Class Terms/Concepts (Final)

Question 1

Corey Ethical Decision-Making Model

Answer 1

1. Identify the problem or dilemma.
2. Identify the potential issues involved.
3. Review the relevant ethics codes.
4. Know the applicable laws and regulations.
5. Obtain consultation (for the final, be specific about who you would obtain consultation with!)
6. Consider possible and probable courses of action. (THREE for the final).
7. Enumerate and consider the possible consequences of various decisions.
8. Choose what appears to be the best course of action.

Question 2

progress notes

Answer 2

required formal clinical record notes that include information about the client’s treatment goals and their progress; ethical-decision making; and crisis management

Question 3

process notes/psychotherapy notes

Answer 3

not required, but permitted notes that involve a therapist’s note-keeping and are theory-based; these can be subpoenaed because the state of CA does not make a distinction between the two types of notes

Question 4

CA Health and Safety Code 123130: Client Access to Records

Answer 4

CA law that allows a mental health professional to provide a summary of treatment rather than the complete record. The client must request their records in writing and the MFT must provide within 5 working days or 15 working days for treatment summary.

Treatment summaries should include the client’s presenting concerns, findings from consultations/referrals, reports of diagnostic assessments, diagnosis, treatment plan, the progress of treatment, prognosis, and discharge summary.

If MFT believes records would be harmful to client, can
withhold for 30 working days, but must document this. AND –> client has a right for MFT to forward to another
mental health professional to discuss content with them so long as there is a release of authorization signed

Question 5

Minimum Summary Information to Include in Informed Consent (CA Health and Safety Code 123130)

Answer 5

o Presenting concerns, relevant history
o Findings from consultations, referrals
o Reports of diagnostic assessments
o Diagnosis
o Treatment Plan
o Progress of Treatment
o Prognosis
o Discharge Summary

Question 6

Counselor responsibilities regarding documentation

Answer 6

1. Clinical – track treatment goals and progress; document standard of care practices.
2. Ethical – document scope of practice and competence; ethical decision-making process; review by supervisors to ensure practice is within standard of care.
3. Legal – legally required to document comprehensive yet concise representation of client progress (having informed consent is required, it is a therapeutic duty, but the actual material in the informed consent form varies depending on agency).
4. Risk management – document clients with danger of harm to self/others, and even more details than you usually would concerning the level of risk, how this risk was assessed, etc. (e.g., antecedents, assessment interventions, consultation, reporting, etc).

Question 7

CA Health and Safety Code 124260 (2011) - Minors

Answer 7

“[A] minor who is 12 years of age or older may consent to [outpatient] mental health treatment or counseling services if, in the opinion of the attending professional person, the minor is mature enough to participate in therapy intelligently in the mental health treatment or counseling services.”

–> the criteria to determine if client is competent enough to consent for therapy by themselves is the reasonable person standard
–> when a minor consents for treatment, the mental health care provider is not permitted to share records with a parent without the minor’s authorization
–but . . . CA law requires mental health care providers to “involve parent(s) in treatment unless, in the opinion of the professional person who is treating the minor, the involvement would be inappropriate.” –> standard of care = treatment summaries, does not equate to full access to all confidential records

Question 8

privilege

Answer 8

protection of private information within the context of the legal system –> informs whether or not we have to enter info from therapy into the legal context or we can assert ___

Question 9

confidentiality

Answer 9

protection of private information within professional relationships i.e., within the therapeutic relationship

CA business and professions code 4982: “It is unprofessional conduct for failure to maintain ____, except as otherwise required or permitted by law, of all information that has been received from a client in confidence during the course of treatment and all information about the client, which is obtained from tests or other means.”

Question 10

privacy

Answer 10

constitutionally established “zone of ____” [sort of]; control of personal info in PHI and HIPAA; there is an expectation our health info is ____

Question 11

waive privilege

Answer 11

client authorizes the release of their information
IMPORTANT: the client holds privilege and determines whether or not to waive it

Question 12

assert privilege

Answer 12

therapist does this when on behalf of the client when the client does not authorize the release of their info –> essentially refuse to disclose any client info

Question 13

exemptions of privilege

Answer 13

1) client sues therapist (i.e., malpractice suit)
2) client claims psychological damages in civil suit
3) court-order psychological evaluation
4) client-initiated psychological evaluation (to establish competency)
5) child/elder/dependent adult abuse
6) imminent danger to self/others/property
7) minor < 16 years of age victim of crime

