PROPOSED RULEMAKING
STATE BOARD OF SOCIAL WORKERS, MARRIAGE AND FAMILY THERAPISTS AND PROFESSIONAL COUNSELORS
[ 49 PA. CODE CHS. 47, 48 AND 49 ]
Code of Ethical Practice and Standards of Professional Conduct
[38 Pa.B. 3253]
[Saturday, June 14, 2008]The State Board of Social Workers, Marriage and Family Therapists and Professional Counselors (Board) proposes to add §§ 47.71, 48.71 and 49.71 (relating to code of ethical practice and standards of professional conduct) to read as set forth in Annex A. The regulations would establish a code of ethical practice and standards of professional conduct for social workers, clinical social workers, marriage and family therapists and professional counselors.
Effective Date
The regulations will be effective upon publication of the final-form rulemaking in the Pennsylvania Bulletin.
Statutory Authority
The regulations are authorized under section 6(2) of the Social Workers, Marriage and Family Therapists and Professional Counselors Act (act) (63 P. S. § 1906(2)).
Background and Purpose
Section 6(2) of the act authorizes the Board to adopt rules and regulations establishing standards of professional practice and conduct for licensed social workers, licensed clinical social workers, licensed marriage and family therapists and licensed professional counselors in this Commonwealth. The Board, through this rulemaking, is implementing section 6(2) of the act.
In developing this code of ethical conduct and standards of professional practice, the Board looked at codes of conduct established by professional associations and organizations as well as other state codes. In particular, the Board modeled these regulations after codes of conduct and professional practice adopted by the following associations and organizations: the National Association of Social Workers; the Clinical Social Work Federation; the Pennsylvania State Board of Psychology; the American Association for Marriage and Family Therapy; the National Board for Certified Counselors; the Professional Counseling Board; the Commission on Rehabilitation Counselor Certification; and the American Psychological Association. In addition, the Board looked at standards promulgated by other state licensing boards.
Description
Sections 47.71, 48.71 and 49.71 explain that this code of ethical practice and professional conduct constitutes the standards by which the licensee shall be measured and that violations of these standards is sufficient reason for the Board to take disciplinary action against a licensee.
The proposed regulations set forth standards pertaining to the responsibility of a licensee to clients/patients. These responsibilities include: competency; informed consent; proper delegation; confidentiality and privacy; manner of terminating services; prohibition of sexual harassment and discrimination; and proper conduct between a licensee and the client/patient.
The proposed regulations also address multiple relationships affecting the licensee's judgment. In particular, §§ 47.71(c), 48.71(c) and 49.71(c) explain that a licensee should avoid multiple relationships and conflicts of interest with any client/patient which could impair professional judgment or increase the risk of client/patient exploitation.
Sections 47.71(d), 48.71(d) and 49.71(d) prohibit a licensee from undertaking or continuing professional relationships with a client, supervisee or student when objectivity or competency of the licensee is or could reasonably be expected to be impaired due to mental, emotional, physiological, pharmacological or substance abuse conditions.
Sections 47.71(e), 48.71(e) and 49.71(e) address standards of conduct relating to research and publication. This includes research responsibility, informed consent, reporting results and publication.
Sections 47.71(f), 48.71(f) and 49.71(f) provide guidance to licensees related to payment for services. Sections 47.71(g), 48.71(g) and 49.71(g) pertain to recordkeeping. These provisions require that licensees keep records of the dates of services, types of services, termination and billing information. They also require that records be maintained by the licensee for 5 years except for records held or owned by government agencies or educational institutions.
Sections 47.71(h), 48.71(h) and 49.71(h) pertain to mandatory reporting and require that all licensees, supervisors and trainees have a responsibility to report any alleged violations of these rules to the Board. Sections 47.71(i), 48.71(i) and 49.71(i) require licensees to notify the Board of any changes of name or address. Sections 47.71(j), 48.71(j) and 49.71(j) require licensees to engage in appropriate advertising and to accurately represent their competencies, education, training and experience relevant to their professional practice.
Fiscal Impact and Paperwork Requirements
The proposed regulations will have no fiscal impact and impose no additional paperwork requirements on the Board or its licensees.
The proposed regulations should not impose any legal, accounting or reporting requirements on the regulated community.
Compliance
The Board solicited predraft input regarding these proposed regulations from licensees, professional associations and educational programs. The Board received seven comments to the draft. The Board considered these comments in developing the proposed rulemaking.
Regulatory Review
Under section 5(a) of the Regulatory Review Act (71 P. S. § 745.5(a)), on June 4, 2008, the Board submitted a copy of this proposed rulemaking and a copy of a Regulatory Analysis Form to the Independent Regulatory Review Commission (IRRC), and the Chairpersons of the Senate Consumer Protection and Professional Licensure Committee and the House Professional Licensure Committee. A copy of this material is available to the public upon request.
Under section 5(g) of the Regulatory Review Act (71 P. S. § 745.5(g)), IRRC may convey any comments, recommendations or objections to the proposed rulemaking within 30 days of the close of the public comment period. The comments, recommendations or objections shall specify the regulatory review criteria which have not been met. The Regulatory Review Act specifies detailed procedures for review, prior to publication of the final rulemaking, by the Board, the General Assembly, and the Governor of comments, recommendations or objections raised.
Public Comment
Interested persons are invited to submit written comments, recommendations or objections regarding the proposed amendments to Sandra Matter, Administrative Assistant, State Board of Social Workers, Marriage and Family Therapists and Professional Counselors, P. O. Box 2649, Harrisburg, PA 17105-2649, within 30 days of publication of this proposed rulemaking in the Pennsylvania Bulletin. Please reference No. 16A-6911, Standards of Professional Conduct, when submitting comments.
RONALD HAYS,
ChairpersonFiscal Note: 16A-6911. No fiscal impact; (8) recommends adoption.
Annex A
TITLE 49. PROFESSIONAL AND VOCATIONAL STANDARDS
PART I. DEPARTMENT OF STATE
Subpart A. PROFESSIONAL AND OCCUPATIONAL AFFAIRS
CHAPTER 47. STATE BOARD OF SOCIAL WORKERS, MARRIAGE AND FAMILY THERAPISTS AND PROFESSIONAL COUNSELORS
CODE OF ETHICAL PRACTICE AND STANDARDS OF PROFESSIONAL CONDUCT § 47.71. Code of ethical practice and professional conduct.
(a) Application. This code of ethical practice and professional conduct constitutes the standards by which the professional conduct of licensed social workers and licensed clinical social workers will be measured.
(1) This code of ethical practice and professional conduct applies to the conduct of all licensees.
(2) A violation of this code of ethical practice and professional conduct constitutes unprofessional conduct and subjects the licensed social worker or licensed clinical social worker to disciplinary action under section 11 of the act (63 P. S. § 1911).
(3) The Board subscribes to the codes of ethics and practice standards promulgated by the National Association of Social Workers, the Pennsylvania Society for Clinical Social Work and the Association of State Social Work Boards and the Board will use these codes and standards as aids in resolving ambiguities which may arise in the interpretation of this section, except that whenever any conflict exists between this section and the professional associations' codes and standards, this section shall prevail.
(b) Responsibility to clients/patients.
(1) Competency.
(i) Licensees may not misrepresent directly, indirectly or by implication their professional qualifications such as education, specialized training, experience or area or areas of competence.
(ii) Licensees may practice only within the competency areas for which they are qualified by education, training or experience.
(iii) Licensees shall maintain appropriate standards of care. The appropriate standard of care is defined as what an ordinary, reasonable professional with similar training would have done in a similar circumstance.
(iv) Licensees shall make appropriate referrals when the client's/patient's needs exceed the licensee's competence level. The referrals must be made in a timely manner.
(2) Informed consent.
(i) Licensees shall inform clients/patients in writing of the extent and nature of services available to them, as well as the limits, rights, opportunities and obligations associated with the services to be provided which might affect the clients'/patients' decisions to enter into or continue the relationship.
