relationship:
Power differential (the more influence, the less ethical)
Duration of the relationship (the longer, the less ethical)
Clarity of termination (the more easy and quick the termination, the more ethical)
Three conditions that must be met for consent to be “informed”:
Capacity (the individual is able to make a rational decision)
Comprehension (the individual is given adequate information and can understand it enough to make an informed decision)
Voluntariness (the individual has given consent freely and without coercion)
Assent
Agreement
Seek this when the person cannot legally provide consent
And take steps to ensure they understand
Ethical Standard 4
Confidentiality
Maintaining, discussing limits of, recording, disclosures, consultations…
4.01 Maintaining Confidentiality
Our primary obligation is to maintain confidentiality and to take reasonable precautions to protect such information.
4.02 Discussing the Limits of Confidentiality
Discuss with persons (able to consent, not able, legal guardians) and organizations…
1 - relevant limits to confidentiality
2 - foreseeable uses of the information gathered
Unless not feasible or contraindicated, do so at the outset and as new circumstances may warrant.
This includes when working over electronic transmission.
4.03 Recording
Before recording voices or images of persons, you must obtain permission from people or their legal representatives.
4.04 Minimizing Intrusions on Privacy
Only include information germane to the purpose of communications.
4.05 Disclosures
You can discuss confidential information with the appropriate consent of the person or organization or legally authorized representative.
Disclose without consent only as mandated by law or for other valid purpose (provide needed professional services, obtain appropriate consultations, obtain payment)
4.06 Consultations
When consulting, psychologists do not disclose confidential information that reasonably could lead identification of the person unless you’ve obtained prior consent. Disclose information only to the extent necessary to achieve consultation.
4.07 Use of Confidential Information for Didactic or Other Purposes
Do not disclose information concerning clients, research participants, students, etc. obtained during their work unless they:
Take reasonable steps to disguise the person or organization,
The person has consented in writing, or
There is legal authorization to do so
Privacy vs. Confidentiality vs. Privilege
Privacy - Freedom for people to choose when information about them is shared
Confidentiality - Obligation of psychologists to protect clients from unauthorized disclosure of their information revealed in the professional relationship
Privilege - Legal concept that protects confidentiality in the context of legal proceedings (Jaffee v. Redmond)
Holder of privilege in a legal proceeding
Normally rests with client unless called to testify in court. Then, the psychologist holds the privilege and should only disclose when court ordered to do so or when the client or their representative consents to the release.
Common exceptions to patient-psychologist privilege
Waivers (a client authorizes the release)
Mandatory reporting (danger to vulnerable parties)
Danger to self or others
Legal or regulatory actions (malpractice investigations, custody, or curt-ordered evaluations)
Confidentiality and minors
A minor’s parent or legal guardian has a legal right to be informed of the information revealed by the minor during the course of his or her treatment.
Exception: minor is emancipated or legally able to consent to their own treatment
Who holds privilege when treating a minor
The minor’s legal guardian
But legal exceptions apply
Confidentiality in group therapy
Inform group members about limits to confidentiality
Discuss need for confidentiality, encourage members to bring up potential violations, and remind group members to maintain until group treatment ends
Confidentiality in couple and family therapy
Suggested that information in individual sessions be divulged in couple or family therapy to the extent that the psychologist sees fit in accordance with the greatest benefit for the couple or family
Confidentiality and deceased clients
Varies on the states, however many states have clauses that say confidentiality is awarded to patients in perpetuity
In such cases, records cannot be released unless consent is given by an executor of the estate
Confidentiality and military psychologists providing services to military personnel
Include in limits of confidentiality that you must divulge if at any point you believe the client is unfit for duty, or a threat to national security
Confidentiality and EAPs
Can breach if authorized to do so or if danger to self or others
Ethical Standard 5
Advertising and Other Public Statements
Avoidance of false or deceptive statements, statements by others, workshops, media presentations, testimonials, and in-person solicitations
5.01 Avoidance of False or Deceptive Statements
Public statements include: advertising, endorsements, applications (grants, licensing, etc.), CVs, lectures, statements in legal proceedings, published materials…
Basically, don’t lie about your credentials, experience, affiliations, offered services, fees, or research findings.
