PROFESSIONAL PRACTICE GUIDELINES FOR CLINICAL PSYCHOLOGISTS

WORKING IN THE

HOSPITAL AUTHORITY

Third Revision August 2004

Quality Management Subcommittee COC in Clinical Psychology

PREFACE
The ambition to write a professional guideline for clinical psychologists in Hong Kong dated back many years ago when there was but a handful of the profession working in the Hospital Services Department. In no time, it transpired that such a task was indeed mammoth in nature, where simplicity and conciseness often gave way to complexity and over-inclusion. In other words, we did not know where to begin; and, certainly, we did not know where to stop. There were a lot of talk and visions, but no one could muster the strength and courage to hit the first letter on the keyboard. From the mid1980’s onward, quality assurance became the buzz word for every profession and institution. The inception of the Hospital Authority in 1991, and the change-over to new management initiatives prompted some serious thoughts about guideline-driven practices. The wait for “someone will do it for us” proved to be futile. So, in one sultry mid-summer’s night in 1994, work finally started. It took almost a year’s painstaking concentration in front of the monitor to draft a document which, as history likes to repeat itself, often-time slipped into redundancy and over-inclusion. The original draft was written specifically for clinical psychologists working in the Kwai Chung Hospital cluster, and hence had a heavy mental health bias. In 1996, the draft was put to review by members of the Quality Assurance Subcommittee of the Central Coordinating Committee in Clinical Psychology (COC ClinPsych). The idea was to adopt the draft for use in a generic sense by all clinical psychologists working in the Hospital Authority. This called for some major revamp of the original draft which, after recent discussions in the new Quality Management Subcommittee, took its present form. No one is sure how good or how inadequate this document is, but we need to start somewhere. With your concerted efforts, comments, and feedbacks for further revision, we could build this derelict into an edifice.

Wong Chee Wing, PsychD Cluster Coordinator (Clinical Psychology) Kowloon West Cluster August 2004

INTRODUCTION
PURPOSE To provide clinical psychologists working in the Hospital Authority (HA) with guidelines to professional practice.

RATIONALE These guidelines are needed for three major reasons: • • • They provide a reference point for commonly accepted good clinical psychological practice standards; For clinical psychologists working in relative isolation, they provide guidance when expertise or experience is limited, and professional support is distant. Many of the professional issues are not addressed fully, at least in practical terms, in the post-graduate training courses of the Hong Kong University (HKU) and the Chinese University of Hong Kong (CUHK).

BACKGROUND The development and maintenance of high standards of professional practice is the responsibility of all clinical psychologists. This requires clinical psychologists to have a clear understanding of the expected standards, operationally defined and exemplified by benchmark criteria and core competencies. These guidelines apply to clinical psychologists engaged in face-to-face work with individuals, couples, families and groups, as well as clinical psychologists who work with systems at group, unit or organisational level, and clinical psychologists involved in program planning, policy, research, evaluation, teaching and training. Much of the information in the guidelines is presented in terms of principles that can be generalised to a range of situations. Much of the focus is on clinical aspects of the profession where the patient/client is an individual receiving treatment. The general principles can also be applied to work within the organization as a whole. The orientation of the guidelines is to indicate what is good practice, rather than adopting a negative approach and focus on `bad' practice.

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It is intended to review and revise these guidelines from time to time. Comments from clinical psychology colleagues to improve the guidelines are welcomed. While the guidelines are not mandatory, action which is contrary to the guidelines warrants serious and careful consideration. Clinical psychologists are advised to seek the opinion of an experienced colleague if considering actions that are contrary to these guidelines.

The QM Subcommittee COC for Clinical Psychologists June 2004

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MEMBERSHIP
(Quality Assurance Subcommittee) (1996-2003)

Dr. WONG Chee Wing (convenor)

Senior Clinical Psychologist

KCH

Dr. NG Kee On

Clinical Psychologist

PWH

Dr. Calais CHAN

Clinical Psychologist

PWH

Miss Sonia CHANG

Clinical Psychologist

KCH

Miss Mary WONG

Clinical Psychologist

PYNEH

Ms. Florence Kwok

Clinical Psychologist

CPH

Mr. Wilson Tsui (until April 1997)

Clinical Psychologist

QMH

Mr. George CHONG (from August 1997)

Clinical Psychologist

KCH

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MEMBERSHIP
(Quality Management Subcommittee) (2004)

Dr. WONG Chee Wing (convenor)

Senior Clinical Psychologist

KW

Mrs. Denise TSANG

Senior Clinical Psychologist

NTW

Ms. Amy KWOK

Clinical Psychologist

NTE

Mr. LI Sing Yuen

Clinical Psychologist

KE

Mr. Max WONG

Clinical Psychologist

KC

Ms. Nina WU

Clinical Psychologist

HKW

Ms. Mary WONG

Clinical Psychologist

HKE

Co-opted Members: Mr. George CHONG Clinical Psychologist KCH

Mr. Mike WONG

Clinical Psychologist

KCH

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ACKNOWLEDGMENTS

These Guidelines were compiled with extracts from:

Guidelines for the Professional Practice of Clinical psychology, The British Psychological Society, Division of Clinical Psychology, 1983, 1990,

Code of Professional Conduct, the Australian Psychological Society, 1986,

Professional Practice Guidelines for Clinical Psychologists, by Bruce Dufty, February 1989.

Code of Professional Conducts, the Hong Kong Psychological Society, 1991.

