Legal and Ethical Issues in Clinical Health Counseling Flashcards

Flashcards covering legal and ethical issues, documentation, record-keeping, managed care, supervision models, and evidence-based practice in clinical mental health settings.

Autonomy

A core principle based on one's basic right to control the direction of one's life and the counselor's responsibility to respect and support client individuality.

Nonmaleficence

The counselor's responsibility to avoid harming the client through egregious offenses or unintentional errors like practicing outside of competence.

Beneficence

The responsibility to work for the good of the individual and society by promoting mental health and well-being.

Justice

Engaging clients equitably and fostering fairness and equality by accepting all diversity statuses and promoting equal treatment systems.

Fidelity

The counselor's responsibility to be true to their word, uphold commitments and promises, and be trustworthy in all actions.

Veracity

The requirement that professional counselors remain truthful and honest in all professional interactions, relating to honor and integrity.

Ethical Decision-Making Model

A series of steps used to make informed decisions when faced with legally or ethically ambiguous situations and provided as form of documentation.

Spirit of the Code

Operating by upholding the fundamental principles and values inherent to counseling rather than just concrete parameters.

Code A.6.b

The ACA Code of Ethics section titled Extending Counseling Boundaries, which discusses bluring boundaries and considering risks.

Code A.6.c

The ACA Code of Ethics section titled Documenting Boundary Extensions, which requires appropriate documentation of the decision-making process.

Friendship Boundary Concern

The worry that shifting a therapeutic relationship to friend-status causes a loss of objectivity and fails to honor the client's needs.

Code A.5.c

Allows the possibility of sexual or romantic relationships with former clients at least $5$ years following the end of the counseling relationship.

APA Romantic Relationship Separation

The American Psychological Association requirement that at least $2$ years pass following termination before a sexual or romantic relationship with a former client.

Indemnity Payments Gap

The difference reported by CNA and HPSO ($2014$) where multiple relationship allegations cost $"500,000"$ vs. sexual misconduct at $"89,177"$ per payment.

Slippery Slope of Ethics

The quick and easy slide from ethically appropriate behavior to unethical behavior through blurring professional-personal boundaries.

Naivety

Barnett's ($2014$) term for being uneducated or unaware of issues relevant to boundaries, sexual feelings, and standards of practice.

Professional Competence Problems

Issues associated with distress, burnout, and impairment in professional judgment and functioning according to Barnett ($2014$).

Section B (ACA Code)

The portion of the ACA Code of Ethics dedicated to Confidentiality and Privacy.

Serious and Foreseeable Harm

Defined by the ACA ($2014$) as when a reasonable counselor can anticipate significant and harmful possible consequences.

Minimal Disclosure (B.2.e)

The practice of revealing only the necessary amount of information to meet ethical and legal obligations when confidentiality must be breached.

Assent

The personal agreement by clients who lack the legal capacity to give consent (such as minors) to participate in the therapeutic process.

Records Custodian

A mental health professional identified by a counselor to protect client information and contact clients in case of the counselor’s death or incapacitation.

Privileged Communication

A legal concept referring to information that is protected by law from being disclosed in court proceedings.

No Secrets Policy

A systems approach policy used in couples or family counseling where info provided by one member is not kept confidential from others.

Section H (ACA Code)

The iteration introduced in the $2014$ revision to address Distance Counseling, Technology, and Social Media.

Online Disinhibition

A sense where individuals feel free to communicate thoughts, ideas, and feelings via technology that they would not share in person.

H.3 Client Verification

The ethical responsibility to verify that the person communicating on the other side of a technology medium is indeed the actual client.

H.6.a Virtual Professional Presence

The guideline allowing professional social media profiles for education or advertisement that must be separate from personal profiles.

Digital Natives

A cultural term for individuals who prefer technology and social media and are part of today's culture of constant information access.

Telebehavioral Health Institute

An organization that provides training and competency for counseling technology use.

BC-TMH

The Board Certified-Telemental Health Provider credential offered by the Center for Credentialing and Education.

