Introduction
This document is a part of an online course on record keeping and focuses on the sections of the Codes of Ethics of the major professional organizations that deal with Record Keeping and Informed Consent.
It is also designed to ensure that California psychologists, MFTs and LCSWs are provided with the relevant and most current and up-to-date information regarding the applicable professional codes of ethics and California Law.
Five major codes of ethics are discussed in this paper: American Psychological Association (APA) Code of Ethics, California Marriage and Family Therapists (CAMFT) Code of Ethics and National Association of Social Workers (NASW) Code of Ethics. The relevant sections of these codes to record keeping and informed consent will be presented and direct links to the codes online will be provided.
Links to the Codes of Ethics
- American Association for Marriage and Family Therapy (AAMFT)
- American Counseling Association (ACA)
- American Mental Health Counselors Association (AMHCA)
- American Psychological Association (APA)
- Canadian Psychological Association (CPA)
- California Association of Marriage and Family Therapists (CAMFT)
- National Board for Certified Counselors (NBCC)
- National association of Social Workers (NASW)
- For additional lists of online Ethics Codes for Therapy: Dr. Pope's list
Codes of Ethics on Record Keeping
American Association for Marriage and Family Therapy (AAMFT) Code of Ethics (2001):
Principle II: Confidentiality
2.4 Marriage and family therapists store, safeguard, and dispose of client records in ways that maintain confidentiality and in accord with applicable laws and professional standards.
2.5 Subsequent to the therapist moving from the area, closing the practice, or upon the death of the therapist, a marriage and family therapist arranges for the storage, transfer, or disposal of client records in ways that maintain confidentiality and safeguard the welfare of clients.
Principle III: Professional Competence and Integrity
3.6 Marriage and family therapists maintain accurate and adequate clinical and financial records.
Principle VII: Financial Arrangements
7.6 Marriage and family therapists may not withhold records under their immediate control that are requested and needed for a client's treatment solely because payment has not been received for past services, except as otherwise provided by law.
American Counseling Association (ACA)
Code of Ethics (2005):
Section A: 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 the
counselor and the client. 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,
and relevant experience; continuation
of services upon the incapacitation
or death of a counselor;
and other pertinent information.
Counselors take steps to ensure that
clients understand the implications of
diagnosis, the intended use of tests and
reports, fees, and billing arrangements.
Clients have the right to confidentiality
and to be provided with an explanation
of its limitations (including how
supervisors and/or treatment 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 change and to be advised
of the consequences of such refusal.
Standard of Practice Two (SP-2): Disclosure to Clients. Counselors must adequately inform clients, preferably in writing, regarding the counseling process and counseling relationship at or before the time it begins and throughout the relationship. (See A.3.a.)
Section B: Confidentiality
B.6. Records
B.6.a. Confidentiality of Records
Counselors ensure that records are
kept in a secure location and that
only authorized persons have access
to records.
B.6.b. Permission to Record
Counselors obtain permission from
clients prior to recording sessions
through electronic or other means.
B.6.d. Client Access
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 record in
the files of clients. In situations involving
multiple clients, counselors
provide individual clients with only
those parts of records that related
directly to them and do not include
confidential information related to
any other client.
B.6.f. 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.
(See A.3., E.4.)
Standard of Practice Thirteen (SP-13): Confidentiality of Records. Counselors must maintain appropriate confidentiality in creating, storing, accessing, transferring, and disposing of counseling records. (See B.4.b.)
Standard of Practice Fifteen (SP-15): Disclosure or Transfer of Records. Counselors must obtain client consent to disclose or transfer records to third parties, unless exceptions listed in SP-9 exist. (See B.4.e.)
American Mental Health Counselors Association (AMHCA)
Code of Ethics (2000):
Section: Principle 3 Confidentiality
B) All materials in the official record shall be shared with the client, who shall have the right to decide what information may be shared with anyone beyond the immediate provider of service and be informed of the implications of the materials to be shared.
H) Counseling reports and records are maintained under conditions of security, and provisions are made for their destruction when they have outlived their usefulness. Mental health counselors ensure that all persons in his or her employ, volunteers, and community aides maintain privacy and confidentiality.
J) Sessions with clients may be taped or otherwise recorded only with their written permission or the written permission of a responsible guardian. Even with a guardian's written consent, one should not record a session against the expressed wishes of a client. Such tapes shall be destroyed when they have outlived their usefulness.
