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Law and Ethics for Mental Health Professionals

Law and Ethics for Mental Health Professionals

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Law & Ethics social justice Law & Ethics social justice Presentation Transcript

  • Law & Ethics: Social Justice Perspective Janlee Wong, MSW May 2014 1
  • Workshop Goals • Understand legal prescriptions and ethical practice regarding key social work issues • Obtain a social justice/action perspective • Learn about how to teach about these issues 2
  • Workshop Objectives • Understand Social Work and Clinical Social Work Definitions • Review Protective Issues and Mandated Reporting • Learn about Legal Mandates and Clinical Practice • Review Ethical Standards for Professional Conduct • Discuss Licensing issues and the role of a clinical social worker versus that of a psychotherapist • Social Justice issues: child welfare, mental health, disproportionality, health care form, immigration, and political action • Teaching Aids: Knowledge and skills for teaching interns about legal and ethical issues related to child welfare and community mental health 3
  • Caveats • Information is presented, not legal advice • Workshop uses the social worker perspective but many elements are applicable to other professionals • Study the “Statutes And Regulations Relating To The Practice Of: Professional Clinical Counseling, Marriage And Family Therapy, Educational Psychology, Clinical Social Work” • When encountering ethical and practice questions, seek consultation • When encountering legal questions involving possible legal action, contact an attorney • Taking this workshop does not guarantee passage of any license exam 4
  • Words • “Lawyers, unless they are also health/mental health professionals, aren’t in a position to tell you how to practice” • The law is not a guide to practice • They can interpret the law as it befits your individual situation and your specific case (without breaking client confidentiality) • BBS law tells you things you have to do to practice but doesn’t tell you how to practice • Law is not the same as ethics. Why? 5
  • NASW Code of Ethics • The standards (6 areas) 1. Client 2. Colleagues 3. Practice Settings 4. As Professionals 5. To the Profession 6. To Society • Supports: – cultural competence/social diversity – Respect for colleagues – Fighting discrimination as professionals and through social action 6
  • Social Worker Definition (4) • Graduates of schools of social work (in the U.S.A. with either bachelor’s, master’s or doctoral degrees) who use their knowledge and skills to provide social services for clients (who may be individuals, families, groups, communities, organizations, or society in general). Social workers help people increase their capacities for problem solving and coping, and they help them obtain needed resources, facilitate interactions between individuals and between people and their environments, make organizations responsible to people, and influence social policies. Social workers may work directly with clients addressing individual, family and community issues, or they may work at a systems level on regulations and policy development, or as administrators and planners of large social service systems (Barker, 2003). 7
  • MSWs & LCSWs • Historical Perspective – Before licensing (early to mid 20th century) – The need for licensing – The first to license • How licensing evolved – From independent unsupervised practice to minimum requirement for jobs and payers 8
  • CA LCSW Scope of Practice (2) CA Business & Professions Code Section: 4996.9. CLINICAL SOCIAL WORK AND PSYCHOTHERAPY DEFINED The practice of clinical social work is defined as a service in which a special knowledge of social resources, human capabilities, and the part that unconscious motivation plays in determining behavior, is directed at helping people to achieve more adequate, satisfying, and productive social adjustments. The application of social work principles and methods includes, but is not restricted to, counseling and using applied psychotherapy of a nonmedical nature with individuals, families, or groups; providing information and referral services; providing or arranging for the provision of social services; explaining or interpreting the psychosocial aspects in the situations of individuals, families, or groups; helping communities to organize, to provide, or to improve social or health services; doing research related to social work; and the use, application, and integration of the coursework and experience required by Sections 4996.2 and 4996.23. 9
  • Scope of Practice Training in Methods (2) • Clinical psychosocial diagnosis, assessment, and treatment, including psychotherapy or counseling • Client-centered advocacy, consultation, evaluation, and research 10
  • Training in Special Subjects (2) • Alcoholism and other chemical substance • Dependency spousal or partner abuse assessment, detection, and intervention • Human sexuality • Child abuse assessment and reporting 11
  • CA LCSW Scope of Practice (2) • Psychotherapy, within the meaning of this chapter, is the use of psychosocial methods within a professional relationship, to assist the person or persons to achieve a better psychosocial adaptation, to acquire greater human realization of psychosocial potential and adaptation, to modify internal and external conditions which affect individuals, groups, or communities in respect to behavior, emotions, and thinking, in respect to their intrapersonal and interpersonal processes. 12
  • CA MFT Scope of Practice (2) CA Business & Professions Code Section: 4980.02. PRACTICE OF MARRIAGE, FAMILY, AND CHILD COUNSELING; APPLICATION OF PRINCIPLES AND METHODS For the purposes of this chapter, the practice of marriage and family therapy shall mean that service performed with individuals, couples, or groups wherein interpersonal relationships are examined for the purpose of achieving more adequate, satisfying, and productive marriage and family adjustments. This practice includes relationship and premarriage counseling. The application of marriage and family therapy principles and methods includes, but is not limited to, the use of applied psychotherapeutic techniques, to enable individuals to mature and grow within marriage and the family, the provision of explanations and interpretations of the psychosexual and psychosocial aspects of relationships, and the use, application, and integration of the coursework and training required by Sections 4980.37, 4980.40, and 4980.41. 13
  • NASW Clinical Social Work Standards (3) • Clinical Social Work Clinical social work is the professional application of social work theory and methods to the diagnosis, treatment, and prevention of psychosocial dysfunction, disability, or impairment, including emotional, mental, and behavioral disorders (Barker, 2003).10 • Counseling This is a procedure that is often used in clinical social work and other professions to guide individuals, families, couples, groups, and communities by such activities as delineating alternatives, helping to articulate goals, and providing needed information (Barker, 2003). • Person-in-Environment Perspective This orientation views the client as part of an environmental system. It encompasses reciprocal relationships and other influences between an individual, relevant others, and the physical and social environment (Barker, 2003). 14
  • NASW Clinical Social Work Standards (3) • Psychodynamic This word pertains to the cognitive, emotional, and volitional mental processes that consciously and unconsciously motivate an individual’s behavior. These processes are the product of the interplay among a person’s genetic and biological heritage, the sociocultural milieu, past and current realities, perceptual abilities and distortions, and his or her unique experiences and memories (Barker, 2003). • Psychotherapy is a specialized, formal interaction between a social worker or other mental health professional and a client (either individual, couple, family, or group) in which a therapeutic relationship is established to help resolve symptoms of mental disorder, psychosocial stress, relationship problems, and difficulties in coping in the social environment. Types of psychotherapy include, but are not limited to family therapy, group therapy, cognitive–behavioral therapy, psychosocial therapy, and psychodrama (Barker, 2003). • Therapy This is a systematic process designed to remedy, cure, or abate some disease, disability, or problem. This term is often used by social workers as a synonym for individual psychotherapy, conjoint therapy, couples therapy, psychosocial therapy, or group therapy (Barker, 2003). 15
