MFT Law & Ethics

• → Minors consenting to their own treatment is only possible when:
• Minor is under 12
• Counseling is done outpatient
• The minor must be mature enough to participate intelligently in treatment.
• The therapist needs to establish a good reason as to why not to involve the parents in treatment. (specifically not appropriate)
• The therapist must specifically document as to why the parental involvement is inappropriate.
• The minor is responsible for the fee.

→ In cases of substance-related treatment minors age 12 and older may seek this treatment if the provide is under contract with state or county to deliver drug or alcohol abuse counseling. LMFTS, MFT Associates, LCSWs, and ASWs can provide this service. The only caveat is that the services cannot include drug replacement treatment.

→ In an occasion that a minor wants to refuse medical care for drug and alcohol related problems and a legal guardian consented to care the minor needs to undergo treatment. Minors may NOT consent to the psychotropic medication, psychosurgery, or electroconvulsive therapy. A minor 12 years or older can consent to medical care related to prevention of sexually transmitted disease.

• → Legal and management practice consideration in treating minors without parental consent:
• The minor age 12+ can exercise their own privilege.
• The minor age 12+ may sign (or refuse to sign) authorizations to release confidential information.
• A minor age 12+ may request access to their treatment records if that request is written.A
• Therapist’s legal option is to allow an inspection, provide copies, provide a summary or refuse.
• A minor 12+ may consent to therapy even against the objection of the parent with legal custody.
• A minor signed authorization is required to release that minor’s information to parents even if those parents did not consent to treatment.
• The therapist is required by law to periodically reconsider parental involvement. Due to this a therapist must state in the minor’s records:
• Whether or when there as an attempt to contact the parent or legal guardian.
• Whether the attempts to contact were successful, or
• The reason parental involvement continues to be inadvisable.

• → Emancipated minors
• Minors can become emancipated from their parents, thereby gaining many of the legal rights of an adult, including the right to enter into contracts, to manage their own financial affairs, and to consent to their own psychotherapy treatment.
• Thus, psychotherapists may treat emancipated minors without the consent of a parent, guardian, conservator, etc.
• Minors can become emancipated if they:
• Have entered into a legal marriage, whether or not the marriage is subsequently dissolved
• Are currently serving the military
• Or have been granted emancipation by the court affirming that the minor is:
• At least 14 years old
• Willingly living separately from parents with their consent or acquiescence
• Managing his or her own financial affairs
• The source of the minor’s income is not derived from any activity considered to be a crime by the laws of this state or the laws of the U.S.
• A court will grant the petition unless it determines that emancipation would not be in the minor’s best interest.
• A psychotherapist would need to see the marriage certificate, enlistment papers, or court order emancipating the minor to ensure that the minor seeking treatment may legally consent to psychotherapy treatment.

• → Confidentiality & minors
• Does a minor have the same general right to confidentiality? Answer is Yes.
• HOWEVER, since the parents have responsibility for making decisions about the health care of their child, the law also states that the parents have a “right to gain information” about the therapeutic treatment the child has received and/or the child’s well-being.
• Therefore at the beginning of treatment, the therapist should discuss with the parents and the minor what information will be kept confidential and what information will be shared with the parents.
• Typically the older the child the greater the confidentiality the younger the child the more information that will be shared with the parents.
• Tips when dealing with parents and children
• Parents of children in treatment should be in agreement with the therapist that they:
• Should not expect much information.
• Will be given updates and progress reports in general terms.
• Will be told how they can help the treatment process.
• Will be notified of any emergencies or if the therapist has any serious concerns about the child's well being ( If this is what parents are told, then the therapist has created a duty to notify the parents of a minor's risk of doing harm to self or others).

• At the age 12 the client can decide whether to release confidential medical information, including the therapist disclosure of any confidential information about their treatment to their parents. Once the minor has consented to their own therapy treatment they must sign a release on their own behalf and may request access to records even if they are participating in family therapy.
• A minor aged 12 or older may same or refused to sign authorizations to release confidential information. Civil code 56.11
• This means that even when a parent has given consent to treat a minor the parent does not necessarily have the right to authorize the release of the miners confidential medical information.

• → Confidentiality and access to the minor's treatment records
• The general rule is that the parent has a right to access his or her minor’s child's therapy records. The therapist must respond to a request for the parent the same way and under the same terms if they would respond to requests from any patient to see their treatment records.
• Offering an inspection, offering a copy of the records clamor offering a summary of the records, refusing the request.
• When can we refuse request:

• The therapist determines that allowing the parents accessing to information or the record of treatment would having harmful effect on the therapist/patient relationship.
• The therapist determines that allowing the parent to inspect the record with threaten the minors physical safety and/or physiological well-being.
• The same goes if a minor request access to his or her confidential information we will respond in the same manner.

• Evidence code section 1013 establishes that the holder of privilege is:
• A patient when she or he has no guardian or conservator.
• A guardian or conservator of the patient when the patient has a guardian or conservator.
• The personal representative of the patient if the patient is dead.

• This case clarified the parents or guardians do not hold privilege for the minor children simply because their parents or legal guardians.
• The court said that the parents or guardians and children can and often do have competing interests in legal proceedings.
• Thus for parent or guardian to exercise privilege for a minor child, the parent or guardian must petition the court for guardian ad litem status.
• If the court finds no competing interests calmer it will appoint the parents or guardians guardian ad litem status.
• Is the court determines that there are competing interests, it will deny the request for guardian ad litem status and appoint a lawyer guardian ad litem status to represent the interests of the minor.

• Counselors may be employed in a school setting to address various student needs including academic guidance.
• A team for counseling and support services might include several professionals, such as a school counselor, a school psychologist, a school social worker, and a child welfare and attendance worker, each of which would have a particular area of expertise.
• In order for a mental health professional to work directly for a school, you pupil personnel services PPS credential is required. Schools outsource their school counseling programs to local nonprofit agencies, including those employing and training MFt's, LPCC's, LEP interns and ASW may do so without requiring a PPS credential as long as the counselor is supervise in these programs for someone with a PPS credential.
• Counseling for students that does not require parental consent: academics, education, and career programs.
• If their best provide services that could constitute mental health counseling the therapist should obtain the appropriate consent usually from a student's parent or school counseling department.
• It's important to keep in mind that school counselors did not include psychotherapy or treatment. Moreover laws governing Services provided by school counselors do include psychological counseling, assessment and diagnosis, consultation, personal and small group counseling, crisis counseling, and referrals to community based agencies. Exceptions to the need for parental consent are the same as above.

The family educational rights and privacy act of 1974 (FERPA): Delineates the conditions for privacy of a student’s “educational record".FERPA Gives parents the right to inspect their child's educational record. Affective generally 1st 2014 permits the release of students records to an agency caseworker, state or local representative, or tribal organization, that has legal rights to the care of the child. This bill is intended to ensure educational continuity and progress.

• → It is important to note that the educational record does not include the counseling notes. Therefore they are not accessible or released any other personnel.
• Information disclosed to a school counselor by a child under the age of 12 may be considered part of the educational record except for the notes a counselor makes and keeps in his or her sole possession.

Authorize that “a counsel of records for a minor” certify in writing To the holder of a people's record that the people information will not be disclosed to another party except under a narrowly defined the specified circumstances.

• →Exceptions to Confidentiality when counseling in a school setting:
• Discussions with health care providers for the sole purpose of referring the student for treatment.
• Disclosure designed to avoid a clear and present danger to the health, safety or welfare of the student or other persons.
• Disclosure that a crime involving personal injury or substantial property loss will be or has been committed
• Disclosing information to those specified in a written waiver after such waiver has been signed and entered in the student's file.
• Conferring with school staff regarding modification of a student's academic program
• Mandated reports for child abuse or neglect.
• Disclose into law enforcement agencies when ordered to do so, or to aid in the investigation of a crime.

• No. Therefore if school counselors were ever to refuse parental access to the records it would become suspicious and questionable. However, the education code provides that school counselors treating students 12 or older shall not incur civil or criminal liability as a result of maintaining confidentiality.
• What to do as defined by the law for school counselors and patient privilege?
• Mental Health Professionals working in school settings should clarify with the school's policies are regarding these issues before beginning work in a school setting.

• Both parents
• Either parent < Preferences for the parent most willing to allow the child free contact with the other parent>.
• Person or persons with whom the child has been living in a stable and wholesome environment.
• Any other person or persons deemed suitable by the court.
• Before the court awards custody to a non parent, it must find the parental custody would be detrimental to the child's and non parental custody is in the best interests of the child.
• Courts are authorized to appoint private counsel to the child if the child's best interests are protected by appointing counsel.

Stipulates that both parents have the legal right to consent or deny to anything that pertains to the child's care for example education, medical, recreational, mental health, exc. Either parent acting alone has the legal authority to consent to mental health services for a minor child's, unless there is a language to the contrary in the custody order that requires the consent of both parents.

Only the designated sole custodial parent can have the right and responsibility to make the decisions relating to the health, education, and welfare of the child. Sole legal custody is typically granted only in the extraordinary circumstances, for example an abusive parent, a mentally incompetent parent, etc.

Simulates and declares where and in what amounts of time the child will spend with each parent. Each of the parents have specified periods of physical custody unless it is determined not to be in the best interests of the child. Joint physical custody is shared by the parents in such a way as to ensure the child of frequent and continuing contact with both parents. Physical custody is irrelevant in determining who can authorize psycho therapeutic treatment for a child.

• A child shall reside with and under the supervision of one parent, subject to the power of the court to order visitation. Physical custody is relevant in determining who can authorize psychotherapeutic treatment for a child.
• In an event that a parent with a minor child dies, the other parent is generally entitled to cuss city of that child's. However, if the surviving parent has not determine paternity or legal guardianship, that parent has no legal right to custody and the child has no right to support. The person seeking guardianship must notify individuals currently have physical custody as well as 1st or 2nd degree relatives.

Seth’s Law: Requires local educational agencies to prohibit discrimination, harassment, intimidation, and bullying based on actual or perceived characteristics. School personnel who witnesses such acts must take immediate steps intervene when safe to do so, and establish a timeline to investigate and resolve complaints and an appeal process. The superintendent of public instruction must post, annually update on his or her Internet website, and provide to each school district a list of statewide resources, to provide support to youth who have been subjected to school based discrimination, harassment, intimidation, or bullying, and their families.

• What are the general requirements for marriage?
• Each person must be of sound mind at the time of a plane for licensure, each person must not be insane or under influence of alcohol or drugs.
• Marriage must be free from duress that is no coercion or shotgun weddings.

• On June 26, 2015 the United States through court ruled that gay marriage is a constitutional right under the 14th amendment, meaning that all 50 States must allow it and that all existing bans are invalid. (Obergefell v. Hodges, 2015). Requires all States to issue marriage license says to same sex couples.
• In June 2013 the California Supreme Court overturned the ban on gay marriage proposition 8 the Supreme Court overturned the defense of marriage act DOMA making and same sex marriage is in any state where it is legal also valid the federal court grants the following federal rights:
• Joint tax filing.
• Same-sex widows and widowers may receive social security benefits.
• Same-sex may receive federal and please may receive health and retirement benefits.
• Binational couples may sponsor a partner for citizenship.
• Same sex military service personnel receive equal.
• Moreover husband and wife were removed from the California family code and replaced with “spouse”

• There is no minimum age for marriage in California.
• Each minor wishing to marry must obtain the written consent of at least one parent or guardian.
• Record may give the consent if a minor has no parent or guardian.
• Superior court order must grant permission for the marriage license to view.
• The court has the option of requiring premarital counseling .

• The couple's considered to be married because they have lived together and have told others that they are married.
• California does not Grant common law marriages.
• Out for you does not recognize common law marriages originate another state's call if they are considered valid within that state.
• → Definitions of Annulment: means that the marriage is considered never to have taken place.
• For the Uno ment one person must have already been married. The people who married were “1st degree relatives” and the marriage is considered incestuous.

• Voidable Marriages are considered a marriage until legal action is taken to set the marriage aside. Ordered for a voidable marriage to happen:
• One person was under the age of consent which is 18 years of age.
• A spouse who was absent or believe dead returns.
• Either person was of unsound mind at the time of marriage.
• Consent of the other person was obtained by fraud.
• Consent of the other person was obtained by force.
• One person is physically and give both consummating the marriage.

• It is a legal name for divorce and California.
• Dissolution of marriage was established by the California family law act of 1970
• Abolished the concept of blame and eliminated a legally required adversarial stance.
• The grounds for dissolution of marriage is irreconcilable differences ; Incurable insanity; For residency requirements to be activated one spouse must reside within the state for 6 months and 1 spells must reside within the cut county for 3 months.
• In order for a dissolution of marriage to happen there must be a petition to the court, the court issues a summons to be served on the petitioners spouse who has 30 days to file written response. Interlocutory Judgment is the 1st hearing in which the judge determines right to dissolution, division of property, custody and support issues if any. The waiting. Is at least 6 months from the date of original petition before the final judgment can be entered.

• Professional Code Violating sex with clients:
• Therapist sex with a Client is legally prohibited by business and professions code sections MF t's 4982.

What cannot be used as a defense: Consent of the patient may not be used by the therapist as defense. Client initiation of sexual contact may not be used by the therapist as a defense. Whether the sexual contact occurred in or out of the office setting is not admissible defense. Sex between client and an aga larger counselors also criminal act cama constituting sexual exploitation.

• Therapist sex with a client is ethically prohibited.
• CAMFT Ethical standard 1.2.2 : Sexual intercourse, sexual contact, or sexual intimacy with a patient where a patient spouse or partner or a patient's immediate family member during the therapeutic relationship or during 2 years following the termination of the therapeutic relationship is unethical.

