Ethics Flashcards
APA 2016 Ethics Code Standards 1&2
Who does it apply to
- activities that are professional, educational, or scientific roles as a psychologist
1&2 Code
APA can take action against
- complaints from community and professionals
- also, a conviction of felony, suspension or revoke of licensure from state psych board
- felony does NOT need to be related to the role/duties as a psychologist
1&2 Preamble
- welfare and protection of individuals and groups, other psychs, students and the Public regarding ethical standards
1&2
5 General Principles
- aspirational “to inspire” NOT enforceable
- Beneficence & Nonmaleficence
- Responsibility & Fidelity
- Intergrity
- Justice
- Respect for Peoples Rights & Dignity
1&2 Ethical Standards
- Enforceable/mandatory by both APA & State Boards
- 10 Categories
- Resolving Ethical Issues
- Competence
- Human Relations
- Privacy & Confidentiality
- Advertising & other public statements
- Record Keeping & fees
- Education & Training
- Research & Publication
- Assessment
- Therapy
Standard I
Resolving Ethical Issues
with whom do these issues address
- resolving issues with
- ethical
- legal
- organizations
Standard I
Conflict and How to address
- Conflict
- make position known
- take steps to resolve
- may not justify violating human rights
Standard I
when to follow legal authority
- Resonable efforts then permitted to follow legal authority when actions do not justify or defend human rights
Ethical Violation by a colleague
- bring violation to the attention of the psychologist
- if not resolved, report the violation to ethics committee or licencing board to take action if likeness of harm or unable to address informally
Request from Ethics Committees
- cooperate with investigation with APA although you have to consider confidentiality
Unfair Discrimination
- cannot discriminate based on eithics compliant although action can be taken after the preceedings/rulings are completed
Competence Standard 2
Boundaries of Competence
scope
gender
refer out
- must work w/n one’s education, scope of practice
- in conjunction w/understanding gender, race, culture or/and other characteristics is also something to consider
- if you do not have training must refer out
Services to new populations or techniques
- When Psychs are asked about things outside scope of practice or training
- must get new training and supervision
- if too great of a challenge must refer out
Telepsychology
delivery
training
consultation
- must be competent in the area to deliver telepsychology
- obtain the training needed to deliver the telepsychology
- get a consultation with a psychologist that is familiar w/telepsych area if needed
Evidence-Based Practice
- treatment is based on the lastest research combined with clinical expertise in context with patients characteristics, culture and preferences
Emergency Services
- allows psychs to work with patients on an emergency services bases
Delegating work to others
- no multiple relationships impede objectivity or effectiveness
- completely independent or while supervised
- psychologist ensures the person can provide the services completely
Use of interpreter
- do not use family member-conflict of interest
- obtain consent BEFORE assessment or to assist with therapy and explain why it is necessary
- the psychologist must have a business contract with interperter that addresses confidentiality
Vicarious Liability
- legally responsible
- has authority to control employee or supervise
- employee deviated from standard of care & caused recipient damage
- supervision must have been w/n scope of practice competence
Personal Problems
- refrain from taking clients that may impede your effectiveness-if you have an issue personally to treat must refer out
- take appropriate measures-if personal problem only affect professionally (-) seek consultation to determine if therapy should be suspended, limited or terminated
Discrimination
cannot discriminate
don’t have to accept& can refer out if believe it is
individual bias will impact diagnosis, values
or (-) affect competence
Sexual Harassment
- sexual solicitation physical, verbal or nonverbal
- unwelcome work or education place & psych knows or has been told
- sever or intense can be single or multiple occasions
- quid pro quo -something for something
Sexual Harassment
ambiguous situations
- no longer unclear when person is told not to do it anymore
- example off-color jokes are not okay once the person has been told that they have gone too far and continues to do it
Harm
- reasonable steps to avoid harm, minimize foreseeable effects
Multiple Relationships
definition and an example
- current or former clients or closely related
- when asked to do forensic and therapeutic services must refer out
Multiple relationship
3 factors to consider treated patient
- power differential between therapist and client
- duration of each relationship
- clarity of termination of each relationship
- ↑differential ↑longer duration between two ↑ likelihood 1 or both may resume in future
*
Potential Harmful Multiple relationship
- if occured psychologist must take reasonable steps to resolve
- best interest of the affected person and max compliance w/ethics code
- speak w/colleague to determine the best course of action
