Court-Ordered Evaluations/Assessments
- If hired by a court or legal counsel the court or legal counsel is the client, not the person being evaluated
- you still need to provide informed consent though the client may be attending involuntarily. In this case include more information about the process, involvement, and assessments so the client knows what to expect
Psychological Assessments are required to be (ethically)?
- Reliable
- Valid
- Practical Utility
- Suitable to age, gender, culture, purpose
- Informed Consent
- Competent Evaluators
Tarasoff
•Supreme Court of CA held that mental health professionals have a duty to protect an individual being threatened with bodily harm by a patient.
•Duty to Warn: a therapist has a duty to warn someone in danger of being harmed by a patient if there is a viable threat (read: plan, means, intent) and the patient has access to this person.
-ie: if a psychotic pt threatens a political figure with no formed plan or access “I would choke the president out” vs a pt threatening an ex “I am going to choke her next time I see her”
Ethics in a Professional Setting
•2 fold pragmatic stance: assessing risks and risk management
•tier of consideration:
•Law
-Federal Law & Administrative Rules
-State Law & Administrative Rules
•Organizational Policies
•Ethical Principles & Practices
•Community Standards
•Personal ValuesRecord Keeping
-how long must they be kept and where?
- 1 of the 10 domains for ethical standards
- records must be kept for 7 years, behind a double lock, and then appropriately destroyed
- Psychotherapy notes must be kept separate from medical records
- HIPAA requires specific things be included in the records (separate card)
HIPAA
- full name
- what is it
- Health Insurance Portability & Accountability Act
- Law for the electronic exchange, privacy, the security of health information; privacy rule for personal health information- requires safeguards to protect the privacy of personal health information and sets limits & conditions on the uses/disclosures that may be made of such information without patient’s authorization
•3 goals: Increase Efficiency; Improve Privacy; Better Security
HIPAA requirements for record-keeping
•document must include
- Prescription Monitoring - start and stop times (to the minute) - frequency, duration, and number of sessions - functioning status - treatment plans - symptoms, prognosis, and progress to date - Type of Therapy
HIPAA requirements for releasing information
- name/identification of the person making the disclosure (us)
- name of the person/organization to whom information is being released
- name of patient
- type of information and purpose for which it is being released
Multiple Relationships
- define
- it is one of the four what?
- are multiple relationships unethical?
- Refers to any situation where multiple roles exist between a therapist and a client
- 1 of the Bersoff 4 areas of ethical concern
- not all types of multiple relationships are unethical; only those that could reasonably be expected to impair the psychologist’s objectivity, competence, effectiveness
What is the most frequent reason for APA dismissal?
•Multiple Relationships
Legal Ethics
- Laws and Statutes, not guidelines. Guidelines are not legal, they are aspirational.
- Psychotherapy notes may still be required for disclosure in legal settings and refusal to cooperate may result in charges for the therapist
•Legal action is normally based on negligence
-malpractice 4 D’s: duty, damage, deviation, direct link
Informed Consent
- what is it
- legal requirements
- Permission granted in the knowledge of the possible consequences, typically that which is given by a patient to a doctor for treatment with full knowledge of the possible risks and benefits
- Legal:
- the client must understand the information presented - consent must be given voluntarily - client must be competent to give consent
Ethics with Diverse Clients
- ADDRESSING
- we have an obligation to work from a place of cultural humility, to do the research on cultural considerations and areas we do not understand so that we can provide equitable treatment for patients
APA Code of Conduct
- we know this- it’s the shit you need to know and follow; 5 aspirational principles; 10 enforceable standards
- in 2018, APA discontinued general enforcement of the code
Identify the main risks to clients for attending therapy
- personal revelation
- shame and embarrassment
- breach of confidentiality
- prosecution or lawsuit
- adverse job consequences
- worse relationships
- cost
- worsening of symptoms
Identify the special ethical vulnerabilities therapists should consider
- Domestic Dispute (custody-children; $)
- Forensic Evaluation ($)
- Disability Evaluation (Disability Determination Services)
- Old Bills for services ($)
Identify the 4 variables of clinical risk assessment
- P= Patient Risk
- C= Context
- D= Disciplinary Consequences
- TF= Therapeutic Factors
What to include when assessing a patient for risk
- not limited to, but most commonly including:
- danger to self (suicidal ideation, self-injurious behaviors, inability to care for self)
- danger to others (homicidal ideation, inability to care for those in their care due to threat or their own state)
Identify the 4 D’s of Malpractice
- Duty
- Damage
- Deviation
- Direct Link
Termination
- Ethically and the clinically appropriate process by which a professional relationship is ended. Keep records for 7 years after termination and then destroy
- adolescent patients: may attend therapy services w/out guardian participation but guardians must be included in termination process/plan
