Caldwell, 2022

Question 1

differences between professions –> differences in approaching same issue

Answer 1

1) psychology: would examine individuals’ inner world to find the root of its dysfunction
2) professional clinical counseling: see individuals’ struggle as an individual, developmental issue
3) clinical social work: would likely see an individual’s struggle as a resource issue
4) MFT: look at behavior in its social and relational context

Question 2

scope of practice

Answer 2

outlines the activities one can legally do as part of that profession
-helps define the boundaries of a profession and the difference between one profession and another
-applies to everyone in your profession equally
-defined by state law
-CANNOT expand unless you get additional licenses

Question 3

scope of competence

Answer 3

consists of those activities that you have appropriate education, training, and experience to do on your own
-applies to YOU specifically
-defined by YOUR education, training, and experience
-CAN expand through additional training, education, and experience

Question 4

scope of practice LMFT

Answer 4

contrary to common misunderstanding among mental health professionals, LMFTs in California ARE allowed to do psych testing, but ONLY in the context of an ongoing psychotherapy relationship, and:
1) must have appropriate training in the instrument used
2) use must be consistent with LMFT scope of practice

Question 5

professional clinical counseling scope of practice

Answer 5

LPCCs are able to use psychological testing and measures while engaging in an ongoing counseling process with limitations - explicitly prohibited from using:
1) projective tests of personality
2) individually administered intelligence tests
3) neuropsychological testing
4) utilization of a battery of 3 or more tests to assess psychosis, dementia, amnesia, cognitive impairment, or criminal behavior

Question 6

MFT Trainees (Practicum) Rules

Answer 6

-can use up to 1300 hours accrued during practicum toward 3000-hour requirement
-225 hours of direct client contact obligated (75 out of the 225 hours can be fulfilled with client-centered advocacy - efforts to link clients with resources outside of a therapy session)
-required to receive at least one unit of supervision for every five hours of client contact

Question 7

one unit of supervision (BBS)

Answer 7

either:
1) one hour of INDIVIDUAL/triadic supervision OR
2) two hours of group supervision (group = max 8 supervisees)

Question 8

Requirements for Supervision for Associates

Answer 8

–10 or fewer hours of client contact a week = ONE unit of supervision required
–GREATER than 10 hours of client contact a week = TWO units of supervision required to cover all additional client contact hours

Question 9

The 90-Day Rule

Answer 9

you can only count hours of experience gained between graduation and registration with BBS if:
1) BBS receives the associate registration application within 90 days of the degree date.
2) hours must be gained at a site requiring Live Scan fingerprinting.

Question 10

The Six-Year Rules

Answer 10

1) registration number for associates lasts 6 years –> must re-register if past that –> determines where you can work as an associate (after 6 years, can’t work in private practice)
2) determines what hours will count toward licensure (BBS reviews experience prior to 6 years)

Question 11

licensure by endorsement

Answer 11

2 year or more licensees coming in from other states can get licensed in CA after taking continuing education classes and the CA law and ethics exam

Question 12

emotional support animals (ESAs)

Answer 12

As of 1/1/2022, CA therapists wanting to write letters that allow clients to have ES dogs must meet ALL of the following obligations:
1) must have a valid, active license in the place where the client is located and provide licensure info (effective date, type, and jurisdiction) in the letter –> unclear if associates permitted to write these letters
2) must have a clinician-client relationship with the client for at least 30 days before providing the letter
3) must complete a clinical-evaluation of client’s needs for ESA
4) must notify client that falsely representing their ESA as a service animal is a crime

Question 13

informed consent

Answer 13

includes:
-describing for your clients what treatments will be performed and for what purposes
-letting clients know the “ground rules” for therapy (e.g., confidentiality and its exceptions)
-information about billing practices and fees

Question 14

Cobbs v. Grant (1972)

Answer 14

California court case that defined health care providers’ informed consent obligations. Four principles were outlined:

1) Clients do not have the same expert knowledge as healthcare providers
2) Clients have a right to choose whether to participate in treatment
3) Clients need info to decide whether to participate in treatment (i.e., risks and benefits)
4) Clients rely on health care providers to give them said info in clear language.