• Sexual harassment of clients color as defined by the law, is also an actionable offense and constitutes sexual misconduct by a therapist.
• Sexual harassment includes making sexual advances, solicitations, sexual requests, demands for social compliance by the client feared, or engaging in other verbal, visual, physical conduct of a sexual nature or a hostile nature based on gender that is unwelcome or severe.
• Sexual harassment applies to verbal, visual, and physical contact of a sexual nature based on gender. For example, Is a therapist looks at a client in a certain way or uses words that the client views a sexually provocative, a claim can seek a legal redress.
• The quiet me not asked that there be stop the unwanted behavior nor visualize this comfort in or just seek legal redress. Accordingly, if their best may be sued for harassment having no knowledge that the behavior was objectionable to the client.
• A clan need not demonstrate an ability to easily terminate the relationship without tangible hardship in order to be successful in a sexual harassment suit. Even if recline is comfortable terminating the therapeutic relationship on his or her own the therapist could still be held liable.
• Decline me not demonstrate that she or he has suffered, or will suffer, economic loss or disadvantage or personal injury as a result bosom misconduct. Emotional distress and violations of a plaintiff’s statutory or constitutional rights are significant enough to warrant legal action.

For administrative action purposes they would report to the board of behavioral science. The appropriate licensing board will discuss the situation with the complainant, Disclose information about filing, and notify a complainant Of any decisions to take disciplinary action. The client and the therapist are interviewed separately. Cases are either settle by stipulated agreement in which the therapist admits to the violation and accepts the disciplinary action or are heard by an administrative law judge who renders a decision. The statute of limitations for filing a complaint with the previous of sexual misconduct on the part of the cycle therapist is within 10 years in the date of alleged sexual misconduct occurred. Mental health professionals who are found to have engaged in sexual misconduct with a client or former client Within 2 years of termination for MFTs or 5 years of termination for LPCCs May have their license revoked. Mental health professionals who are found to have engaged in sexual misconduct with a client or former client when that client was terminated for purpose of engaging in the act will have their licenses revoked to. Until health professionals who are engaged in sexual misconduct with a claimed or former client within 2 years of termination May be fined, order to seek their big, perform community service karma or to meet other terms and conditions for reestablishing their license.

• Complaints in writing may be filed by members or non members of CAMFT.
• Action against violating licensees can result in censure, probation, rehabilitation com I required to provision, education, and/or therapy, termination of membership, or any other action that as a committee deems reasonable.
• Licensees found in violation may be disciplined by having their ethics violation and disciplinary action published to the membership as association including the members full name or in degree geographical location and violation proven.
• Professional association discipline against a therapist or expulsion from any organization will not prevent a therapist from practicing, will not result in monetary recovery for the client, does not result in criminal action against the therapist.

• In sexual exploitation cases, is a lawsuit may be filed against a therapist in order to see compensation for injuries suffered and for the cost of future therapy.
• Most civil lawsuits must be filed within one year after the sexual exploitation.
• Lawsuit may be filed against a therapist, his or her employer, or a mental Heath health agency where if there this works. Prior to suing the mental health agency, a complaint must be filed with the mental health agency within 6 months of sexual exploitations.

• A client files a criminal complaint against the therapist with the police.
• The police then notifies the district attorney with a decides if there is enough evidence the for criminal charge.
• Service may be charged with a misdemeanor, punishable by 6 months in jail and the $1000 fine or may be charged with a felony for repeat offenses punishable by one year in jail and $5000 fine.
• Repeat offenders convicted of the misdemeanor may receive the fine of $1000 and order serve up to one year and in county jail.
• Repeat offenders convicted of a felony may be fined up to $5000 are serving one year and state prison.

• On a therapist told of the claims sexual contact with another therapist the therapist is required by law to provide both the brochure and to discuss the content of the brochure with the client.
• A therapist may report charges of sexual misconduct by another therapist to the BBS. The BBS Policy on 3rd party complaints is that anyone may file a complaint and the board will review each complaint regardless of the source. The board stipulates that these complaints may be impossible to prove. It there person wants to make such a report on behalf of a client must 1st obtain the written authorization of the client.

• What are the Clients rights?:
• 1. Terminate treatment at any time. 2. Terminate treatment at their discretion.
• Therapist’s right regarding termination are?:
• Purpose may terminate treatment for both clinical and ethical reasons.
• General guidelines and considerations in termination are:
• Termination of therapy should be attended to in the early stages of treatment and in writing as a part of the informed consent argument for service process.
• Termination May not be appropriate when a claim is hospitalized, in crisis, or actively suicidal
• Therapists are rarely disciplined for client abandonment and when they are, it is typically because they have terminated the therapeutic relationship marriage pursue a romantic, sexual, social business, or other relationship with the client.

• Non payment of fees
• The failure of the client to benefit from treatment.
• A therapist is physically or emotionally unable to continue treatment.
• Ethical conflicts
• Conflict of interest.

• If therapist should carefully document the terminations process, including:
• A. The clients reasons for terminating
• B. the date of termination
• C. the amount of time or number of sessions used in termination process
• D. key issues discussed in termination
• E. language indicating that the client is aware that the treatment is over and that the therapist is no longer responsible for the client's mental health care and emotional well being.
• F. Any recommendations or referrals given to the client
• 2. In termination doesn't initiated by the therapist common consultation is important to ensure that the therapists reasons return a tion and management of the germination process a consistent with community standards in the standard of care.

• Service may be at risk of liability of a client subs coming for therapy and no termination documentation exists.
• Claims who are taking a break should be documented and record as a current client unless formal termination has occurred. Therapist remains liable for current clients.
• Client who stops coming for their B and/or dissatisfied with their bus or the treatment and may make a claim against the therapist.
• Document attempts to contact the client, inquires about Klein dissatisfaction, and communications regarding offers for emergency sessions come up foreigner online sessions coma and D communication about inference of termination sessions.

• 1.3.1 Marriage and family therapist you sound clinical judgment when terminating their putrid relationships and do so in an appropriate manner. Reasons for termination may include but are not limited to the patient is not benefiting from treatment, continuing treatment is not clinically appropriate, the therapist is unable to provide treatment due to that there this incapacity or extended absence, or in order to avoid an ethical conflict or problem.
• 1.3.2 Marriage And family therapists do not abandon or neglect patience and treatment. If eat their bases unable or unwilling to continue to provide professional services come of the therapist will assist the patient making clinically appropriate arrangements for continuation of treatment.
• 1.3.4 Marriage and family therapist do not terminate patient relationships for non payment fees except one termination is handled in a clinically appropriate manner
• 1.7 Marriage and family therapist continually monitor their effectiveness and take steps to improve when necessary. Martian Valley 3rd discontinue reputed relationships only as long as it is reasonably clear that patients are benefiting from the relationship.
• 1.8 On terminating employment or contractual relationships, marriage and family therapist primarily consider the best interests of the patient when resolving issues continue responsibility for the patient care.

• What is Telehealth?
• Delivering healthcare services and public health via information and communication Technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self banishment of a patient's health care while The patient is at the originating site and the health care provider is at a distant sight. Telehealth Facilitates patient self management and caregiver support for patients and includes synchronous interactions and a synchronous store and forward transfers.

• What does Telehealth involve?
• an audio video or data communication involving a real time or near real time 2 way transfer medical didn't information this includes on going there be conducted over the telephone Skype, facetime, or similar media for the use of providing ongoing therapy.

• Licensed healthcare professionals and interns/trainees under supervision can provide telehealth services.
• There's no cap on the number of telehealth hours an LCSW so seek and obtain toward licensure.
• MFT trainees and register interns may earn up to 357 hours via telehealth according to the business and professional code for 4980.43
• A mental health professional, even license professional performing tell health services, must examine whether it is appropriate given his or her competence calmer and given claims clinical needs and assess, skill, and reason for using technology.

• Must give to client or client’s legal representation:
• The famous be disclosed before treatment begins.
• The patient or patient's legal as per percentage of retains option to withhold or withdraw consent or any time without affecting the right to future care or treatment.
• A description of potential risk, consequences, and benefits of telehealth.
• Description for all occur if there is a medical emergency along with suggestion to see a clinician if they are in need of crisis or on going care.
• A description of what will occur if there is an interruption of services due technological problems.
• Disclaimer that no assistance or diagnoses are made online.
• Allow existing confidentiality protections apply.
• All existing laws regarding medical information and copies of medical records apply.
• Dissemination of any Client identifiable images or information from the telehealth interaction to researchers or other entity shall not occur without patient consent.
• Informed consent should include a statement that the therapist reviewed this information prior to therapy and the client understands the 5 areas above.
• If available the signed written consent statement becomes part of the patient's record.
• The use of any hipper little they did privacy protection of business providers such as softwares or encryption service companies.
• Notification that insurance may not reimburse the clinician or the client for telehealth services as well as clients agreement or disagreeing to continue to hold services under those circumstances.

• → Minors consenting to their own treatment is only possible when:
• Minor is under 12
• Counseling is done outpatient
• The minor must be mature enough to participate intelligently in treatment.
• The therapist needs to establish a good reason as to why not to involve the parents in treatment. (specifically not appropriate)
• The therapist must specifically document as to why the parental involvement is inappropriate.
• The minor is responsible for the fee.

→ In cases of substance-related treatment minors age 12 and older may seek this treatment if the provide is under contract with state or county to deliver drug or alcohol abuse counseling. LMFTS, MFT Associates, LCSWs, and ASWs can provide this service. The only caveat is that the services cannot include drug replacement treatment.

→ In an occasion that a minor wants to refuse medical care for drug and alcohol related problems and a legal guardian consented to care the minor needs to undergo treatment. Minors may NOT consent to the psychotropic medication, psychosurgery, or electroconvulsive therapy. A minor 12 years or older can consent to medical care related to prevention of sexually transmitted disease.

• → Legal and management practice consideration in treating minors without parental consent:
• The minor age 12+ can exercise their own privilege.
• The minor age 12+ may sign (or refuse to sign) authorizations to release confidential information.
• A minor age 12+ may request access to their treatment records if that request is written.A
• Therapist’s legal option is to allow an inspection, provide copies, provide a summary or refuse.
• A minor 12+ may consent to therapy even against the objection of the parent with legal custody.
• A minor signed authorization is required to release that minor’s information to parents even if those parents did not consent to treatment.
• The therapist is required by law to periodically reconsider parental involvement. Due to this a therapist must state in the minor’s records:
• Whether or when there as an attempt to contact the parent or legal guardian.
• Whether the attempts to contact were successful, or
• The reason parental involvement continues to be inadvisable.

• → Emancipated minors
• Minors can become emancipated from their parents, thereby gaining many of the legal rights of an adult, including the right to enter into contracts, to manage their own financial affairs, and to consent to their own psychotherapy treatment.
• Thus, psychotherapists may treat emancipated minors without the consent of a parent, guardian, conservator, etc.
• Minors can become emancipated if they:
• Have entered into a legal marriage, whether or not the marriage is subsequently dissolved
• Are currently serving the military
• Or have been granted emancipation by the court affirming that the minor is:
• At least 14 years old
• Willingly living separately from parents with their consent or acquiescence
• Managing his or her own financial affairs
• The source of the minor’s income is not derived from any activity considered to be a crime by the laws of this state or the laws of the U.S.
• A court will grant the petition unless it determines that emancipation would not be in the minor’s best interest.
• A psychotherapist would need to see the marriage certificate, enlistment papers, or court order emancipating the minor to ensure that the minor seeking treatment may legally consent to psychotherapy treatment.

• → Confidentiality & minors
• Does a minor have the same general right to confidentiality? Answer is Yes.
• HOWEVER, since the parents have responsibility for making decisions about the health care of their child, the law also states that the parents have a “right to gain information” about the therapeutic treatment the child has received and/or the child’s well-being.
• Therefore at the beginning of treatment, the therapist should discuss with the parents and the minor what information will be kept confidential and what information will be shared with the parents.
• Typically the older the child the greater the confidentiality the younger the child the more information that will be shared with the parents.
• Tips when dealing with parents and children
• Parents of children in treatment should be in agreement with the therapist that they:
• Should not expect much information.
• Will be given updates and progress reports in general terms.
• Will be told how they can help the treatment process.
• Will be notified of any emergencies or if the therapist has any serious concerns about the child's well being ( If this is what parents are told, then the therapist has created a duty to notify the parents of a minor's risk of doing harm to self or others).

• At the age 12 the client can decide whether to release confidential medical information, including the therapist disclosure of any confidential information about their treatment to their parents. Once the minor has consented to their own therapy treatment they must sign a release on their own behalf and may request access to records even if they are participating in family therapy.
• A minor aged 12 or older may same or refused to sign authorizations to release confidential information. Civil code 56.11
• This means that even when a parent has given consent to treat a minor the parent does not necessarily have the right to authorize the release of the miners confidential medical information.

• → Confidentiality and access to the minor's treatment records
• The general rule is that the parent has a right to access his or her minor’s child's therapy records. The therapist must respond to a request for the parent the same way and under the same terms if they would respond to requests from any patient to see their treatment records.
• Offering an inspection, offering a copy of the records clamor offering a summary of the records, refusing the request.
• When can we refuse request:

• The therapist determines that allowing the parents accessing to information or the record of treatment would having harmful effect on the therapist/patient relationship.
• The therapist determines that allowing the parent to inspect the record with threaten the minors physical safety and/or physiological well-being.
• The same goes if a minor request access to his or her confidential information we will respond in the same manner.

• Evidence code section 1013 establishes that the holder of privilege is:
• A patient when she or he has no guardian or conservator.
• A guardian or conservator of the patient when the patient has a guardian or conservator.
• The personal representative of the patient if the patient is dead.

• This case clarified the parents or guardians do not hold privilege for the minor children simply because their parents or legal guardians.
• The court said that the parents or guardians and children can and often do have competing interests in legal proceedings.
• Thus for parent or guardian to exercise privilege for a minor child, the parent or guardian must petition the court for guardian ad litem status.
• If the court finds no competing interests calmer it will appoint the parents or guardians guardian ad litem status.
• Is the court determines that there are competing interests, it will deny the request for guardian ad litem status and appoint a lawyer guardian ad litem status to represent the interests of the minor.

• Counselors may be employed in a school setting to address various student needs including academic guidance.
• A team for counseling and support services might include several professionals, such as a school counselor, a school psychologist, a school social worker, and a child welfare and attendance worker, each of which would have a particular area of expertise.
• In order for a mental health professional to work directly for a school, you pupil personnel services PPS credential is required. Schools outsource their school counseling programs to local nonprofit agencies, including those employing and training MFt's, LPCC's, LEP interns and ASW may do so without requiring a PPS credential as long as the counselor is supervise in these programs for someone with a PPS credential.
• Counseling for students that does not require parental consent: academics, education, and career programs.
• If their best provide services that could constitute mental health counseling the therapist should obtain the appropriate consent usually from a student's parent or school counseling department.
• It's important to keep in mind that school counselors did not include psychotherapy or treatment. Moreover laws governing Services provided by school counselors do include psychological counseling, assessment and diagnosis, consultation, personal and small group counseling, crisis counseling, and referrals to community based agencies. Exceptions to the need for parental consent are the same as above.

