Advanced Ethics and Law Review

1. Advanced Ethics and Law Review Samuel Knapp, EdD, ABPP John Gavazzi, PsyD, ABPP

2. About the Presenters • John works as a psychologist in central Pennsylvania and enjoys ethics education as his main hobby. Go to www.ethicalpsychology.com for more info. • Sam has a collection of Pittsburgh Pirate baseball cards, including a Bill Mazeroski rookie card.

3. WORKSHOP DESCRIPTION • This advanced workshop will review the most common, difficult ethical or legal issues faced by psychologists. • These often occur in the areas of professional boundaries, confidentiality, licensing law, competence, and informed consent. • This workshop, which assumes a basic understanding of ethics and Pennsylvania’s laws, will involve collaborative learning exercises, and participant interaction.

4. LEARNING OBJECTIVES Participants will be able to known basic information about common problems areas such as: • Protecting professional boundaries; • Interpreting the licensing law; • Determining limits of competence; • Ensuring informed consent; and • Other areas of ethical difficulty.

5. Warning! The presenters may, however, inadvertently, inject positive ethics and/or humor into the presentation.

6. Blooms Taxonomy • Knowledge- basic facts • Comprehension- understanding basics • Application • Analysis- what principle does it reflect? • Synthesis- how does it interact with other standards or rules? • Evaluation– what is its value or worth?

7. FORMAT We start with easy questions, but then go to less easy questions, and finally to difficult questions. In part the goal is to convey factual information, in part the goal of today is to provide you the opportunity to ask questions.

8. SAMPLE QUESTION The goal of ethics education is to ensure that participants are: • frightened • classically conditioned to avoid future ethics presentations • More vigilant about catching their fellow psychologists doing unethical things • None of the above

9. EASIER QUESIONS Which is TRUE about continuing education? a. Psychologists must receive 30 hours of CE every renewal period. b. APA programs can offer CE programs acceptable to the State Board of Psychology c. Teaching or writing can, under some circumstances, qualify for CE d. All of the above

10. FACT The most common reason that psychologists get disciplined by the PA State Board of Psychology is for their failure to complete mandated continuing education requirements.

11. Records Dr. Dora Copperfield wants to get rid of her old patient records. The State Board of Psychology requires that she keep the records for a minimum of _______ years since the last patient contact. a. 3 b. 5 c. 7 d. 10

12. FACT Often insurance contracts require psychologists to keep records for 7 years. Medicare Advantage plans require psychologists (and other health professionals) to keep records for 10 years after the last patient contact.

13. Which are NOT true? Psychologists must • Keep patient records for at least 5 years • Retain the raw data which includes the basis for which test results were obtained • Plan for the disposition of records in case of their death or disability • Give copies of test materials to anyone who has a sincere interest in getting them

14. STATE BOARD OF PSYCHOLOGY The rules and ethics of the State Board of Psychology apply to all graduate students preparing to become psychologists TRUE FALSE

15. DISCIPLINE The most common reason nationwide for psychologists to be disciplined by a licensing board is: • Breaches of confidentiality • Boundary violations • Incompetent practice • Failure to get mandatory continuing education

16. BOUNDARIES The APA Ethics Code says that multiple relationships are inherently unethical TRUE FALSE

17. Boundaries and Bloom’s Taxonomy Knowledge: Multiple relationships are unethical if exploitative or clinically contraindicated Comprehension: You know what exploitative and clinically contraindicated mean Application: You can apply that principle in a particular case with a particular patient

18. Boundaries and Bloom Analysis/synthesis: We can see how the boundary issue could impact parts of therapy Evaluation: You value the principles or sentiment behind this rule because it coincides with your belief in promoting the well-being of patients and/or avoid harming them

19. BOARD REGULATIONS The PA State Board of Psychology requires psychologists to adhere to all of the guidelines of the American Psychological Association. TRUE FALSE

20. LICENSING The State Board of Psychology can deny a license to any individual who lacks acceptable moral character. TRUE FALSE

21. APA ETHICS CODE The APA Ethics Code applies to all professional work of a psychologist including telehealth services TRUE FALSE

22. Working with Childrenand Adolescents Competence

23. Adolescents Estelle Havisham, a troubled 14 year old, wishes to seek mental health treatment on her own. According to PA law she: • Can seek treatment upon her own consent • Needs the consent of at least one parent • Needs the consent of both parents • Needs consent of both parents if there is a court order of joint legal custody

24. Adolescents In PA a child may consent to mental health treatment if he or she • Is emancipated • Has graduated from high school • Is 14 years old or older • All of the above

25. Children & Adolescents In Pennsylvania a child at any age can seek treatment for drugs or alcohol problems without parental consent. TRUE FALSE

26. Children & Adolescents A psychologist needs the consent of both parents to treat a child under the age of 14 if the parents • are divorced • Do not agree on the need for treatment • Have a court order of joint legal custody • Are not married

