Term
| Your lawyer calls you to warn you that you may receive a subpoena for the complete treatment record of Mr. Milsap, who you have been treating for five years. Two months ago, Mr. Milsap received minor injuries in an accident at work in which three people were killed when a fully loaded forklift overturned. Mr. Milsap is suing for negligence and claiming severe emotional damage, including PTSD. When you tell Mr. Milsap about the subpoena, he is frantic since he doesn't want anyone to know about the brief affair he had with his secretary four years ago, which is documented in your treatment records. He asks that you submit a summary of information relevant to the accident and his PTSD, or to omit from the records information about the long-ago affair. How should you respond? |
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Definition
Tell Mr. Milsap that you cannot honor his request.
Without the permission of the court or the party issuing the subpoena, a therapist may not produce a summary or alter (by omission or any other way) the treatment record subpoenaed. |
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Term
| Some clients are referred to therapists by other helping agencies and collaboration advances client welfare. Your new client tells you that she signed a release with the agency that referred her to you. You ask her to sign your release as well. Which of the following must appear on the release? |
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Definition
Notification to the person signing the agreement that they have a right to receive a copy of it.
An Authorization to Release Confidential Information form must contain a statement that the person signing the agreement is entitled to a copy of the agreement. |
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Term
| A therapist has hired a billing agency to submit insurance company claims for some new clients. Most clients pay with cash or check. Before starting treatment with these new clients who use insurance, the therapist must provide: |
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Definition
Notice to these clients of the use of the billing company.
HIPAA requires that once a therapist is a "covered Provider," all clients be informed of the use of their private information. This would include the use of a Business Associate. |
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Term
| Your client has submitted a written request for access to his records. After deciding to provide the records, which of the following would best fulfill your legal obligation? |
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Definition
Providing a summary of your treatment plan and the client's progress within 10 days.
Providing a summary of your treatment plan and the client's progress would be provided. |
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Term
Your client, a 19-year-old mechanic, confides to you that he recently participated in a robbery. Two weeks later, you are served with a subpoena for information about this client's treatment. You attempt to reach your client but are unable to do so. Legally, you must: |
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Definition
Assert client-therapist privilege.
You must protect client privilege until the client directs you to do otherwise. The vignette does not specify if it is a court ordered subpoena or an attorney directed subpoena. A therapist must comply with a court-ordered subpoena.
Therapists must contact their client regarding the subpoena and respond to the subpoena, in writing, by the due date on the subpoena – even if it is to assert privilege or to inform the Court that the therapist is unable to comply with the subpoena. |
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Term
| You are obtaining a release of information from a client to confer with the client's psychiatrist. The client tells you that she is thinking of finding a new psychiatrist because this one never listens to her. She is concerned that if you talk to the psychiatrist you will develop a negative opinion of her. Which of the following would you find on a release of information form? |
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Definition
The purpose of the release and the therapist's license number
The purpose of the release and the therapist's license number would both be on a release of information form |
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Term
| Cathy is a 28-year-old clerk who works in a department store. A therapist has been seeing Cathy, her 7-year-old son, and her 5-year-old daughter in therapy for a month. She never married her children's father, Bob, who calls "once in a blue moon" requesting to spend time with the kids or will arrive at the door with presents. She receives no support from him and doesn't want to ask him for money because she feels that he will want to visit them more if she does. If Bob subpoenas the children's therapy records, what would be the most appropriate move for the therapist to take? |
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Definition
Keep the records confidential and alert Cathy of the subpoena.
Since Cathy and the children were seen conjointly, the records include confidential information regarding Cathy; therefore, the best option would be to keep the records confidential and let Cathy and her attorney decide how to proceed. |
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Term
A client is referred to you by his attorney. The client tells you that he is reluctant to talk to you because he doesn't want what he says in therapy coming out in court. Choose the statement that could BEST explain privilege to this client: |
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Definition
Explain therapy is confidential. This is a legal principle that protects therapist/client conversations unless there is a court order. This privilege is the legal right of the client not to have confidential information revealed during a legal proceeding. Only a client, judge or court order would challenge privilege. |
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Term
| Before accepting a client for telehealth services, what action should the therapist take? |
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Definition
Determine if the client is a resident of California.
The therapist must conform with the law, which requires that the client reside in the state of California. |
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Term
| Three months after the death of Danielle, whom you treated for several years, you receive a written request from Arthur, her husband of 32-years, asking for access to his late wife's files. You saw them conjointly for a few sessions when Danielle requested he be there. How would you proceed? |
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Definition
Deny his request.