(ii) Licensees shall provide services to clients/patients only in the context of a professional relationship based on valid informed consent. Licensees shall use clear and understandable language to inform clients/patients of the purposes of services, limits to the services due to legal requirements, relevant costs, reasonable alternatives, the clients'/patients' rights to refuse or withdraw consent and the time frame covered by the consent.
(iii) In instances when the client/patient is unable to read or understand the consent document or has trouble understanding the primary language contained in the informed consent document, licensees shall take steps to ensure the client's/patient's comprehension including providing a detailed verbal explanation or arranging for a qualified interpreter or translator, as needed. If a client/patient is not competent to provide informed consent because of age or mental condition, the licensee shall obtain consent from the client's/patient's parent, guardian or court-appointed representative.
(iv) When a client/patient is receiving services involuntarily, licensees shall provide information about the nature and extent of the services and about the client's/patient's rights to the client's/patient's parent, guardian or court-appointed representative.
(v) Licensees who provide services by the electronic means shall inform the client/patient of the limitations and risks associated with the services.
(3) Delegation. A licensee may not delegate professional responsibilities to another person when the licensee delegating the responsibilities knows or has reason to know that the other person is not qualified by training, experience or licensure to perform those responsibilities.
(4) Confidentiality and privacy.
(i) Licensees shall have a primary obligation to protect the client's/patient's right to confidentiality and privacy as established by law and the professional standards of practice. Confidential and private information shall only be revealed to others when the client/patient, or other person legally authorized to give consent on behalf of the client/patient, has given informed consent, except in those circumstances in which failure to do so would violate other laws or result in clear and present danger to the client/patient or others. Unless specifically contrain- dicated by these situations, a client/patient shall be informed and written consent shall be obtained before the confidential and private information is revealed.
(ii) Licensees shall discuss with clients/patients and the client's/patient's legally authorized representatives, the nature of confidentiality and the limitation of the clients'/patients' right to confidentiality. Licensees shall review with clients/patients circumstances when confidential information may be requested and when disclosure of confidential information is legally required. This discussion should occur as soon as possible in the professional relationship and as needed throughout the course of the relationship.
(iii) When licensees provide services to families, couples or groups, licensees should seek agreement among the parties involved concerning each individual's right to confidentiality and obligations to preserve the confidentiality of information shared by others. Licensees shall inform participants in family, group or couples counseling that the licensee cannot guarantee that all participants will honor the agreements. In the context of couple, family or group treatment, the licensee may not reveal any individual's confidences to others in the client unit without the prior written permission of that individual.
(iv) Licensees shall take reasonable steps to protect the confidentiality of information transmitted to other parties through the use of computers, electronic mail, facsimile machines, telephones and telephone answering machines, and other electronic or computer technology.
(5) Termination. Licensees shall terminate services only after giving careful consideration to factors affecting the relationship and making an effort to minimize possible adverse effects. If an interruption or termination of services is anticipated, reasonable notification and appropriate referral for continued services shall be provided to the client/patient.
(6) Sexual harassment.
(i) Licensees may not sexually harass clients/patients or family members of clients/patients.
(ii) Licensees may not sexually harass supervisees, students, trainees, employees, research subjects or colleagues.
(iii) Sexual harassment includes unwanted sexual advances, sexual solicitation, requests for sexual favors and other verbal, visual or physical conduct of a sexual nature.
(7) Discrimination. Licensees may not practice, condone, facilitate or collaborate with any form of discrimination on the basis of race, ethnicity, religion, national origin, color, gender, sexual orientation, age, socio-economic level, marital status, political belief, veteran status, or mental or physical impairment.
(8) Conduct with clients/patients.
(i) Licensees may not physically or verbally abuse or threaten clients/patients or family members of clients/patients.
(ii) Licensees may not use derogatory language in their written or verbal communications to or about clients/patients. Licensees shall use accurate and respectful language in all communications to and about clients/patients.
(c) Dual or multiple relationships affecting the licensee's judgment.
(1) A licensee shall avoid dual or multiple relationships and conflicts of interest with any client/patient which could impair the licensee's professional judgment or increase the risk of client/patient exploitation. Dual or multiple relationships occur when the licensee relates to clients/patients in more than one relationship, whether professional, social or business. Dual or multiple relationships can occur simultaneously or consecutively. The licensee may not undertake or continue a professional relationship with a client/patient, supervisee or student when the objectivity or competency of the licensee is, or could reasonably be expected to be, impaired or when the relationship with the client/patient, supervisee or student is exploitative. The licensee should be particularly aware that familial, social, emotional, financial, supervisory, political, administrative and legal relationships with a client/patient or a person related to or associated with the client/patient must be carefully considered to insure that impaired judgment or exploitation is not involved.
(2) Licensees shall always be sensitive to the potentially harmful effects of other contacts on their practice and on those persons with whom they deal. A licensee shall refrain from entering into, or promising another to enter into, personal, scientific, professional or other relationships with another person if it appears or should appear likely that the relationship might reasonably impair the licensee's objectivity or otherwise interfere with the licensee's effectiveness as a licensed social worker or licensed clinical social worker or might harm or exploit the other party.
(3) When a dual or multiple relationship cannot be avoided, a licensee shall take reasonable professional precautions, such as informed consent, consultation, supervision and documentation, to ensure that judgment is not impaired and that no exploitation occurs.
(4) If a licensee finds that, due to unforeseen factors, a potentially harmful dual or multiple relationship has arisen with a client/patient, the licensee shall attempt to resolve it with due regard for the best interests of the client/patient and maximum compliance with the act and this chapter.
(5) When a licensee provides services to two or more people who have a relationship with each other, such as couples or family members, the licensee shall clarify with all parties which individuals will be considered clients/patients and the nature of the licensee's professional obligation to the various individuals who are receiving services. A licensee who anticipates a conflict of interest among the individuals receiving services or who anticipates having to perform in potentially conflicting roles, such as a licensee who is asked or ordered to testify in a child custody dispute or divorce proceeding involving clients/patients, shall clarify the roles with the parties involved and take reasonable action to minimize any conflict of interest.
(d) Impaired practice. A licensee may not undertake or continue a professional relationship with a client/patient, supervisee or student when the objectivity or competency of the licensee is, or could reasonably be expected to be, impaired due to mental, emotional, physiological, pharmacological or substance abuse conditions. If such a condition develops after a professional relationship has been initiated, the licensee shall terminate the professional relationship in an appropriate manner and shall, either himself or through an appropriate designee, notify the client/patient of the termination in writing and assist the client/patient in obtaining services from another professional.
(e) Research and publication.
(1) Research responsibilities.
(i) Use of human subjects. Licensees shall plan, design, conduct and report research in a manner consistent with pertinent ethical principles, Federal and State laws, host institutional rules and scientific standards governing research with human subjects. Licensees shall conduct research that reflects cultural sensitivity appropriateness.
(ii) Deviation from standard practice. Licensees shall seek consultation and observe stringent safeguards to protect the rights of research participants when a research problem suggests a deviation from standard acceptable practices.
(iii) Precautions to avoid injury. Licensees who conduct research with human subjects are responsible for the subjects' welfare throughout the experiment and shall take reasonable precautions to avoid causing injurious psychological, physical or social effects to the subjects. Licensees shall warn subjects of any possible harm that might come from being involved in a research project.
(iv) Principal researcher responsibility. The ultimate responsibility for ethical research practice lies with the principal researcher. Others involved in the research activities share ethical obligations and full responsibility for their own actions.
(v) Minimal interference. Licensees shall take reasonable precautions to avoid causing disruptions in subjects' lives due to participation in research.
(vi) Diversity. Licensees shall be sensitive to diversity and research issues with special populations and seek consultation when a reasonable researcher would consider it appropriate.
(2) Informed consent.
(i) Topics disclosed. In obtaining informed consent for research, licensees shall use language that is understandable to research participants and that:
(A) Accurately explains the purpose and procedures to be followed.
(B) Identifies any procedures that are experimental or relatively untried.
(C) Describes the attendant discomforts and risks.
(D) Describes the benefits or changes in individuals or organizations that might be reasonably expected.
