Event ID: 2351883Event Started: 7/30/2014 10:21:56 AM ET

Please stand by for real time captions.

Good morning welcome to the Informed Choice: It's a Matter of Ethics. I will be your host today before introduce the presenter I want to make sure that you can hear me. If you can please send an e-mail or message. You can use the question box to the right of your screen and type yes or no. I see that Diana has been actively sending messages. Hello all of you.

Veronica there we go, great to see you. As you do this, if you Julie's the audio apathy access number in the checkbox if you need the information. If you have questions during the session, use the question box or e-mail them to you unty@unt.edu and we will collect the questions and share but the presenter. If you're calling in by phone only use the e-mail to unty to receive the credit for the participation. I will provide more information in regards -- will with regards to the credit . I will introduce you to the presenter, today session is one hour-long. Chandra Kerry is a professor at the University of North Carolina is. She has experience in job placement, career development, disability specialist in mental health counseling and employment. She is the past president for national associate for multicultural and rehabilitation concerns.

So thank you for joining us today.

Good morning. Hello everyone, that -- well, and I am so glad you could join us. I realize I need to send you an updated biography, a couple of things, one I'm not just the immediate past president for -- there are [ Cheering ] past presidents I circle out of the executive role for that organization. I also recently received tenure an now I am an associate for Fessler -- professor.

Today we will talk about the ethics of informed choice and consent and how critical it is for us to make sure we relayed the related information accurately and confidential to the consumer and I am.

-- Consumer and client. There are so many aspects of our duties that we regularly carry out, sometimes we operate on automatic it is the same situation if you drive somewhere, you look up and all of a sudden you are there in you not really remember how you got there new how to get there. We operate that way a lot would work with clients and consumers just kind of -- what we do we go through and do this. The purpose today, is to make sure that we practice conscious ethical practices and we interactor -- interact with both the people we interact with.

I will reference the CRC it is the basins and foundation with the work I do, I will drop and references to APA and ACA code of ethics. This CRC code of ethics specifically addresses aspects of informed consent throughout the document, the first mention is in the first section A which focuses on accounting relationships. There it talk specifically about what the client's rights are in a relationship. It is important for us to think about -- I know we are very conscious of protecting the client and focusing on the right.

Make sure that we slow down and we are really honing in on what the importance of the client is, no one understand and let us know that we understand and will be through the process. There is definitely direction in this CRC code of ethics, and how we should operate in regards specifically to disclosure and informed consent. Today we will focus specifically on the nature of informed consent and everything it entails.

So we will briefly go over -- you cannot talk about the code of ethics or informed consent without looking at the foundational principles. We will have a detailed overview of what informed consent is, and ethical duty attached to this, explore ethical practices, needed to make sure we are following informed consent. We will discuss implications to consider when we serve versus our clients and consumers.

I would like to include quotes, anybody who knows me knows I find there are people who say things better than I can. I would like to use this quote specifically when talking about ethics. Ethical practices for most of us are kind of ingrained in what we do and who we are we operate on automatic pilot in this is kind of -- we know to practice ethically and we do that. There are times there can be conflicts between what our professional, will -- professional ethical code tells us and what the policy tells us and between our own personal epochal and moral clothes. It is here we are in the setting, in the situation where the is the conflict. We may lean one way it is the best way to respond, and operate at Wayne have no consequences for this, we continue to move forward with that.

What I want us to do, to be much more conscious in how we think about some of the minute details of what we do everyday. Informed consent definitely falls into the realm on how we think about our overall practice.

So there are a couple of reasons you want to do applied ethics training, some of you think it is for education credits which is acceptable, one of the most important things here in regards to why we want to cover ethics and specifically for us today informed consent, it keeps us on our toes. In my current courses the student have to record the beginning part of one of their counseling sessions were the discussed confidentiality something that we do as a part of our practice in providing services to our clients.