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CONTENTS
1. 1.1 1.2 1.3 1.4 2. 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 2.10 3. 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 3.10 4. 4.1 4.2 4.3 4.4 4.5 4.6 4.7 5. 5.1 5.2 5.3 Context Legislative framework Organisational structure Professional accountability Professional organisations Legal Responsibilities General Specific Informed consent Detained persons Children and adolescents Intellectually handicapped / mentally ill Suspected criminal behaviour by client Clients who are a danger to themselves / suicidal Clients who are a danger to others Professional Indemnity insurance Professional Responsibilities Referral process Decision to intervene Termination of intervention Special referrals Statutory clients Clarifying the relationship / Confidentiality Miscellaneous Personal conducts and Ethics Relationships with clients Fitness to practice Administrative Responsibilities Good practice Record keeping Clear and concise communication (oral / written) Security of psychologist’s records and psychological tests Official and personal client files Psychological reports Psychological testing Clients' Rights and Responsibilities Right to psychological treatment Right to information Right to choose

9 9 9 10

11 11 12 12 13 13 14 14 14 15

17 17 18 18 18 19 19 20 20 21

23 23 23 24 24 25 26

27 27 27

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5.3 5.4 5.5 5.6 5.7 5.8 5.9 5.10 5.11 5.12 5.13 5.14 5.15 5.16 6 6.1 6.2 6.3 6.4 7. 7.1 7.2 8.

Right to choose Right to privacy Right to complaint Clients' Responsibilities General Operation Guideline for compliance with the Personal Data (Privacy) Ordinance Client rights Informed consent Confidentiality Transfer of information to clients, other interested parties and government agencies Transfer of information to courts and lawyers Statutory clients Second opinion Use of behaviour management techniques Use of aversive techniques Quality Assurance General Evaluation Performance management Use and abuse of psychological principles Professional Development and Training Self Others Research

27 27 28 28 28 29 29 29 30 30 31 31 31 32

33 33 33 35

36 36 38

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1.
1.1 1.1.1

Context
Legislative framework Overall Clinical psychologists should have access to a copy of the "Code of Professional Conduct" published by the Hong Kong Psychological Society and be conversant of its contents. Specific Clinical psychologists should know those Acts and Ordinances that govern the work of their employing department or organisation, and the provisions of these that relate to their work. For example, Mental Health Ordinance, Chapter 136 published under Section 2(3) of the Laws (Loose-Leaf Publication) Ordinance 1990 (published in the Gazette on 10 April 1997 and up to date as of 17 November 2000).

1.1.2

1.2 1.2.1

Organisational structure Clinical psychologists should know about the structure of the organisation in which they are employed and where and how they fit within that structure, both administratively and professionally. Clinical psychologists should understand the position and the roles of clinical psychologists within their respective organisations. These include knowledge of line management arrangements, what types of roles they should fulfill, what are their clinical and administrative responsibilities, and how they relate to other groups within that organisation.

1.2.2

1.3 1.3.1

Professional accountability Clinical psychologists should know to whom they are accountable for their professional conduct and practice. While they have an overall corporate responsibility to their respective Hospital Chief Executives, they are also clinically and administratively accountable to their Line Managers depending on the administrative structure of their respective organisation. Ultimately, clinical psychologists are both accountable and responsible for the decisions they make and the actions they have taken.

1.3.2

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1.4 1.4.1

Professional organisations The professional organisation for psychologists in Hong Kong is The Hong Kong Psychological Society (HKPS). It is strongly advisable for clinical psychologists to be registered as a member of the Division of Clinical Psychology of the HKPS. There is also a Hong Kong Clinical Psychologists Association (HKCPA) which represents the social and industrial interests of its members. Overseas professional bodies include the Division of Clinical Psychology, British Psychological Society (B.P.S.), the College of Clinical Psychologists, Australian Psychological Society (A.P.S.), and Division 12 of the American Psychological Association (A.P.A.). Clinical psychologists should also ensure that they are properly registered as qualified test users of the major psychological testing distribution agencies such as the National Foundation of Educational Research (NFER) and the Psychological Corporation (Psy Corp) in the United States.

1.4.2

1.4.3

1.4.4

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2.
2.1

Legal Responsibilities
General

2.1.1 Clinical psychologists working within the Hospital Authority operate according to the policies of the parent corporate body, i.e. the Hospital Authority Head Office (HAHO) as well as the policies of their individual departments and subsidiary organisations (hospitals, clinical management teams, allied health services). 2.1.2 The clinical psychologist is accountable to the organisation while working within the framework provided by those policies. 2.1.3 The clinical psychologist's employer, defined more specifically as the HAHO, is vicariously liable for the actions of its professional staff. 2.1.4 It is the responsibility of the employing body to ensure that responsibility and accountability are assigned directly or by delegation to employees having the recognised knowledge, skills and expertise. 2.1.5 Clinical psychologists should recognise that within the above framework they are also legally and professionally responsible for their own actions or omissions, and that no other individual can assume this responsibility. 2.1.6 It is thus vitally important that clinical psychologists operate within the policies and framework of their employer, and that they comply with the requirements of the Code of Professional Conduct of The Hong Kong Psychological Society. 2.1.7 For extra personal and professional protection, private insurance coverage can also be arranged via the Hong Kong Clinical Psychologists Association (HKCPA). (see also 2.10)

2.2 2.2.1

Specific Students and other professionals Where a clinical psychologist supervises another individual such as an unqualified clinical-psychologist-in-training, a clinical psychologist trainee, or a member of another profession(i.e. the supervisee), then that particular clinical psychologist (i.e., the supervisor) is responsible for the actions of supervisees only in so far as the supervisee's actions arise directly from, or are a consequence of, the supervision or direction given, or the supervisor's failure to provide adequate or necessary supervision or direction.

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2.2.2

Notwithstanding coverage under Public Liabilities of public institutions, supervisors should ensure that the supervisees are adequately covered by insurance policies of his/her seconding institution, e.g. the universities;. Prior to start of supervision, all supervisees must have proof that they have attended the prescribed infection control courses, and be informed of environmental hazards accordingly. Volunteers (e.g. summer vacation work experience students) are covered by the Public Liability policy of the hospital. Supervisors are encouraged to observe HR policies pertaining volunteers in their respective institutions.

2.2.3

2.2.4

2.3 2.3.1

Informed consent Whereas the term “intervention” is used in the succeeding paragraphs, the statements apply equally well to other psychological procedure such as “assessment”.

