Legal & Ethical Issue Midterm

  1. Principle ethics
    Set of obligations between principle and virtue ethics

    Ex: "What am I going to do best for my client?"
  2. Virtue ethics
    focuses on character traits of counselor and no obligatory ideals to which professionals aspire rather than on solving
  3. Each professional organization has its own _______ you must abide to
    Code of Ethics
  4. Code of Ethics: 3 Objectives
    • 1. Educate professionals about good conduct
    • 2. Ethical standards provide a mechanism for professional acountability
    • 3. Code is catalyst from proving practice generally
  5. Aspirational ethics
    Highest standard of thinking
  6. Positive ethics
    Making sure we can do better things with clients
  7. Pro bono
    Free services to a client
  8. Nonmaleficence
    Avoiding doing harm
  9. Beneficience
    Promote well being of clients
  10. Justice
    Treat others equally
  11. Fidelity
    Make realistic comments, keep promises
  12. Veracity
    Be honest with client
  13. Goal: Enchance relationships
    But PROBLEMS....
    • Dicuss finances (OUTSIDE OF SCOPE)
    • Do not make reports to police
  14. 3 Things Needed for Scope of Competence
    • 1. Education
    • 2. Training
    • 3. Experience

  15. Scope of Practice/Scope of Competence:
    Jack with LMFT Ph.D. And thousands of hours or experience and is contracted to administer a psychological test
    • Inside Scope of Competence 
    • He has his PhD, if he just had LMFT then no because MFT cannot administer tests
  16. Scope of Practice/Scope of Competence:
    Jill is asked to do EMDR, she is not trained and she does 20 minutes of research
    • Outside Scope of Competence
    • She does not have sufficient training
  17. Scope of Practice/Scope of Competence:
    Dick LMFT 3 years of practice working with couples and begin treating someone with multiple personalities
    • Outside Scope of Competence
    • Unless he consults and gets more training
  18. Scope of Practice/Scope of Competence:
    Jane LMFT specializes in domestic violence is treating battered woman in free clinic
    Client can't afford to see doctor, tells client she can get medications to help her sleep
    • Outside Scope of Practice 
    • She can't give medical advice or prescribe medication
    • Might be competent
  19. Do we contact police if a client has committed a crime?
    • NO!
    • Unless it is harm for others
  20. What does a Marriage and Family Therapist do?
    • Assess, Diagnose, and Treat
    • Couples, Individuals, Families, and Children
    • Work with relationship issues/Enhance relationships
  21. Things to say when we have something we can react to from countertransference
    • "I didn't see that coming..."
    • "Oh that breaks my heart..."
  22. If we have an angry client...
    Attack the anger
  23. Countertransference
    • Projection by therapists that distort the way they perceive and react to a client.
    • Learn to discern values and countertransference
    • Can be overprotective because of countertransference
    • Obligated to feel the need to take care of needy ones
  24. Transference
    Clients project onto their therapists past feelings or attitudes they had toward their caregivers or significant people in their lives
  25. Standard of Care
    • Doing what is reasonable and prudent in our prefession
    • What is used if you are accused of malpractice or negligence
    • Do a thorough informed consent, diagnosis, assessment (history), and treatment plan
    • Keep clients safe and unharmed
    • CONSULT with colleagues and other professionals
  26. Maintaining Confidentiality
    • Can consult and share with colleagues
    • If clients pass away, still keep files safe and confidential (unless executor has documentation allowing release of info)
    • Keep files for 7 years after they turn 18
    • Group therapy ⇒ Can't speak outside the group
    • Keep medical conditions in separate folder
  27. MAY break confidentiality
    • When client is suicidal
    • Client consent (after signing authorization)
    • 3rd party payer (insurance, victims of crime)
    • Other mental health people (do NOT use names or details)
    • Subpoena
  28. If you have a client with HIV...
    • Keep separate folder with "General Medical Condition"
    • Must talk about it in the beginning
    • Keep current with current medical condition changes
  29. MANDATED to break confidentiality
    • Danger to others
    • Crimes against minors, elders (65+), dependent adults
    • Terasoft (planning to hurt someone)
  30. Privilege
    • Applies to legal proceeding and release of confidential client information
    • Every client has right to privilege
    • Parent/Guardian ad litem asserts privilege on minor

