Topic 1-5 PDF

Topic 1-5 Hi, welcome to the top 30 topics for the law and ethics exam. So let's start with number one, standard of care. So this is a good one to start with. It's one that I don't foresee a ton of questions being specifically asked about on the exam, but standard of care is this overarching constr...

Topic 1-5 Hi, welcome to the top 30 topics for the law and ethics exam. So let's start with number one, standard of care. So this is a good one to start with. It's one that I don't foresee a ton of questions being specifically asked about on the exam, but standard of care is this overarching construct that defines what is the usual and customary professional standards of practice. So with standard of care, you wanna know the term because as a therapist, this is really what's gonna guide your everyday practice with clients, including how you advertise, how you do intakes, how you record sessions. This all fits under standard of care. So standard of care, like I said, it's defined as the usual and customary professional standards. So what this is, when you follow the standard of care, you're acting in a way that a reasonable and prudent practitioner would. Standard of care is comprised of statutes, licensing board regulations, ethical codes, and consensus of your professional community. So statutes would include things that are in the business code, for example, keeping records or your mandates. So statutes are laws. So your mandates like reporting child abuse. Also another example of a statute is that you need to post your license when you earn your license after all these exams, and you'll get this little kind of envelope sized license in the mail. That needs to be posted at your area of practice. So that's an example of a statute that if you fail to do that, you're failing to meet the standard of care. So statutes are one of the things that define standard of care. Then licensing board regulations. So an example of that would be that once you get licensed, you need to get a certain number of CEUs every time you relicensed. Then ethical codes. So we're gonna go over a lot of these ethical codes, or all the ethical codes that are relevant for the exam in this top three topic. But those ethical standards and codes are what also make up standard of care. The last thing is that consensus of the professionals. So again, this is gonna be based on the area of your treatment practice. And these kind of things come into question when you're actually, for example, in a lawsuit, and they'll pull an expert witness in your area, your field of practice to come in and possibly question what you've done. So one of the things with standard of care that I wanna mention is there's certain things, like we said, that are legal, which we'll cover in the course. But there's also things that there's no law that particularly states you need to do something. But it's the kind of thing that if you fail to do, you wouldn't be meeting the standard of care. A good example of that would be completing an assessment with an individual. So if you open your private practice, you start seeing clients, and you fail to do a full assessment and have that documented in your notes, if you ended up in a lawsuit and they pulled your records for that client and saw that you didn't have a full assessment completed within the first few sessions of the treatment, they would use that as example of how you've failed to meet the standard of care. Another great example of standard of care we'll get in more detail on this topic, but is managing suicide. So while there's not a specific pathway of decisions that you have to follow when you manage suicide, there is a law specifically saying that we're required to manage suicide in a way that meets the standard of care. We'll get into more details on that. For the sake of the exam, remember that standard of care is this overarching guide to help you make decisions. And with this exam, in particular with the law and ethics, all the laws and ethics that are created are really created in order to protect the public. So on the exam, when you're in doubt on a question and you're between two answers, always err on the side of picking the answers that's gonna be more in the benefit of the client and the client's safety and the client's rights than it would be in the making life easier for the therapist. Another thing to note is the standard of care is not a standard of perfection. It's a minimum standard. And one of the things that can protect a therapist when it comes to making sure that you meet the standard of care is doing consultation, having a couple of therapists that you know available as resources in your community to be able to consult with whenever you're in doubt about a particular situation. Standard of care is gonna be pulled from your community of practitioners. So a good example of this is in some communities there may be particular resources that are really easy to access. And maybe there's a really great network for substance abuse treatment or inpatient mental health services where you're in another community where that isn't available. Those kinds of resources are not available. So depending on your community, you're going to be acting in a different way defined by your context. But consultation, and we'll get to that topic later in the topics more specifically, consultation is a great way to show in your notes that you're meeting the standard of care because you're seeking more information from your other practitioners in your community to define what would be the best or to meet the standard of that community. All right, let's take a look at question number one from the pre-test. All of the following are true regarding standard of care in the field of mental health except. So we have an except question and