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Definition
| Telemental Health (TMH) definition 1. Delivery of a variety of mental health services (various therapy modalities, testing, medication management, etc.) via telephone, teleconferencing, videoconferencing, e-mail, and the Internet TMH's benefits 1. Accessibility: May reach remote and disaster areas 2. Eliminates the need for travel, benefitting the disabled and the elders 3. Allows the recipients to receive specialized health services TMH considerations 1. Effectiveness: 2008 study review found that TMH interventions to be of better quality when delivered via Internet and telephone 2. Treatment of depression, schizophrenia, post-traumatic stress, panic disorders, substance abuse, suicide prevention, eating disorders, dementia, and child psychiatry showed success 3. Less effective in managing OCD 4. Physical separation obstacle to building therapeutic relationship: Facial cues and body language cannot be read 5. TMH not suitable for crises or life-threatening situations 6. Reimbursement: Online therapy not covered by most conventional health insurances Ethical and professional concerns 1. Clients are assessed for suitability to receive online therapy 2. Clients are informed of salient research data on what conditions are more effectively treated online 3. Clinician still needs signed informed consent; some states require both verbal and written consent prior to treatment 4. Need most current protective measures; clinicians learn about risks to confidentiality on Internet and inform client 5. Online clinicians seek technical advice to handle possible Internet/computer problems prior to begin treatment 6. Online clinicians only treat clients residing in the state where the clinician is licensed |
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| Standards for research 1. Follow institutional requirements, governing laws, and professional standards 2. Justification of research should be clear, significant enough to justify the animal use 3. Protocol must be reviewed by appropriate animal care committee (e.g., IACUC) 4. U.S. Department of Agriculture inspects facilities twice a year 5. Records regarding the procedures used and care of animals must be kept 6. Acquisition of animals must be lawful; transportation of animals must be humane 7. Experimental procedures are acceptable if non-intrusive or if the animal is properly anesthetized 8. If euthanasia is required, must be done humanely 9. In educational activities involving live animals, include instruction of ethics Personnel 1. Must be properly trained or supervised 2. Must provide proper care and housing for the animals |
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| Established 1. 1974 2. Also known as the Family Educational Right to Privacy Act (FERPA) 3. Federal law Functions 1. Protects the privacy of student school records 2. Rights are given to parents of minors, and to eligible students over 18 3. May request that schools amend incorrect or misleading information 4. Formal hearing may be requested if school denies to amend or correct information 5. Limits disclosure of records; in most instances, written consent required 6. Exceptions include reporting to accrediting organizations, complying with a subpoena |
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| Justifications of use 1. Used to prevent participants from altering their responses 2. Use must be justified by study's value and alternative procedures are not feasible Ethical 1. May include false feedback or withholding information regarding study design 2. Must debrief at the earliest opportunity, explain use of deception 3. After debriefing, participants may withdraw their data Unethical 1. Never permissible to cause emotional or physical harm, or willingness to participate in research Informed consent 1. True informed consent is not obtained when deception is employed 2. Debriefing regarding the Deception must be conducted as soon as possible |
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| Conducting ethical research and publication 1. Conduct research according to general principles of APA ethics code: beneficence/non-maleficence; fidelity and responsibility; integrity; justice; respect for people's rights and dignity 2. Applications to institutional review board: resubmit if changes made to method, compensation, procedures, informed consent, or confidentiality protections 3. Avoid biased language: follow APA Publication Manual 4. Obtain informed consent orally or in writing prior to their participation 5. If participant legally unable to give consent: explain study appropriately, obtain assent, obtain consent from legally authorized person if appropriate 6. Provide participants with explanations of the purpose, expected duration, procedures, voluntary nature of participation including the right to withdraw, potential risks, benefits, limits of confidentiality, contact information if questions arise 7. Do not use passive consent from legal guardians for participants not able to legally consent 8. Informed consent not necessary in studies with no reasonable risk for harm 