Discusion Technology and Counseling – C5WK9

Discusion Technology and Counseling – C5WK9

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C5 WK9 Layout Oct19 This is for a discussion post. There are not set pages or word counts. It needs to be well written in a natural conversational tone using APA. Please documents attached for further information. Discussion Technology and Counseling In 2014, the American Counseling Association added a new section to the code of ethics titled Distance Counseling, Technology, and Social Media (Section G). This section was added in response to the tremendous changes that have occurred in this area since the 2005 code was written. The appropriate use of technology may help counselors manage and provide quality services and programs for their clients in a more efficient manner. However, there are significant ethical challenges associated with the use of technology that counselors need to acknowledge and address. For this Discussion, review the Learning Resources for this week. Then, select two types of technology counselors can utilize with clients. Consider one type of technology that might be useful in the provision of counseling services (e.g., video conferencing, encrypted chat, virtual reality) and one type of technology that might be used in the management of counseling services (e.g., electronic data storage, e-mail, social media). Reflect on the potential ethical challenges counselors face when integrating technology into the counseling profession. Post your position on the use of technology in providing counseling services. Then, explain at least one ethical violation and one ethical challenge related to using technology for providing counseling services. Then, state your position on the use of technology in managing counseling services. Finally, explain at least one ethical implication of integrating technology for this purpose. Justify your position. Be sure to use the Learning Resources and the current literature to support your response. PSYC-5306-5/COUN-6306-5/COUN-6306F-5/COUN-6306A-5/HUMN-8306-5Ethics and Legal Issues2019 Fall Quarter 08/26-11/17-PT27 Week 9 Week 9 Objectives 1 of 3 16/10/2019, 22:30 Q Week 9 – PSYC-5306-5/COUN-6306-5/COUN-6306F-5/COUN-… https://class.waldenu.edu/webapps/blackboard/content/listContent…. Week 9: Technology and Ethics Introduction loner123: Hi Doc! I see that you are online. Can we chat? SuperDoc: Well, it is 2 o’clock in the morning. Are you feeling okay? loner123: I am feeling like an attack is coming on. I am breathing and trying to keep calm, but you know how that does not work all the time. SuperDoc: Sorry to hear that. We can arrange to meet tomorrow. In the meantime, why don’t you tell me what is triggering your attack…. Technology continues to evolve and has had a major influence on how we learn, communicate, and interact with others both personally and professionally. Are there challenges and concerns associated with the use of technology in counseling? How do counselors incorporate technology into client treatment strategies? With the wealth of technological resources that are available to counselors, increased duty to protect client confidentiality and client records follow. While precautions that counselors use today may be insufficient in the future, the foundational definitions of ethics that guide the use of technology in counseling remain intact. This week, you examine the use of technology in the counseling profession. You explore potential ethical violations (e.g., accidental release of confidential information to a behavioral health care professional without client consent) and the challenges mental health counselors face when integrating the use of technology in client treatment strategies (e.g., typing notes during session). Objectives Students will: Analyze the use of technology in the counseling profession Evaluate ethical violations related to the use of technology in the counseling profession Resources 2 of 3 16/10/2019, 22:30 Week 9 – PSYC-5306-5/COUN-6306-5/COUN-6306F-5/COUN-… https://class.waldenu.edu/webapps/blackboard/content/listContent…. Discussion 3 of 3 16/10/2019, 22:30 Week 9 Learning Resources This page contains the Learning Resources for this week. Be sure to scroll down the page to see all of this week’s assigned Learning Resources. Required Resources Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus. Readings • • • • Remley, T. P., Jr., & Herlihy, B. (2016). Ethical, legal, and professional issues in counseling (5th ed.). Upper Saddle River, NJ: Pearson. o Chapter 10, “Technology in Counseling” (pp. 245-263) American Counseling Association (ACA) Code of Ethics. Current Edition. Dror Ben-Zeev, P. a. (2017). Technology in Mental Health: Creating New Knowledge and Inventing the Future of Services. Psychiatric Services, (2), 107. doi:10.1176/appi.ps.201600520 Nielsen, B. A. (2015). Confidentiality and electronic health records: Keeping up with advances in technology and expectations for access. Clinical Practice In Pediatric Psychology, 3(2), 175-178. doi:10.1037/cpp0000096 Vital Source Bookshelf App Bookshelf: Sign in: hwuni333@gmail.com Password: TempPass75! https://support.vitalsource.com/hc/en-us/categories/200132467-Bookshelf-for-Macand-PC Confidentiality and electronic health records: Keeping up with ad… https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/detail/d… Confidentiality and electronic health records: Keeping up with advances in technology and expectations for access. Authors: Nielsen, Britt A.. MetroHealth Medical Center, Cleveland, OH, US, bnielsen@metrohealth.org Address: Nielsen, Britt A., Department 1 of 33 16/10/2019, 23:14 Confidentiality and electronic health records: Keeping up with ad… https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/detail/d… of Psychiatry, Division of Child and Adolescent Psychiatry and Psychology, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH, US, 44109, bnielsen@metrohealth.org Source: Clinical Practice in Pediatric Psychology, Vol 3(2), Jun, 2015. pp. 175-178. NLM Title Abbreviation: Clin Pract Pediatr Psychol Publisher: US : Educational Publishing Foundation ISSN: 2169-4826 (Print) 2169-4834 (Electronic) Language: English confidentiality, 2 of 33 16/10/2019, 23:14 Confidentiality and electronic health records: Keeping up with ad… https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/detail/d… Keywords: electronic health records, pediatric psychology, personal health records Abstract: In the first issue of Clinical Practice in Pediatric Psychology (CPPP), Smolyansky et al. (2013) described experiences and decisions making related to the implementation an electronic health record (EHR) at 4 children’s hospitals. Two years later, the Society of Pediatric Psychology 3 of 33 16/10/2019, 23:14 Confidentiality and electronic health records: Keeping up with ad… https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/detail/d… (Division 54 of the American Psychological Association) listserv continues to be a forum for discussion of EHR confidentiality specific to a pediatric medical setting, reflecting the learning curve involved when implementing an EHR. The purpose of this commentary is to highlight the unique ethical considerations in the use of electronic 4 of 33 16/10/2019, 23:14 Confidentiality and electronic health records: Keeping up with ad… https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/detail/d… health records in a pediatric medical setting. Unique issues related to documentation for a pediatric population, interprofessional teams, trainees, and adapting documentation practices for the ever evolving technology and expectation for information access. (PsycINFO Database Record (c) 2019 APA, all rights reserved) Document Type: Comment/Reply Subjects: *Child Psychology; *Privileged Communication; *Professional Ethics; *Technology; *Client Records; Electronic Communication; Expectations; Electronic 5 of 33 16/10/2019, 23:14 Confidentiality and electronic health records: Keeping up with ad… https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/detail/d… Health Records PsycINFO Classification: Health & Mental Health Treatment & Prevention (3300) Population: Human Location: US Age Group: Childhood (birth-12 yrs) Adolescence (13-17 yrs) Format Covered: Electronic Publication Type: Journal; Peer Reviewed Journal Publication History: Accepted: Apr 3, 2015; Revised: Apr 2, 2015; First Submitted: Mar 30, 2015 Release Date: 20150615 Correction Date: 20190211 Copyright: American Psychological Association. 2015 Digital Object 6 of 33 http://dx.doi.org.ezp.waldenulibrary.org 16/10/2019, 23:14 Confidentiality and electronic health records: Keeping up with ad… https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/detail/d… Identifier: /10.1037 /cpp0000096 PsycARTICLES Identifier: cpp-3-2-175 Accession Number: 2015-25793-003 Number of Citations 5 in Source: Confidentiality and Electronic Health Records: Keeping Up With Advances in Technology and Expectations for Access / COMMENTARY Listen American Accent By: Britt A. Nielsen MetroHealth Medical Center, Cleveland, Ohio, and Case 7 of 33 16/10/2019, 23:14 Confidentiality and electronic health records: Keeping up with ad… https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/detail/d… Western Reserve University School of Medicine; Acknowledgement: Electronic health records (EHR) and issues of confidentiality of behavioral health records continue to be a focus of discussion in the literature, as well as in professional circles. In the first issue of Clinical Practice in Pediatric Psychology (CPPP), Smolyansky et al. (2013) described experiences and decisions made related to the implementation an electronic health record (EHR) at four children’s hospitals. The Society of Pediatric Psychology (Division 54 of the American 8 of 33 16/10/2019, 23:14 Confidentiality and electronic health records: Keeping up with ad… https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/detail/d… Psychological Association) listserv continues to be a forum for discussion of EHR confidentiality specific to a pediatric medical setting, reflecting the learning curve involved when implementing an EHR. As with most technology, while we are adapting to what is available to us now, developers are continuing to push the envelope of who can access a patient’s health information, as well as where, when, and how that access can occur. The purpose of this commentary is to highlight unique ethical considerations in the use of electronic health records in an interprofessional 9 of 33 16/10/2019, 23:14 Confidentiality and electronic health records: Keeping up with ad… https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/detail/d… pediatric setting, while keeping in mind the ever evolving advances in technology. Specific issues of EHR documentation related to pediatric patients, interprofessional teams, and trainees will be explored, with some discussion of how psychologists can adapt documentation practices given changes in technology and increasing expectation for information access. Pediatric Patients and the EHR Pediatric psychology has long dealt with issues of confidentiality and sharing information with parents. Adding 10 of 33 16/10/2019, 23:14 Confidentiality and electronic health records: Keeping up with ad… https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/detail/d… an EHR to the mix magnifies these issues. Informed consents typically identify limits of confidentiality; however, patients (and parents) are not always aware of what information is being shared and with whom (Richards, 2009). With paper documentation, information about care provided to minors was stored separately and not readily accessible. Although EHRs integrate information for all health care services provided to allow better coordination of care, one significant downside is that parents potentially could have electronic 11 of 33 16/10/2019, 23:14 Confidentiality and electronic health records: Keeping up with ad… https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/detail/d… access to information even from confidential psychology visits. This risk is particularly great when personal health records (discussed below) are utilized. Thus, tension is created between