What they also have to do is critique the recording, inevitably as they review their very critical part of the session, and the client counselor relationship, but they sometimes notice, either how fast they have gone, how they may have stumbled over information. How they may not given the client time to ask a question, and so on. Some cases where they are not the person who goes over informed consent or confidential it is something that is handled by office assistant or another individual this is the client goes over the general paperwork before they come into the interaction.

When Dave review this and go over this when they assess themselves students are really critical of them's elves more so than they probably need to be. What we have notice, what I have noticed -- they realize that maybe they did not spend enough time talking about consent, confidentiality, limits of confidentiality and the client protection and rights as they should have. We will have a case study later on that will reveal some of the consequences of not send -- spending enough time on those concepts early on in the process.

What I'm hopeful this session will do, increase her ethical sensitivity to informed consent and the critical role it plays in our relationships we develop and build with our consumers and clients and the services they receive from us.

As I go through this, I have a stop point in a couple of slides were I will ask if you have questions or anything to that, if you have questions prior to that, feel free to either e-mail or use the chat function we can address those as we go along.

Here are the golden boxes, underlying the foundation of this CRC code of access -- ethics, ACA, and APA and the marriage therapy ethics, most of the critical human services code of ethics are based on a foundation of ethical principle.

These principles are initially kind of devised in the early 80s think we did those concepts that some of them are central to the work that rehabilitation providers do. Aton the main -- self-determination, avoiding doing harm, making sure that we promote well-being of others on our clients. Justice to be fair and equitable, fidelity to make realistic commitments and keep promises, more recently added is a concept of [ Indiscernible ] Teufel to be honest with our clients. -- To be truthful and honest with our clients.

You will find the concept and practice of informed consent is closely related to make sure we are making realistic it -- commitments to our clients and keeping promises and giving them full information so they can make the best decision which takes us back to Aton of me -- dealing honesty with our clients. A lot of exposure has to happen at the very beginning so we ensure the client is guaranteeing their rights to make appropriate choices and decisions based off of the information they received from us regarding the services they will provide.

-- We will provide.

So what is informed consent? For most of us it is a form that we sign off on, I recently went to a new physician as I was going in you get your kind of best introductory paperwork. Include if that is the informed, hit

-- HIPAA, disclosures, providing information all of those things as I was sitting with the presentation I'm going through the paperwork. One of the things I ponder, no one really talks to me about the information. One of the things I thought about, if I was not able to fully understand and grasp all of the concepts presented in the information? What if this is a new process or I was unfamiliar, what if I do not have the cognitive capacity to interpret all of the information? Me sending off of net that is expected mode of operation, would not indicate that I fully understand, it is important as we think about informed consent, that we really focus on the concept of due process.

That means that we are allowing a process to occur where people receive full information, they are explained the information and able to make a decision. They are given -- this goes back to the ethical principles of justice. Something that is fairly revealed to them so they can make decisions that they need to.

In 2003 Corey Callahan researched practices asserted that the failure to obtain or document can informed consent have is to be one of the top practice areas that has the greatest general legal risk. One of the top areas that is most often not given enough time and attention to by the counselors they survey. Given this information, we know we need to spend more time and attention talking about informed consent.

Most services or agencies and organizations originally provide those. That is perfectly acceptable, what I want to talk about today in the conscious effort to practice more ethically, as you have signed, as your clients are going over the information and green they understand who we take -- that we take more time, we know this is a stretch our time is tight. The things that we have to achieve and the time we are working with is -- them is tremendous, that extra time really does help us to work to the best ability to protect the client, consumer, agency, ourselves. Protect our profession.

When you have the form that you provide, written consent is the rule, generally what happens you described consistent documentation for informed consent is important that helps maintain ethical principle of justice. Something that everyone sees, standardization of the concept, most justice. It gives ease of administration, you can easily have some money -- someone signoff to understand what they said, it is a community standard. There are times where it is important that you should also assess verbally with the client or consumer is signing off on as they're going all over the documentation.

