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In a CPS reportable incident what age must the victim be? What age must the perpetrator be?
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victim is under age 18. Perpetrator is any age.
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What 4 types of events are reportable to CPS?
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if your minor client is involved in:
- non-accidental physical injury (does not include "affrays between minors"),
- sexual abuse (includes sexual assault and sexual exploitation),
- willful cruelty or unjustifiable punishment (includes mental suffering),
- neglect by person responsible for child's welfare
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What constitutes sexual abuse?
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sexual assault and sexual exploitation (anything relating to pornography)
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At what age/ages (for both partners) is non-consensual sex reportable for minors?
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All ages - you always have to report nonconsensual sex involving a minor client.
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Do you need to report your client's 14 or 15 year old client's consensual sex, with a similar aged partner?
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not reportable, unless there is abuse
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7 factors that must be considered to determine if sexual intimacies are ethical even after the 2 year moratorium
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1)amount of time since termination, 2) the nature, duration and intensity of the therapy, 3) the circumstances of the termination, 4) the ct's personal history, 5) the ct's current mental status, 6) the likelihood of adverse impact on the ct, and 7) any invitation by therapist during therapy suggesting/inviting a posttermination sexual/romantic relationship with ct
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3 situations where the psychologist is required to terminate therapy
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it is reasonably clear that:
the ct no longer needs the service, or
the ct is not likely to benefit, or
the ct is being harmed by continued service
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when can a psychologist do uninvited in-person solicitation of business from persons who may be vulnerable to undue influence?
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1. collateral treatment to benefit existing ct (w/client's permission so confidentiality isn't breached)
2. disaster services
3. community outreach (example is for older adults who the psych field feels do not spontaneously self-refer) Can educate about benefits of mental health intervention and encourage them to seek help
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How long does HIPAA say you need to retain records?
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6 years from the date of its creation or the
date when it last was in effect, whichever is later.
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Can psychotherapy or personal notes be subpoenaed?
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no
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What are APA guidelines for keeping records?
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complete records for a minimum of 3 years after the last contact with the ct, and a summary for an ADDITIONAL 12 years. If ct is a minor, either this or 3 years after the age of majority
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Under FERPA, parents can inspect a student's education records. what about the records of a school psychologist?
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If kept in the sole possession of the psychologist, used only as a personal memory aid and not accessible or reavealed to any other person except a temporary substitute for the psychologist, they are NOT part of the record and so are not subject to parental inspection
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The psychologist does not accept email from cts, or use her computer in any way related to her practice. Does she ever need to be HIPAA compliant?
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If any entity acting on her behalf (such as a bill paying agency, insurance company or HMO) has electronically stored or transmitted PHI related to any ct in the practice, HIPAA applies.
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Can psychologists withhold records under their control for nonpayment even if requested by the ct?
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yes, but only if not under HIPAA, and the situation is not an emergency. HIPAA does not distinguish between emergency and nonemergency requests, nor does it consider failure to pay as a legitmate reason to refuse a request to release records.
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A client requests a list of entities to whom the psychologist has release client's PHI, for the last 4 years. Can the psychologist charge a fee?
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Not if this is the first request in the past year. Each year, clients receive one free accounting of all disclosures during the past six years.
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If you intend to use collection agencies to collect debts, what must you do?
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1. Inform clients during informed consent procedures, that this is a possibility.
2. Inform the individual that you are about to use one to collect a debt, and give the person the opportunity to pay it first. (Should be at least 60 or 90 days after payment would normally be due.)
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Under what conditions can you barter?
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If it is not clinically contraindicated and if the resulting arrangement is not exploitative. Problem is possiblity of harmful dual relationships or loss of professional objectivity
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when does HIPAA permit authorization for use/disclosure of PHI to be combined with informed consent information?
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Research activities (see Fisher p 149). Under HIPAA, during research, you can also refuse treatment if the individual refused to sign the authorization to use/release PHI for the research project.
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What is the "therapeutic misconception" and how do you handle it?
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This is the idea that "experimental" treatment means "better" treatment with known direct benefits. During informed consent procedures for research investigating new types of interventions you have to clarify that this tx is untested, may involve risks, etc., whatever is true.
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when can you record research participants without their consent?
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-observations are in a public setting where you would not expect to have privacy
- procedures do not disturb the natural surroundings, AND
- participants are protected against personal identification and harm
OR if you are doing deception research, with the prior approval of the IRB (and then must get consent during debriefing or destroy the recording)
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what special steps are needed when a psychologist conducts research with cts, students or subordinates as participants?
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Must take steps to protect the prospective applicants from adverse consequences of declining or withdrawing such as NOT doing the informed consent process yourself or not having any research procedures that involve direct contact with the individuals. Par's must know that refusal/withdrawal will not affect services, grades, performance evals, privileges, etc.
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to whom does the APA ethics code apply?
