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Legal & Ethical

CSPE Exam

QuestionAnswer
What is HIPAA? Enacted by Congress in 1996 Title II is most relevant to psychology Includes: privacy rule, security rule, and transaction rule.
When does HIPAA supersede state law? State law preempts HIPAA when it is more stringent than HIPPA, & CA law is more stringent than HIPAA.
What is a covered entity (CE)? Health care providers, health plans, and health care clearinghouses.
What is a health care provider Any person or entity providing, billing for, or paid for health care as a normal part of business.
What is Protected Health Information? Individually identifiable health information maintained or transmitted in any medium providing info about: -Individual's past, present, future condition -provision of care to the individual -past, present, future payment for care
What is deidentified information? -Information that does not identify or cannot be used to identify an individual -Is not covered by the same restrictions as PHI
What is the Family and Educational Rights and Privacy Act (FERPA) -Individually identifiable health information in educational records or employment records maintained by a covered entity -Is not the same as protected health information
HIPAA's Privacy Rule is designed to do what? -Designed to provide clients with protection
HIPAA's Privacy Rule requires what? --Inform clients of privacy policies --Grant clients access to health info --Obtain client consent before sharing health info nonroutine purposes --Secure records --Inform business associates of privacy practices --Train employees to understand
Privacy rule is triggered when? What does it apply to? -When a provider transmits PHI electronically for health care claims, payments, and health plan enrollment/ disenrollment. -Privacy rule applies to all transactions (even non-electronic) when it is triggered
How do HIPAA and California privacy laws differ? -They differ in the circumstances in which clients may be denied access to inspect/copy their records -They differ because HIPAA regulations for denying access pre-empt CA law (HIPAA has more stringent standards)
What are circumstances when a client has a right to request review of a denial to access their own records? -When disclosure of PHI could endanger one's life/safety -Disclosure could harm a 3rd-party identified in the PHI
CA law preempts the privacy rule under what circumstances? 1) When disclosure to a client's representative is requested but could harm the client or another person 2) a health care provider may not withhold records from that representative
Institutional circumstances in which a client does not have a right to request review of a denial to access their records -When information is exempt (PHI for criminal, civil, administrative hearings) -When the CE is a correctional institution (CI) or acting under a CI, and requester is an inmate, and CE believes the request is a threat to others
Research and 3rd party circumstances in which a client does not have right to request review of a denial to access their records -When information was obtained in research study and client agreed to denial of access -PHI was obtained from someone other than the health care provider when confidentiality was promised to that 3rd party
Two types of psychology records -General records (generally accessible to client) -Psychotherapy notes (for use only by the psychologist if revealing notes is deemed risky for client)
CA law differs from HIPAA related to clients viewing psychotherapy notes in what way? -California law preempts HIPAA regulation and allows clients to have a copy of psychotherapy notes, unless psychotherapist deems a substantial risk to the client
General records include what kind of information about the client? -Info related to med Px and monitoring, session onset and duration, modes of therapy, diagnosis, test results, treatment plan, functional status, frequency of Tx, progress, and prognosis.
What is the client's right to request an amendment of their protected health information? -HIPAA gives clients this right if they believe the information is incorrect
A psychologist may deny client's request for an amendment of PHI if: -The info was not created by the psychologist -If the person who created it is not available -The info is not available or part of the record -The psychologist believes the info is correct, complete, accurate
If a psychologist denies a client's request for amendment, what 4 requirements apply: Client must receive timely written explanation describing a) Basis of denial b) Client right to file statement of disagreement c) Procedure for filing a complaint with DHHS d) Client's right to have denial included in future disclosures of information
If psychologist accepts a client's request for amendment of their PHI: a) Psychologist must add amendment to the client's record b) Must inform client amendment has been made, c) Provide amendment to people who have previously received info covered by the amendment
A client's right to accounting of disclosures includes: a) It is a HIPAA guaranteed right, b) It requires accounting of disclosures to all 3rd parties during the previous 6 years
Accounting of disclosures by psychologists: Does or does not apply to what types of disclosures? a) Does not apply to PHI used for Tx, payment, or health care operations, b) Does apply to disclosures to public health authorities, health oversight agencies, & researchers
When should psychologists obtain either written or verbal consent? HIPAA's privacy rule states that "Written authorization is required prior to release of notes to a 3rd party unless there is a valid reason for not doing so"
According to HIPAA, written authorization from a client to release information always includes? a) description of the info disclosed, b) limits on type of info disclosed, c) name and function of entity authorized to use the info, d) expiration date, and e) a statement of right to receive copy of authorization and revoke authorization
According to HIPAA, authorization to release client information is not required when? a) releasing de-identified information, b) release of a limited data set (city, state of residence, birth date, etc.), c) release of PHI to avert serious threat to health/safety of a person
HIPAA privacy rule requires Notice of Privacy Practices (NPP) that includes provision, indication, and information of what? a) Provision of notice prior to onset of Tx, b) Indications of how health info may be used/disclosed, c) Information to client of their rights re: the info
Notice of Privacy Practices (NPP) must include language, effort, and descriptions of what? a) "(G)ood faith effort" to obtain client's signature of receipt, b) Clear language, c) Include description of how provider protects info, d) Description of when info may be used/disclosed without authorization
What are two limits on disclosure of Protected Health Info? a) Disclosures limited to minimum necessary to accomplish purpose of disclosure b) I.D. of circumstances when minimum requirement doesn't apply (giving info to health care providers in order to treat client, disclosures made with client's O.K.)
What is a business associate (BA)? a) A person/organization receiving PHI that allows them to provide services on the psychologist's behalf b) HIPAA contract is required for all BAs. If BA violates the contract, psychologist takes reasonable steps to correct, terminate, or report to DHHS.
What does HIPAA's Security Rule describe related to electronic PHI? This describes admin, physical, technical security standards and specs designed to ensure electronic protected health information (EPHI) remains secure
What do the administrative security standards of HIPAA's security rule address? The administrative standards address procedures relevant to implementing security requirements
What do the PHYSICAL security standards of HIPAA's security rule address? The physical standards address computers/other electronic information systems/facilities in which confidential information is stored
What do the TECHNICAL security standards of HIPAA's security rule address? The technical standards address methods for limiting access to EPHI (e.g. passwords and encryption software)
What does the Transaction Rule require of providers who conduct business electronically? This requires providers who conduct certain business transactions electronically to use the same electronic format, code sets, and identifiers.
What is the Transaction Rule's definition of "transactions"? Transactions refer to electronic exchange of client-identifiable health info for carrying out financial or administrative activities.
What is the Transaction Rule's definition of "electronic exchanges"? Electronic exchanges include transmissions over the Internet, leased lines, dial-up lines, private networks, and those that involve CDs, diskettes, etc. that are carried from one place to another.
What are examples of covered electronic transactions according to The Transaction Rule? Covered electronic transactions include those related to health care claims, claim status, health care plan eligibility, referral certification and authorization, health care plan enrollment or disenrollment, payment, and coordination of benefits.
What are the Boundaries of Competence for a psychologist? a) Psychologists are legally/ethically obligated to practice within their scope of competence, b) CCR Section 1396 and B&PC Section 2960 state this, c) Unprofessional conduct is also defined as "functioning outside their fields of competence"
What are the areas specified in Ethics Code Standard 2.01 (Boundaries of Competence) and actions they take to ensure competence? a) Psychologists provide services, teach, and conduct research with populations and in areas within boundaries of their competence, b) Psychologists have or obtain training, etc. to ensure competence, or make appropriate referrals
What are actions to ensure services are provided correctly by a psychologist according to Boundaries of Competence (Standard 2.01) a) When asked to provide services psychologists may provide such services to ensure that services are not denied, assuming no better qualified provider is available, b) Emerging areas: psychologists take reasonable steps to ensure competence of their work
Standard 2.01 (Boundaries of Competence): What does a psychologist do when needed services fall outside boundaries of competence? Psychologists must obtain training or experience, seek supervision/ consultation, or make a referral when a needed service falls outside boundaries of competence.
Standard 2.01 (Boundaries of Competence): How do psychologists protect clients when standards of training do not exist? a) Psychologists "take reasonable steps" to protect the welfare of clients, b) When a new or experimental technique is to be used, client must be made aware of that fact and the psychologist must take special precautions to protect them
Ethics Standard 2.03 (Maintaining competence) requires what? This requires "ongoing efforts to develop and maintain" competence while minimizing harm to clients.
Providing services in emergencies (Standard 2.02) is allowable when? a) Addresses providing services in emergencies when out of scope of competence, b) This applies when other mental health services are not available c) When practitioner does not have necessary training
What obligation is specified by Ethics Principle 2.06 (Impaired psychologist) when psychologist is having interference with ability to practice? A psychologist has a legal and ethical obligation to take action to remedy problems when interference with psychologist's ability occurs
Impaired psychologist law (CCR S1396.1) says what? a) "Temporary or enduring problems in psychologist's personality may interfere with ability" b) No undertaking of activity where personal problems in personality result in inferior services, c) Where already engaged, seek assistance to know when to end
Impaired psychologist law (B&PC S820 & S821) says what? a) A licensing agency may order a psychologist examined to determine physical/mental fitness b) Failure to comply is grounds for suspension or revocation
What are the potential penalties for an impaired psychologist continuing to work (B&PC S822)? 1) Penalties for continuing work when impaired include: a) revocation, b) suspension, c) probation, d) other action as deemed proper by the license agency. 2) No penalty shall be rescinded until evidence proves issues have been addressed
What do psychologists do when personal problems and conflicts (Ethics Code Standard 2.06) arise? a) Psychologists don't enter into services when problems prevent competent work, b) Psychologists seek consultation/assistance to help them determine whether they limit, suspend, or terminate duties
Confidentiality: Definition a) Confidentiality is the obligation to protect clients from unauthorized disclosure during services. b) Confidentiality is an ethical obligation that is also addressed in law
Confidentiality appears where in California law? What do these laws emphasize? a) Lanterman-Petris-Short Act (LPSA) of the CA Welfare and Institutions Code, S5000 and thereafter b) Confidentiality of Medical Information Act (CMIA) of the CA Civil Code S56-56.16 c) These laws emphasize the assumption of confidentiality
Applying confidentiality law: Differences between How are the Lanterman-Petris-Short Act (LPSA) and Confidentiality of Medical Inforrmation Act (CMIA) applied? Which applies when these two conflict? a) LPSA applies to confidentiality of MH info in the public mental health system & the hospitalized, b) CMIA applies to all mental health professionals, c) When these two conflict, LPSA applies
What are psychologist requirements to breach confidentiality? a) When a client communicates serious threat of physical violence against identified victim b) Reasonable cause to believe client is danger to self c) Suspicion of a minor's or elder's abuse d) Court order e) Patriot Act/FBI demands
When can psychologist ethically disclose protected information about a client? (Standard 4.05: Disclosures)? a) Psychologists may disclose info with consent or from authorized person for client unless legally prohibited b) May disclose info w/o consent "as mandated" or "permitted by law"
What are valid purposes for disclosing confidential information (Standard 4.05: Disclosure)? a) To provide needed professional services, b) To obtain appropriate professional consultations, c) To protect persons from harm, d) To obtain payment for services (limited to minimum necessary to get payment)
What are limitations to revealing confidential information when seeking consultation, according to Standard 4.06? a) When seeking consultation on a client, only share info relevant for the consult, b) No info that leads to I.D. of client, except when client authorized the consult, or when disclosure is unavoidable
What is the definition of Privilege? a) Privilege is AKA "testimonial privilege," b) It is a person's right to not have info revealed in a legal setting, c) Established by Evidence Code (EC) S1014 and B&PC S2918.