(E) Discloses appropriate alternative procedures that would be advantageous for the subject.
(F) Offers to answer any inquiries concerning the procedures.
(G) Instructs that subjects are free to withdraw their consent and discontinue participation in the project at any time.
(ii) Prohibition of deception. The methodological requirements of research study may not include concealment, deception or minimal risk to participants.
(iii) Voluntary participation. Licensees shall assure that participation in research is voluntary and without any penalty for refusal to participate. Involuntary participation is appropriate only when it can be demonstrated that participation will have no harmful effects on subjects and is essential to the investigation. A research procedure may not be used if it is likely to cause serious or lasting harm to a participant. Ethical practice requires the investigator to respect the individual's freedom to decline to participate in, or withdraw from, research and to so inform prospective participants. The obligation to protect this freedom requires special vigilance when a licensee is, in any manner, in a position of authority over the participant. It is unethical to penalize a participant in any way for withdrawing from or refusing to participate in a research project.
(iv) Confidentiality of information. Information obtained about research participants during the course of an investigation is confidential. When the possibility exists that others may obtain access to the information, ethical research practice requires that the possibility, together with the plans for protecting confidentiality, be explained to participants by the licensee as part of the procedure for obtaining informed consent.
(v) Persons incapable of giving informed consent. When a person is not capable of giving informed consent, licensees shall provide an appropriate explanation, obtain agreement for participation and obtain informed consent from a legally authorized person.
(vi) Commitments to participants. Licensees shall take reasonable measures to honor all commitments to research participants.
(vii) Explanations after data collections. After data are collected, licensees shall provide participants with full clarifications of the nature of the study to remove any misconceptions. When scientific or human values justify delaying or withholding information, licensees shall take reasonable measures to avoid causing harm.
(viii) Agreements to cooperate. Licensees who agree to cooperate with another individual in research or publication shall cooperate as promised in terms of punctuality of performance and with regard to the completeness and accuracy of the information required.
(ix) Informed consent for sponsors. In the pursuit of research, licensees shall give sponsors, institutions and publication channels the same respect and opportunity for giving informed consent that they accord to individual research participants. Licensees shall be aware of their obligation to future research workers and ensure that host institutions are given feedback information and proper acknowledgment.
(3) Reporting results.
(i) Information affecting outcome. When reporting research results, licensees shall explicitly mention all variables and conditions known to the licensee that may have affected the outcome of a study or the interpretation of the data.
(ii) Accurate results. Licensees shall plan, conduct and report research accurately and in a manner that minimizes the possibility that results will be misleading and shall provide thorough discussions of the limitations of their data and alternative hypotheses. Licensees may not engage in fraudulent research, distort data, misrepresent data or deliberately bias their results.
(iii) Obligation to report unfavorable results. Licensees shall communicate to other licensees the results of any research judged to be of professional value.
(iv) Identity of subjects. Licensees who supply data, aid in the research of another person, report research results or make original data available shall take due care to disguise the identity of respective subjects in the absence of specific authorization from the subjects to do otherwise.
(v) Replication studies. Licensees shall make available sufficient original research data to qualified professionals who may wish to replicate the study.
(4) Publication.
(i) Recognition of others. When conducting and reporting research, licensees shall be familiar with, and give recognition to, previous work on the topic, observe copyright laws, and give full credit to those to whom credit is due.
(ii) Contributors. Licensees shall give credit through joint authorship, acknowledgement, footnote statements or other appropriate means to those who have contributed significantly to research or concept development in accordance with such contributions. The principal contributor shall be listed first and minor technical or professional contributions may be acknowledged in notes or introductory statements.
(iii) Student research. For an article that is substantially based on a student's dissertation or thesis, the student shall be listed as the principal author.
(iv) Duplicate submission. Licensees shall submit manuscripts for consideration to only one journal at a time. Manuscripts that are published in whole or in substantial part in a journal or published work may not be submitted for publication to another journal without acknowledgment and permission from the previous publication.
(v) Professional review. Licensees who review material submitted for publication, research or other scholarly purposes shall respect the confidentiality and proprietary rights of those who submitted it.
(f) Payment for services.
(1) When setting fees, licensees shall ensure that the fees are fair, reasonable and commensurate with the services performed.
(2) Licensees may not accept goods or services as payment for professional services.
(3) Licensees shall make financial arrangements with clients/patients, third-party payors and supervisees that are reasonably understandable and conform to accepted professional practices.
(4) Prior to entering into the therapeutic or supervisory relationship, a licensee should clearly disclose and explain to clients/patients and supervisees the following:
(i) Financial arrangements and fees related to professional services, including charges for canceled or missed appointments.
(ii) The use of collection agencies or legal measures for nonpayment.
(iii) The procedure for obtaining payment from the client/patient, to the extent allowed by law, if payment is denied by the third-party payor.
(5) Once services have begun, licensees shall provide reasonable notice of changes in fees or other charges.
(6) Licensees shall give reasonable notice to clients with unpaid balances of their intent to seek collection by agency or legal recourse. When that action is taken, licensees may not disclose clinical information.
(7) Licensees shall represent facts truthfully to clients, third-party payors and supervisees regarding services rendered.
(8) Licensees may not withhold records under their immediate control that are requested and needed for a client's/patient's treatment solely because payment has not been received for past services, except as otherwise provided by law.
(g) Recordkeeping.
(1) For each client/patient, a licensee shall keep records of the dates of social work services, types of social work services, termination and billing information.
(2) Records kept by the licensee shall be retained for 5 years from the date of the last entry. Records held or owned by government agencies or educational institutions are not subject to this requirement.
(3) Licensees shall take reasonable steps to ensure that documentation in records is accurate and reflects the services provided.
(4) Licensees shall include sufficient and timely documentation in records to facilitate the delivery of services and to ensure continuity of services provided to the client/patient in the future.
(5) Licensees' documentation should protect clients'/patients' privacy to the extent that it is possible and appropriate and should include only information that is directly relevant to the delivery of services.
(6) Licensees shall store records following termination of services to ensure reasonable future access. Records shall be maintained as required by paragraph (2) unless a longer retention period is otherwise required by statute or relevant contracts.
(7) Licensees shall provide a client/patient with reasonable access to records concerning the client/patient. Licensees who are concerned that clients'/patients' access to their records could cause serious misunderstanding or harm to the client/patient should provide assistance in interpreting the records and consultation with the client/patient regarding the records. Licensees should limit clients'/patients' access to their records, or portions of their records, only in exceptional circumstances when there is compelling evidence that the access would cause serious harm to the client/patient. Both the clients'/patients' requests and the rationale for withholding some or all of the records shall be documented in the clients'/patients' files. When providing clients/patients with access to their records, licensees shall take steps to protect the confidentiality of other individuals identified or discussed in the records.
(8) In the event of the licensee moving from the area or closing the licensee's practice, a licensee shall arrange for the storage, transfer or disposal of client/patient records in ways that maintain confidentiality and safeguard the welfare of clients/patients.
(h) Mandatory reporting.
(1) Licensees, supervisors and trainees have a responsibility to report any alleged violations of the act or this chapter to the Board. If a licensee has knowledge or reason to suspect that a colleague or other licensee is incompetent, impaired or unethical, the licensee shall report that practitioner to the Board.
(2) Licensees shall comply with mandatory reporting requirements in this chapter, including §§ 47.51--47.57 (relating to child abuse reporting requirements).
(i) Notice of name and address change. Licensees shall notify the Board within 30 days of any changes of name or mailing information to ensure that the Board has the licensees' current name and mailing address. Failure to do so may result in disciplinary action by the Board.
(j) Advertising.
(1) Licensees shall engage in appropriate informational activities, including those that enable the public, referral sources or others to choose professional services on an informed basis.
(2) Licensees shall accurately represent their competencies, education, training and experience relevant to their professional practice.
(3) Licensees shall ensure that advertisements and publications in any media, such as directories, announcements, business cards, newspapers, radio, television, internet and facsimiles, convey information that is necessary for the public to make an appropriate selection of professional services. This information may include the following:
(i) Office information, such as name, address, telephone number and credit card acceptability.
