1
Q
Ethics Defined
A
Ethics is the study of those assumptions held by individuals, institutions, organizations, and professions that they believe will assist them in distinguishing between right and wrong and, ultimately, in making sound moral judgments
2
Q
Professions with Ethics
A
Medical - hippocratic oath Research - animal testing IRB - Institutional Review Board (protocols to protect human subjects in research) Lawyer - client privilege Psychologists - client confidentiality Journalists
3
Q
Social Justice
A
- Fairness between the individual and society
- Measured by opportunities for personal activity and social privileges
- Equity for gender, racial and social equality, immigrants, prisoners, the environment, and the physically and mentally disabled
- Tremendous efforts in recent years
4
Q
Female faculty member and male doctoral student - can they go out for dinner?
A
- Not until the research is done
- Are they on an equal level?
- Is the student’s best interest at heart?
5
Q
Forensic psychology & $$
A
- Hefty fees…
- Opinions for sale…
- School psychologists?
6
Q
Clinical psychologist conducting a research study at a college, doesn’t have a subject pool, gives students in abnormal psych class private psychotherapy in return for participation
A
- Incentives are offered in research, where does one draw the line for coercion
- Capacity to understand ramifications of being involved in research study
- Concerned about prisoners - at a disadvantage
7
Q
Deception in research is
A
is acceptable if it is justified by the study’s scientific value and alternative procedures are unavailable
- Must be approved by IRB
- Individuals debriefed at the end
8
Q
Why do we need ethical codes?
A
- Checks and balances on personal judgments
- Integrity for the profession
- Professional standards
- Public Welfare and Trust
- Promote sound relationships with other professions
- Enforcement Value - Monitor
9
Q
What are ethical codes?
A
- APA Ethical Principles of Psychologists and Code of Conduct
- Started after WWII
- 1947 - first APA Committee was established
- 1992 - 180 distinct ethical standards that could be enforced by the APA and licensing boards that adopted them
- Current Ethics Code was last revised in 2010
10
Q
General Standards
A
- Resolving Ethical Issues
- Competence
- Human Relations
- Privacy and Confidentiality
- Advertising and Other Public Statements
- Record Keeping and Fees
- Education and training (Continuing Education)
- Research and Education
11
Q
Current Trends:
A
- Growth of HMOs
- Internet and research
- Cultural diversity
- Increase of psychology in the law
- More autonomy in your medical record
- Increase in federal regulations on research and health care
12
Q
HMO
A
Health Maintenance Organization
- A medical insurance group that provides health services for a fixed annual fee
13
Q
Psychologists and Military Interrogations
A
APA - 2006 - prohibited psychologists from torture but could serve as a consultant for information gathering related to national security.
APA - 2010 - psychologists are prohibited from “engaging in activities that would justify or defend violating human rights.”
14
Q
Indemnified
A
Secure against legal lability
15
Q
Trolley Dilemma
A
This is a classical example of consequentialism, which tells us that our ethical judgments should be determined by the consequences of our actions
16
Q
Therapist Competence (Typical Ethical Dilemmas)
A
Therapists need to provide services for which they are qualified
17
Q
Client Welfare (Typical Ethical Dilemmas)
A
Client needs come before counselor needs and counselor must act in client’s best interest
18
Q
Informed Consent (Typical Ethical Dilemmas)
A
Counselors must inform clients regarding nature of counseling and answer questions so that clients can make an informed decision
19
Q
Confidentiality (Typical Ethical Dilemmas)
A
Clients must be able to feel safe within the therapeutic relationship for counseling to be most effective
20
Q
Dual Relationships (Typical Ethical Dilemmas)
A
More than one relationship with a client (e.g. the counselor is a friend and the counselor) should be avoided when possible
21
Q
Most common complaint
A
- Sex with clients
- After 2 years under the most unusual circumstances…
- 2002 - 70% of psychologists who lost license was because of sexual misconduct
- Sexual relationships with clients are strongly prohibited and in some states constitute a criminal offense
22
Q
Confidentiality
A
- Must discuss it up front
- None in certain forensic arenas
- If a partner has HIV
- Can breach confidentiality if there is child abuse or harm to self or others…
23
Q
Goals of Ethics
A
- Assist psychologists in effectively using the Ethics Code’s principals and standards to conduct their work in an ethically responsible way and protect the fundamental rights and welfare of those they work with.