How does privilege compare to confidentiality and how does it apply? a) Privilege is narrower in scope than confidentiality, b) Privilege applies only to client info in context of court proceeding, deposition, admin hearing
What roles define the holder of privilege? a) The client/patient who has no guardian/conservator, b) A guardian/conservator, c) The personal representative of a dead client
Who is the holder of privilege for minor clients? a) Evidence Code (EC) S1013 states "guardians/conservators" not "parents" hold privilege, b) Case law in CA confirms minors are holders of privilege, c) Under certain circumstances, court-appointed counsel for child may hold privilege
Who has privilege in situations in which there are joint holders of privilege? a) When 2 or more hold privilege, one's waiving does not affect another's privilege, b) A couple need to both agree to waive privilege prior to use of confidential info by psychologist in a court proceeding
When can psychologist claim privilege for client? a) Psychologist may routinely claim privilege on behalf of the client when receiving a first request for info, b) Divulging the info may then proceed if the judge court-orders the psychologist to do so
What are the legally defined exceptions to privilege? a) When client OKs release of info, b) When a legal requirement for psychologist exists to breach confidence c) When the info has already been largely revealed by the client to a 3rd party, d) When a judge decides an exception to privilege applies
What are court- and prison-related examples of exceptions to privilege? a) EC S1016 states no privilege exists when client/client's rep states client's emotional condition is an issue, b) No privilege when therapist is appointed by the court, c) When appointed by Board of Prison Terms -In commission of a crime
Client-initiated or client-related circumstances that are examples of legal exceptions to privilege a) No privilege exists when client or therapist alleges breach of therapy duty, b) When client requests determination of own sanity or competence, c) When belief client is dangerous & disclosure needed to prevent harm, d) When a crime victim age <16
What are legal requirements related to notice of privacy practices (NPP) in a clinical setting? a) CA B&PC S2936 requires posting of notice in conspicuous place, b) HIPAA requires all clients receive Notice of Privacy Practices (NPP) prior to 1st therapy session and in office
What are three conditions in which a client may provide informed consent? a) When has capacity to make rational decisions Re: therapy, b) Has comprehension of information via "language that is reasonably understandable," c) Has voluntariness of consent (without coercion), requiring information about limits of therapy at outset
What are legal requirements of informed consent related to teletherapy? a) Informed consent is largely guided by ethical requirements, b) However, B&PC S2290.5 legally requires consent prior to teletherapy, c) write documentation that consent has been given prior to starting each teletherapy session
With regard to use of understandable language, what is the ethical requirement for informed consent (Standard 3.10, Pt 1)? Research, assessment, therapy, or consulting requires understandable language to be used to gain informed consent, except when mandated by law or regulation.
With regard to those incapable of consent, what are the ethical requirements for informed consent (Standard 3.10, Pt 2)? a) Those incapable of consent are provided explanation, given BOD, their assent is sought, and their preferences are taken into account. b) Permission is still sought from a legally authorized person/representative.
What information is to be provided to court-ordered clients according to Standard 3.10, Pt. 3? Individuals court-ordered to services must be informed of the nature of the services, including limits of confidentiality.
What is the ethical requirement for informed consent according to Standard 3.10, Pt 4? Psychologists document written or oral consent/assent
What are the ethical requirements related to informed consent to therapy according to Standard 10.01? a) Psychologists inform as early as possible about nature of therapy, fees, 3rd parties, and privacy limits, b) Inform clients of the developing nature of new/experimental techniques, risks, other Tx, voluntariness of participation, c) Tell about trainees
What are the exceptions to informed consent to therapy (Standard 9.03, Informed Consent in Assessments)? Informed consent is required except when: a) testing is mandated by law, b) Testing consent is implied by context or setting (applying for a job), c) Testing is to evaluate decision-making capacity -
What needs to be discussed regarding confidentiality and limitations on confidentiality (Standard 4.02)? a) Discuss limits of privacy and uses of info from therapy activities, b) Informing of privacy occurs at beginning of therapy,c) Services offered electronically require warning of risks to privacy and limits of confidentiality
What is Standard 3.07 and what does it require about confidentiality related to third parties? a) Standard 3.07 is guidelines for discussing confidentiality when a 3rd party has requested services, b) Requires clarification of the nature of therapist's relationship with each party, c) Applies to court-ordered and minor clients
What does Standard 3.11 require be provided related to confidentiality and third parties, and to whom is it provided? a) Requires that info about the nature of services is to be provided to clients and others who are directly affected by the services, b) This applies to psychologists delivering services to or thru organizations
What is the policy addressing breach of confidentiality for Employee Assistance Programs? Confidentiality may be breached in an EAP the same as in other contexts (after client signs authorization, danger to self/others)
In considering confidentiality with a third party, what information may be shared with an employer related to a fitness-for-duty evaluation? a) Limited info may be provided to the employer when employer requests this evaluation of an employee's ability to perform. b) Employer has limited right to info, even when employee refuses to consent, c) CA Code details this procedure
When considering confidentiality and third parties, when can fitness-for-duty evaluation information be shared with the employer? a) Includes when info was obtained through employer-requested/paid health-care services, b) When info describes client limits entitling client to work leave, c) When info describes limits to fitness for duty, d) Cannot include cause of med limit
What is expected to be done by a group therapist related to ensuring confidentiality in a multi-client situation (Standard 10.03) ? a) Facilitator must stress the importance of maintaining members' confidentiality, b) Must describe at outset roles and responsibilities of all parties, c) Periodic reminders to group are good strategy
What is expected of the therapist when addressing confidentiality prior to starting couples and family therapy (Standard 10.02)? Therapist must clarify at the outset of clinical work what "probable uses of the services provided" or info obtained during services may be.
How does a therapist legally address confidentiality when clients are minors with parents? a) Parents have a legal right to be informed of info revealed by a minor child, b) Best practice calls for agreement between all parties at start of therapy Re: types of info to be disclosed to parents, c) However, agreement might not be legally binding
What legal stipulations apply to the ownership of records? a) Ownership is governed by law, b) Client owns contents of records even while therapist or organization owns the physical documents, c) Exercise of ownership is determined by laws related to confidentiality and mandatory reporting
Ethically, what duties related to client records define the role of a therapist related to maintenance and retention of professional documentation (Standard 6.01)? a) Therapists are the stewards of the records they create, b) They facilitate services, c) Allow for replication of research, c) Meet institutional requirements, d) Ensure accuracy of billing/paying, e) Ensure lawful compliance
How do psychologists handle client info to ensure confidentiality according to Standard 6.02? a) Psychologists steward records in any medium, b) Client info shared in common must be coded to protect client anonymity, c) Psychologists make a system to ensure confidential transfer of info to a new steward when they retire/can't practice any longer
How does a psychologist know how to ensure confidentiality when the psychologist retires/can't practice any longer? Circumstances determine what to do, typically training staff and having an effective physical security system for info.
What are legal requirements for duration of record retention according to B&PC S2919? a) This law states health records must be maintained for 7 years from date of discharge b) If a minor, records are retained for 7 years after patient reaches 18 years of age, regardless of how long before 18 years of age they leave services
What are corporate and institutional responsibilities for maintenance and retention of records according to H&SC S123145(a)? This law requires outpatient health clinics and other agency entities keep records the same way as an individually licensed practitioner/psychologist
What is the difference between the record-keeping guidelines and B&PC S2919 a that supersede them? The record-keeping guidelines state psychologists keep records at least 7 years, but this recommendation is superseded by B&PC S2919, which are virtually identical
Where can guidelines for electronic record keeping, maintenance, and retention of records be found? a) HIPAA's security rule and CA law both provide these guidelines. b) H&SC S123149 provides a number of the CA legal guidelines
According to H&SC S123149, what is the safety & integrity requirement that applies when electronic record keeping is used exclusively? Storage of records requires ensurance of safety and integrity of all media used for storage using offsite backup, or imaging capture mechanisms to copy signature docs
According to H&SC S123149 (electronic record keeping) what two things may be done with hard copies when electronic copies exist? a) Hard copies may be destroyed if records are electronically stored in adequate fashion b) Prints of electronic version = originals
According to H&SC S123149 (electronic record keeping) what are the regulatory and safety requirements of electronic record keeping? a) Electronic records are to be made available to Division of Licensing, Certification staff upon request b) Electronic recordkeeping requires policies and procedures that include safeguards for confidentiality & unauthorized access and key authentication
Client access to records is addressed in what federal, state, and ethical regulations? 1) HIPAA's privacy rule (PR) 2) CA Patient Access to Health Records Act 3) CA's Confidentiality of Medical Info act, 4) APA's Ethics Code
When considering client access to records, how do HIPAA law and CA law compare? a) CA laws are similar to HIPAA's privacy rule (PR) or else have no analogy to HIPAA, b) Given this, following CA law does not violate HIPAA, c) However, there are situations when HIPAA preempts CA laws
Client access to records and instances of HIPAA preempts to CA law, and CA law preempting HIPAA. a) HIPAA regs Re: denial of access to records preempt CA law, b) CA law preempts HIPAA related to psychotherapy notes due to CA law being more favorable for clients
When comparing HIPAA and CA law related to client access to records, when can a denial be asserted? a) Deny a client access to his record if it is determined that access is likely to endanger life/safety; client given right to review the denial, b) CA law permits denial when deemed risk is high c) HIPAA preempts CA law, guides denial of client request
Client records, Client access to records: Psychotherapy notes where CA law preempts HIPAA regs Re: denial of access to records preempt CA law a) CA law preempts HIPAA because CA law does not ensure absolute denial of access to therapy notes b) CA law allows for client to get access to therapy notes, or for therapist to deny only if legal reason to do so
What is required to provide a client access to their records ? The client is required to write their request & pay reasonable costs associated with making records available.
What is the difference regarding client access to records when comparing CA law and ethics code 6.03? a) CA law states that records may not be withheld because of unpaid bills, b) The ethics code (6.03) states that records may not be withheld when needed for emergency treatment, c) The ethics code would be superseded by CA law: the law empowers clients
Where can specifications about responding to a client's request for access to their records be found? The Health and Safety Code specifies requirements regarding the time frame for responding to the request of a client for access to client's records
What do CA H&SC laws S123110(a) & (b) say a clinician must do when a client requests access to their own records, and how soon? 1) Law (a) says the clinician must permit inspection of records within 5 working days following written request 2) Law (b) says provider must provide copy within 15 days after written request 3) CA law says a provider may choose how to prep a report
How do H&SC requirements differ from HIPAA requirements in how a therapist may respond to a client's request for their records? a) HIPAA allows client to control if a provider may prepare a summary of the record for inspection or copy it, b) Because HIPAA grants greater right of access, it preempts CA law that says provider chooses either to provide summary or copy entire record
What are H&SC requirements Re: time frame for therapist to respond to request for records information? a) When written summary received, provider has 10 working days to respond, b) Provider may need to notify client of any delays in response anticipated by provider
What is the definition of a "multiple relationship" and conflict of interest? A multiple relationship exists when provider is in a professional role and also in another role with same person, in another role with a person closely associated with the client, or promises to enter relationship in future with either of these persons
What is the general guideline regarding multiple relationships and conflicts of interest? A psychologist refrains from a multiple relationship if it could reasonably impair their objectivity, competence, effectiveness, or risk exploiting/harming the client.
What can a therapist do to avoid multiple relationships and conflicts of interest if unforseen factors arise? a) If a psychologist finds a harmful relationship arises, he takes reasonable steps to resolve it, b) Psychologist keeps client's best interests in due regard, c) If required to fill more than 1 role, they clarify role expectations at outset
What does Ethics Standard 3.05 say about multiple relationships and conflicts of interest? 1) Not all multiple relationships are unethical 2) May be acceptable if avoids impairing clinician or harming client 3) However, "post-therapy relationships . . . are likely to be unethical."
What does Ethic 3.05(c) say a therapist is to do to avoid multiple relationships and conflicts of interest in forensic settings? 1) Clinician must clarify his role when expected to wear multiple hats in forensic setting, 2) Expected to disclose potential risk and make effort to refer requests to other professionals and seek to minimize negative effects
What does Code Standard 3.06 say a therapist must do about multiple relationships and conflicts of interest? 1) This Code Standard notes that we must refrain from taking a professional role when special interests/relationships impair our effectiveness/objectivity, or 2) When special interests expose professional relationships to harm/exploitation
According to Gottlieb, what three factors should be considered when following decision guidelines on the acceptability of a multiple relationship? 1) The power differential; 2) Duration of the relationship 3) Clarity of termination
What is Decision Guideline 1: The Power Differential from the Decision-Making Guidelines? a) The greater the difference in power, the more likely it is unethical. b) The more influence the psychologist has over the individual, the less likely the relationship is ethical
What is Decision Guideline 2: The Duration of the Relationship from the Decision-Making Guidelines? The longer the duration of either the professional relationship or the other relationship(s), the more dubious the acceptability of the multiple relationship.
