Workshops by Judy C. Roberts, MA, LMHC

Best Choice vs. "Right" Choice Making the "Right" Choices: Legal & Ethical Issues in Mental Health Treatment Professional Ethical Practice: Not for the Faint-at-Heart! Slippery Slopes for Mental Health Clinicians Basic HIPAA for Outpatient Private Mental Health Practice Got Informed Consent? The Fee in Therapy: If You've Got the Money, Honey, I've Got the Time Boundaries and Dual Relationships SAY WHAT? Ethical Considerations in Creating a Client Record Record Keeping: Covering the Bases  (writing for 3rd party payers) Everything You've NEVER Wanted to Know about Subpoenas Ethical & Legal Challenges of Treatment: Consent & Confidentiality Confidentiality Issues Related to Treatment of Minors Disclosure Statements 101   Author's Vitae  (requires the free Acrobat Reader)   Best Choice vs. "Right" Choice This is the basic ethics workshop designed to provide a foundation for the mental health treatment provider which clarifies the values and principles that underlie all mental health professional ethics codes. The workshop also presents a basic ethical decision-making model that serves as a guide for ethical practice. Six values and principles are identified (i.e., autonomy, fidelity, justice, beneficence, non-malfeasance, and self-interest) with discussion of ways in which these principles have affected current practice standards in the delivery of mental health services. The ethical decision-making model is based on the "utilitarian perspective" which focuses on the consequences that actions or policies have on the well-being of all persons directly or indirectly affected by the action or policy. Case examples are provided or solicited from attendees and there is opportunity for the attendees to actively explore those cases employing the ethical decision-making model. Depending on time options, this workshop can be very focused or expanded to allow for maximized discussion of case examples which are highly relevant to a particular treatment setting. Ideally, time will permit role play of ethical consultation— usually one of the most enjoyable components of this workshop. Making the "Right" Choices: Legal & Ethical Issues in Mental Health Treatment Increasingly mental health clinicians in our society are required to discern and walk a fine line that qualifies as being both legal and ethical. But the challenging truth is, this line is frequently hard to distinguish and often challenging to navigate. This workshop is intended to be an interactive exploration of the foundational ethical values and principles that underlie our professional ethics codes and an introduction to an ethical decision-making model that is designed to take into consideration ethical guidelines, relevant state law, and the particular nuances of whatever situation the clinician is struggling to respond to with professional integrity. This workshop expands on the basic ethics workshop (described above) by including a legal focus section which includes an update of recent changes in WA State law that affect mental health clinicians; selected issues relating to uses and disclosures of protected health information; the new federal HIPAA privacy standard of “minimum necessary”; the unfolding nuances of HIPAA's “psychotherapy notes”; and a brief review of state mandatory reporting laws. This workshop is frequently used as the starting point for in-service trainings provided for staff in mental health treatment agencies. My preference is to customize this basic workshop to the particular audience and its specific needs, which are often shaped by the specific treatment population(s). Professional Ethical Practice: Not for the Faint-at-Heart! Increasingly mental health clinicians in our society are required to discern and walk a fine line that qualifies as being both legal and ethical. But the challenging truth is, this line is frequently hard to distinguish and often challenging to navigate. This workshop includes a section addressing the foundational ethical values and principles that underlie all of our professional ethics codes; another section that focuses on the most recent changes in WA State law that affect mental health clinicians (as well as a review of sections of law that are generally important to just know); discussion of HIPAA's new "psychotherapy notes" and implications for our practices; and exploration and use of an ethical decision-making model that will provide a basis for ethical practice.      Slippery Slopes of the Therapeutic Relationship This is probably one of the most engaging ethical workshops in that it focuses on the more provocative elements of ethical practice. Topics covered include boundaries, touching clients, therapist self-disclosure, and dual relationships. Conceptual information is presented on all these issues with liberal case examples. With adequate allotted time, attendees are encouraged to participate in discussion of these concerns; and without adequate time, it becomes a struggle to keep the attendees from talking about their thoughts or experiences. Basic HIPAA for Outpatient Private Mental Health Practice An overview of HIPAA as it affects the typical private mental health practitioner in WA State: the interaction of HIPAA privacy regulations on WA State privacy laws; incorporating the privacy regulations in the informed consent process (i.e., your Notice of Privacy Practices); HIPAA "valid" and "invalid" authorizations for disclosure of private client information; responding to clients' new HIPAA-based "rights"; HIPAA's mysterious "psychotherapy notes"; required & recommended HIPAA forms for both “covered” and “non-covered entities”; etc. Got Informed Consent? This workshop explores the clinician's legal and ethical responsibility known as informed consent that should precede the provision of mental health treatment. It addresses the legal elements of the informed consent process; identifies what information should be provided in anticipation of mental health treatment delivery; includes