For the providers, make sure that we know what the person is signing, how do we understand and what do we know about the limits of confidentiality? How do we understand and what do we know about the culture? How do we understand HIPAA? We will talk about that in just a little bit, we want to make sure that we provide informed consent we are going over all of the potential benefits, risks, consequences, reporting responsibilities, duration of treatment of services, how many different providers will be coming in town tax best coming into contact with? So they can make deliberate choices about their services.

This goes back to another core concept at the heart of the rehabilitation professionals, to make sure we protect the individuals that we work with. That we allow them to have the right and make sure they have the right to make the best choices for themselves and the treatment or services they may participate in.

So the next couple of slides we will talk about that all of the different things that can be included in informed consent, there is a lot. I will not go over all of these, but I will highlight some specific areas that I think are kind of important for us to remember. As we look for the process and bees talk to some of this for consumers or clients.

Generally as I mentioned before, the concept of informed consent focuses on rights. We want to make sure they have the right to make voluntary decisions about participating and they understand the benefits and risk. They also have a right to understand alternative to treatment and what happens if they are not satisfied with treatment. These are things that should not be glossed over, no one wants to say -- if you're not satisfied with what are you doing, this is what you should do, our ultimate goal is to make sure we are helping and people are satisfied with what we are doing. It is important to make sure that we do provide the information so they have the

information, and have the right to advocate for themselves if for some reason they are not satisfied.

So we will talk about your role and relationship counselor or provider, you will talk about the limits to serve in the an advocacy role, you may need job placement and development, job coaches, counselors, there is a spectrum of different positions you may be in. Some of those required to advocate in a certain way, we also want to make sure their clients understand we are not kind of -- the person who will marshal every cause that they have. Would have to practice within the scope of what is acceptable and policy at our agency and organization. It is important we relayed this information to the client and consumer that we work with.

One thing that is important talk about, when we talk about informed consent, are the limits on confidentiality . When you are in human services, rehabilitation counseling or a service provider, the interaction and relationship you build with the client a lot of that rests on your ability to develop a relationship with that person. The ability to develop the relationship is closely related to your ability to facilitate trust and a safe environment. Often times those concepts of trust and safety are synonymous in some clients eyes to confidentiality.

It is really important that we talk specifically about the limits of confidentiality. So if I were to quiz you guys quickly on the limits of confidentiality, and ask what they were? Particularly here in the state of Texas, I'm sure some of you would say that would include issues with Amy the risk of harm for elderly or child abuse, issue where records are subpoenaed, issue or situation with the person is alleging to call [ Indiscernible ] to themselves. Those are common areas, another major concepts for limit on confidentiality include billing and insurance issues we tend not to think about that often. That is an important concept to relate to the client. Some of the information that we record, the documentation that we hold, will have to be translated to insurance agencies for billing purposes.

Are CRC code of ethics -- our cold of ethics -- our CRC code of ethics talks about interpretation, it is important that we relate insurance and billing issues as another potential limits on off eventuality. So the clients understand that. Let me talk about one specific area of confidentiality that has some -- I guess midst surrounding -- myths surrounding this. If you are familiar with the [ Indiscernible ] decision it was made in the Midshipman to late 70s I think 1976 in California, saying that if you're someone who provide services, there is a limit on your confidentiality. Such that if you are subpoenaed or if someone makes a harmful threating statement regarding a specific individual, you are open to alert that particular individual.

This is for provide protection for the greater good, this decision is one that has been adopted by many restrictions across the nation. However it has not been formally adopted in the Texas code, Texas Supreme Court has not created a new common law cause of action that state's negligence. This is important to understand, and Texas statute provide express limits on confidentiality and thus very few legal protections for professionals who breach that. You should be sure to read Texas code 611 of the Texas health and safety code carefully before breaching any client confidentiality to ensure such a breach would fall within a protected limit.

Some of the more general areas where there are limits to confidentiality child-abuse, elder abuse, depended adult abuse, a threat to kill or harm oneself, communicated and for insurance and

billing situations. Situations involving a threat to someone else, there is reasonable well identified victim, something you really want to be very careful with. Hopefully you will not come into contact with any situation relative to that or any of those particular breaches of confidentiality, if you should, is important for you to be aware you are -- articulate that your client or supervisors so they are aware, information they may sure that will fall outside of the traditional role of confidentiality that you and that person will share.

