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Ethics and Standards Committee Updates

ETHICS AND STANDARDS

BY: Justin Lapilusa, Psy.D.  
DATE: 11/24/20
On Friday November 21, 2020, the San Diego Psychological Association Ethics Committee presented the webinar Anti-Racist Practice as Ethical Practice: A Panel Discussion on Eliminating Systemic Racism and Implicit Bias in the Therapy Room. A big thank you to the 168 attendees who joined us! The event was scheduled from 11:00 to 12:00 but was extended to 12:30 to address the many questions and comments from the live audience. Based on the feedback, the event was a wonderful success! Thank you to Tami Magaro for her guidance and facilitation and thank you to the presenters Dr. Shannon Franklin and Dr. Nikki Johnson. In response to the positive feedback, we are looking into future opportunities to continue the conversation regarding systemic racism and ethical practice. Stay posted!
ETHICS AND STANDARDS

BY: Erinn Tozer, Ph.D.  
DATE: 10/8/18

Ethics of Confidentiality and Consent of Minors

Consent and Assent

Confidentiality and consent are two of the most important aspects of therapy, and minors are no exception to this. It becomes more complicated when parents (understandably) want to be involved in their child’s treatment - not to mention they are typically paying for it. Standard 4.01 of the APA Ethics Code states that "Psychologists discuss with clients or patients as early as is feasible in the therapeutic relationship...the nature...of therapy, fees, and confidentiality."  When first meeting the minor, invite a parent/guardian to the beginning of the intake session to discuss consent and confidentiality with both parties present.

In addition to the signed informed consent by a parent or guardian, it is advisable to have a minor assent form in which they indicate their willingness to participate in treatment and their understanding of the process. This can include a summary of their rights and confidentiality, what to expect in therapy, how the minor’s privacy will be respected with regard to his or her parents/guardians, and an indication of their right to choose to participate in therapy. The assent form ensures that the minor understands these aspects as well as feels he or she has some power over the treatment.

A minor must be 12 years old in California to consent to services on his/her own, and in that case must also be mature enough to participate in treatment as well as a potential danger to self or others, or a victim of abuse. The psychologist must also attempt to communicate with parents, guardians, or caregivers and document these attempts at the outset of treatment. However, there may be cases in which this is not possible or is deemed inappropriate (cases of abuse by the parent, parent incarcerated or otherwise unavailable). In these cases, be sure to document your attempts and/or clinical reasoning, and always seek legal counsel when necessary.

In cases of parents who are not married, are divorced, or otherwise not raising the child in the same home together, you may want to consider a joint parent agreement form in which both parents acknowledge and initial such things as: The treatment itself, each parent’s right to know how the child is doing in therapy, who is responsible for transportation/appointments, any other pertinent office policies, etc.

Confidentiality

Inform both parents and minors of the legal and mandatory limits to confidentiality as well as the possibility that you will need to disclose certain other concerning information (risky behavior, drug/alcohol use, self harm) to the parents in order to best support the minor. With both parent and minor in the room at that time, there is much less room for confusion and frustration when issues arise.

As some parents may feel in the dark about their child’s treatment, it may also be helpful to let them know that they will not be kept completely out of the loop and are welcome to ask for general updates on their child’s status and treatment plan. Whenever possible, you might discuss any concerning issues with the minor prior to disclosing sensitive information to a caregiver or give the minor the option to share the information themselves, to maintain rapport and trust in the therapeutic relationship. 

Deciding When to Break Confidentiality

As with many tough clinical decisions, each case is distinct and has unique factors to consider. Celia B. Fisher’s Decoding the Ethics Code (2017) outlines four helpful steps to explore in making your decision:

1.    Assess and clinically address risk behaviors: Consider factors such as age (a 13 year old vs. a 17 year old will likely have different levels of maturity and relationship with parents), cultural background, the presenting problem, severity of the risky behavior, level of rapport with the patient, and level of insight the minor has.

2.    Consider options if the minor is unwilling or unable to terminate behaviors: Consider the possible consequences to patient if parents are notified and consult with colleagues regarding other possible options for managing the issue.

3.    Prepare the client for disclosure: Use empathy and support while reminding the minor of the agreements made at the beginning of therapy, and when possible invite the patient to participate in disclosing the information.

4.    Disclosing information to parents: Do not disclose extraneous confidential information, support the patient and parents in creating a plan for safety, and make referrals as necessary.

As always, consult with colleagues, your legal support or malpractice insurance, and/or your SDPA Ethics Committee member on-call when in doubt!