2.3.2 Clinical psychologists should obtain valid consent prior to intervening. For consent to be valid, clients must have an appropriate understanding of the nature, the implications and the possible consequences of proposed interventions or procedures. 2.3.3 Consent may take the form of voluntary co-operation (implicit consent), verbal consent or written consent. Where clinical psychologists are doubtful or unsure that consent is being given, it should be sought in an explicit form, preferably in writing. In circumstances where complete information might defeat the aim of intervention, or where, for other reasons, the provision of complete information is thought undesirable, clinical psychologists should exercise great caution. Before proceeding they should take all due care to satisfy themselves that the proposed intervention is consistent with the client's declared goals and is unequivocally in the client's best interests. The obligation to secure the client's valid consent based on an appropriate understanding remains. Clinical psychologists should respect a client's right to withdraw consent to an intervention after it has commenced.

2.3.4

2.3.4

2.4 2.4.1

Detained persons Where a person is compulsorily detained for treatment under the provisions of the Mental Health Ordinance Chapter 136 (up to date as of 17 November 2000), or where the person is otherwise directed by a Court of Law to receive treatment, (e.g. under Sections 3.2, 3.3 and 3.6), clinical psychologists should recognise

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that the person is not necessarily in a position to withhold consent to intervention. Nevertheless, they should make every effort to obtain the person's valid consent to any intervention offered. Where a clinical psychologist considers intervention against the expressed wishes of the person is necessary, he/she should first obtain a second opinion from the Senior Clinical Psychologist, or a clinical line manager to whom he/she is accountable, prior to proceeding.

2.5 2.5.1

Children and adolescents Normally, parental or guardian consent should be obtained prior to psychological involvement with children and adolescents (as a guide, up to the age of 16). At the present time the responsibility for decision-making in matters of psychological practice is shared between the child, the parents or guardians, and clinical psychologists exercising professional discretion, subject to overview by welfare authorities and the courts. There is no requirement that the consent of a parent or guardian is either mandatory or is sufficient authority to conduct a psychological intervention with a minor. The definitive statement on principles involved with the consent with minors comes from a medical treatment case before the British House of Lords [Gillick v West Norfolk Health Area Authority (1985) 3 ALL ER 402]. The U.K. House of Lords regarded the applicable law to be as follows: (i) A parent's rights to determine whether or not his or her child can have medical treatment (psychological treatment) ceases when a minor achieves sufficient capacity to understand the nature and consequences of the proposed treatment. There is no fixed age when a minor gains this capacity and it will always be a question of fact as to whether a minor has that capacity. Until a minor achieves the capacity to consent the parental right to decide continues except in exceptional circumstances (emergency, neglect, abandonment or inability to find the parents) where treatment without parental consent can be justified.

2.5.2

2.5.3

(ii)

2.6 2.6.1

Learning Disabled / Mentally Ill Where a person is severely mentally handicapped or mentally ill, clinical psychologists should seek to obtain the person's consent to intervention, recognising that the person's consent may not be valid.

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2.6.2

Clinical psychologists should take care to satisfy themselves that the proposed intervention is in the best interests of the person concerned. Wherever possible clinical psychologists should take steps to give an appropriate explanation to an involved and responsible relative or guardian regarding the nature, implications and possible consequences of their interventions. Where the person is severely mentally handicapped or mentally ill and refuses consent to intervention, clinical psychologists should consider the need to ensure that the person receives help through the appropriate agent legally empowered to intervene without the patient's consent.

2.6.3

2.6.4

2.7 2.7.1

Suspected criminal behaviour by client Clinical psychologists should advise clients, when appropriate, of the limits of confidentiality when those limits might be breached by clients (e.g., when interviewing offenders). Clinical psychologists may not disclose information about criminal acts of clients unless there is an overriding social or legal obligation to do so. Advice from more senior clinical psychologists or line managers should be sought where appropriate.

2.7.2

2.8 2.8.1

Clients who are a danger to themselves/suicidal From time to time, clinical psychologists may become aware of clients who exhibit: disturbed ideation, behaviour or affect; potentially suicidal or selfinjurious behaviour or intentions; or other emotional or social vulnerabilities. Clinical psychologists must take action to reduce any risk to the client. Clinical psychologists should seek appropriate assistance from a more experienced clinical psychologist, from the client's case manager or some other professional with expertise.

2.8.2

2.9 2.9.1

Clients who are a danger to others From time to time, clinical psychologists need to be aware that clients may be potentially dangerous to others. The Hong Kong Psychological Society Code of Professional Conduct endorses the position of limited breaches of confidentiality and states that disclosure of confidential information should only occur with a person's consent except in unusual circumstances "where there is sufficient evidence to raise serious

2.9.2

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concern about the safety or interest of clients, or about others who may be threatened by the client's behaviour". In such exceptional circumstances, "Members shall take such steps as are judged necessary to inform appropriate third parties even without the prior consent of the clients. Whenever possible, Members shall consult an experienced and independent colleague beforehand". 2.9.3 On disclosure by a client of an intention to harm, clinical psychologists should inform the client that they are going to seek advice if appropriate, inform the client if this action is not likely to increase immediate risk and report to the appropriate agency, such as the Police. The Tarasoff case in the US was the landmark legal case in this area, where it was ruled that clinical psychologists have a duty to warn and to protect the foreseeable victim of that danger, even when this breaches confidentiality. The two considerations are: the questionable ability of clinical psychologists to predict future violent behaviour, and the role of confidentiality in therapy. Furthermore, a definition of dangerousness may be difficult.

2.9.4

2.10

Professional Indemnity Insurance

2.10.1 HA Policy - according to the HA Human Resources Manual (26 July 1994):
The HA pledges to arrange for insurance cover for professional indemnity for allied health staff. “Claims may be granted provided that any action that has led to such claims is believed to be done in good faith in the course of official duties.” (HA Human Resources Manual Chapter G9)

The Hospital Authority states that it will:
(a) (b) (c) protect and uphold its reputation as well as that of its employees; provide legal assistance to its employees in criminal proceedings and civil actions alleging professional negligence in approved circumstances; and define the limits of liability of the Hospital Authority and its interests in such proceedings.”

