1
CA Law and Ethics - 18 Hours
California Law & Ethics – 18 Hours
Introduction
Most mental health professionals have a working definition of ethics, such as this one: “codes developed by mental health associations for the purpose of setting professional standards for appropriate behavior, defining professional expectations, and preventing harm to clients.” Ethics, then, refers to professional rules of conduct, rules that are codified in various ethical codes.
While the definition of ethics contained above is comprehensive, another important aspect of our professional codes is the idea that they are enforceable. Take, for example, this paragraph from the preamble of the American Association of Marriage and Family Therapist Code of Ethics:
The AAMFT strives to honor the public trust in marriage and family therapists by setting standards for ethical. The ethical standards define professional expectations and are enforced by the AAMFT Ethics Committee. The absence of an explicit reference to a specific behavior or situation in the Code does not mean that the behavior is ethical or unethical. The standards are not exhaustive. Marriage and family therapists who are uncertain about the ethics of a particular course of action are encouraged to seek counsel.
This statement reminds us that ethical standards are generally written in broad statements and apply in varied roles and contexts. Ethical standards are not exhaustive and when conduct is not specifically addressed by a standard it does not mean that the conduct is necessarily either ethical or unethical.
Professional ethics play an important role in our daily lives as mental health professionals. When asked what ethical issues they have recently faced, many people in these fields are unable to point to any recent ethical dilemmas. In reality, that is rarely the case and often we have internalized ethical principles to such an extent that we don’t stop to ponder whether a decision we make has ethical ramifications.
Part I of this material, Ethics Refresher, provides a review of California-specific laws and professional ethics. Part II focuses on legal and ethical issues in treating victims of domestic violence. Part III provides a comprehensive look at the federal Health Insurance Portability and Accountability Act (HIPAA), a key topic for providers who take third-party reimbursement. Part IV of this document discusses the provision of E-Therapy, a growing trend among mental health providers. Part V of this document provides an alternative lens through which to look at ethical issues, using the framework of medical errors and root cause analysis.
ce4less.comce4less.com ce4less.com ce4less.com ce4less.com ce4less.com
149
CA Law and Ethics - 18 Hours
______
California Law & Ethics Refresher
Chapter 1
The Statutes And Regulations Relating To The Practice Of Marriage And Family Therapy, Educational Psychology, and Clinical Social Work. The Statutes begin with the reminder that “many California families and many individual Californians are experiencing difficulty and distress, and are in need of wise, competent, caring, compassionate, and effective counseling in order to enable them to improve and maintain healthy family relationships.” Although this passage refers to the practice of marriage and family therapy, the concerns highlighted in these statutes apply to the ethical practice of counseling in an overall sense. The statutes are broad in scope and cover a multitude of issues upon which marriage and family therapists, educational psychologists, and clinical social workers can make informed judgments and choices concerning their efforts, and can address many ethical issues that arise from working with people.
The population in California encompasses a range of socioeconomic and demographic characteristics. This diversity suggests that mental health professionals in California will see a range of clients with varied mental health needs. In order to address these needs the services of skilled marriage and family therapists, educational psychologists, and clinical social workers are critical.
Continuing educational requirements for California mental health professionals contain an ethics requirement that include training in California-specific laws as well as ethical principles. This course will introduce mental health professionals to ethical and legal requirements contained in the Statutes And Regulations Relating To The Practice Of Marriage And Family Therapy, Educational Psychology, and Clinical Social Work (California Board Of Behavioral Sciences) as well as to many common ethical dilemmas and professional issues that they may encounter. Mental health professionals must also be familiar with the ethical guidelines for their specific professions and are encouraged to review these as well. Highlights from the various ethical codes will be covered in this training manual. Case studies and “Questions to Consider,” will also demonstrate this material. Participants in this training are encouraged to reflect on the questions contained prior to each section and before reviewing the material within the segment. A key part of learning and reflection is to develop sound ethical judgment through activities such as:
· Familiarizing yourself thoroughly with established standards
· Being sensitive to ethical problems as they arise, and take into account the complexity of these issues
· Remembering that ethical decision-making is an evolutionary process that requires you to be continually open and self-critical
Educational Objectives
· Discuss established ethical and legal requirements contained in the Statutes And Regulations Relating To The Practice Of Marriage And Family Therapy, Educational Psychology, and Clinical Social Work and specified in the ethical codes for the professions covered in this training
· Be sensitive to ethical problems as they arise, including the complexity of these issues
· Respond to common ethical dilemmas
· Describe why licensure is important for mental health professionals
· Discuss the issue of competence and the steps a provider should take to maintain competence
· Discuss specific areas related to competence, including self-assessment, compassion fatigue and multicultural competence
· Define confidentiality, and discuss informed consent and limits of confidentiality
· Discuss Laura’s Law
· Discuss California law with regard to subpoenas
· List the legal requirements for mandated reporting of child and elder abuse
· Define California laws with regards to minors, consent and confidentiality
· Discuss the dynamics of dual relationships
· Discuss issues related to sexual relationships with clients including harm to therapist and client
· Distinguish between termination and patient abandonment
· Discuss the Tarasoff and Ewing rulings related to the professional Duty to Warn
While this document provides a comprehensive overview of California law and ethics, additional resources which may prove helpful in delving deeper into ethical issues and scenarios includes Knapp & VandeCreek, (2012) and Welfel, (2012).
Scope of Practice for the Professions
Before turning our attention to the specific legal and ethical requirements for mental health professionals, it is important to review our definition of each of these professions.