- Enhance decision making skills
24
Q
Reporting Ethical Violations
A
- Psychologists should attempt to resolve any ethical issue informally at first.
- Must report if the ethical violation resulted in substantial harm and if informal resolution is not appropriate.
- NYS Justice Center
25
Health Insurance Portability and Accountability Act (HIPAA) - 1996
- There was a lack of standardization
- Three components
- Privacy Standards - disclosure of Private Health Information (PHI)
- Transactional Standards - electronic exchange
- Security Standards - how to protect PHI
- Are researchers impacted by HIPAA? Yes
- When can you breach HIPAA? Subpoenaed, emergency situation (someone's in an ER)
26
Patient Protection and Affordable Care Act (ACA)
- Was intended to increase health insurance quality and affordability, lower the uninsured rate by expanding insurance coverage and reduce the costs of healthcare.
- The law requires insurers to accept all applicants, cover a specific list of conditions and charge the same rates regardless of pre-existing conditions
27
US Supreme Court (Jaffee v. Redmond, 1996)
Precedent case: sets the standard for things moving forward
- “Effective psychotherapy…depends upon an atmosphere of confidence and trust in which the patient is willing to make a frank and complete disclosure of facts, emotions, memories, and fears. Because of the sensitive nature of the problems for which individuals consult psychotherapist, disclosure of confidential communications made during counseling sessions may cause embarrassment or disgrace. For this reason, the mere possibility of disclosure may impede development…”
28
Tarasoff v. Board of Regents of the University of California
- Prosenjit Poddar (from Bengal, India)
- University of California, Berkeley
- 1968 - he attended folk dancing classes at the International House and he met Tatiana Tarasoff. They dated briefly
- He interpreted their relationship to be serious
- She said she was involved with other men
- He began to stalk her
- October 27, 1969 - Poddar carried out the plan he had confided to his psychologist, stabbing and killing Tarasoff. Tarasoff's parents then sued Moore and various other employees of the University.
- The California Supreme Court found that:
- a mental health professional has a duty not only to a patient, but also to individuals who are specifically being threatened by a patient. This decision has since been adopted by most states in the US
- Justice Mathew O. Tobriner wrote "The public policy favoring protection of the confidential character of patient-psychotherapist communications must yield to the extent to which disclosure is essential to avert danger to others. The protective privilege ends where the public peril begins."
29
When you can break confidentiality
- When the client is suicidal
- Needs hospitalization
- Court ordered evaluation
- Sues counselor
- Mental disorder as legal defense
- Underage child (under 16) being abused (and elderly)
30
Tuskegee Syphilis Study
Gave black men syphilis, but wouldn't treat them
31
Virtual reality video game (US Military)
Allows users to experience perspective of active school shooter
32
Counterfeit Money
- What if my client gave me counterfeit money and the Secret Service contacted me?
