exam 1 Flashcards
Law
Defines the minimum standards society will tolerate and is enforced by government.
ethics
Represents the ideal standards set by the profession and is enforced by professional associations.
regulation
in all 50 states State licensing laws establish the scope of practice of professionals and how these laws will be enforced.
The major duties of regulating boards are: (4)
- to determine standards for admission into the profession.
- to screen applicants applying for certification or licensure.
- to regulate the practice of counseling for the public good.
- to conduct disciplinary proceedings involving violations of standards of professional conduct as defined by law.
values
Beliefs & attitudes that provide direction to everyday living.
ethics
Beliefs we hold about what constitutes right conduct. Ethics are adopted by an individual or group to provide rules of conduct.
morality
Our perspective of right and proper conduct. Actions are evaluated on the basis of some broader cultural context or religious standard.
community standards
(or mores)
Define what is considered reasonable behavior when a case
involving malpractice is litigated.
reasonableness
Is the care that is ordinarily exercised by others practicing within that specialty in the professional community.
professionalism
Has some relationship to ethical behavior, yet it is possible to act unprofessionally and still not act unethically.
mandatory ethics
level of ethical functioning where counselors comply with minimal standards, acknowledging the basic “musts” and “must not’s”
example: informed consent
aspirational ethics
refer to the highest professional standards of conduct to which counselors can aspire
example: pro bono work
principle ethics
focuses on moral issues with the goal of solving a particular dilemma and establishing a framework to guide future ethical thinking and behavior.
virtue ethics
focuses on character traits of the counselor and non- obligatory ideals.
what are the principle ethics of the aca (6)
autonomy, beneficence, non-maleficence, justice, fidelity, veracity
autonomy
to promote self determination
beneficence
to do good for others and promote well being of clients
non-maleficence
to avoid doing harm, even inadvertently
justice
to be fair by giving equally to others and to treat others justly
fidelity
to make realistic commitments and keep these promises
veracity
to be truthful and deal honestly with clients
what are the virtue ethics (5)
integrity, discernment, acceptance of emotion, self-awareness, and interdependence with the community
integrity
do what is right because it is right – not an obligation. This counselor has stable moral values to which they are faithful.
discernment
can tolerate ambiguity and maintain perspective.
acceptance of emotion
allows to inform reason- does not hinder it
self-awareness
know your own assumptions, beliefs,
biases, AND how these affect relationships with others.
interdependence with the community
aware of context and community – understand values and expectations of communities.
10 steps for making ethical decisions
- Identify and define the problem - legal? clinical? ethical?
- Involve the client in the decision-making process
- Review the relevant ethics codes and the professional literature
- Consider the principles and virtues – Are they competing? Prioritize them. Who do you want to be? How will this decision affect you?
- Tune into your feelings –Your feelings will influence how you interpret the dilemma. Let them inform but not hinder you decision.
- Know the applicable laws
- Obtain consultation from colleagues or experts – Check out your knowledge, instincts, & feelings about the situation. This will help in you need to defend your decision.
- Consider the context – Decision must feel right for you but also be appropriate to the context.
- Consider possible actions to achieve desired outcomes – are they competing?
- Choose and act on your choice
some issues based on unresolved conflicts of counselors? (6)
- a need to tell people what to do
a desire to take away all pain from clients
a need to have all the answers and to be perfect
a need to be recognized and appreciated
a tendency to assume too much responsibility for the
changes of clients
a fear of doing harm, however inadvertently
benefits of therapy for counselors? (4)
- explore motivations to become a helper
- how needs influence action, what your values are
- id and explore blind spots
- remediation purposes
transference
Refers to when clients (unconsciously) project onto their therapists/counselors past feelings or attitudes they had toward significant people in their lives.
countertransference
Any projections/feelings by counselor toward the client that distort the way they perceive and react to a client.
ways to deal with countertransference: 5
-Ask yourself QUESTIONS as to why responding this way
Use supervision more, not less
Reflective practice is key
Accept that feeling towards a client is normal AND work with that
Be consistent with boundaries
stress in counseling profession can lead to what?
empathy fatigue
sources of stress for counselors 5
-Feeling they are not helping their clients
The tendency to accept full responsibility for clients’ progress
Feeling pressure to quickly solve the problems of clients
Having extremely high and perfectionistic goals
Other life stressors
burnout
a state of physical, emotional, intellectual, and spiritual depletion characterized by feelings of helplessness and hopelessness
impairment
the presence of a chronic illness or severe psychological depletion that is likely to prevent a professional from delivering effective services and results in consistently functioning below acceptable practice standards
areas where counselors values influence 4
- assessment strategies
- goals of treatment
3 the design and selection of interventions - evaluation of therapy outcomes
millner and hanks recommendation pertaining to abortion 5
- Do a comprehensive examination of your own moral/ethical views.
