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Ethics II > Confidentiality > Flashcards

Confidentiality Flashcards

1
Q

Confidentiality

A

Clients typically expect everything to be confidential

When learn of breach often feel betrayed

Speaks to importance of Informed Consent
Just about all information is confidential
Confidentiality extends beyond verbal exchange to records

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2
Q

What are the Ethical Principles behind Confidentiality?

A

Primary principles of Autonomy & Fidelity:

  • Autonomy—individuals have power to decide who has access to personal information
  • Fidelity—implicit and explicit promise not to disclose

Secondary principles are Beneficence and Nonmalficence:

  • Indiscretions harm the relationship
  • Clients cannot benefit without faith in process
  • Particularly children/adolescents
  • Breaches may put client at risk
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3
Q

Name 3 codes that discuss that include issue of Confidentiality. What are the commonalities?

A

ACA Code of Ethics § B Confidentiality, Privileged Communication, and Privacy (Welfel, 2010, p. 110)
APA Ethical Principles § 4.01-4.06 (Welfel, 2010, p. 111-112)
AAMFT Code of Ethics Principle II: Confidentiality

Commonalities:

  • Codes establish expectations of confidentiality and exceptions
  • May share some information for consultation purposes
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4
Q

Discuss the concept of Consultation as it relates to Confidentiality.

A

Consult under ethic of beneficence:

  • Professional peers understand importance and ethics of confidentiality
  • —Consultation with Release
  • —One-way consultation
  • Minimal information
  • —Age, gender, sex, occupation, diagnosis, symptomology, culture, race/ethnicity, etc. all depends on the situation and why consulting
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5
Q

Name 3 codes that discuss that include issue of Consultation. What are the commonalities?

A

ACA Code of Ethics §§ B.3. Information Shared with Others and B.8. Consultation
APA Ethical Principles §4.06 Consultations
AAMFT Codes of Ethics § 2.6

Commonalities

  • May share some information for consultation purposes
  • Professionals expected to understand need for confidentiality
  • Must limit identifying information
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6
Q

Discuss Supervision as it relates to Confidentiality

A

Supervisors privy to confidential information of trainees

  • Must disclose status as trainee (& under whose license)
  • Must disclose that supervisor will review records, ask about file, share information, all for benefit of client

Practitioner is also responsible for actions of employees with access to confidential information

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7
Q

Confidentiality & Intimate Partner/Significant Others

A

96% of therapists report sharing client information with partners; 70% characterize the disclosure as anonymous

Disclose to reduce stress, help client, gain self-understanding; therapists find disclosure beneficial

Recommendation: explain ethical standards to significant others and seek alternative outlets

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8
Q

Discuss Privileged Communication.

A

Confidentiality and Privileged Communication are not the same (though often used synonymously)

Privilege belongs to the client, not the professional

Client has privilege to share with you without you sharing with other people

Privilege varies from jurisdiction to jurisdiction

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9
Q

Privileged Information in Minnesota

A

Minnesota Statutes 595.02 Subd. 1 (g)
Licensed Psychologists “shall not, without the consent of the professional’s client, be allowed to disclose any information or opinion based thereon which the professional has acquired in attending the client in a professional capacity…”

Minnesota Statutes 148B.593 (b)
“The confidential relations and communications between [an LPC and LPCC] and a client are placed upon the same basis as those that exist between a licensed psychologist and client.”

alMinnesota Statutes 148B.39
“[An LMFT] cannot be required to disclose any information that the person, employee, or associate may have acquired in renderingmarriageand familytherapy services…”

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10
Q

How is privileged Information demanded in Minnesota?

A

A subpoena ad testificandum (or subpoena ducei tecum) is issued by the Clerk of Court and serve
-In order to get your notes, information

Subpoenas are issued without legal review

  • Lawyers can write subpoena for anything, for anyone
  • Send to anyone and everyone with information
  • Do not need to respond to it
  • Not legally obligated
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11
Q

How should one respond to a subpoena and request for privileged information?

A

Response:

  1. Call client: Release or not
  2. Attend court: defend privilege and do not respond
    - –No ethics codes require or expect practitioners not to comply with court orders
    - –May choose not to, may be in contempt of court
  3. Judge responds: legal or not; ask you questions and may be candid
    - –A judge can compel testimony by court order after legal review that finds the information not privileged
    - —May share if asked by judge without violating ethics codes
  • **Call MN Board of Psychology and anonymously ask what to do about it
  • **APA membership offers 2 hours consultation with lawyer if necessary
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12
Q

What are the 10 Limits to Confidentiality?

A
  1. Client Request for Release of Information
  2. Court Orders
  3. Client Complaints against Practitioner
  4. Other Client Litigation
  5. Limitations by State/Federal Statutes
  6. Duty to Warn and Protect
  7. Planning Future Crimes
  8. Counseling HIV-Positive Clients
  9. End of Life Issues
  10. Sexual Exploitation by Previous Therapist

Minnesota State Law mandates some reporting

  • –Child Abuse and Neglect
  • –Prenatal Exposure to Controlled Substances
  • –Abuse of Vulnerable Adults
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13
Q

Name 3 codes that discuss that include issue of Client Request for Release of Information . What are the commonalities?