(a)
(b)

Main conditions under which Legal Assistance may be provided to employees if he/she is: charged with offences under the Road Traffic Ordinance committed in good faith whilst on duty;
charged with criminal offences other than traffic offences or corruption-related offences if the HCE or the HAHO is satisfied that “the accused was acting in the due and faithful discharge of his duties to the HA”;

(c)
(d) (e)

served a writ or a letter threatening civil proceeding in relation to matters arising out of his employment of official duties;
injured while on duty by the wrongful act of a third party. (Chapter G10) filing legal proceedings for libel or slander in connection with matters arising out of their official duties.

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2.10.2 Legal responsibilities as supervisor to Clinical-psychologists-in-training Clinical Supervisors are not covered by the insurance policy of the universities. 2.10.3 Recommendations As described in the above paragraphs, even though HA may provide legal assistance to HA-employed clinical psychologists in some circumstances, it will be advantageous for the individual clinical psychologist to have their own personal cover, to look after their own interests, even where an employer provides the necessary indemnity. (see 2.1.7)

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3.
3.1 3.1.1

Professional Responsibilities
Referral process Clinical psychologists receive referrals according to the service provision policies of a service unit or department. This may include self referrals and referrals from a third party. Client needs and referral reasons should be specified by referral agents/agencies so that clinical psychologists can reach a speedy decision regarding the appropriateness of the referral. To assist such referral agencies, clinical psychologists should supply guidelines as to what constitutes an appropriate referral. When the referral is accepted, information and feedback should be provided to the referrer, particularly in the case of non-government professionals (e.g., GPs) or organizations(e.g. NGOs). Where the referral is not accepted, the clinical psychologist should advise the referrer and give reasons. When the needs of clients fall outside the boundaries of clinical psychology or of the clinical psychologist's expertise, clinical psychologists should refer such clients to an appropriate service provider. Clinical psychologists are responsible for taking reasonable steps to familiarise themselves with the issues addressed by other disciplines, the approaches they adopt and the service(s) they offer, so they can competently refer clients.

3.1.2

3.1.3

3.1.4

3.1.5

3.1.6

3.2 3.2.1

Decision to intervene Clinical psychologists should intervene only if they consider they can contribute significantly towards a solution or resolution of problem(s) of a psychological nature. Clinical psychologists should only accept referrals that involve behaviour or problems for which there is an acknowledged body of psychological knowledge or to which the scientific method can be applied. Clinical psychologists should only accept referrals that are within the boundaries of their competence, or the competence of another member of their profession. In the latter case, clinical psychologists will become involved with a client either (a) to refer the client to another clinical psychologist, or (b) to be supervised by a professional with competence in the area.

3.2.2

3.2.3

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3.3 3.3.1

Termination of intervention Clinical psychologists must terminate a professional relationship when it is clear that the client is not benefiting from it. Clinical psychologists should offer to help clients locate alternative sources of assistance where appropriate. When there is evidence of a problem or issue with which the clinical psychologist is not competent to deal with, and supervision is not appropriate nor available, the clinical psychologist must make this clear to the client and must offer to refer the client to an appropriate source of expertise. In terminating relationships with clients, clinical psychologists should have regard for the psychological well being of the client. Should changes in clinical psychologists' employment, health or other factors necessitate early termination of a relationship with a client, clinical psychologists should provide clients with an explanation of the need for such early termination. They should take all reasonable steps to safeguard clients' ongoing welfare.

3.3.2

3,3,3

3.4 3.4.1

Special referrals (e.g. colleagues, staff, students, prominent persons) Clinical psychologists should normally avoid professional practice with a client with whom they have prior professional or close social contact, for example a colleague, a student or an acquaintance. In such circumstances the clinical psychologist should assist in securing equivalent psychological services elsewhere. Clinical psychologists should normally avoid professional practice with clients who do not wish to have their identities recorded on official departmental files and in statistics (e.g. prominent persons, staff members). In such circumstances, clinical psychologists should assist the person in securing psychological services elsewhere. There may be exceptions to this directive, for example, where there exists a legal requirement for that clinical psychologist's employing agency to be involved. Occasionally, clinical psychologists may be faced with referrals where there are no alternative psychological services, and the identity of the client concerned needs to be kept confidential. Such cases would be monitored and reviewed in the normal way, without identifying documentation.

3.4.2

3.4.3

3.5

Statutory clients This includes working with clients where authority to do so has come from a government department e.g., CSD, the Courts, or the legal or judicial systems.

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3.6 3.6.1

Clarifying Relationship / Confidentiality Where the clinical psychologist is seeing a client who has been referred by a third party and there is an obligation to report to a third party, it is important that the clinical psychologist inform the client of this fact. The clinical psychologist should advise the client that the clinical psychologist may not be able to maintain confidentiality if the client discloses information about illegal activity (see also 3.7 Suspected Criminal Behaviour by Client). It may also be advisable to inform the client that the clinical psychologist's notes and other written materials can be subpoenaed by Courts of Law. The clinical psychologist should also advise the client of: ² the purpose of the clinical psychologist seeing the client; ² the client's right to participate in the process; ² any potential consequences that may occur if the client decides not to cooperate in the process; ² what information will be passed on to the third party; ² what information need not be passed on to the third party. In most circumstances it is appropriate to explain to the client what will be in a report provided to the third party.

3.6.2

3.6.3

3.7 3.7.1

Miscellaneous Consent The informed consent of the client should always be sought prior to carrying out any intervention. Where a client is judged to be too young or too immature to understand the implications of giving consent, such consent should be sought from the client's parent or guardian. Assessment The purpose of assessment should always be explained to the client. The client has the right to withdraw from assessment at any stage during the process. Treatment Treatment should occur with the free and informed consent of the client. The client has the right to withdraw consent after treatment has commenced. Reports The client has the right to know what is said of him or her. Usually, a brief verbal feedback would suffice. Where the client is too young to understand the report, consideration should be given to showing the report to the parent or guardian.

3.7.2

3.7.3

3.7.4

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3.7.5

With children, it is important to consider where and to whom the report is going. It is important to be mindful of the best interests of the child in circumstances where control or the access to the report cannot be guaranteed.