- Determine when your own personal ethics would make it difficult for you to be objective and respectful of the client’s autonomy.
- Be prepared to refer clients to other professionals when it is appropriate.
- Become familiar with state and federal laws pertaining to abortions.
- Anticipate circumstances that would make it difficult for you to maintain a sense of objectivity because of a value conflict.
spirituality
general sensitivity to moral, ethical, humanitarian, and existential issues without reference to any particular religious doctrine.
religion
the way people express their devotion
t/f: spirituality/religion should be incorporated into the assessment and treatment process, if appropriate
TRUE
Rationale suicide
When a person has decided—after a thorough decision-making process and without coercion—to end his life due to extreme suffering involved with a terminal illness.
aid-in-dying
providing a person with the means to die; the person self-administers the death-causing agent (a lethal dose of a legal medication)
hastened death
ending one’s life earlier than would have happened without intervention. (speeding up the dying process, by withholding or withdrawing treatment or life support )
advanced directives
written documents that specify the conditions under which people wish to receive or refuse certain treatment or discontinue life- sustaining tx
risk management tips 8
- know the legal and ethical rules.
- know what you don’t know
- remember anyone can file a complaint
- always clarify your policy on releasing information
- keep good records
- know the laws and ethics of treating children without parental consent
- set boundaries and avoid dual relationships
- know when and how to terminate
professional advertising 4
No misrepresentation or claims to “superior” efficacy or effectiveness.
No hard selling tactics.
Think of simply informing the public.
Specific descriptors, such as language, types of services offered and license type are permissible.
child abuse prevention and treatment act of 1974
provide funding for the prevention, identification, and treatment of child abuse and neglect
t/f: Reports from mandated reporters are the main source of referrals
true
t/f A team approach by all disciplines is the most successful approach in combating Child Abuse.
true
year first child abuse reporting laws introduced in ca
1963
when did ca establish laws that granted immunity to mandated reporters
1980
five recognized forms of child abuse
physical, emotional, endangerment, neglect, and sexual
difference btwn child abuse and discipline? 6
- age of child
- area struck
- injuries
- weapon/implement used
- mood of the parent
- reason
Why is anonymous reporting permitted by not ideal?
– May be considered less important
– Does not allow for follow-up questions
– Does not provide a clear record of fulfilling mandated reporting responsibilities
what should be reported for child abuse?
Any suspected abuse or neglect. It is not necessary to observe the abuse or an actual injury, but the mere suspicion is enough to report. This mean that you have a “reasonable cause to believe” that child has been, or will be, maltreated.
t/f The mandated reporter’s job is to report suspicions, not conduct investigations.
true
how to report child abuse
Immediately or as soon as possible, a telephone call to either CPS (DCFS) or law enforcement is required, with a follow-up written report within 36 hours.
– Report to the local child protective services or the local police
– Offer as much detail as possible about what you saw/heard
– Provide name and location of child
– Provide name of alleged perpetrator and their relationship to the child if known
t/f School district police or security departments are mandated to report child abuse, but are not authorized to take a child abuse report.
true
who should be contacted in cases of serious physical abuse or sexual abuse?
law enforcement
Consequences for failing to report child abuse
•Misdemeanor •Fines/jail terms •Malpractice
some reasons given for not reporting child abuse
Don’t believe it will help the child – Previous poor response from CPS
– Concern that reporting will damage the therapeutic relationship
who can have names of who called in a child abuse case? 5
- Law enforcement
- Children’s Protective Services
- District Attorney’s Office or County Counsel • State Dept. of Social Services
- Coroners and medical examiners
- Hospital SCAN teams
what is an escars
electronic suspected child abuse reporting system
t/f California law mandates that certain individuals report known or suspected instances of elder or dependent adult abuse.
true
elder adult
65 yrs or older
dependent adult
18-64 that has certain mental/physical disabilities that keep them from being able to do normal activities of protect themselves
who is a mandated reported of elder/dependent adult abuse
Any person who has assumed full or intermittent responsibility for care or custody of an elder or dependent adult, whether or not that person receives compensation.”
when to report elder abuse? 3
-witness an incident
• receive information or evidence, whether visual or audible
• or an elder or dependent adult discloses or describes an incident that reasonably appears to constitute abuse
reporting exceptions of elder abuse?