  • MSWs & LCSWs Discussion • How social work has evolved? • Do people need talk therapy? – According to a 2004 Harris poll, 27 percent of adults received mental health treatment within two years of that year, 30 million of whom sought psychotherapy (1) – Howes “…describes therapy as a college course where you’re the only subject. ‘Therapy will give you a place to focus only on you with the support of a trained expert who works to understand and guide you to reach your goals.’” (1) – What would Harry Specht say? 16
  • Harry Specht & Mark Courtney (5) • “Although we are dubious about the efficacy of psychotherapy in general and strongly opposed to its use as the major mode of social work practice, we begin with the assumption that both social work and psychotherapy serve important functions in modern life, although neither is fulfilling these functions very well. We believe that social work has abandoned its missions to help the poor and oppressed and to build communality. Instead, many social workers are devoting their energies and talents to careers in psychotherapy. A significant proportion of social work professionals - about 40 percent- are in private practice, serving middle-class clients.” 17
  • Discussion Psychotherapy in the Context • How is it used in child welfare? – Is it effective? • How is it used in community mental health? – Is it effective? 18
  • Social Justice Aspects Issues • Child Welfare • Mental Health • Disproportionality • Immigration Social Action • Consumer Education • Systems Change • Community Organization • Political Action • Health Care Reform 19 Reference the NASW Code of Ethics
  • Teaching Aids • Case examples • Vignettes • Small Group Exercises • Individual Introspection • Individual Supervision • Group Supervision • Literature Review 20
  • Protective Issues and Mandated Reporting • Also do additional research and develop a good list of resources including but not limited to: – NASW (Consultation, Practice Pointers, Law Notes) – NASW Assurance Services Inc. – NASW Communications for updates and changes – Board of Behavioral Sciences – CA Laws & Regulations 21
  • Protective Mandates • Reporting known or suspected abuse, neglect, or exploitation of: – dependent adults. elderly adults. children and adolescents. • Duty to warn and report when client indicates intent to harm others. • Protective hospitalization for grave disability or danger to self or others. 22
  • Child Abuse Definitions CA Penal Code • 11165.1. As used in this article, "sexual abuse" means sexual assault or sexual exploitation • 11165.2. As used in this article, "neglect" means the negligent treatment or the maltreatment of a child by a person responsible for the child's welfare under circumstances indicating harm or threatened harm to the child's health or welfare. The term includes both acts and omissions on the part of the responsible person. 23
  • Child Abuse Definitions CA Penal Code • 11165.3. As used in this article, "the willful harming or injuring of a child or the endangering of the person or health of a child,“ means a situation in which any person willfully causes or permits any child to suffer, or inflicts thereon, unjustifiable physical pain or mental suffering, or having the care or custody of any child, willfully causes or permits the person or health of the child to be placed in a situation in which his or her person or health is endangered. 24
  • Child Abuse Definitions CA Penal Code • 11165.4. As used in this article, "unlawful corporal punishment or injury" means a situation where any person willfully inflicts upon any child any cruel or inhuman corporal punishment or injury resulting in a traumatic condition. • What about drug use? 25
  • Pos Tox Screen • CA Penal Code 11165.13. For purposes of this article, a positive toxicology screen at the time of the delivery of an infant is not in and of itself a sufficient basis for reporting child abuse or neglect. However, any indication of maternal substance abuse shall lead to an assessment of the needs of the mother and child pursuant to Section 123605 of the Health and Safety Code. If other factors are present that indicate risk to a child, then a report shall be made. However, a report based on risk to a child which relates solely to the inability of the parent to provide the child with regular care due to the parent's substance abuse shall be made only to a county welfare or probation department, and not to a law enforcement agency. 26
  • Reasonable Suspicion (19) • The California Child Abuse and Neglect Reporting Act created a set of state statutes that establish the whys, whens and wheres of reporting child abuse in California. • “Mandated reporters” are required to make a child abuse report anytime, in the scope of performing their professional duties, they discover facts that lead them to know or reasonably suspect a child is a victim of abuse. • Reasonable suspicion of abuse occurs when “it is objectively reasonable for a person to entertain a suspicion, based upon facts that could cause a reasonable person in a like position, drawing when appropriate on his or her training and experience, to suspect child abuse or neglect.” 27
  • Reporting Chain • CA Penal Code 11165.9. Reports of suspected child abuse or neglect shall be made by mandated reporters, or in the case of reports pursuant to Section 11166.05, may be made, to any police department or sheriff's department, not including a school district police or security department, county probation department, if designated by the county to receive mandated reports, or the county welfare department. 28
  • Time Frame • CA Penal Code Section 11166. The mandated reporter shall make an initial report by telephone to the agency immediately or as soon as is practicably possible, and shall prepare and send, fax, or electronically transmit a written follow-up report within 36 hours of receiving the information concerning the incident. The mandated reporter may include with the report any nonprivileged documentary evidence the mandated reporter possesses relating to the incident. 29
  • Failure to Report • CA Penal Code 11165.7(c) A mandated reporter who fails to report an incident of known or reasonably suspected child abuse or neglect as required by this section is guilty of a misdemeanor punishable by up to six months confinement in a county jail or by a fine of one thousand dollars ($1,000) or by both that imprisonment and fine. If a mandated reporter intentionally conceals his or her failure to report an incident known by the mandated reporter to be abuse or severe neglect under this section, the failure to report is a continuing offense until an agency specified in Section 11165.9 discovers the offense. 30
  • Clergy Rules • CA Penal Code 11165.7. A clergy member, as specified in subdivision (d) of Section 11166. As used in this article, "clergy member" means a priest, minister, rabbi, religious practitioner, or similar functionary of a church, temple, or recognized denomination or organization. (33) Any custodian of records of a clergy member, as specified in this section and subdivision (d) of Section 11166. 31
