HN450 – Unit 4 Client Rights, HSW Responsibilities & Confidentiality Angel R. Doring, Psy.D. Have this slide posted waiting for the class to begin.

Getting to know you! My week has been… As a child my favorite thing to do was… What is most challenging about my current stage of life is… Three things I have learned during my Kaplan education is…

The Unit 4 Project Course Content In paragraph format, discuss and describe the legal challenges, diagnostic criteria, ethical/legal implications, therapeutic recommendations, and mandatory reporting challenges for elder adult clients. – Worth 45 points Catherine is an elder adult who has been brought to counseling by her daughter Linda. As Linda introduces herself to you prior to your first session with Catherine, she shares her concern for Catherine's well- being because of Catherine's insistence that she continue to live unassisted in the family home. Catherine presents herself as a well-maintained, self-sufficient, proud individual who is uninterested in relinquishing her freedom or in becoming any greater burden to her family. Catherine appears to enjoy a trusting relationship with you and soon begins to look forward to her weekly sessions. She shares many stories from her rich life and begins to confide more and more in you as the weeks go by. Eventually Catherine begins to share her recurrent memory lapses and forgetfulness with you. She cites examples of behavior that is indeed worrisome, even to her, such as forgetting to assure that household appliances and cooking facilities are safely turned off after their use. She turns to you and asks, "Is this the beginning of Alzheimer's disease?" Research the chances of being diagnosed with Alzheimer’s as an elderly adult. Explain the numerical data from at least three different studies that support your findings as outlined below. Find at least three studies that discuss Alzheimer's Disease and that include a table or graph of data that displays the percentages or numerical differences in being diagnosed with Alzheimer's in regards to variations of age, gender, and/or race. Explain the differences of the data from each of the three studies. You should compare the averages among different categories within each study being sure to cite each study using APA in-text citation and reference format. How would you explain this to Catherine and her family? Investigate the legal challenges of working with elder adult clients. Describe and discuss the reporting laws in your state. How might you expect to address such legal issues and requirements in your work with elder adult populations? How might you assess and evaluate Catherine's needs at this time? Incorporate any diagnostic guidelines from a professional organization that may help you to diagnosis Catherine and determine your legal obligations on her behalf. What are the ethical and legal implications of this case study? What are your concerns? As Catherine's counselor, how might you direct therapy from this point forward? What, if any, mandatory reporting challenges do you see? Please be sure to actively introduce Catherine's case study in your paper. You should include specifics of Catherine's case in illustrating your understanding and research of our topic. Your Unit 4 Project should be presented in the form of a well-written university level document. It should be approximately 750–1,200 words, double-spaced, and created in 12 point font. All work should be in your own words with quotes used very sparingly. Please be sure to answer every question within the body of your paper, including at least two references in support of your observations and conclusions using proper APA citation and reference formatting. The Kaplan Library offers you credible articles from which to draw your supportive references. 3 3

The Unit 4 Project Addresses each of the following areas in paragraph format: Investigate the legal challenges of working with elder adult clients.  Discuss reporting laws in your state.  How might you expect to address such legal issues and requirements in your work with elder adult populations? How might you assess and evaluate Catherine’s needs at this time?  Incorporate any diagnostic guidelines from a professional organization. What are the ethical and legal implications of this case study?  What are your concerns? As Catherine’s counselor, how might you direct therapy from this point forward? What, if any, mandatory reporting challenges do you see? Uses appropriate references to course material. – Worth 45 points The acronym SEES may help you write a better paragraph. S = Short sentence that states the main idea. E = Explanation of the main idea in more detail. E = Example or quotation given to illustrate the main idea. S = Sum up the main idea in a way that leads to the next paragraph. 4 4

The Unit 4 Project Reflects ability to actively introduce Catherine’s case study and to use specifics from the case study throughout the paper. – Worth 40 points 5 5

The Unit 4 Project Writing Structure: Includes complete paragraphs, proper sentence structure, clear and logical organization throughout.  Primarily student’s own words with quotes used very sparingly.  Includes at least two references in support of observations. – Worth 10 points Mechanics: Uses correct grammar, spelling, and punctuation.  Double-spaced paper that meets the 750- 1,200 word page length. 6 6

Questions for discussion… What do you think is meant by the term: Informed Consent? Take a few minutes to write your thoughts 7 7

Client’s have a right to know Informed consent Know what will happen, how it will happen, who will provide the service, how long the services will take and HAVE A RIGHT TO MAKE DECISIONS ABOUT IT ALL Shared decision making Powerful tool Client must understand in their own language It continues as long as the services are being rendered 8

Client’s have a right to know Includes Service provider background Education/training/certifications How the information collected will be used Who has a right to know about the information Costs associated with services 9

Client’s have a right to know Con’t Access to files Benefits and risks Alternative services available If the sessions will be recorded in any way 10

Record Keeping All interactions with client should be documented Provides a record of progress Is ethically transparent Legally keeps essential track of services promised and provided Risk management – keeps everyone clear about how things are going 11

Working with at-risk populations Federal Gov has certain populations that are considered at risk – Women Adolescents/children CJ populations 12