You can only claim degrees as credentials if they are earned from a regionally accredited institution, or were the basis for licensure in the state in which they practice.
5.02 Statements by Others
You are responsible for statements people submit.
Do not compensate for publicity in a news item.
Paid advertisements must be clearly identified as such.
5.03 Descriptions of Workshops and Non-Degree-Granting Educational Programs
You are responsible for all the materials of your workshop (materials, advertising, brochures…), and that such materials clearly communicate relevant information (presenters, objectives, fees…)
5.04 Media Presentations
When psychologists provide public advice…
Must be based on knowledge, training, and current research…
Must be consistent with Ethics Code…
And does not indicate that a professional relationship has been established with the recipient of the information.
5.05 Testimonials
Do not solicit testimonials from current clients or patients (or other persons because of risk of undue influence)
5.06 In-Person Solicitation
Do not engage in uninvited solicitation of business from actual or potential clients
Factors that can contribute to client vulnerability (when discussing when not to solicit testimonials)
Insecurities, emotional problems, naïveté, lack of information, being in awe of the professional
Ethical Standard 6
Record Keeping and Fees
Documentation, dissemination, withholding records, fees, bartering, referrals
6.01 Documentation of Professional and Scientific Work and Maintenance of Records
Create and manage records in order to
- Facilitate provision of services later by them or another professional
- Allow for replication of research design and analyses
- Meet institutional requirements
- Ensure accuracy of billing and payments
- Ensure compliance with law
6.02 Maintenance, Dissemination, and Disposal of Confidential Records of Professional and Scientific Work
Maintain confidentiality in your records
If not provided consent by the patient, document and encode data in databases without personal identifiers
Make plans in advance to facilitate appropriate transfer of records to keep confidentiality
6.03 Withholding Records for Nonpayment
Psychologists cannot with old records needed for emergency provision of treatment solely because payments have not been received.
6.04 Fees and Financial Arrangements
Set and reach an agreement on fees as early as possible.
Fees must be consistent with the law and not misrepresented.
If there are limitations of services due to limitations in financing, discuss ASAP.
If a person does not pay for services and you are going to send them to collections, you must notify them and allow the time to make prompt payment.
Bartering
The acceptance of goods, services, or other nonmonetary remuneration from patients in exchange for psychological services.
6.05 Barter with Clients/Patients
You may barter only if…
1 - It is not clinically contraindicated
2 - The resulting arrangement is not exploitative
6.06 Accuracy in Reports to Payors and Funding Sources
Take reasonable steps to ensure accuracy when reporting on fees, diagnosis, research, etc.
6.07 Referrals and Fees
When splitting fees with another provider, the split is determined by the work done by each provider, and not simply based on a referral
Ethical Standard 7
Education and Training
Education and training programs, teaching, student disclosure, mandatory therapy, supervision
7.01 Design of Education and Training Programs
If you’re in charge of educational or training programs, you take steps to make sure the material you are teaching is appropriate to provide knowledge for practice, licensure, etc.
7.02 Descriptions of Education and Training Programs
If you are responsible for education and training programs, make sure you display accurate information about the program: stipend, training goals, course content, requirements…
These things must be made available to all interested parties
7.03 Accuracy in Teaching
Ensure course syllabi are accurate, as well as your basis for evaluating students. This does not preclude someone from modifying a syllabus.
7.04 Student Disclosure of Personal Information
Psychologists do not require supervisees or students to disclose personal information in course- or program-related activities regarding sexual abuse, family history, relationships, treatment history, etc… except if
(1) It’s written out and part of program expectations and guidelines
(2) the info is necessary for evaluation or remedy of issues related to successful training
7.08 Mandatory Individual or Group Therapy
If required, students should be allowed to choose form a list of practitioners unaffiliated with the program
Faculty in charge of evaluating the student’s performance is not providing the therapy
7.08 Assessing Student and Supervisee Performance
Establish a timely and specific process for providing feedback. Information regarding this process is given to the student at the outset of the supervision.
Evaluations must be based on relevant skills and established program requirements.
7.07 Sexual Relationships with Students and Supervisees
Don’t do it
Anyone you evaluate or might evaluate
Ethical Standard 8
Research and publication
Informed consent, subordinate research participants, deception, debriefing, animal research, reporting results, publication credit, etc.
