Ethics - Taylor Study Method 2015

Question 1

Animal Research

Answer 1

Standards for research:
1) Follow institutional requirements, governing laws, and professional standards
2) Justification of research should be clear, significant enough to justify the animal use
3) Protocol must be reviewed by appropriate animal care committee (e.g., IACUC)
4) U.S. Department of Agriculture inspects facilities twice a year
5) Records regarding the procedures used and care of animals must be kept
6) Acquisition of animals must be lawful; transportation of animals must be humane
7) Experimental procedures are acceptable if non-intrusive or if the animal is properly anesthetized
8) If Euthanasia is required, must be done humanely
9) In educational activities involving live animals, including instruction of ethics

Personnel
a) Must be properly trained or supervised
b) Must provide proper care and housing for the animals

Reasonable Alternatives
*Institutional Requirements: Regulations of a University or clinic that detail specific ethics and regulations of institutionally based research
**Laws: Legal documents setting forth rules governing a particular kind of activity (e.g., animal research)

Question 2

Buckley Amendment

Answer 2

Established
1) 1974
2) Also known as the Family Educational Right to Privacy Act (FERPA)
3) Federal Law

Functions
a) Protects the privacy of student school records
b) Rights are given to parents of minors, and to eligible students over 18
c) May request that schools amend incorrect of misleading information
d) formal hearing may be requested if school denies to amend or correct information
e) Limits disclosure of records; in most instances, written consent required
f) Exceptions include reporting to accrediting organizations, complying with a subpoena

Reasonable Alternatives
* Least Restrictive Environment: Students with a documented disability should be placed in programs with non-disabled students whenever possible
**Elementary and Secondary Education Act of 1965: Guarantees a high-quality education for all individuals, with a fair and equal opportunity to obtain an education

Question 3

Deception

Answer 3

Justification of use
1) Used to prevent participants from altering their responses
2) Use must be justified by study’s value and alternative procedures are not feasible

Ethical
a) May include false feedback or withholding information regarding study design
b) Must debrief at the earliest opportunity, explain use of deception
c) After debriefing, participants may withdraw their data

Unethical
A) Never permissible to cause emotional or physical harm, or willingness to participate in research

Informed consent
1) True informed consent is not obtained when deception is employed
2) Debriefing regarding the Deception must be conducted as soon as possible

Reasonable Alternatives
*Informed Consent: An agreement in which proposed treatment or research participation requires the disclosure of benefits, risks, and alternatives to the proposed activity; the method by which fully informed, rational persons may be involved in choices about their health care or research participation
**Avoiding Harm: Minimizing harm to research participants, supervisees, clients/patients, and others with whom the psychologist works.

Question 4

Research and Publication

Answer 4

Conducting Ethical Research and Publication
1) Conduct research according to the general principles of APA ethics code: beneficence/non-maleficence; fidelity and responsibility; integrity; justice; respect of people’s rights and dignity
2) Applications to institutional review board: resubmit if changes made to method, compensation, procedures, informed consent, or confidentiality protections
3) Avoid biased language: follow APA publication manual
4) Obtain informed consent orally or in writing prior to their participation
5) If participant legally unable to give consent: explain study appropriately, obtain assent, obtain consent from legally authorized person if appropriate
6) Provide participants with explanations of the purpose, expected duration, procedures, voluntary nature of participation including the right to withdraw, potential risks, benefits, limits of confidentiality, contact information if questions arise
7) Do not use passive consent from legal guardians for participants not able to legally consent
8) Informed consent not necessary in studies with no reasonable risk of harm
9) Experimental treatments: consent must include information about experimental nature of treatment, how assignment to condition is concluded
10) Deception necessary at times to avoid participant “hypothesis-guessing” - value of research must outweigh costs, alternative must be infeasible or ineffective, cannot cause sever distress
11) Debrief as soon as possible
12) After Study involving deception, allow participants to withdraw data
13) Compensation may not be excessive
14) If extra credit is offered in class, offer alternative methods
15) May not ask students, clients, or subordinates to participate in research
16) Do not falsify/fabricate data, correct errors in published work if discovered, share data with other researchers for verification/reanalysis
17) Do not plagiarize
18) Authorship order according to relative contributions regardless of status
19) Minor contributions do not merit authorships

Reasonable Alternatives
*Plagiarism: Presenting another person’s ideas or words as your own; failing to cite another person’s work adequately may constitute plagiarism
**Assessment: The Process through which psychologist gather or integrate data from various sources (e.g., interviews, psych-diagnostic tests, behavior observations, record reviews) in order to evaluate an individual’s psychological, behavioral, social, emotional, or cognitive functioning for the purpose of providing a diagnosis or services to that individual.

