Cpse Clinical

Front 1

Clinical Biases (5)

Back 1

1. preconceived notions
2. confirmation bias
3. primacy effect
4. hindsight bias
5. overconfidence

Front 2

Malingering vs. Defensiveness

Back 2

Malingering: faking bad (use Structured Interview of Reported Sx)
Defensiveness: faking good

Front 3

Actuarial Approach

Back 3

statistics used to explain the results of an assessment

Front 4

Clinical Approach

Back 4

decisions based on impressions, experience and knowledge

Front 5

Privilege

Back 5

When the court requests an eval, the "court" is your client, and there is no privilege in this case. You must warn defendant that the info they disclose will be shared in court; otherwise, eval can't be submitted.

Front 6

when privilege not waived--

Back 6

interview is confidential and not mandated or permitted to share info when the defendant's lawyer is requesting the eval instead of the court.

Front 7

Assessment methods:

Back 7

-must address strengths/limitations of assessment tools in report
-you are responsible for application, interpretation and use of assessment instruments whether you score them or a computer does.

Front 8

"Criteria Have Never Been Met For"

Back 8

Re: lifetime hierarchy b/w disorders. (can't have Major Dep. Episode if they have had a manic episode)

Front 9

"Criteria are not met for"

Back 9

establish a hierarchy b/w2 disorders or disorder subtypes.

Front 10

Can you withold records for nonpayment?

Back 10

Ethics code says yes if its not an emergency; CA Health and Safety Code says no. Always go with the higher standard.

Front 11

HIPAA

Back 11

enacted by Congress in 1996; Title II is most relevant to practice of psych.

Front 12

Title II=Administrative Simplification

Back 12

Designed to improve the efficiency and effectiveness of the health care system by standardizing health care transations.

Front 13

3 parts of Title II

Back 13

1. Privacy Rule: regulations for using and disclosing protected health info (PHI); 2. Security Rule: security safeguards for electronic PHI; 3. Transaction Rule: requires providers who transmit certain transactions electronicallhy to use the same electronic format, code sets, and identifiers.

Front 14

Which has more power, state or HIPAA?

Back 14

State law preempts a HIPAA regulation only when the state law is more "stringent" than HIPAA. CA is more stringent with certain mental health tx and HIV/AIDS testing.

Front 15

How must comply w/ HIPAA?

Back 15

"covered entities" like health care providers, health plans, health care clearinghouses. HCP (def): any person or entity that provides, bills for, and/or is paid for health care as a normal part of business.

Front 16

Protected Health Info

Back 16

provides info about individual's past/present/future phys. and mental health; provision of health care to the individual or past/present/future payment for health care provided to the person. PHI does not include edu. records covered by FERPA or in employment records.

Front 17

HIPAAs Privacy Rule

Back 17

designed to increase protection of PHI. Requires providers to inform clients of their privacy policies; grant clients access to health info; obtain client auth. before sharing health info for nonroutine purposes; secure client records; inform business assoc. of privacy practicies; train employees so they understand procedures.

Front 18

When is the Privacy Rule triggered?

Back 18

when a provider transmits PHI electronically in connection with one of several transactions including claims, payment, plan payment, or enrollment/disenrollment in a plan.

Front 19

APA's recommendation

Back 19

comply w/ HIPAA even if you don't transmit anything electronically

Front 20

HIPAA provides more stringent standards than CA law, T or F?

Back 20

True

Front 21

CA Law vs. HIPAA "disclosure"

Back 21

CA law does not allow a health care provider to withhold records from a patient's personal representative because the provider believes that releasing the records are contrary to patient's best interest (HIPAA says its ok to withhold if causes substantial harm)

Front 22

The client does not have the right to request a review of a denial...

Back 22

info is exempt from the right to access; the CE is a correctional institution or acting for one; info was from a research study and requester agreed to denial of access' PHI obtained from someone other than a health care provider under promise of confidentiality

Front 23

Record keeping (HIPAA)

Back 23

HIPAA allows two sets of records ( a general set readily accessible to clients, insurers and a second set of psychotx notes).

Front 24

Review of notes (CA)

Back 24

clients can be provided w/ copy of psychotx notes or summary. Psychs can decline though if they determine substantial risk or detrimental consequences.

Front 25

Authorization (HIPAA)

Back 25

written auth. required prior to disclosing individually identifiable PHI for reasons other than TPO and prior to releasing psychotx notes to a third party.

Front 26

PHI consent for emergencies?

Back 26

Nope; it is unnecessary to to obtain an auth when PHI or psychotx notes must be disclosed to avert a serious threat to the health or safety of the client or other person.

Front 27

"Notice of Privacy Practices" (NPP)

Back 27

HIPAA requires that clients be provided with a written NPP on or before the onset of tx. Must also be posted in a prominent place in the office, and therapist must make a "good faith effort" to obtain client's written acknowledgement of receipt of the notice. Must be written in clear language and how therapist protects info, used/disclosed without auth, rights to amend PHI, accessing PHI, and how to file complaint.