The family educational rights and privacy act of 1974 (FERPA): Delineates the conditions for privacy of a student’s “educational record".FERPA Gives parents the right to inspect their child's educational record. Affective generally 1st 2014 permits the release of students records to an agency caseworker, state or local representative, or tribal organization, that has legal rights to the care of the child. This bill is intended to ensure educational continuity and progress.

• → It is important to note that the educational record does not include the counseling notes. Therefore they are not accessible or released any other personnel.
• Information disclosed to a school counselor by a child under the age of 12 may be considered part of the educational record except for the notes a counselor makes and keeps in his or her sole possession.

Authorize that “a counsel of records for a minor” certify in writing To the holder of a people's record that the people information will not be disclosed to another party except under a narrowly defined the specified circumstances.

• →Exceptions to Confidentiality when counseling in a school setting:
• Discussions with health care providers for the sole purpose of referring the student for treatment.
• Disclosure designed to avoid a clear and present danger to the health, safety or welfare of the student or other persons.
• Disclosure that a crime involving personal injury or substantial property loss will be or has been committed
• Disclosing information to those specified in a written waiver after such waiver has been signed and entered in the student's file.
• Conferring with school staff regarding modification of a student's academic program
• Mandated reports for child abuse or neglect.
• Disclose into law enforcement agencies when ordered to do so, or to aid in the investigation of a crime.

• No. Therefore if school counselors were ever to refuse parental access to the records it would become suspicious and questionable. However, the education code provides that school counselors treating students 12 or older shall not incur civil or criminal liability as a result of maintaining confidentiality.
• What to do as defined by the law for school counselors and patient privilege?
• Mental Health Professionals working in school settings should clarify with the school's policies are regarding these issues before beginning work in a school setting.

• Both parents
• Either parent < Preferences for the parent most willing to allow the child free contact with the other parent>.
• Person or persons with whom the child has been living in a stable and wholesome environment.
• Any other person or persons deemed suitable by the court.
• Before the court awards custody to a non parent, it must find the parental custody would be detrimental to the child's and non parental custody is in the best interests of the child.
• Courts are authorized to appoint private counsel to the child if the child's best interests are protected by appointing counsel.

Stipulates that both parents have the legal right to consent or deny to anything that pertains to the child's care for example education, medical, recreational, mental health, exc. Either parent acting alone has the legal authority to consent to mental health services for a minor child's, unless there is a language to the contrary in the custody order that requires the consent of both parents.

Only the designated sole custodial parent can have the right and responsibility to make the decisions relating to the health, education, and welfare of the child. Sole legal custody is typically granted only in the extraordinary circumstances, for example an abusive parent, a mentally incompetent parent, etc.

Simulates and declares where and in what amounts of time the child will spend with each parent. Each of the parents have specified periods of physical custody unless it is determined not to be in the best interests of the child. Joint physical custody is shared by the parents in such a way as to ensure the child of frequent and continuing contact with both parents. Physical custody is irrelevant in determining who can authorize psycho therapeutic treatment for a child.

• A child shall reside with and under the supervision of one parent, subject to the power of the court to order visitation. Physical custody is relevant in determining who can authorize psychotherapeutic treatment for a child.
• In an event that a parent with a minor child dies, the other parent is generally entitled to cuss city of that child's. However, if the surviving parent has not determine paternity or legal guardianship, that parent has no legal right to custody and the child has no right to support. The person seeking guardianship must notify individuals currently have physical custody as well as 1st or 2nd degree relatives.

Seth’s Law: Requires local educational agencies to prohibit discrimination, harassment, intimidation, and bullying based on actual or perceived characteristics. School personnel who witnesses such acts must take immediate steps intervene when safe to do so, and establish a timeline to investigate and resolve complaints and an appeal process. The superintendent of public instruction must post, annually update on his or her Internet website, and provide to each school district a list of statewide resources, to provide support to youth who have been subjected to school based discrimination, harassment, intimidation, or bullying, and their families.

• What are the general requirements for marriage?
• Each person must be of sound mind at the time of a plane for licensure, each person must not be insane or under influence of alcohol or drugs.
• Marriage must be free from duress that is no coercion or shotgun weddings.

• On June 26, 2015 the United States through court ruled that gay marriage is a constitutional right under the 14th amendment, meaning that all 50 States must allow it and that all existing bans are invalid. (Obergefell v. Hodges, 2015). Requires all States to issue marriage license says to same sex couples.
• In June 2013 the California Supreme Court overturned the ban on gay marriage proposition 8 the Supreme Court overturned the defense of marriage act DOMA making and same sex marriage is in any state where it is legal also valid the federal court grants the following federal rights:
• Joint tax filing.
• Same-sex widows and widowers may receive social security benefits.
• Same-sex may receive federal and please may receive health and retirement benefits.
• Binational couples may sponsor a partner for citizenship.
• Same sex military service personnel receive equal.
• Moreover husband and wife were removed from the California family code and replaced with “spouse”

• There is no minimum age for marriage in California.
• Each minor wishing to marry must obtain the written consent of at least one parent or guardian.
• Record may give the consent if a minor has no parent or guardian.
• Superior court order must grant permission for the marriage license to view.
• The court has the option of requiring premarital counseling .

• The couple's considered to be married because they have lived together and have told others that they are married.
• California does not Grant common law marriages.
• Out for you does not recognize common law marriages originate another state's call if they are considered valid within that state.
• → Definitions of Annulment: means that the marriage is considered never to have taken place.
• For the Uno ment one person must have already been married. The people who married were “1st degree relatives” and the marriage is considered incestuous.

• Voidable Marriages are considered a marriage until legal action is taken to set the marriage aside. Ordered for a voidable marriage to happen:
• One person was under the age of consent which is 18 years of age.
• A spouse who was absent or believe dead returns.
• Either person was of unsound mind at the time of marriage.
• Consent of the other person was obtained by fraud.
• Consent of the other person was obtained by force.
• One person is physically and give both consummating the marriage.

• It is a legal name for divorce and California.
• Dissolution of marriage was established by the California family law act of 1970
• Abolished the concept of blame and eliminated a legally required adversarial stance.
• The grounds for dissolution of marriage is irreconcilable differences ; Incurable insanity; For residency requirements to be activated one spouse must reside within the state for 6 months and 1 spells must reside within the cut county for 3 months.
• In order for a dissolution of marriage to happen there must be a petition to the court, the court issues a summons to be served on the petitioners spouse who has 30 days to file written response. Interlocutory Judgment is the 1st hearing in which the judge determines right to dissolution, division of property, custody and support issues if any. The waiting. Is at least 6 months from the date of original petition before the final judgment can be entered.

• Professional Code Violating sex with clients:
• Therapist sex with a Client is legally prohibited by business and professions code sections MF t's 4982.

What cannot be used as a defense: Consent of the patient may not be used by the therapist as defense. Client initiation of sexual contact may not be used by the therapist as a defense. Whether the sexual contact occurred in or out of the office setting is not admissible defense. Sex between client and an aga larger counselors also criminal act cama constituting sexual exploitation.

• Therapist sex with a client is ethically prohibited.
• CAMFT Ethical standard 1.2.2 : Sexual intercourse, sexual contact, or sexual intimacy with a patient where a patient spouse or partner or a patient's immediate family member during the therapeutic relationship or during 2 years following the termination of the therapeutic relationship is unethical.

• Sexual harassment of clients color as defined by the law, is also an actionable offense and constitutes sexual misconduct by a therapist.
• Sexual harassment includes making sexual advances, solicitations, sexual requests, demands for social compliance by the client feared, or engaging in other verbal, visual, physical conduct of a sexual nature or a hostile nature based on gender that is unwelcome or severe.
• Sexual harassment applies to verbal, visual, and physical contact of a sexual nature based on gender. For example, Is a therapist looks at a client in a certain way or uses words that the client views a sexually provocative, a claim can seek a legal redress.
• The quiet me not asked that there be stop the unwanted behavior nor visualize this comfort in or just seek legal redress. Accordingly, if their best may be sued for harassment having no knowledge that the behavior was objectionable to the client.
• A clan need not demonstrate an ability to easily terminate the relationship without tangible hardship in order to be successful in a sexual harassment suit. Even if recline is comfortable terminating the therapeutic relationship on his or her own the therapist could still be held liable.
• Decline me not demonstrate that she or he has suffered, or will suffer, economic loss or disadvantage or personal injury as a result bosom misconduct. Emotional distress and violations of a plaintiff’s statutory or constitutional rights are significant enough to warrant legal action.

For administrative action purposes they would report to the board of behavioral science. The appropriate licensing board will discuss the situation with the complainant, Disclose information about filing, and notify a complainant Of any decisions to take disciplinary action. The client and the therapist are interviewed separately. Cases are either settle by stipulated agreement in which the therapist admits to the violation and accepts the disciplinary action or are heard by an administrative law judge who renders a decision. The statute of limitations for filing a complaint with the previous of sexual misconduct on the part of the cycle therapist is within 10 years in the date of alleged sexual misconduct occurred. Mental health professionals who are found to have engaged in sexual misconduct with a client or former client Within 2 years of termination for MFTs or 5 years of termination for LPCCs May have their license revoked. Mental health professionals who are found to have engaged in sexual misconduct with a client or former client when that client was terminated for purpose of engaging in the act will have their licenses revoked to. Until health professionals who are engaged in sexual misconduct with a claimed or former client within 2 years of termination May be fined, order to seek their big, perform community service karma or to meet other terms and conditions for reestablishing their license.

• Complaints in writing may be filed by members or non members of CAMFT.
• Action against violating licensees can result in censure, probation, rehabilitation com I required to provision, education, and/or therapy, termination of membership, or any other action that as a committee deems reasonable.
• Licensees found in violation may be disciplined by having their ethics violation and disciplinary action published to the membership as association including the members full name or in degree geographical location and violation proven.
• Professional association discipline against a therapist or expulsion from any organization will not prevent a therapist from practicing, will not result in monetary recovery for the client, does not result in criminal action against the therapist.

• In sexual exploitation cases, is a lawsuit may be filed against a therapist in order to see compensation for injuries suffered and for the cost of future therapy.
• Most civil lawsuits must be filed within one year after the sexual exploitation.
• Lawsuit may be filed against a therapist, his or her employer, or a mental Heath health agency where if there this works. Prior to suing the mental health agency, a complaint must be filed with the mental health agency within 6 months of sexual exploitations.

• A client files a criminal complaint against the therapist with the police.
• The police then notifies the district attorney with a decides if there is enough evidence the for criminal charge.
• Service may be charged with a misdemeanor, punishable by 6 months in jail and the $1000 fine or may be charged with a felony for repeat offenses punishable by one year in jail and $5000 fine.
• Repeat offenders convicted of the misdemeanor may receive the fine of $1000 and order serve up to one year and in county jail.
• Repeat offenders convicted of a felony may be fined up to $5000 are serving one year and state prison.

• On a therapist told of the claims sexual contact with another therapist the therapist is required by law to provide both the brochure and to discuss the content of the brochure with the client.
• A therapist may report charges of sexual misconduct by another therapist to the BBS. The BBS Policy on 3rd party complaints is that anyone may file a complaint and the board will review each complaint regardless of the source. The board stipulates that these complaints may be impossible to prove. It there person wants to make such a report on behalf of a client must 1st obtain the written authorization of the client.

• What are the Clients rights?:
• 1. Terminate treatment at any time. 2. Terminate treatment at their discretion.
• Therapist’s right regarding termination are?:
• Purpose may terminate treatment for both clinical and ethical reasons.
• General guidelines and considerations in termination are:
• Termination of therapy should be attended to in the early stages of treatment and in writing as a part of the informed consent argument for service process.
• Termination May not be appropriate when a claim is hospitalized, in crisis, or actively suicidal
• Therapists are rarely disciplined for client abandonment and when they are, it is typically because they have terminated the therapeutic relationship marriage pursue a romantic, sexual, social business, or other relationship with the client.

• Non payment of fees
• The failure of the client to benefit from treatment.
• A therapist is physically or emotionally unable to continue treatment.
• Ethical conflicts
• Conflict of interest.

• If therapist should carefully document the terminations process, including:
• A. The clients reasons for terminating
• B. the date of termination
• C. the amount of time or number of sessions used in termination process
• D. key issues discussed in termination
• E. language indicating that the client is aware that the treatment is over and that the therapist is no longer responsible for the client's mental health care and emotional well being.
• F. Any recommendations or referrals given to the client
• 2. In termination doesn't initiated by the therapist common consultation is important to ensure that the therapists reasons return a tion and management of the germination process a consistent with community standards in the standard of care.

• Service may be at risk of liability of a client subs coming for therapy and no termination documentation exists.
• Claims who are taking a break should be documented and record as a current client unless formal termination has occurred. Therapist remains liable for current clients.
• Client who stops coming for their B and/or dissatisfied with their bus or the treatment and may make a claim against the therapist.
• Document attempts to contact the client, inquires about Klein dissatisfaction, and communications regarding offers for emergency sessions come up foreigner online sessions coma and D communication about inference of termination sessions.

• 1.3.1 Marriage and family therapist you sound clinical judgment when terminating their putrid relationships and do so in an appropriate manner. Reasons for termination may include but are not limited to the patient is not benefiting from treatment, continuing treatment is not clinically appropriate, the therapist is unable to provide treatment due to that there this incapacity or extended absence, or in order to avoid an ethical conflict or problem.
• 1.3.2 Marriage And family therapists do not abandon or neglect patience and treatment. If eat their bases unable or unwilling to continue to provide professional services come of the therapist will assist the patient making clinically appropriate arrangements for continuation of treatment.
• 1.3.4 Marriage and family therapist do not terminate patient relationships for non payment fees except one termination is handled in a clinically appropriate manner
• 1.7 Marriage and family therapist continually monitor their effectiveness and take steps to improve when necessary. Martian Valley 3rd discontinue reputed relationships only as long as it is reasonably clear that patients are benefiting from the relationship.
• 1.8 On terminating employment or contractual relationships, marriage and family therapist primarily consider the best interests of the patient when resolving issues continue responsibility for the patient care.