(ii) Earned degrees and State or provincial licensures or certifications.
(iii) Professional association member status.
(iv) Description of practice.
(4) Licensees may not use names that could mislead the public concerning the identity, responsibility, source or status of those practicing under that name, and shall not hold themselves out as being partners or associates of a firm if they are not partners or associates of the firm.
(5) Licensees may not use any professional identification, such as a business card, office sign, letterhead, internet, or telephone or association directory listing, if it includes a statement or claim that is false, fraudulent, misleading or deceptive.
(6) In representing their educational qualifications, licensees shall list and claim only those earned degrees from institutions accredited by regional accreditation sources recognized by the United States Department of Education, from institutions recognized by states or provinces that license or certify the licensee, or from equivalent foreign institutions.
(7) A licensee shall correct, whenever possible, false, misleading or inaccurate information and representations made by others concerning the licensee's qualifications, services or products.
(8) Licensees shall make certain that the qualifications of their employees or supervisees are represented in a manner that is not false, misleading or deceptive.
(9) Licensees may not represent themselves as providing specialized services unless they have the required education, training or supervised experience.
CHAPTER 48. STATE BOARD OF SOCIAL WORKERS, MARRIAGE AND FAMILY THERAPISTS AND PROFESSIONAL COUNSELORS--
LICENSURE OF MARRIAGE AND FAMILY THERAPISTS
CODE OF ETHICAL PRACTICE AND STANDARDS OF PROFESSIONAL CONDUCT § 48.71. Code of ethical practice and professional conduct.
(a) Application. This code of ethical practice and professional conduct constitutes the standards by which the professional conduct of licensed marriage and family therapists will be measured.
(1) This code of ethical practice and professional conduct applies to the conduct of all licensees.
(2) A violation of this code of ethical practice and professional conduct constitutes unprofessional conduct and subjects the licensed marriage and family therapist to disciplinary action under section 11 of the act (63 P. S. § 1911).
(3) The Board subscribes to the codes of ethics and practice standards for licensees promulgated by the National Board for Certified Counselors, Inc., the Commission on Rehabilitation Counselor Certification, the Certification Board for Music Therapists, the American Dance Therapy Association and the American Association for Marriage and Family Therapy and the Board will use these codes and standards as aids in resolving ambiguities which may arise in the interpretation of this section, except that whenever any conflict exists between this section and the professional associations' codes and standards, this section shall prevail.
(b) Responsibility to clients/patients.
(1) Competency.
(i) Licensees may not misrepresent directly, indirectly or by implication their professional qualifications such as education, specialized training, experience or area or areas of competence.
(ii) Licensees may practice only within the competency areas for which they are qualified by education, training or experience.
(iii) Licensees shall maintain appropriate standards of care. The appropriate standard of care is defined as what an ordinary, reasonable professional with similar training would have done in a similar circumstance.
(iv) Licensees shall make appropriate referrals when the client's/patient's needs exceed the licensee's competence level. The referrals must be made in a timely manner.
(2) Informed consent.
(i) Licensees shall inform clients/patients in writing of the extent and nature of services available to them, as well as the limits, rights, opportunities and obligations associated with the services to be provided which might affect the clients/patients of services decisions to enter into or continue the relationship.
(ii) Licensees shall provide services to clients/patients only in the context of a professional relationship based on valid informed consent. Licensees shall use clear and understandable language to inform clients/patients of the purposes of services, limits to the services due to legal requirements, relevant costs, reasonable alternatives, the clients'/patients' rights to refuse or withdraw consent and the time frame covered by the consent.
(iii) In instances when the client/patient is unable to read or understand the consent document or has trouble understanding the primary language contained in the informed consent document, licensees shall take steps to ensure the client's/patient's comprehension including providing a detailed verbal explanation or arranging for a qualified interpreter or translator, as needed. If a client/patient is not competent to provide informed consent because of age or mental condition, the licensee shall obtain consent from the client's/patient's parent, guardian or court appointed representative.
(iv) When a client/patient is receiving services involuntarily, licensees shall provide information about the nature and extent of the services and about the client's/patient's rights to the client's/patient's parent, guardian or court appointed representative.
(v) Licensees who provide services of electronic means shall inform the clients/patients of the limitations and risks associated with the services.
(3) Delegation. A licensee may not delegate professional responsibilities to another person when the licensee delegating the responsibilities knows or has reason to know that the other person is not qualified by training, experience or licensure to perform those responsibilities.
(4) Confidentiality and privacy.
(i) Licensees shall have a primary obligation to protect the client's/patient's right to confidentiality and privacy as established by law and the professional standards of practice. Confidential and private information shall only be revealed to others when the client/patient or other person legally authorized to give consent on behalf of the client/patient, has given informed consent, except in those circumstances in which failure to do so would violate other laws or result in clear and present danger to the client/patient or others. Unless specifically contrain- dicated by these situations, a client/patient shall be informed and written consent shall be obtained before the confidential and private information is revealed.
(ii) Licensees shall discuss with clients/patients and the client's/patient's legally authorized representatives, the nature of confidentiality and the limitation of the clients'/patients' right to confidentiality. Licensees shall review with clients/patients circumstances when confidential information may be requested and when disclosure of confidential information is legally required. This discussion should occur as soon as possible in the professional relationship and as needed throughout the course of the relationship.
(iii) When licensees provide services to families, couples or groups, licensees should seek agreement among the parties involved concerning each individual's right to confidentiality and obligations to preserve the confidentiality of information shared by others. Licensees shall inform participants in family, group or couples counseling that the licensee cannot guarantee that all participants will honor the agreements. In the context of couple, family or group treatment, the licensee may not reveal any individual's confidences to others in the client unit without the prior written permission of that individual.
(iv) Licensees shall take reasonable steps to protect the confidentiality of information transmitted to other parties through the use of computers, electronic mail, facsimile machines, telephones and telephone answering machines, and other electronic or computer technology.
(5) Termination. Licensees shall terminate services only after giving careful consideration to factors affecting the relationship and making an effort to minimize possible adverse effects. If an interruption or termination of services is anticipated, reasonable notification and appropriate referral for continued services shall be provided to the client/patient.
(6) Sexual harassment.
(i) Licensees may not sexually harass clients/patients or family members of clients/patients.
(ii) Licensees may not sexually harass supervisees, students, trainees, employees, research subjects or colleagues.
(iii) Sexual harassment includes unwanted sexual advances, sexual solicitation, requests for sexual favors and other verbal, visual or physical conduct of a sexual nature.
(7) Discrimination. Licensees may not practice, condone, facilitate or collaborate with any form of discrimination on the basis of race, ethnicity, religion, national origin, color, gender, sexual orientation, age, socio-economic level, marital status, political belief, veteran status, or mental or physical impairment.
(8) Conduct with clients/patients.
(i) Licensees may not physically or verbally abuse or threaten clients/patients or family members of clients/patients.
(ii) Licensees may not use derogatory language in their written or verbal communications to or about clients/patients. Licensees shall use accurate and respectful language in all communications to and about clients/patients.
(c) Dual or multiple relationships affecting the licensee's judgment.
(1) A licensees shall avoid dual or multiple relationships and conflicts of interest with any client/patient which could impair the licensee's professional judgment or increases the risk of client/patient exploitation. Dual or multiple relationships occur when the licensee relates to clients/patients in more than one relationship, whether professional, social or business. Dual or multiple relationships can occur simultaneously or consecutively. The licensee may not undertake or continue a professional relationship with a client/patient, supervisee or student when the objectivity or competency of the licensee is, or could reasonably be expected to be, impaired or when the relationship with the client/patient, supervisee or student is exploitative. The licensee should be particularly aware that familial, social, emotional, financial, supervisory, political, administrative and legal relationships with a client/patient or a person related to or associated with the client/patient must be carefully considered to insure that impaired judgment or exploitation is not involved.