Question 15

disclosure requirements

Answer 15

Must include the following in an informed consent document:

-FEES: any type of fee and how it was computed must be disclosed to clients at the beginning of treatment
-BILLING PRACTICES: must disclose insurance’s access to certain clients’ info & what happens when clients unable to pay their fees
-LICENSURE STATUS: disclose whether licensed or under supervision & name of employer
-THERAPIST BACKGROUND (optional): info about professional values and treatment philosophy
-COMPLAINT PROCESSES: must disclose how clients can file a complaint to BBS if necessary
-TECHNOLOGY: clients must consent to telehealth
-PRIVACY PRACTICES: must give client a document titled Notice of Privacy Practices that details how client’s info is protected (if HIPAA compliant)
-LIMITS OF CONFIDENTIALITY: client must know there are certain exceptions to confidentiality
-DEFINING WHO THE CLIENT IS: when working with couples and families, must specify if client an individual or the unit
-CANCELLATION POLICY: must have an agreed-upon policy in writing
-PROCEDURES TO BE USED: must disclose procedures used, why they are used, & expected length of treatment
-RISKS AND BENEFITS: must disclose therapy is not guaranteed to work and disclose particular risks and benefits
-RIGHT OF REFUSAL: must inform client has right to refuse to start treatment or discontinue treatment once it starts
-COMMUNICATION AND EMERGENCY PRACTICES: must disclose emergency practices, in between session responses to calls, emails, texts, etc
-EXPECTATIONS OF CLIENTS: unacceptable client behaviors, what is expected of client in therapy

Question 16

assent agreements

Answer 16

non-legally binding agreements for minors too young to consent to treatment on their own. since they can’t consent entirely, the therapist can describe to children in age-appropriate language what the therapy process is and how it works

Question 17

treatment plan

Answer 17

outlines the goals and methods of treatment that the client and therapist have agreed upon, and usually required to be developed early in the therapy process

Question 18

psychotherapy notes

Answer 18

documented content of a therapy session and nothing else, and must be stored separately from the client’s file –> if a _______ _____ includes info about the client’s symptoms, diagnosis, meds, start/stop time of sessions, does NOT qualify as this type of note

Question 19

How long are therapists required to retain treatment records for after the last professional contact with clients?

Answer 19

For adults –> 7 years
For minors –> 7 years after their 18th bday (minor’s 25th bday)

Question 20

Does CA law specify HOW records must be secured?

Answer 20

No, CA law specifies that health care records must be secured but does not specify how the records must be secured. Federal law requires that security practices be adequate and that they are regularly reviewed and updated.

Question 21

How soon after a client requests their records must you comply?

Answer 21

If client wants to INSPECT record –> 5 working days
If client wants a COPY of record –> 15 working days
*NOTE: request must be made in writing

Question 22

Section 56.10 of the Civil Code

Answer 22

incorporates a portion of the Health and Safety Code, which entitles parents to access records for treatment given that they consented to their child(ren)’s treatment

Question 23

Section 56.11 of the Civil Code

Answer 23

requires minors themselves to authorize the release of info from treatment they were involved in if they legally COULD have consented for treatment, regardless of whether they ACTUALLY did

essentially . . . need to ask anyone who had been 12 and older at time of family treatment to consent for the release of records (assuming those minors at least 12 yrs had been mature enough to participate intelligently in treatment)

Question 24

How soon must a therapist provide a treatment summary when clients request this?

Answer 24

Must be available within 10 business days of the client’s request, unless there is an exceptional circumstance that requires more time

Question 25

requirements for refusing clients’ access to records

Answer 25

1) document within the client’s record the date of their request and reasons for refusing (i.e., potential negative consequences for client viewing their records)
2) inform the client of your refusal of their request and of their right to designate another mental health professional who could review the records on their behalf
3) make the record available to the mental health professional of the client’s choosing

Question 26

source of a subpoena

Answer 26

if it comes from a judge –> typically MUST comply, as it has the power of a court order
if it comes from a private attorney –> should NOT comply, will likely be a violation of the law as you do not have client’s release of authorization to release records

Question 27

options when served a subpoena

Answer 27

1) assert privilege (refuse to provide any info, including knowledge of the client) –> appropriate default position unless you know a judge has determined privilege does not apply, or privilege has been waived
2) object subpoena –> if there was something wrong with it or how it was delivered (consult an attorney!)
3) comply with the request for records or court appearance –> if it is valid (i.e., comes from a judge or client agrees to waive privilege)

Question 28

Bellah v. Greenson (1978)

Answer 28

a court case that set the precedent for therapists’ responsibility when clients are contemplating suicide: the court determined that a therapist does have a responsibility to take reasonable steps to prevent a threatened suicide. However, the court ruling did NOT say what those “reasonable steps” would be; this is determined by the standard of practice.

