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 always ask 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).

Excerpt From The Recent LASWBE Newsletter – Proposed Rule Changes And Chance To Weigh In On Proposals

The Louisiana State Board of Social Work Examiners intends to amend the Rules, Standards and Procedures under the authority granted by La R.S. 37:2705.C.1. These amendments will apply to all Licensed Master’s Social Workers under supervision for licensing and Licensed Clinical Social Workers-Board Approved Clinical Supervisors providing such supervision and amend §503. LMSWs Seeking the LCSW Credential.

All interested persons may submit written comments through April 2, 2020, to Emily DeAngelo, Administrator, Louisiana State Board of Social Work Examiners, 18550 Highland Road, Suite B, Baton Rouge, LA 70809. A public hearing on the proposed rule will be held on April 3, 2020, at the office of the Louisiana State Board of Social Work Examiners, 18550 Highland Road, Suite B, Baton Rouge, LA 70809 beginning at 3:00 p.m. All interested persons will be afforded an opportunity to submit data, views, or arguments, orally or in writing, at said hearing. Individuals with disabilities who require special services should contact Emily DeAngelo at least five business days in advance of the hearing at (225)756-3470.

The following is how the proposed rule reads:

§503. LMSWs Seeking the LCSW Credential

Supervision for the LCSW license can begin after the MSW obtains LMSW. Supervision shall be documented on the forms provided by the Board.

B. Supervision for the LCSW license is conducted by a Board-approved clinical supervisor (BACS). LMSWs may obtain a list of BACS from the Board’s website or office.

C. The Supervision Contract shall be completed by the supervisor, the supervisee, and the agency supervisor and shall be submitted to the Board office by the supervisee within 60 days of the first supervision session. The Employment Verification shall be completed by the employer and shall be submitted by the supervisee along with the Supervision Contract. Failure to do so shall result in supervision being issued from the date that is 60 days from the date received. A new Supervision Contract shall be submitted by the supervisee within 60 days of the change when the supervisee changes employment, changes supervisor and/or there is a change in the agency supervisor. If there is a change in employment, the supervisee must also submit a new Employment Verification. The Board office will email the supervisee and supervisor a notice confirming receipt of the Supervision Contract and the beginning date of supervision, within 60 days of receipt of the Contract.

D. LMSWs seeking the LCSW credential must complete a minimum of 5,760 hours of postgraduate social work practice and at least 3,840 hours of that postgraduate social work practice must be under the supervision of a Board-approved clinical supervisor (BACS).

E. During the 3,840 hours of supervised practice, 96 hours of face-to-face supervision must occur between the supervisor and supervisee. Supervisory meetings must last no fewer than 30 minutes and no longer than 2 hours. In no case should more than 80 hours of practice occur without a supervisory meeting. Supervision credit shall not be issued for the time period that this requirement is not met.

F. One-half (48 hours maximum) of the supervision requirement may be met through group supervision, occurring in increments of no more than two hours per group. No more than five supervisees may participate in a supervision group. In some cases, it may be beneficial to increase the number of group supervision hours. To obtain approval for up to 72 hours of group supervision, the supervisor must submit a written request to the Board indicating the rationale for the increase. The Board shall consider the request at a regularly scheduled Board meeting and notify the supervisor of its decision within 30 business days.

G. School social workers shall count hours of postgraduate social work practice and supervision that occurs when they are employed in a social work position.

H. Occasionally, a need may arise for supervision to occur using electronic communication rather than on a face-to-face basis. The Board may consider alternatives to face-to-face supervision if the applicant can demonstrate an undue burden due to hardship, disability or travel time. All situations of remoted supervision must be approved by the Board. To receive approval, the supervisee should submit a written request containing specific details to the Board. The Board shall consider the request at a regularly scheduled Board meeting and notify the supervisor of its decision within 30 business days. If approved, the supervisor and supervisee agree to use secure technology that provided real-time, visual contact among the individuals involved, and adheres to the confidential nature of the supervisory process.

I. The supervisee and supervisor shall keep accurate records of both the dates of supervision sessions and the time spent in supervision, as well as brief information on the content of the supervisory session. Both the supervisor and supervisee will sign for each supervisory session. This information shall be provided on the form entitled Record of Supervision and should be maintained by the supervisee. Upon completion of supervision, this form shall be submitted to the Board office. The Board may also choose to randomly audit the Record of Supervision form to verify that supervision occurred in accordance with §503. If irregularities are found, supervision credit shall be reduced to reflect actual supervised time.

J. The supervisor shall also keep a supervision folder and it shall include the following:

1. Copy of the Supervision Contract;

2. Narrative of all supervisory sessions, including overview of cases discussed, significant decisions made; any ethical concerns; significant problems arising in supervision, and how they were resolved;

3. Copies of memos and correspondence;

4. Copy of Evaluation of Supervision form;

5. Copies of the Record of Supervision.

K. The supervisor has a professional responsibility to honor his/her commitment to supervise responsibly, which includes covering content as indicated in the Supervision Contract, maintaining accurate records, making themselves available to the supervisee for required sessions and other consultations, and submitting forms on a timely basis. Should the supervisor fail to submit forms appropriately, and on a timely basis, the Board reserves the right to withdraw the BACS designation from the supervisor.

L. The supervisee shall provide to the Board office the following documents at the end of the supervisory period:

1. Evaluation of Supervision

2. Record of Supervision

The Board office does not confirm receipt of these forms. These forms will be reviewed once an application for LCSW is filed by the LMSW.

