Ethics Final SG PDF

**Know the APA and PA standards relative to multiple relationships, assessment, therapy, limitations to confidentiality, advertising, record keeping and fees, education and training, supervision, and research and publication** **Know the major points expressed in the readings** **Know the major fi...

**Know the APA and PA standards relative to multiple relationships, assessment, therapy, limitations to confidentiality, advertising, record keeping and fees, education and training, supervision, and research and publication** **Know the major points expressed in the readings** **Know the major findings in the studies (I will focus more on the studies covered in the lectures but the others are fair game)** **[Know what constitutes a multiple relationship and how to determine whether or not a multiple relationship is unethical ]{.smallcaps}** - psychologist is in a professional role with a person and - \(1) at the same time is in another role with the same person, - \(2) at the same time is in a relationship with a person closely associated with or related to the person with whom the psychologist has the professional relationship, or - \(3) promises to enter into another relationship in the future with the person or a person closely associated with or related to the person. - An attempt to address the loophole of ending therapy to start a secondary relationship - Note: multiple relationships can involve the client or people related to the client - A multiple relationship is unethical if - They are likely to impair the psychologist\'s objectivity, competence, or effectiveness in performing his or her functions as a psychologist - risks exploitation or harm - NOTE: Multiple relationships that would not reasonably be expected to cause impairment or risk exploitation or harm are not unethical **[Be aware of the major stats and research findings on multiple relationships ]{.smallcaps}** Multiple relationships - Multiple relationships were 50% of cases opened by the APA Ethics committee in 2015 - 23% of disciplinary actions by the PA State Board between 1997-2003 involved multiple relationships - 25% of disciplinary actions by licensing boards were due to sexual misconduct or nonsexual dual relationships (ASPPB, 1974-2020) - 5% of the total malpractice claims for psychologists were due to sexual misconduct (APAIT, 2013-2014) - Professional boundary issues was the second most frequently reported ethical dilemma by psychologists (Pope & Vetter, 1992) and graduate students (Fly et al., 1997) Pope and Vasquez, 2016 - 4.4% of therapists report becoming sexually involved with a client - Perpetrators are overwhelmingly male and victims are overwhelmingly female - Therapists who have sexual relationships with their clients are likely to repeat - There is a clear relationship between sexual and nonsexual dual role behaviors (Borys, 1988) - Each year there are about 10% fewer self-reports of therapist-client sex Patients who have been sexually involved with a therapist (Pope and Vetter, 1991) - 32% had experienced incest, child sex abuse, or rape prior to involvement with therapist - 5% were minors at the time of the involvement - 80% were found to have been harmed after termination of the therapy - 11% required hospitalization at least partially resulting from sexual involvement - 14% attempted suicide - 12% filed a formal complaint Sexual Attraction to Clients (Pope, Tabachnick, & Spiegel, 1986) - 87% of psychologists report they have been sexually attracted to their clients - 63% report feeling guilty, anxious, or confused about the attraction - About half report they did not receive any guidance/training on this issue - 9% reported that the training/supervision they did receive was adequate **[Know the difference between boundary crossings and boundary violations ]{.smallcaps}** - *Boundary* -- behavior that is on the "edge" of what is considered to be appropriate - We want to figure out what will be most helpful and least harmful (utilitarian perspective) when considering boundaries - *Boundary Crossing* -- a deviation from usual clinical behavior that is either benign or helpful to the therapy and therapeutic relationship - *Boundary Violation* -- a transgression that is clearly harmful and/or exploitative to the client **[Know Gottleib's Multiple Relationships Decision-making Model ]{.smallcaps}** - A chart with text on it Description automatically generated with medium confidence - Evaluate relationships based on 3 dimensions - Power differential between people - Duration of the relationship - longer the relationship = more power differential - Clarity of situation - Likelihood that consumer and psychologist will have further professional contact - Can evaluate primary and secondary relationship based on these 3 dimensions -  - 1\. Assess the current relationship according to 3 dimensions - 2\. Assess the contemplated relationship according to 3 dimensions - 3\. Examine both relationships for role-incompatibility in terms of expectations - 4\. Obtain consultation from a colleague - We often lack the objectivity to understand our own feelings and behaviors - Helpful to have a sounding board - 5\. Discuss the decision with the consumer **[Be familiar with APA's Statement on The Disclosure of Test Data and Guidelines for Psychological Assessment and Evaluation]{.smallcaps}** Statement of Disclosure of Test Data (APA Committee on Psychological Tests and Assessment, 1996) - Psychologists generally discuss limitations on confidentiality or disclosure of test data and test results prior to testing - Psychologists usually obtain informed consent from test takers prior to the testing, except when the nature of the testing does not require such consent - May not require consent: testing required by law or government regulations, implied bc it is part of routine educational activity, purpose of testing is evaluating one's ability to make decisions - BUT still have a discussion about the nature of what you're doing/what person should expect - Informed consent includes: - Reasons for testing - Intended use of testing and its range of possible consequences - What testing information will be released - To whom the testing information will be released - Psychologists should provide test takers with explanations of test results - Explanation of what the scores mean - Confidence intervals - Letting them know a score may represent a range of scores - Any significant reservations they have about the accuracy or limitations of their interpretations - How scores will be used - When the client's intention to waive confidentiality is viewed by the psychologist to be contrary to his/her best interest the psychologist usually: - Discusses the implications of releasing information - Assists the client in limiting disclosure only to information required by the present circumstances and only to other qualified professionals - Releasing secure test materials to unqualified persons may decrease the test's validity and can impose harm to the client and the general public - Tests and test protocols are generally protected by federal copyright laws and usually may not be copied without permission of the copyright holder - Psychologists requesting test data make reasonable attempts to maintain the integrity and security of requested tests and assessments, to protect the confidentiality of clients and test data, and to take reasonable steps to prevent others from misusing test data. APA Guidelines for Psychological Assessment & Evaluation (APA Task Force on Psychological Assessment and Evaluation Guidelines, 2020) - COMPETENCE - 1\. Psychologists who conduct psychological testing, assessment, and evaluation strive to develop and maintain their own competence. This includes competence with selection, use interpretation, integration of findings, communication of results, and application of measures. - 2\. Psychologists who conduct psychological testing, assessment, and evaluation seek appropriate training and supervised experience in relevant aspects of testing, assessment, and psychological evaluation. - 3\. Psychologists who conduct psychological testing, assessment, and evaluation strive to be mindful of the potential negative impact and subsequent outcome of those measures on clients/patients/examinees/employees, supervisees, other professionals, and the general public. - 4\. Psychologists strive to consider the multiple and global settings (e.g., forensic, education, integrated care) in which services are being provided. - PSYCHOMETRIC AND MEASUREMENT KNOWLEDGE - 5\. Psychologists who provide psychological testing, assessment, and evaluation demonstrate knowledge in and seek to appropriately apply psychometric principles and measurement science as well as the effects of external sources of variability such as context, setting, purpose, and population. - SELECTION, ADMINISTRATION, AND SCORING OF TESTS - 6\. Psychologists who conduct psychological testing, assessment, and evaluation endeavor to select - a\. assessment tools that demonstrate sufficient validity evidence for their uses, sufficient score reliability, and sound psychometric properties and - b\. measures that are fair and appropriate for the evaluation purpose, population, setting, and context at hand. - 7\. Psychologists who conduct psychological testing, assessment, and evaluation strive to use multiple sources of relevant and reliable clinical information collected according to established principles and methods of assessment. - 