Question 14

Mandated disclosures to breaking confidentiality in CA

Answer 14

1) Tarasoff
2) Reasonable suspicion of abuse
3) Court order

Question 15

Permitted disclosures to breaking confidentiality in CA

Answer 15

1) client signs waiver authorizing release of info
2) supervision
3) professional consultation
4) threat of harm to self
5) threat of harm to property (technically exemption to privilege)

Question 16

duty to warn

Answer 16

required to inform law enforcement, and requires breaking confidentiality by definition

Question 17

duty to warn

Answer 17

required to inform law enforcement, and requires breaking confidentiality by definition

Question 18

duty to protect

Answer 18

you must protect the victim, but there is a plethora of ways you can do that, and this could potentially not involve breaking confidentiality

Question 19

Tarasoff case law

Answer 19

-therapist determines client is a serious danger to others
-range of options to discharge duty to protect
-obligation to use “reasonable care” to protect intended victims
-no provision of immunity

Question 20

Tarasoff statute

Answer 20

-client communicates serious threat of violence to therapist
-duty to warn victim (i.e., reasonably identifiable victims) and law enforcement
-provides immunity ONLY when discharged duty to warn
-addresses provisions for how therapists can get immunity (immunity = follow these instructions in duty to protect, won’t be liable to be sued)

Question 21

Jensen (2015) - CA Duty to Report

Answer 21

-therapists have a duty to report serious threats of violence to local law enforcement –> civil immunity will be granted to therapists who comply
-goal: remove current or future firearms/weapons from patients who are assessed as a danger to others (regardless of method) –> patients are prohibited from possessing, controlling, purchasing, or receiving weapons for five years

Question 22

reasonable person standard

Answer 22

likelihood of violence assessed based on therapist’s use of “reasonable degree of skill, knowledge, care ordinarily possessed by members of that speciality under similar circumstances.”

Question 23

assessment of risk (of harm to others)

Answer 23

therapist reasonably determines that client presents a serious danger of violence to another person(s)

–> serious = risk of real, imminent violence (vs. expression of violence that is not probable)
–> dangerous = serious risk of loss of life OR grave bodily injury (GBI = loss of consciousness, concussion, fracture, wounds requiring sure, loss/impairment of organs, serious disfigurement)

Question 24

Assessing Risk of Violence: ACTION (Borum & Reddy, 2001)

Answer 24

a systematic, informal way of assessing the risk of harm to others involving the assessment of seven components:

Attitudes (A): does the client believe that violence is justified in these circumstances?
Capacity (C): does the client have the means to carry out the threats? (e.g., access to weapons)
Threshold (T): does the client have a plan, and what is the extent that the client has put the plan into action?
Intent (I): does the client communicate specific vs. general comments that reveal serious harm to others?
Others’ reactions (O): have others encouraged or discouraged client’s hostile reactions?
Noncompliance (N): does the client demonstrate an unwillingness to consider alternatives to violence?

Other factors:
1- history of violence/assault?
2- carried out previous threats?
3- history of mental instability?
4- history of substance abuse?

Question 25

Lethality Assessment Scale (LAS) of Risk of Harm to Others

Answer 25

Scale 1: No predictable risk = no history or current homicidal ideation (H/I); ____ support system; low alcohol use
Scale 2: Low risk of assault/homicide = occasional H/I with paranoid ideas; no history of ideas/acts; occasional alcohol binges, angry outbursts
Scale 3: Moderate risk of assault/homicide = frequent homicidal ideation without specific plan; history of impulsivity, anger, drinking; stormy relationships
Scale 4: High risk of assault/homicide = plan with obtainable means; drinking history; stormy relationships with verbal abuse, occasional assault
Scale 5: Very high risk of assault/homicide = current high-lethal plan with available means; history of attempts; strong urge to control or “get even”; history of substance abuse

Question 26

CA Evidence Code 1024

Answer 26

privilege does NOT apply if threat is a threat of harm to self (suicidality) –> threat of harm to self (or others) overrides privilege; therefore, cannot withhold records

Question 27

CA Civil Code 56.10[C]19

Answer 27

The information may be disclosed, consistent with applicable law and standards of ethical conduct, by a psychotherapist if [they], in good faith, believe the disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a reasonably foreseeable victim or victims, and the disclosure is made to a person or persons reasonably able to prevent or lessen the threat, including the target of the threat.

