cpse

Feedback: When a psychologist receives a phone call from a third party, and there is no prior written release, the psychologist may listen to what the caller has to say (Response 1) but generally may not share any confidential information, even the fact that the patient is in psychotherapy (Response 2). There are extenuating circumstances in which the psychologist may breach confidentiality (Response 3), such as if the caller is giving credible information to suggest that the patient is a danger to self or others.

Feedback: INCORRECT! Effective January 1, 2005, primary supervisors must be employed by the same work setting in which the supervisee is accruing supervised professional experience (SPE), and must be available 100% of the time that the supervisee is working (Response 4). The requirement that primary supervisors be employed by the same work setting at least 50% of the time the supervisee is accruing SPE (Response 2) was eliminated.

Feedback: INCORRECT! Your best course of action in this situation would be to assess for dangerousness, and consider whether a Tarasoff duty applies (Response 4). The question does not indicate a danger to self, ruling out Response 3. There is not enough information provided to make a Tarasoff determination (Response 1) in that the patient’s statement that, “she won’t get away with this” can mean a number of different things and certainly would not meet the criteria for a direct patient communication of an imminent threat of violence; nor is it clear that hospitalization is warranted (ruling out Responses 1 and 2).

3. Social Phobia

Feedback: INCORRECT! Dementia is diagnosed when there are multiple cognitive impairments due to a general medical condition, persisting effects of a substance, or multiple etiologies. The cognitive impairments must include both memory impairment and one of the following: aphasia (language disturbance), apraxia (impaired ability to carry out motor activities), agnosia (failure to recognize or identify objects), or disturbance in executive functioning (e.g., planning, organizing, sequencing, abstracting). Memory impairments alone (Response 3) would constitute an Amnestic Disorder. Dementia should not be diagnosed when a different Axis I Disorder can better explain the clinical presentation. For example, Major Depressive Disorder and bereavement, especially in older adults, can mimic Dementia (this is often called “pseudo-dementia”). However, Dementia can certainly co-exist with depression and bereavement (Response 2). Delirium (Response 4) can be superimposed on Dementia; in such cases both diagnoses are made.

Feedback: INCORRECT! The APA Ethics Code explicitly states that when a harmful multiple relationship is recognized to exist, a psychologist should attempt to resolve the conflict with “due regard for the best interests of the affected person and maximal compliance with the Ethics Code.” The Code does not state that the multiple relationship should be terminated as soon as possible (Response 1); there may be other important actions that must be taken (e.g., clarification of roles, pre-termination counseling, etc.). Although referring a patient to another therapist (Response 2) may ultimately be appropriate, it is not necessarily the only or the best solution. A psychologist might instead withdraw from the other relationship. For example, if a psychologist’s child is placed in a class with a patient as the teacher, the psychologist might place the child in a different class rather than referring the patient out. “Proceeding with caution” (Response 3) is not the explicit recommendation of the Ethics Code; in addition, this response suggests that it might be acceptable to continue the harmful multiple relationship.

Feedback: INCORRECT! Given that Mr. Smith’s work problems and his relationship problems have been long-standing, an Adjustment Disorder is the least likely diagnosis for Mr. Smith. An Adjustment Disorder is diagnosed when symptoms emerge clearly related to a stressor and do not continue for more than six months after the stressor has ended. Mr. Smith’s work and concentration problems could be due to Depression (Response 1). His marital problems (i.e., four failed marriages) and long-standing work problems might also indicate Substance Abuse or Dependence (Response 2) or a Personality Disorder (Response 3).

Feedback: INCORRECT! Because psychosocial functioning is impaired in Schizophrenia, improvements in this area would be appropriate to use as outcome measures. “Able to attend to activities of daily living 90% of the time” is a specific and operationalized measure. “Schizophrenia has been reduced by 90%” is a vague, almost meaningless statement (ruling out Response 2). While medication compliance (Response 3) is always important, and participation in a psychosocial treatment program (Response 4) may be very important for some patients with Schizophrenia, Responses 3 and 4 do not address treatment outcome.

Feedback: INCORRECT! A Tarasoff duty exists when it is your client who presents a threat to another person (ruling out Response 3). In this case, your client is reporting a threat to you from his friends. The most salient issue is to mobilize law enforcement resources (Response 4) for your own protection. While ultimately you may choose to continue working with this patient (Response 1), or terminate (Response 2), that decision is not most relevant to handling the situation at hand.

