Top 50 Topics Flashcards
Module 3 TDC
Child abuse and neglect
In CA, you can hit a kid under what circumstances?
Spanking with an open hand that does not leave marks/bruises
Child Abuse and Neglect
An aburpt change in behavior of a child could be a sign of _______
sexual abuse
Child abuse and neglect
Homelessness of a family with children is not reportable to CPS unless ____
The children’s basic needs are not being met
Child abuse and neglect
T/F: you have to report someone who sexually abused someone who still has access to children currently
Ex. football coach previsouly abused kids, now coaches for new team
FALSE, proximity to an accussed abuser does not met criteria to trigger mandated report
Child abuse and neglect
T/F: if abuse happens in another state and is reporting in CA, you must report to the state that the abuse occured in
FALSE; always report in CA
Child abuse and neglect
What is the timeline for making a mandated report?
phone call ASAP, written report submitted within 36 hours
Elder abuse and neglect
Age criteria to be considered elder/adult abuse?
65+ y/o OR 18 y/o who is considered disabled
Elder abuse
What are the major areas of elder abuse reporting that the BBS will test competency for?
- Med mismanagement
- Physical and social isolation
- abduction
- abandonment
- neglect
- financial abuse
- emotional abuse (optional)
Elder abuse
If abuse of an adult is occuring in a facility or residential setting, who do you report this information to? and what is the timeline?
law enforcement or local ombudsman
non-physical abuse is reported immediately and written report in 2 business days.
physical abuse with non-serious injury by another person in the care home with dementia is reported to BOTH law enforvment and ombudsman in writing in 24 hours but verbal statement is not required
physical abuse with serious bodily injury must be verbally reported as soon as
possible with no more than 2 hours passing from observing, obtaining knowledge or suspecting abuse or neglect. A written report must be submitted within 24 hours to the local law enforcement, the long term-care ombudsman, and the corresponding state licensing agencies.
Domestic violence
Why is counseling not advised for couples who are actively in a DV situation?
Shame is a pre-cursor to risk and the couple will actually be at increased risk of intimate partner violence. Referrals to outside individual counseling should be provided.
Domestic Violence
When do you file a police or CPS report for DV?
when child is bystander victim; or is hurt incidentally by adult violence
If a couple is 65 or older, do you report DV?
yes, to APS as elder abuse
Domestic violence
T/F: an acceptable form of harm reduction in a couple that is physically violent is a no-harm contract?
False, it is not an acceptable violence prevention measure in couples counseling
Danger to self
What are the 7 steps to risk assessment in order that the BBS is seeking?
- conducting a BPS to assess stressors or substance use
- assess for lethality and immenence of actual danger
- build rapport
- identify major stressors/problems and preceded the crisis (willingness to engage with support system, coping skills, meaning of the crisis)
- Encourage exploration of thoughts and feelings (paraphrasing, reflecting)
- explore alternatives to harm and willingness to engage in alterative actions
- formulate a plan
danger to self
After a risk assessment has been completed and a person is identifed as low risk, you can….
Explore alternatives to violence
Identify supports and/or significant others to decrease isolation
remove lethal means to harm self/others
Implement coping mechanisms
Establish future linkage (events to look forward to)
Provide clinical referrals for outpatient services and medication, if appropriate, and a
24-hour crisis number
danger to self
After a risk assessment has been completed and a person is identifed as high risk, you can….
Hospitalization should occur if a specific suicidal plan and intention is in place and the
client is unable to engage in safety planning for their own safety
Client should not be left alone and an ambulance should be called
Danger to others
If a client DOES communicate a
“serious threat of physical violence against a reasonably identifiable victim or victims”, what two things are triggered?
- Duty to protect (Tarasoff)
- Duty to warn
danger to others
What year did Tarasoff come into effect and who enacted it?
July 1, 1976
CA Supreme Court
Danger to others
Tarasoff duty to warn means…
Requires that therapist may make attemps to warn the intended victim or others likely to apprise the victim of the danger, AND/OR to notify the police, or to take whatever other steps are reasonably necessary under the circumstances.
Danger to others
The purpose of the duty to report in CA is….
law that attempts to keep weapons out of the hands of clients who are considered a danger to others, triggered when a clt reports a serious threat of violence against another
danger to others
According to the duty to report threats of violence to another, what are the reporting timelines?
The duty to report mandates a therapist report to local law enforcement within 24 hours, the identity of a person subject to the prohibition of weapons
Local law enforcement will notify the Department of Justice
and the client will be prohibited from accessing weapons for 5 years.
Mental Status Exams
What are the 11 elements of a mental status exam (MSE)?
