Ethics Final

  1. What are two problems associated with the paternalism that prevailed in healthcare until the 1950s?
    • People were unable to be involved in their own care
    • Abuse was rampant
  2. Informed consent and refusal was created mostly due to what?
    patients rights
  3. By the 1970s mental health philosophy shifted from paternalism to what?
  4. By the 1970s case law established that patients had what three basic rights?
    • informed consent
    • informed refusal
    • voluntary release of information
  5. What is informed consent?
    • The therapeutic contract
    • the document at the beginning of therapy that gives the counselor permission to conduct therapy
  6. What is informed refusal?
    The right to refuse treatement, including medication as long as the client is not a danger to themselves or others and can take care of themselves.
  7. What is the voluntary release of information?
    Patients have the right to decide what information gets shared and when.
  8. What are three components of informed consent?
    • Capacity
    • Comprehension
    • Voluntariness
  9. What does capacity mean?
    • the individual is able to make rational decision
    • the ability to understand
  10. What does comprehension mean?
    • the individual is given adequate information and understands the information sufficiently
    • Are they actually understanding
  11. What is voluntariness?
    The individual has given their consent freely and without coersion
  12. What three circumstances might occur that don't require the same informed consent from clients?
    • Clients in crisis
    • Court mandated clients
    • Minors
  13. What two things are important to remember about informed consent when dealing with a client in crisis?
    • Try to get apparent consent, which means we want them to aggree that they need help
    • Try to balance nonmaleficence with autonomy. They are still individuals with rights, but we need to ensure that no harm is being done.
  14. Why don't court mandated clients have to sign informed consent?
    They are choosing between jail and therapy, so they don't have as many rights
  15. What three things should you try to remember when working with court mandated clients?
    • provide an appropriate explanation
    • seek the individual's assent
    • consider preferences and best interests of the client
  16. What two things should you remember when working with minors?
    • Always seek assent
    • under 14 requires parental consent
  17. What are four common myths about informed consent?
    • It is complete after signing
    • Clients always understand what they read
    • Clients always remember what they read
    • It is a nuisance and a distraction from therapy
  18. What are four truths about informed consent?
    • It is an ongoing process which is presented gradually and repeated over time
    • Should be written at a sixth grade level
    • It should be readable and about the client
    • It makes the therapist/client relationship stronger
  19. Informed consent is
    beneficial to clients
  20. What is not part of informed consent?
    research support
  21. The minimum requirements for OR LPC and ACA ethical codes for what should be included in informed consent are
    • client's access to their records
    • client's right to choose their counselor and be active in treatment planning
    • client's right to refuse counseling & the implications of doing so
    • client's right to ask questions and get answers that make sense
    • It must be written
  22. what question might we ask when creating an informed consent?
    If I were a client, what topics would I want to be included in the informed consent.
  23. Who needs to have a personal disclosure statement?
    • every applicant for licensure
    • every LPC, LMFT, and intern practicing in Oregon
  24. What is included in a professional disclosure statement?
    • name and contact information
    • philosophy and approach
    • education and training
    • name of supervisor if intern
    • fees
    • name and address of board
  25. What is documentation?
    • Goals and rationale
    • demonstrates that you provided the services that you are getting paid for
    • will save your ass if you get sued
  26. in Oregon what is considered part of client records?
    • interview notes
    • assessments
    • diagnosis
    • appraisals
    • correspondence
    • recordings
  27. how long should you keep records for?
    no less than 5 years
  28. what does HIPAA stand for?
    Health Insurance Portability and Accountability Act
  29. what is the purpose of HIPAA?
    to protect consumers' rights to health insurance and confidentiality of records
  30. what three things should you avoid when creating records?
    • opinions
    • detailed discussions of other people
    • sensitive or embarrassing information
  31. What are the four main parts of clinical documentation?
    • Assessments
    • Treatment Plans
    • Progress Notes
    • Discharge Plans
  32. What are assessments?
    • Done at the beginning
    • comprehensive history of client and situation
    • How are they doing in the day to day living
  33. What are clinical formulations?
    • 2-3 paragraphs that illustrate your expertise.
    • figure out what the problem is and which interventions to use
    • expected outcome and justification for treatment
  34. what are treatment plans?
    • the roadmap for therapy
    • what is the main goal, and then what smaller pieces can we tackle on our journey to the main goal.