the health benefits that EHRs bring to pediatric care and the threat to confidentiality, particularly when the patient is an adolescent (Bayer, Santelli, & Klitzman, 2015). Personal Health Records (PHR) In line with the ongoing push for patientcentered care, patients are given access to notes written in the EHR (Kuhn et al., 2015). Personal Health Records (PHRs) 12 of 33 16/10/2019, 23:14 Confidentiality and electronic health records: Keeping up with ad… https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/detail/d… specifically, provide patients with on-demand electronic access to their medical information. For children and adolescents, a parent or a guardian must be identified as a “proxy,” essentially defined as someone who is allowed to access the patient’s PHR. In the most recent upgrade of the EHR at MetroHealth Medical Center, one new feature allows providers to “share notes” with the patient. Currently, the default for this feature is to “not share notes”; however, it is expected that in the future, the default will be changed so that notes will routinely be shared with patients. Institutions must 13 of 33 16/10/2019, 23:14 Confidentiality and electronic health records: Keeping up with ad… https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/detail/d… be careful to assure that confidential information, such as information about sexuality, remains confidential and that parents with proxy access are not inadvertently given permission to view potentially inflammatory progress notes or lab results (e.g., a positive STD screen). Providers also must take extra caution when documenting information that older children or adolescents do not want shared with parents or guardians. Family Information Documented in the EHR In a pediatric setting, providers obtain social, substance use, mental health, 14 of 33 16/10/2019, 23:14 Confidentiality and electronic health records: Keeping up with ad… https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/detail/d… and medical history about extended family members; however, little attention has been focused on protecting parents’ (or extended family members’) information in the EHR (Bayer, Santelli, & Klitzman, 2015). This can lead to a variety of problems. For example, in contentious family relationships, one parent may disclose information about a former spouse that may be seen by the former spouse if, for some reason, that person gains access to the child’s medical record. In other families, custody of the patient may change, either to family members, or to 15 of 33 16/10/2019, 23:14 Confidentiality and electronic health records: Keeping up with ad… https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/detail/d… individuals outside of the family. Again, there is potential for providing individuals with access to information that the reporter most likely did not expect any one else to learn. Additionally, parents may share information that is unknown to a child and that the parent was unprepared to have revealed. For instance, a parent may disclose the identity of the child’s true biological parent, or the fact that they were adopted, without wanting the child to know. Unbeknownst to the parent, there may be a time when this potentially sensitive 16 of 33 16/10/2019, 23:14 Confidentiality and electronic health records: Keeping up with ad… https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/detail/d… information is shared with the child in the course of care. In one such example, a teenager I was working with learned that the man she thought was her father was identified as a “stepfather” in the emergency contact list that was reviewed with her before her surgery. In this case, the parent did not expect that the child would ever have access to that information. Ultimately, one can never be sure who will have access to information in the EHR or how it will be shared in the future. These situations highlight the complexities of maintaining confidentiality using the EHR for a pediatric population that were not as 17 of 33 16/10/2019, 23:14 Confidentiality and electronic health records: Keeping up with ad… https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/detail/d… obvious in paper records. Interprofessional Teams, Staff, and the EHR Although our physician colleagues and other team members understand issues around HIPAA, they often do not fully appreciate the added protections for mental health notes, or what information is confidential in the EHR (Richards, 2009). Colleagues may not understand that even though they have access to specific mental health information, it may not be appropriate to share that information verbally, or copy and paste that information into their own 18 of 33 16/10/2019, 23:14 Confidentiality and electronic health records: Keeping up with ad… https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/detail/d… documentation. Psychologists should take a role in helping educate physicians and other team members on the confidentiality of mental health notes. The psychologist must proactively discuss with the team what information can be shared and what information must be protected (Richards, 2009). With EHRs, staff now have access to a large amount of information and field requests for information from parents, caregivers, schools, or community agencies that may come through appropriate channels with documented release of 19 of 33 16/10/2019, 23:14 Confidentiality and electronic health records: Keeping up with ad… https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/detail/d… information or through informal requests (Nielsen, Baum, & Soares, 2013). It is important to provide education, even to experienced staff, on policies and procedures related to mental health documentation and release of these records in the EHR. Other institutions protect patient information by requiring the medical records office to contact the mental health provider directly when a request for information is received, the provider must then consent for the release to occur. Providers may not always be aware of automatic functions that institutions may add to the EHR. At our institution, if a 20 of 33 16/10/2019, 23:14 Confidentiality and electronic health records: Keeping up with ad… https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/detail/d… patient was referred by an outside provider, a letter is automatically generated and the note associated with the encounter is attached to the letter. These documents get printed at an outside facility for automatic mailing. Typically, our referrals come from inside our institution so, our department does not have to deal with this; however, if there is an error in the entry of the referring provider, a provider with no relationship to our patient could possibly be sent this letter and progress note. There is a way to delete the letter if it is generated; however, if someone unknowingly 21 of 33 16/10/2019, 23:14 Confidentiality and electronic health records: Keeping up with ad… https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/detail/d… comes across it, the chance for an accidental breach of confidentiality exists. Trainees and the EHR Typically, in psychology graduate programs, trainees learn to write extensive notes, lengthy reports, and include all the information they obtained from the patient. They get training on confidentiality; however, this training is not necessarily focused on documenting in the EHR. Many trainees learn from their practicum or internship placements about documenting in an EHR. Some training may be more formal than others. At 22 of 33 16/10/2019, 23:14 Confidentiality and electronic health records: Keeping up with ad… https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/detail/d… our site, it was originally expected that trainees participate in EHR training with physicians, nurses, and so forth. Our department was able to work with the informatics trainers to get permission to train psychology graduate trainees on the EHR to focus on work flow and confidentiality issues related to the EHR and mental health documentation. In the future, graduate training programs will need to focus on teaching graduate students how to document appropriately in an EHR. At our institution, information that trainees document in the 23 of 33 16/10/2019, 23:14 Confidentiality and electronic health records: Keeping up with ad… https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/detail/d… EHR is immediately visible to others with access to the patient’s case. This may happen before the supervisor has a chance to review the documentation or edit it, which can be a cause for concern at times. One possible way around this is to have trainees create a draft note outside of the EHR and upload it after the supervisor has reviewed it. This, of course, has HIPAArelated issues, some of which may be overcome by providing HIPAAcompliant USB storage devices to trainees for this purpose. Another solution is, when creating the security access to the EHR for trainees, 24 of 33 16/10/2019, 23:14 Confidentiality and electronic health records: Keeping up with ad… https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/detail/d… psychologists may choose to work with their informatics department to prevent these notes from being visible until the supervisor is able to sign off on the note. Some institutions use documentation templates that meet the standards of the Joint Commission on Hospital Accreditation, insurance companies, and auditors. These templates help guide trainees on what information to include in the note. Providers Adapting to the EHR To survive the evolution of technology and push for easier access to the health record, 25 of 33 16/10/2019, 23:14 Confidentiality and electronic health records: Keeping up with ad… https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/detail/d… providers will need to adapt their own thinking about mental health documentation. Psychologists are used to thinking of notes as the psychologist’s record of what occurred in a visit. These more traditional “psychotherapy notes” often contain information about family dynamics and social interactions and may have a more “He said/she said” feel. Now, we need to think of the note as belonging to the patient and learn to write “progress notes” to document medical necessity for billing, symptoms, progress, and plan for treatment. Rather than a 26 of 33 16/10/2019, 23:14 Confidentiality and electronic health records: Keeping up with ad… https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/detail/d… verbatim transcription of the clinical interaction, a good note should be a brief synthesis of history, findings, decision making, and plans (Kuhn et al., 2015). Providers may want to read their notes and think, what would a patient think if they read this? Think About Now and the Future At the beginning of EHR use, the concern was about what level of security to give to mental health information for providers inside an institution. As technology evolves there will be a greater expectation for access to medical information. 27 of 33 16/10/2019, 23:14 Confidentiality and electronic health records: Keeping up with ad… https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/detail/d… Now, patients can get access to the EHR and providers at outside institutions are able to share information provided that the patient signs a release of information. As Kuhn et al. (2015) points out, some of the changes may be good, including “avoidance of pejorative language in descriptions of patients, patient behaviors, and findings; increased documentation and clarity in documentation of care plans; and increased efforts for timely completion of notes.” In the future, technology that has not even been developed yet is likely to integrate with, or replace, the 28 of 33 16/10/2019, 23:14 Confidentiality and electronic health records: Keeping up with ad… https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/detail/d… EHR as we think of it now (Kuhn et al., 2015). Providers need to think about now, but also be prepared for advances in technology and anticipated shifts in the mind-set about access to records. Who knows? In the future, the stigma about mental health may evaporate and information about mental health care will come to be viewed as nothing more than health care. References Bayer, R., Santelli, J., & Klitzman, R. (2015). New challenges for electronic health records: Confidentiality and access to sensitive health information about parents 29 of 33 16/10/2019, 23:14 Confidentiality and electronic health records: Keeping up with ad… https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/detail/d… and adolescents. Journal of the American Medical Association, 313, 29–30. http://jama.jamanetwork.com.ezp.waldenulibrary.org. 10.1001/jama.2014.15391 Kuhn, T., Basch, P., Barr, M., Yackel, T., & the Medical Informatics Committee of the American College of Physicians. (2015). Clinical documentation in the 21st century: Executive summary of a policy position paper from the American College of Physicians. Annals of Internal Medicine, 162, 301–303. 