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Search for more papers by this author. Experiments have been used to study the compression after impact of thin face-sheet composite honeycomb core sandwich panels. The sandwich panels consist of very thin, woven S2-fiberglass face sheets adhered to a Nomex honeycomb core. A series of highly instrumented compression after impact tests was then completed. New techniques for studying the response and failure include high-speed video photography as well as digital image correlation for the full-field deformation measurement. Two failure modes were observed.
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It is concluded that the failure mode of these materials depends solely on the honeycomb core density of the coupon, with the lighter density core experiencing an indentation propagation failure, while the heavier specimens experienced a crack propagation failure mode. Google Scholar. Dissertation, Virginia Polytechnic Inst.
Link Google Scholar. The U. Government has a royalty-free license to exercise all rights under the copyright claimed herein for Governmental purposes. All other rights are reserved by the copyright owner. Skip to main content. Volume 51, Issue 1. No Access Full-Length Paper. Thomas D. APA revised its Record Keeping Guidelines in in response to evolving technologies, the advent of electronic health records, the impact of the Health Insurance Portability and Accountability Act and the complexities of record keeping in various organizational settings.
The APA guidelines are designed to "educate psychologists and provide a framework for making decisions regarding professional record keeping. There are 13 guidelines in all, each followed by a rationale and examples that illustrate how the guideline may be applied in practice. This article offers an overview of the guidelines and the key points psychologists should consider as they develop their own record-keeping systems. Practicing psychologists can tailor their record-keeping practices to their setting, type of practice and the characteristics of their treatment or assessment population.
Psychological records document the nature, delivery, progress and outcomes of services.
Records facilitate the coordination of care, as well as the process of transition to other levels of care, and referral or termination. Accurate records can support the clinician in resolving disputes on such issues as the quality of the services provided, fee agreements or treatment progress. Others who handle records—such as the psychologist's employees—should be trained to handle confidential client information with the same level of care. The organizational structure and content of records may be influenced by a variety of factors. Recognizing that psychologists work in diverse settings, APA's Record Keeping Guidelines list basic components of the psychological record—general file information, documentation of service and specific information related to the individual characteristics of the treatment.
Various factors may influence the amount of detail kept in records. These can include the client's wishes for more limited records; the service context or setting; legal and regulatory mandates; and contractual requirements of third-party payers. Psychotherapy notes, which may include more detailed or sensitive client information, must be kept separately from the general record in order to be afforded heightened protection under the Health Insurance Portability and Accountability Act HIPAA Privacy Rule.
For example, health insurers cannot obtain them without a completely voluntary patient authorization. The extent to which psychotherapy notes are protected from patient requests for access varies because state laws that give patients greater access to their records can preempt the Privacy Rule provision providing no access to psychotherapy notes.
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Protecting clients' privacy and ensuring their trust is a key principle of documentation. Whether or not a practitioner can release client information requires the psychologist to be aware of several legal and regulatory requirements, including mandated reporting requirements. Psychologists also need to follow any applicable institutional policies. Special attention is warranted in decisions related to the access or disclosure of records of minor children, especially in situations of divorce where information may be used in adversarial proceedings such as custody conflicts.
The guidelines consider disclosure of "the nature and extent of record keeping procedures" part of the broader process of informed consent to psychological services Ethics Code 3. Psychologists are ethically mandated to discuss the "relevant limitations of confidentiality" and the "foreseeable uses of the information" APA Ethics Code 4. This discussion helps clients understand that their information may be shared with others and that there are potential limits to confidentiality, such as in a litigation context or mandated treatment.
APA's record-keeping guidelines also recognize the importance of multidisciplinary collaboration in providing patient care. Accurate records facilitate adjunctive treatment, such as medication management, coordinated care for chronic illness or family therapy intervention. Should an unforeseen illness befall the psychologist, an up-to-date record facilitates the successful transfer of care. Records may also be requested by the client, or his or her attorney, for other uses, such as divorce or other legal proceedings, applications for disability or life insurance, or requirements for certain types of employment.
