_______________________________________________________________________ Ethics for Psychologists
(d) Psychologists appropriately document written or oral consent, permission, and assent. (See also Standards 8.02, Informed Consent to Research; 9.03, Informed Consent in Assessments; and 10.01, Informed Consent to Therapy.) As discussed, informed consent means providing information on the nature of the services being provided, the anticipated course of services, any anticipated benefits from the services, any anticipated risks in having the services or not, and alterna- tives to the proposed course of services being suggested, includ- ing what might occur with no treatment. These components are required both legally as well as ethically. The first legally recognized use of the term “informed consent” comes from the Salgo v. Leland Stanford etc. Bd. Trustees, 154 Cal. App. 2d 560 [Civ. No. 17045. First Dist., Div. One. Oct. 22, 1957.] case [14]. In this case Mr. Salgo was not told that an angiogram might result in complications such as paralysis. From this case came the outline of the requirements that an individual be fully informed about the nature of procedures, risks, benefits, and alternatives, and that the understanding be documented in the medical record. Over time, informed consent has grown to also include agree- ing to the policies and procedures of the facility in which the person is being seen. These include policies regarding: • Scheduling: Frequency of meetings, time frames for scheduling, time frames for changing or cancelling appointments, and issues that would impact scheduling, such as availability of the psychologist due to other obligations • Cancellation: The method of cancellation or reschedul- ing of services, charges for missed sessions, emergency notification procedures • Payment for services: Cost of services, which services are covered, use of third-party payors (such as insur- ance), when payment is expected, whether credit cards or checks are acceptable, the expected time frames for payment for services, the procedure if an insurance company or other third-party payor declines to pay for services, and fees for other services such as evaluations, court testimony and depositions, reports, record review, and photocopying records to another party • Record keeping: The manner in which records will be kept, how they are kept, length of record retention, information regarding protected health information, patient rights and access to records, legal access to records by the court or others (i.e., who has access to records besides the psychologist, how is security main- tained, how and to whom records may be released), and whether the records will include any audio or video tapes, phone logs, or email correspondence
• Supervision: What information can be discussed with other professionals, including interns and postdoctoral fellows. If the psychologist is providing formal supervi- sion, does the supervisee have an understanding of the exact expectations of the relationship and requirements for hours or completion of the program? Does the supervisee understand the role of the supervisor and has he or she communicated that role to the client? What evaluation methods will be used for the supervi- sion? What is expected in case of a crisis for the client or supervisee? • Collaboration with others: What will be discussed, which people or organizations have access to protected health information, how collaboration will occur, what roles others will have. Limitations regarding the people or organizations the psychologist is allowed to talk with and what information may be shared should be clari- fied. • Rights and responsibilities: What is expected of the client, rights clients have regarding their treatment, what clients have a right to know prior to agreeing to a specific treatment, what clients should expect from the psychologist providing treatment, how treatment will proceed, what clients should do if they are not satisfied with treatment, what regulatory agencies are available to advocate on behalf of a client. Clients should also be advised of the limitations of any rights they are likely to believe they have, such as situations in which they are seen on behalf of the court and information will be provided back to the court. • Children and adolescents: Consent for treatment, obligations to reveal records to parents or guardians on demand, limitations to confidentiality, obligations to reveal information legally for personal or community safety • Availability: When, how, and where patients can interact with the psychologist, expectations of privacy and confidentiality, use of insurance or changes in insurance reimbursement, how to make contact in an emergency or between sessions, options available for dealing with emergencies • Use of insurance or third-party payors: Information regarding Health Insurance Portability and Account- ability Act (HIPAA). (Records are transmitted, accessed, and used electronically for providing services, to handle billing, for healthcare operations, and as required by law, and clients should be advised regarding the stan- dardized formatting of information to be transmitted electronically, such as for insurance billing, and the use of reasonable state-of-the-art protective measures for computer security, such as limiting access by use of
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