Test 1: Professional Boundaries, Ethics, Advance Directives, and Confidentiality • When you stand firm on your ethics, professional boundaries and

keeping confidentiality, your job is made easier for you and the family. It is essential to the success of every child’s program. In the next section we will discuss topics that will help you keep those strong professional boundaries, ethics and confidentiality practices in place while working at Learning ARTS. We will share our policies with you regarding professional guidelines, ethics, advanced directives and confidentiality. We pride ourselves in providing superior programs to our patients and the outcomes of our patients depend on you and your practices while working with families.

ETHICS

Ethics allow Learning ARTS personnel to help to determine what is the morally correct course of action irrespective of convenience, pressures, personal histories/preferences, etc.

Ethics help Learning ARTS personnel to answer: • What is the right thing to do?• What is worth doing?• What does it mean to be a good practitioner?

This Photo by Unknown Author is licensed under CC BY-NC

Procedures used in Applied Behavior Analysis (ABA)When working with patients there are the procedures used when working with patients that must follow certain standards (the BACB ethics code).• The ABA ethics code is set by the BACB. Procedures

used in ABA must:o Meet community standards o Be socially valido Generally agreed upon by society as importanto Abide by the lawo Respect and allow for individual freedomso Respects rights and preferences of patientso Empower patients

The core ethical principles for ABA include: • Do no harm taking care to improve the life of the patient and taking care to avoid unintended harm…such as

working outside of your area of competency• Respect autonomy (independence) means helping patients to gain more independent skills and plan for issues

that come with being more independent (don’t just teach a person to ride a bus, but also to read a map)• Benefiting others by seeking out to benefit others in the various situations where an analyst may find themselves• Being just by treating others as you would want to be treated• Being faithful by striving to be honest and trustworthy, follow through with your statements, and seek to develop

a good reputation• Treat clients with dignity• Treat others with caring and compassion• Pursuit of excellence by staying up to date on current research• Accept responsibility when something doesn’t go right and don’t give excuses• Document all professional work (data, notes, reports) Behavior Analysts have an obligation to collect and

graphically display data• Patient assessments will be performed by Learning ARTS Behavior Analysts to establish what skills to work on

ABA practitioners rely on scientifically and professionally derived knowledge when making judgments, or when engaging in professional endeavors

Coordination of CareABA practitioners at Learning ARTS are responsible to all parties affected by Behavior Analytic Services, if multiple parties are involved they will identify who the primary beneficiary is and make sure roles and responsibilities are outlined

Advance Directives

• Advance Directive is a written statement of a person's wishes regarding medical treatment, or financial arrangements made to ensure those wishes are carried out should the person be unable to communicate them themselves. • In California it is possible that someone even younger than 18 may have an advanced directive. Someone as young as 14 may have been legally emancipated. • Emancipation is a legal process where a minor legally becomes an adult.

The 2 most common types of advance directives are the Living Will and the Durable Power of Attorney for Health Care

• A Living Will is a legal document that provides guidance on what a person wants for their end-of-life care and medical treatment if you are unable to speak for yourself. For Example; Do Not Resuscitate (DNR), no nutrition, no breathing machine etc.

• Durable Power of Attorney for Health Care allows you to have legal control over your health care treatment in the event that you are unable to speak for yourself.

Policy: All Learning ARTS staff are expected to abide by the advance directives, when they are part of a patient’s file/profile. Written acknowledgement of advance directive and understanding of the advance directive will be required by all staff on the patient team.

Sample Acknowledgement Form

Employee ID#__________

Employee Name

I employee full name have received notice that an advance directive is in place for full patient name. My understanding of the advance directive is:__________________________________________________________________________

________________________________________________________________________________________________D

Printed Employee Name_______________________

Employee Signature__________________________

Date______________________________

First Notification_______

Updated Notification_________

CONFIDENTIALITY/STORAGE OF PATIENT RECORDSAll staff at Learning ARTS are required to keep PHI (Personal Health Information) secure/private at all times. The regulating of privacy is part of HIPAA (Health Information Portability Accountability Act) and HITECH (Health Information Technology for Economic and Clinical Health) Act.

In the next few slides you will learn your personal responsibilities, Learning ARTS’ responsibilities and Learning ARTS’ business associates (3rd parties we do business with) responsibilities.

MEET LEARNING ARTS PRIVACY OFFICER

Kelly Alvarez, Sr. Director Operationskalvarez@learningarts.com916.799.6158Anonymous reporting available in the employee and patient portal.Anonymous reporting will require you to leave pertinent information. Who was involved. What happened. When it happened. So I can report a breach, if required.

Kelly’s responsibilities include but are not limited to• Develop and implement written

policies/procedures (available in the portals)• Develop training for staff that handle PHI; establish

sanctions for the misuse of PHI (congratulations you are taking the training now, annually you will renew)

• Establish a complaint receipt process (contact information)

LEARNING ARTS IS A COVERED ENTITY AS A HEALTH CARE PROVIDER.

HIPPA imposes responsibilities on Learning ARTS as a covered entity and our staff including 3rd parties who partner with us. HIPAA ensures the following are a part of our business/services.

