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Federico Grosso, DDS, PhD, MFT, BCFE
FGrosso.com
805-962-3628

fcgt@fgrosso.com

COMPLETE APPLICATIONS OF LAW AND ETHICS FOR CALIFORNIA MARRIAGE AND FAMILY THERAPISTS © 15th Edition (2017)

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COMPLETE APPLICATIONS OF LAW AND ETHICS FOR CALIFORNIA MARRIAGE AND FAMILY THERAPISTS

This book is an authoritative comprehensive legal and ethical academic and clinical resource addressing multiple clinical issues faced by California marriage and family therapists. It addresses the clinical applications of California mental health law and CAMFT Ethical Standards. Readers are also taught the appropriate content of mental health records and how to write these in a manner that addresses the clinicians therapeutic duty to assess, diagnose, and treat according to the standard of care throughout the duration of therapy. This book is written in easy-to-read language and avoids "legalese". Forensic clinical scenarios are presented for clinical reference and "process" questions help readers learn how to navigate through challenging legal issues. Most importantly, clinicians learn how to manage potential crisis issues and high-risk clients to protect themselves from possible BBS and malpractice actions. Note that Chapter 39 is a new chapter.

This book is also an academic resource throughout the state. Academic instructors of law and ethics may request a complimentary copy on university letterhead.

15th Edition: 2017


 

Table of Contents


Introduction


Chapter 1 The Therapist’s Personal Belief System


Personal Frame of Reference

Internal Reality, Clinical Safety, and Protecting the Clinician

The Complexity of Making Safe Legal and Ethical Decisions

Potential Loss of Objectivity

Clinical Example # 1

Questions for Clinical Example # 1

Chapter Questions


Chapter 2 Informed Consent

 

Informed Consent and the Therapeutic Contract

Informed Consent and Case Law

Legally-Required Elements of Informed Consent

Ethical Therapeutic Duty to Obtain Informed Consent

Therapeutic Contract, Part I: The Therapy Process

Therapeutic Contract, Part II: The Client’s Rights

Therapeutic Contract, Part III: Fees and Length of Therapy

Therapeutic Contract, Part IV: Consent for Treatment

Therapeutic Contract, Part V: Office Policies

Informing Clients of the Potential Risks and Benefits of Therapy

Clinical Example

Informed Consent When Using “Challenging” Therapies

Hugging and Psychotherapy

Informed Consent and Touching Therapies

Touch Therapies and Touching Violations

Steps to Help Prevent an Accusation of a  Boundary Violation

Termination and Standard of Care

Managing Termination Safely

Reasonable and Prudent Steps to Take When Terminating Difficult and Uncooperative Clients

Sudden Termination of Therapeutic Services

Termination and CAMFT Ethical Standards

Clinical Example # 1

Questions for Clinical Example # 1

Clinical Example # 2

Questions for Clinical Example # 2

Clinical Example # 3

Questions for Clinical Example # 3

Chapter Questions


Chapter 3 Confidentiality

 

Confidentiality

Mandated Breaches of Confidentiality

Permitted Breaches of Confidentiality

Written Releases of Information

Sample of a Release of Information Document

Releasing Outpatient Psychotherapy Records for Diagnosis and Treatment Only

Group Therapy

“Holding Information” Policy (Secrets): and It’s Clinical Implications

How the “Holding Information” Policy Affects Treatment and The Therapeutic Relationship

Minors and Confidentiality

Minors and Privilege

Safeguarding Sensitive Clinical Information Involving Minors From Insurance Companies

Electronic Devices

The Internet

Fax Machines

Fax Warnings

Sample Fax Warnings

HIV Status

Confidentiality & Mandated Reporting

Making a Decision to Report or Not Report a Legally-Mandated Breach of Confidentiality

Documenting the Decision to Report or Not Report a Legally-Mandated Breach of Confidentiality

Confidentiality Challenges: Employees and Volunteers

Confidentiality Challenges With Ex-Associates, Ex-Interns, and Ex-Trainees

Potential Breaches of Confidentiality in Settings With Multiple Clinicians

Other CAMFT Ethical Standards Related to Confidentiality

Clinical Example # 1

Questions for Clinical Example # 1

Clinical Example # 2

Questions for Clinical Example # 2

Clinical Example # 3

Questions for Clinical Example # 3

Clinical Example # 4 61

Questions for Clinical Example # 4

Chapter Questions


Chapter 4 Privilege

Privilege

Evidence Code 1010-1027

Exemptions to Privilege

Clinical Example # 1

Questions for Clinical Example # 1

Chapter Questions


Chapter 5 Important Legal Concepts in MFT Practice.

