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What is HIPAA

Health information portability and accountability act. Federal legislation created to regulate electronic medical records. Became much broader. If there is a conflict between state and federal guidelines, use the stricter standard.


How do you ensure a client understands their rights?

Give them patient bill of rights at beginning and go over it. Post it prominently in office. Go over informed consent materials at beginning. Note this in client's record.


What is in a client file?

Informed consent docs, client demographics and contact info, diagnosis and treatment plan, any assessments, session notes, any legal documents including releases, fee agreement and record of payment, any consultations, all client contacts, discharge summary with condition at discharge and recommendations.


What is informed consent?

Client must be informed of and able to understand:
1. diagnosis,
2. nature/purpose of treatment,
3. risks of treatment,
4. probability of success,
5. feasible treatment alternatives,
6. ability to make voluntary choice between alternatives,
7. prognosis if treatment not given.


Requirements for continuing education

40 CEU hours every two years. 3 hours must be in ethics. Reporting during odd years. Must be approved by board. CEUs include: trainings, teaching class for first time, conducting research, peer review of research, author a book, self study pre-approved by board. Must document.


Requirements to be a LMFT supervisor

4 years as LMFT, 4000 hours, and: approved 3 credit grad course in supervision, or 30 hours of board-approved coursework, or 30 hours of AAMFT approved supervisor training, and application to board. As supervisor, must complete 4 CEUs per period related to supervision.



Exception to rule, must present reasoning to board in writing, must meet/exceed standard, prove no harm to public, and for what duration


Role in civil commitment process?

No formal role. Only judges and doctors appointed by judges may do this. I may be asked to collaborate.


Someone calls as parent of client, wants to know about treatment. What do you do?

I can't talk to you about who may or may not be a client of mine. I don't know who's on the phone. They would need to prove their identity and I would also need a release from my client.


Who is a mental health professional?

Highest level of licensure in their respective field. 2 years of postgrad supervision. Psychiatric RN, nurse practitioner in psychiatric or family mental health, LICSW, Licensed Psychologist, psychiatrist, LMFT, LPCC, or master's degree in bhvrl sciences/nursing and 4000 hours post-grad experience in delivering clinical services for mental illness.


Half of couple client discloses affair to you without partner's knowledge. What do you do?

Review no secrets policy that they signed. Discuss whether or not they'd like to disclose to partner. If yes, help them disclose safely. If not, let them know that I cannot continue as couples therapist because I cannot hold that secret for them. Provide 3 referrals.


What are the privileges of being an LMFT?

Practice independently, eligible for third party reimbursement, could become a supervisor, could serve on the board.


A Client invites you to their wedding what do you do?

Thank you, I'm honored you would like to include me. Explore meaning for them in my attendance. Validate those feelings and wishes. Let them know that I while I would be happy to see them married, I cannot attend because it could create a dual relationship, and I would want to protect their confidentiality and it would be hard to not disclose my role if I attended. Document conversation in client file.


What are the limits of confidentiality in a board investigation?

Limit to what is necessary and redact anything unrelated. If no client release, must delete any identifying information. Must comply with request.


What is important to know regarding the scope of practice of marriage and family therapy?

If it's outside of scope, let client know, refer to other professionals/disciplines.
Code of ethics states we must limit practice to scope of competence or developing competence.


You have sexual attraction to client, what do you do?

Immediately seek consultation. Process in consultation and discern if I can work through this issue effectively so it doesn't impact the work. If there's any doubt about that, tell client I have a personal conflict and give three referrals.


Client discloses sexual attraction to therapist, what do you do?

Normalize sexual attraction as a result of developing a close relationship, perhaps for the first time. Thank them for telling me. Process it in therapy as a therapeutic issue. Discuss how to find close connection in other areas of their life. Seek consultation where necessary. If can't resolve it, refer to 3 others. Document.


What is therapeutic deception?

Therapist represents sexual contact or unethical conduct as part of therapy/professional work.


What is emotional dependence?

The client is emotionally dependent on the therapist in such a way that they would not be able to withhold consent to sexual contact by therapist.


What are your reporting obligations in regard to reporting misconduct of a licensee?

Any person who has knowledge of misconduct MAY report to board.
Institutions SHALL report actions they have taken on a licensee's privilege to practice.
State/local professional associations SHALL forward complaints and disciplinary actions taken.
Licensed health professionals SHALL report personal knowledge of conduct that is grounds for disciplinary action. (If licensee is a client, may counsel to reduce or stop seeing clients and this may be sufficient discipline.)
Insurers SHALL submit report of malpractice settlements.
Courts SHALL report: person is mentally ill, incompetent, felon, violated narcotics laws/controlled substances act, medicare abuse/fraud, or has an appointed guardian.
Self-reporting to board or Office of Mental Health Practice.
All reports no later than 30 days after reportable event.
Civil penalties for failure to report.


When would board refuse to issue or renew a license?

$500 or more owed in taxes. Commitment. Guardian appointed. Arrears for child support. Felony. Violation of ethics. Delinquent with student loans. Fraud. Impairment.


Who has Immunity in reporting?

Submitting report in good faith. Investigators are immune too.


What is the process for the Board if a complaint is submitted? What is the Board permitted to do?

Board maintains records of all complaints. Each complaint must be investigated. Board shall be given access to records as necessary. If no release from client, must remove identifying information. Board may issue subpoenas for evidentiary material. May order mental or physical exam or chem dependency eval. Failure to submit to exam seen as admission to violation. Board may access data and health records related to licensee without their consent.


What can the board do in regard to Disciplinary actions?

Disciplinary actions are public - includes name and business address, nature of misconduct, and action taken by board.
Forms of discipline: deny right to practice, revoke, suspend, limitations, conditions, civil penalty up to $10,000, fee, censure/reprimand, any other action justified by facts.
Board may issue temporary suspension without a hearing.
Board may issue cease and desist order.


What is recommended for Dispute resolution with clients?

Board encourages: Fee disputes go to binding arbitration. All other disputes go to voluntary mediation.


When is there an Automatic suspension of practice?

Guardian appointed, commitment.


What is your duty to warn with violence toward others?

Specific, serious threat of physical violence against specific, identified person. Duty to warn is discharged if make reasonable efforts to communicate to potential victim, if no contact can be made then communicate to law enforcement. Good faith compliance is NOT a breach of confidence. May not abandon client as a result of this behavior, may refer out.


What is your duty to warn with violence toward self?

Duty to warn does not apply to threat of suicide or self harm. However, this does not prohibit disclosing confidences in good faith effort to prevent violent behavior or threat of suicide if no duty to warn. Not liable if acting in good faith. Rule 5300 allows for disclosure of private information to protect client from harm, may disclose ONLY to law enforcement, potential victim, family of client or others in a position to prevent/avert harm.


What is Marriage and family therapy?

Marriage and family psychotherapy to indivs, couples, families. Use established principles that recognize systemic view of problems and dysfunctions. Premarital, marital, divorce, family therapy. Specialize mode of treatment for purpose of resolving emotional problems and intra/interpersonal dysfunction.


What distinguishes the Board vs MAMFT?

Board is appointed by governor. Duty to protect public, issue licenses, discipline, impose standards for licensure, develop code of ethics, establish CEU requirements. MAMFT is professional association whose goal is to promote marriage and family therapy.