Question 5

Competency to Stand Trial

Answer 5

About
1) Legal decision regarding ability to participate in one’s own defense
2) Assess present mental status, not at the time of the crime
3) Assess ability to understand the nature and purpose of the legal proceedings, comprehension of his/her stats or role in the proceedings and ability to assist in his/her defense
4) If deemed incompetent, defendant receives inpatient treatment until competency regained, or released in a conservator

Reasonable Alternatives
a) Privilege: A legal term that refers to an individual’s right to refuse to have his or her information revealed or released in legal proceedings.
b) Insanity: A legal term used in a court of law to describe an individual who, as a result of a mental disorder, is psychologically impaired to the extend that he or she is unable to distinguish right from wrong and understand the consequences of his or her own behavior
c) Mental Illness: Behavioral or psychological syndromes that cause significant distress or disability or a significantly increased risk of suffering death, pain, or important loss of freedom
d) Rehabilitation: The restoration of the ill or injured patient to an optimal functional level in all areas of activity
e) Informed Consent: The therapist’s obligation to obtain consent from the client to participate in therapy, assessment, research, and so forth
f) Testamentary Capacity: Having the mental competency to execute a last will and testament at the time a will was signed and witnessed
g) Criminal Responsibility: Assessment of a person’s mental status at the time an alleged crime was committed

Question 6

Court-Ordered Evaluations

Answer 6

Evaluations
1) Paid by court (ex., competency to stand trial, mental health status, child custody, etc.,)
2) Never the psychologist’s role to determine guilt or innocence
3) Clarify limits of confidentiality, privilege

If legal representative objects to the testing
a) Psychologist must notify the court and proceed as directed

Child Custody Evaluation
A) Written informed consent from all adults, explanation to all minors
B) No multiple relationships with the child in custody evaluation

Reasonable Alternatives
Insanity: A legal term representing the inability to know right from wrong or understand the consequences of one’s actions
Information Harmful to the Client: Information gained by a therapist in a session or evaluation that may incriminate the client is divulged when privilege or confidentiality is waived
*Waived Privilege: Occurs when the client gives up the right to prevent a therapist from divulging confidential information in a legal proceeding; this information may be harmful to the client’s case; in cases that involve minors, the privilege belongs to the parent; in cases of insanity, the privilege is waived by the courts
**Best Interest of the Child: This term is used by the courts to determine placement in child custody cases
***Privilege: A legal term that refers to an individual’s right to refuse to have his or her information revealed or released in legal proceedings; it is limited in court-ordered evaluations
**Confidentiality: A psychologist’s obligation to take reasonable steps to protect current and former clients’ information from unauthorized disclosure; is limited in court-ordered evaluations
**Guild Versus Innocence: Decision made by the court regarding the likelihood that the client committed the crime

Question 7

Expert Witness

Answer 7

Expert Witness
1) Testify based on special training and professional competence
2) Professional Opinions regarding subject matter
3) Avoid multiple relationships - do not provide expert testimony to acquaintances, therapy clients
4) Assist jury in making their decision
5) Serve as impartial educator to jury
6) Do not accept contingency fees

Reasonable Alternatives
a) Forensic Psychology: The branch of psychology that provides psychological expertise within the legal system
b) Fact Witness: Someone who testifies in court because of his or her direct knowledge of an event

Question 8

Fact Witness

Answer 8

Testimony
1) Regarding direct knowledge of an event

Subpoena
a) For testimony as a witness
b) Through a deposition/interrogation

Under Oath
A) Must give accurate account
B) Decline to answer questions if you do not know the answer, or it appropriate only for expert witness
C) Testify only if client has waived confidentiality/privilege, or if court-ordered

Reasonable Alternatives
Confidentiality: Refers to a psychologist’s obligation to take reasonable steps to protect current or former clients’ information from unauthorized disclosure
**Privilege: A legal term that refers to an individual’s right to refuse to have his or her information revealed or released in a legal proceeding
**Expert Witness: A person who can testify because of his or her expertise or special knowledge about a subject related to the case

Question 9

Insanity

Answer 9

Insanity as a legal defense
1) Individual is unable to distinguish right from wrong and to understand the consequences of their behavior; must be due to a mental disorder
- Also referred to as the Not Guilt by Reason of Insanity (NGRI) defense
2) First case using Insanity defense: M’Naughten
- Most States: defendant deemed insane is not held criminally responsible
- Some States: “Guilty, But Mentally Ill” (GNMI) verdict
3) Decided by court
- Psychologist may give expert testimony regarding Insanity, but it is the court that determines Insanity in defendant

Evaluation
A) Privilege waived, psychologist should review limits of confidentiality with client

Reasonable Alternatives
*Psychosis: A general psychological (rather than legal) term encompassing mental disorders characterized by a significant impairment in reality testing (e.g., hallucinations and delusions) or other sever deficits (e.g., catatonic behavior and severe cognitive disorganization) that prevent individuals from meeting basic life demands.
**Paranoia: A psychotic state of mind characterized by intense fear or anxiety that influences the individual to believe that something or someone is after him or her, in some persecutory fashion.