What is Decision Guideline 3: Clarity of Termination from the Decision-Making Guidelines? What is likelihood the individual will want added professional services? The greater the chance that either relationship will continue, the less acceptable the multiple relationship arrangement.
What are the ethical guidelines (Standard 6.04) regarding fees and financial arrangements? a) Early as possible, all parties agree to billing arrangements/compensation amount b) Fee practices are consistent with law c) No misrepresentation of fees is allowed d) If limited finances lead to limited services, this is to be made known promptly
What are the ethical guidelines (Standard 6.04) regarding the use of collection agencies? If a client doesn't pay as agreed and collection agency is used, psychologist must first inform the person about use of such measures to allow an opportunity to make payment.
What are the ethical guidelines (Standard 6.04a) specifically about the timing of agreements about fees and related financial matters with clients? Requires psychologists to work out agreements about fees and other financial matters with clients "as early as feasible."
What are the ethical guidelines about fixed and sliding scale fees? Psychologists may charge fixed fees or use sliding fees. The latter are considered acceptable as long as they are fair and serve client's best interests.
What are the ethical guidelines about a temporary financial crisis for client? Psychologist may temporarily waive or lower fee, schedule fewer appointments, or suspend therapy for a predetermined period. Never abandon the client; in an emergency one is obligated to continue until crisis is resolved.
What are the ethical guidelines about use of a collection agency? Unpaid fees require discussion with the client to accommodate their situation. If accommodation not reached, then use a collection agency after notifying client and giving them a chance to pay within a specified time frame.
What are the ethical guidelines about limits on the use of a collection agency? Only essential info may be provided to the collection agency: Client's name, address, and amount owed.
What are the ethical guidelines about collection of outstanding fees and termination of services? a) Psychologists may initial legal proceedings to collect, in which the exception to privilege due to breach of duty in the relationship allows psychologist to disclose necessary info. b) Therapist not obligated to treat client who did not pay, may end Tx
What is the definition of and ethical guidelines for pro bono services? a) Defined as services provided w/o charge. b) Gen Principle B (Fidelity & Responsibility) encourages this. c) Recommended, not required because it appears in aspirational General Principles d) Note: free sessions are not to be used to draw in new clients
What are the ethical guidelines about barter (Ethics standard 6.05)? a) Barter is acceptance of goods, services, nonmonetary remuneration b) Only barter if it is not contraindicated, and if it is not exploitative
What is said in the ethics code about conditions in which barter is prohibited? a) Prohibition applies when it may be believed to be contraindicated or exploitative b) If it impairs objectivity, adversely affects client relationship, or unable to determine the equivalence between bartered service and monetary fee value
What are the ethical guidelines when considering bartering? a) Your theoretical orientation b) Client's diagnosis/dependency needs c) Expected duration of Tx d) Nature of barter arrangement
What are circumstances that are clearly contraindicated for bartering purposes? a) Housekeeping or childcare because of potential consequences involved for poor performance b) Client and psychologist both must be considered: Exploitation could be two-way street & affect quality of psychotherapy
When are referral fees ethical (Ethics Standard 6.07)? a) Paying referral fees is not prohibited b) Pay referral services ordinarily c) If paying individual professional, pay must be based on actual costs and services provided by that other professional, not because of the referral itself
What is the APA's ruling on referral fees? Ethics Code allows contractors to pay a % of fee to a colleague when pay is within range of fair market value of services provided.
What is the Board of Psychology allowed to do by the B&PC law ruling on referral fees? The Board of Psychology can discipline professionals for paying or being paid for the referral of clients. It is unprofessional conduct.
What are general legal and ethics guidelines related to insurance fraud? a) Insurance fraud is illegal and unethical b) CA Insurance Code regulates this. c) Ethics Code requires accurate info to insurance companies d) Professionals must take steps to ensure accuracy
Under what terms can a psychologist routinely waive insurance copayments? It is illegal to waive a client's co-payment without notifying insurance company of this action
What is the guideline related to billing for missed appointments? You must not bill an insurance company for missed appointments unless arranged for with the insurance company in advance
What are the guidelines related to providing information to insurance companies? You must provide insurance co. with accurate info about diagnoses and type of therapy. It is illegal to code individual therapy when family therapy is provided.
What does a psychologist do related to insurance company limits on provision of services? a) Notify a client about kind and extent of info needed by insurance co during informed consent process/ limits to Tx required by insurance co. b) Psychologist should file appeal to Co. when they don't authorize needed Tx, then discuss options with clien
What is the response by a psychologist when there is an interruption of services (Ethics Standard 3.12)? Psychologists make reasonable efforts to facilitate services in event of illness, death, retirement, client's relocation, financial limits, etc.
What is the response by a psychologist when there is an end of the psychologist's employment by an institution (Ethics Standard 10.09)? Psychologists make reasonable efforts to provide orderly/appropriate resolution of responsibility for client care if employment by an institution ends, with consideration given to the client's welfare.
When is it time for a psychologist to terminate therapy (Ethics Standard 10.10)? a) Termination of therapy upon recognition that client no longer needs therapy. b) Terminate therapy when threatened/endangered by client or related 3rd party. c) Psychologists provide pre-termination counseling, suggest alternate providers where needed
What are treatment and goals-related therapy conditions necessitating termination? Goals of therapy have been achieved or client is no longer responding to or complying with Tx
What happens when there are threats to the therapist's safety? a) If client or related 3rd party threatens, termination is called for. b) No pre-termination counseling is called for in this situation c) Confidentiality does not apply when obtaining self-protection in coordination with the authorities
What is expected regarding cooperation with other professionals per Ethics Code Standard 3.09? a) Cooperation is called for when serving a client effectively/appropriately. b) Includes consultation per Standard 4.06
What limits are expected when consulting with colleagues about clients? a) therapist does not disclose confidential info that could lead to I.D. of those with whom they have a confidential relationship. b) Disclose info only as necessary for consultation
What is expected of a psychologist when starting therapy with clients who are already receiving services from other professionals per Standard 10.04? If a client or prospect is receiving services already, the therapist must think of Tx issues and client's welfare, discussing these issues with client, consulting other professional as needed, & be cautious and sensitive to therapy issues.
Under what conditions can clients who are receiving services from other professionals begin seeing another therapist at the same time? When client sees another professional it is likely to be acceptable to keep seeing client. Two therapists could see the client simultaneously for two very different problems, i.e. stopping smoking vs. marital therapy
What should a therapist do when a client is receiving services from other professionals when addressing the same problem? a) The best course of action is for therapist to discuss ethical obligations w/ client, find out why client is seeing another for the same Tx issue. b) If determined there's no benefit in seeing both, therapist informs client you should end Tx services
According to the law, where should a therapist find guidelines on performing professional identification in ads, solicitations, & media representations? Legal requirements Re: how psychologists must I.D. themselves in ads and other public statements appear in CCR and B&PC regulations.
What are the legal requirements and limits regarding professional identification of one's license number? a) CCR S1380.6 says I must include license # in any advertising, public directory, solicitation, regardless of whether under corporate name or own name. b) Does not apply to govt. organizations, nonprofits engaged in research, or representing a community
What must a practitioner do when engaged in professional self-identification? a) When engaged in professional activity, identify yourself as a psychologist. b) PA shall I.D. self as psychological assistant under a responsible supervisor
What is required regarding misrepresentation of credentials? CA law prohibits misrepresentation of qualifications or purposes, citing only degrees completed and relevant to professional practice, i.e. no honorary degrees
What are consequences for misrepresentation of license or registration? If a registrant or licensee is guilty of unprofessional conduct or misrepresenting type or status of license held, board may suspend or revoke at will.
What does the law say about advertising guidelines for promoting use of services? a) CA law states that advertising must not promote excessive or unnecessary use of psychological services. b) In advertising, no false or misleading claims can be made that suggest they are based in fact or make comparison to others' services
What are the essential guidelines related to advertising regarding false, fraudulent, or deceptive statements? Psychologists do not make false, deceptive, fraudulent statements about their training, experience, competence, degrees, credentials, affiliations, services, scientific bases or success of services, fees, or publications or research findings.
What are the advertising guidelines related to Statements by Others as found in Ethics Standard 5.02? a) Spokespersons for the practitioner operate under the responsibility of the psychologist, who is accountable for what they say. b) No compensation can be offered for statements in news media. c) Paid ads must be clearly identified as such
What are the advertising guidelines related to educational workshops/programs? When you place an ad describing ed programs, they must be ensured to be accurate in describing who they are aimed at, objectives to be obtained, presenters, & fees involved.
What are the advertising guidelines related to solicitation of testimonials (Ethics Standard 5.05)? a) I do not solicit testimonials from clients or those vulnerable to undue influence. b) This is not absolute, applies to current clients. c) Supervisees may not be solicited for testimonials
What are the guidelines regarding solicitation of business according to Ethics Standard 5.06? a) No uninvited solicitation of business from clients who are vulnerable. b) Does not preclude collateral contacts to benefit current client, provide disaster or outreach service. c) May give business card to those who ask for it or send a brochure
What are the media presentations guidelines according to Ethics Standard 5.04? I need to take precautions when making public advice or comment via media to ensure statements are based on professional knowledge, training, experience corresponding to current psych lit and practice, & maintain consistency with Ethics Code.
What are the media presentations guidelines related to professional relationships? I need to take precautions when making public advice or comment via media to ensure statements do not indicate that a professional relationship has been established with the recipient of such media.
When can minors consent to treatment? Minors under 18 years of age cannot consent to Tx except in legally defined situations, such as when they are emancipated
When can consent to treatment be made by emancipated minors according to CA Family Code (FC)? CFC 7050(e)(1) says a) An emancipated minor is an adult for purpose of consent. b) Such a minor is emancipated when validly married, on active duty with armed forces, or receives a declaration of emancipation from a court of law.
What is the definition of an emancipated minor? A court may emancipate when it finds it would be in minor's best interests, when all following are met: a) Minor at least 14 years of age. b) Is living separate with consent of parent/guardian. c) Managing own finances & not obtaining income from crimes
What are additional rights of emancipated minors in addition to having right of consent? In addition to consenting for own care, such minors may live where they want, apply for work, sign up for school, and be protected from statutory rape according to their actual age. They may not drive, drink or vote until the correct age.
How does the law operate with regard to consent to treatment by unemancipated minors? H&SC law permits a minor who is at least 12 years old to consent to outpatient mental health Tx when professional believes minor is mature enough.
What is the role of clinical judgment related to consent to treatment by unemancipated minors? When the professional treating a minor has consulted with the minor & determines that involvement of a guardian would be uncalled for, the involvement of a guardian shall not be mandated as ordinarily is required.
What is guardian liability for payment during treatment of unemancipated minors in which the guardian is not clinically involved? If a parent is not included in the counseling by the minor or treating professional, that parent/guardian is not liable to pay for mental health services.
Under what conditions are there no waivers of guardian consent allowed for treatment of unemancipated minors? Waiver of guardian consent to Tx of a minor does not apply a) when minors receive MediCal benefits; b) when minors seek to have inpatient mental health Tx; c) seek psychotropic drugs, convulsive therapy, psycho-surgery w/o consent of guardian
When does a minor have the right to waive guardian consent to treatment? The minor can only waive guardian consent when ALL H&SC law requirements are met, BUT ALSO when minor would present serious harm to self/others w/o those services; (Family legal code (FC) Section 6924 is more restrictive than that of H&SC law.
How can unemancipated minors acquire a waiver to guardian consent to Tx according to FC Section 6924? CA Family Code is more restrictive than H&SC law, in that a waiver of guardian consent to Tx also requires that the minor be an alleged victim of incest/child abuse.
