Pennsylvania Physical Therapy Ebook Continuing Education

This interactive Pennsylvania Physical Therapy Ebook contains 30 hours of continuing education. To complete click the Complete Your CE button at the top right of the screen.

FULL CE REQUIREMENT INSIDE!

Elite Learning

PENNSYLVANIA Physical Therapy Continuing Education

Meet YOUR CE HOURS with Elite Learning’s STRESS FREE SOLUTION to completing your CE ONE CONVENIENT BOOK See inside for details Colibri Healthcare, LLC’s courses meet the standards for physical therapy continuing education activities in Pennsylvania. Colibri Healthcare, LLC’s courses that grant Direct Access credit are approved by the Pennsylvania State Board of Physical Therapy.

Scan the QR code to take your exam, or visit ELITELEARNING.COM/BOOK and enter a book code below or scan QR code: Licensed PT/PTA: PTPA3024H Direct Access cert holder: PTPA3024DA

Licensed PT/PTA PTPA3024H

Direct Access cert holder PTPA3024DA

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Licensed PT/PTA

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NON DIRECT ACCESS CERT HOLDER PACKAGE PTPA3024H

DIRECT ACCESS CERT

WANT TO COMPLETE AN INDIVIDUAL COURSE? USE THIS CODE ▼

HOLDER PACKAGE PTPA3024DA

Ethics for the Pennsylvania Physical Therapy Professional (Mandatory) - 2 hours Pennsylvania Mandatory Child Abuse Recognition and Reporting (Renewal Licensure) (Mandatory) - 2 hours Aging Process: What is Happening to the Body and What Does it Mean? - 3 hours Back to the Books: Return to Learn Strategies for Concussed Student-Athletes - 2 hours Introduction to Golf Rehabilitation and Performance: 90 Percent Mental, 90 Percent Physical - 3 hours Treating Connective Tissue Conditions with Muscle Release Techniques, 2nd Edition - 2 hours Trigger Point Therapy for Headaches, Migraines, and TMJD - 6 hours Kinesiology Taping for Orthopedic Conditions - 4 hours Optimizing Outcomes in Rehabilitation: Motor Learning Principles and Beyond - 6 hours Differential Diagnosis for Physical Therapy: Cancer, Hepatic/Biliary and Renal Disease - 3 hours

PTPA02ET-H

PTPA02CA-H

PTPA03AP-H

PTPA02BB-H

PTPA03GR-H

PTPA02TC-H

PTPA06TP-H

PTPA04KT-H

PTPA06ML-H

PTPA03CH-H

Differential Diagnosis for Physical Therapy: Introduction - 4 hours

PTPA04DD-H

Differential Diagnosis for PT: Hematological, Cardiovascular, Immune and Digestive System Disorders - 3 hours

PTPA03HC-H

INCLUDED IN THIS BOOK

Ethics for the Pennsylvania Physical Therapy Professional (Mandatory) [2 contact hours]

This online home study continuing education course is intended to instruct the professional through a self- paced study on the APTA Code of Ethics, APTA Standards of Ethical Conduct for the Physical Therapist Assistant, the Board of Physical Therapy Policy Statement and basic theories and approaches in ethical decision making. 11 Pennsylvania Mandatory Child Abuse Recognition and Reporting (Renewal Licensure) (Mandatory) [2 contact hours] This course fulfills the Pennsylvania Healthcare Professionals 2-year licensure renewal continuing education requirement for 2 contact hours of Child Abuse Recognition and Reporting. The course provides the details of the identification, assessment, and reporting of child abuse and reviews Pennsylvania’s state laws regarding child abuse and neglect. 19 Aging Process: What is Happening to the Body and What Does it Mean? [3 contact hours] This course discusses at an in-depth level the physiological changes that occur with aging, the modifiable factors that impact the effects of aging, and how these contribute to the function of older adults. Participants will gain knowledge in assessing what changes are normal with aging versus those that are not, intervention strategies, and in addressing risk factors when they are identified. 28 Back to the Books: Return to Learn Strategies for Concussed Student-Athletes [2 contact hours] This course covers how to implement return to learn strategies for student athletes following a concussion. Based on the most up-to-date research on concussions in student athletes, athletic trainers, and healthcare practitioners are provided with best-practice recommendations on how to manage post-concussion recovery and learning. Participants will be able to assess their current return to learn the process and modify it in alignment with current guidelines. 35 Introduction to Golf Rehabilitation and Performance: 90 Percent Mental, 90 Percent Physical [3 contact hours] This course will provide value for practitioners of all experience levels, from those who have never touched a golf club or set foot on a golf course to the seasoned professional. It will include a thorough introduction to basic golf language and concepts, a review of the relevant anatomy and biomechanics, a novel approach to evaluation of the patient or client’s physical capabilities, and specific strategies to improve the neuromotor processes that promote recovery from injury and higher quality golf performance. 44 Treating Connective Tissue Conditions with Muscle Release Techniques, 2nd Edition [2 contact hours] Designed to introduce massage therapists, athletic trainers and wellness professionals, this course shows learners how to effectively manipulate adhesions, scar tissue, and trigger points to improve patient outcomes. The purpose of this course is to promote awareness of restrictions in muscle and fascia and tissue adhesions as well as resulting pain and dysfunction. We will explore safe, effective techniques shown to reduce tissue restriction and restore optimum function. 50 Trigger Point Therapy for Headaches, Migraines, and TMJD [6 contact hours] Trigger point therapy can be utilized to treat conditions such as headaches, migraines, temporomandibular joint disorder, tinnitus, and vertigo. This course defines and identifies trigger point pathophysiology and their ability to cause pain and autonomic phenomena. Muscle anatomy of the head, face, neck, shoulders, and back are reviewed along with the associated referral pain and symptoms. Hands-on demonstrations are provided for the back, shoulders, and sternocleidomastoid, as well as the head, face, and muscles of mastication. COURSE LIST CONTINUES ON NEXT PAGE ►

