Transcript From Beginning to Ending: Ethics, Procedures

From Start to Finish: Ethics, Procedures
& Perplexities of Working with Children
Marolyn Morford, Ph.D.
Center for Child & Adult Development
State College, PA
Shirley Woika, Ph.D.
School Psychology Faculty, Penn State University
University Park, PA
Association of School Psychologists of Pennsylvania
Fall Conference, Wednesday, October 23, 2013
State College, PA
Introduction
No matter where in the process, working
with child clients creates questions in our
minds: Who can give me permission to
see the child? Who can see the records?
Who can attend evaluation or treatment
sessions? Is anything confidential? When
should I speak with CYS about concerns?
Objectives
This workshop will help you to work more
confidently with children and their parents
or caregivers from the first session to
destruction of the records and final
discharge.
You will also understand similarities and
differences between psychologists and
school psychologists regarding many of
the concerns that arise in working with
children.
Dr. Small-Town sees a family for therapy.
This family refers another family (friends of
theirs) for therapy. The family friends
begin seeing her, also. The referring parent
asks at the next session if the other family
has begun seeing her yet.
Ethical models and their problems
Rational and irrational decisionmaking
Unnecessary dichotomy
This presentation will try to
emphasize process vs. right/wrong
Practice Ethically & Avoid Pitfalls
Question – What is your role? What will you be
addressing?
Inform – Procedures, payment, informed
consent for child and parent
Communicate – Involve parents along the way.
Make sure everyone knows and approves.
Consult – Any concerns? Review and consult
colleagues.
QICC
Cases can turn forensic quickly!
If you find yourself with concerns
Describe the situation
Consult ethical/legal guidelines, district
policies, peers/supervisors
Consider Consequences
Decide, document, then take action
D-C-C-D
Good ethical decisions are..
Principled – based on ethical principles
Reasoned – action is a reasoned
outcome based on consideration of the
principles involved
Universalizable – the psychologist would
recommend the same course of action to
others in a similar situation
(Haas and Malouf, 1989)
And yet
“...few models have been theoretically
grounded or empirically validated.”
.ethical knowledge does not
necessarily result in ethical behavior
Rational models of cognition fail to
capture the reality of human decisionmaking
from summary in Rogerson, et al., 2011, p. 614)
Consider this position
Moral/ethical judgments are made
similar to perceptual judgments,
“intuitively”, and are followed by
moral reasoning that justifies the
decision. (Haidt, 2011, In Rogerson, et al. 2011, p. 615.)
If we can acknowledge the irrational,
affective processes at work, instead of
trying to diminish them, we may be
able “to take more responsible actions
in the face of uncertainty” avoiding
“subjectivity, bias, and rationalization”
in our models. (Rogerson, et al. 2111, p. 614)
Uncertainty encourages thinking
shortcuts
Availability heuristic – info comes to
mind easily (overestimate deaths from
air crashes vs. car crashes or stomach
cancer). Problem: more memorable or
easily accessed info is not necessarily
more likely to occur
Avoidance of 'hindsight regret' –no action:
fear of not choosing the right option
overcomes the fear of doing nothing.
Passively accepting the frame in which a
problem is presented: e.g., 2-fold increase
in incidence of a disease that is very rare;
sharing test info knowing that 1/100 will vs.
99% won't sue.
Confirmation bias – bias toward initial
impressions
Affect heuristic/bias – acting on basis
of affective response to individual,
rather than facts of the situation
(loyalty, preference, may be more
influential than ethical principles)
Many heuristics do work to save us
time and, often, because of the nature
of those in the profession, we make
good judgments.
But sometimes we don't make good
judgments as a result of biases and
inconsistencies (Rogerson, et al. 2011, p. 619.)
Dr. Room-Mother began seeing a boy when
the child was a Kindergartner. The child
has changed schools and is now in Dr. RM's daughter's 1st grade class. Dr. R-M is
the 1st grade classroom's "room mother"
and at a holiday party her patient tells his
class he knows her and sees her for
“therapy.” The other kids ask Dr. R-M why
the child goes to therapy.