you may see somebody on the exam. When you do, what you wanna do is think of instead of the except where you're having to pick three, but rule out three of the answers, you wanna think of it as the opposite and say which of the following isn't true about standard of care? So which of the following isn't true? A, is a standard of perfection. B, it is a legal concept. C, it is continually changing. D, it is derived from legal professional communal principles. So the one here that isn't true is A, it is where it says it is a standard of perfection. It's not the standard of perfection. It's the minimum standard of care. For B, it is true that it is a legal concept. For C, it is continually changing. So whatever comes as a process through community standards, through laws being passed. So different laws are passed, for example, treating a minor, getting consent to treat a minor under the age of 12. That recently changed where you now can see a minor without having certain guidelines having to be met. So it's continually changing. D, it is derived from legal professional communal principles is true. So we mentioned that throughout the lecture. So the best answer here, the right answer is A, it is the only one that isn't true. So remember on the accept questions on the exam, you wanna switch it and ask yourself which one of these doesn't meet that criteria. Let's move on to topic number two, scope of practice. So scope of practice, the definition is it's the procedures, actions, and processes that are permitted for an individual licensed in a given field. So this depends on the state legal standards. And in California, it's defined by the business and professional code. So the idea here is this dictates what a licensed marriage and family therapist can do, what a licensed clinical social worker can do, what a licensed psychologist can do. So with a scope of practice, that's what defines what you can do when you advertise for being a licensed marriage and family therapist, licensed clinical social worker is what you're allowed to do under that license. So let's consider some examples of scope of practice. So the most obvious one is psychotherapy. Psychotherapy falls within the scope of practice for marriage and family therapists, for social workers, for psychologists. So it doesn't fall within the scope of practice of say a massage therapist. So massage therapists could not provide psychotherapy to their clients. Prescribing, managing and making recommendations regarding medications falls outside of the scope of practice for social workers, MFTs and psychologists. So on the exam, the way that scope of practice could be tested is one, it's a legal issue. So this is an example where the law defines our scope of practice. Two, you could be given scenarios where a therapist is tempted to practice outside of their scope of practice. For example, giving advice about medication or side effects to a particular drug, telling a client, for example, a client may come in and say that they started medication, but they don't feel like it's working. And the therapist says, well, maybe you should double your medication. That would be an example of a therapist working outside of their scope of practice. So let's take a look at question number two. A licensed therapist is also a certified public accountant. In her therapy practice, the therapist is treating a woman with depression and anxiety who has failed to pay her taxes the past two years. One of her goals is to pay her back taxes. The client asks to bring her tax information to the next session to have the therapist help her figure it out. The therapist should, A, agree as long as the client would benefit from the assistance, B, agree because it is within her scope of practice, C, refuse because it is outside of her scope of competence, or D, refuse because it is outside of her scope of practice. So the best answer here is D, refuse because it is outside of her scope of practice with regards to her current role with this client. So she's seen a client for psychotherapy under her license as a psychotherapist. She would want to refer this client out to somebody else in order to meet those clients' needs with regard to her money management and tax issues. So A and B are both wrong. A, agree as long as it would benefit from assistance. Again, this is referring back, it's tempting because the therapist has a background in that information, but it would be operating outside of their scope of practice in this particular situation. Within her scope of practice, while she is licensed in that field, she's not operating under that license in this given relationship. So it would create a dual relationship that would potentially lead to a conflict of interest with this therapist knowing intimacies about the client's taxes, or let's say she helped file the taxes, and then something was wrong with them, and the client got really upset, so it would undermine their clinical relationship. C, refuse because it's outside of her scope of competence. We'll get back to scope of competence. Scope of competence is an ethical standard, and in this case, that does not apply because the therapist is actually trained in that field. So it is her scope of competence, but it's outside of her scope of practice as a therapist. So the best answer to number two is D. All right, let's move on to scope of competence. So we touched on this in the last question. Scope of competence is an ethical issue. So it defines the area of practice within a professional field in which an individual is proficient to work. So basically, it's gonna be your area, your skillset, the background that you have, the knowledge that you have, the training that you have to work in a particular field. So example of scope of competence, I'll use myself as an example, is