Law + Ethics Comp Exam Flashcards
The __________ is set by law and cannot be expanded.
Scope of Practice
The __________ can be expanded.
Scope of Competence
The __________ is set in state law and specifies what an MFT can legally do.
Scope of Practice
The __________ allows MFTs to work with individuals, couples, families, and groups.
Scope of Practice
The scope of practice for MFTs allows professionals to assess and treat _________.
relational issues.
The scope of practice allows MFTs to use psych tests if 1) the therapist is working with the client in ______ and 2) we have adequate ______ to administer the test.
1) therapy setting
2) training
This question helps an MFT determine if they are working within their ______:
Does the need for treatment stem from issues involving the client’s relationships?
Scope of Practice
This statement helps an MFT determine if they are working within their ______:
If anyone would have something negative to say about what you’re doing, don’t do it.
Scope of Practice
The following questions bring clarity to an MFT’s ______:
- How would your peers (other MFTs) evaluate whether or not you were working within your scope of practice?
- What would your professional association say, if given all the facts, about whether or not you were working within your scope of practice?
- What do you believe would be the position of the ethics committee for your professional association?
- What would the licensing board say, if given all the facts, about whether or not you were working within your scope of practice?
Scope of Practice
The knowledge, skills, and tools that help us practice are ___________.
Scope of Comptence
The scope of competence is determined by _____
education, training, and experience
You can expand your scope of _____, but you can not expand your scope of _____.
competence
practice
The most important piece of the scope of practice is understanding its ________.
limits
The scope of ________ varies by person
competence
A guiding question for __________ is:
What is it you’re being asked to do at that moment? Am I competent to administer this?
Scope of Comptentence
______ is the body of rules that govern the profession.
Laws
Laws define the __________ that the government enforces.
minimum standards
What makes laws important in what we do? Laws are important because of __________. Let’s you know what you can/can’t do.
keeping order, protection, safe
_________ is roughly 40% that will cover you legally in working with the client. Everything else is a grey area of _______.
Informed consent
Ethics
_______ represents the ideal standards for the profession.
Ethics
_______ are established and enforced by professional organizations–AAMFT, CAMFT, ACA…
Ethics
The primary purpose of ethics codes is safeguarding ________.
client welfare
_______ are beliefs and attitudes that provide direction to everyday living.
Values
_______ are ideas of right and wrong based on cultural or religious beliefs
Morality
_______ is a process that involves the psychotherapist sharing sufficient information with the client or prospective client so the client can make an informed decision about participation in the proposed course of treatment.
Informed Consent
Informed consent requires that the client understands the information presented, gives consent voluntarily, and is competent to give ___________.
Consent to treatment
Consent to treat is important for working with all clients but especially ________.
minors
Therapists cannot release information unless the client signs an _______. This dictates what information we can/cannot share.
Authorization to Release Information
When working with couples, therapists are encouraged to have a ____________ where the therapist cannot “hold” sensitive information from one or the other participants.
No Secrets Policy
We legally have to disclose ________ before therapy begins.
Fees
Licensure status & date
Complaint process (BBS)
Privacy Practices
Use of technology as a delivery of services (Telehealth)
The important documents are:
1) Informed Consent
2) Consent to treat
3) Authorization to Release Information
4) No Secrets Policy
With Informed Consent, failure to provide relevant information could mean that a therapist is not meeting the ___________.
“standard of care”
The therapist must obtain the client’s _________ by providing information about the nature of therapy so that the client can make meaningful decisions for or against treatment.
informed consent
The following are legally required elements of ___________:
- Competency of the client – the client must have the sufficient mental ability to reasonably understand the treatment
- Inform the client of the information that a “reasonable” person would want to know before deciding on the proposed treatment
- The therapist’s contract and wording must be worded in a language that a “reasonable” person could understand
- The client must be free of coercion, duress, or fraud when they consent to treatment
Informed Consent
The following are ___________ to include in Informed Consent:
- Risk/benefits of therapy
- Therapists’ education, theoretical orientation, background
- Management of confidentiality
- Mandated Reporting
- Self-harm process
- Cancellation policy, no-show rates
- Client behaviors that may necessitate termination
best practice information
What are the four types of child abuse?
