Law & Ethics Final--First Half
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57 terms
Terms | Definitions |
|---|---|
 Confidentiality: | The promise of non-disclosure of information presented in therapy |
| Confidentiality breach mandated by law: | Tarasoff (serious threat to harm an identifiable victim) Child abuse Elder abuse Dependent abuse |
| Confidentiality breach permitted by law: | Evidence code 1024 (when someone is a danger to self, others or property) When the therapist is a defendant When the therapist has a written release |
| Consequences of breach of confidentiality: | BBS considers this unprofessional conduct Possible loss of license Can be sued by the client |
| Tarasoff: | The patient has communicated to the psychotherapist a serious threat of physical violence against a reasonably identifiable victim or victims. Therapists must also protect those living in the same address as the intended victim. |
| Privilege: | The protection of testimony in legal action |
| The holder of the privilege is: | Adults Guardians or conservators Personal representatives |
| Legal Responsibilities: | advertising client a danger to others, property, or self client welfare confidentiality Fees mandated reporting of abuse of child, elder and dependent paying for referrals Privilege record-keeping Scope of practice Scope of competence sex with clients treatment of minors - confidentiality and privilege Treatment of minors without parental consent Unprofessional conduct Client welfare |
| Ethical Responsibilities: | Advertising Dual relationships Boundary issues such as gifts, in-home office, giving out cell phone numbers, etc. Client who is seeing another therapist Client welfare Confidentiality Court referrals-confidential relationships Employee Assistance Program, managed care Fees Informed consent insurance billing Multiple clients Paying a referral source Record keeping Scope of competence Secrets policy Sex with clients Termination of therapy Therapist's values |
| When client is suicidal: | Therapist has a responsibility to protect the life of the client. He is permitted to breach confidentiality (Evidence Code 1024), but is not required to do so if he can protect the client in some other way |
| Exemptions to privilege: | Patient's emotional condition has been raised by the patient or the patient's representative Psychotherapist is appointed by the court Psychotherapy sought in order to plan or commit a crime Malpractice suit or suit against the client for non-payment Psychiatrist/psychologist must determine insanity Disclosure is necessary to prevent threatened danger to the client or person or property of another The proceeding is for establishing the client's competence The child is under 16 and the therapist has reason to believe that the child is the victim of a crime Child abuse/neglect reporting laws |
| Evidence Code 1024: | When someone is a danger to self, others or property, the therapist can break confidentiality. This is what allows the therapist to break confidentiality when the client is suicidal |
| Who is able to hospitalize a person involuntarily? | Not an MFT; an MFT can only call 911 Only a medical doctor or a police officer can do this |
| 5150 | Client is a danger to himself and can be hospitalized for 72 hours The MFT can breach confidentiality in order to call 911, because of Evidence Code 1024 |
| HIV positive and confidentiality issues: | We are not allowed to report someone's HIV status even if they are a danger to someone else Only a doctor is permitted to report, so we should refer the client to see a doctor |
| MFT Scope of practice as defined by BBS: | Service performed with individuals, couples, or groups wherein interpersonal relationships are examined for the purpose of achieving more adequate, satisfying, and productive marriage and family adjustments. This practice includes relationship and premarriage counseling. |
| Who can give informed consent? | 18 and above can make their own decisions Under 18, only one parent's consent is needed if the parents are married If joint custody, then both are needed If one has sole legal custody, then it is just that one from whom you need informed consent |
| We can treat a child without parental consent between 12 & 18 under the following conditions: | Child is mature enough to do therapy Child is either the alleged victim of abuse, or the therapist believes the child will be a danger to self or others without therapy |
| MFTs and Referrals: | According to CAMFT ethical standard 9.1 -- MFTs do not offer payment for referrals MFTs are allowed to use a referral service that has been registered with the BBS |
| Who can we release testing results to? | Only to the client or the client's representative (i.e. attorney, or parent in the case of a minor) |
| Ethical issues such as new client who turns out to be another client's ex-wife: | Should inform the client and let him/her decide |