  • Clergy Rules • CA Penal Code Section 11166 (d) (1) A clergy member who acquires knowledge or a reasonable suspicion of child abuse or neglect during a penitential communication is not subject to subdivision (a). For the purposes of this subdivision, "penitential communication" means a communication, intended to be in confidence, including, but not limited to, a sacramental confession, made to a clergy member who, in the course of the discipline or practice of his or her church, denomination, or organization, is authorized or accustomed to hear those communications, and under the discipline, tenets, customs, or practices of his or her church, denomination, or organization, has a duty to keep those communications secret. 32
  • Sandusky Rule (8) • CA Penal Code 11165.7 (44) Any athletic coach, including, but not limited to, an assistant coach or a graduate assistant involved in coaching, at public or private postsecondary institutions. • “as of January 1, 2013, university employees whose duties involve regular contact with children, or who supervise employees whose duties involve regular contact with children. For purposes of this policy, all CSU employees are designated mandated reporters. Volunteers are not mandated reporters. As designated mandated reporters, all employees are required to report suspected child abuse or neglect. “ 33
  • Receiving Reports • Agencies that are required to receive reports of suspected child abuse or neglect may not refuse to accept a report of suspected child abuse or neglect from a mandated reporter or another person unless otherwise authorized pursuant to this section, and shall maintain a record of all reports received. 34
  • Cuff v. Grossmont (6) • High School Counselor Not Immune From Liability For Improper Disclosure of a Child Abuse Report • The Court of Appeal has held that a school counselor was not immune from liability pursuant to the Child Abuse and Neglect Reporting Act for her unauthorized release of her report of suspected child abuse that was prepared pursuant to that statute. 35
  • Who has access to reports? • Consider PC 11167.5, which dictates that reports of child abuse or neglect are confidential documents and may only be released as provided in that and related penal code sections. Any system maintaining those documents, electronically or otherwise, must ensure that only those entitled to view the report have access. This access may be significantly differ than others in the agency who are permitted access to portions of other electronic health records generally (for example, a tech reviewing the HER to analyze some lab results shouldn’t have access to these reports). The provider/agency should discuss that issue with their legal department to determine whether the system that they’ve established complies with the Penal code requirements for maintaining the confidentiality of the reports. Greg Rose, Deputy Director, Childrens Bureau, CA Dept. of Social Services. 5/2/14 • Persons or Entities Allowed Access to Records Penal Code §§ 11167.5; 11170; 11170.5 36
  • Adolescent Health Working Group Chart on Reporting (19) 37
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  • Elder & Dependent Adult Abuse Definitions (7) CA Welfare and Institutions Code section 15610.07 • Abuse of an elder or a dependent adult is abuse of: – Someone 65 years old or older; or – A dependent adult, who is someone between 18 and 64 that has certain mental or physical disabilities that keep him or her from being able to do normal activities or protect himself or herself. • The law says elder or dependent adult abuse is: – Physical abuse, neglect, financial abuse, abandonment, isolation, abduction (taking the person out of the state against his or her will), or other behavior that causes physical harm, pain, or mental suffering; OR – Deprivation by a caregiver of things or services that the elder or dependent adult needs to avoid physical harm or mental suffering. 39
  • CA Welfare and Institutions Code Section 15630 (b) (1) • shall report the known or suspected instance of abuse by telephone or through a confidential Internet reporting tool, as authorized by Section 15658, immediately or as soon as practicably possible. If reported by telephone, a written report shall be sent, or an Internet report shall be made through the confidential Internet reporting tool established in Section 15658, within two working days. 40
  • Reporting Locations CA Welfare and Institutions Code section 15610.07 • (A) If the suspected or alleged abuse is physical abuse, as defined in Section 15610.63, and the abuse occurred in a long-term care facility, except a state mental health hospital or a state developmental center, the following shall occur: • (i) If the suspected abuse results in serious bodily injury, a telephone report shall be made to the local law enforcement agency immediately, but also no later than within two hours of the mandated reporter observing, obtaining knowledge of, or suspecting the physical abuse, and a written report shall be made to the local ombudsman, the corresponding licensing agency, and the local law enforcement agency within two hours of the mandated reporter observing, obtaining knowledge of, or suspecting the physical abuse. • (ii) If the suspected abuse does not result in serious bodily injury, a telephone report shall be made to the local law enforcement agency within 24 hours of the mandated reporter observing, obtaining knowledge of, or suspecting the physical abuse, and a written report shall be made to the local ombudsman, the corresponding licensing agency, and the local law enforcement agency within 24 hours of the mandated reporter observing, obtaining knowledge of, or suspecting the physical abuse. • (iii) When the suspected abuse is allegedly caused by a resident with a physician’s diagnosis of dementia, and there is no serious bodily injury, as reasonably determined by the mandated reporter, drawing upon his or her training or experience, the reporter shall report to the local ombudsman or law enforcement agency by telephone, immediately or as soon as practicably possible, and by written report, within 24 hours. 41
  • Who are Mandated Reporters? • Social workers (elaborate) • Anonymous and Voluntary Reporting 42
  • Domestic Violence • Are social workers mandated reporters of domestic violence? (22) • Why or why not? 43
  • Domestic Violence Reporters • CA Penal Code 11160. (a) Any health practitioner employed in a health facility, clinic, physician's office, local or state public health department, or a clinic or other type of facility operated by a local or state public health department who, in his or her professional capacity or within the scope of his or her employment, provides medical services for a physical condition to a patient whom he or she knows or reasonably suspects is a person described as follows, shall immediately make a report in accordance with subdivision (b): 44
  • Predicting Violence Tarasoff, Ewing • What are possible risk thresholds to breaking confidentiality, mandatory reports? 45
  • Duty to Protect (Tarasoff) • CA Civil Code 43.92. • (a) There shall be no monetary liability on the part of, and no cause of action shall arise against, any person who is a psychotherapist as defined in Section 1010 of the Evidence Code in failing to protect from a patient’s threatened violent behavior or failing to predict and protect from a patient’s violent behavior except if the patient has communicated to the psychotherapist a serious threat of physical violence against a reasonably identifiable victim or victims. • (b) There shall be no monetary liability on the part of, and no cause of action shall arise against, a psychotherapist who, under the limited circumstances specified in subdivision (a), discharges his or her duty to protect by making reasonable efforts to communicate the threat to the victim or victims and to a law enforcement agency. 46
  • Ewing v. Goldstein • “When the communication of the serious threat of physical violence is received by the therapist from a member of the patient’s immediate family and is shared for the purpose of facilitating and furthering the patient’s treatment, the fact that the family member is not technically a ‘patient’ is not crucial to the statute’s purpose.” (Ewing v. Goldstein (2004) 120 Cal.App.4th 807, 817 [15 Cal.Rptr.3d 864].) 47