 

Scope of Practice

Scope of Competence

CAMFT Ethical Standards Related to Scope of Competence and Integrity

Therapeutic Duty

Some Clinical Examples of Therapeutic Duty

Therapeutic Duty Regarding Assessing Appropriately

Therapeutic Duty Regarding Diagnosing Appropriately

Therapeutic Duty Regarding Treating Appropriately

Collaborating With Others

Standard of Care

Attending to Standard of Care in Clinical Practice

The Clinicians Therapeutic Duty to Assess for Clinically Important Issues Thoroughly and Completely

Mental Health Case Law

Clinical Example # 1

Questions for Clinical Example # 1

Clinical Example # 2

Questions for Clinical Example # 2

Chapter Questions


Chapter 6 Business and Professions Code as it Applies to Marriage and Family Therapists SECTIONS 4980–4989

 

Business and Professions Code

Clinical Example # 1

Questions for Clinical Example # 1

Clinical Example # 2

Questions for Clinical Example # 2

Clinical Example # 3

Questions for Clinical Example # 3

Chapter Questions


Chapter 7 Malpractice and Unprofessional Conduct

 

Malpractice

Unprofessional Conduct

Creating Therapeutic Safety: Learning the Hard Way

Mental Health Records and Lawsuits: A Direct Correlation

How Small Clinical Issues Become Malpractice or BBS Administrative Actions

How Attorneys Develop Malpractice Cases Against Clinicians in Conjunction With an Expert Witness

A Malpractice Action Arising For Reporting as Well As Nor Reporting Child Abuse

Clinical Example # 1

Questions for Clinical Example # 1

Clinical Example # 2

Questions for Clinical Example # 2

Chapter Questions


Chapter 8 The Therapeutic Relationship

 

 The Therapeutic Relationship

CAMFT Ethical Standards Related to the Therapeutic Relationship

Protecting the Therapeutic Relationship

Using the Therapeutic Relationship Appropriately

Injuring the Therapeutic Relationship

The Power Differential of the Therapeutic Relationship

Clinical Example # 1

Questions for Clinical Example # 1

Clinical Example # 2

Questions for Clinical Example # 2

Chapter Questions


Chapter 9 Dual Relationships

 

Dual Relationships

Harmful Dual Relationships 

Friendships With Clients 

Sexuality and Clients 

Civil and Criminal Actions Specific to Sexual Boundary Violations 

Mandated Brochure “Therapy Never Includes Sex” 

Administrative Actions by the BBS

Sexual Harassment: A Workplace Hazard for MFTs 

Testifying On Behalf of Clients Can Create a Harmful Dual Relationship 

Subtle Dual Relationships 

Clinical Example # 1 

Questions for Clinical Example # 1

Clinical Example # 2

Questions for Clinical Example # 2

Clinical Example # 3

Questions for Clinical Example # 3

Chapter Questions


Chapter 10 Managing Crisis Issues and Protecting the Clinician

 

The Danger for Clinicians When Managing Crisis Issues

The Clinician’s Scope of Competence Regarding Crisis Issues

Reasonable and Prudent Steps Required To Manage Crisis Issues

Assessing the Client’s Competence

Initial Assessment of the Client

Consultation With Past and Current Treatment Providers

Observable Clinical Behavior

Psychosocial Stressors and Environmental Problems

Culturally Sensitive Clients

Assessing For Risk Factors

Establishing An Appropriate 5-Axis Diagnosis

The Presenting Crisis Issue

The Emergency “Plan of Action” To Manage Crisis Issues

Applicable California Laws in Managing Crisis and High Risk Issues

CAMFT Ethical Standards and Crisis Issues

Braching Confidentiality in a Safe Manner

Hospitalization as a Clinical Intervention

Post-hospitalization Risk Factors

Suicide-Specific Laws and Codes: Managing This Issue

Serious Threat to Harm an Identifiable Victim (Tarasoff Situation)-Specific Laws and Codes: Managing This Issue