This connects to a duty to warn requirement, I should've connected those two together it focuses on that. Lastly you want to make sure that you talk about disclosing information at the particular agency or organization that varies from place to place. When I was in Michigan practicing as a LPCI I was required by the state to create a disclosure form. That form pretty much relates what my counseling practice or theoretical background is, how I work with pliant, how I build the client, with the season rates are. Insurance I accepted, it was very detailed, so the agencies may have disclosure information with regards to billing and cost and that nature. Is important to review with your client.

You also want to make sure that you talk about your role if you have any at all in determining eligibility benefits. You want to make sure that you talk about how you report results, talking about disclosure from a client and on a client point of view of what the disclosure may look like or mean. In a very a situation, you also want to make sure that you visit with HIPAA. Some of your agencies or organizations may have separate forms for you to complete for HIPAA. That makes sense, HIPAA is a very detailed and explicit federal law that is intended to protect the clients medical records and other health information. So you want to make sure that you cover that very specifically for a minute, there is a separate form that you can spend time talking about HIPAA. I am not a HIPAA guru but I do know when HIPAA -- it provides clients access to the medical records and gives us more control on their personal health information to the act was intended to make sure there is a nationwide score, a foundation of privacy protection.

States can establish more stringent laws, without being in violation of HIPAA there is a minimum level of protection that all individuals receive under the HIPAA act the goal you want to make sure that you talk specifically about that if it is something that you come into contact with a client or consumer as they receive services from your agency or organization.

HIPAA is a separate and pretty lengthy document that were also be signed, but the other things you want to talk about is the bass are the last two -- are the last two here. Talk about the consequences and fill your to disclose. We are all helpers and intent on making sure that what we do works for the good of our client, and would operate so we do not cause harm. The question is, will can be the negative consequence? If everything that we do is working towards benefit? There are specific negative consequences that can come for participation in services. If we work underneath the ideal that all of our services are to improve the person's life and will cause them to change some of their behaviors, some of their prior acquaintances and some issues if you talk about substance use. May be changing their environment, all of these different things can have some negative consequences.

It is important to visit with those that we are talking about the overall informed consent of our client. We do not want to labor the issues -- is this a good idea after all? Receiving our services to benefit them is a good idea, they need to be aware there is potential that they will have a

worsening of symptoms. Potential for increased relationship complex as they shift and change improve their life situation. There is a potential for crisis because they are just not sure how to handle all of the change and what is new in their lives to improve the overall situation.

We want to make sure that we talked very briefly but Safeco -- but specifically about the negative consequences. We also want to talk about the consequences, potential negative consequences for them not to disclose. It would be nice if our clients came in and gave us all of the information. We know that is not the case. For various reasons, for various experiences that they have had, they may hold information back to the we may not -- we may not have the entire story, when we provide services, have been full information is really important and helps us do our best job. When we do not have all of the information, we may be operating off of what they provided us, premise we have based off the information. It may not after all be in their best interest.

We want to make sure that they know potentially the work that we do, may not have the overall great benefit if we do not have all of the information from them. This goes back to what I talked about in regards to confidentiality related to trust and safety. Our clients and consumers particularly those who have been involved in systems and services for a while, they have negative experiences. They may have negative perceptions of what service provision can look like, it is up to us to make sure that we make them feel safe. We make them feel as though we that they can trust us, illustrate and finish at the same level of trust for them. That helps create the -- the relationship they would not give us the whole truth and nothing but the truth, but you can then press harder to say, it seems like there is something you're not telling me. We have the basis of the relationship I hope you can, I want this to work for you. Speaker in order for that to happen I need information from you .

The last couple of things that are generally included in a thorough exchange, I talked about this earlier are appeal rights within the agency. Clients are -- or consumers should be aware of the process should they have a negative experience with you or break the -- or the service provider or a vendor, they should really understand what the process is for them to contact someone. I remember when I was working in Michigan, I was providing professional disclosure statement at the very bottom there was a number for people to call for the licensing board if they felt they had an issue.