Physical
Willful harm and endangerment
Neglect (general and severe)
Sexual (assault and exploitation)
(PNWS)
Mental/Emotional (optional)
Any situation where any person willfully causes, or permits, injury to a child is ______.
Child abuse - physical
Examples of this kind of child abuse are:
Hitting, grabbing, leaving a mark, etc…. “Are there differences in the child between yesterday and today?”
Child abuse - Physical
_______ is a situation where any person willfully inflicts upon any child any cruel or inhuman corporal punishment or injury resulting in a traumatic condition
Unlawful Corporal Punishment
_________ is when any person causing a child “unjustifiable physical pain or mental suffering, or any caregiver allowing it to happen”. (i.e. sleep depravation)
Willful Harm or Endangerment (Child Abuse)
_______ includes incest, oral sex, anal sex, sexual penetration, lewd and lascivious acts, child molestation, and some forms of statutory rape.
Sexual Assault (Child Abuse)
_______ is when parents or other adults encourage a child to participate in sexually explicit acts, performances, or depictions
Sexual Exploitation (Child Abuse)
The following are other considerations of _______:
- Lewd and Lascivious Acts
- Consensual Sex and Reporting
- Sexting and Digital Media
Sexual Abuse
________ is negligent treatment or maltreatment of a child by a parent or caretaker that could or does result in harm or threatened harm to the child’s health or welfare. (2 Types: General and Severe)
Neglect (Child Abuse)
Who do you report child abuse to?
- Child Protective Services (CPS) - county the child lives in.
- Police/Local law enforcement (if in imminent danger, call 911)
You submit a verbal report for child abuse when:
- When you reasonably suspect abuse, see bruises
- Immediately… as soon as possible
- Due within 24 hours
A written report for child abuse is due:
- Within 36 hours
When reporting abuse, what do you need to get from the agency you reported to?
- Get the name and title of the person in the agency you reported to (CPS, police, etc.)
- Case number
If someone already made a report on child abuse, we _______.
We still report it. We don’t trust every clinician has made the report. If our hands touched it, we see it from start to finish.
While managing the therapeutic relationship in reporting child abuse, the therapist must:
- Explain process
- Normalize feelings
- Provide resources
What is the age range of an elder?
Someone 60 years and older
What is the age range of a dependent adult?
18 to 59 years old
A dependent adult means any person residing in this state between 18-59 years of age, inclusive, who resides in this state, and who has a combination of a ___________ and the inability to protect ___________, or who has the inability to carry out ___________.
1) disability
2) their own interest
3) normal activities
What are the six reportable types of elder abuse?
Physical Abuse
Abandonment
Isolation
Neglect
Financial
Abduction
(PAINFA)
With elder abuse, physical abuse is _______________.
inflicting physical pain or injury upon an older adult.
Different types of physical abuse for elders are:
- Assault
- Battery
- Physical restraint
- Sexual assault
- Deprivation of food or water
The following are examples of _________ that are reportable within elder abuse.
- Failure to assist in personal hygiene or provide food
- Failure to provide proper medical needs
- Leaving an at-risk person unattended
- Soiled linens/clothing
- Untreated skin disorders
- Neglected bedsores
Neglect
With elder abuse, ________ is a reportable abuse when someone prevents elder or dependent adult from receiving their mail, phone calls, meeting with visitors, leaving their home, or telling a visitor that the elder or dependent adult is not available.
Isolation
With elder abuse, _________ is a reportable abuse for the following scenarios:
- The disappearance of papers/checkbooks
- Staff or others assisting with purchases/withdrawals
- Sudden changes in spending habits
- Bills left unpaid
- Telemarketing fraud, identity theft, home improvement scams, etc. Should be reported so that the government can investigate.
Financial
With elder abuse, ________ is a reportable abuse when a caretaker deserts their patient/loved one or gives up on their responsibilities when a reasonable person would not have done so.
Abdandonment
________ is a reportable abuse when the elder or dependent adult must have been taken outside the state of California or prevented from returning to the state, and they must not have the ability to consent.