• What is Telehealth?
• Delivering healthcare services and public health via information and communication Technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self banishment of a patient's health care while The patient is at the originating site and the health care provider is at a distant sight. Telehealth Facilitates patient self management and caregiver support for patients and includes synchronous interactions and a synchronous store and forward transfers.

• What does Telehealth involve?
• an audio video or data communication involving a real time or near real time 2 way transfer medical didn't information this includes on going there be conducted over the telephone Skype, facetime, or similar media for the use of providing ongoing therapy.

• Licensed healthcare professionals and interns/trainees under supervision can provide telehealth services.
• There's no cap on the number of telehealth hours an LCSW so seek and obtain toward licensure.
• MFT trainees and register interns may earn up to 357 hours via telehealth according to the business and professional code for 4980.43
• A mental health professional, even license professional performing tell health services, must examine whether it is appropriate given his or her competence calmer and given claims clinical needs and assess, skill, and reason for using technology.

• Must give to client or client’s legal representation:
• The famous be disclosed before treatment begins.
• The patient or patient's legal as per percentage of retains option to withhold or withdraw consent or any time without affecting the right to future care or treatment.
• A description of potential risk, consequences, and benefits of telehealth.
• Description for all occur if there is a medical emergency along with suggestion to see a clinician if they are in need of crisis or on going care.
• A description of what will occur if there is an interruption of services due technological problems.
• Disclaimer that no assistance or diagnoses are made online.
• Allow existing confidentiality protections apply.
• All existing laws regarding medical information and copies of medical records apply.
• Dissemination of any Client identifiable images or information from the telehealth interaction to researchers or other entity shall not occur without patient consent.
• Informed consent should include a statement that the therapist reviewed this information prior to therapy and the client understands the 5 areas above.
• If available the signed written consent statement becomes part of the patient's record.
• The use of any hipper little they did privacy protection of business providers such as softwares or encryption service companies.
• Notification that insurance may not reimburse the clinician or the client for telehealth services as well as clients agreement or disagreeing to continue to hold services under those circumstances.

• Crime related to qualifications and license
• Fraud with licensure
• Alcohol/ substance that was injurious to myself = they may deny license or revoke it
• Misrepresenting my education and/or qualifications
• Engaging in sexual relations with a client or former client within 2 years after termination
• Acting as a supervisor
• Not maintaining confidentiality
• Not telling the client the fee before therapy
• Misleading advertising
• Working out of my scope of competence
• Failure in keeping good records

• Fails the standard of care
• Not having cures and results unless promised to a client

• Average degree of skill, care and diligence used in profession
• Level of skill, knowledge and care in diagnosis and treatment that other reasonably careful therapists would have in similar circumstance
• Examples: having informed consent, thorough diagnosis, correct assessments, treatment plan, working with referrals if outside my scope of practice / competence, making referrals, making steps to prevent harm to suicide.

• Right and good behavior such as
• Professional boundaries
• No dual relationships
• Informed consent

• Clients right to not have confidential info released during a legal preceding
• Privilege protects the client from having confidences released publically
• Interns, trainees and licensed therapists all give clients privilege
• Mental health cooperation has privilege

• Client holds this when no guardian or conservator exists
• When client has a guardian at litem, they hold this instead of client
• The personal representative of the client if client is dead
• All members of the treatment (individual, couple, family)

• The person holding it
• Mental health processionals on behalf of client must assert it until client says otherwise
• MFTs and all other health professionals must assert it for client whenever clients confidential info is after by a subpoena
• But if there is a court order, mental health professionals cannot assert = must go to court
• A mental health professional who’s subpoenaed about a client who is court ordered must know that probation parole would assert privilege.

• Minors hold their own privilege unless they have a guardian ad litem
• Parents cant hold their kids privilege as not guardian ad litem
• Parents can hold minors privilege if court says parents are guardian ad litem
• If subpoenaed therapist asks whom guardian ad litem is, not the parents and obtain written consent from them on whether to assert or wave privilege
• If attorney is the guardian ad litem they can access minors records
• With a foster child, it is needed to find out who is legally holding privilege for that child

• If the search warrant names the therapist as being criminal, surrender all records
• If the client is a criminal a therapist may get search warranted

• Should contact the client or their legal representative (guardian ad litem) to see if they want to assert or wave privilege
• If its for a former client and the therapist doesn’t have contact information, therapist can assert privilege here

• Therapist may not produce a summary of records without court permission
• NB – WHEN A CLIENT INTRODUCES EMOTIONAL OR MENTAL CONDITIONS INTO A LEGAL PROCEEDING, IT REPRESENTS AN EXCEPTION TO PRIVILEGE

• Confidentiality = Both LEGAL and ETHICAL requirement
• Failing to hold confidentiality is unprofessional conduct = means suspicion or revocation of license

• If client discloses crimes previously committed except for crimes of child abuse, dependent or elder abuse
• Keep Confidentiality if client is now a former client. There must be authorization from the personal representative of the old client
• If client is more than one person= every member must sign an authorization prior to disclosing any information to third parties. Also if any have discontinued therapy they must also sign authorization.
• Therapist must maintain confidentiality in group therapy for all members and obtain agreement among all members to respect the confidentiality of other members
• Keep confidentiality if client commits theft or violence against therapist
• (Page 29 has examples of breaking confidentiality)

• Child, adult, elder abuse
• Notify law enforcement within 24 hours if client presents an imminent physical threat to a reasonably identifiable person = tarasoff
• If court ordered
• If ordered from a state board, commissions or administrative agency (e.g. BBS)
• If the therapist gets search warranted themselves
• Coroners request for info for investigation to identify descendent or investigate deaths

• If therapist believes that client due to mental disorder, is a danger to self or the person or property of others that disclosure is made to prevent threatened harm. This means client who is
• Suicidal and can break confidentiality to prevent the harm to self
• Break confidentiality if Engaged in dangerous behavior and is danger to self
• Break confidentiality if doing dangerous behavior that dangers others or property of others
• Can break confidentiality if signed authorization from client
• Can break confidentiality if therapist has good faith that client who is suicidal and says they will harm a reasonably foreseeable victim
• Is in a psychiatric emergency or gravely disabled
• Can ask parents for minor’s mental health records but need to balance minors confidentiality rights
• Can break confidentiality if disclosing means minimizing threat to other victim / victims
• Can break confidentiality if trying to determine guardianship with court investigators, probation offices

• The report must be made to an agency in CA regardless of the location (even if lack geographical info) of the abuse, the abuser, or the victim. Report it in CA only.
• If unsure whether to make report always call CPS and they will determine
• (Document the phone call)
• Each new incident should be reported, even with same child
• If several professionals have knowledge of an incident, each has a duty to report but only one report needs to be made
• Failure to report in a timely manner subjects therapist to disciplinary of license
• Therapists employed by an agency must sign a form stating their acknowledgement of reporting requirements and agreement
• *Minors’ fighting isn’t abuse and reportable if both are willing to fight and size and maturity equal or mutual affray between minors
• *Death of a child is reportable even accidental

• Includes intentional touching including breasts, inner thighs and buttocks or clothing on it covering for sexual purposes
• Sex involving a minor under 18y is reportable if there is oral sex, anal sex, or penetration of anal opening with object
• Sex involving minor is reportable is there is consensual sexual intercourse between a minor under 16 and adult 21 or older
• Sex involving a minor is reportable if there are any sexual acts between 14 or 15y and an adult at least 10 years older than minor. Age difference determined by birth dates
• Sex reportable if minor under age of 14 and any person 14 years or older

• Of adequate food, clothing, shelter or medical care or supervision to prevent injury
• Homelessness is not mandated report necessarily
• Refusal of medical treatment for spiritual or religious reasons is not neglect abuse
• A decision made after parents has seen physician is not neglect

• Where a person has willfully caused a child to suffer or caused pain is abuse
• However, if punishment occurred with a belt or object and did not result in traumatic condition then this is NOT reportable. The defining factor is if it’s traumatizing, not the means by which it occurred
• BUT with punishment that if deemed to be cruel even if no mark would still be reportable
• *Domestic violence (DV) does not represent a mandated report even if minor witnessed it, but the effect of the DV on child is what makes it reportable. If child gets injured or suffered traumatically then this is reportable
• *Fetal abuse = such as drugs and alcohol permits a report but is not mandated

• There’s NO mandate to report child abuse unless victim is currently a minor
• If you believe that the abuser told by an adult client may have victimized others who are under 18 then must make a report. Therefore if the abuser is still around kids now and client believes they are still abusing – report

Don’t need all info to report – must report what ever you have

• Must report regardless of the location of the abuse, abuser, or the victim
• Reporting abuse to another state doesn’t fulfill mandate and breaks confidentiality

Commits a misdemeanor, fine of $1000 and or 6 months in county jail

• Dependent adult = those between 18-64 living in CA, who have physical, mental or financial limitations which restrict his or her ability to carry out normal activates of daily life and protect own rights
• Those who are in 24 hour health care facility
• Inability to carry out normal activities or protect own rights
• Unable to cook, bathe, drive, use phone or toilet without assistance
• ELDER = 65 PLUS, living in CA
• Mandated reporting would not apply to elder who visiting

• Physical abuse – touching harmful in a way or in an offensive way that offends them, threatening in offensive manner (raised fists, weapon). Physically restraining them, sexual, depriving of food or water for long time
• Abandonment – withdrawing care needed to help them
• Isolation – restricting them from social contact by not allowing mail access, phone, visitors or allowing them to leave
• Neglect - failure to help with providing food, shelter, closing basic needs
• Financial abuse - money or property with intent to defraud. Losing from a crime of identity theft
• Abduction - taking them out and not allowing them to come back into CA against their will or without their consent
• *It is abuse when not provided hygiene, clothing, living space, protection from malnutrition and healthy hazards occur
• *Optional reporting includes = any fear, agitation, confusion, severe depression, or treatment that endangers them
• *If abuse occurs outside of a long term care facility (like their home, caregivers home, state mental hospital) report IMMEDIATELY by phone and written report in 2 days
• *If abuse occurs in a state mental hospital = report made by phone asap to investigators is needed

• And results in serious bodily hard, a phone report made immediately. Written report within 2 hours to law, facilities licensing agency and local ombudsman
• If no serious bodily harm, phone within 24 hours to law, and report written within 24 hours (and same other 3)
• Non-physical abuse that occurs in a long-term care facility must be reported asap to law enforcement or local ombudsman, and written report within 2 days
• (Page 53 – is chart that we have at school)
• *If dependent or elder have no evidence for their claim, and/or they have a diagnosis of mental disorder (dementia), mental defect, or under court ordered conservatorship because of these above conditions = we have no obligation to report.
• *Or if I believe abuse didn’t occur = not obligated.

• We have a legal obligation to break confidentiality
• Confidentiality to protect a potential victim from a client’s imminent violence.
• Our mandate is to notify local law enforcement of the client’s identity within 24 hours.
• We can protect a potential victim from the client’s imminent physical violence.
• Our legal obligation moves from client to society
• There is a duty to warn and protect by making reasonable efforts to communicate the threat to the intended victim or victims.

• The client, a close family member of the client or credible third party has said with a reasonable identifiable
• In 24 hours must report to law enforcement = this is a mandate
• Must report within 24 hour period

• MUST warn local law enforcement and then the therapist MAY also fulfill the duty to protect by warning a victim, hospitalizing the client, asking the client to sign a “no violence plan”
• There is NO mandate to warn the victim
• May use assessment and observation of body language as indicator of this report
• When breaking confidentiality therapist can disclose as much as they like while being discreet including reasons as to why wanted to make report
• After fulfilling the mandate of informing law enforcement, MAY – warn the victim(s), warn someone likely to apprise the victim (such as a spouse or parent), have the client dispose of the means, have no violence plan, have client hospitalized.

• Examples of tarrasoft – if client threatened to blow up a building, therapist would notify building management or security to protect the people in there.
• If client threatened to go to an identified intersection and open fire then would have to notify police as people will be there.

