Does legally mandated consent to psychotherapy ensure ethical appropriateness?: the Colorado experience

We analyzed a sample of 356 forms containing information that Colorado law legally requires both licensed and unlicensed therapists to disclose to clients. The majority of forms contained the legally mandated information; fewer forms contained ethically desirable information. The average readability grade level was 15.74, corresponding to upper-level college, and 63.9% of the forms reached the highest (most difficult) readability grade of 17+. Therapists are obeying the law, but do not appear to be taking advantage of the opportunity to provide their clients useful information in an accessible way.     

Are research participants truly informed? Readability of informed consent forms used in research

Researchers typically attempt to fulfill disclosure and informed consent requirements by having participants read and sign consent forms. The present study evaluated the reading levels of informed consent forms used in psychology research and other fields (medical research; social science and education research; and health, physical education, and recreation research). Two standardized measures of readability were employed to analyze a randomly selected sample (N = 108) of informed consent forms used in Institutional Review Board-approved research projects at a midwestern university during the 1987-1988 academic year. Results indicate that informed consent forms are typically written at a higher reading level than is appropriate for the intended population and that there are no consistently significant differences in readability among areas of research or between college student and noncollege student participants. Due to the unacceptably high reading level of the consent forms, one must question whether participants can comprehend the information contained in the consent form.     

The reading grade level of common measures in child and adolescent clinical psychology

The purpose of this article is to provide easily accessible readability information for 49 parent- and 35 child- and adolescent-report measures commonly used by clinicians and researchers. There is a great deal of variability in reading ability required across measures. The majority of parent-report measures (65%) required reading ability above the 8th grade level. The average child-/adolescent-report measure required reading ability above the 6th grade level. Given the potential contribution of readability to a measure's reliability, validity, and overall utility, examining and accounting for readability should be a more common practice in test construction and administration.     

Evaluation of the Informational Content,Readability and Comprehensibility of Online Health Information on Monogenic Diabetes

The purpose of this study was to assess the informational content, readability, suitability and comprehensibility of websites offering educational information about monogenic diabetes available to patients. The top 20 results from 15 queries in four search engines were screened. Content analysis was performed by two independent coders. Readability was determined using Flesch-Kincaid grade level (FKGL) and Simplified Measure of Goobledygook (SMOG). The Comprehensibility Assessment of Materials (SAM + CAM) scale was utilized to evaluate website suitability and comprehensibility. Only 2% (N = 29) of 1200 screened websites met inclusion criteria. Content analysis showed that 16 websites presented information on at least the most common forms of MODY (1, 2 and 3), four addressed the utility of genetic counseling, and none included support resources for patients. All websites exceeded the consensus readability level (6th grade) as assessed by FKGL (10.1 grade) and SMOG (12.8 ± 1.5 grades). Although the majority (N = 20) of websites had an overall “adequate” to “superior” quality score (SAM + CAM score > = 40%), more than one-third scored “not suitable” in categories of content, literacy demand, graphics, and learning motivation. The online educational resources for monogenic diabetes have a high readability level and require improvement in ease of use and comprehensibility for patients with diabetes.     

Form effects on the estimation of students' oral reading fluency using DIBELS

This study examined the effects of passage and presentation order on progress monitoring assessments of oral reading fluency in 134 second grade students. The students were randomly assigned to read six one-minute passages in one of six fixed orders over a seven week period. The passages had been developed to be comparable based on readability formulas. Estimates of oral reading fluency varied across the six stories (67.9 to 93.9), but not as a function of presentation order. These passage effects altered the shape of growth trajectories and affected estimates of linear growth rates, but were shown to be removed when forms were equated. Explicit equating is essential to the development of equivalent forms, which can vary in difficulty despite high correlations across forms and apparent equivalence through readability indices.     

Assessing the Readability of Mental Health Internet Brochures for Children and Adolescents

We investigated the readability of seven mental health brochures on mental, emotional, and behavioral disorders in children that were selected from a website developed by the Center for Mental Health Services at http://www.mentalhealth.org. The reading grade levels of the brochures ranged from 11.1 to 14.8 (mean 13.23), considerably higher than the 8th grade level recommended for educational material by the U. S. Department of Education (1986). On other readability variables, assessed using the Readability Assessment Instrument (RAIN; Singh, 1994), all brochures met criterion on most variables but failed on those for new words (audience appropriateness) and print size. This is a favorable result in comparison with other studies that have assessed readability of mental health information on the Internet using the RAIN, although less so with reading grade levels.     

