CTS Handbook Fall 2014

Counseling Center Handbook Fall 2014

1050 WEST 42ND STREET INDIANAPOLIS, IN 46208 PH (317) 924-5205 FAX (317) 931-2393

Table of Contents FOREWORD………………………………………………………………………………….………..3 Forward, Overview, Mission……………….……………………………………………………3 Counseling Center Handbook Acknowledgment of receipt……..………………………………4 COUNSELING CENTER GROUNDS AND SAFETY ........................……………..…………….. 5 Building Security and Hours...…………….…….…..……….………………………………….5 Emergency & Maintenance……………………………..……………………………………….5 Fire Alarms, Weather & Community Response………..…………………..……………………5 OPERATIONS AND PROCEDURES ...……………………………………………………………8 Counseling Center Job Descriptions ...………………………………………………………….8 Front Desk Procedures .………………….………………….………….………………………12 Practicum Overview ...…….………..…………………………………………………………15 Ethical Standards & Confidentiality .…...……………………………………………………...16 Requirements of Practicum ……..……………………………………………………………...15 Course Objectives .….…….…..………………………………………………………………..20 Clinical Training ………….…..……………………………………………………………….. 22 Group Supervision………………..……………………………………………………22 Individual Supervision……………..………………………………………………….22 Getting Started ...….. ..………………………………….……………………………………..24 1. Observations (Round 1) ………..…………………………………………………. 25 2. Observations (Round 2) ………..……………………………………………….… 26 3. Buddy System …………………..………………………………………………….26 Caseload Management …………..……..………………………………………………….… 26 1. Recommended Caseload …………………………………………………………... 26 2. Client Assignments ……………..…………………………………………………. 27 3. Prospective Client Form’s………….……………………………………………… 27 4. Intake Sessions ………………….……..……………………………………………28 5. Transferring Clients ……………………..………………………………………….29 6. Referrals ……………………………..…………………………………………….. 30 7. Scheduling Client Appointments …..……………………………………………… 30 8. Reserving a Counseling Room ……..………………………………………………30 9. Setting Fees/Session Length/Billing .……………………………………………….30 10. Psychiatric Services ……………….……………………………………………....31 11. Guidelines for Psychiatric Services ….………………………………………...….31 12. Terminations/Closing Client Files ….…………………………………………… .32 13. Release of Mental Health Records/Fees .....…………………………………… 34 Practicum Administrative Tasks & Responsibilities …………….…………………………..34 Correspondence .……………………………………………………………………………....34 Client Files ……. ………………………………………………………………………….....34 Paperwork …………………………………………………………………………………… 34 1. Activity Reports ………………………………………………………………… ..34 2. Progress Notes ……………………………………………………………………. ..34 3. Receipts …………………………………………………………………………… .35 4. Termination and Transfer Summaries …………..…………………………………..35 5. Clinical Assessments …………………….……………………………………….... 35 6. Logging Clinical Hours ………………………………………………………….… 36 1 Last Updated 9/2014

Grievances…………………………………………….………………………..………………36 Probation, Withdrawal, Suspension or Expulsion from Practicum …………………………..37 Departing Practicum ………………………..……………………………………..…………..39 COUNSELING CENTER CLOSINGS……………………………………………………………..40 APPENDICES ……………………………………………………….…………………………….42 Practicum Specific Degrees Program & Policies ………………………………42 AAMFT Code of Ethics …..…………………………………………….……..57 ACA Code of Ethics .……….…………………………………………….……64 AAPC Code of Ethics ….……………………………………………………....96 Clinical Writing ……………………………………………………………...103 How to be a Successful …Practicum Student ………….…………………..…111 CTS Counseling Center Fact Sheet ...…………………………………….….113 MFT/MHC Evaluation Form ...………………………………………….…..114 Capstone Evaluation Rubric . …..……………………………………………..118 Practicum Group Supervision Requirements Grid .…………………………..119 Links to Licensing Information & Licensure FAQ’s ……………………….120 Meeting Room Manager ..…………………………………………………......122 Reporting Abuse/Neglect .…………………………………………………….127 Setting up Voicemail .……………………….……………………………..….138 Suicide Assessment …..…………………….………………..……………..…139 How to Write Treatment Plans ……..…………………………………………144 Clinical Intake Summary Description…………………………………………149 Medical Billing and Accounting.………………..…………….………………152

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Forward The CTS Counseling Center handbook has been written to serve as the guide for those providing service here at our Counseling Center. This handbook contains general information and guidelines, but is not intended to be comprehensive or to address all the possible applications of, or exceptions to, the general policies and procedures described. If you have questions concerning a particular policy or practice, you should address specific questions to your supervisor or the clinic director. The procedures, practices, and policies described here undergo regular revision to maintain relevance and accuracy.

Overview The CTS Counseling Center provides counseling services for individuals, couples, families, and children. The Marriage and Family Therapy MA Program is accredited by COAMFTE, affiliated with AAMFT. The Clinical Mental Health Counseling MA Program is aligned with CACREP standards and the professional orientation of the American Counseling Association (ACA). The American Association of Pastoral Counselors (AAPC) accredits the Counseling Center as a training center which includes both counseling programs.

The center offers a wide variety of services, including:  Ongoing Groups  Individual Counseling  Marital and Family Therapy  Relationship Counseling  Grief and Loss  Faith Based Counseling  Psychiatric Evaluation and Consultation  Psychological Assessment

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Parenting Issues Child and Adolescent Issues Anxiety Depression Stress and Tension Self-Harming Thoughts Domestic Abuse Play Therapy

Mission The mission of the CTS Counseling Center is to provide a distinct advantage to practicum students with an on-campus mental health clinic which also offers a unique opportunity for therapists seeking licensure to experience direct client care and on-going professional development. Through quality supervision and authentic engagement in a transformational community we strive to encourage, strengthen, challenge assumptions, and cultivate therapeutic excellence and spiritual integration in preparation for a variety of clinical careers. *For profession specific codes of ethics, please refer to Appendix

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Counseling Center Handbook Acknowledgment and Receipt I have received a copy of the CTS Counseling Center Handbook.

This handbook describes important information about the Christian Theological Seminary Counseling Center, and I understand that I should consult my supervisor, the Clinic Director, or Executive Director regarding any questions not answered in the handbook.

This handbook and the policies and procedures contained herein supersede any and all prior practices, oral or written representations. By distributing this handbook, the company expressly revokes any and all previous policies and procedures that are inconsistent with those contained herein.

I understand that any and all policies and practices may be changed at any time by CTS Counseling Center.

I have received the handbook, and I understand that it is my responsibility to read and comply with the policies contained in this handbook and any revisions made to it. ________________________________________ Employee or Student Signature ________________________________________ Employee or Student Name (Print) ____________________ Date TO BE PLACED IN PERSONNEL or STUDENT FILE

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COUNSELING CENTER GROUNDS AND OPERATIONS Building Security If you have access to the building after hours be sure that you follow all procedures for securing the building and that the door is locked after you enter and/or when you leave. We also ask that you obey the request of any security guard or facilities manager who may be working on CTS property - either in the building or in a parking area. If you have a question or concern about the request of a security guard or facilities manager, bring it to the attention of your supervisor or clinic director.

If someone is directly threatened or observes such a threat, call the police immediately. At no time should anyone attempt to restrain anyone. You may defend yourself and should if attacked, but the most important thing is to protect yourself or others in harm’s way.

If a theft occurs, the first step should be to notify the Clinic or Executive Director so that multiple thefts could be prevented. If the community member finds it necessary to report the theft to the police, he or she needs to notify the switchboard of the call (the police often call back to verify the report). CTS maintains a public record of all reported crimes on campus through the Dean of Student’s office.

Other Security Employees, Residents, and Practicum students are held responsible for the equipment, supplies, confidential materials, cash or checks and other items of value entrusted to them, and they should take proper precautions to prevent the loss of these items. At the close of the workday, it is expected to lock all confidential files and cabinets and otherwise properly secure all equipment and supplies in the designated area.

Those occupying offices with windows should also be sure to close windows and blinds before leaving the office for the day. CTS accepts no responsibility for personal items stolen or damaged while on Seminary property. All care should be taken to ensure the protection and security of your personal items.

Suspicious Activity Suspicious behavior or activity on campus may necessitate a warning to the CTS community. Should you feel any persons has suspicious behavior please inform the Clinic Director or a member of staff appropriately.

Building Hours The Counseling Center building is open during the following hours: 8:00 a.m. - 9:00 p.m.

Mondays through Thursdays 8:00 a.m. - 1:00 p.m.

Fridays 9:00 a.m. – 1:00 p.m.

Saturdays Closed Sundays The facility includes:      

Twenty private counseling rooms Child and play therapy area Personal meditation area Viewing rooms for supervision Space for professional and academic conferences Full ADA compliance

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There is a handicap accessible entrance located on the east side of the building. It is a secure entrance and front desk staff authorizes access. An elevator with access to basement, second, and third floors is also located near the handicap accessible entrance Floor plan of the counseling center is located in the appendix.

Emergency For police, fire department, or ambulance from the counseling center, dial 911.

Counseling Center address is: 1050 W. 42nd Street Indianapolis, IN 46208 Counseling Center telephone number: 317-924-5205 Security Numbers Butler Police (Emergency) 940-9999 Butler Police (non-emergency) 940-9396 CTS Maintenance     

Dick 223-9132 Lee (evenings) 223-9134 Ralph 223-9133 Jack 223-9135 Contact Dan at ext. 5021 with facilities concerns. For urgent matters, contact facilities directly.

In Case of Accident or Injury Despite our strong efforts to avoid them, accidents can still occur. We are equipped to handle routine cuts and abrasions. First-aid kits are located in the equipment room.

Everyone is encouraged to utilize the "universal precautions" procedures when dealing with emergencies involving loss of blood. If you become injured at work, regardless of the severity of the injury, report the incident to the clinic director immediately. A neglected injury - minor as it may seem - can become a serious problem if not treated promptly and properly.

If your injury is of a serious nature, or if you should become unconscious at work, we will call for emergency medical treatment or arrange for you to be taken to the nearest hospital. Please inform someone to dial 9-1-1 for an emergency vehicle.

Any job related injuries must be reported to the Clinic Director as soon as practical. We ask your cooperation in filling out the necessary medical forms and accident reports. Complete and timely documentation is necessary to expedite claim processing and to enable us to help assure a safe work place.

Fire Extinguishers and Alarms Fire extinguishers and fire alarm boxes are placed in locations throughout the building and are inspected regularly. Only employees who are trained to operate a fire extinguisher should do so to avoid possible injury from improper use.

Fire Alarms, Weather and Community Response Individuals should be aware of the most direct emergency exit from his or her work area and identify the location of the nearest fire extinguisher. To set off the internal fire alarm system, simply pull the lever 6 Last Updated 9/2014

on a fire alarm box all the way down and then let go. If there is no immediate personal danger, the employee is asked to remain at the box until the maintenance staff arrives.

To report a fire to the Fire Department, call 911 on an outside line. To report a minor fire or suspicion of one internally, call one of the following: the Physical Plant Office -ext. 390; the Engineer's Officeext. 391 or the Business Office-ext. 320.

A test evacuation will occur at least once a year, typically in the fall.

When the Fire Alarm Sounds 1) Assume that there is an actual fire in the building.

2) Turn off fans and lights, close the windows and file drawers, close off interoffice doors, leave the room and close the door.

3) Leave the building by the nearest exit and go as far as the street or the parking lot.

4) Stay clear of fire department equipment.

5) Assist visitors and new students in vacating the building.

6) Do not create panic!

7) Return to the building only after it has been determined that the emergency is over.

Designated tornado shelters at the CTS Counseling Center is the Basement away from any windows.

In the event of a threat of severe weather:    

  

Alert the Facilities Maintenance Department at 931-2390 The Facilities Maintenance Department will assign one person to monitor and track the storm.

Review safety rules and severe weather shelter procedures in the event that conditions become conducive for a tornado.

When a warning sounds or a person in charge (PIC) notifies you, all persons should move to the basement of the building they occupy or at least to an inner area on the first floor (in an area where there are no windows, e.g. hallways, etc).

Close and lock all areas containing money including safes.

Shut down all computers and electrical equipment that might be damaged as time permits.

When the warning is over, the Facilities Maintenance Department will notify persons in each building by phone, E-mail, or in person.

If you are inside, go to the shelter nearest your location that you have previously chosen. Once you are in your shelter, stay away from windows. Go to the center of the room; corners attract debris. Stay away from auditoriums, cafeterias, large hallways, and other places with wide-span roofs. Get under a piece of sturdy furniture—a desk, table, workbench—and hold on to it. Put your arms over your head and neck to protect yourself from glass and other flying objects.

If you are caught outdoors: Try to get inside. If that isn't possible, lie in a ditch or a low-lying area, or crouch near a large building. Protect your head and neck. Never try to out-drive a tornado. Get out of the car immediately. Take shelter in a nearby building. If you can't get to a building, get out of the car and lie in a ditch or low-lying area 7 Last Updated 9/2014

Community Response 1. PCC staff will lock outer doors and direct patrons, staff and therapists to a safe location in the building.

2. Help Desk, Facilities and Communications staff will keep the community informed via e-mail and CTS Text Alerts concerning the nature and status of the situation.

All Clear Once the situation is under control, Help Desk, Facilities or Communications staff will issue an "All Clear" message via Text Alert and e-mail message.

1. Text Message: “All Clear. Please resume normal activity. Additional information will be communicated through CTS E-mail.

Liability and Building Safety   

 

Never leave children under the age of 16 unattended in waiting areas, counseling rooms, play therapy rooms, or anywhere else in the building.

Clients and guests of therapists should not be allowed in the basement area and this includes vending area. This is absolutely a restricted area due to therapists’ conversations and exposure to client files and confidential information.

Therapists must not transport clients to a psychiatrist’s office or inpatient facility. Liability insurance does not cover such activity. It is suggested that a family member or friend transport clients. In consultation with your supervisor, you may, however, follow a client or meet them at the facility. If a client is a risk, please consider contacting police or emergency medical personnel (ambulance) for transportation.

THERAPISTS AND CLIENTS ARE TO BE OUT OF THE BUILDING BY 9:00 PM (MTH), 1:00 PM FRIDAY AND 1:00 PM SATURDAY. If at any time a client becomes unmanageable, abusive, or violent, call 911 immediately.

Scheduling Building Uses Scheduling for the use of the facility is done through the online program “Meeting Room Manager.”

Departments may schedule the rooms in the building for meetings or functions. It is recommended that counselors schedule their last appointments no later than 7:30 PM Monday through Thursday, 11:30 AM on Friday and 11:30 AM on Saturday. This allows enough time to finish the session and complete paperwork before the building closes.

Parking As a courtesy, reserve parking spaces closest to counseling center for clients by parking vehicles in spaces further away from center.

Solicitations, Distributions and Posting of Materials Any distribution or postings should be approved by clinic director prior to dissemination

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COMMUNITY OPERATIONS and PROCEDURES

Counseling Center Job Descriptions Executive Director JOB SUMMARY: Provide administrative oversight of the Pastoral Counseling Center and its programs.

ESSENTIAL DUTIES AND RESPONSIBILITIES:  Implement CTS policy in the work of the PCC.  Coordinate the work of the Counseling Center with the degree programs whose students it serves.  Administer and coordinate the educational mission of the Counseling Center with the Program Directors, Clinic Director, and Residency Director.  Act as liaison with the Dean and the Faculty concerning the relationship of the PCC and the academic functions of the seminary.  Recruit or cause to be recruited the supervisory staff necessary to carry out the PCC functions.

Clinic Director JOB SUMMARY: Supervise day to day operations of the CTS Counseling Center.

ESSENTIAL DUTIES AND RESPONSIBILITIES: • • • • •

Plan process and provide supervision for practicum and residency.

Provide backup for on-site student and resident clinical emergencies.

Direct support staff Assist with coordination of clinical supervisors.

Liaise with central administration on all matters relating to building maintenance, security, cleaning, etc.

• Optimize office utilization.

• Liaise with billing and collection providers.

Clinical Supervisor JOB SUMMARY: Clinical Supervisor will provide supervisory services for our MA degree practicum students in Marriage and Family Therapy, and Psychotherapy and Faith programs, and our DMin degree in Pastoral Counseling. These services may include; individual supervision to a specified number of practicum students each semester, group supervision, and group live supervision. The clinical supervisor may be called upon to assist a student with an emergency of one of their clients.

DUTIES AND RESPONSIBILITIES:   

To provide supervision to our practicum students Assist students in integrating theory and practice with the counseling of their clients.

To assist the clinic director in providing quality control in the delivery of services to clients by our student counselors, thereby holding to high standards in the training of our students.

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Sign off on clinical and supervisory hours of the students thereby guaranteeing the accuracy of those hours.

To respond when called upon to assist a student with an emergency of one of their clients.

Hold students accountable for professional and ethical conduct with their clients, case management, paperwork, and general functioning as a professional.

Monitor whether students are taking personal issues that affect their work as a therapist to their own personal therapy, and whether students are going to weekly therapy.

Program Director JOB SUMMARY: Develop clinical training and supervisory experiences for students in the counseling programs.

ESSENTIAL DUTIES AND RESPONSIBILITIES:   

Provide academic advisement to counseling students Coordinate on-going evaluation of the counseling students Provide clinical supervision to practicum students

Billing and Operations Liaison JOB SUMMARY: Perform accounting, customer support and department interface tasks. Assist in maintaining the office as a pleasant space for clients and staff. Hours: 7:45 AM – 12:45 PM ESSENTIAL DUTIES AND RESPONSIBILITIES:        

Process daily receipt deposits and interface with business office and medical billing.

Process payrolls for staff and resident counselors and interface with business office.

Backup staff for switchboard and front desk activities.

Perform interface role to: I/T, Facilities Maintenance and outside service companies (special forms; shredding services; medical billing.)

Orders staff supplies Schedule the rooms for Dr. Galvin and Donna Merritt at the beginning of the year Maintenance of the schedule template in excels spreadsheet on shared drive Perform other related duties as assigned.

Off-Site Bookkeeper JOB SUMMARY: Provide bookkeeping input. Generate income/expense reports, client statements, insurance forms, student client hours, other pertinent information relating to client and student accounting requirements.

ESSENTIAL DUTIES AND RESPONSIBILITIES    

Input weekly student and resident receipts.

Generate semi-monthly insurance billings.

Generate monthly client statements.

Generate monthly (or when requested) financial reports.

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Compute and update student monthly hours completed sheet.

Contact CTS office, via phone or e-mail, should any question or concern arise regarding client accounts. Keep CTS office updated on any address, phone number, or e-mail change.

Administrative Coordinator JOB SUMMARY: Perform administrative support and office coordination duties. Assist in maintaining the office as a pleasant space for clients and staff.

ESSENTIAL DUTIES AND RESPONSIBILITIES:          

Provide basic secretarial duties: answer phones and take messages, greet clients.

Communicate with third party requests for information (i.e. disability requests) Assign work schedule for work study staff Keep record of student malpractice insurance premiums and maintain student files.

Contact counselor when new client assigned, write information on calendar, schedule book, and new folder prepared with pertinent information for counselor.

Criminal Background forms signed and returned by incoming students for student file.

Manage Medicaid/Medicare matters. Liaise with off-site book keeper.

Perform community outreach Manage GeneSight process Perform other related duties as assigned.

Administrative Assistant and Special Project Coordinator JOB SUMMARY: Provide administrative support to enable counselors, directors, and faculty to more effectively carry out their roles. Assist in maintaining the office as a pleasant space for clients and staff.

Assist with special projects as assigned by counseling faculty and staff.

ESSENTIAL DUTIES AND RESPONSIBILITIES:       

Performs special project related duties and computer generated reports as assigned by Clinic Director Provide basic secretarial duties: answer phones, take messages, and greet clients Maintain filing systems including filing in copy room, and perform file audits Perform client scheduling and file preparation for incoming clients Manage psychiatric providers’ schedules Work with Clinic Director on material preparation for start and close of the each term Basic computer software operation for Counseling Center staff.

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Front Desk Procedures Confidentiality Confidentiality is most important throughout center. Never say a client’s full name aloud or talk about clients while sitting at the desk. We do not give out therapists personal phone numbers to clients or anyone else who is not a supervisor, therapist, or staff member of the counseling center. Their clients are to contact them through voicemail ONLY. Some residents give out their cell phone numbers, but this is only at their discretion and it is not ok to give out ANY personal phone numbers, even if the client says that they already have it. Any therapist or client personal information that is at the front desk, for example, a Medicaid receipt or mail, must be turned upside down in order to protect personal information.

Answering the Phone Telephone etiquette should be something similar to the following, “Counseling Center this is______” (your name). Many of the other calls received will be prospective clients inquiring about our services.

Any calls regarding communication or appointments with the psychiatrist should be referred to the Administrative Coordinator and the nurse practitioner should be referred to Administrative Assistant.

Sometimes clients will call the front desk to cancel, reschedule or find out their appointment time with their therapist. Please prompt them to leave them a voicemail in order to cancel, reschedule, etc. If someone calls for staff, ask who is calling and tell them you will see if they are available. If you press transfer and the extension number, you are able to speak with them before transferring the call. . If they pick up the phone, and they want to talk to them, just hang up and they will be connected. If they’re not there, hang up and they will be connected to her voicemail. If they are there, but are unavailable to speak to the person, hit ‘resume’. Tell the caller that she is not available and ask if they would like to leave a voicemail. If they would like her voicemail, press the transfer button, *and then extension number.

Using the Phone System To transfer a call to a “live” extension, such as Clinic Director or Executive Director, press the transfer button, followed by the extension. If you are transferring to voicemail only extension, press the transfer button, followed by * and the extension. If you would like to transfer a call directly to the voicemail of a live extension, you are able to follow the same instructions for transferring to a voicemail only extension.

Taking Prospective Client Information If someone is calling to set up an initial appointment, please take their information using the prospective client form located at the front desk. Here are the steps you will take in filling out this form: 1. Put the date on the form first! Then continue to fill out ALL questions on the form.

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2. Once you get to the question about the concern they are coming in for. Use verbiage similar to this: “Just so we can assign you a therapist that best meets your needs, can you tell me a little bit about why you want to come in?”

3. Continue with the following questions.

4. We do not accept private insurance. We can only see clients who have Medicaid/Medicare (if they say they have HIP or the Healthy Indiana Plan, this is Medicaid) or those who are Self-Pay. This section is important because it will determine if the person is assigned to a resident or intern. If they are selfpay, tell them that we have a sliding scale based on their income. Please refer to our sliding scale sheet.

Also tell them that their first session will be 90 minutes and the fee will be a little more. (Their fee, plus half of that...so a $15 per hour fee would be $22.50 for the first 90 minute session) 5. The final step is to tell them when they might expect to hear from a therapist to set up an appointment.

This can be tricky depending on what time in the week they are calling. Generally, it is safe to say that they can expect to hear from a therapist within 3-5business days to set up an appointment. If they are calling later in the week, it may take an extra day for them to be assigned a therapist.

Lobby Protocol We make every attempt to have the lobby be organized and as peaceful as possible, but it’s a busy place! Phones are ringing, people are asking questions, children are crying, therapists are asking questions, and sometimes dogs are even barking!

The staff’s responsibility is to greet clients, answer phones, take intakes and do their very best to maintain a quiet, safe environment, but we need your help!

Here’s what you can do:  Always check for your clients at their scheduled time. If the front desk staff has time, they call you, but often they are on the phone, or dealing with some other issue and can’t notify you and it is not their primary responsibility to do so.  The area near the front desk needs to remain open for clients to sign in, staff to have a view of the lobby and front door for safety.  Only staff may sit behind the desk; if you are waiting for a client, please have a seat in the lobby or stand. This is again a safety issue; the staff has been trained where the panic button is, have to see who is at the back door, have to be able to reach the phones, etc.  No scheduling therapy appointments in the lobby; only psychiatric appointments when confidential call time is available. Your client’s next appointment should be scheduled with you in the therapy room prior to leaving.

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 Handling payment should also take place in the therapy room to ease congestion, maintain confidentiality as well as safety. If you need to run a credit card, then have your client take a seat, go run the card and take the receipt to where your client is seated.  Inform your clients that children under 16 may not left alone in the lobby or outside in the parking lot unattended. The CTS counseling center does not have the capacity to monitor the safety of unattended children.

Opening the Counseling Center If you are opening: 1. Unlock the copy room and credit card room using the master key located at the front desk.

Maintenance unlocks the building and they will go downstairs and unlock the file room.

2. Go to the 2nd and 3rd floors and turn on the hallway lights.

3. Check your mailbox in the credit card room for any work Clinic Director or Administrative Coordinator might have left for you to complete.

4. Check the client sign in sheet and make sure there are at least 3 spaces for clients to sign in; replace if necessary. Be sure to write the day’s date on the bottom of the sign in sheet.

5. Check the intake calendar for any intakes during your shift. Make sure there are new client packets on the front desk clipboards. When a new client comes in, give them an intake packet to fill out.

6. Logon to one of the front desk computers and check your email for any work or counseling center information that may have been sent to you.

7. Follow the instructions at the beginning of this document for “Things to check when you come in for your shift” Closing the Counseling Center If you are closing: 1.

2.

3.

4.

At close, lock the front door with the allen key and pull it shut.

Turn off the lights and lamps in all of the counseling rooms.

Turn off all of the computers in the building. If there are videos saving, turn them off anyway.

Therapists are to be out of the building by 9pm Monday-Thursday and by 1pm Friday and Saturday. At 9pm (1pm Fri Sat), shut and lock the credit card room, copy room and file room downstairs. If there are therapists in these rooms, tell them that you have to lock up and ask them to leave.

5. Make sure the back door is not propped open.

6. On Fridays and Saturdays, lock the entry door to the basement.

Making Client Files and New Client Clinical Assessments There are sample folders in the file cabinet behind the front desk. You will find the files in the folder on the Q drive called ‘Folders for New Clients’. Open the appropriate folder that you would like to make copies of. (Red, Yellow, Manila) Please print out each form individually and for the 2 sided forms, 14 Last Updated 9/2014

select the ‘2 sided book’ setting in the print settings dialogue box. You will be shown in more detail on how to put together these folders. New Client Clinical Assessments can be found in the folder on the Q drive called ‘New Client Clinical Assessment’. Make about 25-30 copies of this at a time, using the ‘2 sided book’ setting with one staple.

PLEASE BE SURE WHEN YOU ARE MAKING COPIES OF ANYTHING, THEY COME OUT OF THE COPY MACHINE WITH PROPER ALIGNMENT. IT IS IMPORTANT FOR ALL OF THE FORMS WE PRINT OFF TO LOOK PROFESSIONAL. Meeting Room Manager Meeting Room Manager is in place for the therapists to schedule rooms. To log into MRM, go to the insidects homepage and click on the link in the bottom left hand corner. Username: ptstaff; password: therapy1. There may be times where you will be asked by a supervisor to check on a room reservation or to reserve a room for them. You should not reserve rooms or look up room reservations for therapists because it is their responsibility to take care of room reservations.

Running Medicaid Cards Clients, who use Medicaid to pay for their therapy services, will need to run their card prior to sessions in order to verify eligibility. If the client does not have their card, ask for the client’s first and last name and date of birth. Please select the appropriate drop box on the screen. If Medicaid card belongs to a child and the child is not present, be sure to email the therapist to inform them of the use of the card.

Medicaid protocol states in relational therapy, as long as the focus is on the family or child, the parent may use the child’s Medicaid card for individual services that apply. The therapist will follow up with any discrepancies and inform the Clinic Director After the receipt prints out, write the therapist’s last name on the top of the receipt and place in the brown expandable file in the copy room under the therapist last initial. If the client is using Medicare, the therapist will take care of this.

Credit Card Machine Each therapist is responsible for running their individual credit card payments. Psychiatrists’ assistants will process the payments for those sessions. The credit card machine is located in the equipment room.

Should the credit card machine become unavailable, please inform clients that you will need to defer that payment to the next visit and make a note on the receipt.

Practicum Overview The Counseling Center Practicum is a 5-6 semester clinical training experience that includes weekly individual and group supervision (at least 4 hours per week), 6 hours per semester of external clinical education didactics beginning in the 3rdsemester and up, an expectation that students will maintain a case load averaging at least 7 counseling session/week with 400 face to face sessions for MACMHC and 500 face to face sessions for MAMFT students required for graduation. Students are required to see clients at the CTS Counseling Center during the first year but may supplement their clinical hours with sessions at pre-approved off-site placements in the second year.

The CTS MAMFT program is accredited by COAMFTE (Commission on Accreditation for Marriage and Family Therapy Education). The Clinical Mental Health Counseling MA Program is 15 Last Updated 9/2014

aligned with CACREP standards and the professional orientation of the American Counseling Association (ACA). The practicum training for MACMHC and D.Min. MHC is certified by the American Association of Pastoral Counselors (AAPC). For more information about these organizations go to their respective web sites: www.aapc.organdhttp://www.aamft.org/aboutICOAMFTE/AboutCOAMFTE.asp.

In addition, CTS is a fully accredited member of the Association of Theological Schools and the North Central Association of Colleges and Schools.

Requirements for Admission to Practicum Students can apply for admission to practicum after completing P531 Human Growth and Development, P637 Psychopathology and Assessment, and either P510/D810Theories of Counseling, Psychotherapy, and Personality or P520- Introduction to Marriage and Family Therapy. Students choosing CPE as an elective must complete CPE before entering practicum. MFT can receive up to 100 hours of alternative hour’s credit for CPE not used as course electives upon prior approval of the MFT Program director. Further, MDiv/CMHC and MDiv/MAMFT students must complete one year of SCOFE before applying for practicum.

Students are accepted for practicum based upon successful completion of role plays as a screening process. Concerns that arise during those role plays may be addressed through additional evaluation as determined by the counseling faculty and clinic director. Entering cohort groups are normally limited to four persons for summer and six students for fall and spring. Priority is given to students who have the greater number of completed semester hours. Practicum admission is based on limitation of the cohort group due to available supervision in order to provide a conducive learning environment. All MA counseling students will normally be required to enter practicum no later than the 4th semester of coursework.

Ethical Standards and Confidentiality Confidential Information Disclosure of confidential information is detrimental to the reputation and professionalism of CTS and may be illegal. Unauthorized disclosure of confidential information is not only unprofessional, but it also demonstrates a failure to respect the rights of others. Such disclosure may result in discipline, up to and including immediate dismissal.

Our clients and other parties with whom we do business entrust the company with important information relating to their business. It is our policy that all information considered confidential will not be disclosed to external parties or to members of our community without a “need to know.” If there is question as to whether certain information is confidential, he/she should first check with his/her immediate supervisor.

This policy is intended to alert those who handle sensitive information to the need for discretion at all times and is not intended to inhibit normal business communications.

All inquiries from the media must be referred to Clinic Director.

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A. Practicum Confidentiality  Therapist-interns should never discuss their cases or clients with anyone outside of the CTS Counseling Center. Discussions regarding clients are limited to only CTS Counseling Center staff, faculty, supervisors, and current practicum students within the confines of the center.  Therapists should never use a client’s name or discuss a client via email.  Client files: o Under no circumstances are client files to be removed from the CTS Counseling Center. o Client files should never be left unattended; they should either be with the therapist, in Psychiatrist’s appointment bin, or in the file cabinet. Be careful to not leave files in counseling rooms after sessions or supervision. o Client file documents are not to be photocopied and taken home. o Progress notes may be written at home as long as client is not identified on the notes. Editing the notes to include client name or identifying features of client must be done at the counseling center. If therapist is using a flash drive for writing notes, etc., be sure that it is password protected. Therapist should also destroy any saved progress notes, clinical assessment, etc. on flash drive or computer after it has been printed and placed in client file.

B. Practicum Attendance Practicum is training in clinical work, which requires therapists to be reliable and dependable.

More importantly, practicum supervision depends largely on process. When interns miss sessions, the process is disrupted. Therefore, practicum attendance policy is as follows: Attendance is required for all practicum sessions, including community meeting, group supervision didactics and individual supervision. Missing practicum sessions, whether a full session or a partial session, except in cases of emergency, is not recommended. Missing more than any two practicum sessions per session per group, during a semester, means that a student will not receive credit for practicum that semester. Missing more than any two partial practicum sessions per session per group during a semester may lead to a reduction in practicum grade and, if further partial absences occur, possibly to the intern not receiving credit for practicum that semester.

A. Purpose of Practicum Counseling practicum is field experience designed to synthesize classroom theory and coursework with supervised clinical experience in marriage and family therapy and pastoral counseling/psychotherapy. MACMHC, MAMFT and D.Min. programs require 18 credit hours of counseling practicum.

As part of the practicum, the student will be expected to:     

Practice skills learned in previous and current coursework; Receive feedback on his/her level of effectiveness in supervisory groups and individual supervision; Learn what problems others are encountering as therapists in training and what solutions could be considered; Work with a variety of clients and presenting problems; Relate theory to practice; 17 Last Updated 9/2014

           

Begin the formulation of an applied theory of therapy and how change occurs; Research areas of professional interest; Work in an ethical and professional manner; Develop and refine active listening skills as evidenced by established rapport and a positive working relationship with clients; Develop and implement skills of completing a psychological history consistent with student’s theoretical orientation; Make accurate clinical diagnostic impressions using the most current version of the DSM—required on all PDI’s; Ability to conceptualize human problems; Develop treatment plans that will aid clients and that are consistent with current research of effective strategies for the client’s identified problem area(s); Maintain an effective therapeutic process and relationship with client until termination of the treatment; Document therapeutic work in a way that meets the standards of practicum, insurance and state requirements; Understand one’s own personality, biases, and one’s impact upon others in professional and collegial interaction; and Work toward graduation, certification and licensure requirements. Specific requirements for licensure or membership, by a professional licensing board/body, should be explored by the student in conjunction with appropriate program/accreditation guidelines.

B. Practicum Requirements  400 individual hours for MACMHC /D.Min.  200 individual hours / 200 relational hours (couples, family) for MFT.  100 hours of supervision for MACMHC and MFT students.  Attend Monday group sessions, which includes community meeting.  Participate in weekly individual supervision, which includes providing completed progress notes, monthly client hours/log, videotaped sessions and any pertinent documentation or activity required by supervisor.  Maintain a log of all client hours, didactics, individual supervision and group supervision hours (pink slips- see appendix).  Abide by professional code of conduct.  Abide by the standards and requirements of HIPPA.  Maintain client confidentiality.  Maintain client files with timely, accurate and necessary documentation.  Attend weekly personal therapy. Failure to do so may result in suspension from practicum.  3rd semester and up: fulfill 6 hours of external didactics each semester; didactics must be approved by Program Directors prior to attendance and documented by the last day of practicum each semester.

C. Clinical Training Counseling Practicum I (P820, P821, P822) Counseling Practicum II (P823, P824, P825 Counseling Practicum II (P826, P826, P827) MA in Marriage and Family Therapy Syllabus for Practicum 18 Last Updated 9/2014

Counseling Center Christian Theological Seminary Staff: Counseling Faculty and Clinical Supervisors Course Description This course will provide the opportunity for practice of counseling/therapy in the CTS Counseling Center under supervision of licensed professionals in the field. This practicum is designed for Master’s level students to develop clinical skills, refine therapeutic techniques, and understand professional behavior of a clinical field. Emphasis will be placed on developing skills, applying therapeutic and theological theory to clinical practice, and furthering clinical competence with individuals, couples, families and groups. Students will have the opportunity to explore various therapeutic approaches and receive various types of supervision.

Course Overview Required Text: Gehart, D. (2009). Mastering competencies in marriage and family therapy: A practical approach to theory and clinical case documentation. Belmont, CA: Brooks Cole Practicum is designed to provide supervision within a rich, diverse group experience as well as one-toone supervision with an individual supervisor. Feedback is given within a team process to student interns who are beginning to develop skills and techniques as therapists/counselors. Great emphasis is placed on integrating theory into practice and determining best modality for clients such as individual, family or couple’s or group therapy. There will be continuous weekly team discussions to assess the developments that occur from the combined “supervisor/team/treating intern” effort to access, support and promote the growth of clients as well as interns. Similar discussion and emphasis will be placed on the individual intern’s professional therapeutic growth. Professional development will also be emphasized and professional affiliation will be promoted.

Learning Objectives for Marriage and Family Therapy Program In accordance with the Core Competencies for Marriage and Family Therapists as developed by the American Association for Marriage and Family Therapy (AAMFT) and as counseling program accredited by the Commission for Accreditation for Marriage and Family Therapy Education (COAMFTE), upon graduation, students will be able to display competency in five primary domains of activity. Consistent with these competencies, we specifically endeavor to emphasize throughout our coursework, competencies in diversity matters, including racial ethnic, cultural, gender, sexual orientation, and spirituality awareness.

The primary domains are 1) Admission to Treatment – All interactions between clients and therapist up to the point when a therapeutic contract is established.

2) Clinical Assessment and Diagnosis – Activities focused on the identification of the issues to be addressed in therapy.

3) Treatment Planning and Case Management – All activities focused on directing the course of therapy and extra-therapeutic activities.

4) Therapeutic Interventions – All activities designed to ameliorate the clinical issues identified.

5) Legal Issues, Ethics, and Standards – All aspects of therapy that involve statutes, regulations, principles, values, and mores of MFTs. 19 Last Updated 9/2014

6) Research and Program Evaluation – All aspects of research and program evaluation that involve the systematic analysis of therapy and how it is conducted effectively.

Course Objectives Student Learning Objectives for Counseling Practicum This course will provide the student with the ability to: 1. Begin and continue a therapeutic process according to the standards of the program and Counseling Center that demonstrates clinical competence supported by clinical and legal (as necessary) documentation.

2. Maintain an active case load with attention to case conceptualization, case management, treatment planning, and appropriate termination of a case.

3. Assess the client/family’s presenting problem and formulate appropriate interventions based on the student’s clinical theory which needs to be culturally sensitive as to ethnicity, gender, sexual orientation, and spirituality.

All students will be able to demonstrate competencies within the following student learning outcomes:

Course: COUNSELING PRACTICUM (MFT Students) Learning Outcomes 1. Begin and continue a therapeutic process according to the standards of the program and Counseling Center that demonstrates clinical competence supported by clinical and legal (as necessary) documentation.