I've never worked with children with autism or with children with developmental disabilities. So if I have a private practice and somebody contacts me and they have a son who has autism and they want help with that son or even parenting their son, I don't have any training and background in that population. So if I were to accept that case, I would be working outside of my scope of competence. So scope of competence is really defined by the individual. It's defined by the therapist. It's gonna be kind of just like self-assessment of where your skillsets are. One of the things I wanna point out is everybody entering this field of mental health is always gonna have a very limited scope of competence to start out with. Really, most people come into the field and haven't had any background unless they worked, for example, in a residential treatment facility or some other background where they've built some skillsets before getting their actual degree. So how does one expand their scope of competence? Well, you get education, training, and experience. So for people that work at different training sites or have your internship or job experience and you're getting those clinical hours where you're getting supervision. So hopefully your supervisor will be able to give you more specific guidance and training. Some people have these varying degrees of quality of supervision for sure, but hopefully if you want to expand your scope of competence, you will seek out supervision from people that have the expertise and experience in the particular field that you're interested in working. On the exam, they can test scope of competence in a couple of different ways. One, they can easily test whether you understand that it's an ethical value as opposed to a legal issue like scope of practice was. Another thing is that they will want to test whether or not you know how to expand your scope of practice by seeking supervision, by seeking training, by obtaining education. They also would want to know whether or not you would understand if you got a case that was clearly outside of your scope of competence, whether you would understand that you should refer that person out to get more specific services. So one of the things that's tempting when you start a private practice, people may be desperate for clients and they would just take any kind of cases that came their way, even if they didn't have any training or background in say eating disorders or self-cutting or people with borderline personality disorders or domestic violence. That's a great example of domestic violence where somebody doesn't have any background working with that population, you could actually do a lot of potential damage in any of those scenarios if you didn't have the actual clinical training, knowledge and support to be able to intervene in what would be called considered standard of care. So on the test, be on the lookout for those kinds of questions where they're making a statement about the therapist's lack of knowledge, skills and abilities in that area. And you're gonna again pick an answer that's gonna be best suited to meet the needs of the client. Let's take a look at question number three. A new client seeks treatment for alcohol addiction and depression after a breakup from a therapist in a private practice who specializes in relationship issues. The therapist agrees to see the client despite having limited training in substance use treatment. The behavior of the therapist is, so I just wanna highlight a couple of things in this question, STEM. We have clearly an alcohol addiction. So this person is like knowing, comes in knowing that this is an issue that they wanna work on. And we have a therapist who specializes in relationship issues. So right away we see that this therapist doesn't address or have a specialty in that particular field. And yet the therapist agrees and it even states that they have limited training in substance use treatment. So when we look at the answer sets here, we have A, it's illegal because the therapist is working outside of his scope of practice. So again, this isn't scope of practice. Scope of practice that we're working with substance use issues is within the scope of practice of therapists. But that's not what's going on here. B, illegal because the therapist is working outside of his scope of competence. So here's scope of competence. They're referring to it as a legal issue, but it's not, it's an ethical issue. So B is out. C, it's unethical because the therapist is working out of the scope of practice. So here we're mismatching scope of practice as an ethical issue. So that's out. D, unethical because the therapist is working outside his scope of competence. So the best answer here is D because it's linking correctly the unethical nature of the situation, which is that it is outside of his scope of competence. So this therapist, one of the things in real life or on the test potentially is that the therapist could disclose to the client that they have a limited background in alcohol addiction and say that they would be willing to seek out additional training, support and consultation. So one of the things is with those situations in real life or possibly on the exam, we want to expand our scope of competence. We want to be able to treat people with different issues. And so in order to do that, you can do that as long as you get the adequate support that you need. And you would also need to disclose to clients who are suffering from that situation that that isn't what you specialize in and are known for and let them have a choice and a say and informed consent about whether or not they want to see you for what you do specialize in like relationship issues or whether they want to go see a therapist who specializes that or if for