9. Experimental treatments: consent must include information about experimental nature of treatment, how assignment to condition is conducted 10. Deception necessary at times to avoid participant "hypothesis-guessing" – value of research must outweigh costs, alternative must be infeasible or ineffective, cannot cause severe distress 11. Debrief as soon as possible 12. After study involving deception, allow participants to withdraw data 13. Compensation may not be excessive 14. If extra credit is offered in class, offer alternative methods 15. May not ask students, clients, or subordinates to participate in research 16. Do not falsify/fabricate data, correct errors in published work if discovered, share data with other researchers for verification/reanalysis 17. Do not plagiarize 18. Authorship order according to relative contributions regardless of status 19. Minor contributions do not merit authorships |
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| Competency to Stand Trial |
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Definition
| About Legal decision regarding ability to participate in one's own defense. Assess present mental status, not at time of crime. Assess ability to understand the nature and purpose of the legal proceedings, comprehension of his/her status or role in the proceedings and ability to assist in his/her own defense. If deemed incompetent, defendant receives inpatient treatment until competency regained, or released to a conservator |
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| 1. Testify based on special training and professional competence 2. Professional opinions regarding subject matter 3. Avoid multiple relationships – do not provide expert testimony to acquaintances, therapy clients 4. Assist jury in making their decision 5. Serve as impartial educator to jury 6. Do not accept contingency fees |
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Definition
| Testimony 1. Regarding direct knowledge of an event Subpoena 1. For testimony as a witness 2. Through a deposition/interrogation Under oath 1. Must give accurate account 2. Decline to answer questions if you do not know the answer, or if appropriate only for expert witness 3. Testify only if client has waived confidentiality/privilege, or if court-ordered |
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| Insanity as a legal defense 1. Individual is unable to distinguish right from wrong and to understand the consequences of their bx; must be due to a mental disorder a. Also referred to as the Not Guilty by Reason of Insanity (NGRI) defense 2. First case using Insanity defense: M’Naughten a. Most states: defendant deemed insane is not held criminally responsible b. Some states: "Guilty, But Mentally Ill"(GBMI) verdict 3. Decided by court a. Psychologist may give expert testimony regarding Insanity, but it is the court that determines Insanity in defendant Evaluation 1. Privilege waived, psychologist should review limits of confidentiality with client |
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| Subpoena: A legal command to testify about a client or to turn over client records Action 1. Clarify whether the subpoena constitutes a court order 2. If unclear, contact the court 3. May follow court order in releasing client information without client's consent 4. May also contest court order by asking judge for guidance or filing a legal motion to quash 5. If subpoena does not constitute a court order, written release of information must be obtained from client 6. If client refuses to consent to this release, and subpoena does not constitute court order, instruct the requesting attorney that the information cannot be released without the person's consent (do not reveal as client) 7. Requesting attorney will then stop pursuing the records, or will need to get court order Types 1. Subpoena ducestecum: bring physical records, only the information specifically requested 2. Subpoena ad testificandum: oral testimony |
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| Tarasoff murdered by Poddar, fellow student at UC Berkeley undergoing therapy with university psychologist. Poddar told psychologist of specific plans to harm Tarasoff. Psychologist broke confidentiality and warned police. Neither police nor psychologist warned Tarasoff. Poddar killed Tarasoff, psychologist held liable for failure to warn her and her parents. Court ruled "protective privilege ends where the public peril begins" Case results Duty to protect may include warning intended victim, notifying police, contacting others, hospitalization of client. Some states have laws requiring warning of potential victims. Ethics Code allows breaking confidentiality when risk of harm to others. Some argue that warning others may not always be best course of action in fulfilling duty to protect, as breaking confidentiality will ruin the therapeutic alliance |