Quality and readability of internet information about stuttering

PurposeWe examined the quality and readability of English-language Internet information about stuttering and evaluated the results considering recommendations by experts in health literacy.MethodA search of Internet websites containing information about stuttering was conducted. Three key words (i.e., stuttering, stammering, speech disfluency) were entered into five country-specific versions of the most commonly used Internet search engine. A total of 79 websites were assessed. Their origin (commercial, non-profit, government, personal or university), quality [Health On the Net (HON) certification and DISCERN scores], and readability [Flesch Reading Ease (FRE) score, Flesch-Kincaid Grade Level Formula (F-KGL), and Simple Measure of Gobbledygook (SMOG)] were assessed.ResultsOf the 79 websites, 38 % were of commercial, 42 % were of nonprofit organization, 15 % were of government and 5% were of university origins, respectively. Only 13 % had obtained HON certification and the mean DISCERN scores was 3.10 in a 5-point scale. The mean reading grade levels were at 13th and 14th grade and 100 % of the websites exceeded the recommended 5th to 6th reading grade level for health information.ConclusionsThe quality of Internet-based health information about the treatment of stuttering is generally adequate, but actual usability of the sites examined in this study may be limited due to poor readability levels. This is problematic in persons with poor literacy skills. Since the Internet can be readily accessed as a valuable consumer information resource, speech-language pathologists and other healthcare professionals have an opportunity to direct consumers to websites that provide readable information of good quality.     

Child abuse and the limits of confidentiality: forewarning practices

Confidentiality is widely considered to be of great importance in psychotherapy. With few exceptions, the breaching of confidentiality is an ethical violation and grounds for litigation. One such exception is the mandated reporting of known or suspected child abuse, representing a legally sanctioned limitation of confidentiality. Because clients generally expect unlimited confidentiality in therapeutic relationships, many therapists have begun to "forewarn" clients as a matter of informed consent. This research report: (a) briefly reviews issues surrounding mandatory reporting and confidentiality as they relate to forewarning, (b) defines and discusses forewarning as contrasted with "informing," (c) examines state statutes, case law and ethical guidelines relevant to forewarning, and (d) presents a survey of 428 mental health providers (MHPs) on their forewarning practices in which 36.9% forewarned all clients, 36.4% informed clients only upon suspicion of abuse, and 20.6% informed only after receiving a disclosure of abuse. The implications of these findings are discussed.     

From posts to protection: Ethical considerations regarding forensic psychiatrists and a duty to warn based on social media

Increasing use of social media in forensic mental health evaluations will lead to new challenges that must be resolved by forensic practitioners and the legal system. One such dilemma is the discovery of information that would typically trigger a legal duty and professional ethics obligation for mental health professionals to breach doctor-patient confidentiality to promote public safety and prevent harm to vulnerable third parties. Although the law and professional organizations offer clear guidance for practitioners in the treatment role, there is currently no clarity from the law or instruction from professional organizations on what mental health professionals should do if they discover such information during a confidential forensic evaluation. For example, a forensic evaluator may find evidence on social media of an evaluee’s threats to seriously harm others, abuse of children and the elderly, or severely impaired driving. There are no clear guidelines for how a forensic psychiatrist should respond in these complicated situations. We review the legal concepts and historical evolution of confidentiality, privilege, and mandated reporter duties that forensic practitioners should consider in these legally ambiguous situations. Finally, we discuss ethics frameworks practitioners can implement to determine their most ethical course of action when faced with such dilemmas.     

Ethical issues in therapy: therapist self-disclosure of sexual feelings

Although therapist sexual attraction to clients is common, and therapist self-disclosure is an often-used intervention, therapist self-disclosure of sexual feelings to clients is an understudied phenomenon. In this article, I critically review the small base of literature on therapist self-disclosure of sexual feelings, including information on prevalence rates, empirical research, and case studies. By incorporating these findings with information from relevant sections of the American Psychological Association (2002) Ethics Code, my intent is to evaluate different aspects of therapist self-disclosure of sexual feelings and arrive at conclusions regarding therapists' use of these disclosures. It appears that direct, explicit disclosure of sexual feelings can run the risk of harming clients and may therefore be unethical. Therefore, the use of this technique is discouraged. I discuss the issue of using less explicit interventions.     

"有偿新闻"的伦理批判

在新闻传播中,存在着“有偿新闻”的现象,这已是人所共知的事实。有偿新闻有多种多样的表现形式,其产生的原因也是多方面的。有偿新闻严重背离了社会法律与道德。遏止有偿新闻必须运用法律和道德调节两种手段。     

Confidentiality Limits With Clients Who Have HIV: A Review of Ethical and Legal Guidelines and Professional Policies

The publication of the first counseling articles addressing confidentiality limits of clients who have HIV (human immunodeficiency virus) and continue to be sexually active with an uninformed partner occurred 4 years ago. Since that time, dialogue about whether a helping professional may ethically and legally breach confidentiality has not resolved the dilemma but instead has created more questions and controversy for counselors. In this article the authors highlight the barrage of ethical issues regarding HIV and Acquired Immune Deficiency Syndrome (AlDS), review ethical and legal guidelines pertaining to HIV and AIDS and confidentiality, summarize HIV and AIDS confidentiality policies of the major helping professional organizations, articulate questions that contribute to the confidentiality dilemmas, and challenge the American Counseling Association (ACA), formerly the American Association for Counseling and Development (AACD), to develop specific guidelines for counselors.     