One of the persons I was working with, I was working at a comprehensive rehabilitation agencies, services for persons with mental illness, adjustment issues, persons who are psychologically adjusting to newly acquired disability. I had a client who had a cognitive impairment who called the licensing board because they were not sure of whether or not they were supposed to meet with me every day or week. It was an agency situation they were telling the licensing committee be contacted me to make sure my professional disclosure statement include the information. It was not something that was clearly defined previously, there was not a penalty, because I did not take the time at that point to really talk about what their rights were with regards to a killing at what that meant, and how they go through the process of an appeal. That was kind of a consequence, a light consequence but one nonetheless.

Professional disclosures also include your background, scope of practice, any certification or licenses that you hold in order to be a qualified service provider.

Okay so the last section to talk about before we go into looking at our case studies. Is to really focus on the concept of informed consent. On the PowerPoint IV sent out -- I sent out, I struggled with using the term capacity. I do not want it to be linked to the concept of functional capacity. I think the person is best with a very disability can and do have capacity for informed consent. However there are situations where individuals are not capable of giving informed consent, like in my near -- minor or movable adult, we need to provide appropriate explanation to the person who is signing on their behalf, attain everywhere for participating from a legally offers is -- legally authorized representative.

The CRC code of ethics represents this end section B. It will talk about the responsibility to minors or clients lacking capacity for consent, what the responsibility is to the client. B5 Breeds, when counseling minor client or adult clients who lack capacity to give voluntary informed consent, rehabilitation counselors protect cop initially of information received in the counseling relationship specified by national local laws, policies are applicable standards. As I was reading over that, I was like -- that is vague.

I think that is a challenge for some people with the code of ethics. It is not prescriptive it will not say -- if this happens this will happen. If you will do this, this should happen. It is a guide, it is kind of a form for you to really think about how I should behave professionally, practice and what will be in the best interest of the client?

In looking at that statement in regards to individuals who may be -- cannot perform consent I visited other code of ethics to see if there was more specific information. What I found in the APA code of exit -- ethics section number 3, we should provide appropriate explanation, seek individual consent, consider the individual preference and best interest, explained all of the information we would've explained to the client or consumer. In the same way to the legally authorized person.

If there is a situation where substitute consent is not available, then we as professionals need to take reasonable steps to protect the individuals rights and welfare. What that means, we need to locate someone who would be available to provide that consent. We want to make sure that the client or consumer has the ability to understand all of the information if they are not, we relay the information in their presence to an authorized individual, legally authorize.

We want to make sure they have the ability to withdraw consent something that is very important, such that if for some reason the individual that has been authorized as a Guardian, making decisions on behalf of a client, the client and consumer disagrees with the information, we want to make sure the client or consumer is aware of agency policy and procedures. We are aware of jurisdiction legal policy and procedures on how to adjust that particular issue. Script at the end --

At the end of the day what we really want to do is make sure we are protecting the client. By protecting the client we protect ourselves, protecting ourselves we protect our agency and also our profession. It is a point that you Hill me say a couple of times, it is really important that you think about informed consent in the broader scope of what actually is. Versus just a piece of paper we pass over . I to sign off on.

-- Pass over to sign off on. That was a lot of information, I want to stop and see if you have any questions or comments before we move into looking at one of our case studies?

We have some comments. All of our participants you can certainly chat the information in the question box and I will share that with the presenter.

There was a comment that times for with the person competes time spent with the forms. There is never enough time, you pretty much covered that in your presentation.

There was a question about, what are some accommodations, tools or technology that we can use when working with a person that is disabled with a dramatic brain injury that impairs cognitive functioning?

Adjusting the first,, talking about the time concept. -- Adjusting the first -- addressing the first concept, the more familiar you are with your forms and information that is translated into them, the easier it is for you to move away from the form and talk and have interaction or relationship building. Interaction with the client and still cover the necessary information in the forms. You can have a conversation with them talking about who you are, what they are therefore. You can in that the information about informed consent and talk to them about your rights. Going over the information without winning summits in the form because you are so familiar with it. That is away I found that works really well when talking about -- trying to get all of the agencies responsibilities in building the critical relationship.