10.7326/M14-2128 Nielsen, B. A., Baum, R. A., & Soares, N. S. (2013). Navigating ethical issues 30 of 33 16/10/2019, 23:14 Confidentiality and electronic health records: Keeping up with ad… https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/detail/d… with electronic health records in developmentalbehavioral pediatric practice. Journal of Developmental and Behavioral Pediatrics, 34, 45–51. 10.1097/DBP.0b013e3182773d8e Richards, M. M. (2009). Electronic medical records: Confidentiality issues in the time of HIPAA. Professional Psychology: Research and Practice, 40, 550–556. 10.1037/a0016853 Smolyansky, B. H., Stark, L. J., Pendley, J. S., Robins, P. M., & Price, K. (2013). Confidentiality and electronic medical records for behavioral health records: The experience of pediatric psychologists at 31 of 33 16/10/2019, 23:14 Confidentiality and electronic health records: Keeping up with ad… https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/detail/d… four children’s hospitals. Clinical Practice in Pediatric Psychology, 1, 18–27. 10.1037/cpp0000009 Submitted: March 30, 2015 Revised: April 2, 2015 Accepted: April 3, 2015 This publication is protected by US and international copyright laws and its content may not be copied without the copyright holders express written permission except for the print or download capabilities of the retrieval software used for access. This content is intended solely for the use of the individual user. Source: Clinical Practice in 32 of 33 16/10/2019, 23:14 Confidentiality and electronic health records: Keeping up with ad… https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/detail/d… Pediatric Psychology. Vol. 3. (2), Jun, 2015 pp. 175-178) Accession Number: 2015-25793-003 Digital Object Identifier: 10.1037/cpp0000096 Mobile Site iPhone and Android apps EBSCO Support Site Privacy Policy Terms of Use Copyright © 2019 EBSCO Industries, Inc. All rights reserved. 33 of 33 16/10/2019, 23:14 Technology in Mental Health: Creating New Knowledge and Inve… https://ps-psychiatryonline-org.ezp.waldenulibrary.org/doi/10.117… Back to table of contents Previous Article Technology in Mental Health Next Article ! Full Access Technology in Mental Health: Creating New Knowledge and Inventing the Future of Services ” # $ Figures References Cited by Volume 68 Issue 2 February 01 Dror Ben-Zeev, Ph.D. Published Online: 15 Dec 2016 https://doi-org.ezp.waldenulibrary.org/10.1176 /appi.ps.201600520 Abstract The mental health services now in place are intrinsically linked with the technology that has been at our disposal for decades of research and practice. Advancements in Web, mobile, sensor, and informatics technology can do more than serve as tools to enhance existing models of care. Novel technologies can help us better understand the very nature of mental illness and revise our fundamental assumptions about the structure, boundaries, and modalities of mental health treatment. Recognizing the unprecedented opportunities new technology offers to improve the outcomes of people with mental illness, Psychiatric Services announces a new column 1 of 10 16/10/2019, 23:08 Technology in Mental Health: Creating New Knowledge and Inve… https://ps-psychiatryonline-org.ezp.waldenulibrary.org/doi/10.117… on technology and mental health. We are witnessing technological breakthroughs that create exciting opportunities to improve the ” # with $ mental illness. % Most readers Figures References Cited by Details e before the Internet, e-mail, and rces that are commonplace today. In just a few short Volume 68 years, we have made Issue 2 enormous advances in our ability to store, process, and access February 01, 2017 digital information in all fields, including entertainment, commerce, and health care. We have seen phenomenal progress in sensing and imaging capabilities and remarkable global penetration of mobile phones and mobile-cellular infrastructure. Digital technologies are now within the reach of the vast majority of the world’s population, including people with severe mental illness. Revisiting the Parameters of Research and Practice Technological resources can help enhance mental health services by creating new pipelines for dissemination of evidence-based practices and by expanding the reach of potent care. On its own, this would have tremendous value for individuals with mental health problems, clinicians, and health care systems. However, we must consider that our existing models of care are intrinsically linked with the limitations of the technologies we have had at our disposal. For example, most treatments require people to make their way to brick-and-mortar clinics, during office hours, to seek specialty services, even 2 of 10 16/10/2019, 23:08 Technology in Mental Health: Creating New Knowledge and Inve… https://ps-psychiatryonline-org.ezp.waldenulibrary.org/doi/10.117… when their behavioral health challenges may serve as direct barriers to engagement in this type of care. Clinical assessments often rely on a retrospective record of an individual’s mental health and functioning, even when recall bias is at play and when ” # Figures References $ % Cited by health Details th mental problems have nd variation in cognition and Volume 68 emotion, compromising their ability to provide Issue 2 accurate and representative reports of their February 2017 experiences. Psychotherapy and01, rehabilitation approaches generally are built around the premise that people are willing and able to engage in one- or two-hour sessions, learn about and acquire major life skills in artificial clinical settings over months or years, and then apply them successfully in their daily lives in the real world. Even more than augmenting and extending existing resources and services, new digital software and hardware may enable us to redefine the very nature of mental health care by building on research, intervention, and prevention approaches that emerge from novel technology–informed scientific paradigms and clinical frameworks that focus on continuous and seamless data collection, delivery of services in the environments in which people negotiate their lives, and interventions that are administered in dosages, frequencies, and formats that better fit the capacities and characteristics of individual patients rather than the office hours or staff composition of the nearest clinic. I n ve n t i n g t h e F u t u r e of M e n t a l H e a l t h Ca r e 3 of 10 16/10/2019, 23:08 Technology in Mental Health: Creating New Knowledge and Inve… https://ps-psychiatryonline-org.ezp.waldenulibrary.org/doi/10.117… Technology is not a panacea. Effectively treating mental illness and delivering mental health services are complex and multifaceted challenges. New technology may offer us some novel solutions. We now have the capacity to engage with people digitally, ” # Figures References $ % by realCited place.” WeDetails can record nd functioning in unobtrusive, Volume 68 practically invisible ways by using sensors that are Issue 2 embedded in people’s personal technologies or that 2017 are positioned in their February physical 01, environment (for example, motion detectors placed in an apartment and Bluetooth beacons strategically positioned throughout an inpatient unit). We can create and support virtual communities of people who may be hundreds of miles or continents apart by using widely accessible social media platforms or tailor-made Web communities hosted by health care systems and clinics and moderated by trained facilitators. We can build tools that allow for self-assessment and selfmanagement, offering their users the opportunity to modify and tailor treatments to their individual goals and needs as they change over time. For example, individuals can update the motivational content used in a smartphone intervention for psychosis (photos and affirmations) as they progress in their personal recovery plan, or they can increase the intensity of images used for computer-delivered exposure therapy on the basis of their readiness (for example, from the written word “spider” to videos of a tarantula). We can continue to use spoken or written language for technology-assisted services, but we can also expand the scope and dimensions of interventions by 4 of 10 16/10/2019, 23:08 Technology in Mental Health: Creating New Knowledge and Inve… https://ps-psychiatryonline-org.ezp.waldenulibrary.org/doi/10.117… leveraging modalities that engage and convey information nonverbally through sight, sound, and touch. For example, mobile phone vibrations that notify the user of an incoming text message can also be used as a prompt to engage in mindfulness ” # Figures References $ % by e-intervention. Details extCited of an We can nal capacity, individualVolume 68 generated data, informatics, and signal detection to Issue 2 try to identify at-risk individuals who may benefit February 01, 2017 from support in a time-sensitive and targeted manner. We can overhaul clinician training so that it capitalizes on digital educational tools, and we can create new roles for professionals in the digital health system. There will likely be a need for clinical technology specialists who can serve bridging functions—on one hand, connecting patients with the most suitable technological tools, and on the other, supporting and training their clinicians who may not know how to make optimal use of the platforms their patients are using or the new forms of data patients may elect to share with them. We can develop new types of clinicians and researchers who harness the expanding arsenal of technological resources to improve the lives of those who struggle with behavioral health challenges. We may be able to retire the waitlist; in an era when Web-based or downloadable mental health support can be accessed 24/7 from anywhere on the planet with Internet connectivity, asking people to languish with no care until in-person–delivered care is available in their area can become a relic of the past. 5 of 10 16/10/2019, 23:08 Technology in Mental Health: Creating New Knowledge and Inve… https://ps-psychiatryonline-org.ezp.waldenulibrary.org/doi/10.117… The parameters of mental health screening, monitoring, and treatment will change hand in hand with the opportunities created by breakthroughs in technology industries. The evolution of the mobile health (mHealth) field is an instructive exemplar. ” # Figures References $ % nesCited withbyshort Details message service tarted to appear broadly, health Volume 68 care interventions using texting for medication Issue 2 prompts and other notifications emerged. As mobile February 2017 greater phones became “smarter” (that 01, is, with computational capacities, Internet access, and media players), interactive downloadable and Web-based self-directed health apps started to appear, using the full array of what smartphones have to offer— engaging graphics, audio and video content, and game functionality. Since the introduction of embedded sensors in smartphones (for example, GPS and accelerometers), passive sensing technology is increasingly being integrated into treatment software for context-aware and sensor-triggered interventions. The time between when a new invention becomes public and when it starts to appear in health care– related initiatives is now shorter than ever. This is hardly accidental; the scientific research and health care communities are now keenly aware of new technological developments and more streamlined approaches to gaining access to them. This process is certainly encouraged and often initiated by commercial companies who reach out to medical centers and university investigators as first adopters of their innovations as a method for testing, dissemination, and marketing. 