Given the limited information we have in this scenario, denying the request would be the best course of action until proper authorization could be obtained by the dead woman's legal representative |
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Term
| Who holds the privilege for a 14-year-old client in a custody case? |
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Definition
The 14-year-old client.
The client is always the holder of his or her own privilege, unless the court assigns a guardian ad litem or conservator. |
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Term
| A man calls you to ask about his wife's therapy bill since she has been using his insurance. He asks if you can provide copies of the previous three months' bills because the insurance company has lost them. Upon hearing his request, you: |
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Definition
Tell him you cannot confirm or deny that his wife is your client.
Whenever anyone calls asking about anyone other than themselves, it is vital to not reveal any confidential client information. |
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Term
| You are doing family therapy with a family of four. The oldest child, age 17, has suggested that you do telehealth sessions for him. In order to do this you should: |
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Definition
Obtain informed consent from him if he changes from family therapy to individual telehealth therapy.
If he is in family therapy now, but changed to individual telehealth therapy, you would need to engage the minor in an informed consent process. |
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Term
| José, a 14-year-old Mexican-American boy, comes to therapy with his mother. He presents with a flat affect and avoids eye contact during the initial assessment session. When gathering assessment information, he remains quiet as his mother provides a list of José's symptoms and behaviors that she would like you, as the therapist, to address. Before the initial assessment session comes to an end, José requests that you meet with him individually from now on. After deciding that it would be appropriate to schedule individual sessions, what is your legal obligation? |
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Definition
Ask his mother to sign a new consent form for him to be seen individually.
The first legal obligation, since you are changing the unit of treatment from a conjoint unit to the individual treatment of a minor, is to obtain consent to treat a minor individually. |
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Term
| Cynthia, a 42-year-old divorced mother of two children, is your client. She has been seeing you to work on overwhelming feelings of anxiety. Her children are being treated in therapy by a well-respected child psychologist to deal with the divorce. Her ex-husband is suing her for custody of the children and you have been contacted by his lawyer who has subpoenaed your records. You would: |
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Definition
Call your client.
You must call Cynthia to proceed. You cannot confirm or deny that Cynthia is your client until she signs a statement allowing you to assert or waive privilege on her behalf. |
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Term
| You have been seeing a 22-year-old gay client for two years, treating him for depression. You get a call from his partner informing you that your client has committed suicide. Your best course of action would be to: |
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Definition
Maintain confidentiality and retain the client's files for 7 years.
It is your legal responsibility to maintain confidentiality even after the death of a client. Records must be retained for a minimum of 7 years after the date that the client terminates treatment (SB 578, effective January 1, 2015). |
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Term
| You get a call from the emergency room regarding one of your clients, who was brought in by the PET team and is incoherent, delusional, and unstable. While they were going through his belongings they found his driver's license and your card. The psychiatrist on call wants to know if you can give them any information about this person that might be helpful. You would: |
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Definition
Assist them with the information you deem pertinent to the situation at hand.
In the event of a medical emergency it is permissible to give information to medical professionals that are treating the client. Therapists are permitted to speak with other health professionals for purposes of treatment and diagnosis in medical emergencies such as this one. |
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Term
| You are meeting with a client in your private practice for the first time. She tells you that she found you with an internet search, with the search term "expert in eating disorders." Which of the following must, by law, be disclosed prior to beginning the session? |
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Definition
Your fee.
Disclosing your fee is legally required prior to the commencement of therapy. |
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Term
| Your client of five years asks to see a copy of his treatment records, and submits the request to you in writing. How should a therapist respond? |
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Definition
Allow the client to inspect the records, receive a copy, or receive a summary.
Allowing the client to inspect the records, receive a copy, or receive a summary is what the law requires therapists to do. Therapists may also, under limited circumstances, refuse the clients any access to the records at all if they feel that the release of the records will be harmful to the client. |
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Term
| When you check your messages you find a message from an emergency room doctor who says that he is treating a man who overdosed and that this man had your business card in his pocket. You recognize the name as a client you have been treating, and whom you know has a history of substance abuse. The doctor wants information from you. How would you proceed? |
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Definition
Give the doctor the information he needs.
Give the doctor the information he needs. Civil Code 56.10 (The California Medical Information Act) gives licensed health professionals the ability to consult for purposes of diagnosis and treatment without a release authorization. |
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Term
| You are working with a 13-year-old client whose parents are going through a divorce. She texts you one day to tell you that even though she lives full-time with her mother, her dad is now hiring a lawyer so that she can come live with him. You receive a subpoena for your records for the purpose of a custody hearing. You would: |
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Definition
Assert privilege until a guardian ad litem has been appointed for the client.