- you are a md, rn, or therapist and all the below are true
- the elder advises you that they are being abused
- have no evidence to corroborate the statement
- elder/dependent has been diagnosed with a mental illness or is the subject of court-ordered conservatorship because of illness
what constitutes elder abuse? 5
-Physical abuse (includes sexual abuse) o Neglect
o Financial abuse
o Abandonment
o Isolation, abduction, or other treatment with resulting physical harm or pain or mental suffering
o Deprivation by a custodian of goods or services that are necessary to avoid physical harm or mental suffering
making a report for elder/dependent adult abuse:
by telephone immediately to adult protective services
or by written report to dept of social services for 341
who investigates elder abuse?
county aps if in private home,
-licensing & certification program of the ca dept. of health services if hospital or clinic
counselor responsibilities 7
-avoid fostering dependent relationship
-Working with mandated clients
-Assure all techniques and interventions are grounded in theory
Do not abandon client – plan in advance for termination or absence
-interruptions in service
-termination
premature termination
when working with mandated clients
– Think of providing information to the client – What are the potential outcomes?
termination 4
Best if mutually agreed upon
– Ultimately either one can make the decision independently
– Discuss termination before it happens
– Recommendations or referral when appropriate
premature termination 4
-give adequate notice, provide referrals, and facilitate transition
– Client no longer needs counseling, is not likely to benefit, or is being harmed
– Client does not pay agreed upon fees
– Counselor is in danger of harm by client or someone known to client
informed consent is 4
-the client’s right to be informed about their counseling and to make autonomous decisions pertaining to it
-A shared decision-making process
– A clinical, legal, and ethical tool
– A process that continues for the duration of the professional relationship
informed consent requires that the client:
understand the information presented give consent voluntarily
be competent to give consent to treatment
what must be included in informed consent 9 things
Your background – education, training, experience, scope of competence vs. scope of competence
What happens in counseling – purpose, goals, techniques, limitations
-Address the client’s expectations - LIMITATIONS
Length of counseling services & right to termination – managed care?
Fees & policies
– Billing
– Cancellation/no show policy
-Confidentiality & its limits
-Access to records
-Benefits and risks of treatment
-Availability of counselor (emergencies, vacation, or other absence)
privacy
the constitutional right of individuals to be left alone and to control their personal information.
confidentiality
a client’s right to privacy, confidentiality is at the core of effective counseling. It is the counselor’s duty to protect private client communication.
privilege
a legal concept that generally bars the disclosure of confidential communications in a legal proceeding. Privilege belongs to the client — and is asserted by the counselor.
fisher’s model for protecting confidentiality rights: 6
- Preparation – you need to be informed
- Tell clients the truth “up front”
- Obtain truly informed consent before disclosing
- Respond ethically to legal requests for disclosure
- Avoid the “avoidable” breaches of confidentiality
- Talk about confidentiality
limits of confidentiality 7
-when counselor provides information to secretary
-when counselor consults with others
When a counselor is being supervised
When a client has given consent
When a client poses danger to self or others
When a counselor suspects abuse or neglect
When a court orders counselor to make records available
HIPAA 1996
passed by Congress to promote standardization and efficiency in the health care industry and to give patients more rights and control over their health information.
– The HIPAA Privacy Rule developed out of the concern that transmission of health care information through electronic means could lead to widespread gaps in the protection of client confidentiality.
