Decoding The Ethics Code Chapter 2 Notes
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CHAPTER TWO • THE ETHICS CODE INTRODUCTION AND PREAMBLE
Introduction and Applicability; Relationship to Enforcement and Law
How Is the Ethics Code Applied?
Psychologists are committed to increasing scientific and professional knowledge of behavior and people’s self-understanding, and to using that knowledge to improve the condition of individuals, organizations, and society.
Psychologists respect and protect civil and human rights and the central importance of freedom of inquiry and expression in research, teaching, and publication.
They strive to help the public develop informed judgments and choices concerning human behavior.
The APA Ethical Principles of Psychologists and Code of Conduct (APA, 2017a) begins with the Introduction and Applicability section, followed by the Preamble and five General Principles that reflect overarching values and ideals. The remainder comprises 151 enforceable standards describing required, prohibited, and permitted behaviors.
This chapter highlights implications for ethical conduct and enforcement stemming from the Introduction and Applicability section and the Preamble.
Understanding the Introduction and Applicability Section and the Preamble
To Whom Does the Ethics Code Apply?
Membership in the APA commits members and student affiliates to comply with the Ethics Code standards.
Many psychology programs adopt the Ethics Code into their faculty and student policies.
Throughout the United States, portions of the Ethics Code are integrated into state laws, rules, and regulations governing the licensed practice of psychology.
To What Does the Ethics Code Apply?
The answer: all activities, all persons, all settings, and all communication contexts that are conducted, encountered, or used in one’s role as a psychologist.
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Activities include, but are not limited to:
clinical, counseling, and school practice; research; teaching and supervision; public service and policy development; program design, implementation, and evaluation; construction, administration, and interpretation of assessment instruments; organizational consulting; forensic activities; and administration.
Persons include: individual clients/patients, research participants, and students; children and adults of all ages; individuals with or without mental disorders; individuals with disabilities; diverse cultural and language backgrounds and sexual orientations; individuals within families, groups, and organizations; medical and social service providers; attorneys; and other professionals.
Settings include: military bases, schools, research laboratories, universities, private or group practice offices, business organizations, hospitals, integrated care systems and patient-centered medical homes, managed care companies, courts, social services programs, government agencies, and public spaces where research or intervention occurs.
Communication contexts include: in person and via post, telephone, fax, internet, mobile phone, television, radio, and other electronic transmissions.
Important caveat: The Introduction and Applicability section states that lack of awareness or misunderstanding of any part of the Ethics Code is not a defense to a charge of unethical conduct.
Professional Versus Personal Activities
The Ethics Code applies only to psychologists’ activities that are part of their scientific, educational, professional, or consulting roles.
The Code does not apply to purely private conduct, though the APA may act after a member’s felony conviction if it relates to activities performed in a psychologist’s professional role.
Ambiguities between personal and professional actions may arise (examples given):
If psychology professors have personal web pages with racist comments, are these relevant to their professional role if students access the page?
If a counseling psychologist criticizes another school psychologist’s professionalism at a parent meeting, could that be seen as partly professional?
Criteria to help determine overlap (Pipes et al., 2005):
Is the behavior linked to a role played by psychologists?
Does the behavior, on its face, seem at least partially professional?
Is there a high probability that those with whom the psychologist works will be affected?
Does the action threaten the professional credibility of the psychologist or the discipline of psychology?
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CHAPTER TWO • THE ETHICS CODE INTRODUCTION AND PREAMBLE
Professional Versus Personal Values
Values used in personal relationships can conflict with professional ethics, producing conduct that violates the Ethics Code.
Example: A clinical child psychologist might feel ethically compelled by family caring values to assist a brother with a behavioral program for his daughter with pervasive developmental disorder. This could create dual relationships and potential harm; refer the case (Principle B, Fidelity and Responsibility; Standard 3.04, Avoiding Harm; Standard 3.05, Multiple Relationships).
Conversely, overly rigid or mechanical adherence to specific standards can also yield unethical responses in complex moral contexts (e.g., ethnographic research with youth gangs where a participant reports a planned murder; the strict reading of Standard 4.01 Maintanence of Confidentiality vs. Standard 4.05 Disclosures would contradict Principle A, Beneficence and Nonmaleficence).