Abduction
Abduction does not apply if they are moved against their will ________.
within the state
For elder and dependent adult abuse outside of a care facility, therapists report to:
Adult Protective Services (APS)
Local law enforcement
For elder and dependent adult abuse outside of a care facility, when do you make the verbal and written report?
Verbal Report - Within 24 hours
Written Report - Within 48 hours
For elder and dependent adult abuse within a care facility, when do you report physical abuse with a serious bodily injury?
Verbal Report - Within 2 hours
Written Report - Within 24 hours
For elder and dependent adult abuse within a care facility, who do you report physical abuse with a serious bodily injury?
Local ombudsman (advocate) or local law enforcement by phone immediately or as soon as practicably possible
For elder and dependent adult abuse within a care facility, when do you report physical abuse that does not result in serious bodily harm?
Verbal - within 24 hours to contact law enforcement.
Written - within 48 hours (2 working days).
For elder and dependent adult abuse within a care facility, who do you report physical abuse that does not result in serious bodily harm?
Local law enforcement
Local ombudsman
(A phone or internet report and written report to them…)
What are the three requirements that create an exception to reporting elder abuse?
1) The therapist is not aware of any independent evidence that corroborates the alleged abuse
2) The elder or dependent adult has been diagnosed with a mental illness or dementia or is the subject of a court-ordered conservatorship due to mental illness or dementia.
3) In the exercise of clinical judgment, the therapist reasonably believes the abuse did not occur.
When an elder or dependent adult tells the therapist that he or she has been abused, you ________________ if all of the following are true:
1) The therapist is not aware of any independent evidence that corroborates the alleged abuse
2) The elder or dependent adult has been diagnosed with a mental illness or dementia or is the subject of a court-ordered conservatorship due to mental illness or dementia.
3) In the exercise of clinical judgment, the therapist reasonably believes the abuse did not occur.
do not have to report
When is your Duty to Protect triggered?
- A client (or a family member of the client)
- Communicates to the therapist;
- The client’s “serious threat” (which must be imminent in order to be serious);
- Of “physical violence”;
What steps are you to take to carry out your Duty to Protect?
- Consider the hospitalization of the client
- Notify law enforcement
- Make reasonable efforts to warn the intended victim(s) and others who might be in harm’s way
What actions might you take to manage the therapeutic relationship when needing to carry out your Duty to Protect?
Institute a “safety plan”
Increase session frequency
Telephone contact between sessions
Consider the hospitalization of the client
Medication
Consult with a colleague or supervisor
Have the client dispose of the means
Comply with your agency’s policies
Only provide information necessary to meet the legal requirement when contacting law enforcement
Document all steps
For assessment and mandates as a clinician, what is a helpful acronym to utilize?
QRMOTHS
For assessment and mandates as a clinician, what does the acronym QR MOTHS stand for?
Questions
Releases/Referrals
Mental Status Examination (MSE)
Observations
Testing
History
Social Supports
_______ is a legal right to not have confidential information revealed by their therapist during a legal proceeding.
Privilege
Who can waive privilege?
The general rule is the client waives privilege
Who can assert privilege?
- The person who holds privilege (most often the client)
- A mental health professional on behalf of a client
Who is the holder of privilege?
- CLIENT regardless of age, when there is no guardian or conservator
- A GUARDIAN ad litem (guardian for purposes of litigation)
- REPRESENTATIVE of the patient if dead
- All members of a TREATMENT UNIT (individual, couple, family)
The scenarios when we (therapist) legally has to disclose client information and break confidentiality are:
- Ordered by a judge (can say no to an attorney)
- The client files a complaint against the therapist
- Client claims psychological damage in a lawsuit
- Civil Commitment proceedings
Three ways to manage countertransference are:
- Seek personal therapy
- Establish appropriate boundaries
- Consult with your supervisor and colleagues
There is a duty to protect if there’s an ___________, ___________, and ___________.
identifiable victim, timeframe, and plan.
Ethics are established and enforced by professional organizations such as __________.
CAMFT
The goal is to practice within the spirit of the __________.
ethics codes (CAMFT)
Who is responsible for licensing and regulating various professions, including therapists, in California?