Working with children/adolescents Important issues to consider: Minors’ rights regarding informed consent Parental rights to information about a minor’s treatment Minors’ assent versus consent Involving parents in the process with minors Limits to confidentiality Dealing with reluctance 13

Confidentiality and Related Terms rooted in a client’s right to privacy, confidentiality is at the core of effective human service work – but there are limits – but a very narrow path Privileged communication: a legal concept that generally bars the disclosure of confidential communications in a legal proceeding. the specifics of this privilege vary from state to state. Privacy: the constitutional right of individuals to be left alone and to control their personal information 14

Protecting Confidentiality Rights Fisher’s (2008) 6-step ethical practice model for protecting confidentiality rights: Preparation Tell clients the truth “up front” Obtain truly informed consent before making a disclosure Respond ethically to legal requests for disclosure Avoid the “avoidable” breaches of confidentiality Talk about confidentiality Issues and Ethics - Chapter 6 (2) Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning 15

Limits of Confidentiality When clerical assistants handle confidential information When a worker is being supervised When a client has given consent When a client poses danger to self or others When a client discloses intention to commit a crime When a worker suspects abuse or neglect of a child or vulnerable adult When a court orders a worker to make records available Issues and Ethics - Chapter 6 (3) Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning 16

Privacy Issues With Telecommunication Devices Do not acknowledge that clients are receiving services or give out information regarding clients to unknown callers. Strive to verify that you are actually talking to the intended person when you make or receive calls in which confidential information will be discussed. Be aware that there is no way to prevent your conversation from being recorded or monitored by an unintended person. Be professional and cautious in talking about confidential information over the telephone; avoid saying anything off the record. Issues and Ethics - Chapter 6 (4) Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning 17

Privacy Issues With Telecommunication Devices Avoid making any comments that you would not want your client to hear or that you would not want to repeat in a legal proceeding. Do not allow unauthorized persons to hear answering machine messages in your office as they are being left or retrieved. If you use voice mail or an answering service, ensure that your access codes are not disclosed to unauthorized persons. When you leave a message on an answering machine, be aware that the intended person may not be the one who retrieves your message. Issues and Ethics - Chapter 6 (5) Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning 18

Privacy Issues With Telecommunication Devices If you are talking to a client by cellular phone, assume that he or she is not in a private place. Realize that your conversation may be intercepted by an unauthorized person. If you use a pager or a cell phone to send text messages, exercise caution. In sending a text message to a client, be mindful of ensuring your client’s privacy by exercising the same caution you would if you were sending a voice mail message. Issues and Ethics - Chapter 6 (6) Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning 19

Implications of HIPAA for Mental Health Providers The Health Insurance Portability and Accountability Act of 1996 (HIPAA) passed by Congress to promote standardization and efficiency in the health care industry and to give patients more rights and control over their health information. The HIPAA Privacy Rule developed out of the concern that transmission of health care information through electronic means could lead to widespread gaps in the protection of client confidentiality. Issues and Ethics - Chapter 6 (7) Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning 20

Implications of HIPAA for Mental Health Providers If you submit a claim electronically, even once, you are likely to be considered a “covered entity” for HIPAA purposes. Be familiar with the 4 standards of HIPAA: privacy requirements electronic transactions security requirements national identifier requirements Issues and Ethics - Chapter 6 (8) Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning 21

Duty to Protect Potential Victims Balancing client confidentiality and protecting the public is a major ethical challenge Workers must exercise the ordinary skill and care of a reasonable professional to: Identify clients who are likely to do physical harm to third parties Protect third parties from clients judged potentially to be dangerous Treat those clients who are dangerous Issues and Ethics - Chapter 6 (9) Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning 22

Guidelines for Assessing Suicidal Behavior Take direct verbal warnings seriously. Pay attention to previous suicide attempts. Identify clients suffering from depression. Be alert for feelings of hopelessness and helplessness. Monitor severe anxiety and panic attacks. Ascertain whether there has been a recent diagnosis of a serious or terminal health condition. Issues and Ethics - Chapter 6 (16) Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning 23

Guidelines for Assessing Suicidal Behavior Determine whether the individual has a plan. Identify clients who have a history of severe alcohol or drug abuse. Be alert to client behaviors (e.g. giving prized possessions away, finalizing business affairs, or revising wills). Determine the history of psychiatric treatment. Issues and Ethics - Chapter 6 (17) Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning 24

Protecting Children, the Elderly, and Dependent Adults From Harm Mandatory reporting designed to encourage reporting of any suspected cases of child, elder, or dependent adult abuse; thus, HSW’s are advised to err on the side of reporting in uncertain circumstances. If children, the elderly, or other dependent adults disclose that they are being abused or neglected, the professional is required to report the situation under penalty of fines and imprisonment. The professional has an obligation to protect those who cannot advocate for themselves. Issues and Ethics - Chapter 6 (18) Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning 25

Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning Types of Elder Abuse Physical abuse Sexual abuse Psychological or emotional abuse Neglect Abandonment Financial or material exploitation Issues and Ethics - Chapter 6 (19) Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning 26