CORE COMPETENCIES: Domain 1, Admission to Treatment: 1.1.3, 1.2.1, 1.2.2, 1.2.3, 1.3.1, 1.3.2, 1.3.3, 1.3.4,1.2.3, 1.2.6, 1.3.7, 1.3.8, 1.3.9, 1.3.10, 1.4.1,1.4.2, 1.5.2, 1.5.3, 1.5.4, 1.5.5 Domain 2, Clinical Assessment and Diagnosis: 2.1.7, 2.2.1, 2.2.2, 2.2.3, 2.3.1, 2.3.2, 2.3.3, 2.3.4, 2.3.5, 2.3.6, 2.3.7, 2.3.9, 2.3.11 Domain 3, Treatment Planning and Case Management: 3.2.1, 3.3.6, 3.3.8, 3.4.3, 3.4.4, 3.4.5, 3.5.1, 3.5.3, 3.5.4 Domain 4, Therapeutic

Direct Assessment Activities which support the learning outcomes: The faculty-supervisor will evaluate the studenttherapist’s ability to begin and maintain therapy as well as document progress and outcomes by directly observing clinical work through live supervision and videotapes, oral and case presentations in both individual and group supervision through Introduction to Clinical Practice, MFT Conceptualization/Assessmen t, and Live Supervision Group.

Assessment Method Criterion-based rubric which evaluates the learning: The student’s ability to begin and continue therapy with clients through support of peers in live supervision and group supervision and building rapport with clients is assessed by the MFT Competencies Assessment System rubrics for clinical assessment and live supervision and the semester end student evaluation.

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Interventions: 4.3.3, 4.3.5, 4.3.6, 4.3.8, 4.3.13, 4.4.2, 4.4.4, 4.4.5, 4.4.6, 4.5.1, 4.5.3, Domain 5, Legal Issues, Ethics and Standards: 5.1.3, 5.3.3, 5.3.4, 5.3.5, 5.3.6, 5.3.7, 5.5.1, 5.5.2

2. Maintain an active case load with attention to case conceptualization, case management, treatment planning, and appropriate termination of a case.

CORE COMPETENCIES: Domain 1, Admission to Treatment: 1.2.1, 1.2.1, 1.2.3, 1.2.4, 1.3.2, 1.3.6, 1.3.7, 1.3.8, 1.3.9, 1.3.10, 1.4.1, 1.5.2, 1.5.3 Domain 2, Clinical Assessment and Diagnosis: 2.1.7, 2.2.1, 2.2.2, 2.2.3, 2.2.4, 2.2.5, 2.2.6, 2.3.1, 2.3.2, 2.3.3, 2.3.4, 2.3.5, 2.3.6, 2.3.7, 2.3.9, 2.3.11, 2.3.12, 2.4.2, 2.4.4, 2.5.1 Domain 3, Treatment Planning and Case Management: 3.2.1, 3.3.1, 3.3.4, 3.3.5, 3.3.6, 3.3.7, 3.3.8, 3.3.9, 3.4.1, 3.4.3, 3.4.3, 3.4.4, 3.4.5, 3.5.1, 3.5.2, 3.5.3, 3.5.4 Domain 4, Therapeutic Interventions: 4.2.2, 4.3.3, 4.3.5, 4.3.6, 4.3.8, 4.3.11, 4.3.12, 4.3.13, 4.4.1, 4.4.2, 4.4.3, 4.4.4, 4.4.5, 4.4.6, 4.6.1, 4.5.3 Domain 5, Legal Issues, Ethics and Standards: 5.3.1, 5.3.4, 5.3.5, 5.3.6, 5.3.7, 5.5.1, 5.5.2 3. Identify understandings of the client’s presenting problem and then formulate a theoretical clinical approach with appropriate interventions that connect with the student’s personal worldview and clinical theory.

CORE COMPETENCIES: Domain 1, Admission to Treatment: 1.1.3, 1.2.2, 1.2.4, 1.3.3, 1.3.9, 1.3.10, 1.5.2, 1.5.3, 1.5.4, 1.5.5

Activities which support the learning process: The facultysupervisor will evaluate the student-therapist’s ability to lead, plan, and manage by directly observing clinical work through live supervision and videotapes and oral and written case presentations in both individual and group supervision through MFT Conceptualization/Assessmen t, Live Supervision, and Professional Development.

Criterion-based rubric which evaluates the learning: Students’ ability to conceptualize a case based on systemic patterns and family of origin; to manage a case in reference to intrapersonal, larger systems, and referral sources; to plan appropriate treatment; and terminate a case is assessed through the MFT Competencies Assessment rubrics for treatment plan, progress notes, case conceptualization, live supervision, and the semester end student evaluation.

Activities which support the learning: The facultysupervisor will evaluate the student-therapist’s ability to formulate theories of the client’s presenting problem, creation of appropriate interventions, and explain how these clinical processes relate to the student’s personal worldview and clinical theory with feedback through MFT

Criterion-based rubric which evaluates the learning: The student’s ability to understand the client’s presenting problem and respond with an appropriate clinical approach in the context of his/her worldview and how corresponding interventions result in personal and relational growth for a client is assessed through the MFT

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Domain 2, Clinical Assessment and Diagnosis: 2.1.7, 2.2.1, 2.2.2, 2.2.3, 2.2.4, 2.2.6, 2.4.2, 2.5.1 Domain 3, Treatment Planning and Case Management: 3.1.1, 3.2.1, 3.3.1, 3.3.3, 3.3.9, 3.4.1, 3.4.4, 3.4.5, 3.5.2, 3.5.3 Domain 4, Therapeutic Interventions: 4.3.3, 4.3.5, 4.3.11, 4.4.1, 4.4.2, 4.4.3, 4.4.4, 4.4.5, 4.4.6, 4.5.1, 4.5.3 Domain 5, Legal Issues, Ethics and Standards: 5.1.3, 5.2.1, 5.2.2, 5.2.3, 5.2.4, 5.3.1, 5.3.2, 5.3.3, 5.3.5, 5.3.6, 5.3.7, 5.3.8, 5.4.1, 5.5.1, 5.5.2

Conceptualization/Assessmen t, Cultural Competency Group, Live Supervision Group, and Capstone Seminar-Self, Systems, and Spirit.

Competencies Assessment system rubrics for progress notes and live supervision and the semester end students evaluation.

Descriptions of Practicum Supervision (both programs) 1. Group Supervision- Each semester all practicum students must enroll in at least three hours of group supervision related to their program requirements unless an exemption has been authorized or requirements are altered by program director or clinic director. Please consult with program director as to group requirements or see group (program specific) requirements grid located in the appendix. Groups meet every Monday of the semester, including reading week. Students are also required to attend any community meetings that may be offered in practicum.

2. During group supervision, students benefit from participating in peer and supervisory feedback. Students are expected to be prepared with written materials pertaining to a case(s) if required by supervisor(s), share challenging and rewarding experiences working with clients, explore theories and concerns as they pertain to group topics and objectives.

Practicum offers the following supervision groups supervisory experiences and classes. The Practicum Group Supervision Requirements Grid provided to incoming practicum students specifies which groups are taken by students of which program. Some groups are taken by all students (Intro to Clinical Practice; Self of the Therapist; Cultural Competency; Spirit and Therapy; Capstone Seminar); some are taken by students of only the MHC programs (Intake; Psychodynamic Live; Continuous Case; Interdisciplinary) or the MFT program (MFT Conceptualization & Assessment ,Professional Development MFT); and some, while primarily for students of one program, are open to students of another program: while MFT Live is primarily for MFT students, it is, requiring approval by the program directors, open to students from the MHC programs; the same is true, in reverse, for Group Supervision of Group Therapy, which is primarily for MHC students but, requiring approval by the program director, is also open to MFT students.

Introduction to Clinical Practice – 1-hour weekly, take the first half of the 1st semester for all students in the first semester. This group is designed to address the functions of this particular 22 Last Updated 9/2014

counseling center as well as dynamics of the field such as confidentiality, HIPAA regulations, appropriate recordkeeping and other professional development issues. The group is led by one supervisor.

Professional Formation Cohort Group– 1 1/2-hour weekly, 3 semester-long cohort group to address how therapist’s own development, transference and countertransference issues, style of relating, family of origin, etc. interact with beginning clinical work as an intern. The following diversity issues will also be addressed on a rotating basis: (1) Cultural Competency – to address counselor awareness of own cultural values and biases, of client’s world view, and development of culturally appropriate therapeutic interventions. (2) Spirit and Therapy –students explore the relationship between the client’s operational theology, the client’s pathology, the therapist’s operational theology, and the therapeutic steps needed to modify the connection between said theologies and the presenting problem. (3) Gender and Sexuality—students will explore LBGTQ related issues, matters of sexism and heterosexism, and other gender and sexuality related matters as they relate to client and self.

Intake Conference – 1-hour weekly group to be taken the second half of student’s first semester in practicum in which students present clinical material from intakes they have conducted, with the focus being on their technique in joining clients, making assessments of the kind of therapy modality best suited to the presenting problem (individual, couples, family), assessment of appropriate referrals (suicidality/homicidality, hospitalization, support groups or recovery programs for addictions; psychological testing such as MMPI etc.), incl. duty to report child abuse etc., need for consultation with other professionals (release of authorization to obtain information about prior treatment; guidance counselors; etc.), formulating an initial diagnostic impression, and developing a treatment plan or treatment goals and client commitment to such a plan or goals.

MFT Conceptualization & Assessment – 1-hour weekly conference to be taken the second half of student’s first semester in practicum designed to examine how students go from gathering of intake information with couples and families to the development of a systemic formulation, achievement of an appropriate contract, and the implementation thereof.

Live Supervision Groups (MFT or psychodynamic) – 2-hour experience weekly group, in which live therapy is provided by a student in a relational case or individual case (multiple live cases may be observed). Different configurations of live supervision are used based on the supervision models varying according to program. MFT interns take MFT Live all 6 semesters of practicum, while MHC interns take MHC Live for at least 1 semester between their second and fifth semester of practicum. Typically two or more supervisors and six to twelve students are involved in the MFT Live supervision group, while the MHC Live supervision group will involve one or more supervisors depending on the number of live cases to be observed.

Continuous Case – 1-hour weekly experience in which students present the same case in sequences of two or three consecutive weeks, with attention being given to how the longitudinal process of the therapy is being managed.

Group Group Supervision – 2-hour weekly, 2 semester experience to provide intensive training for students preparing to lead therapeutic group experiences. In the first semester, the supervision group will function as an experiential training group in group dynamics. The task of the group during this time, therefore, is to study its own behavior as a group in the here-and-now of the 23 Last Updated 9/2014

group’s life and to seek to strengthen relationships in the group. The group may pursue this task in any way it so wishes, though it may find it useful to explore the ways in which authority, dependency, and intimacy are taken up, emotional roles are distributed and enacted, norms develop and are variously enforced, conflict is channeled, feelings of belonging and alienation emerge, and gender, race, and sexual orientation are constructed and used by the group. During the second semester, students are expected to serve as therapists in groups of their own organizing or groups in organizations CTS has partnered with. For this period, the group will provide group supervision of the group therapy provided by students. This group can fulfill both the LMHC requirement for group therapy and the interdisciplinary requirement for AAPC. Led by 1 or 2 supervisors.

Interdisciplinary Case Conference – 1-hour weekly experience in which 2 supervisors representing different disciplines are present. Attention is given to the quality of therapy relationship that exists, contextual and cultural issues involved in the treatment, and the extent to which it serves the treatment plan and the client’s best interests.

Professional Development--A supervision group focusing on professional issues unique to marriage and family therapists including career niches for MFTs, developing a business plan for clinical practice, job search and interviewing guidelines, licensure requirements, and preparing for the MFT licensure exam.

Self, Systems, and Spirit--Capstone seminar for MFTs focusing on integration of self of therapist concerns, systemic issues, and spirituality in preparation for the Capstone presentation.

3. Individual Supervision- All practicum students are required to meet with their individual supervisors for fifty minutes once a week. Supervisors are ethically and legally responsible for therapists in training as students are working under the supervisor’s license. As such, students need to be especially respectful of supervisors’ time and degree of responsibility.

Students are responsible for scheduling weekly supervision, reserving rooms for supervision and providing supervisor with timely client documentation, videotaped sessions for review and discussion, issues related to client-therapist dynamics, therapist interventions, and any questions and concerns within the scope of therapeutic practice.

Quality supervision is critical to personal and professional growth. Supervision works best when the therapist-intern and supervisor have an effective relationship, which promotes openness, trust, and exploration.

The clinic director apprises students of supervisory assignments at the beginning of the semester. Typically, therapist-intern and supervisor work together for three semesters.

After completion of first three semesters, student will be assigned a new supervisor. The student is encouraged to request a specific supervisor, but a request doesn’t necessarily guarantee the assignment. Clinic director in collaboration with Field V faculty and supervisory team takes the request under advisement and attempts to accommodate request based on supervisor’s availability, and program director’s input.

Program directors and clinic director strongly discourages requests to change supervisor during the course of a semester.

Personal Therapy for Practicum All CTS counseling practicum interns are required to participate in weekly personal therapy. Personal therapy is mandatory and essential for two reasons: self-care and experiential learning. Psychotherapy with a gifted clinician assists student therapists in working through problem areas in their own lives that 24 Last Updated 9/2014

may adversely affect clients and their own participation in an emotionally challenging training program; it provides a unique training experience that helps students understand the process of exploring the depth and interrelationship of systemic and intra-psychic features of human life.

It is incumbent on the student to select a counseling center approved therapist; supervisors or clinic director may be able to provide referrals for local therapists. There is one licensed therapist available in the counseling center for CTS students and practicum interns who work on a sliding scale. Supervisors, program director and/or clinic director may inquire about a student’s involvement (not content) in therapy and may seek to verify intern’s participation via the intern or intern’s therapist.

Background and Reference Checks A. Practicum Background Checks As part of the counseling practicum at Christian Theological Seminary, all applicants are required to have a criminal back ground check administered. This is a one-time check and will be valid through the duration of the program. However, if a student is suspended or discontinues the program and then wishes to return or re-apply, a background check may be required.

A criminal history will not in itself disqualify an applicant for a counseling practicum experience. Incomplete answers on the questionnaire, however, may disqualify an applicant.

Dishonest answers will disqualify an applicant for a counseling practicum experience. Applicants who complete this questionnaire may be required to participate in follow-up interviews with the director of the counseling center and/or Field V faculty.

Personnel Files A. Practicum Intern/Resident Personnel files are kept in a locked file cabinet in the equipment room.

For access to your files, please contact the Clinic Director B. Employees can refer to CTS employee handbook for this info, and interns can refer to CTS student handbook.

Getting Started 1. Observations- (Round 1) All incoming practicum students are required to observe three intake sessions conducted by an experienced practicum student. Observations may be in person or viewed on video. It is recommended that new students complete their observation requirements prior to the start of the semester. The clinic director will not assign clients to new students until this task is completed. Steps for completing this task:  Print copies of the observation form (download from InsideCTS or see appendix).  Contact front desk at the counseling center to determine what therapists have scheduled intakes to schedule the observation.  Contact therapist and determine if it is possible to observe his/her intake. Keep in mind, intakes have a 50% no show rate and the therapist must get permission from the client before session can be observed. Most clients are willing, but some are not—do not take it personally!  Once a therapist has scheduled an intake and the client has agreed for his/her session to be observed, fill out the observation form and have the therapist-intern sign the form after session has ended.

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 Following the session, discuss with the therapist-intern content of the session and ask any questions that you many have, particularly related to history taking, paperwork and confidentiality statements. Be sure to have the therapist explain the paperwork and the trail of paperwork that must be completed. It is recommended that new students observe clients that are self-pay.  Students may also contact therapists to view recordings of past intakes with them.

The same debriefing following the video viewing takes place.  Once you have completed the Verification of Clinical Observation of Intake Form, turn in completed and signed observation forms to clinic director. S/he will put you on the docket to be assigned clients.

2. Observations-(Round 2) After the new student has completed his/her intake observations and has been assigned clients, s/he must have one of his/her intake sessions observed by an experienced practicum student. It is recommended that as soon as an intake session is scheduled the new student recruit an experienced student to observe his/her session. Be sure to identify what counseling room the session will take place and what time. Following the session, discuss the experience with the observing student and solicit feedback.

3. Buddy System–All incoming practicum students will be assigned a buddy to help with the transition into the clinic experience. Please note that the buddy has volunteered his/her time to assist with the transition into the practicum experience. The buddy commits to an entire semester to support an incoming practicum student. S/he will acquaint the new student to the facility, protocol, paperwork, administrative tasks and functions of the clinic. Please utilize your buddy for assistance with the following:  Voice mail set-up (see appendix)  Mailboxes-located in basement work room (wooden cabinet). Boxes are arranged in alphabetical order by last name. Staff will assign and label student mailboxes.  Client (active and terminated) file cabinets-located off the main workroom in basement.  Lockers- located on the west end of the basement. Practicum students may claim any unused locker. Securing the locker with a lock is student’s responsibility.  Facilities- see appendix for floor plan. Have buddy provide a tour of the building.  Videotaping session/recording equipment (iRecord). See appendix for instructions.  Meeting room manager- software used to reserve rooms. See appendix  Client file requirements  Receipts (client and supervisory) see appendix.

The “buddy” will usually be 2nd semester students so that they will have received recent information.

Pertinent changes semester to semester will be communicated to students by clinic director.

D. Caseload Management 1.

Recommended Caseload- In order to complete the practicum requirement of 400 client hours in the MACHMC program within 5 consecutive semesters and the 500 client hours within other 26 Last Updated 9/2014

coursework and then five consecutive semesters in practicum (for a total of 200 individual and 200 relational for MFT students (100 hours will have been met for reflecting team experience in introductory MFT courses) and 500 individual/group/relational hours for CMHC’s), it is recommended that a student see no less than seven clients a week. Students are encouraged to see at least ten clients a week if possible, but no more that fifteen clients a week. Certainly, a student needs to keep in mind the demands of his or her class work, home life and job when determining the number of clients s/he is capable of seeing. Students should also consider administrative tasks, including paperwork required per each client when determining number of clients that s/he can realistically schedule. Rule of thumb is 30 minutes of paperwork per client each week. Keep in mind that time required for clinical assessments may exceed 30 minutes, especially when one is a beginning practicum student.

2.

Client Assignments- Clinic director will provide incoming students with a therapist profile sheet that requires students to indicate times that they will have available to see clients. This profile sheet should be updated every semester and student should notify director if availability changes at any time during the semester. In addition, the profile sheet includes a section for student to indicate areas of counseling interest in descending order. The clinic director utilizes this information in concert with client requirements and requests when making assignments. Clinic director also considers position of the student on client assignment rotation. Please note, when a student declines an assignment, s/he goes to the bottom of the client assignment rotation.

3.

Prospective Clients and Intakes – The prospective client form is an information sheet filled out by staff prior to a client’s intake session (see appendix). When a new client arrives at the counseling center, front desk personnel will provide her/him with initial paperwork to complete (PDI [personal data inventory], Assessment form, HIPPA Regulations, etc.). Therapist notify front desk that a new client is scheduled by submitting the prospective client form so that front desk staff will anticipate a new client’s arrival. Steps involved when therapist is assigned a:  Therapist will be notified via email and/or voice mail that s/he has been assigned a new client. The prospective client form with brief intake information is placed in the red binder located in the equipment room.  Therapist will pull the prospective client form from the red PDI binder and attempt to contact prospective client. Therapist must pick up prospective client form within 3 business days of being notified. When therapist has contacted prospective client and set an appointment, s/he will fill out the date and time of the set appointment on the flip side of the prospective client form and turn the form into the front desk. If the student has made 3-5 attempts to contact a prospective client and has not been able to schedule an appointment, the student may return the prospective client form to the clinic director including notes for all actions taken.  During the initial conversation with the prospective client, remind them of the following: o The first session will be 90 minutes; o Come early to fill out paperwork if possible; o CTS cannot accept cash: money orders, checks, prepaid debit cards, and credit card are accepted. o If Medicaid, please bring card (confirm we accept their type of Medicaid); o A list of all medications they are currently taking; and 27 Last Updated 9/2014

o If they are bringing in a minor and parents are divorced, please tell tell them to bring proof of custody/authority to make decisions regarding treatment.  Front desk staff will place appointment on calendar and create a folder for the prospective client kept at the front desk.  Therapist will pick up new client folder at the front desk at the time of scheduled intake. The prospective client form will be placed in the client folder in addition to critical documents: consent for treatment, statement of confidentiality, permission to videotape sessions, etc.  Following the intake session, the student will staple payment, copy of insurance card (if applicable), counseling receipt and a copy of the completed PDI, including a diagnostic impression. The batch of paperwork should be sent to our offsite booker, by dropping the completed materials in the green box located in the copy room. Student should be sure to make copies of all material for his/her files.

4.

Intake Session- 90-minute, initial session with new clients. The purpose of the intake is to perform the following tasks:  Complete necessary paperwork;  Take client psychosexual history/genograms—usually takes more than 1 session to complete;  Assess for suicidal ideation (see appendix);  Assess for substance abuse (see appendix);  Determine presenting problem;  Determine goals and objectives of therapy;  Setting boundaries/ therapeutic frame;  Building therapeutic alliance; and  Make diagnostic impression—this needed for the PDI sheet that will be given to the offsite bookkeeper. *If client needs exceed the level of services the CTS counseling center can provide (i.e. Client needs inpatient or wrap around services), consult with your supervisor and provide an appropriate level of care referral. * Research indicates that the typical intake session’s time is distributed into the following chunks of time: 15% general conversation and presenting concern; 30% diagnostic inquiry including exploration of suicidal and violent thoughts and actions, other prominent symptoms; 15% medical history, social context, and family history; 25% personal and social history, functioning and impairment; 10% mental status examination; and 5% summarization of session, feedback to client, and planning for next meeting.

Intake Forms- The following forms are included in the client folder.

However, if more forms are needed, these can be found in the equipment room or by accessing InsideCTS/Counseling Center Home. Students should review these forms prior to intake session. Be sure to ask buddy any questions about these forms. a.



Client Information Sheet (Guidelines for Beginning Clients)- This form is filled out by the therapist and it includes therapist’s contact information (VM number and extension), agreed upon fee amount, and notification that appointments not cancelled within twenty-four hours of session will be billed at regular fee 28 Last Updated 9/2014

amount. Therapist will give this sheet to the client. Be sure to emphasize to client that the voicemail number should be used to make contact with the therapist, not the counseling center office number.

Authorization for Clinical Services-Consent for Counseling, Authorization of Recording and Use for Training and Research, Confidentiality PoliciesTherapist should review with client confidentiality policies and be sure that the client understands the therapist’s ethical and legal responsibility to disclose to the proper authorities any reasonable suspicions of abuse, neglect, or injury of a child, elderly person, or a disabled person.

Therapist should also be clear with client that as an intern s/he consults with a supervisor and that part of the consultation may require s/he to videotape sessions. If client refuses to sign videotaping release, therapist will end the session if client is stable and inform client that s/he will forward his/her case on to clinic director for potential referral to a resident. (Residents are not required to videotape sessions.)

If client is a minor, be sure to have his/her guardian or parent(s) sign the applicable sections on this form. 

Fee Agreement- Review this form with client and be sure to have client initial all areas indicated regarding fee agreement. If client is unable to pay the standard fee of $99 for a 50-minute session, (Intake session fee is $148.50) the therapist will need to determine the applicable fee by reviewing the income increments on the sliding scale and setting the fee



Consent for the Treatment of Minors- If client is a minor, therapist should complete this form and have guardian or parent(s) sign.



Authorization to Release Confidential Mental Health, Psychiatric, Alcohol Abuse or Drug Abuse Information- If the client had received previous counseling/therapy or had noted any significant medical treatment, the therapist should encourage the client to allow the therapist to have access to this information.

This is accomplished by having the client sign this release form. After completing this form, the therapist should fax or mail the request to the appropriate agency or persons as soon as possible.

5.

Transferring Clients- The need to transfer a client should first be discussed with the therapist’s supervisor. Therapists may discuss with other therapists the need to transfer a case. This allows transferring therapist to determine if another therapist would be a fit or have interest in working with the prospective client. Supervisor of transferring therapist will discuss the need to transfer a client to the supervisory group or to the specific supervisor of a potentially identified new therapist.

Transferring therapist will need to complete a transfer summary. Once transfer summary has been approved and signed by supervisor it may be transferred to the new therapist. Transferring therapist must notify clinic director of new therapist and client pair. Under no circumstances does a therapist transfer a case to another therapist without going through the proper channels. It is best practice for the transferring therapist and new therapist to conduct a shared session with the client(s) to help create a 29 Last Updated 9/2014

smooth transition of care. The receiving therapist is responsible for creating a new activity log; updating all intake forms and, updating client file color if there is change in method of payment that requires it.

6.

Referrals- At times, a therapist may receive a referral from a client or someone outside of the center. In this case, the therapist should complete the prospective client intake form with the client, or instruct the prospective client to call the front desk and go through the telephone intake and inform the front desk staff member that s/he would like to work with the identified therapist. The therapist will be notified by the clinic director that the prospective client (referral) has been assigned to him/her.

7.

Scheduling Client Appointments- prospective clients must be contacted within 3 business days of notifying the therapist. If the therapist is trying to schedule an appointment with a client from a homeland line or cell phone, be sure to *67 the call. It is strongly recommended that the therapist protect his/her privacy and not provide clients with access to personal telephone numbers.

Telephones are also located in the basement for therapist to use in scheduling appointments and communicating with clients.

It is recommended that the therapist try to keep clients on a regular and consistent schedule. Changing days and times of appointments creates confusion and missed appointments. Consistency is therapeutic!

Therapists should always be on time for their appointments! The front desk is not responsible for calling you to let you know your client has arrived. Therapist should periodically check to see if client has arrived, meet client in the lobby, and escort client to the counseling room.

Therapists should not ask front desk staff to send their client(s) to a counseling room. Therapist should also escort their clients to the lobby upon the end of their session. No unescorted clients are allowed beyond the lobby.

8.

Reserving a Counseling Room- It is the responsibility of the therapist to reserve a room for intakes, regular sessions, and supervision. It is recommended that therapists reserve rooms as soon as possible. Note: Therapists are allowed to reserve rooms only two weeks in advance of appointments. If a therapist is abusing this privilege, please notify clinic director. Room reservations are made through Meeting Room Manager, which is found on InsideCTS. All incoming practicum students will be able to access this site. Please ask buddy to assist with reserving a room. If you have a room signed out and will not be using it, delete your room reservation. Failure to do this will impact your practicum grade and your supervisor will be notified. (see appendix for instructions).Observations rooms on the 2nd floor may be utilized by all therapists, but must reserve room through Meeting Room Manager.

Indicate that the room is in use by sliding the room “occupied” door signage in place. When session is finished, always turn off IRecord at the end of a session; change the door signage to “vacant.” Be sure to finish session on time.

9. Setting Fees/Session length/Billing- (Intake sessions, 90-minutes $148.50; Regular sessions, 50-minutes $99.00. Fees should be pro-rated for shorter or longer sessions, e.g., 25 min = $49.50, and 80 minutes = $148.50) Counseling Center cannot accept cash!

There are two types of paying clients: Self-pay and Medicaid. Interns are not assigned Medicaid clients (some exceptions to this may occur, but this is under the discretion of clinical director).

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Medicaid clients are billed the full fee amount. Self-pay clients are charged based on a subsidized fee or sliding fee scale. Preliminary fee assessments are made during the initial telephone intake by a member of the front desk. Keep in mind this fee is a cursory estimate.

Fee amount should be discussed and agreed upon during initial intake. A sliding fee scale, based on monthly/yearly income, can be found in the back of the client folder. Use this scale when determining fee amount. Have client sign fee agreement. Issues around money and fees should also be part of the supervisory process. Be sure to discuss trepidations and resistance to charging clients with supervisor. (Please review “Money and Therapy” found in appendix.)

If a client’s financial situation should change for the worse and s/he is struggling to pay the fee, client should complete the “Increased Subsidy Request” form. This form should be turned into the clinic director who will determine if fee reduction is warranted.

Clients should be informed that charges will be incurred for missed appointments and appointments not cancelled within 24 hours of appointment.

The therapist is responsible for taking payments and writing receipts for sessions and missed appointments. Financial matters (collecting fees and setting fees) should be done at the beginning or end of the therapy session, not at the front desk.

10. Psychiatric Services- CTS Counseling Center makes psychiatric consultations available to clients of the counseling center. Our psychiatrist and nurse practitioner are available for consultation, evaluation and medication management. Note: Only CTS clients regularly and consistently seeing their therapists (at least twice a month) are eligible to see the doctor or nurse practitioner. There are no exceptions even if a client is on medication.

Fees (no private insurances accepted):  Initial evaluation (1 hour)…………… $110.00  ½ hour follow-up visit ………………….$55.00 11. Guidelines for Psychiatric Services a. If a therapist determines that a psychiatric evaluation is appropriate for his/her client and wishes to set an appointment with one of the doctors or nurse practitioner, the following procedures must be undertaken by the therapist: b. Discuss case with therapist’s supervisor; c. If supervisor concurs that a psych evaluation is appropriate, therapist should discuss with his/her client the possibility of consulting with one of the doctors or nurse practitioner as part of his/her treatment. If client agrees that a psych evaluation/consultation may benefit his/her treatment, then therapist should discuss with his/her client the psychiatric fees, policies on missed appointments and required on-going therapy with the therapist. Therapist should have the client sign the agreement for psychiatric services and the client should understand that fees are not negotiable. Clients may make payment arrangements for these fees. This fee agreement is located on the left side of the client file. d. Therapist will need to complete the Psychiatric Referral Form to expedite an appointment for medical services. These forms are located in the equipment room in the forms bin.

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e. Therapist must have his/her supervisor sign off on the Psychiatric Referral Form; f. Therapist will attach a copy of the PDI face sheet to the Psychiatric Referral Form; g. Therapist will staple all aforementioned signed and completed forms and place them in the yellow folder in the equipment room labeled: Pending Requests; h. Within three to four business days the request for an appointment will be processed and client will be scheduled to see the doctor or nurse practitioner.

Therapist will be notified via email that an appointment has been made.

However, this may not mean that the client has confirmed the appointment. It is incumbent on the therapist to confirm with his/her client that the scheduled appointment will work. Therapist should convey to client that appointments are hard to get and encourage the client to adjust their schedules if possible to accommodate the doctors or nurse practitioner’s available times. Clients declining scheduled appointments could experience a delay in receiving psychiatric services. If, however, the client absolutely cannot make the scheduled appointment, the therapist will need to inform the assistant to the medical staff that the appointment will not work. The therapist will need to serve as a liaison for client and the assistant to the medical staff in scheduling a psychiatric appointment. i. Once an appointment has been made and confirmed, a staff member will remind client and therapist of pending doctor’s appointment prior to the appointment. j. Therapist must have all client files current before doctor will see the client.

This means that an intake summary must be completed as well as all applicable progress notes. k. Therapist will ensure files are properly accessible for assistants of medical staff to pull. Files will be pulled the day before the schedule appointment.

Should a therapist need the file, the therapist is responsible for making sure the file is placed in the mailbox of the proper assistant staff. . l. All Medicaid clients are mandated to have a Psychiatric evaluation per Medicaid standards m. Should a therapist, assistant or member of staff need to leave a note for Psychiatric Services please use the Psychiatric Services Note form.

Urgency: If therapist feels that a client needs to see one of the doctors sooner than current schedule will allow, s/he must discuss with clinical director. Clinical director will determine if the client situation warrants overriding all other clients in queue to see one of the doctors. Therapist should also apprise his/her supervisor of the situation.

12. Terminations/Closing Client Files-. The decision to terminate may be jointly agreed upon by the client (s)and therapist or it may be a unilateral decision by the therapist typically resulting from clients not keeping appointments or violating other boundaries and conditions of the therapeutic frame.

If a therapist is graduating or leaving the practicum program, s/he should consult with his/her supervisor as to how the therapist should process his/her departure with a client.

(E.g. Clients may experience the therapist’s departure as a form of rejection.) Therapist 32 Last Updated 9/2014

should also discuss with his/her supervisor transferring the client another therapist. (See transferring clients) If a therapist and client have mutually agreed that the goals and outcomes desired from therapy have been met, then the therapist should share with the client that s/he will simply be “closing” his/her file following the last agreed upon session. However, the therapist may want to extend his/her willingness to work with the client again in the future if the client’s circumstances should change.

A therapist may decide to terminate a client because the client has stopped coming to therapy, frequently no-shows, has not paid for sessions (limit is one session), or other boundary related incidents. The therapist should notify the client in writing that his/her case file will be closed on a certain date (two weeks from date of letter) unless the therapist hears back from the client. It is recommended that clients be terminated if they have missed three sessions without cancelling the appointments. If the client consistently cancels appointments, the therapist should discuss with his/her supervisor and determine course of action. If the client has not been seen for more than 45 days, a termination letter must be sent unless you have received approval from your supervisors. Avoid keeping open client files of clients who are not actively participating in therapy. If the client is being terminated and also receiving psychiatric services with one of our providers, their psychiatric provider must be notified and discontinue services as well. Be sure to inform the client of this and provide a referral for psychiatric services elsewhere if needed.

In all of the above cases, the therapist must complete a Termination Summary (InsideCTS Counseling Center Home or in the forms bin in the equipment room). Be sure the writing is concise, professional and captures the course of therapy. This form must be signed by the therapist’s supervisor before therapist can place the file in the terminated file section in the equipment room.

Termination summaries should include a brief review of the client’s history and development and treatment progress. Therapist should also include diagnostic impression, progress made, interventions used, and client’s ongoing difficulties and goals. Quantifiable information such as date of intake, number of sessions, number of participants in therapy (i.e. spouse, family members), treatment modality, progress made and areas of heightened need.

13. Leading Support or Therapy Groups MHC students must take Group Group Supervision to lead a support or therapeutic group and MFT students must have approval from their program director. Each client within a group should have their own client folder with new intake forms completed. The receipt should be copied and progress notes on the bottom (create group formatted progress note). These should be signed off on by Group Group supervisor or individual supervisor.

Proposals to run groups must be approved by one’s supervisor as well as the clinic director.

Proposals should include an informational guide for the counseling center website.

Counselors are also encouraged to create a flyer in consultation with the CTS communications office to utilize for marketing. All flyers should have the CTS logo. Use receipts to bill for group sessions and to keep track of hours. Once a group has ended, the group must be terminated and have filed along with other terminated group files. Files 33 Last Updated 9/2014

should include progress notes and forms for each client, as well as attendance records and receipts.

14. Release of Mental Health Records/ Fees- If a client or third party requests his/her mental health records, records should not be released without the client first completing and signing the Authorization to Release Mental Health, Psychiatric, Alcohol or Drug Abuse Information. This form is located in the equipment room in the portable silver file. Therapist should discuss information released with client under the direction of their supervisor. a. Policy on the Release of Mental Health Records of Minor Children to Custodial and Non-Custodial Parents - Indiana law* states that both custodial and non-custodial parents have equal access to their children’s mental health and general health records unless the provider (CTS) has actual knowledge of a court order limiting the non-custodial parent’s right of access. If CTS Counseling Center has no knowledge of, or a copy of a court order prohibiting the release of information, it is the policy of CTS to release the mental health records of minor children to either parent upon receipt of a properly executed “Release of Information” form. *Indiana Code 16-39-1-7-a, “Child’s health records: access to custodial and noncustodial parents,” and Indiana Code 16-39-2-9-b. “Exercise of patient’s rights by others: equal access to records.”

Practicum Administrative Tasks and Responsibilities A. Correspondence- All correspondence with clients must be done on CTS Counseling Center stationery. Stationery and envelopes are located in cabinets in the equipment room.

Therapist should drop off materials to be mailed to clients at the front desk. The CTS business office will take care of postage.

B. Client Files 1. Organization of the file folder- The left side of the client file folder is used for doctor’s notes, psychiatric fee agreement, and activity report. The right side of the folder should include signed PDI, Consent for counseling, videotaping, fee agreement, any medical release and contractual forms, intake summary, progress notes and transfer or termination summary.

C. Paperwork 1. Activity Reports- (see appendix) This form, located on the left side of the folder, is a snapshot of client activity. Client contact information should also be completed on this form. This form is particularly useful in an emergent situation. If the therapist is not in the counseling center and a client is in crisis, counseling center staff can access this form quickly to obtain a telephone number or emergency contact information The therapist records dates and summaries of all communications (verbal and written) with his/her client, cancelled and no-showed appointments, attended sessions, receipt numbers, length of session, type (individual, couple, etc.), number of persons in the session, and etc. There must be a progress note that corresponds to every session recorded in the activity report.

2. Progress Notes-A progress note is completed following every therapy session. It is strongly recommended that a therapist complete a progress note shortly after the 34 Last Updated 9/2014

session has occurred so that the content of the session is easily recalled. A progress note should also be completed if any other therapy related activity has occurred that cannot be summarized on the activity sheet.

Progress notes function as a written synopsis and record of the counseling session. The therapist should discuss with his or her supervisor what type of clinical material to include. Some items that may be included in the notes are as follows:        

Summary of the content and process of the session Effect of the client Any significant changes since previous session, e.g. dress, hygiene, affect, etc.

Any new historical information Any changes in diagnosis Treatment goals attained or changed Any indication of suspected abuse Themes in the session Therapist can either access InsideCTS, counseling center home for a progress note template or find forms in the equipment room.

Note: When writing progress notes, therapist may want to exercise as a rule of thumb or caveat: “What would my client think if he or she read my notes.” Therapists should remember that client files may be subject to subpoena, so be cautious when contemplating the inclusion of any damaging or incriminating information.

3. Receipts- Receipts for clients and supervision are located in the equipment room.

Be sure to sign out receipts by corresponding numbers on the applicable ledgers.

4. Terminations and Transfer Summaries- These forms are located on InsideCTS under Counseling Center Home and in the equipment room.

5. Clinical Assessments- (see questionnaire in appendix). The clinical assessment form is located on InsideCTS Counseling Center Home. The purpose of the intake summary is to capture and briefly articulate the following pieces of client information:  Identifying information;  Overview of the presenting problem, its symptoms, and impact on the person;  Information on mental examination (i.e. oriented to time and place);  Other problems and difficulties;  Present life situation;  Information on family of origin and present family;  Developmental history, important incidents;  Medical and treatment history;  Case conceptualization, including strengths and areas of difficulty;  Multi-axial diagnosis; 35 Last Updated 9/2014

 Treatment plan and other recommendations; and  Conclusion and summary.

6. Logging Clinical Hours- All therapist interns are required to log all client and supervisory hours. The log should be turned into the therapist’s supervisor the beginning of each month. The supervisor will review and sign the log. The therapist should turn in the signed log to the clinic director.

Therapist-interns can access this excel spreadsheet log by going to Inside CTS Counseling Center Home. Therapist-interns should utilize buddies for help with this or contact the Billing and Operations Liaison 7. Out of office management – If going out of town for more than 3 days, the therapist must submit a vacation notification form to clinic director that indications the length of vacation and who is the back-up therapist. It is also a good practice when going on vacation for a week or more to leave an away message on your voicemail indicating your return and numbers to call in cases of urgent need.