(2) Licensees shall always be sensitive to the potentially harmful effects of other contacts on their practice and on those persons with whom they deal. A licensee shall refrain from entering into, or promising another to enter into, personal, scientific, professional or other relationships with another person if it appears or should appear likely that such a relationship might reasonably impair the professional's objectivity or otherwise interfere with the licensee's effectiveness as a licensed marriage and family therapist or might harm or exploit the other party.
(3) When a dual or multiple relationship cannot be avoided, a licensee shall take reasonable professional precautions, such as informed consent, consultation, supervision and documentation, to ensure that judgment is not impaired and that no exploitation occurs.
(4) If a licensee finds that, due to unforeseen factors, a potentially harmful dual or multiple relationship has arisen with a client/patient, the licensee shall attempt to resolve it with due regard for the best interests of the client/patient and maximum compliance with the act and this chapter.
(5) When a licensee provides services to two or more people who have a relationship with each other, such as couples or family members, the licensee shall clarify with all parties which individuals will be considered clients/patients and the nature of the licensee's professional obligation to the various individuals who are receiving services. A licensee who anticipates a conflict of interest among the individuals receiving services or who anticipate having to perform in potentially conflicting roles, such as a licensee who is asked or ordered to testify in a child custody dispute or divorce proceeding involving clients/patients, shall clarify the roles with the parties involved and take reasonable action to minimize any conflict of interest.
(d) Impaired practice. A licensee may not undertake or continue a professional relationship with a client/patient, supervisee or student when the objectivity or competency of the licensee is or could reasonably be expected to be impaired due to mental, emotional, physiological, pharmacological or substance abuse conditions. If such a condition develops after a professional relationship has been initiated, the licensee shall terminate the professional relationship in an appropriate manner and shall, either himself or through an appropriate designee, notify the client/patient of termination in writing and assist the client/patient in obtaining services from another professional.
(e) Research and publication.
(1) Research responsibilities.
(i) Use of human subjects. Licensees shall plan, design, conduct and report research in a manner consistent with pertinent ethical principles, Federal and State laws, host institutional rules and scientific standards governing research with human subjects. Licensees shall conduct research that reflects cultural sensitivity appropriateness.
(ii) Deviation from standard practice. Licensees shall seek consultation and observe stringent safeguards to protect the rights of research participants when a research problem suggests a deviation from standard acceptable practices.
(iii) Precautions to avoid injury. Licensees who conduct research with human subjects are responsible for the subjects' welfare throughout the experiment and shall take reasonable precautions to avoid causing injurious psychological, physical or social effects to their subjects. Licensees shall warn subjects of any possible harm that might come from being involved in a research project.
(iv) Principal researcher responsibility. The ultimate responsibility for ethical research practice lies with the principal researcher. Others involved in the research activities share ethical obligations and full responsibility for their own actions.
(v) Minimal interference. Licensees shall take reasonable precautions to avoid causing disruptions in subjects' lives due to participation in research.
(vi) Diversity. Licensees shall be sensitive to diversity and research issues with special populations and seek consultation when a reasonable researcher would consider it appropriate.
(2) Informed consent.
(i) Topics disclosed. In obtaining informed consent for research, licensees shall use language that is understandable to research participants and that:
(A) Accurately explains the purpose and procedures to be followed.
(B) Identifies any procedures that are experimental or relatively untried.
(C) Describes the attendant discomforts and risks.
(D) Describes the benefits or changes in individuals or organizations that might be reasonably expected.
(E) Discloses appropriate alternative procedures that would be advantageous for the subject.
(F) Offers to answer any inquiries concerning the procedures.
(G) Instructs that subjects are free to withdraw their consent and discontinue participation in the project at any time.
(ii) Prohibition of deception. The methodological requirements of research study may not include concealment, deception or minimal risk to participants.
(iii) Voluntary participation. Licensees shall assure that participation in research is voluntary and without any penalty for refusal to participate. Involuntary participation is appropriate only when it can be demonstrated that participation will have no harmful effects on subjects and is essential to the investigation. A research procedure may not be used if it is likely to cause serious or lasting harm to a participant. Ethical practice requires the investigator to respect the individual's freedom to decline to participate in, or withdraw from, research and to so inform prospective participants. The obligation to protect this freedom requires special vigilance when a licensee is, in any manner, in a position of authority over the participant. It is unethical to penalize a participant in any way for withdrawing from or refusing to participate in a research project.
(iv) Confidentiality of information. Information obtained about research participants during the course of an investigation is confidential. When the possibility exists that others may obtain access to the information, ethical research practice requires that the possibility, together with the plans for protecting confidentiality, be explained to participants by the licensee as part of the procedure for obtaining informed consent.
(v) Persons incapable of giving informed consent. When a person is not capable of giving informed consent, licensees shall provide an appropriate explanation, obtain agreement for participation and obtain informed consent from a legally authorized person.
(vi) Commitments to participants. Licensees shall take reasonable measures to honor all commitments to research participants.
(vii) Explanations after data collections. After data are collected, licensees shall provide participants with full clarifications of the nature of the study to remove any misconceptions. When scientific or human values justify delaying or withholding information, licensees shall take reasonable measures to avoid causing harm.
(viii) Agreements to cooperate. Licensees who agree to cooperate with another individual in research or publication shall cooperate as promised in terms of punctuality of performance and with regard to the completeness and accuracy of the information required.
(ix) Informed consent for sponsors. In the pursuit of research, licensees shall give sponsors, institutions and publication channels the same respect and opportunity for giving informed consent that they accord to individual research participants. Licensees shall be aware of their obligation to future research workers and ensure that host institutions are given feedback information and proper acknowledgment.
(3) Reporting results.
(i) Information affecting outcome. When reporting research results, licensees shall explicitly mention all variables and conditions known to the licensee that may have affected the outcome of a study or the interpretation of the data.
(ii) Accurate results. Licensees shall plan, conduct and report research accurately and in a manner that minimizes the possibility that results will be misleading and provide thorough discussions of the limitations of their data and alternative hypotheses. Licensees may not engage in fraudulent research, distort data, misrepresent data or deliberately bias their results.
(iii) Obligation to report unfavorable results. Licensees shall communicate to other licensees the results of any research judged to be of professional value.
(iv) Identity of subjects. Licensees who supply data, aid in the research of another person, report research results or make original data available shall take due care to disguise the identity of respective subjects in the absence of specific authorization from the subjects to do otherwise.
(v) Replication studies. Licensees shall make available sufficient original research data to qualified professionals who may wish to replicate the study.
(4) Publication.
(i) Recognition of others. When conducting and reporting research, licensees shall be familiar with, and give recognition to, previous work on the topic, observe copyright laws, and give full credit to those to whom credit is due.
(ii) Contributors. Licensees shall give credit through joint authorship, acknowledgement, footnote statements or other appropriate means to those who have contributed significantly to research or concept development in accordance with such contributions. The principal contributor shall be listed first and minor technical or professional contributions may be acknowledged in notes or introductory statements.
(iii) Student research. For an article that is substantially based on a student's dissertation or thesis, the student shall be listed as the principal author.
(iv) Duplicate submission. Licensees shall submit manuscripts for consideration to only one journal at a time. Manuscripts that are published in whole or in substantial part in a journal or published work may not be submitted for publication to another journal without acknowledgment and permission from the previous publication.
(v) Professional review. Licensees who review material submitted for publication, research or other scholarly purposes shall respect the confidentiality and proprietary rights of those who submitted it.
(f) Payment for services.
(1) When setting fees, licensees shall ensure that the fees are fair, reasonable and commensurate with the services performed.
(2) Licensees may not accept goods or services as payment for professional services.
(3) Licensees shall make financial arrangements with clients/patients, third-party payors and supervisees that are reasonably understandable and conform to accepted professional practices.
(4) Prior to entering into the therapeutic or supervisory relationship, a licensee should clearly disclose and explain to clients/patients and supervisees the following:
(i) Financial arrangements and fees related to professional services, including charges for canceled or missed appointments.
(ii) The use of collection agencies or legal measures for nonpayment.
(iii) The procedure for obtaining payment from the client, to the extent allowed by law, if payment is denied by the third-party payor.