6 of 10 16/10/2019, 23:08 Technology in Mental Health: Creating New Knowledge and Inve… https://ps-psychiatryonline-org.ezp.waldenulibrary.org/doi/10.117… With novel opportunities come new challenges. Patients and providers will need to weigh acceptable known (as well as perpetually evolving) risks and benefits of using new technology for mental health services. Patient privacy and data security become ” # Figures References $ % Cited by en they are no Details longer contained ented in a physical clinic. The Volume 68 client-clinician therapeutic alliance will be affected by Issue 2 the introduction of telecommunication and February 01, 2017 telemonitoring technology, as well as by new personal preferences and expectations. With greater involvement of commercial entities in the mental health arena (for example, vendors of patient portals and electronic health records, clinical software developers, and medical device companies), there will be a need to distinguish between hyperbolic marketing claims and genuine demonstration of feasibility and clinical utility. Billing and reimbursement models will need to accommodate new service delivery modalities. Research, product, and professional regulatory standards will need to evolve to remain relevant—guiding ethical and responsible use of technological resources while allowing for clinical innovation. A Call for Creativity in Research, Practice, and Policy With this as the historical backdrop, I am excited to have been invited to serve as the inaugural editor for the new column on Technology in Mental Health in Psychiatric Services. I invite the community of researchers, clinicians, advocates, payers, policy makers, and individuals with lived experience to 7 of 10 16/10/2019, 23:08 Technology in Mental Health: Creating New Knowledge and Inve… https://ps-psychiatryonline-org.ezp.waldenulibrary.org/doi/10.117… submit manuscripts (https://mc.manuscriptcentral.com/appi-ps) focused on technology-based or technology-assisted approaches in the assessment, treatment, monitoring, or prevention of mental health problems (for ” # Figures References $ % Cited bydecision Details Health, support tools, cial media, clinical informatics, 68 training programs, andVolume reimbursement models). My Issue 2 intention is not to focus solely on information February 01,be 2017 technology. The new column will an ideal venue to expose readers to innovative technologies or innovative strategies for using existing technology, broadly defined, to improve mental health outcomes. Submissions may include (but are not limited to) informed opinion pieces, empirical efforts (for example, deployment in the context of real-world care and proof-of-principle studies), conceptual overviews, relevant discussion of policy, and firstperson accounts from users of technology in mental health (patients, providers, administrators). I encourage authors to explore, debate, and demonstrate how we may capitalize on and build new technologies that will redefine the field by generating new science and practice. Dr. Ben-Zeev, who is editor of this column, is with the mHealth for Mental Health Program, Department of Psychiatry and Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire (e-mail: dror.benzeev@dartmouth.edu). Dr. Ben-Zeev has an intervention content licensing 8 of 10 16/10/2019, 23:08 Technology in Mental Health: Creating New Knowledge and Inve… https://ps-psychiatryonline-org.ezp.waldenulibrary.org/doi/10.117… agreement with and provides consultation to Pear Therapeutics. ” # $ % Figures References Cited by Details Volume 68 Issue 2 February 01, 2017 American Psychiatric Association Publishing Powered by Atypon Literatum 9 of 10 16/10/2019, 23:08 Technology in Mental Health: Creating New Knowledge and Inve… Terms of Use Privacy Policy https://ps-psychiatryonline-org.ezp.waldenulibrary.org/doi/10.117… © 2019 American Psychiatric Association ” # $ % Figures References Cited by Details Volume 68 Issue 2 February 01, 2017 10 of 10 16/10/2019, 23:08 2014 ACA Code of Ethics As approved by the ACA Governing Council AMERICAN COUNSELING ASSOCIATION counseling.org Mission The mission of the American Counseling Association is to enhance the quality of life in society by promoting the development of professional counselors, advancing the counseling profession, and using the profession and practice of counseling to promote respect for human dignity and diversity. © 2014 by the American Counseling Association. All rights reserved. Note: This document may be reproduced in its entirety without permission for non-commercial purposes only. Contents ACA Code of Ethics Preamble ACA Code of Ethics Purpose Section A The Counseling Relationship Section B Confidentiality and Privacy Section C Professional Responsibility •3 •3 •4 •6 •8 Section D Relationships With Other Professionals • 10 Section E Evaluation, Assessment, and Interpretation • 11 Section F Supervision, Training, and Teaching • 12 Section G Research and Publication • 15 Section H Distance Counseling, Technology, and Social Media • 17 Section I Resolving Ethical Issues • 18 Glossary of Terms • 20 Index • 21 • 2 • ACA Code of Ethics Preamble The American Counseling Association (ACA) is an educational, scientific, and professional organization whose members work in a variety of settings and serve in multiple capacities. Counseling is a professional relationship that empowers diverse individuals, families, and groups to accomplish mental health, wellness, education, and career goals. Professional values are an important way of living out an ethical commitment. The following are core professional values of the counseling profession: 1. enhancing human development throughout the life span; 2. honoring diversity and embracing a multicultural approach in support of the worth, dignity, potential, and uniqueness of people within their social and cultural contexts; 3. promoting social justice; 4. safeguarding the integrity of the counselor–client relationship; and 5. practicing in a competent and ethical manner. These professional values provide a conceptual basis for the ethical principles enumerated below. These principles are the foundation for ethical behavior and decision making. The fundamental principles of professional ethical behavior are • • • • • • autonomy, or fostering the right to control the direction of one’s life; nonmaleficence, or avoiding actions that cause harm; beneficence, or working for the good of the individual and society by promoting mental health and well-being; justice, or treating individuals equitably and fostering fairness and equality; fidelity, or honoring commitments and keeping promises, including fulfilling one’s responsibilities of trust in professional relationships; and veracity, or dealing truthfully with individuals with whom counselors come into professional contact. ACA Code of Ethics Purpose The ACA Code of Ethics serves six main purposes: 1. The Code sets forth the ethical obligations of ACA members and provides guidance intended to inform the ethical practice of professional counselors. 2. The Code identifies ethical considerations relevant to professional counselors and counselors-in-training. 3. The Code enables the association to clarify for current and prospective members, and for those served by members, the nature of the ethical responsibilities held in common by its members. 4. The Code serves as an ethical guide designed to assist members in constructing a course of action that best serves those utilizing counseling services and establishes expectations of conduct with a primary emphasis on the role of the professional counselor. 5. The Code helps to support the mission of ACA. 6. The standards contained in this Code serve as the basis for processing inquiries and ethics complaints concerning ACA members. The ACA Code of Ethics contains nine main sections that address the following areas: Section A: The Counseling Relationship Section B: Confidentiality and Privacy Section C: Professional Responsibility Section D: Relationships With Other Professionals Section E: Evaluation, Assessment, and Interpretation Section F: Supervision, Training, and Teaching Section G: Research and Publication Section H: Distance Counseling, Technology, and   Social Media Section I: Resolving Ethical Issues Each section of the ACA Code of Ethics begins with an introduction. The introduction to each section describes the ethical behavior and responsibility to which counselors aspire. The introductions help set the tone for each particular section and provide a starting point that invites reflection on the ethical standards contained in each part of the ACA Code of Ethics. The standards outline professional responsibilities and provide direction for fulfilling those ethical responsibilities. When counselors are faced with ethical dilemmas that are difficult to resolve, they are expected to engage in a carefully considered ethical decision-making process, consulting available resources as needed. Counselors acknowledge that resolving ethical issues is a process; ethical reasoning includes consideration of professional values, professional ethical principles, and ethical standards. Counselors’ actions should be consistent with the spirit as well as the letter of these ethical standards. No specific ethical decision-making model is always most effective, so counselors are expected to use a credible model of decision making that can bear public scrutiny of its application. Through a chosen ethical decision-making process and evaluation of the context of the situation, counselors work collaboratively with clients to make decisions that promote clients’ growth and development. A breach of the standards and principles provided herein does not necessarily constitute legal liability or violation of the law; such action is established in legal and judicial proceedings. The glossary at the end of the Code provides a concise description of some of the terms used in the ACA Code of Ethics. • 3 • • ACA Code of Ethics • Section A The Counseling Relationship Introduction Counselors facilitate client growth and development in ways that foster the interest and welfare of clients and promote formation of healthy relationships. Trust is the cornerstone of the counseling relationship, and counselors have the responsibility to respect and safeguard the client’s right to privacy and confidentiality. Counselors actively attempt to understand the diverse cultural backgrounds of the clients they serve. Counselors also explore their own cultural identities and how these affect their values and beliefs about the counseling process. Additionally, counselors are encouraged to contribute to society by devoting a portion of their professional activities for little or no financial return (pro bono publico). A.1. Client Welfare A.1.a. Primary Responsibility The primary responsibility of counselors is to respect the dignity and promote the welfare of clients. A.1.b. Records and Documentation Counselors create, safeguard, and maintain documentation necessary for rendering professional services. Regardless of the medium, counselors include sufficient and timely documentation to facilitate the delivery and continuity of services. Counselors take reasonable steps to ensure that documentation accurately reflects client progress and services provided. If amendments are made to records and documentation, counselors take steps to properly note the amendments according to agency or institutional policies. A.1.c. Counseling Plans Counselors and their clients work jointly in devising counseling plans that offer reasonable promise of success and are consistent with the abilities, temperament, developmental level, and circumstances of clients. Counselors and clients regularly review and revise counseling plans to assess their continued viability and effectiveness, respecting clients’ freedom of choice. A.1.d. Support