27. FACT The last question was tricky. Although most parents get a court order of custody when they get divorced, not all do. The clear bright line on whether to get the consent of both parents when a child is under the age of 14 is whether there is a court order of joint legal custody

28. Children & Adolescents Dr. Bronte received a referral from Children and Youth Services to treat a child. Dr. Bronte may assume • Children and Youth has the legal power to consent to treatment • A judge has ordered treatment • A Guardian Ad Litem must consent • None of the above

29. COMPLEX CASE Child tells a psychologist that she is 14 years old and requests treatment. In good faith the psychologist believes her and starts treatment. The child appears cognitively capable to give consent and participate in treatment. Only later does the psychologist learn that the child is, in fact, under the age of 14 and not legally able to consent to treatment on her own.

30. Discussion In this situation, the psychologist • Would be liable for violating the law • Would not be liable because the child misrepresented her age and the psychologist had no reason to doubt her representation Let’s talk about the law and your practice policies.

31. STATE BOARD OF PSYCHOLOGY When faced with an ethical issue it is useful to call the State Board of Psychology to get an opinion on how to proceed TRUE FALSE

32. STATE BOARD OF PSYCHOLOGY Psychologists being investigated by the State Board of Psychology retain their Constitutional rights prohibiting self-incrimination and the right to an attorney. TRUE FALSE

33. STATE BOARD OF PSYCHOLOGY The function of the State Board of Psychology is to • Protect psychologists • Protect the public • Provide advisory opinions • Both a and c

34. ABANDONMENT Did Dr. Wilkins abandon a patient is she: • was so busy that he did not have time in his schedule to see a patient in a crisis? • Took a vacation and did not arrange for back up coverage? • Terminated a patient who needed more treatment and did not give a referral? • All of the above

35. Competence Dr. Dickens, an experienced adult therapist, wants to expand his work so that he will be working with more older adults. Dr. Dickens can be assured he is competent by • Taking CE courses • Doing readings on his own • Having his work reviewed by someone with proficiency in working with older adults • Taking a graduate course in geropsychology

36. What Do We Know about Competence? Which of the following are true? • Experts estimate that the half –life for psychological knowledge is less than 9 years. • Being disciplined by the State Board of Psychology increases with age • Some studies show that older psychologists have poorer outcomes than younger psychologists • All of the above

37. Cultural Competence Cultural competence can be enhanced by • Readings • Workshops • Supervision or consultation • All of the above

38. Competence Bias Did you know ….. • 25% of psychotherapists rated themselves in the top 10% of all psychotherapists AND • No one rated themselves in the bottom 50% Walfish, S., McAlister, B., O’Donnell, P., & Lambert, M. J. (2012). An investigation of self- assessment bias in mental health providers. Psychological Reports, 110, 639-644.

39. Competence & Self-Reflection Studies with health care professionals have shown implicit (unrecognized) biases among some health care professionals against patients who are: • Non-White • Over weight/Obese • Less attractive • More attractive • Women

40. Competence Biases There is even evidence of a bias blind spot (whereby individuals view themselves as less biased than others).

41. Competence and Bloom Knowledge: Some psychologists take precautions against competence slippage Comprehension: I understand what competence slippage is Application: I keep up with reading, attend meaningful CE programs, consult with peers, and seek out opportunities to stretch my knowledge

42. Competence and Bloom Synthesis/Analysis: I look at my specific areas of work and try to ensure that I do not fall behind in any of them Evaluation: Maintaining competence is consistent with my value of being a beneficent healer

43. APA Ethics Code The APA Ethics Code requires psychologists to: • Document informed consent • Have patients sign an informed consent document • Always get informed consent at the start of treatment • All of the above

44. FACT The APA Ethics Code requires that psychologists document informed consent. One way to do so is to have patients sign an informed consent agreement, although the APA Ethics Code does not specifically require this.

45. APA Ethics Code The APA Ethics Code prohibits • Sex with current patients • Sex with close relatives of current patients • Psychotherapy relationship with former sexual partners • All of the above

46. APA Ethics Code The APA Ethics does not require informed consent for • Archival research • Naturalistic observations • Evaluation of ordinary educational practices • All of the above

47. DIFFICULT QUESTIONS The laws and standards of the State Board of Psychology provide all the answers we need to have for issues that confront us in our professional work. TRUE FALSE

48. Problem Family Dr. Barkus was named in a court order stating that he was to perform parenting education with a couple who were going through a stressful divorce.

49. Problem Family Before accepting this arrangement, it would be prudent for Dr. Barkus to clarify: • what is meant by parenting education • What the court expects concerning release of records • The payment arrangements • All of the above

50. High Conflict Family Psychologists working with high conflict families are advised to • Get informed consent agreements in writing • Clarify that they will not provide custody recommendations • Allow themselves the option to charge for all extra therapy contacts • All of the above