3.8 3.8.1

Personal Conduct and Ethics Personal conduct The Code of Professional Conduct of The Hong Kong Psychological Society applies to all clinical psychologists. The following are the three General Principles of the Code:

Responsibility Clinical psychologists remain personally responsible for the professional decisions they take actions and to make every effort to ensure that their services are used appropriately. Competence Clinical psychologists shall bring reasonable skill and learning to their area(s) of professional practice. They shall not misrepresent their competence, qualifications, training or experience and shall refrain from offering or undertaking work or advice beyond their professional competence. Propriety The welfare of clients, students, research participants and the public, and the integrity of the profession shall take precedence over a clinical psychologist's self interest and the interests of the clinical psychologist's employer and colleagues.

3.8.3

Clinical psychologists must respect the confidentiality of information obtained from persons in the course of their work as clinical psychologists. They may reveal such information to others only with the consent of the person or the person's legal representative, except in those unusual circumstances in which not to do so would result in clear danger to the person or to others. Where appropriate, clinical psychologists must inform their clients of the legal or other contractual limits of confidentiality.

3.9 3.9.1

Relationships with clients Clinical psychologists must not exploit their professional relationships with clients, supervisees, students, employees or research participants sexually, financially, or in any other way.

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3.9.2

A sexual relationship between a clinical psychologist and a client is never acceptable. It is unethical to engage in any form of activity that could be construed as sexual with the client. It is improper for clinical psychologists to have sexual relationships with former clients unless the former client is no longer vulnerable to an approach by virtue of the past professional relationship. It is improper for a clinical psychologist to solicit or accept gifts from clients. An exception may be when a gift is unsolicited and inexpensive (e.g., a box of chocolates) and refusal to accept the gift may adversely affect the working relationship with the client. When practising professionally with a person which necessarily involve(s) physical contact or other actions that may be considered or interpreted by the patient as being improprietous, clinical psychologists should consider the advisability of an appropriate `chaperone' in order to avoid any ambiguity in the circumstances. Clinical psychologists are advised to be conversant with the materials, contents, and suggestions raised in Bersoff, D.N. (2003). Ethical Conflicts in Psychology (Third Edition) published by the American Psychological Association.

3.9.3

3.9.4

3.9.5

3.9.6

3.10

Fitness to practice

3.10.1 Clinical psychologists should not attempt to carry out their professional activities when no longer able to do so competently by reason of their physical condition or psychological state. If they are in doubt about their ability to perform competently, they should seek appropriate professional advice. Where clinical psychologists continue to carry out professional activities although clearly unable to do so competently, it is the duty of colleagues to try and persuade them to desist and, where necessary, to seek treatment. 3.10.2 Clinical psychologists must recognise that if they engage in criminal acts, they will damage public confidence and harm the profession. 3.10.3 Involvement in acts of indecency, violence or dishonesty by clinical psychologists is likely to have damaging consequences, since its public knowledge will undermine professional relationships. 3.10.4 Clinical psychologists should recognise that public abuse of alcohol or drugs is liable to bring themselves and the profession into disrepute. 3.10.5 Clinical psychologists should appreciate that their professional competence may be temporarily diminished and their judgment temporarily impaired through the

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ingestion of drugs or alcohol, for either medical or social reasons. Clinical psychologists should endeavour to conduct themselves so as to minimise the risks of impairing their judgment and competence. 3.10.6 Clinical psychologists should be sensitive to prevailing public standards of behaviour and should consider the consequences of deviating from such standards.

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4.
4.1 4.1.1

Administrative Responsibilities
Good practice Clinical psychologists should recognise that there are administrative aspects to the execution of their professional duties. For psychological services to be effective, these should be attended to efficiently and competently. They should comply with the legal requirements in Hong Kong governing the collection, retention, use, and communication of personal data of their clients, such as the Personal Data (Privacy) Ordinance.

4.1.2

4.2 4.2.1

Record keeping (client records and administrative records) Clinical psychologists should keep only such records as are necessary for optimal service delivery to the client and efficient provision of psychological services. Clinical psychologists must make provisions for maintaining confidentiality in the storage, access and disposal of client records, subject to the legal and administrative requirements of their employment organization.. Clinical psychologists should ensure that an appropriate response is made to every referral received, such that a record is made of the referral and the action taken, and such that the client (where appropriate) and the referring agent are informed of the outcome of the referral. Clinical psychologists should maintain adequate records of all contacts with each client and with others (e.g., staff, relatives) involved with the client, indicating date, time and place of attendance, those present and the nature of the service provided or action taken. Clinical psychologists should maintain adequate records of their administrative activities by retaining copies (electronic or otherwise) of correspondence, minutes of meetings and other documentation for future reference by themselves or other clinical psychologists who may take over their duties.

4.2.2

4.2.3

4.2.4

4.2.5

4.3 4.3.1

Clear and concise communication (oral / written) Undue invasion of privacy must be avoided in the collection and dissemination of information. Information obtained in clinical or consulting relationships, or evaluative data concerning children, students, employees or other clients, may be communicated only for professional purposes and only to persons

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legitimately concerned with the case. Written and oral reports may present only data germane to the purposes of the evaluation. 4.3.2 Clinical psychologists should take care to include in written reports only such material as required for the purposes of the report. Superfluous material should be excluded. When personal information is communicated to others, clinical psychologists should ensure recipients are notified of the confidential nature of the information, and subject to the legal requirements, where appropriate, prior consent from client may be necessary.

4.3.3

4.4 4.4.1

Security of psychologist’s records and psychological tests Clinical psychologists should take steps to guard against the misuse, loss or misappropriation of equipment, test materials and records that relate to the provision of psychological services. Strict control should be maintained over the availability of such materials to unqualified personnel. In the event of a clinical psychologist terminating employment with the service provider, and no qualified clinical psychologist remains, he or she must ensure that equipment, test materials, records and a written inventory thereof are left in the safe-keeping of an appropriate senior administrator, drawing attention to the fact that access to such information be restricted to only qualified clinical psychologists.