example, this person could go seek specific training or specific support, say at Alcoholics Anonymous and see you as a therapist for your relationship issues. But you'd want to be transparent and disclose to your clients where your scope of competence is and what their options are. All right, let's move on to topic number four, self-determination or patient autonomy. So this is an ethical value for both social workers and marriage and family therapists. And the idea behind this is that as therapists, we want to support our clients, support their self- determination, support their own agency in making decisions about their lives. So we don't want to become this person who makes decisions for their clients, who the clients seek out and tell them, oh yes, you should do that, you should take this job, you should get out of that relationship and telling them specifically what they need to do. Instead, a therapist should act in a way that supports the clients to start to learn how to make healthy decisions themselves. And again, this can be through a range of different modalities, depending on your theoretical orientation, whether it's through personal insight, whether it's through examining someone's traditional habitual thought patterns, whether it's through body awareness and sensation awareness. So all these different paths lead to the fundamental idea that as therapists, we're supporting the clients and helping them to have more autonomy, more ability to make decisions in their life. So on the test, we're gonna want to be on the lookout for questions that have the therapist steering the client in a particular direction, because we would not want to pick answers that have the therapist determining what a client should do. Now, one thing I wanna mention is that the thing that overrides self-determination is safety. So on the exam, things, and in real life, when it comes to, for example, a client who's suicidal, who has a plan to hurt themselves and has the means to hurt themselves, so they're determined to end their life. In that situation, you would, the safety would trump the self-determination and the therapist would intervene against what the client's wishes in order to prevent harm. So that's one of the situations that overrides self-determination. Otherwise, in situations that even if you feel very strongly about, for example, a client engaged in a domestic violence relationship, a client who's making just really bad, that you sit back as a therapist and you just think, oh, that's a really bad choice. Say they're gonna leave one job that's really secure to go to work for something that you just can think, oh, this is not gonna end well. In those situations, it's still, as a therapist, as hard as it might be, we still should allow the client to make their own decisions. And this also has to do with formulating treatment goals with the client coming in and them deciding specifically what they wanna work on. So that has the idea with starting where the client's at and also just general decision-making about treatment. And this also leads into the next topic, which we'll talk about, which is informed consent. That a client should know going into therapy exactly what therapy is entailing and what the different treatment options are, what the risks and benefits are, so that they can make an informed, educated decision about their treatment process. Self-determination also plays in determination. When a client may decide they no longer want treatment, even if it's against the therapist's judgment, the client still has a right to make that determination. The last area that I want to mention when it comes to self-determination that I think you can expect to see questions on the exam is working with the elderly. Because when people get older, one of the issues that comes up is what's best for them. And adult children of elderly or older age people oftentimes may have a different idea and agenda of what's good for their parents. And so on the exam, you'd want to be on the lookout for situations in which the focus is about an elderly person and what kind of decisions are being made for them, what they actually want, and supporting whenever possible support self-determination. And again, you'd want to rule out safety issues. So if a person was deemed incompetent to take care of themselves through competency hearing, then that would change and there'd be somebody that could be appointed to make decisions for them. But if that doesn't take place and the elderly person is able to make their own decisions, you would want to support whatever they deemed was appropriate for their life. So this is an area where self-determination comes into play a lot and can easily be tested on the exam. So let's take a look at question number four. A therapist should honor a client's self-determination in all the following scenarios except. So which one of these shouldn't they honor a client's self-determination? A, when a client is in danger of harming himself. B, when a client is in a domestic violence relationship. C, when the therapist knows that a client's decision is going to cause a client additional problems. D, when a client is gambling excessively despite lacking money for housing. So the right answer here is A, it's the one where we're talking about safety. B, can be tempting when the client is in a domestic violence relationship. Again, I feel like a lot of people in those kinds of situations, it would be hard to work with a client who continues to engage in a relationship where there's domestic violence going on. But one of the things, areas where this is really important in honoring self-determination is supporting that client with where they're at and in their ambivalence or in their decision-making. C, the client, so this is a great example where we can