Ethical dilemmas we face daily can
sometimes be resolved by referring to
legal decisions and sometimes by our
professions' ethical guidelines.
Sometimes we are in uncharted water
and must be aware of the complexity
of our own ethical decision making
processes.
Real life practice with children brings up
a lot of questions and unforeseen
scenarios.
Starting from the beginning...
Before Treatment: The phone
referral
Who is calling? Who wants you to see the
child?
One parent or both? Pediatrician?
Grandparent? Stepparent? Parent's
attorney? Agency? Judge (through a
court order)?
Why is this important?
Why is it important as a
psychologist to make sure you have
permission of all legal guardians to
see the child?
What are the problems with getting
these permissions?
Who will be bringing the child to the
appointment?
Whose permission must you have to
treat or assess?
What you need to know
Does the referral source have legal
custody?
Legal vs. physical custody
Joint/shared vs. sole custody
Obtain documentation of legal
custodian(s) permission. See handout
“Agreement for Assessment/Treatment
of a Minor”
May need to ask if other parent's rights
terminated
Obtain copy of custody order or
agreement
Permission/Consent to
Evaluate &Treat
How to obtain permission from both/all
legal guardians
 I've been separated for 18 months and have
custody.
 He's never contributed anything for her.
 She is on my current husband's insurance.
 He saw a social worker last year and he
didn't ask for her mother's permission.
Permission/Consent
What about a missing parent/guardian?
If an absent parent cannot be found and
there is a reasonable belief that the
present parent is telling the truth, then
treat the child. Be sure to document
date/time of your request, the guardian's
statement and whether it was verbal or
written.
Consent and Assent
Consent is permission to assess specific
issues, obtain/document additional areas of
evaluation or treatment – true for clinical
psychologist and school psychologist
Informed Consent means they know what
they are giving consent for
Assent means indication of understanding &
agreement from a minor (too young to
consent) or anyone who cannot give consent.
Treatment begins: Expand your
Informed Consent
Verbal vs written
Do your best to make your role clear
– Therapist vs Custody Evaluator vs
Reunification Therapist vs Parent
Coordinator vs ?
Developmental Informed Consent to child
 Tailor to age/comprehension level
 Sample Child Informed Consent
Example: Consent to treat
The psychologist calls an absent parent to ask
permission to treat. Parent says, “you
psychologists are all quacks, psychology is a
waste of time, you only want money, I don’t care
what you do as long as I don’t have to pay for it.”
Psychologist paraphrased: “You don’t care as
long as you don’t have to pay,” Parent said “Yes.”
Psychologist documented event and treated
child.
(Ex. Provided by S. Knapp, Ed.D.)
More about Informed Consent
Psychologists are required to get consent
and document this.
They are not required to get a signature.
Example: Consent to Treat
Although Parent A initiated treatment, Parent B
brought the child in for therapy several times,
then complained to the Board that he never gave
his consent. The Board did not accept the
complaint: bringing the child in was implied
consent. (Ex. Provided by S. Knapp, Ed.D.)
Although consent can be verbal, best to have it in
writing.
Evaluating the Referral
Factors to consider in Pennsylvania: Age, Legal
Custody, and Law (Act 147)
Age/Legal custody => See Decision Tree for
guidelines regarding who can give consent for
treatment
Act 147 =>Age – 14 or older may consent.
Parents may consent for the child up to age 18.
Other – High school graduate, married,
emancipated may consent to own treatment or
treatment for drugs/alcohol
Age of Minor
Court order of Can minor
shared legal consent?
custody?
