Management Issues in Therapy Flashcards
Client Notices
Notice to consumers must be visible for all psychology licensees
HIPAA privacy rule requires psychologists to give a notice of privacy practices (NPP) at the beginning or prior to the first therapy session, and provide one when requested, it is NOT a substitute for informed consent
Informed Consent
Capacity: Client must have the capacity to make rational decisions about therapy (can’t be under the influence or acute psychotic)
Comprehension: Adequate information must be given to understand it and make an informed decision. Use reasonably understandable language, must be at a reading level consistent with client capacity
Voluntariness: Client must give their consent freely
Legal requirements
Informed concent is primarily ethical, exception is to obtain verbal or written consent from clients prior to initiating telehealth services and to document the consent in the client record.
Ethical Requirements
Guidelines:
a) When psychologists conduct research or provide assessment, therapy, counseling, or consulting services in person or via electronic, they obtain informed consent of the individual using language that is reasonably understandable
b) For persons who are legally incapable of giving informed consent, psychologists provide appropriate explanation, seek assent, and obtain appropriate permission from legally authorized person
c) When court ordered or mandated, inform the individual of the nature of the anticipated service and any limits of confidentiality
d) Appropriately document written or oral consent, permission, and assent.
Client Records
Record ownership is governed by law. Client owns the contents while psychologist or organization owns the physical documents.
Maintenance of records
Create, maintain disseminate, store, retain, and dispose of records to faciliate services, replicate for research, meet institutional requirements, and ensure accuracy of billing and payments, and confidentiality in creating, storing, accessing, trasnferring and disposing of records.
Alternatives in event of death, illness or withdrawal of psychologist
a) Agreement of management with a responsible colleague
b) Arrange with a professional association to assist in managing or maintaining the records
c) Having a professional will that designates an eecutor or other person who will maintain the record, identifies location of client records, and provides other crucial information
Retention of records
Retain minimum 7 years from the patients discharge date
If patient is a minor, 7 years from the date the patient reaches 18 years of age
Electronic Recordkeeping
a) Providers of health services that utilize electronic recordkeeping systems only, shall comply with the additional requirements of this section, they do NOT apply to patient records if hard copy versions of the patient records are retained
b) Any use of electronic record keeping to store patient records shall ensure safety and integrity of records
Electronic Record Keeping (2)
Ensure safety and integirty of all electronic media used to store patient records by employing an offsite backup storage system, an image mechanism that is able to copy signature documents, and a mechanism to ensure that once a record is input, it is unalterable
Original hard copies of patient records may be destroyed once the record has been electronically stored
The printout of the computerized version shall be considered the original for purposes of providing copies to patients, licensing/certification, and evidence for court proceedings
Acces to electronically stored patient records shall be made available to the division of licensing and certification staff upon request
Does not exempt licensed clinics, facilities, agencies from maintaining original copies of patient records that cannot be leectronically stored
Any health care provider is subject to this
Multiple Relationships
Multiple relationship occurs when a psychologist is in a professional role with a person and at the same time is in another role with a person, a person closely associated with them, or promises to enter into another relationship in the future
Pssychologist refrains from entering into a multiple relationship if it could reasonably be expected to impair objectivity, competence, or efectiveness
If a psychologist finds that, due to unforeseen factors, a potentially harmful multiple relationship has arisen, the psychologist takes reasonable steps to resolve it
Not all multiple relationships are unethical if they do not impair objectivity, competence, or effectiveness in their function as a psychologist
Multiple Relationships - Forensic
When psychologists are required by law, institutional policy, or extraordinary circumstances to serve in one role in a forensic setting they must clarify role expectations and issues related to confidentiality
Conflict of Interest
Power differential (influence over an individual)
Duration of the relationship (length of time)
Clarity of termination (What is the likelihood the individual will desire additional services in the future?)
Fees and financial arrangements
Make the arrangement as early as feasible in the professional or scientific relationship
Informed consent should include fees, policy, third party, limitations, collection, missed payments
Sliding Fee Scales
Psychologist may charge a fixed fee (which may be reduced in certain situations) or use a sliding fee scale if they are fair and serve the best interests of clients
Unpaid fees
If recipient does not pay as agreed, and psychologists intends to use collection/legal, psychologist first informs the person such measures will be taken and give the person opportunity for prompt payment
Collection agency
Psychologist may use collection agency or initiate legal proceeding only after notifying of intent to do so. Psychologist must give only essential information such as name,. address, and amount owed.
Temporary financial crisis (patient)
Psychologist may temporarily waive/lower fee, schedule fewer appointments or suspend therapy for an agreed upon period. Psychologist not obligated to continue treatment, but it would be unacceptable to abruptly terminate.
In emergency psychologist has obligation to continue until client is able to pay or crisis has been resolved
Pro Bono Services
Aspirational in general principles, but not mandatory part of ethical standards. aka: recommended but not required
Barter
Standard 6.05, barter may only be used if it is not clinicaly contraindicated, not exploitative, or impair psychologists objectivity
Referral fees
Standard 6.07 ethics code
Referral fee payment based on the services providded (clinical, consultative, administrative), and not based on the referral itself.
Insurance fraud
Common examples:
Routinely waiving copayments
Billing for missed appointments (unless arrangement agreed to by the insurance company)
Assigning an incorrect diagnosis
Interruption of psychological services
Interrupted by factors such as psychologists illness, death, unavailability, relocation or retirement
Make reasonable efforts to provide for orderly and appropriate resolution
Termination of therapy
Terminate when it becomes reasonably clear the client no longer needs the service, is not likely to benefit, or is being harmed by continued service
Suggest alternatives when appropriate
Consultation
Standard 4.06 “when consulting with colleagues, (1) psychologists do not disclose confidential information that reasonably could lead to the identification of a client, research participant, or other person or organization with whom they have a confidential relationship unless they have obtained the prior consent
Service from another mental health professional
carefully consider treatment issues and clients welfare, if seeing another professional for a different problem that is okay, consult with consent, discuss ethical obligations and determine why client seeks the same service from two providers if that is the case
How psychologists identify themselves in advertisements
Include license number in any ad or public directory/soliciation when
a) engaged in any professional psychological activity for fee or otherwise
b) psychological assistant identify themselves to patient as psychological assistant
c) prohibits misrepresenting professional qualifications or affiliation
conseqwuences include refusing license for fraudulently or neglectfully misrepresenting status of license
Advertising
advertise professional services authorized within the field of competence without promoting the excessive or unnecessary use of such services
no false or deceptive statements, accurate training, academic degree, credentials, services, scientific or clinical basis
Do not compensate press, radio, television or other ocmmunication media in return for publicity in a news item
Paid advertisement related to activities must be identified or recognized as such
Descriptions of educational programs
Psychologists responsible for announcements, catalogs, brochures, or educational programs ensure they accurately describe the audience
Soliciation of testimonials
Do not solicit from current therapy clients or persons who are vulnerable to undue influence
Prohibition against soliciting testimonials is not an absolute but applies to testimonials solicited from current clients or other persons vulnerable to influence
Soliciation of business
Psychologists do not engage, directly or through agents, in uninvited in-person soliciation of business from actual or potential therapy clients. Does not preclude implementing appropriate collateral contacts to benefit current client, providing disaster or community outreach
Media presentations
Advice must be based on psychologists professional experience and knowledge, consistent with provisions of the ethics code, not imply a professional relationship has been established
Publication credit
Unacceptable to take credit for someone elses work even if the work or data source is cited occasionally.
