California MFT Law and Ethics Exam 2024

Law: What are the two state requirements for fee disclosures?

1. The fee that will be charged 2. The basis upon which the fee was computed

Law: What are the five main categories of legally-required disclosures of confidential information?

1. Suspected child abuse 2. Suspected elder or dependent adult abuse 3. Danger to self or others 4. Legal authorization, such as court order or client release 5. Other less common instances

Law: Most commonly, who is the holder of privilege for a minor client?

The client

Law: Who determines whether an exception to privilege applies?

A judge

Law: What conditions are required for a minor client to independently consent for therapy?

Age 12 or older, mature enough to participate intelligently in therapy

Law: What are the four steps to responding to a subpoena?

1. Contact an attorney 2. Assess the subpoena 3. Contact the client 4. assert privilege on behalf of the client, unless the client waives priv. or a judge has asserted that privilege does not apply

Law: What are the relevant timeframes for granting clients access to, or copies of, their records?

5 days to access and review, 10 days for a summary, 15 days for complete copy

Law: What are the four things an MFT must do at the first instance of telehealth with a client?

1. Get specific consent 2. Inform client of risks and limitations 3. provide client with licensure/registration information 4. document reasonable effort make to locate crisis resources local to the client

Law: What are the three things an MFT must do at every instance of telehealth with a client?

1. Verbally obtain client's full name and location 2. Assess client's appropriateness for telehealth 3. use best practices for security and confidentiality

Law: When are mandated reporting responsibilities triggered (minors)?

1. In your professional role 2. You develop a reasonable suspicion that a minor has been abused or neglected

Law: meaning of reasonable suspicion

if another MFT with similar training and experience, when presented with the same information, would suspect neglect or child abuse, so should you

Law: Five categories of abuse/neglect that must be reported (minors)

1. Physical abuse 2. Sexual abuse 3. Willful harm or endangerment 4. Neglect 5. Abuse in out-of-home care

Law: 14th Birthday Rule

If one partner is 14 yo and the other partner is under 14yo, therapist must make a report ( if both partners are under 14yo, thp must use clinical judgement to determine if a report is appropriate)(Rule does not apply to oral, anal, or object penetration)

Law: 21/16 rule

If one sexual partner is 21 or older and the other is under 16, thp must report (For any other age combinations, thp should consider the age and maturational levels of the partners in assessing their capacities to consent and the nature of the relationship when deciding whether or not to report)

Law: Reporting sexual abuse of a minor

14th birthday and 21/16 rules not withstanding, thp must make a report if a minor of any age is involved in non-consensual or exploitative sexual activity

Law: Reporting "Lewd and lascivious acts" (Minors)

Non-penetrative behaviors - 1. Must be reported if acts are performed on a minor 13 yo or younger 2. Must be reported if minor is 14 or 15 AND partner is 10 years or more older 3. Not reportable if cl is 16 yo or older

Law: Child sexual abuse material and reporting

Must be reported if intentionally downloaded or distributed

Law: Willful harm or endangerment (reporting, minors)

any person causing a child unjustifiable physical pain or mental suffering or any caregiver that allows it to happen is committing child abuse

Law: Child neglect and reporting

Child's basic needs (food, shelter, supervision, medical care) not being met (excludes parent's informed and appropriate choice to refuse care IF parent has taken child to see physician)

Procedure for reporting child abuse

1. Make report to local cps by phone 2. Follow up with written report within 36 hours, no exceptions

When to report child abuse

1. Must report even if abuser has moved, been jailed, or has died 2. Must report every instance of abuse

When NOT to report child abuse

Adult client is over 18 and disclosing abuse that occurred in the past (unless abuser still has access to other children?)

What age is considered elder in California?

65+

Dependent Adult

Any person who is between the ages of 18 and 64 who has physical or mental limitations which restrict their ability to carry out normal activities/Anyone admitted as an inpatient in a hospital or 24-hourhealth care facility

Reportable Types of Elder/Dependent Adult Abuse

1. Physical abuse, including under or over medication 2. Financial abuse 3. Abduction (taking elder or DP out of state or preventing return) 4. Isolation 5. Abandonment (by caretaker when a reasonable person would not have done so) 6. Neglect, including self-neglect 7. Permissive reporting of abuse not otherwise defined by law

Reporting Elder Abuse (outside of care facility)

1. Make report to APS immediately by phone 2. Follow up with written report within 2 working days

When does involuntary hospitalization occur?

When client is a danger to themselves, a danger to others, or are gravely disabled

Who can write a 5150?

An eligible professional with training and certification

5150 Hold Timeframes

72 hours - 14 days thereafter for intensive treatment if determined necessary by hospital

What do clients/patients have a right two after being on a hold for longer than 72 hours?

A lawyer, an interpreter if needed, and a hearing before a judge

Who is (possibly) contacted when client is suicidal (intent, means, and plan)?

1. Emergency contacts 2. others known to be close to the client 3. law enforcement 4. some combination of the three

Key components of Tarasoff

1. Imminent danger 2. threat of serious bodily harm 3. one or more reasonably identifiable victims

What to do when Tarasoff applies

1. Notify law enforcement 2. Are free to notify potential victim (though there is duty to protect, not duty warn)

What does Tarasoff NOT apply to?

Threats to damage property, including pets/animals

When is someone gravely disabled?