Feedback: INCORRECT! According to the Tarasoff Statue (Civil Code 43.92), a Tarasoff situation exists when three conditions are met: (a) a patient communicates a serious threat, (b) directly to the therapist, (c) against an identifiable victim. The victim must be reasonably identifiable and not just “any victim” to qualify for a Tarasoff situation (Response 2). Similarly, the therapist must learn of the threat directly from the patient (or close family member according to the Ewing decision), not simply from any source (Response 3). Although therapists have legal and ethical duties to protect the public any time a patient poses a threat of violence (Response 1), Tarasoff duties are invoked only when the three conditions described above have been met.

Feedback: INCORRECT! The Business and Professions Code (Section 2290.5) requires both verbal and written consent from either the patient or the patient’s legal representative prior to the delivery of health care via telemedicine.

Feedback: INCORRECT! Critical incident debriefing and the related intervention of psychological debriefing (Response 4) were originally hailed as treatments that could prevent PTSD from developing. The underlying theory was that immediate debriefing of people who had suffered a trauma would resolve their problems without the development of chronic symptoms. Further research has shown that these treatments are not effective in preventing PTSD, and, for a subset of people, actually worsens trauma-related symptoms. Once a patient has been diagnosed with either Acute Stress Disorder or PTSD psychological debriefing is never used for treatment.

Feedback: INCORRECT! California law specifies several requirements if a therapist wishes to keep electronic treatment records. The therapist must institute procedures so that confidentiality is safeguarded. The therapist must also ensure that the records are tamper-proof. An off-site backup storage system is needed so that records aren’t lost if, for example, a computer has an irreparable crash or a fire destroys the computer. California law stipulates that original hard copies of patient records may be destroyed once the record has been electronically stored.

Feedback: INCORRECT! While there is a CPT code for a no-show, a psychologist may not bill insurance when a patient violates the psychologist’s cancellation policy (ruling out Responses 1 and 2). The psychologist may charge the patient the full fee (Response 4) under the terms of the office policy, as stated at the outset of treatment.

Feedback: INCORRECT! APA’s 2007 Record Keeping Guidelines note that in the absence of superseding guidelines (e.g., state law) psychologists may retain a full set of records for adults for seven years after the last date of service delivery, and for minors psychologist may retain a full set of records for either seven years or three years after the minor reaches the age of majority whichever is later.

Feedback: INCORRECT! With a diagnosis of Bipolar II, in conjunction with reports that Arden’s behavior has been frightening to his co-workers, one would expect MMPI-2 elevations on Scale F, Scale 2, and Scale 9. An elevation on Validity Scale F (the Infrequency Scale) suggests pathology, as this scale taps items that are not typically endorsed in the general population. An elevation on Clinical Scale 9, Hypomania indicates high levels of energy, poor impulse control, grandiosity, irritability, and risk-taking associated with mania or hypomania. An elevation on Clinical Scale 2, Depression suggests depression, dissatisfaction, and pessimism. In contrast, a psychotic disorder would most likely be indicated by elevations on Clinical Scale 8, Schizophrenia, and possibly Clinical Scale 6, Paranoia. An elevation on Validity Scale K (Responses 2 and 3) suggest an attempt to present in the best possible light, and would not likely be seen in a case of an active mood disorder or psychosis.

Feedback: INCORRECT! Potential crises must always be immediately addressed as they arise in the course of treatment. The patient has expressed a wish to kill her step-father who molested her, so the psychologist’s first responsibility is to assess further for dangerousness (Response 2). Based on the girl’s statement, it would be premature to consider hospitalization (Response 3) before assessing whether or not the patient has any intent or plan. Assuming she is not homicidal, it would be appropriate to help her understand her PTSD diagnosis and process her anger (Response 1). The girl’s distress, in and of itself, is not reason enough to break confidentiality and talk to her foster mother (ruling out Response 4).

Feedback: INCORRECT! According to the child abuse laws of California, when an individual who is 16 years of age has consensual sex with a partner of the same or any greater age, the sexual relationship is not considered child abuse (ruling out Response 1). When the patient is 14 or 15, a psychologist is obligated to make a report when the partner is 21 or older. While it is true that in this situation the patient’s relationship constitutes statutory rape, there is no obligation to discuss this with her (ruling out Response 4). The psychologist is legally obligated to maintain confidentiality in this situation (Response 2), and unless some type of extenuating circumstance applies, which has not been described here, the psychologist should not inform her parents (ruling out Response 3).

Feedback: INCORRECT! If there is still insufficient basis for a “reasonable” suspicion, a report to Adult Protective Services is not yet warranted (ruling out Response 4). The most logical course of action would be to speak to the alleged victim privately to determine if there is a reason to make a report (Response 1). Talking to the alleged perpetrator or to the entire family together (Response 2 and 3) could put a potential victim in further danger.