Question 28

Bellah v. Greenson (1978) - wrongful death case; professional negligence

Answer 28

–allegations: psychiatrist did not use reasonable care to prevent suicide or inform parents of high-risk behaviors that led to client’s suicide
–ruling: psychiatrist expected to take “appropriate preventative measures” to exercise reasonable care, but this case did NOT determine that psychiatrist had a specific duty to breach confidentiality –> not required to inform parents or do something specific, but established that there is a therapeutic duty to protect

Question 29

CA Welfare Code 5150 - Involuntary Hospitalization

Answer 29

“When any person, as a result of a mental disorder, is a danger to others, or to himself or herself, or gravely disabled, a peace office, a member of the attending staff . . . of an evaluation facility designated by the county, designated members of a mobile crisis team . . . or other professional person designated by a county, may, upon probable cause, take, or cause to be taken, the person into custody and place him or her in a facility designated by the country and approved by the State Department of Mental Health as a facility for 72-hour treatment and evaluation.”

–> therapist must cite “specific and articulable facts” and “rational inferences from these facts”
–> assessing threat to harm of self or others and activating #### requires that there be a mental health disorder, a danger to self or others, and a nexus or a linkage of the two
–> must identify a designated official after a client is assessed as a risk of harm to themselves or others

Question 30

Suicide Assessment Five-Step Evaluation and Triage (SAFE-T)

Answer 30

1. Identify risk factors.
2. Identify protective factors.
3. Conduct suicide inquiry: specific questioning about thoughts, plans, behaviors, and intent.
4. Determine risk level/intervention.
5. Document.

Question 31

Child Abuse and Neglect Reporting Act - CANRA (1980)

Answer 31

deems that it is mandatory to report for all incidents of child abuse when victim is under 18 when there is observed or reasonable suspicion of said abuse

–minor = any individual under 18 yrs (regardless of the age of the offender)
–reporting = not time-limited while victim is a minor

*liable if not reported (misdemeanor up to 6 months jail and $1000 fine) and immunity from prosecution when reported if made in good faith and no other breaches of confidentiality

Question 32

reasonable suspicion

Answer 32

“objectively reasonable for a person to entertain a suspicion, based upon facts that could cause a reasonable person in a like position, drawing, when appropriate, on his or her training, to suspect child abuse or neglect”

Question 33

categories of child abuse under CANRA

Answer 33

1. physical abuse
2. sexual abuse (i.e., sexual assault, sexual exploitation) –> can include consensual sexual activity among minors
3. willful cruelty, unjustified punishment, unlawful injury - includes inflicting/permitting unjustifiable mental suffering (UMS) –> verbal/emotional abuse is a permitted report, not mandatory report, unless UMS is based on willful cruelty/punishment
4. neglect - general or severe

Question 34

elder or dependent adult abuse

Answer 34

elder = resident of CA age 65 years or older
dependent adult = resident of CA 18-64 years old who has physical and/or mental limitations including restricted ability to carry out normal activities or restricted ability to protect own rights OR is a resident of residential health facility (long-term care)

mandated report unless therapist is informed of abuse and therapist determines all 3:
-no independent corroborating evidence is known
-diagnosis of a mental illness/dementia
-reasonable belief abuse did not occur

Question 35

categories of elder/dependent adult abuse

Answer 35

1. physical abuse - assault, battery, assault with a deadly weapon, unreasonable physical restraint; deprivation of food/water, and sexual assault
2. abandonment - deserting, forsaking care, and custody
3. abduction - taking elder/dependent adult outside of CA, preventing return (without consent)
4. isolation - preventing social interactions and communication
5. financial: appropriate money or property for wrongful use; intent to defraud
6. neglect: failure to provide/assist; also includes self-neglect - personal hygiene, medical/mental health care, malnutrition, health/safety hazards

Question 36

types of trouble in psychotherapy

Answer 36

1) criminal: felony charge; standard = beyond a reasonable doubt
2) civil lawsuit: malpractice; standard = preponderance of evidence
3) BBS disciplinary action: unprofessional conduct; standard = clear and convincing evidence