- Do I divulge their name? Cire ethical concerns, get appropriate paperwork from judge
33
Civil Law
- A means to resolve conflicts between individuals. It includes personal injury claims (torts), the law of contracts and property, and subjects such as administrative law and the regulation of public utlities
- Example of torts: Tort cases therefore comprise such varied topics as auto accidents, false imprisonment, defamation, product liability, copyright infringement, and environmental pollution
34
Criminal Law
Violation of penal code, following/enforcing laws of the land
35
A crime
A violation of penal law
36
Tort
Is a violation of civil law (one million tort cases are filed in state courts every year)
- If harmed - you can ask for compensation
- The injured party (plaintiff)
- The responsible party (the defendant)
- The harm (damages)
- The complaint
37
Lawsuit
- Can be for physical or psychological damage
- Emotional distress
- Emotional damages
- Emotional harm
- Pain and suffering
- Tort - liability and damage determinations
38
Complaint
- A civil case begins when a plaintiff files a complaint - a notification to the defendant that he or she is being sued and for what reason
- states why the court has jurisdiction
- provides statement of the facts
- states a cause of action (legal theory about why the plaintiff is entitled to recovery)
- specifies a remedy
39
Service
The formal notification of the defendant - referred to as service and often involves a summons: a notice informing the person that a lawsuit has been filed and that he/she should appear in court at a certain time
40
Discovery
Discovery involves the formal and informal exchange of information between the two sides in a lawsuit
- Every party is entitled to the disclosure of all relevant information, regardless of its source
- Designed to equip both sides fairly
41
Deposition
- The sworn testimony of a witness taken out of court
- Subpoena
- Subpoena duces tecum (documents)
42
Negotiations
- Approximately 95% of all civil cases filed in federal district are settled before trial - voluntary settlements are the norm for case disposition
- Negotiation is where the parties in a civil suit are able to reach a settlement
- Settlements benefit the litigants and save the system money
43
Small Claims
Small claims cases constitute the largest category of civil cases
- Involve debt collection, nonpayment for goods, landlord-tenant disputes
44
Settling Tort Cases
- Jury trials are exceptionally rare
- Jury verdicts do set the parameters for negotiations and settlements - negotiation happens in the shadow of the law
- Trials represent substantial costs which all parties work to avoid
- The typical defendant is a large insurance company
45
Standards of proof
- Preponderance of the evidence (personal injury matters)
- Clear and Convincing (usually civil)
- Beyond a reasonable doubt
46
5th Amendment
Right to say nothing, don't have to incriminate self
47
6th Amendment
Right to a speedy trial by jury
48
8th Amendment
Cruel and Unusual punishment (people who are incarcerated)
49
Three branches of government
Legislative, judicial, executive
50
OJ Simpson
- The parents of Ron Goldman brought suit against Simpson for wrongful death
- The jury in the civil trial awarded the victims' families $33.5 million in compensatory and punitive damages
- "Let's say I committed this crime...Even if I did this, it would have to have been because I loved her very much, right?"
51
Role of Psychologists in Court
- Provide expert analysis and testimony
- E.g. sexual harassment (was it a hostile work environment?)
1. Assess baseline state of plaintiff before the harm occurred
2. The nature and extent of distress
3. The cause of the psychological impairment
4. What intervention may be helpful in their recovery
52
Ethic's Code
- The Introduction and applicability section and the preamble of the 2010 Ethic's code
- The rest is 151 enforceable standards that describe required, prohibited, and permitted behaviors
53
Whom does the ethics code apply?
- APA members and student affiliates need to comply with the ethic's code
- It applies in all settings, all activities, all communications, and all persons in one's role as a psychologist
- Lack of awareness or misunderstanding of any part of the Ethic's code is not itself a defense.
54
Professional versus personal activities
- Are you psychoanalyzing me?
- Questions to answer
1) Is the behavior linked to the role played by the psychologist?
2) Is there a high probability that their behavior will affect their psychological work?
3) Does their behavior threaten the credibility of the psychologist?
4) Come to my show?
55
Where does friendship or family begin and end as a psychologist?
- Can you set up a behavioral plan for your nephew?
- But you are a really good listener...
- Rorschach cards
- Promoting Beneficence and Non-malficience
- Working with a client with racist attitudes and behaviors?
