Evidence Code 1024
an MFT is permitted to break confidentiality when a client's mental or emotional state is such that this person presents a danger to self or others, or the property of others
Involuntary hospitalization is permissible when a clients mental or physical state causes them to be an immanent state of danger to themselves or others. Only an MD is allowed to hospitalize a client.
Tarasoff= Civil Code 43.92
An MFT must use reasonable care to protect and warn third parties who have been identified as possible victims of a serious threat to harm them. A serious threat is a threat that is real and immanent. The third party must be unaware of the threat.
Evidence Code 1194
anyone who is employed by a physician or a licensed health clinic or facility and provides direct medical care to clients, MUST report spousal abuse. Not required by MFT unless employed in one of the listed settings
Mandated breaches of confidentiality
tarasoff, child abuse, dependent abuse, elder abuse, court order
Permitted breaches of confidentiality
evidence code 1024, with a release form signed by the client,
Elder Abuse Reporting
Must report elder and dependent abuse immediately by phone, and in writing within two working days or when it has been directly reported by the clients
Managing Child Abuse
Must be reported immediately by phone and in writing within 36 hours
Leading Reason for Malpractice
Failure to prevent suicide
Assessment of Lethality
Obtain: informed consent, complete client history, written releases to talk to anyone with helpful info, evaluate the clients perturbation & level of hope, eval level of functioning, refer to and consult with other professionals, utilize knowledge of risk factors for high risk populations, apply legal and ethical standards of care, use interventions that are appropriate to the level of crisis
Clinical standard of care
reasonable and prudent judgement, assessing, immediacy of risk, level of agitation, level of hope/hopelessness, presence of suicidal intent, degree of lethality of that intent.
Reporting Child Abuse
Reports by clients over age 18 about child abuse that happened when they were a minor is not reportable unless the alleged perp is still in contact with the children. If abuse takes place out of state the MFT must report to their state, and not to the other state because that is a breech of confidentiality
12 years and younger (Sex)
When 12 and younger all sex is reportable.
13 years (sex)
When 13 y/o you can have sex with someone your same age, but not above or below your age without it being reportable.
14 years (sex)
a 14 y/o can have sex with someone their own age or above but cannot have sex with anyone below their age
under 16 (sex)
under 16, having sex with anyone 21 years or older is reportable.
age 14 or 15 (sex)
sex as well as lewd and lascivious are reportable when having sex with someone 10 years or older
treatment of minors w/o parental consent Family Code 69.24
minors 12 y/o or older, and the minor is mature enough to participate in counseling, and w/o such counseling the minor would present a danger of serious physical or mental health to him/ herself or others, or the minor has been the alleged victim of sexual/child abuse
the court may enter an order restraining the person receiving custody from removing the child from the state pending notice and a hearing on the order seeking or modifying custody
Best Interest of the Child
In awarding custody, the court considers the following:
health, safety, and welfare of the child, any history of child or spousal abuse by those seeking custody, the nature and amount of contact with both parents, drug or alcohol abuse by either parent
the protection of testimony in legal action. is a legal term referring to the protection of confidential information in legal proceedings. the client always holds the privilege
Rules about who the therapist can tell the clients information to. i.e. another licensed therapist.
Scope of Practice
Includes individuals, couples, groups. when interpersonal relationships are examined to make increase client satisfaction
Scope of Competence
Unprofessional conduct for MFT, to perform any professional service beyond the scope of ones confidence (established by ones education training or experience)
Law and Ethics
Client Dangerous to Others
Client dangerous to property
Client dangerous to self
Client seeing another therapist
Law and Ethics
Law and Ethics
Court referral - confidential relationship
EAP, managed care
Law and Ethics
Mandated reporting of child abuse
Mandated reporting of elder/dep abuse
Paying referral source
Law and Ethics
Permitted reporting elder/dep
Law and Ethics
Scope of Competence
Law and Ethics
Scope of practice
Sex with clients
Law and Ethics
Termination of therapy
Treatment of minors, confidentiality and privilege
Treatment of minors w/o parental consent
Required to keep client records for how long?
