COMMON CLINICAL CONUNDRUMS & LICENSING BOARD RADAR
Some food for thought … I hear these same issues in consultations over and over. No simple answers. Balancing risk versus benefit, which is why consultations are sometimes necessary.
I also hear certain themes that surface in Board hearings on disciplinary cases. When pertinent, I will offer some tidbits on what to beware of – a/k/a “licensing Board concern(s) du jour”!!!
Feel free to email me with ideas and I will share them in the next newsletter.
My topic for this year’s training in beyond Ethics, LLC (3-hour Ethics CEUs) concerned the risks for clinicians when seeing divorcing/separating couples and/or their children: Divorcing Couples with Children. I have now presented this webinar three times and the attendees have presented great examples of difficult situations with this target group.
Additionally, most of my legal, risk prevention consultations concern various iterations on this same theme: clinicians being dragged into the litigation of their divorcing/divorced clients. Subpoenas are received, some only days prior to the required testimony of the clinician. Some can be deflected (when I get involved and discuss with the attorney who subpoenaed the clinician’s testimony), but most of them require the records release and deposition or trial testimony from the therapist.
And, so it goes with a few more consultations even since the November 4th Beyond Ethics, LLC training … divorce, divorce, divorce!
I want to add a couple caveats for those who are caught in this web of divorce/custody litigation. If you and your clinical consultation group or agency staff would like to have me present a streamlined version of this year’s (2022) topic on divorcing/divorced couples with children, I will be happy to tailor it to your group’s needs and desired time frame. I worked with one such clinical consultation group and the 6 clinicians sent me specific questions to address during the 2-hour presentation that included quickly reviewing/discussing the Power Point that I used for the Beyond Ethics, LLC trainings this year (2022). I also list other topics on my website that I have developed that can easily be transformed into a presentation for your group or agency.
Caveats for therapists who are seeing child or teen clients of divorced/divorcing parents:
- Always obtain the most recent Order, Judgment, or Consent Judgment so you are aware of the (a) decision-making authority of each parent, and (b) the domiciliary parent status, if one was designated (that parent is supposed to act as tiebreaker if the two cannot agree, but not a dictator/unilateral decision-maker for the minor children).
- If you receive a letter or other type of request from one parent’s lawyer asking for an opinion letter re: the child/teen client, say no. The parent may ask you, but it is the lawyer’s idea for you to give your opinion, often to be appended to a Motion (or some other legal pleading) against the other parent using you as leverage – and if you comply, you may be facing a licensing board Complaint/Grievance from the parent you didn’t write for alleging that you are biased against that parent and favoring the parent for whom you wrote the letter. Just say no – that you cannot offer any opinion on anything to be used in the litigation without a subpoena.
- If you receive a subpoena, please consider getting in touch with a lawyer who also knows clinical work. Not to beat my own drum, but my goal in handling subpoena consultations is to protect my clinician-client, while at the same time protecting the minor therapy client AND the therapeutic relationship. There are various ways to finesse maintaining some layers of protection for the minor’s confidentiality and I have found with several of my recent subpoena consultations that some attorneys actually understand the need for protecting the kid client, so then we can work together to satisfy the attorney’s needs for information regarding the kid or his/her/their feelings about one or both parents, while keeping the child’s confidences somewhat shielded from the litigation.
- One of the above ways to shield kids’ private information from outsiders is to request the court (maybe through one/both of the parent’s attorneys) seal the therapy records.
- Get paid before you go – when at all possible. Again, with legal representation, it’s easier to get that accomplished before the legal event’s occurrence. It’s not fun to be deposed or testify at court, but it feels better (my clients tell me and it’s certainly been my experience) when you have been paid well for your time and efforts.
These and other scintillating topics will be discussed further at the upcoming November 4th webinar on this same topic. Hope you can join us!!
Licensing Board Radar
I attended the Louisiana Social Work Board several times this year and a couple DORA Mental Health board meetings. Both states board meetings are open for all to attend the public portion. In Louisiana, the Social Work Board gives attendees 1 CEU of Ethics and 1 CEU of General for use in renewals. Supervision was a major focus at a past meeting of LABSWE and several licensees presented questions to the Board concerning various issues. The LABSWE members were pretty adamant about licensees and supervisors following the rules expressly, but if extenuating circumstances are present, a licensee can get a Compliance Hearing scheduled. Both Colorado and Louisiana boards consider mandatory reporting when necessary to be of the highest importance, thus they enforce the obligation strictly.
If you have trouble with the Boards in either state regarding supervision or any issues related to your licensing, feel free to reach out to me. I have worked on such matters frequently, usually with positive results.
Meanwhile, supervisors and those in licensure supervision, please follow the rules (and there are some new ones in Louisiana, including online Supervision Plans; in Colorado, therapists in licensure supervision must provide the telephone number of their supervisor to all their therapy clients in your intake paperwork) to the T and then you should probably be fine. It’s never good to learn that numerous hours of paid supervision cannot be counted due to a failure to file some required form with the Board at the inception of the supervision.
