My Deck Flashcards
What are other terms for upholding privilege?
- Claim
- Assert
- Invoke
How should you respond to a subpoena for client records?
- Determine if the subpoena is valid
- Ask client what they want you to do – share info or assert privilege
- If asserting privilege, can write a letter to court or have lawyer file a motion to quash the subpoena
- Continue asserting privilege until the subpoena is dropped or you get a court order for the records
What is a Letter of Warning/Educational Letter?
BOP non-disciplinary action: Such a letter outlines the allegations, informs of the law, and warns the licensee that if the situation is true and repeated, formal action could result.; e.g., not putting license number in communication
What are the requirements for supervision
- Primary supervisor must provide at least 1 hour of individual face-to =-face supervision each week
- Must have supervision for 10% of time worked each week
- Supervisors must be employed at place as supervisee for at least half of the time
- Supervisor must be available to supervisee for 100% of the time they are working
- Supervisors must complete 6 hours of training in supervision every 2 years (psychiatrists are exempt from this)
- Primary supervisor can delegate supervision to other licenses (e.g., MFT)
What APA can do in response to unethical behavior
- Begin an ethics investigation
- Impose sanctions (e.g., revoke membership)
- Notify governing bodies, like BOP or law enforcement
Note: APA typically only cares about professional behavior, but may get involved when personal issues affect professional work, like when psychologist is convicted of a felony
BOP’s potential responses to serious violations
Letter of Reproval Probation Suspension Interim Suspension Order Surrender of License Revocation
Note: All decisions made public
Fitness for Duty Evaluation confidentiality rules
You can tell employer:
- If employee can perform essential job functions
- Any functional limitations related to the job
- Any accommodations needed for job
What to do if you have a case that is outside your competence?
- Get supervision and training if it is a completely new area
- Get consultation if it is adjacent to your competence
- Refer out if you have no experience in that area and cannot (or do not want to) obtain supervision
What is the opposite of claiming privilege?
Waiving it
Who can hold privilege?
- Patient
- Patient’s guardian or conservator
- Parent or guardian if patient
- Patient’s representative if patient is deceased
- Patient who is 12+ and mature (but an adult claims or waives it on their behalf)
Exemptions to CE requirements
- Active military service
- Prevented from getting CEs for health reasons or “good cause”
What to do if CA Law contradicts HIPAA
Go with HIPAA (Federal law trumps state law)
What to do if Ethics Code disagrees with law
Go with the higher/most conservative standard, which is the one that most protects the privacy of the client
Letter of Reproval
BOP disciplinary action: Used only when no patient harm occurred; negotiated between BOP, licensee, and his/her lawyer; describes allegation and disciplinary actions agreed upon, which could include mandated coursework and cost recovery to BOP for investigation
Probation
BOP disciplinary action: Terms/conditions of probation are set forth and the license is technically revoked, but that revocation is stayed; if licensee does not comply with terms, license gets revoked
4 things needed for a valid malpractice lawsuit
Dereliction of duty directly causing damages
Registered Psychologist qualifications and rules
- Must have doctorate in psychology and 1500 hours SPE
- Registration is for 30 months (2.5 years) and is non-renewable
- Must be employed in non-profit receiving 25% of its funding from government (excluding Medi-Cal/Medi-Care)
- Must be supervised by licensed psychologist
BOP’s potential responses to complaints of minor violations
- No Action - Close Case: Outside of jurisdiction or complaint not supported by evidence
- Letter of Warning/Educational Letter
- Citation and Fine
Note: Kept confidential, with the exception that Citations and Fines are made public
How many registered psychologists can a psychologist have
No limit
Citation and Fine
BOP non-disciplinary action: $100-$2500 fine per violation, e.g., false advertising or misrepresentaiton; always accompanied by Order of Abatement telling psychologist to cease some action; may follow unheeded letter of warning
Suspension (of license)
BOP disciplinary action: Typically used prior to the effective date of probation; during a suspension, licensee cannot practice or refer to themselves as a psychologist
What is PHI?
Protected Healthcare Information
Includes any identifying information that is tied to an individual’s past, present, and future healthcare
BOP disciplinary action when incarcerated after conviction of felony
Suspension
Psychology internship must be accredited by ______
Accredited by APA or member of APPIC or CAPIC
What are some exceptions to confidentiality?