Can one
parent
consent to
treatment of a
minor
in absence of
minor's
consent?**
Less than 14
Yes
No
Unclear, but
highly unlikely*
Less than 14
No
No
Yes
14 or older
Yes
Yes (allowed,
but not
mandated)
Unclear, but
highly unlikely*
From Knapp, S., Baturin, R. L., & Tepper, A. M. Questions and Answers About
Parental
Consent and No
Treatment of Minors (retrieved
14 or older
Yes from PPA website
Yes 3/2/2013)
Dr. Young met with a 17 y.o. male client and his
father for an initial consultation. When Dr. Y
spoke with the client alone, he indicated that he
felt forced into treatment by his father and that
he did not want to be in therapy at all. His father
acknowledged they had argued previously
about this and knew that his son did not want
to be in treatment. Dad noted, however, that his
son was highly avoidant, and that, in the past,
forcing him to do things helped him get over his
initial anxiety regarding new situations.
School Psychologists
and Consent
In SCHOOLS, permission is required from
only one parent to conduct an evaluation
(different from service delivery).
What if the parents are divorced?
What if one parent signs the permission
form and the other objects?
What if one parent grants written
permission while the other objects in
writing?
Consent and the School
Psychologist
IDEA defines a parent as:
A birth or adoptive parent
Foster parent
A “guardian” who has the authority to act as the child’s
parent or has the authority to make educational decisions
for the child
A family member with whom the child lives who is caring
for the child, or someone who is legally responsible for the
child’s welfare
A surrogate parent
Consent and the School
Psychologist (continued)
General Guidelines
Birth/adoptive parent must be treated as the
decision maker over other possible “parents”
when the parent is “attempting to act” on behalf
of the child in the SPLED system
If a judge has appointed an alternate decisionmaker, the district must view this individual as
the only person authorized to make SPLED
decisions for the child
School Psychologist
NOTE:
Informed consent officially occurs when
Procedural Safeguards are provided to parent
(not necessarily overtly accepted by parent).
Applies to evaluations, not treatment.
Treatment consent documented through an IEP
or something more specific to the intervention.
When can the child give sole
consent?
Psychologist
School Psychologist
Child is:
(All students are minors*)
Over 13
Minors are granted access
to psychological or medical
treatment without parental
consent in emergency
situations
Requests drug/alcohol
treatment
In “statutorily recognized
situations” : Rare emancipated minor, court
ordered treatment
Emergency situation
Initial contact at student
request
Take away point
Permission/Consent to Treat
Psychologist
School Psychologist
If parents are married,
either may give
permission. If there is a
formal custody agreement
(ask or you'll never know),
obtain both parents'
permission. Child 14 and
over/legal guardian can
give consent. Court order
trumps all.
In schools, permission
is required from only
one parent to conduct
an evaluation.
Take away point: Pennsylvania
leans toward allowing treatment
Psychologist
School Psychologist
Act 147 allows for
either party, child 14 or
over or legal guardian,
to give consent for
treatment. If child
refuses, legal guardian
can consent for a child
under 18
Minors typically are not
legally competent to
consent or refuse
services in schools
Term assent is typically
used when a minor
agrees to participate in
psychological services
Follow up with Staff
Follow up with office staff obtaining consent
-It is not the responsibility of assistants and
other support staff to ensure that the
correct permission has been obtained
-Professionals must assume this
responsibility
Ethics of lengthy consent forms
Readability level of document
Tailor consent (verbal or written) to
parental comprehension level
Treatment Begins:
Boundaries & Ground Rules
Things to address verbally (good), or in written
form (better):
Access to notes
Relationships with outside persons, such as
attorneys
Any forensic role, now or later?
Is this court ordered?
Payment for collateral work (school, pediatrician)
Treatment Begins:
Payment for nonclinical work
Payment for collateral work:
Is it clinically indicated (a phone consultation
with the pediatrician or guidance counselor)?
– probably no charge
Or is it clinically contraindicated contact,
including spending 5 minutes explaining to an
attorney that you cannot grant her request?
You can, when discussed in advance, bill for
activities, for ex., in 15 minute increments
Applied Scenario in the Schools
A 10 year old lives with foster parents. His
father is unknown and his mother is
incarcerated. The school thinks he needs a
new IEP. Who does the school district
notify about the IEP meeting, and who can
attend the IEP meeting and
approve/disapprove of the IEP?