8.01 Institutional Approval
If it’s required, provide the information necessary
DO IT
8.02 Informed Consent to Research
Include: purpose, duration, procedures Right to decline or withdraw Any foreseeable consequences to withdrawing Risks, discomforts, or other factors in decision making (ctrl group selection, etc.) Prospective research benefits Limits of confidentiality Incentives Whom to contact
8.03 Informed Consent for Recording Voices and Images in Research
Obtain consent before recording voices or images unless…
(1) study is entirely naturalistic observation and recording will not cause personal identification or harm
(2) if the research design includes deception (in which case, wait for debriefing)
8.04 Client/Patient, Student, and Subordinate Research Participants
Take steps to avoid any adverse consequences to declining or withdrawing…
If research participation is required for course credit, make sure reasonable alternatives are available
8.05 Dispensing with Informed Consent for Research
Informed consent needn’t be required if
(1) Research would not be expected to cause distress or harm
(2) Involves educational practices
(3) Involves anonymous collection of data
(4) If otherwise permitted by law
(5) If employment research is taking place with no impact on employability
8.06 Offering Inducements for Research Participation
Nothing excessive or inappropriate (likely to coerce)
If you’re offering professional services as inducements, clarify the nature of the services and other relevant information upfront
8.07 Deception
Do not conduct a research involving deception unless it is justified and absolutely necessary
Do not use deception in research that is expected to cause pain or severe emotional distress
At the conclusion of participation, psychologists must explain why deception was necessary and allow participants to withdraw their data
8.09 Debriefing
Take reasonable steps to prevent misconceptions
Answer any questions that participants have
If it is justifiable to withhold information, do so minimizing the risk of harm
If harm occurs, take steps to minimize as soon as you know about it
8.09 Humane Care and Use of Animals in Research
Acquire, use, and dispose of animals in accordance with all state, federal, and local laws
Psychologists training in animal research take responsibility for the other subordinate researchers and the wellbeing of the animals (ensure proper training to researchers)
Take steps to minimize discomfort to the animals - surgery should be under anesthesia with proper anti-infection procedures
Inflict pain only when absolutely necessary and there is no other alternative
Should an animal’s life be terminated, do it quickly, painlessly, and in accordance with accepted procedures
8.10 Reporting Research Results
Don’t fabricate data
If you discover errors in your published data, take reasonable steps to correct the error in a correction, retraction, or other means
8.11 Plagarism
Don’t do it
8.12 Publication Credit
Only take credit for work you have done
Principal authorship and other publication credits accurately reflect the role you had (being of higher academic standing does not mean first author)
Discuss publication credit throughout the project with faculty supervisors
8.13 Duplicate Publication of Data
Don’t publish the same thing in multiple places
8.14 Sharing Research Data for Verification
Don’t withhold your data after publication if people want to reanalyze your claims
Requesting data for this purpose must be in writing, and data could only be used for that purpose (don’t jack someone’s data and then use it for something else)
8.15 Reviews
Maintain confidentiality of the research proposals that you review
Ethical Standard 9
Assessment
9.01 Bases for Assessment
Always substantiate your findings and base them off the data you collected
Clinical interviews, and if not available document thoroughly
9.02 Use of Assessments
Administer, score, interpret, and write about assessments in line with current research and practice
Use measures that have good reliability and validity for the purpose you are using them for
Use assessment methods that are appropriate to the persons language, developmental level, culture, etc. Exception if use of an alternative language test is necessitated
9.03 Informed Consent in Assessments
Obtain informed consent except when mandated by law, implied as part of routine procedures (education), or if a purpose is to evaluate decisional capacity
Use language appropriate to the persons education and background
Obtain informed consent when using an interpreter and make sure that utilization is clear
9.04 Release of Test Data
May refrain from releasing to protect the client or test
In the absence of client or patient request, provide test data only when required by court order
“Test Data”
Raw and scaled scores, responses to test items, notes about statements and behavior
9.05 Test Construction
If you develop tests, use sound psycho metrics
9.06 Interpreting Assessment Results
When interpreting, take into account the purpose of the assessment, as well as other contextual factors, and indicate limitations on your interpretation.