When could parents be needed to consent to substance treatment for unemancipated minors? A minor who is 12 or more years of age may consent to counseling related to Tx of drug or alcohol problems. However, this does not apply to narcotic replacement therapy w/o parent or guardian consent.
According to the consent guidelines for minors who cannot consent to treatment, how many different parental/caregiver circumstances or conditions are there? Consent guidelines for minors who cannot legally consent to their own mental health treatment include 8 different circumstances and conditions.
What are the eight conditions or circumstances in the Guidelines for Consent by parents/others for Tx of minors? 1)Biological or adoptive parents are married; 2) Parents divorced, share legal custody; 3) Parents divorced; 4) Unmarried parents; 5) Minor has a legal guardian; 6) Has a stepparent 7) Is in the dependency system; 8) Has a caregiver
What is the consent guideline when a minor's parents are married? a) Either parent alone may authorize Tx. b) When parents disagree, best course is guidance from court. c) Court may order Tx, appoint guardian ad litem for decisions
What is the consent guideline when a minor's parents are divorced, share custody? a) Either parent may consent unless custody order contradicts this. b) Even when 1 parent must consent, get consent from both. c) If 1 parent refuses, therapist attempts to resolve with them or request court decision when Tx is in best interests of minor
What is the consent guideline when a minor's parents are divorced, 1 parent has sole custody? a) Parent with sole custody may make mental health care decisions. b) If parent withdraws consent, no Tx for minor is allowed
What is the consent guideline when a minor's parents are unmarried? a) When paternity not in dispute, either may consent. b) If bio parents disagree Re: Tx, court order necessary. c) When unestablished paternity, only bio mother gives consent.
What is the consent guideline when a minor has a legal guardian rather than parents? Legal guardian has same rights as parent, has legal custody to give or deny consent to Tx.
What is the consent guideline when a minor has a stepparent? a) Stepparent does not have authority to consent to Tx until legal adoption is accomplished. b) When adopted, stepparent has same authority as a bio parent.
What is the consent guideline when a minor is in the dependency system? a) The person authorized to give consent is determined by the court. b) A parent/guardian retains right of consent or court or its agent designated by court gives consent. c) Not foster parents.
What is the consent guideline when a minor has a caregiver? a) Caregivers who are relatives, are 18 years old & have completed/signed Caregiver's Authorization Affidavit may consent to Tx.
What are a minor’s treatment rights regarding confidentiality & access to records? a) Minors are legally/ethically entitled to confidentiality. b) Therapist must balance parents' concerns Re: Tx against child's need to trust confidentiality of therapy. c) Discuss confidentiality at outset of Tx. d) If no agreement reached, then no Tx
What are the circumstances when a psychologist may legally breach a minor’s confidentiality? A psychologist may breach minor client's confidentiality when required by law, i.e. when ordered to do so by court or in cases of child abuse.
What are a minor client’s rights regarding access of their own records & disclosure of records of minors to guardians/ parents? a) H&SC states that minors may get copy of their records. b) Provider should not share these with parents/guardians w/o minor's authorization
What are parental rights and limits regarding access to minor’s records when these do not pertain to health care? a) Parents/guardians of minors ordinarily may access their minor's records. b) Exception: H&SC law allows refusal of access by provider if it is determined that access would be detrimental to the relationship, or impact well-being/safety.
What are provider responsibilities regarding disclosure of records of minors when disclosure affects safety/well-being of minor? a) When refusing to disclose, provider must provide written reason for denial. b) Provider must permit inspection of records by a licensed physician, psychologist, or other professional designated by the patient.
What is a CA legal exception to confidentiality related to disclosing records of minors to their parents? a) H&SC S123115(a)(2), which applies only to minors who do not have legal permission to consent to their own Tx. b) Other regulations apply to denial of access by clients themselves, but not H&SC S123115(a)(2)
What is the law related to a non-custodial parent's right to access their child's confidential records? (FC S30125) Notwithstanding other provisions of law, access shall not be denied to parent just because parent is not child's custodial/physical custody parent.
What are the laws related to disclosing minor's confidential records to 3rd parties (CA Confidentiality of med Info Act [CMIA])? a) Both CA and HIPAA privacy rule (PR) require a patient's written authorization be obtained before disclosing. b) CA code also says a minor must sign whenever the minor could have legally consented to release of his own info
What is the duty to protect/warn (Tarasoff v. Board of Regents) when clients are a danger to others? a) The 1974 ruling (the Tarasoff decision) established "duty to warn" intended victims of client dangerousness, but this was changed to "duty to protect" victim. b) I must warn him/her, notify police, take other reasonable steps. c) CA allows immunity
When a client is dangerous, what are my responsibilities for carrying out my duty to protect/warn? How do I determine a reasonably identifiable victim? a) I must determine if a victim is identifiable, if there's a serious threat of physical violence. b) No duty to protect if this cannot be done. c) No name needed, only that victim can be I.D.'d. May hospitalize client if danger is due to mental disorder
In carrying out duty to warn/protect, how do I interpret the term "serious" in "serious threat?" a) An imminent threat provides indication of the "seriousness" rather than degree of threatened violence b) Client's past history of violence to be considered. c) Context of current threats considered. d) Consulting is a good strategy to define "threat"
What is the extent of disclosure to protect confidentiality when carrying out my duty to warn/protect? When discharging duty to protect, I should only disclose info necessary to protect a victim: my name, client's name, name of victim, and content of threat.
What is the expanded duty to warn/protect and definitions of terms in the law according to Ewing v. Goldstein? a) In 2004 the court expanded meaning of patient communication to include patient's immediate family. b) Court concluded family member may trigger duty to protect. c) Court defined "serious" & "physical violence" to mean "grave bodily injury," or mayhem.
What is the exception provision in the duty to warn/protect according to CA law? What does the added law in the Confidentiality of Medical Info Act (CMIA) more clearly cover? a) CA law provides exception to privilege when client poses danger to self, others, property. b) Additional CA law (CC S 56.10(c)(19) was added to CMIA to more clearly cover confidentiality breaches.
Related to the Confidentiality of Medical Info Act (CMIA) when a duty to warn exists, what may a therapist disclose and to whom? a) Med info may be lawfully & ethically disclosed when therapist has good faith belief that disclosure is needed to prevent/lessen imminent threat to health/safety of a forseeable victim. b) May be disclosed to person(s) reasonably able to help the victim
What are situations in which a therapist's duty to protect a client does not apply? a) when someone other than the client is dangerous. b) when someone other than a family member reports client is threatening harm. c) When there is no reasonably identifiable victim. d) When client threatens suicide
What does CA law say about a therapist's duty to warn/protect about HIV+? a) When an HIV+ client says he is sharing needles, engaging in unprotected sex w/ identifiable partner is a grey area. b) CA law protects doctors when notifying sex/needle-sharing partners c) No such law protects therapists.
What does CA law say about HIV+ persons infecting others and what can a therapist do related to warn/protect others? a) Unclear if infecting others w/ life-threatening disease is physical violence under CA law. b) I face an ethical dilemma in this case, but have options available to guide decision-making and action-taking.
What are some initial options for therapists related to client HIV+ transmission risks? What liability does the therapist have? a) Therapist could encourage client's use of safe practices. b) Could help client make disclosure to partners. c) Could discuss legal consequences. d) Therapist could otherwise be liable for negligence.
Under what condition may a therapist take decisive action to mitigate danger from an HIV+ client? What may therapist do? If therapist believes client's danger to others is mental in origin, therapist may involuntarily hospitalize the client.
What can therapist do to protect a potential victim of an HIV+ client while minimizing liability? a) I may decide to breach confidentiality to protect victim. b) Before this, explain decision to client, try to get consent. c) If no consent, I may be charged w/ misconduct, face legal action by client. d) Consult w/ colleague to determine best course
What are the conditions for involuntary commitment/ conservatorship of a client? Client's behavior warrants hospitalization, involuntary is only considered when these conditions are met: a) Danger client poses is imminent or client gravely disabled. b) Danger or disability is result of mental disorder, chronic alcohol
When should a client be considered for involuntary commitment? Involuntary commitment should be considered when the client refuses or is unable to comply w/ recommendation to enter a psych hospital voluntarily.
What are the legal requirements for various involuntary holds? a) Lanterman-Petris-Short Act. b) Commitment begins w/ 72-hour hold ("5150"). c) May be followed by 14-day hold ("5250"). d) Possibly followed by postcertification holds.
What does WIC S5150 specify about who may place someone on an involuntary hold? a) Specifies conditions for 72-hour hold. b) Says county-designated professionals, peace officers, certain members of crisis team, or staff of county-designated facility, may on probable cause take person into custody, place in CA-approved facility.
What does CA law specify regarding 72-hour involuntary commitment of adults impaired by alcohol or drugs, (WIC S5230) a) This is similar to WIC S 5150. b) If a person is a danger to others or gravely disabled and needs Tx, he may be detained in Tx facility for 72-hour Tx and eval.
What is the definition of gravely disabled in an adult? a) A condition in which a person is unable to provide for basic personal needs as a result of mental disorder. b) A condition in which person found mentally incompetent and is facing charges involving death, great bodily harm, serious threat to well-being
What are legal/court conditions defining "gravely disabled" in adults? a) If an indictment or info have not been dismissed, then if a person is unable to understand or rationally assist counsel in proceedings taken against him, they are considered gravely disabled.
What are conditions defining "gravely disabled" enough to be involuntarily committed in alcoholic adults? a) When this person is unable to provide for his own basic personal needs for food, clothing, shelter. b) This does not include mentally retarded persons when they are otherwise not psychologically impaired.
What is the legal definition of "mental disorder" related to involuntary hospitalization? The law does not define mental disorder for involuntary hospitalization, although CA courts usually interpret this to include significant mental disorders from DSM 5.
What is the difference between initiating versus instituting involuntary holds? Anyone may initiate an involuntary hold (psychologist or lay-person), but only police officers, attending staff of county facility, designated county mobile crisis team members, or other designated county professionals institute this.
What are admission and release time frame procedure requirements for 72-hour holds? a) Admission requires evaluation ASAP, receipt of Tx as required during entirety of hold. b) Release occurs prior to 72 hours only if psychiatrist deems appropriate. c) Disagreements over release time are referred to the facility medical director.
What are facility release procedure requirements and alternatives after 72-hour holds? After 72 hours, a facility must: a) release the individual, b) refer individual for voluntary Tx, c) certify individual for added involuntary Tx, or d) begin appointing a conservator.
When does the law allow the involuntary commitment/ conservatorship to be extended by an additional 14 days? CA law permits a person detained 72 hours and been evaluated to be certified for up to 14 added days of intensive Tx related to chronic alcoholism or mental disorder only when: a) person is danger to self or others, b) gravely disabled
When may an involuntary commitment / conservatorship be extended by an additional14-day hold? A person can be involuntarily committed for 14 added days only after being advised that Tx is required, but the person refused to consent voluntarily to such Tx.
What notice does CA law require for an initial 14-day hold? a) a notice of certification be signed by two people (evaluating psychologist & those in charge of the facility/agency providing evaluation) and, b) a copy of the notice be delivered to the certified person or his official representative.
By law, what must a person being committed for 14 additional days be informed about? A person being committed to 14 added days of evaluation/Tx must be informed by the one delivering his certification notice that he is entiteld to a review hearing or judicial review by habeas corpus to request release from the certification holding
What is an involuntary commitment and certification review hearing, and what is its time frame? What are the person's rights about such review hearings? This is a probable cause hearing and must be held within 4 days of date on which person is certified unless request for postponement is made (up to 48 hours). Person may waive right to cert review and right to be present at hearing.
Where is an involuntary commitment judicial review hearing held? CA law says judicial review shall be in superior court for county in which facility is located, or in which 72-hour hold was maintained when the person informs professional staff at the facility they want judicial review.
What are limits to involuntary transfer following a judicial writ request? When must the review hearing be held? No transfer from one county to another is allowed once request for review is sought. An evidentiary hearing is to be held within two judicial days after petition is filed.
At the conclusion of a 14-day hold, what must a facility do regarding the involuntary commitment? Facility must do one of these: a) release individual, b) refer individual for voluntary Tx, c) certify individual for added involuntary Tx (initiate post-certification hold), or d) begin the process of appointing a conservator.