What is a surrogate parent?
Surrogate Parent
Has all the rights and can make all SPLED
decisions usually made by birth/adoptive parents
Can review records, request and consent to
evaluations/re-evaluations, challenge
recommendations of the LEA
No rights outside of the special education system
Surrogate Parent (continued)
Appointed by a juvenile court judge or a school
to make SPLED decisions
Must be appointed within 30 days
Cannot be an employee of a child welfare
agency or of the SEA/LEA
Cannot have a personal or professional interest
that conflicts with the child’s interest
Must have knowledge and skills to represent the
child competently
Applied Scenarios in the Schools
Birth parents are deceased. Child resides
with family member who is caring for her.
Is a surrogate needed?
Child is in a group home. Parental rights
have been terminated. Is a surrogate
needed?
Clarification of activities/role
Identify goals
Is this an appropriate case for you?
Whether this is a court or agency referral,
or parent request, be confident and clear
about the referral question
If necessary, clarify by calling agency or
judge's administrative office
Clarification of activities/role
Examples:
If the court orders “parent education” or “parenting
training.” this intervention may not meet medical
necessity criteria for insurance companies. Parents
may refuse to pay or may be volatile in your office.
You may refuse even a court ordered case if you
wish, with appropriate justification.
If one or both parents will not agree to the structure
of your practice, e.g., that they must agree not to
subpoena you, or that they agree to privacy of the
child's treatment, you may refuse to accept the
case.
Clarification of activities/role
For agency or forensic work, provide a
referral sheet that asks for specific goals
(evaluation, treatment, testimony). See
Handout Agency Referral Form.
Ask family what their goals are for your
work with the child – not just complaints,
rather their desired outcome
Clarification of role
Expert Witness or Fact Witness
• Dr. Caring has been working with a 4 year old
child of divorced parents for 6 months. While
both parents agreed (consented) to
treatment, only the mother has brought the
child and attended appointments. The mother
requests that Dr. Caring write a letter to the
judge verifying how anxious the child is after
returning from visits and in anticipation of
visits.
If caregivers fail to agree to parameters of
treatment that are essential for effective therapy,
do not accept the case. Set the standards for
treatment.
IMPORTANT POINT: The legal ability to treat
does not mean you have to treat; if you don’t
think you can be helpful, do not accept
child/family.
School Psychologist
Evaluation Questions
Does child qualify for Special Education
Services
- Meet definitional criteria
- Does s/he demonstrate a need
Take away point: Clarification
Psychologist
School Psychologist
Know why your
services are being
requested, especially if
the referral source is
other than family.
Identify goals. Actively
decide to accept or
refer on.
May need to reassign
cases if not competent
in area or conflict of
interest arises. (Rural
psychology possible
exceptions)
Communicate
(about your procedures and
expectations)
. A school psychologist and Dr. New
attended a local conference. The school
psychologist stated that a new student at
the school he serves is seeing Dr. N. for
therapy; he wants to discuss the child.
During Treatment: Records and
Confidentiality
HIPAA permits mental health professionals
to keep two sets of notes
–
Primary/office record
–
Psychotherapy notes, “personal notes” These
must be physically separate: The following is
NOT included, and can be released:
information about medication, start/stop times,
results of clinical tests, frequency/modality of
treatment, diagnosis, treatment plan,
symptoms, prognosis, progress to date
DuringTreatment:
Records and Confidentiality
Who can give permission for records to be
released?
–
Legal guardians have a say
–
When can the child have a say?
Child 14 and over can sign release; Parent can
sign for child under 14 and over 14 if parent
signed Consent to Treat
Whoever signs Consent controls release of
records, but engage 14 and older
(See Knapp, Baturin, & Tepper, PA Psychologist, March, 2010);
PAPSY.ORG, Members Only section: Pennsylvania Psychologist
During Treatment: Do minors
have confidentiality?*
Who controls the records? Negotiate
with parents and child, if appropriate,
the level of access that will be useful to
treatment
*Does any child client have
confidentiality?