L) In work with families, the rights of each family member should be safeguarded. The provider of service also has the responsibility to discuss the contents of the record with the parent and/or child, as appropriate, and to keep separate those parts, which should remain the property of each family member.
Section on: The client has the right:
H) To obtain information about their case record and to have this information explained clearly and directly.
American Psychological Association (APA)
Ethical Principles of Psychologists and Code of Conduct (2002):
6. Record Keeping and Fees
6.01 Documentation of Professional and Scientific Work and Maintenance of Records
Psychologists create, and to the extent the records are under their control, maintain, disseminate, store, retain, and dispose of records and data relating to their professional and scientific work in order to (1) facilitate provision of services later by them or by other professionals, (2) allow for replication of research design and analyses, (3) meet institutional requirements, (4) ensure accuracy of billing and payments, and (5) ensure compliance with law. (See also Standard 4.01, Maintaining Confidentiality.)
6.02 Maintenance, Dissemination, and Disposal of Confidential Records of Professional and Scientific Work
(a) Psychologists maintain confidentiality in creating, storing, accessing, transferring, and disposing of records under their control, whether these are written, automated, or in any other medium. (See also Standards 4.01, Maintaining Confidentiality, and 6.01, Documentation of Professional and Scientific Work and Maintenance of Records.)
(b) If confidential information concerning recipients of psychological services is entered into databases or systems of records available to persons whose access has not been consented to by the recipient, psychologists use coding or other techniques to avoid the inclusion of personal identifiers.
(c) Psychologists make plans in advance to facilitate the appropriate transfer and to protect the confidentiality of records and data in the event of psychologists' withdrawal from positions or practice. (See also Standards 3.12, Interruption of Psychological Services, and 10.09, Interruption of Therapy.)
6.03 Withholding Records for Nonpayment
Psychologists may not withhold records under their control that are requested and needed for a client's/patient's emergency treatment solely because payment has not been received.
California Association of Marriage and Family Therapists (CAMFT) Ethical Standards for Marriage and Family Therapists (2008):
1.10 WITHHOLDING RECORDS/NON-PAYMENT:
Marriage and family therapists do not withhold patient records or information solely because the therapist has not been paid for prior professional services.
1.15 DOCUMENTING TREATMENT DECISIONS:
Marriage and family therapists are encouraged to carefully document in their records when significant decisions are made, e.g., determining reasonable suspicion of child, elder or dependent adult abuse, determining when a patient is a danger to self or others, when making major changes to a treatment plan, or when changing the unit being treated.
2.4 MAINTENANCE OF PATIENT RECORDS—CONFIDENTIALITY:
Marriage and family therapists store, transfer, transmit, and/or dispose of patient records in ways that protect confidentiality.
3.3 PATIENT RECORDS:
Marriage and family therapists create and maintain
patient records, whether written, taped, computerized, or stored in any other medium, consistent with sound clinical practice.
The National Association of Social Workers (NASW) Code of Ethics (1999):
1.07 Privacy and Confidentiality
(j) Social workers should protect the confidentiality of clients during legal proceedings to the extent permitted by law. When a court of law or other legally authorized body orders social workers to disclose confidential or privileged information without a client's consent and such disclosure could cause harm to the client, social workers should request that the court withdraw the order or limit the order as narrowly as possible or maintain the records under seal, unavailable for public inspection.
(l) Social workers should protect the confidentiality of clients' written and electronic records and other sensitive information. Social workers should take reasonable steps to ensure that clients' records are stored in a secure location and that clients' records are not available to others who are not authorized to have access.
(n) Social workers should transfer or dispose of clients' records in a manner that protects clients' confidentiality and is consistent with state statutes governing records and social work licensure.
1.08 Access to Records
(a) Social workers should provide clients with reasonable access to records concerning the clients. Social workers who are concerned that clients' access to their records could cause serious misunderstanding or harm to the client should provide assistance in interpreting the records and consultation with the client regarding the records. Social workers should limit clients' access to their records, or portions of their records, only in exceptional circumstances when there is compelling evidence that such access would cause serious harm to the client. Both clients' requests and the rationale for withholding some or all of the record should be documented in clients' files.
(b) When providing clients with access to their records, social workers should take steps to protect the confidentiality of other individuals identified or discussed in such records.
3.04 Client Records
(a) Social workers should take reasonable steps to ensure that documentation in records is accurate and reflects the services provided.
(b) Social workers should 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.
(c) Social workers' documentation should protect clients' privacy to the extent that is possible and appropriate and should include only information that is directly relevant to the delivery of services.