The Board of Behavioral Sciences (BBS)
The __________ oversees the licensing, examination, and enforcement of licensed professionals in the fields of psychology, marriage and family therapy, clinical social work, and professional counseling.
Board of Behavioral Sciences (BBS)
The most important component of a therapist’s therapeutic duty is:
The therapist will do no harm
A therapist’s therapeutic duty when a client reveals that he/she is HIV positive is _______________.
to keep the information confidential
Three parts of the therapeutic duty of a therapist is:
Assess,
diagnose and treat,
do no harm
The ___________ differentiates with every client.
standard of care
The ________ means the “skills level, knowledge, and care in diagnosis and treatment that other responsibly careful therapists would possess and use in similar circumstances.
standard of care
The following are examples of a ______________:
- Obtaining thorough informed consent
- Completing a thorough diagnosis on a client
- Conducting adequate assessments (e.g., personal history, medical history, family history, presenting problems, mental state, etc.)
- Creating a treatment plan
Standard of Care
The following are guidelines for ____________ to a client:
1) What are the potential consequences of engaging in sex with former clients?
2) What do you think of the statement, “Once a client, always a client?”
3) Self-care and healthy boundaries
Managing sexual attraction
Informed consent is a ___________ obligation
legal and ethical
____________ sets the foundation for trust
Confidentiality
The following are ____________ information to include in Informed Consent:
Risk/benefits of therapy
Therapists’ education, theoretical orientation, background
Management of confidentiality
Mandated Reporting
Self-harm process
Cancellation policy, no-show rates
Client behaviors that may necessitate termination
best practice
What do we legally have to disclose in an Informed Consent before therapy begins?
Fees,
licensure status,
complaint process,
privacy practices (NOPP),
use of technology as a use of delivery of services (risk of telehealth)
_______ is the ethical and legal responsibility of a mental health professional to safeguard clients from unauthorized disclosures.
Confidentiality
The following are situations when it is ________ to break __________:
Suicidal client – legally permitted, not legally mandated to disclose
Client consent: Release of Information
For reimbursement - insurance, 3rd party payers with limits
Managed care personnel
Consultation, supervision, peers
Other mental health providers
Other professionals in the treatment team
permissible
confidentiality
The following situations are when we legally have to _________:
Ordered by a judge (can say no to an attorney)
The client files a complaint against the therapist
Client claims psychological damage in a lawsuit
Civil Commitment proceedings
disclose client information
Mandates require us to breach confidentiality when:
Duty to protect (tarasoff)
Child abuse
Elder abuse
Dependent adult abuse
For confidentiality with HIV/AIDS, the therapist must maintain confidentiality unless there is ___________ to release this information.
permission from the client
______ is an issue involving an actual or potential physical or emotional threat to the well-being of the client and/or others not directly involved in the treatment.
Crisis
_____ is an event or circumstance that prevents therapy from proceeding until it is stabilized.
Crisis
What are clinical steps to managing a crisis?
Active listening, reflecting back to the client, more direct/assertive in a non-judgmental way.
What are the steps for treatment of suicidality?
Confidentiality
Interventions – Use increasingly protective measures
Clinical Approach
Development of a Self-care Program
The following is _______________ for suicide:
1. Recognize and detect risk
2. Thoroughly interview regarding current suicidal desire/ideation, plans, means, intent and especially past attempts and protective factors
3. Determine level of imminent risk
4. Develop and document a collaborative intervention plan (safety plan) appropriate to the situation and level of risk
Competent Clinical Care
The following is important to _________:
Client statements about suicidal TIPM
Acute risk factors – including previous suicide attempts and family history
Your judgment about lethality
Degree of hopelessness
Severity Risk – None, Low, Moderate, Severe – provide support for risk level
Details of the Safety Plan
Action taken, including supervision and consultation with experienced professional.
Results of actions
Periodical inquiry about suicidal thoughts
Reasons to discontinue suicide checks
document
There is no mandate or provision to report ___________.
domestic violence
With domestic violence, Refer to a _________, as they can report domestic violence.
medical doctor
To manage a client experiencing domestic violence:
- Refer to a medical doctor, as they can report domestic violence
- Create a safety plan, when possible including extended family
- Describe the Cycle of Violence
In the Cycle of Violence, the ________ stage is when:
- When the abuser will apologize or try to make up for their abusive actions.