    • measure if symptoms are changing
  35. When should you write progress notes?
    after every session
  36. What is a discharge plan?
    • summary of what happened in therapy
    • recommendations about how and when to reenter treatment
    • relapse prevention plan
  37. What is privacy?
    The right to decide what information about themselves will be shared, and what will be kept private
  38. What is confidentiality?
    everything that is said when we go to therapy (with a few exceptions) is confidential
  39. What should you do to ensure that the client understands when you will breach confidentiality?
    put it in the informed consent
  40. What is privilege?
    the legal term for confidentiality
  41. Does privilege go away when a client dies?
    no, you must get next of kin or lawyer to give consent
  42. what are four main reasons that confidentiality is so important?
    • Beneficence
    • Nonmaleficence
    • Autonomy
    • Fidelity
  43. What are the seven limits to confidentiality?
    • Client requests release
    • court orders
    • client makes a complaint
    • abuse
    • danger to self or others
    • minors
    • groups and couples
  44. Oregon law and HIPAA say that records should be release to what three entities at the patient's request?
    • Other health providers
    • Insurers
    • the patient
  45. What are three responsibilites that a counselor has when releasing information?
    • release no more than necessary
    • assist client in determining what to release in order to meet goals
    • attempt to ensure that the recipient keeps the information confidential
  46. Releases of information must be:
    • In writing
    • Dated
    • Contain language about non-redisclosure
    • In compliance with HIPAA
    • Fully explained to clients
  47. Under what three circumstances do clients waive their right to privilege?
    • If they bring legal action against a counselor
    • File an ethics complain against a counselor
    • Rely on their mental or emotional condition as an element of their claim or defense.
  48. We are mandatory reporters for abuse against what types of people?
    • Children
    • Elderly
    • Mentally ill/divelopmentally disabled
    • Animals
  49. What three items came out of the Tarasoff Ruling with respect to Duty to warn?
    • must warn when therapist believes client is a clear and imminent danger
    • client has indicated a specific victim
    • therapists must warn the victim and the authorities
  50. When must LPC's in Oregon report with respect to duty to warn?
    when a communication reveals the intent to commit a crime or harmful act.
  51. Wen may a counselor initiate involuntary commitment?
    • When client is a danger to self or others
    • When client is unable to provide for basic personal needs and is not receiving such care as is necessary for health or safety.
  52. In oregon when can a minor seek treatment without parental knowledge?
  53. How can therapists address confidentiality with couples and groups?
    • have all parties sign an informed consent
    • educate them about professional ethics and moral responsibility.
  54. What are Pederson's three ethnographic variables?
    • Nationality
    • Ethnicity -- may overlap with race, but more about values, world views, and customs.
    • Language
  55. What are Pederson's three deographic variables?
    • Age
    • Gender -- masculinity and femininity. What does it mean to be a man or a woman
    • Location of residence -- culture is impacted by region. What values does their community have
  56. What are Pederson's three status variables?
    • Social -- how do people interact with each other
    • Economic -- how do they deal with money
    • Educational -- both formal and life education
  57. What are Pederson's two affiliation variables?
    • Formal
    • Informal
  58. What do affiliation variables deal with?
    how we address people and how we communicate with each other. either formal or informal
  59. What does Triandis' notion of shared world view provide understanding of?
    • how well the person fits with values and beliefs of their primary group
    • How much majority view has been assimilated by client. This measures acculturation
  60. what perspective focuses on a universal perspective that looks at sameness as more important than differences and believes counseling practices apply across cultures?
  61. What perspective is culture-specific and stresses the importance of recognizing differences?
  62. What bias do we risk when we focus mostly on how similar we are?
    that the dominant culture is right and if we are different we are wrong.
  63. What is the danger of focusing on differences?
    We may rely on stereotypes
  64. Pedersen suggested a more enmeshed perspective of etic and emic by saying they were each part of the process in what ways?
    working alliance is etic factor, means of establishing it is emic.
  65. Culture is defined as
    • Shared elements of language, history, and geographic location.
    • It is the most general and inclusive
  66. Race is defined as
    • Classifications based on physical characteristics
    • biology and anthropology in perspective
  67. What is ethnicity?
    Common ancestry with shared values and customs
  68. who are minorities?
    Groups whose access to power is limited by the dominant culture
  69. What are the five compenents that privilege uses to maintain itself?
    • Bias
    • Stereotyping
    • Prejudice
    • Discrimination
    • Isms
  70. What is bias?
    Bias is a tendency or habit of thinking, feeling, or acting in a particular way.
  71. When can bias become stereotypes?
    when it is rigid
  72. What is stereotyping?
    generalized beliefs about members of a social group.
  73. What is prejudice?
    • preformed and unsubstantiated judgment or opinion about and individual or group either favorable or unfavorable.
    • Generalized attitude toward members of a social group
  74. What does prejudice rely on?
  75. how much more do hispanics and african americans pay on average for the same house?