Question 10

Subpoena

Answer 10

Definition: A legal command to testify about a client or to turn over client records

Action
1) Clarify whether the subpoena constitutes a court order
2) If unclear, contact the court
3) May follow court order in releasing client information without client’s consent
4) May also contest court order by asking judge for guidance or filing a legal motion to quash
5) If Subpoena does not constitute a court order, written release of information must be obtained from client
6) If client refuses to consent to this release, and a subpoena does not constitute court order, instruct the requesting attorney that the information cannot be released without the person’s consent (do not reveal as client)
7) Requesting attorney will then stop pursuing the records, or will need to get court order

Types
A) Subpoena duces tecum: Bring physical records, only the information specifically requested
B) Subpoena ad testificandum: Oral testimony

Reasonable Alternatives
Confidentiality: A psychologist’s obligation to take reasonable steps to protect current or former clients’ information from unauthorized disclosure
Privilege: An individual’s right to refuse to have his or her information revealed or released in a legal proceeding
*Deposition: Out-of-court testimony, under oath, which is transcribed in writing; takes the place of a courtroom testimony
**Fact Witness: Someone who testifies in court because of his or her direct knowledge of an event
**Expert Witness: Someone who testifies in court because of his or her expertise or special knowledge about a subject related to the case

Question 11

Tarasoff v. Regents of the University of California

Answer 11

Case Details:
- Tarasoff murdered by Poddar, fellow student at the UC Berkeley undergoing therapy with the university psychologist
- Poddar told psychologist of specific plans to harm Tarasoff
- Psychologist broke confidentiality and warned police
- Neither police nor psychologist warned Tarasoff
- Poddar killed Tarasoff, psychologist held liable for failure to warn her and her parents
- Court ruled “protective privilege ends where the public peril begins”

Case Results:
- Duty to protect may include warning intended victim, notifying police, contacting others, hospitalization of client
- Some states have laws requiring warning of potential victims
- Ethics code allows breaking confidentiality when risk of harm to others
- Some argue that warning others may not always be the best course of action in fulfilling duty to protect, as breaking confidentiality will ruin the therapeutic alliance

Reasonable Alternatives:
Confidentiality: A psychologist’s obligation to keep anything revealed by a client in confidence private; the ethical principle or legal right that psychologists will hold all information regarding a client secret, unless the client consents to disclosure.
**Privilege: A legal term that refers to an individual’s right to refuse to have his or her information revealed or released in a legal proceeding
**Mandated Reporting: Psychologists and others’ legal obligation to disclose any knowledge of child maltreatment, and in some states, partner abuse, domestic violence, or elder abuse

Question 12

Confidentiality

Answer 12

Confidentiality:
1) Keep client information private unless client consents or as required by law
2) Essential in building effective therapeutic relationship; “primary obligation” of psychologists
3) Maintaining security of records
4) Inform clients of limits of confidentiality at outset of therapeutic or professional relationship

Disclosing Information without client consent
A) Allowable to provide needed professional services, to protect client/psychologist/others from harm, for professional consultation, for payment of services, court-ordered evaluation
B) Provide minimum necessary information
C) Preventing self-harm: may contact family members, other professionals
D) When a client sues the therapist

Reporting Abuse:
a) Required for child abuse, depends on state law for domestic abuse, abuse of vulnerable adults
b) Tarasoff case - “duty to protect” - mandate varies by state

“Duty to protect” regarding HIV transmission
1) State laws vary; APA resolution opposes legal duty, acceptable only if the their party is identifiable, with compelling reason to be at risk, is unsuspecting, and the client is unwilling or unreliable in notifying

Employee Assistance Program (EAP): Release information about attendance, compliance may be mandatory condition of therapy

Military: Confidentiality is limited; information must be released in the lawful conduct of investigations, other special circumstances, provide informed consent of these limits

Minors: Parents retain right to records of treatment unless such release is detrimental; balance minor’s needs for privacy and parental rights, clarify with both minor and parents at outset of therapy

Privilege: client holds right to withhold information from legal proceeding; waived if client sues therapist, if therapist is acting in a court-appointed capacity, if client introduces mental health condition as a defense in a civil suit, if client seeks out assistance form psychologist for the exclusive purpose of committing a crime, if psychologist determines that a client requires hospitalization

Information regarding client requested by Professional Standards Review Committee - obtain waiver of confidentiality that is specific in wording

National Survey: Confidentiality is most ethically challenging issue

Reasonable Alternatives
Privacy: A client’s right to refrain from disclosing personal thoughts, feelings, or beliefs that are known only to the client; private information becomes confidential when it is disclosed by the client to his or her therapist; while privacy is an aspect of the individual, confidentiality is an aspect of the client-therapist relationship.
**Duty to Protect: A psychologist’s responsibility to take reasonable steps to protect the intended victim when a client has made a threat against an identifiable individual.
**Informed Consent: The process by which a psychologist explains and a client agrees to the purpose and nature of psychological services, the possible uses of information obtained during psychological services, the possible benefits of psychological services, the risks or costs associated with psychological services, and the limits of confidentiality.
**Mandated Reporting: Psychologists and other’s legal obligation to disclose any knowledge of child maltreatment, and in some states, partner abuse, domestic violence, or elder abuse.