- They may blame abusive behaviors on the victim
- Ignore or deny abuse
Honeymoon
In the Cycle of Violence, the ________ stage is when:
Walking on eggshells
Threats and intimidation
Fear
Guilt
Unpredictable behavior
Tension
In the Cycle of Violence, the ________ stage is when:
When the abuse actually occurs
Violent behaviors
Emotional, physical, financial, and/or sexual abuse
Violence
The cycle of violence often repeats itself _____________.
inter-generationally
The following are ways to _________________:
1) Couple’s therapy is rarely recommended, not recommended unless the batterer is in treatment
2) The batterer interested in treatment can be referred to a group or have individual sessions.
3) Physical and emotional safety are primary concerns for survivors
4) Introduce the Power and Control Wheel & Equality Wheel
Manage domestic violence
What does the acronym TIPM stand for?
T – Thoughts – is the person thinking about killing themselves? Or dying? Or just going to sleep? Ask directly if they have thoughts of suicide. How frequent are the thoughts?
I – Intent – Is the person intending to act on the thoughts?
P – Plan – Does the person have a plan? How or what does the person imagine doing? How extensive is the plan?
M – Means – Does the person have the means to carry out the plan?
Two helpful acronyms to assess suicidality are:
IS PATH WARM
TIPM
To assess for suicidal ideation, what does the acronym IS PATH WARM stand for?
I Ideation = threatened or communicated
S Substance Abuse = excessive or increased
P Purposeless = no reason(s) for living
A Anxiety, Agitation/Insomnia
T Trapped = feeling no way out
H Hopelessness
W Withdrawal = disconnection family, friends, society
A Anger = uncontrolled rage seeking revenge
R Recklessness = risky, unthinking acts
M Mood Changes
In assessing for suicidality, SAL can be used to:
Assess lethality of suicidal plan
In assessing for suicidality, SAL stands for:
Specific
Available
Lethality
In assessing for suicidality, CARL can be used to:
Assess Lethality of Prior Attempts
In assessing for suicidality, CARL stands for:
Chronological Factors
Awareness of Lethality
Rescue
Lethality
__________ are those relationships between a therapist and a client that involve more than one “identity.”
Dual Relationships
Family friends, social settings (church) can be a ___________
Dual Relationship
Dual Relationships exist on a continuum from ________ to ________.
Boundary-crossing to boundary-violation
Not all dual relationships are ________ or ________.
unethical or avoidable
The following are risks of ____________:
Might impair their judgmeent and objectivity
Affect their ability to render effective services
Result in harm or exploitation to clients
Dual relationships
__________ is a departure from a commonly accepted practice that could potentially benefit clients
Boundary Crossing
_________ is a serious breach results in harm to clients
Boundary Violation
The following are guidelines for __________:
Work with the client to determine the value of the goods or service in the beginning of the arrangement
Determine an appropriate length of time for the arrangement
Document the value of the goods, the length of time of the agreement
Goods are better to exchange than services
Bartering
Important aspects of gifts in Psychotherapy are:
Value of the Gift
Nature of the Gift
Cultural Considerations
Clinical Implications of accepting, rejecting, or giving a gift
What handbook is given to the client when they report sexual behavior with a previous therapist?
“Therapy Never Includes Sexual Behavior”
The following are important in assessing ________ in the __________:
Clients can file an ethical complaint with a professional association (this action does not prevent the therapist from practicing)
Administrative action begins with the client filing a complaint with the therapist’s licensing board
The client can also file a civil suit or criminal actions
Victims
Complaint Process
_________ is when the therapist intentionally withholds certain information from the client.
“Holding Information”
The purpose of _________ is to protect the client’s emotional well-being by preventing them from becoming overwhelmed or re-traumatized by information that may be too difficult for them to handle.
“Holding Information”
The therapist may choose to hold back information about traumatic events or past experiences that the client is not yet ready to process. By doing so, they can help the client build the necessary emotional resources and skills to cope with difficult information in a safe and healthy way.