A

ACA Code of Ethics § B.5.c Release of Confidential Information (Welfel, 2010, p. 120)
APA Ethical Principles § 4.05 Disclosures (Welfel, 2010, p. 539)
AAMFT Code of Ethics, Principle II: Confidentiality § 2.2

Firmly established by Principle of Autonomy
Allow access to own records unless not in best interest
—Best practice is that client would be able to read the notes.
—Occasionally information that would not be beneficial for them to read.
—Obligation to help client consider implications of release, may want to rescind release; always respond but talk to client first

Client signs a release and directs practitioner with whom to share; practitioner may also request release or a release to/from therapist may be requested by another party, e.g., psychiatrist

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14
Q

Discuss Court Orders

A

Courts can demand access to records or testimony (as discussed under privileged communication)

If a therpaist as expert witness, no privilege between you and person you assessed for the court, thus the court is your client not the assessee; same with I/O

Different than court-ordered therapy, depending on what is court-ordered may be certain aspects that are required to disclose; client should know what information will be disclosed

No privilege exists when therapist is expert witness or consultant for the court: Client is essentially court, not individual being assessed

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15
Q

Client complaints against practitioner

A

When suing therapist or bringing forth ethics complaint, client must waive right to confidentiality
—Most jurisdictions require a written consent to waive rights when lodging complaint
(thus allows professional to defend self without violating ethical standards)

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16
Q

Discuss other topics surround client litigation.

A

When suing someone besides therapist and claiming psychological harm or emotional distress, client must waive right to confidentiality

Therapist must be able to testify about the case and present records to establish the veracity of the client’s alleged harm

*Allowed to testify on behalf of client: must think through implications, sign release of information. Don’t need to testify on their behalf but may get subpoenad; get release of information whenever available

17
Q

Reporting Child Abuse & Neglect: Statutes

A

Reporting Maltreatment of Minors—Minnesota Statutes 626.556, subd. 3(a)
A person who knows or has reason to believe a child is being neglected or physically or sexually abused…or has been neglected or physically or sexually abused within the preceding three years, shall immediately report the information to the local welfare agency, agency responsible for assessing or investigating the report, police department, or the county sheriff if the person is (1) a professional…engaged in the practice of…psychological or psychiatric treatment…

*May have been changed to longer than 3 years

18
Q

Reporting Child Abuse & Neglect

A

As many as 1/3rd of therapists decline to report because they feel better outcome from continued counseling

Some practitioners contend that confidentiality is sacred and should never be breached

Some report hesitation to report suspected abuse vs. confirmed abuse

Can always call children’s services for anonymous guidance when uncertain of proper course of action

19
Q

Prenatal Exposure to Controlled Substances: Statutes

A

Reporting of Prenatal Exposure to Controlled Substances—Minnesota Statutes 626.5561
A [mandatory reporter] shall immediately report to the local welfare agency if the person knows or has reason to believe that a woman is pregnant and has used a controlled substance for an nonmedical purpose during the pregnancy, including, but not limited to, tetrahydrocannabinol, or has consumed alcoholic beverages during the pregnancy in any way that is habitual or excessive.

20
Q

Abuse of Vulnerable Adults: Statutes

A

Reporting of Maltreatment of Vulnerable Adults—Minnesota Statutes 626.557
A mandated reporter who has reason to believe that a vulnerable adult is being or has been maltreated, or who has knowledge that a vulnerable adult has sustained a physical injury which is not reasonably explained shall immediately report the information…

21
Q

Duty to Warn and Protect: History

A

Duty arises from Tarasoff Case (1974; 1976)
1974 ruling established Duty to Warn
1976 rehearing established Duty to Protect
Overarching idea is that practitioners have obligations to both client and the public.
“The protective privilege ends where the public peril begins”

Must take reasonable precautions to protect others

22
Q

Duty to Warn and Protect: Statutes

A

Minnesota Statutes 148.975, subd. 2
The duty to predict, warn of, or take reasonable precautions to provide protection from, violent behavior arises only when a client or other person has communicated to the licensee a specific, serious threat of physical violence against a specific, clearly identified or identifiable potential victim. If a duty to warn arises, the duty is discharged by the licensee if reasonable efforts are made to communicate the threat

23
Q

Assessing Risk of Violence

A

Assess risk of violence to determine course of action
Client history of violent behavior
Legal, criminal record?
Social considerations that increase or decrease risk
See risk factors (deck below)
Current psychological functioning

24
Q

Risk Factors for Violent Behavior

A

Demographic: Male, unemployed

Diagnosis: Antisocial, co-occuring substance abuse, possibly paramoid schizophrenia, adjustment disorder

Childhood/Family: Abused as a child (seriousness & frequency), raised in disadvantaged neighborhood, parents used/abused drugs (specifically father)

Legal Issues: Prior arrests (seriousness & frequency)