sit back and watch a client continually make what we would deem as poor decisions. But being that secure base for the client, we would still wanna withhold judgment and be available for them to process the situations that they're engaged in. And that last one is a great example more specifically of what is in C, when a client continues to behave in a way that puts them in a bad predicament, we would still be there to support client self-determination. So the right answer to question number four is A. Let's move on to topic five, informed consent. So this is a biggie. This is a really important topic for people to be familiar with. If you, obviously people taking this exam have worked in the field in an internship or some kind of training site at this point. So everyone should be familiar with informed consent. So the idea behind informed consent is that when we go to seek some kind of treatment in the health field, including mental health, that we have a right to know in advance what the procedures that are gonna be used, the relevant facts about the treatment that we're going to be receiving and risks that are involved. So the person, whoever is giving consent needs to be of a sufficient mental capacity to be able to do that. So this is where the idea of getting consent to treat a minor comes in from an adult. And then also somebody who is not in the capacity due to their cognitive abilities or in the current state of like a mental health crisis may not be able to be able to give consent. But in general, most people seeking therapy are gonna be able to give consent for their treatment. So one of the things with informed consent is that it should take place at the onset of therapy, but it also should be reviewed over the course of treatment as needed. And I'll get more specifics on what kinds of things should be talked about at different points of therapy or reviewed again. So failure to obtain informed consent would be a failure to meet the standard of care. So if you're practicing as a therapist, you absolutely should obtain informed consent from your clients. So one of the kind of tricky issues with informed consent is whether it needs to be in writing or not. So according to the law, you don't actually need to get written signed consent from your clients unless you're treating a minor. If you're treating a minor, it needs to be signed. But if you're treating an adult, it does not have to be signed. Now, if you're going to have it in your records that you covered informed consent with an adult client, your best course of action is to have it signed because then you could actually show the courts, look, I went over this with my new client, Sue. She initialed all the different components of it and she signed it at the bottom. So it's clear that you obtained informed consent. If you don't do that, at the bare minimum, you would want to enter in your notes at that first session, at the intake session, that you reviewed the informed consent and all the different capacities within that or the components of the informed consent that you reviewed and document that in your notes. But again, it would be better to sign. It doesn't have to be signed, but we would recommend that you have it signed. I can't imagine on the exam that they would test per se whether or not they would have to be signed or not, but they're going to definitely would want to know that you've documented that you obtained informed consent. So there's a couple of things within informed consent that are legally required. And then there's another handful of items that are considered the standard of care requirements. So this is a little bit splitting hairs, but the legal requirements would fall also under standard of care. But these, again, are those things that there's actual statutes out there that say these must be in there. And then the standard of care are things that would be what are required through ethics, through the community standards, and what's just considered the best way to educate clients and actually give them informed consent. So the legal requirements, the number one thing is the fees for service. So people need to know in advance what fees you're going to be charging for what, your license status, and also your license needs to be posted in your office. If you're going to be using any kind of technology, technology utilization needs to be included in the informed consent. So if there's going to be any kind of email or if there's going to be utilizing any kind of internet submission of insurance forms. If there's any fictitious business name being used, so let's say you open the Santa Monica Mental Health Center, and that's the name that's on your letterhead, that's the name that's on your informed consent, you're going to have to include in your informed consent what the actual name of the person whose license is the owner of that business. The last thing that is a legal requirement for informed consent is if you are a HIPAA covered entity, and we'll get into HIPAA later, but if you're a HIPAA covered entity, you're going to have to provide in the informed consent process the notice of privacy practices. And we'll get into that in more detail, but that would be probably more a HIPAA related type of question, but that's covered under the legal requirements of informed consent. One thing I want to pause and mention is we've created a quick study on informed consent, which is a summary of this information that I'm reviewing that you'd be able to read over. So at this point, I would just recommend taking notes and listening, but when you're done with all this and you get to the step that's actually reviewing some of the content, you'll see the quick study there. All right, let's move on to the standard of care requirements. So again, this could be argued