Network Involvement Counselors recognize that support networks hold various meanings in the lives of clients and consider enlisting the support, understanding, and involvement of others (e.g., religious/spiritual/community leaders, family members, friends) as positive resources, when appropriate, with client consent. A.2. Informed Consent in the Counseling Relationship A.2.a. Informed Consent Clients have the freedom to choose whether to enter into or remain in a counseling relationship and need adequate information about the counseling process and the counselor. Counselors have an obligation to review in writing and verbally with clients the rights and responsibilities of both counselors and clients. Informed consent is an ongoing part of the counseling process, and counselors appropriately document discussions of informed consent throughout the counseling relationship. A.2.b. Types of Information Needed Counselors explicitly explain to clients the nature of all services provided. They inform clients about issues such as, but not limited to, the following: the purposes, goals, techniques, procedures, limitations, potential risks, and benefits of services; the counselor’s qualifications, credentials, relevant experience, and approach to counseling; continuation of services upon the incapacitation or death of the counselor; the role of technology; and other pertinent information. Counselors take steps to ensure that clients understand the implications of diagnosis and the intended use of tests and reports. Additionally, counselors inform clients about fees and billing arrangements, including procedures for nonpayment of fees. Clients have the right to confidentiality and to be provided with an explanation of its limits (including how supervisors and/or treatment or interdisciplinary team professionals are involved), to obtain clear information about their records, to participate in the ongoing counseling plans, and to refuse any services or modality changes and to be advised of the consequences of such refusal. • 4 • A.2.c. Developmental and Cultural Sensitivity Counselors communicate information in ways that are both developmentally and culturally appropriate. Counselors use clear and understandable language when discussing issues related to informed consent. When clients have difficulty understanding the language that counselors use, counselors provide necessary services (e.g., arranging for a qualified interpreter or translator) to ensure comprehension by clients. In collaboration with clients, counselors consider cultural implications of informed consent procedures and, where possible, counselors adjust their practices accordingly. A.2.d. Inability to Give Consent When counseling minors, incapacitated adults, or other persons unable to give voluntary consent, counselors seek the assent of clients to services and include them in decision making as appropriate. Counselors recognize the need to balance the ethical rights of clients to make choices, their capacity to give consent or assent to receive services, and parental or familial legal rights and responsibilities to protect these clients and make decisions on their behalf. A.2.e. Mandated Clients Counselors discuss the required limitations to confidentiality when working with clients who have been mandated for counseling services. Counselors also explain what type of information and with whom that information is shared prior to the beginning of counseling. The client may choose to refuse services. In this case, counselors will, to the best of their ability, discuss with the client the potential consequences of refusing counseling services. A.3. Clients Served by Others When counselors learn that their clients are in a professional relationship with other mental health professionals, they request release from clients to inform the other professionals and strive to establish positive and collaborative professional relationships. A.4. Avoiding Harm and Imposing Values A.4.a. Avoiding Harm Counselors act to avoid harming their clients, trainees, and research participants and to minimize or to remedy unavoidable or unanticipated harm. • ACA Code of Ethics • A.4.b. Personal Values Counselors are aware of—and avoid imposing—their own values, attitudes, beliefs, and behaviors. Counselors respect the diversity of clients, trainees, and research participants and seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor ’s values are inconsistent with the client’s goals or are discriminatory in nature. A.5. Prohibited Noncounseling Roles and Relationships A.5.a. Sexual and/or Romantic Relationships Prohibited Sexual and/or romantic counselor– client interactions or relationships with current clients, their romantic partners, or their family members are prohibited. This prohibition applies to both inperson and electronic interactions or relationships. A.5.b. Previous Sexual and/or Romantic Relationships Counselors are prohibited from engaging in counseling relationships with persons with whom they have had a previous sexual and/or romantic relationship. A.5.c. Sexual and/or Romantic Relationships With Former Clients Sexual and/or romantic counselor– client interactions or relationships with former clients, their romantic partners, or their family members are prohibited for a period of 5 years following the last professional contact. This prohibition applies to both in-person and electronic interactions or relationships. Counselors, before engaging in sexual and/or romantic interactions or relationships with former clients, their romantic partners, or their family members, demonstrate forethought and document (in written form) whether the interaction or relationship can be viewed as exploitive in any way and/or whether there is still potential to harm the former client; in cases of potential exploitation and/or harm, the counselor avoids entering into such an interaction or relationship. A.5.d. Friends or Family Members Counselors are prohibited from engaging in counseling relationships with friends or family members with whom they have an inability to remain objective. A.5.e. Personal Virtual Relationships With Current Clients Counselors are prohibited from engaging in a personal virtual relationship with individuals with whom they have a current counseling relationship (e.g., through social and other media). A.6. Managing and Maintaining Boundaries and Professional Relationships A.6.a. Previous Relationships Counselors consider the risks and benefits of accepting as clients those with whom they have had a previous relationship. These potential clients may include individuals with whom the counselor has had a casual, distant, or past relationship. Examples include mutual or past membership in a professional association, organization, or community. When counselors accept these clients, they take appropriate professional precautions such as informed consent, consultation, supervision, and documentation to ensure that judgment is not impaired and no exploitation occurs. A.6.b. Extending Counseling Boundaries Counselors consider the risks and benefits of extending current counseling relationships beyond conventional parameters. Examples include attending a client’s formal ceremony (e.g., a wedding/commitment ceremony or graduation), purchasing a service or product provided by a client (excepting unrestricted bartering), and visiting a client’s ill family member in the hospital. In extending these boundaries, counselors take appropriate professional precautions such as informed consent, consultation, supervision, and documentation to ensure that judgment is not impaired and no harm occurs. A.6.c. Documenting Boundary Extensions If counselors extend boundaries as described in A.6.a. and A.6.b., they must officially document, prior to the interaction (when feasible), the rationale for such an interaction, the potential benefit, and anticipated consequences for the client or former client and other individuals significantly involved with the client or former client. When unintentional harm occurs to the client or former client, or to an individual • 5 • significantly involved with the client or former client, the counselor must show evidence of an attempt to remedy such harm. A.6.d. Role Changes in the Professional Relationship When counselors change a role from the original or most recent contracted relationship, they obtain informed consent from the client and explain the client’s right to refuse services related to the change. Examples of role changes include, but are not limited to 1. changing from individual to relationship or family counseling, or vice versa; 2. changing from an evaluative role to a therapeutic role, or vice versa; and 3. changing from a counselor to a mediator role, or vice versa. Clients must be fully informed of any anticipated consequences (e.g., financial, legal, personal, therapeutic) of counselor role changes. A.6.e. Nonprofessional Interactions or Relationships (Other Than Sexual or Romantic Interactions or Relationships) Counselors avoid entering into nonprofessional relationships with former clients, their romantic partners, or their family members when the interaction is potentially harmful to the client. This applies to both in-person and electronic interactions or relationships. A.7. Roles and Relationships at Individual, Group, Institutional, and Societal Levels A.7.a. Advocacy When appropriate, counselors advocate at individual, group, institutional, and societal levels to address potential barriers and obstacles that inhibit access and/or the growth and development of clients. A.7.b. Confidentiality and Advocacy Counselors obtain client consent prior to engaging in advocacy efforts on behalf of an identifiable client to improve the provision of services and to work toward removal of systemic barriers or obstacles that inhibit client access, growth, and development. • ACA Code of Ethics • A.8. Multiple Clients When a counselor agrees to provide counseling services to two or more persons who have a relationship, the counselor clarifies at the outset which person or persons are clients and the nature of the relationships the counselor will have with each involved person. If it becomes apparent that the counselor may be called upon to perform potentially conflicting roles, the counselor will clarify, adjust, or withdraw from roles appropriately. A.9. Group Work A.9.a. Screening Counselors screen prospective group counseling/therapy participants. To the extent possible, counselors select members whose needs and goals are compatible with the goals of the group, who will not impede the group process, and whose well-being will not be jeopardized by the group experience. A.9.b. Protecting Clients In a group setting, counselors take reasonable precautions to protect clients from physical, emotional, or psychological trauma. A.10. Fees and Business Practices A.10.a. Self-Referral Counselors working in an organization (e.g., school, agency, institution) that provides counseling services do not refer clients to their private practice unless the policies of a particular organization make explicit provisions for self-referrals. In such instances, the clients must be informed of other options open to them should they seek private counseling services. A.10.b. Unacceptable Business Practices Counselors do not participate in fee splitting, nor do they give or receive commissions, rebates, or any other form of remuneration when referring clients for professional services. A.10.c. Establishing Fees In establishing fees for professional counseling services, counselors consider the financial status of clients and locality. If a counselor’s usual fees create undue hardship for the client, the counselor may adjust fees, when legally permissible, or assist the client in locating comparable, affordable services. A.10.d. Nonpayment of Fees If counselors intend to use collection agencies or take legal measures to col- lect fees from clients who do not pay for services as agreed upon, they include such information in their informed consent documents and also inform clients in a timely fashion of intended actions and offer clients the opportunity to make payment. A.10.e. Bartering Counselors may barter only if the bartering does not result