Is Wisconsin a Tarasoff State? What Does This Mean?
Yes, the state of Wisconsin follows the result in Tarasoff v. Regents of the University of California,
17 Cal. 3d 425 (Cal. 1976), a California Supreme Court decision which held that mental health professionals’ have a duty to exercise reasonable care in the treatment of their patients by warning others of threats of harm by the patient. See
Schuster v. Altenberg, 144 Wis. 2d 223 (1988). In Schuster, the Wisconsin Supreme Court held that the duty to warn extends to whatever other steps are reasonably necessary under the circumstances, including contacting the police, recommending or requiring hospitalization, or notifying a family member or friend who can help ensure safety. The case law in Wisconsin rejects the idea that the victim must be foreseeable; a psychotherapist has a duty to warn even if the actual victim was not foreseeable. Also, Wisconsin does not create a distinction between a generalized statement of dangerous intent and a particularized statement specifying the patient’s intended victims.
The ruling in Schuster was supported by later Wisconsin decisions in
Steinberg v. Jensen, 194 Wis. 2d 439 (1995), and
Wisconsin v. Agacki, 226 Wis. 2d 349 (1999). These decisions held that there is no privilege between psychotherapists and patients regarding communications relevant to the discovery of the physical, mental or emotional condition of the patient in a proceeding in which that condition is an element of the patient’s claim or defense. Thus, the principle that the confidentiality of patient communications gives way in certain instances is embodied even in the rules of evidence in court proceedings.
Does the Wisconsin Psychology Board's Rules of Professional Conduct Include a Tarasoff Exception?
Yes, Wis. Admin. Code,
PSY 5.01(12)(c) provides an exception to the prohibition against the breaching patient confidentiality if such disclosure is necessary to prevent injury to the client or other person. Thus, psychologists may disclose confidential information without the consent of the patient in order to warn potential victims and/or to contact the police when a patient presents a serious risk of danger to himself or others. In deciding whether to disclose and to whom to disclose, a psychologist is required to exercise reasonable care to protect the victim from the danger presented.
Does the American Psychological Association (APA) Allow a Psychologist to Disclose Confidential Patient Information in Certain Situations?
APA Ethical Principles of Psychologists and Code of Conduct (2002) provides that psychologist may disclose confidential information without the consent of the individual when mandated by law or permitted by law for a valid purpose, such as to protect the client, the patient, a psychotherapist or other third parties from harm.
What Should a Psychologist Consider in Determining Whether to Report Confidential Information Provided by a Patient That Involves Threats of Harm?
A psychologist should consider several factors in determining whether confidential patient communications involving threats of harm should be disclosed. These factors include the sincerity, capability, imminence and gravity of the threat. Psychotherapists may want to consider the following questions:
- Does this person have a genuine intent to inflict harm?
- Does the person have the ability and opportunity to carry out the threat?
- Is there some sense of immediacy to the threat?
- Is there a serious risk of harm?
Although it may be difficult to answer these questions definitively, they provide useful guidance to assess the risk presented by the patient. Ultimately, the psychologist should make an informed decision that reflects what a reasonable practitioner would do under similar circumstances.
A Client, in April, Informed a Psychologist That the Client Intends to Commit Suicide by Christmas. The Psychologist has not Seen the Client Since May of That Same Year. Should the Psychologist Report the Threat?
Chapter 51 of the Wisconsin Statutes, an imminent risk of harm is defined to be based upon “recent acts or statements.” If the patient made threats to take harmful action in the distant future, there is no imminent threat, and thus, no duty to warn or protect. However, if a threat by a certain date means that it could happen sooner, the psychologist has a duty to at least determine how soon the patient is considering. The psychologist must also consider whether the individual was still considered a patient at the time of the threat, or whether the patient/therapist relationship has been terminated. A psychologist who is not actively seeing an individual in therapy has no obligation to report the individual’s threat of harm to self or others. It is generally advisable to close a case 90 days after the last face-to-face contact to establish that the patient is no longer considered to be in active treatment and, consequently, the psychologist has no further professional responsibility to that patient unless the patient returns to therapy. During those 90 days, it would be clinically wise and ethically responsible, though, to periodically monitor the patient’s status, especially if a suicide threat was made shortly after ending therapy and the patient was unwilling to continue or return to treatment. However, it is important to note that the duty to warn/protect is different from the mandated reporting obligation of reporting suspected abuse or neglect of a child patient.
