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Chapter 5

PSYC32 Chapter 5.docx

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University of Toronto St. George
Michael Inzlicht

Chapter 5: Issues in Clin Neuro Practice Case: • Tom had a mild TBI, no loss of consciousness, but a concussion (car hitting him as a pedestrian) when he was 16, now 22 • Being tested for residual effects (bc trying to enlist in military, therefore third-party referreal from the military) • Chaotic family life • Npsy test showd no residual effects Ethical Issues in Clin Neuro Practice th • APA’s Ethical Principles of Psychologists and Code of Conduct, 2002 = the 10 ethics code adopted by the APA o To protect rights and make sure no unintentional harm of public, by pscychologists o For all psychologists, including clin neuro, who are members of the APA are bound by this code o For both in-person and other forms of interaction w/ public (mail, email, etc) • This code of conduct contains 3 components: o 1)Preamble: describes the code + its use o 2)General Principles = aspirational goals to guide psych’ists to the highest ideals of psych  1-Beneficence + Nonmalfeasance  2-Integrity  3-Fidelity + Responsibility  4- Justice  5- Respect for Peoples’ Rights and Dignity  These principles are not sanctionable or enforceable rules o 3)Sanctionable Ethical Standards, has 10 major sections:  1-Outlines the procedures for resolving ethical issues or complaints • Guidelines for reporting the issue, with the first step being to talk with the offending person • If this does not work, or if for some reason they are scared for talking to the psychologist, they can talk to their supervisor, and if not that, the board of psychology • Sequence of reporting is similar regardless of whether the psychologist themself receives the complaint or if someone receives a complaint about another psychologist • This section includes sanctions for psychologists who pursue others to make improper complaints + stipulations against retaliation for making a complaint  2-The idea of providing services only in one’s area of competency • i.e. someone who is not trained as a clin neuropsychologist should not administer neuropsych tests and make recommendatiosn about the person’s life • Pope + Brown defined competence as 3 components: o Knowledge o Technical skills o Emotional competence (i.e. if they neglect their own self- care, they may be more likely to disrespect pt’s feelings, let dysphoric mood interfere, or make clinical mistakes) • Also, competence w/ regards to other cultures, LGBTQ, etc. is recommended and APA has specific guidelines exist for these groups • also, making sure that one’s personal problems do not affect their professional judgement + abilities o i.e. could be found guilty of impaired judgement if say someone going through a divorce was helping a pt in a divorce sit’n  3- Standards related to human relations • Provisions directing them to avoid discrimination, sexual harassment, or exploitative relationships • Dual relationships = the term for having 2 simultaneous relationships with a client = this is also highly discouraged o i.e. to be both a clin neuro for a person and an employee of the court that is involved in their MVC suit o bc objectivity is lost • this section also addresses third party referrals/requests for info (like in Tom’s military sit’n) and the limits of confidentiality in this sit’n • also talks about how to obtain informed consent for assessment, therapy, rehab  4-Pricacy + Confidentiality • Confidentiality, use of disclosures, and consultations are discussed • Everything stays confidential btwn client and psy’ist, unless suicide, homicide, child abuse (client = victim or perpetrator), abuse of a vulnerable adult (client = victim or perpetrator) • For clients under 18 (and vulnerable adults who cannot give their own consent and have a legal guardian) the parent/legal guardian can have access to the content of therapy and/or records o And the client must be informed that this is the case • Mandated reporters = suspected child abuse, etc. MUST be reported by the psy’ist and it is suggested that every psy’ist be aware of specific abuse laws in their state • Privileged communications= the limited right to withhold info from a court (if psych-pt confidentiality) o Again, this depends on specific state laws • Clin Npsy’ists are more likely than other psy’ists to be involved in forensic issues o They will probably have to testify about a client at least once in the course of treatment • Neurolaw = a new field of jurisprudence that arose in 1991 that synthesizes npsy, med, rehab, law (especially relevant to TBI)  5- Advertising + Other Public Statements • No false/deceptive advertising, presentations, testimonials, or any other forms of solicitation • Psy’ists are limited in their advertising to their highest degree received, their practice specialties, and the insurance companies for whom they are providers  6- Record Keeping + Fees • Record keeping = use, storage + maintenance of client records + data • HIPPA = Health Insurance Portability and Accountability Act = at the federal govn’t lvl (therefore carries the force of the law), this protects client privacy, particularly as it pertains to advances in biotech and comm. tech o Related to record-keeping, informed consent, psychotherapy notes, forensic services, psych testing  7- Education + Training • Ensures the presentation of materials in