a special focus on the mental health clinician's legally formalized requirement of informed consent known as the Personal Disclosure Statement; and includes a special focus on the exceptions to confidentiality in Washington State for both master's level clinicians as well as psychologists; and includes some specifics on our duty to warn or protect. The Fee In Therapy: If You’ve Got the Money, Honey, I’ve Got the Time This workshop is designed to prompt the clinician to consider our culture’s conflicted attitudes toward money and to assess one’s own, and one’s clients’ individual relationships with money. With this in mind, the attendees are challenged to think about what it is they exchange for the therapy fee, and how they might develop a more integrated attitude and behaviors involving money as a part of the therapeutic relationship. Boundaries & Dual Relationships An engaging workshop that focuses on two of the more provocative and professionally dangerous areas of mental health treatment delivery. It includes a focus on the significance of understanding our various professional role boundaries, boundary crossings & boundary violations. The workshop also explores the perplexing possibilities of dual relationships and highlights the particular aspects of a therapeutic relationship that makes a secondary relationship risky. Record Keeping: Covering the Bases   This workshop reviews the state’s requirements for record keeping for individual clinicians providing mental health treatment and provides a basic format for meeting that standard. The workshop also includes an explanation of the distinction between traditional progress notes and HIPAA's more protected "psychotherapy notes" as well as some caution about the effect of WA State law on the Feds' vision of "psychotherapy notes". The workshop addresses the current expectations of third-party payers, including documentation of assessment data, case formulation, and session notes. Finally, we will review how one can write treatment plans or outpatient treatment reports in such a way as to support the illusive "medical necessity" requirement. This workshop provides each attendee with an entire clinical record keeping system, appropriate for meeting both state and third party payor documentation standards.             slides SAY WHAT? Ethical Considerations in Creating a Client Record As mental health clinicians, our clinical records serve as both medical and legal documentation of our observations of, and interactions with the people we serve. The assumption is that those files will document the assessment, decision-making, general management, and the specific treatment(s) we provide. Traditionally they are presumed to facilitate continuity of care by the treating clinician and any successors; to verify that specific services took place, to establish “medical necessity” for third-party payers; and/or to function as evidence in the legal arena. The fact that our records may serve in these multiple-roles leaves us in an ethical bind. How does one create a functional, accurate clinical record for a client without also putting at risk the confidentiality upon which the effectiveness of that psychotherapy process is also based? This workshop is intended to be an exploration of the complicating factors of that ethical predicament, and a presentation of a model intended to minimize its associated risks. <workshop slides text>  <session note formats>  <SOAP Note Cheat-Sheet> Everything You’ve NEVER Wanted to Know About Subpoenas In the therapeutic relationship where confidentiality is so crucial to effective work, the intrusion of a subpoena served on a therapist creates an anxiety based on concern for the best interest of the client, the legal requirements incumbent on the therapist, and protection of the perception of therapy as a totally private relationship. This workshop addresses Washington State law that affects master’s level clinicians who are faced with the question of how to respond appropriately to a subpoena requiring them to either produce records or provide sworn testimony at a deposition. It also addresses ways in which clinicians might be proactive about getting paid for legally required responses to these legal intrusions. Ethical & Legal Challenges of Treatment: Consent & Confidentiality This workshop was initially conceived in response to the many questions posed by a mental health agency whose work focused on providing mental health treatment to minors and their families. This treatment population provides a unique complexity of questions about appropriate securing of consent for treatment, release of information, conflicts of interest, etc. The workshop reviews the mix of Washington State laws purporting to address these questions and provides discussion about the inevitable binds and legal & ethical challenges these conflicts provide the treating clinician. Confidentiality Issues Related to Treatment of Minors This workshop material is generally presented as one component of the workshop listed immediately above, and is of value for clinicians who work with minors as a treatment population. It includes review of the complex collection of WA State laws that address confidentiality for minors, and makes recommendations based on principles of ethical conduct, for strategies to deal with secondary parties wanting information about the minor client.                  slides Disclosure Statements 101 This workshop is targeted for the private practice clinician who is required by state law to provide a disclosure statement to all clients at the beginning of treatment. It explains the required elements as listed in state law, makes suggestions for specific language, includes strategies for providing clients adequate information that is simultaneously helpful to the potential client and protective of the clinician’s legal risk. The distinction between the HIPAA-required Notice of Privacy Practices and the WA State required Disclosure Statement will be discussed.