Feedback: INCORRECT! Psychologists may not withhold records that are necessary for emergency treatment because a client owes them money. Thus, in a situation in which the client might potentially be harmed, the psychologist may not withhold records. In this situation, the employer will not be harmed (Response 4) if you withhold the pre-employment screenings pending payment. The fact that the employees will not be harmed (Response 3) is irrelevant because the employer is your “client” in this case. The Ethics Code does not differentiate between assessment records and treatment records in terms of guidelines for withholding records (ruling out Response 1). Whether or not you have secured the services of a collection agency (Response 2) does not address the main issue with regard to withholding records, which is the potential for harm. NOTE: California law and HIPAA do not allow psychologists to withhold treatment records for non-payment under any circumstances (emergency or non-emergency treatment).

Feedback: INCORRECT! According to the 2002 APA Ethics Code, at the outset of family therapy the psychologist should clarify who is the patient, clarify roles, and discuss limits of confidentiality (Response 1). It would be premature to discuss treatment goals at the outset of therapy, before the psychologist has had a chance to assess the family (ruling out Responses 2, 3 and 4). The Ethics Code also stipulates that fees and billing must be agreed upon as early as is feasible in a professional or scientific relationship; there is no requirement that fees and billing arrangements be decided at the outset of treatment (ruling out Response 4).

Feedback: INCORRECT! A person who fails to report an instance of child abuse, which he or she knows to exist or should reasonably know to exist, is guilty of a misdemeanor, punishable by a jail term not to exceed six months, or a fine of not more than one thousand dollars ($1,000), or both. A person willfully fails to report abuse or neglect or who impedes or inhibits a report of abuse or neglect, where that abuse or neglect results in death or great bodily injury, shall be punished by not more than one year in a county jail, by a fine of not more than five thousand dollars ($5,000), or both.

Feedback: INCORRECT! Evidence Code 1024 states that in a legal proceeding, no privilege exists when the therapist believes that the patient’s mental or emotional condition causes him or her to be a danger to himself or herself or to the person or property of others and the disclosure is necessary to prevent that danger. Thus Evidence Code 1024 does not state that any time a patient is a danger to self, others or property that there is no privilege (Response 1), but rather when disclosure is necessary to prevent the danger, there is no privilege. Evidence Code 1024 does not distinguish between danger to self, others or property (Response 3). Evidence Code 1024 is much more specific than merely stating “most compelling circumstances” (Response 4).

Feedback: INCORRECT! There is a minimum age requirement (ruling out Response 1) in order for a minor, who has been the alleged victim of rape, to consent to treatment. The minor must be at least 12 years old (ruling out Response 4). The minor may consent to both treatment and collection of evidence (ruling out Response 2).

Feedback: INCORRECT! The APA Ethics Code dictates that interns only be given duties within their scope of competence, and that supervisors have the responsibility for providing appropriate training and supervision. In this question, the supervisor is failing on both counts. Fully informing the patient of the intern’s status and lack of experience (Response 4) does not mitigate these ethical obligations. The intern is clearly practicing outside of his scope of competence. In addition, the supervisor is not competent in the area. Recommending that the intern undertake a literature review is not adequate to ensure competence (Responses 1 and 2).

Feedback: INCORRECT! In a case of “potential” for child abuse, your consideration is for the future possibility of abuse. For this reason, you are not justified in making a report to CPS (Response 1), since there is not a reasonable suspicion that abuse has occurred. However, because you are treating this couple and working on parenting issues, you have an opportunity to intervene before the abuse takes place and take steps to promote the welfare of the children (Response 4). While it is important to continue to evaluate the situation (Response 2), and to maintain confidentiality at this point in time (Response 3), ideally the therapist should take action to attempt to prevent the abuse from occurring.

Feedback: INCORRECT! When a minor receives outpatient mental health treatment or residential shelter services without parental consent, there are different requirements for contacting the parent or guardian. If the minor is receiving residential shelter services, the provider must attempt to contact the parent or guardian. If the minor is receiving outpatient mental health services, the provider may choose not to involve the parent or guardian if involvement is deemed inappropriate (Response 3). The provider must then carefully document why the contact was deemed inappropriate (Response 1). Treating a minor without parental consent does not necessitate a call to a child protective agency, unless there is a reasonable suspicion of child abuse.