Colibri Healthcare, LLC is an approved Child Abuse Recognition and Reporting Continuing Education Provider (Pennsylvania Department of State – Child Abuse Recognition and Reporting Training Provider # CACE000025).

INCLUDED IN THIS BOOK

Kinesiology Taping for Orthopedic Conditions [4 contact hours]

Kinesiology taping is redefining the role of therapeutic taping for rehabilitation professionals. Taping was once used to physically hold structures in place; now kinesiology taping is used to influence fascia and underlying neural tissues to cause functional changes in both the local tissue as well as the central nervous system. Often relegated to the athletic world, kinesiology taping has many orthopedic, neurological, pediatric, geriatric, and other specialty applications. Course content will include orthopedic assessment, adjunctive manual therapies, and kinesiology taping for joint mobility and stability applications. 75 Optimizing Outcomes in Rehabilitation: Motor Learning Principles and Beyond [6 contact hours] By the end of this course, participants will gain a knowledge and understanding of how to optimize rehabilitation outcomes in their patients by using current and evidence-based application of motor learning concepts and principles of neuroplasticity, including contemporary evidence for autonomy support and the effects of improving patient motivation and focus. 89 Differential Diagnosis for Physical Therapy: Cancer, Hepatic/Biliary and Renal Disease [3 contact hours] This course is intended to instruct the professional on screening multiple body organ systems for diseases and syndromes that are not of musculoskeletal origin. 103 Differential Diagnosis for Physical Therapy: Introduction [4 contact hours] As the profession of Physical Therapy has progressed, the importance of differential diagnosis and medical screening has increased, especially with the mandate of autonomous practice. This course will give the clinician the ability to screen the multiple body organ systems for diseases and syndromes that are not of musculoskeletal origin. The further addresses effective mechanisms that result in client referrals to appropriate health care practitioners. Through lectures and case studies, the therapist will be able to determine the best course of action with a patient utilizing the best available assessment tools and measures and evidence-based practice to determine diagnosis, need for referral, or method of treatment. 116 Differential Diagnosis for PT: Hematological, Cardiovascular, Immune and Digestive System [3 contact hours] This course is intended to instruct the professional on screening multiple body organ systems for diseases and syndromes that are not of musculoskeletal origin.

FREQUENTLY ASKED QUESTIONS

License Expires

Contact Hours Required

Mandatory Subjects

2 hours - law or ethics 2 hours - child abuse recognition and reporting

30 (All hours are allowed through home-study)

Biennial renewal. Licenses expire December 31 of the even year.

Are you a Pennsylvania board-approved provider? Colibri Healthcare, LLC is an approved Child Abuse Recognition and Reporting Continuing Education Provider (Pennsylvania Department of State – Child Abuse Recognition and Reporting Training Provider # CACE000025). What are the mandatory requirements for Direct Access certificate holders? A licensed physical therapist with a certificate allowing practice without a referral must meet an additional specific requirement. For license renewal, at least 10 of the required 30 contact hours must be in evaluative procedures for treating patients without a referral. Are my credit hours reported to the Pennsylvania board? Yes, we will report your 2-hour Pennsylvania Mandatory Child Abuse Recognition and Reporting course within two business days. For the remaining courses, the board performs random audits at which time proof of continuing education must be provided. Is my information secure? Yes! We use SSL encryption, and we never share your information with third-parties. We are also rated A+ by the National Better Business Bureau. What if I still have questions? What are your business hours? No problem, we have several options for you to choose from! Online at EliteLearning.com/Physical-Therapy you will see our robust FAQ section that answers many of your questions, simply click FAQs at the top of the page, e-mail us at office@ elitelearning.com, or call us toll free at 1-888-857-6920, Monday-Friday 9:00 am - 6:00 pm EST, Saturday 10:00 am-4:00 pm EST. Important information for licensees: Always check your state’s board website to determine the number of hours required for renewal, mandatory topics (as these are subject to change), and the amount that may be completed through home-study. Also, make sure that you notify the board of any changes of address. It is important that your most current address is on file. Implicit bias in healthcare: Implicit bias significantly affects how healthcare professionals perceive and make treatment decisions, ultimately resulting in disparities in health outcomes. These biases, often unconscious and unintentional, can shape behavior and produce differences in medical care along various lines, including race, ethnicity, gender identity, sexual orientation, age, and socioeconomic status. Healthcare disparities stemming from implicit bias can manifest in several ways. For example, a healthcare provider might unconsciously give less attention to a patient or make assumptions about their medical needs based on race, gender, or age. The unconscious assumptions can lead to delayed or inadequate care, misdiagnoses, or inappropriate treatments, all of which can adversely impact health outcomes. Addressing implicit bias in healthcare is crucial for achieving equity in medical treatment. Strategies to combat these biases involve education and awareness programs for healthcare professionals. These programs help individuals recognize and acknowledge their biases, fostering a more empathetic and unbiased approach to patient care. Additionally, implementing policies and procedures prioritizing equitable treatment for all patients can play a pivotal role in reducing healthcare disparities. Ultimately, confronting implicit bias in healthcare is essential to creating a more just and equitable healthcare system where everyone receives fair and equal treatment regardless of their background or characteristics. Disclosures: Resolution of conflict of interest Colibri Healthcare, LLC implemented mechanisms prior to the planning and implementation of the continuing education activity, to identify and resolve conflicts of interest for all individuals in a position to control content of the course activity. Sponsorship/commercial support and non-endorsement It is the policy of Colibri Healthcare, LLC not to accept commercial support. Furthermore, commercial interests are prohibited from distributing or providing access to this activity to learners. Disclaimer: The information provided in this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition. ©2024: All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Colibri Healthcare, LLC. The materials presented in this course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals with practical knowledge of the areas covered. It is not meant to provide medical, legal, or professional advice. Colibri Healthcare, LLC recommends that you consult a medical, legal, or professional services expert licensed in your state. Colibri Healthcare, LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing, but does not represent or warrant that it will apply to your situation nor circumstances and assumes no liability from reliance on these materials. Quotes are collected from customer feedback surveys. The models are intended to be representative and not actual customers.