Grievances All formal complaints/grievances must be written and filed with clinic director. The director will attempt to resolve all disputes in an unbiased and timely manner. Procedures and remedies utilized at the director’s discretion include, but are not limited to the following: o The director will maintain a formal, confidential file of the complaint. o The director will meet with all affected parties in an attempt to understand the nature, scope, and potential resolution of the alleged complaint. It is the goal of the director to conduct a meeting within five days of the filed complaint; however, exceptions may occur. Notes from the meeting will be maintained in the file. o The director may also conduct a thorough investigation, which may include interviews with students, faculty and staff, written statements by parties involved as well as others who may offer substantiating complaints, consultation with faculty/supervisors and staff members. o Remedies available to the director include exclusion of the offending party from certain parts of the program, grade penalties, probation, suspension, or expulsion from the practicum program. o The director in consultation with other faculty in Field V. will make decision as to the necessity for action and level of action required by director. o If either party is dissatisfied with the director’s decision, they may file a complaint with the academic dean of the seminary who may also consult with the academic council.

1. Complaints between students.  It is recommended that a student who feels s/he has been treated in a manner in which violates the professional code of conduct (see appendix) by another student, first seek to remedy the infraction by a direct and civil conversation with the offending student. If the matter is unable to be resolved, the clinic director should be apprised of the offense by the complainant; additionally, the complainant should provide a written explanation detailing the nature, time(s) 36 Last Updated 9/2014

and places the offense(s) occurred. The complainant should also include what actions were taken to resolve the issue.  Quality of care: If a student believes another student has engaged in unethical treatment of a client, the student should file a written complaint with the clinic director. The complaint should include that nature of the offense and the means by which the complainant became aware of the offense.  The clinic director will exercise grievance procedures cited in the aforementioned.

2. Complaints against students issued by faculty/staff.  If a supervisor or faculty member believes a student has violated the professional code of conduct (see appendix), s/he will first attempt to resolve the matter in conversation with the student. If this conversation does not occur, or fails to resolve the matter, the supervisor/faculty member shall file a written complaint with the clinic director. If the faculty member/supervisor believes that client care is in jeopardy, s/he may bypass this step and contact the clinic director immediately.  The director will convene a meeting with supervisor/faculty member and student within five days of receipt of written complaint. The director will exercise grievance procedures cited in the aforementioned..

3. Complaints by students involving faculty, staff, or supervisors.  If a student believes that a faculty member, staff member, or supervisor has violated the professional code of conduct (see appendix), s/he should first discuss the matter with the faculty member or supervisor. However, if the student’s complaint involves sexual impropriety, emotional duress or physical harm, the student should immediately report the incident(s) to the clinic director.  Director will exercise applicable grievance procedures cited in the aforementioned.

4. Complaints involving clinic director.

If a student or supervisor believes the director has violated the professional code of conduct (see appendix), s/he should consult with a faculty member of the Field V. If the complainant feels uncomfortable approaching a member of the Field V, s/he may file a complaint with the academic dean of the seminary.

Probation, Withdrawal, Suspension or Expulsion from Practicum 1. A student may choose to withdraw from clinical training after consultation with the clinic director.

2. A student may be issued a written warning, put on probation, and/or asked to withdraw from clinical experience based on the following reasons:  Unsatisfactory progress as a clinician;  Failure to work cooperatively with supervisor(s);  Failure to abide by the policies and procedures of the clinic and the practicum program.  Failure to maintain up-to-date documentation of client files; 37 Last Updated 9/2014

    

Failure to comply with attendance policies; Failure to maintain adequate client caseload; Failure to uphold the AAPC or AAMFT Code of Ethics; Failure to uphold HIPAA standards and requirements; Failure to cope with personal struggles in a manner that does not negatively impact work with clients; and  Conduct unbecoming of a student enrolled in a seminary program or that is otherwise inconsistent with the seminary’s Christian values or mission.

3. The action taken by the program will be consistent with the nature of the violation.

The director, in consultation with program director and intern supervisor, may create a probationary plan with measurable goals and outcomes to be achieved by the student within a designated amount of time.

Violation of probations will begin with a warning documented by e-mail. 2. If no improvement is made, after time frame probation, then withdrawal of program will be enforced.

Conditions Under Which a Therapist May be Removed from Practicum 1. Any sexual activity with a client. Examples of prohibited verbal or physical conduct include, but are not limited to: a. Direct or implied threats of a sexual nature; b. Direct or indirect propositions of a sexual nature; c. Subtle pressure for sexual activity, an element of which may be conduct such as repeated and unwanted staring or leering; d. Conduct that discomforts, humiliates, and/or titillates in one or more of the following ways: i. Personal comments of a sexual nature, except where clearly indicated as a necessary part of the therapy, of which the therapist’s supervisor has knowledge and to which the supervisor has consented; or II. Inappropriate sexually explicit statements, questions, jokes or anecdotes; e.

Conduct that would ordinarily discomfort or humiliate a person at whom the conduct is directed, including one or more of the following: i.

Unwanted or unnecessary touching, patting, hugging, or brushing against a person’s body. ii.

Remarks of an implicit or explicit sexual nature about a person’s clothing or body, except where clearly indicated as a necessary part of the therapy, of which the supervisor has consented; or iii. Remarks about sexual activity or speculation about a person’s sexual experience, except where clearly indicated as a necessary part of the therapy, of which the therapist’s supervisor has knowledge and to which the supervisor has consented.

2. Refusal to seek and/or maintain personal therapy when it is required by the supervisory staff.

3. Behaviors that are deemed disruptive to the work of the counseling center and/or the work of practicum.

4. Failure to follow requirements related to client services required by the therapist’s supervisor.

5. Absences in excess of normal vacations, sick days, etc.

6. Failure to maintain an adequate caseload.

7. Failure to maintain client files in an appropriate manner, including appropriate intake reports, progress notes, timely termination summaries, etc.

8. Other inappropriate or improper behavior, including but not limited to: 38 Last Updated 9/2014

a. improper behavior directed toward oneself or other students, toward faculty, administration, staff, clients or property of CTS or toward the public; b. violation of the law or of CTS rules and regulations; c. conduct that would impugn the reputation of CTS; d. conduct unbecoming of a student enrolled in a seminary program or that is otherwise inconsistent with the seminary’s Christian values or mission.

Departing Practicum The process for exiting practicum: While some situations are different, the typical way of exiting practicum is as follows: Notify your supervisor at the beginning of the semester that you plan on this being your last semester Notify the clinic director after you have notified your supervisor. An audit of your files will be conducted mid-semester so you are aware what you need to complete prior to leaving practicum; all files must be completed before the registrar will be notified to release all of your paperwork for graduation  Contact Medical Billing for their tally of your hours; you must have at least 500 hours to complete your practicum requirement (250 of those must be relational for MFTs) and 150 hours of supervision. It is your responsibility to justify your hours with medical billing’s total.

Sometimes this is a very complicated process, so I suggest you start on this early.  You will discuss with your supervisor what clients need to be transferred to another therapist and which ones will need to be terminated. Once this is determined, contact the therapist(s) you’d like to refer to, and see if they have availability to take on more clients. This is best done by emailing them and their supervisor, and cc’ing your supervisor on it.  In consultation with your supervisor, determine when to begin letting your clients know that you are leaving.  If you are transferring, the best transfer situations are when you can introduce the client and new therapist to one another, so attempt to schedule enough time for that to be orchestrated.  Write your termination and/or transfer summaries signed by your practicum supervisor, and submit your files for a final audit.  Provide a list to the Clinic Director of the status of your clients (i.e. terminate, or transferred, and if transferred the name of the therapist accepting the transfer)  Your last “official” act will be to fill out the “Hours documentation” form from the registrar, and have the clinic director sign off on it ~ it will not be signed until the center director receives a goahead from the final audit, and the hours from Medical Billing.  If you are a resident, your last step is that you must return your keys to Dan Pritchard.

Congratulations!!!!! What you saw as an overwhelming task a few semesters ago, you have now completed!

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COUNSELING CENTER CLOSINGS The building is customarily closed on holidays; however, the counseling center may remain open to serve clients. The president reserves the right to adjust the holiday schedule as necessary, but generally, holidays include: Independence Day Labor Day Thanksgiving Day & the Friday following Christmas Day New Year’s Day Martin Luther King, Jr. Day Maundy Thursday & Good Friday Memorial Day The clinic director will send announcements confirming all scheduled closings prior to dates of closing.

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APPENDICES Practicum Specific Degrees Program & Policies I.

II.

Degree Programs  MACMHC Curriculum CACREP/LMHC correspondence sheet  MAMFT Curriculum Clinical & Supervision Requirements COAMFTE educational outcomes  D.Min. Curriculum Residency Program

I. Degree Programs: Clinical Mental Health Counseling The Master of Arts in Clinical Mental Health Counseling provides professional preparation and theological/spiritual integration for mental health counselors, pastoral psychotherapists and spiritual care specialists.

The MACMHC degree meets State of Indiana academic requirements for licensure as a Mental Health Counselor. It is aligned with CACREP standards and the professional orientation of the American Counseling Association (ACA). An approved training program of the American Association of Pastoral Counselors (AAPC), the program also prepares students for certification as pastoral counselors without requiring ordination.

Grounded in a relational understanding of human psychological and interpersonal dynamics, the program enables students through clinical practice and theological/spiritual reflection to facilitate mental health and to effectively engage psychological, socio-cultural and existential concerns. Students seeking in-depth preparation for mental health work with individuals and groups emphasizing theological/spiritual integration in a variety of settings are encouraged to apply to this program.

Requirements The Master of Arts in Clinical Mental Health Counseling requires 69 semester hours (SH) of required and elective courses, with a cumulative grade point average of 2.7. Courses marked with an asterisk (*) are prerequisites for practicum.

The time to complete a degree depends on the number of hours taken each semester. Typically, full-time students complete the degree over three and a half years, by enrolling in nine semester hours during each fall and spring semester in addition to at least one term of summer practicum in the final portion of the degree. Some students complete the degree in three years. Students have six years in which to complete the Master of Arts in Clinical Mental Health Counseling degree unless an extension for special circumstances is granted by the Academic Council.

Students are required to complete 1,000 hours of supervised clinical experience, which includes a minimum of 400 hours of direct service to clients of clinical mental health counseling, of which at least 10 hours must be group therapy, and receive at least 100 hours of individual and group supervision in practicum.

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Students conclude their degree by completing a Capstone Presentation as described in section D below.

While CTS makes every effort to be in compliance with the requirements of specific licensure boards (LMHC, LPC) and professional credentialing bodies (CACREP, AAPC), students must take individual responsibility for monitoring and meeting licensure and credentialing requirements that may change between admission and graduation and may vary from state to state.

A. Studies in Religion (9 hours) I. General (6 hours) B-501: Introduction to the Hebrew Bible/Old Testament (3 SH) Or B-502: Introduction to New Testament (3 SH); T-500: Introduction to Theology (3 SH) Or X-___: Any course from Fields II, III or IV (courses focusing on theology, religion, culture, church history, ethics, and social justice) (3 SH) II. Integration of Spirituality and Mental Health Counseling (3 hours) P-634: Theological Perspectives on Pastoral & Spiritual Care and Counseling (3 SH) ** B. Therapeutic and Clinical Studies (45 hours) I. Core Studies in Mental Health Counseling (36 hours) P-510: Theories of Counseling, Psychotherapy, and Personality (3 SH)* P-511: Counseling Skills and Helping Relationships (3 SH) P-531: Human Growth and Development (3 SH)* P-632: Foundations of Mental Health Counseling (3 SH) P-635: Ethical and Professional Issues in Clinical Practice (3 SH) P-637: Psychopathology and Assessment (3 SH)* P-639: Testing and Appraisal (3 SH) P-656: Social and Cultural Dimensions of Counseling (3 SH) P-657: Contextual Dimensions of Mental Health Counseling (3 SH) P-675: Career Development and Counseling (3 SH) P-760: Group Counseling and Psychotherapy (3 SH) P-770: Research Methods (3 SH) II. Specialized Studies in Mental Health Counseling (9 SH) P-630: Psychoanalytic Theory & Technique (3 SH)

And two electives from the following four areas: social justice, choose P-619, P-641, or P-650; couples, marriage and family, choose P-520, P525, P-621, P-623, P-711, P-774, or P-775; psychodynamic, choose P-633, P-640, P-644, P739, P755, or P-766; spiritually integrated counseling, choose P-633, P-638, P-641, P-644, P-739, or P-800, 801) P-520: Introduction to Marriage & Family Therapy (3 SH) P-525: Aging and the Family (3 SH) P-619: Sexuality, Gender and Culture (3 SH) P-621: Integration of Marriage & Family Therapy Theory (3 SH) P-623: Couples Systems Therapy (3 SH) P-626: Loss and Mourning (3 SH) P-633: History of Healing (3 SH) P-638: Religion, Medicine and Pastoral Care (3 SH) P-640: Transference and Countertransference (3 SH) P-641: Spirituality and God Images in Counseling and Society (3 SH) P-644: Dreams and Discernment (3 SH) P-650: Treating Addictive Behaviors (3 SH) P-711: Children and Adolescents in Families (3 SH) P-739: Freud, Jung and Religion (3 SH) P-755: Affect in Human Transformation (3 SH) 42 Last Updated 9/2014

P-766: Dissociative Processes in Groups and Systems (3 SH) P-774: Psychodynamic Family Therapy (3 SH) P-775: Short-term Family Therapy (3SH)

P-800, 801: Clinical Pastoral Education I (6 SH) (Students electing P-800, 801 must complete it before beginning P-820 Practicum.)

C. Supervised Clinical Practice (15 hours) Required: complete 1,000 hours of supervised clinical experience, which includes a minimum of 400 hours of direct service to clients of clinical mental health counseling to clients, of which at least 10 hours must be group therapy, and receive at least 100 hours of individual and group supervision in practicum, with at least 50 hours of that supervision based on video tape, audio tape or direct observation. Supervised clinical experience falls into three portions: 100 hour practicum (P-820), incl. at least 40 direct service to clients; 600 hour internship (P-821, P-822, P-823), incl. at least 240 direct service to clients; and 300 hour advanced internship (P-824), incl. at least 120 direct service to clients.

P-820, 821, 822: Counseling Practicum I (9 SH) P-823, 824: Counseling Practicum II (6 SH) D. Integration and Competency Assessment (0 SH) X-999B “Self, Countertransference, and Spirit” culminating in a Capstone Presentation and a 1215 page integration paper in preparation of the Capstone Presentation Capstone is normally taken the 5th semester of practicum. Students must have completed 280 hours of client contact hours prior to taking the Capstone. Course authorization is required. * Prerequisite for Supervised Clinical Practice ** Prerequisite for X999B MHC Capstone X-999B Self, Countertransference, and Spirit A one hour weekly practicum seminar integrating use of self, countertransference and spiritual/theological reflection culminating in a Capstone presentation and an integrative paper in preparation for the Capstone presentation.

Requirements for CMHC Capstone: CMHC Capstone is normally taken the 5th semester of practicum. Students must have completed 280 hours of client contact hours prior to taking the capstone; Guidelines for CMHC Capstone: 1. Each student participates in “Self, Countertransference, and Spirit” weekly one hour practicum seminar and discusses clinical cases in an integrative method with faculty and peers.

2. Each student will invite a faculty member outside Field V to participate once in the weekly seminar, read the integrative paper, and participate in the Capstone Presentation.

3. Student selects a clinical case and video material to demonstrate Masters level competency with approval of Program Director or Field V faculty and current clinical supervisor.

4. Student schedules Capstone Presentation upon consultation with Program Director or Field V faculty, faculty member outside Field V, and current supervisor.

5. Students submits supporting documentation and integrative paper to clinical and faculty evaluators two weeks prior to Capstone Presentation.

6. Student presents Capstone Presentation to selected peers and clinical staff and to Program Director or Field V faculty, faculty member outside Field V, and current supervisor.

7. Peers rate Capstone Presentation for peer feedback.

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8. The Capstone Presentation and the integrative paper are evaluated by Program Director or Field V faculty, faculty member outside Field V, and current supervisor using a scale of items with possible item scores of 1-5 with 5 being the highest.

9. In order to pass student must receive from evaluators at least an average of 3s on an itemized evaluation scale with possible item scores of 1-5 with 5 being the highest.

10. Evaluators sign the evaluation with score report.

11. Program Director or Field V faculty submits Pass/Fail grade using InsideCTS faculty grade entry.

12. Evaluation and scores are placed in the student portfolio which is in the MACMHC file under the oversight of the Program Director in the Counseling Center.

CACREP's course content areas for Mental Health Counselor Licensure in Indiana The following CTS degree programs are designed to meet LMHC requirements: MACMHC (MA in Mental Health Counseling — formerly MAPF) D.Min. MHC — licensure track (D.Min. in Pastoral Care & Counseling, Mental Health Counseling concentration) (while the MAMFT, the MA in Marriage and Family Therapy, is primarily designed to meet MFT licensure requirements, additional CACREP content courses can be elected) Christian Theological Seminary courses designed to meet CACREP course content requirements are listed below in bold for the LMHC course requirements of Indiana. Additional courses addressing each content area are listed in regular font.

A. HUMAN GROWTH AND DEVELOPMENT - studies that provide an understanding of the nature and needs of individuals at all developmental levels.  Theories of individual and family development and transitions across the life-span;  Theories of learning and personality development;  Human behavior including an understanding of developmental crises, disability, addictions, psychopathology, and environmental factors as they affect both normal and abnormal behavior;  Strategies for facilitating development over the lifespan; and  Ethical considerations.

P-531: Human Growth and Development P-635: Ethical and professional issues in clinical practice P-637: Psychopathology and assessment P-755: Affect in Human Transformation P-650: Treating addictive behaviors B. SOCIAL AND CULTURAL FOUNDATIONS– studies that provide and understanding of issues and trends in a multicultural and diverse society.  Multicultural and pluralistic trends including characteristics and concerns of diverse groups;  Attitudes and behavior based on such factors as age, race, religious preference, physical disability, sexual orientation, ethnicity and culture, family patterns, gender, socioeconomic status, and intellectual ability;  Individual, family, and group strategies with diverse populations; and 44 Last Updated 9/2014



Ethical considerations.

P-656: Social and Cultural Dimensions of Counseling P-525: Aging and the Family P-619: Sexuality, gender and culture P-635: Ethical and professional issues in clinical practice P-641: Spirituality and God-Images in Counseling and Society P-675: Career development and counseling P-773: Feminist family therapy C. HELPING RELATIONSHIPS - studies that provide an understanding of counseling and consultation processes.  Counseling and consultation theories including both individual and systems perspectives as well as coverage of relevant research and factors considered in applications;  Basic interviewing, assessment, and counseling skills;  Counselor or consultant characteristics and behaviors that influence helping processes including age, gender and ethnic differences, verbal and nonverbal behaviors and personal characteristics, orientations, and skills;  Client characteristics and behaviors that influence helping processes including age, gender and ethnic differences, verbal and nonverbal behaviors and personal characteristics, traits, capabilities, and life circumstances; and  Ethical considerations.

P-511: Counseling Skills and Helping Relationships P-510/D-810: Theories of Counseling, Psychotherapy, and Personality P-630: Psychoanalytic Theory and Technique P-766: Dissociative Processes in Groups and Systems P-520: Introduction to Marriage & Family therapy P-623: Couples Systems Therapy P-800,801: Clinical pastoral education D. GROUP WORK – studies that provide an understanding of group development, dynamics, counseling theories, group counseling methods and skills, and other group approaches.  Principles of group dynamics including group process components, developmental stage theories, and group members' roles and behaviors;  Group leadership styles and approaches including characteristics of various types of group leaders and leadership styles;  Theories of group counseling including commonalities, distinguishing characteristics, and pertinent research and literature;  Group counseling methods including group counselor orientations and behaviors, ethical standards, appropriate selection criteria and methods, and methods of evaluation of effectiveness;  Approaches used for other types of group work, including task groups, prevention groups, support groups, and therapy groups; and  Ethical considerations.

P-760: Group Counseling and Psychotherapy P-624: Group Dynamics P-766: Dissociative Processes in Groups and Systems 45 Last Updated 9/2014

E. CAREER AND LIFESTYLE DEVELOPMENT– studies that provide understanding of career development.         

Career development theories and decision-making models; Career, vocational, educational, and labor market information resources, visual and print media, and computer-based career information systems; Career development program planning, organization, implementation, administration, and evaluation; Interrelationships among work, family, and other life roles and factors including multicultural and gender issues as related to career development; Career and educational placement, follow-up and evaluation; Assessment instruments and techniques relevant to career planning and decision-making; Computer based career development applications and strategies, including computerassisted career guidance systems; Career counseling processes, techniques and resources including those applicable to specific populations; and Ethical considerations.

P-675: Career Development and Counseling

F.

APPRAISAL - studies that provide an understanding of individual and group approaches to assessment and evaluation.    

   

Theoretical and historical bases for assessment techniques; Validity including evidence for establishing content, construct, and empirical validity; Reliability including methods of establishing stability, internal and equivalence reliability; Appraisal methods including environmental assessment, performance assessment, individual and group test and inventory methods, behavioral observations, and computermanaged and computer-assisted methods; Psychometric statistics including types of assessment scores, measures of central tendency, indices of variability, standard errors, and correlations; Age, gender, ethnicity, language, disability, and culture factors related to the assessment and evaluation of individuals and groups; Strategies for selecting, administering, interpreting, and using assessment and evaluation instruments and techniques in counseling; and Ethical considerations in appraisal.

P-639: Testing and Appraisal P-637: Psychopathology and assessment P-675: Vocation and appraisal

G. RESEARCH AND PROGRAM EVALUATION - studies that provide an understanding of type of research methods, basic statistics, and ethical and legal considerations in research.  Basic types of research methods to include qualitative and quantitative research designs;  Basic parametric and non-parametric statistics; 46 Last Updated 9/2014

  

Principles, practices, and applications of needs assessment and program evaluation; Uses of computers for data management and analysis; and Ethical and legal considerations in research.

P-770: Research Methods

H. PROFESSIONAL ORIENTATION - studies that provide an understanding of all aspects of professional functioning including history, roles, organizational structures, ethics, standards, and credentialing.  History of the helping professions including significant factors and events;  Professional roles and functions including similarities and differences with other types of professionals;  Professional organizations, primarily ACA, its divisions, branches, and affiliates, including membership benefits, activities, services to members, and current emphases;  Ethical standards of the ACA and related entities, ethical and legal issues, and their applications to various professional activities (e.g., appraisal, group work);  Professional preparation standards, their evolution, and current applications;  Professional credentialing including certification, licensure, and accreditation practices and standards, and the effects of public policy on these issues; and  Public policy processes including the role of the professional counselor in advocating on behalf of the profession and its clientele.

P-635: Ethical and Professional Issues in Clinical Practice P-510/D-810: Theories of Counseling, Psychotherapy, and Personality (one of two options for MAMFT) I. FOUNDATIONS OF MENTAL HEALTH COUNSELING – Studies in this area include, but are not limited to, the following:  Historical, philosophical, societal, cultural, economic, and political dimensions of mental health counseling;  Roles, functions, and professional identity of mental health counselors;  Structures and operations of professional organizations, training standards credentialing bodies, and ethical codes pertaining to the practice of mental health counseling;  Implications of professional issues unique to mental health counseling including, but not limited to, recognition, reimbursement, right to practice, core provider status, access to and practice privileges within managed care systems, and expert witness status; and  Implications of sociocultural, demographic, and lifestyle diversity relevant to mental health counseling.

P-632: Foundations of Mental Health Counseling P-635: Ethical and Professional Issues in Clinical Practice J. CONTEXTUAL DIMENSIONS: MENTAL HEALTH COUNSELING - Studies in this area include, but are not limited to, the following: 47 Last Updated 9/2014



 



Assumptions and roles of mental health counseling within the context of the health and human services systems, including functions and relationships among interdisciplinary treatment teams, and the historical, organizational, legal, and fiscal dimensions of the public and private mental health care systems; Theories and techniques of community needs assessment to design, implement, and evaluate mental health care programs and systems; Principles, theories, and practices of community intervention, including programs and facilities for inpatient, outpatient, partial treatment, and aftercare, and the human services network in local communities; and Theoretical and applied approaches to administration, finance and budgeting; management of mental health services and programs in the public and private sectors; principles and practices for establishing and maintaining both solo and group private practice; and concepts and procedures for determining accountability and cost containment.

P-657: Contextual Dimensions of Mental Health Counseling P-770: Research Methods P-650: Treating Addictive Behaviors K. KNOWLEDGE AND SKILLS FOR THE PRACTICE OF MENTAL HEALTH COUNSELING - Studies in this area include, but are not limited to, the following:      

 

General principles of etiology, diagnosis, treatment, and prevention of mental and emotional disorders and dysfunctional behavior, and general principles and practices for the promotion of optimal health; Specific models and methods for assessing mental status; identification of abnormal, deviant, or psychopathological behavior, and the interpretation of findings in current diagnostic categories [e.g., Diagnostic and Statistical Manual (DSM)]; Application of modalities for maintaining and terminating counseling and psychotherapy with mentally and emotionally impaired clients, including crisis intervention, brief, intermediate, and long-term approaches; Basic classifications, indications, and contraindications of commonly prescribed psychopharmacological medications for the purpose of identifying effects and side effects of such medications; Principles of conducting an intake interview and mental health history for planning and managing of client caseload; Specialized consultation skills for effecting living and work environments to improve relationships, communications and productivity, and for working with counselors of different specializations and with other mental health professionals in areas related to collaborative treatment strategies; The application of concepts of mental health education, consultation, outreach and prevention strategies, and of community health promotion and advocacy; and Effective strategies for influencing public policy and government relations on local, state, and national levels to enhance funding and programs affecting mental health services in general and the practice of mental health counseling in particular.

P-510/D-810: Theories of Counseling, Psychotherapy, and Personality (one of two options for MAMFT) 48 Last Updated 9/2014

P-511: Counseling Skills and Helping Relationships P-637: Psychopathology and assessment (Required for all 3 degrees) P-775: Short-term Family Therapy P-800, 801: Clinical pastoral education (one of two options for MACMHC& MAMFT, pre-req. for D.Min. MHC) I. Degree Programs: Marriage and Family Therapy--COAMFTE (New degree requirements will be effective Fall 2014 and updated at that time.)

The Master of Arts in Marriage and Family Therapy program provides theological and professional preparation in marriage and family therapy, and is accredited by the Commission on Accreditation for Marriage and Family Therapy Education of the American Association for Marriage and Family Therapy, as well as an AAPC approved training program.

The program consists of religious studies to help students ground themselves in the JudeoChristian tradition, as well as clinical techniques and theory to undergird clinical work.

Students who matriculated before Fall 2011 must write a satisfactory integrative paper that presents a coherent, constructive statement of the relationship of marriage and family therapy and ministries to Jewish and/or Christian communities. He or she must also pass an oral exam on that paper. Students must enroll in X-999 during the semester in which this work will be completed.

Students matriculating in Fall 2011 and after will complete the requirements of X-999A, Self, Systems, and Spirit and do not complete X-999.

Students matriculating before Fall 2011 may elect to complete X-999A, “Self, Systems, and Spirit� which culminates in a clinical capstone presentation in place of X-999.

The M.A.M.F.T. degree meets State of Indiana academic requirements for licensing of marriage and family therapists. Students in the program receive at least 100 hours of individual and group supervision in practicum; at least 50 hours of that supervision is based on direct observation, videotape or audiotape.

Requirements The Master of Arts in Marriage and Family Therapy requires 75 semester hours (SH) of required and elective courses, with a cumulative grade point average of 2.7. Courses marked (*) are prerequisites for practicum. Courses marked (**) are co requisites, to be taken with a semester of practicum.

A. General Studies in Religion (18 hours) A. I. 12 hours Theological Background (3) B-501: Introduction to Hebrew Bible/Old Testament (3) B-502: Introduction to the New Testament (3) T-500: Introduction to Theology (3) _____: _________________ (one elective that focuses on the theological understanding of American culture or modern church history from fields II-IV.) A. II. Theology and Counseling (6 hours) Pick two from 49 Last Updated 9/2014

(3) P-510/D-810: Theories of Counseling, Psychotherapy, and Personality (Students selecting this option must take P510 before enrolling in P823 the start of Practicum II.) and One of the following: (3) P-634: Theological Perspectives on Pastoral and Spiritual Care and Counseling (3) P-641: Spirituality and God-Images in Counseling and Society or (6) P-800, 801: Clinical Pastoral Education I (CPE) (Students taking the CPE option must take P800, P801, P520, P531 & P637 before enrolling in P820 Practicum) B. Marriage and Family Therapy Studies (57 hours) B. I. Theoretical Foundations of Marital and Family Therapy (3 hours) (3) P-621: Integration of Marriage and Family Therapy Theory (**concurrent with a semester of practicum) B. II. Assessment and Treatment in Marital and Family Therapy (15 hours) (3) P-520: Introduction to Marriage and Family Therapy (*prerequisite for practicum) (3) P-637: Psychopathology and Assessment (*prerequisite for practicum) (3) P-745: Narrative and Collaborative Approaches to Therapy (**concurrent with a semester of practicum) (3) P-623: Couples Systems Therapy (**concurrent with a semester of practicum) and One of the following: (3) P-650: Treating Addictive Behaviors (3) P-774: Psychodynamic Family Therapy (3) P-775: Short Term Family Therapy B. III. Human Development and Family Studies (9 hours) (3) P-531: Human Growth and Development (*prerequisite for practicum) (3) P-619: Sexuality, Gender and Culture and One of the following: (3) P-525: Aging and the Family (3) P-626: Loss and Mourning (3) P-646: Families and Larger Systems (3) P-755: Affect in Human Transformation B. IV. Ethical and Professional Studies (3 hours) (3) P-635: Ethical and Professional Issues in Clinical Practice B. V. Research (3 hours) (3) P-770: Research Methods B. VI. 18 hours Additional Learning ~ Required: 500 client-contact hours (250 MFT) plus 100 hours supervision (9) P-820, 821,822: Counseling Practicum I (9) * P-823,824,825: Counseling Practicum II * Students not electing CPE (A.II above) must take P510 before enrolling in P823 50 Last Updated 9/2014

B.VII. 6 hours Two elective courses from any field (3) Any elective (3) Any elective C. Integration and Competency Assessment (0) Portfolio of papers from P520, P621 and P623 or P745 (non-credit) (0) X-999A: Self, Systems, and Spirit (non-credit) Personal Counseling: All students are expected to receive psychotherapy during their program. Personal therapy is a prerequisite for practicum. Personal therapy with a gifted clinician serves two purposes. First, it assists student therapists in working through problem areas in their own lives that may adversely affect clients and students’ participation in an emotionally challenging training program. Second, it is a unique training experience, helping students understand the process of exploring the depth and interrelationship of systemic and intrapsychic features of human life.

Practicum Note: Students in the program will receive at least 100 hours of individual and group supervision in practicum and at least 50 hours of that supervision will be based on direct observation, video tape or audio tape.

MAMFT (COAMFTE Accredited) Educational Outcomes In order to support the institution and program’s mission in training marriage and family therapists, the following student learning outcomes are identified as part of the educational outcomes: Student Learning Outcomes 1.

Students will be able to conceptualize, assess, and demonstrate competency in systemic approaches for clinical practice in keeping with current best practice in MFT. Desired Outcomes a. Students will be evaluated at 1st, 3rd, and 5th semester intervals on the Trainee Evaluation Form - Individual Supervision Report. This evaluation is used with permission by St. Mary’s University, a BTG program, with internal validity to the MFT Core Competencies) achieving an upward numerical trend culminating with a minimum average of 3 on Likert scale of 1-5 at the last semester of Practicum. b. Students will be evaluated each semester of Live Supervision on the Live Supervision Evaluation Rubric ( based on Gehart’s MFT Core Competencies System) achieving an upward numerical trend culminating with a minimum average of 3 on Likert scale of 1-5 at the last semester of Live Supervision. c. Students will achieve a minimum average of 3 on a Likert scale of 1-5 on Case Conceptualization Rubric V 1.0 and Treatment Plan Rubric (see Gehart, 2007) in P520, P621 and either P619 or P645 for a portfolio of papers for the Integration and Competency Assessment at graduation. d. Students will receive a minimum average of 3 on a 1-5 Likert scale for the Capstone Presentation Rubric linked to the MFT Core Competencies, which includes the Case Conceptualization Rubric V 1.0 ( Gehart, 2007), Clinical Assessment Rubric (see Gehart, 2007), Treatment Plan Rubric ( Gehart, 2007), and Capstone Presentation Rubric ( modified and expanded from Gehart, 2007).

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NOTE: The evaluation rubrics cited here connect with the MFT Core Competencies as identified in the right column of the rubrics.

2. Students will be able to critically reflect upon personal and professional development of self in a multicultural context.

Desired Outcomes a. Students will achieve a minimum average of 3 out of 1-5 Likert scale on “Assessment of Cultural Competency” at the end of the practicum group, based on Sue, Arrendondo, and McDavis, “Multicultural Counseling Competencies and Standards: A Call to the Profession,” Journal of Counseling and Development, March/April 1992 Vol. 70, pp.

477-486. b. Students will achieve a minimum of 3 out of 1-5 Likert scale on Case Conceptualization Rubric V 1.0 and Treatment Plan Rubric of the Capstone Presentation.

3.

Students will be able to critically reflect upon personal and professional development of self from theological/spiritual perspectives.

Desired Outcomes a. Students will receive a minimum rating of 3 on Likert scale of 1-5 on the Capstone Presentation Rubric evaluating theological reflection in written paper and oral presentation. b. Students will receive a minimum average rating of 3 on a Likert scale of 1-5 on Capstone Presentation Rubric evaluating integration of theological and systemic perspectives in written paper and oral presentation.

Faculty Outcomes Desired Outcomes 1. Faculty members will receive an overall satisfactory evaluation from the Faculty Review Committee through a narrative document at least once every three years. (Non-tenured faculty members are reviewed annually.) a. Teaching Effectiveness—MFT faculty members will receive course evaluations of “3” or above from students and satisfactory peer reviews through the Faculty Review Committee.

(Supporting documents can be found in the faculty files in the Academic Dean’s Office.) b. Church and World—MFT faculty members are required to maintain state licensure, complete clinical CEUs necessary to maintain licensure, and attend a MFT professional conference annually. MFT faculty members who supervise MFT students in practicum are required to be an AAMFT Approved Supervisor. (Supporting documents can be found in the faculty files in the Academic Dean’s Office.) c. Service to CTS—Faculty members will participate in community life and committee assignments as determined by the Faculty Review Committee. d. Scholarship and Publication—Faculty members will demonstrate record of publications, peer reviewed MFT presentations, and grants as determined by the Faculty Review Committee.

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Program Outcomes 1. Students will complete the Cultural Competency Group in Practicum.

2.

Students will complete course requirements for graduation, graduate within the required frame, and pass the MFT licensure exam.

time

Desired Outcomes a. 70% of the graduates taking the AMFTRB licensure exam shall pass within any one year period. b. 50% of enrolled students will complete the program within the advertised length of the program (4 years for MAMFT and 6 years for M.Div./MAMFT). c. 65% of enrolled students will complete the program within the maximum allowable MFT Program Time Frame for program completion (6 years for MAMFT and 9 years for M.Div./MAMFT).

3. Students will be hired by regional counseling organizations and will receive satisfactory ratings by employees.

Desired Outcomes a. 50 % of employees surveyed will return the evaluations. b. 80% of employed alumni will receive a rating of “3” or higher on returned evaluations from employers. (See Appendix TT on Employer Evaluations) 4. 30 % of students enrolled in the MFT program will be persons of color.

5. Faculty will receive evaluations rating “3” or above out of “5” or higher on returned evaluations from students; faculty reviews will be satisfactory as determined by the Faculty Review Committee; and complete anti-racism training.

Clinical & Supervision Requirements (MAMFT) Organization COAMFTE: Requirements for graduate students in accredited programs,

Client Contact Hours • 1,000 face-to-thee hours • 250/500 must be relational hours (couple and family)

Supervision Requirements • 100 hours of supervision by an Approved Supervisor in Training (SIT) • 501100 must involve raw data (live, video, audio) • 1 hour of supervision required for every 5 client contact hours • Individual supervision must occur at least one hour per week when student is seeing clients

COAMETE Internship requirements

• At least 9 months duration • 30 hours at internship per

• Student must be involved in some form of group supervision • provided by Approved Supervisor or SIT

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for students from accredited programs

AAMFT Requirements for Clinical Members (CM) * State License qualifies for CM. The following requirements are for people in states that do not have MFT licenses

week • 500 total face-to-face hours • 250/500 hours must be couple, family clients • Master’s degree in MFT or related field with supervised practicum experience and at least 300 face-to-face hours • At least 2 years of postgraduate clinical work encompassing 1000 thee-toface hours (COAMF1’E graduates may meet 1/5 of required hours with practicum internship hours)

•

1 hour per week

• 200 hours, post-graduate provided by AS • 100/200 hours must be in individual supervision

• Master’s degree in MFT or • 200 hours by AS related field • 1500 face-to-face hours post-graduate over . minimum of 2 years COAMFTE • provide 180 hours of MFT • 36 hours of metaavision by approved Approved Supervisor supervision over a mm. of 18 AS (IS hours must be within previous 2 months and max. of 5 years years of applying for AS designation) • 2000 thee-to-face client contact hours over miii. 3 years • (COAMFTE grads may count up to 500 hours from practicum or internship and up to 500 hours of SIT experience) To contact A.AMFT: 1133 15th Street, NW Suite 300, Washington, DC 20005-27 10 Phone: (202) 452-0109 To contact the IHPB: 402 W. Washington St., Room 041, and Indianapolis, IN 46204 Phone: (317) 233-4422 Indiana Health Professions Bureau (IHPB)

I. Degree Programs: Doctor of Ministry The Doctor of Ministry degree is a systematic program of advanced professional work and theological study intended for experienced ministers who seek to strengthen their competence as leaders of religious organizations. The D.Min. MHC licensure track allows qualified applicants to develop a specialized counseling ministry with eligibility for Mental Health Counseling Licensure (LMHC) and professional membership in the American Association of Pastoral Counselors (AAPC). The pastoral care track supports advanced study focusing on chaplaincy, spiritual direction or pastoral care in 54 Last Updated 9/2014

congregational settings. Additional concentrations may be negotiated in consultation with the Director of Advanced Professional Studies prior to admission.

Doctor of Ministry in Pastoral Care and Counseling, Mental Health Counseling concentration The Doctor of Ministry in Pastoral Care and Counseling, Mental Health Counseling concentration (D.Min. MHC) focuses on specialized pastoral care and counseling ministries in the congregation or in other settings.

The DMin PF requires 60 semester hours (SH) and a cumulative grade point average of 3.0 with at least a B- in all courses applied toward the degree. Prior to completing the project, the student must demonstrate by faculty signature that the Reading Committee has been established, and the Reading Committee has approved the project proposal. A minimum of 500 hours of pastoral counseling and 125 hours of interdisciplinary supervision are required.