Question 13

Privacy and HIPAA

Answer 13

Privacy:
1) Keeping persons or information about them protected from public knowledge
2) Vital to psychological practice, closely associated with confidentiality and anonymity

1996
*Health Insurance Portability and Accountability Act (HIPAA)

Privacy rule of 2003
1) Standards for the privacy, use and dissemination of health care information that is transmitted electronically

“Protected Health Information” (PHI)
1) Includes any information “about health status, provision of health care, or payment for health care that can be linked to an individual”
2) Disclose minimum amount of information necessary to their parties
3) Includes oral, written, typed, and electronic data
4) Clients must sign an “acknowledgement of receipt” regarding HIPAA policy
5) May include diagnosis, treatment plans
6) Requests for psychotherapy notes require additional written authorization
7) Keep psychotherapy notes separate from other PHI
8) Clients may request access to records, review their records, ask for a duplicate copy, and ask for an amendment to any inaccurate information
9) PHI must be kept for six years
10) Applies to covered entities that disseminate information electronically
11) When state laws and HIPAA are contradictory, Follow the more stringent law

Reasonable Alternatives
Informed Consent: The process through which psychologists ensure that clients are aware of potential risks and benefits associated with therapy or psychological testing.
**State and Federal Laws: Legal documents setting forth rules governing a particular type of activity.
**APA: American Psychological Association, a scientific and professional organization representing psychology in the US. The APA has 150,000 members worldwide.

Question 14

Privilege

Answer 14

Rights/Limits
1) Refusal to release information to court proceedings
2) Holder of Privilege: legally competent adult, parent/guardian for minor, legal guardian for in competent client
3) May be asserted by psychologists to challenge subpoenas

Privilege between client and therapist
- supported by Jaffee v. Redmond case

Granting Privilege
A) varies by state and by court
B) Waived by client if release of information is signed

Reasonable Alternatives
*Confidentiality: A psychologists’ obligation to take reasonable steps to protect current and former clients’ information from unauthorized disclosure. Privilege is a legal right of clients; confidentiality is a therapist’s professional duty.
**Clinical Privileges: Possessing specific credentials to provide certain types of services in a clinical setting.

Question 15

Consultation

Answer 15

Seeking advice of another therapist not involved with case
1) Do not reveal identifying information
2) Share information only pertinent to consultation issue

Used for Questions regarding:
A) Countertransference
B) Competence
C) Ethical Dilemmas
D) Clinical Decisions

Differs from supervision, which involves formal responsibility

Ideal Consultant
a) Forthright, trustworthy, ethically sensitive, and competent

Multiple opinions beneficial because advice can be flawed

Document consultation
- In writing

Reasonable Alternatives
Countertransference: The process by which the therapist has an emotional reaction to the client due to his/her own personal issues.
**Refer Out: To give a client the names of other therapists who are qualified to treat him or her.
**Confidentiality: A psychologists’ obligation to take reasonable steps to protect current and former clients’ information from unauthorized disclosure.
**Supervision: Mentoring and oversight of a psychologist-in-training. Is different from Consultation in that it has a formal responsibility.

Question 16

Ethics Code

Answer 16

Ethics Code: Introduction, Preamble, General principles, specific ethical standards

General Principles:
1) Beneficence and non-maleficence
2) Fidelity and responsibility
3) Integrity
4) Justice
5) Respect for people’s rights and dignity

• General principles are aspirational only, specific standards are enforceable
• Some standards are concrete, others include qualifying language
• Ethics are not laws, by laws may mirror ethical standards
• State licensing boards enforce ethical behavior of psychologists
• If unsure, consult with other psychologists or state psychological association ethics division
• Document such consultation in writing to reduce liability risk

Professional Standards Review Organizations (PSRO):
1) Developed under the Social Security Act to promote healthcare services that are effective, efficient, and economical.

General Guidelines for Providers of Psychological Services:
1) Improve quality, effectiveness, and accountability of psychological services.

Specialty Guidelines for the Delivery of Services:
1) Addresses the aspects of the clinical setting to ensure both the quality and delivery of counseling services.

Guidelines for Providers of Psychological Services to Ethnic, Linguistic, and Culturally Diverse Populations:
1) Provide guidance to psychologists to be successful in providing services for ethnic, linguistic, and culturally diverse populations.

Reasonable Alternatives:
Law: Rules established by a governing authority to institute and maintain orderly coexistence.
**Values: Beliefs held by a person or social group in which they have an emotional investment either for or against something.
**Judgement: The cognitive process of reaching a decision or drawing conclusion.