8\. Psychologists who conduct psychological testing, assessment, and evaluation strive to be aware of the need for test selection, scoring, and administration to reflect the appropriate normative comparison, situational influences, effort, and standardized administration as indicated. - DIVERSE, UNDERREPRESENTED, AND VULNERABLE POPULATIONS - 9\. Psychologists who conduct psychological testing, assessment, and evaluation strive to practice with cultural competence. - 10\. Psychologists who conduct psychological testing, assessment, and evaluation aspire to ensure awareness of individual differences, various forms of biases or potential biases, cultural attitudes, population appropriate norms, and potential misuse of data. - 11\. Psychologists who conduct psychological testing, assessment, and evaluation endeavor to recognize the nature of and relationship among individual, cohort, and group differences. - 12\. Psychologists who conduct psychological testing, assessment, and evaluation seek to consider the unique issues that may arise when test instruments and assessment approaches designed for specific populations are used with diverse populations. - TRAINING, AND SUPERVISORY QUALIFICATIONS AND ROLE - 13\. Psychologists who educate and train others in testing, assessment, and evaluation strive to maintain their own competence in training and supervision and competency in assessment practice. - 14\. Psychologists who supervise employees or individuals who lack training in testing, assessment, and evaluation strive to ensure that supervision ultimately provides examinees/clients with testing, assessment, and evaluation that meets the ethical and professional standard of care and scope of practice. - TECHNOLOGY - 15\. Psychologists who use technology when testing, assessing, or evaluating psychological status strive to remain aware of technological advances; of the influence of technology on assessment; and of standard practice, laws, and regulations in telepsychology. - 16\. Psychologists who conduct services using technology for online or in-person testing, assessment, and evaluation make every effort to ensure their own competency. - 17\. Psychologists who use technology based assessment instruments are encouraged to take reasonable steps to ensure the security, transmission, storage, and disposal of data. Psychologists also strive to ensure that security measures are in place to protect data and information related to their clients/patients/examinees from unintended access, misuse, or disclosure. **[Be aware of assessment issues -- competency, confidentiality, informed consent, release of test data, providing feedback ]{.smallcaps}** - Competency - be aware of ethical standards and guidelines, stay within areas of competence, understand measurement, validation, and research, follow standard procedures for administering tests - Strive to develop own competence (selection, interpretation, communication of results) - Appropriate training and experience - Be mindful of potential negative impact of/outcomes of measures on clients and public - Consider multiple and global setting testing is being done in - Consent - ensure the client understands and consents to testing before starting the assessment, clarify access to the test report and raw data - Obtain informed consent prior to testing - exception = when nature of testing doesn't require consent - Informed consent includes: - Reasons for testing - Intended use of testing & range of possible consequences - What test information will be released & to whom - Confidentiality - Discuss limitations to confidentiality or disclosure of test data results BEFORE testing - When client waives confidentiality: - Discuss implications of releasing information - Assist them in limiting disclosure only to information required - Only release to qualified professional - Release of test data - disclose to anyone with a proper release, protected copyrighted test materials, obey orders from courts, release reports to clients - Can disclose test data to anyone with a proper release - Exception = can refuse to release if it would cause harm to client - Should protect copyrighted test materials - Should always obey orders from the court to release specific test materials - Privacy rules = required to release testing reports to clients - Providing feedback - dynamic, clarify tasks/roles, prepare to handle crisis, be careful in how you frame results, acknowledge fallibility, assess client's reactions, and ensure they adequately understood - Should explain test results - What scores mean - Confidence intervals - Any significant reservations about accuracy / limitations of interpretation - How scores will be used **[Know the Detroit Edison Co. vs. National Labor Relations Board case]{.smallcaps}** - Supreme Court ruled that the NLRB had abused its discretion in requiring Detroit Edison Co. to turn over test battery and answer sheets that it had used for hiring decisions - This case affirms the necessity for protecting test security. - Ethics: Test materials are offered greater protection than test data **[Know APA code's definitions of test data and test materials ]{.smallcaps}** - Test Data - "...refers to raw and scaled scores, client/patient responses to test questions or stimuli, and psychologists' notes and recordings concerning client/patient statements and behavior during an examination. Those portions of test materials that include client/patient responses are included in the definition of *test data*." -- APA ethics code - Test Materials - "... refers to manuals, instruments, protocols, and test questions or stimuli and does not include *test data* as defined in Standard 9.04, Release of Test Data." -- APA ethics code - Does NOT include test data **[Know the conditions defined by the APA code that warrant terminating therapy ]{.smallcaps}** - Psychologists terminate therapy when it becomes reasonably clear that the client/patient no longer needs the service, is not likely to benefit, or is being harmed by continued service. - Psychologists cannot abandon client - If they still need services, but psychologists still need care MAKE SURE THERE IS A TRANSFER OF CARE - Want to empower clients to be involved in the decision-making process - Don't want to make a unilateral decision - Conversation back and forth - Information: other care options, tx orientations, more intensive needs - Want to be respectful of autonomy and stay true to fidelity - Make sure decision-making is documented for termination and transfer of care - Psychologists may terminate therapy when threatened or otherwise endangered by the client/patient or another person with whom the client/patient has a relationship. - Except where precluded by the actions of clients/patients or third-party payors, prior to termination psychologists provide pre-termination counseling and suggest alternative service providers as appropriate. - Can't just abandon - Need a conversation that helps facilitate the transfer of care **[Know what the codes have to say about ethical termination/referral ]{.smallcaps}** APA Ethics Code (2017; Standard 10.10.b) - Psychologists may terminate therapy when threatened or otherwise endangered by the client/patient or another person with whom the client/patient has a relationship. APA Ethics Code (2017; Standard 10.10.c) - Except where precluded by the actions of clients/patients or third-party payors, prior to termination psychologists provide pre-termination counseling and suggest alternative service providers as appropriate. - Can't just abandon - Need a conversation that helps facilitate the transfer of care Termination Topics (Pope & Vasquez, 2016) -- for a planned termination - Review initial tx goals - Describe changes made in therapy - Highlight gains they've made and skills they've developed - Boosting client's confidence and acknowledge the hard work they've put in - Process feelings about therapy ending - Future tx/referrals - What things may come up in their life where they may need to use the therapy skills - termination plan: what ways they can practice their skills on their own **[Know what constitutes abandonment ]{.smallcaps}** - "*Abandonment* means termination of and failure to refer a patient when the psychologist did not know or should have known that more tx was needed." - Intentional vs. unintentional abandonment - Intentional - When psychologists know further tx is needed, but still terminate care or withhold referral - Unintentional - Didn't know but should have known more tx was needed and the client goes on to harm - Can lead to malpractice suit - Intentional -- lower standard of proof - De facto abandonment - When therapist is not reasonably available or the tx ends abruptly - failure to provide adequate accessibility to tx - Planning a termination - Important to talk about client's needs that aren't being met and provide a list of referrals - Follow up and making sure client connects to other tx provider - Open to follow up/available if the client needs a different referral **[Know the Osheroff vs. Chestnut Lodge case ]{.smallcaps}** - Court determined that psychiatrists should have modified their tx plan when the patient was not responding to therapy - Psychologists should reconsider tx plans, seek consultation, and refer out when their tx plan is not working - Don't want psychologists to be rigid in their tx planning **[Know what to do when providing services to patients who are served by others ]{.smallcaps}** APA Ethics Code (2017; 10.04) - In deciding