- Medical emergencies
- Danger to self (suicide)
- Danger to others (Tarasoff)
- Mandated abuse reporting
- Court order (NOT a subpoena)
- Professional consultation (only share minimum needed info)
- To obtain payment from insurance (name and diagnosis)
What to do if Ethics Code contradicts the law
Make known your commitment to the Ethics Code
Take steps to resolve the conflict
Safeguard human rights and do no harm
Note: Contradict means you cannot do both things
What to do if colleague is unethical
- If there is no substantial harm, try to resolve informally
- If there is substantial harm, or if informal resolution fails, file a formal complaint
Psychological Assistant qualifications and rules
- Must have master’s in psychology or be a doctoral candidate
- Cannot provide services on their own
- Must be employed by licensed psychologist (can have 3), board-cert psychiatrist (can have 1), or psychology clinic
In what case(s) can a minor hold privilege?
If they are at least 12 y/o and “mature”
What 3 conditions must be met for informed consent to be valid?
- Patient must have capacity
- Information must be comprehensible
- It must be voluntarily given
CE requirements
Need 36 hours every 2 years
75% can be independent learning; 25% must be in-person
Do not rollover
Must have some training in laws and ethics each renewal cycle; not further specified
Do not need to submit documentation every cycle, but must keep records for 4 years from last renewal in case of audit
Who can claim privilege?
- Patient
- Patient’s guardian or conservator
- Minor’s parent or guardian
- Patient’s personal representative, if patient is dead
- Psychologist
BOP disciplinary action if outstanding tax obligations
License suspended or denied
NGRI requirements
Lack the capacity to understand act was wrong
and/or
Unable to behave according to the law
Exceptions to privilege
- If the client waives privilege
- Legal mandate like abuse reporting
- If the client has already willingly shared information with a 3rd party, like posting something online
- When mental status or emotional stability is in question in the legal proceeding (e.g., CST, NGRI)
- Court appointed evaluation (court gets to know results)
- Board of Prison Appointed Evaluations
- When someone seeks psychological services to help them commit a crime (like faking a worker’s comp claim)
- Client sues therapist for Breach of Duty
- Patient danger to self or others
- Patient is under 16 and the victim of a crime
How long do you have to keep CE records?
4 years from last license renewal
Interim Suspension Order
BOP disciplinary action: Used when there is evidence the licensee is likely to engage in behaviors that present an immediate threat to the public; BOP requests hearing through AG’s office for an expedited suspension; the BOP then has 15 days to file a formal Accusation
Revocation
BOP most serious disciplinary action: License taken away; always the response to psychologist sexual conduct with clients; can petition for reinstatement after 3 years
How do you have to inform clients of HIPAA Privacy Rule?
Provide in writing to client and post in office
Do group members have to keep information confidential?
No, not legally, but they should be encouraged to do so
In what cases is informed consent not needed?
- Court-ordered evaluation
- Routine educational or institutional activity (e.g., job application)
- Evaluating decisional capacity
Note: In court-ordered treatment, you do need informed consent from patient, but court may be entitled to treatment summaries or updates
Informed consent includes these aspects
- Nature and course of service
- Fees
- Involvement of 3rd parties
- Limits to confidentiality, including supervisor
- Risks involved
- Voluntariness
- Opportunity for Q and A
When can you practice outside your competence?
In an emergency situation when other mental health services are not available – to ensure that services are not denied
These services should stop as soon as the emergence has passed or more appropriate services become available
What to do if CA Law disagrees with HIPAA
Go with HIPAA, unless CA Law is more conservative, then go with CA Law
What is a subpoena?
A court document requiring someone to appear and give testimony in court
Subpoena duces tecum requires someone to bring specific documents with them
What is the difference between supervision and consultation?
In supervision there is a power differential
Consultation is between peers
HIPAA Rules
- Privacy Rule
- Security Rule
- Transaction and Code Sets Rule
What is the difference between confidentiality and privilege?
Confidentiality is the legal and ethical obligation to keep a client’s PHI private
Privilege is a legal concept that refers to a person’s right have information kept private in a legal proceeding
How many interns can a psychologist have?