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| 1. Keep client information private unless client consents or as required by law 2. Essential in building effective therapeutic relationship; "primary obligation" of psychologists 3. Maintaining security of records 4. Inform clients of limits of confidentiality at outset of therapeutic or professional relationship Disclosing information without client consent 1. Allowable to provide needed professional services, to protect client/psychologist/others from harm, for professional consultation, for payment for services, court-ordered evaluation 2. Provide minimum necessary information 3. Preventing self-harm: may contact family members, other professionals 4. When a client sues the therapist Reporting abuse 1.Required for child abuse, depends on state law for domestic abuse, abuse of vulnerable adults 2. Tarasoff case – "duty to protect" – mandate varies by state "Duty to protect" regarding HIV transmission 1.State laws vary; APA resolution opposes legal duty, acceptable only if the third party is identifiable, with compelling reason to be at risk, is unsuspecting, and client is unwilling or unreliable in notifying EAP– release information about attendance, compliance may be mandatory condition of therapy Military– confidentiality limited; information must be released in the lawful conduct of investigations, other special circumstances, provide informed consent of these limits Minors– parents retain right to records of treatment unless such release is detrimental; balance minor's need for privacy and parental rights, clarify with both minor and parents at outset of therapy Privilege– client holds right to withhold information from legal proceeding; waived if client sues therapist, if therapist is acting in a court-appointed capacity, if client introduces mental condition as defense in civil suit, if client seeks out assistance from psychologist for the exclusive purpose of committing a crime, if psychologist determines that a client requires hospitalization. Information regarding client requested by Professional Standards Review Committee– obtain waiver of confidentiality that is specific in wording National survey– confidentiality is most ethically challenging issue |
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Definition
| Privacy 1. Keeping persons or information about them protected from public knowledge 2. Vital to psychological practice, closely associated with confidentiality and anonymity 1996 1. Health Insurance Portability and Accountability Act Privacy rule of 2003 1. Standards for the privacy, use, and dissemination of health care information that is transmitted electronically "Protected Health Information"(PHI) 1. Includes any information "about health status, provision of health care, or payment for health care that can be linked to an individual" 2. Disclose minimum amount of information necessary to third parties 3. Includes oral, written, typed, and electronic data 4. Clients must sign an "acknowledgment of receipt" regarding HIPAA policy 5. May include diagnoses, treatment plans 6. Requests for psychotherapy notes require additional written authorization 7. Keep psychotherapy notes separate from other PHI 8. Clients may request access to records, review their records, ask for a duplicate copy, and ask for an amendment to any inaccurate information 9. PHI must be kept for six years 10. Applies to covered entities that disseminate information electronically 11. When state laws and HIPAA are contradictory, follow the more stringent law |
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| Rights/ limits 1. Refusal to release information in court proceedings 2. Holder of Privilege: legally competent adult, parent/guardian for minor, legal guardian for incompetent client 3. May be asserted by psychologists to challenge subpoenas Privilege between client and therapist 1. Supported by Jaffee v. Redmond case Granting of Privilege 1. Varies by state and by court 2. Waived by client if release of information is signed |
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Definition
| Seeking advice of another therapist not involved with case 1. Do not reveal identifying information 2. Share information only pertinent to consultation issue Used for questions regarding 1. Countertransference 2. Competence 3. Ethical dilemmas 4. Clinical decisions Differs from supervision, which involves formal responsibility Ideal consultant 1. Forthright, trustworthy, ethically sensitive, and competent Multiple opinions beneficial because advice can be flawed Document consultation 1. In writing |
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Term
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Definition