Front 28

"Minimum Necessary Standard"

Back 28

limit disclosure of PHI to the minimum necessary to accomplish the purpose of the disclosure.

Front 29

BA=Business Associate

Back 29

a person who receives PHI on the behalf of the shrink (billing, answering service, shredding, accounting). Shrink must have HIPAA contract with all BAs.

Front 30

HIPAA's Security Rule (EPHI)

Back 30

to ensure the confidentiality of electronic protected health info (EPHI).

Front 31

"Transaction Rule"

Back 31

requires providers who conduct business electronically to use the same electronic format, code sets and identifiers. "transactions"=electronic exchange of client-identifiable health info. "Electronic exchanges"=transmission over internet, leased lines, dial-up, private networks, cds, etc.

Front 32

Under HIPAA's privacy rule, what are the requirements for a client to be denied PHI?

Back 32

access may be denied when the psych believes that providing info is reasonably likely to endanger the phys. safety of the client or other person and the client is given the right to have the denial reviewed.

Front 33

Under HIPAAs privacy rule, a provider can disclose PHI without consent

Back 33

when info is used for routine tx, payment, and health care operations purposes.

Front 34

CA Competence (California Code of Regulations)

Back 34

a psych shall not function outside their particular field or fields of competence as est. by edu, training and experience.

Front 35

Ethical requirements (Boundaries of Competence)

Back 35

psychs provide services, teach conduct research w/ pops and in areas only within the boundaries of their competence, based on their edu, training, supervised experience, consultation, study or prof. experience.

Front 36

If standards for preparatory training do not yet exist...

Back 36

ensure competence to protect clients/patient, students, supervisees, participants, etc.

Front 37

When a new or experimental technique is to be used...

Back 37

client must be made aware of that fact and take special precautions to protect them from harm

Front 38

Providing ER services when out of scope of practice

Back 38

you must provide services to ensure that services are not denied. Then discontinue services as soon as the emergency has ended or approp. services are available.

Front 39

Psychs personal problems...

Back 39

a psych shall not knowingly undertake any activity when temporary or more enduring probs result in inferior service. If already engaged in services, seek competent prof. assistance to determine whether services should be continued or terminated.

Front 40

B&PC thoughts on personal probs...

Back 40

the licensing agency may order them to be examined by one or more physicians/surgeons/psychs designated by the agency.Failure to agree is grounds for suspension or revocation of certificate or license.

Front 41

Personal problems (Ethics code)

Back 41

refrain from engaging in activities when there is substantial likelihood that personal probs will prevent them from performing work-related duties adequately. When aware of them and already working, seek consultation or assistance, and determine to limit/suspend/terminate work-related duties.

Front 42

Consultation...

Back 42

need not be in-person. can be telephone.

Front 43

Confidentiality

Back 43

"obligation to protect clients from unauthorized disclosure of info revealed in the context of the professional relationships." Ethical obligation.

Front 44

Lanterman-Petris-Short Act and Confidentiality of Medical Information Act

Back 44

protect confidentiality in CA

Front 45

LPSA vs. CMIA

Back 45

confidentiality of mental health info for those who receive services in the public mental health sys. or hosp. in a facility on voluntary/involuntary basis. CMIA=applies to all mental health profs. LPSA applies when there is a conflict.

Front 46

When can we legally breach confidentiality?

Back 46

1. serious threat of violence against a reasonably identifable victim
2. reasonable cause to believe a client is a danger to self/disclosure is necessary to avert the danger
3. when a minor is being abused/elder abuse/dependent adult and psych is in professional role
4. a court order to release records or provide testimony that is needed as evidence in a legal proceeding.

Front 47

Can ethically break confidentiality when

Back 47

1. providing needed professional services
2. obtain appropriate prof. consultations
3. protect client/psych from harm
4. obtain payment for services from client (but limit info)

Front 48

Privilege

Back 48

aka "testimonial privilege"; legal term that refers to a person's right not to have confidential info revealed in a legal proceeding. Privilege is narrower in scope than confidentiality: applies in context of a court proceeding, deposition or admin. hearing

Front 49

Holder of the Privilege

Back 49

1. the patient when there is no guardian or conservator
2. personal rep. of the patient if the patient is dead

Front 50

minors in CA and privilege

Back 50

minors are considered the holders of the privilege in CA, even though they may rely on adults to claim or waive the privilege on their behalf. When wards of the court, can do the same as long as 12.

Front 51

If not 12 or not considered mature?

Back 51

counsel is holder of these privileges

Front 52

what about two or more joint holders of privilege? (i.e. a couple)

Back 52

waiver of privilege by one does not affect the other clients right to claim privilege.

Front 53

can the shrink invoke privilege for a client?