No limit
Inactive license
- Can ask to put your license on inactive status
- Do not need to accrue CEs while inactive
- To make active again, have to pay renewal fee and have 36 hours of CEs in the 2 years prior
- If inactive for 3+ years, license is delinquent, and need to reapply for licensure and take EPPP
What are the Ethics Code General Principles?
Beneficence and Nonmaleficence Fidelity and Responsibility Integrity Justice Respect for People's Rights and Dignity
Surrender of License
BOP disciplinary action: Action requested by licensee in lieu of going through administrative hearing process; licensee must wait 3 years before they can petition BOP for reinstatement, and if they do, previous allegations will be held to be true
Do clients have the right to their records?
Yes, unless the provider determines there is a risk of adverse consequences to the client
BOP disciplinary action for sexual contact with client
Revocation - no judge can stay revocation
Informed consent required format for telehealth services
Verbal OR written
When should you obtain informed consent?
As early as is feasible
How long do you have to retain records per CA law?
- 7 years from end date of treatment for adults
- 7 years after patient turns 18 for minors (i.e., until age 25)
- 7 years and at least until patient turns 19 for emancipated minors
How long do you have to retain records per APA Ethics Code?
- 7 years from end date of treatment for adults
- 7 years or until patient turns 21 for minors
HIPAA requirements for electronic records
- Must have back up storage system
- Must ensure entered info is unalterable (e.g., use pdf instead of .doc)
- Ensure a way to copy signature documents
When can you deny a patient access to their records per CA law?
When there is substantial risk of adverse or detrimental consequences (can include physical and emotional/mental)
When can you deny a patient access to their records per CA law?
When there is substantial risk of adverse or detrimental consequences (can include physical and emotional/mental)
When can you deny a patient access to their records per HIPAA?
If access is reasonably likely to endanger the physical safety of the patient or another person. The patient is allowed to have the denial reviewed.
- This trumps CA law
What do the Ethics Code and HIPAA say about withholding records for non-payment?
Ethics Code: Can withhold records except in case of emergency
HIPAA: Cannot withhold records for any reason
Under what circumstances do parents have and not have access to a minor’s records?
Parents who have legal custody (at least 50%) have a legal right to a minor’s records, UNLESS the psychologist determines that access would have detrimental effect on therapeutic relationship or minor’s physical safety or well-being
Who consents to release of records for a minor?
Parent or guardian
Minor if they could have lawfully consented to treatment (i.e., 12+ and mature)
What are psychotherapy notes?
Notes that are kept separate from the patient’s chart, like the psychologist’s process/progress notes
These can be subpoenaed
How long do you have to respond to request to inspect records?
5 working days
How long do you have to respond to request for a copy of records?
15 calendar days
How long do you have to respond to a request for a summary of records?
10 working days
But up to 30 calendar days under special circumstances, like a long chart
When to include license number in communications
Always – any professional communication that includes your signature, and any advertisement
Advertising/communication don’ts
- Do not misrepresent yourself or mislead the public
- Do not compensate press/media for media publicity
- Do not solicit testimonials from current therapy patients or persons vulnerable to influence (including personality disordered patients)
- Do not solicit business from vulnerable persons
When should you agree upon fees?
As early as is feasible
When can you send to a collection agency?
For unpaid fees if person is given a warning first and are given a chance to pay within a specified time period
Can only give name, address, and amount owed (not diagnosis)
Can you offer free sessions?
Not to bring in new clients, but you can offer a free consultation
What are some examples of insurance fraud?
- Waiving a copay
- Billing for no-shows (but can do if patient paying out-of-pocket)
- Making incorrect diagnosis
Is bartering allowed?
Yes, unless it is clinically contraindicated or resulting arrangement would be exploitative (for either party)
What is fee splitting and is it allowed?
Fee splitting means you split the fee the client gives you with someone else.
It is okay if the split is based on the services provided and not the referral itself. You cannot give someone money for making a referral to you. You can give a portion of the fee to cover office rent, marketing, admin/scheduling, etc.
When should you terminate services?
- When client no longer needs services; e.g., treatment is not working or there are no treatment goals
- When client is not benefitting
- When continuing would cause harm to client
When terminating, you should provide termination counseling and referrals, except you are not obligated to do so if you feel threatened by the client or someone close to the client, or when the client drops out of tx
What do you do if a patient has trouble paying?