(d) Social workers should store records following the termination of services to ensure reasonable future access. Records should be maintained for the number of years required by state statutes or relevant contracts.
5.02 Evaluation and Research
(l) Social workers engaged in evaluation or research should ensure the anonymity or confidentiality of participants and of the data obtained from them. Social workers should inform participants of any limits of confidentiality, the measures that will be taken to ensure confidentiality, and when any records containing research data will be destroyed.
Codes of Ethics on Informed Consent
American Association for Marriage and Family Therapy (AAMFT) Code of Ethics (2001):
Principle I. Responsibility to Clients
1.2 Marriage and family therapists obtain appropriate informed consent to therapy or related procedures as early as feasible in the therapeutic relationship, and use language that is reasonably understandable to clients. The content of informed consent may vary depending upon the client and treatment plan; however, informed consent generally necessitates that the client: (a) has the capacity to consent; (b) has been adequately informed of significant information concerning treatment processes and procedures; (c) has been adequately informed of potential risks and benefits of treatments for which generally recognized standards do not yet exist; (d) has freely and without undue influence expressed consent; and (e) has provided consent that is appropriately documented. When persons, due to age or mental status, are legally incapable of giving informed consent, marriage and family therapists obtain informed permission from a legally authorized person, if such substitute consent is legally permissible.
1.12 Marriage and family therapists obtain written informed consent from clients before videotaping, audio recording, or permitting third-party observation.
American Counseling Association (ACA)
Code of Ethics (2005):
Section A: The Counseling Relationship
A.2.d. Inability to Give Consent
When counseling minors or 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.5.a. Current Clients
Sexual or romantic counselor–client
interactions or relationships with current
clients, their romantic partners, or
their family members are prohibited.
A.5.b. Former Clients
Sexual 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.
Counselors, before engaging in
sexual or romantic interactions or
relationships with clients, their romantic
partners, or client family
members after 5 years following the
last professional contact, demonstrate
forethought and document (in
written form) whether the interactions
or relationship can be viewed as
exploitive in some 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 such an interaction
or relationship.
A.5.c. Nonprofessional Interactions
or Relationships (Other Than
Sexual or Romantic
Interactions or Relationships)
Counselor–client nonprofessional
relationships with clients, former
clients, their romantic partners, or
their family members should be
avoided, except when the interaction
is potentially beneficial to the client.
(See A.5.d.)
A.5.d. Potentially Beneficial
Interactions
When a counselor–client nonprofessional
interaction with a client or
former client may be potentially
beneficial to the client or former
client, the counselor must document
in case records, 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. Such
interactions should be initiated with
appropriate client consent. Where
unintentional harm occurs to the
client or former client, or to an individual
significantly involved with
the client or former client, due to
the nonprofessional interaction,
the counselor must show evidence
of an attempt to remedy such
harm. Examples of potentially beneficial
interactions include, but are
not limited to, attending a formal ceremony
(e.g., a wedding/commitment
ceremony or graduation); purchasing
a service or product provided
by a client or former client (excepting
unrestricted bartering); hospital
visits to an ill family member; mutual
membership in a professional
association, organization, or community.
(See A.5.c.)
A.5.e. Role Changes in the
Professional Relationship
When a counselor changes a role
from the original or most recent contracted
relationship, he or she obtains
informed consent from the client and
explains the right of the client to
refuse services related to the change.
Examples of role changes include
1. changing from individual to relationship
or family counseling, or
vice versa;
2. changing from a nonforensic
evaluative role to a therapeutic
role, or vice versa;
3. changing from a counselor to a
researcher role (i.e., enlisting
clients as research participants),
or vice versa; and
4. 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, or therapeutic) of
counselor role changes.
Section B: Confidentiality
B.6. Records
B.6.a. Confidentiality of Records
Counselors ensure that records are
kept in a secure location and that
only authorized persons have access
to records.
B.6.b. Permission to Record
Counselors obtain permission from
clients prior to recording sessions
through electronic or other means.
B.6.d. Client Access
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 record in
the files of clients. In situations involving
multiple clients, counselors
provide individual clients with only
those parts of records that related
directly to them and do not include
confidential information related to
any other client.
B.6.f. 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.
(See A.3., E.4.)
A.2.d. Inability to Give Consent
When counseling minors or 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.