in exploitation or harm, if the client requests it, and if such arrangements are an accepted practice among professionals in the community. Counselors consider the cultural implications of bartering and discuss relevant concerns with clients and document such agreements in a clear written contract. A.10.f. Receiving Gifts Counselors understand the challenges of accepting gifts from clients and recognize that in some cultures, small gifts are a token of respect and gratitude. When determining whether to accept a gift from clients, counselors take into account the therapeutic relationship, the monetary value of the gift, the client’s motivation for giving the gift, and the counselor’s motivation for wanting to accept or decline the gift. A.11. Termination and Referral A.11.a. Competence Within Termination and Referral If counselors lack the competence to be of professional assistance to clients, they avoid entering or continuing counseling relationships. Counselors are knowledgeable about culturally and clinically appropriate referral resources and suggest these alternatives. If clients decline the suggested referrals, counselors discontinue the relationship. A.11.b. Values Within Termination and Referral Counselors refrain from referring prospective and current clients based solely on the counselor’s personally held values, attitudes, beliefs, and behaviors. Counselors respect the diversity of clients and seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor’s values are inconsistent with the client’s goals or are discriminatory in nature. A.11.c. Appropriate Termination Counselors terminate a counseling relationship when it becomes reasonably apparent that the client no longer needs assistance, is not likely to benefit, or is • 6 • being harmed by continued counseling. Counselors may terminate counseling when in jeopardy of harm by the client or by another person with whom the client has a relationship, or when clients do not pay fees as agreed upon. Counselors provide pretermination counseling and recommend other service providers when necessary. A.11.d. Appropriate Transfer of Services When counselors transfer or refer clients to other practitioners, they ensure that appropriate clinical and administrative processes are completed and open communication is maintained with both clients and practitioners. A.12. Abandonment and Client Neglect Counselors do not abandon or neglect clients in counseling. Counselors assist in making appropriate arrangements for the continuation of treatment, when necessary, during interruptions such as vacations, illness, and following termination. Section B Confidentiality and Privacy Introduction Counselors recognize that trust is a cornerstone of the counseling relationship. Counselors aspire to earn the trust of clients by creating an ongoing partnership, establishing and upholding appropriate boundaries, and maintaining confidentiality. Counselors communicate the parameters of confidentiality in a culturally competent manner. B.1. Respecting Client Rights B.1.a. Multicultural/Diversity Considerations Counselors maintain awareness and sensitivity regarding cultural meanings of confidentiality and privacy. Counselors respect differing views toward disclosure of information. Counselors hold ongoing discussions with clients as to how, when, and with whom information is to be shared. B.1.b. Respect for Privacy Counselors respect the privacy of prospective and current clients. Counselors request private information from clients only when it is beneficial to the counseling process. • ACA Code of Ethics • B.1.c. Respect for Confidentiality Counselors protect the confidential information of prospective and current clients. Counselors disclose information only with appropriate consent or with sound legal or ethical justification. B.1.d. Explanation of Limitations At initiation and throughout the counseling process, counselors inform clients of the limitations of confidentiality and seek to identify situations in which confidentiality must be breached. B.2. Exceptions B.2.a. Serious and Foreseeable Harm and Legal Requirements The general requirement that counselors keep information confidential does not apply when disclosure is required to protect clients or identified others from serious and foreseeable harm or when legal requirements demand that confidential information must be revealed. Counselors consult with other professionals when in doubt as to the validity of an exception. Additional considerations apply when addressing end-of-life issues. B.2.b. Confidentiality Regarding End-of-Life Decisions Counselors who provide services to terminally ill individuals who are considering hastening their own deaths have the option to maintain confidentiality, depending on applicable laws and the specific circumstances of the situation and after seeking consultation or supervision from appropriate professional and legal parties. B.2.c. Contagious, LifeThreatening Diseases When clients disclose that they have a disease commonly known to be both communicable and life threatening, counselors may be justified in disclosing information to identifiable third parties, if the parties are known to be at serious and foreseeable risk of contracting the disease. Prior to making a disclosure, counselors assess the intent of clients to inform the third parties about their disease or to engage in any behaviors that may be harmful to an identifiable third party. Counselors adhere to relevant state laws concerning disclosure about disease status. B.2.d. Court-Ordered Disclosure When ordered by a court to release confidential or privileged information without a client’s permission, counselors seek to obtain written, informed consent from the client or take steps to prohibit the disclosure or have it limited as narrowly as possible because of potential harm to the client or counseling relationship. B.2.e. Minimal Disclosure To the extent possible, clients are informed before confidential information is disclosed and are involved in the disclosure decision-making process. When circumstances require the disclosure of confidential information, only essential information is revealed. B.3. Information Shared With Others B.3.a. Subordinates Counselors make every effort to ensure that privacy and confidentiality of clients are maintained by subordinates, including employees, supervisees, students, clerical assistants, and volunteers. B.3.b. Interdisciplinary Teams When services provided to the client involve participation by an interdisciplinary or treatment team, the client will be informed of the team’s existence and composition, information being shared, and the purposes of sharing such information. B.3.c. Confidential Settings Counselors discuss confidential information only in settings in which they can reasonably ensure client privacy. B.3.d. Third-Party Payers Counselors disclose information to third-party payers only when clients have authorized such disclosure. B.3.e. Transmitting Confidential Information Counselors take precautions to ensure the confidentiality of all information transmitted through the use of any medium. B.3.f. Deceased Clients Counselors protect the confidentiality of deceased clients, consistent with legal requirements and the documented preferences of the client. B.4. Groups and Families B.4.a. Group Work In group work, counselors clearly explain the importance and parameters of confidentiality for the specific group. • 7 • B.4.b. Couples and Family Counseling In couples and family counseling, counselors clearly define who is considered “the client” and discuss expectations and limitations of confidentiality. Counselors seek agreement and document in writing such agreement among all involved parties regarding the confidentiality of information. In the absence of an agreement to the contrary, the couple or family is considered to be the client. B.5. Clients Lacking Capacity to Give Informed Consent B.5.a. Responsibility to Clients When counseling minor clients or adult clients who lack the capacity to give voluntary, informed consent, counselors protect the confidentiality of information received—in any medium—in the counseling relationship as specified by federal and state laws, written policies, and applicable ethical standards. B.5.b. Responsibility to Parents and Legal Guardians Counselors inform parents and legal guardians about the role of counselors and the confidential nature of the counseling relationship, consistent with current legal and custodial arrangements. Counselors are sensitive to the cultural diversity of families and respect the inherent rights and responsibilities of parents/guardians regarding the welfare of their children/charges according to law. Counselors work to establish, as appropriate, collaborative relationships with parents/guardians to best serve clients. B.5.c. Release of Confidential Information When counseling minor clients or adult clients who lack the capacity to give voluntary consent to release confidential information, counselors seek permission from an appropriate third party to disclose information. In such instances, counselors inform clients consistent with their level of understanding and take appropriate measures to safeguard client confidentiality. B.6. Records and Documentation B.6.a. Creating and Maintaining Records and Documentation Counselors create and maintain records and documentation necessary for rendering professional services. • ACA Code of Ethics • B.6.b. Confidentiality of Records and Documentation Counselors ensure that records and documentation kept in any medium are secure and that only authorized persons have access to them. B.6.c. Permission to Record Counselors obtain permission from clients prior to recording sessions through electronic or other means. B.6.d. Permission to Observe Counselors obtain permission from clients prior to allowing any person to observe counseling sessions, review session transcripts, or view recordings of sessions with supervisors, faculty, peers, or others within the training environment. B.6.e. Client Access B.6.i. Reasonable Precautions Counselors take reasonable precautions to protect client confidentiality in the event of the counselor’s termination of practice, incapacity, or death and appoint a records custodian when identified as appropriate. B.7. Case Consultation B.7.a. Respect for Privacy Information shared in a consulting relationship is discussed for professional purposes only. Written and oral reports present only data germane to the purposes of the consultation, and every effort is made to protect client identity and to avoid undue invasion of privacy. B.7.b. Disclosure of Confidential Information Counselors provide reasonable access to records and copies of records when requested by competent clients. Counselors limit the access of clients to their records, or portions of their records, only when there is compelling evidence that such access would cause harm to the client. Counselors document the request of clients and the rationale for withholding some or all of the records in the files of clients. In situations involving multiple clients, counselors provide individual clients with only those parts of records that relate directly to them and do not include confidential information related to any other client. When consulting with colleagues, counselors do not disclose confidential information that reasonably could lead to the identification of a client or other person or organization with whom they have a confidential relationship unless they have obtained the prior consent of the person or organization or the disclosure cannot be avoided. They disclose information only to the extent necessary to achieve the purposes of the consultation. B.6.f. Assistance With Records Professional Responsibility When clients request access to their records, counselors provide assistance and consultation in interpreting counseling records. B.6.g. Disclosure or Transfer Unless exceptions to confidentiality exist, counselors obtain written permission from clients to disclose or transfer records to legitimate third parties. Steps are taken to ensure that receivers of counseling records are sensitive to their confidential nature. B.6.h. Storage and Disposal After