    • If judge asks YES, attorney NO
    • Minors hold own privilege but only guardian can waive it
    • A deceased person has court order, there has to be a person with legal authority for client info
  31. Malpractice & Unprofessional Conduct: What can happen
    • Lose license/Revoked license(temporary)
    • Suspended
    • Fines
    • Probation
    • Lose intern registration

    DUI, criminal cases like fraud, disciplinary actions, sexual misconduct (2 years)
  32. If working with a couple and the male filed a claim, but female didn't...What can you do?
    Can testify against because both have to file and sign the claim.
  33. Malpractice & Unprofessional Conduct: Harshest penalty
    • Sexual conduct or intimacy
    • Illegal and Unethical
    • Has to be outside of 2 years (BBS)
  34. What is considered Malpractice & Unprofessional Conduct?
    • Not practicing in scope of practice
    • Misdiagnose client (not getting correct treatment)
    • Breach of confidentiality
    • Managing a dangerous client
    • Not doing mandated reporting
  35. Malpractice & Unprofessional Conduct: How to avoid getting in trouble
    • Abide by laws
    • Build good relationships with clients
    • Continuing education
    • Liability insurance
    • Keep excellent records and documentation
    • CAMFT membership
    • CONSULT!!!
  36. Therapeutic Duty
    • 1. Do NO Harm
    • 2. Work in scope of practice
    • 3. Assess, diagnose, and treat
  37. Informed Consent (Umbrella)
    • 1. Fees (On the phone before you see them)
    • 2. Trainee status and supervisor
    • 3. Technology use
    • 4. HIPPA (privacy practices)
    • 5. Risk/Benefits to treatment (may not meet client expectation, may lead to deeper issues, diagnosis may be on permanent record, improved relationships, learn coping mechanisms)
    • 6. Authorization to release information
    • 7. Tape of video
    • 8. Length of treatment (45-60 minutes)
    • 9. Termination policy
    • 10. Office policies (cancellation policy, vacations, available on call, communication policies, 911 emergencies)
  38. Informed Consent (Client Needs)
    • Must be verbally and physically gone over
    • Client needs to be competent
    • Need to understand their treatment
    • Need to know what they are getting themselves into and understand
    • Need to sign "consent to treatment"
    • Need to know Limits of Confidentiality
    • Set foundation of trust
    • Know what therapists do
  39. Termination: What to do
    • P: Premature Exits (bad fit, financial issues, moving, transportation, disability, legal issues
    • L: Loss (how they feel about leaving)
    • A: Anticipated challenges (where they might stumble)
    • R: Referrals (places of additional support)
    • G: Goals met (positive feedback)
    • O: Open door policy (come back anytime)
  40. Therapeutic Duty
    • Assess, diagnose, treat
    • Do no harm
    • Work in scope of practice
  41. Crisis: Definition
    An event or circumstance that prevents therapy from proceeding until the crisis is stabilized
  42. Crisis: Characteristics
    • Requires active role of therapist regardless of theoretical orientation
    • Situation beyond control of individual's resources
    • Turning point when things get better/worse
    • Interruption in normal psychological state of individual/family unit
    • Can be one-time event or accumulation of events over time
    • Is client dangerous to themselves, you, others?
    • Is child involved?
  43. Crisis Management: Questions to Ask Yourself
    • 1. Is the client dangerous to you?
    • 2. Is the client dangerous to self? (Ex: suicidal, substance abuse)
    • 3. Is the client dangerous to others? (Ex: homicidal)
    • 4. Is the client endangered by others? (Ex: child abuse, spouse/partner abuse, elder/dependent adult abuse)
    • 5. How will you assess for the crisis? (QRMOTH)
    • 6. How will you manage the crisis?
  44. Crisis Management: Assessment (QRMOTH)
    • Q = Questions (How much do you eat a day?, Do you feel safe at home?, How did you get that bruise?, What does displine look like in your house?)
    • R = Referrals/Resources (releases)
    • M = Mental Status Exam (Questionnaire helps with DSM diagnosing)
    • O = Observations (bruises, cuts, hair, body language, family interactions)
    • T = Testing (anxiety, depression, etc.)
    • H = History (parent abuse, domestic violence)
    • S = Social Support
  45. Evidence Code Section _____ allows us to break confidentiality
  46. Preventative Measures that Break Confidentiality
    • Clinical consultation with client's other health care providers
    • 24 hour watch by family or friends arranged without client's permission
    • If no one present → 5150
  47. What you can do with Evidence Code Section 1024?
    • Not mandated to report suicidality
    • Patient dangerous to self and others
    • Legally allows you to break confidentiality
  48. WIC (Welfare Institutions Code) 5150
    • Call 911 and state you want to initiate 5150
    • Involuntary hospitalization
    • Last thing you want to do
    • 72 hour hold for treatment and evaluation
  49. 10 Major Reasons for Suicide
    • Escape from an unbearable situation
    • Join a dead loved one
    • Gain attention or manipulate
    • Avoid punishment for a crime
    • To punish self for a crime
    • To punish the survivors
    • In response to a voice (e.g. Hallucination such as in schizophrenia)
    • To have control over when death occurs(e.g. Terminal illness)
    • To become a martyr ("She'll be so mad at me & I can't stand that")
  50. Guidelines for Assessing Suicidal Behavior
    • Suicidality is dyadic nature; there is often another person involved
    • a. The suicidal person AND the significant other (parents, sibling)
    • b. Ask - if you were to kill yourself, who would be most affected by your death? Ask - if you wrote a suicide note, who would you address it to?
    • c. Wonder: what has happened recently with the communication between these two people? How can you help restore that communication? (Unless they are hostile or negative)