- Once a relationship has been established, you cannot abruptly terminate tx due to patient’s temporary financial crisis.
- You can reduce your fee, reduce appointments, or suspend sessions.
- If the client is in crisis/emergency, you must continue seeing them until the crisis has resolved, regardless of their ability to pay.
Can you have a multiple relationship with client?
Yes, unless it is harmful to the client or impairs the competency or objectivity of the psychologist.
In general, avoid doing assessment and therapy with the same patient.
Note: Includes relationship with someone close to the client
In some forensic contexts you may be the therapist and assessor.
Who can give consent to treatment of a minor?
Parent or guardian with legal custody. If one legal guardian refuses consent, cannot proceed.
If minor is 300, court appoints someone to have temporary legal custody.
Emancipated minor
Conditions for becoming emancipated minor
- 14+ years old
- Living apart from parents with the consent of parents (i.e., not a runaway)
- Managing own finances
- Income is not obtained illegally
In what situations can minors consent to treatment?
- If they are emancipated
- 12+ and seeking medical care or counseling for drug and EtOH related problems; BUT must have parental consent for narcotic treatment
- 12+ and “mature enough to participate intelligently”, but treatment should still involve the parents unless there is abuse
- 12+ and mature and seeking outpatient or residential care (e.g., runaway house, crisis center) and is a serious threat of hard to self or others without services or is alleged victim of incest or child abuse; BUT parental consent is still needed for inpatient treatment, medication, ECT, or psychosurgery
What are the consequences for having sexual contact with clients?
- BOP revokes license
- If incident occurs with one client and psychologist has no priors: Up to 6 months in county jail and/or up to $1000 fine
- If incident occurs with 2+ clients or with 1 client but psychologist has priors: State prison for 16 mos, 2 yrs, or 3 yrs and up to $10,000 fine
What do you do if your colleague has sexual contact with clients?
- Give the client a copy of “Professional Therapy Never Includes Sex” (give to any client who discloses sexual history with a therapist)
- If client was a minor during encounter and therapist still sees minors, make child abuse report
- If client is an adult, encourage them to report it, but you cannot confidentiality to do so
Can you break confidentiality to report a psychologist’s sexual contact with a client?
No, not if client was an adult at the time
Can make child abuse report if client was a minor at the time and the therapist still sees minors
With whom is a psychologist prohibited from having sexual relations?
- Client
- Close relatives, guardians, or significant others of clients (and cannot terminate therapy to start a relationship)
- Supervisees or students over whom psychologists have evaluative authority
- Research participants
Can psychologists ever have sexual relationships with former clients?
Yes, if two years have passed since termination of treatment and only under the “most unusual circumstances”
The burden is on the psychologist to prove that there was no exploitation
Definitely cannot terminate early in order to start a relationship
What is the penalty for not reporting abuse?
Up to 1 year in jail and/or up to $5000 fine
When are you mandated to report abuse?
- When you learned about it in your professional capacity (not just during work hours; e.g., if you check your work voicemail on the weekend)
- When you have a “reasonable suspicion” abuse occurred
- When it was abuse of a child, elder, or dependent adult
Who is an elder?
Age 65+
Who is a dependent adult?
18-64 years old and physical or mental limitations that impact normal activities or ability to protect their rights
Who is a child?
Under 18
What are the categories of elder and dependent adult abuse?
- Physical
- Sexual
- Abandonment
- Abduction
- Financial abuse
- Isolation
- Neglect
What are the mandated report categories of child abuse?
Physical abuse
Sexual abuse
Neglect
Emotional abuse _____ be reported
may
What are the categories of neglect?
Severe: severe malnutrition; failure to thrive – any time the life or health of the child is endangered
General: inadequate food, clothing, shelter, medical care, or supervision
Note: neglect includes both omissions and actions
In what way and in what timeline do you have to make a CPS report?
ASAP by phone
W/in 36 hours in writing
Do you have to make a CPS report if the abused child is now an adult?
Only if the abuser has current exposure/access to children
When is sexual intercourse with a minor legal?
When the person is married to the minor
What counts as statutory rape?