| Reportable/Nonreportable sexual relationships: | The charts we must memorize are found on page 27 of the notes for Class #4 12 & under: always reportable 13 with another 13-year-old: not reportable 14 with a 14-20 year-old: not reportable 16 and older with any age: not reportable lewd and lascivious conduct between 14 or 15 year-old and a person 10 years older: reportable Oral or anal sex with someone under 18: reportable |
| Criteria to be used in reporting child abuse: | When there is a "reasonable suspicion," i.e. when it is "objectively reasonable for a person to entertain such a suspicion" |
| Consequences if we fail to report child abuse: | We can be sued Could face jail time or pay a fine Generally it's a misdemeanor but can be a felony depending on severity |
| Consensual sex: | Between a 21-year-old and child under 16, it is either a misdemeanor or a felony |
| Consensual sex between children under 18: | A misdemeanor if they are within 3 years of each other A misdemeanor or a felony if they are 3 years or more apart in age |
| Abuse toward adults involving money: | Fiduciary abuse |
| Elder abuse begins at: | Age 65 |
| Time period within which abuse needs to be reported for children: | within 24 hours by phone; 3 days in writing |
| Time period within which abuse needs to be reported for Elders and dependent adults: | within 36 hours by phone; 2 days in writing |
| Judgment of nullity of marriage: | Annulment |
| Grounds for dissolution of marriage in California: | At least one spouse with irreconcilable differences |
| Basis for deciding child custody: | The best interests of the child |
| Emancipation in California: | You are considered an adult under the following circumstances: if you are over the age of 18 If you are married If you are in the armed services If a court has emancipated you |
| Registered interns - our obligations in promoting our services: | Interns can advertise but must state that they are an intern and must include the license number of their supervisor |
| Trainees - our obligations in promoting our services: | Trainees are not encouraged to advertise beyond using business cards Trainees must clearly state their licensing status and the name & license number of their supervisor |
| Therapeutic specialties we can practice only if we have training for them: | Hypnosis EMDR Forensics Sex therapy |
| CAMFT guidelines in relation to advertising: | Cannot be false, fraudulent, misleading, or deceptive Must include the exact name of the license used or the license number Can use the term psychotherapy or psychotherapist, if the ad states that we are an MFT PhD can be included as long as we make clear we are an MFT Cannot use words like "medical" or "psychological" If using a fictitious name, we must state whether or not we are incorporated, unless our business is already registered with the BBS Clients must be informed of the status of the fictitions name at the beginning of therapy In the yellow pages, we must be listed under marriage & family therapy and not under psychologists |
| Items to get informed consent about during the first session: | Fees and fee arrangements such as a "no show" policy Confidentiality Your theoretical orientation, specialties, education, experience Training status Outline of the projected course of therapy Client's right to seek outside consultation Client's right to terminate at any time Possible risks of therapy Limits of confidentiality Client's GAF Client/therapist agreement signed Client's consent to treatment Extent of therapist availability Client's right and responsibility to make their own relational decisions Office policies Mandated reporting Fictitious business ownership Negative risks and positive rewards Recording or videotaping License status |
| How would you work with a client who is actively suicidal? | Code 1024: Break confidentiatlity when the client's mental or emotional state is such that this person presents a danger to self or others, or the property of others No duty to protect and warn (Tarasoff) in a suicide situation; but MFT must take steps to protect the lives of their clients WI Code 5150: Hospitalization is okay if the client is in imminent danger of harming self or others. Only an MD is permitted to hospitalize a client. CAMFT Ethical Standard 2.1: The therapist must protect the client's confidentiality except when permitted or mandated by law 1) An MFT is NOT mandated to break confidentiality to report a suicide risk 2) Other options must be exhausted (i. e. referring, increasing visits, a no-suicide contract, etc.) 3) It's a good idea to consult with other experts Assessment of Lethality: Obtain informed consent from the client Obtain a complete client history Obtain written releases to talk to anyone with helpful info about the client's history or current state. Evaluate the clients perturbation, level of hope, communication of intentions to others, finalization of personal affairs, and ability to carry a suicide out Refer to an consult with other professionals Utilize knowledge of risk factors for high-risk populations Apply the legal and ethical standards of care Use interventions that are appropriate to the level of crisis |