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In What Manner, and to Whom, Should a Psychologist Report a Threat of Harm by a Patient?
The responsibility to report a patient threat of harm to self or others may be fulfilled in whatever manner is most appropriate including contacting the police, recommending or requiring hospitalization, or notifying a family member or friend who can help ensure safety. Depending on the seriousness of the threat and the imminent ability of the threat to be carried out (e.g. the patient has a gun, has threatened to shoot a potential victim, and knows where to find that victim), the psychologist should act in a manner that is consistent with the seriousness of the threat in deciding how, and to whom, to report the threat.
Is a Psychologist Mandated to Report Suspected Child Abuse or Neglect if the Information is Obtained From an Alleged Perpetrator or Person Other Than the Alleged Child Victim?
No. Wis. Stats.
§ 48.981 (The Children's Code) mandates specific individuals including mental health professionals to report to the appropriate agency when, in the course of professional duties with the child, there is a reasonable suspicion that the child has been abused or neglected or has been threatened with abuse or neglect.
When the suspicion of child abuse or neglect derives from information provided by an alleged perpetrator or person other than the alleged child victim, a psychologist MAY report this suspicion without liability if the report is made in good faith. In addition, in accordance with two California Supreme Court rulings (1974 & 1976) a psychologist MAY have a duty to warn or protect victim or intended victim(s) or risk a negligence claim. Finally, most psychologists would consider such an action to fall within the
APA Ethical Principles of Psychologists and Code of Conduct (2002) if there is reasonable suspicion that a child is currently being harmed or if that child or other children are still at risk of abuse or neglect.
Is Suspected Elder Abuse a Mandated Reporting Requirement?
No. Currently, it is discretionary. However, the duty to warn and protect remains relevant.
Is a 14 Year Old's Permission Needed Before Records can be Released, and can a Minor who is 14 or Older Block Release of Records?
No to both questions. While a child over 14 may release mental health records, the parents also retain the ability to release and access records, even without the child's permission, unless denied periods of physical placement after divorce as stated in Wis. Stats.
Ch. 767 (Actions Affecting the Family). Under Wis. Stats.
48.396(1b), either a child over the age of 14 or his/her parents or legal guardian may release records without the signed release of the other. Thus, a child 14 or older cannot deny a parent access to his/her mental health records or prevent release of these records, unless that parent has been denied periods of physical placement. Parents may certainly be asked to respect confidentiality but cannot legally be denied access to records (even if it is not in the child's best interests) without a court order.
Under Wis. Stats.
51.47 (2) a health care provider or outpatient facility may only release records regarding outpatient, or detoxification, drug or alcohol services WITH the consent of a minor patient, provided the minor is 12 years of age or older.
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Can a Provider Send a Communication to the Board Asking Advice on Whether or not to File a Complaint?
No, the provider should send the complaint to the
Department of Safety and Professional Services, which permits the Board to investigate the matter. You will find the necessary information at the
Department’s website. The Board will not advise licensees about whether or not to file a complaint.
If I Fail the EPPP, How Many Opportunities Will I Have to Pass the Examination?
If you fail, you can apply for up to three more attempts for examination. If you fail after the fourth attempt, you will be required to petition the board for further opportunities to pass the EPPP.
As per Psy 2.08 Reexamination " An applicant who fails to achieve a passing grade in the examinations require...May apply for reexamination on forms provided by the board and pay the appropriate fee... An applicant who fails to achieve a passing grade may be reexamined 3 times at not less than 3 - month intervals.
If the applicant fails to achieve a passing grade on the third reexamination, the applicant may not be admitted to any further examination until the applicant reapplies to the board for permission to be reexamined and presents evidence satisfactory to the board of further professional training or education as the board may prescribe or approve following its evaluation of the applicant's specific case."