  • Calderon v. Glick • “Section 43.92 strikes a reasonable balance in that it does not compel the therapist to predict the dangerousness of a patient. Instead, it requires the therapist to attempt to protect a victim under limited circumstances, even though the therapist's disclosure of a patient confidence will potentially disrupt or destroy the patient's trust in the therapist. However, the requirement is imposed upon the therapist only after he or she determines that the patient has made a credible threat of serious physical violence against a person.” (Calderon v. Glick (2005) 131 Cal.App.4th 224, 231 [31 Cal.Rptr.3d 707].) 48
  • Violence/Harm, Predicting Violence, Risk Assessment • Is HIV/AIDs status an exception to confidentiality? A mandatory report? • Is deliberate exposure to a person by a HIV infected person a crime? (21) • Is past criminal activity or violence (other than to children, elders, or dependent adults) an exception to confidentiality? A mandatory report? 49
  • 5150 in CA • CALIFORNIA WELFARE AND INSTITUTIONS CODE, SECTION 5150, second paragraph, "... an application in writing stating the circumstances under which the person's condition was called to the attention of the officer, member of the attending staff, or professional person, and stating that the officer, member of the attending staff, or professional person has probable cause to believe that the person is, as a result of mental disorder, a danger to others, or to himself or herself, or gravely disabled." 50
  • LPS Considerations (10) • Danger to others: This term is not defined by statute or regulation, but can be manifested by words or actions indicating a serious intent to cause bodily harm to another person due to a mental disorder. If the dangerous to others finding is based on the person’s threats rather than acts, the evaluator must believe it is likely that the person will carry out the threats. • Danger to self: This term is not defined by statute or regulation, but can be manifested by threats or actions indicating the intent to commit suicide or inflict serious bodily harm on oneself, or actions which place the person in serious physical jeopardy, if these actions are due to a mental disorder. • Gravely Disabled-Adult: A condition in which a person, as a result of a mental disorder (rather than a chosen lifestyle or lack of funds) is unable to provide for his or her basic needs for food, clothing or shelter (WIC 5008). 51
  • More LPS • The threat to harm oneself may be through neglect or inability to care for oneself. • Courts have ruled that if a person can survive safely in freedom with the help of willing and responsible family members, friends or third parties, then he or she is not considered gravely disabled. • Gravely Disabled-Minor: As a result of a mental disorder, a minor (person 17 years old or younger) is unable to utilize the elements of life, which are essential to health, safety and development, including food, clothing, or shelter, even though provided to the minor by others (WIC 5585.25). • Probable Cause: is the legal standard we use to determine whether or not a person meets the criteria for a hold due to a mental disorder. When enacted in 1967, section 5150 of the LPS Act required only “reasonable cause "for detention. This section was amended in 1975 to require probable cause” for detention. 52
  • Social Justice Aspects Issues • Child Welfare • Mental Health • Disproportionality • Immigration Social Action • Consumer Education • Systems Change • Community Organization • Political Action • Health Care Reform 53 Reference the NASW Code of Ethics
  • Teaching Aids • Case examples • Vignettes • Small Group Exercises • Individual Introspection • Individual Supervision • Group Supervision • Literature Review 54
  • BREAK 55
  • Legal Mandates Clinical Practice • Also do additional research and develop a good list of resources including but not limited to: – NASW (Consultation, Practice Pointers, Law Notes) – NASW Assurance Services Inc. – NASW Communications for updates and changes – Board of Behavioral Sciences – CA Laws & Regulations 56
  • PROFESSIONAL CONDUCT INFORMATION • RECORDS • CONTROL OF INFORMATION • CONFIDENTIALITY • PRIVILEGE • CONSENT • RELEASE • SEXUAL CONDUCT • OTHER 57
  • RECORDS Definitions • What are records? • Who owns the records? • Who must keep Records? • How to Keep Records (security) 58
  • Must Keep Records (11) • Maintaining patient records is the law. All licensees and registrants of the Board must “keep records consistent with sound clinical judgment, the standards of the profession, and the nature of the services being rendered.” • Failure to do so may result in disciplinary action against a person’s license or registration. Failure to maintain records is deigned as unprofessional conduct in sections 4982(v), 4992.3 (s), and 4989.54(j) of the Business and Professions Code. 59
  • Liability (11) • Keeping accurate records benefits mental health care providers. If a licensee or registrant were ever to come under investigation, records could become a key source of information. Accurate, concise, record keeping may help to prove compliance with the law in instances of consumer complaints. 60
  • How Long? (11) • While the law requires mental health professionals within the Board’s jurisdiction to keep records, the law does not specify for how long or in what format to keep these records. he law states generally that records must be kept “consistent with sound clinical judgment, the standards of the profession and the nature of the services being rendered.” his may cause concern among licensees and registrants. For advice on the format and duration of record keeping, the Board encourages licensees and registrants to contact their professional association or an attorney of their choice for guidance. 61
  • Client Access (11) • Adult patients, minor patients authorized by law to consent to medical treatment, and patient representatives have the right to request any portion of the practitioner’s records on the patient. California Health and Safety Code section 123110 provides timelines on providing different types of records to patients and any reasonable clerical costs that may be charged for providing the records. This section of law applies to health care providers, including the Board’s licensees and registrants. Key timelines for compliance written into this law include: • Permitting inspection within five working days from receipt of written request • Transmitting copies of records within 15 days from receipt of written request • Transmitting copies, at no charge, of the relevant portion of a patient’s records to support an appeal regarding eligibility for a public benefit program within 30 days from receipt of written request 62
  • Access to Records • CA Health and Safety Code §123110. INSPECTION AND COPYING; VERIFICATION OF IDENTITY; RETENTION AND QUALITY OF RECORDS; LIABILITY FOR DISCLOSURE; VIOLATIONS; PENALTIES • (a) Notwithstanding Section 5328 of the Welfare and Institutions Code, and except as provided in Sections 123115 and 123120, any adult patient of a health care provider, any minor patient authorized by law to consent to medical treatment, and any patient representative shall be entitled to inspect patient records upon presenting to the health care provider a written request for those records and upon payment of reasonable clerical costs incurred in locating and making the records available. However, a patient who is a minor shall be entitled to inspect patient records pertaining only to health care of a type for which the minor is lawfully authorized to consent. A health care provider shall permit this inspection during business hours within five working days after receipt of the written request. The inspection shall be conducted by • the patient or patient's representative requesting the inspection, who may be accompanied by one other person of his or her choosing. 63