Any sex between an adult and a minor
This should not be considered child abuse or neglect
A mutual affray between minors
Reporting rules for abuse that occurs at a long-term care facility (adult or elder)
If there was no serious bodily injury:
- call law enforcement ASAP, at least w/in 24 hours
- make a written report to law enforcement, ombudsman, and facility licensing agency w/in 24 hours
If there was serious bodily injury:
- call law enforcement ASAP, w/in 2 hours
- make a written report to law enforcement, ombudsman, and facility licensing agency w/in 2 hours
Reporting rules for adult/elder abuse that occurs at a state hospital or state center
If abuse included sexual assault or serious injury:
- call state department of state hospitals and law enforcement
For other reasons, just call law enforcement
Reporting rules for adult/elder abuse that occurs at home or other non-facility location
Call APS or law enforcement ASAP
Make a written report to APS or law enforcement w/in 2 working days
What counts as “danger to others”?
Tarasoff
When do you have to break confidentiality under Tarasoff? What meets criteria for Tarasoff?
There needs to be a serious threat, reported by client or family member of client, that the client (not anyone else) is a danger to others
There needs to be a threat of physical violence
There must be a reasonably identifiable victim or victims (do not have to have a name)
What do you have to do in a Tarasoff situation?
Notify law enforcement
Notify/warm the victim(s)
Tarasoff is the “Duty to Protect”
What does “grave disability” mean?
When, as a result of a mental disorder or chronic alcoholism, someone is unable to provide for their food, clothing, or shelter
ID alone does not qualify as grave disability
When can an involuntary hold be initiated? What situations?
When, as the result of a mental disorder or chronic alcoholism, someone is a danger to self (suicide risk) or others (Tarasoff), or is gravely disabled (unable to care for self)
Who can initiate an involuntary hold?
Anyone over 18
Initiate meaning ask for it to be looked into
Who can institute an involuntary hold?
Only qualified individuals, including police, crisis workers, psychologists, etc.
What is a 5150?
72 hour involuntary hold
At the end, person is either released or certified (held longer)
What is a 5250?
- 14 additional days of hold beyond an initial 72-hour hold
- This is called “certification”
- Requires 2 professionals to sign off
- The person is entitled to a review hearing w/in 4 days of certification
- At the end, either released or put on post-certification hold
What is a 5260?
Post-certification hold for SI, 14 days max
What is a 5270?
Post-certification hold for gravely disabled, 30 days max
What is a 5300?
Post-certification hold for danger to others, 180 days max
What happens at the end of a post-certification hold?
Either released or a conservator is appointed by the court for 30 days (temporary) to 1+ years
If a conservator is appointed, they create a treatment plan within 10 days, with the goal of helping the person become independent again
What is the code for a 72-hour involuntary hold?
5150
What is the code for an involuntary certification hold?
5250
What are the codes for post-certification holds?
5260 - Danger to self
5270 - Gravely disabled
5300 - Danger to others
Supervisors must complete ________ of training in supervision every ________.
6 hours, 2 years
For how long is a registered psychologist registration?
30 months, non-renewable
What is required to invoke a 5250?
2 professionals must sign off
When is a child abuse report mandated in instances of sexual activity between an adult and a minor?
When the adult is 21+ and the minor is under 16, or when the sex is non-consensual (rape)
The relationship between a supervisor and psychological assistant is one of _________ to _________.
Employer to employee
Who can be a primary supervisor?
Mostly only a licensed clinical psychologist
But, psych assistants can accrue up to 750 hours under the primary supervision of a board certified psychiatrist
Who can be a delegated supervisor?
- LCSW
- MFT
But not to a psych assistant
Is documentation of treatment (e.g., progress notes) mandated?
Yes, it is both an ethical and legal mandate
Are psychotherapists required to interrogate their clients to find out the identity of a potential victim if homicidal ideation is mentioned?
No
What are the required pre-licensure courses and how many hours of each do you have to complete?
Aging and Longterm Care - 10 hours
Spousal and Partner Abuse - 15 hours (used to be 2 hours)
Chemical Dependency - 15 hours (must be completed at educational institution)
Suicide Risk Assessment - 6 hours
Child Abuse Reporting - 7 hours
Human Sexuality - 10 hours