Training recommendations (Handlesman et al.) suggest integrating new professional values with preexisting moral values to promote ethical responsibility and social roles of psychologists; see discussion of aspirational principles and virtues in Chapter 3.
NEED TO KNOW: Personal versus Private Political Acts
The Introduction and Applicability section states that requirements apply to professional activities, not purely private conduct.
Debate exists about political advocacy being personal vs professional.
General Principles urge awareness of political factors that could lead to misuse of influence (Principle A, B, D, E). APA has supported social justice reforms (criminal justice reform, reproductive rights, LGBTQ+ rights, anti-racism).
Some argue political actions by psychologists, even when framed as social justice, may affect welfare and autonomy of those served, potentially constraining rights and leading to unequal outcomes (Allen & Dodd, 2018).
(Continued) WHAT IS THE RELEVANCE OF SPECIFIC LANGUAGE USED IN THE ETHICS CODE?
To meet professional and enforcement goals, language should provide notice of violations, be applicable across roles, and support good practice without impeding practice. The section gives guidance on interpreting code language.
Due Notice issues: Adjudicatory decisions can be overturned on appeal if there was no forewarning that a behavior was a violation (Bersoff, 1994). Language like "alert to," "guard against," or "to respect" can be problematic because they are undefined; the enforceable standards describe specific required/prohibited behaviors to avoid ambiguity.
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CHAPTER TWO • THE ETHICS CODE INTRODUCTION AND PREAMBLE
Applicability Across Diverse Roles and Contexts
Psychologists engage in a wide variety of roles: teaching, research, therapy, testing, consulting, legal testimony, program evaluation, etc.
An enforceable ethics code must be broad enough to apply across activities, with clearly presented role-specific standards, and without compromising scientific, practice, or consulting activities due to inflexibility.
This balance led to the decision not to include some universally desirable standards (e.g., a general “honesty” standard) because they could unduly constrain other areas (e.g., deception research, paradoxical therapy).
The aspirational principle of integrity is reflected in more specific standards (e.g., ext{5.02}, ext{Statements by Others}; ext{8.10}, ext{Reporting Research Results}).
NEED TO KNOW: The Use of Modifiers
Modifiers are words/phrases that qualify the meaning of an ethical rule (e.g., appropriate, potentially, to the extent feasible, attempt to).
Modifiers help apply broad standards to specific contexts without creating blanket prohibitions.
Example uses of modifiers:
What Is “Reasonable”?
Definition: the prevailing professional judgment of psychologists engaged in similar activities in similar circumstances, given the knowledge the psychologist had or should have had at the time.
Purposes:
Prohibits idiosyncratic ethical judgments that diverge from prevailing professional norms.
Provides a standard against which to judge ethical behavior and supports legitimate defense based on current best practices.
Examples:
: disclose confidential info only after taking "reasonable steps to disguise the person or organization". The term
reasonable acknowledges that even de-identified disclosures may allow recognition.: delegate only to individuals capable of performing competently given their education, training, or experience, with appropriate supervision. The example contrasts an interpreter with legitimate credentials vs one with fabricated credentials.
The combined concepts of modifiers and reasonableness allow standards to remain adaptable over time while preserving protective boundaries.
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CHAPTER TWO • THE ETHICS CODE INTRODUCTION AND PREAMBLE
Client/Patient and Organizational Client (terminology usage throughout the Code)
The combined term client/patient refers to individuals who receive treatment, intervention, or assessment services.
Organizational clients refer to organizations or their representatives for whom psychologists provide consultation, organizational evaluations, test development, forensic expertise, or other non-treatment services.
Example: A bank hiring a psychologist to counsel employees after a traumatic incident: the bank is the organizational client; the employees are the clients/patients.
For consistency, compare the use of the term client in with .
How Is the Ethics Code Related to APA Ethics Enforcement?
The APA Ethics Committee investigates complaints against APA members alleging violations of the Ethics Code that were in effect when the conduct occurred.
The APA Ethics Committee Rules and Procedures outline the enforcement process (online at https://www.apa.org/ethics/code/committee.aspx).
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Ethics Enforcement Continuum
The text introduces enforcement mechanisms and the relationship between the Ethics Code and professional practice.