The second question with regards to intellectual the moment or cognitive impairment is a great question. One of the things that is most important is to try to really figure out, what works well for that particular individual? While I can list off some of the common accommodations are, you can of course record some of the information regarding the informed consent, you can modify the language from the informed consent form -- so is much more concrete and less abstract, sometimes we find in the forms, those are general things that may be helpful. What I think is really important and really does help our check in our examples, you may say to a client, who has intellectual developments will disability or cognitive impairment. You're talking about limits of confidentiality, you may relate to them, things that you tell me are going to be just between you and I. But there are times where I may have to tell other people. What does that mean to you or how do you understand? Checking to see what the response is. Provide examples, let's say that you want to take time off from work, because you have a personal family engagement that you want to attend.

The employer we are working with has a policy within the first few days of work dispersed -- the first mother work you have to be there every time you're on call, your try to find a way out of that, the working with the employer, that puts me in a difficult position, I may say, this may not be the best time for the person to start their job. You want to make sure that you provide -- this may not be the best example, provide examples that the person can relate to. That fits the situation for each of these different concepts.

It also helps to take out similar to how it looks in the PowerPoint, bullet some of the concepts so it is not paragraph text. A getting can be overwhelming, it can impact the ability of their process

information to allow them to understand and sign off. When you bullet the information you could stop after each run, you can -- what do you think that means? You can have a conversation with them about a.

-- It. When you talk to people who have cognitive impairment you need to fill everything down so they have the ability based on their dental illness to use their processing to the best of their ability within their functional capacity so they fully understand what you say and can agree in a voluntary nature.

That is a lot of information.

We have another question, I'm glad that we are recording this so we can review this and provide information.

The next question we have, when I am going through the discovery process for employment, which is our right on my report? -- What should I write on my report? Sometimes people need to know something but not writing in the report such as behavioral issues, I share this with the person, counselor and the family. Obligated to provide information that impacts the employment placement.

That is a fantastic question, that would be a great question for our follow-up session next week. Ethically, you have the responsibility to present the information as requested in your report as presented to you, if you have information from psychologic evaluations, behavior, other documentation that is part of what is required any report. You are not able to exclude the information not ethically -- based on the client's preference for this is something -- this is something to be talk about up front with the client as you talk about evaluation and assessment. Make sure the client understands there is information that may come out during the evaluation process, that maybe not represent the way that you see yourself or your capacity.

Based on the assessment provided, however ethically I am still obligated to include the information, however we you can also do, provide counter information. If there are behavioral issues that the person experiences, something you observed, you include the in the report. You also include that there are positives, things that you have observed, things they do well on, those are a valid of information regarding the individual.

We can spend more time on that next three, I can take you to specific places in the code and also talk about specific examples that I just -- that address that very issue.

Let's spend a little bit of time looking at a case of proper disclosure.

What can happen or what it may look like when proper disclosure is not provided?

The case on the screen, I will read this out for you. Kathy has been assisting Philip in developing a homebase business and antique rookery. Initially Kathy felt the business to be more of a hobby than actual business and for the first your some -- they barely broke even. Kathy believe activity was very important to the emotional well-being and that earnings were secondary to his improved mental state. She told Philip you would not have to be concerned about losing

[ Indiscernible ] penance he had been receiving. Philip earnings increased dramatically in the second year, substantial part due to the acquisition of a very valuable piece of art that he found at a garage sale. Kathy was able to close folks case regarding annual salary as reflected by the current your income in the case file.

We should be sending earnings records from cases for reimbursement purposes. This information is considered common use, and assured without further consent requirement. When Phillips any information was reviewed by the Social Security agency, his disability and benefits were terminated based on his recent income. Here is a situation where there was -- some lover of disclosure that may not have occurred between Kathy and Philip Virgo

-- What are some of the initial thoughts that I revealed so far about their interaction?