• You CAN break confidentiality when the client tells you about someone else who is a minor, dependent on elderly who might be in danger
• You CANT break confidentiality when the client tells you about someone else who is not a minor hurting others
• Read page 70 for perfect explanation for COMPS
• Read page 72 hard pop quiz questions need to know for comps

• Suicidal clients
• If clients are intoxicated and going to drive etc
• Threatening to destroy property, vandalize, arson, kill neighbors dog
• Mental or physical condition which makes them a risk

• Therapist has no duty to prevent suicide
• But has a responsibility to prevent harm to suicidal clients
• Law permits therapists to break confidentiality when clients are a danger to themselves in order to prevent the danger

• No self harm / no suicide contract
• Increased contact (extra sessions)
• Involve the client support systems (release to speak to family or friends)
• Referral to physician for meds
• Voluntary hospitalization

• Clinical consultation with client’s other health care providers
• 24 hour watch with family arranged without clients permission
• Involuntary hospitalization

for adult (18plus) who is diagnosed with a terminal illness to self-administer a lethal dose of an aid dying drug that is prescribed by a doctor. They must be diagnosed with a terminal illness and the drug prescribed, plus it’s confirmed that they will die in 6 months

• A 5150 can be initiated by a therapist but can be invoked only by a peace officer
• To initiate, therapists call the law enforcement or a local PET team in which the mental health professional may assess the client’s mental state
• Invoking pertains to locating, transporting and applying for placement in a hospital
• Mental health processionals may only invoke for a 5150 if they have completed a training and exam by their county department of mental health
• Clients are held for 72 hours
• Clients have the right to be told the name of the facility that they will be taken to

• Not mandated or permitted to report DV
• If report DV one is breaching confidentiality
• Required to report DV IF child abuse came out of it
• DV witnessed by children does not automatically constitute ad child abuse, the effect that the DV has constitutes whether it’s a report
• If child, dependent adult or elder are injured or health in dangered in DV then report
• These reports then become their own abuse reports, not DV reports

• It is unprofessional conduct, fraudulent and illegal to backdate records
• A therapist should never omit relevant clinical info at a client’s request
• Good records are a therapist’s best legal defense
• Child and elder/dependent adult abuse records must be kept separate from the rest of the record in case of request for access or subpoena
• Must keep records for at least 7 years after the date of termination
• For minors under age 18, must retain records for a least 7 years after they turn 18 (25y)

• Chief complaints
• Findings from other healthcare providers
• Diagnosis
• Treatment plan
• Progress of treatment
• Prognosis
• Procedures and tests
• Any instances that cause therapist to consider breaking confidentiality

• Intake forms authorizations to treat a minor
• Informed consent documents
• Documentation of discussions about informed consent
• Written fee arrangements
• Dates of therapy
• Session start and stop times
• Insurance info
• Transference management
• Countertransference management
• Documentation around breaking confidentiality regarding abuse
• Termination process
• Crises and response documentation

• Failing to crease treatment plans
• Maintaining minimal or no treatment records
• Failing to accurately record treatment dates
• Creating progress notes for sessions that did not occur

• Intake forms
• Consent forms
• Release waivers
• Notes from consultation or supervision
• Print outs from electronic communication
• Fees and billing info

• Chief complaints, including pertinent history
• Findings from consultations and referrals from other health providers
• Diagnosis, where determined
• Treatment plan
• Progress of treatment
• Prognosis, including significant problems or conditions
• Pertinent reports of diagnosis procedures and tests

• Are akin to medical records
• Documents that treatment was provide and document the client’s need for treatment
• Release is not required from the client to share with other health care providers
• Client has full access

• The client’s reactions and therapist subjective impressions of the client and treatment process
• Release is required from client to share with other healthcare providers
• Client has no access

• Clients have statutory right to access a therapists records
• Child and dependent adult / elder abuse reports should NOT be released to the client unless mandated by the court
• Any request from the client must be in writing

• Allow an inspection within 5 business working days
• Produce a copy within 15 business working days, can charge up to 25c per page
• Produce a treatment summary within 10 business days. If record is extensive then therapist can increase time to 30 days and even charge a “reasonable fee”
• If therapist is covered by HIPPA, may not provide a summary unless the client agrees in writing to receive a summary

A “substantial risk” to the client, if the client were to see the records

• Document the date of their written request
• Document the foreseen detrimental consequences
• Inform client that request is being refused
• Inform client of the right to permit inspection by providing copies to another licensed health processional designated by the client
• Record whether the client requested an inspection or copies to be received by another mental health processional
• Other health care provider does not make records available for the client

the therapists, not clients

incomplete or incorrect with their records, this is then attached to their file

• If the parents are in an intact marriage or if the parents are divorced and there is legal joint custody = legally, either parents may authorize treatment for their minor. Yet, it is more clinically sound to gain consent from both parents. Also if custody agreement states equal consent must be by both parents, then both must
• If the parents are divorced and there is sole legal custody = the parents with the sole legal custody and only this parent can authorize the treatment for the minor
• If the parents are adoptive parents = legally either parent may authorize treatment for their minor. Yet, it is more legally sound to gain consent from both parents
• If the parents are unmarried biological parents = either parent can make a unilateral decision regarding consent to treat a minor
• If the parents are minors = a minor parent can consent to treatment of a minor child as long as the minor’s parent is mature enough to understand the therapeutic process
• If there is a legal guardian = they can consent to a minors treatment
• If the parent is a stepparent = they have no legal standing to consent; however if they sign a caregivers authorization form then it is acceptable
• If there are foster parents = they do not have right to make health care decisions, the attorney of the minor is given authority to consent for treatment

• Participating in interactive, online, or self-study continuing education courses offered by California approved continuing education providers
• Choosing continuing education courses from a list of providers in other states from BBS website: www.bbs.ca.gov
• Requesting license put on inactive status
• Requesting BBS exception from continuing education requirement (if license reside outside of country for more than one year)

• Privacy
• Electronic transaction and code sets standard
• Security
• National provider identifier number

• The right to request restrictions on certain uses and disclosures of their health information
• The right to receive confidential communications from health care providers.
• Essentially this means that clients can ask that confidential information be transmitted to them at the address or phone number of their choice
• There is a HIPAA form that clients may fill out designating the addresses numbers where you may contact them.
• Right to inspect and receive a copy of their PHI
• This is access to medical/psychotherapy record; not access to psychotherapy notes
• If providing a summary, therapist has 10 days from the date of Patient’s written request. If the record is large, a therapist may request a one-time extension of 30 days. Extension request must be in writing and provided to the client. Unlike California law, HlPAA does not allow summaries unless the client agrees.
• If allowing an inspection, therapists have 5 days from the time they receive a request in writing from client
• If a therapist decides to make a copy she/he has 15 days from receiving written request. Therapists may charge a reasonable fee based on their costs for producing copies of the client’s PHI.
• If a client agrees (in writing) to receive a summary, therapist has 10 days from client agreement to produce the summary
• May require that the client submit the request on a standard HIPAA form: Request & Receive a Copy of PHI.
• The right to a review of a denial of access.
• Within 30 days, therapist must provide a written statement in response to the request
• Statement must include basis of the denial, patient’s right to a review by another licensed health care professional, and description of how the patient may pursue the request
• Review by the 2nd licensed professional determines whether the original therapist must allow of may deny access
• Right to amend their PHI
• Clients can make requests to amend errors or omission in their records
• If therapist accept the amendment:
• They must add the amended information to the client’s PHI and notify patient of the amendment
• Must send the amended information to persons or entities identified by the patient and to anyone that has received the information and relied upon it before it was amended
• Therapist can reuse to accept amendment in some circumstances
• HIPAA forms for:
• Clients request their records to be amended
• Therapist respond to the request
• Therapists notify the client that records have been amended
• The right to receive a paper copy of the therapist’s Notice of Privacy Practices (NPP)
• Must be given to clients on or before receiving treatment
• Must be posted on the therapist’s premises and/or prominently on the therapist’s website
• Therapists must receive some form of written acknowledgement from clients that they have received a copy of the NPP
• NPP must be:
• Written in plain language
• Contain a statement about how therapist will use and disclose the client’s PHI
• Describe how the therapist protects health information under the privacy rule
• Specify circumstances when health information may be used without patient’s consent or authorization (exceptions to confidentiality)
• Describe the uses and disclosures that are allowed for treatment, payment, and health care operation purposes
• Describe the rights that clients have respect to their PHI
• Notify clients of how they may obtain access to PHI
• Notify clients of therapist’s availability to provide additional information regarding privacy practices
• Notify clients that their PHI will not be used for marketing purposes of be sold without written authorization
• Notify clients of a breach of PHI
• Describe uses and disclosures of “psychotherapy notes

• Established by the Department of Health and Human Services, to give the medical industry a common, standardized language
• They are to be used by covered entities, insurers, HMOs, and health care clearinghouses.
• The code set standards are to be used whenever covered entities transmit covered transactions (claim submissions, reimbursement, claim status, patient eligibility, and referral authorizations) electronically.
• Codes are either:
• Medical, including DSM diagnoses
• Non-medical or administrative, which would be used in conducting covered transactions electronically
• Codes are generally translated on insurance company forms
• Therapists who have their own software for billing insurance are using what HIPAA calls EDI, electronic data interchange.
• This software must comply with HIPAA privacy practices and standards, and must be tested to ensure compliance.

• Requires that covered entities abide by administrative, physical, and technical safeguard security standards whenever using EPHI (electronic personal health information).
• EPHI Is information stored on a computer disk, magnetic tape, or computer hard drive, as well as information transmitted over the Internet when dealing with third-party payers.
• When dealing with EPHI, covered entities must:
• Ensure the confidentiality, integrity, and availability of all EPHl that the covered entity creates, receives, maintains, or transmits.
• Protect against any reasonably anticipated threats or hazards to the security or integrity of EPHI that the covered entity creates, receives, maintains, or transmits.
• Protect against any reasonably anticipated uses or disclosures of EPHI that are not allowed or required by HlPAA.
• Ensure compliance with these security standards by its workforce
• Business Associates
• If a covered provider uses the services of another organization, that organization is called a “Business Associate” (BA)
• The therapist is mandated by HlPAA to sign a “Business Associate Agreement” with any service providers that may access client information.
• BAs are bound by the same privacy and security laws that govern HIPAA. BA can be held accountable for a data breach and penalized for noncompliance with HIPAA
• Examples of BA’s: CPA, Collections agency, lawyer, technological support, transcriptionist, software vendor, etc.
• Covered providers may disclose information to Business Associates without a release from clients, only insofar as that information enables their service to the therapist
• HIPAA requires “HIPAA-compliant software”
• Note: no single software package will be compliant with all HIPAA requirements, only an organiztion’s people and policies can be “HIPAA-compliant”
• Electronic date interchange (EDI) of patient records requires that software meet HIPAA requirements for privacy and security
• Software must meet privacy and security provision in the areas of data storage and data transmission
• Software must be able to monitor and track all activities in an organization that pertain to security as well as breaches or attempted security breaches and how they are remediated
• Computer or IT vendors must sign a Business Associate agreement if they have access to the covered entities’ systems and provide software or hardware updates
• Software on health care apps or on mobile devices that might be removed from the premises must be HIPAA compliant
• HITECH Act
• Congress enacted the Health Inforation Technology for Economic and Clinical Health Act in 2009
• HITECH adds an enforcement arm to HIPAA and has penalties for “willful neglect” of HIPAA policies
• HITECH
• Requires organizations to conduct internal audits for HIPAA compliance
• Uses compliance officers to conduct external audits.
• Makes “Business Associates” liable for a breach, requires Business Associates to notify the covered entity of the breach.
• requires that encryption capabilities are part of the organization’s software
• Requires that patients are notified of any unsecured breach of their PHI

• NPI is a 10-position identification number and is the primary health care provider identifier for standard transactions
• HIPAA mandates that all covered entities be “enumerated,” (be assigned a NPI)
• NPI replaces the tax ID number or Social Security when covered entities conduct standard transactions under HIPAA
• Covered entities are required to submit NPI on all standard electronic transactions
• Health care providers who bill insurance but who are not covered entities:
• Do not need to be enumerated and do not need to use an NPI in billing for insurance

• California law advocates “Freedom of Choice” for consumers of mental health services.
• Upon referral by a physician or surgeon, licensed mental health professional shall be reimbursed for services provided.
• Insurance company located within the state of California is mandated to reimburse mental health professionals.
• Insurance companies located outside California and writing coverage within California are required to reimburse mental health professionals.
• Unless authorized by an employee, disability insurers, health care service, and nonprofit hospital service plans are bound by confidentiality. The plan is prohibited from releasing any information to an employer that an employee is receiving covered services from a health care provider
• Mental Health Parity Bill established that Californians suffering from severe mental illnesses are entitled to insurance coverage equal to other forms of illness. Requires insurers and managed care companies to provide comparable co-pays, deductibles and maximum lifetime benefits for the treatment of severe mental disorders and significant emotional disturbances of children
• Following mental illnesses are covered: Schizophrenia, Bipolar Disorders, Major Depressive Disorder, Schizoaffective Disorder, Panic Disorder, Obsessive-Compulsive Disorder, Anorexia Nervosa, Bulimia Nervosa, and Autism Spectrum Disorder
• Disability benefits must also be provided for the mental disorders that are covered by the Parity Act
• Insurance companies typically reimburse only for the diagnosis and treatment of mental disorders.
• Insurance companies must pay claims within 30 working days (more time is allotted if a claim is contested).

Medicare reimburses LCSWs, not LMFTs, LPCCs and LEPs

• Services and reimbursement are determined on a county-by-county basis.
• In May, 2014, private practice LMFTs were added to the list of Medi-Cai providers
• Therapist must be licensed to apply to become a Medi-Cal Provider ( about $550 application fee).
• Applicants may apply as an Individual or a Group

• The Affordable Care Act, passed in 2010, required that state “exchanges” be established in every state, which allows consumers to compare insurance plans.
• “Covered California” is the name given to those exchanges in which individuals, families and businesses can locate health coverage.
• Main changes that the Affordable Care Act made to private health insurance coverage:
• Insurers may not refuse coverage for a pre-existing condition
• Benefits were expanded for health and reproductive benefits for women
• Insurance plans became “portable” from one employment situation to another
• Young adults up to age 26 may be covered by a parent or guardian’s health plan
• Medi-Cal eligibility is expanded to provide benefits for more low-income people

• Managed care is abroad term and encompasses many different types of organizations, payment mechanisms, review mechanisms and collaborations.
• Types of managed care organizations
• Health Maintenance Organizations (HMOs)
• Preferred Provider Organization (PPO)
• Exclusive Provider Organization (EPO)
• Point of Service Plans (POS)

• As a general rule, California law does not specifically provide for reimbursement for services provided by interns and associates. However, some insurers do reimburse for services provided by interns and associates.
• Claims for services provided by interns and associates that are denied should be appealed. It can be argued that an intern or associate in a private practice setting is working I behalf of their licensed employer, like a nurse practitioner provides services on behalf of a doctor.
• Interns or associates billing third-party payers must indicate that they provided the service. The intern or associate’s supervisor must sign the billing form.

• Mental health professionals, both licensees and prelicensees under supervision, are eligible for victim compensation program reimbursement if they are approved as such.
• To be eligible for compensations assistance, s/he must be a victim of crime involving physical injury, threat of physical injury or presumed injury. Applicant must also meet the following additional eligibility requirements:
• Victim must have been a California resident at the time of the crime.
• The crime must have been reported to law enforcement.
• The victim must not have been involved in or have participated in the crime

• Anyone injured as a result of a crime (a “direct victim”)
• Anyone who pays for the medical and/or funeral/burial expenses of a deceased victim.
• Anyone who is not directly injured or killed as a result of a crime but who, at the time of the crime, was a resident of California, AND
• Is the parent, sibling, spouse, or child of the victim; OR
• Is the victim at the time of the crime; OR
• Has lived with the victim for at least two years in a relationship similar to a parent, sibling, spouse, or child of the victim; OR
• Is another family member of the victim, including fiancé, and witnessed the crime; OR
• Is the primary caretaker of a minor victim but was not the primary caretaker at the time of the crime; OR
• Is the grandparent or grandchild of the victim.