DUTY TO PROTECT POTENTIAL VICTIM
Balancing client confidentiality and protecting the public is a major ethical challenge
When dealing with duty to protect potential victims, Counselors must exercise the ordinary skill and care of a
reasonable professional to:
Identify clients who are likely to do physical harm to
third parties
– Protect third parties from clients judged to be potentially dangerous
– Treat those clients who are dangerous
liability for civil damages
The responsibility to protect the public from dangerous acts of violent clients entails liability for civil damages when practitioners neglect this duty by:
-Failing to diagnose or predict dangerousness
– Failing to warn potential victims of violent behavior
– Failing to commit dangerous individuals
– Prematurely discharging dangerous clients from a hospital
tarasoff case 1969
duty to warn
duty to protect
bradley case
duty to not negligently release a dangerous client
jablonski case
duty to commit a dangerous individual
hedlund case
extends duty to warn to anyone who might be near the intended victim and might also be in danger
Risk Management:
Cases of Duty to Warn/ Protect
Consult with an attorney if you are not clear about your legal duty.
Ask about a client’s access to weapons, homicidal ideation, and intentions, including whether a specific victim is involved.
Consider all appropriate steps to take and the consequences of each.
Know and follow the policy of your institution. Document all actions & rationale behind each.
t/f Counselors may be justified in disclosing information to a third party who is at risk, yet they are not necessarily obligated to take this course of action
true
ethical guidelines for disclosure of a clients hiv status
Sufficient factual grounds for high risk of harm to third party must exist
Third party is at risk of death or substantial bodily harm
Harm to the third party is not likely to be prevented unless counselor makes disclosure
Third party cannot reasonably be expected to foresee or comprehend high risk of harm to self
recommendations for counseling with hiv clients
- All limits to confidentiality should be discussed with the client at the beginning of treatment
- Therapists must be aware of state laws regarding their professional interactions with HIV-positive clients
- Therapists need to keep current with regard to relevant medical information
- Therapists need to know which sexual practices are safe
malpractice
professional misconduct
-unreasonable lack of skill
civil lawsuit
client is suing the counselor for wrongdoing and damage to the client
elements of malpractice
DUTY - a professional relationship between the counselor and the client must have existed
BREACH OF DUTY - the counselor must have acted in a negligent or improper manner, or have deviated from the “standard of care”
INJURY - the client must have suffered harm or injury, which must be verified
CAUSATION - there must be a legally demonstrated causal relationship between the practitioner’s negligence or breach of duty and the damage or injury claimed by the client
some caustions to take when dealing with suicidal clients
– Agreed upon check-ins
– Family contact – suicide watch – Voluntaryhospitalization
– Involuntary hospitalization
resolving legal and ethical challenges
- speak to client
- consult with colleagues
- consult with attorney
- elevate it to clinical supervisor
- be clear on how issue involves you
- check your reactions
justice obsession syndrome
individuals who believe important to get justice when they feel like they have been wronged/when an injustice has occurred
informal complaints
-anyone can file a complaint
-practice within legal and ethical requirements
-be open to discussing (take seriously, be genuine, correct mistakes)
-try to resolve at this level
document everything
formal complaint
Elevate
Consult with an attorney & follow their advice Who has jurisdiction?
If a board has jurisdiction
– Cooperate fully and truthfully with advice or attorney – They are your “jury”
– May appeal decision
Always respond and conduct yourself professionally Do NOT contact the complainant
Self-care!
Continue to educate yourself
core professional values of counseling profession
- enhancing human development throughout the lifespan;
- honoring diversity and embracing a multicultural approach in support of the worth, dignity, potential, and uniqueness of people within their social and cultural contexts;
- promoting social justice;
- safeguarding the integrity of the counselor–client relationship; and
- practicing in a competent and ethical manner.
six main purposes for ACA code of ethics
- The Code sets forth the ethical obligations of ACA members and provides guidance intended to inform the ethical practice of professional counselors.
- The Code identifies ethical considerations relevant to professional counselors and counselors-in-training.
- The Code enables the association to clarify for current and prospective members, and for those served by members,
the nature of the ethical responsibilities held in common by its members. - The Code serves as an ethical guide designed to assist members in constructing a course of action that best serves those utilizing counseling services and establishes expectations of conduct with a primary emphasis on the role of
the professional counselor. - The Code helps to support the mission of ACA.
- The standards contained in this Code serve as the basis for processing inquiries and ethics complaints concerning ACA members.
according to cacrep, how many semester hours should your master’s program be
48-60