Ethics for the Pennsylvania Physical Therapy Professional: Summary

Ethics for the Pennsylvania Physical Therapy Professional 2 Contact Hours

ACCESS THE FULL VIDEO PRESENTATION

Scan the QR CODE to start video or visit https://uqr.to/paethics

Author Lisa Milliken, MA, CCC-SLP

Lisa is a member ASHA, where she currently serves as a State Advocate for Medicare Policy (StAMP) to Texas and she serves on the TSHA Executive Council as Chair of the Business Management Committee. She has also recently been awarded as a Distinguished Fellow of the National Academies of Practice in Speech- Language Pathology. In prior years she served in multiple positions on the Louisiana Speech Hearing and Language Association to include State Advocate for Medicare Policy, Director of Publications, President Elect, President and Past President.

LEARNING OUTCOMES • Define ethics and the components of ethical standards and behavior • Identify the 10 medical principles of ethics • Cite the five roles of the physical therapist, which are noted as the foundation of the APTA code of ethics

• Describe the seven core values that guide the APTA principals of professional ethics • State the components of the Realm- Individual Process-Situation (RIPS) model of ethical decision making • Identify the types of documentation fraud in healthcare

SELF-ASSESSMENT QUESTIONS

1. Ethics is:

3. Which of the following is considered fraud? a. Billing in excess or inaccurately

a. Doing and saying the right thing b. Keeping the law c. Reacting to a situation d. Following society protocol 2. Which ethical principle states, “Do no harm”? a. Beneficence b. Nonmaleficence

b. Requesting to be done or performing services that are unnecessary c. Misrepresenting treatments d. All of the above

c. Veracity d. Fidelity

ANSWERS: 1: A 2 : B 3: D

Ethics for the Pennsylvania Physical Therapy Professional: Summary

Hedonism: Maximizes intellectual pleasure without worry regarding the future. The Golden Rule: “Love your neighbor as yourself.” Utilitarianism: “The greatest good for the greatest number of people.” Normative Ethics: Seeks to understand how Autonomy: Moral right to make choices and decisions about a course of action and allowing and enabling patients to make their own choices. Nonmaleficence: Providers should do no harm. Harm encompasses a range extending beyond physical or psychological harm including harm to reputation, liberty, or property. a person should act. Ethical Principles Beneficence: Duty to prevent harm to others, remove harm from others, and promote good. This obligation ends where action can bring harm to oneself. Justice: Fairly distributing burdens and benefits in society and focusing on who should get the resources. Informed Consent and Veracity: Presenting patients with details, benefits, risks, and potential risks of proposed interventions. Consent relies on veracity—obligation to speak and act truthfully. Confidentiality: Obligation to limit access to information gathered during treatment. Clinicians must keep information strictly between the therapist and the patient. There are certain laws that mandate breach of confidentiality to protect citizens. Fidelity: Moral duty to keep promises and commitments. Patients expect therapists to keep explicit and implicit promises. Duty: Obligations to others in society. Duties exist because of the nature of the relationship between the parties.

INTRODUCTION THE FOUNDATIONS OF ETHICS

Ethics Defined

Ethics are not: • Having a good feeling about words or actions LEARNING TIP! Ethics are the moral principles we adopt to guide our actions and our behavior. These principles are widely categorized as good or bad, acceptable or unacceptable. Ethics are doing and saying the right thing. “Professionally accepted standards of personal and business behavior, values and guiding principles. Codes of professional ethics are often established by professional organizations to help guide members in performing their job functions according to sound and consistent ethical principles” (http://wwwbusinessdictionary.com) Ethical Models Four essential features that should be in every ethical model for clinicians are: • Doing what the law says • A set of religious beliefs • Following society’s protocol Professional Ethics

1. Medical indications 2. Patient preferences 3. Quality of life issues 4. Contextual features Ethical Philosophies Categorical

Imperative: Promotes unconditional execution, where right is right and must by all means be done under whatever circumstances.