Question 17

Fees

Answer 17

Charging Clients:
1) Establish agreement as soon as feasible, may be delayed if the client is in crisis
2) Specify fees, billing arrangements, all anticipated costs
3) Collection agencies can be used if disclosed to client and opportunity provided for payment
4) Provide minimum information necessary for collection
5) In emergency, do not withhold records because of nonpayment
6) Do not terminate because of nonpayment if client is in crisis
7) Bartering acceptable only if not clinically contraindicated and not exploitative
8) Cannot waive copayments
9) Accurately report services provided, client diagnoses to insurance companies
10) Do not engage in fee splitting (payment for client referrals); payments must be based on services provided

Reasonable Alternatives:
*Sliding Scale: A fee scale in which fees vary based on the client’s income or ability to pay.
**Barter: The exchange of goods, services, or other non-monetary remuneration for provision of psychological services.
**Pro Bono Services: Services that are donated or provided free of charge.
**Fee Splitting: The practice of sharing fees with professional colleagues for client referrals: Also referred to as kickbacks.

Question 18

Informed Consent

Answer 18

Steps in Informed Consent:
1) Disclose potential risks and benefits associated with therapy, assessment, and research
2) Explain nature of the services, limits of confidentiality, involvement of third parties, fees
3) Provide opportunity to ask questions and receive clarification
4) Use understandable language, document written/oral consent/assent
5) If legally incapable of consent, obtain appropriate permission from a legally authorized person if possible, explain services, and consider client’s preferences and best interests.
6) Laws regarding treatment of children without parental consent vary by state
7) Disclose if treatment method is not established or risky, alternative methods
8) Disclose if trainee is under supervision
9) Obtain consent for therapy as early as feasible; may be delayed in emergency situation
10) In psychological assessments, explain nature of testing and potential uses of testing
11) Consent not necessary if testing mandated by law/government, if testing is a routine activity, or if assessing decisional capacity
12) Must obtain consent to use client information in novel way
13) Informed consent demonstrates respect of client’s autonomy, sets up collaborative atmosphere
14) Continuing process as necessary during course of treatment

Reasonable Alternatives:
* Confidentiality: A psychologists’ obligation to take reasonable steps to protect current and former clients’ information from unauthorized disclosure.
**Assent: An affirmative agreement by a client to participate in research or psychological services when the client is legally incapable of providing consent.

Question 19

Licensing

Answer 19

To Obtain Credentials:
1) Must meet state/province requirements
2) Must complete doctoral program in psychology, pass the EPPP, and state jurisprudence exam

State Requirements:
A) Many states have oral evaluation, most states require post-doctoral hours
B) State licensing boards ensure that licensed psychologists have met minimal requirements, monitor their conduct, can revoke license
C) Non-licensed psychologists should be supervised by licensed psychologists
D) Many states require CE credits/units to maintain licensure; CE program sponsor must be approved by APA

Reasonable Alternatives:
Ethics Code: Guidelines set by the APA that outline psychologists’ standards of practice and standard of care for clients.
**Professional Development: CE courses required for licensed psychologists to deepen and broaden their knowledge of mental health and related issues.
**Legal Guidelines: Decisions made by a court of law regarding mandates for psychological practice.
**Job Proficiency Measure: A measure of how well one is doing in one’s current job.

Question 20

Multiple (Dual) Relationships

Answer 20

Avoid multiple roles that impair effectiveness or cause harm/exploitation:
1) May occur with clients, supervisees, students
2) Can impair competence, objectivity, overall performance efficacy, and case harm or exploitation of client

Encountering client out of session:
- Allow client to decide whether to acknowledge you or not

When multiple roles are unavoidable:
A) Clarify roles at onset and as roles change
B) Occur more often in rural communities

When problematic multiple relationship does occur:
a) Take immediate action to comply with ethics code
b) Most frequent cause of legal/disciplinary action

Ethical Violations:
1) Most frequent cause for legal or disciplinary action
2) 46% of disciplinary actions by psychology boards involve Multiple Relationships
3) 43% of APA’s open cases

Reasonable Alternatives:
*Bartering: The acceptance of goods or services in return for psychological services.
**Conflict of Interest: Occurs for a psychologist when he or she has competing professional or personal obligations toward a person, as well as personal or financial interests with that person, that would make it difficult to fulfill the psychologist’s duties fairly.

Question 21

Pro Bono

Answer 21

This type of service is:
1) Work done for the public good without compensation

Recommended in the General Principles of Ethics Code:
A) Aspirational, not enforceable
B) Ethical when administered appropriately and does not involve insurance
C) Waiving co-payments on insurance considered fraud

Reasonable Alternatives:
*Bartering: The provision of psychological care in exchange for something other than money; this is unethical if exploitative or clinically contraindicated.