Elements of Informed Consent
competency of the client, disclosure of material info to client, clients understanding of material presented, clients voluntary consent
Options before court grants divorce
legal separation, legal separation with brief therapy, legal separation with long therapy
common residence, shared living expenses, both persons are single and of legal age, neither is related to other, both persons are able to consent, same sex unless over 62
Qualifications required for licensure
doctor's or master's degree, 175 hours of supervised practicum before grad, at least 18, pass written and vignette exam, no criminal record, required coursework completed, 3,000 hours of supervised experience, ratio of supervision to client-contact hours, ratio for professional enrichment activities, settings where clinical hours may be obtained, intern registration with the BBS within 90 days
CAMFT Ethical Standard 2.1
do not disclose any confidences of clients except as mandated by law, permitted by law, therapist is a defendant in a civil, criminal, or disciplinary action arising from therapy, or if there is a waiver previously obtained in writing and then only under terms of waiver
Elder and Dependent Abuse
when one or more take place (not accidental) on someone between 18 and 64: Physical, Financial, Neglect, Abandonment, Isolation
A subpoena is a legal document generated by an attorney or court used to obtain records, to compel testimony, or other legal action pending in criminal, civil, federal, or worker's comp. court
Notice to Consumer
a document which informs the client that records are being sought by a third party
Steps in Responding to a Subpoena:
1) claim "priviledge" for your client (the therapist refuses to release the recordes until he or she has been able to speak to the client or the client's attorney)
2) Contact the client and tell them that you have received a subpoena
3) obtain a release of information to confer with the client's attorney
4) Ask the client's attorney what he or she wants you to do with the record (documenting the response)
5) follow the instructions provided by the client's attorney
6) if the clients attorney doesn't want you to release the info, contact the person requesting the info and ask them to work it out with the client's attorney.
7) The judge in the case will determine what to do with the records. If the judge orders you to release them, you must do so
-In the relationship the power is differential, need to be up do date w/ law and ethics, 6 hours of continuing education every 2 years, must understand the scope of competence for themselves and their trainees.
-Must sign a "responsibility state for supervisors of Marriage Family and child counselor trainee or intern"
-MUst hold a valid CA license for at least 2 years
-must maintain an average of at least 5 clients contact hours per week.
-if supervisor is not licensed as an MFT, he or she must have suffcient training and experience to competently practice marital and family therapy in CA.
1:10 intern ratio (1 hour of direct supervision for every 10 client contact hours), 1:5 trainee (1 hour of direct supervision for every 5 client contact hours)
Payment for Intern & Trainee
They cannot be paid by the patient, they MUST be paid by the employer
Personal Therapy Hours
T&I can receive up to 100 hours which converts into 300 hours for BBS
Where can Trainees gain expereince
Goverment entities, schools, college or university, non profit or charities, licensed health facility or subtance abuse treatment facility.
Supervisor & Trainee at private practice
The supervisor must be an employee and practice at the same site that the intern is employed at
Private Practice Interns
Interns cannot work within a private practice until they are registered with the BBS
I&T cannot partially own their employers business
In CA one supervisor and one person being supervised is allowed.
In CA no more than 8 persons can be supervised by one supervisor
Supervisor must give at least one weeks written notice before termination.
Registered interns must tell the BBS within 30 days if they have an address change
I&T must inform clients they are unlicensed before therapy, but that they are working under the supervision of a licensed MFT, SW, Psychologist/ psychiatrist
Supervisor must monitor counseling by using:
-review of audio or videotapes of therapy
-review of progress notes and records
-review of the manner in which emergencies are to be handled
-evaluation of sites where an intern or trainee will be gaining client contact hours
-cooperation with the BBS
MFT therapists must not advertise in a "false, fraudulent, misleadin or deceptive" manner through available communication including:
directory of practitioners
requirements for advertising
-must be truthful
-must include the exact name of the licese being used, or the license number
-the term "psychotherapy" or MFTs, if the advertisement establishes that the practitioner is a therapist.
- if the Yellow Pages are used, then the heading must be under marriage and family therapists and not under psychologists.
Fictitious name requirements
-a therapist is permitted to use a fictitious business name that avoids using words that might mislead the public
-requires the MFT to state whether or not the business is incorporated.
-this is waived if a business is already registered with the BBS as a corporation or are using their true name.
-clients must be informed prior to beginning therapy of the status of the "fictitious name" business
Interns/Trainees and Advertising
-trainees are not encouraged to advertise beyond using business cards
-if they use business cards, the cards must clearly state their licensing status and the name and license number of their supervisor
-registered interns can advertise as long as their ads are not misleading or false.
CAMFT Ethical Standards 10.8
MFT therapists may represent themselves as specializing within a limited area of marriage and family therapy, but only if they have the education, training and experience, which meet recognized professional standards to practice in that specialty
Advertising Specialty Practice
-requires that the MFT have the scope of competence which includes appropriate training, experience, and knowledge.
