● If you send a fax, don’t leave the material unattended. Make sure that all of the pages go through and check the fax numbers carefully to make sure the information is sent to the correct person. You should also add a disclaimer stating that the information in your fax is confidential. ● Avoid using client names in hallways, elevators, restaurants, etc., unless absolutely necessary. ● Post signs and routine review standards to remind employees to protect client privacy. ● Secure documents in locked offices and file cabinets. Note that there is another law, 42 CFR Part 2, which provides additional protections for clients receiving alcohol and drug treatment. Information is available at the Substance Abuse and Mental Health Services Agency (SAMHSA) website at https://www.samhsa.gov/about-us/ who-we- are/laws-regulations/confidentiality-regulations- faqs This law applies to any program that engages in substance abuse education, treatment, or prevention and is regulated by or receives assistance from the federal government (Kunkel, 2012). Although the SAMHSA (2019) Web page on this subject provides detailed legal information, some salient points are as follows: ● A client or patient who has signed a consent form allowing disclosure to multiple parties can revoke the consent to one or more of those parties. ● A single consent form can allow information to be exchanged for different purposes, such as treatment and management, but the form must specify the type and amount of information that can be disclosed to each of the recipients and the information disclosed must be solely for the purpose at hand. ● In the case of an immediate threat to the health and safety of the individual or the public, steps must be taken before information can be disclosed. These steps can include notification of medical personnel in the case of an emergency or notification of the police if a crime against program personnel or a crime on program property poses a threat to an individual. The information that can be disclosed is limited, however, to such facts as name, address, last known whereabouts, and status as a patient in the program. ● The restrictions on disclosure do not apply in the case of child abuse or neglect, except that “restrictions continue to apply to the original alcohol or drug abuse patient
records maintained by the program including their disclosure and use for civil or criminal proceedings which may arise out of the report of suspected child abuse and neglect [42 CFR 2.12 (c)(6)].” ● In certain circumstances, the Court can order a disclosure. Recently, Congress has attempted to override some of the confidentiality regulations in 42 CFR Part 2, with the introduction and reintroduction of the Overdose Prevention and Patient Safety Act. The purpose of this Act, which was proposed in reaction to the opioid crisis, is to bring confidentiality requirements for substance abuse records closer in line with those for other medical records (Walden, 2019). According to the American Society of Anesthesiologists (2019), this Act, if passed, would provide them with more information to help them to more safely treat patients. In 2009, President Barack Obama signed into law the Health Information and Technology for Economic and Clinical Health (HITECH) Act, as part of the American Recovery and Reinvestment (ARRA) Act. The goal of HITECH was to improve health care through the use of updated information technologies (Witten, 2018). This Act provided financial incentives that led to the wider use of electronic health records. The purpose of greater and more efficient use of electronic records was: ● Empowerment of clients and patients. ● Better outcomes. The HITECH Act also added strength to the HIPAA Privacy and Security Rules (HIPAA Journal, 2018), clearing up confusion about protecting health information. Some ways that HITECH strengthened HIPAA included making business associates of HIPAA-covered entities accountable for HIPAA violations, increasing the penalties for HIPAA violations, and enabling clients or patients to obtain their own health records. This Act also required that clients and patients be notified if their health information was exposed in a security breach. Although the HITECH Act does not offer incentives to behavioral health professionals, it represents the future of healthcare privacy regulations, and some states are already expecting all providers to switch to electronic record keeping (Boyd, 2020). ● Greater transparency and efficiency. ● Improvements in population health. ● Acquisition of data on health systems.
SUPERVISION AND CONSULTATION
Mental health supervision and management generally include three primary aspects of the supervisory role: 1. Administration. 2. Support. 3. Education. (Kadushin & Harkness, 2014) While the supervisor of mental health work is forced to be increasingly involved in the administrative and political realm, supervision, coaching, mentoring, and consultation remain key roles. Mental health practitioners need to be keenly aware of the role of a supervisor, because he/ she is responsible for both the actions and omissions of a supervisee. This is called “vicarious liability.” To provide competent supervision, supervisors – particularly those in clinical settings – should remember the following: ● They need to possess the necessary knowledge and skill and work only within their area of competence. ● They must set clear, appropriate, and culturally sensitive boundaries that would include confidentiality, sexual
appropriateness, and respect for other sensitive boundaries outlined earlier in this training. ● They should not engage in dual or multiple relationships with supervisees when there is risk of exploitation or potential harm. ● They should fairly and respectfully evaluate supervisee performance. ● They should avoid accepting supervisees when there has been a prior or an existing relationship that might compromise the supervisor’s objectivity. ● They should take measures to assure that the supervisee’s work is professional. ● They should not provide therapy to current students or supervisees. Supervisors should consult their particular professional association guidelines regarding supervision, human resource policy, and other applicable resources. Effective and ethical supervisory practices benefit, not only the supervisees and their clients, but the supervisor as well.
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