Question 22

Professional Competence

Answer 22

Ethics in providing service:
1) Offer services only in areas within one’s boundaries of competence
2) Need proper training, or appropriate supervision; otherwise, refer to another provider who has competence in that area
3) If suitable provider not available, may proceed while making efforts to obtain the necessary competence
4) If emergency exists and no other provider is available, may proceed until emergency ends or appropriate services become available
5) Work with populations or in areas in which one has received appropriate training or experience
6) Be aware of individual differences that affect research or provision of services
7) Must work to eliminate biases based on culture/ethnicity
8) Monitor efficacy of services, base work on scientific knowledge
9) Must maintain lifelong learning to develop and maintain competence
10) If standards for preparatory training do not exist, take reasonable steps to ensure competence and avoid harm
11) Supervisors must ensure that delegated work is performed competently
12) Seek assistance if personal problems interfere with work
13) Avoid activities that are likely to impair one’s professional competence

Reasonable Alternatives:
Board Certification: The process through which the American Board of Professional Psychology certifies that a psychologist has acquired specialty competency through formal education, training, and experience; psychological specialties recognized by the American Board of Professional Psychology include child and adolescent, clinical, clinical health, clinical neuropsychology, cognitive and behavioral, counseling, couple and family, forensic, group, organization and business, psychoanalysis, rehabilitation, and school.
Competency to Stand Trial: A defendant’s ability to assist in his or her own defense.
*Referring Out: The process of providing a client with the contact information of another therapist whos is willing and able to provide services; it is important to provide continuation of care in instances where the current therapist must terminate with the client unexpectedly.
**Termination: The process by which a psychologist and client end their relationship.
**Licensure: Authorization from a state licensing board to practice psychology; licensure protects the public by legally allowing only suitable qualified persons (as defined by state law) to practice psychology.

Question 23

Advertising and Public Statements

Answer 23

Includes:
1) Advertising
2) Listings
3) Display of Credentials
4) Media
5) Lectures
6) Legal Testimony
7) Published materials

Standards:
A) Ethical to promote services, but must not be deceptive or inaccurate
B) Must amend any false information that has been released
C) Unethical to pay media members
D) Must be clear to public that advertising has been paid for
E) May not solicit business from vulnerable individuals, but may provide outreach services and provide emergency services during disasters
F) Public advice through media should be presented as educative, not therapeutic
G) Such advice must be based on professional knowledge and established literature

Reasonable Alternatives:
*Confidentiality: A psychologist’s obligation to take reasonable steps to protect current or former clients’ information from unauthorized disclosure.
**Bias: A preference or inclination, particularly one that inhibits impartial judgement.

Question 24

Record Keeping

Answer 24

Keep records to:
- Facilitate future provision of services, allow for replication of research, meet institutional requirements, ensure accuracy of billing and payments, ensure compliance with law

Minimum information:
A) Identifying data, dates and types of services, fees, assessment, treatment plan, consultation/summary/testing reports as appropriate, and any releases of information
B) Document major treatment decisions and rationale
C) If records are likely to be subpoenaed, higher standard should be followed based on court expectations and legal regulations

Exempt Notes:
- Psychotherapy notes exempt from HIPAA provisions allowing clients access to their health records, but must be kept separate from rest of record

Release, Transfer, and Retention of Records:
1) Obtain authorization for release of records, protect physical security and confidentiality of records
2) Make plans for appropriate transfer of records if leaving a position or agency
3) Retention requirements vary by state law and regulations; follow stringent guideline - HIPAA requires six years
4) APA suggests retaining records for seven years after treatment, and three years after minor reaches age of majority (18)
5) Records may not be withheld in emergency situation solely based on nonpayment of fees
6) Release records only if valid authorization form has been obtained

Reasonable Alternatives:
*Psychotherapy Notes: As defined by the health Insurance portability and Accountability Act (HIPAA), psychotherapy notes include notes recorded (in any medium) by a health care provider who is a mental health professional documenting or analyzing the contents of conversations during a private, group, joint, or family counseling session that are separate from the rest of the individual’s medial record; psychotherapy notes are immune from subpoena; clients do not have the right to access psychotherapy notes, although psychologists may allow client access.

Question 25

Resolving Ethical Issues

Answer 25

Resolving Ethical Issues:
1) Must act ethically and also must assist in maintaining ethical profession
2) APA gives “charge letter” to psychologist after potential violation - 30 days to respond
3) Correct any misuse of your work - notify that individual, request retraction
4) Frist step if ethical violation by colleague suspected - informal resolution
5) If substantial harm likely, or informal resolution fails, must file report
6) Do not violate client confidentiality in making ethical complaint - obtain client consent
7) Failure to cooperate with ethics investigation is in itself ethical violation
8) False/frivolous complain against colleague is unethical
9) Cannot discriminate solely for making ethical complain or being subject of ethical complaint
10) Conflict between ethics and law - attempt resolution of conflict
11) May follow law over ethics of no choice - this ethical standard is currently being considered for revision by APA (still? this might be a 2015 thing)

Reasonable Alternatives:
*Law: Rules established by a governing authority to institute and maintain orderly coexistence.