-this scope must be certified by a recognized organization within the specific specialty area.
-however, this is NOT required if the therapist simply limits practice to this specific area.
Advertising Specialties include
Advertising Specialty Practice (contin)
-by limiting one's practice to a specific clinical area, one may become an expert, provided they have the scope of competence.
-however, that person SHOULD NOT advertise as a specialist.
MFT's can join referral services IF they register with the BBS prior to providing services. ILLLEGAL TO USE NON BBS REFERALS
must disclose amount of services before therapy session. The fee will either be the full fee, or an adjusted fee, "low fee slot" and/or "sliding-fee schedule"
Intern & Trainee Fees
I&T cannot dicate what the fee will be. ONLY the supervisor. Cost should be decided between the supervisor and intern/trainee BEFORE therapy
Not regulared by law & ethics. Bartering can lead to a "dual relationship"
-Should be done in the first phone call. If the therapist discloses the fee at the end of the session, it can be seen as abandonment.
- a written statement on a form letter should follow the discussion of the fee (this creates a greater therapeutic relationship
-the therapist does not have a legal obligation to take a client who cannot pay for services
- the therapist does not have the legal obligation to refer the client to a low cost center
High Risk Clients and Fees
The therapist may want to see a high risk client, even if they cannot pay for it, until the patient is stable enough to send somewhere else. This should be done after obtaining an informed consent regarding the limited number of sessions and lower cost
Therapists Rights with Fees
-Therapists have the right to collect unpaid balances, by using small claims or a collection services
-If these services are used, privilege is no longer upheld, but only the theraputic contract should be devulged. Other info should be guarded
How many CE hours do you need to be a supervisor?
Six hours every two year focusing on supervision issues. can be included in the 36 total needed for an MFT therapist
if someone requests records in writing, what is the length of time to send them?
consquences of mandated reporter who fails to report?
Therapist can be sued, can face jail time or pay a fine; This is a misdemeanor but could be felony depending on severity.
Malpractice actions, what kind of insurance expectations, standard coverage?
1 million dollars per person, it is 200 dollars per year after licensing with AAMFT
emancipation of a minor
under 18 they are emancipated
if any of the following:
-they have entered into a vaild marriage
-person is on active duty with us military
-they have received declaration of emancipation
Handling child abuse if happened in different state?
Report it to your own state
grounds for dissolution of marriage in CA
irreconcilable difference and incurable insanity.
define marriage in CA
A civil contract between a man and woman. stating that each will respect fidelity and support
Legal minimum age for marriage?
18 year old or with the consent from the parents of each individual or court ordered
Status of common law marriages in CA?
judgment of nullity of marriage called
severe eating disorder
treated the same as suicide; protects confidentiality but can break when danger to self. can refer for 5150
client reports previous sexual relation with therapist
no action allowed unless client decides he/she wants to pursue
how long is involuntary hospitalization?
according to AAMFT how many interns per supervisor?
2:1 - individual
6:1 - group
completed quarter units to become a trainee
requirements for psychological testing
we are not experts in testing. Only psychologists are. We need to be certified to give and read results
client contact hours for MFT program
guidelines for spousal support
required if spouse is insane
who are psychotherapists
Licensed MFTs, Licensed Clinical Social Workers, Psychologists, Psychiatrists
who determines ethics in CA?
CAMFT - California Association of Marriage and Family Therapy
who is a minor?
less than 18
To protect the confidentiality of the client; To recognize symptoms and assess correctly; To diagnose correctly using appropriate procedures and analysis; To treat correctly; To know when to consult professionally; To know when to hospitalize a client; To provide proper treatment; To give proper advice, instructions, and warnings; To avoid abandoning the client; To keep proper records.
actions for homicidal client
1. address scope of practice: does this case address the improvement of relationships? 2. address the scope of competence: does the therapist have the training, experience, and education to work with this issue? 3. develop a sensitive, caring, and firm therapist alliance. 4. obtain a complete patient history, including a complete medical eval, a family history, and a history of all previous therapy. 5. evaluate the client's perturbation, lethality, and sense of anger and frustration. 6. be familiar with risk factors for dangerousness associated with high-risk population. 7. know the legal/ethical standards of care and apply them appropriately in a timely manner. 8. consider the advantages of gaining a second opinion through consulting with experts. 9. document in case notes an and all decisions. 10. use sound clinical judgment