Feel free to include any information in the question box.

I am waiting for a response.

There was confusion whether it was a hobby or a business.

Yes.

Kathy felt as well it's a off as a hobby, substantial earnings had to be reported, it may not have been then left to be a business for Social Security, it is still reported income . Because of the income and the information, it has to be provided to the Social Security administration.

False statements about being concerned about the loss of SSI.

Yes.

Overall in this case, you are thinking about this, Philip felt he was not properly informed about the information sharing agreement. The information that was provided really was not accurate since the current income was based on the one-year which she had not had a pretty lucky acquisition. -- She had a pretty lucky acquisition.

There may be little likelihood to find something similar to that to make the income, the earnings do not reflect it the true nature of what he is doing -- the true nature of what he was doing, he sitters or by hobby than a means to earn a living.

Did Kathy properly disclose to Philip how information provided to her would be shared?

What we see from the basic information it is likely Kathy did not, the person who mentioned the false statement, it is important. When you talk about people who are doing antique work, sometimes it can be a very lucrative business even if it is nothing. It started off as a hobby, she shouldn't talk about in her overview with Philip, she had to report income and that it is possible, this is a potential negative consequence, at any point in time his income passes a certain point, the SS a -- SSA may look at that and move his benefits based off how much was acquired or the income for the reported timeframe.

We have some, six came in with regards to the benefit issue. It seems the case closure was predicted. [ Indiscernible-low volume ] this is coupled with the statement about meeting the benefits cause the behavior of the professional into question.

You have to give a thorough benefit analysis explanation. This is a good example how full disclosure may seem [ Indiscernible ] at the time the would have a big impact.

Definitely. Kathy had a ethical responsibility to make sure she followed her agency policy and sharing her client a possible outcome of the disclosure, it seems as though that did not happen in this interaction. On that level as we mentioned before you're going over informed consent and disclosures, these can sometimes be rushed and sometimes we are very relaxed with them. We are on autopilot, it is really critical that we spent time with this and make sure the client understands every step. So they are aware of the potential negative consequences may be for them receiving our services.

As a CRC specifically for Kathy, she has to ensure her clients are fully informed about the negative consequences. We can see from this interaction that is something she did not follow through.

Given that, Philip would have the right to file a grievance with her at her agency. Potentially with the licensing and certification board. It varies again, this area of informed consent and documentation is one of the areas that poses the greatest legal risk. One of the top areas for practitioners, it is important though our time is trust we find a way to make sure that we clearly articulate all of the different aspects included in the informed consent and disclosures for our client.

So this is another -- I like cartoons. I took this from Dr. Leon

As I came to UNT I found this is something that he includes in his presentation. I found this as I was looking up, I thought I would share with you. There is a cartoon here with the person this is thank you I cannot accept my gift I was just doing my job

I'm sorry I cannot disclose customer information. Of course I cannot you -- slat you see, finally in the training class, they mention -- I am sorry -- my screen is little bit --

My webinar panel is in the way.

I do not have an example.

[ Laughter ]

This is an example of a person who is operating on autopilot, but very much so grounded in ethical situations. The challenge for this individual, even though they are on autopilot and said to be grounded in ethical principles, we do not know how conscious that is. We can sometimes come into trouble and find ourselves in conflict and in a ethical lemma.

-- Dilemma.

We are familiar with the ethical dilemma. Have a choice between actions, there is potential consequences going one way or the other. Both of those actions can be supported by the ethical principles. Sometimes choosing one course or the other, will support one principle but compromise another. When you talk about informed consent in you trying to make the decision about whether or not and how you relate the information? How detailed the information and thoughtful about accommodating the information? You are definitely protecting fidelity, justice. It may be all of these, there are times so it's what we saw with Kathy, she really was Workplace Inclusion and Sustainable Employment wrote Phillips mental health and well-being that was her focusing on his inferences, we find overall justice was over the compromise. She was not as fair to him she did not reveal, the truthful outcome that can potentially happen for him being successful in his venture.

