Hello everybody welcome back we are on mft Law and ethics week 10 congratulations you are moving quite fast in this things are ramping up um towards the end of the term um you know just wanted to check in with you guys see how things are going if anyone needs anything please let me know uh during office hours or anything like that um grades um I you know with my slides snapu um things have kind of set me a little bit back um but I have been looking at grades I am going to be submitting some grades to you guys all I my goal is to get it try to get it all to you guys by Friday if possible um and I've been looking at everything nothing really too serious through out of ordinary so you guys are looking okay um but if anything I will reach out to you individually if you know I didn't get your file correctly or anything like that um all else as well um one of the things we were talking about earlier um in terms of um just kind of looking ahead at assignments start looking ahead many of your courses from what I'm hearing um a lot of the courses kind of ramp up towards the end unfortunately I wish that wasn't the case because when you have multiple courses like everything just jumble piles the last few weeks of the school and the term and you've got holidays and all these things also combined so it can get crazy my advice to start looking ahead week 10 onwards now in this course and any course that you're taking even with me or with not with me um want you to take a peek start Jing down things that you can do um I did have a question um that came up about week um 14 I'm going to look real quick down at my phone just so I can kind of pull it up basically um we're going to conduct an interview you with at least uh two mft professionals um for that assignment um you know it lists like mft supervisor a colleague um someone from camp or mft interns and things like that it is best to find two within this section two people that are different um so that you can kind of compare and contrast their takes their sides of the um interview you're going to be asking them interview questions about challenges that they face in the current profession you're going to talk about the rule of law and ethics and other aspects that are listed in the assignment and then creating a 15 to 20 minute recorded video presentation please note you do not need to um have like a live video recording chat with them or um we don't we don't need the interview necessarily with that person um so it's more about you having an interview whether it be Zoom or phone or however way you guys conduct it and then you creating a video presentation um either on PowerPoint canva however way you like it to be able to upload um kind of like you know describing law and ethics and some of the prompts that they listed for the assignment so I hope that helps um you know um we don't need the actual interview and the dialogue between you two um if you can start thinking about this assignment start doing some now trying to connect with providers and people that are of the field that can help um in the interview um so that you can already get an interview scheduled um you know things happen people cancel things you know just planning ahead um and maybe getting the interview at least part done um in the next few weeks so that you can concentrate on the write up later so um that would be my advice in coming as semester starting to turn to the end um especially for that big assignment okay so let's move on to week 10 um this week we have a bunch of slides we are talking this week about contemporary ethical issues and uh contextual and practice our learning objectives we're going to explain the influence of HIPPA requirements on communication amongst mft professionals describing the professionals responsibil abilities and recordkeeping discussing the ethics issues involved with alternative Service delivery methods in the field of mft those are the three learning objectives for this week um so by Sunday you would have accomplished those learning objectives um once you've done all the readings and um videos for this week what are the readings and videos well we have chapter five um and six actually in issues and ethics in the helping profession they're not the whole entire chapter there's certain sections of the pages so please take a look at those sections chapter nine of the basics of law California law for lmfts lpccs and lcsws and there's four videos uh to watch one of them please note is about an hour and a half long so it is long the last one um it's going to you're going to be talking about progress notes documenting in different um things about ethics and psychological research so good stuff um but please pace yourself because they are kind of long your assignment that you have do is a case study it's a soap note we're going to talk a little bit about that um so what you're going to do for this case study is you're going to do it on a soap note which is subjective objective assessment and plan that is what soap stands for so when you're doing your case notes you always want to talk about what is subjective objective the assessment and the plan and including those in your progress notes I'll go into detail a little bit in the um few future slides in a minute but what you're going to do for this assignment is you're going to prepare for the case study so you're going to watch this video which is the family therapy session um it's a YouTube video that's uploaded um you're going to watch that and then you're going to write at least a 500w response which you're going to write a soap progress note that's based on the video from what you watched So based on what you watched how would you create a soap note so including subjective objective assessment and a plan in addition to the note you're going to describe different professional responsibilities for a therapist when it comes to recordkeeping okay so you're going to add that to it as well um does not necessarily need to be an APA style none of that because when you're writing a soap note they're not in APA style so um I'm going to kind of talk a little bit about how to kind of put it together um so submitting it by Sunday so this is due on Sunday so you do have some time on it first we're going to talk about the readings and then I'm going to switch to talking about the soap notes