Feedback: INCORRECT! HIPAA is federal law. When HIPAA and state law are contradictory, making it impossible to follow both, psychologists should generally comply with HIPAA. In addition, when HIPAA provides stricter privacy safeguards than state law, psychologists should comply with HIPAA. However, when state law provides stricter safeguards than HIPAA, psychologists should comply with state law (Response 2). In other words, psychologists must comply with whichever regulations are the strictest, and if the laws contradict, then psychologists must generally comply with HIPAA. When ethics and state law contradict, psychologists should make known their commit to the ethics code and take reasonable steps to resolve the conflict.

Feedback: INCORRECT! Registered psychologists may only work in non-profit agencies that receive at least 25% of their funding from government sources. One may accrue SPE in exempt settings without being either a psychological assistant or a registered psychologist (Response 1). Government facilities and many educational institutions (Response 2) are considered exempt settings. It is not necessary to be at a formal post-doctoral internship or fellowship (Response 4) to be a registered psychologist. In fact, many such positions would not meet the criteria necessary to qualify as a setting for a registered psychologist.

Feedback: INCORRECT! Effective January 1, 2007, the Business and Professions Code (2919) requires that for minors treatment records must be maintained for at least seven years from the date the patient reaches 18 years of age, in other words, until the person is 25 years old.

Feedback: INCORRECT! Parental consent is not required when a minor 12 years of age or older is seeking drug or alcohol-related treatment from a provider with a county or state contract. The requirement that a minor be “mature enough to participate intelligently” (Responses 2 and 4) applies to general outpatient mental health treatment. HINT: Almost all the laws having to do with minors receiving treatment without parental consent either stipulate no minimum age, or stipulate a minimum age of 12 years. The exception is for self-sufficient minors, who must be 15 years of age or older to legally consent to medical or dental care.

Feedback: INCORRECT! It is possible for a psychologist to believe that a patient may pose a danger of violence and not be required to make a Tarasoff warning. For a Tarasoff warning, the patient must directly communicate to the therapist "a serious threat of physical violence against a reasonably identifiable victim." This patient may veil her intentions or even deny dangerousness outright, and the therapist may nevertheless believe that she may in fact be a danger. Therefore, it is possible that a Tarasoff warning would be required (i.e., assuming a specific threat is made) and it is possible that a Tarasoff warning would not be required (i.e., she appears dangerous but does not make a specific threat). Therefore, Responses 2 and 4 should be eliminated. Similarly, hospitalization is just one way to manage dangerousness. It may or may not be necessary in this case, especially if the threat is in no way imminent or outpatient measures are sufficient. Reponses 2 and 3 should therefore be eliminated.

Feedback: INCORRECT! Cognitive-behavioral therapy (Response 1), interpersonal therapy (Response 2), and medication (Response 3) are all appropriate and empirically validated interventions for Major Depressive Disorder. However, the first step in treatment would be to assess for and address any crises, particularly suicidality.

Feedback: INCORRECT! This question is specifically asking about what collateral information would be helpful. Collateral information provides input about the patient from either the perspective of significant people in the patient's life, or from other sources (e.g., records review). Collateral information that would be most beneficial in the clinical assessment of Nancy would include any mental health records, medical records, interviews with her family whom she lives with, and access to hospital records (Response 1). The vignette has indicated that Nancy is currently unemployed, and typically employment records are not included as part of a clinical assessment of an adult (ruling out Response 2). While a thorough clinical interview and mental status examination (Response 3) are very important in a clinical assessment, they are not considered collateral information. Similarly, psychological testing (Response 4) is also not collateral information.

Feedback: INCORRECT! The BOP requires that candidates who began their graduate training on or after January 1, 2004 complete at a minimum 10 hours of coursework in aging and long-term care, and 15 hours of coursework in spousal or partner abuse, prior to licensure. The BOP also requires that licensed psychologists renewing after January 1, 2004 complete a one-time course in spousal or partner abuse, of a minimum of one hour, and that licensed psychologists renewing after January 1, 2005 complete a one-time course in aging and long-term care, of a minimum of three hours (Response 1).

Feedback: INCORRECT! The Psychology Board of the State of California may use APA’s Ethics Code to sanction a licensed psychologist, even if he or she is not a member of the APA or other organization that has endorsed the code (Responses 3 and 4). The Ethics Code, however, does not have the full force of law (Response 1), meaning that infractions of the code are not automatically considered infractions of law.

Feedback: INCORRECT! When a psychologist receives a phone call from a third party, and there is no prior written release, the psychologist may listen to what the caller has to say (Response 1) but generally may not share any confidential information, even the fact that the patient is in psychotherapy (Response 2). There are extenuating circumstances in which the psychologist may breach confidentiality (Response 3), such as if the caller is giving credible information to suggest that the patient is a danger to self or others.