What does a post-certification hold (following a 14-day hold) depend upon? Several types of postcert holds can follow 14-day hold, and depends on person's suicidality status, grave disability, or serious danger to others.
When and for what reason can a second 14-day involuntary hold be imposed? A second 14-day hold can be provided for suicidal behavior that occurred during or prior to the initial 14-day hold or 72 hour evaluative period prior to that.
When may a person request a habeas corpus hearing? What must happen after such a hearing? Although not required for this hold, a person may request a habeas corpus hearing at any time during the 14 days, then must: a) be released, b) referred for voluntary Tx, or c) begin process of appointing conservator.
How does the decision get made on when a patient may be released from involuntary commitment and postcertification hold? Psych responsible for med treatment and psych responsible for collaborative treatment must agree if/when patient should be released, otherwise it is up to the facility med director.
What does the law say may happen following completion of 14-day intensive treatment? What conditions apply to allow added intensive Tx? Person may be certified for added period of intensive Tx of 30 days or less under both of these conditions: a) staff at facility find person is gravely disabled, & b) person is unwilling/unable to voluntarily attend Tx
According to CA law, what is one reason that 180 added days of involuntary commitment may be imposed upon someone in a postcertification hold? At the expiration of the 14-day period of intensive Tx if at least one of the following exists: has attempted, inflicted, made serious threat of harm upon another after being taken into custody, as a result of mental disorder.
When may a person be subject to an additional 180 days of involuntary hold? A person made serious threats of physical harm to another and presents a demonstrated danger toward others within 7 days of custody.
What is the legal hold court process for involuntary commitment and postcertification hold following serious threats of danger to others? a) DA must file a petition with court, b) court hearing takes place within 4 days after filing of petition, or 10 days if jury trial requested, c) Client has right to request habeas corpus hearing at any time
What is the release process related to involuntary commitment and post-certification hold when a person has presented a serious threat of danger to others? At end of 180 days, facility must a) release person, b) refer person for voluntary Tx, or c) file new petition to certify person for Tx an an imminently dangerous person
What is the process for imposing a conservatorship upon a person who is a danger to self or others? A conservator may be appointed by the court for any gravely disabled as result of mental disorder, impairment by chronic alcoholism. This may be temporary (30 days) or long-term (renewable 1-year periods)
What are the limits for the definition of "gravely disabled" as it applies to clients who may be a danger to self or others? CA law clarifies this term by saying a person is not so disabled if person can survive safely w/o detention, receiving help from responsible family, friends, others who are willing and able to help with basic needs
What are the limits on defining someone as gravely disabled related to the role of family's, friends', others' willingness to help? A person is not gravely disabled unless family, friends, others do not indicate in writing willingness and ability to help.
What is the time frame of, and requirements for, conservatorship, and release from conservatorship, for the "gravely disabled"? Within 10 days after being conserved, a) the person shall receive an individualized Tx plan unless specifically found to not be appropriate by the court, b) when progress review determines goals of Tx are reached & person no longer gravely disabled
When is conservatorship for the "gravely disabled" to be discontinued? When progress review determines goals of Tx are reached & person no longer gravely disabled, conservatorship shall be terminated by the court
Who is authorized to involuntarily commit a minor? a) Authorization from parent/guardian is required prior to hospitalization. b) Exception provided by CA law is the usual persons (peace officer, designated county professional, etc.) can take him into custody to a Tx facility for 72-hour hold.
Who must be notified of the involuntary commitment of a minor? Parents shall be notified by county-designated facility of minor's detention for 72-hour hold.
What is the definition and limits of the definition of "gravely disabled" for a minor? Unable to utilize elements essential to life, health, safety, development, even when provided by others. MR, epilepsy, dev disability, alcohol/drug abuse, antisocial behavior are not mental disorders for purposes of this definition
What is the procedure, including informed consent, for involuntary commitment of minors? a) Clinical eval is to be conducted, Tx plan written, least restrictive environment provided to receive needed Tx. b) Minor and guardian/caretaker to be consulted, informed of any further Tx, placements. c) Consent of minor's guardian to be obtained
What are limits of informed consent related to the involuntary commitment of minors (guardian/parental consent unavailable)? Inability to obtain consent of minor's parent/guardian doesn't preclude involuntary Tx of minor determined to be gravely disabled or dangerous to self or others.
What are child abuse reporting requirements? a) Psychologists mandated to report suspected cases of abuse/neglect of kids, adolescents under age 18 years, including emancipated. b) Also report to be made about who perpetrator is (adult or child?) c) Requirements of reporting are included in the law
What is the child abuse reporting procedure? a) Mandated reporter contacts specified agency when reasonable suspicion exists of abuse, b) Initial phone call with written follow-up report within 36 hours after learning of the abuse, c) include any nonprivileged evidence of the abuse
What is the definition of "reasonable suspicion" when reporting child abuse? This means that it is objectively reasonable for a person to feel suspicion, based upon facts, training, experience, to suspect abuse/neglect.
What is the child abuse reporting procedure when 2 or more mandated reporters have joint knowledge? When 2+ mandated persons agree abuse is happening, just 1 person will make the report by mutual agreement. If failure to report occurs, anyone may and should make the report.
What are the various types of child abuse? CA law distinguishes between various types: a) Physical abuse comprised of injury or death resulting from an incident not including affray with a peer, and b) Sexual abuse comprised of assault or exploitation, including rape, incest, sodomy, lewd acts
What are the types of child sexual exploitation? This is preparing, selling, distributing pornographic materials involving minors, employing minor to perform obscene acts, or employing/coercing child in prostitution
No report is needed about child sexual abuse when? a) When client is ages 11-13 years and partner is ages 12-13, b) When client is ages 14-18 and partner is ages 14-20, c) and when client is ages 16-18 and partner is ages 21-22. These are consensual intercourse.
Reporting child sexual abuse is required when? Report is needed when: a) Client is ages 11-13 and perpetrator is ages 14-22+, b) Client is ages 14-18 and partner is ages 12-13, c) Client is ages 14-15 and perpetrator is ages 21-22 years. These are non-consensual ages for sexual intercourse.
How old might the partner be when suspicion of sexual abuse is reportable if child is under 18 and/or 14 years of age? How old when lewd/lascivious acts are reportable? Reporter must report when minor is less than 18 years old and reasonable suspicion is present, while lewd/lascivious acts are always reported regardless of consent when client is under 14 years of age and partner is 14+ years old.
How old might the partner be when reporting child sexual abuse upon reporter's suspicion of non-consensuality when client is 14 or 15 years of age? Lewd & lascivious acts must be reported when occurring against a minor who is: a) 14 years old when the partner is 24+ years of age, b) 15 years old when partner is 25+ years of age.
What is the definition of reportable child abuse & willful harm or injury? A situation in which any person causes or permits children to suffer or inflicts unjustifiable physical pain, mental suffering, or permits health of person to be endangered. But, fetal abuse is not reportable in CA.
What is the definition of unlawful corporal punishment or injury that is reportable child abuse? Willful infliction of cruel/inhuman corporal punishment or injury upon any child that results in trauma.
What is not considered unlawful corporal punishment or injury? Unlawful corporal punishment does not include a) reasonable force by public school staff, self-defense, or removal of a weapon from a child, b) age-appropriate & reasonable spanking that leaves no evidence of serious physical injury
What is the definition of reportable child abuse & neglect? a)Negligent Tx of a child by the person responsible for child in conditions indicating harm/threats of harm to child, b) Includes omissions & acts, c) distinguishes between severe neglect & general neglect, d) Does not include religious reasons for non-Tx
What is the definition of reportable general neglect of a child? Negligent failure of a child's custodian to provide adequate food, clothing, shelter, med care, or supervision where no physical injury occurred
What is the definition of reportable severe neglect of a child? The negligent failure of a child's custodian to protect from severe malnutrition, medically diagnosed, non-organic failure to thrive.
When is leaving a child unsupervised not necessarily neglect? Leaving a child unsupervised is not necessarily neglect unless it involves "harm or threatened harm to the child's health or welfare."
When do psychologists report serious emotional damage? Psychologists may, are not required to, report such damage when knowledge or reasonable suspicion exists that a child is at risk of suffering serious emotional damage as evidenced by states of being or behavior (severe anxiety, depression, aggressive)
What are limits on sharing confidential information about child abuse among multidisciplinary personnel team members? Members of such a team may freely exchange info with one another: a) Re: incidents of child abuse if a team member believes info is relevant to cases of child abuse or child welfare services. b) without fear that such discussion could be used in court
What are conditions of immunity from liability for mandated reporters making a required report? a) Mandated reporters have immunity even when info or suspicion of abuse was acquired outside professional capacity or scope of work. b)Non-mandated reporters may be subject to non-immunity if found to make false or reckless reports when reports proven so
What general penalties are there for mandated reporters' failure to make a required report? Penalties (criminal & civil) may be imposed on a mandated reporter who fails to make a report of abuse, as well as discipline by the Board.
What kind of offense is it for a mandated reporter to intentionally conceal or fail to report child abuse or severe neglect? Intentionally concealing failure to report an incident known by a reporter of abuse/severe neglect is a continuing offense.
What legal penalty or punishment can a mandated reporter be liable for after intentional failure to report child abuse that results in death? A mandated reporter who fails to report abuse or neglect resulting in death or severe injury of a child is punishable by jail, fine of $5,000.00, or both.
What are best practices in the clinical relationship for reporting child abuse? a) Reporters find it is best to advise a client of intent to make a report, unless belief exists that client could become violent, etc. b) Such notice can be made via office policy form before therapy begins, followed by a simple reminder at time of repor
What are the mandated reporting requirements for reporter when an adult client's abuse occurred when they were a child? a) For abused victims who are now 18 or more, reporter is not required to report about their past abuse. b) Be alert that the victim's abuser may still be abusing, & if suspicion arises to make the report. c) Anonymous calls to CPS for guidance may help
What may a mandated reporter do for a client who was a victim of child abuse (advising adults abused as children)? a) Psychologist may advise client to file assault charges or initiate civil action for damages, b) Particularly when empowering client this way is therapeutic c) Inform client of potential negative consequences of such action d) Client decides
How does a reporter responsibly address cultural issues related to reporting child abuse? a) Be sensitive to client's religious/cultural values/beliefs when determining if abuse/neglect is occurring b) Note legitimate differences in child-rearing practices, c) Note when such practices cross the line to abuse, i.e. punishment requiring stitches
What may a reporter do when child abuse involves 3rd-party information? When learning of abuse from a 3rd party, a report must be made if the information was learned about in a professional capacity (during therapy, consultation, etc.)
What are report requirements related to older and dependent adult abuse? What ages are elders and dependent adults for purposes of reporting abuse? a) CA law in WIC S 15600-15675 requires reporting. b) Definition of elder is any person residing in CA 65+ years old. c) Dependent adult is between ages 18 and 65 years, has physical or mental limitations restricting normal activity/self-protection
Non-age related definition of who an elder or dependent adult is in terms of eligibility for reporting abuse Persons with physical, developmental, age-related-decline disabilities, or who is admitted to a 24-hour health facility as an inpatient.
How does a mandated reporter know when and how to report elder and dependent adult abuse? During his professional capacity, reporter has observed, has knowledge of, or been told of behavior, acts, omissions that constitute physical abuse, abandonment, abduction, isolation, financial abuse or neglect shall report by telephone or internet.
How soon and by which means does a therapist report elder and dependent adult abuse? a) When abuse is suspected, telephone or confidential internet reporting tool is used as soon as practicably possible, if not immediately. b) Written report must follow if first report by telephone within 2 working days.
What locations of adult abuse determine particulars of a report? Location of abuse: a) long-term care facility, b) state mental health hospital/developmental center, c) other locations
What types of adult abuse are used to determine where to send or make a report? a) physical abuse with serious bodily injury; b) physical abuse w/o serious bodily injury, c) physical abuse w/o serious bodily injury believed caused by resident with Dx of dementia, d) non-physical abuse, e) all other types of abuse.