  76. What is discrimination?
    Behavior directed toward people based on group membership
  77. What does privilege maintain?
    Status quo
  78. how are prejudice, stereotypes, and discrimination described?
    • Prejudice is the attitude
    • Stereotypes are the beliefs
    • Discrimination is the behavior
  79. What is the counterpart to discrimination?
    unearned privilege or opportunities and positive expectations that come from not being a minority.
  80. What are examples of unearned privilege
    • white skin
    • male/female privilege
    • heterosexual privilege
    • able-bodied privilege
    • middle class privilege
  81. What is "privilege"
    higher status that allows one group benefits more than other groups
  82. Where does privilege typically occur?
    in areas that we have knowledge about or the most experience in.
  83. What contributes to our identity and expectations about our lives?
  84. How can we deal with our privilege?
    assist under-privileged individuals in being empowered to gain more privilege and deal with institutional oppression
  85. When can we believe that our lives and how we do our work is free from bias and judgment?
  86. What is one of the largest biases that we may hold?
    • inflexible focus on individualistic world view.
    • self-awareness
    • self-fulfillment
    • self-discovery
  87. what does ADDRESSING stand for?
    • age
    • development
    • disability
    • religion
    • ethnicity
    • socioeconomic status
    • sexual orientation
    • indigenous heritage
    • national origin
    • gender
  88. Sometimes clients want a more flexible relationship, but as the professional it is our job to:
    Set and maintain boundaries
  89. What is a multiple relationship?
    A relationship that is happening in two ways with the same person
  90. When does a multiple relationship occur?
    • when the therapist is also in another role with client
    • when the therapists is in a relation ship with a person closely related to the client
    • when there is a promise of a future relationship with the client or a person close to the client
  91. Is it unethical to have a profession to professional relationship?
    it isn't explicitly unethical, but should be carefully evaluated
  92. Is it unethical to have a professional to personal relationship?
    likely to be unethical and should be carefully evaluated
  93. is sexual attraction unethical?
    attraction is okay and happens. It isn't unethical, but it should be carefully monitored
  94. attraction is fine, but sex is
    never okay
  95. When should counselors avoid entering into a dual relationship?
    when it could impair professional judgment or increase the risk of harm to clients
  96. when engaging in a dual relationship what do counselor need to use?
    • informed consent
    • consultation
    • supervision
    • documentation
  97. when is a multiple relationship ethical?
    • not exploitative
    • doesn's cause impairment
    • potentially beneficial to client
  98. what does the ACA and APA say about Sexual multiple relationships?
    • Therapists don't engage in sex with current clients
    • Therapists do not provide therapy for former sexual partners
    • Therapists who do engage in sex with former clients must wait a certain amount of time
  99. What are the time periods for waiting to have sex with former clients for the APA, ACA, and OR LPC?
    • APA 2 years
    • ACA 5 years
    • OR LPC 3 years
  100. How common is sexual attraction in therapy?
    87% of therapists endorsed sexual attraction to a client
  101. what percentage of therapists reported becoming sexually involved with a client?
  102. What are some potential predictors of acting on sexual attraction?
    • excitement or longing for session
    • romantic daydreams about client
    • you touch or desire to touch client more than others
    • you have engaged in post-therapy relationships with clients in the past
  103. What should you do if you are attracted to a client
    • acknowledge feelings
    • understand why you are attracted
    • seek consultation
    • set clear boundaries
    • do not touch patient
    • refer if unable to resolve
  104. What percentage of clients are adversely affected by sex with their therapist?
  105. how can sex with clients hurt them?
    • mistrust other therapists
    • impaired emotional social or sexual adjustment
    • increased suicidality
    • less likely to seek subsequent therapy
  106. what percentage of complaints opened by the APA were sexual misconduct complaints?
  107. What conditions must be true for ethical post therpy sexual relationships
    • termination of therapy could not have happened in order to facilitate relationship
    • therapy was brief and not deeply personal
    • must have been initiated by client
  108. What do you do if a client is sexually attracted to you?
    • Be clear
    • Set limits
    • Say no
    • Be direct
  109. What is a boundary crossing?
    departure from commonly accepted practices that could potentially benefit clients
  110. What is a boundary violation?
    a serious breach that results in harm to clients
  111. What are the risks associated with non-erotic touching?
    • client may misunderstand
    • higher risk of developing sexual relationships
    • blurred boundaries
  112. what are the benefits of non-erotic touching?
    client may feel suppoted in a time of need
  113. What are the risks associated with accepting gifts from clients?
    • therapists may give special treatment
    • may be a sign that the client feels unworthy of attention
    • blurred boundaries
  114. What are the benefits of accepting gifts from clients?
    may give clients a way to express appreciation
  115. what guidelines should you follow with regards to gift giving?