“Holding Information”
______ is a policy that reduces the potential for a conflict of interest between the therapist and the unit of treatment (couples, families, groups).
“No Secrets” policy
A spouse or family member who is part of the treatment calls you and privately shares therapeutically relevant information. Your _______ would be applied in this instance.
“No Secrets” policy
For the Treatment of Minors in Custody Situations, people in ______ have the right to make decisions regarding the health, welfare, and education of the minor children.
Legal custody
For the Treatment of Minors in Custody Situations, is where the children live the bigger percentage of the time. Many parents “share” __________ by dividing the time the children spend with each parent.
Physical custody
With physical custody, if the parents are ____________, either parent may unilaterally consent if paternity has been confirmed. Father’s name is on the birth certificate or paternity has been established through the legal system.
biological but not married
Generally, foster care parents ________________ to consent to treatment. The consent lies with the dependency court. Each county has different laws about who can consent for foster children.
do not have the authority
In the treatment of minors and the family code, ________ sign the consent to treat for the minor (in most cases).
Parents
In the treatment of minors and the family code, ________ agree to the informed consent for minors.
Parents and minor
In the treatment of minors and the family code, ________ sign the written authorization to release information forms.
Parents and minor
In the treatment of minors and the family code, there is legal protection & the ___________.
Caregiver’s Authorization Affidavit
In the treatment of minors and the family code, a therapist must include __________ in the minor’s treatment and emergency treatment.
parents
Minors are the __________ but are not permitted to enter into legal contracts.
holders of privilege
In a 2014 Law, it is unprofessional conduct to attempt to change a minor’s ________. We cannot offer reparative therapy, conversion therapy, or ex-gay therapy.
sexual orientation
Legally, __________ must be broken when a client under the age of 18 is a victim of child abuse
confidentiality
Minors have the same right to __________ as adults
confidentiality
Parents who consent to treatment for a minor have a right to ________ the child is receiving and the child’s well-being.
information about the treatment
Treatment of Minors Without Parental Consent
- The minor is 12 years of age or older, and
- The clinician determines that the minor is mature enough to participate intelligently in outpatient mental health treatment or counseling, and
- Counseling must be on an outpatient basis
- The intent is to include the parents in the child’s treatment
- If, after consulting with the minor, the clinician determines that involving the parents is detrimental to the health of the minor the parent shall be excluded.
______________ may be seen without parental consent and have the right to make their own legal decisions.
Emancipated minors
_________ if:
Legally married
Serving in the military
Under age 18 (notes say 14 years old)
not living with parents
financially independent (money not from illegal sources)
Emancipated
Four goals of ___________:
Promote supervisee growth and development
Protect the welfare of the client
Monitor supervisee performance and serve as gatekeeper for profession
Empower supervisee to self-supervise and carry out these goals as an independent professional
Supervision
Supervisor requirements in order to provide supervision to ____________.
unlicensed clinicians
As an unlicensed clinician, you must:
Notify clients of the supervisor
The following are _________ of a __________:
Adhere to BBS Statutes and Regulations
Monitor trainee’s progress
Be familiar with trainee’s caseload
Maintain records pertaining to supervision with trainees
Do not supervise more trainees than is ethically manageable
Ultimately responsible, ethically and legally, for the actions of their trainees
Roles and Responsibilities
Supervisor
Legal aspects of supervision are:
Informed Consent
Confidentiality and its limits
Liability
The following are __________ with problem supervisors:
Boundary violations
Misuse of power
Sexual contact with supervisees
Substance abuse
Extreme burnout
Diminished clinical judgment
Common issues
For Supervisors and Supervision, the three aspect required are:
Required Paperwork
Supervisor Requirements
Methods of Supervision
Major licensing requirements are:
Education
Experience
Exams
The following are aspects of ___________:
Selecting a theory
Theoretical orientation
Division of responsibility in therapy
Deciding on Goals
Use of Techniques in Counseling
Developing a counseling style
In advertising, it cannot be _______, _______, or _______.
false, misleading, or deceptive
In advertising, you cannot make _______ or _______ for treatment.