When, where, how, and to whom does a mandated reporter report the abuse of an adult when serious bodily injury occurs at a non-state, long-term care facility? Phone call to local law enforcement, written report to local ombudsman, facility licensing agency, & law enforcement within 2 hours
When, where, how, and to whom to report physical abuse when no serious bodily injury occurring at non-state, long-term care facility? Phone call to local law agency, written report to local ombudsman, facility licensing agency, & local law agency within 24 hours.
When, where, how, and to whom to report physical abuse when no serious bodily injury caused by resident with Dx of dementia occurring at non-state, long-term care facility? Phone call to local ombudsman or law agency as soon as possible, written report to local ombudsman, law agency, facility licensing agency within 24 hours.
When, where, how, and to whom to report non-physical abuse occurring at non-state, long-term care facility? Phone call to local ombudsman or law agency immediately, written report to local ombudsman or local law agency within 2 working days.
When, where, how, and to whom to report all types of abuse occurring at state mental health hospital or developmental center? Phone call to designated investigators of State Dept. of Hospitals or Developmental Services, or to local law enforcement immediately, written report to designated investigator or local law enforcement within 2 working days
When, where, how, and to whom to report all types of abuse occurring at all other locations? Phone call to adult protective services or local law agency immediately, written report to adult protective services or local law enforcement agency within 2 working days
What is the exception to reporting abuse of elder and dependent adults? Do not file when told by elder/dependent adult of their abuse, but all of the following apply: a) No independent evidence that abuse occurred, b) elder/dependent Dx of dementia/mental illness, c) reasonable belief there's no abuse, and d) conservatorship
When do you report elder / dependent spousal / partner abuse? Report only when abuse involves spouse/partner who is either under age 18, an elder or a dependent adult. Report as child abuse when under 18 years old.
What are types of elder and dependent adult abuse? CA law distinguishes between physical abuse, abandonment, abduction, isolation, financial abuse, and neglect.
What is the definition of elder and dependent adult physical abuse? Assault, battery, assault w/ deadly weapon or force likely to produce great bodily injury, unreasonable constraint, prolonged / continual deprivation of food/water, sexual assault, use of physical or chemical restraint, psychotropic med for punishment
What is the definition of elder and dependent adult abandonment? Desertion or willful forsaking of elder or dependent adult by carer or custodian in circumstances in which it would be reasonable to continue to provide care and custody.
What is the definition of elder and dependent adult abduction? Removing elder or dependent adult from CA, restraining them from returning to CA when they do not have capacity to consent, nor do their conservator, nor the court consent to removal or restraint.
What is the definition of elder and dependent adult isolation? Deliberately preventing elder/dependent from receiving mail, phone calls, telling callers/visitors that elder/dependent isn't present, doesn't want to talk in order to prevent elder from having contact, false imprisonm,ent,
What is the definition of elder and dependent adult physical restraint? Physical restraint is a form of isolation to prevent meetings with visitors.
What are legal exceptions to elder and dependent adult isolation? Isolating actions may not constitute legally abusive isolation if performed under instruction of licensed physician or in response to threat/danger to a person's physical safety/property.
What is the definition of elder and dependent adult financial abuse? When someone takes, secretes, appropriates, retains, or assists others to do this in regard to real or personal property of elder/dependent for a wrongful use or intent to defraud.
What is the definition of elder and dependent adult neglect? Negligent failure of a carer or custodian to exercise degree of care a reasonable person would provide in that position.
What is the definition of carer or custodian failures in elder and dependent adult neglect? Includes failing: a) to assist in personal hygiene, b) to provide food, clothing, shelter, or necessary physical/mental health care, or c) to protect adult from health/safety hazards, malnutrition, dehydration.
What constitutes carer or custodian failures in preventing elder and dependent adult self-neglect? Self-neglect as a result of impaired cognitive functioning, mental limitation, substance abuse, or chronic health problems can be reportable if not addressed by responsible carer/custodian of the individual.
When may a mandated reporter use the option to report in cases of non-mandated elder and dependent adult abuse? CA law allows mandated reporter to make a report when reasonable suspicion is present that types of non-mandated elder or dependent adult abuse are occurring that may affect well-being, including emotional well-being
When reporting adult abuse, confidential info may only be disclosed to whom? a) legally indicated persons/agencies, b) persons trained & qualified to be multidisciplinary personnel, c) such qualified persons are under the same obligations as those who disclose that info
What are the limits to sharing confidential info about adult abuse? Information obtained shall be maintained in a manner ensuring maximum protection of privacy and confidentiality rights for the adult victim of the abuse.
What are the limits of immunity from liability for making a required report of adult abuse? Mandated reporters are not civilly/criminally liable for making reports authorized by law, and other persons are not liable unless proven that they knew the report was false.
What is the liability for failing to make a required report of elder and dependent adult abuse? CA law describes criminal penalties imposed on mandated reporters failing to make required reports: failure to report, impeding/inhibiting reporting is a misdemeanor punishable by up to 6 months jail, $1,000.00
What is the liability / penalty for failing to make a required report that results in death / injury of an adult? Failure to report that results in death or great bodily injury also punishable by up to 1 year jail, $5,000 fine.
What sorts of legal liability pertain to therapists' sexual relations with clients? Criminal and civil liability for sexual relations w/ clients, sexual misconduct may lead to discipline by Board.
What are types of sexual misconduct that constitute illegal exploitation, and what role does the client play in this exploitation? a) Sexual intercourse, sodomy, oral copulation, touching an intimate part of another person, sexual contact with current or former client when therapy terminated for purpose of sex is defined as illegal exploitation. b) Consent of client is not a defense
What are the penalties pertaining to sex exploitation of clients? a) Imprisonment in jail for up to 6 months, fine of no more than $1,000, b) Multiple exploitative acts w/ 1 victim = jail for up to 6 months, fine of $1000, c) Acts w/ 2+ victims = up to 1 year jail or 3 years prison, and/or $1,000 to $10,000 (if prison)
What are penalties pertaining to sex exploitation of clients when previous conviction is present and there has been just 1 victim? If 2+ acts with 1 victim, then prison for 16 months up to 3 years, fine not more than $10,000 or jail for up to 1 year, fine not more than $1,000, or both
What are penalties pertaining to sex exploitation of clients when previous conviction is present and there have most recently been 2+ victims? If 1+ acts with 2+ victims, then prison for 16 months to 3 years, and also a fine of up to $10,000. This is the only penalty that demands both prison time and the fine be imposed, all other sentences involve one, the other, or both.
What does the law generally state about cause of action related to sex relations with clients & civil liability? CA law states that a cause of action against a psychotherapist exists for client for injury caused by sex contact if it occurred under any one of several conditions.
What does the law state in regard to conditions of sexual contact leading to civil liability? 1) contact occurred during period client received therapy. 2) Within 2 years of termination. 3) By means of therapeutic deception
What does the business/professions law say about unprofessional behavior regarding sexual relationships with clients? CA business/professions law states that any act of sexual misconduct . . . substantially related to qualifications, functions, duties of psychologist is unprofessional and subject to disciplinary action.
What guidelines are provided by the Ethics Code related to whom the psychologist may or may not have sexual relationships with? The Ethics Code includes guidelines about sex with clients or their relatives, therapy with former sex partners, and sex with students/supervisees.
What does the Ethics Code say about sexual intimacy w/ current clients? a) Ethics Code doesn't specify what sexual intimacies are. b) They are generally interpreted as intercourse, fondling, erotic hugging, communications intended to elicit sexual arousal.
What does the ethical standard say that pertains to sexual intimacy w/ former clients? a) No sexual intimacies with former clients for 2 years after cessation. b) No sexual intimacies with former clients except in the most unusual circumstances.
What does the Ethics Code say about what are the various "burdens of proof" on the therapist to demonstrate no exploitation in sex with former clients? 1) amount of time passed since cessation; 2) nature, duration, intensity of therapy, 3) circumstances of termination, 4) client's personal history, 5) client's current mental state, 6) likelihood of adverse impact, 7) statements/actions by therapist
What responsibility does the therapist have related to statements / actions of therapist during therapy where this pertains to sex intimacy w/ former clients? Therapist is responsible for demonstrating that any statements or actions made by the therapist during the course of therapy suggesting or inviting possibility of a posttermination sexual or romantic relationship with the client are not now exploiting her
What does the Ethics Code state pertaining to sex intimacy w/ client's relatives & acquaintances? Ethics Code prohibits sexual intimacies with those they know are close relatives, guardians, or significant others of current clients, and they do not end therapy in order to circumvent this.
What does the Ethics Code state pertaining to therapy with former sex partners? This is not allowed.
What does the Ethics Code state pertaining to sex with students and supervisees? Ethics Code states we are not to engage in such relationships with these persons when they are in our department, agency, training center, or whenever we have a likelihood of evaluative authority.
What is the ethical duty of a colleague who learns of sexual intimacies between colleagues and clients? When a therapist learns a colleague has had sexual relations with a therapy client, the therapist must take steps to protect the client
What is the ethical duty of a therapist who learns via report by the client that sex has been happening between a colleague and a client or minor client? a) The clinician receiving the client's report gives "Professional Therapy Never Includes Sex" and discusses it with the client. b) File a child abuse report if client was a child at time of abuse, especially if suspicion that abuse is ongoing by peer
What is the ethical duty of a therapist who learns of sexual intimacies reported by the client as happening between a colleague and the adult client? If a client was an adult when sex occurred, no information should be revealed to reporting agencies without signed consent.
What is the ethical duty of a colleague learning of sexual intimacies reported by a colleague as happening between the colleague and a client? a) I need to carefully weigh implications of taking action. b) Review Ethics Code Standards 1.04 and 1.05. c) It may be possible to resolve informally through persuasion of colleague. d) No complaint possible if it violates client's confidentiality.
What are the limits of informal resolution for a colleague when sexual intimacies reported by a colleague as happening between the colleague and a client? A sexual relationship with a client may not be appropriate for informal resolution.
What is the definition of forensic psychology according to the Specialty Guidelines for Forensic Psychology? Professional practice within any sub-discipline of psychology when applying scientific, technical, or specialized knowledge of psychology to law assisting in addressing legal, contractual and administrative matters.
How do the Guidelines for Forensic Psychology distinguish between forensic and non-forensic practice of psychology? The Guidelines note that professional practice is not necessarily forensic because it occurs in a forensic setting, so psychological testimony that is solely based on provision of psychotherapy is not definitely forensic practice.
What is the definition of an expert witness? A person who has special training, knowledge, skill, or experience in area relevant to resolution of legal dispute & allowed to offer an opinion as testimony in court.
What is the definition of a fact witness? A person who testifies as to what was seen, heard, otherwise observed regarding a circumstance, event, occurrence as it took place. They are generally not allowed to offer opinion, issues they don't have personal knowledge of, or hypothesize
When may privilege be waived and what are the limits to confidentiality in a court appointment evaluation? a) Testimonial privilege may be waived by client, doesn't apply in certain legally defined situations. b) When appointed by court to evaluate client, privilege does not apply in that court.
What are the limits of privileged information related to client emotional condition in a courtroom? No therapeutic relationship privilege exists in a court proceeding attempting to establish client's emotional condition when client raised this as an issue at stake in the court case.
What are the limits of privilege related to determination of state of mind in a courtroom? When assigned by the court to determine if a defendant is competent to stand trial or ascertain defendant's state of mind, there is no privilege.
What are the requirements of privilege related to forensic psychologist ethical behavior according to Specialty Guidelines for Forensic Psychology? Forensic psychologists must recognize their ethical obligations to maintain confidentiality of info relating to a client/retaining party, except as disclosure is consented to by client or required by law
What are the limitations to privilege & duty of the psychologist according to Specialty Guidelines for Forensic Psychology when client is court-ordered to evaluation? When an individual is ordered to undergo Tx but goals of Tx are determined by legal authority instead of the client, forensic practitioner informs client of nature and purpose of Tx, and limits on confidentiality/privilege
What are the limits of privilege & confidentiality regarding disclosure of confidential case materials according to Specialty Guidelines for Forensic Psychology? a) Forensic practitioners using case materials for teaching, training, research strive to present info in a fair, balanced, respectful manner. b) They attempt to protect privacy by disguising personally identifiable info who claim privacy interest
What are the privilege & confidentiality concerns regarding client consent and use of case material? The forensic practitioner uses only aspects of case materials available in public domain, or else obtain consent from clients and organizations to use the materials for teaching, research, training, etc.