Question 29

least intrusive means

Answer 29

a balance between confidentiality and safety; when a client is a threat to themselves, granting as much confidentiality as possible while still keeping the person safe

Question 30

safety plan

Answer 30

a written agreement used for clients who are thinking about committing suicide but are assessed to be low risk where the client commits to taking a number of specific actions before doing anything that would be harmful to themselves; used as a protective measure just in case a client’s symptoms worsen; follows a step-wise progression

Question 31

Section 5150 of the California Welfare and Institutions Code

Answer 31

a law that states if a client poses an immediate threat to themselves and is unable or unwilling to receive appropriate care, they can be hospitalized involuntarily - as therapists, we can begin the process, but we can’t invoke hospitalization in most counties

applies if a client is a GENERAL danger to others rather than an imminent danger (i.e., general danger = client is a danger to others, but there is no reasonably identifiable victim to protect)

Question 32

California End of Life Option/ELO Act

Answer 32

a law created for terminally ill individuals who meet specific qualifications and want to end their lives on their own terms –> must make two separate requests to their physicians for a prescription for aid-in-dying medication

Question 33

Tarasoff v. California Board of Regents

Answer 33

In the outcome of this case, California courts determined that therapists have a duty to protect reasonably identifiable victims of a dangerous or threatening client; “The protective privilege ends where the public peril begins.”

You have a duty to PROTECT, not a duty to WARN
If a client leaves your office presenting an imminent danger of severe bodily harm to reasonably identifiable others, you must act to resolve that threat

Question 34

imminent danger

Answer 34

in the context of an individual being a threat to others, this term is not defined as a specific time frame, but rather suggests that danger is soon and relatively certain in the absence of intervention

Question 35

severe bodily harm

Answer 35

generally understood to mean danger that is either life-threatening or otherwise seriously endangering

Question 36

reasonably identifiable victims

Answer 36

in the context of a client being a threat to others, must act to protect these victims in accordance with the Tarasoff ruling –> does not require you to know the names of the people in danger, but rather that you could easily identify the people at risk, which could involve:
-warning victims directly
-contacting law enforcement
-& any other steps necessary to eliminate the threat

Question 37

California Welfare and Institutions Codes 8100 and 8105(c) - Possession of Guns

Answer 37

both laws involve the possession of a gun for a person who is a danger to others

8100: client cannot possess a gun for FIVE years unless the court grants permission
8105(c): therapist MUST inform law enforcement within 24 hours so gun possession bun can take effect

Question 38

Gun Violence Restraining Orders (GRVOs)

Answer 38

a court order that temporarily prohibits someone from purchasing guns or ammunition due to he/she being a threat to others; it also authorizes law enforcement to remove any guns or ammunition the person already owns –> therapist cannot directly petition for this

Question 39

Section 1024 of the California Evidence Code - Danger to Property

Answer 39

law stating that the therapist-client privilege does not apply if a client, because of a mental or physical condition, poses a threat to themselves or property of another –> psychotherapists are ALLOWED, but not required, to communicate with law enforcement to reduce/remove threat (sort of a gray area bc privilege vs. confidentiality, but breaking confidentiality to prevent danger of property may be crucial because a person may accidentally be hurt in the process)

Question 40

release of information

Answer 40

a written request from a client to share information from therapy with a specific third party

–> in order to make contact with any other important adults in a child’s life & share info with them about the minor’s treatment, you must have this signed (parent must fill out if they consented to treatment, or minor if they consented)

*NOTE: HIPAA allows health care providers across multiple settings to share info about a client, even without a written release, for the purposes of treatment planning (most settings still require this form tho)

Question 41

privilege/privileged communications

Answer 41

the state considers the privacy of conversations between a client and a therapist to be of the utmost importance –> the content of therapy cannot be used in most court proceedings unless the client or judge allows it