Let me know some odd situations that you or colleagues have encountered, and I will address them in a future newsletter!!
UPCOMING WEBINARS IN 2023
As usual, I mulled and pondered … and reviewed the “suggested future topics” in the webinar evaluations that many of you have sent to me after taking one of my Beyond Ethics, LLC webinars. Thank you for your ideas and perhaps some of you will recognize your suggested topic!!
Description of workshop
Questions about how much to document? What about separate files for HIPAA Privacy Rule and why would a clinician go to that trouble? Separate teletherapy consent forms? Why and what should it cover?
Are there any ways to avoid getting grieved/complained about to the licensing board?
And if by (unlucky) chance you do receive that email or letter from your licensing board saying that a Complaint has been filed against you, what do you do and how does the process unfold?
Oh no! I’ve been served!! Now what?
We will address these issues and more. This workshop will cover these questions and other sticky wickets of ethical managing of some business aspects of clinical practice.
ADDITIONAL CUSTOM TRAINING that Deb has planned for this coming Spring (2023)
- March 4th New Orleans-Birmingham Psychoanalytic Center – LIVE presentation: “Advance Ethical Planning for Therapist’s Unexpected Departure: The Professional Will!!”
- April 12th University of Colorado at Colorado Springs School of Social Work in partnership with UCHealth-Memorial Behavioral Health (Zoom): “Ethics and Risk Prevention”
NOTE: If your agency, clinic, university, or consultation group would like a custom training, I am happy to tailor such to your needs. Together we can plan the substance of the training, case examples, length of training, etc.
What people said about my most recent seminars:
- “This was great information for if/when I’m subpoenaed. Wonderful reminder of my role as a counselor and how to make sure I’m protecting myself and [my] license.”
- “The April 1st session on Divorcing Couples with Children was … interactive and informal, balanced well with [Deb’s] knowledge and expertise in the area. I like that she and participants shared real cases that presented a challenge.”
- “Great job with Zoom. It almost was a good as being in the room with you.”
- “Very detailed, helpful … in navigating the legal world from a clinical perspective.”
- “Content was practical and presented in ‘layman’s’ terms. Easy to understand and able to take into practice immediately.”
- “Topic was very pertinent to many things I have experienced.”
- “Very helpful and plan to attend future seminars.”
DEB IS AVAILABLE FOR LEGAL / CLINICAL CONSULTATION and/or TRAINING
I am available to provide legal consultations for your high-risk clients or situations. I offer consultations to individual therapists or clinical group (e.g., clinical consultation groups, suite mates, etc.). I often schedule therapist consultations via telephone but can also schedule via Zoom if you prefer.
Additionally, I also can work with you to design custom training for your agencies, academic mental health programs, and small group practices. The trainings I have provided in the past have included a focus on: (1) ethically managing high-risk clinical situations and legal involvement of the therapist, (2) helping therapists prepare for deposition or trial testimony, and (3) responding to a subpoena request for clinical records or therapist testimony at deposition or trial.
If interested or need additional information, please email me: firstname.lastname@example.org.
PREVIOUS ETHICS WEBINARS
[NOTE: these topics/presentations are available for consultation groups, agencies, or university custom trainings – contact Deb for more information or to schedule.]
Divorcing Couples with Children: Ethical, Self-Protective Management of High-Risk Cases and Legal Involvement – April, June, November.
Divorce and custody litigation can draw therapists into a black hole and destroy their ability to maintain a healthy, therapeutic relationship with the child client who needs them sorely.
This workshop will help clinicians prepare to handle these white-water rapids with a better understanding of how to shield themselves from harm, albeit probably not from all anxiety.
Deb invites participant discussion throughout the webinar and encourages registrants to submit specific situations in advance to enhance our grist for the training mill.
June, September, November – a topic that will either intrigue or depress you: The Professional Will. Why would it depress you? Because most of us prefer to avoid the inevitable knowledge that one day we will no longer be around. This topic has been requested by some folks over the years but arises primarily from my several consultations with mental health professionals who had to “pick up the pieces” after a beloved colleague suddenly passed away.
In all my consultations, the mental health provider died, but some situations present a slightly different twist: the therapist suffers a stroke or other type of sudden, debilitating medical event. Poof! Clinical practice is OVER. Suddenly. Without the therapist’s ability to terminate or even email or text her/his clients. How will clients of the suddenly gone therapist be notified that their therapist will no longer be able to see them for their scheduled appointments this coming week?
These experiences that I have been involved with peripherally caused great angst in the mental health professionals who met with me to figure out what to do and how to do it ethically. They were torn between wanting to notify the deceased therapist’s clients but worrying about entering forbidden territory: CONFIDENTIAL MATERIAL IN CLIENTS’ CASE FILES.