HIPAA

The Health Insurance Portability and Accountability Act which addresses federal regulations for protected health information ($PHI$).

Wellness Model

The philosophical framework from which professional counselors typically approach mental health, as opposed to medical models.

IPEC Expert Panel

A collaborative panel that determined core competencies including interprofessional communication and values for collaboration.

Self-Injury (SI)

Direct and deliberate bodily harm in the absence of suicidal intent as defined by Nock ($2010$).

SI/Suicide Comorbidity

The finding that approximately $60\%$ of people who self-injure also have suicidal thoughts and behaviors according to Whitlock et al. ($2013$).

Deliberate Self-Harm Inventory (DSHI)

A $17$-item self-report questionnaire screening for presence, age of onset, and frequency of SI developed by Gratz ($2001$).

SITBI

A $169$-item structured interview developed by Nock et al. ($2007$) that measures suicidal ideation and self-injurious thoughts.

SASII

A $37$-item structured interview developed by Dr. Marsha Linehan to evaluate lethality and rescue likelihood.

Inventory of Statements About Self-Injury (ISAS)

A $46$-item inventory assessing the history and motivations/functions of self-injury.

NSSI-AT

A $39$-item self-report questionnaire administered online to address behaviors surrounding SI and habituation.

Suicide Probability Scale (SPS)

A $36$-item inventory measuring ideation, hopelessness, negative self-evaluation, and hostility.

Beck Scale for Suicide Ideation (BSI)

A $21$-item self-report inventory detecting current intensity of suicidal plans within the past week.

SBQ-R

A $4$-item self-report assessment measuring lifetime ideation and likelihood of future suicidal behavior.

C-SSRS

The Columbia Suicide Severity Rating Scale, a $6$-item structured interview examining suicidal thoughts and attempts.

Clinical Documentation

Any written or electronic record of contact between client and counselor encompassing service notes, assessment results, and rationale.

Standard of Care

The prevailing level of care provided to a client that meet the standards of the counseling profession according to Corey et al. ($2014$).

Assent Significance

Documentation of a child's personal agreement to engage in therapy as a step to building rapport, even though parent consent is legal requirement.

Psychosocial Assessment

A comprehensive evaluation of a client's mental health, well-being, and social functioning, collecting historical and current data.

Mental Status Examination (MSE)

A structured assessment of behavioral and cognitive functioning used to develop a baseline understanding and aid diagnosis.

Oriented x 4

A term meaning the client is aware of identity, place, date (time), and the current situation.

Safe Harbor Method

A federal deidentification approach involving the removal of $18$ pieces of identifying information from a client file.

Safe Harbor Name Removal

The removal of names of the client and immediate family members to prevent relating identities to case file information.

Treatment Plan Overview

A brief recap of salient issues, how they are experienced, and how the problem was addressed in the past according to Berman ($2015$).

Case Notes

Session-to-session archives documenting what was discussed, the outcome, and plans for the future while protecting confidentiality.

SOAP Note

A case note format standing for Subjective, Objective, Assessment, and Plan, developed by Weed in $1964$.

Subjective (SOAP)

Information voiced directly to the counselor including the client's thoughts, feelings, and progress since the last session.

Objective (SOAP)

Factual and quantifiable observations of the client’s affect, attitude, participation, and noteworthy behavior without personal judgment.

Assessment (SOAP)

A synthesis of subjective and objective observations concluding with counselor impressions or a diagnosis.

STIPS Note

An acronym standing for Signs and symptoms, Topics of discussion, Interventions, Progress and plan, and Special issues.

DAP Note

A key component case note format standing for Describe, Assess, and Plan.

Child Protective Services (CPS) Deadline

The requirement to report belief of child abuse or neglect no later than $48$ hours after becoming aware.

Adult Protective Services (APS) Deadline

The requirement to report abuse, neglect, or exploitation immediately upon becoming aware.

Case Note Writing Standard

The ethical best practice of writing all notes within $24$ hours to ensure accurate information is documented.

Yellow Schedule

A cloud-based electronic record keeping software starting at "$29.95" per month that syncs with Google Calendar.