Ethics for the Pennsylvania Physical Therapy Professional: Summary

Cultural Competence It is important to be aware of a patient’s cultural differences. Patient’s values and perspectives may significantly affect their behavior. A therapist must manage these social and cultural differences so that there are no negative health consequences. This involves being able to provide treatment efficiently to individuals with diverse behaviors, beliefs, and social or linguistic needs. A patient responds to treatment more quickly when there is cultural concordance between the physical therapist and the patient. Continual Learning Being on the cutting edge of knowledge and medical advancements will always be to the physical therapist’s advantage. Continual learning gives the medical professional the ability to understand evidence-based healthcare. This can be achieved in academic institutions, undergraduate training, and inter- professional and collaboration workshops. APTA’s Five Roles of the Physical Therapist The APTA Code of Ethics is built upon these five roles: 1. Management of patient: Examination, evaluation, diagnosis, and prognosis 2. Patient consultation: One of the most important factors is the art of listening 3. Pursuing advanced education: Information is power to make better diagnoses and to administer treatment in a more effective manner 4. Research: Applying current evidence- based techniques to best address patient needs 5. Applying effective administration: Administer the application of thorough processes, for patient’s best recovery Professional obligations to the patient include the following: • Continuing competence: Obligation to develop competence in regard to the ongoing application of professional knowledge, skills and abilities

Rights: Ability to take advantage of a moral entitlement to do something or not to do something. Examples include Patient’s Bill of Rights, federal statutes (e.g., HIPAA), and facility-specific bills of rights. Paternalism: Failure to respect autonomy; acting with disregard to individual rights and substituting one’s beliefs, opinions, or judgments for the patient’s. The attempt to justify by claiming they acted in the person’s best interests. Decisions made are serious matters. Medical professional holds the life and health of patients in their hands. Professionals in physical therapy should believe in a universal ethical belief system. Ethical beliefs must be logically consistent with the facts of the decision or the situation. Decisions must be made a system more substantial than “gut feelings.” Ethical thinking is required. Ethical justification will prevent harm and ensure that good will comes from the decision made. Professional Ethics for the Physical Therapist Traits of the professional include the following: • Is an expert in their field • Is able to identify the needs of a patient and to treat those needs • Is willing to do what it takes to satisfy the demands of their job • Produces results and strives to do it before the due dates and better than is expected Emotional intelligence comprises: • Self-regulation : the ability to control oneself in an out-of-control or tense situation • Internal motivation : the passion and love for work because of an internal satisfaction THE APPLICATION OF PROFESSIONAL ETHICS • Empathy : the skill of a professional to comprehend the emotional triggers of a patient

Ethics for the Pennsylvania Physical Therapy Professional: Summary

Principle 1 Physical therapists shall respect the inherent dignity and rights of all individuals. Core Values: Compassion, Integrity Principle 2 Physical therapists shall be trustworthy and compassionate in addressing the rights and needs of patients. Core Values: Altruism, Compassion, Professional Duty Principle 3 Physical therapists shall be accountable for making sound professional judgments. Core Values: Excellence, Integrity Principle 4 Physical therapists shall demonstrate integrity in their relationships with patients, families, colleagues, students, research participants, other healthcare providers, employers, payers, and the public. Core Value: Integrity

• Appropriate self-disclosure: Obligation to the public to state title and the applicable designations • Not practicing beyond expertise: Obligation to refer the patient to another medical professional when the patient needs a different kind of treatment than what the physical therapist is able to provide Model Decision Making for the Physical Therapist The ethical decision-making process has certain steps: 1. Recognize and define the ethical issues. 2. Reflect on the ethical situation. 3. Determine the right thing to do. 4. Implement the solution to resolve the ethical issue (may be the most difficult step). 5. Evaluate the effects of the solution. 6. Reassess the ethical issue, the solution, and its effect. Purpose • Define ethical principles • Provide standards of behavior and performance • Provide guidance for ethical challenges • Educate individuals regarding core values, ethical principles and standards • Establish standards for judging unethical conduct Physical Therapy Core Values Built upon five roles of the PT, these core values guide the principals of professional ethics: • Accountability • Altruism • Compassion/caring • Excellence • Integrity • Professional duty • Social responsibility APTA CODE OF ETHICS AND PROFESSIONAL CONDUCT

LEARNING TIP!

Principle 5 Physical therapists shall fulfill their legal and professional obligations. Core Values: Professional Duty, Accountability

Principle 6 Physical therapists shall enhance their expertise through the lifelong acquisition and refinement of knowledge, skills, abilities, and

professional behaviors. Core Value: Excellence Principle 7 Physical therapists

shall promote organizational behaviors and business practices that benefit patients/clients and society. Core Values: Integrity, Accountability