um in chapter five of the issues in ethics and the helping professions text it talks about different thing ideas about recordkeeping and Managed Care Program so Managed Care programs they can audit reports and we must keep adequate documentation and notes um for our clients um the charts reimbursements are there's reimbursement regulations and information that's required for documentation um like you're going to need the identifying information the chief complaint the history the objective examinations intake sheets like all these things are going to be required in part of the documents the managed care companies they can demand for a refund for services if the records do not contain a complete description of the services that were rendered um school counselors and in recordkeeping sometimes it's difficult to keep up with recordkeeping with this type of case load so the system needs to be in place for repor recordkeeping as well you know a lot of companies um private practices Health Care Centers and everywhere are doing a lot with electronic health records now EHR um so they're switching over or have switched um from the traditional paper method um and filing systems um but um you know we have to be mindful of those as well especially in safety encryption and all that that's injured the family education rights and Privacy Act of 1974 that was a federal law that required all schools that receiveed federal funds to provide access to all school records to parents of students under the age of 18 and to students who are 18 Student Records are not to be released to third parties without the consents of the parents or the minors or adult students chapter to five also talks about securing records obviously records have to be kept confidential um the American the AC a code 2014 code of ethics um provides the guidelines for storing transferring sharing disposing of Records um you know we have a responsibility to make sure that they're stored correctly secure um and like if you're emailing them electronically or scanning them in that it is you know already um it's indicated there should be statements on there that talk about it being confidential cloud storage they talk about record keeping can be risky data should be encrypted to reduce the risks of hacking and whatnot um clients can request their record at any time and it's mandatory to treat clients in a respectful manner when you're writing your notes um we have a responsibility to write what you write what they write how you store access the records what you do with them and how to destroy them um ethically and legally we're required to keep them them secure and protect you know the confidentiality of the clients we also have to take reasonable steps to establish and maintain confidentiality based on our delivery of services or those that were working under supervision we need to consider state and federal laws and policies of work setting and how to retain a records of a client Extra Care it should be taken and consider thinking about what happens to your records after you're passing away death or one is incapacitated who's going to handle the records you know that your supervisors is your site you just want to have those things in mind a lot of um private practices they've already kind of set those things up with their attorneys and people and just kind of had a a plan in place as anything um have you also identified a colleague who's willing to take over your practice in case of a passing even if you're out of the office office we've talked about that as well like if a client has a crisis or needs something you know what would they do so having that set as well um let's see code of ethics um code code ethics codes and Technology there are guidelines for online counseling addressing confidentiality client and counselor identification waivers um so take a peek at that in the text on chapter 5 um and if you're offering online services like telea Health Services make sure that you complete um an informed clients of the risk to privacy and limits of confidentiality for example like Zoom is not encrypted right that is not really a HPP compliant means of um having a session I have heard of therapist that have done Zoom um I mean not zoom sorry FaceTime um did I say Zoom earlier sorry I'm I'm talking about uh FaceTime um Zoom has a HIPPA compliant um Wing or arm that you can purchase that is Hippa compliant um FaceTime is not so um I have heard of therapists that have uh done FaceTime with some of their clients um I have not um I really just would not prefer my clients not have my personal number um and it's also not Hyer compliant um those that I've talked to that have done FaceTime with their clients in the past is those that um had couldn't get on the phone or their phones were messed up they weren't able to use zoom things like that very very um you know um unique circumstances is from when I've talked to my colleagues about it yeah you would have to document that too in your notes to allow for like the reasons to why it was chosen um and let letting the clients know that you know there are risks to privacy for this um let's see we have a duty to protect that's always the case when a client discloses threats uh of um and [Music] um you know um for to self or others it can happen you know um it can happen on tele health or online sessions so we want to make sure that we're Vigilant of that um some pitf Falls I like this part of what therapists that can make when they're doing online therapy or online counseling sometimes they omit some of these important fact doors their failure to obtain clients informed consent but before providing online services we shouldn't be doing that we need to make sure that that's included uh limit clients's access to personal information on client's social networking site and clinici social networking site obtain a clinical license to practice in the state in which client resides comply with HIPPA confidentiality requirements regarding electronic communications and and responding timely to their emails and texts I have some questions that I wanted to ask you folks um those of you that are online feel free to chime in if you feel if you don't feel no worries no pressure um those of you that are watching lecture um um you know the recorded lecture please think about these things and feel