- Appearance in context
- Attitude (cooperative)
- Behavior/physicality (mannuerisms)
- mood/affect
- speech (normal)
- thought process (normal vs circumstantial v. tangential)
- thought content (Delusion, phobia, obsessions)
- perceptions (hallucinations)
- cognition (alertness/oriented x4)
- insight into their condition
- Judgment
Initial phase of treatment
What are some of the key things that the BBS considers an appropriate first intervention?
- Addressing safety first
- rapport building
- identifying motivation for tx
- making appropriate referrals
- psychoeducation
Middle phase of treatment
What are some of the key things that the BBS considers an appropriate middle phase of tx intervention?
- any theory based interventions
- teaching, modeling, practicing skills in session
- addressing issues that occuring in the tx process
Termination/end phase of tx
What are 3 things the BBS wants you to do upon termination phase of tx?
- seeking adequate referrals if ending due to not making progress
- processing the ending of tx with the client
- creating a plan that support ongoing mental wellness OR plan for sxs re-occuring
Working with elderly
BBS will test for your ability to balance an elderly person’s right to self-determination against BLANK
their level of competency, which you cannot assess
Couples counseling
When engaging with a couple for counseling, the BBS wants you to do three things at the outset of therapy
- be clear about goals and never guarantee anything
- be clear about risk of seperation
- conduct baseline assessment in how much they actually want to stay together
Emotionally focused couples counseling
What is the role of the therapist in EFCT?
The therapist is viewed as a process consultant.
Helps the client(s) not only understand their emotions, but experience the emotions as
well within the safety of a therapy session.
Assists the client(s) becoming aware of and experiencing the emotions that have been
previously dismissed or pushed away.
emotionally focused couples counseling
What is the goal of EFCT?
Learn how to be more adaptive with feelings, memories, thoughts, and physical
sensations that have previously been feared or avoided.
Develop new kinds of interactions within the couple system and foster secure bonding
between partners.
forming secure attachment bonds
Family Counseling
If the BBS asks about shifting from family counseling to individual counseling with one member of the family, what will they want you to do?
process the change in dynamic with the family
Group therapy
3 phases of group therapy
- Forming
- Storming
- Norming
Substance use
Steps in readiness to change:
- precomtemplation
- contemplation
- planning
- action
- maintaining
Substance use
If someone shows up to session under the influence, what does the BBS expect you do?
- Do not engage in session, end immediately
- Call police if they intend to drive home and refuse to find alternative way home bc Tarasoff and danger to self
Disorders in childhood
In order to ADHD to be dx in children, what do you need to see?
Functional impairment in at least two domains of life
disorders of childhood
Attachment disorders: reactive attachment vs. disinhibited social engagement disorder?
Reactive attachment: the child is aloof when around parent and does not seek comfort like normal child would in distress
Disinhibited social engagement d/o: child knows no boundaries with adults and gets too comfortable too quickly with strangers
Childhood disorders
ODD
v.
CD
v.
DMDD
ODD: issue is primarily with authority figures
CD: issues typically occur with the law or property destruction
DMDD: Issue with regulating extreme/severe angry moods
Psychotic disorders
T/F: you can treat someone who is actively experiencing psychosis?
False
psychotic disorders
For safety purposes, the BBS will want you to do THIS at the beginning on therapy with people who have a prior dx of a psychotic disorder?
get an ROI for their psych team
psychotic disorders
what is the first goal of tx planning for someone who experiences psychosis sxs?
Sxs stabilization
Anxiety disorders
Tx planning for anxiety disorders focuses on these 4 things:
- focus on sxs reduction
- building coping skills
- identifying triggers
- coping with physiological response
Bereavement
Can MDD and bereavement be dx at the same time?
yes, but you would need to rule our prolonged bereavement first (new dx in DSM-TR)
Eating disorders
What tx method does the BBS recommend for eating disorder tx? and what does it not recomment?
Nutritional tx, MD stabilization, CBT
medications do not work
Somatic sxs disorders
What is going to be an indicator on the test of a possible somatic sxs disorder?
Referral source was from an MD
Telehealth
What are the 4 things that need to be done for telehealth clt’s at the beginning of tx?
Give an informed consent specific to the risks/benefits of telehealth, does not need to be signed for adult clts
Assess for fit of telehealth services
Identify their specific location prior to services
Emergency contacts for clt
Consent to tx w/ minors
What age can a child consent for their own tx? and do they need an informed consent?
12+
They need to have a signed informed consent for tx
Consent to tx w/ minors
who can consent?
Married parents
Either parent can consent, dont need both signatures
consent to tx w/ minors
Who can consent?
Never married parents of minor
only need one parent to consent
consent to tx with minors
who can consent?