    • Take direct verbal warning seriously
    • Pay attention to previous suicide attempts
    • Identify client's suffering from depression
    • Be alert for feelings of hopelessness
  51. Assessing Suicdality - TIPM
    • T: Thoughts
    • I: Intent
    • P: Plan
    • M: Means

    Also ask about personal and family history of suicide attempts
  52. The suicidal plan may be assessed using SAL
    • S: Specific - How is the pla? Get the details of the plan if possible
    • A: Availability - Does the person have the means to carry out the pla?
    • L: Lethality - What is the likelihood of death by this method?
  53. Prior attempts: assess for CARL
    • C: Chronically factors - 
    • A: Awareness of lethality - 
    • R: Rescue
    • L: Lethality, what is the actual lethality of the attempt?
  54. Risk Factors for Suicidality: Intention and History
    • Recent/ prior attempts
    • Direct or indirect communication of intent
    • Extensiveness of plan
    • Lethality of means
    • Access to means
    • Family history
  55. Risk Factors for Suicidality: Demographics
    • Age (teens, middle age, elderly)
    • Gender (males more often succeed, females make more attempts)
    • Homosexuals (Additional stressors/lack of social supports)
    • Race (White)
    • Marital Status (Separeted, widowed divorced)
    • Social Support (lack of, living alone)
    • Employment Status (unemployed, unstable job performance, change in status or performance)
  56. Risk Factors for Suicidality: Emotional Functioning
    • Diagnosis
    • Auditory Halluciation
    • Recent loss
    • Fantasy to reunite with dead loved one
    • Stresses
    • Poor coping abilities
    • Degree of hopelessness
  57. Goals of Intervention for Suicidality
    • 1. Reassurance
    • 2. Comfort
    • 3. Hope
    • 4. Prevention of Suicide
  58. Interventions for Suicidality
    • H: Hooks (future goals, who or what they care about)
    • E: Exceptions (When have they not felt this way before?)
    • C: Coping strategies (What has worked in the past when they felt hopeless, sad, and lonely?)
  59. What to Document with Suicidal Clients
    • 1. Statements about suicidal thoughts, plans, and intent
    • 2. Past suicide attempts
    • 3. Degree of hopelessness
    • 3. Acute risk factors (family, alcohol, stresses, support)
    • 5. Your judgment about lethality
    • 6. Action taken
    • 7. Results of action
    • 8. Periodical inquiry about suicidal thoughts
  60. Management of Suicidality: Basics of Increasingly Protective Interventions
    • Refer to a psychiatrist/physician for evaluations
    • Maintain communication 
    • Provide emergency contact info/suicide hotline
    • Develop safety plan
    • Allow for telephone contact between sessions, as needed
    • Increase number of sessions
    • Provide 24 hour coverage
    • Incorportate family/significant others into therapy
    • Involve family/significant other, should a 24 hour coverage become necessary
    • Encourage voluntary hospitalization, if necessary
    • Breach confidentiality to initiate involuntary hospitalization, if necessary (5150)