Practitioners need to have a security plan that provides adequate protection for either paper or electronic records from loss or damage, and ensures only appropriate access by trained professionals or others with a legitimate need to see them. With expanding wireless and computer technologies, client data may be kept in various electronic formats, such as emails, text messages and online scheduling calendars. Practitioners should be particularly cautious when exchanging protected health information via fax, email, text messaging and electronic claims submission. Many psychologists store patients' electronic records on their office computers, laptops and tablets.
However, psychologists must be vigilant in preventing unauthorized access to the data and protecting the actual equipment from theft. Psychologists should store backup media as carefully as they do their original electronic files. Perhaps the most welcomed change in the guidelines' revision is a shorter requirement to keep records.
The guidelines state: "In the absence of a superseding requirement, psychologists may consider retaining full records until seven years after the last date of service delivery for adults or until three years after a minor reaches the age of majority, whichever is later. As previously mentioned, psychologists must also consider any applicable state laws and other regulatory or institutional requirements in determining specific records retention policies. This guideline may be useful as psychologists prepare for retirement and plan for how records will be stored and later disposed of.
The original rationale for disposing of records was to prevent "obsolete" clinical data from being misused in other contexts.
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Today, with electronic health records and the ability to store data in larger electronic systems, clinical information can be kept indefinitely. The Record Keeping Guidelines suggest that psychologists document the context in which the record is created, such as the reason for referral or evaluation, and specific circumstances impacting the client at the time of service.
Professionals who review records at a later date also have the responsibility to recognize when clinical documents or testing results are obsolete or unduly prejudicial to current decision-making.
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In most cases, this is of greatest concern when the record creates a negative impression of the client. The advent of electronic health records has radically altered the documentation landscape. At a minimum, electronic records are subject to similar concerns and requirements as paper records. Because of the rapid expansion of data technologies, the guidelines primarily offer general suggestions for managing information and electronic health records, such as using appropriate levels of encryption and passwords to protect digital information.
The rule requires that psychologists take special care in maintaining electronic records, and that they conduct a documented risk analysis of specified issues, and select security measures that are reasonable and appropriate for those risks and for the practice. Practitioners who do not have in-house IT departments should maintain adequate technological competence and consider using IT consultants for more complex security questions.
The law's initial goal is to promote health professionals' adoption of electronic health records.
Record keeping for practitioners
The next stage of the law's implementation involves integrating medical records through interfacing with large, centralized data systems such as Health Information Exchanges or through systems of transactional, interoperable exchanges with other providers or organizations. Psychologists are encouraged to actively participate in developing state-level policies regarding the implementation of HITECH.
Psychologists are uniquely qualified to advocate for enhanced security measures in handling sensitive mental health information, and to provide thoughtful insights on consent policies for health information exchange that allow clients to make informed choices about the sharing of their mental health information. In multidisciplinary settings—such as community health centers, the VA or hospitals—records may be created or accessed by many health-care providers.
Health-care reform is focused on transforming delivery systems into collaborative or integrated care models, such as accountable-care organizations, that will share records through state or regional health information exchanges. As psychological services become integrated into larger systems of care, protecting the confidentiality of patients' psychological records will become more complex Richardson, In many settings, record-keeping policies are already defined by applicable laws as well as institutional policy.
Psychologists who work in these settings may not have full control over the record. However, they can advocate for record-keeping practices that meet psychological guidelines and also address the needs of other disciplines to coordinate care. For psychologists who work as independent consultants for organizations, it is important to clarify at the outset who owns and has access to psychological records.
Guideline 10 addresses conflicts between organizational requirements, professional guidelines, ethics and legal standards. It is important to note that the Amendment to the Language of the Ethics Code, effective June 1, , occurred after the guidelines revision and publication of the article this article is based on anguage of the Ethics Code with Changes Marked can be found at the end of the online Ethics Code yurxrrsfbrvcqbqyvuazatxwzfq.
Psychologists will find it useful to familiarize themselves with the amendments to Ethics Codes 1. Documentation for couples, families and groups is one of the most complex and challenging areas of record keeping. Experienced psychologists usually develop a philosophy of documentation for couple and family therapy that fits their theoretical orientation, treatment model and practice setting.