Spousal Abuse-Specific Laws and Codes: Managing This Issue

Child Abuse-Specific Laws and Codes: Managing This Issue

Elder and Dependent Abuse-Specific Laws and Codes: Managing This Issue

HIV-Positive Clients-Specific Laws and Codes: Managing This Issue

Eating Disorders-Specific Laws and Codes: Managing This Issue

Substance Abuse/Dependence to the Degree Where the Client is a Danger to Self or Others-Specific Laws and Codes: Managing This Issue

Documenting Intake Information

Documenting A Mental Status Exam

Sample Mental Status Exam

Documenting a Beck Depression Inventory

Documenting Consultations

Documenting Treatment Plans for Crisis Issues

Documenting a 5-Axis Diagnosis

Documenting the Legal Challenge

Legal/Ethical Documentation Examples

Clinical Example # 1

Questions for Clinical Example # 1

Chapter Questions


Chapter 11 The Suicidal Client and Standard of Care

 

The Suicidal Client

Legal, Ethical, and Clinical Standards of Care for Treating Suicidal Clients

Reasonable and Prudent Steps to Manage Suicidality

Permitted Breaches of Confidentiality Under Evidence Code 1024

Clinical Example # 1

Questions for Clinical Example # 1

Chapter Questions


Chapter 12 The Dangerous Client in a Tarasoff Situatio


The Dangerous Client

Dangerous Clients and Laws Affecting Psychotherapists

Civil Code 43.92

Ewing v. Goldstein

Clinical Applications Under Ewing v. Goldstein

Calderon v. Glick (2005), Ca. App. 4th

Managing “Serious Threat to Harm”

Clinical Example # 1

Questions for Example # 1

Clinical Example # 2

Questions for Clinical Example # 2

Chapter Questions


Chapter 13 Mandated Child Abuse Reporting

 

Child Abuse

Managing Child Abuse Reporting

Reporting Child Abuse Involving Adults Abused as Children

Employees and Child Abuse Law

Child Abuse Reporting and Immunity

The Use of Anatomically Correct Dolls to Prove Child Abuse

Reporting Consensual Sex Between Minors

Reporting Consensual Sex Between Minors and Adults

The Confidentiality Bind in Child Abuse Reporting

The Child Abuse Laws—Penal Code 11164-11174.3

Child Abuse Report

Clinical Example # 1

Questions for Clinical Example # 1

Clinical Example # 2

Questions for Clinical Example # 2

Clinical Example # 3

Questions for Clinical Example # 3

Chapter Questions


Chapter 14 Elder and Dependent Abuse

 

Management of Elder and Dependent Abuse

Employees and Elder/Dependent Abuse Laws

Elder and Dependent Abuse Reporting and Immunity for LPCs

Recent Changes to the Elder/Dependent Abuse Laws

The Elder and Dependent Abuse Laws: Welfare and Institutions Code Section 15600-15755

Elder/Dependent Abuse Report

Clinical Example # 1

Questions for Clinical Example # 1

Clinical Example # 2

 

Questions for Clinical Example # 2

 



Chapter 15 Mental Health Records

Chapter Questions

Mental Health Records and Psychotherapy

 

Mental Health Records: The Law and Ethical Standards

 

Health and Safety Code 123130 — The Foundation for the Content of  Mental Health Records

 

The Clinical Foundation for Content of Mental Health Records

 

 

Patient Access to His/Her Mental Health Records

Computerized Records

 

Clinical Example # 1

 

Questions for Clinical Example # 1

 

Clinical Example # 2

 

Questions for Clinical Example # 2

 

Chapter Questions

 

Chapter 16 The Content of Mental Health Records

 