  • NASW Code of Ethics • 1.08 Access to Records • (a) Social workers should provide clients with reasonable access to records concerning the clients. Social workers who are concerned that clients’ access to their records could cause serious misunderstanding or harm to the client should provide assistance in interpreting the records and consultation with the client regarding the records. Social workers should limit clients’ access to their records, or portions of their records, only in exceptional circumstances when there is compelling evidence that such access would cause serious harm to the client. Both clients’ requests and the rationale for withholding some or all of the record should be documented in clients’ files. • (b) When providing clients with access to their records, social workers should take steps to protect the confidentiality of other individuals identified or discussed in such records. 64
  • A Summary Rather Than • CA Welfare & Institutions Code 123130. (a) A health care provider may prepare a summary of the record, according to the requirements of this section, for inspection and copying by a patient. If the health care provider chooses to prepare a summary of the record rather than allowing access to the entire record, he or she shall make the summary of the record available to the patient within 10 working days from the date of the patient's request. However, if more time is needed because the record is of extraordinary length or because the patient was discharged from a licensed health facility within the last 10 days, the health care provider shall notify the patient of this fact and the date that the summary will be completed, but in no case shall more than 30 days elapse between the request by the patient and the delivery of the summary. In preparing the summary of the record the health care provider shall not be obligated to include information that is not contained in the original record. 65
  • Summary Content • (1) Chief complaint or complaints including pertinent history. (2) Findings from consultations and referrals to other health care providers. (3) Diagnosis, where determined. (4) Treatment plan and regimen including medications prescribed. (5) Progress of the treatment. (6) Prognosis including significant continuing problems or conditions. (7) Pertinent reports of diagnostic procedures and tests and all discharge summaries. (8) Objective findings from the most recent physical examination, such as blood pressure, weight, and actual values from routine laboratory tests. 66
  • Federal Law (12) Health Information Portability and Privacy Act • HIPAA Privacy Rule. HIPAA is a federal law that 1) protects the privacy of patients’ medical records and other health information provided to health plans, doctors, hospitals and other health care providers; 2) provides patients with access to their medical records; and 3) allows patients to determine how their personal health information is used and disclosed. 67
  • HIPAA Medical Privacy Rule (13) • The HIPAA medical privacy regulations (Privacy Rule) affect almost every segment of the health care industry, including professional social workers. The Privacy Rule sets out specific patient/client rights as well as providers’ responsibilities to maintain records according to federal standards. Social workers will need to develop written privacy policies, provide a notice of privacy practices to all clients and use specific forms for authorizations to release client records. In addition, special provisions pertain to “psychotherapy notes,” as they are defined in the Privacy Rule. Social workers will need to be informed about the new requirements and train their staff. 68
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  • Personal Notes Psychotherapy Notes • Notes that belong to the practitioner, not the client – Info from a 3rd party, not written in the client’s record – Info that might be injurious to the client – Info that is speculative, hunches, reminders 71
  • Confidentiality (14) NASW Code of Ethics • (c) Social workers should protect the confidentiality of all information obtained in the course of professional service, except for compelling professional reasons. The general expectation that social workers will keep information confidential does not apply when disclosure is necessary to prevent serious, foreseeable, and imminent harm to a client or other identifiable person. In all instances, social workers should disclose the least amount of confidential information necessary to achieve the desired purpose; only information that is directly relevant to the purpose for which the disclosure is made should be revealed. • (d) Social workers should inform clients, to the extent possible, about the disclosure of confidential information and the potential consequences, when feasible before the disclosure is made. This applies whether social workers disclose confidential information on the basis of a legal requirement or client consent. • (e) Social workers should discuss with clients and other interested parties the nature of confidentiality and limitations of clients’ right to confidentiality. Social workers should review with clients circumstances where confidential information may be requested and where disclosure of confidential information may be legally required. This discussion should occur as soon as possible in the social worker- client relationship and as needed throughout the course of the relationship. 72
  • Confidentiality (15) California Medical Information Act • CMIA prohibits a health care provider, health care service plan, or contractor from disclosing medical information regarding a patient, enrollee, or subscriber without first obtaining an authorization, except as specified. • CMIA requires a health care provider, health care service plan, pharmaceutical company, or contractor who creates, maintains, preserves, stores, abandons, destroys, or disposes of medical records to do so in a manner that preserves the confidentiality of the information contained within those records. • CMIA defines “medical information” to mean any individually identifiable information, in electronic or physical form, in possession of or derived from a provider of health care, health care service plan, pharmaceutical company, or contractor regarding a patient’s medical history, mental or physical condition, or treatment. “Individually identifiable” means that the medical information includes or contains any element of personal identifying information sufficient to allow identification of the individual, such as the patient’s name, address, electronic mail address, telephone number, or social security number, or other information that reveals the individual’s identity. • - See more at: http://consumercal.org/confidentiality-of-medical-information-act- cmia/#sthash.FD5ZaWpb.dpuf 73
  • Privilege Privileged Communications • Information used in the assessment, evaluation, treatment of clients is confidential and therefore “privileged” • Communication between the practitioner and the client can be “privileged” US Supreme Court Decision Jaffe v. Redmond 518 U.S. 1 (1996) • Who owns the information in a client record? • The owner is the holder of privilege • The practitioner may possess the physical or electronic records of a client but is not the holder, but is the protector of privilege • Communication between attorney and client is “privileged” 74
  • Releases Written Releases • The privilege holder (client) may “release” his or her information to anyone they wish to • The practitioner shall honor that the privilege holder’s request to release information with some exceptions • Exceptions: Information if released could lead to harm to the client; personal notes belonging to the practitioner 75
  • Written Releases • For documentation and record keeping purposes, all releases of information should be documented and a written release signed by the holder should be obtained and retained. • The release should be specific: To whom the information is released, what information and what amount is to be released, and the time frame of the release 76