Prerequisites Basic Human Development, Introduction to Pastoral Counseling and one unit of CPE. Prerequisites not completed before admission can be made up after admission with the permission of the director but do not count towards the 60 semester hours required for the degree and must be completed prior to registration for Clinical Practice.

I. Seminars (6 hours) Seminars involve one week of intensive study on campus, significant reading before the seminar begins and written work after it ends.

D-907: God, Congregations, and Contemporary Culture (3 SH) D-909: Practical Theology and Project Development (3 SH) II. Therapeutic and Clinical Studies (30 hours) Students must have the following prerequisites: Basic Human Development, Introduction to Pastoral Counseling and one unit of CPE. 3 P-630: Psychoanalytic Theory and Technique 3 P-624: Group Dynamics (OR P-760: Group Counseling and Psychotherapy) 3 P-632: Foundations of Mental Health Counseling 3 P-635: Ethical and Professional Issues in Clinical Practice 3 *P-637: Psychopathology and Assessment (*prerequisite for Counseling Practicum) 3 P-770: Research Methods 3 P-634: Theological Perspectives on Pastoral and Spiritual Care and Counseling 3 P- 675: Career Development and Counseling 3 D-810: Theories of Counseling, Psychotherapy, and Personality OR P-646: Families and Larger Systems 3 P-____: One 600 or 700 level course III. Clinical Practice (18 hours) P-820, 821, 822: Pastoral Counseling Practicum (9 SH) P-823, 824, 825: Advanced Pastoral Counseling Practicum (9 SH) IV. D-999: DMin Project, Written Presentation and Oral Examination (6 SH) The DMin in Pastoral Care and Counseling requires students to demonstrate the capacity to engage in advanced reflection in an area of pastoral care and counseling through the 55 Last Updated 9/2014

written presentation of a significant Project in Ministry. The project includes the identification, description and analysis of a segment of pastoral counseling; clarification of theories that bear on the practice; critical and constructive theology in relationship to clinical work. When the written phase of the project is completed, a faculty committee appointed by the director of the DMin program conducts an oral examination.

OR D-X999A_____”Self, Countertransference, and Spirit” (6SH) Prerequisite: P-634: Theological Perspectives on Pastoral & Spiritual Care: A one hour weekly practicum seminar integrating use of self, countertransference and spiritual/theological reflection culminates in a Capstone presentation and an integrative paper. Criteria for evaluation by the thesis advisor, DMin Director, faculty member outside Field V, and current supervisor include 1) advanced understanding of the nature and purposes of counseling ministry, 2) enhanced competencies in pastoral analysis and counseling skills, 3) theologically reflective practice of ministry, 4) new knowledge about the practice of counseling ministry, 5) growth in spiritual maturity vis-a-vis the self of the counselor.

II. Residency Program (for graduates of both CMHC and MFT programs) Postgraduate Residency in Supervised Counseling Indiana licensure laws for Licensed Marriage and Family Therapist and/or Licensed Mental Health Counselor require a two-year supervised clinical experience following graduation. A candidate for licensure cannot qualify to sit for the license exam without this experience. CTS offers a postgraduate residency aimed at meeting the state licensure requirements and helping the graduate establish a viable clinical practice. Applicants are accepted from CTS master’s programs and from academic programs at other approved universities and graduate schools.

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Professional Codices of Ethics American Association for Marriage and Family Therapy (AAMFT) CODE OF ETHICS Effective July 1, 2001 Preamble The Board of Directors of the American Association for Marriage and Family Therapy (AAMFT) hereby promulgates, pursuant to Article 2, Section 2.013 of the Association’s Bylaws, the Revised AAMFT Code of Ethics, and effective July 1, 2001.

The AAMFT strives to honor the public trust in marriage and family therapists by setting standards for ethical practice as described in this Code. The ethical standards define professional expectations and are enforced by the AAMFT Ethics Committee. The absence of an explicit reference to a specific behavior or situation in the Code does not mean that the behavior is ethical or unethical. The standards are not exhaustive. Marriage and family therapists who are uncertain about the ethics of a particular course of action are encouraged to seek counsel from consultants, attorneys, supervisors, colleagues, or other appropriate authorities.

Both law and ethics govern the practice of marriage and family therapy. When making decisions regarding professional behavior, marriage and family therapists must consider the AAMFT Code of Ethics and applicable laws and regulations. If the AAMFT Code of Ethics prescribes a standard higher than that required by law, marriage and family therapists must meet the higher standard of the AAMFT Code of Ethics. Marriage and family therapists comply with the mandates of law, but make known their commitment to the AAMFT Code of Ethics and take steps to resolve the conflict in a responsible manner. The AAMFT supports legal mandates for reporting of alleged unethical conduct.

The AAMFT Code of Ethics is binding on Members of AAMFT in all membership categories, AAMFTApproved Supervisors, and applicants for membership and the Approved Supervision designation (hereafter, AAMFT member). AAMFT members have an obligation to be familiar with the AAMFT Code of Ethics and its application to their professional services. Lack of awareness or misunderstanding of an ethical standard is not a defense to a charge of unethical conduct.

The process for filling, investigating, and resolving complaints of unethical conduct is described in the current Procedures for Handling Ethical Matters of the AAMFT Ethics Committee. Persons accused are considered innocent by the Ethics Committee until proven guilty, except as otherwise provided, and are entitled to due process. If an AAMFT Member resigns in anticipation of, or during the course of, an ethics investigation, the Ethics Committee will complete its investigation. Any publication of action taken by the Association will include the fact that the Member attempted to resign during the investigation.

Principle I Responsibility to Clients Marriage and family therapists advance the welfare of families and individuals. They respect the rights of those persons seeking their assistance, and make reasonable efforts to ensure that their services are used appropriately.

1.1. Marriage and family therapists provide professional assistance to persons without discrimination on the basis of race, age, ethnicity, socioeconomic status, disability, gender, health status, religion, national origin, or sexual orientation.

1.2 Marriage and family therapists obtain appropriate informed consent to therapy or related procedures as early as feasible in the therapeutic relationship, and use language that is reasonably understandable to clients. The content of informed consent may vary depending upon the client and treatment plan; however, informed consent generally necessitates that the client: (a) has the capacity to consent; (b) has been adequately informed of significant information concerning treatment processes and 57 Last Updated 9/2014

procedures; (c) has been adequately informed of potential risks and benefits of treatments for which generally recognized standards do not yet exist; (d) has freely and without undue influence expressed consent; and (e) has provided consent that is appropriately documented. When persons, due to age or mental status, are legally incapable of giving informed consent, marriage and family therapists obtain informed permission from a legally authorized person, if such substitute consent is legally permissible.

1.3 Marriage and family therapists are aware of their influential positions with respect to clients, and they avoid exploiting the trust and dependency of such persons. Therapists, therefore, make every effort to avoid conditions and multiple relationships with clients that could impair professional judgment or increase the risk of exploitation. Such relationships include, but are not limited to, business or close personal relationships with a client or the client's immediate family. When the risk of impairment or exploitation exists due to conditions or multiple roles, therapists take appropriate precautions.

1.4 Sexual intimacy with clients is prohibited.

1.5 Sexual intimacy with former clients is likely to be harmful and is therefore prohibited for two years following the termination of therapy or last professional contact. In an effort to avoid exploiting the trust and dependency of clients, marriage and family therapists should not engage in sexual intimacy with former clients after the two years following termination or last professional contact. Should therapists engage in sexual intimacy with former clients following two years after termination or last professional contact, the burden shifts to the therapist to demonstrate that there has been no exploitation or injury to the former client or to the client's immediate family.

1.6 Marriage and family therapists comply with applicable laws regarding the reporting of alleged unethical conduct.

1.7 Marriage and family therapists do not use their professional relationships with clients to further their own interests.

1.8 Marriage and family therapists respect the rights of clients to make decisions and help them to understand the consequences of these decisions. Therapists clearly advise the clients that they have the responsibility to make decisions regarding relationships such as cohabitation, marriage, divorce, separation, reconciliation, custody, and visitation.

1.9 Marriage and family therapists continue therapeutic relationships only so long as it is reasonably clear that clients are benefiting from the relationship.

1.10 Marriage and family therapists assist persons in obtaining other therapeutic services if the therapist is unable or unwilling, for appropriate reasons, to provide professional help.

1.11 Marriage and family therapists do not abandon or neglect clients in treatment without making reasonable arrangements for the continuation of such treatment.

1.12 Marriage and family therapists obtain written informed consent from clients before videotaping, audio recording, or permitting third-party observation.

1.13 Marriage and family therapists, upon agreeing to provide services to a person or entity at the request of a third party, clarify, to the extent feasible and at the outset of the service, the nature of the relationship with each party and the limits of confidentiality.

Principle II Confidentiality Marriage and family therapists have unique confidentiality concerns because the client in a therapeutic relationship may be more than one person. Therapists respect and guard the confidences of each individual client 2.1 Marriage and family therapists disclose to clients and other interested parties, as early as feasible in their professional contacts, the nature of confidentiality and possible limitations of the clients' right to confidentiality. Therapists review with clients the circumstances where confidential information may be requested and where disclosure of confidential information may be legally required. Circumstances may necessitate repeated disclosures.

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2.2 Marriage and family therapists do not disclose client confidences except by written authorization or waiver, or where mandated or permitted by law. Verbal authorization will not be sufficient except in emergency situations, unless prohibited by law. When providing couple, family or group treatment, the therapist does not disclose information outside the treatment context without a written authorization from each individual competent to execute a waiver. In the context of couple, family or group treatment, the therapist may not reveal any individual's confidences to others in the client unit without the prior written permission of that individual.

2.3 Marriage and family therapists use client and/or clinical materials in teaching, writing, consulting, research, and public presentations only if a written waiver has been obtained in accordance with Sub-principle 2.2, or when appropriate steps have been taken to protect client identity and confidentiality.

2.4 Marriage and family therapists’ store, safeguard, and dispose of client records in ways that maintain confidentiality and in accord with applicable laws and professional standards.

2.5 Subsequent to the therapist moving from the area, closing the practice, or upon the death of the therapist, a marriage and family therapist arranges for the storage, transfer, or disposal of client records in ways that maintain confidentiality and safeguard the welfare of clients.

2.6 Marriage and family therapists, when consulting with colleagues or referral sources, do not share confidential information that could reasonably lead to the identification of a client, research participant, supervisee, or other person with whom they have a confidential relationship unless they have obtained the prior written consent of the client, research participant, supervisee, or other person with whom they have a confidential relationship.

Information may be shared only to the extent necessary to achieve the purposes of the consultation.

Principle III Professional Competence and Integrity Marriage and family therapists maintain high standards of professional competence and integrity.

3.1 Marriage and family therapists pursue knowledge of new developments and maintain competence in marriage and family therapy through education, training, or supervised experience.

3.2 Marriage and family therapists maintain adequate knowledge of and adhere to applicable laws, ethics, and professional standards.

3.3 Marriage and family therapists seek appropriate professional assistance for their personal problems or conflicts that may impair work performance or clinical judgment.

3.4 Marriage and family therapists do not provide services that create a conflict of interest that may impair work performance or clinical judgment.

3.5 Marriage and family therapists, as presenters, teachers, supervisors, consultants and researchers, are dedicated to high standards of scholarship, present accurate information, and disclose potential conflicts of interest.

3.6 Marriage and family therapists maintain accurate and adequate clinical and financial records.

3.7 While developing new skills in specialty areas, marriage and family therapists take steps to ensure the competence of their work and to protect clients from possible harm. Marriage and family therapists practice in specialty areas new to them only after appropriate education, training, or supervised experience.

3.8 Marriage and family therapists do not engage in sexual or other forms of harassment of clients, students, trainees, supervisees, employees, colleagues, or research subjects.

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3.9 Marriage and family therapists do not engage in the exploitation of clients, students, trainees, supervisees, employees, colleagues, or research subjects.

3.10 Marriage and family therapists do not give to or receive from clients (a) gifts of substantial value or (b) gifts that impair the integrity or efficacy of the therapeutic relationship.

3.11 Marriage and family therapists do not diagnose, treat, or advise on problems outside the recognized boundaries of their competencies.

3.12 Marriage and family therapists make efforts to prevent the distortion or misuse of their clinical and research findings.

3.13 Marriage and family therapists, because of their ability to influence and alter the lives of others, exercise special care when making public their professional recommendations and opinions through testimony or other public statements.

3.14 To avoid a conflict of interests, marriage and family therapists who treat minors or adults involved in custody or visitation actions may not also perform forensic evaluations for custody, residence, or visitation of the minor. The marriage and family therapist who treats the minor may provide the court or mental health professional performing the evaluation with information about the minor from the marriage and family therapist's perspective as a treating marriage and family therapist, so long as the marriage and family therapist does not violate confidentiality.

3.15 Marriage and family therapists are in violation of this Code and subject to termination of membership or other appropriate action if they: (a) are convicted of any felony; (b) are convicted of a misdemeanor related to their qualifications or functions; (c) engage in conduct which could lead to conviction of a felony, or a misdemeanor related to their qualifications or functions; (d) are expelled from or disciplined by other professional organizations; (e) have their licenses or certificates suspended or revoked or are otherwise disciplined by regulatory bodies; (f) continue to practice marriage and family therapy while no longer competent to do so because they are impaired by physical or mental causes or the abuse of alcohol or other substances; or (g) fail to cooperate with the Association at any point from the inception of an ethical complaint through the completion of all proceedings regarding that complaint.

Principle IV Responsibility to Students and Supervisees Marriage and family therapists do not exploit the trust and dependency of students and supervisees.

4.1 Marriage and family therapists are aware of their influential positions with respect to students and supervisees, and they avoid exploiting the trust and dependency of such persons. Therapists, therefore, make every effort to avoid conditions and multiple relationships that could impair professional objectivity or increase the risk of exploitation. When the risk of impairment or exploitation exists due to conditions or multiple roles, therapists take appropriate precautions.

4.2 Marriage and family therapists do not provide therapy to current students or supervisees.

4.3 Marriage and family therapists do not engage in sexual intimacy with students or supervisees during the evaluative or training relationship between the therapist and student or supervisee. Should a supervisor engage in sexual activity with a former supervisee, the burden of proof shifts to the supervisor to demonstrate that there has been no exploitation or injury to the supervisee.

4.4 Marriage and family therapists do not permit students or supervisees to perform or to hold themselves out as competent to perform professional services beyond their training, level of experience, and competence.

4.5 Marriage and family therapists take reasonable measures to ensure that services provided by supervisees are professional.

4.6 Marriage and family therapists avoid accepting as supervisees or students those individuals with whom a prior or existing relationship could compromise the therapist's objectivity. When such situations cannot be avoided, therapists take appropriate precautions to maintain objectivity. Examples 60 Last Updated 9/2014

of such relationships include, but are not limited to, those individuals with whom the therapist has a current or prior sexual, close personal, immediate familial, or therapeutic relationship.

4.7 Marriage and family therapists do not disclose supervisee confidences except by written authorization or waiver, or when mandated or permitted by law. In educational or training settings where there are multiple supervisors, disclosures are permitted only to other professional colleagues, administrators, or employers who share responsibility for training of the supervisee. Verbal authorization will not be sufficient except in emergency situations, unless prohibited by law.

Principle V Responsibility to Research Participants Investigators respect the dignity and protect the welfare of research participants, and are aware of applicable laws and regulations and professional standards governing the conduct of research.

5. 1 Investigators are responsible for making careful examinations of ethical acceptability in planning studies. To the extent that services to research participants may be compromised by participation in research, investigators seek the ethical advice of qualified professionals not directly involved in the investigation and observe safeguards to protect the rights of research participants.

5. 2 Investigators requesting participant involvement in research inform participants of the aspects of the research that might reasonably be expected to influence willingness to participate.

Investigators are especially sensitive to the possibility of diminished consent when participants are also receiving clinical services, or have impairments which limit understanding and/or communication, or when participants are children.

5.3 Investigators respect each participant's freedom to decline participation in or to withdraw from a research study at any time. This obligation requires special thought and consideration when investigators or other members of the research team are in positions of authority or influence over participants. Marriage and family therapists, therefore, make every effort to avoid multiple relationships with research participants that could impair professional judgment or increase the risk of exploitation.

5.4 Information obtained about a research participant during the course of an investigation is confidential unless there is a waiver previously obtained in writing. When the possibility exists that others, including family members, may obtain access to such information, this possibility, together with the plan for protecting confidentiality, is explained as part of the procedure for obtaining informed consent.

Principle VI Responsibility to the Profession Marriage and family therapists respect the rights and responsibilities of professional colleagues and participate in activities that advance the goals of the profession.

6.1 Marriage and family therapists remain accountable to the standards of the profession when acting as members or employees of organizations. If the mandates of an organization with which a marriage and family therapist is affiliated, through employment, contract or otherwise, conflict with the AAMFT Code of Ethics, marriage and family therapists make known to the organization their commitment to the AAMFT Code of Ethics and attempt to resolve the conflict in a way that allows the fullest adherence to the Code of Ethics.

6.2 Marriage and family therapists assign publication credit to those who have contributed to a publication in proportion to their contributions and in accordance with customary professional publication practices.

6.3 Marriage and family therapists do not accept or require authorship credit for a publication based on research from a student's program, unless the therapist made a substantial contribution beyond 61 Last Updated 9/2014

being a faculty advisor or research committee member. Co-authorship on a student thesis, dissertation, or project should be determined in accordance with principles of fairness and justice.

6.4 Marriage and family therapists who are the authors of books or other materials that are published or distributed do not plagiarize or fail to cite persons to whom credit for original ideas or work is due.

6.5 Marriage and family therapists who are the authors of books or other materials published or distributed by an organization take reasonable precautions to ensure that the organization promotes and advertises the materials accurately and factually.

6.6 Marriage and family therapists participate in activities that contribute to a better community and society, including devoting a portion of their professional activity to services for which there is little or no financial return.

6.7 Marriage and family therapists are concerned with developing laws and regulations pertaining to marriage and family therapy that serve the public interest, and with altering such laws and regulations that are not in the public interest.

6.8 Marriage and family therapists encourage public participation in the design and delivery of professional services and in the regulation of practitioners.

Principle VII Financial Arrangements Marriage and family therapists make financial arrangements with clients, third-party payors, and supervisees that are reasonably understandable and conform to accepted professional practices.

7.1 Marriage and family therapists do not offer or accept kickbacks, rebates, bonuses, or other remuneration for referrals; fee-for-service arrangements are not prohibited.

7.2 Prior to entering into the therapeutic or supervisory relationship, marriage and family therapists clearly disclose and explain to clients and supervisees: (a) all financial arrangements and fees related to professional services, including charges for canceled or missed appointments; (b) the use of collection agencies or legal measures for nonpayment; and (c) the procedure for obtaining payment from the client, to the extent allowed by law, if payment is denied by the third-party payor. Once services have begun, therapists provide reasonable notice of any changes in fees or other charges.

7.3 Marriage and family therapists give reasonable notice to clients with unpaid balances of their intent to seek collection by agency or legal recourse. When such action is taken, therapists will not disclose clinical information.

7.4 Marriage and family therapists represent facts truthfully to clients, third-party payors, and supervisees regarding services rendered.

7.5 Marriage and family therapists ordinarily refrain from accepting goods and services from clients in return for services rendered. Bartering for professional services may be conducted only if: (a) the supervisee or client requests it, (b) the relationship is not exploitative, (c) the professional relationship is not distorted, and (d) a clear written contract is established.

7.6 Marriage and family therapists may not withhold records under their immediate control that are requested and needed for a client's treatment solely because payment has not been received for past services, except as otherwise provided by law.

Principle VIII Advertising Marriage and family therapists engage in appropriate informational activities, including those that enable the public, referral sources, or others to choose professional services on an informed basis.

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8.1 Marriage and family therapists accurately represent their competencies, education, training, and experience relevant to their practice of marriage and family therapy.

8.2 Marriage and family therapists ensure that advertisements and publications in any media (such as directories, announcements, business cards, newspapers, radio, television, Internet, and facsimiles) convey information that is necessary for the public to make an appropriate selection of professional services. Information could include: (a) office information, such as name, address, telephone number, credit card acceptability, fees, languages spoken, and office hours; (b) qualifying clinical degree (see sub-principle 8.5); (c) other earned degrees (see sub-principle 8.5) and state or provincial licensures and/or certifications; (d) AAMFT clinical member status; and (e) description of practice.

8.3 Marriage and family therapists do not use names that could mislead the public concerning the identity, responsibility, source, and status of those practicing under that name, and do not hold themselves out as being partners or associates of a firm if they are not.

8.4 Marriage and family therapists do not use any professional identification (such as a business card, office sign, letterhead, Internet, or telephone or association directory listing) if it includes a statement or claim that is false, fraudulent, misleading, or deceptive.

8.5 In representing their educational qualifications, marriage and family therapists list and claim as evidence only those earned degrees: (a) from institutions accredited by regional accreditation sources recognized by the United States Department of Education, (b) from institutions recognized by states or provinces that license or certify marriage and family therapists, or (c) from equivalent foreign institutions.

8.6 Marriage and family therapists correct, wherever possible, false, misleading, or inaccurate information and representations made by others concerning the therapist's qualifications, services, or products.

8.7 Marriage and family therapists make certain that the qualifications of their employees or supervisees are represented in a manner that is not false, misleading, or deceptive.

8.8 Marriage and family therapists do not represent themselves as providing specialized services unless they have the appropriate education, training, or supervised experience.

This Code is published by: American Association for Marriage and Family Therapy 112 South Alfred Street, Alexandria, VA 22314 Phone: (703) 838-9808 - Fax: (703) 838-9805 www.aamft.orgŠ Copyright 2001 by the AAMFT. All rights reserved. Printed in the United States of America. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher.

Violations of this Code should be brought in writing to the attention of: AAMFT Ethics Committee 112 South Alfred Street, Alexandria, VA 22314 Phone: (703) 838-9808 - Fax: (703) 838-9805 email: ethicsaamft.org

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American Counseling Association (ACA) Code of Ethics Effective 2014 Mission The mission of the American Counseling Association is to enhance the quality of life in society by promoting the development of professional counselors, advancing the counseling profession, and using the profession and practice of counseling to promote respect for human dignity and diversity.

ACA Code of Ethics Preamble The American Counseling Association (ACA) is an educational, scientific, and professional organization whose members work in a variety of settings and serve in multiple capacities. Counseling is a professional relationship that empowers diverse individuals, families, and groups to accomplish mental health, wellness, education, and career goals.

Professional values are an important way of living out an ethical commitment. The following are core professional values of the counseling profession: 1. enhancing human development throughout the life span; 2. honoring diversity and embracing a multicultural approach in support of the worth, dignity, potential, and uniqueness of people within their social and cultural contexts; 3. promoting social justice; 4. safeguarding the integrity of the counselor–client relationship; and 5. practicing in a competent and ethical manner.

These professional values provide a conceptual basis for the ethical principles enumerated below.

These principles are the foundation for ethical behavior and decision making. The fundamental principles of professional ethical behavior are • autonomy, or fostering the right to control the direction of one’s life; • no maleficence, or avoiding actions that cause harm; • beneficence, or working for the good of the individual and society by promoting mental health and well-being; • justice, or treating individuals equitably and fostering fairness and equality; • fidelity, or honoring commitments and keeping promises, including fulfilling one’s responsibilities of trust in professional relationships; and • veracity, or dealing truthfully with individuals with whom counselors come into professional contact.

ACA Code of Ethics Purpose The ACA Code of Ethics serves six main purposes: 1. The Code sets forth the ethical obligations of ACA members and provides guidance intended to inform the ethical practice of professional counselors.

2. The Code identifies ethical considerations relevant to professional counselors and counselors-intraining.

3. The Code enables the association to clarify for current and prospective members, and for those served by members, the nature of the ethical responsibilities held in common by its members.

4. The Code serves as an ethical guide designed to assist members in constructing a course of action that best serves those utilizing counseling services and establishes expectations of conduct with a primary emphasis on the role of the professional counselor.

5. The Code helps to support the mission of ACA. 64 Last Updated 9/2014

6. The standards contained in this Code serve as the basis for processing inquiries and ethics complaints concerning ACA members.

The ACA Code of Ethics contains nine main sections that ad-dress the following areas: Section A: The Counseling Relationship Section B: Confidentiality and Privacy Section C: Professional Responsibility Section D: Relationships With Other Professionals Section E: Evaluation, Assessment, and Interpretation Section F: Supervision, Training, and Teaching Section G: Research and Publication Section H: Distance Counseling, Technology, and Social Media Section I: Resolving Ethical Issues Each section of the ACA Code of Ethics begins with an introduction. The introduction to each section describes the ethical behavior and responsibility to which counselors aspire. The introductions help set the tone for each particular section and provide a starting point that invites reflection on the ethical standards contained in each part of the ACA Code of Ethics. The standards outline professional responsibilities and provide direction for fulfilling those ethical responsibilities.

When counselors are faced with ethical dilemmas that are difficult to resolve, they are expected to engage in a care-fully considered ethical decision-making process, consulting available resources as needed. Counselors acknowledge that resolving ethical issues is a process; ethical reasoning includes consideration of professional values, professional ethical principles, and ethical standards.

Counselors’ actions should be consistent with the spirit as well as the letter of these ethical standards. No specific ethical decision-making model is always most effective, so counselors are expected to use a credible model of decision making that can bear public scrutiny of its application.

Through a chosen ethical decision-making process and evaluation of the context of the situation, counselors work collaboratively with clients to make decisions that promote clients’ growth and development. A breach of the standards and principles provided herein does not necessarily constitute legal liability or violation of the law; such action is established in legal and judicial proceedings.

The glossary at the end of the Code provides a concise description of some of the terms used in the ACA Code of Ethics.

Section A: The Counseling Relationship Introduction Counselors facilitate client growth and development in ways that foster the interest and welfare of clients and promote formation of healthy relation-ships. Trust is the cornerstone of the counseling relationship, and counselors have the responsibility to respect and safeguard the client’s right to privacy and confidentiality. Counselors actively attempt to understand the diverse cultural backgrounds of the clients they serve. Counselors also explore their own cultural identities and how these affect their values and beliefs about the counseling process. Additionally, counselors are encouraged to contribute to society by devoting a portion of their professional activities for little or no financial return (pro bono publico).

A.1. Client Welfare A.1.a. Primary Responsibility The primary responsibility of counsel-ors is to respect the dignity and promote the welfare of clients.

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Counselors create, safeguard, and maintain documentation necessary for rendering professional services.

Regardless of the medium, counselors include sufficient and timely documentation to facilitate the delivery and continuity of services. Counselors take reasonable steps to ensure that documentation accurately reflects client progress and services provided. If amendments are made to records and documentation, counselors take steps to properly note the amendments according to agency or institutional policies.

A.1.c. Counseling Plans Counselors and their clients work jointly in devising counseling plans that offer reasonable promise of success and are consistent with the abilities, temperament, developmental level, and circumstances of clients. Counselors and clients regularly re-view and revise counseling plans to assess their continued viability and effectiveness, respecting clients’ freedom of choice.

A.1.d. Support Network Involvement Counselors recognize that support networks hold various meanings in the lives of clients and consider en-listing the support, understanding, and involvement of others (e.g., religious / spiritual/community leaders, family members, friends) as positive resources, when appropriate, with client consent.

A.2. Informed Consent in the Counseling Relationship A.2.a. Informed Consent Clients have the freedom to choose whether to enter into or remain in a counseling relationship and need adequate information about the counseling process and the counselor. Counselors have an obligation to re-view in writing and verbally with clients the rights and responsibilities of both counselors and clients.

Informed consent is an ongoing part of the counseling process, and counselors appropriately document discussions of informed consent throughout the counseling relationship.

A.2.b. Types of Information Needed Counselors explicitly explain to clients the nature of all services provided. They inform clients about issues such as, but not limited to, the following: the purposes, goals, techniques, procedures, limitations, potential risks, and benefits of services; the counselor’s qualifications, credentials, relevant experience, and approach to counseling; continuation of services upon the incapacitation or death of the counselor; the role of technology; and other pertinent information. Counselors take steps to ensure that clients understand the implications of diagnosis and the intended use of tests and reports. Additionally, counselors inform clients about fees and billing arrangements, including procedures for nonpayment of fees. Clients have the right to confidentiality and to be provided with an explanation of its limits (including how supervisors and/or treatment or interdisciplinary team professionals are involved), to obtain clear information about their records, to participate in the ongoing counseling plans, and to refuse any services or modality changes and to be advised of the consequences of such refusal.

A.2.c. Developmental and Cultural Sensitivity Counselors communicate information in ways that are both developmentally and culturally appropriate.

Counselors use clear and understandable language when discussing issues related to informed consent.

When clients have difficulty understanding the language that counselors use, counselors provide necessary services (e.g., arranging for a qualified interpreter or translator) to ensure comprehension by clients. In collaboration with clients, counselors consider cultural implications of informed consent procedures and, where possible, counselors adjust their practices accordingly.

A.2.d. Inability to Give Consent When counseling minors, incapacitated adults, or other persons unable to give voluntary consent, counselors seek the assent of clients to services and include them in decision making as appropriate.

Counselors recognize the need to balance the ethical rights of clients to make choices, their capacity to give consent or assent to receive services, and parental or familial legal rights and responsibilities to protect these clients and make decisions on their behalf.

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Counselors discuss the required limitations to confidentiality when working with clients who have been mandated for counseling services. Counselors also explain what type of information and with whom that information is shared prior to the beginning of counseling. The client may choose to refuse services. In this case, counselors will, to the best of their ability, discuss with the client the potential consequences of refusing counseling services.

A.3. Clients Served by Others When counselors learn that their clients are in a professional relationship with other mental health professionals, they request release from clients to inform the other professionals and strive to establish positive and collaborative professional relationships.

A.4. Avoiding Harm and Imposing Values A.4.a. Avoiding Harm Counselors act to avoid harming their clients, trainees, and research participants and to minimize or to remedy unavoidable or unanticipated harm.

A.4.b. Personal Values Counselors are aware of—and avoid imposing—their own values, attitudes, beliefs, and behaviors.

Counselors respect the diversity of clients, trainees, and research participants and seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor’s values are inconsistent with the client’s goals or are discriminatory in nature.

A.5. Prohibited Non-counseling Roles and Relationships A.5.a. Sexual and/or Romantic Relationships Prohibited Sexual and/or romantic counselor– client interactions or relationships with current clients, their romantic partners, or their family members are prohibited. This prohibition applies to both in-person and electronic interactions or relationships.

A.5.b. Previous Sexual and/or Romantic Relationships Counselors are prohibited from engaging in counseling relationships with persons with whom they have had a previous sexual and/or romantic relationship.

A.5.c. Sexual and/or Romantic Relationships With Former Clients Sexual and/or romantic counselor– client interactions or relationships with former clients, their romantic partners, or their family members are prohibited for a period of 5 years following the last professional contact. This prohibition applies to both in-person and electronic interactions or relationships. Counselors, before engaging in sexual and/or romantic interactions or relationships with former clients, their romantic partners, or their family members, demonstrate forethought and document (in written form) whether the interaction or relationship can be viewed as exploitive in any way and/or whether there is still potential to harm the former client; in cases of potential exploitation and/or harm, the counselor avoids entering into such an interaction or relationship.

A.5.d. Friends or Family Members Counselors are prohibited from engaging in counseling relationships with friends or family members with whom they have an inability to remain objective.

A.5.e. Personal Virtual Relationships With Current Clients Counselors are prohibited from engaging in a personal virtual relationship with individuals with whom they have a current counseling relationship (e.g., through social and other media).

A.6. Managing and Maintaining Boundaries and Professional Relationships A.6.a. Previous Relationships Counselors consider the risks and benefits of accepting as clients those with whom they have had a previous relationship. These potential clients may include individuals with whom the counselor has had 67 Last Updated 9/2014

a casual, distant, or past relationship. Examples include mutual or past membership in a professional association, organization, or community. When counselors accept these clients, they take appropriate professional precautions such as informed consent, consultation, supervision, and documentation to ensure that judgment is not impaired and no exploitation occurs.

A.6.b. Extending Counseling Boundaries Counselors consider the risks and benefits of extending current counseling relationships beyond conventional parameters. Examples include attending a client’s formal ceremony (e.g., a wedding/commitment ceremony or graduation), purchasing a service or product provided by a client (excepting unrestricted bartering), and visiting a client’s ill family member in the hospital. In extending these boundaries, counselors take appropriate professional precautions such as informed consent, consultation, supervision, and documentation to ensure that judgment is not impaired and no harm occurs.

A.6.c. Documenting Boundary Extensions If counselors extend boundaries as described in A.6.a. and A.6.b., they must officially document, prior to the interaction (when feasible), the rationale for such an interaction, the potential benefit, and anticipated consequences for the client or former client and other individuals significantly involved with the client or former client. When unintentional harm occurs to the client or former client, or to an individual significantly involved with the client or former client, the counselor must show evidence of an attempt to remedy such harm.

A.6.d. Role Changes in the Professional Relationship When counselors change a role from the original or most recent contracted relationship, they obtain informed consent from the client and explain the client’s right to refuse services related to the change.

Examples of role changes include, but are not limited to 1. changing from individual to relationship or family counseling, or vice versa; 2. changing from an evaluative role to a therapeutic role, or vice versa; and 3. changing from a counselor to a mediator role, or vice versa.

Clients must be fully informed of any anticipated consequences (e.g., financial, legal, personal, therapeutic) of counselor role changes.

A.6.e. Nonprofessional Interactions or Relationships (Other Than Sexual or Romantic Interactions or Relationships) Counselors avoid entering into non-professional relationships with former clients, their romantic partners, or their family members when the interaction is potentially harmful to the client. This applies to both in-person and electronic interactions or relationships.

A.7. Roles and Relationships at Individual, Group, Institutional, and Societal Levels A.7.a. Advocacy When appropriate, counselors advocate at individual, group, institutional, and societal levels to address potential barriers and obstacles that inhibit access and/or the growth and development of clients.

A.7.b. Confidentiality and Advocacy Counselors obtain client consent prior to engaging in advocacy efforts on be-half of an identifiable client to improve the provision of services and to work toward removal of systemic barriers or obstacles that inhibit client access, growth, and development.

A.8. Multiple Clients When a counselor agrees to provide counseling services to two or more persons who have a relationship, the counselor clarifies at the outset which person or persons are clients and the nature of the relationships the counselor will have with each involved person. If it becomes apparent that the counselor may be called upon to perform potentially conflicting roles, the counselor will clarify, adjust, or withdraw from roles appropriately.

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A.9. Group Work A.9.a. Screening Counselors screen prospective group counseling/therapy participants. To the extent possible, counselors select members whose needs and goals are compatible with the goals of the group, who will not impede the group process, and whose well-being will not be jeopardized by the group experience.

A.9.b. Protecting Clients In a group setting, counselors take reasonable precautions to protect clients from physical, emotional, or psychological trauma.

A.10. Fees and Business Practices A.10.a. Self-Referral Counselors working in an organization (e.g., school, agency, institution) that provides counseling services do not refer clients to their private practice unless the policies of a particular organization make explicit provisions for self-referrals. In such instances, the clients must be informed of other options open to them should they seek private counseling services.

A.10.b. Unacceptable Business Practices Counselors do not participate in fee splitting, nor do they give or receive commissions, rebates, or any other form of remuneration when referring clients for professional services.

A.10.c. Establishing Fees In establishing fees for professional counseling services, counselors consider the financial status of clients and locality. If a counselor’s usual fees create undue hardship for the client, the counselor may adjust fees, when legally permissible, or assist the client in locating comparable, affordable services.

A.10.d. Nonpayment of Fees If counselors intend to use collection agencies or take legal measures to collect fees from clients who do not pay for services as agreed upon, they include such information in their informed consent documents and also inform clients in a timely fashion of intended actions and offer clients the opportunity to make payment.

A.10.e. Bartering Counselors may barter only if the bartering does not result in exploitation or harm, if the client requests it, and if such arrangements are an accepted practice among professionals in the community. Counselors consider the cultural implications of bartering and discuss relevant concerns with clients and document such agreements in a clear written contract.

A.10.f. Receiving Gifts Counselors understand the challenges of accepting gifts from clients and recognize that in some cultures, small gifts are a token of respect and gratitude. When determining whether to accept a gift from clients, counselors take into account the therapeutic relationship, the monetary value of the gift, the client’s motivation for giving the gift, and the counselor’s motivation for wanting to accept or decline the gift.

A.11. Termination and Referral A.11.a. Competence Within Termination and Referral If counselors lack the competence to be of professional assistance to clients, they avoid entering or continuing counseling relationships. Counselors are knowledgeable about culturally and clinically appropriate referral resources and suggest these alternatives. If clients decline the suggested referrals, counsel-ors discontinue the relationship.

A.11.b. Values Within Termination and Referral Counselors refrain from referring prospective and current clients based solely on the counselor’s personally held values, attitudes, beliefs, and behaviors. Counselors respect the diversity of clients and 69 Last Updated 9/2014

seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor’s values are inconsistent with the client’s goals or are discriminatory in nature.

A.11.c. Appropriate Termination Counselors terminate a counseling relationship when it becomes reasonably apparent that the client no longer needs assistance, is not likely to benefit, or is being harmed by continued counseling. Counselors may terminate counseling when in jeopardy of harm by the client or by another person with whom the client has a relationship, or when clients do not pay fees as agreed upon. Counselors provide pretermination counseling and recommend other service providers when necessary.

A.11.d. Appropriate Transfer of Services When counselors transfer or refer clients to other practitioners, they ensure that appropriate clinical and administrative processes are completed and open communication is maintained with both clients and practitioners.

A.12. Abandonment and Client Neglect Counselors do not abandon or neglect clients in counseling. Counselors assist in making appropriate arrangements for the continuation of treatment, when necessary, during interruptions such as vacations, illness, and following termination.

Section B: Confidentiality and Privacy Introduction Counselors recognize that trust is a cornerstone of the counseling relationship. Counselors aspire to earn the trust of clients by creating an ongoing partnership, establishing and upholding appropriate boundaries, and maintaining confidentiality. Counselors communicate the parameters of confidentiality in a culturally competent manner.

B.1. Respecting Client Rights B.1.a. Multicultural/Diversity Considerations Counselors maintain awareness and sensitivity regarding cultural meanings of confidentiality and privacy. Counselors respect differing views toward disclosure of information. Counselors hold ongoing discussions with clients as to how, when, and with whom information is to be shared.

B.1.b. Respect for Privacy Counselors respect the privacy of prospective and current clients. Counselors request private information from clients only when it is beneficial to the counseling process.

B.1.c. Respect for Confidentiality Counselors protect the confidential information of prospective and current clients. Counselors disclose information only with appropriate consent or with sound legal or ethical justification.