(5) Once services have begun, licensees shall provide reasonable notice of changes in fees or other charges.
(6) Licensees shall give reasonable notice to clients with unpaid balances of their intent to seek collection by agency or legal recourse. When that action is taken, licensees may not disclose clinical information.
(7) Licensees shall represent facts truthfully to clients, third-party payors and supervisees regarding services rendered.
(8) Licensees may not withhold records under their immediate control that are requested and needed for a client's/patient's treatment solely because payment has not been received for past services, except as otherwise provided by law.
(g) Recordkeeping.
(1) For each client/patient, a licensee shall keep records of the dates of marriage and family therapy services, types of marriage and family therapy services, termination and billing information.
(2) Records kept by the licensee shall be retained for 5 years from the date of the last entry. Records held or owned by government agencies or educational institutions are not subject to this requirement.
(3) Licensees shall take reasonable steps to ensure that documentation in records is accurate and reflects the services provided.
(4) Licensees shall include sufficient and timely documentation in records to facilitate the delivery of services and to ensure continuity of services provided to clients in the future.
(5) Licensees' documentation should protect clients'/patients' privacy to the extent that it is possible and appropriate and should include only information that is directly relevant to the delivery of services.
(6) Licensees shall store records following termination of services to ensure reasonable future access. Records shall be maintained as required by paragraph (2) unless a longer retention period is otherwise required by statute or relevant contracts.
(7) Licensees shall provide a client/patient with reasonable access to records concerning the client/patient. Licensees who are concerned that clients'/patients' access to their records could cause serious misunderstanding or harm to the client/patient should provide assistance in interpreting the records and consultation with the client/patient regarding the records. Licensees should limit clients'/patients' access to their records, or portions of their records, only in exceptional circumstances when there is compelling evidence the access would cause serious harm to the client/patient. Both the clients'/patients' requests and the rationale for withholding some or all of the records shall be documented in the clients'/patients' files. When providing clients/patients with access to their records, licensees shall take steps to protect the confidentiality of other individuals identified or discussed in the records.
(8) In the event of a licensee moving from the area or closing the licensee's practice, a licensee shall arrange for the storage, transfer or disposal of client/patient records in ways that maintain confidentiality and safeguard the welfare of clients/patients.
(h) Mandatory reporting.
(1) Licensees, supervisors and trainees have a responsibility to report any alleged violations of the act or this chapter to the Board. If a licensee has knowledge or reason to suspect that a colleague or other licensee is incompetent, impaired or unethical, the licensee shall report that practitioner to the Board.
(2) Licensees shall comply with mandatory reporting requirements set forth in this chapter, including §§ 48.51--48.57 (relating to child abuse reporting requirements).
(i) Notice of name and address change. A licensee shall notify the Board within 30 days of any changes of name or mailing information to ensure that the Board has the licensee's current name and mailing address. Failure to do so may result in disciplinary action by the Board.
(j) Advertising.
(1) Licensees shall engage in appropriate informational activities, including those that enable the public, referral sources or others to choose professional services on an informed basis.
(2) Licensees shall accurately represent their competencies, education, training and experience relevant to their professional practice.
(3) Licensees shall ensure that advertisements and publications in any media, such as directories, announcements, business cards, newspapers, radio, television, internet and facsimiles, convey information that is necessary for the public to make an appropriate selection of professional services. This information may include the following:
(i) Office information, such as name, address, telephone number and credit card acceptability.
(ii) Earned degrees and state or provincial licensures or certifications.
(iii) Professional association member status.
(iv) Description of practice.
(4) Licensees may not use names that could mislead the public concerning the identity, responsibility, source or status of those practicing under that name, and may not hold themselves out as being partners or associates of a firm if they are not partners or associates of the firm.
(5) Licensees may not use any professional identification, such as a business card, office sign, letterhead, internet, or telephone or association directory listing, if it includes a statement or claim that is false, fraudulent, misleading or deceptive.
(6) In representing their educational qualifications, licensees shall list and claim only those earned degrees from institutions accredited by regional accreditation sources recognized by the United States Department of Education, from institutions recognized by states or provinces that license or certify the licensee, or from equivalent foreign institutions.
(7) The licensee shall correct, whenever possible, false, misleading or inaccurate information and representations made by others concerning the licensee's qualifications, services or products.
(8) Licensees shall make certain that the qualifications of their employees or supervisees are represented in a manner that is not false, misleading or deceptive.
(9) Licensees may not represent themselves as providing specialized services unless they have the required education, training or supervised experience.
CHAPTER 49. STATE BOARD OF SOCIAL WORKERS, MARRIAGE AND FAMILY THERAPISTS AND PROFESSIONAL COUNSELORS--
LICENSURE OF PROFESSIONAL COUNSELORS
CODE OF ETHICAL PRACTICE AND STANDARDS OF PROFESSIONAL CONDUCT § 49.71. Code of ethical practice and professional conduct.
(a) Application. This code of ethical practice and professional conduct constitutes the standards by which the professional conduct of licensed professional counselors will be measured.
(1) This code of ethical practice and professional conduct applies to the conduct of all licensees.
(2) A violation of this code of ethical practice and professional conduct constitutes unprofessional conduct and subjects the licensed professional counselor to disciplinary action under section 11 of the act (63 P. S. § 1911).
(3) The Board subscribes to the codes of ethics and practice standards for licensees promulgated by the National Board for Certified Counselors, Inc., the Commission on Rehabilitation Counselor Certification, the Certification Board for Music Therapists, the Art Therapists Certification Board, the American Dance Therapy Association, the National Association for Drama Therapy, the Academy of Certified Clinical Mental Health Counselors, the NorthAmerican Association of Master's in Psychology, the International Certification and Reciprocity Consortium/Alcohol and Other Drug Abuse Inc. and the National Association of Alcoholism and Drug Abuse Counselors. The Board will use these codes and standards as aids in resolving ambiguities which may arise in the interpretation of this section. Whenever any conflict exists between this section and the professional associations' codes and standards, this section shall prevail.
(b) Responsibility to clients/patients.
(1) Competency.
(i) Licensees may not misrepresent directly, indirectly or by implication their professional qualifications such as education, specialized training, experience or areas of competence.
(ii) Licensees may practice only within the competency areas for which they are qualified by education, training or experience.
(iii) Licensees shall maintain appropriate standards of care. The appropriate standard of care is defined as what an ordinary, reasonable professional with similar training would have done in a similar circumstance.
(iv) Licensees shall make appropriate referrals when the client's/patient's needs exceed the licensee's competence level. The referrals must be made in a timely manner.
(2) Informed consent.
(i) Licensees shall inform clients/patients in writing of the extent and nature of services available to them, as well as the limits, rights, opportunities and obligations associated with the services to be provided which might effect the clients'/patients' decisions to enter into or continue the relationship.
(ii) Licensees shall provide services to clients/patients only in the context of a professional relationship based on valid informed consent. Licensees shall use clear and understandable language to inform clients/patients of the purposes of services, limits to the services due to legal requirements, relevant costs, reasonable alternatives, the clients'/patients' rights to refuse or withdraw consent and the time frame covered by the consent.
(iii) In instances when the client/patient is unable to read or understand the consent document or has trouble understanding the primary language contained in the informed consent document, licensees shall take steps to ensure the client's/patient's comprehension including providing a detailed verbal explanation or arranging for a qualified interpreter or translator, as needed. If a client/patient is not competent to provide informed consent because of age or mental condition, the licensee shall obtain consent from the client's/patient's parent, guardian or court-appointed representative.
(iv) When a client/patient is receiving services involuntarily, licensees shall provide information about the nature and extent of the services and about the client's/patient's rights to the client's/patient's parent, guardian or court appointed representative.
(v) Licensees who provide services by means of electronic means shall inform the clients/patients of the limitations and risks associated with such services.
(3) Delegation. A licensee may not delegate professional responsibilities to another person when the licensee delegating the responsibilities knows or has reason to know that the other person is not qualified by training, experience or licensure to perform those responsibilities.
(4) Confidentiality and privacy.