as a legal requirement also, because if you didn't do it, you could be subjected to legal ramifications if you were ever sued. So some of the things that we should have in our informed consent, number one, limits of confidentiality. So letting somebody know in advance what are your mandated reports, when would you have to break their confidentiality and share with an outsider information about them? So child abuse reporting, elder abuse reporting, danger to others if they share that they're going to do harm to somebody else. If they're going to possibly want to commit suicide, you may have to break their confidentiality in that situation. So letting people know in advance what these limits of confidentiality are. This is a great example of something that you'd want to review over the course of treatment in any situation where you felt like a client might be on the verge of sharing information that would require you to file a report or break their confidentiality that you'd want to remind them. I use the example of reading a criminal there or somebody who's arrested, their Miranda rights. So if you think of that situation, you have a right to remain silent, anything you say can and will be used against you in a court of law. So somebody who walks out of a bank with a bag of money and a gun and they clearly just robbed the bank, those people get to be told what the limits of their confidentiality are. Similarly with our clients, this would be something over the course of treatment that we would want to remind them of. And you could see this on the test tested where they're asking you at some point, if you saw a client over the course of treatment, you've seen them for a while, so it's been a long time since you did the initial informed consent and they start to share something and it had an option where it said, remind them of the limits of confidentiality, that would be potentially a good answer in the situation. The other thing that should be included in standard of care are the risks and benefits of treatment. So more specifically the risks, that sometimes people when they start therapy can actually feel worse because you can start to uncover, dark feelings of shameful events, thoughts that they may have not shared with anybody else before that can actually make the client walk out into the world and feel worse about themselves. So as part of that standard of care, putting that in your informed consent so people don't come to therapy with the misconception that I'm just gonna feel awesome after I see my therapist. It's always gonna, I'm always gonna end up feeling better. Another example is with couples. It's a risk going to therapy because you can't guarantee that you're gonna keep a couple together. And so a potential risk is that therapy may lead to the couple breaking up. So you would want to have that stated in your informed consent. Another thing to include in your informed consent would be alternative treatments. So for example, medication, acupuncture, other kinds of seeing a medical doctor, dietary alternative options so that people can see that there are other things that they could do to possibly treat their issue. You wanna have a cancellation policy, especially if you're gonna be charging people if they miss their sessions, any kind of billing procedure, communication and emergency practices if you are gonna be, if they can't reach you or if they have a crisis, what's the protocol of how to take care of situations. You'd wanna have a background of the therapist. So you'd wanna have some information about what your area of kind of expertise and skill is. The last thing that's important with an informed consent is overall the informed consent should define who the client is. So I, in my practice, I see couples, I see individuals and I have had at different points of group practice. So I have informed consents for each of those treatment units. I have one for an individual adult, I have one for a couple and I have one for a group member. So each one of those informed consents kind of defines who the client is and what kind of treatment they're seeking. All right, I'm gonna move on now to specifically informed consent with minors because there's some issues related to getting consent from minors. So like I said earlier, it must be signed. You need to have a signed informed consent in your record when you're treating a minor. If a minor is 12 years or older, they may consent for treatment on their own if they are determined to be mature enough to do so and if there is reason not to include the parents. So if a client comes to you who's 12 and wants to see you for therapy and tells you my parents are against therapy, they would never support me being here but I really wanna get therapy because I'm depressed or I don't get along with my mom, I need help. That's enough reason right there alone if the parents were against treatment and wouldn't be supportive of the client's treatment to be able to see a 12-year-old and have them sign for their own treatment. If a minor signs for their own treatment, they're responsible for the payment. So the client who signs for it, the person who signs for it, if it's an adult, that person would be responsible for the payment. If it's the minor, it's that person's responsible for the payment. So treating a 12-year-old or older is acceptable. With a parent, if a parent is signing the consent for treatment, so even if it's a 13-year-old, a 14-year-old, if the parents bring the child in, then the parents themselves would sign. So the only time that you'd actually have a minor sign and be the sole signer of an informed consent would be if they were seeking treatment on their own. If a 12-year-old or older or even a 10-year-old came in with the parents, you could have that child also sign the