APA and release of records
4.05 Psychologists may disclose
confidential information with the appropriate
consent of the organizational client, the
individual client/patient or another legally
authorized person on behalf of the
client/patient unless prohibited by law.
Example: Release of Records
A psychologist is treating a child of
divorced parents, between whom
there is great conflict. Parent A
sought treatment, both signed
consent. Parent B now wishes all
treatment records; Parent A refuses
to sign release. What are some
questions and concerns?
HIPAA
Laws around HIPAA permit release
of mental health records to legal
guardians, similar to physical health
records.
Psychotherapy notes are not
included in this release requirement.
School Records
FERPA and IDEA both require disclosure of
all educational records
Educational record – records, files,
documents and other materials that are:
- Directly related to a student and
- Maintained by an educational agency or
institution or by a party acting for the
agency or institution
Types of Records Kept in Schools
Permanent record
School health record
Attendance records
Category B (Sp. Ed.)
Disciplinary File
Student Assistance Program (SAP)
Protocols
Educational records need not be
personally identifiable – only need to
be directly related to the student
There is no qualifier or suggestion of
exception for a document that may be
subject to professional privilege
Protocols (continued)
Sole Possession Exclusion
Educational records do not include records
of instructional, supervisory, and
administrative personnel and educational
personnel ancillary to these persons that
are kept in the sole possession of the
maker of the record and are not accessible
or revealed to any other person except a
temporary substitute for the maker of the
record
Protocols (continued)
OSEP, hearing officers and courts have been in
agreement with interpretation
Test protocols are NOT covered by the sole
possession exclusion in FERPA
Protocols must be made accessible to parents as
with any other educational record
Parent’s right includes “the right to request that the
agency provide copies of the records containing the
information” if failure to provide them “would
effectively prevent the parent from exercising the
right to inspect and review the record”
Protocols and Copyright
Does the commercial interest override
access rights provided by law?
School psychologists have no
copyright interest in the tests they use
and, thus, cannot rely on copyright law
as a reason to refuse copies
Access has been upheld over
copyright objections
Protocols and Copyright
Copyright law is intended to protect the
author’s property interest by prohibiting
unauthorized duplication.
Copyright law contains a “fair use”
exception, which allows copying without
copyright owner’s consent “for purposes
such as criticism, comment, news
reporting, teaching, … scholarship, or
research.”
Protocols and Copyright
Publishers argue that any copying of
protocols is a violation of their
copyright interest, but recognize that
parent rights will trump copyright
protection
Typically ask for more limited
protections such as providing materials
only to qualified professionals, portions
of the hearing record be sealed, etc.
Protocols and Copyright
Federal district CA court required NewportMesa Unified SD to provide copies of
protocols (Harcourt Assessment and
Riverside publishing participated in the
proceedings)
Reasoned that providing copies was fair use
but noted that schools could use safeguards
such as requiring review of originals prior to
obtaining copies, requiring a written request
for copies, signing a nondisclosure
agreement, etc.
Protocols and Copyright
Precautions:
Have parent clarify request in writing.
Explain the nature and purpose of documents.
Explain that some documents cannot be
distributed, but be sure you are correct. For
example, you could explain that a blank test
protocol could not be distributed because of
contractual limitations required by the test
publisher, test integrity, and copyright.
Protocols: What must be disclosed?
Booklet or test questions (math worksheet)
Sheet where answers are recorded
Summary sheet/cover sheet
Test manual need NOT be disclosed unless
it contains some writing relating directly to
the student
Stimulus book or other materials need NOT
be disclosed
Releasing Testing Materials
Psychologist
School psychologist
Test copyright and
concern over sample
norms support not
providing test materials;
however, a child's
responses and other test
data* must be released,
unless there is a question
of endangerment.
Booklet or test questions
Sheet where answers are
recorded
Summary sheet/cover
sheet
Test manual need NOT be
disclosed
Stimulus book or other
materials need NOT be
disclosed
*9.04 Release of Test Data
(a) The term 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.
