Ethics Midterm - 2

Question 0

APA Ethics Code-Set Up

Answer 0

1. Introduction
       A. Intent, organization, procedures
       B. all APA members
       C. BOP and courts will apply
       D. Apply to professional life
2. Preamble
       A. Based upon research
       B. to improve human condition
       C. Welfare and protection of ppl 
       D. Respect civil rights
3. General Principles ( A-E)
      A. Beneficence and Nonmaleficence
      B. Fidelity and Responsibility 
      C. Integrity
      D. Justice
      E. Respect and Dignity
4. Numbered Codes (1-10)
      -enforceable

Question 1

APA Ethics Code- Importance

Answer 1

.

Question 2

4 Mechanisms holding us accountable

Answer 2

1) Licensing boards (BOP)
2) Ethics Committees (APA/CPA)
3) Civil law/suits (monetary damages)
4) Criminal law/allegations (criminal action)
Four Type of Laws:
US. Constitution
Statues (state and federal)
Regulations (BOP; BBS)
Case law (appellate or supreme crt. Rulings)

Question 3

4 Elements of civil suit for malpractice

Answer 3

• Duty of Care: Relationship established
• Standard of Care:
  1) reasonable therapist doctrine;
  2) ethics codes;
  3) statues;
  4) Case law
• Demonstrable Harm: Harm must be shown to have resulted in damage ($$$)
• Proximate Cause: Due to therapist action or failure to act.

Question 4

How did Ewing change Tarasoff

Answer 4

EWING:
Added elements to the law
1) Danger communicated by patient
addition: OR immediate family member (tx team member) AND for purpose of advancing therapy
2) Serious through of injury or physical violence- addition: GRAVE BODILY INJURY.
3) Identifiable victim(s) within a moments reflection- no change.

Question 5

Assessment of dangerousness includes:

Answer 5

• Gender
• Plan
• Feasibility
• Previous Violence
• Current Problem
• Substance Use
• SX
• Support System.

Question 6

Taking Steps

Answer 6

1. Increase frequency
2. Phone contact
3. Engage support system
4. Medication
5. Adjunctive Tx.
6. No harm Contracts
7. Hospitalization.

Question 7

Difference between confidentiality and privilege

Answer 7

Privacy : 4th amendment right to privacy.
Confidentiality: Standard of professional conduct
Privilege: Legal protection from disclosure in legal proceedings.

Question 8

SAD PERSONS

Answer 8

Evaluates suicide risk, identify suicidal from non-suicidal

S- sex
A- age
D- depression

P- previous attempts
E- ethanol abuse
R- rational thinking loss
S- social support lacking
O- organized plan
N- no significant other 
S- sickness

Most likely population:
Males 4 times more likely than females
90% of completers have DSM diagnosis
Usually MDD or Bipolar Disorder
Age 65+ or between 16-24

Question 9

What is the duty for Tarasoff, Homicide and Suicide

Answer 9

Tarasoff/Ewing:
   -Duty to Warn and Protect
       -Mandated to Breach 
       -Warn Victims/Notify Police
       -Mandated to take steps
Homicide:
    -Duty to Protect
        -Permitted to Breach
        -Mandated to Take Steps
Suicide:
        -Mandated/Permitted to Breach
        -CONSULT/DOCUMENT/case by case
        -mandated to take steps

Question 10

CCARQ

Answer 10

C- Client’s culture

C- Countertransference

A- Area of competence

R- Rule out GMC/ substance use

Q- Question reporter

Question 11

Four Considerations (The Wheels on the Car):

Answer 11

1. Legal (jurisdiction, state, federal, regulatory)
2. Clinical (patient welfare)
3. Ethical (Standard of care, best action to take)
4. Risk Management (Liability, decision making model)

Question 12

Tarasoff updates and additions (discussed in class & on slides)