56
Beneficence
Researchers should have the welfare of the research participant as a goal of any clinical trial or other research study - balance benefits against risks
57
Non-malficience
Avoiding the causation of harm
58
The Language used in the Ethic's code
- Due notice - The language is such that the behaviors that are required and those that are prescribed in a manner that readers would reasonably understand
- Applicability across diverse roles and contexts: Standards apply across a broad range of activities and standards do not compromise scientific, practice, or consulting activities
59
"Feasible and Reasonable"
- Informed consent should be obtained as early as is feasible
- The psychologist must take "reasonable steps to disguise the person or the organization"
- "Take reasonable steps to authorize only those responsibilities...to perform competently on the basis of their education, training, or experience..."
e.g. Using a housekeep to translate for a psych assessment.
Do things you wouldn't normally do in emergency
60
Ethic's complaints
- May be brought by anyone
- May be dismissed by the ethic's committee outright
- Failing to respond to the ethic's committee is an ethic's violation
61
Reprimand
A violation was not likely to harm another person
62
Censure
The violation was likely to cause harm but not substantial harm
63
Expulsion
The violation was likely to cause substantial harm to a person or the profession. They are expelled from the APA.
64
Stipulated Resignation
Committed a violation and are offered a "stipulated resignation." The psychologist failed to show good cause as to why they should not be expelled.
65
The Ethic's Committee can also direct them to:
- Cease and desist the activity
- Obtain supervision or additional training and education
- Obtain treatment if appropriate
- Agree to probationary meeting
E.g. client terminated treatment with psychologist who made sexual advances - ethically you are required to - encourage client to make a report, but must maintain confidentiality
66
Ethical Commitment and Virtue
Psychologists are encouraged to be
1. Conscientious - Do what is right because it is right
2. Discerning - Bring insight and good judgment to determine what is right
3. Prudent - apply practical wisdom to ethical challenges
67
Belmont Report
- National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research
- 1978
- Summarizes ethical principles and guidelines for research involving human subjects. Three core principles are identified: respect for persons, beneficence, and justice
- Reaction to Tuskegee
68
Obedience Experiments
```
Stanley Milgran (1963) - electric shocks
Person doing the shocking listening to man in white coat - he's taking responsibility
```
69
NY Woman Sues Hospital After Terminating Life Support on A Stranger
- Told her brother was dying, on his death bed
- Turned out hospital made a mistake about next of kin, not her brother
- Her brother was actually in jail, figured out later
- Emotional damage - trauma: something outside the normal realm of human experience
- PTSD Symptoms: flashbacks, re-experiencing trauma, anxiety associated with similar situations, nightmares, dissociation
- Hospital culpability
- Did defendant act intentionally or recklessly, conduct extreme or outrageous, conduct cause of severe emotional distress
70
Dr. Lifschutz was a psychiatrist in San Mateo, CA
- Treated patient in 1950s
- Patient sued another person for damages in alleged assault
- Records were subpoenaed, should've reached out to client and asked if it's okay to release records
- Doctor refused to give up records; showed up for deposition
- Doctor claimed psychotherapist-patient privilege
- Doctor went to jail; privilege is not absolute
71
Standards on Research and Publication
- IRB - also known as an "independent ethics committee" (IEC), "ethical review board" (ERB), or "research ethics board" (REV)
- A committee used in research in the US that has been formally designated to approve, monitor, and review biomedical and behavioral research involving humans
- They often conduct risk-benefit analysis in an attempt to determine whether or not research should be done. The purpose of the IRB is to assure that appropriate steps are taken to protect the rights and welfare of humans participating as subjects in a research study
72
Nuremberg Code
- 1947
- Required is the voluntary, well-informed, understanding consent of the human subjects in a full legal capacity
- The experiment should aim at positive results for society that cannot be procured in some other way
- It should be based on previous knowledge (like, an expectation derived from animal experiments) that justifies the experiment
- The experiment should be set up in a way that avoids unnecessary physical and mental suffering and injuries
- It should not be conducted when there is any reason to believe that it implies a risk of death or disabling injury
- The risks of the experiment should be in proportion to (that is, not exceed) the expected humanitarian benefits
- Preparations and facilities must be provided that adequately protect the subjects against the experiment's risks
- The staff who conduct or take part in the experiment must be fully trained and scientifically qualified
- The human subjects must be free to immediately quit the experiment at any point when they feel physically or mentally unable to go on.