When subpoenas are received for testimony or records involving clients who are minors, therapists should assert privilege until the child obtains a guardian ad litem. |
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Term
A Minor comes to the clinic where you are doing intakes and asks if they can get a therapist. What do must you determine in order for you to provide therapeutic services? |
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Definition
- They are mature enough to participate intelligently in therapy.
- They are at least 12 years old.
- The treatment can occur in an outpatient setting.
- They are able to pay the fee.
- There a clinically justifiable reason to exclude her parents.
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Term
| A 13-year old named Colleen leaves you a voicemail asking if you'll be her therapist. Before treating Colleen without parental consent, you need to determine that all of the following factors are present EXCEPT: |
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Definition
Colleen has a history self-harm.
Although a history of self-harm may be a valid clinical reason to treat a minor without parental consent, this is not a legal requirement. Therapists may treat a minor 12 or older without parental consent if the minor is mature enough to participate intelligently in therapy and there is no longer a requirement for the minor to be a victim of child abuse or a danger to self or others without treatment. |
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Term
| A 6-year-old child has been brought in by his mother for counseling. She wants you to explain to him why he is in therapy because she feels like she doesn't have the right words and it could scare him. How do you handle obtaining consent for the child? |
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Definition
If the parents are divorced, review the custody papers. Determine whether one or both parents must consent.
Joint custody may require one or both parents to consent. You must look over the custody papers to review what the court mandates. |
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Term
| Which of the following is a legally allowable scenario in which a therapist may treat a minor without parental consent? |
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Definition
A 12-year old depressed male whose cultural background strongly discourages therapy.
If a minor is at least 12-years-old and is mature enough to participate in outpatient treatment, you may provide treatment without parental consent for various clinical issues if, in your professional opinion, parental involvement would be ill-advised. |
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Term
| Deanne is a 13-year-old who is in therapy with you without her parents' consent. In this case, who is the holder of the privilege? |
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Definition
Deanne.
Privilege resides with all clients unless the ability to exercise (i.e., assert or waive) privilege has been adjudicated away from them. |
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Term
| Frank Griffon, a licensed mental health care provider, would like to provide therapy over the Internet. What considerations would guide his ability to do so? |
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Definition
Frank can only accept clients who are in California or who are residents of California, since that is where he is licensed.
Legal standards state that therapists do not initiate services by internet or other electronic media to patients located in jurisdictions where the therapist may not lawfully provide such services. Since Frank is licensed in California he can do therapy only with clients who are in or who are residents of California. |
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Term
| You have been seeing Marsha, 11, with the consent of her mother, Jan. Jan is requesting a copy of Marsha's therapy notes because she wants to provide them to the school counselor. Under which of the following conditions can you refuse Jan's request? |
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Definition
The content of the therapy notes may have a harmful effect on Marsha's psychological well-being.
If releasing the content of therapy notes will result in a negative impact on the minor's physical safety and/or psychological well-being, then the therapist has a right to refuse a parent's inspection of the records. |
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Term
| As you arrive to work in the morning, you notice your office has been broken into, and your client Matilda, who has been diagnosed with Borderline Personality Disorder, has pried open your locked file cabinet, has her file under her arm, and is about to leave the premises. She tells you she knows that she has a legal right to her own records. You tell her that this is true, but that legally, in order for her to see the records: |
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Definition
She must submit to you a request in writing.
Clients must submit in writing any request to see their records. |
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Term
| Your client Maurice tells you that he was involved in a bank robbery and "got away with it." He says the money is stashed in a safety deposit box at a local bank. You are: |
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Definition
Required to maintain confidentiality.
A therapist is legally obligated to maintain confidentiality in this instance. |
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Term
| You've been treating a woman who is in the midst of a divorce. You receive a subpoena in the mail from her husband's lawyer asking for your client's records. Upon opening the subpoena, you read that the request is for six months during which your client saw you twice a week and the husband paid for the therapy. You: |
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Definition
Contact your client to determine if she wants you to waive or assert privilege.
Clients hold their own privilege and a therapist must consult with the client to determine whether privilege is to be waived or asserted. |
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Term
| A 13-year old named Colleen leaves you a voicemail asking if you'll be her therapist. Before treating Colleen without parental consent, you need to determine that all of the following factors are present EXCEPT: |
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Definition
Colleen has a history self-harm.