Confidentiality in Treatment
What if you find out your child client is
involved in self-destructive behaviors
–
Cutting, burning?
–
Unprotected sex or sex with questionable
people?
–
Drinking alcohol/smoking MJ/using other
drugs?
–
Engaging in petty crime
What questions come to mind to help think
about this?
A psychologist can't predict all situations. It
helps to be clear about where the clinician
draws the line. You may need to discuss with
the parent about what you mean by “at-risk” of
harm.
A dental office in town sends a fax to Dr
Helpful explaining that a mutual child
patient had recently been at their office.
The dentist's office knew about the
patient from discussion among the
children in their office The dentist's office
neglected to update the patient's file and
are in need of the contact info in order to
get updated insurance information.
Records and Confidentiality
Oops!: High conflict parents
Protect yourself and your clients: use the
psychotherapy note option, only keep those notes
which are essential
Assume an unhappy parent or an attorney is
reading your notes
With a custody order specifying joint legal
custody, best to obtain both parents' permission
for any release and inform them regarding
treatment goals and modalities
Confidentiality and
I
rd
3
party biller
Dr. Pay has someone do his billing and
frequently has need to communicate info in
order for billing to be done appropriately
e.g., parents are separated and wish for
each other to pay every other session;
grandparents are paying instead of
parents; parents are divorced and are very
unfriendly toward one another so only a
certain parent is to be contacted about the
billing as it is that parent's insurance.
Psychologist:
School Psychologist:
Whoever gives consent
controls the records and
their release (mostly). With
a court order, or
appropriate release, parent
has right to the records at
any time. If there is no
court order, there is no
obligation to give
psychotherapy notes, only
treatment notes. Disputed
custody? Get both parents'
signatures for a full
release.
Many school individuals
with legitimate interest may
access psychological
records such as evaluation
reports without a signed
release from the parent. To
forward records to others
outside school setting,
signed parental release is
required.
Parental control ends at
graduation or age 21.
Confidentiality and the Internet
Dr. Web has some child patients desiring
.
to communicate via Facebook/Instagram,
etc. She also has parents who wish to do
so.
How should she respond? What might
she keep in mind and she considers
these requests?
Dr. Community is on a city task-force and
is given a list of key contacts in town
who are likely to donate a large sum of
money for an early childhood event coming
up. She is supposed to call them for their
support. When she gets the list, she
notices the names of a child patient's
parents.
During Treatment: Questions of
Abuse & Confidentiality
Parent reports to you suspicions that the other
parent is sexually/physically abusing the child*
*Note when in the treatment stream this
suspicion is shared
Parent reports she physically struck child
Child reports that parent struck her, requests
you not say anything
Child reports parent abuses child chronically
Questions of Abuse:
CYS Report or Not?
RE: CHILD:
Under 18
Any adult (not just
caregiver)
Seen in a professional
capacity/or in your
organization
Suspicion or
reasonable cause to
suspect
RE: BEHAVIOR
Meets “statutory”
definition of abuse:
Sexual abuse or
exploitation
Nonaccidental injury
Neglect
Serious mental Injury
Allegedly consensual sex? You
still have to report if:
Less than 14 years of
14 and under 18,
age, even if consensual partner is 4 or more
years
older
than
child
=> Childline/CYS
Report
=> Childline/CYS
Report
Anyone may report abuse, even if not
mandated to do so.
When in doubt, call Childline
(800) 932-0513
Consult
During Treatment: Should you stop?
One parent rescinds permission to treat: do
you stop immediately? Do you have a final
session with child?
Neither parent rescinds, but one parent
regularly accuses you of bias or of poor
psychological practice.
A child under 14 tells you that a parent thinks
therapy is a joke/thinks the therapist has it out
for the parent; child expresses wish to stop.
After treatment ends: Records &
Confidentiality
Child is now 14. Parent requests records be
sent to new therapist.
Child of any age: parent requests records be
sent to parent.
Child deceased: parent requests records be
sent to parent, attorney, or another
professional, “for review.”