What are the CE Requirements for the Current Biennium?
Requirements for the current biennium can be found at the Board of Psychology's
Education Web Page on the Department Website.
Requirements for Psychology Licensing for International Graduates
The State of Wisconsin psychology licensure requirements are outlined in Ch
Psy 2 and
Stats 455.04, including:
- doctoral degree in psychology;
- 3000 hours (2 years) of supervised practice;
- Passage of the national exam (EPPP) and State Elements of Practice Essential to Public Health, Safety, or Welfare Examination, and;
- Oral interview if requested by the board.
These requirements apply to those graduates from jurisdictions within the United States of America and Canada. For candidates originating from other areas outside the USA and Canada, there are additional requirements as outlined in
Psy 2.13. Your degree must be evaluated by a degree evaluation service which is a member of NACES such as the World Education Service. In addition, you may be required to pass an examination of English proficiency.
Are Retired Psychologists Still Able to Practice?
For retired psychologists, pro bono work is acceptable as this does not constitute the “practice of psychology” since it is not being done for a fee per Wis. Stats. 455.01 (5). However, title restrictions do apply in these circumstances as the person is no longer licensed by the state (see Stats
455.01 (7)(a) and
Continuing Education requirements also apply to retired psychologists. These are outlined in Ch. Psy 4.02(1)(h) through (i).
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Can I Work in Wisconsin Without a Wisconsin License if I'm Licensed in Another State?
No. There is a temporary practice provision in Wisconsin statute that allows psychologists licensed in other jurisdictions to practice on a temporary basis in Wisconsin. For temporary practice to be allowed, the psychologist must have equivalent or greater license requirements in the jurisdiction of origin. The Wisconsin Board of Psychologists interprets this as at least 2 years of supervised practice (at least one postdoctoral), a PhD in psychology and passage of the EPPP exam.
If practice is going to exceed 20 days the board must be notified, and the psychologist may practice for up to 60 days in a year. See
stats. 455.03 and Wisconsin Administrative Code Section
What are the CE Requirements for the Current Biennium?
Requirements for the current biennium can be found at the Board of Psychology’s
Education Web Page on the Department Website.
Can a Trainee Have Only one Supervisor?
No. In order for the trainee to have diversity in training, they may be supervised by several licensed psychologists with different levels of expertise. This is noted in Psy 2.09 (3)(a)(5). While the trainee can have several supervisors, the primary supervisor that is specified in Psy 2.09(3)(a)(2) and (3) will be the responsible party for the quality of the trainee’s overall work.
When Documenting the Number of Hours of Supervised Experience, What Services Count Toward "Face-To-Face Client Contact Hours" and What Services Count Toward "Direct Service Hours?"
“Face-to-face client contact hours” are those spent working directly with your client. “Direct service hours” are those activities a psychologist performs that support the provision of face-to- face client contact hours. As described in Psy 2.09(3)(a)(9), examples of direct service hours include note and report writing, studying test results, case consultations and reviewing published works relating to the client's needs. Direct service hours do not include face-to-face client contact hours.
Can a Trainee Receive Payment for Services Provided During his or her Supervisory Training Period?
Per Psy 2.09 (3)(a)(8),"The trainee must inform potential clients in writing of his or her trainee status, lack of license, and of the possibility that insurance companies may not reimburse services rendered by the non-licensed trainee. Fees for client services may neither be billed independently nor accepted by the trainee." Trainees may not direct bill or charge for services and receive payment directly, however this is not to say that the clinic in which they work can’t bill for services and then pay the trainee as a service provider, with the caveat being that insurance carriers may choose not to reimburse for services provided by trainees. Please note that the Board does not regulate or provide information about billing/business practices, proper coding, etc. Professional associations and practice mentors are a more appropriate resource.
What is Within the Scope of Practice of a Psychology Trainee/Intern?