Client is unable to provide for their basic needs for food, clothing, shelter, personal safety, or necessary medical care DUE TO mental illness, severe substance use disorder or both and are at IMMEDIATE risk and unable to protect their own rights

Privilege information

Confidential information regarding client that can be excluded from court proceedings

Privilege Exceptions

1. When client makes mental condition an issue in lawsuit 2. Client alleges breach of duty by therapist 3. Evaluation or therapy is taking place by court order 4. Defendant in criminal case requests evaluation or therapy to determine sanity 5. Client younger than 16 is victim of a crime and therapist believes disclosure in child's best interest 6. Therapist was sought for purposes of committing a crime or avoiding detection after the fact **always initially assert privilege until judge decides to waive privilege based on this criteria

Areas of assessment to determine if client is a harm to SELF

1. Ideation 2. Intent 3. Plan 4. Means 5. History 6. Protective Factors

Five categories of child abuse that are a mandated report

1. Physical 2. Sexual 3. Willful Harm or Endangerment 4. Neglect 5. Abuse or Neglect outside the home

One category of child abuse that is permissive, not mandated

Emotional Abuse

Who can an MFT work with, within their scope of practice

Individuals, couples, families, and groups

MFT Scope of Practice

1. Use psychotherapeutic techniques 2. Diagnose mental illness 3. Use psychological tests (under conditions)

What are the conditions under which an MFT can use psychological tests?

1. Must be within a therapeutic relationship 2. Must have adequate training

What is NOT in an MFTs scope of practice?

MFTs cannot provide legal advice, medical advice or guidance beyond MFT scope of practice

Definition of unprofessional conduct

actions taken regarding a professional role that are below minimum professional standards

Unprofessional conduct categories

Sexual misconduct, scope of practice and competence, impairment, confidentiality, crimes and bad acts, fraud, testing, supervision, fees and advertising, record keeping, telemedicine, general misconduct

To issue a penalty, what does the BBS need to find in their investigation?

Clear and convincing evidence that the unprofessional conduct occurred

When must you issue the Therapy Never Includes Sexual Behavior brochure?

If a client informs you that they were in a sexual relationship with their former therapist

What does a licensed MFT need to include when advertising?

Legal name as it exists on file with BBS, their license number, and their title (licensed marriage and family therapist or LMFT)

What does parity mean in the context of mental health care?

Insurance coverage for mental health and substance use/abuse must be equal to or better than coverage for other physical health issues

What does an AMFT need to include in any advertisement?

1. Name registered with BBS 2. Registration number 3. title or AMFT 4. Name of their employer 5. indication that they are under licensed supervision

Scope of Competence

Defined by education, training, and professional experience. Basically your knowledge and ability to treat a specific population or diagnosis.

How can an MFT expand their scope of competence?

By getting additional training or education. Also by doing their own research through reading books, volunteering within a certain population, watching informational videos, etc.

True or False: If a client's issue falls outside of an MFTs scope of competence, the therapist must automatically refer the client out?

False. MFT has the option to expand their competence and to consult or seek supervision from a licensed therapist for whom the issue is within their scope of competence

Ethical standards for providing services to diverse groups

1. obligated to be mindful of all forms of historical and social prejudice 2. actively strive to identify and understand the diverse backgrounds of clients by obtaining knowledge, gaining personal awareness, and developing sensitivity and skills pertinent to working with a diverse client population.

In any instance of potential conflict of interest, an MFT has an obligation to -

1. Clarify their role 2. distinguish how any non-therapist role is different from therapy

When an MFT is providing therapy to multiple people in the same family system, the MFT is ethically obligated to -

1. carefully consider potential conflict 2. take steps to minimize or avoid conflict

Appropriate steps to avoid conflict of interest when working with more than one member of a family system in different capacities are -

1. having a clearly identified client 2. maintaining a clear policy on secrets 3. regularly addressing confidentiality issues 4. following a clear treatment plan that all members understanding and agree on

What kinds of issues might lead to therapist impairment?

physical, psychological or substance issues

Other than sexual relationships, what dual relationships are specifically highlighted by CAMFT codes of ethics as potentially problematic?

1. borrowing money 2. hiring 3. joining a business venture 4. close personal relationship

What are the key considerations when weighing whether a potential dual relationship can be ethically entered into?

1. Impaired clinical judgement 2. risk of exploitation

Ways of managing boundaries (re: conflicts of interest)

1. conversations about boundaries with client 2. maintaining clear treatment plan with goals 3. focus communication on therapeutic issues 4. starting and ending sessions on time 5. limiting contact via phone or other means

In addition to the client themselves, who is an MFT prohibited from entering into a sexual relationship with?

Client's spouse, partner, or immediate family member

How should information for informed consent be presented to a client?

Can be delivered verbally or in writing, must be in clear understandable language

What is the ethical requirement when an MFT is considering engaging in concurrent therapy with a client already served by another therapist?

Discuss potential conflicts or confusion with client, including whether consulting or coordinating of care with the other therapist would be appropriate

How can an MFT minimize conflict when working with a treatment unit that includes multiple members of the same couple or family?

1. clarity on who is the "client" (the entire unit) 2. clear policy regarding the handling of individual secrets 3. following a clear and agreed upon treatment plan 4. regularly addressing confidentiality issues

What information should an MFT consider when determining client's risk of harm to self or others?

History, ideation, intent, plan, means, immediacy, and risk/protective factors

What are some ways MFT can manage safety concerns in terms of harm to self or others?

continued assessment, detailed assessment, safety plan, increasing frequency of contact, involving others (loved ones), higher level of care, voluntary hospitalization, involuntary hospitalization, conservatorship (as a long term plan)

When legal and ethical obligations conflict, which one should be followed or maintained?

Legal

Which client decisions are highlight in CAMFT code of ethics as ones where the MFT should highlight that the decision is the client's responsibility?

Decisions about personal relationships

What are the key ethical responsibilities when interrupting or terminating therapy?

Non abandonment and continuity of care

When is a therapist ethically required to terminate therapy?

When the client is clearly no longer benefitting from therapy