Ethics for the Pennsylvania Physical Therapy Professional: Summary

Principle 8 Physical therapists shall participate in efforts to meet the health needs of people locally, nationally, or globally. Core Value: Social Responsibility MODELS AND CASE ANALYSIS Developmental model: Supervisee moves from the beginner stage (rigid and imitative style) through the intermediate and advanced (more competent style). Integrative model: Forces the supervisor to choose interventions geared to the needs of the supervisee above preferences regarding their comfort zone. Orientation model: Views client problems as learning problems requiring identification of the problem and selection of learning technique . Psychodynamic/psychoanalytic models: Therapist’s personal issues surface because of treatment they are administering. Transgenerational models: Past behavior patterns influence present and future patterns. CASE ANALYSIS 1: DR. ADAIR Dr. Adair, a distinguished neurosurgeon, was approached by an intern who challenged his decision to do surgery to relieve pressure after a football player had dislocated his left knee. The intern said that he understood the patient’s chart to say that he was a bleeder and special precautions had to be taken to do any surgery. Dr. Adair dismissed the intern’s concern and told the intern that he knew what he was doing and that the intern should mine his own business. The neurosurgeon continued to plan for the surgery just to prove the intern was wrong. However, he did review the patient’s chart, and in doing so, he found that the intern was correct. Now he had a decision to make between doing the right thing or protecting his pride and continuing with the surgery.

Rectifying the problem will be accomplished by going through the ethical decision-making process which will guide the intern to making the right decision, which is, of course, to consider other options for relieving the pressure in the injured knee. Humility will be part of the solution to this dilemma. CASE ANALYSIS 2: MARLENE QUINN Marlene Quinn had been assigned three PTs to supervise. The rules of the supervisory relationship were discussed with each PT. Full disclosure regarding each of the supervisees’ patient load and the therapy techniques were provided. Then Jane, one of the three PTs, shared that she had romantic feelings for one of her male patients. The other two supervisees told Jane it would be unethical for her to pursue it and that she needed to speak to Marlene regarding the situation. A week later, Jane shared with her two friends that the patient had invited her out for dinner, just on a casual basis. Significant points include the following: • The supervisee cannot become romantically involved with a patient. • When a situation arises such as what Jane was in, her first responsibility was to counsel with her supervisor, so that changes could be made in the patient load and so on. • The other two supervisees have the ethical responsibility to discuss the situation with Marlene if Jane would not.

Ethics for the Pennsylvania Physical Therapy Professional: Summary

THE REALM-INDIVIDUAL PROCESS- SITUATION (RIPS) MODEL OF ETHICAL DECISION MAKING Realm Individual: Concerned with the good of the patient/client and focus on rights, duties, relationships, and behaviors between individuals. It deals with the least complex problems. Organizational/Institutional: Concerned with the good of the organization and focused on structures and systems that will facilitate organizational or institutional goals. Societal: Concerned with the common good; the most complex realm. What Is the Individual Process? Ask: What does the ethical situation most require of me? Is it to recognize the ethical situation (moral sensitivity)? To make a decision about right or wrong (moral judgment)? To put moral values above other values (moral motivation)? Or whether to implement my decision or take action at all (moral courage)? It may also be important to evaluate the moral processes of others involved in the situation. Example: Are there significant moral temptations for others that would require moral courage? Determine the Type of Ethical Situation Dilemma: Two alternative courses of actions may be taken, both of which fulfill an important duty, and it is not possible to fulfill both obligations. Known as the “right versus right” decision. Distress: You know the right course of action but are not authorized or empowered to perform it. Note that ethical distress may be present as a later complication of any of the ethical situations. Ethical distress is often identified during the implementation phase of decision making. Temptation: Involves a choice between a “right” and “wrong” in which you may stand

CASE ANALYSIS 3: Consider the case of a lady who has been diagnosed with terminal cancer and has been given three months to live. She is a married mother of three and has shared her diagnosis and prognosis with her husband but does not want to share the information with her three children: a boy, 17; a girl, 15; and a boy, 10. You, as a healthcare professional, personally believe that your patient should share her prognosis with her children in order to give them a chance to say goodbye. On a personal level, you also believe that she should tell her children that she will likely die. • Given that your patient does not want her children to know her prognosis, what should you do? Is it ethical to withhold information from the children? Is your patient your only obligation? Should you tell the children, or should you keep your patient’s secret? • Honesty could mean that when the children, or other family members, ask how your patient is doing, you may need to direct their inquiries to the patient and/or her husband. • Your primary obligation is to your patient. You must respect her wishes. However, it is ethical to encourage her to share her prognosis with her children. In this way, you have maintained honesty in an ethical manner.

Ethics for the Pennsylvania Physical Therapy Professional: Summary

to benefit from doing the wrong thing. Known as the “right versus wrong” decision. Silence: Ethical values are challenged, but no one is speaking about this challenge to values. This may actually be the course taken by an individual who is experiencing moral distress. Steps of the RIPS Model Step 1: Recognize and Define the Ethical Issue • Realm • Individual process • Implications for action • Type of ethical situation • Barrier Step 2: Reflect • Background • Major stakeholders • Consequences of action or inaction • Laws broken? • Professional guidance • Right-versus-wrong tests ○ Legal test: Is something illegal? (Refer to Practice Act and the Rules). If so, it is probably not a true dilemma but a “hard choice.” ○ Stench test: Does it feel wrong, such as a “gut” reaction? ○ Front-page test: How would you like this on the front page of your local newspaper? ○ Mom test: If I were my mother (or parent), would I do this? ○ Professional ethics test: Do the Code of Ethics, Guide for Professional Conduct for the PT, Standards of Ethical Conduct, Guide for Conduct of the PTA, or Core Values prohibit or discourage the action? Step 3: Decide the Right Thing to Do Step 4: Take Action • Implement • Evaluate • Assess needed changes to prevent recurrence