    • should be at end of treatment not beginning
    • don't let it compromise objectivity
    • should be rare and not recurrent
    • not expensive
  116. What are the risks associated with bartering?
    • exploitation
    • conflict
    • blurred boundaries
  117. What are the benefits of bartering
    may give client who don't have the means a way of paying for treatment
  118. What are the guidelines for bartering?
    • have a contract
    • use goods with an easily definable value
    • collaborate with client to determine value
  119. what percentage of mental health costs occur in inpatient and residential settings?
  120. what percentage of patients use inpatient or residential settings?
  121. Where were the bulk of mental health costs incurred between 1960 and 1990?
    inpatient services at non-profit organizations
  122. What are the four reasons that mental health is getting more expensive?
    • psychotropic medicine and assessments are more expensive
    • More people are seeking services
    • Clinical abuse
    • Inpatient very costly
  123. What are five reasons that health care costs are increasing?
    • Aging population
    • Higer expectations from patients
    • Increase in malpractice suits
    • Higher cost of administration
    • Improved technology
  124. What percentage of the GNP is health care estamated to be in 2011?
  125. What are four reasons for managed care?
    • Practioners were the ones making decisions (oversight)
    • Sky rocketing health care costs
    • Corporations taking the brunk of the costs
    • Need for stricter resource management
  126. What are the four types of managed care?
    • HMO
    • PPO
    • POS
    • Medicare/Medicaid
  127. What are the characteristics of an HMO?
    provide insurance to clients and deliver services through their own providers
  128. What are the characteristics of a PPO?
    Clients can go to providers either in or out of network, but get financial incentives for choosing in network providers
  129. What are the characteristics of a POS?
    • hybrid of HMO and PPO
    • PCP contracted by POS
    • Options to see other out of network providers
  130. What are some cost controlling strategies?
    • Gatekeeping
    • Session Limits
    • Cover less expensive alternatives
    • pre-treatment authorization
    • Practice profiling
  131. What are some concerns for minorities under MCOs?
    • Access
    • Quality
    • Fit
    • Provider awareness
  132. How can counselors manage client abandonment in MCOs?
    • Referral to public agencies
    • Referral to self help groups
    • Schedule sessions less frequently
  133. What is a parity law?
    • Mandates that insurance companies provide the same coverage for mental health and addiction treatment as they do for general health.
    • Deductibles and coinsurance can't be greater than those for other medical treatments
    • End limits to number of visits
  134. How can counselor's manage session limits?
    • Train in brief treatments
    • Know appeal process for each MCO you join
  135. What are some ethical considerations of belonging to a managed care organization?
    • MCO wnats cost effectiveness, but ethical guidelines require patient allegiance
    • Patients who need more care may not have services covered
  136. What makes up knowledge of cost effecive treatments?
    • Use of effectiveness literature
    • Training in effective treatments
    • Brief treatments
    • Group treatments
    • Preventative services
    • Step care treatment
  137. What are some problems with gatekeeping?
    • Prefer pharmacological interventions
    • Poor assessments
    • Often dont use DSM criteria
  138. What are the consequences of managed care on mental health?
    • Limited number of providers on panels
    • Obsession with cost
    • Changes in services available and who can deliver them
    • De-empasizes psychiatric hospitalization
    • More paperwork
    • More ethical dilemmas
  139. In what ways can crossing a boundary be beneficial to a client?
    • Strengthen therapist and client's working relationship
    • Can help client re-think a certainty
    • Emotional growth
    • Reach treatment goals
  140. What is the secon most reported ethical dilemma?
    Blurred, dual, or conflictual relationships
  141. What are five potential causes for boundary crossing being such a challenge for professionals?
    • They catch us off guard
    • They often tap into basic needs or strong desires
    • Need for clarity seen as inflexibility
    • They often evoke fear or anxiety
    • Very little real world guidance
  142. What factors should be considered when determining if a boundary crossing is likely to help or hurt?
    • Setting
    • Culture
    • Expectations
    • Theoretical orientation
  143. When are dual role relationships likely to lead to harm?
    • Expectations between roles are incompatible
    • Loss of objectivity
    • Increased power or prestige increases potential exploitation
  144. In what ways can boundary crossing be risky?
    • It can knock therapy off track
    • Sabotage the treatment plan
    • Offend, exploit, or harm the patient
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Ethics Final
Cards for the Ethics Final