Other Clinical: Anger control/impulse control issues, violent (especially persistent) fantasies, involuntary status

25
Q

Discuss Duty to Warn as relates to Suicide Attempts

A

~70% of counselors report working with a client who attempts suicide; ~20% of trainees report dealing with a suicide attempt

When client is at imminent risk of suicide, practitioner has obligation to protect client from self-destructive impulses

Unclear whether this means confidentiality should be breached to inform significant others

26
Q

MN Board of Psych. Position Re: Duty to Warn about Suicide

A

Minnesota Rules of Conduct 7200.4700 subp. 2
Private information may be disclosed without the informed written consent of the client when disclosure is necessary to protect against a clear and substantial risk of imminent serious harm being inflicted by the client on the client or another individual.

27
Q

Suicide Assessment

A

Suicide is complex, multitude contributing factors
Identify risk factors and protective factors
Recognize which risk factors can/cannot be modified
Ask directly about suicide
Determine level of suicide risk (Low/Moderate/High)
Create a plan and document assessment

28
Q

Components of Suicide Assessment

A

Psychiatric Illness: Affective disorders, alcohol/substance abuse, schizophrenia, Cluster B

History: Prior attempts, aborted attempts, self harm, medical diagnoses, family history

Individual Strengths/Vulnerabilities: Coping skills, personality traits, past responses to stress, capacity for reality testing; tolerance of psychological discomfort

Psychosocial Situation: Acute, chronic stressors, changes in status, quality of support, religious beliefs

Suicidality & Symptoms: Past & present ideation, plans, behavior, intent; methods; hopelessness, anhedonia, anxiety symptoms; reasons for living; associated substance use; homicidal ideation

29
Q

Risk Factors for Suicidality

A

Demographic: male, widowed, divorced, single, increases with age, white

Psychosocial: lack of social support; unemployment; drop in SES; firearm access

Psychiatric: psychiatric diagnosis; comorbidity

Psychological Aspects: hopelessness; psychic pain/anxiety; psych. turmoil; decreases self-esteem; fragile narcism; perfectionism

Behavioral Aspects: impulsivity; aggression; severe anxiety; panic attacks; agitation; intoxication; prior attempts

Cognitive Aspects: thought constriction; polarized thinking

Childhood Trauma: sexual/physical abuse; neglect; parental loss

Genetic & Familial: family history of suicide, mental illness, abuse

30
Q

Protective Factors of Suicidality

A 
Children in home (except postpartum psychosis)
Pregnancy
Deterrent religious beliefs
Life satisfaction
Reality testing ability
Positive coping skills
Positive social support
Positive therapeutic relationship (able to leverage)
31
Q

Planning Future Crimes

A

Minnesota rules and statutes do not compel the disclosure of planned crimes by clients

32
Q

HIV+ clients

A

At least three key issues

  1. Maintaining confidentiality of disclosure
  2. Risk of discrimination if health status is not protected
  3. Welfare of others at risk due to client contact

Dilemma is balancing responsibility to protect confidentiality with the welfare of people the client places at risk

ACA Code allows counselor to breach in some instances

  • –3rd parties must be identifiable
  • –Diagnosis must be confirmed
  • —Client’s intent to inform or engage in high risk behaviors must be assessed
33
Q

Under which conditions, if any, would a breach of confidentiality to report the planning of a criminal act would be justified?

A

Something involving harm against self, specific person/population, or abuse/neglect of a child or vulnerable adult.

34
Q

End of Life Issues:
Does the obligation to protect client/prevent suicide vary depending on lifespan and health issues? What are confidentiality obligations?

A

ACA Code doesn’t mandate breach; suggests a case-by-case analysis; APA doesn’t reference in code

Considerations

  • Competence/capacity of client to consent
  • Pain and suffering, quality of life, cultural factors
  • Available social support
  • Alternative interventions to relieve pain
  • Direct or indirect pressure from others to end life
35
Q

What is an exceptions to Privilege in Minnesota?

A

Mandated to report sexual exploitation at the hands of a previous therapist.

Minnesota’s statute 147.111 requires licensed health professionals to report sexual exploitation of former client to the Board of Medical Practice. If the name of the abusive professional is known, the report is required with or without the consent of the patient.

36
Q

Discuss Confidentiality as it relates to minors.

A

Attempt to protect confidential as with any client

Ethical principles do not vary with age

However, minors don’t legally have equal rights to privacy

Parents have legal right to information form counseling unless they waive that right

ACA, APA, AAMFT Codes not very specific

Ethics scholars suggest degree of confidentiality is related to age and maturity of minor

37
Q

Discuss Confidentiality as it relates to Group & Family Counseling.

A

Group and Family Therapy complicates confidentiality

Can’t force or guarantee others will protect privacy

Information may not be privileged in shared in group setting (Third-Party Rule)

Minnesota law protects privilege in group/family therapy for Licensed Marriage and Family Counselors.

Same privilege may not exist for counselors and psychologists

Ethics II (5 decks)

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