What are ethical requirements related to confidentiality in a forensic/court-related setting When psychological services are court ordered or mandated, we inform client of nature of anticipated services, including court-ordered nature of service and limits of confidentiality. Usually, client signs release of information ahead of time.
What is required related to informed consent according to Specialty Guidelines for Forensic Psychology? The Guidelines require psychologists to strive to inform clients of nature and parameters of services provided as soon as is feasible.
What do we do about informed consent when a forensic examinee is unwilling to consent? Unless court ordered, we obtain informed consent prior to examination, although when unwilling we may consider postponing exam, advising examinee to contact lawyer, & notifying retaining party of examinee's unwillingness to proceed.
What do we do when attempting to conduct an exam over the objection of the examinee? a) We can conduct the exam without consent of examinee when mandated or ordered to do so. b) After notice to client of nature & purpose of exam, we may consider a variety of options such as postponing exam, advising examinee to contact attorney, & notify
What do we do when the client lacks capacity to give informed consent? When the client lacks capacity for consent, we provide an appropriate explanation, seek client's assent, and obtain permission from legally authorized party as permitted or required by law.
What is the definition of insanity in relation to the insanity defense? a) Insanity is a legal concept reflecting a rule of American Law Institute. b) A person is not guilty by reason of insanity when, because of mental defect, they lack substantial capacity to appreciate the wrongfulness of the act or capacity to behave
How does the insanity defense work in CA? a) In a criminal proceeding/juvenile court as well, if a plea of not guilty by reason of insanity, the defense shall be found only when accused proves by a preponderance of evidence incapability of knowing/understanding nature and quality of his action
Limits to the insanity defense in CA This defense shall not be found on the sole basis of a personality disorder, adjustment disorder, seizure disorder, or addiction to, abuse of, or intoxication by substances.
What are two types of subpoenas in a court setting? a) A subpoena is court document requiring a person to appear to give testimony at a deposition or in court. b) Subpoena duces tecum requires a person to personally bring to court a specified document or property in his possession or under his control.
Who may issue subpoenas? Judges, court clerks, and attorneys for plaintiffs or defendants may issue subpoenas
Where can we find guidance on how to respond to subpoenas? What records, tests, other info can we get guidance about? Guidelines have been provided by APA's Committee on Legal Issues, providing guidance on requests for disclosure of client records, test data, other confidential info.
What is the 1st step in responding to subpoenas? Determine if subpoena is a legally valid demand. If court doesn't have jurisdiction over psychologist, or subpoena improperly served: not valid. Formal response required if valid, but 1st contact client to discuss.
What to do with a subpoena regarding client consent or denial of consent? After discussion with client, if no objection from client and no other reason to withhold info, provide requested info. If client doesn't consent, negotiate w/ party issuing subpoena. If demand continues, seek informal guidance from court w/ a letter
What do we do about filing a motion to quash a subpoena? If client doesn't want info released and ongoing demand is made from subpoenaing party for info, have attorney file motion to quash or file motion for a protective order.
What is the procedure for handling a first request for confidential info during testimony or deposition? a) Psychologist should claim privilege on client's behalf, refuse to provide info until court-ordered to do so. b) This is consistent w/ CA laws EC S1014(c) & S1015.
What is the procedure for handling a court order? a) After failure to modify or have court order vacated, comply w/ order, avoid contempt of court. b) Release to court only info relevant to case, & present in sealed envelope marked "confidential."
Malpractice defined a) Civil suits that require client to prove a claim by preponderance of evidence. b) Client must establish a standard of care and that we deviated from it. c) Involves expert witness testimony, legal statutes, professional journal articles, 3rd-parties
What are the 4 conditions for a claim of malpractice to be brought against us? To bring a claim against us, these must be present: 1) professional relationship with client was established. 2) Demonstrable standard of care breached by me. 3) Person suffered harm/injury. 4) Breach of duty was within context of standard of care
What allows a claim of malpractice to go forward in a court of law? If the aggrieved client can demonstrate that both the other 3 conditions and psychologist's breach of duty within the context of the standard of care was to blame for the person's harm or injury, a malpractice claim can go forward.
What are the 3 types of compensation in a malpractice suit? 1) Award of compensatory damages to restore plaintiff to pre-harm condition. 2) Nominal damages when harm cannot be translated into monetary terms. 3) Punitive damages to penalize us, usually awarded only when reckless, malicious, or willful acts present
What are some basic, general guidelines for reducing risk for charges of malpractice? 1) Be familiar with legal/ethical standards. 2) Keep detailed, well-organized records.
What are some basic facts about the CA Board of Psychology? a) CA Board established in 1958, part of Department of Consumer Affairs. b) Purpose: to ensure professions impacting public health, safety, welfare are adequately regulated to protect the public.
What are some Board of Psychology activities that serve to protect the public? a) Board establishes minimum qualifications, levels of competency for us. b) License persons after determining they possess requisite skills/qualifications to be safe & effective. c) I.D. practitioners & ensure performance at established standards.
What is the Board of Psychology's role in public safety enforcement? a) Board provides means to redress grievances thru investigation of allegations of unprofessional conduct, fraud, incompetence, & unlawful activity. b) Conduct periodic checks of professionals to ensure compliance with CA code.
Where can requirements for licensure as a psychologist be found? Specified in Business & Professional Code & CA Code of Regulations
What are some legal requirements for licensure as a psychologist? 1) Must have a doctorate degree in psychology from accredited school of higher learning. 2) Must complete at least two years of supervised experience. 3) Must pass required exams. 4) Complete coursework in a number of additional areas deemed essential
What are coursework topics currently legally required to be licensed? Coursework in human sexuality, child abuse, assessment and reporting, alcoholism & chemical dependency detection & Tx, spousal & partner abuse assessment, detection, intervention, & aging/long-term care.
What are the limited terms of practice in CA as a psychologist? If licensed in another state, such a psychologist may practice for up to 30 days in any calendar year.
What are requirements when you are licensed in another state and wish to be licensed in CA? a) Must pass board's supplemental licensing exam. b) Must have been licensed for at least 5 years in another state. c) After applying in CA for licensure, or establishing residence in CA, may practice without license for up to 180 calendar days.
When may the board waive the need for exams for licensure? a) When in the judgment of the board, applicant has already demonstrated competence in areas covered by exams. b) Applicant is a diplomate of the American Board of Professional Psychology
Who could potentially be a psychological assistant's employers? Employed by a licensed psychologist, certified psychiatrist, mental health clinic under a contract to CA, a psychological corporation, CA licensed psychology clinic, or medical coporation.
What are qualifications of a psychological assistant to be employed? PAs can perform limited functions only if: a) termed a PA. b) Has a master's degree in psychology or education. c) Been admitted to candidacy for doctorate in psych. d) Completed 3 or more years of postgrad ed in psych & passed prelim exams. e) PhD degree
What are requirements to employ a psychological assistant? a) PA must at all times be under immediate supervision of a licensed psychologist or psychiatrist. b) The supervising entity must register the assistant with the board. c) Registration must be renewed annually
What are the limits on how many psychological assistants can be employed at one time? Three PAs at any given time by a psychologist, one PA at any given time by a psychiatrist.
What are a PAs limitations in working for the public in a capacity as an employee of a licensed psychologist? No psychological services are allowed to be charged for a fee except as an employee of a licensed psychologist, psychiatrist, clinic, or a psychological or medical corporation.
What qualifications are required to be a registered psychologist? a) RPs are authorized by CA law to accrue SPE for licensure. b) Must have a doctoral degree qualifying for licensure. c) must have completed at least 1500 hours SPE. d) Be employed at nonprofit community agency receiving at least 25% of funding from gov't
Who is a valid supervisor for a registered psychologist? The supervisory staff required for a registered psychologist is a licensed psychologist.
What is the definition of supervised professional experience (SPE)? CA law defines SPE as organized programming with planned, structured, administered sequencing of professional supervised comprehensive training.
How does supervised professional experience (SPE) provide preparation for independent practice? a) Logical training sequence, builds on skills and competencies. b) Includes only time spent engaged in psychological activities that prep trainee for practice. c) SPE does not include clerical activity
What is the time needed for supervised professional experience (SPE)? a) Requires 2 years SPE before licensure. b) Each year is 1500 hours. c) At least 1 year completed post-doctorally. d) Each year to be completed within 30 consecutive month period. e) 2 years completed postdoctorally to be done within 60 months
How does one receive predoctoral supervised professional experience (SPE)? At what kind of settings? a) Formal placement accredited by APA, APPIC, or CAPIC, b) Employee of exempt setting, c) PA registered with the board, or d) pursuant to Dept. of Mental Health Waiver.
What are valid postdoctoral supervised professional experience (SPE) settings? a) Formal postdoc training program accredited by APA or APPIC, b) Registered psychologist, c) employee of exempt setting, d) PA registered at board, e) pursuant to Dept. of Mental Health Waiver
What are the time requirements for supervision for SPE? Trainees provided with supervision for 10% of total time they work, at least 1 hour of which is face-to-face w/ primary supervisor.
What are the primary supervisor requirements for supervision for SPE? Primary supervisor must be employed by same work setting as trainee, available 100% of time during accrual of SPE by phone, pager, or in-person.
What is a supervisor's plan to protect client in emergency for? Primary supervisors must develop plan in the event client experiences emergency/crisis when supervisor is not physically present at site.
What happens when someone attempts to use another mental health license during accrual of experience? SPE accrued under another license isn't credited toward requirements for psychology license.
Can a supervisee pay their supervisor? SPE cannot be obtained for payment to a supervisor in exchange for supervision.
Can supervisees have a proprietary interest in their supervisor's business? Trainees must have no stake in the business of the supervisors, must not serve in any capacity that would give influence over the supervisor(s)
What elements must each supervision agreement include? 1) Name and signature of the primary supervisor, 2) Name and signature of the trainee, 3) Statutory authority under which trainee will function, 4) Start date and anticipated completion 5) Duties, 6) Address of location duties will be performed, 7) goals
A written weekly log of SPE includes what? 1) The work setting, 2) Dates, 3) # of hours worked weekly, 4) # of hours supervision received weekly, 5) Type of supervision received, 6) Indication of satisfactoriness of weekly SPE, 7) Supervisee's name, signature, license & #, date signed
What is the supervisor's contribution to supervisee's written weekly log of SPE? 1) Delegated supervisor's name, license & #, & date signed, 2) description of duties performed during SPE, and 3) Statement signed by primary supervisor attesting to information's accuracy.
Who may be primary supervisors to registered psychological assistants? a) Qualifications and responsibilities are specified in CA law, saying "all primary supervisors are licensed psychologists or a board certified psychiatrist.
In what way may a psychiatrist qualify and act as a Primary Supervisor to a registered psychological assistant? a) Maximum of 750 hours of experience out of 3000 can be from supervision by board certified psychiatrist. b) Supervisor's license must be free of formal discipline or charge affecting ability or qualification to supervise
What training is necessary for qualifying Primary Supervisors of a PA or psychological intern? 1) Must have education, training, experience relevant to areas of practice they supervise, 2) Must complete minimum 6 hours supervision coursework per 2 years, 3) Responsible for ensuring trainee complies with Licensing Law and complies with Ethics Code
What are the Primary Supervisor's responsibility to clients and supervisees? 1) Must monitor welfare of trainee's clients, 2) Monitor performance & professional development of trainees, 3) Make sure each client knows trainee is unlicensed & supervised, supervisor has access to client's records, & fees paid go to the supervisor
What are the Primary Supervisor's boundaries and limits related to supervising trainees? 1) No family, intimate, business, other relationships with trainee, 2) No former therapy clients can be trainees, 3) No sex or exploitation, 4) Require trainees to read Professional Therapy Never Includes Sex
How may supervisors meet minimum requirements and still delegate supervision of psychological trainees? 1) Primary supervisors may delegate supervision to other qualified psychologists or other licensed mental health professionals, 2) Primary supervisor has to spend at least 1 hour per week of face-to-face supervision with trainee
Who may provide basic supervision requirements for interns, registered psychologists, and PAs? This is necessary for psychological interns and registered psychologists. PAs may be supervised by board certified psychiatrists as well.