| Ethics Code: Introduction, preamble, general principles, specific ethical standards. General principles 1. Beneficence and non-maleficence 2. Fidelity and responsibility 3. Integrity 4. Justice 5. Respect for people's rights and dignity. General principles are aspirational only, specific standards are enforceable. Some standards are concrete, others include qualifying language. Ethics are not laws, but laws may mirror ethical standards. State licensing boards enforce ethical bx of psychologists. If unsure, consult with other psychologists or state psychological association ethics division. Document such consultation in writing to reduce liability risk. Professional Standards Review Organizations (PSRO) 1. Developed under the Social Security Act to promote healthcare services that are effective, efficient, and economical. General Guidelines for Providers of Psychological Services 1. Improve quality, effectiveness, and accountability of psychological services. Specialty Guidelines for the Delivery of Services 1. Addresses the aspects of the clinical setting to ensure both the quality and delivery of counseling services. Guidelines for Providers of Psychological Services to Ethnic, Linguistic, and Culturally Diverse Populations 1. Provide guidance to psychologists to be successful in providing services for ethnic, linguistic, and culturally diverse populations. |
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Definition
| Charging clients 1. Establish agreement as soon as feasible, may be delayed if client in crisis 2. Specify fees, billing arrangements, all anticipated costs 3. Collection agencies can be used if disclosed to client and opportunity provided for payment 4. Provide minimum information necessary for collection 5. In emergency, do not withhold records because of nonpayment 6. Do not terminate because of nonpayment if client in crisis 7. Bartering acceptable only if not clinically contraindicated and not exploitative 8. Cannot waive copayments 9. Accurately report services provided, client diagnoses to insurance companies 10. Do not engage in fee splitting (payment for client referrals); payments must be based on services provided |
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Term
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Definition
| Steps in informed consent 1. Disclose potential risks and benefits associated with therapy, assessment, research 2. Explain nature of the service, limits of confidentiality, involvement of third parties, fees 3. Provide opportunity to ask questions and receive clarification 4. Use understandable language, document written/oral consent/assent 5. If legally incapable of consent, obtain appropriate permission from a legally authorized person if possible, explain services, and consider client's preferences and best interests 6. Laws regarding treatment of children without parental consent vary by state 7. Disclose if treatment method is not established or risky, alternate methods 8. Disclose if trainee under supervision 9. Obtain consent for therapy as early as feasible; may be delayed in emergency situation 10. In psychological assessments, explain nature of testing and potential uses of testing 11. Consent not necessary if testing mandated by law/government, if testing is a routine activity, or if assessing decisional capacity 12. Must obtain consent to use client information in novel way 13. Informed consent demonstrates respect for client's autonomy, sets up collaborative atmosphere 14. Continuing process as necessary during course of treatment |
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Definition
| To obtain credentials 1) Must meet state/province requirements 2) Must complete doctoral program in psychology, pass the EPPP and state jurisprudence exam State requirements 1) Many states have oral evaluation, most states require post-doctoral hours 2) State licensing boards ensure that licensed psychologists have met minimal requirements, monitor their conduct, can revoke license 3) Non-licensed psychologists should be supervised by licensed psychologists 4) Many states require CE credits/units to maintain licensure; CE program sponsor must be approved by APA |
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| Multiple (Dual) Relationships |
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Definition
| Avoid multiple roles that impair effectiveness or cause harm/exploitation 1. May occur with clients, supervisees, students 2. Can impair competence, objectivity, overall performance efficacy, and cause harm or exploitation of client Encountering client out of session 1. Allow client to decide whether to acknowledge you or not When multiple roles are unavoidable 1.Clarify roles at outset and as roles change 2. Occur more often in rural communities When problematic multiple relationship does occur 1. Take immediate action to comply with ethics code 2. Most frequent cause of legal/disciplinary action Ethical Violations 1. Most frequent cause for legal and disciplinary action 2. 46% of disciplinary actions by psychology boards involve Multiple Relationships 3. 43% of APA's open cases |
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Definition
| This type of service is 1) Work done for the public good without compensation Recommended in the General Principles of Ethics Code 1) Aspirational, not enforceable 2) Ethical when administered appropriately and does not involve insurance 3) Waiving co-payment on insurance considered fraud |
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Definition