Question 26

Sexual Relationships

Answer 26

Guidelines:
1) Psychologists do not engage in sexual intimacies with current clients, nor do they provide therapy to former sex partners
2) Power differential between psychologist and client places client at risk for exploitation
3) Impairs psychologist’s objectivity and ability to act with beneficence in the professional relationship
4) Dealing with client’s attraction: clearly reinforce the professional boundary, discuss client’s attraction in a therapeutic context
5) Psychologists who engage in sexual intimacies with current clients often are meeting unfulfilled personal needs, likely to do so again in the future, are more likely to engage in nonsexual multiple relationships; not related to client diagnosis or level of professional achievement
6) Sexual relationships with relatives, guardians, or significant others of current clients prohibited; cannot bypass this by terminating therapy
7) Sexual relationships between psychologists and former clients: two years post-termination and exceptional circumstances must exist to prove lack of exploitation
8) Most frequent reason for loss of license, most expensive type of malpractice claim
9) Sexual relationships with students/supervisees prohibited when evaluative authority exists
10) Sexual harassment prohibited

Reasonable Alternatives:
*Multiple Relationship: When a psychologist is in a professional relationship with an individual and is, at the same time, in another role with that individual or another person closely associated with that individual; when a psychologist is in a professional relationship with an individual and promises to enter into a separate future relationship with that individual or another person closely associated with that individual; also known as a dual relationship.

Question 27

Supervision

Answer 27

This Experience:
1) Required for psychologists-in-training to demonstrate competence
2) Timely feedback must be given
3) Clarify evaluative process at outset
4) Be sensitive of the power differential and its impact on relationship

Avoid:
A) Harmful multiple relationships in supervision
B) Supervisor-Supervisee sexual relationship prohibited

Responsibility:
a) Trainee must inform patient they are being supervised
b) Client must be provided name of supervisor

Reasonable Alternatives:
Competence: An area of service in which one has received sufficient professional training.
**Consultation: When a psychologist seeks the advice of another professional in order to clarify or obtain necessary information to treat a client appropriately.
**Dual Relationship: When a psychologist is in a professional role with a person and engages in another role with that person.

Question 28

Abuse

Answer 28

Requirements:
1) Child Abuse Prevention and Treatment Act (1976) - all states require psychologists, other professionals to report suspect child abuse or neglect
2) Responsibility is not to determine whether abuse actually occurred, but to allow legal authorities to ascertain this
3) Many states laws mandate report when “reasonable cause to suspect” exists
4) If unclear whether cause is “reasonable,” Consult and/or present case anonymously to child protective agency
5) States vary regarding requirements for reported past abuse
6) Inform clients of limits of confidentiality related to mandatory report of abuse
7) Psychologists who make reports in good faith are protected from liability
8) State laws vary regarding mandatory report of domestic violence, partner abuse, and elder abuse
9) If you are aware of a colleague not reporting abuse, you must report the abuse and the non-reporting colleague

Reasonable Alternatives:
Informed Consent: The process by which a psychologist explains and a client agrees to the purpose and nature of psychological services, the possible uses of information obtained during psychological services, the possible benefits of psychological services, the risks or costs associated with psychological services, and the limits of confidentiality.
**Confidentiality: A psychologist’s obligation to take reasonable steps to protect current or former clients’ information from unauthorized disclosure.
**Duty to Protect: A psychologist’s responsibility to take reasonable steps to protect the intended victim when a client has made a threat against an identifiable individual.

Question 29

Suicide Risk

Answer 29

Assess:
1) Severity of threat
2) Intent

Other risk factors:
1) Coping Skills
2) Level of impulsivity
3) Family members or friends that have committed suicide
4) Suicide plan
5) Means
6) Presence of weapons or medications

“No Suicide” contract
1) May be useful for ideation without intent

High risk:
1) Must call police or mental health professional for possible involuntary hospitalization
2) Confidentiality waived if high suicide risk

Suicidal minor:
1) Parents must be immediately notified

Do Not:
a) Abandon suicidal clients by terminating
b) Waive confidentiality for past incidents

Reasonable Alternatives:
Informed Consent: A therapist’s obligation to obtain consent from the client to participate in therapy, assessment, research, and so forth.
Pro Bono: Works undertaken, without compensation, for the public good.
*Privacy: The private information the client shares with the therapist on the understanding that the client is at liberty to determine when and how much of his or her disclosure can be shared or withheld from third parties.
**Confidentiality: A psychologist’s obligation to take reasonable steps to protect current or former clients’ information from unauthorized disclosure.
**Privilege: A legal term that refers to an individual’s right to refuse to have his or her information revealed or released in a legal proceeding

Question 30

Termination

Answer 30

End of the psychologist-client relationship
- Reasons:
1) Client’s request
2) Client or therapist relocation
3) Client or Therapist illness
4) Treatment no longer benefiting client
5) Treatment is harming client
6) Therapist’s inability to remain objective
7) Client endangering the therapist