classes, etc. is done in an unbiased manner • Also includes topics of sexual harassment, exploitation, etc. of students by peers, faculty  8- Research + Publication • Conditions for conducting research • Consent • Treatment of both human + animal subjects • Debriefing • Publication issues related to credit for participation in research and the provision against plagiarism  9- Assessment • Current tests need to be used w/ appropriate norms for the pop’n tested o If longitudinal study, older forms of tests may be used • Translated tests should be used if needed and if a translated version does not exist an ethical decision must be made • Right of the client to view and understand the results of the testing • If child/vulnerable adult, testing must be explained to both client + guardian  10- Variables involved within Therapy • Structure of therapy w/ the roles of therapist and client are described • Various forms that therapy can take are described (individual, couple, etc.) with a focus on who is the therapy client in each of these cases • Sexual intimacy w/ clients are clearly banned in this section • Also, therapist should not have friends, relatives, or former intimate partners as clients due to the lack of objectivity they would have • Some state licensing boards (also called boards of psychology) (where ppl can get a license to practice as a clinical psychologist, etc.) also adopt the ASPPB: Association of State and Provincial Psychology Boards’ code of conduct • These boards grant licenses on the basis of adequate edu, training, a certain # of supervised clin hours, must pass the EPPP (= Exam for Professional Practice in Psych) o Valid for a set number of years and must be renewed • Also, in some states, psychologists must complete CEU = Continuing Edu Credits (designed to make sure that one has a current knowledge of psy theory + research) • Members of these state boards are mainly appointed by the Governor o Mainly composed of psychologists but there must be at least one member of the general public o The members are basically volunteers as they receive very little compensation o They decide what sanctions to give a psychologist who has committed an ethical violation • STPAs (State, provincial, territorial psych associations, such as APA) are different from boards of psych o Their goal is usually less to protect the public and more to promote the sci and app of psych o They protect psychologist in various employment situations and offer ethical advice o They only have jurisdiction over members of them, not over all licensed psychologists o Ethics committees are able to disciple members of the association though, or to remove them from the association, or to suggest eduction o They can also refer issues to boards of psychology • First ethical code = Hippocratic code • Ethics code is not the same as laws • In the case in which the ethics code is the higher standard of conduct, you must abide by that • If there is ever a conflict btwn the code, board of psych req’s, and the law, the psychologiest is supposed to inform all parties about the conflict and their commitment to the code above the others o Being ethical is not always the same as being legal o Positive ethics = thinking of ethics as a way to promote pt welfare, as opposed to a way to avoid disciplinary actions Sanctions for Violation of Ethical Principles: • APA made the code of conduct but sanctions are administered by state boards of psych o Each state board may vary somewhat regarding their interpretation of APA’s code • Minor ethical violation  discussion with the board of psych regarding whether they were cognizant of the violation or not o Lack of awareness is not a legitimate defense but education (attend a class or read the lit and then explain to the board) is often the sanction in this scenario o Ex. Making a racist/sexist remark without realizing it would be construed that way • Next level of severity  o Could cause the psy’ist to not be allowed to practice in a particular area until overcome the reason for the inappropriate behv  = restriction of practice o Ex. Personal issues, like having a person w/ TBI in your family while being a clin npsy’ist working w/ ppl w/ TBI and having this influence your objectivity  Sanction = board may require that they don’t work w/ TBI clients until the appropriate issues have been resolved • Most serious violation  o Board could remove their license to practice o Sexual assault, sexual relations, conviction of any felony (whether related to their professional duties or not!) Availability of Resources • Psy services are often reimbursed by insurance or other programs (i.e. military paid for Tom’s) • Often ppl even w/o insurance or w/ limited insurance can still receive services through gov’nt agencies Δ1: Private Insurance Programs • Clin npsy’ists should be aware of the differences btwn various insurance policies • Also, some states require insurance vendors to provide coverage for certain services • Insurance carriers must maintain HIPAA compliance • Many insurance companies require a written referral by the physisican • In some circumstances, the receptionist may deal directly w/ insurance company if a client does not understand their coverage Δ2: Govn’t Programs • If no insurance, underinsured, or no coverage for a specific service even w/ a physician’s referral, various govn’t programs can help w/ financing • M
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