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

fcgt@fgrosso.com

MANAGING HIGH-RISK ISSUES © 5th Edition (2014)

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Managing High-Risk Clients: Protecting the Mental Health Clinician © 4th Edition 2011

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

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

Chapter 2

  • Applicable California Laws When Managing Crisis and High-Risk Issues
  • Legal Standards and High-Risk Issues
  • California Laws
  • Vignette 4
  • Vignette 5
  • NASW Ethical Standards and Crisis Issues
  • CAMFT Ethical Standards and High-Risk Issues
  • CAADAC Ethical Standards and High-Risk Issues
  • CAADE Ethical Standards and High-Risk Issues
  • ACA Ethical Standards and High-Risk Issues
  • Vignette 6 30 The Clinical Application of These Laws and Ethics
  • Opposing Attorneys Involved in a Legal Action Against the Clinician
  • The Opposing and the Defense Attorneys
  • Vignette 7
  • Vignette 8

Chapter 3

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

Chapter 4

  • Assessment Protocols
  • Assessment Protocols
  • Assessing the Client’s Competence
  • The Clinician’s Initial Assessment
  • Consultation with Past and Present Treatment Providers
  • Vignette 13
  • The Client’s Refusal to Cooperate with Treatment
  • Observable Clinical Behavior 68 Assessing Psychosocial Stressors and Environmental Problems
  • Assessing for Risk Factors
  • Culturally Sensitive Assessments
  • Vignette 14
  • Mental Status Exam
  • Beck Depression Inventory
  • Consultations
  • Vignette 15
  • Integrating Assessment Information Into a Protective Structure

Chapter 5

  • Diagnostic Protocols
  • The Purpose for Diagnosing
  • The Process of Providing a Diagnosis
  • How a DSM 5 Diagnosis Protects the Clinician
  • Using the Five Diagnostic Axes Reasonably and Prudently
  • Integrating the 5-Axis Diagnosis Into Treatment
  • The Treatment Plan as an Assessment Tool
  • Sample Treatment Plan
  • Using the Treatment Plan Effectively
  • Vignette 16
  • Vignette 17

Chapter 6

  • Treatment Protocols
  • Treatment Protocols
  • The Initial Phase of Treatment
  • The Middle Phase of Treatment
  • The Ending Phase of Treatment
  • Vignette 18
  • Sample Generic Issues Treatment Plan
  • Treatment According to the Standard of Care
  • Treatment and the Opposing Attorney

Chapter 7

  • Mental Health Records and Documentation
  • Mental Health Records
  • The Purpose of Documentation
  • Mental Health Records and Treatment
  • Evidence Code 1016 and Privilege
  • Mental Health Records: The Law and Ethical Standards
  • Health and Safety Code 123130 - The Foundation for the Content of Mental Health Records
  • Patient Access to His or Her Mental Health Records
  • Computerized Records
  • Appropriate Content of Mental Health Records
  • Intake Form
  • Sample Intake Form
  • Informed Consent Form
  • Additional Informed Consent
  • Sample Informed Consent Form
  • Psychometric Testing
  • Mental Status Exam
  • Beck Depression Inventory
  • Sample Mental Status Form
  • Written Release of Information
  • Sample Release of Information Form
  • DSM 5 Diagnosis
  • Treatment Planning for Crisis Issues
  • Generic Crisis Issue Treatment Plan
  • Consultations
  • Sample Consultations Form
  • Progress Notes
  • Sample Progress Notes Forms
  • Process Notes 126 Documentation of Legal Challenges
  • Legal Documentation Example # 1
  • Legal Documentation Example # 2
  • Legal Documentation Example # 3
  • Discharge Summary
  • Sample Discharge Summary
  • Summary

Chapter 8

  • Confidentiality and High-Risk Issues
  • Confidentiality
  • Breaching Confidentiality in a Safe Manner
  • Legally Defined Conditions Permitting or Mandating a Breach of Confidentiality
  • Child Abuse and a Mandated Breach of Confidentiality
  • Elder/Dependent Abuse and a Mandated Breach of Confidentiality
  • Tarasoff and a Mandated Breach of Confidentiality
  • Danger to Self/Others and Evidence Code 1024 and a Permitted Breach of Confidentiality
  • The Confidentiality Bind When Addressing Crisis Issues
  • Vignette 19
  • Child Abuse Reporting and the Confidentiality Bind
  • Elder/Dependent Abuse Reporting and the Confidentiality Bind
  • Suicidal Intent and the Confidentiality Bind
  • Spousal Abuse and the Confidentiality Bind
  • Eating Disorders and the Confidentiality Bind
  • Substance Abuse/Dependence and the Confidentiality Bind
  • Protecting the Clinician When Facing a Confidentiality Bind
  • Using Mental Health Records Effectively
  • Vignette 20

Chapter 9

  • Addressing High-Risk Issues
  • The Presenting High-Risk Issue
  • Vignette 21
  • The Clinician’s Responsibility
  • The Emergency Plan of Action to Manage High-Risk Issues
  • Hospitalization as a Clinical Intervention
  • Post-hospitalization Risk Factors
  • Vignette 22
  • Post-hospitalization Mental Health Treatment
  • The Aftermath of an Injury to Self and/or Others
  • Determining the Extent of the Client’s Injury
  • The Clinician’s Role in the Lawsuit

References

Appendix

Index