4.4.2

4.5 4.5.1

Official and personal client files Official client files Clinical psychologists should recognise that the official client records (i.e., file, register, attendance records) are the property of the employing organization. They should consider carefully the nature of the information about the client that they commit to permanent record. Personal client files Clinical psychologists' personal client files are also the property of the employing organisation. They are an extension of the official records. Clinical psychologists should recognise that it is often not possible to make valid interpretations of certain materials on these files where memory of the original context has faded or there was no involvement in obtaining the material. Furthermore, it is often difficult to interpret the meaning of old material in relation to the present, even if the original context is known and clearly remembered.

4.5.2

4.5.3

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4.5.4

Destruction of some dated information on clinical psychologists' personal client files can be in the interests of all parties (i.e., client, clinical psychologist and department). However, inappropriate timing and destruction of reliable materials can place the clinical psychologist and the employing organization in an indefensible situation if their actions are legally challenged. Guideline to the timing of destruction of such records and materials are stipulated by individual hospital or departmental policies. Professional supervisors should be consulted prior to the destruction of any personal client file records.

4.5.5 Closing client files Where a clinical psychologist is closing a file on a client, it is desirable to provide a case summary on file. The summary should include the following: • • • • • • full identification details (name, date of birth, address) nature of psychological involvement dates (or period) of service type of intervention clinical psychologist's assessment of primary presenting problem at beginning and end of treatment significant changes and outcomes from the psychological intervention

4.5.6 Where the clinical psychologist is leaving the setting, but the client requires continuing psychological treatment, this should be clearly stated in the clinical psychologist's closing report and communicated directly to the clinical psychologist's supervisor (with a copy of the closing report).

4.6 4.6.1

Psychological reports Psychological reports should be written such that they contain the following features: • essential factual information (dates, names, referral details, assessment procedures); • the referral questions should be adequately addressed; • the appropriate assessment procedures should have been employed; • the conclusions and interpretations should be soundly based; and • the writing should be objective. Psychological reports should be written with a specific audience in mind. Files (see 4.2) Case presentations When details of a case are used for illustrative or teaching purposes, the clinical psychologist involved must ensure that the identity of the client is adequately concealed and that the client's right to privacy is observed.

4.6.2 4.6.3 4.6.4

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4.6.5

Courts (including privilege) (see 11. Courts)

4.7 4.7.1

Psychological testing Clinical psychologists should be aware that psychological assessment involving tests and other procedures may be stressful for the testee. Clinical psychologists should make every effort to minimise distress without invalidating the assessment instruments. Clinical psychologists should administer tests only when this is judged to be in the best interest of the client. Qualification and training (see ACER & Psychological Corporation guidelines) Tests as selection and assessment instruments Disclosure to non-clinical psychologists Clinical psychologists should communicate tests results and assessments to appropriate persons, guarding against misuse and misinterpretation. Generally, an interpretation, including implications, of a test result rather than a test score is communicated. Security (see 4.4)

4.7.2

4.7.3 4.7.4 4.7.5

4.7.6

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5
5.1 5.1.1

Clients' Rights and Responsibilities
Right to psychological treatment The right to receive clinical psychology service, both assessment and treatment, which fully meets the currently accepted standards as stipulated by The Hong Kong Psychological Society.

5.2 5.2.1

Right to information The right to information about what clinical psychology services are available, and what charges are involved. The right to be given a clear description of your psychological condition, with problem formulation, prognosis, and the treatment proposed. The right to know the assessment methods / psychological approaches of treatment to be used, and the required commitment in terms of time and effort. The right of access to the psychological information which relates to your condition, or assessment and treatment.

5,2,2

5,2,3

5.2.4

5.3 5.3.1

Right to choose The right to accept or refuse any assessment or treatment procedures, and to be informed of the likely consequences of doing so. The right to a second opinion from another clinical psychologist. The right to choose whether or not to take part in psychological research programmes.

5.3.2 5.3.3

5.4 5.4.1

Right to privacy The right to have your privacy, dignity and religious and cultural beliefs respected. The right to have information related to your psychological condition kept confidential.

5.4.2

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5.5 5.5.1

Right to complaint The right to make a complaint through channel provided for this purpose by The Hong Kong Psychological Society, and to have any complaint dealt with promptly and fairly if the defendant is a member of the Society.

5.6 5.6.1

Clients' Responsibilities Give your clinical psychologist as much information as you can about your psychological condition, past mental illnesses, personal and family history, and any relevant details. Following the assessment and treatment plan as mutually agreed by you and your case clinical psychologist, and conscientiously comply with the agreed treatment regime.

5.6.2

5.6.3 Keep any appointments that you make, or notify the clinical psychologist or the relevant personnel in question as early as possible if you are unable to do so. 5.6.4 Should not ask the clinical psychologist to provide incorrect information, reports, or certificates.

5.7

General Operation Guideline For Compliance with the Personal Data (Privacy) Ordinance Compliance with the Personal Data (Privacy) Ordinance It is advisable that for each clinical psychology unit, a clinical psychologist may be appointed to be the subject officer to ensure compliance with the Ordinance by that unit. Security of Personal Data Records and assessment protocols of clients should be properly stored and locked up to protect them against unauthorized or accidental access, processing, erasure or other use. Electronic storage and transmission of personal data, including mobile carriage of storage devices, should advisably by encrypted. Clinical psychologist should not keep clients’ records or films on their own to avoid their loss. Use of Personal Data In general, communications should be restricted to only the referral agent and other professionals directly involved with the care of the client. Clinical psychologists should explain to the client the nature of such communications. Clinical psychologists should obtain the client's valid consent in an explicit form (i.e., written or witnessed).