Ethical Considerations in the Treatment of Compulsive Hoarding

Although empirically supported treatment for compulsive hoarding is in its preliminary stages, some information has emerged regarding ethical challenges experienced in treating this population. Our aims are twofold: (a) to inform the clinical community of ethical complications when conducting treatment for hoarding clients, and (b) to provide a decision-making model for ensuring quality and ethical care of hoarding clients. The ethical challenges (boundary crossings, dual roles, privacy/confidentiality, record keeping, fees, and cultural competence in treatment) were discovered through multiple roundtable discussions, supervision, and in the course of delivering empirically supported treatment protocols. A literature search was conducted to identify research that addressed ethical concerns. A decision-making model addressing ethical challenges in treatment of compulsive hoarding was developed.     

The Intersession Report: Development of a Short Questionnaire for Couples Therapy

This article describes the Intersession Report, a short, easily administered nine-item questionnaire that clients complete at the beginning of each therapy session. This questionnaire was developed to enable clinicians and researchers to routinely collect standardized data on clients. Results showed that the Intersession Report has three subscales that represent Functioning, Symptoms, and Alliance. The subscales scores demonstrated multiple forms of validity and reliability. The Intersession Report provides clinicians a quick and easy way to assess clients. It also provides researchers information on clients who discontinue therapy and information that can be used in assessing attrition bias.     

THE READABILITY OF CONTENT TEXTBOOKS USED IN MIDDLE AND JUNIOR HIGH SCHOOLS

Current external criticism of American schooling includes an assumption that content textbooks used in upper grades fail to challenge the abilities of pupils. To investigate this assumption, the multiformula readabilities of 111 content textbooks currently employed in grades six through nine in 30 middle or junior high schools were obtained. Five and six formula, same sample readability data were collected and analyzed by 37 teacher researchers. Two or more formulas placed 49% of these texts one or more grade levels above grade of use. The results also were analyzed in light of current concerns about the accuracy and use of readability formulas. Readability placements varied notably and significantly between‐texts and within‐texts for each content area and grade level of use. Significant mean differences occurred in grade placement by formulas differing in comprehension criteria and in word count procedures. Extending sample selection from three to six and nine within‐text samples did not change readability estimates notably or significantly. Teacher researcher procedural error occurred rarely. Teacher participants preferred the formulas combining realistic school estimates with efficiency in estimation.     

The Ethical Dangers of Ethical Sensitivity

ABSTRACT All ethical systems seem to call for more ethical sensitivity. The dangers to personal life of too much ethical sensitivity have received much attention lately, in attempts to limit the demands of morality. But the ethical dangers of ethical sensitivity have hardly been noticed. I argue that, in a number of different ways, too much ethical sensitivity can be ethically harmful. The normative, the psychological and the pragmatic pictures are for more complex than is commonly realised.     

公德建设要超越伦理本位传统

公德是公共行为的道德规范.公德建设能够推动法治建设.在中国,由于长期伦理本位传统的影响,公德建设滞后,影响了中国道德建设,也遏制了中国法治建设的发展.推动中国公德建设必须超越伦理本位传统,将公德建设纳入法治轨道.     

Help Wanted: People With Disabilities and Recruitment Advertising

People with disabilities rely heavily on specialist agencies to find suitable employment. This research examines how agency consultants use recruitment ads in their work with clients. The authors analyzed the ads collected by consultants and learned that the ads were dominated by organization and job attributes. The ads contained less information about preferred applicant characteristics and selection procedures. Consultants used the ads to facilitate immediate matches between clients and employers, but they also used the ads to nudge clients in new career directions. The results reflect challenges consultants experience in balancing the long‐term needs of clients against the short‐term demands of employers.     

Ethical issues in internet counselling

This paper examines the advantages and difficulties associated with using the internet as a communication medium for counselling. Access to the internet is increasing rapidly and counselling services are starting to be offered to clients. Such services may be particularly attractive to clients who may not be able to find such services locally. The disadvantages of using the internet for counselling include the loss of the non-verbal communication level. The paper addresses the ethical implications of counselling in this medium. It concludes that there is a need for more guidelines in professional codes of practice.