Appropriate Content of Mental Health Records

Intake Form

Informed Consent Form

Additional Informed Consent

Ledger Form

Psychometric Testing

Written Releases of Information

DSM 5 Diagnosis, Treatment Plan, and Prognosis

Consultation and Medical Information

Progress Notes

Discharge Summary

Chapter Questions


Chapter 17 Sample Clinical Forms

 

Sample Intake Form

Sample Informed Consent Form

Sample Ledger Form

Sample Mental Status Exam Form

Sample Release of Information Form

Sample Diagnosis, Treatment Plan, and Prognosis Form

Sample Consultation Form

Sample Progress Form

Sample Discharge Summary


Chapter 18 Writing Case Notes

 

A Repeatable Format

Documenting Scope of Practice

Documenting Diagnosis

Consultations and Referrals

Writing Progress Notes

Documenting Legal Issues and Challenges

Treatment Plans as Assessment and Documentation Tools

The Appropriate Use of Treatment Plans

Writing Discharge Summaries

Clinical Charting for Hospital Cases

           

Chapter 19 Subpoenas

 

Subpoenas

Managing Subpoenas

Document 1: Actual Subpoena

Document 2: Notice to Consumer

Document 3: Proof of Service

Document 4: Declaration of Records Released

Clinical Example # 1

Questions for Clinical Example # 1

Chapter Questions


Chapter 20 Supervision of Trainees and Interns

 

Supervision Issues

Dual Relationship with Interns and Trainees

Contractual Agreements

Interns and Trainees as Employees

Additional Requirements for Interns and Trainees

Advertising

Supervisor’s Responsibilities

Clinical Example # 1

The Supervisee’s Dual Relationship With a Client Can Affect the Clinical Supervisor

Questions for Clinical Example # 1

Clinical Example # 2

Questions for Clinical Example # 2

Chapter Questions


Chapter 21 Advertising

 

Advertising

Fictitious Names and Yellow Pages

Advertising and Interns/Trainees

Specialty Practice

Other Ethical Standards Defining Advertising

Referral Services

Clinical Example # 1

Questions for Clinical Example # 1

Chapter Questions


Chapter 22 Fees

 

Fees

Bartering

Disclosure of Fees

Non-Affordability of Fees

Collecting Unpaid Balances

Maintaining Clinical Objectivity With Third Party Payers

Serious Challenges Faced By Clinicians When Third Parties Pay For Clinical Services

Ethical Guidelines Regarding Fees

Clinical Example # 1

Questions for Clinical Example # 1

Clinical Example # 2

Questions for Clinical Example # 2

Clinical Example # 3

Questions for Clinical Example # 3

Chapter Questions


Chapter 23 Insurance and Managed Care

Insurance and Confidentiality

Insurance Fraud

Ethical Standards Regarding Insurance Fraud

Appealing Adverse Utilization Review Decisions in Managed Care

Confidentiality and the Internet

Reasonable and Prudent Actions To Take Before Clients Run Out of Insurance Benefits

Clinical Example # 1

Questions for Clinical Example # 1

Chapter Questions

 

Chapter 24 Forensics, Telephone and Online Counseling

 

Expert Witness

Child Custody Evaluations

Personal Injury Evaluations

Psychometric Testing

Criminal Forensic Assessments

CANMFT Ethical Standards Related to Forensic Activities

Telephone and Online Counseling

Witness of Fact Versus an Expert Witness

Business and Professions Code 805

Clinical Example # 1

Questions for Clinical Example # 1

Clinical Example # 2

Questions for Clinical Example # 2

Chapter Questions


Chapter 25 Cultural Diversity

 

Cultural Diversity and Psychotherapy

Therapeutic Duty and Cultural Diversity: Example — The Mexican-American Client

Clinical Example # 1

Questions for Clinical Example # 1

Clinical Example # 2

Questions for Clinical Example # 2

Chapter Questions


Chapter 26 Treatment of Minors, Family Law

 