- speak with individual
Conflict of Interest
- cannot accept if it will impair judgement, effectiveness, exposure, harm or exploitation
- violation can include if psych recommendation proceeds they gain benefit from it (psych recommends client purchase a product because they get a kick back from purchase)
Third Party
- Identify role (therapist, diagnostician, or expert witness) & also discuss limits in confidentiality
Supervision Guidelines for Education
Who is the client
- the client ordinarily refers to a direct recipient of psychological health care service
- adult
- adolescent
- child
- couple
- family group
- organization
- community
Guidelines for Forensic Psychology
Client
- CLIENT
- attorney
- law firm
- court
- agency
- entity
- party
- or other people who has retained
- contractual relationship
Informed Consent
definition
- must obtain unless mandated by courts or governmental agency
- exception court order evaluations & research with deception
Informed consent
Legally incapable of giving consent
- provide explanation, assent, permission from legal government by the state
- minors w/cog maturity
- minors w/medical condition
- alcohol, substance or STD
- minors w/medical condition
- presumed consent-life threatening for a minors
- should be obtained w/ ongoing treatment
- ↑risk for suicide
Doctrine of implied consent
assumes if minors parent were present they would consent
Informed Consent
Court Ordered Services
- psych must inform person nature of service and limitations of confidentiality
Informed consent
Forensic court-ordered services
- must explain nature of exam but can proceed w/o consent
- if subject refuses psych can postpone, contact attorney, or notifiy retaining party
Informed Consent Documentation
must document:
written
or oral permission
or assent
Informed Consent
Teletherapy
- strive to obtain and document informed consent that will adhere concerns of teletherapy
- this includes
- emergency plan
- procedures of contact between sessions
- process of documenting and storing information
- potential technical failure
- procedure for coordinating care with other professionals
- conditions under which teletherapy must terminate and a referral made for in-person treatment
*
Informed consent
Interruption of services
- when forseeable , predetermination counseling, discuss w/client and find provide counseling and referrals
- due to death or illness must plan a professional will where Executor will contact clients and ensure severity of clients records
Privacy and Confidentiality
Limits of Confidentiality
- limits of confidentiality and foreseeable uses of information generated through their psychological activities
- and onset of relationship occurs may need to discuss as needed or with new circumstances
Limits of confidentiality
Couples and families
- discuss how family information will be shared
- will all information disclosed by an individual separately be shared or kept closed from other family members and partners
Limits of Confidentiality
Group Members
- cannot gaurantee confidentiality in groups nor are group members ethically bond
- ↓likelihood of disclosure by explaining the importance of maintaining the confidentiality and possible negative consequences
- discuss at
- initial screenings
- group sessions
- subsequent and final sessions
Limits of Confidentiality
Minors
- confidentiality with minors best to discuss with all parties at the same time
- devise a confidentiality agreement with minor and parent to know what will and will not be discussed
- inform parents that law enforcement, medical personnel and others will be informed if sexual or physical abuse is suspected
- also make known that parent/gaurdian will be contacted if client is engaging in potentially harmful behavior that may impact his/her safety
Limits of Confidentiality
Deceased Clients
- disclose only with permission from executor, estate admin
Limits of Confidentiality
Members of the Military
- DoD limited confidentiality-confidentiality can never be guaranteed in the military
- may need to keep conservative documentation
Limits of Confidentiality
Correctional Facilities
treatment driven vs security-driven
- range from essential confidentiality to no confidentiality
- treatment driven-therapeutic benefit (acting best4client)
- security driven-confidentiality respect but safety of others is more important
*
Correctional Facility
Level of threat-duty to protect
inside vs outside of jail
- level of threat includes
- inside jail could cause harm (office, inmate)
- breach confidence to warn (wardon)
- outside jail
- less likely to pose a threat due to the inability to carry out
- continue therapy to reduce violence of threat and behavior
- may need to breach if inmate is due to release soon or person to harm may be a possible visitor
- inside jail could cause harm (office, inmate)
Limits of Confidentiality
Employee Assistance Programs
person seen information is not shared with employers without authorization
Limits of Confidentiality
telepsychology
- telepsychology increases risk for confidentiality in both delivery of services and recordkeeping
Limits of Confidentiality
Disclosing Confidential Information
- appropriate authorization
- mandated by law legally required to breach for child abuse