The Use of Modifiers (Continued Examples)
The page provides further illustration of modifiers in standards such as:
Informed Consent to Therapy (as early as is feasible)
Informed Consent (appropriate explanation)
Boundaries of Competence (relevant education, training, supervision, or study)
The overall message: modifiers enable flexible, context-sensitive application without sacrificing protections.
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CHAPTER TWO • THE ETHICS CODE INTRODUCTION AND PREAMBLE
Client/Patient and Organizational Client (Clarified)
Reiteration of client/patient vs organizational client terminology for consistency across standards.
How Is the Ethics Code Related to APA Ethics Enforcement? (Continued)
The Ethics Committee process overview and the role of the Ethics Office in handling complaints.
What to Expect in Enforcement (Overview)
The section foreshadows the kinds of actions and processes that follow in enforcement chapters (not fully elaborated on this page).
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CHAPTER TWO • THE ETHICS CODE INTRODUCTION AND PREAMBLE
How the APA Ethics Code Is Related to Enforcement by the APA
The APA Ethics Committee handles complaints against APA members alleging violations of the Ethics Code enforced at the time the conduct occurred.
The APA may publish enforcement outcomes and notify relevant parties as part of the process.
Ethics Complaints
Complaints can be filed by APA members or nonmembers, or initiated by the Ethics Committee (sua sponte).
Time limits: within less than 3 years after conduct occurred or was discovered, and file within less than 10 years after the conduct is alleged to have occurred.
Dismissal: A complaint may be dismissed before review if it lacks jurisdiction or if preliminary review by the Ethics Office director and chairs finds no grounds for action.
If jurisdiction exists and grounds are present, a case is opened, standards violations are charged, and an investigation begins.
The respondent receives a charge letter and may comment and provide materials; confidentiality is emphasized (no individually identifiable patient information without a valid authorization).
Non-cooperation by the respondent is itself an ethical violation (Standard , Cooperating With Ethics Committees).
The Ethics Committee can stay or proceed if the respondent is involved in civil/criminal litigation elsewhere.
Resignation while under investigation is an option offered by the Ethics Committee.
Outsourcing Adjudication
In 2018, the APA Board of Directors announced that complaints would be accepted only if there is no alternative forum (e.g., state licensing boards, university grievance processes, custody matters).
Rationale: APA cannot revoke licenses or issue monetary penalties; it can expel members, but cannot fully substitute for other bodies.
This decision prompted concern among some APA members (open letter by 14 former Ethics Committee chairs, Aug 2018).
Critics argue outsourcing may allow policies to reflect external priorities rather than APA ethics codes (Pope, 2018).
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Sanctions
The Ethics Committee reviews cases and may impose:
Reprimand: for violations not likely to cause harm or substantial harm to the profession or individuals.
Censure: for harms that may affect individuals but not to the extent of substantial professional harm.
Expulsion: for violations likely to cause substantial harm or of grave gravity.
Stipulated resignation: contingent on a signed affidavit and board approval following a finding of violation or failure of good cause.
The Committee may also issue directives such as: (a) cease and desist; (b) obtain supervision or training; (c) be evaluated or treated if appropriate; (d) probationary monitoring.
A psychologist found in violation may seek an independent case review or an in-person hearing before a formal hearing committee (especially in expulsion cases).
Notification duties: The Ethics Office director informs the respondent and complainant of the final disposition; publishes annual notices of expulsions and resignations under investigation; may notify state boards, ABPP, ASPPB, and other relevant parties.
Show Cause Procedure: The Ethics Committee can act if a criminal court, licensing board, or state association has already taken adverse action against the member; the rationale may extend beyond ethical code violations (e.g., felony conviction).
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CHAPTER TWO • THE ETHICS CODE INTRODUCTION AND PREAMBLE
How Is the Ethics Code Related to Sanctions by Other Bodies?
The APA Ethics Code is widely used by other bodies regulating psychology.
Actions violating the Ethics Code may lead to sanctions by bodies other than APA (state psychological associations, psychology boards, federal agencies, payors, etc.).
The Ethics Code is adopted in whole or in part by more than half of state boards responsible for licensing psychology. Insurance companies may consider ethics findings when setting rates or policy eligibility.
The APA Ethics Committee can notify other bodies and individuals of sanctions imposed for ethical violations.
