Coun Law & Ethics Chpt. 5

Front 1

What is involved in informed consent?

Back 1

Definition: the rights of clients to be informed about their therapy and to make independent decisions related to it. Content: 1) benefit/risks of tx, 2) medical concerns, 3) assessment, 4) professional records, 5) fees, 6) cancellation policy, 7) emergencies, 8) length of counseling, 9) child confidentiality, 10) limits to confidentiality.

Front 2

The counselor's responsibility regarding record keeping.

Back 2

For adults: Keep records for 7 years after patient discharge; For minors: keep for at least 1 year after minor reaches 18 and in any case, not less than 7 years. For school counselors: keeps sole possession of counseling records separate from student educational records; parents have access to records at all times; children have access once they reach 18.

Front 3

What is FERPA?

Back 3

Family Educational Rights and Privacy Act of 1974; for school counselors: parents have access to records at all times; children have access once they reach 18. Third parties are prohibited access to records unless written consent is provided by parents or minor once he/she reaches 18.

Front 4

What is HIPAA?

Back 4

Health Insurance Portability and Accountability Act. Privacy regulations protecting patients by limiting the ways health providers can use individually identifiable health information. Applies to those who transmit health care information electronically. Psychotherapy notes handled under higher standard of protection.

Front 5

Some ethical issues in working with minors.

Back 5

Children should assent (agree) to treatment and parents should consent to child's treatment; every child has right to confidentiality, with some exceptions (i.e., parents demand information, child is risk to self or others, court order, child abuse, child under 16 victim of crime); only need consent of one parent in order to counsel minor;

Front 6

Parental consent issues related to counseling children.

Back 6

minors under 12 cannot receive treatment without parent consent unless 1) need medical care related to prevention or treatment of pregnancy or 2) need medical care related to sexual assault. Parental consent not needed for minors 12 or over if 1) minor is mature/intelligent enough to participate in treatment, 2) minor would present danger to self/others without treatment, 3) is the victim of incest of child abuse, 4) treatment of alcohol/drug issues (except methadone) and provider is with state or county, 5) medical care related to prevention/treatment of pregnancy (except sterilization), 6) been raped or contracted a communicable disease and needs medical treatment.

Front 7

Procedure to follow when treating minor age 12 or over without parental consent.

Back 7

1) State in record whether and when you attempted to contact parent and whether contact was successful or not, or the reason why it would be inappropriate to contact parent (e.g., child abuse or incest occurring); 2) parents not responsible for paying fees; work with minor would be pro bono.

Front 8

Common reasons why school counselors breach confidentiality

Back 8

1) suicide, 2) violent retaliation for victimization, 3) drug use, 4) sexual promiscuity while HIV positive, 5) armed robbery, 6) signs of serious depression.

Front 9

Confidentiality in schools

Back 9

1) school counselors do not need parental consent before counseling students; 2) should inform student, parents, and teachers of confidentiality and when confidentiality will be breached. Parents right to inspect a minor's record is not absolute; can deny access if you feel it will be detrimental to client; non-custodial parent cannot be denied access to mh records.

Front 10

Students right to know act

Back 10

Students have the right to 1) inspect information contained in their education record, 2) obtain a response to request for explanation of records, 3) challenge contents of records, 4) request hearing if results of challenge is unsatisfactory, 5) submit explanations into their file if the hearing decision is unacceptable.

Front 11

Clinician records

Back 11

1) clients have right to inspect and have copies of their records, 2) records need to be written in a descriptive, nonjudgmental way, 3) inform clients diagnosis will become permanent part of file, 4) inform client that managed care may have access to file, 5) must keep records of all professional client contacts (e.g., when/why appointment missed, etc.), 6) records provide evidence of meeting standard of care/protection against malpractice claims, 7) law requires "progress" (i.e., case/clinical notes), not "process" (clincal impressions) notes. Keep notes in accordance with acronym SOAP: Subjective (reported by client), Objective (results of counselors tests/assessments), Assessment (counselors interpretation of the data), Plans (diagnosis and treatment plan). Assume notes will be read by others.

Front 12

Record storage issues

Back 12

Secured in secure location that only authorized person have access to; locked file cabinet; educate employees/subordinates regarding safe handling.

Front 13

Online counseling issues

Back 13

1) California permits online counseling 2) inform clients of benefits and limits of using technology in counseling, 3) ethical/legal issues include: privacy/confidentiality concerns, data validity, professional credentials, misuse of internet interventions. Recommend the following: 1) initial face-to-face contact session, 2) require physical exam, 3) inform client of limits/expectations for online counseling, 4) plan to deal with emergencies, 5) discuss limits of confidentiality with internet technology, 6) how technology failure will be dealt with in advance.

Front 14

4 elements of proving malpractice

Back 14

1) Duty: counselor had a duty to the client, 2) Breach of Duty: Counselor failed to conform to the required duty of care, 3) Injury: client was injured, 4) Causation: reasonably close causal connection between counselor's conduct and resulting injury.

Front 15

Main reasons for malpractice suits

Back 15

1) sexual misconduct with client, 2) unprofessional conduct/negligence.

Front 16

Risk management issues

Back 16

Risk management: practice of identifying, evaluating, and treating problems that may injure clients, lead to filing of ethics complaints, or lead to malpractice suit. It involves a four-step process: 1) identify potential risk areas, 2) does risk area warrant further attention, 3) employ preventative and risk control strategies, 4) review treatment periodically to ascertain effectiveness.