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ethical codes and criteria to report patients if a person is a threat to himself or someone
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Life endangering patients If A Person Is A Threat To Someone Else
HIV/ INFECTIOUS DISORDERS Child abuse
“Therapists’ No. 1 concern for clients is safety,” said Walwyn-Duquesnay. “Not only are therapists responsible for creating a safe therapeutic environment, they also work to make sure that clients take care of themselves and the people around them on a daily basis.” • And in the event that they have to report something, they are simply doing what they are required to do by law. • “If a therapist fails to take reasonable steps to protect the intended victim from harm, he or she may be liable to the intended victim or his family if the patient acts on the threat,” Reischer said.
Reporting of HIV/ infectious disorders • Is there any law?? • What does a state law say?? • What has happened if there’s no law any negligence reported ??? VandeCreek and Knapp (2001) were unable to find any cases in which mental health professionals were found negligent for failure to report HIV/AIDS infection.
Steps to be followed • - Identify or Scrutinize the Problem • Sometimes patients who are HIV positive present a concern because they may engage in behaviors that place others at risk for acquiring the infection. Consequently, there is an apparent conflict between general beneficence and beneficence with respect for patient autonomy. • Assessing the degree of risk requires an understanding of the seriousness/ status of the patient
An Anxious Psychologist • The patient picked up on the high anxiety of the psychologist • feared a compromise in her confidentiality • Quits therapy • cause psychologists to focus so much on protecting third parties that they fail to focus adequately on the needs of the patient. • become fixated on warning or jump to the first just-good-enough solution without considering all
Develop Alternatives or Hypothesize Solutions • consider treatment options designed to diffuse the danger and to implement that plan. • Psychologists who understand the psychological aspects of HIV/AIDS infection are best able to make interventions designed to address the danger. • And may be more inclined to consider other therapeutic options before even thinking about warning an identifiable third party. • when permitted by law, warning an identifiable third party should be a last resort, used only when all reasonable efforts at a voluntary disclosure have failed.
Contd. • Has the psychologist given adequate time to allow psychotherapy to work? • Does the psychologist understand why the patient is reluctant to disclose? • Patients may fear abandonment, social rejection (Kozlowski, Rupert, & Crawford, 1998), or abuse. • Effective treatment needs to address these fears.
Evaluate or Analyze Options • Warning an identifiable third party without the consent of the patient would be done rarely, even if permitted by state law. If the decision is made to warn an identifiable party, it is prudent, if feasible, to minimize harm to the offended principle of respect for patient autonomy • combine the advantages of the different options considered in the second step and attempt to involve the patient in the decision making.
Act or Perform and Look Back or Evaluate with aggressive patients, • it is important to ensure that the treatment plans are being implemented as intended. • It is also important to reconsider the effectiveness of the interventions and modify them as needed.
Psychologists encounter other difficult situations in which the life or welfare of patients is at risk. • Perhaps the most common situation that psychologists encounter, however, involves children who are suspected of being abused. • States’ child protective service law requires professionals to report suspected child abuse
Psychologists should be aware of at least three important features of the child protective services law in their state: • how their state defines child abuse, • the conditions that activate the duty to report, • and the definition of a perpetrator of child abuse.
Definition • definition of child abuse varies from state to state, But most include • non accidental injuries, • neglect, • emotional abuse, • and sexual abuse.
Conditions for reporting • some states the duty to report under the child protective services law only applies when the child victim comes before the psychologist in a professional capacity. In other words, professionals may not have a duty to report under the child protective services law if only the alleged perpetrator has come before them in therapy.
definition of perpetrator • every state, the guardians or parents of the child could qualify as perpetrators under the child protective services law. • Other states include teachers, • babysitters, • paramours of parents, • or live-in adults in the definition.
Despite the positive goals of child-abuse-reporting laws, they can create a barrier to effective therapy if parents view the psychologist primarily as a punitive agent who is required to report them. • Psychologists can minimize the negative influence of these laws by informing patients of the confidentiality limitations before starting treatment.
other steps to minimize the harm to the therapeutic relationship. • For example, if possible, • may be helpful to discuss with the family the necessity to file a child abuse report and • to obtain their consent before filing the report. • the family should call the child welfare agency, • or the psychologist can call with the family present. The effort to clarify what was done and why it was done may minimize damage to the relationship.
An Ill-Informed Psychologist • ignorant of the law • caused the psychologist to report behavior that should never have been reported. • the patient never returned for treatment.
EXAMPLE • A highly motivated patient revealed that he had physically abused his son several years earlier. On hearing this, the psychologist immediately reported the patient to the child protective services. However, the psychologist was not aware that the standards for physical abuse in his state required that the abuse had to have occurred within the last 2years. The report was unfounded, and the patient never returned for treatment.