Treatment of Minors With Parental Consent

Treatment of Minors Without Parental Consent

Treatment of Emancipated Minors

Treatment of Minors in Divorce Situations

Drug and Alcohol Counseling Treatment for Minors

Holding Information Policy and Minors

Minors and Releasing Sensitive Clinical Information to Third Party Payers

Family Code

Clinical Example # 1

Questions for Clinical Example # 1

Clinical Example # 2

Questions for Clinical Example # 2

Chapter Questions


Chapter 27 Clinical Challenges With Legal Implications

 

Clinical Objectivity: The Foundation of Making Clinical Decisions

The Risks and Benefits of Keeping Minimal vs. Voluminous Records

Clinicians Ignore Risk Factors At Their Own Risk

The Out of Compliance and Uncooperative Client

The impaired Clinician and His or her Immediate Colleagues

The “It Will Never Happen to Me” Syndrome

Working and Collaborating With Unlicensed Mental Health Clinicians

Closing an Office and Avoiding Harm to Clients

The Clinician’s Malpractice Experience

 

Chapter 28 CAMFT Ethical Standard 1 - Responsibility to Patients

 

   1.0     Responsibility to Patients

1.1     Non-Discrimination

1.2     Dual Relationships: Definitions

1.2.1  Unethical Dual Relationships

1.2.2  Sexual Contact

1.2.3  Prior Sexual Relationships

1.3    Treatment Disruptions

1.3.1  Termination

1.3.2  Abandonment

1.3.3  Financial Gain

1.3.4  Non-Payment of Fees

1.4     Patient Autonomy

1.4.1  Electronic Therapy

1.5     Therapist Disclosures

1.5.1  Risks and Benefits

1.5.2  Emergencies/Contact Between Sessions

1.5.3  Consent for Recording Observations

1.5.4  Limits of Confidentiality

1.5.5  Therapist Background

1.6     Exploitation

1.7     Patient Benefit

1.8     Employment and Contractual Terminations

1.9     Family Units/Conflicts

1.10   Withholding Records/Non-Payment

1.11   Consultations

1.12   Advocate With Third-Party Payers

1.13   Treatment Alternatives

1.14   Potential Conflicts

1.15   Documenting Treatment Decisions

1.16  Non-Therapist Roles

1.17  Third Party Payer Disclosures

Clinical Example # 1

Questions for Clinical Example # 1

Clinical Example # 2

Questions for Clinical Example # 2

Clinical Example # 3

Questions for Clinical Example # 3

Clinical Example # 4

Questions for Clinical Example # 4

Clinical Example # 5

Questions for Clinical Example # 5

Chapter Questions


Chapter 29 CAMFT Ethical Standard 2 - Confidentiality

 

   2.0   Confidentiality

2.1   Disclosure of Confidential Information

2.2   Signed Authorizations – Release of Information

2.3   Electronic Media

2.4   Maintenance of Patient Records – Confidentiality

2.5   Employees – Confidentiality

2.6   Use of Clinical Materials – Confidentiality

2.7   Group – Confidentiality

Clinical Example # 1

Questions for Clinical Example # 1

Clinical Example # 2

Questions for Clinical Example # 2

Clinical Example # 3

Questions for Clinical Example # 3

Chapter Questions

 

Chapter 30 CAMFT Ethical Standard 3 - Professional Competence and Integrity

 

3.0   Professional Competence and Integrity

3.1   Conviction of a Crime

3.2   Financial Incentives

3.3   Clinical Records

3.4   Professional Assistance

3.5   Staying Current

3.6   Cultural Sensitivity

3.7   Therapist Cultural Values

3.8   Harassment or Exploitation

3.9    Scope of Competence

3.10  Patient Seeing Two Therapists

3.11  Electronic Services

3.12  Research Findings

3.13  Public Statements

3.14  Limits of Professional Opinions

Clinical Example # 1

Questions for Clinical Example # 1

Clinical Example # 2

Questions for Clinical Example # 2

Clinical Example # 3

Questions for Clinical Example # 3

Chapter Questions


Chapter 31 CAMFT Ethical Standard 4 - Responsibility to Students and Supervisees

 