B.1.d. Explanation of Limitations At initiation and throughout the counseling process, counselors inform clients of the limitations of confidentiality and seek to identify situations in which confidentiality must be breached.

B.2. Exceptions B.2.a. Serious and Foreseeable Harm and Legal Requirements The general requirement that counsel-ors keep information confidential does not apply when disclosure is required to protect clients or identified others from serious and foreseeable harm or when legal requirements demand that confidential information must be revealed. Counselors consult with other professionals when in doubt as to the validity of an exception. Additional considerations apply when addressing end-of-life issues.

B.2.b. Confidentiality Regarding End-of-Life Decisions Counselors who provide services to terminally ill individuals who are considering hastening their own deaths have the option to maintain confidentiality, depending on applicable laws and the specific 70 Last Updated 9/2014

circumstances of the situation and after seeking consultation or super-vision from appropriate professional and legal parties.

B.2.c. Contagious, Life Threatening Diseases When clients disclose that they have a disease commonly known to be both communicable and life threatening, counselors may be justified in disclosing information to identifiable third parties, if the parties are known to be at serious and foreseeable risk of contracting the disease. Prior to making a disclosure, counselors assess the intent of clients to inform the third parties about their disease or to engage in any behaviors that may be harmful to an identifiable third party. Counselors adhere to relevant state laws concerning disclosure about disease status.

B.2.d. Court-Ordered Disclosure When ordered by a court to release confidential or privileged information without a client’s permission, counselors seek to obtain written, informed consent from the client or take steps to prohibit the disclosure or have it limited as narrowly as possible because of potential harm to the client or counseling relationship.

B.2.e. Minimal Disclosure To the extent possible, clients are informed before confidential information is disclosed and are involved in the disclosure decision-making process. When circumstances require the disclosure of confidential information, only essential information is revealed.

B.3. Information Shared With Others B.3.a. Subordinates Counselors make every effort to ensure that privacy and confidentiality of clients are maintained by subordinates, including employees, supervisees, students, clerical assistants, and volunteers.

B.3.b. Interdisciplinary Teams When services provided to the client involve participation by an interdisciplinary or treatment team, the client will be informed of the team’s existence and composition, information being shared, and the purposes of sharing such information.

B.3.c. Confidential Settings Counselors discuss confidential information only in settings in which they can reasonably ensure client privacy.

B.3.d. Third-Party Payers Counselors disclose information to third-party payers only when clients have authorized such disclosure.

B.3.e. Transmitting Confidential Information Counselors take precautions to ensure the confidentiality of all information transmitted through the use of any medium.

B.3.f. Deceased Clients Counselors protect the confidentiality of deceased clients, consistent with le-gal requirements and the documented preferences of the client.

B.4. Groups and Families B.4.a. Group Work In group work, counselors clearly explain the importance and parameters of confidentiality for the specific group.

B.4.b. Couples and Family Counseling In couples and family counseling, counselors clearly define who is considered “the client” and discuss expectations and limitations of confidentiality. Counselors seek agreement and document in writing such agreement among all involved parties regarding the confidentiality of information. In the absence of an agreement to the contrary, the couple or family is considered to be the client.

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B.5. Clients Lacking Capacity to Give Informed Consent B.5.a. Responsibility to Clients When counseling minor clients or adult clients who lack the capacity to give voluntary, informed consent, counselors protect the confidentiality of information received—in any medium—in the counseling relationship as specified by federal and state laws, written policies, and applicable ethical standards.

B.5.b. Responsibility to Parents and Legal Guardians Counselors inform parents and legal guardians about the role of counselors and the confidential nature of the counseling relationship, consistent with cur-rent legal and custodial arrangements. Counselors are sensitive to the cultural diversity of families and respect the inherent rights and responsibilities of parents/guardians regarding the welfare of their children/charges according to law. Counselors work to establish, as appropriate, collaborative relation-ships with parents/guardians to best serve clients.

B.5.c. Release of Confidential Information When counseling minor clients or adult clients who lack the capacity to give voluntary consent to release confidential information, counselors seek permission from an appropriate third party to disclose information. In such instances, counselors inform clients consistent with their level of understanding and take appropriate measures to safeguard client confidentiality.

B.6. Records and Documentation B.6.a. Creating and Maintaining Records and Documentation Counselors create and maintain records and documentation necessary for rendering professional services.

B.6.b. Confidentiality of Records and Documentation Counselors ensure that records and documentation kept in any medium are secure and that only authorized persons have access to them.

B.6.c. Permission to Record Counselors obtain permission from clients prior to recording sessions through electronic or other means.

B.6.d. Permission to Observe Counselors obtain permission from clients prior to allowing any person to observe counseling sessions, review session transcripts, or view recordings of sessions with supervisors, faculty, peers, or others within the training environment.

B.6.e. Client Access Counselors provide reasonable access to records and copies of records when requested by competent clients. Counselors limit the access of clients to their records, or portions of their records, only when there is compelling evidence that such access would cause harm to the client. Counselors document the request of clients and the rationale for withholding some or all of the records in the files of clients. In situations involving multiple clients, counselors provide individual clients with only those parts of records that relate directly to them and do not include confidential information related to any other client.

B.6.f. Assistance With Records When clients request access to their re-cords, counselors provide assistance and consultation in interpreting counseling records.

B.6.g. Disclosure or Transfer Unless exceptions to confidentiality exist, counselors obtain written permission from clients to disclose or transfer records to legitimate third parties. Steps are taken to ensure that receivers of counseling records are sensitive to their confidential nature.

B.6.h. Storage and Disposal After Termination Counselors store records following termination of services to ensure reasonable future access, maintain records in accordance with federal and state laws and statutes such as licensure laws and policies 72 Last Updated 9/2014

governing records, and dispose of client records and other sensitive materials in a manner that protects client confidentiality. Counselors apply careful discretion and deliberation before destroying records that may be needed by a court of law, such as notes on child abuse, suicide, sexual harassment, or violence.

B.6.i. Reasonable Precautions Counselors take reasonable precautions to protect client confidentiality in the event of the counselor’s termination of practice, incapacity, or death and appoint a records custodian when identified as appropriate.

B.7. Case Consultation B.7.a. Respect for Privacy Information shared in a consulting relationship is discussed for professional purposes only. Written and oral reports present only data germane to the purposes of the consultation, and every effort is made to protect client identity and to avoid undue invasion of privacy.

B.7.b. Disclosure of Confidential Information When consulting with colleagues, counselors do not disclose confidential information that reasonably could lead to the identification of a client or other person or organization with whom they have a confidential relationship unless they have obtained the prior consent of the person or organization or the disclosure cannot be avoided. They disclose information only to the extent necessary to achieve the purposes of the consultation.

Section C: Professional Responsibility Introduction Counselors aspire to open, honest, and accurate communication in dealing with the public and other professionals. Counselors facilitate access to counseling services, and they practice in a nondiscriminatory manner within the boundaries of professional and personal competence; they also have a responsibility to abide by the ACA Code of Ethics. Counselors actively participate in local, state, and national associations that foster the development and improvement of counseling. Counselors are expected to advocate to promote changes at the individual, group, institutional, and societal levels that improve the quality of life for individuals and groups and remove potential barriers to the provision or access of appropriate services being offered. Counselors have a responsibility to the public to engage in counseling practices that are based on rigorous research methodologies. Counselors are encouraged to contribute to society by devoting a portion of their professional activity to services for which there is little or no financial return (pro bono publico). In addition, counselors engage in self-care activities to maintain and promote their own emotional, physical, mental, and spiritual well-being to best meet their professional responsibilities.

C.1. Knowledge of and Compliance With Standards Counselors have a responsibility to read, understand, and follow the ACA Code of Ethics and adhere to applicable laws and regulations.

C.2. Professional Competence C.2.a. Boundaries of Competence Counselors practice only within the boundaries of their competence, based on their education, training, supervised experience, state and national professional credentials, and appropriate professional experience. Whereas multicultural counseling competency is required across all counseling specialties, 73 Last Updated 9/2014

counselors gain knowledge, personal awareness, sensitivity, dispositions, and skills pertinent to being a culturally competent counselor in working with a diverse client population.

C.2.b. New Specialty Areas of Practice Counselors practice in specialty areas new to them only after appropriate education, training, and supervised experience. While developing skills in new specialty areas, counselors take steps to ensure the competence of their work and protect others from possible harm.

C.2.c. Qualified for Employment Counselors accept employment only for positions for which they are qualified given their education, training, supervised experience, state and national professional credentials, and appropriate professional experience. Counselors hire for professional counseling positions only individuals who are qualified and competent for those positions.

C.2.d. Monitor Effectiveness Counselors continually monitor their effectiveness as professionals and take steps to improve when necessary. Counselors take reasonable steps to seek peer supervision to evaluate their efficacy as counselors.

C.2.e. Consultations on Ethical Obligations Counselors take reasonable steps to consult with other counselors, the ACA Ethics and Professional Standards Department, or related professionals when they have questions regarding their ethical obligations or professional practice.

C.2.f. Continuing Education Counselors recognize the need for continuing education to acquire and maintain a reasonable level of awareness of current scientific and professional information in their fields of activity. Counselors maintain their competence in the skills they use, are open to new procedures, and remain informed regarding best practices for working with diverse populations.

C.2.g. Impairment Counselors monitor themselves for signs of impairment from their own physical, mental, or emotional problems and refrain from offering or providing professional services when impaired. They seek assistance for problems that reach the level of professional impairment, and, if necessary, they limit, suspend, or terminate their professional responsibilities until it is determined that they may safely resume their work. Counselors assist colleagues or supervisors in recognizing their own professional impairment and provide consultation and assistance when war-ranted with colleagues or supervisors showing signs of impairment and intervene as appropriate to prevent imminent harm to clients.

C.2.h. Counselor Incapacitation, Death, Retirement, or Termination of Practice Counselors prepare a plan for the transfer of clients and the dissemination of records to an identified colleague or records custodian in the case of the counselor’s incapacitation, death, retirement, or termination of practice.

C.3. Advertising and Soliciting Clients C.3.a. Accurate Advertising When advertising or otherwise rep-resenting their services to the public, counselors identify their credentials in an accurate manner that is not false, misleading, deceptive, or fraudulent.

C.3.b. Testimonials Counselors who use testimonials do not solicit them from current clients, former clients, or any other persons who may be vulnerable to undue influence. Counselors discuss with clients the implications of and obtain permission for the use of any testimonial.

C.3.c. Statements by Others When feasible, counselors make reason-able efforts to ensure that statements made by others about them or about the counseling profession are accurate.

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Counselors do not use their places of employment or institutional affiliation to recruit clients, supervisors, or consultees for their private practices.

C.3.e. Products and Training Advertisements Counselors who develop products related to their profession or conduct workshops or training events ensure that the advertisements concerning these products or events are accurate and disclose adequate information for consumers to make informed choices.

C.3.f. Promoting to Those Served Counselors do not use counseling, teaching, training, or supervisory relationships to promote their products or training events in a manner that is deceptive or would exert undue influence on individuals who may be vulnerable. However, counselor educators may adopt textbooks they have authored for instructional purposes.

C.4. Professional Qualifications C.4.a. Accurate Representation Counselors claim or imply only professional qualifications actually completed and correct any known misrepresentations of their qualifications by others. Counselors truthfully represent the qualifications of their professional colleagues. Counselors clearly distinguish between paid and volunteer work experience and accurately describe their continuing education and specialized training.

C.4.b. Credentials Counselors claim only licenses or certifications that are current and in good standing.

C.4.c. Educational Degrees Counselors clearly differentiate between earned and honorary degrees.

C.4.d. Implying Doctoral-Level Competence Counselors clearly state their highest earned degree in counseling or a closely related field. Counselors do not imply doctoral-level competence when possessing a master’s degree in counseling or a related field by referring to themselves as “Dr.” in a counseling context when their doctorate is not in counseling or a related field. Counselors do not use “ABD” (all but dissertation) or other such terms to imply competency.

C.4.e. Accreditation Status Counselors accurately represent the accreditation status of their degree program and college/university.

C.4.f. Professional Membership Counselors clearly differentiate between current, active memberships and former memberships in associations. Members of ACA must clearly differentiate between professional membership, which implies the possession of at least a master’s degree in counseling, and regular membership, which is open to individuals whose interests and activities are consistent with those of ACA but are not qualified for professional membership.

C.5. Nondiscrimination Counselors do not condone or engage in discrimination against prospective or current clients, students, employees, supervisees, or research participants based on age, culture, disability, ethnicity, race, religion/spirituality, gender, gender identity, sexual orientation, marital/ partnership status, language preference, socioeconomic status, immigration status, or any basis proscribed by law.

C.6. Public Responsibility C.6.a. Sexual Harassment Counselors do not engage in or condone sexual harassment. Sexual harassment can consist of a single intense or severe act, or multiple persistent or pervasive acts.

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Counselors are accurate, honest, and objective in reporting their professional activities and judgments to appropriate third parties, including courts, health insurance companies, those who are the recipients of evaluation reports, and others.

C.6.c. Media Presentations When counselors provide advice or comment by means of public lectures, demonstrations, radio or television programs, recordings, technology-based applications, printed articles, mailed material, or other media, they take reasonable precautions to ensure that 1. the statements are based on appropriate professional counseling literature and practice, 2. the statements are otherwise consistent with the ACA Code of Ethics, and 3. the recipients of the information are not encouraged to infer that a professional counseling relation-ship has been established.

C.6.d. Exploitation of Others Counselors do not exploit others in their professional relationships.

C.6.e. Contributing to the Public Good (Pro Bono Publico) Counselors make a reasonable effort to provide services to the public for which there is little or no financial return (e.g., speaking to groups, sharing professional information, offering reduced fees).

C.7. Treatment Modalities C.7.a. Scientific Basis for Treatment When providing services, counselors use techniques/procedures/modalities that are grounded in theory and/or have an empirical or scientific foundation.

C.7.b. Development and Innovation When counselors use developing or innovative techniques/procedures/ modalities, they explain the potential risks, benefits, and ethical considerations of using such techniques/procedures/ modalities.

Counselors work to minimize any potential risks or harm when using these techniques/procedures/modalities.

C.7.c. Harmful Practices Counselors do not use techniques/procedures/modalities when substantial evidence suggests harm, even if such services are requested.

C.8. Responsibility to Other Professionals C.8.a. Personal Public Statements When making personal statements in a public context, counselors clarify that they are speaking from their personal perspectives and that they are not speaking on behalf of all counselors or the profession.

Section D: Relationships With Other Professionals Introduction Professional counselors recognize that the quality of their interactions with colleagues can influence the quality of services provided to clients. They work to become knowledgeable about colleagues within and outside the field of counseling. Counselors develop positive working relation-ships and systems of communication with colleagues to enhance services to clients.

D.1. Relationships With Colleagues, Employers, and Employees D.1.a. Different Approaches Counselors are respectful of approaches that are grounded in theory and/or have an empirical or scientific foundation but may differ from their own. Counselors acknowledge the expertise of other professional groups and are respectful of their practices.

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Counselors work to develop and strengthen relationships with colleagues from other disciplines to best serve clients.

D.1.c. Interdisciplinary Teamwork Counselors who are members of interdisciplinary teams delivering multifaceted services to clients remain focused on how to best serve clients. They participate in and contribute to decisions that affect the well-being of clients by drawing on the perspectives, values, and experiences of the counseling profession and those of colleagues from other disciplines.

D.1.d. Establishing Professional and Ethical Obligations Counselors who are members of inter-disciplinary teams work together with team members to clarify professional and ethical obligations of the team as a whole and of its individual members. When a team decision raises ethical concerns, counselors first attempt to resolve the concern within the team. If they cannot reach resolution among team members, counselors pursue other avenues to address their concerns consistent with client well-being.

D.1.e. Confidentiality When counselors are required by law, institutional policy, or extraordinary circumstances to serve in more than one role in judicial or administrative proceedings, they clarify role expectations and the parameters of confidentiality with their colleagues.

D.1.f. Personnel Selection and Assignment When counselors are in a position requiring personnel selection and/or assigning of responsibilities to others, they select competent staff and assign responsibilities compatible with their skills and experiences.

D.1.g. Employer Policies The acceptance of employment in an agency or institution implies that counsel-ors are in agreement with its general policies and principles. Counselors strive to reach agreement with employers regarding acceptable standards of client care and professional conduct that allow for changes in institutional policy conducive to the growth and development of clients.

D.1.h. Negative Conditions Counselors alert their employers of inappropriate policies and practices. They attempt to effect changes in such policies or procedures through constructive action within the organization. When such policies are potentially disruptive or damaging to clients or may limit the effectiveness of services provided and change cannot be affected, counselors take appropriate further action. Such action may include referral to appropriate certification, accreditation, or state licensure organizations, or voluntary termination of employment.

D.1.i. Protection From Punitive Action Counselors do not harass a colleague or employee or dismiss an employee who has acted in a responsible and ethical manner to expose inappropriate employer policies or practices.

D.2. Provision of Consultation Services D.2.a. Consultant Competency Counselors take reasonable steps to ensure that they have the appropriate resources and competencies when providing consultation services. Counselors provide appropriate referral resources when requested or needed.

D.2.b. Informed Consent in Formal Consultation When providing formal consultation services, counselors have an obligation to review, in writing and verbally, the rights and responsibilities of both counselors and consultees. Counselors use clear and understandable language to inform all parties involved about the purpose of the services to be provided, relevant costs, potential risks and benefits, and the limits of confidentiality.

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Section E: Evaluation, Assessment, and Interpretation Introduction Counselors use assessment as one component of the counseling process, taking into account the clients’ personal and cultural context. Counselors promote the well-being of individual clients or groups of clients by developing and using appropriate educational, mental health, psychological, and career assessments.

E.1. General E.1.a. Assessment The primary purpose of educational, mental health, psychological, and career assessment is to gather information regarding the client for a variety of purposes, including, but not limited to, client decision making, treatment planning, and forensic proceedings. Assessment may include both qualitative and quantitative methodologies.

E.1.b. Client Welfare Counselors do not misuse assessment results and interpretations, and they take reasonable steps to prevent others from misusing the information pro-vided. They respect the client’s right to know the results, the interpretations made, and the bases for counselors’ conclusions and recommendations.

E.2. Competence to Use and Interpret Assessment Instruments E.2.a. Limits of Competence Counselors use only those testing and assessment services for which they have been trained and are competent. Counselors using technology-assisted test interpretations are trained in the construct being measured and the specific instrument being used prior to using its technology-based application.

Counselors take reason-able measures to ensure the proper use of assessment techniques by persons under their supervision.

E.2.b. Appropriate Use Counselors are responsible for the appropriate application, scoring, interpretation, and use of assessment instruments relevant to the needs of the client, whether they score and interpret such assessments themselves or use technology or other services.

E.2.c. Decisions Based on Results Counselors responsible for decisions involving individuals or policies that are based on assessment results have a thorough understanding of psychometrics.

E.3. Informed Consent in Assessment E.3.a. Explanation to Clients Prior to assessment, counselors explain the nature and purposes of assessment and the specific use of results by potential recipients. The explanation will be given in terms and language that the client (or other legally authorized person on behalf of the client) can understand.

E.3.b. Recipients of Results Counselors consider the client’s and/ or examinee’s welfare, explicit under-standings, and prior agreements in determining who receives the assessment results. Counselors include accurate and appropriate interpretations with any release of individual or group assessment results.

E.4. Release of Data to Qualified Personnel Counselors release assessment data in which the client is identified only with the consent of the client or the client’s legal representative. Such data are released only to persons recognized by counselors as qualified to interpret the data.

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E.5. Diagnosis of Mental Disorders E.5.a. Proper Diagnosis Counselors take special care to provide proper diagnosis of mental disorders. Assessment techniques (including personal interviews) used to determine client care (e.g., locus of treatment, type of treatment, recommended follow-up) are carefully selected and appropriately used.

E.5.b. Cultural Sensitivity Counselors recognize that culture affects the manner in which clients’ problems are defined and experienced. Clients’ socioeconomic and cultural experiences are considered when diagnosing mental disorders.

E.5.c. Historical and Social Prejudices in the Diagnosis of Pathology Counselors recognize historical and social prejudices in the misdiagnosis and pathologizing of certain individuals and groups and strive to become aware of and address such biases in themselves or others.

E.5.d. Refraining From Diagnosis Counselors may refrain from making and/or reporting a diagnosis if they believe that it would cause harm to the client or others. Counselors carefully consider both the positive and negative implications of a diagnosis.

E.6. Instrument Selection E.6.a. Appropriateness of Instruments Counselors carefully consider the validity, reliability, psychometric limitations, and appropriateness of instruments when selecting assessments and, when possible, use multiple forms of assessment, data, and/or instruments in forming conclusions, diagnoses, or recommendations.

E.6.b. Referral Information If a client is referred to a third party for assessment, the counselor provides specific referral questions and sufficient objective data about the client to ensure that appropriate assessment instruments are utilized.

E.7. Conditions of Assessment Administration E.7.a. Administration Conditions Counselors administer assessments under the same conditions that were established in their standardization. When assessments are not administered under standard conditions, as may be necessary to accommodate clients with disabilities, or when unusual behavior or irregularities occur during the administration, those conditions are noted in interpretation, and the results may be designated as invalid or of question-able validity.

E.7.b. Provision of Favorable Conditions Counselors provide an appropriate environment for the administration of assessments (e.g., privacy, comfort, freedom from distraction).

E.7.c. Technological Administration Counselors ensure that technologically administered assessments function properly and provide clients with accurate results.

E.7.d. Unsupervised Assessments Unless the assessment instrument is designed, intended, and validated for self-administration and / or scoring, counselors do not permit unsupervised use.

E.8. Multicultural Issues/ Diversity in Assessment Counselors select and use with caution assessment techniques normed on populations other than that of the client. Counselors recognize the effects of age, color, culture, disability, ethnic group, gender, race, language preference, religion, spirituality, sexual orientation, and socioeconomic status on test 79 Last Updated 9/2014

administration and interpretation, and they place test results in proper perspective with other relevant factors.

E.9. Scoring and Interpretation of Assessments E.9.a. Reporting When counselors report assessment results, they consider the client’s personal and cultural background, the level of the client’s understanding of the results, and the impact of the results on the client. In reporting assessment results, counselors indicate reservations that exist regarding validity or reliability due to circumstances of the assessment or inappropriateness of the norms for the person tested.

E.9.b. Instruments With Insufficient Empirical Data Counselors exercise caution when interpreting the results of instruments not having sufficient empirical data to support respondent results. The specific purposes for the use of such instruments are stated explicitly to the examinee. Counselors qualify any conclusions, diagnoses, or recommendations made that are based on assessments or instruments with questionable validity or reliability.

E.9.c. Assessment Services Counselors who provide assessment, scoring, and interpretation services to support the assessment process confirm the validity of such interpretations. They accurately describe the purpose, norms, validity, reliability, and applications of the procedures and any special qualifications applicable to their use. At all times, counselors maintain their ethical responsibility to those being assessed.

E.10. Assessment Security Counselors maintain the integrity and security of tests and assessments consistent with legal and contractual obligations. Counselors do not appropriate, reproduce, or modify published assessments or parts thereof without acknowledgment and permission from the publisher.

E.11. Obsolete Assessment and Outdated Results Counselors do not use data or results from assessments that are obsolete or outdated for the current purpose (e.g., noncurrent versions of assessments/ instruments). Counselors make every effort to prevent the misuse of obsolete measures and assessment data by others.

E.12. Assessment Construction Counselors use established scientific procedures, relevant standards, and current professional knowledge for assessment design in the development, publication, and utilization of assessment techniques.

E.13. Forensic Evaluation: Evaluation for Legal Proceedings E.13.a. Primary Obligations When providing forensic evaluations, the primary obligation of counselors is to produce objective findings that can be substantiated based on information and techniques appropriate to the evaluation, which may include examination of the individual and/or review of records. Counselors form professional opinions based on their professional knowledge and expertise that can be supported by the data gathered in evaluations. Counselors define the limits of their reports or testimony, especially when an examination of the individual has not been conducted.

E.13.b. Consent for Evaluation Individuals being evaluated are in-formed in writing that the relationship is for the purposes of an evaluation and is not therapeutic in nature, and entities or individuals who will receive the evaluation report are identified. Counselors who perform forensic evaluations obtain written consent from those being evaluated or from their legal representative unless a court orders evaluations to be conducted without the written consent of the individuals being evaluated. When children or adults who lack the 80 Last Updated 9/2014

capacity to give voluntary consent are being evaluated, informed written consent is obtained from a parent or guardian.

E.13.c. Client Evaluation Prohibited Counselors do not evaluate current or former clients, clients’ romantic partners, or clients’ family members for forensic purposes. Counselors do not counsel individuals they are evaluating.

E.13.d. Avoid Potentially Harmful Relationships Counselors who provide forensic evaluations avoid potentially harmful professional or personal relationships with family members, romantic partners, and close friends of individuals they are evaluating or have evaluated in the past.

Section F Supervision, Training, and Teaching Introduction Counselor supervisors, trainers, and educators aspire to foster meaningful and respectful professional relation-ships and to maintain appropriate boundaries with supervisees and students in both face-to-face and electronic formats. They have theoretical and pedagogical foundations for their work; have knowledge of supervision models; and aim to be fair, accurate, and honest in their assessments of counselors, students, and supervisees.

F.1. Counselor Supervision and Client Welfare F.1.a. Client Welfare A primary obligation of counseling supervisors is to monitor the services provided by supervisees.

Counseling supervisors monitor client welfare and supervisee performance and professional development. To fulfill these obligations, supervisors meet regularly with supervisees to review the supervisees’ work and help them become prepared to serve a range of diverse clients. Supervisees have a responsibility to understand and follow the ACA Code of Ethics.

F.1.b. Counselor Credentials Counseling supervisors work to ensure that supervisees communicate their qualifications to render services to their clients.

F.1.c. Informed Consent and Client Rights Supervisors make supervisees aware of client rights, including the protection of client privacy and confidentiality in the counseling relationship. Supervisees provide clients with professional disclosure information and inform them of how the supervision process influences the limits of confidentiality.

Supervisees make clients aware of who will have access to records of the counseling relationship and how these records will be stored, transmitted, or otherwise reviewed.

F.2. Counselor Supervision Competence F.2.a. Supervisor Preparation Prior to offering supervision services, counselors are trained in supervision methods and techniques.

Counselors who offer supervision services regularly pursue continuing education activities, including both counseling and supervision topics and skills.

F.2.b. Multicultural Issues/Diversity in Supervision Counseling supervisors are aware of and address the role of multiculturalism/ diversity in the supervisory relationship.

F.2.c. Online Supervision When using technology in supervision, counselor supervisors are competent in the use of those technologies. Supervisors take the necessary precautions to protect the confidentiality of all information transmitted through any electronic means.

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F.3. Supervisory Relationship F.3.a. Extending Conventional Supervisory Relationships Counseling supervisors clearly define and maintain ethical professional, personal, and social relationships with their supervisees. Supervisors consider the risks and benefits of extending current supervisory relationships in any form beyond conventional parameters. In extending these boundaries, supervisors take appropriate professional precautions to ensure that judgment is not impaired and that no harm occurs.

F.3.b. Sexual Relationships Sexual or romantic interactions or relationships with current supervisees are prohibited. This prohibition applies to both in-person and electronic interactions or relationships.

F.3.c. Sexual Harassment Counseling supervisors do not con-done or subject supervisees to sexual harassment.

F.3.d. Friends or Family Members Supervisors are prohibited from engaging in supervisory relationships with individuals with whom they have an inability to remain objective.

F.4. Supervisor Responsibilities F.4.a. Informed Consent for Supervision Supervisors are responsible for incorporating into their supervision the principles of informed consent and participation. Supervisors inform supervisees of the policies and procedures to which supervisors are to adhere and the mechanisms for due process appeal of individual supervisor actions. The issues unique to the use of distance supervision are to be included in the documentation as necessary.

F.4.b. Emergencies and Absences Supervisors establish and communicate to supervisees procedures for contacting supervisors or, in their absence, alternative on-call supervisors to assist in handling crises.

F.4.c. Standards for Supervisees Supervisors make their supervisees aware of professional and ethical standards and legal responsibilities.

F.4.d. Termination of the Supervisory Relationship Supervisors or supervisees have the right to terminate the supervisory relationship with adequate notice.

Rea-sons for considering termination are discussed, and both parties work to resolve differences. When termination is warranted, supervisors make appropriate referrals to possible alternative supervisors.

F.5. Student and Supervisee Responsibilities F.5.a. Ethical Responsibilities Students and supervisees have a responsibility to understand and follow the ACA Code of Ethics.

Students and supervisees have the same obligation to clients as those required of professional counselors.

F.5.b. Impairment Students and supervisees monitor themselves for signs of impairment from their own physical, mental, or emotional problems and refrain from offering or providing professional services when such impairment is likely to harm a client or others. They notify their faculty and/or supervisors and seek assistance for problems that reach the level of professional impairment, and, if necessary, they limit, suspend, or terminate their professional responsibilities until it is determined that they may safely resume their work.

F.5.c. Professional Disclosure Before providing counseling services, students and supervisees disclose their status as supervisees and explain how this status affects the limits of confidentiality. Supervisors ensure that clients are aware of the services rendered and the qualifications of the students and supervisees rendering those services.

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Students and supervisees obtain client permission before they use any information concerning the counseling relationship in the training process.

F.6. Counseling Supervision Evaluation, Remediation, and Endorsement F.6.a. Evaluation Supervisors document and provide supervisees with ongoing feedback regarding their performance and schedule periodic formal evaluative sessions throughout the supervisory relationship.

F.6.b. Gatekeeping and Remediation Through initial and ongoing evaluation, supervisors are aware of supervisee limitations that might impede performance. Supervisors assist supervisees in securing remedial assistance when needed. They recommend dismissal from training programs, applied counseling settings, and state or voluntary professional credentialing processes when those supervisees are unable to demonstrate that they can provide competent professional services to a range of diverse clients. Supervisors seek consultation and document their decisions to dismiss or refer supervisees for assistance. They ensure that supervisees are aware of options available to them to address such decisions.

F.6.c. Counseling for Supervisees If supervisees request counseling, the supervisor assists the supervisee in identifying appropriate services. Supervisors do not provide counseling services to supervisees. Supervisors address interpersonal competencies in terms of the impact of these issues on clients, the supervisory relationship, and professional functioning.

F.6.d. Endorsements Supervisors endorse supervisees for certification, licensure, employment, or completion of an academic or training program only when they believe that supervisees are qualified for the endorsement.

Regardless of qualifications, supervisors do not endorse supervisees whom they believe to be impaired in any way that would interfere with the performance of the duties associated with the endorsement.

F.7. Responsibilities of Counselor Educators F.7.a. Counselor Educators Counselor educators who are responsible for developing, implementing, and supervising educational programs are skilled as teachers and practitioners. They are knowledgeable regarding the ethical, legal, and regulatory aspects of the profession; are skilled in applying that knowledge; and make students and supervisees aware of their responsibilities. Whether in traditional, hybrid, and/or online formats, counselor educators conduct counselor education and training programs in an ethical manner and serve as role models for professional behavior.

F.7.b. Counselor Educator Competence Counselors who function as counselor educators or supervisors provide instruction within their areas of knowledge and competence and provide instruction based on current information and knowledge available in the profession. When using technology to deliver instruction, counselor educators develop competence in the use of the technology.

F.7.c. Infusing Multicultural Issues/Diversity Counselor educators infuse material related to multiculturalism/diversity into all courses and workshops for the development of professional counselors.

F.7.d. Integration of Study and Practice In traditional, hybrid, and/or online formats, counselor educators establish education and training programs that integrate academic study and supervised practice.

F.7.e. Teaching Ethics Throughout the program, counselor educators ensure that students are aware of the ethical responsibilities and standards of the profession and the ethical responsibilities of students to the profession. Counselor educators infuse ethical considerations throughout the curriculum.

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F.7.f. Use of Case Examples The use of client, student, or supervisee information for the purposes of case examples in a lecture or classroom setting is permissible only when (a) the client, student, or supervisee has reviewed the material and agreed to its presentation or (b) the information has been sufficiently modified to obscure identity.

F.7.g. Student-to-Student Supervision and Instruction When students function in the role of counselor educators or supervisors, they understand that they have the same ethical obligations as counselor educators, trainers, and supervisors. Counselor educators make every effort to ensure that the rights of students are not compromised when their peers lead experiential counseling activities in traditional, hybrid, and/or online formats (e.g., counseling groups, skills classes, clinical supervision).

F.7.h. Innovative Theories and Techniques Counselor educators promote the use of techniques/procedures/modalities that are grounded in theory and/or have an empirical or scientific foundation. When counselor educators discuss developing or innovative techniques/ procedures/modalities, they explain the potential risks, benefits, and ethical considerations of using such techniques/ procedures/modalities.

F.7.i. Field Placements Counselor educators develop clear policies and provide direct assistance within their training programs regarding appropriate field placement and other clinical experiences. Counselor educators provide clearly stated roles and responsibilities for the student or supervisee, the site supervisor, and the program supervisor. They confirm that site supervisors are qualified to provide supervision in the formats in which services are provided and inform site supervisors of their professional and ethical responsibilities in this role.

F.8. Student Welfare F.8.a. Program Information and Orientation Counselor educators recognize that program orientation is a developmental process that begins upon students’ initial contact with the counselor education program and continues throughout the educational and clinical training of students. Counselor education faculty provide prospective and current students with information about the counselor education program’s expectations, including 1. the values and ethical principles of the profession; 2. the type and level of skill and knowledge acquisition required for successful completion of the training; 3. technology requirements; 4. program training goals, objectives, and mission, and subject matter to be covered; 5. bases for evaluation; 6. training components that encourage self-growth or self-disclosure as part of the training process; 7. the type of supervision settings and requirements of the sites for required clinical field experiences; 8. student and supervisor evaluation and dismissal policies and procedures; and 9. up-to-date employment prospects for graduates.

F.8.b. Student Career Advising Counselor educators provide career advisement for their students and make them aware of opportunities in the field.

F.8.c. Self-Growth Experiences Self-growth is an expected component of counselor education. Counselor educators are mindful of ethical principles when they require students to engage in self-growth experiences. Counselor educators and supervisors inform students that they have a right to decide what information will be shared or withheld in class.

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F.8.d. Addressing Personal Concerns Counselor educators may require students to address any personal concerns that have the potential to affect professional competency.

F.9. Evaluation and Remediation F.9.a. Evaluation of Students Counselor educators clearly state to students, prior to and throughout the training program, the levels of competency expected, appraisal methods, and timing of evaluations for both didactic and clinical competencies. Counselor educators provide students with ongoing feedback regarding their performance throughout the training program.

F.9.b. Limitations Counselor educators, through ongoing evaluation, are aware of and address the inability of some students to achieve counseling competencies. Counselor educators do the following: 1. assist students in securing remedial assistance when needed, 2. seek professional consultation and document their decision to dismiss or refer students for assistance, and 3. ensure that students have recourse in a timely manner to address decisions requiring them to seek assistance or to dismiss them and provide students with due process according to institutional policies and procedures.

F.9.c. Counseling for Students If students request counseling, or if counseling services are suggested as part of a remediation process, counselor educators assist students in identifying appropriate services.

F.10. Roles and Relationships Between Counselor Educators and Students F.10.a. Sexual or Romantic Relationships Counselor educators are prohibited from sexual or romantic interactions or relationships with students currently enrolled in a counseling or related pro-gram and over whom they have power and authority.

This prohibition applies to both in-person and electronic interactions or relationships.

F.10.b. Sexual Harassment Counselor educators do not condone or subject students to sexual harassment.

F.10.c. Relationships With Former Students Counselor educators are aware of the power differential in the relationship between faculty and students.

Faculty members discuss with former students potential risks when they consider engaging in social, sexual, or other intimate relationships.

F.10.d. Nonacademic Relationships Counselor educators avoid nonacademic relationships with students in which there is a risk of potential harm to the student or which may compromise the training experience or grades assigned. In addition, counselor educators do not accept any form of professional services, fees, commissions, reimbursement, or remuneration from a site for student or supervisor placement.

F.10.e. Counseling Services Counselor educators do not serve as counselors to students currently enrolled in a counseling or related pro-gram and over whom they have power and authority.

F.10.f. Extending Educator–Student Boundaries Counselor educators are aware of the power differential in the relationship between faculty and students.

If they believe that a nonprofessional relation-ship with a student may be potentially beneficial to the student, they take pre-cautions similar to those taken by counselors when working with clients.

Examples of potentially beneficial interactions or relationships include, but are not limited to, attending a formal ceremony; conducting hospital visits; providing support during a stressful event; or maintaining mutual membership in a professional association, organization, or community. Counselor educators 85 Last Updated 9/2014

discuss with students the rationale for such interactions, the potential benefits and drawbacks, and the anticipated consequences for the student. Educators clarify the specific nature and limitations of the additional role(s) they will have with the student prior to engaging in a nonprofessional relationship.

Nonprofessional relation-ships with students should be time limited and/or context specific and initiated with student consent.

F.11. Multicultural/Diversity Competence in Counselor Education and Training Programs F.11.a. Faculty Diversity Counselor educators are committed to recruiting and retaining a diverse faculty.

F.11.b. Student Diversity Counselor educators actively attempt to recruit and retain a diverse student body. Counselor educators demonstrate commitment to multicultural/diversity competence by recognizing and valuing the diverse cultures and types of abilities that students bring to the training experience. Counselor educators provide appropriate accommodations that enhance and support diverse student well-being and academic performance.

F.11.c. Multicultural/Diversity Competence Counselor educators actively infuse multicultural/diversity competency in their training and supervision practices. They actively train students to gain awareness, knowledge, and skills in the competencies of multicultural practice.

Section G: Research and Publication Introduction Counselors who conduct research are encouraged to contribute to the knowledge base of the profession and promote a clearer understanding of the conditions that lead to a healthy and more just society.

Counselors support the efforts of researchers by participating fully and willingly whenever possible.

Counselors minimize bias and respect diversity in designing and implementing research.

G.1. Research Responsibilities G.1.a. Conducting Research Counselors plan, design, conduct, and report research in a manner that is consistent with pertinent ethical principles, federal and state laws, host institutional regulations, and scientific standards governing research.

G.1.b. Confidentiality in Research Counselors are responsible for under-standing and adhering to state, federal, agency, or institutional policies or applicable guidelines regarding confidentiality in their research practices.

G.1.c. Independent Researchers When counselors conduct independent research and do not have access to an institutional review board, they are bound to the same ethical principles and federal and state laws pertaining to the review of their plan, design, conduct, and reporting of research.

G.1.d. Deviation From Standard Practice Counselors seek consultation and observe stringent safeguards to protect the rights of research participants when research indicates that a deviation from standard or acceptable practices may be necessary.