- Likewise, the medical staff must stop the experiment at any point when they observe the continuation would be dangerous
Bizarre experiments - changing eyes, can twins feel each other's pain
People put on trial post WWII
73
IRB (APA Standard 8.01)
- Know if IRB is required
- If you receive funding for biomedical or behavioral research
- Write an accurate application
- Wait for approval before doing research
- Procedures follow the approved protocol
- Changes to protocol resubmitted to IRB
74
At least 5 members on the IRB
- Varying race, gender, and cultural backgrounds
- Sensitivity to community attitudes
- Knowledge of regulation/standards
- Knowledgable about and experienced in working with vulnerable subjects
- One scientific and one non-scientific
- One person not affiliated with the institution
- May invite outside reviewers
75
Tips for IRB Submissions
- Scientific justification
- $$ is not a research benefit
- Expedited review if it is minimal risk
- Only part of the board will review it
76
Minimal Risk
Minimal risk means that
- the probability and magnitude of harm or discomfort anticipated in the research are not greater in and of themselves than those ordinarily encountered in daily life or during the performance of routine physical or psychological examinations or tests
77
Informed Consent must include:
- The purpose of research
- Duration
- Procedures
- Right to decline and withdraw and consequences
- Potential risks, discomfort, or adverse effects
- Prospective research benefit
- Limits of confidentiality
- Incentives to participate
- Whom to contact for questions about the research
78
Informed, Rational, and Voluntary
- Language level (English as a second language)
- Must be documented
- Informed consent is an ongoing process
79
Titicut Follies
- It is a 1967 American documentary filmed at Bridgewater State Hospital for the criminally insane, a Massachusetts Correctional Institution
- The government of Massachusetts tried to get an injunction banning its release. The government claimed that the film violated patients' privacy and dignity.
- Although they received permission from all the people portrayed or the hospital superintendent (their legal guardian), Massachusetts claimed that this permission could not take the place of valid release forms from the inmates.
- A New York state court allowed the film to be shown. In 1968, however, Massachusetts Superior Court ordered the film to be recalled from distribution and called for all copies to be destroyed, citing the state's concerns about violations of the patients' privacy and dignity.
- They appealed to the Massachusetts Supreme Judicial Court, which in 1969 allowed it to be shown only to doctors, lawyers, judges, health-care professionals, social workers, and students in these related fields.
- Wiseman appealed to the US Supreme Court, which refused to hear the case
80
Certificate of Confidentiality
- Receive from Department of Health and Human Services (DHHS)
- It protects investigators from being compelled by law enforcement to disclose information collected during the research.
- Helpful with forensic subjects
81
Capacity to consent
- Substance user's capacity may vary depending on intoxications and withdrawal
- Those with schizophrenia depends on the stage of the illness - may not be based in reality
- Those with Dementia
- Assent (can't give consent, but understand proposed research)
- May obtain permission from a legally authorized person
82
Research on Children
- Assent may be waived if the benefit of the treatment during the research cannot be obtained outside of the research.
- Direct File - Juvenile's in adult criminal justice system
83
Digital Ethics
Verification of legal age?
- e.g. YouTube
- May be handled by host provider
- Must explain how the data is maintained and how it is de-identified
84
Unique Research Issues
- Research with Native Americans
- May require permission from tribal leaders
- International Research
- Research should never be conducted where the politics or power imbalance is such that it impacts on voluntary consent
- Random Assignment
- You may receive treatment or you may not
- Benefits - Access to new experimental treatment
- Comprehensive treatment
85
Dispensing with informed consent
- When research is not assumed to cause distress
- If the questionnaires are anonymous
- Naturalistic observations
- On the internet? Is there a "reasonable expectation of privacy" on the internet?