- legally permitted to contact a collection agency for a fee
Limits of Confidentiality
Danger to self
- must take into consideration safety of client
- ↑ risk of suicide must take actions to protect safety (hospitalization)
Client is a danger to others
Tarasoff
- dut to protect only when clear and imminent threat of physical harm to an identifiable victim
- warn victims, notify police, take reasonable steps to hospitalize client
Health Insurance Portability & Accountability Act (HIPPA) & Protective Health Information (PHI)
- health information can be disclosed without patients authorization for
- treatment
- payment
- or other health care operations
- however it cannot be disclosed if state law trumps HIPPA if they indicate do not disclose
*
How much do you disclose in HIPPA
health information
forensic information
- Health information should always be kept in a minimum disclosure necessary specifically for the purpose and requirement
- Forensic Psychology-should focus on relevant information to questions only regarding evaluation
HIPPA
Psych consult w/collegues
- can get a consultation from another psych but cannot provide/ask any identifying information without authorization
- names must be changed, birthdates, locations, and other private information in addition to changing the season or year of the event to modify details, including family size.
Confidentiality Vs Privilege
- confidentiality-ethical, legal requirement
- privilege (privileged communication is a legal term for the right to have confidentiality in legal process
Holder of Privilege
- the client or the clients legal representative holds the privilege
- a psychologist may exert privilege on behalf of the client
Exceptions to privilege
- court decides if an exception applies
- For example court order examination to determine competency, person sue therapist for malpractice, person uses mental status as claim for defense
APA Code 5 and 6
Advertising and Public Statements
Public Statements
- do not make false statements & fraudulent which includes training, experience, service, fees, advertisements, listing, lectures
- responsible for statement made by others
- can only acknowledge degrees from an accredited agency or one that has received approval from qualified licensing agency
Public statements
Press
Public advice in print
- cannot compensate press for statements
- must be based on training, education or experience
- a psychologist cannot indicate that interaction during media establishes professional relationship
Client testimonials
- cannot use current therapy clients/patients because of possible vulnerable to undue influence
In-Person Solicitation of Business
- cannot encourage others to get therapy due to influence
- excludes encouraging family members to participate in current therapy or disaster relief
Record keeping and fees
Maintaining, Disseminating Disposing of Records
- maintain confidentiality of records
- when entering information be sure information & access is coded if needed
- leave a plan to transfer files & clients
- record if a patient withdraws from practice
Disposing of records
- Record adults 7 years
- Children 3 years after they turn of age whichever greater
- federal support 3 years after project completion
- Publication Manual raw data 5 years after publication
Fees
- as early as feasible
- must inform client first before sending them to collections
- if session is free must understand the limits of the session and what is expected for the future sessions
Financial Arrangements
withhold records
barter
- cannot withhold client records just because of unpaid fees if needed for emergency services
- it maybe illegal to withhold
- Barter is accepted when not clinically contradicted or exploitative although goods less risky than services
Forensic Psychology contingency fees
- due to impartiality presented forensic practitioners should avoid providing services on the basis of contingent fees
Payors (insurance company)
diagnosis
billing
group therapy vs individual billing
copay (waive)
- insurance company should receive actual diagnosis
- do not say you are billing for one thing and treat for another or say psych did service when really the assistant did
- it is illegal to bill for individual therapy if it was group therapy
- cannot waive copay
*
Referral fee
- only the cost of actual time with the client
- or copying and forwarding the clients file
- does not apply to dividing fees with another professional when both service client or paying a percentage of clients fee
APA Ethics 7 & 8
Education and Training programs
program accuracy
course syllabi
- reasonable steps programs accurate
- course syllabi should provide accurate information for grading and expectations
- changes must be made in a manner student can still complete degree
Education and Training Programs
Private information disclosure
admission material
threat/harm
- must be a part of admissions materials
- or information found may be harm/threat to others keep them from performing training or professional competent manner
Individual/group therapy requirement
individual/group therapy required cannot be current professor and must be allowed to seek outside of university if desired
Assessment of student and supervisee performance
- timely feedback for students and supervisor