G.1.e. Precautions to Avoid Injury Counselors who conduct research are responsible for their participants’ welfare throughout the research process and should take reasonable precautions to avoid causing emotional, physical, or social harm to participants.

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G.1.f. Principal Researcher Responsibility The ultimate responsibility for ethical research practice lies with the principal researcher. All others involved in the re-search activities share ethical obligations and responsibility for their own actions.

G.2. Rights of Research Participants G.2.a. Informed Consent in Research Individuals have the right to decline requests to become research participants. In seeking consent, counselors use language that 1. accurately explains the purpose and procedures to be followed; 2. identifies any procedures that are experimental or relatively untried; 3. describes any attendant discomforts, risks, and potential power differentials between researchers and participants; 4. describes any benefits or changes in individuals or organizations that might reasonably be expected; 5. discloses appropriate alternative procedures that would be advantageous for participants; 6. offers to answer any inquiries concerning the procedures; 7. describes any limitations on confidentiality; 8. describes the format and potential target audiences for the dissemination of research findings; and 9. instructs participants that they are free to withdraw their con-sent and discontinue participation in the project at any time, without penalty.

G.2.b. Student/Supervisee Participation Researchers who involve students or supervisees in research make clear to them that the decision regarding participation in research activities does not affect their academic standing or supervisory relationship. Students or supervisees who choose not to participate in research are provided with an appropriate alternative to fulfill their academic or clinical requirements.

G.2.c. Client Participation Counselors conducting research involving clients make clear in the informed consent process that clients are free to choose whether to participate in re-search activities. Counselors take necessary precautions to protect clients from adverse consequences of declining or withdrawing from participation.

G.2.d. Confidentiality of Information Information obtained about research participants during the course of re-search is confidential.

Procedures are implemented to protect confidentiality.

G.2.e. Persons Not Capable of Giving Informed Consent When a research participant is not capable of giving informed consent, counselors provide an appropriate explanation to, obtain agreement for participation from, and obtain the appropriate consent of a legally authorized person.

G.2.f. Commitments to Participants Counselors take reasonable measures to honor all commitments to research participants.

G.2.g. Explanations After Data Collection After data are collected, counselors provide participants with full clarification of the nature of the study to re-move any misconceptions participants might have regarding the research. Where scientific or human values justify delaying or withholding information, counselors take reasonable measures to avoid causing harm.

G.2.h. Informing Sponsors Counselors inform sponsors, institutions, and publication channels regarding research procedures and outcomes. Counselors ensure that appropriate bodies and authorities are given pertinent information and acknowledgment.

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G.2.i. Research Records Custodian As appropriate, researchers prepare and disseminate to an identified colleague or records custodian a plan for the transfer of research data in the case of their incapacitation, retirement, or death.

G.3. Managing and Maintaining Boundaries G.3.a. Extending Researcher–Participant Boundaries Researchers consider the risks and benefits of extending current research relationships beyond conventional parameters. When a non-research interaction between the researcher and the research participant may be potentially beneficial, the researcher must document, prior to the interaction (when feasible), the rationale for such an interaction, the potential benefit, and anticipated con-sequences for the research participant. Such interactions should be initiated with appropriate consent of the research participant. Where unintentional harm occurs to the research participant, the researcher must show evidence of an attempt to remedy such harm.

G.3.b. Relationships With Research Participants Sexual or romantic counselor–research participant interactions or relationships with current research participants are prohibited. This prohibition applies to both in-person and electronic interactions or relationships.

G.3.c. Sexual Harassment and Research Participants Researchers do not condone or subject research participants to sexual harassment.

G.4. Reporting Results G.4.a. Accurate Results Counselors plan, conduct, and report research accurately. Counselors do not engage in misleading or fraudulent re-search, distort data, misrepresent data, or deliberately bias their results. They describe the extent to which results are applicable for diverse populations.

G.4.b. Obligation to Report Unfavorable Results Counselors report the results of any research of professional value. Results that reflect unfavorably on institutions, programs, services, prevailing opinions, or vested interests are not withheld.

G.4.c. Reporting Errors If counselors discover significant errors in their published research, they take reasonable steps to correct such errors in a correction erratum or through other appropriate publication means.

G.4.d. Identity of Participants Counselors who supply data, aid in the research of another person, report research results, or make original data available take due care to disguise the identity of respective participants in the absence of specific authorization from the participants to do otherwise. In situations where participants self-identify their involvement in research studies, researchers take active steps to ensure that data are adapted/ changed to protect the identity and welfare of all parties and that discussion of results does not cause harm to participants.

G.4.e. Replication Studies Counselors are obligated to make available sufficient original research information to qualified professionals who may wish to replicate or extend the study.

G.5. Publications and Presentations G.5.a. Use of Case Examples The use of participants’, clients’, students’, or supervisees’ information for the purpose of case examples in a presentation or publication is permissible only when (a) participants, clients, students, or supervisees have reviewed the material and agreed to its presentation or publication or (b) the information has been sufficiently modified to obscure identity.

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G.5.b. Plagiarism Counselors do not plagiarize; that is, they do not present another person’s work as their own.

G.5.c. Acknowledging Previous Work In publications and presentations, counselors acknowledge and give recognition to previous work on the topic by others or self.

G.5.d. Contributors Counselors give credit through joint authorship, acknowledgment, foot-note statements, or other appropriate means to those who have contributed significantly to research or concept development in accordance with such contributions. The principal contributor is listed first, and minor technical or professional contributions are acknowledged in notes or introductory statements.

G.5.e. Agreement of Contributors Counselors who conduct joint research with colleagues or students/supervisors establish agreements in advance regarding allocation of tasks, publication credit, and types of acknowledgment that will be received.

G.5.f. Student Research Manuscripts or professional presentations in any medium that are substantially based on a student’s course papers, projects, dissertations, or theses are used only with the student’s permission and list the student as lead author.

G.5.g. Duplicate Submissions Counselors submit manuscripts for consideration to only one journal at a time. Manuscripts that are published in whole or in substantial part in one journal or published work are not submitted for publication to another publisher with-out acknowledgment and permission from the original publisher.

G.5.h. Professional Review Counselors who review material sub-mitted for publication, research, or other scholarly purposes respect the confidentiality and proprietary rights of those who submitted it. Counselors make publication decisions based on valid and defensible standards. Counselors review article submissions in a timely manner and based on their scope and competency in research methodologies. Counselors who serve as reviewers at the request of editors or publishers make every effort to only review materials that are within their scope of competency and avoid personal biases.

Section H: Distance Counseling, Technology, and Social Media Introduction Counselors understand that the profession of counseling may no longer be limited to in-person, face-toface inter-actions. Counselors actively attempt to understand the evolving nature of the profession with regard to distance counseling, technology, and social media and how such resources may be used to better serve their clients. Counselors strive to become knowledgeable about these resources. Counselors understand the additional concerns related to the use of distance counseling, technology, and social media and make every attempt to protect confidentiality and meet any legal and ethical requirements for the use of such resources.

H.1. Knowledge and Legal Considerations H.1.a. Knowledge and Competency Counselors who engage in the use of distance counseling, technology, and/ or social media develop knowledge and skills regarding related technical, ethical, and legal considerations (e.g., special certifications, additional course work).

H.1.b. Laws and Statutes Counselors who engage in the use of distance counseling, technology, and social media within their counseling practice understand that they may be subject to laws and regulations of both the counselor’s practicing location and the client’s place of residence. Counselors ensure that their clients are aware of 89 Last Updated 9/2014

pertinent legal rights and limitations governing the practice of counseling across state lines or international boundaries.

H.2. Informed Consent and Security H.2.a. Informed Consent and Disclosure Clients have the freedom to choose whether to use distance counseling, social media, and/or technology within the counseling process. In addition to the usual and customary protocol of informed consent between counselor and client for face-to-face counseling, the following issues, unique to the use of distance counseling, technology, and/ or social media, are addressed in the informed consent process: • distance counseling credentials, physical location of practice, and contact information; • risks and benefits of engaging in the use of distance counseling, technology, and/or social media; • possibility of technology failure and alternate methods of service delivery; • anticipated response time; • emergency procedures to follow when the counselor is not available; • time zone differences; • cultural and/or language differences that may affect delivery of services; • possible denial of insurance benefits; and • social media policy.

H.2.b. Confidentiality Maintained by the Counselor Counselors acknowledge the limitations of maintaining the confidentiality of electronic records and transmissions. They inform clients that individuals might have authorized or unauthorized access to such records or transmissions (e.g., colleagues, supervisors, employees, information technologists).

H.2.c. Acknowledgment of Limitations Counselors inform clients about the inherent limits of confidentiality when using technology.

Counselors urge clients to be aware of authorized and/ or unauthorized access to information disclosed using this medium in the counseling process.

H.2.d. Security Counselors use current encryption standards within their websites and/or technology-based communications that meet applicable legal requirements. Counselors take reasonable precautions to ensure the confidentiality of information transmitted through any electronic means.

H.3. Client Verification Counselors who engage in the use of distance counseling, technology, and/ or social media to interact with clients take steps to verify the client’s identity at the beginning and throughout the therapeutic process. Verification can include, but is not limited to, using code words, numbers, graphics, or other nondescript identifiers.

H.4. Distance Counseling Relationship H.4.a. Benefits and Limitations Counselors inform clients of the benefits and limitations of using technology applications in the provision of counseling services. Such technologies include, but are not limited to, computer hardware and/or software, telephones and applications, social media and Internet-based applications and other audio and/or video communication, or data storage devices or media.

H.4.b. Professional Boundaries in Distance Counseling Counselors understand the necessity of maintaining a professional relationship with their clients.

Counselors discuss and establish professional boundaries with clients regarding the appropriate use and/or application of technology and the limitations of its use within the counseling relationship (e.g., lack of confidentiality, times when not appropriate to use).

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H.4.c. Technology-Assisted Services When providing technology-assisted services, counselors make reasonable efforts to determine that clients are intellectually, emotionally, physically, linguistically, and functionally capable of using the application and that the application is appropriate for the needs of the client. Counselors verify that clients understand the purpose and operation of technology applications and follow up with clients to correct possible misconceptions, discover appropriate use, and assess subsequent steps.

H.4.d. Effectiveness of Services When distance counseling services are deemed ineffective by the counselor or client, counselors consider delivering services face-to-face. If the counselor is not able to provide face-to-face services (e.g., lives in another state), the counselor assists the client in identifying appropriate services.

H.4.e. Access Counselors provide information to clients regarding reasonable access to pertinent applications when providing technology-assisted services.

H.4.f. Communication Differences in Electronic Media Counselors consider the differences between face-to-face and electronic communication (nonverbal and verbal cues) and how these may affect the counseling process. Counselors educate clients on how to prevent and address potential misunderstandings arising from the lack of visual cues and voice intonations when communicating electronically.

H.5. Records and Web Maintenance H.5.a. Records Counselors maintain electronic records in accordance with relevant laws and statutes. Counselors inform clients on how records are maintained electronically. This includes, but is not limited to, the type of encryption and security assigned to the records, and if/for how long archival storage of transaction records is maintained.

H.5.b. Client Rights Counselors who offer distance counseling services and/or maintain a professional website provide electronic links to relevant licensure and professional certification boards to protect consumer and client rights and address ethical concerns.

H.5.c. Electronic Links Counselors regularly ensure that electronic links are working and are professionally appropriate.

H.5.d. Multicultural and Disability Considerations Counselors who maintain websites provide accessibility to persons with disabilities. They provide translation capabilities for clients who have a different primary language, when feasible. Counselors acknowledge the imperfect nature of such translations and accessibilities.

H.6. Social Media H.6.a. Virtual Professional Presence In cases where counselors wish to maintain a professional and personal presence for social media use, separate professional and personal web pages and profiles are created to clearly distinguish between the two kinds of virtual presence.

H.6.b. Social Media as Part of Informed Consent Counselors clearly explain to their clients, as part of the informed consent procedure, the benefits, limitations, and boundaries of the use of social media.

H.6.c. Client Virtual Presence Counselors respect the privacy of their clients’ presence on social media unless given consent to view such information.

H.6.d. Use of Public Social Media Counselors take precautions to avoid disclosing confidential information through public social media.

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Section I: Resolving Ethical Issues Introduction Professional counselors behave in an ethical and legal manner. They are aware that client welfare and trust in the profession depend on a high level of professional conduct. They hold other counselors to the same standards and are willing to take appropriate action to ensure that standards are upheld. Counselors strive to resolve ethical dilemmas with direct and open communication among all parties involved and seek consultation with colleagues and supervisors when necessary. Counselors incorporate ethical practice into their daily professional work and engage in ongoing professional development regarding current topics in ethical and legal issues in counseling. Counselors become familiar with the ACA Policy and Procedures for Processing Complaints of Ethical Violations1 and use it as a reference for assisting in the enforcement of the ACA Code of Ethics.

I.1. Standards and the Law I.1.a. Knowledge Counselors know and understand the ACA Code of Ethics and other applicable ethics codes from professional organizations or certification and licensure bodies of which they are members. Lack of knowledge or misunderstanding of an ethical responsibility is not a defense against a charge of unethical conduct.

I.1.b. Ethical Decision Making When counselors are faced with an ethical dilemma, they use and document, as appropriate, an ethical decision-making model that may include, but is not limited to, consultation; consideration of relevant ethical standards, principles, and laws; generation of potential courses of action; deliberation of risks and benefits; and selection of an objective decision based on the circumstances and welfare of all involved.

I.1.c. Conflicts Between Ethics and Laws If ethical responsibilities conflict with the law, regulations, and/or other governing legal authority, counselors make known their commitment to the ACA Code of Ethics and take steps to resolve the conflict. If the conflict cannot be re-solved using this approach, counselors, acting in the best interest of the client, may adhere to the requirements of the law, regulations, and/or other governing legal authority.

I.2. Suspected Violations I.2.a. Informal Resolution When counselors have reason to believe that another counselor is violating or has violated an ethical standard and substantial harm has not occurred, they attempt to first resolve the issue informally with the other counselor if feasible, provided such action does not violate confidentiality rights that may be involved.

I.2.b. Reporting Ethical Violations If an apparent violation has substantially harmed or is likely to substantially harm a person or organization and is not appropriate for informal resolution or is not resolved properly, counselors take further action depending on the situation. Such action may include referral to state or national committees on professional ethics, voluntary national certification bodies, state licensing boards, or appropriate institutional authorities. The confidentiality rights of clients should be considered in all actions. This standard does not apply when counselors have been retained to review the work of another counselor whose professional conduct is in question (e.g., consultation, expert testimony).

I.2.c. Consultation

1

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When uncertain about whether a particular situation or course of action may be in violation of the ACA Code of Ethics, counselors consult with other counselors who are knowledge-able about ethics and the ACA Code of Ethics, with colleagues, or with appropriate authorities, such as the ACA Ethics and Professional Standards Department.

I.2.d. Organizational Conflicts If the demands of an organization with which counselors are affiliated pose a conflict with the ACA Code of Ethics, counselors specify the nature of such conflicts and express to their supervisors or other responsible officials their commitment to the ACA Code of Ethics and, when possible, work through the appropriate channels to address the situation.

I.2.e. Unwarranted Complaints Counselors do not initiate, participate in, or encourage the filing of ethics complaints that are retaliatory in nature or are made with reckless disregard or willful ignorance of facts that would disprove the allegation.

I.2.f. Unfair Discrimination Against Complainants and Respondents Counselors do not deny individuals employment, advancement, admission to academic or other programs, tenure, or promotion based solely on their having made or their being the subject of an ethics complaint. This does not preclude taking action based on the outcome of such proceedings or considering other appropriate information.

I.3. Cooperation With Ethics Committees Counselors assist in the process of enforcing the ACA Code of Ethics. Counselors cooperate with investigations, proceedings, and requirements of the ACA Ethics Committee or ethics committees of other duly constituted associations or boards having jurisdiction over those charged with a violation.

Glossary of Terms Abandonment – the inappropriate ending or arbitrary termination of a counseling relationship that puts the client at risk.

Advocacy – promotion of the well-being of individuals, groups, and the counseling profession within systems and organizations. Advocacy seeks to remove barriers and obstacles that inhibit access, growth, and development.

Assent – to demonstrate agreement when a person is otherwise not capable or competent to give formal consent (e.g., informed consent) to a counseling service or plan.

Assessment – the process of collecting in-depth information about a person in order to develop a comprehensive plan that will guide the collaborative counseling and service provision process.

Bartering – accepting goods or services from clients in ex-change for counseling services.

Client – an individual seeking or referred to the professional services of a counselor.

Confidentiality – the ethical duty of counselors to protect a client’s identity, identifying characteristics, and private communications.

Consultation – a professional relationship that may include, but is not limited to, seeking advice, information, and/ or testimony.

Counseling – a professional relationship that empowers diverse individuals, families, and groups to accomplish mental health, wellness, education, and career goals.

Counselor Educator – a professional counselor engaged primarily in developing, implementing, and supervising the educational preparation of professional counselors.

Counselor Supervisor – a professional counselor who en-gages in a formal relationship with a practicing counselor or counselor-in-training for the purpose of overseeing that individual’s counseling work or clinical skill development.

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Culture – membership in a socially constructed way of living, which incorporates collective values, beliefs, norms, boundaries, and lifestyles that are co-created with others who share similar worldviews comprising biological, psychosocial, historical, psychological, and other factors.

Discrimination – the prejudicial treatment of an individual or group based on their actual or perceived membership in a particular group, class, or category.

Distance Counseling – The provision of counseling services by means other than face-to-face meetings, usually with the aid of technology.

Diversity – the similarities and differences that occur within and across cultures, and the intersection of cultural and social identities.

Documents – any written, digital, audio, visual, or artistic recording of the work within the counseling relationship between counselor and client.

Encryption – process of encoding information in such a way that limits access to authorized users.

Examinee – a recipient of any professional counseling service that includes educational, psychological, and career appraisal, using qualitative or quantitative techniques.

Exploitation – actions and/or behaviors that take advantage of another for one’s own benefit or gain.

Fee Splitting – the payment or acceptance of fees for client referrals (e.g., percentage of fee paid for rent, referral fees).

Forensic Evaluation – the process of forming professional opinions for court or other legal proceedings, based on professional knowledge and expertise, and supported by appropriate data.

Gatekeeping – the initial and ongoing academic, skill, and dispositional assessment of students’ competency for professional practice, including remediation and termination as appropriate.

Impairment – a significantly diminished capacity to perform professional functions.

Incapacitation – an inability to perform professional functions.

Informed Consent – a process of information sharing associated with possible actions clients may choose to take, aimed at assisting clients in acquiring a full appreciation and understanding of the facts and implications of a given action or actions.

Instrument – a tool, developed using accepted research practices, that measures the presence and strength of a specified construct or constructs.

Interdisciplinary Teams – teams of professionals serving clients that may include individuals who may not share counselors’ responsibilities regarding confidentiality.

Minors – generally, persons under the age of 18 years, unless otherwise designated by statute or regulation. In some jurisdictions, minors may have the right to consent to counseling without consent of the parent or guardian.

Multicultural/Diversity Competence – counselors’ cultural and diversity awareness and knowledge about self and others, and how this awareness and knowledge are applied effectively in practice with clients and client groups.

Multicultural/Diversity Counseling – counseling that recognizes diversity and embraces approaches that support the worth, dignity, potential, and uniqueness of individuals within their historical, cultural, economic, political, and psychosocial contexts.

Personal Virtual Relationship – engaging in a relationship via technology and/or social media that blurs the professional boundary (e.g., friending on social networking sites); using personal accounts as the connection point for the virtual relationship.

Privacy – the right of an individual to keep oneself and one’s personal information free from unauthorized disclosure.

Privilege – a legal term denoting the protection of confidential information in a legal proceeding (e.g., subpoena, deposition, testimony).

Pro bono publico – contributing to society by devoting a portion of professional activities for little or no financial return (e.g., speaking to groups, sharing professional information, offering reduced fees).

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Professional Virtual Relationship – using technology and/ or social media in a professional manner and maintaining appropriate professional boundaries; using business accounts that cannot be linked back to personal accounts as the connection point for the virtual relationship (e.g., a business page versus a personal profile).

Records – all information or documents, in any medium, that the counselor keeps about the client, excluding personal and psychotherapy notes.

Records of an Artistic Nature – products created by the client as part of the counseling process.

Records Custodian – a professional colleague who agrees to serve as the caretaker of client records for another mental health professional.

Self-Growth – a process of self-examination and challenging of a counselor’s assumptions to enhance professional effectiveness.

Serious and Foreseeable – when a reasonable counselor can anticipate significant and harmful possible consequences.

Sexual Harassment – sexual solicitation, physical advances, or verbal/nonverbal conduct that is sexual in nature; occurs in connection with professional activities or roles; is unwelcome, offensive, or creates a hostile workplace or learning environment; and/or is sufficiently severe or intense to be perceived as harassment by a reason-able person.

Social Justice – the promotion of equity for all people and groups for the purpose of ending oppression and injustice affecting clients, students, counselors, families, communities, schools, workplaces, governments, and other social and institutional systems.

Social Media – technology-based forms of communication of ideas, beliefs, personal histories, etc. (e.g., social networking sites, blogs).

Student – an individual engaged in formal graduate-level counselor education.

Supervisee – a professional counselor or counselor-in-training whose counseling work or clinical skill development is being overseen in a formal supervisory relationship by a qualified trained professional.

Supervision – a process in which one individual, usually a senior member of a given profession designated as the supervisor, engages in a collaborative relationship with another individual or group, usually a junior member(s) of a given profession designated as the supervisee(s) in order to (a) promote the growth and development of the supervisee(s), (b) protect the welfare of the clients seen by the supervisee(s), and (c) evaluate the performance of the supervisee(s).

Supervisor – counselors who are trained to oversee the professional clinical work of counselors and counselors-in-training.

Teaching – all activities engaged in as part of a formal educational program that is designed to lead to a graduate degree in counseling.

Training – the instruction and practice of skills related to the counseling profession. Training contributes to the ongoing proficiency of students and professional counselors.

Virtual Relationship – a non–face-to-face relationship (e.g., through social media).

Contact: AMERICAN COUNSELINGASSOCIATION (ACA) 5999 Stevenson Avenue Alexandria, VA 22304 counseling.org • 800-422-2648 x222 Note: This document may be reproduced in its entirety without permission for non-commercial purposes only.

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American Association of Pastoral Counselors (AAPC) CODE OF ETHICS Amended April 16, 2010 PRINCIPLE I – PROLOGUE As members of the American Association of Pastoral Counselors, we are respectful of the various theologies traditions and values of our faith communities and committed to the dignity and worth of each individual. We are dedicated to advancing the welfare of those who seek our assistance and to the maintenance of high standards of professional conduct and competence. As pastoral counselors and pastoral counseling students we are accountable for our work regardless of our professional functions, the settings in which we work, or the populations of which we serve. This accountability is expressed in our conduct of relationships with clients, colleagues, students, our faith communities, and through the acceptance and practice of the principles and procedures of this Code of Ethics. The Code articulates standards that the Association will use to determine whether pastoral counselors have engaged in unethical conduct. In subscribing to this Code, pastoral counselors are required to be knowledgeable of these standards, cooperate with association procedures for responding to complaints of ethical misconduct, participate in AAPC adjudication proceedings, and abide by any AAPC disciplinary rulings or sanctions. The Ethics Code is not intended to be a basis of civil liability. Whether a pastoral counselor has violated the Ethics Code standards does not by itself determine whether the pastoral counselor is legally liable in a court action, whether a contract is enforceable, or whether other legal consequences occur.

In order to uphold our standards, as members of AAPC we covenant to accept the following foundational premises and core values: A. To affirm the importance of being both spiritually grounded and psychologically informed.

B. To maintain responsible association with the faith group with which we identify and in which we may have ecclesiastical standing.

C. To avoid discriminating against or refusing employment, educational opportunity or professional assistance to anyone on the basis of race, ethnicity gender identity, sexual orientation, religion, health status, age, disabilities or national origin; provided that nothing herein shall limit a member or center from utilizing religious requirements or exercising a religious preference in employment decisions.

D. As members of AAPC we recognize our responsibility to stay current with research that affects our understanding of clinical issues and the conduct of our practice. We agree at all levels of membership to continuing education and professional growth including supervision, consultation, and active participation in the meetings and affairs of the Association.

E. To seek out and engage in collegial relationships, recognizing that isolation can lead to a loss of perspective and judgment.

PRINCIPLE II - PROFESSIONAL PRACTICES In all professional matters members of AAPC maintain practices that protect the public and advance the profession.

A. We use our knowledge and professional associations for the benefit of the people we serve and not to secure unfair personal advantage.

B. We clearly represent our level of membership and limit our practice to that level.

Publication of practice or agency material clearly explains the levels of membership that apply to individuals.

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C. Fees and financial arrangements, as with all contractual matters, are always discussed without hesitation or equivocation at the onset and are established in a straight—forward, professional manner.

D. We are prepared to render service to individuals and communities in crisis without regard to financial remuneration when necessary.

E. We neither receive nor pay a commission for referral of a client.

F. We conduct our practice, agency, regional and association fiscal affairs with due regard to recognized business and accounting procedures. We respect the prerogatives and obligations of the institutions, agencies, or organizations by whom we are employed or with which we associate.

G. Upon the transfer of a pastoral counseling practice or the sale of real, personal, tangible or intangible property or assets used in such practice, the privacy and well-being of the client shall be of primary concern.

1. Client names and records shall be excluded from the transfer or sale.

2.

Any fees paid shall be for services rendered, consultation, equipment, real estate, and the name and logo of the counseling agency.

3.

We provide recent and current clients information regarding the closing or transferring of our practice and assure the confidentiality of their records.

H. We are careful to represent facts truthfully to clients, referral sources, and third party payers regarding credentials and services rendered. We shall correct any misrepresentation of our professional qualifications or affiliations.

I. We do not malign other professionals, nor do we plagiarize or otherwise present, distribute, or publish another's work as our own.

PRINCIPLE III - CLIENT RELATIONSHIPS It is the responsibility of members of AAPC to maintain relationships with clients on a professional basis. We take all reasonable steps to avoid harming our clients and to safeguard the welfare of those with whom we work.

A. We do not abandon or neglect clients. We make reasonable efforts to ensure continuity of services in the event that services are interrupted by factors such as unavailability, relocation, illness, or disability. If we are unwilling for appropriate reasons, to provide professional help or continue a professional relationship, every reasonable effort is made to arrange for continuation of treatment with another professional. Prior to leaving an agency or practice we complete all files and paper work is documented and signed.

B. We make only realistic statements regarding the pastoral counseling process and its outcome. We inform our clients of the purpose of the counseling, risks related to counseling, possible limits to the services because of third party payer limits, reasonable alternatives, clients rights to refuse or withdraw consent, and the time frame covered by the consent. We take reasonable steps to make sure the client understands the counseling process and has the opportunity to ask questions.

C. We show sensitive regard for the moral, social, and religious values and beliefs of clients and communities. We avoid imposing our beliefs on others, although we may express them when appropriate in the pastoral counseling process.

D. Counseling relationships are continued only so long as it is reasonably clear that the clients are benefiting from the relationship.

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acknowledging those dual or multiple relationships with clients which could impair our professional judgment, compromise the integrity of the treatment, and/or use the relationship for our own gain. A multiple relationship occurs when a pastoral counselor is in a professional role with a person and 1) at the same time is in another role with the same person, 2) at the same time is in a relationship with a person closely associated with or related to the person with whom the pastoral counselor has the professional relationship, or 3) promises to enter into another relationship in the future with the person or a person closely associated with or related to the person.

F. In instances when a dual or multiple relationships are unavoidable, particularly within congregations or in family or couples counseling, we take reasonable steps to protect the clients and are responsible for setting clear and appropriate boundaries.

G. We do not engage in harassment, abusive words or actions, or exploitative coercion of clients or former clients.

H. All forms of sexual behavior or harassment with clients are unethical, even when a client invites or consents to such behavior or involvement. Sexual behavior is defined as, but not limited to, all forms of overt and covert seductive speech, gestures, written communication, and behavior as well as physical contact of a sexual nature; harassment is defined as but not limited to, repeated comments, gestures, written communication, or physical contacts of a sexual nature.

I. We recognize that the therapist/client relationship involves a power imbalance, the residual effects of which are operative following the termination of the therapy relationship.

Therefore, all sexual behavior or harassment as defined in Principle III G, with former clients is unethical.

J. Interactive long-distance counseling delivery, when the client resides in one location and the pastoral counselor in another, may be utilized to supplement but not to completely replace face-to-face therapy. We take all reasonable steps to ensure that the client understands the limits of long-distance therapy, the computer application, what it is used for, and its possible effects.

PRINCIPLE IV – CONFIDENTIALITY As members of AAPC we respect the integrity and protect the welfare of all persons with whom we are working and have an obligation to safeguard information about them that has been obtained in the course of the counseling process. We have a responsibility to know and understand civil laws and administrative rules that govern confidentiality requirements of our profession in the setting of our work.

A. All records kept on a client are stored under lock and key and are disposed of in a manner that assures security and confidentiality. Records should be maintained for the number of years required appropriate government regulatory statues.

B. We take reasonable steps to ensure that documentation in records is accurate and reflects the services provided. Such documentation is intended to facilitate provision of services later by other professionals, meet institutional requirements, ensure accuracy of billing and payments, and ensure compliance with law.

C. We recognize that confidentiality belongs to the client. We treat all communications from clients with professional confidence and take reasonable precautions to protect confidential information obtained through or stored in any medium. These precautions include an awareness of the limited confidentiality guarantees of electronics communication.

D. Except in those situations where the identity of the client is necessary to the understanding of the case, we use only the first names of our clients when engaged in supervision or consultation. It is 98 Last Updated 9/2014

E.

F.

G.

H. I.

our responsibility to convey the importance of confidentiality to the supervisor/consultant; this is particularly important when the supervision is shared by other professionals, as in a supervisory group.

We do not disclose client confidences to anyone, except: as mandated by law; to prevent a clear and immediate danger to someone; in the course of a civil, criminal or disciplinary action arising from the counseling where the pastoral counselor is a defendant; for purposes of supervision or consultation; or by previously obtained written permission. In cases involving more than one person (as client) written permission must be obtained from all equally accountable persons who have been present during the counseling before any disclosure can be made.

We disclose confidential information for appropriate reasons only with valid written consent from the client or a person legally authorized to consent on behalf of a client. We obtain informed written consent of clients before audio and/or video tape recording or permitting third party observation of their sessions.

We do not use these standards of confidentiality to avoid intervention when it is necessary, e.g., when there is evidence of abuse of minors, the elderly, the disabled, and the physically or mentally incompetent.

When current or former clients are referred to in a publication, while teaching or in a public presentation, their identity is thoroughly disguised.

We as members of AAPC agree that as an express condition of our membership in the Association, Association ethics communications, files, investigative reports, and related records are strictly confidential and waive their right to use same in a court of law to advance any claim against another member. Any member seeking such records for such purpose shall be subject to disciplinary action for attempting to violate the confidentiality requirements of the organization. This policy is intended to promote pastoral and confessional communications.

PRINCIPLE V - SUPERVISEE, STUDENT &EMPLOYEE RELATIONSHIPS As members of AAPC we have an ethical concern for the integrity and welfare of our supervisees, students and employees. These relationships are maintained on a professional and confidential basis. We recognize our influential position with regard to both current and former supervisees, students and employees, and avoid exploiting their trust and dependency. We make every effort to avoid dual relationships with such persons that could impair our judgment or increase the risk of personal and/or financial exploitation.

A. We do not engage in ongoing counseling relationships with current supervisees, students and employees.

B. We do not engage in sexual or other harassment of supervisees, students, employees, research subjects or colleagues.

C. All forms of sexual behavior, as defined in Principle III.G, with our supervisees, students, research subjects and employees (except in employee situations involving domestic partners) are unethical.

D. We advise our students, supervisees, and employees against offering or engaging in, or holding themselves out as competent to engage in, professional services beyond their training, level of experience and competence.

E. Supervisors have a responsibility to provide timely and fair evaluations of their supervisees and employees.

F. We do not harass or dismiss an employee who has acted in a reasonable, responsible and ethical manner to protect, or intervene on behalf of, a client or other member of the public or another employee.

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G. To protect the public, employers and supervisors who have dismissed employees and supervisees for ethical cause must report that fact as part of any official report of service or enrollment in a pastoral counseling center or training program.

H. We are sensitive to the requirements of an organization with which we are affiliated or for whom we are working. In case of conflict with the Code of Ethics and the organization, we clarify the nature of the conflict, make known our commitment to the Code of Ethics, and to the extent feasible, resolve the conflict in a way that permits adherence to the Code.

PRINCIPLE VI - INTERPROFESSIONAL RELATIONSHIPS As members of AAPC we relate to and cooperate with other professional persons in our community and beyond. We are part of a network of health care professionals and are expected to develop and maintain interdisciplinary and inter-professional relationships.

A. We do not offer ongoing clinical services to persons currently receiving treatment from another professional without prior knowledge of and in consultation with the other professional, with the clients' informed consent. Soliciting such clients is unethical.

B. We exercise care and inter-professional courtesy when approached for services by persons who claim or appear to have inappropriately terminated treatment with another professional.

PRINCIPLE VII – ADVERTISING Any advertising by or for a member of AAPC, including announcements, public statements and promotional activities, is undertaken with the purpose of helping the public make informed judgments and choices.

A. We do not misrepresent our professional qualifications, affiliations and functions, or falsely imply sponsorship or certification by any organization.

B. We may use the following information to describe ourselves and the services we provide: name; highest relevant academic degree earned from an accredited institution; date, type and level of certification or licensure; AAPC membership level, clearly stated; address and telephone number; office hours; a brief review of services offered, e.g., individual, couple and group counseling; fee information; languages spoken; and policy regarding third party payments. Additional relevant information may be provided if it is legitimate, reasonable, free of deception and not otherwise prohibited by these principles. We may not use the initials "AAPC" after our names in the manner of an academic degree.

C. Announcements and brochures promoting our services describe them with accuracy and dignity, devoid of all claims or evaluation. We may send them to professional persons, religious institutions and other agencies, but to prospective individual clients only in response to inquiries.

D. We do not make public statements which contain any of the following:  A false, fraudulent, misleading, deceptive or unfair statement.  A misrepresentation of fact or a statement likely to mislead or deceive because in context it makes only a partial disclosure of relevant facts.  A testimonial from a client regarding the quality of services or products.  A statement intended or likely to create false or unjustified expectations of favorable results.  A statement implying unusual, unique, or one—of—a—kind abilities, including misrepresentation through sensationalism, exaggeration or superficiality.  A statement intended or likely to exploit a client's fears, anxieties or emotions.

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ďƒ˜ A statement concerning the comparative desirability of offered services. ďƒ˜ A statement of direct solicitation of individual clients.

E. We do not compensate in any way a representative of the press, radio, television or other communication medium for the purpose of professional publicity and news items. A paid advertisement must be identified as such, unless it is contextually apparent that it is a paid advertisement. We are responsible for the content of such advertisement. Any advertisement to the public by radio or television is to be pre-recorded, approved by us and a recording of the actual transmission retained in our possession.

F. Advertisements, web postings or announcements by us of workshops, clinics, seminars, growth groups or similar services or endeavors, are to give a clear statement of purpose and a clear description of the experiences to be provided. The education, training and experience of the provider(s) involved are to be appropriately specified.

G. Advertisements or announcements soliciting research participants, in which clinical or other professional services are offered as an inducement, make clear the nature of the services as well as the cost and other obligations or risks to be accepted by participants in the research.

Principle VIII– RESEARCH A. Pastoral Counselors who are conducting research are responsible for assuring informed consent for all human subjects. Research participants must be informed about: I. Purpose and sponsorship of the research, expected duration, expected procedures, and the manner and scope of reporting on the findings of the research.

2. Their right to withdraw from participation at any time.

3. Any consequences of withdrawing from a research project.

4. Any discomfort or adverse effects of research procedures that would influence a subject's willingness to participate.

5. Any benefits from participating in a research project.

6. A contact person for questions about the project or participant's rights.

B. Pastoral Counselors take appropriate measures to protect research subjects who may also be receiving pastoral counseling services in schools, agencies, private practices, or churches in which research is conducted. This includes: I. Taking steps to protect client/participants from any adverse consequences of declining or withdrawing a study.

2. Taking steps to assure clients are not exploited by research-related dual relationships.

3. Assuring that therapeutic services are not compromised by research procedures or goals.

4. To the extent that services may be compromised by participation in research, investigators seek the ethical advice of qualified professionals not directly involved in the investigation and observe safeguards to protect the rights of research participants.

C. Pastoral Counselors guarantee confidentiality of information obtained from a research participant unless confidentiality is waived in writing. When it is possible that information might be recognized by others (including family members) researchers disclose a plan for protecting confidentiality as part of informed consent.

1. Pastoral Counselors consider the effects of research procedures on communities in which it takes place, and take adequate precautions to protect the integrity of these 101 Last Updated 9/2014

communities.

2. Pastoral Counselors comply with Federal standards and local institutional review procedures governing human subject research. When AAPC is a principal investigator, the Judicial Ethics Panel of AAPC will act as a review board to ensure compliance.

3. Pastoral Counselors are truthful in reporting research results.

4. Pastoral Counselors: i. Do not plagiarize by presenting another's work or data as one's own; ii. Assure that research results are not presented or published in a deceptive or manipulative manner; iii. Pastoral counselors do not withhold their research data, methods of analysis, or procedures from other qualified researchers who in good faith wish to replicate or validate research results, to the extent that confidentiality of research subjects can be guaranteed.

Principle IX – PROCEDURES A. The Association will develop and maintain a set of procedures for receiving, investigating and adjudicating complaints of ethical misconduct against a member.

B. AAPC will direct the Executive Director and his/her staff in the association office to receive complaints.

C. AAPC will establish and maintain a Judicial Ethics Panel to investigate and adjudicate complaints.

D. AAPC will take complaints of ethical misconduct with the utmost seriousness and will exercise appropriate care and diligence in responding both to the complainant and the member.

Please Note: The AAPC Code of Ethics and the Ethics Committee Procedures were separated by action of the AAPC membership on April 17, 1993. The Board of Directors is now authorized to modem ethics committee procedures without further action by the membership. Members should note that the substantive rule from the Code of ethics to be applied to an alleged violation will continue to be determined by the date of the alleged violation and not the date the complaint is received. However, as a result of the action taken, the current procedures in effect will be followed for all complaints brought after April 17, 1993, regardless of the date of alleged violation.

1 The use of "member," "we," "us," and "our" refers to and is binding upon all levels of individual and institutional membership and affiliation of AAPC. Š2005-2009 American Association of Pastoral Counselors 9504A Lee Highway I Fairfax, VA 22031-2303 I info@aapc.org703-385-6967 Fax: 703-352-7725

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Clinical Writing Keys to good writing 1. Simplify your writing but not your clients.

