Week 2 Flashcards

Question

# Understanding Modern Healthcare Ethical issues

Answer 1

* (do not use up sessions in beginning, only so many are covered)

Answer 2

* documentation of how client is on day one, * then what we did, * how things unfolded, * whether we made a positive impact today. * Must be written legibly

Answer 3

* (if you must change an error on a document, you must draw a line through it so it can still be read, make the correction, initial and date the change; no white out!) * Write in a way that you would feel confident defending in court

Answer 4

* Clinical Intelligence and Therapeutic Skills * (JCAHO Standards– Joint Commission for Accreditation of Health Care Organizations) * \*set all standards across health care, and accredits them. BCBS will only pay for accredited services.

Answer 5

* Coherent, logical, functional serves a helpful purpose and meaning of recording the clinical progress of the client while under my care.

Answer 6

* Use the correct/acceptable (clinical) language * Whatever you tell BCBS on the phone to get auths for treatment, you need to have the same thing demonstrated in that client’s case notes, or it’s FRAUD * Have a crisp treatment plan (There is a correct & acceptable language in our field that we must use.)

Answer 7

* **between different professionals serving the client** * If the client must see a psychiatrist, and the psychiatrist needs your record

Answer 8

* (colleagues will review charts, committees will review them such as quality assurance, etc., a psychiatrist seeing your client may review it, etc.) * Used to be a bigger feature of clinical practice than it is today b/c of managed care

Answer 9

* (to insurance companies, it documents the person was there)

Answer 10

* keeps us on task for our goals and objectives) * tells us what’s working, what isn’t working, what we have changed/haven’t changed in our treatment

Answer 11

* (should not provide treatment to anyone until they sign consent for treatment) * (may contain reasons why their treatment might be cancelled * not putting forth any effort, wasting time, etc.) * (must always be written by an attorney)

Answer 12

* Intake Info

Answer 13

* (tail end of the biopsychosocial history)

Answer 14

* (what are we doing to treat it?)

Answer 15

* (occur after every session, outline)

Answer 16

* (analogous to our team presentations, talked about the case and got advice from one another)

Answer 17

* (happens for every person, even if the person never returns) * Summary of how they were when they left and why did they leave. * Presenting problem * Therapy provided * Progress that was made * Plan for discharge or no plan if the client is leaving on their own accord

Answer 18

* Legible o Black or blue ink * Signed with credentials, date, and time (beginning and end time) * **REMEMBER: “If it is not written down, it did not happen.”** * You must document everything to make it legal.

Answer 19

* “If you know, it will show.”

Answer 20

* Denial of treatment to client o Rejection of payment in audit

Answer 21

* “Depressed, doing well, making progress” are too vague. * Vague language is not acceptable. * Have something AEB. (ex: the patient’s progress is slow as evidenced by….) * “As evidenced by…” (AEB) → a little phrase that explains why * Describe symptoms, conditions, motivations concretely

Answer 22

* Public Health Department (can come by anytime) – No spoons in coffee area! No running wires! * **Joint Commission for the Accreditation of Health Care Organizations** - JCAHO (sets tone for country, “Gold Standard”, they accredit, paid by everyone because they set the standard) Come back every 3 years for charts, reports, to get re-accredited. * Payor (BCBS, HMOs, etc.--have their own standards) * The Clinic Administration (where you work – have their own regulations)

Answer 23

* A clinician with clinical privileges may do so independently

Answer 24

* (clinical credentials would be that a person has a degree, but doesn’t possess the expertise yet and will need supervision/training). * Supervisor is responsible for your actions.

Answer 25

* the board of directors of your clinic or agency

Answer 26

* specific services independently * (eating disorder, adolescents, women, psychological testing, cognitive therapy, etc. all the services we offer)

Answer 27

* credentials and move onto privileges in independent practices

Answer 28

* You can do it if you have something in your resume that shows that you are capable of doing this, course work, training, preparation, etc.