• Crimes typically covered include
• Assault with a deadly weapon
• Battery
• Child abuse/molestation
• DV
• Driving under the influence
• Hit and run
• Vehicular manslaughter
• Murder
• Robbery
• Sexual assault
• Stalking
• Other violent crimes

• Under HIPAA, insurance fraud is a federal offense punishable by up to 10 years in prison, fines, and other penalties.
• It is a felony to knowingly:
• Present or cause to be presented any false or fraudulent claim for payment under a contract of insurance
• File multiple claims for the same loss or injury with more than one insurer with intent to defraud the insurer.
• Unprofessional Conduct:
• “The commission of any dishonest, corrupt, or fraudulent act substantially related to the qualifications, functions, or duties of a licensee or registrant.”
• insurance fraud could result in action against the licensee by the BBS, prosecution by the state and federal government on a felony charge, and or civil suits by an insurer.
• Common examples of insurance fraud are:
• Submitting of changing a patient’s diagnosis for the sole purpose of reimbursement
• Treating a couple and billing each partner’s insurance for individual
• Billing insurance for a missed appointment without clearly indicating that appointment was missed.
• Billing insurance for unperformed services

• Continuing education mandatory for mental health professionals.
• Therapists renewing an initial license (initial licenses are for a period of one year) must earn 18 hours of continuing education in that initial licensing year.
• Therapists renewing subsequent licenses (subsequent licenses are for a two year period) must complete 36 hours of continuing education within the two-year licensing period.
• All accrued hours must be completed within the designated renewal period. The renewal period runs from license expiration date to license expiration date. All licenses display an expiration date

• Law and Ethics
• All mental health professionals are required to have completed no less than six hours of continuing education in the subject of professional law and ethics in each and every renewal period
• These 6 hours would be part of the 36 hour CE requirement for each licensing period.
• HIV/AIDS
• . This is a one-time requirement.
• Atleast 7 hours in length and cover the characteristics and and method of assessment and treatment of people living with HIV and AIDS.
• The Board may accept evidence of completion of an equivalent HIV/AIDS course or courses or may accept prior teaching or practice experience to fulfill the continuing education requirement.
• Previous coursework or experience, while satisfying this requirement cannot be credited towards the 36 CE hours needed for renewal in any given renewal period.
• Spousal or Partner Abuse
• This is a one-time requirement.
• Must be at least 7 hours in length and cover assessment, detection, and intervention strategies including community resources cultural factors, and same gender abuse dynamics.
• The Board may accept evidence of completion of an equivalent course or courses or may accept prior teaching or practice experience to fulfill the continuing education requirement.
• Previous coursework or experience, while satisfying this requirement cannot be credited towards the 36 CE hours needed for renewal in any given renewal period.
• Aging and long-term care
• This is a one-time requirement.
• Must be at least 3 hours in length and cover the biological, social, and psychological aspects of aging.
• The Board may accept evidence of completion of an equivalent course or courses or may accept prior teaching or practice experience to fulfill the continuing education requirement.
• Previous coursework or experience, while satisfying this requirement cannot be credited towards the 36 CE hours needed for renewal in any given renewal period.

• Professionals may obtain all of their hours of required continuing education through interactive, electronic means. Including teleconferencing and videotape viewing.
• May accrue up to one half of required CE hours through self-study
• Self-study course is a course offered by an approved provider hat is performed at the residence, office, or other private location of the licensee
• Includes things like reading books or magazines and listening to audiotapes, and then participating in self-assessment testing

• The BBS defines a course as “a form of systematic learning at least one hour in length
• Training, education, and coursework by approved providers shall incorporate one or more of the following
• Counseling that is fundamental to the discipline.
• Counseling in which significant recent developments have occurred
• Other disciplines that enhance the understanding or practice of counseling.

• Requires licensees to maintain records of course completion (certificates, transcripts, etc.) for at least two years after the renewal period for which the courses were taken.
• A licensee would be well advised to keep records of mandatory coursework indefinitely
• When renewing a license:
• . mental health professional need only submit the renewal fee and check the box under penalty of perjury certifying completion of required CE coursework.
• Renewing licensee does not send in CE course certificates or other proof of coursework with the license renewal form.

People who hold multiple BBS licenses (LMFT. LCSW, LPCC and LEP) may apply continuing education credits from one course to the other licenses, if the subject matter relates to LMFT, LCSW. LPCC, or LEP scopes of practice.

• A therapist does not complete the required hours of continuing education by the license expiration date, the license expires and may not be renewed until all required continuing education hours are completed.
• A therapist whose license expires for failure to complete CE hours must stop practicing
• Continuing education courses taken in the subsequent renewal period to complete requirements of the previous renewal period will only count for the previous renewal. CE courses may only be credited to one renewal period, no matter the circumstances

• License may submit written request for exception from continuing education requirement for any reasons below
• For at least one year during the licensee’s previous license renewal period, the licensee was absent from California due to military service
• For at least one year, the licensee resided in another country
• During previous renewal period, licensee or an immediate family member (for whom license he has primary responsibility for the care of the family member), was suffering from or suffered a disability
• Physical or mental impairment limits one or more of major life activities of individual
• Must be verified by a licensed physician or psychologist w/ special expertise in area of disability
• The board will notify the licensee, w/in 30 working days after receipt of the request for exception, whether the exception was granted
• If request is denied, the licensee is responsible for completing the full amount of continuing education required for license renewal

• Continuing education not required for an active licensees
• To reactivate, licensee must complete 36 hours of continuing education in 2 years preceding the reactivation date
• Practicing w/ an expired or inactive license is a violation of the law
• Person working w/ an expired or inactive license is not entitled to remuneration from a patient or an insurer for perform services
• If person provide supervision, hours earned by the intern, trainee for associate may not be counted towards the licensing requirement

• BBS-approved providers, which can include accredited or approved schools, associations, Health Facilities, governmental entities, educational institutions, individuals, Etc.
• Gerry Grossman Seminars
• Can be requested on BBS website. Providers updated quarterly.
• Approved providers must include a provider number (PCE ___) on ads and each course add must include “Course meets the qualifications for ___ hours of continuing education credit for mental health professionals as required by the California Board of Behavioral Sciences.”
• Providers responsible for courses, instructors, ads, and record-keeping that meet BBS criteria. Must allow attendees to evaluate the course, and most issue records of course completion to attendees.
• Each provider sets course hours. 1 hour of instruction is equivalent to 1 hour of CE credit.
• Academic courses: 1 semester unit = 15 CE hours AND 1 quarter unit = 10 CE hours.
• Complaints about CE providers
• If you have a complaint, the BBS recommends contacting the provider of the course to resolve matter
• It's complaint isn't addressed, right to the BBS and include course name, date, and location, the names of the instructor and provider, and the specifics of your complaint

• LPCCs license for at least two years in another state will be allowed to take the MFT licensing exams w/out any additional coursework if their education and experience in the other state is substantially similar to that required in California
• Must take the qualifying lpcc law exam in California to obtain an lpcc license in California
• Instead of two exams upon completion of hours, there will be a law and ethics exam taken as a trainee or intern and then a clinical examination following the completion of hours.

Trainees enrolled in a practicum may see clients outside of practicum if that time. Is less than 90 calendar days, that. Is preceded and followed immediately by enrollment and practicum.

• 1 hour of individual supervision / 2 hours of group supervision = 10 hours of experience
• Only 1 hour of individual supervision / 2 hours of group supervision = all additional hours at a given work setting
• 6 hours of supervision per week counted towards pre-licensure 3000 hours.
• Supervision can occur via teleconferencing for interns and nonprofit or governmental entities
• W-2 tax forms or some other form of verification of employment or volunteer status required when applying for licensure

• Co-occurring disorders
• Cultural competency
• Case management.
• Collaborative treatment.
• Advocating
• Increase in instruction units
• 48 semester / 72 quarter units -> 60 semester / 90 quarter units
• Increase in counseling hours required w/in the education program
• 150 hours --> 225 hours (75 hours maybe client centered advocacy)
• SB 363 (2012) allows trainees to
• Gain hours of experience outside of their practicum assignments for a period of 90 days.
• Number of hours of client-centered advocacy that can be counted as interns and trainees
• Total of 500 hours of experience for client centered advocacy, writing clinical reports and process / progress notes will be allowed
• In 2010, client centered advocacy hours for entrance and trainees LMFTwere Unlimited.
• First 150 couple hours are double counted

• Received 18 hours of CE hours per year and each 2-year licensing period
• Take at least 18 hours of live workshops in addition to any online, interactive, electronic, or self study courses
• Keep proof of continuing 2 years past the licensing period for which the continuing education was taken
• Complete all 36 required continuing hours by no less than 30 days prior to the licensing expiration date.
• C Correct

• Behavior, practices, and standards considered “right and good.” Ethical standards are directed toward avoiding client exploitation and acting in way that advance the client's best interests and welfare.
• Ethical Behavior must be considered in the unique particular T of each therapist, each client, and each clinical relationship
• Adhering to appropriate ethical behavior requires ongoing consideration, reflection, education, and consultation w/ peers, supervisors, and legal and ethical experts.
• Enforcement of professional ethical standards can include any of the following:
• Supervision or revocation of membership from the professional organization promulgating the ethical standards
• Action against the professional license by the BBS
• Publication of the therapist name in the nature of the offense and professional journals
• Failure to comply or at w/in spirit and intent of professional ethical standards can expose therapist to civil liability and charges of negligence or unprofessional conduct
• Therapist must act in accordance w/ the spirit and intent of the ethical standards. Not enough to claim ignorance because of particular Behavior wasn't specifically prohibited, if engaging in such a behavior violates the spirit and intent of professional ethical standards.The family has indicated they have had their be previously and are familiar with how the therapeutic process works.
• The family has insisted on not being informed.
• There is no ethical reason to obtain informed consent unless videotaping, audio taping, or permitting live observation of the session.
• There is no obligation to obtain informed consent unless the therapist has knowledge or reasonable suspicion that there has been some form of reportable abuse.
• B

“patients are dependent upon and trust therapist for correct information”.

failure to maintain standard of care / exposes therapist to civil liability

• Changes in policy
• A therapist’s evolving understanding of how they would like to conduct their practice
• Changes in process / goals, such as whether the client is benefiting from a particular course of treatment, will their clients issues remain in the scope of practice or the scope of the therapist’s competence

• The client must have the legal capacity to consent
• The client must be mature or intelligent enough to understand the info presented
• The client must clearly understand the right to decline or refuse treatment

• Failure to obtain informed consent exposes therapist to liability, so therapist should:
• Carefully document in clients records the info relevant to treatment that was presented to the client, and the client's consent to treatment under those conditions
• Fully demonstrate / maintain high standard of care, therapist would be best advice to obtain informed consent in writing

• Before videotaping therapy sessions
• Before audio recording of therapy sessions
• Before permitting third-party observation of therapy sessions

• Confidentiality
• Clinical limitations
• Transmission difficulties
• The therapist's ability to respond to emergencies

• A client's mental or emotional condition necessitates crisis or emergency interventions that preclude obtaining informed consent.
• A client's request or insist upon not being informed.
• When the client does not or cannot give informed consent, therapist should consider whether this is justification to proceed under ethically questionable circumstances.
• In these situations, therapist should attempt to obtain informed consent appropriate to the client's condition or at a more appropriate time.
• Therapy consists of a simple procedure w/ a remote chance of danger.
• If a therapist does proceed, the reasons for not obtaining informed consent should be documented, along w/ the therapist at the goal and clinical justification.

• When working w/ couples or families, it is important to clearly state a “no secrets” policy
• A “no secrets” policy = info shared by member of a couple w/ therapist, when the other member of the couple is not present, maybe it is close to the other partner at the therapist discretion and in the best interest of the therapy
• An informed consent agreement w/ parents to not involve the therapist and legal proceedings is not legally binding.
• If the unit of treatment changes, the remaining parties must agree to treatment under new circumstances + agree to any new payment responsibilities
• A mental health professional who is working w/ clients involved in legal system must inform the client of the limits of the therapist role in providing advocacy her testimony.

• Group therapy requires another variation of informed consent documentation, including:
• Original agreement precluding clients from disclosing confidential info obtained in group therapy.
• Guidelines of dressing out of group relationships between members.
• Requirements that members give advance notice of termination to allow time for processing the meaning of the loss / termination to the group
• If a spouse, parent, significant other, family member, friend, etc. participates in a client session this is seen as a “visitor” or “collateral visit”
• The collateral visit is done to advance the care and treatment of the client and the session records become part of the client's treatment file.
• It is important to clarify with such third-party “visitors” that they are not the patient and has no right to confidentiality and / or therapist patient privilege.
• For example, if the client is a child, the parent(s) may be included in the therapy from time to time but the parent(s) should be told that they do not have the legal rights afforded to the child who is the client.
• An informed consent document clarifying the visitor / collaterals legal status, signed by the third-party visitor, constitute a high standard of care in obtaining informed consent.
• If a client authorizes a release of the records, the “visitor” or “collateral” information should be redacted.
• If the clients records are subpoenaed the therapist should inform the subpoenaing party that third-party records will be redacted and contact the client and the client's attorney (with a release) to determine any legal issues associated with redaction
• The client has the right to inspect the records of the collateral session, as these records are considered part of the client’s treatment record

• Fees in the basis for their determination must be disclosed before treatment begins.
• If the therapist is utilizing a fictitious business name, the name + license destination of the owners of the practice must be disclosed.
• If the therapist is a trainee, intern or associate, they must have performed each client prior to performing professional services that they are unlicensed and under the supervision of a LMFT, LCSW, LPCC, LEP, psychologist, or a physician or surgeon certified in psychiatry.
• The therapist must display his or her license in his or her primary place of business.
• All therapists who are covered entities under HIPAA must provide clients a copy of their Notice of Privacy Practices.

