REVIEWS/OBSERVATIONS
from MAY 31, 2019 TRAINING IN NEW ORLEANS

The May 2019 workshop in New Orleans had close to 80 participants!! The largest group ever, and it was a lively, participative group of seasoned clinicians.

I had asked the Louisiana registrants to submit case examples of their (or colleagues’) “nightmare cases” (the subtitle of the seminar). So many therapists submitted diverse situations; we had a fun and instructive time analyzing them in the seminar.

It was such a diverse set of situations – some absolutely clinically resolvable, some quasi clinical/legal, and some mostly legal (e.g., responding to subpoenas and filing Motions to Quash subpoena when the release is objected to by the therapy client).

LEGAL NEWS FOR LPCs

There has been a rule change regarding teletherapy, effective March 2019. It’s a long and complex enough rule to be incorporated into an entire seminar on Clinical Practice in the Digital Age – I gave one such seminar a few years ago.

All LPCs should review this new Rule!

The new LPC Rule is found within Chapter 5, the chapter entitled “License and Practice of Counseling.” Rule 505 provides as follows:

§ 505. Teletherapy Guidelines for Licensees (Formerly Diagnosing for Serious Mental Illnesses)

1. This Chapter defines and establishes minimum standards for the delivery of mental health counseling, psychotherapy, and marriage and family therapy services using technology-assisted media. Teletherapy references the provision of counseling and psychotherapy services from a distance which is consistent with the same standards of practice as in-person counseling settings.
2. Teletherapy is defined as a method of delivering mental health counseling, psychotherapy, and marriage and family therapy services as prescribed by R.S. 37:1101 and R.S. 37:1116 using interactive technology-assisted media to facilitate prevention, assessment, diagnosis, and treatment of mental, emotional, behavioral, relational, and addiction disorders to individuals, groups, organizations, or the general public that enables a licensee and a client(s) separated by distance to interact via synchronous video and audio transmission.
3. The board recognizes that safe and effective practices in teletherapy require specific training, skills, and techniques and has set forth the following regulatory standards to ensure competence and safety. This Rule shall not be construed to alter the scope of practice of any licensee or authorize the delivery of services in a setting, or in a manner, not otherwise authorized by law. Nothing in this Section shall preclude a client from receiving in-person counseling, psychotherapy, and marriage and family therapy services after agreeing to receive services via telemental health. Teletherapy shall be delivered in real-time (synchronous) using technology-assisted media such as telephonic and videoconferencing through computers and mobile devices. The use of asynchronous modalities (e-mail, chatting, texting, and fax) is not appropriate and shall not be used for teletherapy, except in a crisis to ensure the client’s safety and stability.
4. Licensees shall provide services consistent with the jurisdictional licensing laws and rules in both the jurisdiction in which licensee is physically located and where the client is physically located. Licensees providing teletherapy services to clients outside of Louisiana must comply with the regulations in the state in which the client is located at the time of service. The licensee shall contact the licensing board in the state where the client is located and document all relevant regulations regarding teletherapy. A nonresident of Louisiana who wishes to provide teletherapy health services in Louisiana must be licensed by the board.
5. Teletherapy is a specialty area and requires board approval. Licensees who may provide teletherapy must meet the following requirements.
   1. The licensee must be licensed in Louisiana.
   2. The licensee must be licensed in the state where the client is located if licensing is required.
   3. The licensee must have been practicing for at least one year.
   4. The licensee must complete either option below.
      1. Graduate-Level Academic Training. At least one graduate-level academic course in telemental health counseling. The course must have included at least 45 clock hours (equivalent to a three-credit hour semester course).
      2. Professional Training with a minimum of nine synchronous clock hours in teletherapy. The presenter shall meet continuing education standards established by the board. Teletherapy education/training shall include but is not limited to:
         1. appropriateness of teletherapy;
         2. teletherapy theory and practice;
         3. theory integration;
         4. modes of delivery;
         5. risk management;
         6. managing emergencies;
         7. legal/ethical issues.
   5. Licensees privileged in teletherapy must accrue three clock hours of continuing education during each renewal period.