  • Other Exceptions (16) • Subpoenas: – Issued by courts and attorneys (considered officers of the courts) – Upon receipt, if the client hasn’t provided a written release, the provider must obtain a release or ask the issuer of the subpoena to withdraw it (without confirmed the identity of the client) – Court action may be need to reject a subpoena and an attorney should be retained – check with malpractice insurance company 77
  • Other Exceptions to Privilege CA Evidence Code • 1016: When client presents their emotional condition as an issue in court • 1018: Psychiatric eval in deterring criminal defendant’s state of mind • Using mental health services to commit or plan a crime, a tort, or to escape detection or apprehension after committing a crime • 1020: When suing a mental health professional • 1024: Danger to self or others 78
  • The USA Patriot Act (20) Social workers and other health care professionals are alarmed that under Section 215 of the PATRIOT Act, clients' private psychotherapy records could be disclosed to government officials without notice or an opportunity for the clients to consent. Social workers recognize that confidentiality is the cornerstone of mental health treatment, as codified in state and federal statutes and affirmed in Supreme Court and other federal court decisions, and set out in detail in the NASW Code of Ethics , Standard 1.7. NASW, in its updated policy statement, Confidentiality and Information Utilization (NASW, 2003, p. 58), sets out recommendations regarding disclosure of client records. Especially pertinent to Section 215 of the PATRIOT Act is the recommendation to enact legislation, regulations, and policies to ensure that … “Information obtained about individuals for one purpose must not be used or made available for other purposes without the individual's explicit informed consent.” Another relevant NASW recommendation states: Information about an individual client should not be shared with any other individual or agency without the individual's authorized informed consent unless state laws require the release of information, and in that case, the client will be informed about the legal process and what is to be released (NASW, 203, p. 59). The PATRIOT Act's automatic gag order directly conflicts with the NASW policy regarding client notice and consent. 79
  • Record Security • Paper files • Electronic files • Electronic transmission of data 80
  • Social Justice Aspects Issues • Child Welfare • Mental Health • Disproportionality • Immigration Social Action • Consumer Education • Systems Change • Community Organization • Political Action • Health Care Reform 81 Reference the NASW Code of Ethics
  • Teaching Aids • Case examples • Vignettes • Small Group Exercises • Individual Introspection • Individual Supervision • Group Supervision • Literature Review 82
  • BREAK 83
  • CONSENT Informed Consent • When an adult seeks treatment, it is assumed that by seeking treatment, the adult is consenting to their own treatment. • This should be evidenced by information that is provided to the adult and their signed agreement • This includes but is not limited to: Terms of treatment, privacy considerations including exceptions, terms of payment, qualifications of the provider, client/patient rights 84
  • CONSENT Informed Consent • Exceptions for adults (partial list): – Any adult who is involuntarily held (except electro shock) – Any adult who is conserved (court ordered) – Any adult who is in an emergency situation (life or death) and is not cognitive, and does not have life sustaining directives – Any adult who poses a risk to the health and safety of others in an emergency situation 85
  • CALIFORNIA FAMILY CODE §6924. MENTAL HEALTH TREATMENT OF MINORS • (b) A minor who is 12 years of age or older may consent to mental health treatment or counseling on an outpatient basis, or to residential shelter services, if both of the following requirements are satisfied: • (1) The minor, in the opinion of the attending professional person, is mature enough to participate intelligently in the outpatient services or residential shelter services. • (2) The minor (A) would present a danger of serious physical or mental harm to self or to others without the mental health treatment or counseling or residential shelter services, or (B) is the alleged victim of incest or child abuse. 86
  • CALIFORNIA FAMILY CODE §6924. MENTAL HEALTH TREATMENT OF MINORS (17) • (d) The mental health treatment or counseling of a minor authorized by this section shall include involvement of the minor’s parent or guardian unless, in the opinion of the professional person who is treating or counseling the minor, the involvement would be inappropriate. The professional person who is treating or counseling the minor shall state in the client record whether and when the person attempted to contact the minor’s parent or guardian, and whether the attempt to contact was successful or unsuccessful, or the reason why, in the professional person’s opinion, it would be inappropriate to contact the minor’s parent or guardian. 87
  • CALIFORNIA FAMILY CODE §6924. MENTAL HEALTH TREATMENT OF MINORS • (e) The minor’s parents or guardian are not liable for payment for mental health treatment or counseling services provided pursuant to this section unless the parent or guardian participates in the mental health treatment or counseling, and then only for services rendered with the participation of the parent or guardian. The minor’s parents or guardian are not liable for payment for any residential shelter services provided pursuant to this section unless the parent or guardian consented to the provision of those services. • (f) This section does not authorize a minor to receive convulsive therapy or psychosurgery as defined in subdivisions (f) and (g) of Section 5325 of the Welfare and Institutions Code, or psychotropic drugs without the consent of the minor’s parent or guardian. 88
  • Adolescent Health Working Group Chart on Minors Consent (19) 89
  • 90
  • Social Justice Aspects Issues • Child Welfare • Mental Health • Disproportionality • Immigration Social Action • Consumer Education • Systems Change • Community Organization • Political Action • Health Care Reform 91 Reference the NASW Code of Ethics
  • BREAK 92
  • Mental Health Services Act (MHSA) (17) • Includes in the definition of mental health services: – Prevention, early intervention and wellness – Community services and supports – Recovery oriented services or “social rehabilitation” – Innovation, best practices – employment, vocational training, education, and social and community activities. • Organizes public mental health services around community planning, stakeholder involvement, local government delivery and oversight 93
  • MHSA • Funds raised by a 1% surtax on incomes over $1,000,000. • 51% of the funds must be spent on children • 20% on Prevention and Early intervention • Funds cannot supplant existing services (as of implementation – 2004-2005) • Workforce, Capital projects and investments included 94
  • MHSA • Funds suicide prevention education efforts by the California Mental Health Services Authority • Efforts to reduce racial and ethnic disparities 95
  • Social Justice Aspects Issues • Child Welfare • Mental Health • Disproportionality • Immigration Social Action • Consumer Education • Systems Change • Community Organization • Political Action • Health Care Reform 96 Reference the NASW Code of Ethics
  • Teaching Aids • Case examples • Vignettes • Small Group Exercises • Individual Introspection • Individual Supervision • Group Supervision • Literature Review 97
  • Telehealth/OnlineTherapy • "Synchronous interaction" means a real-time interaction between a patient and a health care provider located at a distant site • Psychotherapy within scope of license • Must be licensed • Verbal consent • Information on confidentiality and privacy 98
  • Supervision CA Business & Professions Code §4996.18 • (d) All applicants and registrants shall be at all times under the supervision of a supervisor who shall be responsible for ensuring that the extent, kind, and quality of counseling performed is consistent with the training and experience of the person being supervised, and who shall be responsible to the board for compliance with all laws, rules, and regulations governing the practice of clinical social work. 99