whether to offer or provide services to those already receiving mental health services elsewhere, psychologists carefully consider the tx issues and the potential client\'s/patient\'s welfare. Psychologists discuss these issues with the client/patient or another legally authorized person on behalf of the client/patient in order to minimize the risk of confusion and conflict, consult with the other service providers when appropriate, and proceed with caution and sensitivity to the therapeutic issues. - Doesn't say you canNOT accept patient, but you should ask pertinent questions before deciding to accept them - When it works - Therapists have specific role and those roles don't overlap - When roles are delineated and it won't negatively impact care - Want efficient care - Want helpful - Don't want to negatively impact therapy care - Want to determine what's in the best interest of the client - May want to ask follow-up questions about the purpose that you are serving - Also want to know what orientation of therapy the other therapist is giving - May be times when it's appropriate to consul with other treating therapist - Need client's consent for release of information - Can check with them how intended plan may or may not interact with other therapy **[Be familiar with APA's Guidelines for Telepsychology ]{.smallcaps}** - *Telepsychology* - "the provision of psychological services using telecommunication technologies" - Telecommunication technologies: - Telephone, mobile devices, interactive video conferencing, e-mail, chat, text, Internet - 1\. Psychologists who provide telepsychology services strive to take reasonable steps to ensure their **competence** with both the technologies used and the potential impact of the technologies on clients/patients, supervisees, or other professionals. - Professional competence - And competence and doing teletherapy - Training - Technical competence (comfort using the technology) - Knowledge about individual differences - Age of client - Understanding of using technology - 2\. Psychologists make every effort to ensure that ethical and professional **standards of care and practice** are met at the outset and throughout the duration of the telepsychology services they provide. - Ability to assess and reevaluate - 3\. Psychologists strive to obtain and document **informed consent** that specifically addresses the unique concerns related to the telepsychology services they provide. When doing so, psychologists are cognizant of the applicable laws and regulations, as well as organizational requirements, that govern informed consent in this area. - Have separate consent form that specify description of services/procedures specific to telehealth - Document that they are consenting specifically to telehealth - 4\. Psychologists who provide telepsychology services make reasonable efforts to protect and maintain the **confidentiality** of the data and information relating to their clients/patients and inform them of the potentially increased risks of loss of confidentiality inherent in the use of the telecommunication technologies, if any. - HIPPAA compliant software - Make sure that the client is in a confidential location - Regularly checking in that this is the case - Make sure that the client is aware of possible negative impacts/ consent if there is a person in the room - Even if client is ok with someone in the room, it may be impacting therapy (a therapeutic issue) - Make sure that your own location is confidential - 5\. Psychologists who provide telepsychology services take reasonable steps to ensure that **security** measures are in place to protect data and information related to their clients/patients from unintended access or disclosure. - Password protecting data - Encryption software when sending information - 6\. Psychologists who provide telepsychology services make reasonable efforts to **dispose of data** and information and the technologies used in a manner that facilitates protection from unauthorized access and accounts for safe and appropriate disposal. - Dispose data in a way that protects the client's confidentiality - 7\. Psychologists are encouraged to consider the unique issues that may arise with **test instruments** and assessment approaches designed for in-person implementation when providing telepsychology services. - Assessment procedures should be suitable for telehealth - Limitations should be discussed with client beforehand - Making appropriate accommodations for diverse clients - 8\. Psychologists are encouraged to be familiar with and comply with all relevant laws and regulations when providing telepsychology services to **clients/patients across jurisdictional and international borders**. - Laws and regulations for both where you and your client are both located - Practicing in the jurisdiction that we are under **[Know what PSYPACT is]{.smallcaps}** - Interjurisdictional compact - Allows for practicing over state lines as long as state is within PSYPACT - Developed by ASPBB to allow licensed psychologists to practice telepsychology and temporarily face-face services across state lines - PSYPACT commission oversees the program - Have to apply to commission for an E-Passport for telepsychology or Interjurisdictional Practice Certificate (IPC) for face-face practice in other states - Designate your home state of where you practice and then you can practice with clients who are located in other PSYPACT states - Need 3CE credits that are telehealth specific each time you renew your ability to practice with PSYPACT **[Be familiar with Principle D of the APA code as it relates to social justice ]{.smallcaps}** - Psychologists recognize that fairness and justice entitle all persons to access to and benefit from the contributions of psychology and to equal quality in the processes, procedures, and services being conducted by psychologists. Psychologists exercise reasonable judgment and take precautions to ensure that their potential biases, the boundaries of their competence, and the limitations of their expertise do not lead to or condone unjust practices. - Assist marginalized groups - Doing some sort of advocacy - Be able to call attention to policies and institutions that may be putting historically marginalized individuals at a disadvantage - About increasing own consciousness - Aware of the lived experiences of those same and different than us - The way macro policies have impacted individuals - Cultural humility **[Know statistics on child abuse in PA (general trends) ]{.smallcaps}** - PA has the lowest rate of substantiated abuse in the US - Percentage of victims = lowest in the US - PA identifies childhood sexual abuse at about the same rate as other states but identifies other forms of abuse at a much lower rate - PA's rate of reporting child abuse is 1/5th the national average - Sexual abuse = leading category (then physical abuse) - Parents = most often perpetrators - Decrease in deaths & substantiated claims - 2014 revisions to CPSL expanded role of mandated reporters and expanded definitions of child abuse - Since revisions, \# of reports of child abuse and \# of substantiated reports have increased - **[Know how PA defines child abuse, perpetrators, and mandated reporters]{.smallcaps}** *Child Abuse* - PA child abuse covers: Bodily injury, serious neglect, sexual abuse or exploitation, and emotional abuse - Covers instances of risk of harm -...intentionally, knowingly, or recklessly doing any of the following: - 1\. Causing [bodily injury] to a child through any recent act or failure to act. - Failure to act = 2 years since instance of harm - 2\. Fabricating, feigning or intentionally exaggerating or inducing a medical symptom or disease which results in a potentially harmful medical evaluation or tx to the child through any recent act. - 3\. Causing or substantially contributing to serious mental injury to a child through any act or failure to act or a series of such acts or failures to act. - 4\. Causing [sexual abuse or exploitation] of a child through any act or failure to act. - 5\. Creating a reasonable likelihood of bodily injury to a child through any recent act or failure to act. - 6\. Creating a likelihood of sexual abuse or exploitation of a child through any recent act or failure to act. - 7\. Causing serious [physical neglec]t of a child. - 8\. Engaging in any of the following recent acts: - i\. Kicking, biting, throwing, burning, stabbing or cutting a child in a manner that endangers the child. - Ii. Unreasonably restraining or confining a child, based on consideration of the method, location or the duration of the restraint or confinement. - Iii. Forcefully shaking a child under one year of age. - Iv. Forcefully slapping or otherwise striking a child under one year of age. - V. Interfering with the breathing of a child. - Vi. Causing a child to be present at a location while a violation of 18 Pa.C.S. § 7508.2 (relating to operation of methamphetamine laboratory) is occurring, provided that the violation is being investigated by law enforcement. - Vii. Leaving a child unsupervised with an individual, other than the child\'s parent, who the actor knows or reasonably should have known: - a\. Is required to register as a Tier II or Tier III sexual offender under 42 Pa.C.S. Ch. 97 Subch. H (relating to registration of sexual offenders), where the victim of the sexual offense was under 18 years of age when the crime was committed. - b\. Has been determined to be a sexually violent predator under 