  61. Diabetes and menopause can lead to ______
  62. When writing a safety plan with client.....
    Client must write and sign that agreement and keep a copy on file
  63. 10 Most Common Errors in Suicide Prevention
    • A: Avoidance of strong feelings
    • I: Inadequate assessment of suicidal intent
    • D: Defensiveness
    • S: Superficial reassurance
    • I: Insufficient directiveness
    • F: Failure to identify the precipitating event 
    • P: Passivity
    • A: Advice giving
    • P: Professionalism
    • S: Sterotypic responses
  64. Domestic Violence Statistics
    • Prevalence: raped, beaten, stalked, killed by intimate partner than by strangers
    • Women are murdered by intimate partners (33%)
    • 33% of emergency room visits are made by women experiencing intimate violence 
    • Such violence in major contributor to homelessness for women
    • 20% of pregnant women are abused by their partners during pregnancy
    • Violence against women in dating relationships is as common as violence against married women
    • Men don't report domestic violence as much
  65. Cycle of Violence
    • Shows a pattern in abusive relationships - 3 phases repeat over and over - pattern escalates over time
    • Intergenerational - repeats itself by emerging later in the relationship of people who have experience and witness violence in the home as they grew up
  66. Victim Personal Safety Plan: If you had perpetrator evicted or are living alone, you may want to:
    • Change locks
    • Install security system
    • Teach children to call the police
    • Get children to be picked up from parents or teachers
    • Get a lawyer
    • Get a restraining order
  67. Victim Personal Safety Plan: If you are leaving your abuser, ask yourself the following questions:
    • When is the safest time to leave? - Go where?
    • Comfortable calling police?
    • Who can you trust to tell you are leaving?
    • How will you travel safely to pick up kids?
    • What legal resources will help you feel safer?
    • Do you know the # of the local shelter?
    • What custody will keep you and the kids safe?
    • Should I get a restraining order?
  68. Victim Personal Safety Plan: If you are staying with you batterer, think about:
    • What's the best way to keep you safe in an emergency?
    • Who can you call in a crisis?
    • Are there signals you can give to kids/neighbors to help call 911?
    • If you need to leave, where will you go?
    • Know escape routes in house
    • Have important paper close (SSN, driver's license, passport, money, keys)

    Remember you cannot stop abuser, BUT you can find help
  69. Clinician Safety (Potentially Dangerous Client)
    • Seek consultation
    • Don't see client at beginning or end of the day
    • Alert other clinicians
    • Keep door open and sit by door
  70. Domestic Violence: Legal and Ethical Issues
    • First goal: implement safety plan
    • Include extended family in safety plan
    • Don't see them together
    • Allow victim to implement all of their plans
    • Only medical doctors can report
    • If domestic violence and child abuse, report child abuse

