MANAGING HIGH-RISK CLIENTS: PROTECTING THE MENTAL HEALTH CLINICIAN © 4th Edition (2011)-1 SPECIAL PURCHASE

When clinicians face crisis issues, the unpredictable nature of this process can end up in tragedy or severe injury to a client and/or others. Should a malpractice lawsuit ensue with a concurrent accusation of having harmed the client, the clinician can expect a barrage of challenges to his/her wellbeing. Likely, the clinician will be accused of acting below the standard of care, practicing incompetently, and failing to protect the client. 

Defense attorneys recognize that an important protection for clinicians facing this challenges it to have crisis management protective structure already in place. This structure is presented in this book. This structure is based on his experience as an effective and successful an expert witness and consultant to attorneys. The basis for this structure is first knowing the clinical information opposing attorneys seek from clinicians' records. Dr. Grosso's approach intends to deflect the attempt by opposing attorneys to undermine the credibility of the clinician.

This book intends to strengthen a clinician's vulnerabilities when working with any population that can turn into a high-risk population in an unpredictable manner. Ultimately, each clinician has the duty to avoid harming a client. This book provides clinicians with the necessary tools to protect themselves when they face unpredictable and potentially damaging high-risk issues and ultimately preventing harm to the client.

Table of Contents

Introduction

Chapter 1

1. High Risk Issues and Clinicians
2. The Danger for Clinicians When Facing Crisis Issues
3. Clinical Objectivity and the Clinician’s Personal Values
4. Vignette 1
5. How Attorneys Decide to Initiate a Malpractice Action Against a Clinician
6. How a Client Decides to Sue or Not Sue
7. Predicting Harm to Self or Others
8. Vignette 2
9. Simi Valley, California
10. Example of a High-Risk Client Causing Harm to Self and Others
11. The Unpredictability of a Client’s Action 17 Protecting the Clinician
12. Vignette 3

Chapter 2

1. Applicable California Laws When Managing Crisis and High-Risk Issues
2. Legal Standards and High-Risk Issues
3. California Laws
4. Vignette 4
5. Vignette 5
6. NASW Ethical Standards and Crisis Issues
7. CAMFT Ethical Standards and High-Risk Issues
8. CAADAC Ethical Standards and High-Risk Issues
9. CAADE Ethical Standards and High-Risk Issues
10. Vignette 6 30 The Clinical Application of These Laws and Ethics
11. Opposing Attorneys Involved in a Legal Action Against the Clinician
12. The Opposing and the Defense Attorneys
13. Vignette 7
14. Vignette 8

Chapter 3

1. Reasonable and Prudent Steps Required to Manage High-Risk Issues
2. Protecting the Clinician
3. The Clinician’s Scope of Competence Regarding High-Risk Issues
4. Vignette 9
5. Determining the Client’s Competence to Enter Into a Professional Relationship
6. Assessing the Client
7. Vignette 10
8. Communicating Legally With Others
9. Observing Cliical Behavior
10. Vignette 11
11. The Presenting High-Risk Issue
12. Hospitalization
13. Protective Documentation
14. The Clinician
15. Vignette 12
16. Assessing Clinical Information, Making Appropriate Clinical Decisions, and Avoiding Clinical Pitfalls – Figure 1
17. Assessing Clinical Information, Making Appropriate Clinical Decisions, and Avoiding Clinical Pitfalls – Figure 2
18. Assessing Clinical Information, Making Appropriate Clinical Decisions, and Avoiding Clinical Pitfalls – Figure 3
19. Assessing Clinical Information, Making Appropriate Clinical Decisions, and Avoiding Clinical Pitfalls – Figure 4
20. Suicide - The Transition Into a Potential Crisis Issue
21. Serious Threat to Harm an Identifiable Victim (Tarasoff Situation The Transition Into a Potential Crisis Issue
22. Spousal Abuse - The Transition Into a Potential Crisis Issue
23. Child Abuse - The Transition Into a Potential Crisis Issues
24. Elder/Dependent Abuse - The Transition Into a Potential Crisis Issue
25. Eating Disorders - The Transition Into a Potential Crisis Issue
26. Substance Abuse/Dependence to the Degree That the Client is a Danger to Self/or Others - The Transition Into a Potential Crisis Issue
27. Only the Clinician Can Protect Him/Herself