• Privacy Rule – grants individual rights with regard to their health information and imposes obligations on covered entities to protect all types of health information.

• Security Rule – requires covered entities to safeguard electronic health information. Confidentiality – Storage – Access electronic information.

• Electronic Data Exchange – transfer format of electronic information between providers and payers.

• HIPAA may impose penalties on individuals and covered entities for both intentional and accidental breaches concerning the release of PHI

BEFORE WE GO FURTHER LET’S DEFINE PHI (PERSONAL HEALTH INFORMATION). THIS IS DEFINED AS ANY INFORMATION THAT LINKS OUR WORK AND PATIENTS TOGETHER. PHI MUST BE SECURE AND PRIVATE AT ALL TIMES.

Examples of PHI• Name• Address• All dates directly related to patients including birthdate, admission

date, dates of service, discharge date• Phone/Fax numbers• E-mail addresses and URLs• Social Security Numbers• Unique identifying numbers, characters or codes• Identification numbers, including but not limited to, medical

record numbers, health plan numbers, certificate/license numbers, vehicle numbers (license/vin), device identifiers and IP addresses

• Billing or Account Receivable records• Patient Lists and Patient Data• Full Face photographic images and any comparable images

NOW THAT WE KNOW WHAT INFORMATION TO KEEP SECURE AND PRIVATE. WHAT FORM (TYPE) OF INFORMATION CAN BE CONSIDERED PHI?

• All types of paper records (including discarded)• Labels on patient items• Photos and Graphics• Electronic and Computer based records• Portable storage media• Video recordings• Verbal communications

BE SURE YOU KNOW WHO YOU ARE CHOOSING TO RELEASE INFORMATION TO. MAKE SURE YOU HAVE WRITTEN DOCUMENTED PERMISSION BEFORE YOU RELEASE PHI

These can be tricky relationships be sure you are confident who you can release information to.

Divorced ParentsStep ParentsCare Givers, Grand Parents, Siblings etc.Teachers/Schools

Check with a PCC (Patient Care Coordinator) if you are uncertain whether there is an active ROI (Release Of Information) on file.

FOLLOW THE MINIMUM NECESSARY RULEThe Rule ISOnly disclose PHI necessary for Treatment , Payment or Operations (TPO).

Identify First Identify First Identify First Identify First Identify First Identify First

Make sure the person you are talking to is who you think they are

PHONE CALLS-can they tell you 3 out of 4 of the following?1. Name2. Date of Birth (DOB)3. Address4. Learning ARTS patient ID5. Insurance ID number (only PCC may use this)

IN PERSON-can they prove the following?1. Their name and relationship to the patient2. Photo ID used to verify #1

and/or3. Business card used to verify #1

FIRST TYPE OF VIOLATION

IncidentalThis means reasonable steps were taken to keep the PHI secure and private, but someone happens to overhear or see PHI that you are using. Incidental disclosures are going to happen (even in the best of circumstances). Typically you are not liable for this type of disclosure

SECOND TYPE OF VIOLATION

AccidentalMistakes happen. You must learn from your error and revise a procedure to prevent it from happening again.A written corrective action plan is required.Typically this breach would need to be reported to federal and state authorities (depends on impact).Individual and Company penalties may be imposed from Federal and/or state agency/s.

THIRD TYPE OF VIOLATION

IntentionalThis means you ignore the rules and carelessly or deliberately use or disclose PHI or confidential information.Disciplinary action up to termination of employment. Individual and Company penalties may be imposed from Federal and/or state agency/s. Civil and/or criminal charges.

REMEMBER: Remember, it is your responsibility, as an employee or

provider, to comply with all privacy and security laws, regulations, and business policies pertaining to them.

Employees and providers suspected of violating a privacy or security law, regulation, or business policy should be provided reasonable opportunity to explain their actions.

Violations of any law, regulation, and/or business policy should result in disciplinary action, up to and including termination, according to Policy along with penalties imposed by Federal and State Agencies

Don’t be afraid to tell someone “no, I’m sorry I can’t disclose that until I verify some information”

• Dual Relationships-babysitting, attending patient parties, receiving or giving of gifts and business solicitation and or discounts, and exchanging personal information with families are against Learning ARTS polices.

• Social Media-Sharing information about families and taking pictures of patients for personal use is against Learning ARTS policies.

• Confidentiality-all patient records including but not limited to data, reports, and notes, are kept confidential at all times. This includes not approaching a family in public.

• Medical Advice-we do not provide medical advice to families.

Breaching professional boundaries, ethics, or a patient’s confidentiality and or patient's rights may result in immediate termination of employment. Ask a supervisor if you are not sure.

Are you Serious??

Test Professional Boundaries, Ethics, Advance Directives, and Confidentiality

Don’t sweat it: 5 questions true or false. When you submit your test it, will highlight any question you did not answer correctly. Read the question and answer again once you have answered the question correctly your test will be uploaded into your employee file. Good Luck: don’t forget to put your user ID number on the test and use your workemail in the required field. It is not necessary to download or email your test to yourself but the option is there if you would like to use it.