- Archival research
86
Humane care to animals
- Minimize discomfort
- Can subject to pain only when an alternative is unavailable and the goal is justified by its potential value
- If termination is necessary, pain is minimized
87
Hierarchy of Needs
```
Abraham Maslow
Fulfill base needs to reach self actualization
- Physiological
- Safety
- Love/belonging
- Esteem
- Self-actualization
```
88
Can an algorithm be racist?
They just repeat our past failures. Even though it may seem like success, it rules people out. Black men die younger and white men and black men have been charged more.
89
Unfair Discrimination
- Psychologists do not discriminate based on age, gender identity, race, ethnicity, culture, natural origin, religion, sexual orientation, disability, socioeconomic status, or any bias
- Performing psychological tests on individuals it is not validated on (e.g. MMPI Spanish)
90
Knowing your limitations
- Knowing your competence
- Knowing your biases
- You can still treat someone even if you don't agree with their values
- Knowing the issues up from
- It may be detrimental to the client if treatment is started and you find out that you can't treat them based on your biases
91
Willowbrook State School
- 1972 Gerado Rivero went in
- School was designed for 4,000, but by 1965 it had a population of 6,000. At the time it was the biggest state-run institution for people with mental disabilities in the US
- Public outcry led to its closure in 1987, and to federal civil rights legislation protecting people with disabilities
92
Saul Krugman (NYU)
- Dr. Krugman fed live hepatitis virus to sixty healthy children. Krugman watched as their skin and eyes turned yellow and their livers got bigger. He watched them vomit and refuse to eat.
- All the children fed hepatitis virus became ill, some severely
- Senator Robert Kennedy toured the institution in 1965 and compared it to a zoo
93
Spofford Juvenile Center
- Formerly the New York City Department of Juvenile Justice
- Secure Detention Center
- Started as the Youth House for Boys and Youth House for Girls
- Bridges Juvenile Center in 1999
- Closed in early 2011
- "a history of poor conditions and brutality against children"
94
Kalief Browder
- RNDC (Rikers)
- Browder was accused of the theft of a backpack containing a camera, $700, a credit card, and an iPod Touch.
- He was incarcerated on Rikers Island for 3 years with time in solitary confinement
- He was released when the prosecutor's case was found lacking in evidence and witnesses
- Two years after his release from prison, Browder committed suicide
- Altogether, Browder spent approximately 800 days in solitary confinement, mostly after fights with inmates. Browder later said that while in solitary confinement, he was beaten by corrections officers when in the shower. He said a verbal confrontation with a guard would escalate into a physical altercation.
- While in solitary confinement, Browder had lost weight and was depressed. He attempted suicide in early 2011 and on February 8, 2012 when he tried to hang himself using strips of sheet tied to a ceiling light in the cell. Browder later said the guards goaded him to commit suicide. On another occasion, after an appearance before a judge, Browder made a sharp implement from the bucket in his cell and started to slit his wrists. An officer intervened.
95
Civil Rights of Institutionalized Peoples Act
- 1980
- DOJ
- Protects the rights of those individuals who were in the care of state institutions
- State and locally operated jails and prisons, juvenile correctional facilities, public nursing homes, mental health facilities and institutions for individuals with intellectual disabilities
- AG can intervene on behalf of institutionalized people whose rights may have been oppressed
96
Ward v Polite
- At counseling program in East Michigan U
- Expressed concern over counseling a client who is gay. She asked for the case to be reassigned.
- The school expelled her
- She sued and they eventually reinstated her
- Eastern Michigan University prohibits students from discriminating against others based on sexual orientation
- Julea Ward frequently expressed a conviction that her faith (Christianity) prevented her from affirming a client's same-sex relationships as well as certain heterosexual conduct, such as extra-marital relationships
- That stance did not sit well with her professor
- When the university asked Ward to counsel a gay client, Ward asked her faculty supervisor either to refer the client to another student or permit her to begin counseling and make a referral if the counseling session turned to relationship issues. The faculty supervisor referred the client
- The university commenced a disciplinary hearing into Ward's referral request and eventually expelled her from the program
97
As a result of Ward the APA
Professional psychology programs should
- Train students to work with all clients
- Students need attain core competencies as determined by the profession
- Policy should be explicitly stated
- Trainees values and beliefs are treated with dignity and respect. Dismissal from program should be prudent, fair, and consistent with the core values of the program
98
Use of the internet to look up potential students...