Although a history of self-harm may be a valid clinical reason to treat a minor without parental consent, this is not a legal requirement. Therapists may treat a minor 12 or older without parental consent if the minor is mature enough to participate intelligently in therapy and there is no longer a requirement for the minor to be a victim of child abuse or a danger to self or others without treatment. |
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Term
| What does the law state about the length of time clients' records must be maintained in a private practice setting after a client has been terminated |
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Definition
Records must be retained for a minimum of 7 years after the date that the client terminates treatment.
Records must be retained for a minimum of 7 years after the date that the client terminates treatment (SB 578, effective January 1, 2015). For minors who terminate treatment, records must be retained for a minimum of 7 years after the minor would have been 18 or at least until the minor client would have been 25. |
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Term
| You recently began treating a 16-year-old female without parental consent. The client has been feeling suicidal and feels unable to discuss her problems with her parents. You receive a voicemail message from her father, angrily wanting to know why you're treating his daughter. What would be your responsibility? |
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Definition
Do not contact the father and maintain the client's confidentiality.
You would maintain the client's confidentiality because she has the legal right to it and suicide is not a mandated breach of confidentiality. You might consider breaking her confidentiality if her suicidal ideation includes an imminent plan and timeframe, but the vignette does not indicate crisis-level suicide that would warrant a breach of confidentiality. |
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Term
| A 6-year-old child has been brought in by his mother for counseling. She wants you to explain to him why he is in therapy because she feels like she doesn't have the right words and it could scare him. How do you handle obtaining consent for the child? |
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Definition
If the parents are divorced, review the custody papers. Determine whether one or both parents must consent.
Joint custody may require one or both parents to consent. You must look over the custody papers to review what the court mandates. |
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Term
| Which of the following is true in a court custody case? |
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Definition
The court may appoint an attorney to represent the best interests of the child.
The court can assign a guardian ad litem, if needed, to represent the best interests of the child. |
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Term
| John, 15, has lived with his father since his parents divorced. When expelled from school, his father brought him to you for counseling. The following week you get a call from Clara, who identifies herself as John's mother. She says that her son needs to live with her if he is ever going to "be a better man than his father." Your initial step would be to: |
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Definition
Not disclose to John's mother that John is your client.
Given the choices available, not disclosing to the mother John is your client is the legal course of action, because we don't know if the woman on the telephone is actually John's mother. In order to speak to her a release would be required, therefore the therapist's initial obligation is to maintain John's confidentiality. |
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Term
| A recently divorced 40-year-old client tells you that her ex-husband is leaving threatening remarks on her social network pages. She has tried to block him but he finds ways to get on anyway. He lives out of state so she tells you that she doesn't really think he is a threat. She says "he's just trying to get under my skin, and it is working!" As a mental health professional, what would be your best legal course of action? |
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Definition
Discuss the situation with your client and determine the best way for the client can keep herself safe.
A therapist's legal responsibility in this situation is to maintain confidentiality, so discussing it and working with the client on options to best protect herself would be a reasonable thing to do. |
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Term
| Molly brings 13-year-old Marvin to your office and indicates that she believes the boy is depressed and needs therapy. She indicates that she is Marvin's legal guardian and that she has consulted with the father, who also wants therapy for Marvin and says he is willing to cooperate in any way necessary to see that Marvin gets treatment. How would you proceed in obtaining consent to treat Marvin? |
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Definition
Obtain consent from Molly since she is the legal guardian.
You would obtain consent from Molly since she is the legal guardian. |
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Term
| The court sends Sue and Jerry to you for marital counseling after a domestic violence incident. A month after the referral, the court requests a report on the couple's attendance and progress. You: |
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Definition
Need a written release signed by both Sue and Jerry before you can communicate with the court.
Since Sue and Jerry are your clients, you must get a written release from both before divulging any information about them. |
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Term
| Two therapists are dating. They are at dinner and they are talking about their clients. They discover that each of them is seeing a different member of the same couple for individual therapy. What should these therapists do? |
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Definition
Stop the discussion and do not talk about these clients again.
The rules of confidentiality would require the therapists to stop the discussion and not talk about these clients again without clinical justification and/or releases from their clients. |
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Term
| A LMFT in California who is a "covered entity" under HIPAA, when dealing with issues covered both by California law and federal law must follow: |
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Definition
Whichever law provides the most stringent standards.
In any instance in which there is a difference between HIPAA guidelines and California law, licensed health professionals must follow whichever law sets the most stringent standard. |
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