Question 37

malpractice four elements

Answer 37

based on allegations of professional malpractice, these elements must be present for therapist to get in trouble:
1. professional-relationship between therapist-client must have existed
2. legal duty based on this relationship must have been breached – therapist must have acted in a negligent or improper manner or deviated from the “standard of care” by not providing services that are considered “standard practice in the community”
3. client must have suffered harm or injury, which must be verified via documentation
4. nexus: there must be a legally demonstrated causal relationship between MFT negligence/breach of duty and damage/injury claimed by the client

Question 38

reasons for malpractice suits: clinical standard of care (Corey, 2019, p. 193-198)

Answer 38

1. Practicing beyond scope of practice or competency.
2. Client abandonment and premature termination.
3. Negligent assessment and misdiagnosis.
4. Unhealthy transference/countertransference relationships.
5. Failure to assess and manage dangerousness of client.

Question 39

reasons for malpractice suits: scientific standard of care (Corey, 2019, p. 193-198)

Answer 39

1. Marked departures from established therapeutic practices (EBP, EVT)
2. Inducing repressed or false memories

Question 40

reasons for malpractice suits: legal/ethical standard of care (Corey, 2019, p. 193-198)

Answer 40

1. Failure to obtain or document informed consent.
2. Refusal to counsel clients due to value differences.
3. Sexual misconduct with a client.

Question 41

accusation (BBS disciplinary term)

Answer 41

formal statement of charges against the registrant/licensee

Question 42

revoked (BBS disciplinary term)

Answer 42

the registration/license is cancelled, voided, rescinded –> the right to practice is terminated

-e.g., occurs with the most severe offense = sexual misconduct

Question 43

revoked, stayed, probation (BBS disciplinary term/action)

Answer 43

“stayed” = revocation is postponed –> professional practice may continue so long as the registrant/licensee complies with specific probationary terms and conditions –> violation of probation may result in the revocation that was postponed

-license put on hold, but therapist is given a change to remediate
-most common BBS ruling

Question 44

suspension (BBS disciplinary term)

Answer 44

the registrant/licensee is prohibited from practicing for a specific period of time

Question 45

license surrender (BBS disciplinary term)

Answer 45

to resolve a disciplinary action, the registrant/licensee has given up his/her registration/license - subject to acceptance by BBS –> the right to practice is terminated

-e.g., most common route taken when therapist gets a DUI

Question 46

BBS Types of Violations

Answer 46

1. Sexual misconduct (e.g., sexual contact with current client/former client)
2. Impairment (e.g., impaired ability to function safely due to mental illness, physical illness, or chemical dependency)
3. Commission of Crime or “Bad Act” (e.g., commission of a crime substantially related to the duties, functions, and responsibility of a licensee)
4. Fraud and Misrepresentation (e.g., securing, or attempting to, a license by fraud)
5. Fees and advertising (e.g., failure to disclose fees in advance)
6. Record-keeping (e.g., failure to keep records consistent with sound clinical judgment)
7. General misconduct (e.g., gross negligence or incompetence)
8. Others (e.g., failure to maintain confidentiality)

Question 47

effectiveness of telehealth

Answer 47

–therapists can have translator on a call for clients who need this service and can reach them from far distances instead of being limited to in-person translators
–clients can reach experts not in their area for specific mental health issues (e.g., trichomania)
–for clients who are physically disabled or who have children, telehealth more accessible for them
–general accessibility leads to increased attendance because of convenience
–empirical evidence demonstrating no difference in perceived effectiveness between online modality and in-person

Question 48

non-effectiveness or barriers to telehealth

Answer 48

–issues of confidentiality - no control over environment
–technology issues - access to technology and connectivity issues
–texting/email modalities = 0 non-verbal cues (unable to read tone, inflection, etc)
–too many distractions at home (e.g., noise, children, etc)

Question 49

considerations with telehealth informed consent

Answer 49

–if having connectivity issues, could consider rescheduling
–therapist does not have control over client recording of sessions, could discuss this with client though
–emergency/crises procedures – local hospitals, ER locations, which police jurisdiction to call
–risks and benefits - inform clients of actions taken and some of the additional risks that might be inherent; reminder for client to not engage in distractions
–problems may arise that may not be appropriate to be dealt with in a telehealth setting - discuss this possibility with clients
–must ensure a private and quiet setting