informed consent and it would probably be a nice way to kind of empower them with their treatment. But if the parents are there, you would need to have the parents sign as well. So the parents would absolutely need to sign consent to treat a minor if the parents are involved. When the parents are, so here's a couple issues that can come up on the exam. What happens if you only have one parent come in for the treat a minor? So if the parents are married, either parent may consent for treatment. If the parents have never been married, either parent may consent for treatment. So it really hinges on whether they've been married or not. If they're married, you need either parent. If they've never been married, you can get either parent. If the parents are divorced, so this is where you have to worry about who can sign, then you have to look at the custody agreement to determine who can consent for treatment. So you would need to have the legal guardian or whoever has legal custody would be the one that can sign for treatment. If they both have legal custody and the custody agreement requires both of them to sign, then you would have to have both signatures in order to treat the minor. If they both have legal custody, but the custody agreement does not state that they both need to sign, best practices is that you would have both of them sign, but you're not required to do so. So in a case where you had a client come in with, a child come in with one parent and you check the custody agreement and that parent said that they wanna get mental health services and you see that either parent can consent, you would want to contact the other parent to try to get that other parent on board as well. That would be what was considered best practices. If that other parent is not interested in being involved in the mental health treatment, as long as the custody agreement states that either parent can consent for treatment, you could move forward with just the single parents agreement. If one has sole legal custody, then you would need to get the signature of the person who has sole legal custody. The person who doesn't have legal custody who may only have physical custody say on the weekends, they would not be able to consent for treatment. So if you had a situation where a child was 11, the parents were divorced, the dad brings the child for treatment because he thinks he's depressed, but he only has physical custody and the mom refuses to sign for therapy, you could not see that 11 year old. Once he turns 12, he could consent for his own treatment. And if the mom again was against him getting therapy, that would be a good enough reason to not include her in that process. And the 12 year old could seek treatment and signed consent himself. But if he was 12 and you had the dad sign, that wouldn't hold up. You'd need to have the minor sign for consent for themselves once they're 12, if one of the parents is against the treatment. If there's a legal guardian of the child, so let's say they were living with their grandma and the grandma was made legal guardian, that person may consent for treatment. There are situations where grandma's taking care of the child and parents are missing, we don't know where they are, but grandma has not been granted legal guardianship. In those situations, you can have grandma sign a caregiver's affidavit stating that she is the caregiver. And honestly, when you're working with parents of children that let's say the parents are separated and one of the dad is missing, we don't know where dad is. Let's say the parents are divorced or they're not divorced, whatever the situation is. When a person comes in with a child, we're trusting that they're the parent. And so it's good practice to always have whoever is saying that they're the parent or the guardian sign that caregiver's affidavit saying that they actually are the caregiver. If a child's in foster care, then it's the child's lawyer who must consent. And if the lawyer, the only other situation is if it's a child's lawyer who would consent for treatment for mental health services, unless the court has issued a minute order for a social worker or a foster parent to consent. So on the exam, if you've got a question related to foster care, unless they give you a condition in which the court has issued a minute order, for a social worker or a foster parent to consent, the right answer would be the child's lawyer who must consent. If child's lawyer wasn't on the list, next person I would pick to consent would be the social worker, unless the foster parent has been given legal guardianship of the child. So legal guardianship would trump anything, but after that, you'd be looking at a child's lawyer than the social worker to consent for treatment for mental health services of a child in foster care. You could also see a situation in which there was a court order for mental health services. And in that case, the foster parents could consent for treatment because basically you've had the judge issue a court order. And so the judge has, and if I think from a distance, agreed that the child should get therapy and that would allow for the foster parent in that case to sign the informed consent for treatment. All right, I wanna move on to situations with couples, families and groups for informed consent. So when you're working with a couple or a family, one of the things that should be included in the informed consent is a no secrets policy. And a no secrets policy basically is addressing preemptively the possibility of somebody outside of treatment in that treatment unit contacting you with some information related to them or some dynamic in the family or some dynamic in the couple. And so what you wanna do in advance is let people know that you're not gonna be the holder of secrets, that