(i) Licensees shall have a primary obligation to protect the client's/patient's right to confidentiality and privacy as established by law and the professional standards of practice. Confidential and private information shall only be revealed to others when the client/patient or other person legally authorized to give consent on behalf of the client/patient, has given informed consent, except in those circumstances in which failure to do so would violate other laws or result in clear and present danger to the client/patient or others. Unless specifically contrain- dicated by these situations, a client/patient shall be informed and written consent shall be obtained before the confidential and private information is revealed.
(ii) Licensees shall discuss with clients/patients and the client's/patient's legally authorized representatives, the nature of confidentiality and the limitation of clients'/patients' right to confidentiality. Licensees shall review with clients/patients circumstances when confidential information may be requested and when disclosure of confidential information is legally required. This discussion should occur as soon as possible in the professional relationship and as needed throughout the course of the relationship.
(iii) When licensees provide services to families, couples or groups, licensees should seek agreement among the parties involved concerning each individual's right to confidentiality and obligations to preserve the confidentiality of information shared by others. Licensees shall inform participants in family, group or couples counseling that the licensee cannot guarantee that all participants will honor the agreements. In the context of couple, family or group treatment, the licensee may not reveal any individual's confidences to others in the client unit without the prior written permission of that individual.
(iv) Licensees shall take reasonable steps to protect the confidentiality of information transmitted to other parties through the use of computers, electronic mail, facsimile machines, telephones and telephone answering machines, and other electronic or computer technology.
(5) Termination. Licensees shall terminate services only after giving careful consideration to factors affecting the relationship and making an effort to minimize possible adverse effects. If an interruption or termination of services is anticipated, reasonable notification and appropriate referral for continued services shall be provided to the client/patient.
(6) Sexual harassment.
(i) Licensees may not sexually harass clients/patients or family members of clients/patients.
(ii) Licensees may not sexually harass supervisees, students, trainees, employees, research subjects or colleagues.
(iii) Sexual harassment includes unwanted sexual advances, sexual solicitation, requests for sexual favors, and other verbal, visual or physical conduct of a sexual nature.
(7) Discrimination. Licensees may not practice, condone, facilitate or collaborate with any form of discrimination on the basis of race, ethnicity, religion, national origin, color, gender, sexual orientation, age, socio-economic level, marital status, political belief, veteran status, or mental or physical impairment.
(8) Conduct with clients.
(i) Licensees may not physically or verbally abuse or threaten clients/patients or family members of clients/patients.
(ii) Licensees may not use derogatory language in their written or verbal communications to or about clients/patients. Licensees shall use accurate and respectful language in all communications to and about clients/patients.
(c) Dual or multiple relationships affecting the licensee's judgment.
(1) A licensee shall avoid dual or multiple relationships and conflicts of interest with any client/patient which could impair the licensee's professional judgment or increase the risk of client/patient exploitation. Dual or multiple relationships occur when the licensee relates to clients/patients in more than one relationship, whether professional, social or business. Dual or multiple relationships can occur simultaneously or consecutively. The licensee may not undertake or continue a professional relationship with a client/patient, supervisee or student when the objectivity or competency of the licensee is, or could reasonably be expected to be, impaired or when the relationship with the client/patient, supervisee or student is exploitative. The licensee should be particularly aware that familial, social, emotional, financial, supervisory, political, administrative and legal relationships with a client/patient or a person related to or associated with the client/patient must be carefully considered to insure that impaired judgment or exploitation is not involved.
(2) Licensees shall always be sensitive to the potentially harmful effects of other contacts on their practice and on those persons with whom they deal. A licensee shall refrain from entering into, or promising another to enter into, personal, scientific, professional or other relationships with other persons if it appears or should appear likely that the relationship might reasonably impair the licensee's objectivity or otherwise interfere with the licensee's effectiveness as a licensed professional counselor or might harm or exploit the other party.
(3) When a dual or multiple relationship cannot be avoided, licensees shall take reasonable professional precautions, such as informed consent, consultation, supervision and documentation, to ensure that judgment is not impaired and that no exploitation occurs.
(4) If a licensee finds that, due to unforeseen factors, a potentially harmful dual or multiple relationship has arisen with a client/patient, the licensee shall attempt to resolve it with due regard for the best interests of the client/patient and maximum compliance with the act and this chapter.
(5) When a licensee provides services to two or more people who have a relationship with each other, such as couples or family members, the licensee shall clarify with all parties which individuals will be considered clients/patients and the nature of the licensee's professional obligation to the various individuals who are receiving services. A licensee who anticipates a conflict of interest among the individuals receiving services or who anticipates having to perform in potentially conflicting roles, such as a licensee who is asked or ordered to testify in a child custody dispute or divorce proceeding involving clients, shall clarify the roles with the parties involved and take appropriate action to minimize any conflict of interest.
(d) Impaired practice. A licensee may not undertake or continue a professional relationship with a client/patient, supervisee or student when the objectivity or competency of the licensee is, or could reasonably be expected to be, impaired due to mental, emotional, physiological, pharmacological or substance abuse conditions. If such a condition develops after a professional relationship has been initiated, the licensee shall terminate the professional relationship in an appropriate manner and shall, either himself or through an appropriate designee, notify the client/patient of the termination in writing and shall assist the client/patient in obtaining services from another professional.
(e) Research and publication.
(1) Research responsibilities.
(i) Use of human subjects. Licensees shall plan, design, conduct and report research in a manner consistent with pertinent ethical principles, Federal and State laws, host institutional rules, and scientific standards governing research with human subjects. Licensees shall conduct research that reflects cultural sensitivity appropriateness.
(ii) Deviation from standard practice. Licensees shall seek consultation and observe stringent safeguards to protect the rights of research participants when a research problem suggests a deviation from standard acceptable practices.
(iii) Precautions to avoid injury. Licensees who conduct research with human subjects are responsible for the subjects' welfare throughout the experiment and shall take reasonable precautions to avoid causing injurious psychological, physical or social effects to their subjects. Licensees shall warn subjects of any possible harm that might come from being involved in a research project.
(iv) Principal researcher responsibility. The ultimate responsibility for ethical research practice lies with the principal researcher. Others involved in the research activities share ethical obligations and full responsibility for their own actions.
(v) Minimal interference. Licensees shall take reasonable precautions to avoid causing disruptions in subjects' lives due to participation in research.
(vi) Diversity. Licensees shall be sensitive to diversity and research issues with special populations and seek consultation when a reasonable researcher would consider it appropriate.
(2) Informed consent.
(i) Topics disclosed. In obtaining informed consent for research, licensees shall use language that is understandable to research participants and that:
(A) Accurately explains the purpose and procedures to be followed.
(B) Identifies any procedures that are experimental or relatively untried.
(C) Describes the attendant discomforts and risks.
(D) Describes the benefits or changes in individuals or organizations that might be reasonably expected.
(E) Discloses appropriate alternative procedures that would be advantageous for the subject.
(F) Offers to answer any inquiries concerning the procedures.
(G) Instructs that subjects are free to withdraw their consent and discontinue participation in the project at any time.
(ii) Prohibition of deception. The methodological requirements of research study may not include concealment, deception or minimal risk to participants.
(iii) Voluntary participation. Licensees shall assure that participation in research is voluntary and without any penalty for refusal to participate. Involuntary participation is appropriate only when it can be demonstrated that participation will have no harmful effects on subjects and is essential to the investigation. A research procedure may not be used if it is likely to cause serious or lasting harm to a participant. Ethical practice requires the investigator to respect the individual's freedom to decline to participate in, or withdraw from, research and to so inform prospective participants. The obligation to protect this freedom requires special vigilance when a licensee is, in any manner, in a position of authority over the participant. It is unethical to penalize a participant in any way for withdrawing from or refusing to participate in a research project.
(iv) Confidentiality of information. Information obtained about research participants during the course of an investigation is confidential. When the possibility exists that others may obtain access to the information, ethical research practice requires that the possibility, together with the plans for protecting confidentiality, be explained to participants by the licensee as part of the procedure for obtaining informed consent.