After Treatment Ends:
Records & Confidentiality
Mother calls to get records for the
treatment of her now 18 year old
daughter.
– Daughter seen in therapy several
years ago.
– There is a large unpaid balance.
After Treatment Ends
Parent calls for a written report of evaluation
and/or treatment: Insurance will not pay
–
Insurance did not pay for evaluation activities
–
Neither client nor psychologist verified that
insurance would pay for the evaluation or the
written report
–
There is a substantial balance owed
–
What if the parent was private pay from
outset?
Parent calls for written summary of treatment
be sent to her, 2 years after treatment ends.
– Does parent have right to treatment summary or
treatment records? (HIPPA says 'yes': can be very
brief, basic)
– Can the psychologist charge for the summary?
(Can charge for anything established at beginning;
consider clinical vs legal goals)
– Does the age of the child during treatment matter?
– Does the age of the child at the time of the request
matter?
After treatment: Keeping Records
State Board of Psychology states records
are kept a minimum of 5 years since last
patient contact
http://www.pacode.com/secure/data/049/chapter41/chap41toc.html
BUT
The PA statute of limitations of
malpractice suits is 2 years after age of
18
Physicians' guidelines are to keep for 7
years total or 7 years after age of 18
Take away point
Psych
School Psychologist
The Psychology Board
instruction is to keep
records for 5 years
beyond the last date of
service. It is a
conservative practice to
keep records for child
clients 2-7 years after
18
General Education
Provisions Act requires
recipients of federal
funds to retain records
(such as SPLED
records) for 3 years after
completion of the activity
for which funds are
used. Cyclical
monitoring requires 6
years.
Dr. Helpful's child client will be going on a
community volunteer activity to help victims of a
natural disaster and provides you with a form to
make a donation. Dr. Helpful has been working
with the child and the family for months to
identify just such an opportunity for the child for
therapeutic reasons.
-What are the ethical concerns, if any?
-How should the psychologist respond?
Dr. Available began to see a 6 year old child at
the request of both parents who acknowledged
that they were having a lot of conflict. One
parent was having visa problems. Having some
experience in the area of immigration, Dr. A
began to advise the parent about how to
expedite the handling of her problem. The
marital situation escalated. Dr. A found herself in
hour long crisis calls with one parent or the other.
What are the ethical questions and how would
you advise Dr. A.?
Dr. Care was referred a child based on her
expertise with school phobia. She saw the child
for 4 sessions and was making good progress
with the child attending school. She then
discovered from a relative that the child had
been present when her mother had been killed
by her father; that the person she thought was
the mother is the aunt. She is very anxious that
this should come up in her session with the child.
She does not trust herself to respond properly.
What are the ethical issues? What should she
do?
Dr. Foster is seeing a child for social skills who
was recently brought to this country for adoption.
He is 7 years old. The adoptive mother tells Dr.
F that she has been told the child has reactive
attachment disorder and that Dr. F is to beware
that the child lies, is manipulative, and steals
food. The parent suggests a couple of
techniques that she thinks Dr. F should use with
the child so that the child sees the same
response from all adults. She also tells Dr. F he
is not to be friendly with the child, so he won't be
confused.
Links for Information
www.papsy.org:
–
Go to Members Only, Pennsylvania Psychologist,
Legal and Ethical articles
www.apait.org:
– Resources, Downloads, Resources
PA Board of Psychology, PA Code 41.61, Ethics
www.pacode.com/secure/data/049/chapter41/s41.61.html
http://kspope.com/ethics/index.php
Ed Zuckerman's The Paper Office, Guilford Press,
(document your ethical procedures)
Haidt, J. (2001). The emotional dog and its
rational tail. A social intuitionist approach ro
moral judgment. Psychological Review, 108,
814-834.
Rogerson, Mark, M. Gottlieb, M. Handelsman,
S. Knapp, J. Younggren (2011) Nonrational
processes in ethical decision making.
American Psychologist vol. 66 (7), 614-623.