M. An Evaluation of Supervision form shall be submitted to the Board office at the completion of that supervisor’s supervisory period. Sometimes it is necessary for a supervisor to discontinue supervising a LMSW for licensure. When this occurs, no matter what length of time the supervisor actually supervised the supervisee, the supervisor must submit an Evaluation of Supervision form.

N. The Professional Experience Verification Record shall be submitted by the Supervisee to the Board office from each place of employment to verify dates employed and the hours of social work practice completed during the time employed. The Professional Experience Verification Record shall be completed by the employer(s).

O. If the LMSW receives supervision outside of the state of Louisiana, that supervision will be accepted if:

1. the supervisor has completed the authorized forms of the Louisiana State Board of Social Work Examiners; and

2. the supervisor is licensed at the time of supervision at a level substantially equivalent to a LCSW-BACS in the other state and submits the license verification of out of state supervisor form (available from board office).

P. The board’s publication, Supervision for Professional Development and Public Protection: A Guide, provides more information relative to supervision.

Deb’s NOTE: The essential differences aim to clarify who is responsible for turning in what, what happens if it is not turned in, and what is the board’s response time for approving a supervision agreement and plan. I have had some consultations and defense cases that involved supervision issues, so I am glad to see the Board striving to clarify responsibilities that they intend to enforce. (If you want a “marked up” copy of the proposed rule changes, please email me or Emily DeAngelo at the Board). Specifics in the rules always help me defend clinicians because where there is grey area, there is room for Board discretion, which is not always a good thing.

Question/Answer Corner: What’s On Your Mind?

Q: This situation arose in a legal consultation I handled recently.

Clinician was seeing a 14 year old teenager brought to therapy by his mother. Parents are divorced and mom is the parent with whom the kid lives, but legally, the parents share joint custody (as is typical). The boy had reluctantly engaged with the clinician, but now they have a great therapeutic relationship. The teen does not want anything to do with the father who was abusive to his mom and emotionally/verbally abusive to the kid himself. Dad is pushing for visitation time with the teen, who resists.

Dad and his new wife live in Texas and have a therapist there (not sure why); that therapist sent a request for the clinical records of the teenager to Clinician. This was the presenting issue for the consultation: how should Clinician respond? If he were to share the records with the Dad’s therapist, the boy would surely lose trust in the fragile therapeutic relationship and close down entirely. Plus, the release would not help re-establish the Dad-Son relationship, but rather would undermine it due to the boy’s communications about his intense dislike/hatred feelings for his father.

But, does Clinician have an obligation to share records with another therapist?

A: We discussed this dilemma from a clinical as well as legal perspective, which is how I handle consultations. The therapeutic relationship is always paramount, in my mind. So, how to carefully handle this was the question.

You might say, “Well, just deny the records” but then Dad’s attorney would merely subpoena them. As a joint custody parent, Dad has a legal right to the records (any parent with joint custody has a right to medical, educational, etc. information about the children UNLESS the Court has restricted parental rights in some way, perhaps giving exclusive rights to the other parent). I always ask clinicians to obtain from their therapy clients the MOST RECENT COURT ORDER in cases of divorce so that the clinician knows who has what rights as to the minor clients.

I suggested that Clinician disregard the request for records until he met with Dad and Stepmother. I encouraged Clinician to attempt to establish some form of relationship with Dad so that he would understand Clinician’s dilemma about releasing records of a teen therapy client; that is, that if trust is undermined with teens, therapy is impossible.

Clinician had a session with Dad that began with much suspicion, but ended up well. Here are the comments from Clinician after the fact (he agreed for me to share):

When father and stepmother arrived, I presented them with my standard first visit paperwork that included a new form [Clinician had revised it a bit based upon our discussion]. I was pleased, and impressed, that Father signed the form indicating agreement with the policy before the session began. (I presented the same form to the mother who also signed with agreement). In general, once the father determined that a) I will not testify in any custody hearings, and b) will not take sides as to who is the better parent, he and stepmother relaxed and we were able to focus on what they want to accomplish (to forge a better father/son relationship), and that a major goal of treatment will be to help the youth develop the best possible relationship with both parents. The only sticking point, and this proved to be minor, occurred when Father asked when he would be able to have a session with his son. I counseled that his son has many issues, real, imagined, or engineered, to work out affectively before his son will be willing to see him in therapy. I explained this may take some time, and that it would be harmful to force the youth to participate in family sessions before he is ready. He conceded to this explanation. Father also agreed that there needs to be certain rules in place necessary to support the goals of treatment, not the least of which is that both parents will henceforth refrain from making derogatory comments about the other parent within sight and/or earshot of the youth. I addressed the issue of the consent for release for information to the therapist in Texas at the end of the session. Father said he would cancel that request given agreements made during the session.

This illustrates the principle of maintaining (or trying to, at least) an objective position with parents despite problems in the marriage. The crucial position for the clinician is to protect the therapeutic relationship with the minor client.

In this case example, Dad was expecting Clinician to be on Mom’s side, including in the litigation. He thought that Clinician would be drawn into the litigation battle and would testify that the boy should not be seeing Dad. When Clinician was able to establish a neutral position with Dad and his wife, Dad’s insistence on obtaining his son’s records was dropped. He relaxed and was able to learn that Clinician’s primary goal is to his teen client – not, to thwart Dad at Mom’s behest. The therapeutic relationship with the teen client was preserved! Very skillful handling by Clinician!!

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NEW YEAR – NEW GROWTH – NEW WONDER

We humans seem to love rituals, anniversaries, and recurring certain times to celebrate something. Birthdays are a great example. Each year on our special day, we celebrate our arrival in this world. That’s cool. As we age, we may not want to celebrate or call attention to another year added to the many, but even if we are more reserved about our celebration, don’t all of us have some special feelings on our special day?

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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)