Vignette

Read

(B) Chapter 4 Confidentiality, Privilege and Privacy pp. 159-213 and HIPAA, pp. 543-545.

 
 

(F) Chapter 7 Standards on Privacy and Confidentiality pp. 190-203; and review Preface pp. xxi-xxxvi.

 

Vignette

 
 

Please read the vignette below and respond to it via the assignment submission link by Day Six. You MUST apply an appropriate ethical decision making model from Bersoff or apply another ethical decision making model which you may prefer (e.g., Canadian Psychological Association; NASP, etc.). Use the steps of the decision making model to discuss your decision making process.

 
 

Tell Tale Vignette

 
 

Maria is a 32 year old, Latina. Her child, Rosalinda, age 6, was referred to counseling after having been exposed to domestic violence (Maria reports having been the victim) in the home.

 
 

Maria is separated from Rosalinda’s father who is the alleged perpetrator in the domestic violence.

 
 

When Maria brought Rosalinda to her first evaluation session (symptoms included: nightmares, regression, easily moved to tears, clingy with Maria), Maria read and signed an informed consent form while in the waiting room. The form was fairly standard issue, citing all the usual exceptions to confidentiality. The psychology intern properly introduced herself to Maria and briefly went over the informed consent. Maria expressed understanding of and agreement with the evaluation and treatment for her daughter.

 
 

Maria was the principal informant during the assessment, and the psychology intern documented in her notes that Maria reported she had started to date again. She noted that Rosalinda’s symptoms had gotten worse (for example, she is upset when left with the family babysitter).

Please address the following questions:

 
 

Can Rosalinda’s Dad have access to the child’s record?

 
 

What about the reference to Maria starting to date – should this be documented in the record? Should Rosalinda’s father have access to this information?

 
 

Explain your reasoning, referring to the appropriate rules and citing ethical guidelines (these may include the practice act, rules of board, etc.).

Confidentiality

Purpose

A hallmark of psychological practice is the privacy and confidentiality that psychologists must observe to protect the well-being of their clients. This session will focus on the intricacies of maintaining confidentiality and when it is required by law to be disclosed.

Objectives

1. Define confidentiality and its limitations and exceptions.
 

2. Examine situations where there may be a duty to warn or protect third parties.

3. Introduction to HIPAA

In most situations the law recognizes the psychologist(therapist)/patient relationship. There are exceptions. All states now have rules for reporting child abuse, most have rules for reporting elder abuse. The “Duty to Warn” (from Tarasoff) is often written into the practice act or rules of state psychology licensing boards but not in all jurisdictions. Indeed, there is no duty to warn in some jurisdictions. This is complicated, because if you follow the law a person could be harmed due to your lack of action. While there is no affirmative (must do) requirement to intervene in threat to others, you can assume that you will be found negligent if your patient is actively suicidal and you do nothing.
 

Privilege relates to the legal protection from being forced to break the expectation of confidentiality. Parents are the holder of privilege for minor children but many jurisdictions allow exceptions for some types of confidences.
 

Remember, like the attorney or priest, the confidentiality between psychologist and client is “sacred.” It is protected by law and tradition. However, unfortunately, some state laws increasingly infringe on that indispensable element. Thus, psychologists face increasing conflict among their professional ethics, their concern for clients, and their legal obligations.