*there are of course exceptions to ____

Question 42

guardian ad litem

Answer 42

a court-appointed representative or attorney who is responsible for protecting a child’s legal rights, including decisions regarding privilege, particularly if the client is a minor

Question 43

asserting privilege

Answer 43

refusing to release client’s info on the grounds that any communication between a therapist and a client is considered privileged communications under the law –> CANNOT be done if client asks or a judge demands that privilege be waived

Question 44

waiving privilege

Answer 44

it is never up to the therapist to determine whether privilege be waived, it is always the choice of the client, the client’s guardian (including guardians appointed by the court), another court appointee, or a judge

Question 45

exceptions to privilege

Answer 45

only a judge has the power to determine whether an exception to privilege applies

Question 46

no secrets policy (family therapy)

Answer 46

an agreed-upon policy/understanding when working with couples or families that everyone agrees that any info any individual in the family shares with the therapist, even if other family members are not around at the time, is fair game for the therapist to bring up with the family in future sessions

if choose this policy, each member of the couple or family must agree to it in writing

Question 47

limited secrets policy (family therapy)

Answer 47

an agreed-upon understanding/policy when working with couples or families that the therapist DOES keep some info learned from individuals secret from others, even when the focus of treatment is the family or couple

if choose this policy, each member of the couple or family must agree to it in writing

Question 48

sole custody

Answer 48

one parent has full authority to make decisions for the child, who is with the parent all (or almost all) of the time –> the other parent does NOT have any authority to make legal decisions for the child

Question 49

primary custody

Answer 49

one parent who is with the children most of the time, while the other parent maintains some time in charge –> the parent who is with the child(ren) most of the time typically has legal decision-making authority (but this is not always the case)

Question 50

joint custody

Answer 50

AKA shared custody because both parents have the legal authority to make decisions for the child

Question 51

split custody

Answer 51

one or more children go to one parent while the other children go to the other parent; typically, each parent has legal decision-making authority for only the children who live with them –> this is an uncommon arrangement, as courts (and families too) usually want to keep siblings together when possible

Question 52

rule of thumb for custody arrangements

Answer 52

As a therapist, you cannot make assumptions about the specifics of a custody order simply based on the type of custody it sets forth because:
1. Some custody orders add specific requirements for the parents to collaborate on health care decisions.
2. Even a parent who is in charge of their children most of hte time does not always have complete and independent decision-making

Question 53

juvenile court guardianship

Answer 53

often used when a child has been removed from their home following an accusation of abuse or neglect when the county has found evidence supporting that accusation
e.g., foster parents, relatives

Question 54

probate court guardianship

Answer 54

most commonly used when a child is living with an adult who is not their parent, and the parent needs the legal authority to make decisions (e.g., health care decisions) on the child’s behalf

e.g., for single parent in military overseas

Question 55

probate conservatorship

Answer 55

type of conservatorship in which the conservator may be responsible for the conservatee (i.e., their living arrangements, health care, and general well-being), their finances (i.e., paying bills, responsibly investing, & budgeting), or both, depending on the conservatee’s needs

–this type is much more commonly used
–a spouse, relative, other interested party, or even the person needing conservatorship can file a request for conservatorship with the court

Question 56

Lanterman-Petris-Short (LPS) conservatorship

Answer 56

type of conservatorship that is only used when an adult has a serious mental health problem that requires extensive care and the person is unable or unwilling to receive that care i.e., the person is gravely disabled due to mental illness

–this type is much less common
–process must be initiated by local govt, can’t be initiated by fam/caregiver

Question 57

consent for treatment on behalf of children

Answer 57

The law offers protections for clinicians who provide treatment under good-faith belief that the person who claimed to be able to consent for a child’s therapy is actually legally able to do so . . . for the therapist to get this protection:
1. Person who brings minor in for therapy must be a relative.
2. Person must live in same home as child.
3. Person must complete “Caregiver’s Authorization Affidavit” –> must follow the very specific content and structure requirements required by law.