42 Pa.C.S. § 9799.24 (relating to assessments) or any of its predecessors. - c\. Has been determined to be a sexually violent delinquent child as defined in 42 Pa.C.S. § 9799.12 (relating to definitions). - 9\. Causing the death of the child through any act or failure to act. - 10\. Engaging a child in a severe form of trafficking in persons or sex trafficking, as those terms are defined under section 103 of the Trafficking Victims Protection Act of 2000 *Perpetrators* - A person who has committed child abuse - 1\. The term includes only the following: - \(i)  A parent of the child. - \(ii)  A spouse or former spouse of the child\'s parent. - \(iii)  A paramour or former paramour of the child\'s parent. - \(iv)  A person 14 years of age or older and responsible for the child\'s welfare. - \(v)  An individual 14 years of age or older who resides in the same home as the child. - If perpetrator doesn't fit the criteria you would get different law enforcement involved - \(vi)  An individual 18 years of age or older who does not reside in the same home as the child but is related within the third degree of consanguinity or affinity by birth or adoption to the child. - 2\. Only the following may be considered a perpetrator for failing to act, as provided in this section: - \(i)  A parent of the child. - \(ii)  A spouse or former spouse of the child\'s parent. - \(iii)  A paramour or former paramour of the child\'s parent. - \(iv)  A person 18 years of age or older and responsible for the child's welfare. - \(v)  A person 18 years of age or older who resides in the same home as the child. *Mandated Reporters* - A person licensed or certified to practice in any health-related field under the jurisdiction of the Department of State - A medical examiner, coroner, or funeral director - An employee of a health care facility or provider licensed by the Department of Health, who is engaged in the admission, examination, care, or tx of individuals - A school employee - An employee of a child-care service who has direct contact with children - A clergyman, priest, rabbi, minister, Christian Science practitioner, religious healer, or spiritual leader - An individual paid or unpaid, who, on the basis of the individual\'s role as an integral part of a regularly scheduled program, activity or service, is a person responsible for the child\'s welfare or has direct contact with children - An employee of a social services agency who has direct contact with children in the course of employment - A peace officer or law enforcement official - An emergency medical services provider - An employee of a public library who has direct contact with children - Someone managed by a person who has direct contact with children - An independent contractor - An attorney affiliated with an agency, institution, organization or other entity, including a school or regularly established religious organization that is responsible for the care, supervision, guidance or control of children - A foster parent - An adult family member who is a person responsible for the child\'s welfare and provides services to a child in a family living home, community home for individuals with an intellectual disability or host home for children **[Know the PA mandated reporting requirements ]{.smallcaps}** - \(1)  A mandated reporter shall make a report of suspected child abuse if the mandated reporter has reasonable cause to suspect that a child is a victim of child abuse under any of the following circumstances: - \(i)  The mandated reporter comes into contact with the child in the course of employment, occupation and practice of a profession or through a regularly scheduled program, activity or service. - \(ii)  The mandated reporter is directly responsible for the care, supervision, guidance or training of the child, or is affiliated with an agency, institution, organization, school, regularly established church or religious organization or other entity that is directly responsible for the care, supervision, guidance or training of the child. - \(iii)  A person makes a specific disclosure to the mandated reporter that an identifiable child is the victim of child abuse. - \(iv)  An individual 14 years of age or older makes a specific disclosure to the mandated reporter that the individual has committed child abuse. - \(2)  Nothing in this section shall require a child to come before the mandated reporter in order for the mandated reporter to make a report of suspected child abuse. - \(3)  Nothing in this section shall require the mandated reporter to identify the person responsible for the child abuse to make a report of suspected child abuse. **[Know the Child Protective Services Law]{.smallcaps}** *Definition of bodily injury (CPSL) (23 Pa. C. S. § 6301-6388)* - Impairment of physical condition or substantial pain *Definition of serious mental injury (CPSL) 23 Pa. C. S. § 6301-6388* - A psychological condition, as diagnosed by a physician or licensed psychologist, including the refusal of appropriate tx, that: - \(1)  renders a child chronically and severely anxious, agitated, depressed, socially withdrawn, psychotic or in reasonable fear that the child\'s life or safety is threatened; or - \(2)  seriously interferes with a child\'s ability to accomplish age-appropriate developmental and social tasks. *Definition of sexual abuse (CPSL) (23 Pa. C. S. § 6301-6388) * - Any of the following: - \(1)  The employment, use, persuasion, inducement, enticement or coercion of a child to engage in or assist another individual to engage in sexually explicit conduct, which includes, but is not limited to, the following: - \(i)  Looking at the sexual or other intimate parts of a child or another individual for the purpose of arousing or gratifying sexual desire in any individual. - \(ii)  Participating in sexually explicit conversation either in person, by telephone, by computer or by a computer-aided device for the purpose of sexual stimulation or gratification of any individual. - \(iii)  Actual or simulated sexual activity or nudity for the purpose of sexual stimulation or gratification of any individual. - \(iv)  Actual or simulated sexual activity for the purpose of producing visual depiction, including photographing, videotaping, computer depicting or filming. - \(2)  Any of the following offenses committed against a child: - \(i) Rape - \(ii) Statutory sexual assault - (iii) Involuntary deviate sexual intercourse - \(iv) Sexual assault - \(v) Institutional sexual assault - \(vi) Aggravated indecent assault - \(vii) Indecent assault - \(viii) Indecent exposure - \(ix) Incest - \(x) Prostitution - \(xi) Sexual abuse - \(xii) Unlawful contact with a minor - \(xiii) Sexual exploitation *Definition of Serious Physical Neglect (CPSL) (23 Pa. C. S. § 6301-6388)* - Any of the following when committed by a perpetrator that endangers a child\'s life or health, threatens a child\'s well-being, causes bodily injury or impairs a child\'s health, development or functioning: - \(1)  A repeated, prolonged or egregious failure to supervise a child in a manner that is appropriate considering the child\'s developmental age and abilities. - \(2)  The failure to provide a child with adequate essentials of life, including food, shelter or medical care. - Application of this should consider child age, emotional functioning, and behavior in question *Definition of Imminent Risk (CPSL) (23 Pa. C. S. § 6301-6388)* - "...a situation where there is a likelihood of serious physical injury or sexual abuse.." **[Know what is required to make a child abuse report ]{.smallcaps}** - A report must be made immediately to ChildLine either by phone or electronically - After making the report to ChildLine, mandated reporters are required to immediately notify the person in charge of the institution, school, facility, or agency - If an oral report was made, a written report must follow within 48 hours - The mandated reporter must identify themselves and where they can be reached - The identity of the person making the report is kept confidential with the exception of being released to law enforcement officials or the district attorney's office - CPS must investigate within 24 hours of receiving a report - Investigation must be completed within 30 days - Mandated reporters will receive information from the Department regarding the final status of the report, whether it was unfounded, indicated, or founded, and the services planned or provided to protect the child **[Know the consequences for failure to report abuse ]{.smallcaps}** - Depending on severity, ranges from 2^nd^ degree misdemeanor to 2^nd^ degree felony - Failure to report abuse may also result in civil liability and discipline from state board **[Know CDC statistics on suicide in the US (general trends) ]{.smallcaps}** - 45,979 people died by suicide in the US - 12.2 million adults seriously thought about suicide - 3.2 million adults made a plan - 1.2 million adults attempted suicide - For every suicide death there are - 4 hospitalizations for suicide attempts - 8 emergency department visits related to suicide - 27 self-reported suicide attempts - 275 people who seriously considered suicide - The racial/ethnic groups with the highest rates of suicide in 2021 were non-Hispanic American Indian and Alaska Native people and non-Hispanic White people - The suicide rate among males in 2021 was approximately 4x higher than the rate among females - Males make up 50% of the population but nearly 80% of suicides - Men die more