According to the American Association of Marriage and Family therapy, Marriage and Family Therapists (MFTs) are trained in psychotherapy and family systems, and are licensed to diagnose and treat emotional disorders within the context of marriage, couples and family systems. The practice of marriage, and family therapy and psychotherapy is both an art and a science. It is varied and often complex in its approach, technique, modality and method of service delivery. Marriage and family therapists evaluate and treat mental and emotional disorders, other health and behavioral problems, and address a wide array of relationship issues within the context of the family system. Marriage and family therapy seeks to broaden the traditional emphasis on the individual to attend to the nature and role of individuals in primary relationship networks such as marriage and the family. Marriage and family therapists have graduate training in marriage and family therapy and at least two years of clinical experience. Marriage and family therapists are recognized as a core mental health profession. The practice of marriage and family therapy is defined as services performed with individuals, couples, or groups wherein interpersonal relationships are examined for the purpose of achieving more adequate, satisfying, and productive marriage and family adjustments. This includes relationship and pre-marriage counseling as well as client-centered advocacy efforts.
Educational Psychologists are mental health professionals that are concerned primarily with the study of how humans learn in educational settings, the effectiveness of educational interventions, the psychology of teaching, and the social psychology of schools as organizations. The practice of educational psychology includes the performance of any of the following professional functions pertaining to academic learning processes or the educational system or both: (a) Educational evaluation (b) diagnosis of psychological disorders related to academic learning processes (c) administration of diagnostic tests related to academic learning processes including tests of academic ability, learning patterns, achievement, motivation, and personality factors. (d) interpretation of diagnostic tests related to academic learning processes including tests of academic ability, learning patterns, achievement, motivation, and personality factors (e) providing psychological counseling for individuals, groups, and families. (f) consultation with other educators and parents on issues of social development and behavioral and academic difficulties (g) conducting psychoeducational assessments for the purposes of identifying special needs (h) developing treatment programs and strategies to address problems of adjustment. (i) coordinating intervention strategies for management of individual crises.
Clinical Social Workers seek to apply social theory and research methods to study and improve the lives of people, groups, and societies. According to a mission statement contained in the National Association of Social Work (NASW) Code of Ethics The core task of social work is to “enhance human well being and help meet the basic human needs of all people, with particular attention to the needs and empowerment of people who are vulnerable, oppressed, and living in poverty.” One essential feature of social work is the profession’s focus on individual well being in a social context and the well being of society. Fundamental to social work is attention to the environmental forces that create, contribute to, and address problems in living. Clinical social workers provide mental health services for the prevention, diagnosis, and treatment of mental, behavioral, and emotional disorders in individuals, families, and groups. Their goal is to enhance and maintain their patients' physical, psychological, and social function (see appendix for core competencies of social work).
Core values of social work include:
· Service
· Social justice
· Dignity and worth of the person
· Importance of human relationships
· Integrity
· Competence
Although specific to social work, these values can provide guidance in the application and understanding of all mental health professions.
Professional Clinical Counselors (LPPCs) are mental health professionals who apply “mental health, psychological, or human development principles through cognitive, affective, behavioral, or systemic intervention strategies that address wellness, personal growth, or career development, as well as pathology. The primary purpose of counseling is to empower the client to deal adequately with life situations, reduce stress, experience personal growth, and make well-informed, rational decisions.” (U.S. Dept. of Human Services, Mental Health, United States, 2002). With legislation that passed in 2009, all 50 states now license LPPCs. In California, LPPCs are among the professionals who can be termed “psychotherapists.”
Content of Statutes And Regulations Relating To The Practice Of Marriage And Family Therapy, Educational Psychology, and Clinical Social Work
Statutes And Regulations Relating To The Practice Of Marriage And Family Therapy, Educational Psychology, and Clinical Social Work was developed by the California Board of Behavioral Sciences (BBS) to outline the important considerations related to regulation of the professions, denial, suspension, and revocation of licenses, revenue information, professional corporations, continuing education requirements, and information related to disciplinary actions. The California Board of Behavioral Sciences website is located at http://www.bbs.ca.gov/. This training manual is meant to be used as a reference, and as such this training manual will not cite specific information such as fees or specific number of hours required for education, but will describe the broader issues related to these topics. For example, continuing education requirements are related to the need for BBS licensees to maintain competence in practice. Participants reading this training manual are encouraged to become familiar with the Statutes as well as the specific ethical codes for their specialty areas. References as well as appropriate website information can be found in the References section at the end of this text.
Ethics vs. Law
Questions to consider:
Are ethical standards and legal standards always consistent?
If they are not, what is the best way to handle this?
Many ethical issues faced by mental health professionals involve legal issues. Ethical decisions in social work and marriage and family therapy that involve legal issues do not always involve ethical dilemmas. In many cases such decisions are compatible with both legal and ethical standards.
However, other situations are more difficult ethical dilemmas, particularly when clinicians’ decisions are compatible with legal standards but not consistent with prevailing ethical standards or vice versa. In reading the following training material, such conflicts will be highlighted. It is important for professionals to use their own judgment or to seek consultation with colleagues when such conflicts arise (Reamer, 2008).
Licensure of Mental Health Professionals
Questions to consider:
Why is licensure important?
What standards do you believe are important in the licensure of the state’s mental health professionals?
What specific coursework and training is necessary for your specialty area?
The following is an excerpt from a letter posted on a large Internet site:
My daughter is 30 years old and is one of the wisest people I have ever known. She has an extraordinary ability to effectively help other people with their most difficult emotional or psychological problems. Up until now she has been providing her counseling "services" to friends and relatives on a gratuitous basis. I am suggesting that she start providing counseling or psychotherapy services to residents of her small California town on a fee basis. She seems interested in the idea but is concerned that it might not be legal for her to provide such services for money since she lacks any formal degrees, credentials, licenses or certificates. Please inform me as to whether or not my daughter could provide counseling or psychotherapy services in California without obtaining any formal degrees, licenses, credentials, or certificates.