  • Online Supervision • Qualified licensed professionals may supervise registrants online if they are in the following settings: 100
  • Unprofessional Conduct CA Code of Regulations §1881 • The following is a summary for discussion purposes for social workers (there are other sections for other professionals) • The detailed regulation should be the actual source of information • If there is a question regarding one’s conduct and one’s own culpability, an attorney should be consulted 101
  • • Misrepresentation, impersonates, aids unlicensed • Harms a client, dishonest, corrupt, fraudulent • Sex with a client • Incompetent, permits incompetence • Breaks confidentiality • Fails to disclose fees, mis-advertising • Misapplies testing or a device • Gross negligence • Pays or accepts compensation or consideration for or for soliciting referrals 102
  • • Payment must be for services delivered • No fee for collaboration unless pre-disclosed • Mandated reporting failure • 15 day window for providing records to Board • Failure to cooperate in investigation (ex. 5th) • Failure to report to the Board any conviction, disciplinary action, 30 days for documentation • Failure to comply with court order or subpoena for records for the Board 103
  • Sexual Misconduct • Therapy Never Includes Sex • Two year statute (after therapy ends) of limitations on enforcement • Ethical standards have no statute of limitations 104
  • As used in Section 4992.3 of the code, unprofessional conduct includes, but is not limited to: (a) Misrepresents the type or status of license held by such person or otherwise misrepresents or permits the misrepresentation of his or her professional qualifications or affiliations. (b) Impersonates a licensee or who allows another person to use his or her license. (c) Aids or abets an unlicensed person to engage in conduct requiring a license. (d) Intentionally or recklessly causes physical or emotional harm to a client. (e) Commits any dishonest, corrupt, or fraudulent act which is substantially related to the qualifications, functions or duties of a licensee. (f) Has sexual relations with a client, or who solicits sexual relations with a client, or who commits an act of sexual abuse, or who commits an act of sexual misconduct, or who commits an act punishable as a sexual related crime if such act or solicitation is substantially related to the qualifications, functions or duties of a Licensed Clinical Social Worker. (g) Performs or holds himself or herself out as able to perform professional services beyond his or her field or fields of competence as established by his or her education, training and/or experience. (h) Permits a person under his or her supervision or control to perform or permits such person to hold himself or herself out as competent to perform professional services beyond the level of education, training and/or experience of that person. (i) Fails to maintain the confidentiality, except as otherwise required or permitted by law, of all information that has been received from a client during the course of treatment and all information about the client which is obtained from tests or other such means. (j) Prior to the commencement of treatment, fails to disclose to the client, or prospective client, the fee to be charged for the professional services, or the basis upon which such fee will be computed. (k) Advertises in a manner which is false or misleading. (l) Reproduces or describes in public or in publications subject to general public distribution, any psychological test or other assessment device, the value of which depends in whole or in part on the naivete of the subject, in ways that might invalidate such test or device. The licensee shall limit access to such test or device to persons with professional interest who are expected to safeguard their use. (m) Commits an act or omission which falls sufficiently below that standard of conduct of the profession as to constitute an act of gross negligence. (n) Pays, accepts or solicits any consideration, compensation or remuneration for the referral of professional clients. All consideration, compensation or remuneration must be in relation to professional counseling services actually provided by the licensee. Nothing in this section shall prevent collaboration among two or more licensees in a case or cases. However, no fee shall be charged for such collaboration except when disclosure of such fee is made in compliance with subparagraph (j) above. (o) Fails to comply with the child abuse reporting requirements of Penal Code Section 11166. 105
  • (p) Fails to comply with the elder and dependent adult abuse reporting requirements of Welfare and Institution Code Section 15630. (q) Failure to provide to the board, as authorized by law, copies of records within 15 days of receipt of the request or within the time specified in the request, whichever is later, unless the licensee or registrant is unable to provide the records within this time period for good cause. Good cause includes, but is not limited to, physical inability to access the records in the time allowed due to illness or travel, or inability to obtain the necessary patient release authorization, if applicable. This subsection shall not apply to a licensee or registrant who does not have access to, and control over, medical records. (r) Failure to cooperate and participate in any board investigation pending against the licensee or registrant. This subsection shall not be construed to deprive a licensee, registrant, or a consumer of any rights or privilege guaranteed by the Fifth Amendment to the Constitution of the United States, or any other constitutional or statutory rights or privileges. This subsection shall not be construed to require a licensee or registrant to cooperate with a request that would require the licensee, registrant, or a consumer to waive any constitutional or statutory rights or privilege or to comply with a request for information or other matters within an unreasonable period of time in light of the time constraints of the licensee’s or registrant’s practice. Any exercise by a licensee or registrant of any constitutional or statutory rights or privilege shall not be used against the licensee or registrant in a regulatory or disciplinary proceeding against the licensee or registrant. (s) Failure to report to the board within 30 days any of the following: (1) A conviction of any felony or misdemeanor, which is not subject to Health & Safety Code sections 11357 (b), (c), (d), (e), or 11360 (b). A conviction includes any verdict of guilty, or plea of guilty or no contest. (2) Any disciplinary action taken by another licensing entity or authority of this state or of another state or an agency of the federal government or the United States military. (t) Failure to provide, within 30 days of a request, documentation to the Board regarding the arrest of the licensee or registrant, except for records of convictions or arrests protected under Penal Code section 1000.4, or Health and Safety Code sections 11361.5 and 11361.7. (u) Failure or refusal to comply with a court order, issued in the enforcement of a subpoena, mandating the release of records to the board. Note: Authority cited: Section4990.20, Business and Professions Code. Reference: Sections 4990.20, 4992.3, 4992.33 and 4996.11, Business and Professions Code; Sections 1000.4 and 11166, Penal Code, Sections 11357, 11360, 11361.5 and 1 106
  • Fees CA Code of Regulations §651 • (b) A false, fraudulent, misleading, or deceptive statement, claim, or image includes a statement or claim that does any of the following: • Relates to fees, other than a standard consultation fee or a range of fees for specific types of services, without fully and specifically disclosing all variables and other material factors. 107
