Legal vs. Ethical

Question 1

Advertising

Answer 1

Legal: Do not engage in false or misleading advertising

Ethical: Avoid false misleading advertising: Avoid/correct misleading claims and info; Do not solicit testimonials from clients

Question 2

Authorization to share information

Answer 2

Legal: Yes: Anyone 12+ should sign release

Ethical: Yes: All members of treatment until who are 12+ should sign

Question 3

Business Practices

Answer 3

Legal: Yes: Post license, disclose owner’s name and license of business

Not an ethical issue.

Question 4

Child Abuse

Answer 4

Yes: Mandated report if reasonable suspicion

No - but BBS likes the therapist to process need to report with the client

Question 5

Confidentiality

Answer 5

Legal: Yes: HIPAA - provide NPP; maintain confidentiality except when mandated or permitted to break it.

Ethical: Yes: inform of limits, maintain confidentiality except when mandated or permitted to break it

Question 6

Consultation

Answer 6

Legal: No

Ethical: Yes: should be done when clinically indicated; protect identity of client.

Question 7

Countertransference

Answer 7

Legal: No.

Ethical: Yes: manage it, seek consultation when problematic.

Question 8

Dual relationships/conflict of interests

Answer 8

Legal: No.

Ethical: Yes: a valid dual relationships because of potential conflict of interest; manage unavoidable dual relationships

Question 9

Diversity

Answer 9

Legal: No

Ethical: Yes: Understand cultural factors affecting clinical issues

Question 10

Elder/Dependent Abuse

Answer 10

Legal: Yes: mandated report if reasonable suspicion; report to appropriate agency

Ethical: No but BBS would like the therapist to process need to report with client

Question 11

Fees

Answer 11

Legal: Yes. Disclose fees.

Ethical: Yes. Manage fees, disclose fee policies, alert client before using collections, consider ability to pay for services

Question 12

Gifts

Answer 12

Legal: Not a legal issue

Ethical: Yes: do not give or receive gifts that could compromise integrity of therapy, consider monetary value and clinical significance

Question 13

Groups

Answer 13

Legal: No

Ethical: Yes. Discuss issues of confidentiality

Question 14

Harm to others

Answer 14

Legal: Yes. Assess for harm, notify police if there is imminent plan, possibly notify victim if clinically appropriate

Ethical: Not an ethical issue.

Question 15

HIPAA

Answer 15

Legal: Yes: comply with HIPAA when electronically communicating with 3rd party payers

Ethical: Not an ethical issue.

Question 16

Informed consent

Answer 16

Legal: Yes: disclose fees, license status (should be posted), use of technology utilization, fictitious business name, if I am a provider bound by HIPAA, signed for minor, potential risks

Standard of care which could become legal issue:

Limits of confidentiality, risks and benefits of treatment, alternative treatment possibilities, cancelation policy, billing, communication and emergency protocol, background of therapist (expertise), define who the client is (individual, couple, group)

Ethical: Yes: alternate treatments, office policies, limits of confidentiality, and therapist background.

Question 17

Insurance

Answer 17

Legal: Yes: Illegal to submit false claims, advise patients of info that will likely be disclosed to 3rd party payer

Ethical: Yes: advocate if needed services are denied, advise client that information would be shared with insurance, avoid false claims.

Question 18

Issues with other therapists

Answer 18

Legal: Not a legal issue

Ethical: Yes: support when compromised, do not see a client who is being treated by another therapist, do not solicit clients from other therapists

Question 19

Personal Problems

Answer 19

Legal: Not a legal issue.

Ethical: Yes: seek professional help for mental health/substance abuse issues. (DUI can result in suspension of license)

Question 20

Privilege

Answer 20

Legal: Yes: only applies to legal situations, notify client of subpoena, assert privilege

Ethical: Yes - should inform client of potential risks of waiving privilege

Question 21

Records

Answer 21

Legal: Yes: maintain sound record for 7 years or until minor is 25, keep records locked and secure, comply with record requests appropriately, never alter records

Ethical: Yes: Maintain sound records, do not withhold for lack of payment, protect client records

Question 22

Referral

Answer 22

Legal: Yes: illegal to pay or receive payments for referrals

Ethical: Yes: unethical to pay or receive payments for referrals, provide clinically appropriate referrals

Question 23

Scope of Competence

Answer 23

Legal: Not a legal issue

Ethical: Yes: should only work within bounds of education, skills and training and stay current with skills

Question 24

Scope of Practice

Answer 24

Legal: Yes: must work within legally defined scope

Ethical: not an ethical issue

Question 25

Self Determination

Answer 25

Legal: not a legal issue Ethical: Yes: avoid advice giving, support client to make own decisions, jointly create treatment plan Safety overrides self-determination. Watch for questions about the elderly. Supporting self-determination whenever possible.

Question 26

Sexual Relations

Answer 26

Legal: Yes: illegal to have sexual contact during therapy and for 2 years following, must provide brochure if adult client discloses sexual activity with past therapist. Ethical: Yes: also includes sexual relationships with relatives/friends of client, avoid treating someone within whom you’ve had a prior sexual relationship

Question 27

Standard of Care

Answer 27

Defines usual and customary professional standards. How I would do things like: advertise, intake process, recording of sessions. Includes: statutes (business code), licensing regulations (ex. CEUs), ethical codes, consensus of community of practitioners (ex. Expert witness) Legal: Yes: legally, therapist must provide care that meets standards Ethical: not an ethical issue; however, ethical standards contribute to standard of care

Question 28

Suicide

Answer 28

Legal: Yes: meet standard of care, assess, intervene according to level of risk Ethical: Yes. Addressing overall well-being of client.

Question 29

Telehealth

Answer 29

Legal: Yes: obtain informed consent, follow jurisdictional laws (client’s location), provide license number, document efforts to obtain local resources in case of emergency, each session determine if telehealth is appropriate for client Ethical: Yes: provide appropriate resources in case of emergency, determine that technologically assisted services are appropriate for clients, inform clients of the potential risks and limitations associated with technologically assisted services, ensure security of communication, follow jurisdictional laws (client’s location)

Question 30

Termination

Answer 30

Legal: No but should avoid abandonment Ethical: yes: terminate when client is no longer benefiting. Provide referrals for premature termination, maintain professional will.

Question 31

Treating minors

Answer 31

Legal: Yes: comply with consent laws, can deny parents access to records if harmful to patient or treatment Ethical: No but should manage issues of confidentiality

Question 32

Treating multiple people in treatment unit

Answer 32

Legal: Not a legal issue Ethical: Yes: should consider and discuss risks/conflicts of interest, review informed consent for new treatment unit, discuss “secrets” policies

Question 33

Informed consent with minors - who should sign?

Answer 33

``` Only one signature required when: Parents are still married Parents were never married Parent has 100% legal custody Parents have joint custody but custody agreement allows for one of the parents to sign (although best practice is to have both) ``` Two parent signatures required when: Custody agreement dictates both parents must consent.

Question 34

Informed consent with minors - when parents aren’t the ones signing

Answer 34

Who can sign on behalf of a minor: 1) Legal guardianship trumps anything! 2) Attorney for child in foster care 3) If attorney is not an answer option, LCSW would be next in line. 4) if mental health is court ordered, foster parent can consent 5) If a guardian brings child in and doesn’t know where parents are located care affidavit should be signed 6) If court has issued minute order for LCSW or foster parent to sign &) Minor 12 and older if determined to be mature enough to do so and there is reason to not include parents