The ASPPB Code of Conduct (ASPPB, 2018) may supersede the APA Code if there is a conflict, and it provides more specific or binding rules in some areas (e.g., informed consent for minors; reporting unethical behavior; discrimination; sexual harassment; etc.).
The ASPPB adds/expands prohibitions beyond the APA standards (e.g., certain harassment and sexual relationship prohibitions; confidentiality at organizational level; disclosure following client death; credential misrepresentation).
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What to Do When You Receive an Ethics Complaint
Practical guidance (Koocher & Keith-Spiegel, 2013):
1) Gather facts to determine the nature of the complaint, whether it is formal or informal, the jurisdiction, and the procedures for responding; know the consequences of not responding (Standards , Informal Resolution; , Formal Resolution; , Cooperating With Ethics Committees).
2) Do not respond to the complaint without a clear, written explanation of the charges; do not contact the complainant directly; obtain a waiver to disclose confidential information if the complainant is a client/patient (Standards , Maintaining Confidentiality; , Discussing the Limits of Confidentiality).
3) Obtain consultation and, if appropriate, legal advice before responding or providing materials; in most cases, respond personally even if you retain an attorney.
4) In crafting a response, assess the credibility of the charge; limit your response to the scope of the inquiry; provide documentation; begin remediation actions immediately if you are at fault (e.g., supervision or training).
5) Understand the professional, legal, and economic consequences of any offered settlement, “consent decree,” sanction, or other resolution that is not a full dismissal of charges; seek additional professional or legal consultation.
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CHAPTER TWO • THE ETHICS CODE INTRODUCTION AND PREAMBLE
How Is the APA Ethics Code Related to Law? Civil Litigation
The Introduction and Applicability section states that the Ethics Code is not intended as a basis for civil liability: “Whether a psychologist has violated the Ethics Code standards does not by itself determine whether the psychologist is legally liable in a court action, whether a contract is enforceable, or whether other legal consequences occur.”
However, compliance with or violation of the Ethics Code may be admissible as evidence in some legal proceedings depending on circumstances.
Attorneys may introduce the General Principles or Ethical Standards into litigation as evidence of ethical values/requirements, even though the General Principles are aspirational.
Compliance With Law
Law does not dictate ethics, but awareness of relevant laws helps protect professional integrity.
Few standards require compliance with the law, but many are written to minimize conflicts with state/federal regulations. Standards that require compliance with the law include:
Unfair Discrimination
Informed Consent
Disclosures
Documentation of Professional and Scientific Work and Maintenance of Records
Fees and Financial Arrangements
Humane Care and Use of Animals in Research
Maintaining Test Security
The chapter notes that many standards were crafted to align with legal requirements and to minimize conflicts with applicable laws.
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Conflicts Between Ethics and Law, Regulations, or Other Governing Legal Authority
When applying the Ethics Code, psychologists may encounter conflicts with laws/regulations. The Guidelines state that psychologists must comply with the Ethics Code if it establishes a higher standard of conduct than law.
If a direct conflict cannot be resolved by ethical means, psychologists may comply with the law but only if such compliance cannot be used to justify or defend violations of human rights (Standard , Conflicts Between Ethics and Law, Regulations, or Other Governing Legal Authority).
The section references historical discussion (e.g., 2010 Amendments: Involvement in inhumane military interrogations) and relevance to human rights (see related topics in Chapters 1, 5).
Risk Management is introduced as important for ethical practice, incorporating HIPAA and legal considerations.
Risk Management in Professional Practice
Risk management involves identifying, reducing, and mitigating the probability and consequences of negative outcomes.
Taube et al. (2018) outline risk-management guidance in psychotherapy practice:
Risk Management and Informed Consent
Boundaries of Competence
Involvement of collateral and multiple roles (therapy vs forensic, etc.)
Confidentiality and disclosure issues in complex cases
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Specific Risk Management Topics (continued)
Collateral involvement in therapy can raise issues of confidentiality and scope. The text discusses the need to discuss and clarify who is the client and to address HIPAA and ethical safeguards at the outset of treatment when a collateral attends.
Boundaries of Competence remain critical when lawyers or courts request testimony; psychologists must have appropriate forensic or neuroscience competencies, avoid conflicts of interest, and consider financial incentives that may bias judgment (Standards , Boundaries of Competence; , Multiple Relationships; , Conflicts of Interest).