Section E: Evaluation, Assessment, and Interpretation
E.3. Informed Consent in
Assessment
E.3.a. Explanation to Clients
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 the language of the client (or
other legally authorized person on
behalf of the client), unless an explicit
exception has been agreed upon in
advance. Counselors consider the
client’s personal or cultural context, the
level of the client’s understanding of
the results, and the impact of the results
on the client. (See A.2., A.12.g., F.1.c.)
American Psychological Association (APA)
Ethical Principles of Psychologists and Code of Conduct (2002):
3.10 Informed Consent
(a) When psychologists conduct research or provide assessment, therapy, counseling, or consulting services in person or via electronic transmission or other forms of communication, they obtain the informed consent of the individual or individuals using language that is reasonably understandable to that person or persons except when conducting such activities without consent is mandated by law or governmental regulation or as otherwise provided in this Ethics Code.
(b) For persons who are legally incapable of giving informed consent, psychologists nevertheless (1) provide an appropriate explanation, (2) seek the individual's assent, (3) consider such persons' preferences and best interests, and (4) obtain appropriate permission from a legally authorized person, if such substitute consent is permitted or required by law. When consent by a legally authorized person is not permitted or required by law, psychologists take reasonable steps to protect the individual's rights and welfare.
(c) When psychological services are court ordered or otherwise mandated, psychologists inform the individual of the nature of the anticipated services, including whether the services are court ordered or mandated and any limits of confidentiality, before proceeding.
(d) Psychologists appropriately document written or oral consent, permission, and assent.
California Association of Marriage and Family Therapists (CAMFT) Ethical Standards for Marriage and Family Therapists (2008):
1.10 WITHHOLDING RECORDS/NON-PAYMENT:
Marriage and family therapists do not withhold patient records or information solely because the therapist has not been paid for prior professional services.
1.15 DOCUMENTING TREATMENT DECISIONS:
Marriage and family therapists are encouraged to carefully document in their records when significant decisions are made, e.g., determining reasonable suspicion of child, elder or dependent adult abuse, determining when a patient is a danger to self or others, when making major changes to a treatment plan, or when changing the unit being treated.
2.4 MAINTENANCE OF PATIENT RECORDS—CONFIDENTIALITY:
Marriage and family therapists store, transfer, transmit, and/or dispose of patient records in ways that protect confidentiality.
3.3 PATIENT RECORDS:
Marriage and family therapists create and maintain
patient records, whether written, taped, computerized, or stored in any other medium, consistent with sound clinical practice.
The National Association of Social Workers (NASW) Code of Ethics (1999):
1.03 Informed Consent
(a) Social workers should provide services to clients only in the context of a professional relationship based, when appropriate, on valid informed consent. Social workers should use clear and understandable language to inform clients of the purpose of the services, risks related to the services, limits to services because of the requirements of a third-party payer, relevant costs, reasonable alternatives, clients' right to refuse or withdraw consent, and the time frame covered by the consent. Social workers should provide clients with an opportunity to ask questions.
(b) In instances when clients are not literate or have difficulty understanding the primary language used in the practice setting, social workers should take steps to ensure clients' comprehension. This may include providing clients with a detailed verbal explanation or arranging for a qualified interpreter or translator whenever possible.
(c) In instances when clients lack the capacity to provide informed consent, social workers should protect clients' interests by seeking permission from an appropriate third party, informing clients consistent with the clients' level of understanding. In such instances social workers should seek to ensure that the third party acts in a manner consistent with clients' wishes and interests. Social workers should take reasonable steps to enhance such clients' ability to give informed consent.
(d) In instances when clients are receiving services involuntarily, social workers should provide information about the nature and extent of services and about the extent of clients' right to refuse service.
(e) Social workers who provide services via electronic media (such as computer, telephone, radio, and television) should inform recipients of the limitations and risks associated with such services.
(f) Social workers should obtain clients' informed consent before audiotaping or videotaping clients or permitting observation of services to clients by a third party.
1.13 Payment for Services
(b) Social workers should avoid accepting goods or services from clients as payment for professional services. Bartering arrangements, particularly involving services, create the potential for conflicts of interest, exploitation, and inappropriate boundaries in social workers' relationships with clients. Social workers should explore and may participate in bartering only in very limited circumstances when it can be demonstrated that such arrangements are an accepted practice among professionals in the local community, considered to be essential for the provision of services, negotiated without coercion, and entered into at the client's initiative and with the client's informed consent. Social workers who accept goods or services from clients as payment for professional services assume the full burden of demonstrating that this arrangement will not be detrimental to the client or the professional relationship.