• The nature and limitations of confidentiality.
• Explanations of a therapist’s requirement to report instances of child abuse, dependent adult abuse, and elder abuse; a therapist responsibilities of a client is dangerous to self or others.
• How and under what circumstances confidential information may be released to third parties.
• When treating families are couples, clarifying the nature of the relationship of therapist will have to the treatment unit in each member of the treatment unit.
• Info regarding the nature of the treatment, the benefits and drawbacks of therapy, and alternatives to treatment, which might include no treatment at all.
• Adequate information so that clients can make meaningful decisions about their therapy.
• Explanations two clients that decisions on status of client personal relationships are the responsibilities of the client.
• The therapist’s professional qualifications, theoretical orientation, experience, Specialties, length of time and practice, and other info deemed appropriate by the licensee.
• The expected length of sessions and length of treatment.
• Info about mutual right to terminate therapy by both the patient and the therapist.
• Procedures for collecting the fee and raising the fee.
• Destination of a therapist fee for time spent responding to a subpoena on behalf of a client (preparing, copying and mailing records, and testifying).
• The therapist’s cancellation policy, telephone policy and availability between sessions and in emergencies.
• Any vacation policy and the name of the designated colleague who is covering the practice in the therapist absence.
• Any policy that their business may have requiring the consent of both parents to treat a minor child where there is joint legal custody.

The family has insisted on not being informed.

If the therapist is a trainee, intern, or associate being supervised by a licensed therapist.

Clients

make well-informed decisions about the services they are purchasing

the importance of providing client with clear and realistic expectations of the therapeutic process.

• Decline in process a client's request that the therapist contact the client attorney. Contacting the attorney, even with a release, could imply that the therapist has agreed to collaborate with the lawyer, advocate for the client, Etc.
• Obtain a copy of the order for a court-ordered client and discuss it with the client. The clinician must determine if the clients needs are within the therapist scope of competence, and if there are any specific limits of confidentiality to discuss before starting therapy.
• Discuss a divorced parents expectations of the therapist before therapy starts. If the parent expects the therapist to advocate for custody, it is better to discuss this at the start of therapy.
• Appearances specs that his slash her child has been abused and wants the mental health professional to evaluate / confirm those suspicions. The therapist (after making a report if necessary) we need to clarify the parents expectations, such as does the parent plan to bring this to court? Against whom? Is s/he expecting the therapist to testify?

• 1.4 MFTs respect the right of patients to make decisions and help them to understand the consequences of their decisions. When clinically appropriate, MFTs advise their patients that decisions on the status of their personal relationships, including dissolution, are the responsibilities of the patient(s).
• 1.5 MFTs provide adequate info to patients in clear / understandable language so that patients can make meaningful decisions about their therapy
• 1.5.1 where in MFT’s personal values, attitudes, and / or beliefs are a determined active factor in diagnosing or limiting treatment provided to a client, the MFT shall disclose such information to the patient
• 1.5.2 MFTs inform patients of potential risks / benefits of therapy when utilizing novel or experimental techniques or where there is a risk of physical harm that could result from the utilization of any technique
• 1.5.3 MFTs inform patients of availability for emergencies slash for other contacts between sessions. When MFT not located in same geographic area as a patient, they shall provide appropriate resources and patient’s locale for contact in case of emergency
• 1.5.4 MFTs obtain written informed consent from patients before videotaping, audio recording, or permitting third-party observation.
• 1.5.5 MFTs inform patients as to certain exceptions to confidentiality child abuse reporting, elder and dependent adult abuse reporting, and patients dangerous to themselves or others.
• 1.5.6 MFTs inform patients at an appropriate time within the context of psycho therapeutic relationship of their experience, education, specialties, and theoretical on professional orientation, and any other info deemed appropriate by the therapist
• 1.7 MFTs continually monitor their effectiveness and take steps to improve when necessary. MFTs continue therapeutic relationships only so long as it reasonably clear that patients are benefiting from the relationship.
• 1.9 When treating a family unit(s), MFTs carefully consider the potential conflict that may arise between the family unit(s) and each individual. MFs clarify, at the commencement of treatment, which person or persons are clients and the nature of relationship(s) the therapist will have with each person involved in the treatment.
• 1.10 MFTs do not withhold patient records / info solely because therapist has not paid for prior professional services
• 1.11 When appropriate, MFTs consult, collaborate with, and refer to physicians, other healthcare professionals, and community resources in order to improve and protect health / welfare of patient
• 1.12 When appropriate, MFTs advocate for mental health care they believe will benefit their patients. Inappropriate circumstances, they challenged denials of care, or denials of payment for care, by managed care organizations, insurers, or other pairs.
• 1.13 MFTs discuss appropriate treatment alternatives with patients. MFTs do not limit their discussions of treatment alternatives to what is covered by third-party payers.
• 2.1 MFTs do not disclose patient confidences, including names / identities of their patients, to anyone except a) as mandated by law b) as permitted by law c) when the MFT is a defendant in a civil, criminal, or disciplinary action arising from the therapy (in which case patient confidences may only be disclosed in the course of that action), or d) if there is an authorization previously obtained in writing, and then such info may only be revealed in accordance w/ terms of the authorization.
• 3.10 MFTs don't generally provide professional services to a person receiving treatment / therapy from another psychotherapist, except by agreement w/ such other psychotherapist or after the termination of the patient's relationship w/ other psychotherapist
• 8.7 MFTs shall only express professional opinions about clients they have treated or examined. MFTs, when expressing professional opinions, specify the limits of the info upon which their professional opinions are based. Such professional opinions include, but are not limited to, mental / emotional conditions or parenting abilities.
• 9.3 MFTs disclose, in advance, their fees and the basis upon which they are computed, including, but not limited to, changes for cancelled or missed appointments and any interest to be charged or unpaid balances, at the beginning of treatment and give reasonable notice of any changes in fees or other charges
• 10.1 MFTs accurately represent their competence, education, training, and experience relevant to their professional practice to patients and others
• 10.5 MFTs correct, wherever possible, false, misleading, or inaccurate info / representations made by others concerning the therapist’s qualifications, services, or products

• Hours of a therapist’s availability by telephone.
• A therapist’s policy about house when phone calls will be returned.
• How much time the therapist is willing to spend on the phone with clients in emergency slash in non-emergency situations.
• A therapist’s availability slush unavailability went on vacation.
• The name of the clinician fulfilling therapeutic responsibilities when the primary therapist is unavailable.

Prior

• Charge a fair fee
• Commensurate w/ the services offered and the client’s ability to pay

Before; Before

must receive of refund within 15 days of the client's request

• Method of payment, e.g., checks or credit cards.
• Frequency of billing, e.g., per session or monthly billing.
• When the payment should be made, e.g., the beginning or the end of the session. If the unit of treatment changes, e.g., the remaining parties must agree to any new payment responsibilities.
• Any policies related to seeing increases a notification of fee increases.
• If the unit of treatment changes, the remaining parties must agree to any new payment responsibilities.
• Any fees related to legal procedures: Cost for preparing documents for a subpoena, Appearing at a deposition, As a recipient or expert witness
• Policies related to collection / breaches of confidentiality there in. Therapists must provide notice that collections will occur before doing so, giving a client a chance to pay the therapist before this breach of confidentiality occurs. If a therapist is a HIPAA provider, the collections agency must know HIPAA regulations and sign a “Business Associates” document agreeing to liability for breaches of privacy.

• 1.3.3 MFTs don't maintain therapeutic relationship solely for financial gain.
• 1.3.4 MFTs don't terminate patient relationships for non-payment of fees except when the termination is handled in a clinically appropriate manner.
• 9.2 MFTS don't financially exploit their patients.
• 9.3 MFTs disclose, in advance, their fees + the basis upon which they are computed, inducing, but not limited to, charges for canceled / missed appt. + any interest to be charged on unpaid balances, at the beginning of treatment and give reasonable notice of any changes in fees or other charges
• 9.5 MFTs ordinarily refrain from accepting goods, services, or other non-monetary remuneration from patients in return for professional services. Such arrangements often create conflicts and may lead to exploitation or distortion of the professional relationship.

ethical principles, statutes, and court cases

• 2. MFTs have unique confidentiality responsibilities because the “patient” in a therapeutic relationship maybe more than one person. The overriding principle is that MFTs respect the confidences of their patient(s)
• 2.1 MFTs to not disclose patient confidences, including the names are identities of their patients, to anyone except a) as mandated by law b) as permitted by law c) when the MFT is a defendant in a civil, criminal, or disciplinary action arising from the therapy (in which case patient confidences may only be disclosed in the course of that action), or d) if there is an authorization previously obtained in writing, and then such info may only be revealed in accordance with the terms of the authorization
• 2.2 and there is a request for info related to any aspect of psychotherapy or treatment, each member of the unit receiving such therapeutic treatment must sign an authorization before a MFT will disclose info received from any member of the treatment unit.
• 2.3 MFTs are where's the possible adverse effects of technological changes w/ respect to the dissemination of patient info, and take care when disclosing such info. MFTs are also aware of the limitations regarding confidential transmission by internet or electronic media and take care when transmitting or receiving such info via these mediums
• 2.4 MFTs store, transfer, transmit, and / or dispose of patient records in ways that protect confidentiality
• 2.5 MFTs take appropriate steps to ensure, insofar as possible, that the confidentiality of patients is maintained by their employees, supervisees, assistance, and volunteers
• 2.6 MFTs use clinical materials and teaching, writing, and public presentations only if a written authorization has been previously obtained in accordance with 2.1 d), or when appropriate steps have been taken to protect patient identity.
• 2.7 MFTs, when working with a group, educate the group regarding the importance of maintaining confidentiality, and are encouraged to obtain written agreement from group participants to respect the confidentiality of other members of the group

life, presentation, expression, and the therapeutic process

Yes. Copies can be made, however, at the discretion of the BBS a “sanitized version” may be provided to protect the identity of the informant/plaintiff.

Scope of competency, patient safety and standard of care.

Limited liability companies (LLC).

No, but it is advised in order to properly document the incorporation.

Personal negligence. I.e., patient malpractice claims against the individual therapist are not protected by the corporate contract.

51%: leaving the other 49% for investors.

Marriage, family or child followed by counseling, counselor, therapy or therapist.

Violations of state law, business code, standard of care expectations and ethics principles.

Fraud, theft, sex with a client, non-licensure, HIPPA violations ADA violations, discrimination, etc.

Malpractice suits.

Breach of confidentiality, dual relationships and negligence in standard of practice.

2 years and 6 CEU’s.

No, that would make them independent contractors and thus the hours would not count toward licensure.

True

Advice given in an attempt to meet personal, career by overcoming obstacles.

No: it does not include diagnosis, treatment, personal history or the healing of mental disorders.

No

No. They must be separate entities.

False. Certification must be obtained from the EMDR International Association.

False. No standard is applied and scope of competence is subjective.

Yes, with an additional 40 hours of training in regard to the health safety and welfare of the child.

Yes

Yes.

Yes. As long as proper notice is placed in a conspicuous place for the clients to observe and it meets the state governed criteria for signage, nutrition is considered a part of treatment planning.

Not necessarily: If the LPCC is also an MFTT then yes. If not, additional training is required for the LPCC – LPCC’s are not qualified to treat children, families or couples.

• Therapists are obligated to understand the impact of cultural differences on the client’s life, presentation, expression, and process of therapy. Therapists are obligated to avoid assumptions or impositions based upon their own values or experiences.
• CAMFT Ethical Standards of Cultural Differences and Human Diversity

Answer: race, gender, religion, national origin, age, sexual orientation, disability, socioeconomic, or marital status.

Answer: Physical Disabilities

Answer: They do so by gaining knowledge, personal awareness, and developing sensitivity and skills pertinent to working with diverse populations.

• Their own personal identity, values, and beliefs.
• Gender Diversity

Answer: The individual cannot be UNDER THE AGE OF 18.

• Countertransference
• What is the term that describes the therapist’s feelings and perceptions that emerge during therapy.
• Answer: Countertransference - Feelings may interfere with a therapist’s ability to experience and treat the client objectively. To the degree that therapists are unaware, unprepared, or unable to manage stresses and strains of therapy, their efforts may prove unhelpful or provoke harm by violating client/clinician boundaries.

Answer: Journaling, discussion through consultation or professional supervision, receiving personal therapy, or referring the client to another therapist

• 3.4 MFTs are to seek appropriate professional assistance for what circumstances?
• Answer: For any personal problems or conflicts that impair clinical performance or clinical judgment.

Answer: Influential position; to avoid exploiting

Answer: Dual Relationships

Answer: 1) borrowing money from a client, 2) hiring a client, 3) engaging in business ventures with clients, or 4) engaging in a close personal relationship with clients. Acts with a client’s spouse, partner or family member may also be considered unethical dual relationships.

• Dual Relationships
• When does a Dual Relationship begin? -
• Answer: When a therapist and client engage in a separate or distinct relationship during the therapeutic relationship or during a period of time following termination.

Answer: False

Emphasis is placed on avoiding relationships that are likely to impair professional judgement or lead to exploitation.

Answer: that the dual relationship was not the result of mishandling the client’s or therapist’s transference/countertransference

• By engaging in a dual relationship whose impact constituted an act of “gross negligence or incompetence in the performance of marriage and family therapy.”
• And/or 4982 section (i): by engaging in a dual relationship that was sufficiently inappropriate or avoidable and thereby intentionally or recklessly causing physical or emotional harm to any client.
• Therapists are to carefully consider whether or not extra-therapeutic contact with a client will impair professional judgement, exploit the client, potentially be construed as gross negligence or incompetence, or cause emotional harm to client.
• Nonsexual post-therapuetic relationships
• Any relationship developed after termination of client is still considered a dual relationship and therapists are held to the standard of “reasonableness” for non-sexual post-therapeutic relationships.
• Reasonableness of the nature of the relationship and elapsed time since termination

Answer: Becoming a legal advocate for a child; Gift Giving; Bartering; Sexual contact with clients or supervisees; Caretaking; Exploiting Power Differential; Self-Disclosure; and Becoming overinvolved in the client’s life.