When a primary supervisor must complete 6 hours supervision coursework every 2 years, who may they supervise? Applies to Psych intern, psych ass't, and registered psychologists
When a primary supervisor must be employed by same agency and available to trainee 100% of time, what kinds of trainees may the supervisor supervise? Applies to Psych intern, psych ass't, and registered psychologists
Who may the supervisor supervise when primary supervisor must provide minimum 1 hour individual, face-to-face supervsion weekly? Applies to Psych intern, psych ass't, and registered psychologists
Who may a supervisor supervise when primary supervisor must provide at least 10% of total hours worked as supervised time for trainee? Applies to Psych intern, psych ass't, and registered psychologists
How many trainees can be supervised per primary supervisor? No limit on numbers of psychological interns, 3 psych ass't per psychologist, 1 psych ass't per psychiatrist, no limit on numbers of registered psychologists
What are some Board of Psychology nondisciplinary actions? 1) Such actions are usually confidential, imposed for minor violations. 2) May include letter of warning, educational review, citations & fines (although these latter may be available to the public.)
What are some of the Board of Psychology disciplinary actions? 1) These are public information provided upon request. 2) These actions include a letter of reprimand, probation, & suspension, surrender, or revocation of license. 3) Three years has to pass before petition to reinstate a revoked license.
What are the Board of Psychology's actions undertaken to punish unprofessional conduct? 1) Order denial of an application for licensure, 2) Issue a license with terms/conditions. 3) Suspend/revoke registration or license of registrant
What is the definition of unprofessional conduct? 1) Conviction of a crime related to psychology, 2) Use of controlled substances until it causes a danger or impairs ability to perform work, 3)Fraudulently or neglectfully misrepresenting type of license held, 4) Impersonation of a license holder,
What is the definition of unprofessional conduct related to unethical conduct? 1) Use of fraud or deception in applying for license or passing license exam, 2) Paying compensation for referral of clients, 3) Making false/misleading statements about one's services, 4) Unauthorized, willful communication Re: confidential info
What is the definition of unprofessional conduct related to negligent, unlawful, or being corrupt in practice? 1) Gross negligence, 2) Abetting unlawful practice of psychology, 3) Being suspended/revoked by another state or country, 4) Fraud, 5) Sexual abuse/misconduct, 6) beyond scope of competence, 7) Failure to provide verification of SPE to board, 8) Negligenc
What is mandatory continuing education (CE) & acceptable courses for CE? 1) MCEP Accrediting Agency or APA approves acceptable CE to the Board, 2) Continuing medical education courses (CME) relevant to psychology, 3) CA Med Association accredited are acceptable, 4) Accreditation Council for CME
What is the definition of mandatory continuing education (CE) & equivalence of CE credits? CA law defines the hour value for CE courses, stating: 1) One hour CE credit for each hour of approved instruction. 2) One 3-unit academic quarter = 10 hours CE, one 3-unit academic semester = 15 hours CE.
How does mandatory continuing education (CE) credits work when teaching a course? Approved instructor may claim his own course one time for CE when teaching that approved course during a renewal cycle
How do mandatory continuing education (CE) units work for initial renewal of license? 1) Only CE for number of months license in effect, including month license was issued. 2) Rate of 1.5 hours of CE per month.
How does mandatory continuing education (CE) & independent learning work? 1) CE earned via independent learning is accrued at 75% of CE required for first time renewal. 2) CE may not be earned prior to issuance of the license.
What is the definition of independent learning as it relates to mandatory continuing education (CE)? What does independent learning include? 1) Independent learning is organized and directed learning occurring when instructor is not in direct contact with student. 2) Includes instruction via Internet, CD-ROM, and correspondence.
How do license renewals after the initial renewal work? 1) Require 36 hours of approved CE per 2 years. 2) Independent learning can be used to meet no more than 75% (27 hours) of continuing ed in each renewal cycle.
How do license renewals work after delinquent/inactive status has occurred? 1) During inactive status, psychologist exempt from CE requirements. 2) To activate inactive license, submit evidence of completion of 36 hours qualifying CE courses for the most recent two-year period. 3)
How does one renew a delinquent license? 1) Within 3 years of expiration of license, applicant can provide documentation of required hours of CE. 2) After 3 years of delinquency, license is automatically cancelled, unless a board waiver is pursued by applicant.
What are required courses for mandatory continuing education (CE) and initial requirements for licensure? 1) Course in law & ethics applicable to CA psychology (every X), 2) Spousal or partner abuse assessment, detection, intervention (1x only), 3) Aging & long-term care (1x only)
How does one obtain law & ethics training? 1) Formal coursework from accredited ed institution, 2) approved CE course; 3) Workshops in laws and ethics; 4) Grand rounds, professional association presentation, & other experience providing direction & ed in laws & ethics
What are exemptions from mandatory CE requirements? These may be granted by the Board following written verification during 2 years prior to expiration date of license, that: 1)Resident in another country or state, 2) Engaged in active military service, or ?
What are exemptions from mandatory CE requirements due to health considerations? When psychologist provides written explanation that CE couldn't be completed due to health reasons or good cause due to a) Total physical and/or mental disability for at least 1 year, b) Likewise for an immediate famil member where psychologist responsib
What happens when non-completion of mandatory CE? If psychologist doesn't complete required CE, license is invalid on its expiration date. If CE is not completed within 6 months, psychologist subject to citation and fine or disciplinary action by Board.
What are the APA's Ethics Code and the four sections of the code? 1) Introduction and Applicability, 2) Preamble, 3) General Principles, 4) Ethical Standards
How can the APA Ethics Code Preamble and General Principles be best described? 1) These are aspirational and nonenforceable, providing general guidelines for ethical decision-making. 2) They do not serve as basis for disciplinary action
How can the APA Ethics Code Standards best be described in general terms? 1) These are mandatory, enforceable provisions. 2) These will be cited in a charge of ethical misconduct
How can the APA Ethics Code Introduction and Applicability section best be described in general terms? 1) This states that APA membership commits members and student affiliates to comply with APA Ethics Code standards, rules, and procedures used to enforce them. 2) Lack of awareness or misunderstanding of a Standard is not itself a defense to a charge
Describe the APA Ethics Code & Introduction statement in general terms. This says that 1) Ethics Code (EC) applies only to activities part of scientific, educational, professional roles. 2) APA may take action against a member after conviction of a felony. 3) Private conduct is not ordinarily of interest.
Describe what psychologists are expected to do in regard to the Ethics Committee when there is an ethics complaint 1) Psychologists are expected to cooperate with ethics committee in investigations, proceedings, and requirements of APA or affiliated state associations. 2) Failure to cooperate is an ethics violation, although deferment is not alone noncooperation
What does the Ethics Committee do in handling ethical violations by APA members and non-members? 1) These violations are handled by the Ethics Committee or other entities such as state licensing board, courts, etc. 2) Violations by nonmembers are not within APA pervue, are handled by other entities.
What does the Ethics Committee do related to complaints against APA members, and how soon? 1) Complaints again APA members are evaluated by Committee Chair & Director of Ethics Office. 2) Determination of whether breach of ethics occurred warranting added consideration. 3) Complaints considered only within 3 years of occurrence or 5 years
What are some common Ethics Committee recommendations of action on investigated complaints? Upon conclusion of investigation, Committee will dismiss or recommend an action: 1) Reprimand for an ethics violation when not likely to cause harm, 2) Censure if there is a violation likely to cause harm
What are Ethics Committee recommendations of action on violations that are likely to cause substantial harm? Expulsion for this kind of violation is a typically expected response, although a stipulated resignation may be offered by the Committee.
What are typical reprimand or censure directives that the Ethics Committee may hand down? Directives include: 1) cease & desist from activity; 2) obtain supervision or added training or ed; 3) Be evaluated for and possibly receive Tx; 4) Agree to probationary monitoring; 5) Take corrective action; 6) Educative letter issued by Committee
What are the Ethics Committee guidelines for improper complaints & unfair discrimination against complainants? 1) Psychologists do not file or encourage filing ethics complaints made with reckless disregard. 2) Do not deny persons based solely on having made or being subject of ethics complaint
What are informal and formal means of handling ethical violations & complaints related to colleagues? 1) This encourages psychologists to handle ethical violations informally, discussing matter with an offender. 2) In other cases a formal report is made to Ethics Committee, license board, or other authority when substantial harm is present
How does client confidentiality affect responses to ethical violations & complaints against colleagues? 1) Psychologists must always consider client confidentiality prior to taking action. 2) This takes priority over penalizing or educating an offending psychologist.
What to do when ethical violations & complaints related to colleagues require taking action on matters of substantial harm 1) Each psychologist must determine what action is most appropriate to take. 2) Each psychologist must determine if a violation involves substantial harm, including what the substantial harm is.
Notice of Privacy Practices (NPP) must include what in the office? a) Posting in prominent location in the office, b) Information about how to access health info, c) Complaint procedure, d) Client's right to amend the record or revoke authorization
Who does HIPAA's security rule apply to and what happens to make the security rule apply? HIPAA's security rule applies to those electronically transmitting or maintaining clients' health info
Ethics standard 2.02 says to provide services in emergencies when? a) A psychologist may provide services to ensure service not denied when otherwise not available, b) Then discontinue services as soon as emergency is over or expert services are available
Under what federally defined special law is a psychologist required to breach confidentiality and not inform the client he has done so? When the FBI (via the Patriot Act) demands certain info about a client.
When may the psychologist share a client's information in court? Privilege must be waived by one of the designated holders of privilege (the client, client's conservator/guardian, or the deceased client's personal representative) prior to the psychologist sharing info in court.
Who is the holder of privilege for minor clients who are wards of the court? Children who are wards of the court have the privilege unless under age 12 years, then their court-appointed counsel holds privilege for them.
What is the difference between consent and assent? a) Assent is informed agreement or approval by an underage client. b) Consent is provision of permission that is informed and free of coercion or undue influence as provided by an emancipated minor, minor of 12 years of age or older, or adult.
What is the one California law that allows parents access to their children's records? Other regulations apply to denial of access to their records by clients themselves, but not H&SC S123115(a)(2). It is an exception to confidentiality related to disclosing records of minors to their parents.
What more recent CA law updates the guidelines for Tarasoff duty to protect? Ewing vs. Goldstein (2004)
What is the expanded legal duty to protect according to Ewing vs. Goldstein? The expanded duty applies to credible threats received from the patient, or the patient's family, however, the court made clear that its decision did not go beyond "family members."
According to Ewing vs. Goldstein, a therapist has a duty to warn if they learn what from whom? A therapist has a duty to warn if, and only if, the threat which the therapist has learned - whether from the patient or a family member - actually leads him or her to believe the patient poses a risk of grave bodily injury to another person."
What does the law say may happen following completion of a 30-day intensive treatment? a) The person must be released, b) Must be referred for voluntary Tx, c) Must certify them for Tx as an imminently dangerous person, or d) Begin appointing a conservator for them.
What is a reason that 180 added days of involuntary commitment may be imposed upon someone at the expiration of a 14-day hold period? If the person was taken into custody after attempted or inflicted physical harm upon another person, and if the person presents a demonstrated danger of inflicting harm upon others as a result of mental disorder or defect.
What is a reason that 180 added days of involuntary commitment may be imposed upon someone at the expiration of a 14-day hold period? If the person made serious threat of physical harm to another within 7 days of being taken into custody and that threat was also at least part of the reason for the person being taken into custody, and the person continues to be a physical danger to other
What factor is common to all reasons that 180 added days of involuntary commitment may be imposed upon someone at the expiration of a 14-day hold period? The person must be a danger as a result of mental disorder or mental defect.
Created by: lyzimmerman
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