Termination Counselors store records following termination of services to ensure reasonable future access, maintain records in accordance with federal and state laws and statutes such as licensure laws and policies governing records, and dispose of client records and other sensitive materials in a manner that protects client confidentiality. Counselors apply careful discretion and deliberation before destroying records that may be needed by a court of law, such as notes on child abuse, suicide, sexual harassment, or violence. Section C Introduction Counselors aspire to open, honest, and accurate communication in dealing with the public and other professionals. Counselors facilitate access to counseling services, and they practice in a nondiscriminatory manner within the boundaries of professional and personal competence; they also have a responsibility to abide by the ACA Code of Ethics. Counselors actively participate in local, state, and national associations that foster the development and improvement of counseling. Counselors are expected to advocate to promote changes at the individual, group, institutional, and societal levels that improve the quality of life for individuals and groups and remove potential barriers to the provision or access of appropriate services being offered. Counselors have a responsibility to the public to engage in counseling practices that are based on rigorous re- • 8 • search methodologies. Counselors are encouraged to contribute to society by devoting a portion of their professional activity to services for which there is little or no financial return (pro bono publico). In addition, counselors engage in self-care activities to maintain and promote their own emotional, physical, mental, and spiritual well-being to best meet their professional responsibilities. C.1. Knowledge of and Compliance With Standards Counselors have a responsibility to read, understand, and follow the ACA Code of Ethics and adhere to applicable laws and regulations. C.2. Professional Competence C.2.a. Boundaries of Competence Counselors practice only within the boundaries of their competence, based on their education, training, supervised experience, state and national professional credentials, and appropriate professional experience. Whereas multicultural counseling competency is required across all counseling specialties, counselors gain knowledge, personal awareness, sensitivity, dispositions, and skills pertinent to being a culturally competent counselor in working with a diverse client population. C.2.b. New Specialty Areas of Practice Counselors practice in specialty areas new to them only after appropriate education, training, and supervised experience. While developing skills in new specialty areas, counselors take steps to ensure the competence of their work and protect others from possible harm. C.2.c. Qualified for Employment Counselors accept employment only for positions for which they are qualified given their education, training, supervised experience, state and national professional credentials, and appropriate professional experience. Counselors hire for professional counseling positions only individuals who are qualified and competent for those positions. C.2.d. Monitor Effectiveness Counselors continually monitor their effectiveness as professionals and take steps to improve when necessary. Counselors take reasonable steps to seek peer supervision to evaluate their efficacy as counselors. • ACA Code of Ethics • C.2.e. Consultations on Ethical Obligations Counselors take reasonable steps to consult with other counselors, the ACA Ethics and Professional Standards Department, or related professionals when they have questions regarding their ethical obligations or professional practice. C.2.f. Continuing Education Counselors recognize the need for continuing education to acquire and maintain a reasonable level of awareness of current scientific and professional information in their fields of activity. Counselors maintain their competence in the skills they use, are open to new procedures, and remain informed regarding best practices for working with diverse populations. C.2.g. Impairment Counselors monitor themselves for signs of impairment from their own physical, mental, or emotional problems and refrain from offering or providing professional services when impaired. They seek assistance for problems that reach the level of professional impairment, and, if necessary, they limit, suspend, or terminate their professional responsibilities until it is determined that they may safely resume their work. Counselors assist colleagues or supervisors in recognizing their own professional impairment and provide consultation and assistance when warranted with colleagues or supervisors showing signs of impairment and intervene as appropriate to prevent imminent harm to clients. C.2.h. Counselor Incapacitation, Death, Retirement, or Termination of Practice Counselors prepare a plan for the transfer of clients and the dissemination of records to an identified colleague or records custodian in the case of the counselor’s incapacitation, death, retirement, or termination of practice. C.3. Advertising and Soliciting Clients C.3.a. Accurate Advertising When advertising or otherwise representing their services to the public, counselors identify their credentials in an accurate manner that is not false, misleading, deceptive, or fraudulent. C.3.b. Testimonials Counselors who use testimonials do not solicit them from current clients, former clients, or any other persons who may be vulnerable to undue influence. Counselors discuss with clients the implications of and obtain permission for the use of any testimonial. C.3.c. Statements by Others When feasible, counselors make reasonable efforts to ensure that statements made by others about them or about the counseling profession are accurate. C.3.d. Recruiting Through Employment Counselors do not use their places of employment or institutional affiliation to recruit clients, supervisors, or consultees for their private practices. C.3.e. Products and Training Advertisements Counselors who develop products related to their profession or conduct workshops or training events ensure that the advertisements concerning these products or events are accurate and disclose adequate information for consumers to make informed choices. C.3.f. Promoting to Those Served Counselors do not use counseling, teaching, training, or supervisory relationships to promote their products or training events in a manner that is deceptive or would exert undue influence on individuals who may be vulnerable. However, counselor educators may adopt textbooks they have authored for instructional purposes. C.4. Professional Qualifications C.4.a. Accurate Representation Counselors claim or imply only professional qualifications actually completed and correct any known misrepresentations of their qualifications by others. Counselors truthfully represent the qualifications of their professional colleagues. Counselors clearly distinguish between paid and volunteer work experience and accurately describe their continuing education and specialized training. C.4.b. Credentials Counselors claim only licenses or certifications that are current and in good standing. C.4.c. Educational Degrees Counselors clearly differentiate between earned and honorary degrees. C.4.d. Implying Doctoral-Level Competence Counselors clearly state their highest earned degree in counseling or a closely related field. Counselors do not imply doctoral-level competence when possessing a master’s degree in counseling or a related field by referring to them- • 9 • selves as “Dr.” in a counseling context when their doctorate is not in counseling or a related field. Counselors do not use “ABD” (all but dissertation) or other such terms to imply competency. C.4.e. Accreditation Status Counselors accurately represent the accreditation status of their degree program and college/university. C.4.f. Professional Membership Counselors clearly differentiate between current, active memberships and former memberships in associations. Members of ACA must clearly differentiate between professional membership, which implies the possession of at least a master’s degree in counseling, and regular membership, which is open to individuals whose interests and activities are consistent with those of ACA but are not qualified for professional membership. C.5. Nondiscrimination Counselors do not condone or engage in discrimination against prospective or current clients, students, employees, supervisees, or research participants based on age, culture, disability, ethnicity, race, religion/spirituality, gender, gender identity, sexual orientation, marital/ partnership status, language preference, socioeconomic status, immigration status, or any basis proscribed by law. C.6. Public Responsibility C.6.a. Sexual Harassment Counselors do not engage in or condone sexual harassment. Sexual harassment can consist of a single intense or severe act, or multiple persistent or pervasive acts. C.6.b. Reports to Third Parties Counselors are accurate, honest, and objective in reporting their professional activities and judgments to appropriate third parties, including courts, health insurance companies, those who are the recipients of evaluation reports, and others. C.6.c. Media Presentations When counselors provide advice or comment by means of public lectures, demonstrations, radio or television programs, recordings, technology-based applications, printed articles, mailed material, or other media, they take reasonable precautions to ensure that 1. the statements are based on appropriate professional counseling literature and practice, 2. the statements are otherwise consistent with the ACA Code of Ethics, and • ACA Code of Ethics • 3. the recipients of the information are not encouraged to infer that a professional counseling relationship has been established. C.6.d. Exploitation of Others Counselors do not exploit others in their professional relationships. C.6.e. Contributing to the Public Good (Pro Bono Publico) Counselors make a reasonable effort to provide services to the public for which there is little or no financial return (e.g., speaking to groups, sharing professional information, offering reduced fees). C.7. Treatment Modalities C.7.a. Scientific Basis for Treatment When providing services, counselors use techniques/procedures/modalities that are grounded in theory and/or have an empirical or scientific foundation. C.7.b. Development and Innovation When counselors use developing or innovative techniques/procedures/ modalities, they explain the potential risks, benefits, and ethical considerations of using such techniques/procedures/ modalities. Counselors work to minimize any potential risks or harm when using these techniques/procedures/modalities. C.7.c. Harmful Practices Counselors do not use techniques/procedures/modalities when substantial evidence suggests harm, even if such services are requested. C.8. Responsibility to Other Professionals C.8.a. Personal Public Statements When making personal statements in a public context, counselors clarify that they are speaking from their personal perspectives and that they are not speaking on behalf of all counselors or the profession. Section D Relationships With Other Professionals Introduction Professional counselors recognize that the quality of their interactions with colleagues can influence the quality of services provided to clients. They work to become knowledgeable about colleagues within and outside the field of counseling. Counselors develop positive working relationships and systems of communication with colleagues to enhance services to clients. D.1. Relationships With Colleagues, Employers, and Employees D.1.a. Different Approaches Counselors are respectful of approaches that are grounded in theory and/or have an empirical or scientific foundation but may differ from their own. Counselors acknowledge the expertise of other professional groups and are respectful of their practices. D.1.b. Forming Relationships Counselors work to develop and strengthen relationships with colleagues from other disciplines to best serve clients. D.1.c. Interdisciplinary Teamwork Counselors