    If we report, BREACH OF CONFIDENTALITY - California penal code 11160(A) - Only medical practitioners who provide medical services for physical conditions
  71. Distinguish Reporting Domestic Violence VS. Other Mandated Reports
    • Victim = Minor/Elder/Dependent Adult
    • Child witness only, mandated report depending on effect on minor
    • If minor is mentally suffering
    • May be mandated to report if effect of observation of DV is significant on child
  72. 4 IMPORTANT FACTS on Domestic Violence
    • We don't report
    • We create safety plan
    • Don't see client as couple
    • Can keep secrets?
  73. Reasonable suspicion
    If you suspect child abuse, make a report
  74. Child Abuse
    Abuse to anyone under the age of 18
  75. Type of Child Abuse
    • Physical abuse
    • Sexual abuse
    • Neglect
    • Emotional abuse
    • Fetal abuse
  76. Child Abuse: Physical Abuse
    • Non-intentional --> then consult
    • Bruises, fracture, burns, etc.
    • Willful cruelty and on purpose
    • Cultural = gray area
    • Intent and how often (IMPORTANT)

    Signs: Child flinches, weird clothing, unexplainable bruises/cuts
  77. Child Abuse: Sexual Abuse
    • Luid/Lucivious/Lascivious acts on children (sexual desire)
    • Downloading or streaming child porn
    • Coerces a minor or suggestions to minor

    Signs: Trouble walking/sitting, excessive knowledge of sex for their age, real seductive behavior, avoid uncle/aunt, run away from home, bed wetting, doesn't want to change in front of others, 14 and under has STD, promiscuity, drug use, cutting, self-injury
  78. Child Abuse: Neglect
    Child left uncared for and unsafe

    Severe Signs: leaving child alone in car/bathtubs, living in a car, no adequate food/clothing

    Signs: not giving home, not being fed, medical conditions not met, smell of urine, low hygiene, dress inappropriately, late for school, noticeable body odor, untreated illnesses, physical injuries, 

    Latch-key kids and homelessness NOT REPORTABLE
  79. Child Abuse: Emotional Abuse

    • Support that child suffering due to emotional abuse
    • Hard to prove
  80. Child Abuse: Fetal Abuse

    • Woman harming fetus
    • Abuse of drugs/alcohol
    • Wire hanger abortions
  81. Management of Abuse
    • Most cases, unless suspicion on parent, NOTIFY PARENT
    • CAN incorporate child, unless to young, otherwise make report with child and explain process
    • Making report does not mean child taken from home 
    • Parents may be angry and may not come back
    • Keep in mind, report to take care of child
    • Write out always, child protective services
  82. Elder Abuse
    Abuse to anyone age 65 and older
  83. Types of Elder Abuse
    • Physical abuse
    • Isolation
    • Neglect
    • Financial
  84. Elder Abuse: Physical Abuse
    • Sexual falls under this
    • Assault/Abandonment
    • Bruises, bed sores, fractures, cuts
    • Left alone, family leaves them
    • No resources for survival
  85. Elder Abuse: Isolation
    Cuts off visitors, family, and friends
  86. Elder Abuse: Neglect
    • Lack of medication, food
    • Not retreating illness
  87. Elder Abuse: Financial
    • Bills not paid
    • Fininacnial scams
    • Use of info and credit cards

  88. Exceptions to Reporting Elder Abuse
    • 1. No evidence
    • 2. Dementia or any kind of mental illness
    • 3.Clinical judgment that the of use did not occur
  89. Dependent Adult Abuse
    Abuse to anyone 18-64
    Protocol for working n faculty and care for elders
  91. Procedures for Elder Abuse
    • Serious bodily injury
    • Call police, OMBUDSMAN, within 2 hours of in-care facility
    • If you know elder abuse happening at home, call adult protective services within 2 hours, and written report in 2 days
Card Set
Legal & Ethical Issue Midterm
Legal and Ethical Issues Miterm Spring 2017