consent under specific, exceptional conditions, or obtaining proper consent at a later time when the patient is fully able to comprehend their decision. ● Valid consent forms. The consent document or language must be carefully written to explain key aspects of the patient’s informed consent decision within the integrated care setting. Consent documents must not be vague or overly general, omitting details that encompass valid consent for the patient. As Reamer (2018) writes, behavioral providers should “include details that refer to specific information to be released to other providers in the integrated health care setting or to professionals outside of the organization. Typical elements include details of the nature and purpose of a disclosure of information; advantages and disadvantages of disclosure; substantial or possible risks to clients, if any; potential effects on clients’ families, jobs, social activities” (p. 120). ● Termination of consent. Providers must clearly explain that consent can be revoked or terminated at any time by the patient. Helping the patient understand that their treatment is free from pressure or obligation is an important duty of the provider. Ordinarily, consent automatically expires on a specified date, and this expiration date should be clearly stated in the consent language or document. Reviewing the rights of the patient to withdraw from treatment and terminate consent are important steps to avoiding ethical and legal mistakes during treatment. Another issue in integrated care involves HIPAA provisions related to psychotherapy notes within the patient’s health record. According to Reamer (2018), psychotherapy notes are “defined as notes recorded in any medium by a health care provider who is a mental health professional documenting or analyzing the contents of conversation during a private counseling session or a group, joint, or family counseling session, and that are separated from the rest of the individual’s health record” (p. 121). This HIPAA-mandated issue of separation is key. Key HIPAA protections are lost If the psychotherapy notes are not kept separate in the health record, namely, the provider’s right to “not have to disclose psychotherapy notes to insurance companies Case Record Research: Integrated Care in New Zealand A recent study in New Zealand explored case records and the related dynamics involving accessing and sharing documentation within integrated care settings, revealing several issues worthy of study. The research outlines several principles involved in effective documentation and an ethical analysis of record- keeping practices. According to the authors (Cairns et al., 2018), their research uncovered the overarching ethical concern of providers that records can influence professional opinions about the patient, for better and for worse. Given this ethical concern, the authors identified three core principles that providers followed in their recording decisions: Neutrality, accuracy, and necessity. Neutrality as a guiding ethic in recording decisions is usually well understood among behavioral professionals who are experienced in clinical practice (Corey et al., 2020). However, for younger professionals or those who are new to integrated care settings, their perceived view of this ethic might benefit from additional information. For example, a provider “who has reached an unfavourable assessment of a client is less likely to be motivated and concerned in the appropriate way and is thus less deserving of the client’s trust. Pejorative judgements, if discovered, are likely to be resented by clients and to damage the trust required to sustain therapeutic success” (Cairns et al., 2018, p. 363). Moreover, in integrated care settings the case record is shared, creating greater necessity for neutrality to ensure other professionals aren’t unnecessarily biased against the patient. Accuracy is perhaps the best understood principle when making recording decisions. Providers must adhere to factual representations of objective factors discussed within sessions,
or in response to a subpoena, unless a client provides consent or there is a court order requiring disclosure” (Reamer, 2018, p. 121). In 2009 the Health Information Technology for Economic and Clinical Act (HITECH) became law (42 CFR Part 2). Subtitle D of the HITECH Act, addresses the privacy and security issues regarding electronic transmission of health information via provisions that heighten the criminal and civil laws of the HIPAA rules, raising financial penalties up to $1.5 million for violations made by a covered healthcare provider, health plan or clearinghouse. Specifically, within integrated care, practitioners must adhere to this federal rule in relation to diagnosing, treating or referring patients with alcohol or substance abuse problems. According to Reamer (2018) this “applies to any individual or entity that holds itself out as providing, and provides, alcohol or drug abuse diagnosis, treatment, or referral for treatment. This would apply to any integrated health care setting that offers specific substance abuse–related services. That is, providers may have to redact information related to substance abuse treatment from the health record that health center colleagues can access” (p. 121). The National Center for Excellence for Integrated Health Solutions is a valuable resource for behavioral providers who are practicing within an integrated care setting. The Center is the creation of the combined energies of the Health Resources and Services Administration (HRSA) and the Substance Abuse and Mental Health Services Administration (SAMHSA). The Center functions as a resource to promote the growth of integrated care (physical health and behavioral health), especially for behavioral providers who treat patients with substance use and mental illness problems. The Center offers a variety of training, tools, and support for practitioners within integrated care settings, partnering with a variety of like-minded organizations such as the American Psychiatric Association, the Weitzman Institute Inspiring Primary Care Innovation, the National Association of State Mental Health Program Directors Research Institute, and the Primary Care Development Corporation (Reamer, 2018). especially those factors which are crucial to the patient’s health record, for example, suicidal ideation, intentions to harm others, or disclosed abuse of minors. More complicated in recording methods is the inclusion of accurate subjective factors, data which are less quantifiable, yet create definite impressions upon the provider. As discussed by Cairns and colleagues, “[T] he greater challenge in the social work context is recording the contestable, less demonstrable information, observations and assessments that support the team’s understanding of the client’s situation. The nature of the role means that social workers are especially likely to encounter the challenges that accuracy poses to the recording of opinions, impressions and unverifiable statements” (Cairns et al., 2018, p. 362). For example, clinicians might have intuitive reactions during a session with a patient that are counter to the objective report made by the patient. This can often be the case with undisclosed suicidal ideation on the part of the patient, who can be embarrassed about disclosing suicidal thoughts or plans. Clinical intuition is subjective and needs to be understood as a clinical hunch that needs to be investigated, often by other providers serving the same patient within an integrated care setting. This approach widens the clinical lens placed upon the patient and can lead to a sound clinical consensus of risk factors or disorders that may be affecting the patient. Necessity in record keeping is about making recoding judgements, and an incomplete record can impair the care that patients receive (Tabesh et al., 2022). These professional decisions help provide safe and effective care for patients as they interact within the system of care and with the various members of the integrated treatment team.
EliteLearning.com/Social-Work
Book Code: SWTX1524
Page 16
Powered by FlippingBook