who are members of interdisciplinary teams delivering multifaceted services to clients remain focused on how to best serve clients. They participate in and contribute to decisions that affect the well-being of clients by drawing on the perspectives, values, and experiences of the counseling profession and those of colleagues from other disciplines. D.1.d. Establishing Professional and Ethical Obligations Counselors who are members of interdisciplinary teams work together with team members to clarify professional and ethical obligations of the team as a whole and of its individual members. When a team decision raises ethical concerns, counselors first attempt to resolve the concern within the team. If they cannot reach resolution among team members, counselors pursue other avenues to address their concerns consistent with client well-being. D.1.e. Confidentiality When counselors are required by law, institutional policy, or extraordinary circumstances to serve in more than one role in judicial or administrative proceedings, they clarify role expectations and the parameters of confidentiality with their colleagues. • 10 • D.1.f. Personnel Selection and Assignment When counselors are in a position requiring personnel selection and/or assigning of responsibilities to others, they select competent staff and assign responsibilities compatible with their skills and experiences. D.1.g. Employer Policies The acceptance of employment in an agency or institution implies that counselors are in agreement with its general policies and principles. Counselors strive to reach agreement with employers regarding acceptable standards of client care and professional conduct that allow for changes in institutional policy conducive to the growth and development of clients. D.1.h. Negative Conditions Counselors alert their employers of inappropriate policies and practices. They attempt to effect changes in such policies or procedures through constructive action within the organization. When such policies are potentially disruptive or damaging to clients or may limit the effectiveness of services provided and change cannot be affected, counselors take appropriate further action. Such action may include referral to appropriate certification, accreditation, or state licensure organizations, or voluntary termination of employment. D.1.i. Protection From Punitive Action Counselors do not harass a colleague or employee or dismiss an employee who has acted in a responsible and ethical manner to expose inappropriate employer policies or practices. D.2. Provision of Consultation Services D.2.a. Consultant Competency Counselors take reasonable steps to ensure that they have the appropriate resources and competencies when providing consultation services. Counselors provide appropriate referral resources when requested or needed. D.2.b. Informed Consent in Formal Consultation When providing formal consultation services, counselors have an obligation to review, in writing and verbally, the rights and responsibilities of both counselors and consultees. Counselors use clear and understandable language to inform all parties involved about the purpose of the services to be provided, relevant costs, potential risks and benefits, and the limits of confidentiality. • ACA Code of Ethics • Section E E.2.c. Decisions Based on Results Evaluation, Assessment, and Interpretation Counselors responsible for decisions involving individuals or policies that are based on assessment results have a thorough understanding of psychometrics. Introduction E.3. Informed Consent in Assessment E.1. General Prior to assessment, counselors explain the nature and purposes of assessment and the specific use of results by potential recipients. The explanation will be given in terms and language that the client (or other legally authorized person on behalf of the client) can understand. Counselors use assessment as one component of the counseling process, taking into account the clients’ personal and cultural context. Counselors promote the well-being of individual clients or groups of clients by developing and using appropriate educational, mental health, psychological, and career assessments. E.1.a. Assessment The primary purpose of educational, mental health, psychological, and career assessment is to gather information regarding the client for a variety of purposes, including, but not limited to, client decision making, treatment planning, and forensic proceedings. Assessment may include both qualitative and quantitative methodologies. E.1.b. Client Welfare Counselors do not misuse assessment results and interpretations, and they take reasonable steps to prevent others from misusing the information provided. They respect the client’s right to know the results, the interpretations made, and the bases for counselors’ conclusions and recommendations. E.2. Competence to Use and Interpret Assessment Instruments E.2.a. Limits of Competence Counselors use only those testing and assessment services for which they have been trained and are competent. Counselors using technology-assisted test interpretations are trained in the construct being measured and the specific instrument being used prior to using its technologybased application. Counselors take reasonable measures to ensure the proper use of assessment techniques by persons under their supervision. E.2.b. Appropriate Use Counselors are responsible for the appropriate application, scoring, interpretation, and use of assessment instruments relevant to the needs of the client, whether they score and interpret such assessments themselves or use technology or other services. E.3.a. Explanation to Clients E.3.b. Recipients of Results Counselors consider the client’s and/ or examinee’s welfare, explicit understandings, and prior agreements in determining who receives the assessment results. Counselors include accurate and appropriate interpretations with any release of individual or group assessment results. E.4. Release of Data to Qualified Personnel Counselors release assessment data in which the client is identified only with the consent of the client or the client’s legal representative. Such data are released only to persons recognized by counselors as qualified to interpret the data. E.5. Diagnosis of Mental Disorders E.5.a. Proper Diagnosis Counselors take special care to provide proper diagnosis of mental disorders. Assessment techniques (including personal interviews) used to determine client care (e.g., locus of treatment, type of treatment, recommended follow-up) are carefully selected and appropriately used. E.5.b. Cultural Sensitivity Counselors recognize that culture affects the manner in which clients’ problems are defined and experienced. Clients’ socioeconomic and cultural experiences are considered when diagnosing mental disorders. E.5.c. Historical and Social Prejudices in the Diagnosis of Pathology Counselors recognize historical and social prejudices in the misdiagnosis and • 11 • pathologizing of certain individuals and groups and strive to become aware of and address such biases in themselves or others. E.5.d. Refraining From Diagnosis Counselors may refrain from making and/or reporting a diagnosis if they believe that it would cause harm to the client or others. Counselors carefully consider both the positive and negative implications of a diagnosis. E.6. Instrument Selection E.6.a. Appropriateness of Instruments Counselors carefully consider the validity, reliability, psychometric limitations, and appropriateness of instruments when selecting assessments and, when possible, use multiple forms of assessment, data, and/or instruments in forming conclusions, diagnoses, or recommendations. E.6.b. Referral Information If a client is referred to a third party for assessment, the counselor provides specific referral questions and sufficient objective data about the client to ensure that appropriate assessment instruments are utilized. E.7. Conditions of Assessment Administration E.7.a. Administration Conditions Counselors administer assessments under the same conditions that were established in their standardization. When assessments are not administered under standard conditions, as may be necessary to accommodate clients with disabilities, or when unusual behavior or irregularities occur during the administration, those conditions are noted in interpretation, and the results may be designated as invalid or of questionable validity. E.7.b. Provision of Favorable Conditions Counselors provide an appropriate environment for the administration of assessments (e.g., privacy, comfort, freedom from distraction). E.7.c. Technological Administration Counselors ensure that technologically administered assessments function properly and provide clients with accurate results. • ACA Code of Ethics • E.7.d. Unsupervised Assessments Unless the assessment instrument is designed, intended, and validated for self-administration and/or scoring, counselors do not permit unsupervised use. E.8. Multicultural Issues/ Diversity in Assessment Counselors select and use with caution assessment techniques normed on populations other than that of the client. Counselors recognize the effects of age, color, culture, disability, ethnic group, gender, race, language preference, religion, spirituality, sexual orientation, and socioeconomic status on test administration and interpretation, and they place test results in proper perspective with other relevant factors. E.9. Scoring and Interpretation of Assessments E.9.a. Reporting When counselors report assessment results, they consider the client’s personal and cultural background, the level of the client’s understanding of the results, and the impact of the results on the client. In reporting assessment results, counselors indicate reservations that exist regarding validity or reliability due to circumstances of the assessment or inappropriateness of the norms for the person tested. E.9.b. Instruments With Insufficient Empirical Data Counselors exercise caution when interpreting the results of instruments not having sufficient empirical data to support respondent results. The specific purposes for the use of such instruments are stated explicitly to the examinee. Counselors qualify any conclusions, diagnoses, or recommendations made that are based on assessments or instruments with questionable validity or reliability. E.9.c. Assessment Services Counselors who provide assessment, scoring, and interpretation services to support the assessment process confirm the validity of such interpretations. They accurately describe the purpose, norms, validity, reliability, and applications of the procedures and any special qualifications applicable to their use. At all times, counselors maintain their ethical responsibility to those being assessed. E.10. Assessment Security Counselors maintain the integrity and security of tests and assessments consistent with legal and contractual obligations. Counselors do not appropriate, reproduce, or modify published assessments or parts thereof without acknowledgment and permission from the publisher. E.11. Obsolete Assessment and Outdated Results Counselors do not use data or results from assessments that are obsolete or outdated for the current purpose (e.g., noncurrent versions of assessments/ instruments). Counselors make every effort to prevent the misuse of obsolete measures and assessment data by others. E.12. Assessment Construction Counselors use established scientific procedures, relevant standards, and current professional knowledge for assessment design in the development, publication, and utilization of assessment techniques. E.13. Forensic Evaluation: Evaluation for Legal Proceedings E.13.a. Primary Obligations When providing forensic evaluations, the primary obligation of counselors is to produce objective findings that can be substantiated based on information and techniques appropriate to the evaluation, which may include examination of the individual and/or review of records. Counselors form professional opinions based on their professional knowledge and expertise that can be supported by the data gathered in evaluations. Counselors define the limits of their reports or testimony, especially when an examination of the indivi…