● If referring, offer at least three detailed referrals, and, if the client consents, assist in the transition. ● If possible, conduct the final session in person, and not electronically. ● Be certain that the client understands why and how therapy is being terminated. ● Document termination discussions. ● Send the client a personalized termination letter. Do not use a form letter. When a referral is made, the referring clinician is obligated to determine the appropriateness of the referral, including the abilities of the receiving professional or agency, and should follow up on the client’s progress wherever possible and permitted. Finally, mental health practitioners should continue to refer to their professional association’s ethical code guidelines and state laws regarding a related issue: the disposition of client records upon termination, referral, or practice closure.
noncompliance or a client ceasing to communicate (Felton, 2015). In the case of termination for nonpayment of agreed-upon fees, there are criteria to be met (Felton, 2015): ● The fee arrangements have been made clear to the client. ● The client poses no imminent danger to himself or herself or others. ● The consequences, including the clinical consequences, of nonpayment have been discussed with the client. In any case, if the client is in crisis, termination should be delayed, and it is vitally important to avoid abandonment of a client, for both legal and ethical reasons. Felton (2015) offers the following termination tips: ● Start preparing for termination and discuss termination with the client early on so that the process can be discussed during several sessions. Administration Mental health administrators should advocate within and outside their agencies for adequate resources, open and fair allocation procedures, and a work environment that is not only consistent with but encourages compliance with ethical standards of Billing Practitioners need to establish and maintain accurate billing practices that clearly identify the provider of services. Many agencies, associations and boards include these expectations Client transfer Mental health practitioners should consider the needs and best interests of clients being served by other professionals or agencies before agreeing to provide services, and discuss with the client the appropriateness of consulting with the previous Client records Maintaining records of service and storing them is not always easy. Aside from the potential negative legal fallout of not doing so, there are good reasons for keeping records including: ● Assisting both the practitioner and client in monitoring service progress and effectiveness. ● Ensuring continuity of care should the client transfer to another worker or service. ● Assisting clients in qualifying for benefits and other services. ● Ensuring continuity of care should the client return. Record keeping State statutes, contracts with state agencies, accreditation bodies, and other relevant stakeholders prescribe the minimum number of years records should be kept. For example, HIPAA has a requirement of six years for electronic records. The NASW Insurance Trust actually strongly recommends retaining clinical records indefinitely .
ETHICS IN PRACTICE SETTINGS
practice. Ethical standards of practice should be included with materials given to new workers and emphasized during staff hiring. And some form of ethics language should be included with a mission statement.
in their own values and codes of ethics, commonly under the category of stewardship.
service provider. Informed consent is an important aspect of this issue, in that a practitioner must discuss all implications, including possible benefits and risks, of entering into a relationship with a new provider. To facilitate the delivery and continuity of services, the practitioner, with respect to documentation and client records, must ensure that: ● Records are accurate and reflect the services provided. ● Documentation is sufficient and completed in a timely manner. ● Documentation reflects only information relevant to service delivery. ● Client privacy is maintained to the extent possible and appropriate. ● Records are stored for a sufficient period after termination. Professionals who are primary custodians of client records should refer to additional legal requirements, such as those established by state licensing boards, regarding care for client records in the event they retire and/or close their business or practice.
THE ETHICAL IMPORTANCE OF DOCUMENTATION
Documenting according to ethical standards is relevant to all clinicians. With technological advances, digital documentation has become increasingly the norm; however, electronic health records and other forms of electronic communication pose their own ethical risks in documenting services. For social workers, counselors, marriage and family therapists, and psychologists, documentation is equally important before, during, and after a clinical encounter. A common adage states: “If it isn’t written, it didn’t happen.” Although documentation serves multiple essential purposes, it is fraught with risk and liability.
Practitioners usually know what is minimally required in documentation; however, what is least required may differ significantly from what is recommended or optimal. Optimal documentation includes information that is relevant to the clinical services being provided and that addresses legal, ethical, and administrative obligations. Agency practice and time demands often result in practitioners documenting only what is required. This practice may leave the agency and practitioner open to scrutiny and risk and, at the same time, shortchange the client’s services.
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Book Code: SWTX1524
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