if there's something that's gonna affect the whole treatment unit, that that person is gonna be directed to share that with everybody in the group. And if they don't, that the therapist has basically the permission or is telling the people in advance that they would share it if they deemed it necessary. One thing to note with no secrets policy, I don't know whether or not this would be tested or not, but one of the things that trumps this is safety issues. So if someone were to disclose outside of session that somebody was being abusive or threatening their life or some situation like that that you would deem would possibly increase risk to bring it up in the session, you would not share that information. But things like affairs or something like drug use or other issues that were going on that were relevant to the whole treatment unit would not be something that the therapist would hold as outside information. The other thing I wanna mention with informed consent is with groups, someone's joining a group, the therapist has the legal responsibility to hold confidentiality, but the other members of the group are not covered under that same legal requirement to keep everything confidential. So while it's something in the informed consent that you'd wanna review and encourage group members to maintain confidentiality, you also wanna let members of the group know that there is an inherent risk in participating in group and that these people do know these things about you and they could potentially share them with other people and they wouldn't be able to sue that person for doing so. There is not a legal barrier for them to do so, so that should be included in an informed consent with somebody in a group. The last thing I wanna mention is there's two situations in which you're allowed to treat without informed consent. And those situations are, the first one's a crisis situation. So in some kind of safety issue where there's this possible suicide is the main one, whether someone's suicidal or someone's in a psychotic state and you need to make an intervention right away and that person doesn't have the mental capacity to sign an informed consent in that situation. So a lot of times in an actual emergency room situation or somebody going into a psychiatric hospital, they may not do informed consent before they start doing some kind of treatment. The second situation is when a client actually refuses informed consent. So if somebody actually says, you know what, I don't want to go over this information, I just want you to start talking about my problems. And you document that, that the person refuses informed consent, then you would be able to treat that person without that, but you'd want to definitely document that you made an attempt to get an informed consent and that the client refused. The last thing I wanna mention about informed consent is if you're engaging in any kind of treatment that's possibly experimental or like hypnotherapy where a client may be a little out of their normal, and you're having them in hypnotherapy kind of enter an altered state, any kind of treatment that involves some kind of touch, any kind of treatment that's deemed possibly experimental or the client is kind of outside the normal kind of comfort zone of a treatment that you'd want to have signed informed consent for the client to understand the risks and benefits. Another example would be EMDR, for example, where there's inherent risks with somebody being kind of re-traumatized and entering a state where they're in a heightened state of exposure to past trauma. So in those situations where if you're doing some kind of very specific treatment where there's a higher risk for somebody like discomfort level or possible ramifications, that in those situations, you absolutely would wanna have a sign informed consent. And we're going to get into later on research and recordings if you were ever gonna record a session with a client, you have to get signed consent to do so. All right, let's take a look at question number five. In which of the following scenarios would a therapist not be required to obtain informed consent prior to the onset of therapy? A, the therapist was seeing a couple and starts to see the husband for individual therapy. B, a therapist is contacted by an adult patient who has suicidal ideation and a plan. C, a therapist is contacted by a former client from the therapist's internship site. D, a therapist offers a six session premarital counseling package. So the right answer here is B. It's one of the two scenarios we mentioned where it's a crisis issue. So a person has suicidal ideation and a plan. The therapist would want to move forward with this client on helping them do a safety plan or doing some kind of referral and basically engage in what would be some interventions with this person before necessarily doing informed consent. Again, it's always better to have informed consent but in a crisis situation is one of the situations where you're not required to have informed consent before you intervene. Again, it's a great example where safety trumps the normal standard of care practices. One thing I want to mention about the answer B is if you note it says an adult patient. So one of the scenarios on the test that would be a little bit of a flip on this is if an adult parent brought in a minor who was under the age of 12, so let's say an 11 year old who had suicidal ideation and a plan but that parent who brought the child in and didn't have legal custody, didn't have the authority to consent, you would not be able to treat an 11 year old who's, if he didn't have informed consent from the person you could get it from even if they were in a crisis situation. So that's one of those situations where your hands are tied as a therapist.