This is the type of dilemma that a Professional Will seeks to avoid. Similar to a personal estate Last Will and Testament, the Professional Will involves planning for an untoward event where the therapist himself/herself has suddenly departed. Moreover, because therapist’s clients are notified ahead of time, the concerns about breach of confidentiality are eliminated; the client has given advance consent – and those of you who have attended my trainings in Self-Protective High-Risk Clinical Practice know I am keen on advance consents in your Intake paperwork because client’s agreement in advance protects you from breach of confidentiality Complaints/Grievances.
Additionally, as you have heard me say frequently in Beyond Ethics, LLC seminars, self-protective practice is not at odds with caring for our clients’ wellbeing, but rather ensures excellence in clinical practice. This is a great example. If you are self and colleague protective by creating a Professional Will, it also serves to give clients notice not only pertaining to the individual who would handle your caseload wrap-up, but also demonstrates to the client that you care for them enough to plan ahead to protect their confidentiality and continuation of care should something happen to you.
Anyway, for more on why we need Professional Wills, how to create them, how to advise our clients of their existence, how to prepare our practices and assemble a team of trusted others who will be ready to jump in … and lots more: Advance Ethical Planning for Therapist’s Unexpected Departure: The Professional Will!!
March – there were about 30 mental health professionals in the Zoom webinar offered to both Louisiana and Colorado clinicians – Walking the Clinical High Wire with Couples, Families and Legal Involvement: Ethical Management of Risk.
One participant who had sent a couple scenarios to me in advance agreed to present them in our meeting. We had a robust discussion of ideas for her that morphed into other issues and analyses. Quite a fun, engaged, and productive 3 hours.
More comments from my most recent seminars:
- “Really good informative seminar…lots of information that I didn’t know I needed but am so glad to have it! Thank you so much!””
- “Great topic and delivery – love Deb’s navigation of the grey areas. Thank you!”
- “I really enjoyed the training; it was quite applicable to practice.”
- “Information presented in a very clear and precise manner with relevant examples.”
- “Great info – very knowledgeable and great examples. Great reminders as well as some new nuggets.”
- “Could have listened to you all day! Great info. Lots to think about.”
- “Thank you for the best Ethics presentation I have been to in 25 years of practice. Your recommendations for protecting ourselves and our clients were exceptional! I will come to any presentation you have in the future. Thank you so very much!”
- “I always enjoy your trainings. I appreciate your flexibility in regards to discussing audience members’ concerns/experiences.”
- “My third seminar with you — you are great! Keep on teaching this class…”
- “Always great! Thank you! Wish you had more throughout the year… You are engaging and positive.”
- “Excellent! I could not think of anything to improve on this workshop. Keep doing what you’re doing.”
- “I thoroughly enjoyed your training. The intimate setting allowed for increased participation. I enjoyed the relevant examples/cases. I have been to Ethics seminars where the presenter went through the code of ethics (boring!). You discussed relevant issues that stimulated our interest in a fascinating way.”
- “Excellent presentation. Very informative and well thought out frame work. Thanks Deb!”
- “Nice work! Very interesting, especially when examining specific case studies.”
Deborah (Deb) Henson is an Attorney and LCSW (Tulane School of Social Work, MSW) in private practice in Colorado and Louisiana, specializing in mental health licensing defense. She represents clinicians in DORA grievances (CO) and licensing board Complaints (LA) and regularly consults with clinicians in both states to help them deal with legal and clinical conundrums, such as: (1) the receipt of subpoenas for records or testimony; (2) the escalation of high-risk clinical situations; and (3) other sticky ethical wickets that arise in clinical practice. Deb helps clinicians develop self-protective, clinically sound and legally proper strategies for risk prevention.
Deb has taught in the MSW programs at Tulane University School of Social Work and the University of Denver Graduate School of Social Work. She also serves as Expert Witness for litigation cases around the country involving assertions of malpractice against clinicians. She offers Divorce Mediation long-distance (Zoom; Skype; telephone) in Colorado and Louisiana. See her website for more details.
Deb has been presenting half- and full-day seminars on “Avoiding Ethics Complaints and Malpractice Lawsuits” or “Legal and Ethical Issues in Clinical Practice” around the country through PESI, Inc. for over 7 years and presenting for many CEU groups in Louisiana and Colorado. She also has lectured for Tulane School of Social Work Continuing Education and the University of Texas School of Social Work (Austin) Continuing Professional Development program, and for many other clinical and counseling groups. Deb started her own training biz — Beyond Ethics, LLC — in 2009. Contact Deb for group presentations to agency staff and/or private practice consultation groups.
Deb can be reached through her law and social work web site: www.deborahmhenson.com or through her training web site: www.beyond-ethics.com. Deb can also be emailed at email@example.com or firstname.lastname@example.org. And, you can use the old tried and true method of calling her at 504.232.8884.