• Guidelines:
  1) May not arbitrarily terminate with a client
  2) Avoiding abandonment includes providing pre-termination therapy: discuss end of treatment, refer to another psychologist if necessary
  3) Have plan for patient care in event of psychologist’s untimely death or severe injury: include instructions for referral and record keeping
  4) May not have option of avoiding termination if mandated by managed care company; if necessary, appeal managed care decision

Reasonable Alternatives:
Referring Out: The process of providing a client with the contact information of another therapist whos is willing and able to provide services; it is important to provide continuation of care in instances where the current therapist must terminate with the client unexpectedly.
**Consultation: When a psychologist seeks the advice of another professional in order to clarify or obtain necessary information to treat a client appropriately.
**Objectivity in Therapy: A psychologist’s ability to make judgements based on observable phenomena, which are uninfluenced by emotions or personal prejudices.

Question 31

Child Custody

Answer 31

Child Custody:
1) Legal decisions regarding guardianship of a child
2) APA’s guidelines for child custody evaluations in divorce proceedings (1994)
3) Assess both adults: psychological functioning, needs, and wishes of child; and evaluation of each parent’s functional ability to meet these needs
4) If one parent does not participate in the evaluation, psychologists may still testify and make recommendations based on the evaluation of the parent who did participate. Such testimony and recommendations must be limited to discussion of the participating parent’s evaluation.
5) Based on the best interests of the child
6) Evaluation includes assessments of parents, child, and important others
7) Parent with custody holds child’s privilege rights and make decisions regarding child’s psychological treatment and services

Avoid multiple relationships:
- Do not conduct custody evaluations of therapy clients

Reasonable Alternatives:
Foster Placement: Temporary placement of children into a home supervised by adults other than their biological or adoptive parents or legal guardians.
**Custodial Parent: The parent who, if the child’s parents are divorced, has the legal rights regarding the child.
**Multiple Relationship: When a psychologist is in a professional relationship with an individual and is, at the same time, in another role with that individual or another person closely associated with that individual; when a psychologist is in a professional relationship with an individual and promises to enter into a separate future relationship with that individual or another person closely associated with that individual; also known as a dual relationship.

Question 32

Psychological Testing

Answer 32

Steps to testing:
1) Used to determine cognitive, academic, emotional, or behavioral functioning
2) Obtain informed consent from cleint/guidian
3) Use valid and reliable instruments
4) Use normative data
5) Have requisite expertise/training
6) Eliminate distractions from testing room
7) Do not provide opinion about a client unless you have personally examined the client
8) Use multiple methods
9) Feedback to client should be comprehensible
10) Secure testing materials from the public

Reasonable Alternatives:
Forensic Psychology: The brand of psychiatry or psychology that deals with the legal questions raised by disordered behavior.
**Expert Witness: A person who can testify because of his or her expertise or special knowledge about a subject related to the case.
**Confidentiality: A psychologist’s obligation to take reasonable steps to protect current or former clients’ information from unauthorized disclosure.

Question 33

Telemental Health

Answer 33

Telemental Health (TMH) definition:
- Delivery of a variety of mental health services (various therapy modalities, testing, medication management, etc.) via telephone, teleconferencing, videoconferencing, e-mail, and the internet

TMH’s benefits:
1) Accessibility: May reach remote and disaster areas
2) Eliminates the need for travel, benefitting the disabled and the elders
3) Allows the recipients to receive specialized health services

TMH considerations:
A) Effectiveness: 2008 study review found that TMH interventions to be of better quality when delivered via Internet and telephone (this may have changed since 2015 though…)
B) Treatment of depression, schizophrenia, post-traumatic stress, panic disorders, substance abuse, suicide prevention, eating disorders, dementia, and child psychiatry showed success
C) Less effective in managing OCD
D) Physical separation obstacle to building therapeutic relationship: Facial cues and body language cannot be read (only if this is not a video call)
E) TMH not suitable for crises or life-threatening situations
F) Reimbursement: Online therapy was not covered as much by conventional health insurances before the pandemic - this may be changing at this point

Ethical and professional concerns:
1) Clients are assessed for suitability to receive online therapy
2) Clients are informed of salient research data on what conditions are more effectively treated online
3) Clinician still needs signed informed consent; some states require both verbal and written consent prior to treatment
4) Need most current protective measures: clinicians learn about risks to confidentiality on internet and inform client
5) Online clinicians seek technical advice to handle possible internet/computer problems prior to beginning treatment
6) Online clinicians only treat clients residing in the state where the clinician is licensed

Reasonable Alternatives:
*Chat therapy: The use of internet chatting to address issues commonly addressed in the therapist’s office. It provides accessibility and anonymity; it is not to be confused with telemental health, which has a wider scope and aims to reach remote areas and underserved populations
**Telemedicine: The use of electronic communications to exchange information from one site to another to improve patients’ health.