| Ethics in providing service 1. Offer services only in areas within one's boundaries of competence 2. Need proper training, or appropriate supervision; otherwise, refer to another provider who has competence in that area 3. If suitable provider not available, may proceed while making efforts to obtain the necessary competence 4. If emergency exists and no other provider is available, may proceed until emergency ends or appropriate services become available 5. Work with populations or in areas in which one has received appropriate training or experience 6. Be aware of individual differences that affect research or provision of services 7. Must work to eliminate biases based on culture/ethnicity 8. Monitor efficacy of services, base work on scientific knowledge 9. Must maintain lifelong learning to develop and maintain competence 10. If standards for preparatory training do not exist, take reasonable steps to ensure competence and avoid harm 11. Supervisors must ensure that delegated work is performed competently 12. Seek assistance if personal problems interfere with work 13. Avoid activities that are likely to impair one's Professional Competence |
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| Advertising and Public Statements |
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Definition
| Includes 1) Advertising 2) Listings 3) Display of credentials 4) Media 5) Lectures 6) Legal testimony 7) Published materials Standards 1) Ethical to promote services, but must not be deceptive or inaccurate 2) Must amend any false information that has been released 3) Unethical to pay media members 4) Must be clear to public that advertising has been paid for 5) Cannot solicit testimonials from current clients due to power differential 6) May not solicit business from vulnerable individuals, but may provide outreach services and provide emergency services during disasters 7) Public advice through the media should be presented as educative, not therapeutic 8) Such advice must be based on professional knowledge and established literature |
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Term
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Definition
| Keep records to 1. Facilitate future provision of services, allow for replication of research, meet institutional requirements, ensure accuracy of billing and payments, ensure compliance with law Minimum information 1. identifying data, dates and types of services, fees, assessment, treatment plan, consultation/summary/testing reports as appropriate, and any releases of information 2. Document major treatment decisions and rationale 3. If records are likely to be subpoenaed, higher standard should be followed based on court expectations and legal regulations Exempt Notes 1. Psychotherapy notes exempt from HIPAA provisions allowing clients access to their health records, but must be kept separate from rest of record Release, Transfer, and Retention of Records 1. Obtain authorization for release of records, protect physical security and confidentiality of records 2. Make plans for appropriate transfer of records if leaving a position or agency 3. Retention requirements vary by state law and regulations; follow most stringent guideline – HIPAA requires six years 4. APA suggests retaining records for seven years after treatment, and three years after minor reaches age of majority 5. Records may not be withheld in emergency situation solely because of nonpayment of fees 6. Release records only if valid authorization form has been obtained |
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| Resolving Ethical Issues 1. Must act ethically and also must assist in maintaining ethical profession 2. APA |
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Definition
| 1. Must act ethically and also must assist in maintaining ethical profession 2. APA gives "charge letter" to psychologist after potential violation – 30 days to respond 3. Correct any misuse of your work – notify that individual, request retraction 4. First step if ethical violation by colleague suspected – informal resolution 5. If substantial harm likely, or informal resolution fails, must file report 6. Do not violate client confidentiality in making ethical complaint – obtain client consent 7. Failure to cooperate with ethics investigation is in itself ethical violation 8. False/frivolous complaint against colleague is unethical 9. Cannot discriminate solely for making ethical complaint or being subject of ethical complaint 10. Conflict between ethics and law – attempt resolution of conflict 11. May follow law over ethics if no choice – this ethical standard is currently being considered for revision by APA |
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| Guidelines 1) Psychologists do not engage in sexual intimacies with current clients, nor do they provide therapy to former sex partners 2) Power differential between psychologist and client places client at risk for exploitation 3) Impairs psychologist's objectivity and ability to act with beneficence in the professional relationship 4) Dealing with client's attraction: clearly reinforce the professional boundary, discuss client's attraction in a therapeutic context. 5) Psychologists who engage in sexual intimacies with current clients often are meeting unfulfilled personal needs, likely to do so again in future, are more likely to engage in nonsexual multiple relationships; not related to client diagnosis or levels of professional achievement 6) Sexual relationships with relatives, guardians, or significant others of current clients prohibited; cannot bypass this by terminating therapy 7) Sexual relationships between psychologists and former clients: two years post-termination and exceptional circumstances must exist to prove lack of exploitation 8) Most frequent reason for loss of license, most expensive type of malpractice claim 9) Sexual relationships with students/supervisees prohibited when evaluative authority exists 10) Sexual harassment prohibited |