ETHICS AND STANDARDS

BY: Erinn Tozer, Ph.D.  
DATE: 6/6/18

Did you know that the SDPA has an Ethics and Standards Committee and a team of on-call psychologists ready and waiting to help you with your ethical dilemmas?  The ethics consultants are on-call year round. We are proud to serve the SDPA community and are waiting to help guide you through any professional situation(s).  Here are some common questions callers have about our confidentiality policy and when it’s the right time to call.

SDPA Ethics Committee Frequently Asked Questions (FAQ)

I have an ethical question, but I’m worried that I could get into trouble just for asking?

We all question our ethics from time to time. The ethics consultant is here to help guide you toward the most ethical outcome by providing you with feedback and information. All the conversations will be confidential. We understand the importance of confidentiality and you can trust that your identity will remain confidential. So, give us a call!

I feel embarrassed and I don’t want to appear incompetent.

Therapy is complex. It involves a combination of creativity, empathy, and up-to-date knowledge of clinical and ethical issues. It is normal to feel confused or unsure of yourself from time to time. Not unlike any other consultation service, our job is not to judge you and compare you to anyone else. We are here because we know how difficult it can be to find the right answer to a new ethical dilemma. Let us help narrow down your options so that you can come up with the best ethical solution to your dilemma.

When should I call?

You should call anytime you are facing an ethical dilemma and you are uncertain how to proceed. We have all been there, therapy throws a curve ball, you swing and miss. Sometimes, a situation offers several ethical solutions and you are not sure which one to take. It’s not always easy to notice that something is off. It can just be a feeling of uneasiness that spurs you to call. No situation is too big or too small. We are here to support you and your client, and the sooner you call, the sooner we can help.

ETHICS AND STANDARDS

BY: Claudia Law-Greenberg, Ph.D.   
DATE: 8/11/17

MEET DAVID K. LEATHERBERRY,  J.D.

As many of you already know, David Leatherberry provides invaluable legal and ethical counsel to the San Diego Psychological Association (SDPA) Ethics Committee whenever they need assistance with a legal or ethical question. In addition, as a benefit to SDPA members, he provides one free consultation per year. He is the go-to person for the question, “How do I get an answer to my legal or ethical concern”? Needless to say, the Ethics Committee and the SDPA membership at large are deeply appreciative of his indispensable expertise and the service which he has provided, pro bono, for the last ten years. He answers every concern one might have, large or small, in a thoughtful way. Contact information for David is listed on the SDPA website.

The road to which David became an attorney includes a Bachelor of Arts degree from University of California, Berkeley and a Doctor of Jurisprudence degree from University San Diego School of Law (USD).  While at USD he worked extensively with the law school’s mental health legal clinic. His work included advocacy for patients and regulatory guidance to staff of psychiatric acute care hospitals, long-term care and residential care facilities. Because of his advocacy skills, he was selected to be a member of the USD National Trial Team. After remaining with USD School of Law for several years after graduating, he joined Gordon & Rees, LLP, one of the nation’s “Top 100” law firms in 2006. However, he continued volunteering legal services for the mentally ill, for which in 2010, he received both the California State Bar Association’s Wiley W. Manuel Award and the San Diego Legal Aid Society’s Outstanding Service Award.

In addition to the pro bono consultation work he gives to SDPA members, he is a partner at with what is now Gordon & Rees. Scully, Mansukhani located in their San Diego Office where he heads their Health Care Group.  He is also the Secretary and Vice Chair of the Health Law Committee for the California State Bar Association’s Business Law Section. His Owever, Has aHpractice at Gordon and Rees primarily consists of advising hospitals with regard with regard to mergers and acquisitions, regulatory compliance, as well as representing licensed health care providers who are called to appear before licensing boards. In addition, to acute care hospitals and individual providers, his clients include long-term care and behavioral health facilities, adult residential facilities, and drug and alcohol rehabilitation facilities. He often comments that his experience advising individual psychologists and mental health facilities is the part of his work that he most enjoys and that he intends to continue work in that area.

Among his other professional activities, David has taught mental health law in the Forensic Psychology Department at Alliant University and currently teaches the Law & Ethics course for counselors and MFTs at Bethel Seminary. And as a benefit to SDPA, he participates as the key expert speaker whenever an educational panel is formed to discuss legal and ethical issues.  

David has published numerous papers in the California Psychologist for the California Psychological Association (CPA) and has been an invited ethics panel member at the California Psychological Association’s Annual Meeting. He has also been providing HIPPA training to psychologists through periodic free webinars.