5.7.1

5.7.2

5.7.3

5.7.4

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5.7.5

The personal data cannot be used for purposes other than those purposes the client has been advised at the time of collection, i.e., assessment, treatment, research and education. The personal data should not be transferred/disclosed to other parties except the followings: • Appropriate persons of the institutions in which the clinical psychologists are working • Clinical psychologists/doctors/other relevant persons outside the work setting of the psychologists who require it for matters related for the patient's health care purposes • Relevant government departments/appropriate authorities when the institutions in which the clinical psychologist are working in is required to provide it under the relevant legislation for use for the purposes of the legislation • Health care or directly related purposes • Permitted by law

5.8

Client rights (see 5.1 ~ 5.5)

5.9

Informed consent (see section 2.3)

5.10

Confidentiality

5.10.1 Clinical psychologists should recognise that information acquired by them about clients is confidential within the limits of the law. This means that clinical psychologists do not have privilege regarding communication and all reports, personal notes and records (audio and visual) can be subpoenaed by courts. 5.10.2 In general, communications should be restricted to only the referral agent and other professionals directly involved with the care of the client. Clinical psychologists should explain to the client the nature of such communications. Clinical psychologists should obtain the client's valid consent in an explicit form (i.e., written or witnessed). 5.10.3 Clinical psychologists must not refuse any reasonable request from clients, or former clients, for the release of data for which they have professional responsibility. Such psychological data may be released only to appropriately qualified persons who have a legitimate interest in such data, subject to the legal requirements of their employment conditions. 5.10.4 Where clients are transferred within a department, it is advisable that the new treatment/intervention/programme management agent contract the author(s) of previous reports to discuss matters raised in them, or failing this, contact the author's senior clinical psychologist to discuss the report.

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5.10.5 Where personal information or a report about a client is communicated to others, clinical psychologists should ensure that the recipients, whether within or external to the service or unit, are notified of the confidential nature of the information. 5.10.6 Clinical psychologists are advised to adopt as a normal procedure, the writing of "STRICTLY CONFIDENTIAL" in bold letters at the top of their reports. The Government Legal Department recommends the use of this statement because it clearly conveys the author's intent even though it, like other statements, has no status in law.

5.11

Transfer of Information to Clients, Other interested parties and Government Agencies

5.11.1 The transfer of information in the above circumstances will be subject to the Freedom of Information Act. It is unclear at this stage exactly how this will impact on information transfer, client access to files and so on. 5.11.2 The Freedom of Information Act, 1982 [Section 3(1), 11, 12 and 41(1)] provides clients with the right of direct access to psychological reports and information prepared by government department clinical psychologists and transferred to Government agencies. 5.11.3 There is no mechanism under the Act which prevents release of psychological information to clients that may be damaging on them. 5.11.4 Where direct release of psychological information by a Government agency could be prejudicial to a client's health or well-being, the clinical psychologist should either: (a) omit the prejudicial material from the submission; OR (b) not submit a report until the client can be prepared by the clinical psychologist (or another clinical psychologist nominated by the client) for direct release of the information.

5.12

Transfer of Information to Courts and Lawyers

5.12.1 Prior to providing reports to requesting lawyers, the clinical psychologist should obtain the client's consent. Clients should be advised when court reports have been subpoenaed.

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5.12.2 Access to documents containing psychological information on a client presented to court or the lawyers concerned with the case, is totally controlled by the court and the presenting/defending lawyers. They may allow access to any person whom they consider can assist them to protect their clients interests. As the court is an adversary situation, there are two clients with different interests requiring protection. 5.12.3 Clinical psychologists submitting reports/information to lawyers and courts should prepare reports/information that are meticulous, concise, accurate and understandable, avoiding the use of psychological jargon. The psychological material being submitted must be able to withstand the `proof of evidence' i.e., it must stand by itself in court by giving all the relevant facts, opinions (and reasons for them) and recommendations. 5.12.4 Clinical psychologists are advised to discuss the contents of such reports/information with the requesting lawyer prior to their submission, particularly when such reports/information contain material that could be prejudicial to the client's health or well-being.

5.13

Statutory clients (see section 3.1.5)

5.14

Second opinion When a client indicates to a clinical psychologist that he or she would like a second opinion, the clinical psychologist should offer every practical assistance to obtain a competent second opinion.

5.15

Use of behaviour management techniques

5.15.1 Behaviour management techniques may be used by clinical psychologists to teach appropriate behaviours to clients whose current behaviours are disrupting their own life, the lives of others and/or present dangers to the person or others. Behaviour management strategies aim to teach behaviours acceptable and appropriate for the client's current daily routine and circumstances. Such behaviours can be modified by systematic change of the consequences of the behaviour. Positive behaviour management strategies include: * * * * positive reinforcement modelling shaping redirection

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5.15.2 Certain behaviours are not readily changed by positive environmental manipulations and may require specialised strategies. Aversive strategies are considered in a separate section below.

5.16

Use of aversive techniques (see also the HKPS Code of Professional Conduct).

5.16.1 Aversive procedures should only be considered when it is clear that alternative procedures are ineffective. 5.16.2 Aversive techniques should only be undertaken by, or under the direct supervision of, experienced clinical psychologists. 5.16.3 The use of aversive procedures should be sanctioned and monitored by a panel (of clinical psychologists and other independent professionals), which should, in the case of developmentally disabled persons, include the parents, guardian or advocate for that person. 5.16.4 Clinical psychologists should always use the least intrusive and restrictive procedure to meet the client's needs. 5.16.5 All normal safeguards should be imposed, including informed consent, awareness of client rights and adequate evaluation of the procedure.

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6
6.1

Quality Management
General Quality assurance refers to the delivery of services which employ resources designed to provide maximum output (efficiency) and to achieve the intended results (effectiveness). Typically, these aims should be met at minimum cost (economy). A framework within which these aims can be achieved should involve evaluation (and monitoring), the management of performance and a consideration of a conducive and productive environment for the delivery of psychological services.

6.2 6.2.1

Evaluation The focus is on the accountability of psychological services and service delivery (often for political and financial reasons, but also for professional purposes). Evaluation involves measurement of: clients' needs programme goals and outcomes treatment outcomes process of change client satisfaction

6.2.2 6.2.3

There may be research implications. The overall goal is to maximise the quality of services to clients. Evaluation permits the identification of strengths and weaknesses of psychological practice and raises the quality of the service provided. It is advisable that evaluation strategies be determined and implemented prior to the commencement of the programme or treatment to be evaluated.