| Clinical Standard of Care with suicidal client: | Reasonable and Prudent Judgment Assessment of... Immediacy of the risk The level of agitation of the client The level of hope or hopelessness of the client The presence of suicidal intent The degree of lethality of that intent The therapist fosters a sensitive, caring, and appropriately firm therapeutic relationship The therapist uses "languaging" to help the client create new and healthier meanings about self and others |
| Scientific Standard of Care: | Familiarity and application of the scientific literature regarding suicide: Demographics Sociocultural Perspectives Biological Considerations Psychological Factors Theoretical Approaches Effective Interventions Combining the Legal, Clinical, and Scientific Standards the therapist must... 1) Address the scope of practice: Improvement of relationships? 2) Address the scope of competence: Got skills? 3) Develop a sensitive, caring, and firm therapeutic alliance. 4) Obtain patient history (medical, family, psych evals, diagnoses, etc.) 5) Evaluate the client's perturbation, lethality, and sense of hopelessness 6) Consider the advantages of gaining a second opinion though expert consult 7) know the risk factors of suicide and high-risk populations 8) Know legal and ethical standards of care and apply (EC 1024) 9) Document in case notes any and all decisions including suicide prevention precautions, rationale for any clinical and legal decisions, consultations with experts or colleagues, outreach to family members (with or without the client's authorization.) 10) Use sound clinical judgment demonstrated by: Obtaining informed consent Increasing the number and regularity of visits Including telephone contact Providing 24 hour emergency Making adequate evening, weekend, and holiday arrangements Referring to a psychiatrist, making sure the client has no more than a weeks supply of meds on hand Obtaining a no-suicide contract Incorporating the family or significant others in therapy (with or without client consent). Initiating involuntary hospitalization if necessary. |
| Basis of determining child support: | The best interests of the child According to a formula based on who the child lives with and the income of each parent Either parent may be ordered to pay child support amounts reasonably necessary for the support, maintenance and education of the marital children |
| Confidentiality issues in group therapy: | Therapists need make clear to group members the importance of confidentiality Group members are not liable |
| Who is responsible for creating safety in a therapeutic environment? | The therapist |
| Confidentiality in relation to electronic devices: | Cell phones are not considered confidential Fax machines are not considered confidential The Internet is not considered confidential |
| What determines the scope of one's practice? | Business and Professions code that states we are allowed to treat individuals, couples, or groups as long as we are improving relationships |
| What determines the scope of one's competence? | Our education, training or experience |
| Required hours for continuing education: | 36 every two years--8 of which must be about law and ethical issues |
| Required hours for continuing education for supervisors: | 6 every two years |
| Therapeutic duty: | To protect the confidentiality of the client To recognize symptoms and assess correctly To diagnose correctly using appropriate procedures and aanalysis To treat correctly To know when to consult professionally To know when to hospitalize a client To provide proper treatment To give proper advice, instructions, and warnings To avoid abandoning the client To keep proper records |
| What constitutes standard of care? | The Standard of Care is Reasonable and Prudent Care Knowing the research literature Understanding professional debates Utilizing appropriate assessment instruments. Knowing demographic-specific risk factors Matching theoretical approach to client needs Working within one's scope of competence Knowing what legal and ethical issues apply Documenting appropriately Obtaining consultation and utilizing referrals |
| Lewd & lascivious conduct between a 14 or 15 year-old and a person 10 years older is reportable or not reportable? | Reportable |
| Consensual sex between a 12 year-old and another 12 year-old is reportable or not reportable? | Reportable |
| Consensual sex between a 13 year-old and another 13 year-old is reportable or not reportable? | Not reportable |
| Consensual sex between a 14 year-old and a 20 year-old is reportable or not reportable? | Not reportable |
| Consensual sex between a 14 year-old and another 14 year-old is reportable or not reportable? | Not reportable |
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