Answer 29

* (do studies all the time, Joint Commission also reviews, improving quality all the time) * where do we need to set the marker? * If we’re missing it, what do we have to do to fix it? * If we are missing it too often, what or who can we bring in to deliver better services.

Answer 30

* are we providing the services that are needed? * Do we have the right personnel? * (Go through the charts and ask if all resources are being used, specializations – usurped by managed care now)

Answer 31

* (involves plugs and wires – no heaters, etc.)

Answer 32

* (how do we deal with infections, what are the rules for when a clinician is supposed to come to work after they have the flu)

Answer 33

* committee of peers whose task it is to grant **privileges** for clinicians to practic * can be restricted or non-restricted * the **credentials** of the clinician must be proven to the committee

Answer 34

- Boundaries in therapeutic relationship: social, sexual, financial - Treatment outside competency: addictions, eating disorders, etc. - Violations of confidentiality: phone, room #, etc.

Answer 35

* Because the icons of ethics have been found wanting: * West Point cheating o Catholic Church clergy scandal * FBI investigative Laboratories

Answer 36

* Poor practice = failure to meet accepted standards of care * Boundary violations = dual or sexual relationship * Conflict of interest = Therapist’s interest before that of client * Honesty = fraudulent, misleading and deceitful acts * Confidentiality

Answer 37

* From data to Information o Medical condition/physiological functioning * Psychological functioning o Life and times of the client * **\*\*\*Let things happen when doing this in the room w/ the client, but know when to move and when to stay\*\*\***

Answer 38

* why they made the choice to seek out therapy * (do this b/c at this point the client may be feeling more comfortable and able to be more open with you)

Answer 39

* Summary of the Biopsychosocial history. * Pull things together in the context of the problem that brought the client in for help. * At the end of the summary, there will be a diagnosis. * List symptoms that the client has that goes with the disorders. * **It must be 5 to 9.**

Answer 40

* What are we going to do to help this person?

Answer 41

* How do we communicate to this client that they came to talk to the right person? Therapeutic relationship is pivotal to outcome. * What will help them and what is supported in the research? * Every question is required by somebody (regulatory agency) * Must meet JCAHO standards

Answer 42

* necessary to include for insurance

Answer 43

* part of business * Get back with the physician and thank them for the referral. * It lets them know the client came in and that we appreciate their business

Answer 44

* What brings you here? * If someone else sends, ask why? * What brings you to treatment now? * Something often precipitates their coming * wife threatens to leave, judge orders, etc. * If a judge sent them, write the problem first and write last the judge sent them so they will be covered by insurance * presentation is important!

Answer 45

* Average Amount Used/Maximum Amount Used * must find out exact amount (ex. beer – was it a 12 oz, or a forty?) * Last use matters * are they sober enough to be able to recall valuable information * Level of drug problem is based on the level of consequences for use rather than amount * Pattern and frequency of use is important

Answer 46

* There is nothing wrong with changing diagnosis in light of new information * When you discover additional information, make a reference to the progress notes along with a date on the Biopsychosocial History

Answer 47

* Breathalyzer score, comparison of events over time is requiring more of the chemical over time to get an effect

Answer 48

* What kind are they? Hangovers, blackouts?

Answer 49

* Used more than intended, or for longer than intended. Include unsuccessful efforts to try and cut down and control use.

Answer 50

* energy and time spent using substance

Answer 51

* no longer engages in activities once enjoyed, now focused on substance

Answer 52

* How has it affected home life, family, school, work?

Answer 53

* known problems with work, school, family, drunk driving, yet use anyway

Answer 54

* Craving * History of adverse reaction or overdose

Answer 55

* When, where, how long, what kind of care & results

Answer 56

* treatment plan needs to address these so they cannot happen again * Longest period of abstinence?