This case study is another example when the ethical principle collides. I will read this to you, it talks about you being a rehabilitation caseworker at a assisted living facility for patients with Alzheimer's and dementia. Your client severe -- suffered a severe stroke rule impacted her memory further affecting her process of information. Her daughter Janet assume medical power of attorney Tourette's or her mother's care. Following visa permit with the physician on site, it was noted or discovered that she had stage 2 lung cancer, after speaking with the doctor Janet was informed, she is adamant that her mother not be told about her newly acquired disability. Serve obviously --

Honestly there are ethical issues and complex issues, what is the ethical complex -- conflict in the principles that we hold to meet Janet request?

While we give people a couple of minutes to think about that and send in comments, we got an additional comment on the previous story. [ Indiscernible-low volume ]

Been informed and up-to-date with what was talked about.

We are waiting on responses to the current story with regards to Janet and Alma.

Alma these retold because she will be making decisions in the future as a medical power of attorney.

Another comment, [ Indiscernible ].

Yes.

Because of the time let me work with those couple of comments that we have. With regards to Alma needed to be told, that person is exactly right. The code of ethics let us know it is important that our client should have the freedom to understand what treatment and services they experience or they will experience. They are going to participate ongoing services they need to have the ability to make informed choices regarding planning and make decisions.

In that respect Alma needs to be made aware of this newly acquired condition. For the second, Everett regards to the [ Indiscernible ] when you think about this and you take off the practitioner hat and think about this in regard to the possible family members or people that we know. We can certainly understand what Janet is trying to do in her viewpoint.

Given what Alma is expressing already, we have to consider what is going to be the potential negative consequence of her having the information ? Will that make this -- her disengage from the treatment will withdraw, initiate some additional depression for her to deal with? Impacting her overall recovery process we have to think about that but also think about the truthfulness that we have to uphold for Janet. This goes back to looking at the ability or inability to give consent, in this situation is not clear to us whether or not Alma is unable to provide consent. Even though she has a medical power of attorney, making some of those decisions, Alma needs to be involved in decision-making process, Alma can be ultimately making the decisions. Alma has every right to understand what is going on with her. Were her services will look like in treatment.

And what she is going to be participating in. The code of ethics in the situation even though our principal is completing desk afflicting is clear on how we proceed in this situation we should have both Alma and Janet present and we review what are agency policy is moving forward in this situation. It may happen that Alma me each event outside what she receives from the assisted living facility she needs to be obeyed aware -- to be made aware of that. Although Janet has medical power of attorney we have to go back to section A of the code of ethics and look at the client's right. In this situation although we are working with family, Alma is the media client and immediate concern -- immediate client and consent, we need to be making this aware to Janet.

With Janet having the medical power of attorney, it is essential she is involved in the consent process early on so she is aware of the responsibilities and ethical practices are so we can refer back to them it is from the time with this conflict.

We have more comments -- one of them they did not agree with the decision by the daughter. The issue would have the information disclosed.

Definitely.

As researcher wrap up -- as we start to wrap up, how this on is the -- we want to make sure clients can deliberately decide if they want services to purchase be fully. To make educated decisions about services. What I provided for you to take away if you need the information, additional content on HIPAA so you could review that and articulate that in the wave that is best for the client or consumers you provide services to.

The last point I want to say, consciously practicing ethically I mentioned this before is good for the consumer or the client. The practitioner and the agency and professional overall, I hope you're able to do so as you work day today.

-- day to day

The next session if you're able to send me any scenarios or questions that you have specific to informed consent and ethical practice I could work on those over the week we can use the next 20 as a working session to go through the scenarios and share them with your peers in case they may have had similar experiences or run into similar experiences.

You can e-mail those to unty@unt.edu.

A reminder for everyone this is a two-part webinar, we will see you next Wednesday at 938 -- 9:30 AM.

We will pick those scenarios up and be view for the session next three. Thank you for your attention, I will be talking to you next week. You have a good day.

[ Event Concluded ]