Answer 12

• 1983 Hedlund update: ALL FORESEEABLE BYSTANDERS. i.e. potential victim(S).
• 1983 VA case: Must attempt to seek past records.
• 1985: Property damage: ARSON requires warning.
• 1999-Demasi – desires and urges to molest boys to analyst: Imminent danger or identifiable victims?? Court said yes.
• Stone 2000: second therapist breaks confidentiality to warn boss about employee fantasy after 2 weeks: NO! Not imminent harm!
• EWING: Added duty to warn when the danger is communicated by an immediate family member (or reasonable other for the purpose of advancing therapy) – Grave bodily Injury
• Tarasoff codified in 1985. Ewing added in 2004, CC 43.92(b) 2011.

Question 13

Handling counter-transference and self care

Answer 13

Best predictors for successful management of CT are:

 - Self-Insight and Self-Integration. 
 - Anxiety management. 
 - Conceptualizing skils. 
 - Empathic ability.

Question 14

RECOGNIZE VULNERABILITIES for poor Self-Care & Recommendations

Answer 14

• Professional Blind Spots
• Increased vulnerabilities
• Self-Care is an ethical imperative.

Recommendations

1) Do not demonize distressed psychotherapists.
2) Be honest about impairments.
3) Encourage consultations
4) Be concerned about isolation
5) Continuing education
6) Active support of self
7) Awareness of consequences
8) Educate oversight bodies
9) Expand our knowledge
10) Expand our knowledge

Question 15

Difference between Confidentiality, Privacy and Privilege

Answer 15

Privilege: legal protection from disclosure during legal proceedings

Confidentiality: General standard of professional conduct

Privacy: 4th amendment, basic rights (suggested)

Question 16

Why is it important to take steps?

Answer 16

Taking Steps ensures that you are providing the least restrictive treatment to your clients.

Question 17

Conditions for Tarasoff

Answer 17

1. C- communicated directly to therapist
2. S- Serious threat of physical harm
3. I- Reasonably identifiable victim upon a moments reflection

Question 18

Three parts of the unenforceable section-APA Ethics code

Answer 18

1. Introduction and applicability
2. Preamble
3. General principles

Question 19

Holder of Privilege

Answer 19

Patient, Guardian or conservator, in death a personal representative. NO MENTION OF PARENT

Question 20

BOP

Answer 20

Board of Psychology. Licensing body.

Question 21

Consultation

Answer 21

Always! The standard of professional competence and care

Question 22

Referrals for medication

Answer 22

***Standard of care when a patient is dangerous. **

Question 23

Informed consent

Answer 23

Use of thorough informed consent

• Structures the treatment
• Establishes the ground rules of treatment, legal parameters, limits of confidentiality.
• Explains the process in crisis situations.
• Sets up Tx plan options.
• Office and billing policies.
• Delineates limits of confidentiality situations
• Support system involvement; 9-1-1; insurance

Question 24

Release of information

Answer 24

Non-HIPAA, it’s a waiver of information, must be signed by the patient, can only release specific information, lasts for 12 months or until withdrawn by the pt.

Question 25

Malpractice

Answer 25

Professional misconduct or unreasonable lack of Skill: Negligently failing to meet the standard of care. 1) Foreseeability? Conduct a thorough assessment of risk for the patient. 2) Causation? Was a propers safety plan in place and acted upon? - Reassess at high risk time. - Keep accurate a detailed records.

Question 26

Adequate Assessment of Risk

Answer 26

- Must be thorough, extensive, appropriate to specific client - Age group, culture - Beyond simple clinical interview - Use of objective assessment tool - I.e. Suicide Assessment Checklist, Beck Depression Inventory, Suicide Probability Scale - Documentation of method used

Question 27

Foreseeability and Causation (Suicide and Malpractice)

Answer 27

Primary Legal Issues: Foreseeability: Whether the clinician should have anticipated the suicide Causation: whether the clinician took sufficient steps to protect the client -Clinicians will not be considered negligent for a failure to predict suicide but they will be held negligent for a failure to conduct a comprehensive risk assessment.