6.2.4

6.3 6.3.1

Performance Management The focus is on the clinical psychologist. Review and appraisal should not be linked specifically to monetary increments (salary increases or bonuses) but to issues such as staff training and future performance. Performance management includes: * human resource management - recruitment and selection - job specification and definition - induction programs - personnel planning

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* staff development and training * performance appraisal - individual performance review - development of career opportunities - analysis of developmental needs - analysis of competencies - objective setting * dealing with structural change and conflict * disciplinary action (when, how) * conflict management and resolution 6.3.2 Establishment and maintenance of a productive and conducive environment The focus is on the organisation in which the clinical psychologist works, and specifically, on the physical, intellectual and emotional environments. In terms of the physical environment, the following should be considered: 6.3.4 legal standards and requirements safety occupational health office layout, temperature, lighting ergonomic considerations

6.3.3

In terms of the intellectual environment, the following should be considered: stimulating, non-repetitive work access to professional development programs opportunity to initiate and implement innovative programs

6.3.5

In terms of the emotional environment, the following should be considered: dealing with harassment (sexual or otherwise) equal opportunity access to staff counselling access to peer support and consultation.

6.3.4

Other organisational consideration include: the means, frequency and method of communication from upper levels of the hierarchy the threat (perceived or real) of job insecurity

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6.3.5

stress and burnout

Who conducts quality assurance reviews? Depending on the purpose, the aspect and the reason for the review, it can be conducted by the clinical psychologist himself or herself, by a process of peer review, by external `experts', by quality assurance teams or by administrators.

6.4 6.4.1

Use and abuse of psychological principles Clinical psychologists should recognise the importance of preserving high standards of behaviour towards members of their own and other professions. In doing so, they should appreciate and respect the professional standards of their colleagues and other professionals. Clinical psychologists should not publicly denigrate colleagues in respect of their personal, professional or ethical conduct. If another clinical psychologist violates accepted standards of professional behaviour, a clinical psychologist with reliable knowledge of the fact should take steps to rectify the situation in the interest of the client, the profession or the clinical psychologist involved. Where there is concern about the possible inappropriate or incompetent administration of psychological procedures by members of other professions, and where the matter cannot be resolved informally, clinical psychologists should take formal action through the appropriate channels of the relevant employing organisation, professional body or Registration Board.

6.4.2

6.4.3

6.4.4

6.4.5 Clearly delineated arrangements must be made in the case of joint service delivery with another professional to a client. 6.4.6 Clinical psychologists should be aware of the limitations of their competencies and areas of expertise. Accordingly they should not attempt to fulfill the functions of another profession by overstepping the boundaries of their competence or offering a service that is normally the responsibility of another profession.

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7.
7.1

Professional Development and Training
Self

7.1.1 Clinical psychologists should recognise and act on the need for continuing education in virtue of advances in knowledge, developments in theory and practice, and changes in their professional role and in social values and expectancies. They should actively seek to update their knowledge and skills wherever possible. 7.1.2 Clinical psychologists should recognise the dangers of working in isolation and the value of feedback in improving their professional skills. They should seek opportunities to present their work to others and establish mechanisms for doing so where these are lacking. 7.1.3 Clinical psychologists should continually monitor their interventions and the outcomes with a view to improving the quality of the services offered. 7.1.4 Clinical psychologists should seek special training, knowledge, experience or advice to enable them to provide a competent service to particular clients (e.g., children, migrants, etc).

7.2

Others

7.2.1 Supervision of students/trainees Clinical psychologists should recognise the importance of the rights and obligations that occur within supervisor-trainee relationships. 7.2.2 The supervising clinical psychologist should ensure the continuing and adequate supervision of the trainee and maintain sufficient knowledge, familiarity and control of the trainee's work to guard against deficiencies in service delivery to clients. 7.2.3 The trainee should ensure he or she receives adequate supervision from the supervisor. 7.2.4 The supervisor should tailor the supervisory process to meet the specific needs of the individual student or trainee. 7.2.5 The nature and the purpose of the supervision being provided plus the trainee's role in the process should be understood by and be acceptable to both parties, the Registration Board or the University supervisor/lecturer.

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7.2.6 Clinical psychologists respect the right of the trainee to develop an individual orientation within his or her professional skill provided this is consistent with generally recognised psychological knowledge and practice.

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8.
8.1

Research
Decision to undertake research rests upon careful consideration by the clinical psychologist about how best to contribute to psychological science and to human welfare. Research investigations must be carried out with respect for the participants and with concern for their dignity and welfare. Caution should be exercised in respect of research that restricts or materially alters the quality of care provided. Planning a research study or investigation, clinical psychologists must undertake a careful evaluation of its ethical acceptability. The researcher bears responsibility for ethical practice in research. Stringent safeguards should be imposed to ensure that the welfare of the participants is not compromised. Clinical psychologists have an obligation to inform participants of the general nature of the research. As in all psychological practice, participants must give freely of their consent and have the right to withdraw at any time. Confidentiality of information must be maintained by the researcher. When a research procedure involves participants in significant levels of emotion or arousal or high levels of physical or mental stress, the researcher must ensure no psychologically vulnerable person participates. Participants must be fully informed of the expected physical and psychological effects. If unexpected stress reactions occur, it is the researcher's duty to alleviate the reactions and terminate the study. Deception of the participant or the withholding of relevant information may occur only when the clinical psychologist is satisfied that the aims and objectives of the study cannot be achieved otherwise. After deception or concealment, revelation should follow participation as a matter of course. Researchers must not exercise undue pressure on potential participants for the purpose of securing their involvement in a research study. Most institutions (teaching hospitals, tertiary research and teaching institutions) have an Institutional Ethics Committee (IEC) constituted. Wherever possible, research projects involving human subjects (particularly children, the mentally ill and those in dependent situations) should be submitted for approval to an IEC. In HAHO, there are formalized cluster-based Clinical Research Ethics Committees (CREC) in situ which are akin to Institution Review Boards (IRB) in other developed countries.

8.2

8.3

8.4

8.5

8.6

8.7

8.8

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8.9

Prior to undertaking clinical research, familiarization of the Declaration of Helsinki is essential. Prior to undertaking clinical research involving the administration of drugs, , familiarization of the International Conference on Harmonization – Good Clinical Practice (ICH-GCP) is essential.

8.10

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