free to include them when you're in class discussions or anytime um even uh office hours things like that um thinking about some of the advantages to online counseling and therapy and disadvantages to both um so I want you to kind of think about some of those things um and if anyone has any thoughts I briefly did online counseling and I found it to be really satisfying actually um as a client and part of it is it was um I I liked that I could do it from home you know that it was I found it easier to find somebody that I connected with um than having to go to multiple appointments to find the right therapist for myself and carve out time in my day it's uh you know disadvantages I do think you lose a little bit of that that uh personal connection in the therapeutic relationship yeah those are my two initial things thank you yeah definitely um you know it's definitely one of those things that some people like it some people don't like it right some therapists like it some therapists don't like it some like a hybrid model like doing some in person some tella Health um it also kind of depends on the clientele if you have a highly suicidal client and things like that online is not really fit from that kind of what I was gonna say I wasn't dealing with anything too um yeah scary it was it was you know pretty light issues I was working on yeah and and for that type of thing I think it can be a good fit for someone who has a very busy schedule and cannot commit to coming in all the time maybe a good fit uh for some of the folks that I work with with psychooncology and cancer it's a good fit because it's another appointment that they would have to go into a clinical setting where they're already being exposed to different doctor's appointments and their illnesses and are their imuno compromised and can get sick so you know it's worked um for that setting um it's been helpful for me as a clinician when I have been sick because a lot of the folks that I see are have cancer so for me if I was coughing and I felt like okay this is allergies I've still stayed away from the office for the protection of my clients and I said look I'm not coming into the office because I have allergies but just in the airing on the side of caution I'm going to stay away from the office I don't want to get my co-worker sick or you my client um so we're going to do end up doing Zoom you know on the day that you would normally come in um so they appreciate that it's you know um I'm sure during the pandemic it must felt like a godsend to everybody though like yeah we can continue treatment and not be afraid I think for some of the folks that definitely needed it yes I think some of the folks that really wanted that in person right it didn't work so well um but yeah it can be helpful in multiple settings it can also be um challenging to some you know in some settings so you also want to make sure like if you're doing telea Health you want to make sure that there's no other there's no children or I mean animals you know yes I have had this cat come through or a dog or they've heard my dog you know things like that um and I think that's just the nature of that and it can actually be a very humaning humanizing experience it's like you know um I've had some of my older folks say oh is that your dog yeah it's my dog can I see him okay okay you know I've I've done that you know um um you know things like that have happened so um it can it obviously technical issues can also be a problem right we all know that so kind of varies but yeah good thoughts thank you um let's see chapter six of our text starts talking about terasa um like the decisions that we can have to make as therapists um where we must accurately diagnose a client's tendency to behave in a dangerous way towards others obviously our duty to warn duty to protect just take a look at that 226 to 229 in the text um for this chapter um chapter nine now we're switching over to the other aspect of our um reading which is in the California law and ethics or basis of California law for L mfgs lpccs and lcsws talking about technology kind of what we've talked about before and currently today providing Services by phone or Internet to a client who is physically located in another state at the time of service service could be considered practicing in that or state could be considered practicing in that other state without a license you really want to make sure what your state requirements are um what do their state requirements where they're at you want to make sure it all lines up find out what located means is it mean physically located right that clients who are temporarily out of state like traveling to Arizona Colorado Wyoming Florida may allow for short windows of time for practice online practice okay but you have to Trav these things are subject to change okay some agencies that you work at will have specific guidelines on this like we do not accept or we do accept you know that type of thing technology and teleah health LP lft lpcc and LCSW um will need that should be will uh need to uh complete 3 hours of tella Health Training through CE units as part of a graduate program there are some California teleah Health regulations prior to any service a client must be informed that tele health services will be used given verbal consent and all that um you also need to include a sample this is a sample of what is included um actually this is what we use at our practice for for um tella health services so this is a good example of what to say in your notation prior to the hell tell Health session private provider maintain obtained patients informed consent to psychotherapy via syn synchronous two-way video confirm patients's name identity and location at the time of tele Health Therapy originating site notified patient of provider's location at the time of therapy provided a provider confirmed if and who was present with the room at and at home and home provider attests to consent for tell Health Services I've always included here you know there are times I've had patients that were doing tella health and I all of a sudden see them in the car not driving they're in the car and I'm like where are you today um you're not driving are you no no no I'm not driving I'm parked in my parking lot see I'm not I'm Park okay here's the thing I need to know your