Confidentiality and Disclosure: The Ethics Code permits limited disclosure without consent to provide needed services and protect others from harm, but requires discussion of limits at the outset (Standards Disclosures; Discussing the Limits of Confidentiality; Informed Consent to Therapy).
Without specifics, general terms like “harm to self or others” can lead to patient distrust; clinicians are encouraged to specify disclosure circumstances (e.g., risk of self-harm, imminent danger) and align with HIPAA/other regulations.
The discussion includes examples of disclosure decisions in cases like serious nonsuicidal self-injury (NSSI) and suicidal ideation, and the need to describe in initial consent the circumstances that might require disclosure (see related Hot Topics in Chapter 8).
A Word About HIPAA
Background: HIPAA (1996) established requirements to standardize health information exchange, protect privacy, and secure health information, with updates via the Omnibus Rule (2013) and integration with HITECH and GINA.
HIPAA components: (1) Privacy Rule (PHI privacy), (2) Transaction Rule (electronic data exchange), (3) Security Standards (protect PHI).
The HIPAA changes addressed interoperability with other health IT rules and genetic information nondiscrimination.
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Protected Health Information (PHI) and Covered Entities
PHI includes any individually identifiable health information related to past, present, or future health status, health care provision, or health care payments.
Covered Entities include:
Health plans
Health care clearinghouses
Health-care providers who transmit PHI electronically in connection with health care transactions
Educational records, employment records, and de-identified records are not PHI.
Covered entities may engage business associates to perform health-care activities; PHI may be shared with a business associate if there is assurance of limited use, safeguards, and compliance with privacy rules.
Definition of Electronic Media includes electronic PHI creation, storage, and transmission across networks and devices; some transmissions (paper, fax, voice) are not considered electronic in some contexts.
Psychologists should ensure that portable devices containing ePHI are encrypted; data breaches can carry severe penalties.
The rise of mobile health (mHealth) apps introduces new concerns about HIPAA compliance for apps used in mental health services.
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The COVID-19 Notification of Telehealth Enforcement Discretion
During the COVID-19 crisis, the Department of Health and Human Services Office for Civil Rights (OCR) exercised enforcement discretion regarding remote communications technologies that might not fully comply with HIPAA Rules.
The goal was to empower providers to serve patients wherever they are during the national emergency, permitting use of common platforms like Apple FaceTime, Facebook Messenger, Zoom, Skype, etc., while restricting use of public-facing apps like TikTok or Facebook Live.
OCR also issued a list of HIPAA-compliant video-communication products as appropriate Business Associates.
Providers who used noncompliant tools during the crisis should return to HIPAA-compliant communications after the crisis ends.
HIPAA Protections and Requirements (Overview)
HIPAA rules protect PHI by:
Standardizing PHI formats for electronic records
Securing electronic PHI transactions and storage
Limiting use and disclosure of PHI, including patient requests to restrict disclosure to health plans when services are paid in cash
Increasing patient control and access to health records
Establishing penalties for unauthorized PHI use/disclosure
Identifying public health needs that permit PHI disclosures without authorization
Strengthening limits on PHI use for marketing and other purposes
Prohibiting genetic information use by health plans for underwriting
Creating system of tiered penalties for willful, noncompliant violations
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What Do Covered Entities Need to Do to Comply With HIPAA?
Key duties include:
Provide patients with a Notice of Privacy Practices
Permit patient access to records and provide an accounting of disclosures upon request (including electronic disclosures under HITECH)
Obtain patient authorization for PHI use/disclosures when required
Implement privacy procedures for electronic transmission and storage of PHI
Designate a Privacy Officer
Implement security procedures to prevent unauthorized PHI access
Train employees on privacy, transaction, and security procedures
Ensure that business associates and contractors comply with privacy and transaction rules
Take corrective action or terminate relationships if violations occur
Notice of Privacy Practices must be provided before initiating treatment or relevant assessments; the notice (or a summary) should be posted in a prominent location.
Right to an Accounting of Disclosures: Patients may request a listing of disclosures not listed in the Notice of Privacy Practices; under HITECH, disclosures through electronic health records for treatment, payment, and health care operations are included.