often by suicide but women are more likely to attempt suicide - People ages 85+ have the highest rate of suicide - Firearms are the most common method used in suicides - Firearms are used in more than 50% of suicides **[Know statistics on treating suicide in the US and in PA (general trends) ]{.smallcaps}** - PPA found over the course of a year - 89% of its members treated at least one patient with suicidal thoughts - 49% treated at least one patient with a suicide plan - 29% treated at least one patient who attempted suicide while in tx - 6% treated at least one patient who died from suicide while in tx - Up to 40% of psychologists will have a patient die from suicide during their careers (Gill, 2012) - 31% of suicide decedents had contact with a mental health professional in the year prior to their deaths (Stene-Larsen & Reneflot, 2019) - 37% -38% of patients who had suicidal thoughts did not reveal them to their health care professionals (Levy et al., 2019) - 75% of patients who died from suicide did not disclose suicidal thoughts in their last visit with a health care professional (Berman, 2018) - 21% of psychotherapists who worked with suicidal patients reported that their training/expertise was inadequate (Jahn et al., 2016) - Many recent psychology graduates did not think they had adequate training in suicide prevention in their graduate program (Bongar & Sullivan, 2013) **[Know suicidal risk factors ]{.smallcaps}** *Individual Risk Factors* - Previous suicide attempt - History of depression and other mental illnesses - Serious illness such as chronic pain - Criminal/legal problems - Job/financial problems or loss - Impulsive or aggressive tendencies - Substance use - Use can lower inhibition for people who already have suicidal ideation - Current or prior history of adverse childhood experiences - Sense of hopelessness - Violence victimization and/or perpetration *Relationship Risk Factors* - Bullying - Family/loved one's history of suicide - Loss of relationships - Marital separation 4x higher risk than other marital statuses - High conflict or violent relationships - Social isolation - People who live alone at greatest risk - Live with spouse is less risk - Live with spouse and children even less risk *Community Risk Factors* - Lack of access to healthcare - Suicide cluster in the community - Stress of acculturation - Community violence - Historical trauma - Discrimination *Societal Risk Factors* - Stigma associated with help-seeking and mental illness - Easy access to lethal means of suicide among people at risk - Unsafe media portrayals of suicide **[Know reasons why clients may not reveal their suicidal thoughts ]{.smallcaps}** - Fear of punishment or negative consequences - Shame or internalized stigma - Feel it's a sign of weakness or they may be burdening others - Fear of disapproval or embarrassment - Belief that tx will not work - Desire not to burden others - Belief that problems are not serious enough **[Strategies for increasing disclosure of suicidal ideation ]{.smallcaps}** - Ask clients directly about suicide and avoid negatively worded questions - Important to consider how you're framing the question - Ask open ended question - Show you're comfortable talking about he situation - Ask clients about suicide twice using different formats - Written measures (items in BDI) - Ask questions in the session as well - Sequence the timing of suicide questions during the initial interview - Want to have time to create a safety plan if needed - Respond to potentially indirect communications about suicidal thoughts - Create facilitative conditions within therapy - Be calm, curious, and supportive - Informed consent as quality enhancement - Clear about confidentiality (limits and specific conditions and when it may be broken) and their autonomy - Involve friends and/or family members if indicated - Depends on the individual **[Know Emerich standard for duty to warn with suicide/homicide risk ]{.smallcaps}** - Specific and immediate threat of serious bodily injury - Specifically identified or readily identifiable party - Professional determines that the patient presents a serious danger of violence **[Know how to use Truscott, Evans, and Mansell's decision-making model for addressing dangerous clients ]{.smallcaps}** - A diagram of a patient\'s health Description automatically generated - HIGH violence risk + WEAK therapeutic alliance - Build rapport and/or involve significant others and/or hospitalize - May consider breaking confidentiality - LOW violence risk + WEAK therapeutic alliance - Build rapport - HIGH violence risk + STRONG therapeutic alliance - Intensify therapy and manage environment (separate from the means they have that increase risk of suicide or working with psychiatrist on dose management) - Would make things more effortful - LOW violence risk + STRONG therapeutic alliance - Shift focus to violence management **[Be familiar with risk evaluation and management procedures covered in class ]{.smallcaps}** *Evaluation of Suicidal Risk* - Direct verbal warning - Plan - Past attempts - Indirect statements and behavioral signs - Depression - Hopelessness - Intoxication - Clinical diagnoses - Marital separation - Living alone - Bereavement - Unemployment - Health status - Impulsivity - Rigid thinking - Stressful events - Release from hospitalization - Lack of sense of belonging *When is a good time to asses for suicidal risk* - CBT has mood check and can ask with the mood check if they have had any suicidal thoughts - Previous history of suicidal or self-harm behavior - Severe depression - Looking at when there is change in depression as well - Increased hopelessness - Looking at when - Endorses suicidal items (2 & 9) on BDI - Check these items before the person leaves the session - Reports suicidal ideation - Vague comments about "not being around," "not coming back," etc. - Giving away important possessions - Composing farewell letters and making "good-bye" comments - Writing a will or note - An incongruous detachment, lifting of affect, and sense of peace - Putting financial and other business affairs in order - Abrupt cancellation of therapy session or other appointments *Risk Assessment Questions* - Formal measures - Increased depression or hopelessness - Think of mood check - Active/passive suicidal thoughts - Plan - Specificity - Availability (means to carry out plan) - Lethality - More specific and lethality = greater risk - Means - Availability - Intent - Can ask 1-10 what it is now and what the highest it was during the week - Deterrents - Is it just logistical (haven't required means, don't have the opportunity) - Coping resources - Using alcohol or drugs - Level of support - Acute life stressors - Evidence of recent attempts or gestures *Managing Suicidal Patients* - Set up monitoring plan for the patient - Motivate the patient for tx - Implement means restriction counseling - Create an effective crisis intervention plan - 4 M's (motivate, means, medicate, monitor) *Risk Management with Suicidal Patients* - Conduct a comprehensive examination of the patient at intake - Assess risk factors, mood, hopelessness, depression - If the patient is at risk, hospitalization should be seriously considered and only rejected in the event of a comprehensive safety plan - Review the level of risk a patient presents at particularly stressful times in the patient's life - Maintain accurate records that explain significant tx decisions and that clearly delineate reasons for rejecting hospitalization/discharge - Include the patient's family/friends in safety plans - Talk about where the client is at mentally and emotionally, what the client may need, how to best support them **[Know Weissberg's therapeutic targets for suicidal patients]{.smallcaps}** - Perceived burdensomeness - individuals who are suicidal over time often see themselves as a burden to others, "people are better off without me", won't use their social support network - Feelings of hopelessness - whatever emotional pain they are experiencing will never go away - Thwarted belongingness - Feeling lonely, isolated, estranged from others - Feelings of helplessness - Feeling you're trapped and you can't get out of it, nothing will improve problems - Emotional dysregulation and distress intolerance - Address with distress tolerance, develop communication strategies to improve one's relationships, CBT to address underlying beliefs **[Know the difference between no suicide contracts and safety planning type interventions and their effectiveness ]{.smallcaps}** - Safety agreements - No data that safety agreements are effective deterrents to suicide - No support for the idea that safety agreements reduce legal liability - Safety agreements should NOT be a substitute for comprehensive evaluation and tx plan - Safety agreements do NOT respect clients' autonomy nor contribute to favorable tx outcomes - Safety plans - Collaborative document that includes actions the client can use to help protect themselves - Should have warning signs, coping strategies, contacts for if they are in distress, health professionals they can contact **[Know Knapp's recommended components of safety plans ]{.smallcaps}** - 1\. Warning signs - 2\. Reasons for living - 3\. Distracting activities/coping strategies - 4\. Distracting contacts - Activities and coping strategies - 5\. Supportive contacts; - 6\. Professional contacts - Your number or alternative numbers - Crisis help lines and text lines - 7\. Ways to make the environment safe - Safety plan - Tailored to individual - Base it on their needs - Should be made collaboratively - Redundant protections - Multiple things they can do - Multiple contacts they can try to reach **[Know the requirements for involuntary commitment in PA ]{.smallcaps}** *Involuntary Examination and Tx (50 Pa. C. S. A. § 7301)* - Person must be "severely mentally disabled and in need of immediate tx" - Must pose "clear and present danger to others" demonstrated by either: - 1\. person is unable, without care...to satisfy his need for nourishment, personal or medical care, shelter, or self-protection and safety - 2\. person has attempted suicide and there is the reasonable probability of suicide unless adequate tx is provided - 3\. person has substantially mutilated himself or attempted to mutilate himself substantially and there is reasonable probability of mutilation unless adequate tx is provided *Involuntary Examination and Tx: 302 commitment -- 120 hours (50 Pa. C. S. A. § 7302)* - Petitioner states in writing why person is severely mentally disabled and needs tx - Delegate can order transportation to an approved facility for examination by a physician - If physician finds that person needs emergency tx, the facility can hold the person for 120 hours *Involuntary Examination and Tx: 303 Commitment -- up to 20 more days (50 Pa. C. S. A. § 7302)* - Requires a hearing to determine if tx needs to be extended - A MH review officer acts as judge and decides the case - Common Pleas Court judge must affirm the decision - Patient has right to counsel and right to appeal **[Know what APA and PA codes have to say about teaching, supervision, and research ]{.smallcaps}** *Teaching* - 7.01 Design of Education and Training Programs (Competence) - Psychologists responsible for education and training programs take reasonable steps to ensure that the programs are designed to provide the appropriate knowledge and proper experiences, and to meet the requirements for licensure, certification, or other goals for which claims are made by the program. - APA accreditation has many requirements for the curriculum that must be hit to keep accreditation (many of these relate to competency) - 7.06 Assessing Student and Supervisee Performance (Fairness) - a\. In academic and supervisory relationships, psychologists establish a timely and specific process for providing feedback to students and supervisees. Information regarding the process is provided to the student at the beginning of supervision. - b\. Psychologists evaluate students and supervisees on the basis of their actual performance on relevant and established program requirements. - 7.02 Descriptions of Education and Training Programs (Accuracy) - Psychologists responsible for education and training programs take reasonable steps to ensure that there is a current and accurate description of the program content (including participation in required course- or program-related counseling, psychotherapy, experiential groups, consulting projects, or community service), training goals and objectives, stipends and benefits, and requirements that must be met for satisfactory completion of the program. This information must be made readily available to all interested parties. - Information now much be clearly accessible on website or in student handbooks - 7.03 Accuracy in Teaching (Accuracy) - a\. Psychologists take reasonable steps to ensure that course syllabi are accurate regarding the subject matter to be covered, bases for evaluating progress, and the nature of course experiences. This standard does not preclude an instructor from modifying course content or requirements when the instructor considers it pedagogically necessary or desirable, so long as students are made aware of these modifications in a manner that enables them to fulfill course requirements. - b\. When engaged in teaching or training, psychologists present psychological information accurately. - 7.04 Student Disclosure of Personal Information (Respect/sensitivity) - Psychologists do not require students or supervisees to disclose personal information in course- or program-related activities, either orally or in writing, regarding sexual history, history of abuse and neglect, psychological tx, and relationships with parents, peers, and spouses or significant others except if (1) the program or training facility has clearly identified this requirement in its admissions and program materials or (2) the information is necessary to evaluate or obtain assistance for students whose personal problems could reasonably be judged to be preventing them from performing their training- or professionally related activities in a competent manner or posing a threat to the students or others. - Second part relates to competency - 7.05 Mandatory Individual or Group Therapy (Boundaries) - a\. When individual or group therapy is a program or course requirement, psychologists responsible for that program allow students in undergraduate and graduate programs the option of selecting such therapy from practitioners unaffiliated with the program. - b\. Faculty who are or are likely to be responsible for evaluating students\' academic performance do not themselves provide that therapy - 7.07 Sexual Relationships With Students and Supervisees (Boundaries) - Psychologists do not engage in sexual relationships with students or supervisees who are in their department, agency, or training center or over whom psychologists have or are likely to have evaluative authority. - Ethics - Competence - Fairness - Accuracy - Respect/sensitivity - Boundaries - General beneficence *Research* - 8.01 Institutional Approval (Informed Consent) - When institutional approval is required, psychologists provide accurate information about their research proposals and obtain approval prior to conducting the research. They conduct the research in accordance with the approved research protocol. - Independent body that determines research is safe for human participants - 8.02 Informed Consent to Research (Informed Consent) - \(a) When obtaining informed consent...psychologists inform participants about - 1\. the purpose of the research, expected duration and procedures - 2\. their right to decline to participate and to withdraw from the research once participation has begun - 3\. the foreseeable consequences of declining or withdrawing - 4\. reasonably foreseeable factors that may be expected to influence their willingness to participate such as potential risks, discomfort or adverse effects - 5\. any prospective research benefits - 6\. Limits of confidentiality - 7\. incentives for participation; and - 8\. whom to contact for questions about the research and research participants\' rights. They provide opportunity for the prospective participants to ask questions and receive answers. - \(b) Psychologists conducting intervention research involving the use of experimental txs clarify to participants at the outset of the research - 1\. the experimental nature of the tx - 2\. the services that will or will not be available to the control group(s) if appropriate - 3\. the means by which assignment to tx and control groups will be made - 4\. available tx alternatives if an individual does not wish to participate in the research or wishes to withdraw once a study has begun; and - 5\. compensation for or monetary costs of participating including, if appropriate, whether reimbursement from the participant or a third-party payor will be sought - 8.05 Dispensing with Informed Consent for Research (Informed Consent) - Psychologists may dispense with informed consent only... - \(1) where research would not reasonably be assumed to create distress or harm and involves - a\. the study of normal educational practices, curricula, or classroom management methods conducted in educational settings - b\. only anonymous questionnaires, naturalistic observations, or archival research for which disclosure of responses would not place participants at risk of criminal or civil liability or damage their financial standing, employability, or reputation, and confidentiality is protected; or - c\. the study of factors related to job or organization effectiveness conducted in organizational settings for which there is no risk to participants\' employability, and confidentiality is protected or - \(2) where otherwise permitted by law or federal or institutional regulations. - 8.04 Client/Patient, Student, and Subordinate Research Participants (Protecting student research participants) - a\. When psychologists conduct research with clients/patients, students, or subordinates as participants, psychologists take steps to protect the prospective participants from adverse consequences of declining or withdrawing from participation. - Don't want to be coercive - b\. When research participation is a course requirement or an opportunity for extra credit, the prospective participant is given the choice of equitable alternative activities. - 8.06 Offering Inducements for Research Participation (Recruitment) - a\. Psychologists make reasonable efforts to avoid offering excessive or inappropriate financial or other inducements for research participation when such inducements are likely to coerce participation. - b\. When offering professional services as an inducement for research participation, psychologists clarify the nature of the services, as well as the risks, obligations, and limitations. - 8.08 Debriefing (Debriefing) - a\. Psychologists provide a prompt opportunity for