Promises or guarentees
Advertising Requirements are:
Your full name
License status
Your specific license/registration number
The fully spelled out title of your license/registration, or an acceptable abbreviation
Associates must also include the name of their employer or agency where they volunteer
_________ cannot personally advertise their services. However, your traineeship may advertise your services
Trainees
The acronym for ethical guidelines for termination with a client is:
PLARGO
For ethical guidelines for termination with a client, PLARGO stands for:
Premature
Loss
Anticipated Challenges/Set Backs
Referrals
Goals Met
Open Door
Termination should be ________ and ________.
discussed and planned
For termination, if there are __________, plan from the beginning.
Limited sessions
For telehealth and mental health services, the clinician must develop the _____ to use technology.
skill
For telehealth and mental health services, in emergency situations, the therapist needs to know the ____________.
area (or address) the client lives in
For telehealth and mental health services, the therapist is responsible for staying current with all the __________.
legal and ethical requirements
Trainees must have supervision ___________
in person
Legal for MFT Associates to have supervision via __________ (EXCEPT in private practices where it still has to be in person)
videoconferencing
When communicating with clients over email, the therapist must _________ clients and get specific ________ for communicating with clients via unsecured email.
Inform
Consent
When communicating with clients over email, clients tend to appreciate a conversation about ______. It is also important to ________ what kinds of information will be shared via email.
Security
Discuss
_________ is unsecured, as simple password protection does not qualify as encryption.
text messaging
If the phone is lost/stolen you may need to report a __________.
breach of confidentiality
If you are going to ______, talk to the client about policies for communication and how you protect their information
text
If it’s not __________ it did not happen!
Documented
The purpose of mental health records are:
- MFTs must assess, diagnose and treat clients
- Records establish reference point to support treatment decisions
- Records protect MFTs should they face legal action
The benefits of mental health records are:
Provide continuity of treatment
Demonstrates that adequate care was provided
Perspectives on record keeping:
Clinical – review course of treatment
Ethical – assist in providing quality of care to clients
Legal – law requires record keeping
Risk Management – standard of care
The following are content of __________:
Intake Form
Signed Consent to Treat
Informed Consent
DSM 5 Diagnosis including prognosis
Treatment Plan
Progress Notes
Ledger Form
Testing
Signed Authorization to Release Information
Consultations
Discharge Summary (very important in documentation)
No Secrets Policy as needed
Mental Health Records
For mental health records, therapists must retain them for ______.
7 years (10 recommended for adult clients)
For mental health records of minors, therapists must retain them until client reaches the age of _____.
25 years old (7 years after they turn 18)
Mental health records must be kept in ______.
Secure Storage
HIPPA compliance for mental health records is between ______ secure locks.
two
______ are the owners of their mental health records.
Clients
Clients have the right to ______ and ______ their records.
inspect and copy
Clients must request to copy/inspect their mental health records in ______.
writing
Clients have _____ to inspect their mental health records.
5 days
Therapists have _____ to provide a copy of mental health records to clients who request them in writing.
15 days
Clients can be given a ______ of their mental health records which must be provided in _______.
summary
10 days
Law doesn’t specify the content but does specify __________ for a SUMMARY:
health records:
Chief complaints; including pertinent history
Objective findings from the most recent physical examination
Findings from consultations and referral to other health care workers
Pertinent reports of diagnostic procedures and tests
the minimum
If the MFT believes that giving the client the records would be ______ to the client, they can refuse to make them available.
injurious
If the MFT believes that giving the client the records would be injurious to the client, they can refuse to make them available. The MFT must _________ why and make the records available to another therapist that the client chooses. That therapist cannot ______ the records but can discuss the content with the client
document
release
The following are reasons for mental health records to be _______ for a court proceeding:
Auto accident, divorce, sexual harassment, etc.
subpoenaed
There is no ________ when the patient’s emotional condition has been raised by the patient (mental health records and court proceeding)
privilege
What are the risk factors for suicidality?
- Intention and History - “no hope”
- Demographics - young people, elderly (in retirement/stagnation), and males have a higher success rate in suicidality (tend to use more fatal and lethal means)
- Emotional functioning
- Behavioral problems