In this step we might also need to examine the policies of the facility or employer to determine whether those policies are sufficient to protect both patients and staff. CASE STUDY APPLICATION OF THE RIPS MODEL: HELEN Helen L. has just left the office of a local orthopedic surgeon. She had hoped to illustrate her quality outcomes in order to encourage referrals. Midway through the visit, it became clear that the physician was unenthusiastic about positive outcomes of her private practice. Helen had the clear impression that the MD expected some kind of gift—in fact, he almost stated bluntly that he would need tee times at the exclusive country club to consider her request. Helen wonders if she is just being naïve—perhaps she should just “play the game.” R ealm: Societal/organizational—The problem is within the for profit health care system and the lack of regulation of gifts for referral. Even if Helen successfully negotiates the individual aspects with this MD, it will not resolve the structural problem that permits this practice. Individual Process: Moral courage— Helen appears to believe that there is a right-versus-wrong component but is concerned about the financial consequences as well. Situation: Moral temptation: Helen may first perceive this as an ethical dilemma— whether to save her practice (employee, jobs, and patient care) by complying with the MD or to obey professional standards regarding gifts to referral sources. It is a right-versus-wrong situation. The APTA Guide for Professional Conduct and other regulatory statutes indicate that this practice is unethical and, in some cases, illegal.

Ethics for the Pennsylvania Physical Therapy Professional: Summary

MEDICARE FRAUD AND ABUSE

• Unbundling: Arranging the services differently for higher profits • Kickbacks: Gifts or money required to use product or service • Off-label marketing: Prescribing a drug for unapproved uses Protect Thy Patients and Thyself Avoid ethical dilemmas by using the acronym PROTECT THY PATIENTS and THYSELF: P— Put a copy of your licensure law on your desk and read it! R— Report ethical and legal violations. O— Open your eyes. T— Tell them you want it in writing or in email. E— Encourage ethical behavior. C— Complete, thorough documentation. T— Think! T— Take the patient’s interest above all. H— Handle situations as they arise. Y— Yearn to learn. P— Plug into your professional associations. A— Ask a lot of questions. T— Train and supervise all subordinates properly. I— Internet sources. E— Establish a relationship with a mentor or peer. N— Never fall behind. T— Take a good look at the professional literature. S— Surf the Internet for regulatory changes. And T— Take the time to read your code of ethics. H—Hand over patients to those with expertise. Y— Yield to the dictates of payers. S— Save a copy of correspondence. E— Explore all alternatives. L— Look at professional association/ licensure homepages. F— Fill out all forms accurately and truthfully.

Fraud and Abuse Fraud: The provider of therapy services knowingly or willingly lies in order to get paid. Abuse: Medicare pays for an item or service it should not, or any time a provider bills Medicare for services not medically necessary. The Office of the Inspector General (OIG) fights Medicare fraud and abuse through task forces and audits. Failure to report illegal activity may result in federal criminal charges of conspiracy. Fraud and Deceit Fraud is more than unfaithfulness or dishonesty. It is blatantly indulging in actions that cause harm to patients, other healthcare providers, and society in general. Fraud can involve: • Billing for services which were not rendered • Billing in excess or inaccurately • Requesting to be done or performing • Accepting kickbacks for patient referrals Documentation Fraud in Healthcare • Duplicate submissions: Billing for the same service twice • Upcoding: Billing for services that are more costly than the actual procedure that was done is upcoding and is fraudulent • Violating disclosure agreements: Withholding relevant information or providing false or inaccurate information • Excessive services and unnecessary services • Misbilling: Billing for things that never happened services that are unnecessary • Misrepresenting treatments • Falsifying patient diagnosis

Ethics for the Pennsylvania Physical Therapy Professional: Summary

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FINAL EXAM QUESTIONS

Ethics is: a. Doing and saying the right thing b. Keeping the law c. Reacting to a situation d. Following society’s protocols “Do no harm” describes which of the following ethical principles? a. Nonmaleficence b. Fidelity c. Autonomy d. Veracity Four essential features which should be in each and every ethical model for clinicians are: a. Medical indications, gut instinct, quality of life issues, and contextual features b. Medical indications, patient preferences, quality of life issues, and best financial choice c. Medical indications, patient preferences, previous experience, and contextual features d. Medical indications, patient preferences, quality of life issues, and contextual features

Emotional Intelligence includes empathy, internal motivation, and:

a. Gut feeling b. Education c. Certification d. Self-regulation

The professional obligations clinicians have to the patient are continuing competence, appropriate self-disclosure, and: a. To follow the law b. To be a religious individual c. To limit patient load d. To not practice beyond expertise AOTA’s Principal 5 states that physical therapists shall fulfill their legal and professional obligations. Which core values are represented in this principal? a. Social Responsibility, Excellence b. Integrity, Accountability c. Professional Duty, Accountability d. Excellence, Professional Duty

Ethics for the Pennsylvania Physical Therapy Professional: Summary

Which model of clinical supervision views client problems as learning problems requiring identification of the problem and selection of learning technique? a. Developmental model b. Orientation model c. Psychodynamic model d. Transgenerational The four types of ethical situations in the RIPS model of decision making are: a. Dilemma, distress, temptation, and silence b. Sensitivity, judgement, motivation, and courage c. Individual, organizational, societal, and corporate d. Dilemma, judgement, motivation, and courage

What is step 3 of the RIPS Model? a. Assess needed changes to prevent recurrence

b. Recognize and define the ethical issue c. Reflect on the consequences of action or inaction d. Decide the right thing to do 10. Billing for services that are more costly than the actual procedure that was done is: a. Euplicate submissions b. Excessive services

c. Upcoding d. Kickbacks

Access the final exam to this course here!