  • §1811. ADVERTISING CA Code of Regulations • (a) All persons or referral services regulated by the board who advertise their services shall include all of the following information in any advertisement: • (1) The full name of the licensee, registrant, or registered referral service as filed with the board. • (2) The complete title of the license or registration held or an acceptable abbreviation, as follows: • (A) Licensed Marriage and Family Therapist, or MFT, or LMFT. • (B) Licensed Educational Psychologist or LEP. • (C) Licensed Clinical Social Worker or LCSW. • (D) Marriage and Family Therapist Registered Intern or MFT Registered Intern. The abbreviation “MFTI” shall not be used in an advertisement unless the title “marriage and family therapist registered intern” appears in the advertisement. • (E) Registered Associate Clinical Social Worker or Registered Associate CSW. • (F) Registered MFT Referral Service. • (G) Licensed Professional Clinical Counselor or LPCC. • (H) Professional Clinical Counselor Registered Intern or PCC Registered Intern. • The abbreviation “PCCI” shall not be used in an advertisement unless the title “professional clinical counselor registered intern” appears in the advertisement. 108
  • Advertising • (3) The license or registration number. • (b) Registrants must include the name of his or her employer in an advertisement, or if not employed, the name of the entity for which he or she volunteers. • (c) Licensees may use the words “psychotherapy” or “psychotherapist” in an advertisement provided that all the applicable requirements of subsection (a) are met. • (d) It is permissible for a person to include academic credentials in advertising as long as the degree is earned, and the representations and statements regarding that degree are true and not misleading and are in compliance with Section 651 of the Code. For purposes of this subdivision, “earned” shall not mean an honorary or other degree conferred without actual study in the educational field. • (e) The board may issue citations and fines containing a fine and an order of abatement for any violation of Section 651 of the Code. • (f) For the purposes of this section, “acceptable abbreviation” means the abbreviation listed in subsection (a)(2) of this Section. • Note: Authority cited: Sections 129.5, 137, 650.4, 651, 4980.60 and 109
  • Samples Francis Jay, M.S.W., LCSW LCS 54321 Address Phone Fax Email Francis Jay Licensed Clinical Social Worker License No. LCS 54321 Address Phone Fax Email Jackie Smith Registered Associate Clinical Social Worker ASW 11111 Agency Address Phone Fax Email Jackie Smith, M.S.W., Ph.D. Registered Associate CSW Agency ASW 11111 Address Phone Fax Email 110
  • NASW Code of Ethics • The standards (6 areas) 1. Client 2. Colleagues 3. Practice Settings 4. As Professionals 5. To the Profession 6. To Society • Supports: – cultural competence/social diversity – Respect for colleagues – Fighting discrimination as professionals and through social action 111
  • ETHICS • Starts with the art of knowing oneself • Self is the key to knowing: – One’s values (how you practice) – Competence (what you can do and can’t) – Conflicts of interest, boundaries, dual relations – Cultural humility (diversity) • Supervisors can also use this paradigm in providing supervision 112
  • Ethics, Knowledge, Skills • This workshop isn’t about how much you know in case something happens, it’s about how much you know so you’re better able to help your client • It isn’t about what you should be doing to cover all the bases or check the list, it’s about what you do to better help your client • THE TOP VALUE: Best interest of your client 113
  • Self and Power • Is the social worker in an equal relationship with the client? Should it be equal? • “Social workers must be willing to take a proactive approach to considering, rethinking and changing power relationships in the interests of service users.” (18) Roger Smith • Information and knowledge is one of the first steps to empowerment 114
  • Knowledge Empowerment • Information about: – Therapist qualifications, credentials, license, experience – Therapeutic process and services – Informed decision making – Confidentiality and exceptions – Office policies, emergency procedures, contact information – Fees, avoiding money/consideration for referrals 115
  • Self and Practice • Know thyself. Own value system. • Personal issues that interfere with practice and require consultation or referral • Own physical or cognitive impairments that might affect service provision • Competence, additional training, consultation, referral • Business, personal, professional, social relationships that might conflict 116
  • Practice • Client goals, engagement • Self determination, (participation) • Confidentiality and its limits • Countertransference issues • Boundaries, dual relationships, sex • Interrupting and terminating services 117
  • Self and Diversity • Race, culture, country of origin, gender, age, religion, socio-economic status, marital status, sexual orientation, level of ability – Non-discrimination – Ability to form relationship – Interplay with treatment – Community and environmental implications • Cultural Humility 118
  • Social Justice Aspects Issues • Child Welfare • Mental Health • Disproportionality • Immigration Social Action • Consumer Education • Systems Change • Community Organization • Political Action • Health Care Reform 119 Reference the NASW Code of Ethics
  • Teaching Aids • Case examples • Vignettes • Small Group Exercises • Individual Introspection • Individual Supervision • Group Supervision • Literature Review 120
  • NASW • NASW’s mission is advance of the profession and advocating best policies for clients • What it means to be a professional • You can’t be a professional and not a member of professional association. Join. • Not a union or government agency • Private, non-profit (more versatile) • We can’t do it without members 121
  • References • Law References: http://leginfo.legislature.ca.gov/faces/codes.xhtml • (1) Tartakovsky, M. (2011). 9 Myths and Facts About Therapy. Psych Central. Retrieved on May 3, 2014, from http://psychcentral.com/lib/9-myths-and-facts-about-therapy/0009331 • (2) http://www.bbs.ca.gov/pdf/publications/lawsregs.pdf • (3) NASW Standards for Clinical Social Work in Social Work Practice (2005). Retrieved on May 3, 2014, from https://www.socialworkers.org/practice/standards/NASWClinicalSWStandards.pdf • (4) http://www.naswdc.org/practice/intl/definitions.asp Retrieved on May 3, 2014 • (5) Specht,Harry and Mark E. Courtney. Unfaithful Angels: How Social Work Has Abandoned its Mission. New York: The Free Press, 1995 • (6) http://www.einhornlawoffice.com/whats-new/ Retrieved on May 3, 2014 • (7) http://www.courts.ca.gov/selfhelp-elder.htm Retrieved on May 3, 2014 • (8) http://www.fresnostate.edu/adminserv/hr/compliance/childreport.html Retrieved on May 3, 2014 • (9 Child Welfare Information Gateway. Available online at https://www.childwelfare.gov/systemwide/laws_policies/statutes/confide.cfm Retrieved May 3, 2014 • (10) http://lacdmh.lacounty.gov/Training&Workforce/documents/LPS_Training_Manual_updated.pdf Retrieved May 3, 2014 • (11) http://www.bbs.ca.gov/pdf/newsletters/summer_07.pdf Retrieved May 3, 2014 • (12) http://www.aidslawpa.org/get-help/legal-information/confidentiality/ Retrieved May 3, 2014 122
  • References • (13) https://www.socialworkers.org/hipaa/medical.asp Retrieved May 3, 2014 • (14) http://www.socialworkers.org/pubs/code/code.asp Retrieved May 3, 2014 • (15) http://consumercal.org/confidentiality-of-medical-information-act-cmia/ Retrieved May 3, 2014 • (16) https://www.socialworkers.org/ldf/lawnotes/subpoenas.asp Retrieved May 3, 2014 • (17) http://www.mhsoac.ca.gov/MHSOAC_Publications/Fact-Sheets.aspx Retrieved May 3, 2014 • (18) Smith, Roger. Social Work and Power Reshaping Social Work. New York: Palgrave Macmillan, 2008 • (19) Understanding Confidentiality and Minors Consent in California. http://www.ahwg.net/uploads/3/2/5/9/3259766/2010mcmoduleblackwhite.pdf Retrieved May 4, 2014 • (20) Social Workers and the USA Patriot Act. https://www.socialworkers.org/ldf/legal_issue/2004/200409.asp Retrieved May 4, 2014 • (21) CA Health and Safety Code 120291 • (22) CA Penal Code 11160 123