Back 53

yes, a shrink may in court. release only if ordered to by the court or if the client or client's representative consents.

Front 54

When privilege does not apply

Back 54

1. client authorizes a release of info
2. legally mandated to breach confidentiality
3. clint has disclosed a significant part of the info to a third person
4. situation represents a legally defined exception to privilege on next card (these are not automatic. usually a judge has to issue an order)

Front 55

Judge-issued order

Back 55

1. Patient-Litigant Exception: in a legal proceeding when a patient's emotional condition has been raised as an issue by the patient or their rep.
2. Court-Appointed Shrink: competency to stand trial, sanity. Must first inform defendant that communications wont be confidential. Priv. is not waived when asked by the defendant's attorney.

Front 56

3, Board of Prison Terms-Appt Shrink

Back 56

no privilege when a shrink is appointed by Board of Prison Terms to evaluate an inmate to determine need for MH tx.

Front 57

4. Crime or Tort

Back 57

no privilege if the shrink was sought to enable or aid anyone to commit a crime

Front 58

Tort

Back 58

legal wrong

Front 59

Breach of Duty Arising out of Psychotherapist-Patient Relationship

Back 59

no privilege when a shrink or patient alleges a breach of duty arising out of the therapeutic relationship.

Front 60

6. Proceeding to Determine the Sanity of Criminal Defendant

Back 60

no privilege when the defendant requests determination of sanity

Front 61

7. Patient Dangerous to Self or Others

Back 61

to self, others, property, and disclosure is necessary to prevent the danger.This does not designate shrinks as mandated reporters; it only discusses privilege.

Front 62

8. Proceeding to Est. Competence

Back 62

no privilege when proceeding brought on by or on behalf of individual to est. competence.

Front 63

10. Patient under 16 us a victim of a crime

Back 63

no privilege when patient is under 16 and disclosure is in the best interest of the patient.

Front 64

Separation Anxiety

Back 64

beh interventions (exposure). cog tx for older children. meds rare but may be used for a planned separation

Front 65

Delirium

Back 65

brief mental status inventory; recent memory test (words). intoxication, withdrawal and use of mult. meds are often causes. Meds commonly used (antipsychotics like haloperidol) to reduce agitation, hallucations, and delusions. Sedatives contraindicated bc of side effects and they mask sx

Front 66

Dementia

Back 66

assess for si, potential for violence. Assess supervision to prevent falls, wandering. Check for abuse. Determine if restrictions necessary. Refer to medical personnel for cause. Refer to psychiatrist. Eval. memory. Tx is behavior-oriented, modify enviro.Reminiscence tx to improve mood/beh. Stimulation-oriented tx (art).CBT not recommended. Antipsychotics to reduce agitation SSRIs for dep.Tacrine and donepezil for chonilesterase inhibitors.

Front 67

Amphetamine Intoxication

Back 67

evidence of 2:
(1) tachycardia or bradycardia
(2) pupillary dilation
(3) elevated or lowered blood pressure
(4) perspiration or chills
(5) nausea or vomiting
(6) evidence of weight loss
(7) psychomotor agitation or retardation
(8) muscular weakness, respiratory depression, chest pain, or cardiac arrhythmias
(9) confusion, seizures, dyskinesias, dystonias, or coma

Front 68

Stages in Development of Lesbian and Gay identities

Back 68

Stage 1: Sensitization
Stage 2: Identity Confusion
Stage 3: Identity Comparison
Stage 4: Identity Tolerance
Stage 5: Identity Acceptance
Stage 6: First Relationships
Stage 7: Identity Commitment and Pride
Stage 8: Identity Synthesis

Front 69

Obsessive-Compulsive Personality Disorder

Back 69

assessment may be difficult due to digressions, resistance to self-disclosure, and denial of emotions. Tx may be difficult due to intellectualization, unwillingness to express feelings, tendency to engage in power struggles

Front 70

Conduct Disorder

Back 70

Flagrant disregard for rules and rights of others. 3 sx within 12 months and 1 within 6 months: (before 18) fire setting, forcing sex, burglary, breaking curfew

Front 71

oppositional defiant disorder

Back 71

6 months w/ 4 or more:
(1) often loses temper
(2) often argues with adults
(3) often actively defies or refuses to comply with adults' requests or rules
(4) often deliberately annoys people
(5) often blames others for his or her mistakes or misbehavior
(6) is often touchy or easily annoyed by others
(7) is often angry and resentful
(8) is often spiteful or vindictive

Front 72

Tx for GAD

Back 72

group not usually considered. Cog restructuring, self-monitoring, progressive muscle relaxation and self-control desensitization

Front 73

GAD characteristics

Back 73

poor prob solving, procrastination/avoidance, low sense of self-efficacy

Front 74

Sustainment intervention

Back 74

i.e. empathic responding, reassurance would help reduce intensity of emotional distress and anxiety, give sense of hope. Interpretation is helpful but not necessary.