- Some states ban universities from doing searches on students
- Looking up potential hires for a job
99
Sexual Harrassment
- Unwelcome
- Hostile workplace
- A single act or repeated
100
Is aversion therapy unethical?
- Unpleasant images
- Nausea (Antabuse)
- Sex Offenders (Castration)
- Is it empirically validated?
- Will discomfort arise?
101
HMOs Refuse to Extend Coverage when...
1. Did not take reasonable steps at the outset of therapy to estimate and communicate to patients and their insurance company the number of sessions anticipated
2. Did not familiarize themselves with the insurers' policy
3. Recognized a need for continuing treatment but did not communicate with insurers in an adequate or timely fashion
4. Were unprepared to handle client/patient response to termination of services
102
Multiple Relationships
- When a psychologist is the patient's therapist and in another role
- Does it impact one's objectivity?
- e.g. A Rabbi/psychologist in a small Orthodox Jewish Community
103
According to the 2002 APA ethics code, when psychologists enter into a multiple relationship with a client, they
must make sure that there is no impairment to the therapy and that no harm will befall the client
104
According to the APA ethics code, what should a psychologist do when ethical guidelines conflict with the law?
Make known his or her commitment to the Ethics Code and attempt to resolve the conflict responsibly.
- A genuine effort at resolution must be made. If this effort fails, the 2002 Ethics Code explicitly permits a psychologist to then comply with the law.
- Serious crime that needs to be reported right away - contact law enforcement
105
What is the ethical principle that guides the decision to subject animals to pain or stress during research projects?
Justifiable prospective scientific values with no alternative procedure available
106
Self-Disclosure
- Not unethical if communications meet the therapeutic, educational, or supervisory need of those they serve
107
Nonsexual physical contact
- Is the contact consistent with the goal of a therapeutic relationship?
- You can hug, hold hands, and put your arm around appropriately
- How will the contact be perceived by the recipient?
- Does the act serve the needs of the psychologist over that of the patient?
108
Working with forensic patients and inmates - psychical contact
- Learn self-defense
| - Disarm inmates
109
What happens if you violate HIPAA
Warning, hefty fine, could lose your job
110
Psychologists need to:
- Take reasonable precautions to protect confidential information
- With electronic data: develop security measures, use encrypted data transmission, password protected, make sure the receiver of the information has adequate security
- Avoid leaving phone messages if possible to clients
111
What is sensitive information:
- Medical and mental health conditions
- Drug/alcohol use
- Legal issues
- Genetic information (23 and me, ancestry)
- Reputation, employability, financial
- Other sensitive information (sexual orientation, etc.)
- The fact of that an individual is in a study
112
STD...
- Guthrie Clinic Steuben in Corning, NY
- A nurse learned of a patient's sexually transmitted disease, she sent 6 text messages to the patient's girlfriend
- The GF was the nurse's sister-in-law
- The patient learned about the text messages, called the clinic to complain, and the sued the clinic
- The clinic terminated the nurse's employment
- Typically under NY common law, employers are liable for the actions fo their employees under 2 conditions: that their conduct was something that should have been foreseen, and that they were acting within the scope of their employment
- Liable for accidental transmission, not purposeful
- Plaintiff's case dismissed
113
Protecting clients during research
- Minimizing risk
- Coding participants
- Keep the coding list in a separate file
- Limit access to PHI
- De-identifying data
- Locking file cabinets
- Password protecting documents and computers
- Certificates of Confidentiality
114
Audio, Video, or Digital Recording of Voices or Images
- Store in safe place
- Password protected computer
- Distort voice records or mask faces to protect
- Destroy recordings when they are no longer needed
115
When can we breach confidentiality?