9.07 Assessment by Unqualified Persons
Don’t promote this unless it is a supervised part of a training or educational experience
9.08 Obsolete Tests and Outdated Test Results
Don’t base assessment recommendations or interpretations on outdated data or tests for the current purpose
9.08 Test Scoring and Interpretation Services
If you provide such a service, accurately describe the purpose, norms, validity, reliability, and applications for the scores.
Select scoring programs based on evidence and appropriateness
Psychologists are ultimately responsible for their assessments, regardless of whether or not interpretation services are used.
9.10 Explaining Assessment Results
Psychologists take reasonable steps to ensure all explanations of the test results are properly delivered and explained
Unless the relationship precludes such explanation (preemployment testing, etc.), in which case the person is notified of that at the outset.
9.11 Maintaining Test Security
Maintain the integrity and security of testing materials
“Test Materials”
Manuals, instruments, protocols, stimulus items, test questions
Ethical Standard 10
Therapy
Informed consent, couples and families, group therapy, treatment to those served by others, sexual interactions, interruption of therapy, termination of therapy
10.01 Informed Consent to Therapy
Notify them as early as is feasible about nature of relationship, anticipated course of treatment, fees, third party involvement, and limits to confidentiality. Also include alternative treatment information.
Solicit questions from patient.
If you’re a trainee, make that known and provide information regarding your supervisor.
10.02 Therapy Involving Couples or Families
Take steps to clarify at outset who is are the patients and the relationship the psychologist has with each one.
If conflicting roles emerge, take reasonable steps to clarify, modify, or withdraw from roles.
10.03 Group Therapy
Describe at the outset the expectation of privacy and confidentiality for all group members.
10.04 Providing Therapy to Those Served by Others
If you are considering providing tx to someone who is already receiving tx elsewhere, consider treatment issues and the clients welfare.
Proceed with caution, and raise concerns to pt or legal representative
10.05 Sexual Intimacies with Current Therapy Clients
Don’t do it
10.06 Sexual Intimacies with Relatives or Significant Others of Current Therapy Clients
Don’t do it and don’t terminate therapy to circumvent this Standard
10.07 Therapy with Former Sexual Partners
Don’t do it
10.08 Sexual Intimacies with Former Therapy Clients/Patients
Don’t do it for at least two years after termination of services
If you do it, you bear the burden to ensure there is no exploitation
10.09 Interruption of Therapy
Take reasonable efforts to resolve interruption of services
10.10 Terminating Therapy
Terminate therapy when the patient no longer needs the service, is unlike to benefit from further services, or is being caused harm
You can terminate if you feel threatened or otherwise endangered by the client or someone with whom the client has a relationship
Except when precluded, offer alternatives to other treatment or counseling about the termination
Psychological Services Unit
A functional unit that provides psych services comprised of at least one professional psychologist and supporting staff
Users
Direct recipients of psychological services
Institutions receiving services
Four conditions for a malpractice claim
Must have a professional relationship with plaintiff
Must be a demonstrated breech in standard of care
Plaintiff must have suffered harm or injury
The breech in care had proximate cause to the injury or harm
The best defense against litigation is…
…adequate record keeping.
Steps to responding to a subpoena
Is it legally valid
Contact the client to discuss implications of releasing the information
Respond based on client’s wishes: give up the info requested, or negotiate with a legal representative
Should the court continue - file motion to quash the subpoena or a motion for a protective order
Cost-Benefit Analysis
Comparing costs and benefits of a treatment or program in monetary terms.
May be difficult to assign monetary values to an outcome.
Cost-Effectiveness Analysis
Costs are compared to nonmonetary outcomes (six improvement, number of dropouts, etc.)
Which intervention has the greatest effect per dollar spent.
Cost-Utility Analysis
Comparing costs of a treatment with outcomes in terms of quality life years.
Cost-Feasibility Analysis
Evaluates the feasibility of a treatment based on the resources it would require
Is the intervention worth considering?
Cost-Minimization Analysis
Used to determine the least costly option that achieves the same outcomes
Ex. can paraprofessionals offer the same services as psychologists and a fraction of the cost?
Cost-Offset Analysis
Examines the reduction in medical costs as a result of a mental health (or other non-medical) treatment