participants to obtain appropriate information about the nature, results, and conclusions of the research, and they take reasonable steps to correct any misconceptions that participants may have of which the psychologists are aware. - Able to contact investigator to get summary of research - b\. If scientific or humane values justify delaying or withholding this information, psychologists take reasonable measures to reduce the risk of harm. - c\. When psychologists become aware that research procedures have harmed a participant, they take reasonable steps to minimize the harm. - 8.07 Deception in Research (Deception) - a\. Psychologists do not conduct a study involving deception unless they have determined that the use of deceptive techniques is justified by the study\'s significant prospective scientific, educational, or applied value and that effective nondeceptive alternative procedures are not feasible. - b\. Psychologists do not deceive prospective participants about research that is reasonably expected to cause physical pain or severe emotional distress. - c\. Psychologists explain any deception that is an integral feature of the design and conduct of an experiment to participants as early as is feasible, preferably at the conclusion of their participation, but no later than at the conclusion of the data collection, and permit participants to withdraw their data. - Conclusion w that specific participant - 8.10 Reporting Research Results (Accurate reporting of research results) - a\. Psychologists do not fabricate data. - b\. If psychologists discover significant errors in their published data, they take reasonable steps to correct such errors in a correction, retraction, erratum, or other appropriate publication means. - Contact the publisher as soon as it becomes apparent - 8.12 Publication Credit (authorship) - a\. Psychologists take responsibility and credit, including authorship credit, only for work they have actually performed or to which they have substantially contributed. - b\. Principal authorship and other publication credits accurately reflect the relative scientific or professional contributions of the individuals involved, regardless of their relative status. Mere possession of an institutional position, such as department chair, does not justify authorship credit. Minor contributions to the research or to the writing for publications are acknowledged appropriately, such as in footnotes or in an introductory statement. - c\. Except under exceptional circumstances, a student is listed as principal author on any multiple-authored article that is substantially based on the student\'s doctoral dissertation. Faculty advisors discuss publication credit with students as early as feasible and throughout the research and publication process as appropriate. - 8.13 Duplicate Publication of Data (duplicate publications) - Psychologists do not publish, as original data, data that have been previously published. This does not preclude republishing data when they are accompanied by proper acknowledgment - 8.11 Plagiarism (Plagiarism) - Psychologists do not present portions of another\'s work or data as their own, even if the other work or data source is cited occasionally. - Ethics - Informed consent - Protecting student research participants - Recruitment - Competence - Not defined by code - Protection of vulnerable participants - Debriefing - Deception - Accurate reporting of research results - Authorship - Duplicate publications - Plagiarism **[Be familiar with research on supervision covered in your readings ]{.smallcaps}** *Six Fundamental Areas of Supervision Competency (Watkins, 2014)* - 1\. Supervision models, methods, and intervention - Supervisor should be competent in the models and skills in which they are supervising students on - 2\. Attending to matters of ethical, legal, and professional concern - You are responsible for the care so you should be aware of ethical issues when they come up - 3\. Managing supervision relationship processes - Form and maintain good alliance - Make good and constructive feedback - Good at setting goals - Setting good boundaries - 4\. Conducting supervisory assessment/evaluation - Appropriate and fair process - Formal/standard measures can be used for evaluation - 5\. Fostering attention to difference and diversity - Being effective multicultural supervisor - Making sure issues that pertain to identities are part of supervision - Sensitive to supervisees that have different backgrounds - Talk as multicultural issues emerge in the area - 6\. Openness to/Utilization of a self-reflective, self-assessment stance - We are always developing, learning, and growing - Be aware of areas we are doing well and areas of growth *The Supervisory Relationship (Pope & Vasquez, 2016)* - Clear tasks, roles, and responsibilities - Avoid multiple relationships - Client's welfare is primary - If conflicts emerge they should be addressed in an appropriate way - Shared agreement about day to day responsibilities and what days/times they are working - Shared understanding of what's expected - Set evaluation points - Competence - PA: post-doc supervisors must have a course or CE credit to be a supervisor - but NOT required for practicum - Assessment and evaluation - able to determine when supervisee is unable to do the clinical work - notification when a student has problems - student has to have opportunity to discuss concerns - supervisor provides information on what will happen for remediation - followup process post-remediation (for evaluation and giving feedback) - Informed consent - Let client know if trainee and who their supervisor is - Supervisor's job to make sure client doesn't misunderstand trainee's credentials - Sexual issues - Must have a safe space to discuss transference or countertransference - No sexual relationship with supervisees - Supervisee perceptions of supervisor's behavior - Actions and words should be consistent - Beginnings and endings, absence and availability - Prepare for next phase of training *Nondisclosure in Supervision (Ladany, et al., 1996)* - Supervisees reported an average of 8.06 nondisclosures (SD = 4.92) - Nondisclosures = supervisee is not telling supervisors something important - Nondisclosures were of moderate importance - 66% of nondisclosures were discussed with someone other than the supervisor - Over half of were to a friend or coworker - The more important the nondisclosures were, the less attractive/sensitive the supervisor was perceived to be and the less satisfied the supervisee was with supervision *Discussing Cultural Differences in Supervision (Gatmon, et al., 2001)* - Cultural differences were not discussed frequently in supervision - Supervisors and supervisees were more likely to discuss ethnicity and sexual orientation issues when there was a perceived match b/w supervisor and supervisee - Supervisees who discussed similarities and differences in ethnicity with supervisors rated higher working alliance with their supervisors - Supervisees who discussed similarities and differences in gender reported higher levels of satisfaction with supervision - Comfort comes from proactive discussion from the supervisor - Supervisees who discussed similarities and differences in sexual orientation reported higher levels of satisfaction with supervision and viewed their supervisors as more competent - There was a significant positive correlation between quality of supervisory discussions of cultural differences, working alliance, and satisfaction - No significant differences on working alliance and satisfaction between those who matched on cultural variables and those who did not **[Know criteria for IRB approval]{.smallcaps}** - 1\. Risks to participants are minimized - 2\. Risks to participants are reasonable in relation to anticipated benefits, and the importance of the knowledge that may reasonably be expected to result - 3\. Selection of participants is equitable - 4\. Informed consent will be sought from each subject - 5\. Informed consent will be appropriately documented - 6\. When appropriate, the research plan makes adequate provision for monitoring the data collected to ensure the safety of participants - 7\. When appropriate, there are adequate provisions to protect the privacy of participants and to maintain the confidentiality of data **[Know the types of unethical research practices ]{.smallcaps}** - Poorly designed studies - Hyperclaiming - Causism - Fabricating data - Data dropping - Misrepresenting data - Failing to report or publish research - Not properly crediting authors - Informed consent - 8.02 Informed Consent to Research - \(a) When obtaining informed consent...psychologists inform participants about - 1\. the purpose of the research, expected duration and procedures - 2\. their right to decline to participate and to withdraw from the research once participation has begun - 3\. the foreseeable consequences of declining or withdrawing - 4\. reasonably foreseeable factors that may be expected to influence their willingness to participate such as potential risks, discomfort or adverse effects - 5\. any prospective research benefits - 6\. limits of confidentiality - 7\. incentives for participation; and - 8\. whom to contact for questions about the research and research participants\' rights. They provide opportunity for the prospective participants to ask questions and receive answers. - \(b) Psychologists conducting intervention research involving the use of experimental txs clarify to