- Child or elder abuse
- Contact family about suicidal client
- Contact law enforcement about a crime if they have foreknowledge
- Assist law enforcement with investigations
- Provide third-party payers when mental health treatment if covered by a health plan
- Some states: Domestic Violence
116
Assessment and Psychotherapy
- Store in a locked file cabinet
- Make sure client knows you are working with a HMO and are disclosing
- Obtain appropriate HIPAA signed releases
117
Notice of Privacy Practices
- It described the psychologists policies for use and disclosure of PHI
- Client's rights under HIPAA
- They can restrict certain disclosure
- Have the right to be notified if there is a breach
- Right to opt out of fund-raising communications
- Must sign another release for other issues
118
The Family Educational Rights and Privacy Act of 1974
- It gives patients access to their child's educational records, an opportunity to seek to have the records amended, and some control over the disclosure of information from the records
- With several exceptions, schools must have a student's consent prior to the disclosure of education records after that student is 18 years old. The law applies only to educational agencies and institutions that receive funding under a program administered by the US Department of Education
119
Children and those who cannot consent...
- Psychologists should inform children, parents, and legal guardians of information that is being shared
- Limits of confidentiality should always be stated at the beginning of the relationship (e.g. child and elder abuse)
120
Military
- No psychologist-client privilege in the traditional sense
- Psychologists have to release for lawful investigations or to determine suitability of person's for service of assignment
121
Murder/Suicide
Douglas Kelly 2/2/19
Killed wife then shot himself in daughter's room
- Verbally abusive to mom
- Mom told daughter to stay at a friend's because her father was in a "foul mood"
122
What are the chances you are alive?
1 in 400 trillion
| - Life preserver thrown at turtle
123
Suicide Prevention
- 42,773 deaths
- Suicide rate increase 24%
- Increased rates for 10-14 females, 45-65 males
- Males: firearms, females: poisoning
- Suffocation increased between 1999 and 2014
124
Who is most at risk for suicide?
Older, white males
125
Suicide Rates in the US
- More dramatic in the Midwest
- High in Huntington, WV
- Alaska: isolation and darkness; high alcohol abuse with NA population
126
Is living in a "Happy" place a risk factor for suicide?
- States with people who are generally more satisfied with their lives tended to have higher suicides rates than those with lower average levels of life satisfaction
- e.g. Utah is ranked first in life-satisfaction, but has the 9th highest suicide rate. Compared to New York was ranked 45th in life satisfaction, yet had the lowest suicide rate in the country
127
Mental illness and suicide scenarios
- People with MDD getting better...
- Schizophrenics recognizing the devastation of their illness
- Substance Use
- Alcohol intoxication present in 20-50% of completed suicides
- Alcohol has been identified as a contributory factor to death in more than 1/3rd of completed suicides
128
Myths about suicide
- People who threaten will not carry it out - in one study more than half clearly stated their intent 3 months before
- Just looking for sympathy - 40% has a previous attempt
- More attempt = greater likelihood
- Questioning depressed people about suicide will put the thought in their head
129
Werther Effect
- People copy suicide when reported
- Robin Williams - 30% increase in strangulation
- Did not occur with Kurt Cobain
- Increase in suicide calls
- Media coverage different
130
Most popular place to commit suicide
- Used to be Golden Gate Bridge
| - Now in China
131
Henrietta Lacks
- Malignant epidermoid carcinoma of cervix
- Dr. George Grey took samples from cervix without permission or knowledge on follow up
- Consent was not provided
- Family members coerced into giving blood samples without knowing it was for research
- Medical records and DNA strains published online without family knowledge
- Poor treatment of patient
132
Lil Albert
- John B. Watson
- Classical conditioning: bunny/rat with loud noise
- Albert fearful of animals --> generalized to anything white/fuzzy
- No ethical standards
- No informed consent
- Benefits did not justify risks, and method not necessary to achieve research results
Research Ethics
flashcards
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