Question 58

minor’s independent consent

Answer 58

any minor age 12+ can independently consent for their own psychotherapy, as long as the therapist determines that the minor is mature enough to participate intelligently in treatment –> minor responsible for payment

–therapist still must attempt to involve parent unless therapist can document why doing so would likely be detrimental
–parents do not have a right to access records for a minor seen under the minor’s independent consent

Question 59

emergency treatment of minors under 12 yrs

Answer 59

parental consent is generally not required to treat a minor in life-threatening emergency situations, such as an immediate risk of serious harm to self or others –> however, this general rule comes with some meaningful cautions

Question 60

when parents or guardians must be involved

Answer 60

–when a minor consents independently for therapy, you must document both:
1) whether and when you attempted to contact the parent/guardian
2) whether each attempted contact was successful or unsuccessful
–> alternatively, you may decide it would not be appropriate to contact the parent/guardian but you must document reason why
–don’t have to contact parents before beginning therapy, just have to make a determination about whether and how the parents should be involved after consulting with the minor
–parents should be included in the treatment in some way unless there is good reason not to –> level of involvement is a clinical decision

Question 61

reasonable suspicion standard

Answer 61

it is objectively reasonable for a person to entertain a suspicion based upon facts that could cause a reasonable person in a like position, to suspect child abuse or neglect

–>determining whether suspicion level meets this standard –> consultation

Question 62

What types of suspected child abuse must be reported?

Answer 62

1. Physical abuse: any situation where any person willfully causes an injury to a child or engages in cruel or inhuman corporal punishment
2. Sexual abuse: includes both sexual assault and sexual exploitation
3. Willful harm or endangerment: any person causing a child “unjustifiable physical pain or mental suffering” or any caregiver allowing it to happen (e.g., adults who lock children in cages for long periods)
4. Neglect: person responsible for child’s welfare fails to provide adequate food, clothing, shelter, medical care, or supervision –> child does not have to suffer harm for this to be reported
5. Abuse in out-of home care: catch-all category for physical injury or death that occurs to minors in child-care or school settings

Question 63

emotional abuse

Answer 63

–requires behavioral evidence of the emotional harm the child is suffering or at risk of suffering (e.g., severe anxiety, depression, withdrawal, aggression - including toward self)
–it is a permissive report, not a mandated report - you can make a report and are protected from lawsuits if you do, but there is no penalty for failing to report

Question 64

14th Birthday Rule (to determine if consensual sexual intercourse involving minors is reportable)

Answer 64

if one minor is 14 years or older, and the other is under 14, this is a mandated report

Question 65

21/16 Rule (to determine if consensual sexual intercourse involving minors is reportable)

Answer 65

if one sexual partner is old enough to drink (i.e., 21 years old), the other needs to be at least old enough to drive (i.e., 16 years old) –> if one partner is 21 yrs or older and the other is under 16 yrs, this is a mandated report

Question 66

must report regardless of age of partner…

Answer 66

any behavior that a minor reports was not consensual, that you believe was coerced or exploitative, or that you do not believe could have been consented to because of a minor’s developmental stage or intoxication should be reported, regardless of the age of the partner

Question 67

rules for reporting child abuse

Answer 67

1) once you have developed reasonable suspicion that abuse has taken place, it must be reported by phone to a local child welfare agency immediately
2) if you make the report by phone, the phone report must be followed up with a written report within 36 hours, with no exceptions
3) once you have filed a written report, if you keep a copy, it should be stored separately from the client record

Question 68

What types of suspected elder or dependent adult abuse must be reported?

Answer 68

1. Physical abuse: physical attacks (assault, battery, and the like), unreasonable physical restraint, and depriving a person of food or water –> do not need to see a physical injury in order to reasonably suspect abuse has taken place
2. Abandonment: if a caretaker deserts their patient or gives up their responsibilities when a reasonable person would not have done so
3. Abduction: must have been taken outside of the state of CA or prevented from returning to the state, and they must not have the ability to consent to this
4. Isolation: attempts to prevent contact with outside individuals
5. Financial abuse: recipient took the financial gift “for wrongful use or with intent to defraud” or if they knew or should have known that taking the gift would be harmful to the elder or dependent adult
6. Neglect: any person responsible for the care of an elder who is not ensuring that hygiene, medical care, health and safety hazards, and malnutrition/dehydration are being appropriately addressed; not just caregivers, elder or dependent adults can be reported for neglecting themselves