Strunk and White (1972) instruct the writer to "Use definite, specific, concrete language. Prefer the specific to the general, the definite to the vague, the concrete to the abstract" (p. 15). In a similar vein, Zinsser's first principle of writing well is "simplicity." As he describes it: "The secret of good writing is to strip every sentence to its cleanest components" (1980, pp. 8-9). I strongly endorse these principles but add that the clinician's task is to simplify writing without simplifying the client. You must strive to write as simply and directly as possible, but you must also communicate accurately about your client.

The following examples demonstrate how simplicity and directness in writing can contribute to improved clinical reports.

Example #1 a. At various occasions during the interview Mr. Johnson exhibited signs of nervousness and distress. b. In response to questions about his family, Mr. Johnson began to shift in his chair, stammered slightly, and appeared to avoid eye contact.

Note how the first example may sound as if it uses clinical language and form, but it actually speaks in very general terms. Words like "various occasions" and "signs of nervousness" do not really tell what the client did or when. By comparison, the second example directly describes Mr. Johnson's behavior and when it occurred. This lets the reader better visualize the client and connects specific behaviors with specific stimuli. Thus, by following the principle of preferring the definite to the vague, the concrete to the abstract," the sentence is improved both stylistically and clinically.

The second example is one of the sentence pairs presented earlier in this chapter.

Example #2 a. William Smith is an affable, energetic, 75-year-old male, who arrived neatly attired in a dark gray suit, spoke openly about his presenting concerns, and expressed a willingness to "do whatever it takes to get going again." Mr. Smith indicated that he came to therapy out of concern that his sex life has begun to decline from a frequency of five to three times per week. b. William Smith is a 75-year-old male with a presenting problem of decreased sexual performance. At the time of the interview, he was well dressed and groomed and appeared to be well motivated.

Which of the two descriptions, A or B, do you prefer? Why? This example is more subtle and might be subject to more dispute, but for most situations I would prefer the description offered in A. There are several reasons for this preference. First, although the second example is clearly more succinct, that quality alone does not necessarily mean it is more direct or that it better represents the client. Describing a "presenting problem of decreased sexual performance" does not tell the reader what the problem is. For some, decreased sexual performance might mean going from having sex twice a month to once per month. As the alternative version shows, for this man decreased performance has a much different meaning. A second reason I prefer Example A is that it gives the reader a better sense of who the client is as a person, again because the description is more specific. "Neatly attired in a dark gray suit" paints a clearer picture than "well 103 Last Updated 9/2014

dressed and groomed." Similarly, using the direct quote that the client would "do whatever it takes..."brings the reader closer to the client than saying he "appeared to be well motivated."

Fischer (1985) offers advice consistent with this example: Early in a report I provide physical descriptions of the client, in part so that the reader can picture the client throughout the written assessment. I try to describe the client in motion rather than statically, so the reader will be attuned to the ways the person moves through and shapes and is shaped by his or her environment. (p. 37) Please note that although I would prefer the description offered in A for most situations, there are advantages to Example B and there are instances in which it would be preferable. The main advantage of B is brevity. If time is at a premium and there is little need to convey a sense of the person beyond the clinical data that follow, the description can be shortened. Your task as a clinician and as a writer is first to make a choice about what matters, then determine how best to include that in your report.

H. Omit needless words One way to simplify your writing is to leave out words that are not needed. To appreciate this, compare the sentence you just read with the heading that preceded it. The heading, "Omit needless words," was borrowed directly from Strunk and White (1972, p. 17). It conveys the main idea in three words. By comparison, the sentence that followed took seven words (i.e., "leave out words that are not needed") to say the same thing.

Zinsser (1980) observes that: "writing improves in direct ratio to the numbers of things we can keep out of it that shouldn't be there" (p. 14). Strunk and White state: Vigorous writing is concise. A sentence should contain no unnecessary words, a paragraph no unnecessary sentences. ... This requires not that the writer make all his sentences short, or that he avoids all detail and treats his subjects only in outline, but that every word tell. (1972, p. 17) To illustrate this point, let us return again to the examples offered in the discussion of focused reading.

Example # 1 a. During the interview, the client said that he had never before been seen in therapy by a therapist. b. The client indicated no previous experience in therapy.

What unnecessary words has the second sentence eliminated? The phrase "During the interview" is removed because it can be assumed that is when the client spoke. The phrase "said that he had never before been seen in therapy," ten words, is replaced by "indicated no previous experience in therapy," six words that mean the same thing. This cutting of words saves time and makes the report shorter but sacrifices no important information about the client. A similar process can be applied to a second example from our earlier discussion. Read the two examples and identify where and how needless words are omitted.

Example # 2 a. Test results suggest the presence of mild to moderate depression, anxiety, and concerns about family matters. b. According to the results of the test, there is evidence of depression in the mild to moderate range, along with anxiety and apparent concerns about issues relating to family.

Strunk and White offer similar examples of how everyday expressions contain many needless words. For instance, "This is a subject that ... ;" versus, "This subject ....; "I was unaware of the fact that .."versus “I was unaware that ..." Common speech also unnecessarily places 104 Last Updated 9/2014

prepositions after many phrases or uses prepositions when other phrases would work better.

Compare "Wake me up at seven" versus "Wake me at seven"; "Find out about.... versus". Learn.

Within the helping professions, clinical verbiage can complicate very simple matters. For example, "The subject was engaged in walking behaviors" versus "He was walking." Or, "He produced little verbal material" versus "He was quiet."

Just as dietary fat clogs your arteries, verbal fat will clog your writing. As shown in the preceding examples, learning to trim unnecessary words or phrases is a key step toward improving your writing. Zinsser puts this very nicely when he says, "Be grateful for everything you can throw away" (1980, p. 18).

As with the earlier recommendation to embrace rewriting, responding to the instruction to shorten your writing will take some adjustment. Students have learned that excess verbiage helps stretch papers to meet the 10-page minimum so often imposed by faculty. Now the message is to shorten those 10-page papers to the fewest pages possible and make every word count. Tallent suggests that one can tell a report is too long if the person who has written it: ... is unhappy over the length of time required to write it and experiences difficulty in organizing a multitude of details for presentation. It is too long when it contains content that is not relevant or useful, when the detailing is greater than can be put to good use.

(1988, p. 73) Tallent (1988) offers examples of lengthy reports to illustrate his point. Following one such example he quips, "Just glancing at this report one may wonder if it is too long. On reading it, one may be sure that it is" (p. 139). To avoid such statements about your own work, practice trimming the use of jargon. Fischer recommends to writers: "Say what you mean in concrete terms rather than dressing up the text in professionalese" (1985, p. 125).

Tallent concurs: In our view words like oral, narcissistic, masochistic, immature, compulsive, and schizophrenia are often more concealing than revealing. Technical words do not cause, but readily lend themselves to, imprecise or incomplete thinking. There is the error of nominalism, wherein we simply name a thing or an occurrence and think we understand something of the real world. (1988, p. 69; italics in the original) Earlier in this book, I made similar observations about the overuse of the word "inappropriate." Other words or phrases, such as "manipulative," "dependent," or "just doing it for attention" are used with similar frequency and with equal ambiguity. As an antidote to such jargon, Fischer asserts: Saying what one means, both in speech and in writing, requires one to anchor abstractions in concrete examples. Ask yourself how you would explain what you mean to a 12-yearold. If you can't figure out how to do that then you do not yet know what you mean—what your technical information comes down to in terms of your client's life. (1985, p. 134) Harvey (1997) takes this advice one step further and actually subjects her student's reports to formal "readability" measures that assess such things as word choice and sentence length. Harvey then uses the measures to calculate a grade and difficulty level and asks students to re-write their reports so they can be read at grade levels of 13 or below. Harvey explains this approach by pointing out that psychological and other mental health reports are increasingly being reviewed by parents and others who have less formal education than those writing the reports. Thus, making reports more intelligible to these consumers may enhance their usefulness and reduce misunderstandings.

Exercise: Read the following three sentences and ask yourself if the differences in wording might communicate subtle yet important differences in meaning.

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A. B. C.

Mr. Smith denied any abuse of alcohol or drugs.

Mr. Smith said he does not abuse alcohol or drugs.

Mr. Smith does not abuse alcohol or drugs.

In the first sentence of this exercise, we encounter another of the many misused clinical words. The word "denied" in this sentence is very important. You will have much greater impact if you can express the most meaning with the fewest words, rather than the least meaning with the most words.

I. Choose words carefully Along with limiting the number of words you use, be attentive to their meaning. Careful choice of words is essential to all your work as a clinician. In staff meetings, therapy sessions, and your written reports, the words you use will be crucial. As a clinician, you cannot afford to be careless or haphazard about what you say or write. You must be aware of all the subtleties of language and learn to say exactly what you mean. This is especially true of written reports because once a report is written others may read it without you being present to explain, clarify, or correct mistakes. Careless use of words can also come back to haunt you if your records or reports are ever used in a legal proceeding.

Zinsser advises: "... you will never make your mark as a writer unless you develop a respect for words and a curiosity about their shades of meaning that is almost obsessive ..." (1980, p. 35). I agree and would expand this statement by substituting the word clinician for writer. You will never be a fully skilled clinician unless you are acutely aware of words, attend precisely to the words used by others, and think carefully about the words you use.

Tallent (1988) describes a series of studies in which various groups of mental health professionals were asked to indicate what they like and what they dislike in typical psychological reports. Among the factors most often criticized, ambiguous wording was frequently cited as a problem. The use of vaguely defined clinical terms also receives criticism in the literature. Tallent cites a classic study by Grayson and Tolman (1950) in which clinical psychologists and psychiatrists offered definitions for the 20 words most commonly used in psychological reports. Reviewing the list of words and definitions, the authors of the study were struck by how loosely the professionals defined many of the words.

Fifteen years after the original study by Grayson and Tolman, Siskind (1967) replicated the design and found similar results. Although the specific words included in such lists might differ if the study were performed again today, there is no reason to assume the definitional ambiguities would be any less now than they were in 1950 and 1967. For students and interns, ambiguity can be particularly challenging because many of the words that sound the "most clinical" are in fact highly ambiguous. Students may be eager to use technical terms as a way of demonstrating their knowledge to supervisors. The trouble is that a great deal of what passes for clinical wording may sound scientific but often obfuscates rather than elucidates. Harvey (1997) makes a similar observation and advises students to shorten sentence lengths, minimize the number of difficult words, and reduce being fully honest or that he or she is unconsciously repressing information. In this case, it might be that Mr. Smith "denies" alcohol abuse but we know or suspect that he does in fact abuse. It might also be that Mr. Smith is genuine and does not abuse alcohol or drugs. If that is the case, the second sentence would be better because it avoids the subtle intimation raised by the word "denies." The third sentence is still more clear about whether or not Mr. Smith abuses, but it may suffer from a different problem. Do we really know the statement is true, or is it just something Mr. Smith has told us? The sentence as written implies that we know it to be fact, but if the source 106 Last Updated 9/2014

of information is Mr. Smith, we should so indicate. If this sounds like nitpicking, it is not. To appreciate why, ask yourself what might happen if you gave a report containing these sentences to other professionals who based clinical decisions on a misunderstanding of what you wrote. Do other readers conclude from the first sentence that Mr. Smith really drinks but does not admit it, or do they conclude that Mr. Smith does not drink? Do they conclude from the third sentence that we are sure alcohol and drugs are not a problem, or do they assume that is just what the client has told us?

If the scenario of clinical misinterpretation is not convincing, imagine trying to explain the meaning while testifying in your own defense in a liability suit. One way to reduce ambiguity in reports is to read questionable passages to colleagues and ask them to tell you whether the passage is clear and what they think it means. In some cases, I ask non-clinicians to read my reports and offer feedback.

This is particularly helpful if a report might be read by family members or others who are not trained in the profession.

Another, and too often overlooked, tool is the dictionary. I encourage students to use both a standard dictionary and a dictionary of professional terms. The standard dictionary can help you understand what words mean and imply in ordinary usage. Be careful, however, not to assume that definitions offered in a normal dictionary carry the same meanings when applied in clinical writing. If a word has specific clinical meanings, the professional dictionary will cite specific meanings within the clinical context. Time after time, students use words they think they know only to discover that the word means or implies something entirely different than they thought.

One student used the word "limpid" to describe how a brain-injured patient held his arm.

Another spoke of a situation attenuating the client's anxiety when the situation in fact exacerbated the anxiety. I recently heard a colleague repeatedly use the word duplicity when he clearly meant duplication.

If you do not know the meaning of any of the words used in the previous paragraph, did you look them up? If not, why? One of my students answered a similar question in class by saying, "I already took the GRE." That student did not get the point, nor did he get a letter of recommendation.

Misuse of clinical terms is also common. Students frequently confuse delusions with hallucinations, obsession with compulsion, schizophrenia with multiple personality, and so on.

Certainly one of the most commonly misused terms is negative reinforcement. Even if you are sure you know what this means, look it up in a textbook. In one upper-division undergraduate class, out of 20 students who said they were sure they knew the definition, only 5 were actually right. Again, to appreciate the importance of precise wording, consider that misunderstanding the meaning of negative reinforcement in a report could lead to interventions that are exactly the opposite of those that the writer intended.

J. Clarity Choosing words carefully is part of the larger issue of achieving clarity in writing and clinical work. This demand includes both clarity of individual words and clarity in syntax and organization. If the organization of a report is not clear the reader will have to search to find important information. If the syntax of a sentence is unclear, the meaning may be misinterpreted.

For example: The therapist told the client about his problems. Whose problems is the 'therapist talking about—the therapist's or the client's?

Strunk and White (1972) caution: "Muddiness is not merely a disturber of prose, it is also a destroyer of life, of hope' (p. 72). In clinical work, this is not an overstatement. I know of a case in which one therapist told another he had an appointment to see a client "next Friday." As the conversation took place on a Wednesday, the listener assumed the appointment was two days away. The 107 Last Updated 9/2014

speaker, however, was referring to Friday of the following week. Because the client in question was experiencing a serious crisis, this was a difference of potentially grave consequence.

Although most people would agree that clarity is important in clinical reports, the difficulty lies in recognizing when our own reports are unclear. Because we think we know what we mean when we write something, we assume that what we have written adequately conveys our intention.

Thus, we readily overlook passages that may be virtually incomprehensible or, worse, that may appear comprehensible but will be misinterpreted by others.

As suggested earlier, one way to limit misunderstanding is to have someone else read a report before it goes to the intended recipient. If this is not possible, it is often helpful to pretend you know nothing of the case yourself, then read the report out loud. Reading aloud brings out aspects of writing that we do not recognize when we read silently to ourselves. If time permits, another extremely valuable technique is to set a report aside for several days and then read it again with an open mind. Along with helping to identify writing problems, this also allows one to think more about the case before sending the report.

I cannot overemphasize how important clarity is to your writing. Clinicians simply must learn to be extremely careful about their words. You must know and say precisely what you mean.

It is not enough to defend with "C' mon, you know what I meant." That may work in everyday discourse but it is unacceptable in professional work. If the reader does not know exactly what is meant, the responsibility falls on the writer, not the reader. Say what you mean and say it clearly. I feel so strongly about this that I have on occasion told students bluntly, "If you do not want to learn to use words carefully and accurately, you should probably consider another profession."

K. Know your audience The final recommendation about writing is to know your audience. Some instructors and articles about clinical writing dictate specific and fixed rules for the style and content to be included in clinical reports. I prefer an approach that offers suggestions but at the same time encourages you to choose and adapt your style and content with an awareness of your audience.

Fischer (1985) says repeatedly in her book: "Reports are for readers, not for the author" (p.

115). Tallent stresses this principle as well and cites a report by Hartlage and Merck (1971) which showed that the utility of reports is primarily weakened by, as Tallent (1988) describes it, a "profound ... lack of reflection by report writers on what might be useful to report readers, a simple failure to use common sense" (p. 20). Hartlage and Merck observed, "Reports can be made more relevant to their prospective users merely by having the psychologists familiarize themselves with the uses to which their reports are to be applied" (p. 460).

A report prepared for a fellow professional in your discipline may differ from a report prepared for an attorney, family members, or others with different backgrounds and needs.

Similarly, if you believe certain aspects of a client are being overlooked by others, you may want to emphasize those in your report. The most important thing is for you to write with conscious awareness of how your style and content meet your clinical and professional purpose.

Exercise: As a way of enhancing your awareness of different groups to which your reports might be targeted, read the following list and write some of the concerns that you might keep in mind if preparing a report for each of these people.

You might consider factors such as the readers' level of training or knowledge, how much time they have, and the style of reports they are accustomed to reading. How do these and other factors differ for each group: The client. Family members of the client. Insurance companies.

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Clinical

psychologists. Counselors. Social workers. Psychiatrists. Non-psychiatrist M.D.s. Schoolteachers. Students. Attorneys. Judges. Professional journals. Newspapers. Others for whom you might write.

Reviewing the list should enhance your awareness of general factors to consider in writing, but you must also remember that, regardless of their profession or role, different individuals will have different preferences and needs. One schoolteacher may be well versed in diagnostic categories, but another may know nothing at all about them. One psychiatrist may prefer reports that are as brief as possible and that convey "just the facts." Another may appreciate more detailed reports that convey a sense of the client as a person.

If you know for whom you will be writing before you write a report, it is sometimes a good idea to contact the person and ask about his or her preferences for style and content and any specific requirement for the report. After you write a report, you can follow up by asking the recipient for feedback. Your role as an intern gives you a perfect opportunity to ask for such information, and many people will be glad to offer their suggestions.

L. References Baird, B., & Anderson, D. (1990). A dual-draft approach to writing. Teaching Professor, 4(3), 5-6.

Fischer, C. (1985). Individualized psychological assessment. Monterey, CA: Brooks/Cole.

Grayson, H. M., &Tolman, R. S. (1950). A semantic study of concepts of clinical psychologists and psychiatrists. Journal of Abnormal and Social Psychology, 45, 216-231.

Hartlage, L. C., & Merck, K. H. (1971). Increasing the relevance of psychological reports. Journal of Clinical Psychology, 27, 459-460.

Harvey, V. S. (1997). Improving readability of psychological reports. Professional Psychology: Research and Practice, 28, 271-274.

Hodges, J. C., Whitten, M. E., Horner, W. B., & Webb, S. S. (1990).Harbrace college handbook (11th ed.). New York: Harcourt Brace Jovanovich.

Piercy, F. P., Sprenkle, D. H., & McDaniel, S. H. (1996). Teaching professional writing to family therapists: Three approaches. Journal of Marital and Family Therapy, 22, 163-179.

Siskind, G. (1967). Fifteen years later: A replication of "A semantic study of concepts of clinical psychologists and psychiatrists." Journal of Psychology, 65, 3-7.

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Strunk, W., Jr., & White, E. B. (1972).The elements of style. New York: Macmillan.

Tallent, N. (1988).Psychological report writing (3rd ed.). Englewood Cliffs, NJ: Prentice-Hall.

Zinsser, W. (1980). On writing well (2nd ed.). New York: Harper & Row. Zuckerman, E. L. (1990). The clinicians thesaurus: A guidebook for wording psychological reports and other evaluations. Pittsburgh, PA: Three Wishes Press.

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How to Be a Successful Practicum Student Adapted from Don Rosen, PhD. – Texas Woman’s University The purpose of practicum, in part, is to orient students to the profession and to provide a set of values and expectations for working as a representative of the program. Students will find that experiences in practicum are professionally cumulative and will follow them into their career.

1. Practicum is a job- you should behave like a good employee even though you are in a learning environment.  Attendance- be on time; don’t cut corners with your time. Being late for a client or practicum group or supervision means you did not plan your schedule effectively.  Policies and procedures- know the rules for paperwork, processing money, supervision, groups, etc. In most cases the rules were created for good reason; if you have questions, ask about the history of a policy.  “But I have too much work besides practicum.” This is not the place to try to cut corners.

If you’re too busy with other things in order to give practicum the time it deserves, prioritize your time appropriately or consider taking a leave of absence until you create the balance you need in order to do practicum. The primary concern is providing high quality services to your clients.  Calendar- be absolutely sure you write everything down ~ never miss an appointment with an “I didn’t know.” Missing an appointment is unprofessional.

2. Supervision is invaluable; no matter what, so use it well.  Attitude is one of the most important attributes of a practicum student that supervisors notice.

Having the attitude, “You have nothing to teach me,” or “This is just who I am; I can’t change.” will likely lead to disaster and you will not get the most benefit from your supervision experiences.  Be prepared- negotiate with your supervisor how supervision is conducted and be prepared for each session as if it was really important to you. Have your sessions ready to be viewed; do not waste important supervision time “looking” for a session you want to review. Have your forms filled out, ready to signed, etc. Bring the files of the cases you will discuss to supervision, in case your supervisor wants to review them.

3. Structure your time to be most effective Scheduling clients-Think about what is reasonable for you, and try to “group” hours together to see clients. This will depend on how tired you become and when you are most alert so you can be “present” with clients.  Leave time for paperwork, review of recorded sessions, questions, phone calls, and thinking.

If you think you’ll “get to it,” you won’t. Schedule it! No matter how little time you have, part of being a responsible therapist is to complete all of the paperwork required from receipts, to progress notes.

4. Do your work.  Be reliable-your word is all you have. If you make a commitment, keep it. If you are not sure you can do something don’t promise to do it; rather negotiate with the other person and work out what is agreeable for both of you. You may be tempted to say “yes” to all opportunities to feel you are maximizing your training opportunities. However, ask any supervisor and they will tell you that one of the developmental tasks of trainees is to learn when to say, “No.” 111 Last Updated 9/2014



Ask for what you need-if you see a problem coming, don’t wait. Talk to your supervisor well in advance and see what can be flexible. Don’t ask the day before or cancel at the last minute.

What often causes the most trouble with therapists is working in isolation; not consulting their supervisors, or asking other students rather than supervisors.

5. Remember, people do you a big favor by supervising you.  You are your supervisor’s liability. This is one of those unspoken things about the profession. Those that supervise are legally and ultimately responsible for what you do with your clients. They are adding to their own risk of being involved in litigation just by being a supervisor. Please don’t take this gift for granted.  Supervision is fun, but it is a lot of work and it’s easier just to see a few more clients than to supervise. This is also an unspoken. Yes, supervising provides more variety and challenges, but if the challenges get too great, it’s just easier for the licensed therapist to see a few more clients. If no one wants to supervise you, you can’t progress!  Supervisors have the right and the obligation to give you feedback- Positive and negative, and that’s what you’re here for! It is a requirement of supervisors to give feedback in order to guide the professional growth of those they supervise. From their perspective, they are looking at and evaluating potential future colleagues. You might be surprised to know how many times supervisees resent the feedback from supervisors. Please remember that just because you are good student academically, being a good academic, and being a therapist are two entirely different things. Take any and all feedback your supervisor gives you.

6. Dress appropriately for the counseling setting.  Most training centers don’t expect you to have a sophisticated wardrobe, but you need to be aware of limits of acceptability. Remember you are trying to project a particular image to the community that CTS serves. If you go to work in a hospital ER, you would be expected to wear scrubs or a lab coat. You are expected to dress professionally when seeing clients (and even when you are in CTS Counseling Center’s building, consider your attire, as there are still clients in the building) which means no jeans, no shorts, and inappropriate necklines and waistlines are not acceptable.

7. Remember, you are a visitor.  Ultimately, you will be at CTS Counseling Center a short time. As in backpacking, only pack what in what you plan to pack out. Leave the center in better condition than when you arrived by the work that you do and the relationships you form with staff, faculty and other students which will help both you and the center have the best possible experience.  And just when you thought you are ready to move on and go full speed ahead because practicum is over....you will discover, you are going to miss practicum! Also remember that these are the people who will provide recommendations for the beginning of your professional life, and perhaps long into your professional career. Other sites where you practice will want to hear from those who have supervised your work previously. Letters of recommendation from direct supervisors of your clinical work carry weight. Plan accordingly.

Good luck to you as your head off into your practicum experience! Have a great time. Learn as much as you can. Let your supervisor help you to become the best therapist you can be.

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Counseling Center 1050 West 42nd Street Indianapolis, IN 46208 CTS Counseling Center Fact Sheet      

Established in 1967 Moved into 1050 building in 1997 18 Therapy rooms all equipped with digital recording capability COAMFTE Accredited Marriage and Family Therapy Program AAPC Approved Program 24 Practicum Students and 13 Graduate Resident Students for a total of 37 available therapists (no waiting list)  14 Supervisors with years of valuable clinical experience as well as training experience  Psychiatric Services available one day each week  Medicaid/Medicare Eligible Services available  In 2008 we provided 11,828 hours of therapy  Participate in National Depression Screening Day  Provide Couple’s Checkup in February  Our counseling students have provided service at The Women’s Prison, The Girl’s School, Plainfield Rehabilitation and Education Facility, Fathers and Families, KIPP School, Jesus Metropolitan Community Church, National Alliance for Mentally Ill.

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Counseling Center MHC / PF Intern Individual Supervision Evaluation Form Supervisee: _____________________________________ Sem.: ______ Please rate the intern on each of the following items based on the scale below: 5 = Very strong in this area with all clients. This comes naturally.

4 = Generally strong in this area, though it may be more difficult with some clients.

3 = Generally competent in this area, but continues to work on this skill.

2 = Inconsistent in this area – sometimes does well, and sometimes this is a weakness; continues to work on this skill.

1 = This is a weakness; continues to work on this skill.

NA = Cannot be assessed at this time. (*Please describe why not on the reverse side of this page.)

l. Facilitates the development of the therapeutic alliance and provides a safe environment.

2. Describes the therapeutic process to clients so that they can make informed decisions about treatment and develops mutually agreeable goals.

3. Able to assess the level of risk of harm a client's behavior poses and, where indicated, makes appropriate referrals to other professionals or institutions.

4. Identifies psychosocial and environmental influences and responds respectfully and appropriately to a client’s culture, ethnicity, gender, and sexual orientation.

5. Coordinates therapy with relevant individuals and institutions based on assessed needs of clients.

6. Determines the appropriate treatment modality with all necessary participants in treatment and provides, where indicated, couples or family therapy.

7. Is able to effectively integrate a variety of theoretical approaches based on the needs of the client and has a theory of how change occurs.

8. Assists the client in developing ego strength and effective coping skills.

9. Uses ongoing assessment to monitor clients’ therapeutic needs and evaluates outcomes for the continuation or termination of therapy.

NA * NA

Novice

Apprentice

Proficient

Master

Expert

CACREP Area

1

2

3

4

5

3, 11

NA

1

2

3

4

5

3, 8, 11

NA

1

2

3

4

5

6, 11

NA

1

2

3

4

5

2, 6

NA

1

2

3

4

5

10, 11

NA

1

2

3

4

5

3, 6, 11

NA

1

2

3

4

5

3, 6, 11

NA

1

2

3

4

5

5, 3, 11

NA

1

2

3

4

5

6, 7

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10. Integrates supervisor/team communications into treatment and seeks consultation when appropriate.

11.Is able to utilize transference and countertransference dynamics in the therapeutic process, incl. the impact of projective identification and attachment styles.

12. Maintains adequate and timely clinical records.

13. Is able to assess clients’ needs based on DSM-IV criteria, incl. child or adolescent behavior, and utilizes published assessment instruments where indicated.** 14. Understands group process and responds effectively to group dynamics.

15. Tailors therapy to the client’s developmental needs, incl. the cognitive level of a child or adolescent.

16. Recognizes ways in which his/her assumptions about human nature and culture may influence therapy.

17. Is able to assess clients’ religious or spiritual beliefs in terms of healthy functioning, and has the ability to respect and understand religions and denominations other than her/his own.

18. Is able to assess for and provide appropriate supportive and/or insight/transference-based therapy, incl. work with symbolic content and dream material.

19. Monitors for internal conflict and needs of empathy based on early deficits of emotional nurture.

20. Assesses for trauma and tailors therapeutic interventions based on its presence or absence.

21. Establishes appropriate boundaries and provides adequate containment to meet clients’ needs.

NA * NA

Novice

Apprentice

Proficient

Master

Expert

CACREP Area

1

2

3

4

5

8, 9

NA

1

2

3

4

5

3, 11

NA

1

2

3

4

5

6, 8, 10

NA

1

2

3

4

5

6

NA

1

2

3

4

5

4

NA

1

2

3

4

5

1

NA

1

2

3

4

5

2, 8, 9

NA

1

2

3

4

5

2, 3, 6

NA

1

2

3

4

5

2, 3, 6

NA

1

2

3

4

5

1, 3, 6

NA

1

2

3

4

5

1, 3, 6, 11

NA

1

2

3

4

5

3, 8, 9

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What do you believe are this trainee’s strongest clinical skills?

Which clinical skills do you think require particular focus in this trainee’s supervision at this time?

Do you have specific concerns regarding this trainee’s skills? If so, please describe them here.

************************************************************************************ Signatures indicate that trainee has been provided with a copy of this evaluation and allowed the opportunity to have all questions answered regarding the evaluation. The trainee’s signature does NOT imply agreement with the evaluation. _______________________________________ Trainee Signature Date

_____________________________________ Supervisor Signature Date

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Counseling Center

MFT Student Self-Evaluation Trainee Name: _______________________________________________________________ Please rate the above named trainee on each of the following items based on the scale below:

1.

2.

3.

1 = This is a weakness for the trainee; s/he should continue to work on this skill.

2 = The trainee is inconsistent in this area- sometimes s/he appears competent and other times this is a weakness; s/he should continue to work on this skill 3 = The trainee is generally competent in this area, but s/he should continue to work on this skill.

4 = The trainee is generally strong in this area, though it seems to be more difficult with some clients.

5 = The trainee is very strong in this area with all clients. This comes naturally for him/her now.

N/A = I am not able to assess the trainee on this competency at this time.

Trainee Evaluation NA Novice Apprentice Proficient Master Expert Creates an atmosphere of acceptance and NA 1 2 3 4 5 understanding.

Attends to clients’ emotional climate in order NA 1 2 3 4 5 to build trust.

Engages clients in the therapeutic process.

NA 1 2 3 4 5

4.

Develops mutually agreeable goals for therapy.

5.

Determines boundaries, hierarchies, and patterns within families.

Identifies psychosocial and environmental influences on each client.

Coordinates therapy with relevant individuals and institutions.

Facilitates therapeutic involvement of all necessary participants in treatment.

Matches the needs of the client with an appropriate therapeutic approach.

Establishes a sequence of treatment processes in a treatment plan.

Assists the client in developing effective problem-solving abilities.

Responds appropriately to a client’s culture or ethnicity.

Evaluates clients’ outcomes for the need to continue or terminate therapy.

Integrates supervisor/team communications into treatment.

Recognizes when personal biases may influence the therapeutic process.

Recognizes when consultation with a colleague or supervisor is appropriate.

Maintains adequate and timely clinical records.

Can assess an adult client’s behavior based on DSM-IV criteria.

Can assess a child or adolescent client’s behavior based on DSM-IV criteria.

Can assess the level of risk of harm that a client’s behaviors pose.

Integrate spirituality/theological reflection into treatment.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

NA

1

2

3

4

5

NA

1

2

3

4

5

NA

1

2

3

4

5

NA

1

2

3

4

5

NA

1

2

3

4

5

NA

1

2

3

4

5

NA

1

2

3

4

5

NA

1

2

3

4

5

NA

1

2

3

4

5

NA

1

2

3

4

5

NA

1

2

3

4

5

NA

1

2

3

4

5

NA

1

2

3

4

5

NA

1

2

3

4

5

NA

1

2

3

4

5

NA

1

2

3

4

5

NA

1

2

3

4

5

NA

1

2

3

4

5

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Counseling Center

Capstone Evaluation Rubric Date:___________ Therapist/Intern: Evaluator/Instructor: Level of Clinical Training: Pre-clinical training; coursework only 0-12 months 12-24 months  2+ years Rating Scale 5=Exceptional: Skills and understanding significantly beyond developmental level 4=Outstanding: Strong mastery of skills and thorough understanding of concepts 3=Mastered Basic Skills at Developmental Level: Understanding of concepts/skills evident 2=Developing: Minor conceptual and skill errors; in process of developing 1=Deficits: Significant remediation needed; deficits in knowledge/skills NA=Not Applicable: Unable to measure with given data (do not use to indicate deficit) Note: Scores of 3 and above indicate performing well for developmental level

Evaluation of Therapeutic Relationship (clinical evaluators) Evaluation of Therapist’s Reactions to Client (clinical evaluators) Evaluation of Systemic Perception (clinical evaluators) Rationales for Choice of Theory, Assessment, & Interventions (clinical evaluators) Evaluation of Content vs. Process (clinical evaluators) Evaluation of Managing Session Interactions (clinical evaluators) Evaluation of Treatment Outcome (clinical evaluators) Evaluation of Clinical Skill (clinical evaluators) Summary of Scores from Case Conceptualization, Clinical Assessment, and Treatment Plan (clinical evaluators) Evaluation of Integrative Paper (all evaluators) Evaluation of Response to Feedback from Evaluators (all evaluators) Evaluation of Oral Presentation (all evaluators) Theological Reflection in Paper (theological evaluators) Theological Reflection in Oral Presentation (theological evaluators)

Score  1  2  3  4  5  NA  1  2  3  4  5  NA  1  2  3  4  5  NA  1  2  3  4  5  NA  1  2  3  4  5  NA  1  2  3  4  5  NA  1  2  3  4  5  NA  1  2  3  4  5  NA  1  2  3  4  5  NA  1  2  3  4  5  NA  1  2  3  4  5  NA  1  2  3  4  5  NA  1  2  3  4  5  NA  1  2  3  4  5  NA

Notes:

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Grade:

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Links to Licensing Information Licensing Board Link (“generic”): http://www.in.gov/pla/social.htm Application Links: LMHC: http://www.in.gov/pla/2888.htm LMFT: http://www.in.gov/pla/2949.htm Additional licensing information: MACMHC (EFFECTIVE JULY 1, 2014) (see: http://www.in.gov/pla/3444.htm) LICENSED MENTAL HEALTH COUNSELOR ASSOCIATES (LMHCA) ATTENTION APPLICANTS WHO GRADUATE PRIOR TO JULY 1, 2014 APPLICANTS WHO GRADUATE PRIOR TO JULY 1, 2014 CAN CHOOSE ONE OF THE FOLLOWING TWO OPTIONS: OPTION #1: If you graduate prior to July 1, 2014 and have already begun your post graduate clinical experience and supervision by July 1, 2014, then you do not need to apply for a mental health counselor associate license “LMHCA”. Once you complete your post graduate clinical experience and supervision requirement (3,000 hours of post degree clinical experience including 100 hours of face-to-face supervision in a period of time between 21-48 months), you may apply for the mental health counselor license “LMHC”. This section also applies to students within a doctoral program.

OPTION #2: If you graduate prior to July 1, 2014 and wish to apply for the LMHCA, you may apply to sit for the exam. You also will be allowed to count all post graduate clinical experience and supervision hours earned since the date certified by the degree-granting institution as that on which all requirements for the Master’s degree have been completed. This section also applies to students within a doctoral program.

ATTENTION APPLICANTS WHO GRADUATE ON OR AFTER JULY 1, 2014 All applicants earning their Master’s degree after July 1, 2014 will be required to obtain a LMHCA prior to completing their 2-year post degree experience and supervision hours requirement in compliance with Indiana Code 25-23.6-8.5-4. Any clinical hours earned prior to the receipt of your LMHCA will not be counted toward the 3000 hours needed to meet the LMHC supervision and experience requirement unless the requirements of Indiana Code 2523.6-8.5-4 have been met.

Indiana Code 25-23.6-8.5-4 provides that if an individual applies for, takes, and passes the first available examination (defined as the first examination offered after the date of an individual’s graduation or upon moving into Indiana) he or she may count 1,500 hours of the post degree clinical experience accumulated before taking the examination toward licensure as a LMHCA. If an individual applies for, takes, but does not pass the first available examination, the individual may retain the hours accumulated before taking the examination, continue working, but may not accumulate any additional hours until the individual passes the examination.

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PLEASE NOTE: Your application will not be considered complete until your degree is conferred on your transcript. The Board WILL NOT accept letters from an academic advisor, registrar, or department chair attesting that all degree requirements will be met by the end of the current term of enrollment in lieu of a college transcript.

MAMFT licensing information: EFFECTIVE JULY 1, 2008 All applicants earning their Master’s Degree after July 1, 2008 will be required to obtain a LMFTA prior to earning any post-graduate clinical hours. Any clinical hours earned prior to the receipt of your LMFTA will not be counted toward the 1000 hours needed to meet the LMFT supervision and experience requirement.

PLEASE NOTE: Your application will not be considered complete until your degree is conferred on your transcript. The Board WILL NOT accept letters from an academic advisor, registrar, or department chair attesting that all degree requirements will be met by the end of the current term of enrollment in lieu of a college transcript.

Frequently Asked LMFT Licensure Questions 1. How do I purchase a study guide for the exam?

For information regarding study guides please visit the following websites: LMFT – http://www.amftrb.org/ 2. How often is the AMFTRB examination offered?

The exam is offered three times a year, January, May, and September, in 28 day windows.

3. Does the board offer a temporary permit?

No, LMFTA applicants are not eligible for a temporary license.

4. I am not sure if I have the right coursework, will the board review my transcript if I send it in?

No, however, you can submit an official application with a letter requesting that your courses be reviewed at the next available board meeting.

5. Who is considered a qualified supervisor?

A licensed marriage and family therapist who has at least five (5) years of experience; or An American Association of Marriage and Family Therapy (AAMFT) approved supervisor; or An AAMFT approved supervisor candidate; or A supervisor who: a) has possession of a masters degree or higher in a mental health field; and b) has five (5) years of post-master’s professional practice experience; andc)is supervising within their scope of experience and training.

6. Does the Board accept degrees from on-line universities?

Yes, as long as the degree is from an approved program and you have met the coursework requirement.

7. How many hours of supervision and experience are required to qualify for a LMFT license?

1000 hours of post degree clinical experience are required to obtain your license with 200 hours of post degree supervision, of which, 100 hours must be individual supervision.

8. What is an official transcript?

An official transcript is a transcript sent directly from the university to our office or submitted in a sealed envelope.

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Instructions for Meeting Room Manager

After you login at http://mrm.cts.edu, this should be the first screen you see:

If you do not see the list of rooms, click on the location Counseling Rooms under available locations.

Change Password One of the first things you should do if you have not already is to change your password if you are currently using the default.

1.

Click on the orange circle with the shadow of a person’s head in the right-hand corner.

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2.

Here is the screen it will bring up:

3.

There is a space for you to enter your password. You will then have to enter it again to confirm. Once complete, click “OK.”

4.

Once complete, click “OK.”