If the supervising licensed psychologist has sufficient training and experience in treatment of a particular disorder, they can train the resident intern in that area and the resident intern can provide those services (under supervision). See standards of supervised training outlined in Ch. Psy 2.09 for additional information.
Can Supervision be Obtained Through an Outside Contract?
Psy 2.09 (3)(b) notes that Supervisors shall not be a relative by blood or marriage nor be involved in any other dual relationship which obliges the supervisor to the trainee. Paying a supervisor creates a dual relationship. Therefore, if a supervisor is in a paid contract with the trainee, this would create a dual relationship.
Can Unlicensed Persons Provide Psychological Services?
Under the exceptions listed in Stats.
455.02 (2m)(b) a person may provide psychological services as directed by a psychologist who has the power to direct, decide and oversee the implementation of the services provided. In this sense, the services would be provided under the license of the psychologist and therefore any discipline that would be raised against the unlicensed individual would be reflected under the license of the supervisor.
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Fee Splitting for Referrals - Is This Acceptable?
While the rules do not explicitly prohibit this,
Psy 5.01(22) does provide guidelines as to the appropriate process for fee splitting. If the client is aware of the entire financial pictures it is acceptable to charge a client directly for a referral and receive a kickback. By knowing the entire picture the client must know who is involved, how an amount is determined and the actual dollar figure.
Are Fees and Fee Disputes Regulated by the Psychology Examining Board?
No, the board does not intercede in disputes involving issues such as fee disputes. However, the Wisconsin Psychological Association's Professional Issues Committee and its Ombudsman do respond to inquiries regarding disputes between professionals, ethics concerns regarding psychologists who are WPA members, and issues such as fee disputes.
Is There a Requirement for me as a Credentialed Professional to Report Unprofessional Conduct by Another Member of my own Profession?
No. Child abuse must be reported, and the reporting of sexual abuse by a therapist must be discussed with the victim, but mandatory reporting of unprofessional conduct has not been added to the Code of Professional Conduct. There is a statute, section
440.042 (2), that encourages people to report unprofessional conduct by a grant of civil immunity (“any person who in good faith ... provides the department or any examining board ... with advice or information on a matter relating to the regulation of a person holding a credential is immune from civil liability”) but a credential-holder is not subject to disciplinary action for failing to report unprofessional conduct by another.
Can out of State Credentials be Used in Marketing Materials Submitted in Wisconsin?
Title protection language found in Wis. Stats.
455.02 specifies that the use of the title “psychologist” or “licensed psychologist” requires the Wisconsin license. Likewise,
Psy 5.01(1) contains standards for conduct in advertising. This appears to prohibit the use of out-of-state credentials in Wisconsin sales materials.
Role of the Psychology Board
The Psychology Examining Board is authorized by law to protect Wisconsin citizens through the regulation and licensure of Psychologists and Private School Psychologists. The Board accomplishes this mandate through a variety of activities in collaboration with the Department of Safety and Professional Services (formerly known as the Department of Regulation and Licensing).
- Establish educational, experience and examination requirements for licensure.
- Monitor the continued competency of licensees through enforcement of professional conduct pursuant to
Psy 5, Wis. Admin. Code.
- Assess, investigate and discipline in response to complaints of unprofessional conduct. Board members serve as case advisors.
- Render the final decision in stipulated disciplinary matters and after formal administrative hearings.
- Establish continuing education requirements for license renewal and monitor compliance through random audits and enforcement actions.
- Promulgate administrative rules and procedures that promote the professional conduct of licensees.
- Publish scope of practice FAQs, position papers and other information for licensees and the public on the DSPS Psychology webpage.
Outside the Purview of the Board
- Questions relating to the structure and operation of public or private psychology practices, including business formation, billing, or insurance matters.
- Questions relating to research, analysis or information needed to complete educational courses or professional degrees. This includes questions from students or faculty regarding course assignments, dissertations or supervised practice prior to internship or post doc experience.
- Questions relating to patient/client care, treatment, or professional ethics.
- Questions relating to pending disciplinary complaints, malpractice litigation, or legal advice.
- Questions relating to employee-employer relationships.
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