Therapy Notes

A browser-based software with professional to-do lists, electronic billing, and a patient portal costing "$59" per month individually.

Care Logic Enterprise

Qualifacts software built for larger health care providers to compare peer performance and track progress across many employees.

Managed Care

An umbrella term describing practices providing oversight in the delivery of health care services to provide cost-effective quality care.

Health Maintenance Organization (HMO)

A type of managed care focusing on preventative care and utilization management using contracted in-network providers.

Preferred Provider Organization (PPO)

A plan offering flexibility in selecting providers where in-network preferred providers offer reduced rates.

Point-of-Service (POS)

A plan combining HMO and PPO features where a primary care physician acts as a gatekeeper but out-of-network coverage exists.

Exclusive Provider Organization (EPO)

A plan where in-network providers must be used exclusively, though no specialist referrals are necessary.

Medical Necessity

Services or procedures used to diagnose/treat justifiable health conditions meeting accepted standards of medicine according to Medicare.com ($2018$).

Preauthorization

The determination of whether prescriptions, procedures, or services are appropriate before they begin to qualify for reimbursement.

Upcoding

A deceptive practice where counselors give clients with less severe problems a more severe classification to gain access to services.

Downcoding

When counselors give clients with more severe problems a less severe classification, often to appease family or insurance limits.

National Provider Identifier (NPI)

A $10$-digit identifier issued to care providers for administrative and financial transactions under HIPAA.

Entity Type 1 (NPI)

The type of identifier designated specifically for sole proprietorships or individual private practices.

Entity Type 2 (NPI)

The type of identifier designated for partnerships, hospitals, or corporations separate from individual individuals.

EIN

The Employer Identification Number, a $9$-digit number used by the IRS to identify a counselor's company.

Occurrence Limit

The maximum amount an insurer is willing to pay for any one claim on a malpractice policy.

Aggregate Limit

The maximum amount an insurer is willing to pay for the lifetime of a malpractice policy (renewed annually).

Taxonomy Code

A unique $10$-character alphanumeric code identifying the specific type, classification, and specialization of a health care provider.

Clinical Supervision

A relational experience between a senior counselor and a less experienced junior counselor to enhance functioning and ensure professional fitness.

Holding Environment (Supervision)

Barnet and Molzon’s ($2014$) term for a safe place for supervisees to share knowledge, fears, and successes without fear of judgment.

Integrated Developmental Model

Stoltenberg et al.’s ($1998$) model containing $4$ counselor levels from dependent to independent practice.

Discrimination Model

An atheoretical model based on technical eclecticism where the supervisor assume roles of teacher, counselor, or consultant.

Microcounseling Supervision Model (MSM)

A model using the Counseling Interview Rating Form ($CIRF$) to evaluate the mastery of foundational skills in session.

Parallel Processes

When supervisees unconsciously reenact with supervisors the same dynamics that their clients enacted with them in counseling.

Isomorphism

A repeated, bidirectional relational pattern occurring either in counseling or supervision originating from systems theory.

Triadic Supervision

A format including a supervisory relationship between one supervisor and $2$ supervisees.

Reflecting Team

A team format created by Tom Anderson where a group observes a counselor and family then discusses the session while the family observes.

Asynchronous Technology

Technology involving a delay in response between initiation and reply, like email or text messaging in supervision settings.

Synchronous Technology

Technology products that allow for real-time interaction, such as video calling or telephone conferencing.

Evidence-Based Practice (EBP)

The integration of the best available research with clinical expertise in the context of client characteristics and preferences.

Empirically Supported Treatment (EST)

A specific technique or intervention shown to be efficacious in previous research, such as those in the NREPP registry.

Statistical Significance Threshold

Requirement for EST review where the intervention produced positive outcomes at $p ≤ .05$ in at least one study.

A-level Practices

Practices supported by the combined research findings of meta-analyses and meta-syntheses.

B-level Practices

Practices supported by individual effectiveness studies using experimental or quasi-experimental designs.

C-level Practices

Practices supported by qualitative studies, cohort studies, or descriptive/correlational studies with less control rigor.