COURSE CODE: PTPA02ET-H

Pennsylvania Mandatory Child Abuse Recognition and Reporting (Renewal Licensure): Summary 11

Pennsylvania Mandatory Child Abuse Recognition and Reporting (Renewal Licensure) 2 Contact Hours

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Author Margaret Hughes, MSN, RN, CPNP

Margaret is a pediatric nurse practitioner who graduated from the Yale School of Nursing in 2016 with a concentration in global health. Her interest in healthcare started at a young age when she had several opportunities to shadow doctors in France and Belgium. She currently works in student health at a large university in Boston. Before that, she worked at community-based and school-based health centers providing primary care to high-risk, medically underserved populations. She also has experience as a nurse and worked in a private pediatric clinic in Connecticut and at an overnight summer camp in New York.

LEARNING OUTCOMES • Describe the child welfare system in Pennsylvania • Explain the differences between Child Protective Services (CPS) and General Protective Services (GPS) • Define various terms from the Child Protective Services Law (CPSL)

• Discuss child abuse types and indicators • List the various legislative updates made to the CPSL • Apply the updated requirements and reporting procedures for reporting child abuse in Pennsylvania

SELF-ASSESSMENT QUESTIONS

1. Mandated reports include: a. Teachers b. Doctors

3. A mandated reporter shall _________ make an oral report of suspected child abuse to the statewide toll-free telephone number.

c. Police officers d. All are correct 2. What is considered a behavior indicator?

a. Within 24 hours b. Within 48 hours c. Within 72 hours d. Immediately

a. Unexplained injuries b. Fear of going home c. Bruising d. Burns

4. Pennsylvania has identified all of the following scenarios that should NOT be considered child abuse EXCEPT: a. Environmental factors

b. Practice of religious beliefs c. Use of force for supervision d. All are not considered child abuse

ANSWERS: 1: C 2 : A 3: C 4: D

Pennsylvania Mandatory Child Abuse Recognition and Reporting (Renewal Licensure): Summary 12

Child Protective Services (CPS) Cases that are identified as being under the purview of CPS require abuse investigations because the alleged act or failure to act has been identified as one of the 10 categories of child abuse. Protective Services Law (CPSL). General Protective Services (GPS) Cases that are identified as being under the purview of GPS require an assessment for services and support. In these cases, the act or failure to act is detrimental to a child but does not fall under the 10 categories of child abuse per the CPSL. These services can help parents recognize and correct conditions that are harmful to their children. GPS services may be employed to help prevent harm to a child who meets one or more of the following conditions: • Is without proper parental care or control; subsistence; education as required by law; or other care or control necessary for their physical, mental, or emotional health, or morals • Has been placed for care or adoption in violation of the law • Has been abandoned by parents, guardian, or other custodian • Is without a parent, guardian, or legal custodian Definitions Related to the Child Protective Services Law Child: An individual under the age of 18.

INTRODUCTION Approximately 3.5 million children in the U.S. were the subjects of at least one child abuse report in 2017. In Pennsylvania alone, there were 46,208 reports of suspected child abuse in 2017. The Pennsylvania Child Protective Services Law (CPSL) was enacted in 1975 and has had numerous updates over the years. The goal was to protect children from abuse, thereby allowing the opportunity for the healthy growth and development of children and whenever possible, the preservation of family stability. Act 33 of 2014 amended Title 23 (Domestic Relations) known as the Child Protective Services Law, which In the Commonwealth of Pennsylvania, child welfare is state supervised and county administered. The Pennsylvania General Assembly created the Task Force on Child Protection in 2011. The objective was to conduct a thorough review of the law and its procedures for reporting child abuse while protecting children. As a result of this law, many pieces of legislation have been enacted by the Pennsylvania General Assembly. was effective December 31, 2014. Overview of Child Welfare in Pennsylvania The Child Protective Services Law (CPSL) This law was enacted to protect children from abuse; allow the opportunity for healthy growth and development; and, whenever possible, preserve and stabilize the family. Children, Youth and Families agencies have two essential functions: Child Protective Services (CSP) and General Protective Services (GPS). Mandated reporters do not have to determine which service is most appropriate for their specific situation when contacting ChildLine.

LEARNING TIP! Child abuse: The term "child abuse" shall mean intentionally, knowingly, or recklessly doing any type of sexual abuse, exploitation, bodily injury, or neglect.

