privilege & confidentiality cont. and ethical fallacies and pitfalls

Question 1

what is a fallacy

Answer 1

Logically invalid argument; appears logical and feels logical, but there is a lot of errors in reasoning; the brain is a powerful thing (brains try and help us make sense of a situation that makes no sense); same idea of PTSD

Question 2

some example of cutting ethical corners

Answer 2

-Reading the law and going by the law
-Going with someone of a higher status
-Not considering alternatives
-Doing what requires less of you
-Tired, fatigued, stressed

Question 3

what is bias and how does it impact ethical judgment

Answer 3

Something that impacts your judgment

How does bias impact ethical judgment
-Dictates what we think is important vs. unimportant

Question 4

how to handle ethical fallacies

Answer 4

-Have to stop, pause and think before you begin to address question
-Easy to fall into, automatic is so powerful

Question 5

cognitive commitments

Answer 5

-Committed to the way we are thinking, not considering other alternatives

-Confirmation bias: looking for evidence that confirms what we are thinking

-Cognitive dissonance also plays out: uncomfortable in ethics because there is a value in it; we want a good grade and we have clients that we care about; uncomfortable to be wrong and want to avoid the feeling

Question 6

authorities

Answer 6

Automatically go with what supervisor says

Question 7

groups

Answer 7

Groupthink
-Have to learn to challenge the group consensus

Question 8

hindsight bias

Answer 8

After you already know the outcomes, saying that you would have been able to make the best predictions

Question 9

correspondence bias

Answer 9

Fundamental attribution error
-Attribute something more to person than the environment

Question 10

false consensus

Answer 10

Tendency to believe that people think like we do, when in reality there might be another way of thinking

Question 11

status quo bias

Answer 11

Not wanting to make decisions that lead to change

Question 12

optimistic bias

Answer 12

Tendency to believe that our decisions have less weight than they actually do, “it’ll be fine”

Question 13

narrative bias

Answer 13

Leads us to construct or believe narratives that explain why events happen by oversimplifying and overinterpreting

Question 14

equality bias

Answer 14

We are socialized to believe that the right thing to do is to make decisions based on the principle of equality; but equality is insufficient and assumes an equal playing field

Question 15

PA ethics code two provisions to disclosure/confidentiality

Answer 15

1) Psychologist may not disclose confidential information to a third party without the consent of patient

2) Psychologists can discuss clinical information with other persons clearly concerned with case if reasonable efforts are made to avoid undue invasions of privacy
-Psychologist can utilize clinical material in classroom teaching and writing when information is deidentified
-APA code mentions this as well
-Consultation/ group supervision
-When you are working with folks under the same laws as you, you can discuss but de-identified

Question 16

what are some of the things you have to do to be HIPAA compliant

Answer 16

Must provide information to patients about their privacy rights (notice of privacy practices)

Permit patient access to records
-Allowed to see everything, but you are not required to hand everything over; does not mean you need to give everything over, but you just have to let them see it
-Process notes are not a part of the record, unless someone subpoenas you; have to have a system of shredding them so you are not caught with them

Obtain patient authorization for use and disclosures to others

Implement clear privacy procedures for electronic transmission and data storage

Designate privacy officer

Implement security procedures

Train employees in compliance

Reasonable ensure that business associates etc. comply with privacy transition rules

Correction of potential violations (privacy officers role)

Question 17

what is useful to include in an ROI

Answer 17

Required by HIPAA and Pas mental health procedures act
-Name of patient
-Name of agency or individual releasing information
-Name and title of individual or agency receiving information
-Expiration date or condition under which release expires
-best practice to have an expiration date
-You will not know someone later; what would you do if someone comes to you with information and you are not actively seeing them, call client and see about releasing information?
-Discharges do not always indicate release
-Rule is around releasing information, not taking information
-Identification of information to be released
-Signature of patient and date (parents and sign for children under 14 and personal representative or guardians for adults who are declared incapacitated around healthcare)
-Other mandated language
-Other discretionary information (e.g. two signatures if patient is physically unable to sign, limitations to release)

Would be helpful to also include how information will be shared

Question 18

ROI for assessment reports

Answer 18

-Depends who your client is, if it is a forensic case you are not giving it to the person you are assessing
-Do not give raw scores

Question 19

laws included in HIPAA surrounding releases

Answer 19

-Patient may have right to obtain copy of records
-Institutions or treating practitioner may own the physical records themselves
-Debate around complete access to records and raw data due to potential harm
-Requires access to PHI but does not require access to psychotherapy notes

Question 20

APA ethics code and releases

Answer 20

Does not explicitly state that patients have rights to their records

Question 21

PA law and releases

Answer 21

Mental health procedures act
-Drug and alcohol settings: patients have right to inspect entire record
-Institutional setting: project director may remove portions of record prior to inspection if the director believes information may harm patient
-Patients can appeal decisions to limit information