Authorization to Release Information: Written authorization must be specific about data disclosed, recipients, purpose, expiration, and signature.
Minimum Necessary: When disclosing or requesting PHI, entities must limit information to the minimum necessary; exceptions include disclosures to other providers for treatment or as required by law.
Privacy Officer: Covered entities must designate a privacy officer to oversee HIPAA compliance.
Researchers: Researchers who access PHI may be treated as business associates and must comply with PHI rules; HIPAA may apply to research that creates, uses, or discloses PHI.
HIPAA and Industry: HIPAA typically does not apply to data collected solely for research purposes if PHI is not shared or included in health records; external IRBs are not per se HIPAA business associates solely by overseeing research.
HIPAA does not apply to data collected by some industrial-organizational or consulting psychologists when used for training or quality assurance purposes only.
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The Patient Protection and Affordable Care Act (ACA)
The ACA (2010) redefines health-care delivery and expands health insurance coverage; it includes psychology as a health-care profession in sections on research and evaluation, and psychosocial services are described for several patient populations.
Expanded Medicaid coverage has increased access to mental health treatment and naloxone availability for lower-income adults; parity protections ensure that limits on medical or mental health services are not more restrictive than for medical/surgical services.
Since the ACA, more uninsured individuals with mental health disorders have gained access to coverage and treatment, though access remains incomplete for many groups.
Interprofessional organizational structures include two main models: Accountable Care Organizations (ACOs) and Patient-Centered Medical Homes (PCMHs).
These frameworks shift from episodic, illness-based care to continuous, coordinated, team-based care that integrates psychologists into primary care and preventive services across the lifespan.
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Interprofessional Organizations and Team-Based Care Models
The chapter enumerates competencies and responsibilities for psychologists in team-based care settings, including:
Identify and resolve ethical conflicts in patient-centered care contexts and in coordination with other health professions (Standards , Conflicts Between Ethics and Organizational Demands; , Informal Resolution of Ethical Violations; , Reporting Ethical Violations).
Acquire training appropriate to competently engage in coordinated care services and identify evidence-based practices for team-based primary care (Standards , Boundaries of Competence; , Bases for Scientific and Professional Judgments).
Develop and communicate confidentiality policies within teams and with patients (Standards , Maintaining Confidentiality; , Discussing the Limits of Confidentiality).
Obtain training for treatment management consultations in response to requests from other health providers (Standards , Cooperation With Other Professionals; , Consultations).
Create and maintain records documenting evolving health service categories and outcomes; appropriate billing for team-based services (Standards , Documentation of Professional and Scientific Work and Maintenance of Records; , Fees and Financial Arrangements).
Design, implement, and evaluate the efficiency, quality, and cost-effectiveness of biobehavioral and team-based services (Standard , Client/Patient, Student, and Subordinate Research Participants).
Select and interpret assessment instruments suitable for screening and targeted interventions and communicate results to patients and the medical team (Standards , Bases for Assessments; , Interpreting Assessment Results; , Explaining Assessment Results).
Provide appropriate informed consent procedures for patients in ACO/PCMH settings compatible with shared decision-making models (Standards , Informed Consent; , Informed Consent in Assessments; , Informed Consent to Therapy; , Therapy Involving Couples or Families; , Group Therapy).
This page sets the stage for Chapters 3 and 4, which provide deeper exploration of the General Principles and ethical decision-making in applying the Code to psychological science and practice.
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CHAPTER TWO • THE ETHICS CODE INTRODUCTION AND PREAMBLE
The Chapter’s Purpose and Transition
The material on ACA and interprofessional care frames subsequent chapters’ deeper dive into applying the Ethics Code to real-world practice, including ethical decision-making and the roles of ethical commitment and competence in promoting responsible science and practice.
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Closing Overview
This chapter lays the groundwork for more detailed exploration in Chapters 3 and 4, focusing on:
The General Principles guiding ethical thinking and behavior.
The relationship between aspirational values and enforceable standards.
How ethics integrate with enforcement, law, risk management, HIPAA, and contemporary health-care delivery systems.
The necessity of balancing professional duties across diverse roles and settings while maintaining the rights and dignity of individuals served.
The remainder of this book builds on this foundation, applying the Ethics Code to a wide range of ethical considerations in psychological science and practice.