Divorced parents of minors
You need to check custody agreement to determine who can sign
Conservatorship
Who holds confidentiality and privilege when someone has a conservatorship?
Conservatee still is entitled to confidentiality in sessions, but the conservatee holds privilege
Confidentiality
Is duty to protect/warn triggered when HIV staus comes into play?
No, it’s considered protected. Even in couples counseling, you cannot out a client.
Consultation
When should you seek clinical consultation for transference related issues v. your own personal therapy?
Consultation is indicated when your own thoughts or feelings are distracting in session, or you are unsure of how to process. Therapy is indicated when you are experiencing a high level of emotional distress bc of the transference issues (flashbacks, distressing memories, prolonged emotions after session has ended)
Sex between minors
What are the basic age rules for minors who have sex?
13> is okay with 13> only
If one person can drink, the partner must be of driving age
Sex with clients
Is is a legal or ethical issue to fuck a client?
both legal and ethical issue
Sex with clients
If a clt tells you that they had sex with their prior therapist, what are your next steps?
Mandated to distribute the “professional therpay never includes sex” paphlet and encourage them to file a complaint with the BBS
Fees
Can money be exchanged for giving or accepting referrals?
No, this is a legal and ethical issue
Insurance and EAP
What extra piece of information needs to be included in an informed consent when the client is using their insurance or EAP benefits?
You must disclose how their information will be shared and with who, notice of privacy practices
Records
If a client asks to inspect their records and you determine that it’s clinically appropriate and will not cause harm, what are the timelines to provide their records
They are legally able to inspect records within 5 days of the request in your office
You have 10 working days to provide a summary of the records
15 days to provide a physical copy of the records
Records
What must you do if your records are stolen or compromised?
Notify police and all affected parties with stolen records
HIPAA
What are the rules about the notice of privacy practices?
They must be given prior to any tx
must be physically posted in your office
must sign an acknowledgment that it was received by them
ROI’s
What the basic rules for an ROI to be valid?
Everyone in the tx unit who is old enough must sign
Start and end dates
nature of information allowed to be shared
14pt font
If it’s handwritten, must be in clt’s writing
Privilege
Who holds privilege?
The client (regardless of age)
All members of the treatment unit
A guardian ad litem or conservator
If the patient is deceased, the personal representative of the patient
Privilege
10 exceptions to privilege
- When the client has introduced their emotional condition in a legal proceeding.
- When the client has treated confidential information as though it were not confidential.
- When there is a breach of duty: The client sues the therapist for malpractice OR the therapist sues the client for non-payment (content of therapy remains confidential).
- When the therapist has been appointed by the court to examine the client.
- When the client has sought psychotherapy to commit a crime and/or escape punishment for a crime.
- When the client is under 16 years of age and has been the victim of a crime (e.g., extortion, statutory rape).
- In a proceeding requested by a defendant to determine sanity.
- When the psychotherapist has reasonable cause to believe that the client is in such
mental or emotional condition as to be dangerous to themselves or to the person or property of another and that disclosure of the communication is necessary to prevent the threatened danger. - In a proceeding brought by or on behalf of a client to establish competence.
- When a coroner requests information in the course of an investigation of deaths involving public health concerns, abuse, suicides, poisonings, accidents, SIDS, suspicious deaths, unknown deaths, criminal deaths, or when authorized by the decedent’s representative.
Privilege
If a clt wants to waive privilege, you must….
Express your concerns to the clt, but ultimately honor their wishes and have them sign something acknowledging they are waiving privilege
Advertising
Advertising is considered a legal or ethical issue?
Both
Advertising
All your ads must include…
License #, but it’s best practice to also state your crendentials
Advertising
Are testimonials for your services an acceptable form of advertisement?
No, unethical.
Scope of practice and competence
Scope of practice refers to…
The range of services you can provide under your MFT license– legal issue.
Scope of practice and competence
Scope of competence refers to…
The background, knowledge, training and experience you have working with specific populations – ethical issue
Social media
What does the BBS want you to assess for social media use?
- the impact of the usage on the individual
- How the adults monitor and protect the minor
Legal system involvement
What does the BBS want you to assess when working with those involved in the criminal justice system?
- the impact of the legal system involvement on their overal fx
- sensitivity to racial injustices
- Trauma from arrest or incarceration
- assessing social supports upon re-entry into society
Motivational interviewing
what is motivational interviewing and who is it used for?
Motivational Interviewing is a treatment model that focuses on resolving ambivalence and using
the person’s own values and concerns to elicit change. Substance users primarily. Highlights discrepancy of actions against one’s own values.
Motivational interview
Motivational interviewing: 4 key interventions used in modality
- open ended questions
- affirmations
- Reflecting
- Summarizing