 4.0   Supervisor, Students and Supervisee Responsibilities

4.1   Dual Relationships

4.2   Competence of Supervisees

4.3   Maintaining Skills of Supervisors

4.4   Knowlege of Supervisors

4.5   Changes in Laws and Ethics

4.6   Cultural Diversity

4.7   Policies and Procedures

4.8   Performance Appraisals

4.9   Business Practices

4.10  Performance Assistance

4.11  Dismissal

4.12  Review of Trainee Agreements

4.13  Patiens are Patients of Employer

4.14  Knowledge of Laws and Regulations

4.15  Maintaining Registrations

Clinical Example # 1

Questions for Clinical Example # 1

Chapter Questions


Chapter 32 CAMFT Ethical Standard 5 - Responsibility to Colleagues

 

5.0   Responsibility to Colleagues

5.1   Respecting Confidence of Colleagues

5.2   Impaired Colleagues

5.3   Frivolous Complaints

5.4   Soliciting Other Therapist’s Patients

Clinical Example # 1

Questions for Clinical Example # 1

Chapter Questions


Chapter 33 CAMFT Ethical Standard 6 - Responsibility to Research Participants

 

6.1   Safeguards

6.2   Diminished Consent When Receiving Services

6.3   Dual Relationships With Research Participants

6.4   Confidentiality

Clinical Example # 1

Questions for Clinical Example # 1

Chapter Questions


Chapter 34 CAMFT Ethical Standard 7 Responsibility to the Profession

 

7.0   Responsibility to the Profession

7.1   Accountable to the Standards of the Profession

7.2   Publication Credit

7.3   Authors – Citing Others

7.4   Authors –  Advertising By Others

7.5   Pro Bono Services

7.6   Developing A Public Policy

7.7   Failure To Cooperate With Committee

Clinical Example # 1

Questions for Clinical Example # 1

Chapter Questions


Chapter 35 CAMFT Ethical Standard 8 - Responsibility to the Legal System

 

8.0   Responsibility to the Legal System

8.1   Testimony

8.2   Expert Witness

8.3   Conflicting Roles

8.4   Dual Roles

8.5   Impartiality

8.6   Minors And Privilege

8.7   Opinions About Persons Not Evaluated

8.8   Custody Evaluators

8.9   Consequences Of Changes In Therapist Roles

8.10 Familiarity With Judicial And Administrative Rules

Clinical Example # 1

Questions for Clinical Example # 1

Chapter Questions


Chapter 36 CAMFT Ethical Standard 9 - Financial Arrangements

9.0   Financial Arrangements

9.1   Payments for Referrals

9.2   Financial Exploitation

9.3   Disclosure of Fees

9.4   Collecting Unpaid Balances

9.5   Barter

9.6   Third Party Payers

Clinical Example # 1

Questions for Clinical Example # 1

Clinical Example # 2

Questions for Clinical Example # 2

Clinical Example # 3

Questions for Clinical Example # 3

Chapter Questions


Chapter 37 CAMFT Ethical Standard 10 - Advertising

 

10.0   Advertising

10.1   Accuracy Re: Qualifications

10.2   Assuring Accuracy

10.3   Fictitious/Other Names

10.4   False, Misleading, Or Deceptive

10.5   Corrections

10.6   Solicitation Of Testimonials

10.7   Employee – Accuracy

10.8   Specializations

10.9   Advertising Of CAMFT Membership

10.10 Use of “CAMFT”

10.11 Use of CAMFT Logo

10.12 CAMFT Membership

Clinical Example # 1

Questions for Clinical Example # 1

Chapter Questions


Chapter 38       Processing Legal and Ethical Decisions Appropriately and Utilizing Applicable Documentation to Help Protect the clinician


Phase One: Clinical Interaction

Phase Two: Initial Treatment Protocols

Phase Three: The Clinician’s Legal and Ethical Preparation

Phase Four: Preparing for Opposing Attorneys

Accepting or Rejecting a Potential Client

Processing This Issue

Informed Consent

Determination and Utilization of Assessment Protocols

Continuous Assessment for Risk of Harm to Self/Others

Treatment Management 

  

Chapter 39 Accessing California Law Through the Internet


Appendix Answer Key

 

Answers to Chapter Questions


References


Index