• When writing reports or letters: write only what the therapist has seen or heard first-hand, cite the source of any claims on behalf of client (not the therapist’s opinion), do not make predictions about client’s future behavior, do not make custody recommendations unless appointed to do so by a court (judge).
• Acting as a visitation supervisor for a client whose divorced parents require supervision
• Testifying on behalf of a client. NOTE: Be aware when or if the therapist is working out of his/her scope of competence (ethical violation) and out of scope of practice (legal violation).
• Becoming and individual therapist for a partner of a former conjoint couple that has divorced.
• Gift Giving
• Depending upon the circumstances, giving or receiving gifts may be lawful and ethical not always needing to be avoided, unless specific prohibition against it in laws, regulations, or ethical standards.

Answer: Small, inexpensive, seasonally or situationally appropriate

• [I left out 4 examples here, wasn’t sure if they’d be needed]
• Cultural factors are to be considered, but are not the determining factor in whether or not a therapist accepted an inappropriate gift
• Be culturally sensitive in managing refusal of such gifts
• Although client may be offended, it is not an acceptable defense for accepting expensive gifts, vacations, romantic gifts, cash, etc.
• Bartering

Answer: Ordinarily Refrain

• Therapists bare the full burden to demonstrate such arrangements were not exploitive of the client and there was no distortion of therapy
• Sexual Contact with Clients or Supervisees

Answer: Sexual Contact

Answer: True

Answer: After a 2 year period of termination. For LPCCs the time is 5 years. (This is what I found in the book, however, in class I remember Vicki possibly mentioning the term to be longer or indefinite.)

• Sexual misconduct is prohibited, including but not limited to: Asking out on dates, declaring romantic love for the client/supervisee, frequently complimenting or commenting on their appearance, clothing, sex appeal, etc.
• Caretaking

Answer: Caretaking

• Imposing the therapist’s beliefs/values when interpreting client dreams or memories
• Coercing or pressuring clients to become a member of the therapist’s religious or spiritual organization
• Arranging for clients to date one another
• Tutoring a client
• Advising a client to take herbs for specific conditions
• Self-Disclosure
• Can be seen as reversing roles such that the client feels pressure to listen to or to take care of the therapist
• Self-disclosure must be monitored if the therapist has an online presence (i.e., advertising, social networking, blogging.)
• Therapists have recently been cited by the BBS for divulging:
• Information about their personal lives, discussing business issues, sharing information about the therapist’s health, sharing information about the health of a therapist’s family member
• Over-Involvement in the client’s life
• Becoming an intermediary in a client’s relationships
• Becoming an investigator of child abuse
• Arranging for employment (or a job interview) for a client or a client’s family member
• CAMFT Ethical Standards of Dual Relationships

Answer: Reasonably impair professional judgment; lead to exploitation.

1.2.1 Other acts resulting in unethical dual relationships include, but are not limited to, borrowing money, hiring a patient, engaging in a business venture, or engaging in a close personal relationship. Acts with a patient’s spouse, partner or family member may also be considered unethical dual relationships.

Answer: Unethical.

Answer: False

• 3.14 MFTs do not express professional opinions about an individual’s mental or emotional condition unless they have treated or conducted an examination of the individual, or unless they reveal the limits of the information upon with their professional opinions are based, with appropriate cautions as to the effects of such limited information upon their opinions.
• 4.1 MFTs are aware of their influential position with respect to students and supervisees, and they avoid exploiting the trust and dependency of such persons. MFTs avoid dual relationships that are reasonably likely to impair professional judgement or lead to exploitation. Provision of therapy to students or supervisees is unethical. Provision of MFT supervision to clients is unethical. Sexual intervourse, contact or intimacy and/or harassment of any kind with students or supervisees is unethical. Other acts which could result in unethical dual relationships include, but are not limited to, borrowing money from a supervisee engaging in a business venture with a supervisee, or engaging in a close personal relationship with a supervisee. Such acts with a supervisee’s spouse, partner or family member may also be considered unethical dual relationships.

Answer: Influential position; exploiting the trust and dependency of such persons.

• Termination/Interruption of Services
• Clients have the right to terminate at will
• Therapists have the right to terminate services, but must do so for sound reasons and in an ethical manner

Answer: Both the client and therapist. The client can terminate at will; the therapists must have sound reasons in an ethical manner.

Answer: 1) Non-payment of fees, 2) lack of therapeutic progress, 3) conflicts of interest, 4) ethical conflicts, and 5) the therapist’s physical or mental impairment or other inability to continue treatment.

Answer: The therapist’s potential incapacity or death.

CAMFT Ethical Standards of Collaboration and Consultation

Answer: MFTs consult, collaborate with, and refer to physicians, other health care professionals, and community resources

Answer: by agreement with the other psychotherapist or after the client’s relationship has terminated

Scope of Competence

Answer: Scope of Competence

Answer: The therapist’s education, training and experience

If unit of treatment changes, the practitioner must asses whether treating the new unit is in the best interest of that unit and assess the practitioner’s own competence to treat the unit objectively and competently

Answer: False

• When clients ask about custody, releasing their therapeutic information, employment situations such as sexual harassment, etc., professionals should refrain from any legal advice
• Therapists must inform clients of their limits of forensic education or skill such as, providing custody evaluation, providing expert testimony, determining need for or release of conservatorship, or determining competence to stand trial
• Clinicians must carefully consider whether to write letters to the court in custody determinations or client competence
• Therapists must carefully consider whether to accept clients who are referred by attorneys: possibility of a higher level of scrutiny or competency, an expectation that records will be disclosed, and/or expectation that the therapist will provide “expert testimony”
• Therapist should obtain consultation whenever the client’s needs exceed therapist’s scope of competence documenting: 1) need for consultation, 2) names and credentials of consultants, 3) issues discussed, 4) outcome on the client’s treatment. Also, networks of professional resources should be developed before a crisis emerges
• Letters
• Carefully consider whether to write letters to the court in custody determinations or client competence. Letters to court have legal implications, out of therapist’s scope of competence
• Opposing party may claim bias and malpractice, putting client’s confidentiality and practice at risk
• Avoid expression professional opinion about someone therapist has not treated
• Therapist may include in informed consent documents they do not write letters on client’s behalf - letters place therapist at risk of a dual relationship
• Letters may also be intended to reduce liability of the person/organization requesting letter by transferring it to a third party “expert”
• Treatment of Disabilities - “Emotional Support Animals”
• Emotional Support Animals are not legally equivalent to “Service Animals” - if incorporating in client’s treatment plan, consult literature, studies and other treatment professionals with expertise
• Client must meet definition of “disability” in “major life activities” and have a DSM diagnosis
• Client may request letter from a mental health professional citing the client’s need
• Considerations to write the letter include: 1) Scope of competence, 2) treatment plan, 3) confidentiality
• CAMFT Ethical Standards of Scope of Competence

Answer: beyond the level of their competence

Answer: Continuing education, training, consultation, and/or supervision.

Answer: training, level of experience, competence, or unlicensed status.

Answer: Consultation or supervision

Answer: False

• Responsibility to Patients - MFTs advance ___________ of families and individuals, _____________ of those persons seeking their assistance, and make ____________ to ensure that their services are used appropriately
• Answer: The welfare; respect the rights; reasonable efforts

Answer: Condone or engage in discrimination, or refuse professional service to anyone

Answer: Historical and social prejudice

MFTs are aware of their influential position with respect to patients, and they avoid exploiting the trust and dependency of such persons. MFTs therefore avoid dual relationships with patients that are reasonably likely to impari professional judgment or lead to exploitation. A dual relationship occurs when a therapist and his/her patient engage in a separate and distinct relationship either simultaneously with the therapeutic relationship, or during a reasonable period of time following the termination of the therapeutic relationship. Not all dual relationships are unethical, and some dual relationships cannot be avoided. When a concurrent or subsequent dual relationship occurs, MFTs take appropriate profession precautions to ensure that judgment is not impaired and that no exploitation occurs.

Other acts that would result in unethical dual relationships include, but are not limited to, borrowing money from a patient, hiring a patient, engaging in a business venture with a patient, or engaging in a close personal relationship with a patient. Such acts with a patient’s spouse, partner or family member may also be considered unethical dual relationships.

Sexual intercourse, sexual contact or sexual intimacy with a patient, or a patient’s spouse or partner, or a patient’s immediate family member, during the therapeutic relationship, or during the two years following the termination of the therapeutic relationship, is unethical. Should a MFT engage in sexual intimacy with a former patient or a patient’s spouse or partner, or a patient’s immediate family member, following the two years after termination or last professional contact, the therapist shall consider the potential harm to or exploitation of the former patient of the patient’s family

Answer: A Sexual Relationship

Answer: Undisrupted Care

1.3.1 Termination - MFTs use sound clinical judgment when terminating therapeutic relationships and do so in an appropriate manner. Reasons for termination may include, but are not limited to, the patient is not benefitting from treatment; continuing treatment is not clinically appropriate; the therapist is unable to provide treatment due to the therapist’s incapacity or extended absence, or in order to avoid an ethical conflict or problem.

Answer: Abandon or neglect

Answer: assist the patient in making clinically appropriate arrangements for continuation of treatment

Answer: True

Answer: A clinically appropriate manner

Answer: to make decisions; understand the consequences of their decisions

Answer: the patient’s goals

Answer: the potential risks, consequences, and benefits, including but not limited to, issues of confidentiality, clinical limitations, transmission difficulties, and ability to respond to emergencies

Answer: California Telemedicine Act.

Answer: clear and understandable language

Answer: False

Answer: Risks and benefits

Answer: Written Informed Consent

Answer: child abuse reporting, elder and dependent adult abuse reporting, and patients dangerous to themselves or others

Answer: their experience, education, specialites, and theoretical and professional orientation, and any other information deemed appropriate by the therapist

Answer: Their own interests; exert undue influence

Answer: Effectiveness

Answer: it is reasonably clear that patients are benefiting from the relationship

Answer: which person or persons are clients and the nature of the relationship(s) the therapist will have with each person involved in the treatment

Answer: Never, even if the therapist has not been paid for prior professional services

Answer: The purpose is to improve and protect the health and welfare of the patient

Answer: they challenge denials of care, or denials of payment for care, by managed care organizations, insurers, or other payers

Answer: False

Answer: determining reasonable suspicion of child, elder or dependent adult abuse, determining when a patient is a danger to self or others, when making major changes to a treatment plan, or when changing the unit being treated.

Answer: they act solely within that role and clarify, when necessary to avoid confusion with consumers and employers, how that role is distinguished from the practice of MFT

Answer: Information can include dates of treatment, diagnosis, prognosis, progress, and treatment plans

Answer: It’s that MFTs respect the confines of their patient(s)

• Answer: a) as mandated by law
• b) as permitted by law
• c) when the MFT is a defendant in a civil, criminal, or disciplinary action arising from the therapy (in which case patient confidences may only be disclosed in the course of that action) or,
• d) if there is an authorization previously obtained in writing, and then such information may only be revealed in accordance with the terms of the authorization

Answer: False. Each member of the treatment unit must sign an authorization.

Answer: Possible adverse effects; limitations

Answer: Protect confidentiality

Answer: employees, supervisees, assistants, and volunteers

Answer: Only if a written authorization has been previously obtained in accordance with 2.1 d), or when appropriate steps have been taken to protect patient identity

Answer: confidentiality, and are encouraged to obtain written agreement from group participants to respect the confidentiality of other member of the group

Answer: professional competence and integrity

• Answer: a) are convicted of a crime substantially related to their professional qualifications or functions;
• b) are expelled from or disciplined by other professional organizations;
• c) have licenses or certificates that are lapsed, suspended, or revoked or are otherwise disciplined by regulatory bodies;
• d) if they continue to practice when they are no longer competent to practice because they are impaired due to physical or mental causes or the abuse of alcohol or other substances; or
• e) fail to cooperate with the Association or the Ethics Committee at any point from the inception of an ethical complaint through the completion of all proceedings regarding that complain

Answer: Contractual Arrangements

Answer: Create and Maintain

Answer: Issues that relate to their personal problems or conflicts that impair work performance or clinical judgment

Answer: True.

Answer: by gaining knowledge, personal awareness, and developing sensitivity and skills pertinent to working with a diverse client population

Answer: Their own cultural/racial/ethnic identities, values, and beliefs MFTs do not exert undue influence on the choice of treatment or outcomes based on such identities, values and beliefs

Answer: sexual or other harassment or exploitation

Answer: Beyond the level of their competence; education, training, and experience.

Answer: Only in jurisdictions where the therapist may lawfully provide such services. Possibly refer to California Telemedicine Act.

Answer: Distortion or Misuse

• 3.13 Public Statements - MFTs, because of their ability to ______ and ______ the lives of others, exercise care when making public their professional recommendations and opinions through testimony or other public statements
• Answer: Influence and Alter

Answer: treated or conducted and examination

Answer: trust and dependency

Answer: False

• 4.4 Knowledge of Supervisors - Supervisors and educators are knowledgeable about supervision, relevant laws and regulations, and the practice of MFT. Supervisors and educators are __________ and ________ by the laws and regulations governing the conduct of supervisors and supervisees.
• Answer: Knowledgeable about and abide

Answer: Professional and Ethical standards and legal responsibilities

Answer: Issues of culture and diversity

Answer: at the commencement of supervision or education

Answer: Periodic Performance Appraisals and evaluative feedback

Answer: Lawful business practices and employer policies

Answer: personal psychotherapy, additional education, training, or consultation

Answer: True

Answer: trainee agreements

Answer: the patients of their employers

Answer: responsibility to be knowledgeable

Answer: All Registrations

Answer: to promote the welfare and best interests of patients

Answer: Respect the confidences

Answer: Substance abuse, emotional problems, or mental illness

Answer: Frivolous

Answer: False

Answer: Respect the dignity; protect the welfare

Answer: Ethical Acceptability

Answer: willingness to participate

Answer: freedom to decline; withdraw

Answer: written authorizations is previously obtained

Answer: rights; responsibilities

Answer: Members or employees of organizations

Answer: False

Answer: Credit for original ideas

Answer: promotes and advertises the materials accurately

Answer: little or no financial return

Answer: Serve the public interest

Answer: Itself a violation of these standards.

Answer: objective; truthful

Answer: truthfully; making misleading statements

Answer: appropriate data; limits of their data

Answer: Disclose any potential conflicts

Answer: Treatment and Evaluations

Answer: Remain Impartial

Answer: Confirm the holder (of privilege)