cross streets I need to know what where are you located what is something you're in a parking lot of the target where's the cross streets what is the address I look up that Target and I put that in the notation that patient is for that session reason being Insurance's might kick it back and say no because you know they would want details on that and it could be that patient couldn't make it home in time because of tra traffic I've had that happen I've had someone especially special times during Co I've had um clients go sit in their car and do a tahal session but they're in their driveway they're in their garage obviously with the car not on um but you know um I've notated that specifically in the notes because they're going to need to know that um so definitely make sure of that I do have one patient that toggles between two homes okay and so when I see her I'm like oh you're in this home today you're in that home today and I can tell but I also verify and then I write the address of where they are located for that session so those are important pieces to continue to add and adjust along with this type of statement okay moving on to Hippa Hippa Privacy Rule protects the privacy of individually identifiable health information um sets of standards for security confidentiality Provisions are also important U patient safety rule um the breach notification rule as well providing requires providers to inform the department of health services if there's been a data breach um there's a great page uh table on page 278 of this chapter um ethical requirements link to technology take a peek at that I think it's a great table so I wanted to kind of highlight that in our notes today um for the readings other aspects to consider FaceTime we just talked a little bit about that working from home what does that mean supervision face tace video in person real quick about working from home you want to make sure that your your internet is encrypted and the best that it can be for providing Services um things like that you know when the whole world went online during covid I remember um I was associate dean of an online psychology school at the time and that morning I think it was a Monday morning I believe um everyone had meetings and I was getting calls WebEx is not working zoom's not working this is not working our catalog into our site and I just was like you know killing all these fires saying you know what guys the whole world is on the internet right now we will get our chance when we get our chance you miss a meeting you miss a meeting there's nothing we can do right now at this point we don't know what's going on and this was like obviously like the day like shutdown happened that Friday kind of I think Monday was the first working day uh everyone went back to whatever was considered their work at that time but people were on standstill we had kids at home kids couldn't get online parents dressing trying to work remember that time like that is a big pivotal moment in our society and I always bring it up because I mean pandemic yes it affected each and every person each and every patient you'll see was affected at some point in some way it was across all SCS all cultures all religions all um countries some some way some shape your clients would have felt the impact so you know it may get brought up in sessions um so yes you know that was a big time where internet it was like oh my gosh how many people can all be in internet in the world at the same time right great test for the internet Community but um you want to make sure your Internet is the best that you can provide stability wise making sure that it is um you know also encrypted as well and making sure it is um hippoc compliant um and they talk about different other things with emailing clients texting clients and being um mindful of some of those things important I'm going to switch over a little bit to the soap notes because that is part of the assignment for this week again it's watching the video uh the family therapy session and then doing a soap note I have included simplepractice.com resource how to write soap notes um they I like this site because it's easy simple practice it's a common type of uh platform that some clinicians use U for electronic health records we specifically don't use this one but um it is a common one um but it talks about what soap means subjective objective assessment and plan so when you write your soap note you're going to want to include it in these four what does it mean okay subjective is where you describe the symptoms in detail when did they start how long have they been going what's the severity of the symptoms and what makes it better what makes it worse what's your medical and mental history what other health rated issues are you experiencing what medications are you taking the objective is basically what the client is telling you okay that is what the client the family is telling you objective is vital signs any relevant medical records or information um the client's appearance right you want to know their behavior their mood and sex session factual information um you know are they able are they intact in terms of their thought process um you know know um what's their grooming like you know can you tell on Zoom you sure you can on Zoom can you tell in person obviously you can in person but in Zoom you can still kind of get some of that information so when you're doing your objective notes you want to include some of that mood Behavior things like that the website um that I sure will also give some examples for you assessment for the a soap um it's where you describe what you think is going on with the patient your impressions your interpretation draw any clinical knowledge DSM criteria um maybe possible diagnosis possible rule out of anxiety vers depression or something like that and the plan is outlining the next steps for the treatment what's the plan plan is to meet patient once a week for six weeks and reassess possible attend attending group therapy or a grief group or something like that you know you want to include a plan here's some more examples subjective okay client reports feeling more anxious this week she says she felt more Jitter jittery on edge and reports having more anxious thoughts having more anxious thoughts that were harder to control objective during the