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Term
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Definition
| This experience 1. Required for psychologists-in-training to demonstrate competence 2. Timely feedback must be given 3. Clarify evaluative process at outset 4. Be sensitive of the power differential and its impact on relationship Avoid 1. Harmful multiple relationships in supervision 2. Supervisor-supervisee sexual relationship prohibited Responsibility 1. Trainee must inform patient the are being supervised 2. Client must be provided name of supervisor |
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Definition
| Requirements 1.Child Abuse Prevention and Treatment Act (1976) – all states require psychologists, other professionals to report suspect child abuse or neglect 2. Responsibility is not to determine whether abuse actually occurred, but to allow legal authorities to ascertain this 3. Many state laws mandate report when "reasonable cause to suspect" exists 4. If unclear whether cause is "reasonable," consult and/or present case anonymously to child protective agency 5. States vary regarding requirements for reporting past abuse 6. Inform clients of limits of confidentiality related to mandatory reporting of abuse 7. Psychologists who make reports in good faith are protected from liability 8. State laws vary regarding mandatory reporting of domestic violence, partner abuse, and elder abuse 9. If you are aware of a colleague not reporting abuse, you must report the abuse and the non-reporting colleague |
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Definition
| Assess 1. Severity of threat 2. Intent Other risk factors 1. Coping skills 2. Level of impulsivity 3. Family members or friends that have committed suicide 4. Suicide plan 5. Means 6. Presence of weapons or medications "No suicide" contract 1. May be useful for ideation without intent High risk 1. Must call police or mental health professional for possible involuntary hospitalization 2. Confidentiality waived if high suicide risk Suicidal minor 1. Parents must be immediately notified Do Not 1. Abandon suicidal clients by terminating 2. Waive confidentiality for past incidents |
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Definition
| End of psychologist-client relationship. Reasons 1) Client's request 2) Client or therapist relocation 3) Client or therapist illness 4) Treatment no longer benefiting client 5) Treatment is harming client 6) Therapist's inability to remain objective 7) Client endangering the therapist Guidelines 1) May not arbitrarily terminate with a client 2) Avoiding abandonment includes providing pre-termination therapy: discuss end of treatment, refer to another psychologist if necessary 3) Have plan for patient care in event of psychologist's untimely death or severe injury: include instructions for referral and record keeping 4) May not have option of avoiding termination if mandated by managed care company; if necessary, appeal managed care decision |
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| 1. Legal decisions regarding guardianship of a child 2. APA's Guidelines for Child Custody Evaluation in Divorce Proceedings (1994) 3. Assess both adults; psychological functioning, needs, and wishes of child; and evaluation of each parent's functional ability to meet these needs 4. If one parent does not participate in the evaluation, psychologists may still testify and make recommendations based on the evaluation of the parent who did participate. Such testimony and recommendations must be limited to discussion of the participating parent's evaluation 5. Based on the best interests of the child 6. Evaluation includes assessments of parents, child, important others 7. Parent with custody holds child's privilege rights and make decisions regarding child's psychological treatment and services Avoid multiple relationships 1. Do not conduct custody evaluations of therapy clients |
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Definition
| Steps to testing 1. Used to determine cognitive, academic, emotional, or bxal functioning 2. Obtain informed consent from client/guardian 3. Use valid and reliable instruments 4. Use normative data 5. Have requisite expertise/training 6. Eliminate distractions from testing room 7. Do not provide opinion about a client unless you have personally examined the client 8. Use multiple methods 9. Feedback to client should be comprehensible 10. Secure testing materials from the public |
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