Pennsylvania Mandatory Child Abuse Recognition and Reporting (Renewal Licensure): Summary 13

Sexual abuse or exploitation (any of the following): The employment, use, persuasion, inducement, enticement, or coercion of a child to engage in or assist another individual to engage in sexually explicit conduct. Bodily injury: Impairment of physical condition or substantial pain. Serious mental injury: A psychological condition, as diagnosed by a physician or licensed psychologist, including the refusal of appropriate treatment. Serious physical neglect: Any of the following when committed by a perpetrator who endangers a child’s life or health; threatens a child’s well-being; causes bodily injury; or impairs a child’s health, development, or functioning. Perpetrator: A person who has committed child abuse (defined in Section 6303 of the CPSL). Child Abuse Indicators Bodily Injury Physical indicators: Unexplained injuries; unbelievable or inconsistent explanations of injuries; multiple bruises in various stages of healing; bruises located on the face, ears, necks, buttocks, back, chest, thighs, back of legs, and genitalia; bruises that resemble objects such as a hand, fist, belt buckle, or rope; injuries that are inconsistent with a child’s age/developmental level; and burns. Behavioral indicators: Fear of going home, extreme apprehensiveness/vigilance, pronounced aggression or passivity, flinches easily or avoids being touched, play includes abusive behavior or talk, unable to recall how injuries occurred or account of injuries that is inconsistent with the nature of the injuries, fear of parent or caregiver. Sexual Abuse or Exploitation Physical indicators: Sleep disturbances, bedwetting, pain or irritation in genital/anal area, difficulty walking or sitting, difficultly urinating, pregnancy, positive testing for

sexually transmitted infection r HIV, excessive or injurious masturbation. Legislative Updates to the CPSL The following list does not include all legislative updates but rather highlights some of the recent changes in legislation impacting mandated reporters and the process of recognizing and reporting suspected child abuse. In 2014, Pennsylvania passed Act 105 Pennsylvania's anti–human trafficking law, which defined human trafficking to include both sex trafficking and labor trafficking. The Pennsylvania legislature then enacted Act 115 of 2016, which amended Title 23 (Domestic Relations) and Title 42 (Judiciary and Judicial Procedure) of the Pennsylvania Consolidated Statutes to include human trafficking. In 2016, Pennsylvania passed Act 115 This act added engaging a child in a severe form of trafficking in persons or sex trafficking as a form of child abuse. This type of child abuse includes both sex trafficking and labor trafficking of children. Child sex trafficking: Any child under the age of 18 who is induced to engage in commercial sex is a victim of sex trafficking. Examples of sex trafficking of children includes prostitution, pornography, and sex tourism. Child labor trafficking: The use of force, fraud, or coercion for the purpose of subjection in involuntary servitude, peonage, debt bondage, or slavery. Human trafficking: The recruitment, harboring, transportation, provision, or obtaining of a child for labor or services through use of force, fraud, or coercion. Under federal law, sex trafficking such as prostitution, pornography, and exotic dancing does not require there be force, fraud, or coercion if the victim is under age 18.

Pennsylvania Mandatory Child Abuse Recognition and Reporting (Renewal Licensure): Summary 14 In 2018, Pennsylvania Passed Four Legislative Acts

Environmental factors example: If a family lives at the poverty level through no fault of the parents, it is not considered child abuse. Practice of religious beliefs example: If an individual’s religion does not believe in seeking medical attention for a child who has an upper respiratory infection, this is not considered child abuse unless it results in the child’s death. Use of force for supervision example: In the grocery store, you witness a woman (parent) who is upset with her child for climbing on a half-empty shelf. The parent grabs the child’s arm, pulls the child down, and the child falls to the floor and sprains his ankle. This is not child abuse, as the parent or caregiver is using reasonable force to prevent the child from several actions, including the self-inflicted harm of the child falling. Rights of parents example: Spanking a child is a perfect example of parental rights. Many people do not believe in spanking their child or any type physical discipline. Not long ago, spanking was a generally accepted method of discipline, and parents believed a little spanking would go a long way toward reprimanding their child. However, not all parents today agree on this issue. But Pennsylvania believes in the rights of parents to use reasonable force on or against their child in order to maintain control, to supervise, and to discipline. There is a fine line between corporal punishment and child abuse, and each case should be looked at individually. Corporal punishment can be referred to ChildLine, and the case will be reviewed. A parent may claim their actions constitute corporal punishment, but that doesn’t mean they will be not be deemed child abuse. Child on child contact example: When two boys engage in a consensual fist fight after school, neither is deemed a perpetrator.

Act 10: States that Pennsylvania’s sexual offender registration applies only to individuals who have committed a sexually violent offense on or after December 20, 2012. Act 29: Expanded Pennsylvania’s definition of child abuse to include when a person leaves a child unsupervised with an individual, other than the parent, whom they know to be a sexually violent predator. Act 54: Requires all schools to display a child abuse informational poster on premises, reports to be maintained for a period of ten years or until the youngest child identified in the most recent general protective services report attains 23 years of age, whichever occurs first. Act 54 Update Mandatory Notification of Substance Exposed Infants by Health Care Providers: A healthcare provider shall immediately give notice or cause notice to be given if the provider is involved in the delivery or care of a child under one year of age and the healthcare provider has determined, based on standards of professional practice, that the child was born affected by: ○ Substance use or withdrawal symptoms resulting from prenatal drug exposure ○ A fetal alcohol spectrum disorder Act 88 2019 Update: Clarifies penalties for failure to report child abuse. A mandated reporter who willfully fails to report suspected child abuse or to make a referral to the appropriate authorities commits an offense. Exclusions from Child Abuse per the CPSL Exclusion is relevant when substantiating a report, not when making a report. Pennsylvania has identified scenarios that should not be considered child abuse. Pennsylvania statute § 6304 (exclusions from child abuse) details the following scenarios that have been excused from such a determination.

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