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APA members
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What are the statute of limitations for ethics complaints to the APA?
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member of the public - 5 years
APA member - 3 years
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What is confidentiality?
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An ethical concept that has legal consequences related to maintaining the privacy and integrity of information given to a psychologist in our professional role
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What determines if a contact is "professional" in the context of confidentiality?
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The intent of the parties, and the context of the exchange (in or out of office, on personal or private line, etc.)
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when can psychologists break confidentiality?
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I. Permissive Exceptions
- clt gives permission
- ct is danger to self
II. Mandated Exceptions
- child abuse reporting
- elder/dependent adult abuse reporting
- court ordered
- Tarasoff situation (danger to others)
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If client is in danger of suicide is there a duty to report?
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not legally. maybe ethically if can't manage it in professional confidential context.
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significance of Ewing vs. Goldstein?
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extends Tarasoff requirements to family members who tell psychologist that his client is going to harm others, IF it is done "to further treatment" (i.e., aren't telling to get back at client)
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Can friends or domestic partners trigger Tarasoff warning?
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not according to law. must be family members or client himself.
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Under which do clients have more access to their records: APA Ethics Code or HIPAA?
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HIPAA
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What are important concepts that make up informed consent?
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Tx must be voluntary (except minors, mandated by courts, police or military e'ees, etc)
Ct must be legally competent
Ct must be informed about tx (see separate question about what constitutes "informed")
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What are the things that must be included for information about treatment for ct to be "informed"?
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-the nature and purpose of the service (length of sessions, duration of tx, goals of tx, individual/group, homework, talk therapy, etc.)
-the potential risks & benefits of tx
-methods used
This must ALL be in understandable language. Should also include info re $ esp limitations associated w/3rd party payments
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What kind of grievance procedures are necessary for private practitioners?
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If under HIPAA, must give info on how to file complaints under HIPAA. In CA, must give contact info for complaints to Board of Psychology
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Does consent always have to be given in writing?
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No, if situation demands it, consent can be brief, and verbal, but you should document it, and get written consent as soon as practical.
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What are the 3 exceptions to an assessment client's right to an explanation of the nature and purpose of the assessment?
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They are job applicants where testing is standard, or it's standard educational testing, OR if testing is for determining decisional capacity (i.e., Alzheimer's type cognitive effects - but still need to do best to explain what is happening)
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Assessment clients have right to know test results and appropriate interpretation of them? T/F
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true, unless told ahead of time that this will not be possible
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Psychologists must release the raw data to clients and client's designees if requested. T/F
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true, but must also maintain the integrity of the test materials.
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Psychologists can publish their own tests for others to use. T/F
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true, IF they give data re: reliability, validity, stats on normed populations, administration info, interpretation info
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In CA, the WISC (and other cognitive ability tests) can be used for educational placement decisions. T/F
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T, except for African Americans, because of the Larry P. decision that stated that the WISC discriminates against them.
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When are multiple relationships permitted?
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If there is no risk of exploitation or harm to the client, and psychologist won't lose professional objectivity, and won't impair professional effectiveness
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when can Jane Professor have sexual intimacies with Joe College?
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When they are in different departments/schools, and the professor has no/will never have any evaluative or direct authority over Joe
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How is competency developed in any particular area of practice?
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Education and supervised experience
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Psychologist maintain scientific and educational knowledge about their areas of practice solely because of state CEU requirements. T/F
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False. We are ethically mandated to maintain our skills and knowledge.
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Psychologists are ethically mandated to charge all the clients the same rate. T/F
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F. you can have a sliding scale
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Under HIPAA, when can a covered entity decline to release PHI?
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Only if it is reasonably likely to endanger the life or physical safety of the individual or another person, or is likely to cause equally substantial harm. the psychologist must allow the ct to have the denial reviewed by a designated licensed health care professional, if desired.
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What is the Tarasoff rationale?
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the client's privacy ends where public peril begins, so you must contact the intended victim and police, in an attempt to protect the victim (NOT just a duty to warn, but also a duty to protect)
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What 4 things do you need to have established to make a Tarasoff report?
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1. Someone who has made a threat (your client)
2. An intended and identifiable victim
3. The nature of the threat
4. Facts that make the threat "Serious" such as a plan, a proposed method, hx of violence, intensity and veracity of the threat
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When might you do a 5150 instead of a Tarasoff?
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When you can't adequately identify the victim, but you believe the harm will occur.
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What should you do if your HIV-positive client is having unprotected sex?
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Can't breach confidentiality even if you know the name of the partner. should counsel clt on safe sex practicies. Should work w/ct re why NOT practicing safe sex.
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Is punishing a child by hitting her with a belt reportable to CPS?
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Depends. If there was blistering or bruising, yes. If hit w/the belt buckle, yes. You can also consult w/CPS if you are in doubt.
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