6. At the onset of teletherapy, the licensee shall obtain verbal and/or written informed consent from the client and shall document such consent in the client’s record.
   1. Electronic signature(s) and date may be used in the documentation of informed consent.
   2. Provisions of informed consent for teletherapy services shall include:
      1. mode and parameter of technology-assisted media(s), and technical failure;
      2. scheduling and structure of teletherapy;
      3. risks of teletherapy;
      4. privacy and limits of confidentiality;
      5. contact between sessions;
      6. emergency plan;
      7. consultation and coordination of care with other professionals;
      8. referrals and termination of services;
      9. information and record keeping;
      10. billing and third-party payors;
      11. ethical and legal rights, responsibilities, and limitations within and across state lines and/or international boundaries.
7. The licensee shall provide each client with his/her declaration or statement of practice on file with the board office.
8. At the onset of each session the licensee shall verify and document the following:
   1. The identity and location of the licensee and the client. If the client is a minor, the licensee must also verify the identity of the parent or guardian consenting to the minor’s treatment. In cases were conservatorship, guardianship, or parental rights of the minor client have been modified by the court, the licensee shall obtain and review a copy of the custody agreement or court order before the onset of treatment.
   2. The location and contact information of the emergency room and first responders nearest to the client’s location.
9. The licensee shall determine if the client may be properly diagnosed and/or treated via teletherapy; and shall affirm that technology-assisted media are appropriate for clients with sensory deficits. The licensee shall affirm the client’s knowledge and use of selected technology-assisted media(s) (i.e., software and devices). Clients who cannot be diagnosed or treated properly via teletherapy services shall be dismissed and treated in-person, and/or properly terminated with appropriate referrals. The licensee shall use technology assisted media(s) that is in compliance with HIPPA and HiTECH standards. The licensee shall not use social media platforms or functions (tweets, blogs, networking sites, etc.) in the delivery of teletherapy, and shall not reference clients generally or specifically on such formats.
10. Policies and procedures for the documentation, maintenance, access, transmission and destruction of record and information using technology assisted media shall be consistent with the same ethical and regulatory standards for in-person services. Services must be accurately documented in teletherapy services, denoting the distance between the licensee and the client. Documentation shall include verification of the licensee’s and client’s location, type of service(s) provided the date of service, and duration of service. The licensee shall inform clients of how records are maintained, type of encryption and security assigned to the records, and how long archival storage is maintained.
11. Telesupervision is defined as a method delivering clinical mental health and marriage and family therapy supervision as prescribed by R.S 37:1101 and R.S. 37:1116 using technology-assisted media that enables a supervisor and a supervisee separated by distance to interact via synchronous video and audio transmissions. Up to 25 percent of total supervision hours may be used within a telesupervision format.
    1. Teletherapy supervision may include but is not limited to, the review of case presentation, audio tapes, video tapes, and observation to promote the development of the practitioner’s clinical skills.
    2. Teletherapy supervision shall be provided in compliance with the same ethical and regulatory standards as in-person supervision.
    3. The supervisor shall inform supervisees of the potential risks and benefits associated with telesupervision.
    4. The supervisor shall determine if the supervisee may be properly supervised via teletherapy supervision. Supervisees who cannot be supervised via teletherapy supervision shall be restricted to in-person supervision, and/or properly terminated with appropriate referrals.
    5. The supervisor shall affirm the supervisee’s knowledge and use of selected technology-assisted media(s) (i.e., software and devices).
    6. The supervisor shall use technology assisted media(s) that is in compliance with HIPPA and HiTECH standards.
    7. The supervisor shall not use social media platforms or functions (tweets, blogs, networking sites, etc.) in the delivery of teletherapy supervision, and shall not reference supervisee generally or specifically on such formats.
    8. AUTHORITY NOTE:    Promulgated in accordance with R.S. 37:1101-1123.
       HISTORICAL NOTE:    Promulgated by the Department of Health, Licensed Professional Counselors Board of Examiners, LR 45:438 (March 2019).