Answer 57

* Don’t wait for them to report all the symptoms * if you suspect a certain condition, run down the DSM-5 list of symptoms. * No matter what the condition is, it must be clinically significant - * there must be some psychological, social or occupational impairment. * Must use concrete criteria questions. Must write down DSM-5 criteria met as the “Reported Symptoms of Primary Diagnosis” * (i.e. Generalized Anxiety Disorder * client reports worrying about everything all the time → so this would be written down as “excessive worry” to match DSM-5 criteria

Answer 58

* History of the condition * Age of onset, etc.

Answer 59

* Alcohol use disorder, Opiate use, None, etc.

Answer 60

* Where, from when to when, reason and result. Include medications used, when last seen, etc.

Answer 61

* If you feel client is actively suicidal, you better be writing when they will be seeing a psychiatrist and not just that they are a danger to themselves

Answer 62

* Suicide attempts, must know when, where and how. * If not current threat, then write “There is no current danger to self or others” * Current is an important protective word! If there is a threat write “There is a significant current danger to self or others” and then there must be a psychiatric evaluation within 24 hours, or you assume liability! * [Must refer; failure to do so is negligence.]

Answer 63

* History of psychological, physical or sexual abuse * Significant Life experiences (positive/negative) * Relatives have any troubles like the client is talking about? “Does anyone else in the family experience or have experienced any of the same struggles as you?” * Psychotherapy involvement (past/present) and response to it * Medications used (by history) – where, from/to, reason, result * “Have you been to counseling?” “How did that go?” “That must have been very disappointing for you? What happened?” Pay close attention to their prior experience!

Answer 64

* [Relationships with client and how they connect to the problems of the client.] * Description of Self * Description of father – What kind of relationship? Quality? Job? * Description of mother – What kind of relationship? Quality? Job? * Siblings – Birth order, relationship to patient and to parent * Ethnicity * Cultural influence – if raised in a different country…it may have an impact * Parent’s Discipline style * Family Activities

Answer 65

* Education – What is patient’s highest level attained? If college, where did they study? If dropped out early, why? * Vocational Training – Gives person opportunity to feel they have achieved, if did not complete school, shows they do have special skills. * Military – Any problems while in military? When did you serve? What branch? Rank? * Quality of Relationship – Is the quality of the relationship moving up or down? * Description of Children – Get ages and such; different fathers, etc. * Current Occupation? Shift? * Employment History? Have they held down a job? How long?

Answer 66

* Marriage? Age when married? How long? Separations? Describe your marriage Describe impact of condition on relationship * Previous marriage(s) * Children * Patient’s discipline style * Describe impact of condition on children * Description of present home life (relationships, activities, etc.) * Potential for family involvement in therapy: outcomes improve when family is involved.

Answer 67

* Religious Beliefs * basic needs * financial status * legal involvement * key findings from Physical Health Assessment * Recreation? * Peer group? * Social Skills?

Answer 68

* Note if client has not seen a physician recently, may want to add as an objective to the Treatment Plan * If patient tells you they have chest pains, you should write in the assessment (and put into action), “Chest pains, agrees to make appointment and see doctor within next 3 days”

Answer 69

* look for themes * (altruistic, materialistic, idealistic, etc.)

Answer 70

* Attire * facial expression * posture * gait

Answer 71

* How do they go from one thought to the next?

Answer 72

* Indifferent, fearful, angry, euphoric etc

Answer 73

* normal, auditory hallucination, * visual hallucination, * depersonalization (experience of being outside of yourself, observing yourself in the situation), * illusions, * derealization (the attribution of non-human factors to people, so others are things rather than people), * hypochondriasis

Answer 74

* obsessive and ruminative, * preoccupied, * self-depreciatory, * idiosyncratic, * stereotyped

Answer 75

* what are you obsessed about? * obsessions, * phobias, compulsive rituals, * religiosity, ideas of reference * belief that inanimate objects are communicating with you) * passivity feelings (feelings of non-person), * nihilistic (pessimism/vague), * delusions, self-derogatory delusions, * suicidal ideation, * bizarre ideas (thoughts of things that couldn’t happen) vs. * non-bizarre ideas (thoughts of things that realistically could have happened), * paranoid ideation (paranoid beliefs/thoughts)