- eval must be based on actual performance
*
dismissal of supervisees
supervision has due process rights
- must provide regular feedback (constructive)
- including remediation if necessary
- ↑supervision hours
- recommend personal therapy
- ↓workload
- complete additional course work
- recommending a leave of absence or second internship in another setting
Sexual relationships with students/supervisees
- prohibits sexual involvement with students/supervisee that is in their department, agency or training center or over them
- or if they have or likely to have evaluative authority
Informed Consent for research
- purpose of research, duration & procedures
- right to decline or withdraw at any time
- foreseeable consequence to withdraw or decline
- potential risks, discomforts & adverse effect
- research benifits
- limits of confidentiality
- incentives
- content information about who to contact regarding rights & questions
must also be given the right to ask and receive answers to questions about research
Informed consent
effects of experimental treatment, control group
- people must be given information regarding treatment, available alternative treatments & any other things not assigned to control group
Informed consent
NOT NEEDED
- look at others at schools
- looking at job behaviors & confidentially maintained
- anonymous questionnaires
- does not need to consent to record images or voices when the is
- in public places & not likely to cause personal identification
- or harm or cause deception AND consent will be obtained during debriefing
Inducement for Research
- course requirement of opportunity for extra credit provide alterations more reasonable efforts to avoid excessive financial inducements
- offer things in exchange for research
Deceptions in research
- certain conditions or applied value
- alternative non-deception option not available
Cannot be deceived about
- things that will cause physical pain or emotional distress
- can quit at anytime
- told as feasible possibly no later than conclusion of date of collection of data
Use of Animals in Research
- these with animals experience must supervise all procedures & are responsible for ensuring
- comfort
- health
- humane treatment
- can only experience pain, stress, privation (food and warmth lacking) only when NO other alternative is available
- when animal needs to die it must be quick & with little pain
Reporting & Publishing Research
- cannot lie about data & must correct errors
- when you know it is wrong, no plagiarizing
Principal Authorship
- principle author must reflect contribution not status
- if student did the work they should get 10 credit
- must be listed principal on doctoral dissortations
Duplicate Publication of Data
- can not publish old data as new data unless it is acknowledged
- can only submit one article at a time to be published
Assessment Techniques and Results
and interpretation
7 key components
- conclusion are derived from sufficient information past or present. Be able to explain why you used previous testing
- use updated test materials and standard procedures
- do not allow others to use test w/o supervision
- updated test result should be recognized and when retest due to new skills learned
- you are responsible for test data & scoring templates
- explain results unless for employment screening or courts
Informed consent for assessment
4 parts
- informed consent must include nature & purpose of assessment fee and limits of confidentiality
- it is not needed if
- mandated by law
- routine & educational
- it is not needed if
- questionable capacity & must be in understandable language
- an interpreter must hold confidentiality & discussion of limitation testing with interpreter
Test data and Test materials
- test data, notes, scores, materials can release to client unless the worry is it may cause harm if the law allows
Test scores and items discussion with client
- protect integrity of test materials, consult with law requirement and can discuss a test item to help person understand results
Informed consent for therapy
- as early as feasible in therapeutic relationship
- includes fees, third party & limits of confidentiality
Informed consent regarding trainee
- if trainee supervisor is responsible client must be informed of trainee status and given name of supervisor
Provide therapy to clients serviced by others
- caution if person is seeing someone for the same issue in group but wants individual it maybe okay
- if person is seeking treatment for the same issue its not
- Also get permission 2 speak w/therapist to coordinate treatment
Sexual Intimacies
bear the burden of demonstrating
- no to current
- former patient must wait 2 years and no exploitative
- time passed
- nature of therapy
- circumstances
- clients history
- mental status
- impact on client
- action from a therapist (no suggesting to end a therapeutic relationship in order to have sex or have a mutual relationship
- NO SEX with known relatives of current therapy clients
- cannot provide therapy to someone you have had sex relations with in the past
Termination of therapy
- clearly no longer needs it
- therapist and client can reevaluate progress
- terminate when feeling treaten by or engaged by client or relative