SOME GUIDANCE – LEGAL AND OTHER – FOR SOCIAL WORKERS (really for all disciplines)

There are no new rule changes of which I am aware, but I thought you might want a brief review of the “mission” of the Social Work Board. Actually, this information also applies to all other state regulatory boards.

As stated on the home page of the LABSWE web site:

“The Board exists because the legislature declared “in order to safeguard the public heath, safety, and welfare of the people of this state against unauthorized, unqualified and improper practice of social work, it is necessary that a proper regulatory authority be established and adequately provided for.”

Yes, that is a typo – should be “health” not “heath.” But, the information is essential.

In recent seminars I have heard, “I called the Board to ask [whatever advice] and they were not too helpful.” I remind seminar participants, “THE BOARD IS NOT YOUR SUPPORT ORGANIZATION, BUT RATHER YOUR MONITOR AND ENFORCEMENT OFFICIAL.” That’s not bad thing, really. We all know of or have heard of outrageously unethical conduct of other social workers. I hope that is not too frequent; it is not for me and I deal with many clinicians with a variety of ethical problems. Most social workers I know and/or have had professional dealings with are the greatest, well-meaning caring souls that you could imagine. But, unfortunately, some bad apples contaminate the barrel. And, that is why we should not be upset that the LABSWE is here to regulate the profession, not support our practices.

Yet, I want to reiterate to all disciplines that although there is merit for the existence of regulatory boards, if a Complaint has been filed against you, the Board and its arms (e.g., investigators, Assistant Attorney Generals, etc.) are your adversary in the Complaint process. If the Complaint has merit at all (if the allegations were accepted as true, which often they are not, but the Board does not know that until we file our Response to the Complaint), the Board usually assigns an investigator. These folks are law enforcement trained – big-time. One of them brags that he worked for the DEA for 30 years (drug enforcement federal agency known for sometimes brutal methods and surely the agents consider the suspects guilty, even though that is not the law: innocent until proven guilty.) Please protect yourself and DO NOT talk to or meet with an investigator without legal counsel.

Deb’s Louisiana Law Practice

(1) Case/Clinical/Legal Consultations – can be undertaken via teleconference or in person. Call or email for appointment. Flat fee for up to one hour is charged. I am in New Orleans every month or so to meet with licensees who prefer face-to-face in person consultations, but also can arrange consultations via Skype or video face time (with android phones).

(2) Defense for Licensing Board Complaints – with Social Work, LPC, or Psychology Board. Other health professionals are also represented.

(3) Adoptions – while I do not have an “inventory” of babies, many of my clients have found babies who are available for adoption through friends or relatives. The latter is easier to accomplish because it is an “intrafamily” adoption and much easier to accomplish. Stepparent adoptions are considered “intrafamily” adoptions, too. Private (non-family) adoptions are not extremely expensive, but do require a private Home Study by another social worker and that adds to the cost of that type of adoption. Now that the United States Supreme Court has ruled in favor of same-sex marriage, Louisiana has to recognize the marriage of same-sex couples and I can get a second parent adoption accomplished via the Intrafamily adoption statute in any parish.

Training/Legal Consultation For Clinicians/Agencies

I have been providing training for high risk clinical situations and legal involvement of the therapist for individual clinicians and clinical groups in Louisiana and Colorado for some years now. I consult with individual practitioners, small groups of clinicians, and agencies to help therapists prepare for deposition or trial testimony, or to handle a subpoena request for clinical records.

Occasionally, I am available to meet in person with individual therapists who need risk prevention consultation and/or with groups of any size for any type of self-protective, clinical practice in this litigious age. I can custom tailor training to your particular agency or small group with questions submitted in advance by participants, if desired.

Legal Services Offered

• Legal Representation & Consultation for grievances (complaints) to licensing boards and/or malpractice lawsuits
• Training & Consultation for Clinicians and Agencies (e.g., respond ethically to subpoenas while protecting yourself and your clients; identify high-risk clients and situations to avoid client disciplinary complaints and harm to clients or third parties)