It’s well established that David has a wealth of information regarding legal and ethical concerns.  This knowledge and proficiency is demonstrated in a website that he’s developed. The website offers links to answers and their primary sources for many of the questions one might have regarding law and ethics.  The web address is:  lawandethicsresource.com. 

In a previous communication with David, his strong advice was that it is vitally important for practitioners to pay close attention to the ethics standards and to be aware of the rules and laws that enter into the scope of practice.  Resources to assist with this knowledge are:

Decoding the Ethics Code:  A Practical Guide for Psychologists by Celia B.

American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct. www.apa.org/ethics/code/

www.lawandthicsresource.com by David K.Leatherberry, Esq.  You can also connect with David via LindedIn and look for his periodic updates regarding legal issues that affect psychologists.

ETHICS AND STANDARDS

BY:  Ruth Samad, Ph.D. and
Karen Hyland, Ph.D.
DATE: 6/22/17

ETHICAL TIPS FOR TELEPSYCHOLOGY

Telepsychology, also known as Telemental Health Therapy (TMHT), is becoming more widely utilized for providing therapy to those clients who require or prefer distance counseling.  Since this type of therapy is an emerging modality, many of us have not had coursework on this topic in our graduate programs.  Thus, it is necessary for psychologists to inform themselves about the ethical and legal issues involved in TMHT.  

Although the APA Ethics Code (2010) did not address TMHT, in 2013, the APA adopted "Guidelines for the Practice of Telepsychology" (American Psychologist, 2013).  Other mental health professions have specifically revised their ethics codes to include TMHT.  For example, the ACA Code of Ethics (2014) has added a section on "Distance Counseling, Technology, and Social Media." (p.17).  We recommend reviewing both of these sources as a place to start.

Included in the APA Guidelines are the familiar areas of competence, privacy and confidentiality, informed consent, and ethical and professional standards of care as they relate to TMHT.  While we realize there is much overlap between these areas, we will attempt to briefly describe each of these while giving examples of behavior.

1. Competence

  • Demonstrate knowledge of "...both the technologies used and the potential impact of the technologies on clients..." (American Psychologist, p, 793).
  • Assess whether certain technologies (Skype, teleconferencing, email, videoconferencing, etc.) are appropriate for specific clients based on the client's particular needs and multicultural issues as well as how the technology may impact effectiveness of therapy with each client.
  • Continue to assess the appropriateness of the medium throughout the delivery of services.

2. Privacy and Confidentiality

  • Understand the risks involved in TMHT, including the security of the software being used and encryption processes.
  • Consider where this service will take place both for the therapist and the client since computer screens in one's home may not be private.  Walls at home may not be soundproof. 

3. Informed Consent 

  • Include in this process the unique circumstances of TMHT.  Revise consent forms to include additional concerns such as managing the need for emergency, crisis intervention, and discharge plans in the jurisdiction of the client. 
  • Review with the client the issues of possible malfunctions of equipment and disruption of services during the session. 
  • It has even been suggested by Lustgarten and Colbow (2017) that the informed consent process can include a discussion of the client's computer system and suggestion for software, which would require the psychologist to have a working knowledge of secure telehealth products, for example. 

4. Ethical and Professional Standards of Care 

  • Understand the laws and regulations of the jurisdiction in which the client is receiving services, including the validity of the psychologist's license in the client's location and approval from the insurance company for TMHT if insurance is the payor. 
  • Consider the environment in which the TMHT is occurring on both ends of the communication.  When a camera is utilized for video calls, consideration of what is in our background (and the client's), both visually, and aurally is important.  Is a dog barking, a baby being comforted by a sitter, a family member within earshot? 

This article was written with the goal of sharing some of the concerns to be addressed by the psychologist before embarking on TMHT with your clients.  Since it is more of an introduction to the types of issues involved rather than an in-depth presentation, we recommend the references that follow the article be utilized as resources for further study.

References:

2014 ACA Code of Ethics. (2014). American Counseling Association.

Guidelines for the Practice of Telepsychology. (2013). American Psychologist, 68(9), 791-800.

Lustgarten, S. D., & Colbow, A. J. (2017). Ethical Concerns for Telemental Health Therapy Amidst Governmental Surveillance. American Psychologist, 72(2), 159-179.

TeleMental Health Institute. (n.d.). Retrieved May 27, 2017, from https://telehealth.org/

Digital Ethics, HIPAA, & TeleMental Health. (n.d.). Retrieved May 27, 2017, from http://www.zurinstitute.com/hipaa-digitalethics-telementalhealth-resources.html


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