session the client was fidgety ringing her hands speaking quickly she appeared to have difficulty concentrating and asked me to repeat questions multiple times before responding client described a fear of losing her job and her housing though admitted she didn't have any evidence of those what's the assessment based on the client's reports and in session observation client's anxiety has increased but continues to meet criteria for generalizing anxiety disorder so what's our plan it's recommended the client see a primary care physician to rule out any thyroid or medical condition client will continue coming to therapy once a week for the foreseeable future to treat anxiety through CBT also recommend recommended to client to try some meditation and other mindfulness techniques at home and in between sessions you know interventions you can include those in the assessment as well these next couple slides are from chapters five and six of the user guide hopefully that was helpful to kind of outline a little bit of what soap meant um what a soap note sorry I'm going to scroll up what it means um each of those acronyms as well as kind of an example um that website on simplepractice.com will also be some additional information that will be be helpful for you um let's see um chapter 5 and six of the users guide double mft code of ethics this came from the recommended text so this is actually just additional reading um if you don't have this text you don't necessarily need to get it I just wanted to pull from the recommended text that we had for this course um it talks about standard five which is research and publications as well as um standard six which talks about technology assisted Professional Services so it's all related to technology um if you have this or get access to it or can rent it or something like that and take a peek that' be great but again this is additional material these last two slides not required of that um let me see real quick I'm going to try to see if I can pull up um I'm going to see sorry I'm going to see if I can pull up for you guys um the simple practice that website that I was talking about because I want you to take a if I can share with you all um in person a little bit of what it means what I was talking about share my screen again okay can you see that yes okay perfect so it talks here this is the simple practice resource on how to write soap notes so it kind of talks about one of the effective ways that we can document there's a template here okay streamlining so if you look here on the table contents it talks about what is a soap note how to write a soap note breaks it down to the subjective objective assessment and plan a therapy soap note example okay and just really kind of gives you additional information so I thought it was helpful for you guys all to take a look um and it kind of like really kind of helps you kind of walk you through some of those um sections um and gives you some examples like of a real life example case study uh kind of like you were going to you're going to be doing for your work um there is a secondary piece remember to our assign um it's not just creating the soap note um I'm looking back at it right now sorry um multitasking um you're because you're going to describe the different professional responsibilities for therapists when it comes to record keeping I would just kind of when you do this it's I've gotten the question where do I write this go ahead in your um in your document that you're uploading just do the soap note s o a p break it down right and write that then at the bottom you can write about recordkeeping okay just kind of like just including some information there again 500 words for all of it um but I think you'll be able to hit that um so take a look at this um it talks about Great Links it takes you to other links as well a lot of good information here about soap notes so um wanted you to kind of be aware of that as well um any thoughts any questions yeah that's amazing I'm definitely gonna look at that I think that look will be really helpful um I noticed that in my copy the 11th edition of California lawn you know California law for lmfts chapter eight is on technology and chapter nine is oh what it what was it in the it says chapter nine in the assignments I just want to make sure we're talking about the technology chapter though right as opposed to the chapter n business and marketing chapter it could be an earlier Edition still chapter nine but in this chapter nine basics in California law yes it is chapter nine for that but wait what book are you talking about let me see real quick which one was that yeah yeah chapter nine in that b basics of California chapter nine in that is business and marketing whereas chapter eight is technology let me take a peek at this syllabus this is the one they sent me when I ordered it yeah yeah that's the that's the updated version yeah um yeah this is the 2024 verion yeah they okay they want you to read on chapter nine which is now you're saying um business practices yeah it says the chapter nine title is uh business and marketing okay okay but if we're then I mean everything you just talked about was technology so that's why I'm well I mean I mean it's not it's not that information it goes with the information as well so it would kind of both work so take a peek at that as well I know eventually I've read the whole book anyway but I know right I know yeah okay thanks for that we make note of that for them and let them know okay right any other thoughts questions no if anything comes up you know you can reach me um so have a good rest of your week um start looking ahead at your syllabus um start looking actually at you know week 14 start to really look at some of those things um so that we can get it prepared um so that you all you know have an idea of what to expect um you know for as the weeks kind of come by um I will be I know there's a final exam for this course I will be working on a PowerPoint some slides just some topics um so that I can start to give you in the next couple weeks so that you can start preparing a little bit ahead of time so um that will be coming your way um in the next couple weeks as I put it all together okay all right have a good rest of your week and I will see you guys soon take care thank you thank you take care bye