Question 69

hearing directly from the victim of elder or dependent adult abuse

Answer 69

with an elder or dependent adult, the law states that you must report any instance of abuse that an elder or dependent adult tells you about directly – even if you do not believe them– unless ALL three of the following are true:
1. the client diagnosed w/ mental illness/dementia (or under conservatorship for that reason)
2. you reasonably believe the abuse did not occur
3. you are aware of no evidence that would support the claim

Question 70

requirements for filing a report of elder or dependent adult abuse

Answer 70

1) Known or suspected instances of elder or dependent adult abuse that occurred outside of a long-term care facility must be reported by phone or Internet immediately, and in writing within two working days to law enforcement or your local adult protective services agency
2) For abuse that takes place inside a long-term care facility, reporting requirements vary based on the circumstances of the case –> in some cases, as many as 3 separate reports must be filed within a specific timeframe
3) Any copy you keep of the written report should be stored separately from the client’s record.

Question 71

ombudspersons

Answer 71

–some reports of elder and dependent adult abuse must be sent to the county ________
–long-term care _____ serve 2 purposes:
1) receive and work to resolve complaints from individual long-term care residents
2) work with Department of Aging & w/other local and state officials to develop policies and practices that will best serve the larger and long-term care population

Question 72

unprofessional conduct statues

Answer 72

the collective set of clear behavioral standards that the state can enforce in order to govern licensure properly

Question 73

civil charges for unprofessional conduct

Answer 73

client alleges that the therapist’s actions were outside of the standards of the profession and caused them harm; judges make a decision based on the preponderance (i.e., majority) of evidence; awards = typically $

Question 74

criminal charges for unprofessional conduct

Answer 74

the government or district attorney’s office alleges that the therapist is to have violated the public in some way and deserving of punishment; consequences = fine, jail time, or both; guilty = judge/jury found evidence against you to be convincing beyond a reasonable doubt

Question 75

disciplinary action

Answer 75

focused on your performance in (or fitness for) a professional role and the actions against you that can result based on that role; potential consequences = license put on probation, suspended, or revoked or classes, no jail bc BBS does not have that authority

Question 76

disciplinary process

Answer 76

1. Complaint - if the complaint is against a current licensee/registrant and is something that would be actionable if true, it is typically forwarded to the BBS’s investigative unit
2. Investigation - involves interviews with the person filing the complaint and the therapist accused of wrongdoing, as well as others relevant to the issue; may also involve a review of the therapist’s records
3. Hearing - the burden of proof here is clear and convincing evidence –> judge’s proposed decision is forwarded to the BBS for their consideration
4. Resolution - licensee or registration disciplined - suspension and probation periods in addition to more consequences

Question 77

Five Common Sense Things to Do to Help Ensure Your Practice is As Safe as Possible

Answer 77

1. Maintain familiarity with professional standards.
2. Maintain professional liability insurance
3. Address potential complaints.
4. Keep excellent records.
5. Follow the law, even outside of work.

Question 78

CA Telehealth Law

Answer 78

“A licensee or registrant of this state may provide telehealth services to clients located in another jurisdiction only if the California licensee or registrant meets the requirements to lawfully provide services in that jurisdiction, and delivery of services via telehealth is allowed by that jurisdiction.” –> translation: licensure stops at the state line - can only practice within CA

CA Telemedicine Act: client must be informed that telehealth services will be used prior to any service delivery, the client must give verbal consent, and this must be written in their record

CA Telehealth regulations: prior to providing therapy via telehealth, therapist must:
-obtain informed consent for use of telehealth
-inform client of potential risks and limitations specific to telehealth treatment
-provide client with license type and number
-document efforts to gather contact info for relevant resources (i.e., crisis or emergency resources) local to the client

Question 79

Health Insurance Portability and Accountability Act (HIPAA)

Answer 79

a federal law that places several requirements on the therapists and other health care providers who are governed by it, broken down into 4 essential rules:
1. Privacy Rule - protects the privacy of individually identifiable health info
2. Security Rule - sets national standards for the security of electronic protected health info
3. Patient Safety Rule (confidentiality provisions) - protects identifiable info being used to analyze patient safety events and improve patient safety
4. Breach Notification Rule - requires providers to inform Health and Human Services of data security breaches and to inform those patients whose data has been breached.