- when therapist feels threaten they specifically by client must provide preterm counseling and referrals for alternative service providers
Professional Issues
Malpractice Claims
- Four conditions
- professional relationship
- dereliction of breach of duty
- client suffered harm
- direct or approximate harm can be measured
Professional Issues
Responding to Subpoena
- subpena legal (served correctly)
- formally respond after contacting a client
- if client authorizes release information if not contact party to ask if they will withdraw
- attempt to negotiate to seek guidance informally from court or formally motion quash a subpoena
Forensic Psychology Legal Teams
Insanity
- legal term
- not guilty by insanity-mental issues or defeated
- fail to recognize actions were wrong or immoral
- aka guilty by insane, or guilty but mentally ill
- 1% of all cases successful 25% of the time
Competency to stand trial
- cooperate with an attorney & understand charges against them
- methods to evaluate, interviews, mental status psych test
- review of information
- psych tests as well as determine competency to insanity, stand trial, waive right to counsel
- & can person really make the decision he is making
Fact Witness
- testify on what he has seen or what has taken place
- not allowed to provide an opinion
- not allowed to respond to hypothetical situations
- can only give confidential information w/permission from client or court order
Expert Witness
- eduction or expertise
- person possesses superior knowledge
- respecting subject the are allowed to provide an opininon and answer hypothectical situations
Avoiding Bias in Language
Gender vs sex
- get rid of gender exclusivity
- gender refers to social identity
- sex-refers to sex assignment
- if gender or sex identity is unknown use they, them and their
Sexual Orientation
- avoid inaccurate terms
- identity-first terms to describe sexual orientation (lesbian woman, bisexual people)
- sexual and gender minorities use these terms
- LGBTQ (+) are acceptable
*
Age
- avoid using males and females with groups of a wide range of ages
- 12 years or less say child, boy, or girl
- 13-17 say young person or adolescent
- 18+ say adult, woman and man
- 65+ say older adult NOT elderly, senior citizen or the aged
Disability
Physical, psychological, socioemotional impairments
- avoid - and condescending language
- person in a wheelchair
- person with AIDS
-
person-first language
- Adolescent w/ASD
- people w/visual impairments
-
identity first language
- autistic adolescent
- visually impaired person
Race/Ethnicity-General Guidelines
- Capitalize racial/ethnic groups
- Do not hyphenate names of racial groups
- avoid using term without a specifier
- use ethnic minority students not minorities
- use racial-ethnic minority students
- parallel comparisons
- African Americans and European Americans
- or Blacks and Whites
Race/Ethnicity
Racial and Ethnic groups
- African American, Black
- or more specific to region Nigerian or Haitian
- Asain, Asian American, Asian Canadian, Japanese, Japanese American
- Latinx, Salvadoran, Costa Rican
- European, European American, European Canadian in North America White is acceptable
- Native American, Hawaiian Native, Pacific Islander, Alaska Native
- alternatively, Indigenous People, or First Nations may be preferred
- Middle East or North African Origin or Arab American is fine
Responding to negative online reviews
- responding to negative reviews violates HIPPA privacy
- ↓ (-) views by establishing + online presence, patient satisfaction rating & + evals from colleagues
Telepsychology
- aka telehealth and teletherapy
- services by phone, email, chat, text, internet
Telepsychology
Interisdictional Practice
- patient is located in another state,, province or country than the therapist
- the therapist needs to be considered in the location of the patient (state) permanently or temporarily at the time of the services
Telepsychology
Interisdictional Practice
regarding PSYCPACT
- therapist needs to know child abuse reporting laws in another state
- duty to warn
- local resources available to the client
- should only advertise to people they can legally provide services consider in brochures and professional websites
PsychPact
- Psychology interjurisdictional compact (PsychPact)
- aggreement allows doctoral level psychs to provide services across compact states through telepsychology or temporary in-person basis without licensure in that state
PsychPact
Telepsychology
- psychs in a compact state must obtain E.Passport and Authority to Practice Interjurisdictional Telepsychology (APIT) from PSYPACT commission
- must initiate while client is in their home state
- psych must remain w/n scope of practice in clients home state
PsychPact
Temporary Services
- psychs provide temporary in-person services to clients in other compact states
- must obtain Interjurisdictional Practice Certificate (IPC) and Temporary Authorization to Practice (TAP) from PSYPact Commission
- after certificates may provide in any compact state up to 30 days per year
Journal Article reporting Standards
- APA created Journal Article Reporting Standards (JARS)
- Consolidated Standards of Reporting Trials (CONSORT)-medical experts guidelines for reporting randomized control trials.