participants at the outset of the research - 1\. the experimental nature of the tx - 2\. the services that will or will not be available to the control group(s) if appropriate - 3\. the means by which assignment to tx and control groups will be made - 4\. available tx alternatives if an individual does not wish to participate in the research or wishes to withdraw once a study has begun; and - 5\. compensation for or monetary costs of participating including, if appropriate, whether reimbursement from the participant or a third-party payor will be sought - 8.05 Dispensing with Informed Consent for Research - Psychologists may dispense with informed consent only - \(1) where research would not reasonably be assumed to create distress or harm and involves - a\. the study of normal educational practices, curricula, or classroom management methods conducted in educational settings - b\. only anonymous questionnaires, naturalistic observations, or archival research for which disclosure of responses would not place participants at risk of criminal or civil liability or damage their financial standing, employability, or reputation, and confidentiality is protected; or - c\. the study of factors related to job or organization effectiveness conducted in organizational settings for which there is no risk to participants\' employability, and confidentiality is protected or - \(2) where otherwise permitted by law or federal or institutional regulations. - Protecting student research participants - 8.04 Client/Patient, Student, and Subordinate Research Participants - a\. When psychologists conduct research with clients/patients, students, or subordinates as participants, psychologists take steps to protect the prospective participants from adverse consequences of declining or withdrawing from participation. - b\. When research participation is a course requirement or an opportunity for extra credit, the prospective participant is given the choice of equitable alternative activities. - Recruitment - 8.06 Offering Inducements for Research Participation - a\. Psychologists make reasonable efforts to avoid offering excessive or inappropriate financial or other inducements for research participation when such inducements are likely to coerce participation. - b\. When offering professional services as an inducement for research participation, psychologists clarify the nature of the services, as well as the risks, obligations, and limitations. - Competence - Protection of vulnerable participants - Debriefing - 8.08 Debriefing - a\. Psychologists provide a prompt opportunity for participants to obtain appropriate information about the nature, results, and conclusions of the research, and they take reasonable steps to correct any misconceptions that participants may have of which the psychologists are aware. - b\. If scientific or humane values justify delaying or withholding this information, psychologists take reasonable measures to reduce the risk of harm. - c\. When psychologists become aware that research procedures have harmed a participant, they take reasonable steps to minimize the harm. - Deception - 8.07 Deception in Research - a\. Psychologists do not conduct a study involving deception unless they have determined that the use of deceptive techniques is justified by the study\'s significant prospective scientific, educational, or applied value and that effective nondeceptive alternative procedures are not feasible. - b\. Psychologists do not deceive prospective participants about research that is reasonably expected to cause physical pain or severe emotional distress. - c\. Psychologists explain any deception that is an integral feature of the design and conduct of an experiment to participants as early as is feasible, preferably at the conclusion of their participation, but no later than at the conclusion of the data collection, and permit participants to withdraw their data. - Accurate reporting of research results - 8.10 Reporting Research Results - a\. Psychologists do not fabricate data. - b\. If psychologists discover significant errors in their published data, they take reasonable steps to correct such errors in a correction, retraction, erratum, or other appropriate publication means. - Authorship - 8.12 Publication Credit - a\. Psychologists take responsibility and credit, including authorship credit, only for work they have actually performed or to which they have substantially contributed. - b\. Principal authorship and other publication credits accurately reflect the relative scientific or professional contributions of the individuals involved, regardless of their relative status. Mere possession of an institutional position, such as department chair, does not justify authorship credit. Minor contributions to the research or to the writing for publications are acknowledged appropriately, such as in footnotes or in an introductory statement. - c\. Except under exceptional circumstances, a student is listed as principal author on any multiple-authored article that is substantially based on the student\'s doctoral dissertation. Faculty advisors discuss publication credit with students as early as feasible and throughout the research and publication process as appropriate. - Duplicate publications - 8.13 Duplicate Publication of Data - Psychologists do not publish, as original data, data that have been previously published. This does not preclude republishing data when they are accompanied by proper acknowledgment. - Plagiarism - 8.11 Plagiarism - Psychologists do not present portions of another\'s work or data as their own, even if the other work or data source is cited occasionally. **[Know APA guidelines for determining authorship credit ]{.smallcaps}** - 8.12 Publication Credit - a\. Psychologists take responsibility and credit, including authorship credit, only for work they have actually performed or to which they have substantially contributed. - b\. Principal authorship and other publication credits accurately reflect the relative scientific or professional contributions of the individuals involved, regardless of their relative status. Mere possession of an institutional position, such as department chair, does not justify authorship credit. Minor contributions to the research or to the writing for publications are acknowledged appropriately, such as in footnotes or in an introductory statement. - c\. Except under exceptional circumstances, a student is listed as principal author on any multiple-authored article that is substantially based on the student\'s doctoral dissertation. Faculty advisors discuss publication credit with students as early as feasible and throughout the research and publication process as appropriate. **[Know APA record keeping guidelines]{.smallcaps}** - Complete records are maintained for a minimum of 7 years after last contact - Philadelphia law says 5 years only - If the client is a minor, the period is extended until 2 years after the age of majority or 5 years after (whichever is longer) **[Know HIPAA rules and what PHI is ]{.smallcaps}** - 4 major rules: - Privacy rule (4/14/03) - focuses on when and to whom confidential info can be disclosed - Transaction rule (10/16/13) - addresses technical aspects of electronic health care transactions process and requires the use of standardized formats whenever health care transactions, such as claims, are sent or received electronically (compliance date: October 16, 2003). - Security rule (4/20/05) - focuses on the healthcare provider's physical infrastructure to ensure confidentiality of patient information - The Security Rule seeks to assure the security of confidential electronic patient information. For psychologists, this usually means addressing administrative, physical and technical procedures such as access to offices, files and computers, as well as the processes a psychologist uses to keep electronic health information secure (compliance date: April 20, 2005). - Final rule (9/23/13) - modifies privacy rule; enforces penalties, new rules re: breach notification and notices and business associate agreements - PHI - Information related to the past, present, or future physical or mental health condition of an identifiable individual, the provision of such health care to such an individual, and to the past, present, or future payment for the provision of health care to such an individual **[Know HIPAA distinctions between PHI and Psychotherapy Notes ]{.smallcaps}** - PHI - Information related to the past, present, or future physical or mental health condition of an identifiable individual, the provision of such health care to such an individual, and to the past, present, or future payment for the provision of health care to such an individual - Psychotherapy notes - Notes recorded by a MH care professional that documents or analyzes contents during a private counseling session or a group, joint, or family counseling session (must be separated from the rest of the patient's medical record) **[Know guidelines on advertising ]{.smallcaps}** - Business cards, website, blog, social media - Network with colleagues and referral sources - Reach out to local associations, community groups - E.g., presentation for local YMCA (how to control stress) - Build a professional support system - Reach out and try to build consultation groups - Prevent burnout - Discuss difficult situations - Join your local and state psychological associations **[Know what APA and PA codes have to say about business issues]{.smallcaps}**