Inpatient and publicly funded licensed outpatient mental health centers
-Right to inspect records unless director believes
-Disclosure of specific information concerning treatment will constitute substantial detriment to the patient’s treatment
-When disclosure of specific information will reveal the identity of persons or breach the trust or confidentiality of persons who have provided information upon an agreement to maintain their confidentiality
-E.g. family or couples cases
-Patients can always appeal

Question 22

how to handle HIPAA in group practices

Answer 22

All staff are formally trained in HIPAA regulations

Staff must sign an employee confidentiality form

Emails and fax coversheets communicating PHI must indicate “confidential”

Fax policy posted by fax machine
-Have to have confidential on the top or first page of the fax

All vendors must sign contract with practice

Officer manage who oversees HIPAA authorizations, completion, and maintenance of records, receives complaints and applies sanctions

Information can be shared internally without consent

PA ethics codes does not have rules around independent practice

Question 23

things to consider about confidentiality

Answer 23

HIPAA privacy and security rule

PA ethics code principle 5

APA ethics code standard 4

PA state laws

Also need to consider
-Psychologist’s role
-Purpose of the psychological activity
-Legal status of the person with whom the psychologist is working
-Institutional and organizational policies

Question 24

electronic media and confidentiality

Answer 24

Being knowledgeable about and obtain technical assistance in employing appropriate methods for protecting confidential records

Recording audio, video, or digital images
-Store recordings in safe locations, passwords to protect access
-Distort voice or mask faces when possible
-Proper measures to destroy recordings when no longer needed
-Reformatting flash drives
-Eraser for PCs
-File Vault 2 for Mac

Question 25

best practice for patient communication under HIPAA

Answer 25

-Always seek permission of patients to leave messages on their phones, send email messages or to send confidential snail mail to their addresses
-Where is it okay to leave messages? Cell, home, work
-Include line on intake forms with checkboxes
-Only leave “minimally necessary” information
-Do you anticipate reasonably foreseeable threats?

Question 26

how to do faxes

Answer 26

Include a cover sheet that states “confidential information”

Question 27

how to do emails

Answer 27

Email encryption
-HIPAA does not require encryption but strongly recommends

Question 28

how to do cloud storage

Answer 28

not HIPAA compliant
-Currently exempt from HIPAA compliance, however this may change (PA state law)
-Use companies that require Business associate agreements

Question 29

searching for people on social media?

Answer 29

-Minimize intrusions on privacy
-If you come across information via the news where you were not snooping, you can bring this up

Question 30

how to handle disclosure

Answer 30

-Be discreet , only release information when necessary
-Can refuse to disclose even with a signed release

Question 31

explain minimizing intrusions on privacy

Answer 31

-Assessment reports: including only relevant information
-Research data: what information is relevant
-share minimally necessary information

Question 32

breach of confidentiality in PA?

Answer 32

-No reported cases in PA involving monetary recovery for breach
-Some case law in which recovery damages against other health professionals were given
-Investigation by office of civil rights if HIPAA privacy rules were violated
-Electronic breaches in confidentiality?
-Cyber insurance/security will pay people off if they are threatening to release information for money

Question 33

how to handle working with families or couples

Answer 33

Informed consent should have limits on who you see at a time and if secrets are not allowed

Question 34

laws/ethics on families

Answer 34

No clear laws or ethics codes

Who is the patient vs. collaterals

Family secrets
-APA specifics be clear on your policy at the outset of treatment

Parents/groups
-No need to get everyone to sign a release

Marital relationship
-Couple is usually viewed as the patient and both parties must authorize; cannot be introduced in court or released to any other party without the mutual consent of the couple, unless the ROI is authorized by specific state law

Question 35

how to handle billing

Answer 35

How is information represented to the insurance companies?
-Have to have an identified patient with a diagnosis for insurance, this is why people don’t often work with insurance

Who do the records belong to

How might you address the vagueness of the laws

Remember confidentiality attaches to the patient

Question 36

how to handle ages 14-18

Answer 36

Parent can get access of record to send to another medical professional, but not to get into their hands

Kid could potentially request it, but that is definitely a conversation that you have with that individual

14 you can consent to therapy, parent can also consent for you to be in therapy and take you there; cannot take away consent that their parent gave
-Kid cannot take away parents consent, can be forced to go to therapy; and parents cannot take away kids consent

Notes are not automatically the parents

Question 37

death of client?

Answer 37

Does the executor inherit privilege?

Depends on state

HIPAA states that personal representative of the patient does have access to the records upon the death or incapacity of the patient

People have confidentiality in death
-If they have an executor they can petition or sue to get that information and a court could decide

Question 38

professional will?

Answer 38

-Is there someone who has access to your stuff that can contact clients for you
-If you are working privately you should have a will or someone to get to your stuff

Question 39

common pitfalls of confidentiality

Answer 39

-Referral sources
-Public consultation
-Gossip
-Case notes and patient files
-Phones, faxes, and messages
-Home office
-Sharing with loved ones
-Post death confidentiality
-Communications in group or family therapy
-Written consent
-Managed care organizations
-Disclosed confidential information for mandated reports (law)
-Publishing case studies
-Distraction
-Focusing on legal responsibilities to the exclusion or ethical responsibilities