- JAS also includes guidelines for research experimental and nonexperimental, meta analyses, replication studies and structural equation models
Clinical Supervision
Professional Guidelines
Clinical supervision
Professional/Ethical Guidelines
- assist in thoughtful relevant & consultant, supervision, competency &
- enhance accountability& protection to the public
- fixing areas where not meeting the criteria for competence
- prepare for independent practice
- act as a gatekeeper to make sure supervise is ready for independent practice
- facilitate professional development
- discrete competency that presents unique eitical issues
Clinical Supervision
competence
- ongoing monitoring & professional development to supervise
Clinical supervision
Confidentiality
- limits of confidentiality and be sure clients have been informed
- when they are a trainee clients should be informed
Clinical Supervision
Multiple relationships
- Power differiential-closely monitor that they have objectivity and not explore the supervisor
- 10 Primary supervisor doctoral level ultimate responsibility
-
Delegate supervisor license health practitioner with a supervisor
- may delegate certain supervisor responsibilities
- maintain dates of supervision, adequate notes and maintain until supervise gets licensed or 7 years which ever greater
Clinical Supervision
Telepsychology
- cannot be more than 50% of total supervision.
- Must be in the same state and must verify identity at beginning of contact.
Clinical Supervision
Health Service Provider
- developed to inform educate & training regarding implementation of competency asked coperations-
Clinical Supervision HSP
*metatheatrical approach
- knowledge, skills, attitude and learning, evaluation procedures, criterion reverence standards and evidenced-based practice
- priority is given to protecting clients
Supervisors Roles
- supervisors are gatekeepers
- also look at supervisees abililty to sustain in this role independently
Ethical Guidelines of Supervision
4 principles
- respect dignity of people
- responsible caring
- integrity & relationship
- responsibility to society
Models of Supervision
Psychotherapy-based supervision model
- observation/selection data for discussion during supervision as well as meaning of data
Models of supervision
person-centered supervision
- relationship between supervisor & supervisee rather than supervision
- involves empathy, genuineness, unconditional regard
Models of supervision
cognitive behavioral supervision
- parrells cognitive therapy
- collaborative relationship behavioral rehearsal
- Socratic questioning & guided imagery
- consists of
- check-ins
- building a bridge
- getting work agents
- summary work
- assigning homework
- giving feedback
Development Model supervision
- Intergrated developmental model-3 levels
- self-awareness, motivation & autonomy
Developmental supervision model
Integrated development 3 stages
- Level 1
- supervisees are focus on self, limited self -eval, ↑ motivation, ↑anxiety depending on supervisor
- Level 2
- supervisees focus better on client, empathetic, ↑↓ motivation, & confidence, (-) autonomy & independence from supervisor
- Level 3
- Remain focus on client & attend & attend to actions
- consistent motivation, confident about skills and judgements (it is important to foster independence)
Models of supervision
Process-Based
- aka social role models
- describes competent roles, and task process w/in supervision to classify events, discrimination model
Models of Supervision
Process-based focus areas
- intervention (process) skills
- conceptualization skills
- personalization skills
- also, supervisors roles are
- educator
- counselor
- consultation
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