Chapter 4

1. Assessment Protocols
2. Assessment Protocols
3. Assessing the Client’s Competence
4. The Clinician’s Initial Assessment
5. Consultation with Past and Present Treatment Providers
6. Vignette 13
7. The Client’s Refusal to Cooperate with Treatment
8. Observable Clinical Behavior 68 Assessing Psychosocial Stressors and Environmental Problems
9. Assessing for Risk Factors
10. Culturally Sensitive Assessments
11. Vignette 14
12. Mental Status Exam
13. Beck Depression Inventory
14. Consultations
15. Vignette 15
16. Integrating Assessment Information Into a Protective Structure

Chapter 5

1. Diagnostic Protocols
2. The Purpose for Diagnosing
3. The Process of Providing a Diagnosis
4. How a 5-Axis Diagnosis Protects the Clinician
5. Using the Five Diagnostic Axes Reasonably and Prudently
6. Integrating the 5-Axis Diagnosis Into Treatment
7. The Treatment Plan as an Assessment Tool
8. Sample Treatment Plan
9. Using the Treatment Plan Effectively
10. Vignette 16
11. Vignette 17

Chapter 6

1. Treatment Protocols
2. Treatment Protocols
3. The Initial Phase of Treatment
4. The Middle Phase of Treatment
5. The Ending Phase of Treatment
6. Vignette 18
7. Sample Generic Issues Treatment Plan
8. Treatment According to the Standard of Care
9. Treatment and the Opposing Attorney

Chapter 7

1. Mental Health Records and Documentation
2. Mental Health Records
3. The Purpose of Documentation
4. Mental Health Records and Treatment
5. Evidence Code 1016 and Privilege
6. Mental Health Records: The Law and Ethical Standards
7. Health and Safety Code 123130 - The Foundation for the Content of Mental Health Records
8. Patient Access to His or Her Mental Health Records
9. Computerized Records
10. Appropriate Content of Mental Health Records
11. Intake Form
12. Sample Intake Form
13. Informed Consent Form
14. Additional Informed Consent
15. Sample Informed Consent Form
16. Psychometric Testing
17. Mental Status Exam
18. Beck Depression Inventory
19. Sample Mental Status Form
20. Written Release of Information
21. Sample Release of Information Form
22. 5-Axis Diagnosis
23. Treatment Planning for Crisis Issues
24. Generic Crisis Issue Treatment Plan
25. Consultations
26. Sample Consultations Form
27. Progress Notes
28. Sample Progress Notes Forms
29. Process Notes 126 Documentation of Legal Challenges
30. Legal Documentation Example # 1
31. Legal Documentation Example # 2
32. Legal Documentation Example # 3
33. Discharge Summary
34. Sample Discharge Summary
35. Summary

Chapter 8

1. Confidentiality and High-Risk Issues
2. Confidentiality
3. Breaching Confidentiality in a Safe Manner
4. Legally Defined Conditions Permitting or Mandating a Breach of Confidentiality
5. Child Abuse and a Mandated Breach of Confidentiality
6. Elder/Dependent Abuse and a Mandated Breach of Confidentiality
7. Tarasoff and a Mandated Breach of Confidentiality
8. Danger to Self/Others and Evidence Code 1024 and a Permitted Breach of Confidentiality
9. The Confidentiality Bind When Addressing Crisis Issues
10. Vignette 19
11. Child Abuse Reporting and the Confidentiality Bind
12. Elder/Dependent Abuse Reporting and the Confidentiality Bind
13. Suicidal Intent and the Confidentiality Bind
14. Spousal Abuse and the Confidentiality Bind
15. Eating Disorders and the Confidentiality Bind
16. Substance Abuse/Dependence and the Confidentiality Bind
17. Protecting the Clinician When Facing a Confidentiality Bind
18. Using Mental Health Records Effectively
19. Vignette 20

Chapter 9

1. Addressing High-Risk Issues
2. The Presenting High-Risk Issue
3. Vignette 21
4. The Clinician’s Responsibility
5. The Emergency Plan of Action to Manage High-Risk Issues
6. Hospitalization as a Clinical Intervention
7. Post-hospitalization Risk Factors
8. Vignette 22
9. Post-hospitalization Mental Health Treatment
10. The Aftermath of an Injury to Self and/or Others
11. Determining the Extent of the Client’s Injury
12. The Clinician’s Role in the Lawsuit

References

Appendix

Index