(v) Persons incapable of giving informed consent. When a person is not capable of giving informed consent, licensees provide an appropriate explanation, obtain agreement for participation and obtain informed consent from a legally authorized person.
(vi) Commitments to participants. Licensees shall take reasonable measures to honor all commitments to research participants.
(vii) Explanations after data collections. After data are collected, licensees shall provide participants with full clarifications of the nature of the study to remove any misconceptions. When scientific or human values justify delaying or withholding information, licensees shall take reasonable measures to avoid causing harm.
(viii) Agreements to cooperate. Licensees who agree to cooperate with another individual in research or publication shall cooperate as promised in terms of punctuality of performance and with regard to the completeness and accuracy of the information required.
(ix) Informed consent for sponsors. In the pursuit of research, licensees shall give sponsors, institutions and publication channels the same respect and opportunity for giving informed consent that they accord to individual research participants. Licensees shall be aware of their obligation to future research workers and ensure that host institutions are given feedback information and proper acknowledgment.
(3) Reporting results.
(i) Information affecting outcome. When reporting research results, licensees shall explicitly mention all variables and conditions known to the licensee that may have affected the outcome of a study or the interpretation of the data.
(ii) Accurate results. Licensees shall plan, conduct and report research accurately and in a manner that minimizes the possibility that results will be misleading and provide thorough discussions of the limitations of their data and alternative hypotheses. Licensees may not engage in fraudulent research, distort data, misrepresent data or deliberately bias their results.
(iii) Obligation to report unfavorable results. Licensees shall communicate to other licensees the results of any research judged to be of professional value.
(iv) Identity of subjects. Licensees who supply data, aid in the research of another person, report research results or make original data available shall take due care to disguise the identity of respective subjects in the absence of specific authorization from the subjects to do otherwise.
(v) Replication studies. Licensees shall make available sufficient original research data to qualified professionals who may wish to replicate the study.
(4) Publication.
(i) Recognition of others. When conducting and reporting research, licensees shall be familiar with, and give recognition to, previous work on the topic, observe copyright laws, and give full credit to those to whom credit is due.
(ii) Contributors. Licensees shall give credit through joint authorship, acknowledgement, footnote statements or other appropriate means to those who have contributed significantly to research or concept development in accordance with such contributions. The principal contributor shall be listed first and minor technical or professional contributions may be acknowledged in notes or introductory statements.
(iii) Student research. For an article that is substantially based on a student's dissertation or thesis, the student shall be listed as the principal author.
(iv) Duplicate submission. Licensees shall submit manuscripts for consideration to only one journal at a time. Manuscripts that are published in whole or in substantial part in a journal or published work may not be submitted for publication to another journal without acknowledgment and permission from the previous publication.
(v) Professional review. Licensees who review material submitted for publication, research or other scholarly purposes shall respect the confidentiality and proprietary rights of those who submitted it.
(f) Payment for services.
(1) When setting fees, licensees shall ensure that the fees are fair, reasonable and commensurate with the services performed.
(2) Licensees may not accept goods or services as payment for professional services.
(3) Licensees shall make financial arrangements with clients/patients, third-party payors and supervisees that are reasonably understandable and conform to accepted professional practices.
(4) Prior to entering into the therapeutic or supervisory relationship, a licensee should clearly disclose and explain to clients/patients and supervisees the following:
(i) Financial arrangements and fees related to professional services, including charges for canceled or missed appointments.
(ii) The use of collection agencies or legal measures for nonpayment.
(iii) The procedure for obtaining payment from the client, to the extent allowed by law, if payment is denied by the third-party payor.
(5) Once services have begun, licensees shall provide reasonable notice of changes in fees or other charges.
(6) Licensees shall give reasonable notice to clients with unpaid balances of their intent to seek collection by agency or legal recourse. When that action is taken, licensees may not disclose clinical information.
(7) Licensees shall represent facts truthfully to clients, third-party payors and supervisees regarding services rendered.
(8) Licensees may not withhold records under their immediate control that are requested and needed for a client's/patient's treatment solely because payment has not been received for past services, except as otherwise provided by law.
(g) Recordkeeping.
(1) For each client/patient, a licensee shall keep records of the dates of professional counseling services, types of professional counseling services, termination and billing information.
(2) Records kept by the licensee shall be retained for 5 years from the date of the last entry. Records held or owned by government agencies or educational institutions are not subject to this requirement.
(3) Licensees shall take reasonable steps to ensure that documentation in records is accurate and reflects the services provided.
(4) Licensees shall include sufficient and timely documentation in records to facilitate the delivery of services and to ensure continuity of services provided to clients in the future.
(5) Licensees' documentation should protect clients'/patients' privacy to the extent that it is possible and appropriate and should include only information that is directly relevant to the delivery of services.
(6) Licensees shall store records following termination of services to ensure reasonable future access. Records shall be maintained as required by paragraph (2) unless a longer retention period is otherwise required by statute or relevant contracts.
(7) Licensees shall provide a client/patient with reasonable access to records concerning the client/patient. Licensees who are concerned that clients'/patients' access to their records could cause serious misunderstanding or harm to the client/patient should provide assistance in interpreting the records and consultation with the client/patient regarding the records. Licensees should limit clients'/patients' access to their records, or portions of their records, only in exceptional circumstances when there is compelling evidence that the access would cause serious harm to the client/patient. Both the clients'/patients' requests and the rationale for withholding some or all of the records shall be documented in the clients'/patients' files. When providing clients/patients with access to their records, licensees shall take steps to protect the confidentiality of other individuals identified or discussed in the records.
(8) In the event of the licensee moving from the area or closing the licensee's practice, a licensee shall arrange for the storage, transfer or disposal of client/patient records in ways that maintain confidentiality and safeguard the welfare of clients/patients.
(h) Mandatory reporting.
(1) Licensees, supervisors and trainees have a responsibility to report any alleged violations of the act or this chapter to the Board. If a licensee has knowledge or reason to suspect that a colleague or other licensee is incompetent, impaired or unethical, the licensee shall report that practitioner to the Board.
(2) Licensees shall comply with mandatory reporting requirements in this chapter, including §§ 49.51--49.57 (relating to child abuse reporting requirements).
(i) Notice of name and address change. A licensee shall notify the Board within 30 days of any changes of name or mailing information to ensure that the Board has the licensee's current name and mailing address. Failure to do so may result in disciplinary action by the Board.
(j) Advertising.
(1) Licensees shall engage in appropriate informational activities, including those that enable the public, referral sources or others to choose professional services on an informed basis.
(2) Licensees shall accurately represent their competencies, education, training and experience relevant to their professional practice.
(3) Licensees shall ensure that advertisements and publications in any media, such as directories, announcements, business cards, newspapers, radio, television, internet and facsimiles, convey information that is necessary for the public to make an appropriate selection of professional services. This information may include the following:
(i) Office information, such as name, address, telephone number and credit card acceptability.
(ii) Earned degrees and state or provincial licensures or certifications.
(iii) Professional association member status.
(iv) Description of practice.
(4) Licensees may not use names that could mislead the public concerning the identity, responsibility, source and status of those practicing under that name, and may not hold themselves out as being partners or associates of a firm if they are not partners or associates of the firm.
(5) Licensees may not use any professional identification, such as a business card, office sign, letterhead, Internet, or telephone or association directory listing, if it includes a statement or claim that is false, fraudulent, misleading or deceptive.
(6) In representing their educational qualifications, licensees shall list and claim only those earned degrees from institutions accredited by regional accreditation sources recognized by the United States Department of Education, from institutions recognized by states or provinces that license or certify the licensee, or from equivalent foreign institutions.
(7) The licensee shall correct, whenever possible, false, misleading or inaccurate information and representations made by others concerning the licensee's qualifications, services or products.
(8) Licensees shall make certain that the qualifications of their employees or supervisees are represented in a manner that is not false, misleading or deceptive.
(9) Licensees may not represent themselves as providing specialized services unless they have the required education, training or supervised experience.
[Pa.B. Doc. No. 08-1102. Filed for public inspection June 13, 2008, 9:00 a.m.]
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