Your password is now changed.

Scheduling a Session Choose the date on the calendar in the top left.

1.

Find the Column for the room you need. The list extends to the right. Use the horizontal scroll bar at the bottom of the screen to navigate.

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2.

Click on the time of day you need the session to start. The times may extend off the bottom of the screen. Use the vertical scroll bar to navigate.

3.

This will bring up the scheduling screen:

4.

The program is automatically set up for 30 min segments. Please remember to change it for as long as you would like.

Do not use the all day event option or the reoccurrence option.

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5.

For Meeting Title, please include your name.

6.

You need to complete the reservation type, please click on the arrow next to the

space.

7.

This will bring up this window. (If you have a pop-up blocker turned on, you may need to allow pop-up for this site.) Select the most appropriate label for your meeting and click SELECT.

8.

The only other information you need to complete is how many people are attending. (This should include you as the therapist.)

You do not need to put anything in Host, Client Name or Client Code.

9.

You can choose to change the font and background color if you want.

10.

Click Save and Close.

It will ask if you want to email the appropriate departments. Click cancel.

You have set up your appointment.

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Deleting and Appointment 1. When looking at the calendar, if you put your mouse over your appointments, you have a menu pop-up giving you the option to delete the appointment. Click delete

will

.2. It will ask you if you are sure. Click OK.

3. It will then ask if you want to email the appropriate department and participants. Click Cancel.

Your appointment has been cancelled.

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PROTOCOL FOR REPORTING ABUSE/NEGLECT Policy on Reporting & Investigating All Cases of Suspected Child Abuse & Neglect The state law of Indiana makes it mandatory for all individuals to report all suspected cases of non-accidental injury, unexplainable failure to thrive, sexual abuse, and physical neglect to Child Protection Services of the County Department of Public Welfare. No one has an option in the matter of reporting such cases for investigation. Reporting in good faith frees the reporter from any liability if the report proves to be unfounded. On the other hand, willful failure to report opens an individual to criminal or civil liability.

If disagreement arises between personnel as to whether or not a case of child abuse exists, the matter must be turned over to the Child Protection Services of the County Department of Public Welfare for evaluation and disposition.

Client Files and Records Keep to the facts. Do not write feelings or impressions Avoid generalizations when charting behavioral indicators. Give specific examples which have been observed.

Data collecting 

If it is necessary, interview a parent to determine the cause of a questionable bruise or injury.  When collecting data, remember it is not your decision to decide who is responsible for suspected abuse or neglect. Therefore, no insinuations and/or verbal attacks are to be made.  Keep the interview short.  Ask how injuries occurred.  Do not lie to anyone.  Do not comment on the credibility of the story or stories.

Reporting Child Abuse and Neglect by Telephone After checking with the individual supervisor and/or the Clinical Director and/or the Director, the therapist will telephone Child Protection Services to report suspected child abuse or neglect. All pertinent information will be given to Child Protection Services to establish the basis of the child abuse or neglect report, and to indicate severity of the problem, including: • Identifying information: name, address, phone number of child and caretaker; • Description of injuries/physical indicators; be as specific as possible regarding location, size and severity of physical injuries or conditions; • If available, describe the caretaker's explanation of physical injury/condition and why it was found to be inadequate; • Verbal reports made by the child, behavior of the child which may indicate abuse or neglect (give one two specific examples to clarify the point), any evidence of problems between the caretaker and child that have been observed; and • Other pertinent information.

Reporting Child Abuse and Neglect in Writing If requested by Child Protective Services (CPS) telephone reports should be followed up by a written report within 48 hours. Information to be included in the report should include at least the following: •Pertinent history •Pertinent physical findings •Pertinent lab results 127 Last Updated 9/2014

•Concluding statement on why those findings represent child abuse or neglect A copy of the written report should be placed in the client's file.

Follow —Up After 30 days, request a written report on the results of the investigation from Child Protection Services to keep the clinic up to date. Child Protection Services may make a follow-up report only to a hospital, community mental health center, referring physician or school or to the appointed designee of the above. Establish with Child Protection Services a protocol for follow-up reports.

Dealing with Parents when Reporting A frequent cause of anxiety for therapists is the assumption that a parent or guardian must be told of a report for suspected child abuse or neglect. Health care providers are under no obligation to disclose the report to the parent/guardian, but under some circumstances, may feel more comfortable in doing so.

Under no conditions should the parents be told if is felt that this information would endanger the child or agency personnel.

Consider the following in dealing with parents/guardians:  Consider whether to tell the parent or guardian of the report before calling CPS. Consult with your supervisor and/or a Counseling Center Administrator concerning the appropriateness of this.  Avoid a confrontive stance. Stay calm and unemotional.  Be direct. "Due to the unusual nature of the injury, I am obligated by Indiana State Law to file a report to child Protection Services”.  Consider having another professional act as a witness or to provide emotional support.  Be reassuring and positive in attitude. "Child Protection Services is just that. It exists to protect kids and to serve families”.  If the parent adamantly denies abuse occurred, repeat your obligation under the law to report suspected abuse. "It isn't my determination to make. I am simply  under obligation by law to report injuries of this nature."  Mention that it is in the parent and child's best interest to work cooperatively with Child Protective Services to clear up any misunderstanding.

REMEMBMER — Mental health care providers, like every other individual in Indiana, have the legal responsibility to report suspected child abuse or neglect. Think of the report as a request for an investigation, not an accusation of bad parenting.

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NOTE: IT IS THE POLICY OF CHRISTIAN THEOLOGICAL SEMINARY COUNSELING CENTER THAT ALL COUNSELORS MUST PROMPTLY REPORT ALL SUSPECTED CASES OF CHILD ABUSE OR NEGLECT TO THE APPROPRIATE AUTHORITIES UPON LEARNING OF A SITUATION THAT REQUIRES SUCH A REPORT. THE REPORT SHOULD BE MADE BOTH VERBALLY (BY PHONE) AND SUBSEQUENTLY IN WRITING IF CHILD PROTECTIVE SERVICES REQUESTS A WRITTEN REPORT. COUNSELORS MUST CONSULT WITH THE CLINICAL DIRECTOR AND/OR THEIR INDIVIDUAL SUPERVISOR ABOUT THIS REPORT; HOWEVER, IF SUCH A CONSULTATION CANNOT BE ARRANGED IN A TIMELY MANNER THE COUNSELOR IS NOT RELIEVED OF THE OBLIGATION TO MAKE THE REPORT TO THE APPROPRIATE CHILD PROTECTIEVE SERVICE. FAILURE TO FOLLOW THIS GUIDELINE CAN RESULT IN SUSPENSION OR TERMINATON FROM THE PRACTICUM.

Procedural Flow for Child Abuse and Neglect Investigation by Child Protective Service 1. Intake worker receives report on reporting hotline.

2. If report accepted for investigation: * have DPW 310 completed, * caseworker assigned 3. Time limit for investigations: * Immediate – severe or extensive injuries, young children left alone, abuse of infants * Within 24 hours – abuse other than above * Within 15 days – neglect other than above 4. Issues considered during investigation: * nature, extent and cause of alleged abuse or neglect * identity of person allegedly responsible * names and conditions of other children in home * evaluation of parent, guardian, or custodian * home environment and relationship 5. Investigative Activities * interview with child * photographs and x-rays * home visit * medical or psychological condition * collateral contacts 6.

Assessment of potential risk to child * extent and severity of injury or neglect * prior history of abuse or neglect * attitude of parents toward child * potential of family members to change * ability of parents to protect child 7. Determination of Case Status Substantiated :evidence of facts provide reasonablebasis to assume that abuse or neglect has occurred.

Indicated: significant indicators of abuse or neglect.

Unsubstantiated: no evidence, facts or indicators found.

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8.

Further Services * family and/or rehabilitative services offered to child and family * may involve intervention of the court * services provided for, arranged by and monitored by CPS 9. CHINS Proceedings- (Child In Need of Services) * Child becomes a ward of the court because the parent cannot or will not take steps to protect the child from abuse or neglect.

10. Protective custody * Law enforcement officer, probation officer or caseworker. Parents notified. * Detention hearing within 72 hours.

11. CHINS Hearings * Initial- inform parents of consequences or lack of cooperation. * Guardian Ad Litum/CASA appointed to represent child * Fact finding – CDPW prove allegation of abuse. * Disposition - child remains at home and CDPW supervises -outpatient treatment for child - removal of child to foster or institutional care - wardship - emancipation - order for child or family to receive services 12. Completion of case plan by caseworker 13. Case Reviews * first six months-court hearing or administrative review *second sex months-same as first * first 18-month dispositional hearing formal court hearing to review child's case * reviews continue as above as long as child is in CHINS. Reporting Child Abuse/Neglect Identification of possible child abuse and neglect involves an awareness of the signs that indicate that child abuse or neglect may be occurring. These signs or "indicators" may be physical or behavioral; often both physical and behavioral indicators will be present if child abuse or neglect is occurring.

Presence of one or more indicators would prompt a closer look at the child and the child's environment. It is important to keep in mind that many of the indicators may be observed in children or families where abuse is not occurring. A history of suspicious injuries, patterns of behavior, or sudden changes in behavior, and verbal reports of abuse are all key elements in recognizing possible child abuse or neglect.

A. Physical Abuse Physical abuse of children includes any non-accidental physical injury caused by the child's caretaker. By definition, the injury is not an accident. Neither is it necessarily the intent of the child's caretaker to injure the child. Physical abuse may result from severe corporal punishment or from punishment that is inappropriate to the child's age or condition.

Physical indicators of physical abuse should be considered in light of inconsistent medical history, the child's developmental stage and the presence of other indicators. Does the explanation the caretaker gives for the injury make sense or fit the extent or pattern of the injury? Are the injuries common or reasonable given the child's age and physical development? Are there other indicators of 130 Last Updated 9/2014

abuse in the behavior of the child or caretaker? Are there other problems that could be putting stress on the family?

Behavioral indicators should be considered in light of other evidence. Are there any other physical or behavioral indicators? Are there family/environmental stresses of which you are aware?

1. Physical Indicators of Physical Abuse a. Unexplained bruises and welts(other than the common scrapes on elbows, knees, shins, etc.)

• On face, lips, mouth • On torso, back, buttocks, thighs • In various stages of healing • Clustered, forming regular patters • Reflecting shape of article used to inflict injury (such as electric cord, belt buckle, wooden spoon, fist) • On several different surface areas • Bite marks, especially in multiples and in various stages of healing • Regularly appearing after absence, weekend, or vacation b. Unexplained burns • Cigar or cigarette burns, especially on soles, palms, back, or buttocks • Immersion burns (sock-like, glove-like, doughnut shaped on buttocks or genitals) c. Unexplained fractures • To skull, nose, facial structure • Various stages of healing • Multiple long bone or spiral fractures • Injuries to growth centers in bone structure d. Unexplained lacerations or abrasions  To mouth, lips, gums, soft palate, eyes  To external genitals  To limbs, back, chest, abdomen  Ruptured labial/lingual frenulum (folds under the tongue or folds in the vaginal area) e.

• •

Hemorrhages Retinal Beneath scalp due to hair pulling/absence of hair

f.

• •

Dental/Oral injuries Torn lingual frenulum (folds under the tongue) Fractured or missing teeth without adequate explanation Scars of previous intra-oral (within the mouth) lesions Lip scars Jaw fractures Multiple healed tooth root fractures Unusual malocclusions (badly arranged teeth)

• • • • •

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2. Behavioral Indicators of Physical Abuse —in a Child •

Too eager to please, indiscriminate attachment • Depression • Low self-esteem • Wary of adult contact • Apprehensive when other children cry • Behavioral extremes o Extremely aggressive, demanding, rageful o Overly compliant, passive, withdrawn o Self-destructive • Role-reversal o child seems to parent the parent o child acts inappropriately adult-like and responsible • Developmental lags — may fall behind in: o toilet training o motor skills o socialization o language development o Appears frightened of the caretaker o Wears long-sleeved shirts in hot weather (to cover bruises) o Cringes or jumps at a sudden movement o Verbally reports abuse o School absenteeism 3. Behavioral Indicators in an Adult of Physical Abuse - to a Child  Uses harsh discipline which is inappropriate to child's age, behavior, and/or condition  Describes the child in a consistently negative manner (bad, stupid, ugly, evil, etc.)  Gives explanation of the child's injuries that do not make sense given the child's age, developmental stage, type or extent of injuries  Becomes defensive or refuses to explain when questioned about the child's injury  Attempts to conceal the child's injury  Misuses drugs or alcohol 4. Information on Bite Marks in Children Pediatric dentist, Glenn R. Wagner, states the following on bite marks in children. "Bite marks in children represent child abuse until proven differently. They are rarely accidental and are good indicators of genuine child abuse. There is a spectrum in the appearance of bite marks throughout childhood. In infancy, the bites tend to be punitive in nature and generally reflect bite marks, which represent assault or sexual abuse. Human bite marks are identified by their shape and size. They have an elliptical or oval pattern containing tooth and arch marks. These impressions can be matched against the dentition and dental impressions of the victims and suspects. Using tool-mark technology, comparisons are possible even in limited material.

Computer enhancement of bite mark photographs increases a favorable comparison by further delineating unique characteristics of thearch and individual teeth." These injuries should be photographed on discovery, that is, at the time of examination. They fade rapidly in children.

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Photographs should be made of the complete general area containing the bite ark to show its location in relation to their anatomic landmarks.

5. Munchausen's Syndrome by Proxy In recent years, a form of child abuse has been identified which is quite different in form than most other types of physical abuse. Munchausen's Syndrome by Proxy describes the actions of an adult caretaker, usually the mother, which causes the child to appear to be ill and result in extensive medical care including hospitalization or surgery for the child. Examples are the elaborate description of violent seizures in the child, or the deliberate warming of a thermometer to mimic high fever in the child. Once the child is hospitalized, the adult may introduce fecal material or other foreign substances into the child's IV actualizing the child's fabricated symptoms. The perpetrator of such abuse is usually one who has sophisticated knowledge of medical systems, appears to be a dedicated, attentive parent, but uses the attention paid by the medical staff to gratify personal unmet needs. Children abused through Munchausen's syndrome

by Proxy can have long-term physical and psychological effects from unnecessary medical procedures. Death of the child, although usually not deliberate on the part of the adult, is not an uncommon result.

B. Physical Neglect Neglect involves inattention to the basic needs of a child, such as food, clothing, shelter, medical care, and supervision. While physical abuse tends to be episodic, neglect tends to be chronic. When considering the possibility of neglect, it is important to note the consistency of indicators. Do they occur rarely or frequently? Are they chronic (present most of the time), periodic (noticeable after weekends or absences), or episodic (seen during illness in the family)? In a given community or sub-population, do all children display these indicators, or only a few? Is this culturally acceptable child rearing, a different life-style, or intentional neglect? Regardless of lifestyle or cultural norms, children have basic needs, which must be met by caretakers. If these needs are not being met and the children's caretaker cannot or will not accept offered assistance, then a report of neglect must be made.

1. Physical Indicators of Physical Neglect a. Lack of supervision  flat, bald spot on the back of an infant's head  very young children left unattended  children inadequately supervised over long periods of time or when engaged in dangerous activities  

children left in the care of children too young to protect them abandonment

b.    

Lack of adequate clothing and good hygiene children dressed inappropriately for the weather consistently wearing torn and dirty clothing severe diaper rash or other persistent skin disorders resulting from poor hygiene children chronically dirty and unbathed

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c. Lack of medical or dental care  Children whose needs for medical or dental care or medication and health aids are unmet 

Lice, rat, or roach bites

d. Lack of adequate nutrition  children lacking sufficient quantity or quality of food  children who fall three to four standard deviations below normal height or weight for age, with no physiological explanation e. Behavioral Indicators of Physical Neglect — in the Child  Begging, stealing food consistently complaining of hunger  Developmental lags  Constant fatigue, listlessness  Apathetic, depressed  Infant — affective withdrawal from interpersonal interactions, nonresponsive • Alcohol or drug use 

Delinquency ( i.e., theft, vandalism, etc.)

3. Behavioral Indicators of Physical Neglect — evident in Caretaker • Misuses alcohol or other drugs • Maintains chaotic home life • Shows evidence of apathy or futility • Expects child to care for him/herself at an early age C. Sexual Abuse Sexual abuse includes any contact or interactions between a child and an adult in which the child is being used for the sexual stimulation of the perpetrator or another person. Sexual abuse may also be committed by a person under the age of 18 when that person is either significantly older than the victim or when the perpetrator is in a position of power or control over another child. Males and females can both be victims. It is important to remember that the perpetrator of sexual abuse is usually well known to his/her child victim.

There are both physical and behavioral indicators of sexual abuse, as in physical abuse or neglect.

A major difference with physical indicators of sexual abuse is that they are not normally seen in young children. Absence of physical indicators does not mean sexual abuse is not occurring. Some of the behavioral indicators are exclusive to the sexually abused child; others are behaviors which may also be seen in children experiencing physical or emotional abuse, or neglect.

1. Physical Indicators of Sexual Abuse  Any venereal disease, gonorrhea infection of the throat, genitals, eyes or rectum  Pregnancy in a girl under 16 years of age  Foreign matter in the bladder, rectum, urethra, or vagina  Bruised or dilated genitals or rectum  Pelvic inflammatory disease 134 Last Updated 9/2014

 Recurrent urinary tract infections without a physiological basis  Difficulty or pain in walking and/or sitting  Torn, stained or bloody underclothing 2. Behavioral Indicators of Child Abuse -- Child  Seductive behavior, advanced sexual knowledge for age, promiscuity, prostitution  Drawing pictures of people which show genitals  Exhibiting extreme behavior — fear of adults, withdrawn, aggressive or violent, disruptive  Sexually abusing another child  Self-destructive behavior such as suicide attempts  Notable change in behavior — regression, withdrawing from friends, drop in concentration at school, fearful  Sleep disorders  Taking frequent baths, particularly after seeing one person  Unwilling to change for gym or participate in physical education class  Compulsive masturbation, precocious sex play, excessive curiosity about sex  Reporting child abuse  Expressing fear of particular person or place  Fire-starters 3. Behavioral Indicators of Sexual Abuse — Caretaker  Extremely protective or jealous of child  Encouraging child to engage in prostitution or sexual acts in presence of caretaker  Misusing alcohol or other drugs D. Emotional Treatment Emotional maltreatment is a pattern of behavior that has a harmful effect on the child. The effect can be observed in the child's abnormal performance and behavior, is long lasting, and constitutes a handicap to the child. In emotional abuse, all indicators are either behavioral — those shown by the child and the interaction of parent and child — or physical manifestations of behavioral disturbances. It is important to note that maltreatment by a caretaker is not the cause of all behavioral, emotional, or developmental problems in children. Consider behavioral indicators of emotional maltreatment in light of interactions between caretaker and child. Do interactions seem primarily negative? Are examples of emotional maltreatment frequently observed?

1. Physical Indicators of Emotional Maltreatment • Eating disorders — bulimia, anorexia nervosa, extreme obesity • Elimination problems — extreme constipation, constant vomiting or diarrhea • Speech disorders, stuttering 2. Behavioral Indicators of Emotional Maltreatment - Child • Habit disorders such as biting, rocking, head-banging or thumb-sucking in an older child • Daytime anxiety and unrealistic fears • Withdrawal and anti-social behaviors • Poor relationships with children of own age • Defiant behavior 135 Last Updated 9/2014

• Behavioral extremes — aggressive or passive, inappropriately adult-like or infantile • Apathetic — seems indifferent and listless • Daydreaming frequently, over fantasizes, seems removed from reality • Irrational and persistent fears, dreads, or hatreds • Sleep problems, nightmares • Appearing to get pleasure from hurting other children, adults or animals, • Appearing to get pleasure from being mistreated • Developmental lags • Suicide attempts 3. Behavioral Indicators of Emotional maltreatment —evident in Caretaker a.Rejecting • Belittling the child so he/she is made to feel he/she can do nothing right • Criticizing the child harshly • Treating the child coldly, not showing affection • Treating the child differently from other children in the household b. Ignoring • Taking little/no interest in the child, or activities and seeming not to care about the child's problems. c. Terrorizing • Blaming the child for things over which the child has no control • Using the child as a scapegoat when things go wrong • Ridiculing and shaming the child • Threatening the child's safety and health • Destroying the child's possessions d. Isolating • Cutting the child off from normal social experiences • Attempting to prevent the child from forming friendships and attachments. e. Corrupting • •

Teaching the child socially deviant patterns of behavior (demanding and/or rewarding aggression, stealing, or other delinquent acts, or sexually precocious behavior) Allowing or encouraging substance abuse

E. Disclosure of Abuse by the Child 1. No disclosure. Despite the physical and emotional pain inflicted as a result of abuse or neglect, few children choose to directly disclose what has happened to them. Some of the reasons for this may include:  Child is too young to understand that abuse or neglect is wrong.  Child believes that s/he deserved or caused the abuse  Child is fearful of reprisal from the abuser  Child doesn't want to get the abuser in trouble or to break up the family.  Child doesn't believe that help is available to solve the problem.

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A child will actually lie, because of fear, embarrassment or guilt to cover up signs of abuse or neglect. If this appears to be the case and if there are physical and behavioral signs of abuse or neglect, a report must be made despite the child's denial.

2. Indirect disclosure. Children may give indirect hints about an abusive home situation. They may make subtle references to angry parents or uncomfortable touches.

Questions may center on the abuse of a fictitious friend. They may ask "what would happen if..." questions to test the reaction of the listener.

If health care providers become aware of these indirect hints of abuse or neglect from children, especially in the presence of physical and behavioral signs of abuse, immediate intervention must be made. The child may never speak up again. Away from the parent, the child should be simply asked to say more about the statement or question. Unless the child's response clearly clarifies a non-abusive circumstance, there would be reason to believe that the child is a victim of abuse or neglect and a report must be made. The child should not be questioned any further.

3. Direct disclosure. Occasionally, a child will openly disclose abuse or neglect. This is reason to believe that the child is a victim and a report must be made. Again, the child should not be questioned any further.

Health care providers may have concerns about children making a false disclosure of abuse. All the available evidence suggests that outright false allegations by children are rare occurrences. In one study of 576 sexual abuse allegations, only 8% were found to be false. Of the 8%, only 2% were false reports made by children; the other 6% were false reports made by adults (Jones and McGraw, 1987). **It is not the responsibility of the health care provider to prove whether the allegations are true or false. The only obligation is to report.**

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Setting Up Voicemail How to record your Name and a Person Greeting the FIRST TIME you access Voicemail Functions First Time Enrollment: Messages button on any phone.

135246 and press #.

Check Messages from another phone on your company’s network: Messages button

Check Messages remotely: -931-2379

Refer to document CTS Unity VM Handout for additional ‘Menu Options and Shortcuts.

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Suicide Assessment Level # 1 Low Risk

Level #2 Mid-Risk

[------------------------Level 3---------------------------------] High Risk Situation

PROCEDURES FOR LEVELS #1. LOW RISK LEVEL ASSESS  has no serious consideration of suicide  has no plan  seems to be suffering a brief reactive episode in regards to defined situational stressors  suicidal thoughts are brief and fleeting  open and willing to work on the stressors/problems ACT  negotiate a family contract  client signs "no harm" contract  clarify coping options (plan); include professional resources  set up follow-up session within 24 hours FOLLOW UP  document facts, action, etc.  monitor for 30 days  signs of deterioration —immediate intervention and parent contact # 2.MID-RISK LEVEL ASSESS

ACT

   

client has some intent to harm self client has a plan does not have access to method any prior history

   

immediate contact of supervisors keep client monitored have client sign "no harm" contract inform client you must make a family contact ( address resistance and fears) work with client to create 1 week coping plan



««CONTACT FAMILY>>>»  give the information at hand — share concern and utmost gravity of the situation  share need of next level of professional assessment  establish cooperative monitoring  share need to "suicide proof' the home  establish an emergency plan

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FOLLOW UP  check client plan the next day  meet with client  contact family to discuss their plan of action (professional assessment)  review emergency plan  clarify further contact with family  document all interactions #3. HIGH RISK LEVEL ASSESS:  has intent to kill self  has a plan  has access to the method  remains fixed on intent while coping options are reduced  manifests late stage high risk behaviors ACT:  immediate detention  Individual Supervisor and/or the Clinical Director and/or the Director to consider the following steps:  conduct an intervention/interview  emergency contact of family  clarify professional service options  get release of information, etc.  make necessary professional contacts  have family come to location of client  share facts, concerns *need for immediate professional assessment by psychiatrist or emergency room physician  need for close monitoring at home  need for a plan of services  establish a 36 hour plan of action  give support FOLLOW-UP    

document all facts, protocol, etc. contact family, clarify the plan of action if client returns to counseling, clarify a support and monitoring plan work with family and service provider

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FURTHER THOUGHTS ON RESPONDING TO A SUICIDAL CLIENT Once it has been established that a client is a potential suicide risk, A definitive counseling intervention is a must The first facilitative task is to help the client stay alive and move out of his or her endangered psychological position and then to facilitate them toward the next level of professional help.

1. In all but the most imminent emergency relationship-building with the client is critically important. Since suicidal clients tend to be alienated from meaningful relationships, this initial relationship building phase is particularly vital. The more effective the interpersonal contact is at this point, the more helpful will be the overall process.

2. There are few more powerful healing forces than the positive impact of consistent caring, acceptance and genuine concern.

3. Do not wait to ask if the person has been having suicidal thoughts. Just talking about the suicidal thoughts releases energy that might otherwise be used to motivate the act. (The idea that talking about or mentioning suicide will put the idea into their head is a myth.)

4. Bring counseling focus to bear directly upon the immediate problems precipitating the suicidal impulses.

5. Explore the client's motivations that drive the suicidal impulses. Find out through sensitive questioning and attentive listening what it is that suicide represents to the client.

6. Confront the client about his or her beliefs about death. Clients often have very unrealistic beliefs and highly romanticized illusions about death.

7. Discuss the method by which the individual is planning to commit suicide. The method usually has a symbolic meaning, so get the person to talk about it.

8. Soon after the problems are classified, establish the available resources the client can use to work through the problems.

9. A plan for action needs to be established quite soon to facilitate the client toward the next level of professional help.

10. *The plan should take into account what has been learned.

11. *The plan relates first to reducing the risk of a completed suicide.

12. *The plan should include realistic goals that go beyond simply keeping the individual from committing suicide. (Clients who are struggling with suicide impulses need to have something concrete to do. They need some assignment or specific plan of action in order to feel a sense of security and assurance that they can really do something about their painful situation.

13. Establish firm, verbal, and if possible, written contracts. Use the "No harm contract" and provide the client with crisis center and "hot line' phone numbers. The contract tightens the relationship. It is another way of communicating active caring that helps the insecure client feel that he or she can really depend upon your commitment to be there for him or her.

Predicting Suicides As counselors we can be helpful in two ways: 1.

We should be aware of the "signs" of a suicide ideation.

2.

We need to facilitate high-risk individuals and those who have survived attempts to a psychiatrist or for an evaluation at a hospital or crisis center.

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Common signals of potential suicide: 1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

Previous suicide attempt. — Probably the strongest predictor.

A threat to commit suicide — those who talk intentionally about killing themselves are more apt to carry out the act.

A plan — the presence of a plan to carry out the suicide threat is very strong indicator if risk.

Stress — sudden, unexpected, severe and prolonged stress can over-whelm the person's defenses.

Loss and rejection — Experiencing loss of any kind or rejection from people who are cared about often leads to a questioning of the values of living.

Loneliness — Feelings of alienation and loneliness, especially when the person is in a relatively isolated or withdrawn condition.

Mental illness — The presence of mental illness, especially depression, is a high-risk factor.

Sudden behavior change — Any marked and sudden behavior change is worthy of concerned attention. Something is causing the alternation.

Negative emotions — the presence of hostile, masochistic, hopeless, guilty, worthless and helpless feelings sometimes indicates a propensity toward suicide.

Impulsiveness — Lack of adequate impulse control especially in combination with depressive symptoms.

Dependency combined with dissatisfaction — the dependent individual who is dissatisfied with life usually combines inadequacy and anger. This combination often results in intense, self-directed hostility.

Physical illness — physical illness weakens the psychological as well as organic defenses.

Success irony — the attainment of success can be associated with suicidal acts.

Success can bring new responsibilities that can feel overwhelming.

Preparing to die — getting their affairs in order.

Suicide note — this should be taken as an immediate warning and requires fast action.

Prediction of suicide attempts by adolescents is usually very difficult. Since their emotions, thoughts, and attitudes change so quickly, suicidal ideas come and go quite readily.

Note especially the following:  depressed mood  significant breakdown in previously effective communication channels  previous suicide attempts or accident proneness  high degree of lethality in previous suicide attempts  the presence of conscious wishes to die coupled with attempts thatoccur in isolation from these.

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1.

2.

3.

4.

Additional Information to Note: Males are at a higher risk of successful suicide.

As age increases, so does suicidal risk, especially for males.

The level of social connectedness is an important factor. The greater the social isolation, the greater the risk.

If the client will not sign a "No Harm Contract", consider the risk immediate and inform the client that you need to protect them from harming themselves and will contact police or family.

**Remember to call your supervisor in such an emergency.**

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How to Write Comprehensive and Congruent Treatment Plans Treatment Planning is both a Process and a Product    

Sets the direction of treatment Establishes methods of treatment Identifies expected outcomes of treatment Begins the discharge planning process

Purpose of Treatment Plans • Determine expected outcome • Increase coordination between services • Decrease fragmentation and duplication of services • Promotes consideration of alternative treatments Functions of a Treatment Plan • Engages the person served in the healing process • Supports utilization management o Treatment authorization o Coordinates services between clinicians, supervisor, and agency o Communication with payment sources (Medicaid, DFC, and other funders) o Streamlines report writing process for other agencies (court, DFC, etc.)

• Clearly states the expected outcome(s) • Assigns responsibility • Anticipates the frequency, intensity, and duration of services 7 Steps in Treatment Planning 1.

2.

3.

4.

5.

Assessment, evaluation, and diagnosis Identify strengths and needs Prioritize needs Formation of goals and objectives Interventions/treatment (individual, family and group therapy, psychological and/or medication evaluation, etc) 6. Evaluation of impact/outcome 7. Modification of needs/objectives Goals Express in the words of the client o Global client statement of what they want to accomplish through treatment — "to keep my daughter," " to feel better," "to live independently," "to get along better with my parents," etc. o Their stated goal can be identified by history, observation, interviews and serve to assist the client in determining what barriers prevent him/her from obtaining stated goals(s).

Strengths • Those items in the client's life that will support obtaining their goal.

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Objectives  Statement(s) of observable, and where possible, measureable behavioral change(s) that demonstrate significant reduction of identified barriers. o Divide the larger goals into manageable tasks o Deal with the behavior, not the services o Measureable and time limited Interventions/Plans  Planned clinical procedures designed by the staff to bring about the behavior changes identified in the objectives. Interventions include the responsible staff, frequency and purpose of treatment, where services will be provided, and modality of services. Multiple interventions may be used to assist the client in obtaining a stated goal. Interventions are based on the clinical assessment of the data and what services/treatment the client is willing to receive. o What services the client will receive o What the staff will do to assist in obtaining the goals and how often o What is the purpose and intent of the service in relation to the objective/goal Goal Attainment  Statement of what behavior will have been met to indicate that the client has obtained a specific goal.

Progress Notes  Sequential narratives that depict the client's progress in relationship to meeting objectives and obtaining their goal. They may also be used to record other significant events.

Use plain English rather than global, or all-encompassing, terminology in clinical documentation. o Communicate to the client and other professionals what, where, when, how, and why clinical events occur o Establish a clinical road map for progress o Monitor progress toward obtaining stated goals o Establish a means for measuring organization and clinical performance for the purpose of improvement o Devote less time to paperwork and more time to direct, and directed, client care  Current third party pa sources are requiring a focus more on neutralization of problematic behaviors (barriers to goals) rather than the attainment of an enhanced quality of life for clients.  If the client record lacks specificity, outcome data will lack specificity, and it will be impossible to substantiate the effectiveness and efficacy of treatment. Documentation is no longer an administrative intrusion into clinical time. More than ever, quality documentation should be considered a primary professional responsibility that clinicians have to their client, to peers, and to the organization for which they work.

Review Questions for the Clinician  Does the goal reflect resolution of the client's needs/problems?  Is the objective stated in measureable and behavioral terms?  Do the problems/needs identified in the treatment plan flow from the client's identified needs?  Do the interventions directly relate to the objectives?  Is the purpose of each intervention described?  Does the plan specify the responsible staff member along with the frequency, intensity, and duration of services provided?

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 Will the plan likely achieve the desired outcomes?

Common Mistakes/Problems Goals:  Not global  Not directed towards recovery  Not responsive to client's needs  Not strength based  Too Many Objectives:  Don't support the goal  Not measurable or behavioral  Interventions become objectives  Not time framed  Too many objectives If a client's treatment plan remains unchanged, particularly for a client who remained for a prolonged period within a continuum of care, one or more of the following assumptions might be made:  There has been no demonstrated improvement or regression  The plan is documented and so vaguely written that client change is not observable  Documenting the treatment plan was perceived as an "event" and the staff considers the event history  No one has looked at it lately EXAMPLE: DSM-IV Axis I Code: 309.0 Adjustment disorder, unspecified, chronic Descriptors (client specific): Client has experienced 3 deaths in family in last 5 years. Her unresolved grief, in addition to current stressors in her dysfunctional home life, have contributed to client's depressed mood, social withdrawal, poor communication, failing grades at school etc.

Problem A: Unresolved grief Goal A: Work through grief to reach point of emotionally reinvesting in life Objective 1: Client will ID 3+ things about deceased loved ones and/or the relationship.

Objective 2: Client will verbalize and resolve at least 2 feelings of anger or guilt focused on her or the deceased loved ones that block the grief process.

Objective 3:Client and family will ID 2 ways to encourage and support client in the grieving process.

Treatment Interventions: 1. Assist client in ID her feelings connected to losses using Cognitive-Behavioral Therapy (CBT) and Art Therapy.

2. Assist client to ID things about deceased loved ones using CBT. 3. Assist client and family on how to be supportive using CBT. Treatment Services: 1.Individual therapy 2 hrs weekly 2.Family Therapy 1 hr weekly Progress on Objectives: 1. Client ID 2 out of 3 things about deceased loved ones and/or relationship. Continued.

2. Client verbalized and resolved feelings of anger or guilt. Objectives met.

3. Client and family had difficulty addressing this objective. Continued.

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Problem B: Poor anger management.

Goal B: To decrease angry feelings and increase positive coping skills.

Objective 1:Client will ID and discuss 3 triggers to anger.

Objective 2:Client will learn and demonstrate 3 anger management techniques.

Objective 3:Client will learn 3 situations in which use of anger management techniques would be appropriate.

Treatment Interventions: 1. Assist client in identifying triggers to anger using CBT. 2. Teach client anger management techniques and encourage client to use techniques.

3. Teach client which situations would be appropriate to use techniques.

Treatment Services: 1. Individual Therapy 2. Individual Rehab Interpretive Treatment Summary: Client is a 16 year old female who just recently moved out from her mother's and step-father's home and in to her 29 year old cousin's apartment. Client has to transfer to a new high school in the 2"d semester. Her cousin brought client to counseling out of concern for her emotional well-being. Client has never talked to anyone about how she felt. Client has experienced 3 family member losses in the last 5 years. Client is dealing with guilt and delayed grief and bereavement issues. Client appears to have low self-esteem and tends to isolate from her peers. Client's step-father, as reported by client and her cousin, had a baby with client's 16 year old best friend. This greatly upsets client and has caused friction in her mother's home. Client has met her biological father once when she was approximately 7 years old.

Client's biological mother forbids her to see him. This is additionally troubling for client and biological mother and causes friction between client and biological mother. Reportedly, there is no level of communication between client and her biological mother. Client sees her other a few hours once a week, if at all. Biological mother lives 30 minutes away. Client feels closest to her cousin.

LIST OF SAMPLE ACTION VERBS Verbs to consider when writing goals: Goals are general outcome statements. Therefore, when writing goals, nonspecific and subjective verbs may be used. improve increase restore obtain reduce

decrease eliminate achieve attain control

maintain accomplish gain

Since goals are relatively vague, usually too vague to permit clear-cut determination of achievement, specific objectives which will define exactly what is trying to be accomplished must be developed.

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Verbs to sue when writing objectives: Action verbs are usually sued when writing objectives. Verbs to consider include: 1. KNOWLEDGE arrange define duplicate label list memorize name order recognize relate recall repeat reproduce quote

2. COMPREHENSION classify describe discuss explain identify indicate locate recognize report restate review select translate describe study converse engage negotiate state

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Counseling Center 1050 West 42nd Street Indianapolis, IN 46208

Clinical Intake Summary Description Client: Intake Counselor:

Date: Referring Source:

Descriptive Information:           

Age, gender, race, marital status, religion Family (i.e. single, married, children, divorced, etc.)

Work situation (i.e. employed, unemployed, in school, etc.) education housing Appearance (i.e. clothing, grooming, etc.)

Behavior (i.e. facial expressions, body language, posture, gestures, tics, gait, movements, impulse control, psychomotor agitation or retardation, etc.)

Manner of speech (i.e. volume, rate, coherence, loud, rapid, pressured, slowed, soft, hesitant, slurred, monotonous, latent etc.)

Mood: subjectively experienced feeling of the client (what the client tells you she/he feels): elevated, euphoric, expansive.

Affect: instantaneous, observable expressions of emotions, (what I see him/her feeling): i.e. broad, flat, blunt, constricted, liable, inappropriate.

Report any psychosis. Is client oriented to time, place, and person?

Presenting Problem and Goals: Describing of the client’s view of the main problem, preferably in the client’s exact words using quotation marks.  Subjective complaints (describe symptoms, e.g. irritability, sadness, marital dissatisfaction)  Brief description of the problem.

Example goals of the client  explore emotions  explore origin of depression or other maladies  reduction of depressive behavior and experience  building up alternative coping strategies

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History of the Problem:             

When did the problems begin?

Which symptoms did the client show with the first occurrence of the problem?

What initiated or exacerbated the problem?

Which symptoms started later?

How did symptoms change?

What problems existed concurrently?

What effect did the problem have on the clients functioning?

How have the clients tried to resolve it?

Why are they seeking help now?

Recent changes in life or family situation?

Was the client referred?

Current feelings?

Have they received a previous diagnosis (e.g. anxiety, depression, etc.)?

Background and Psychosexual History: 1. Description of the family of origin  Father/Mother/Siblings: age, birth order, occupations, education, attributes, religion, what were these relationships like? Typical interactional patterns?  Other relevant persons?

2. Stress factors in childhood  experience of abuse and/or violence  loss of significant persons  divorce  illness 3. Relationship history (i.e. marriages/partnerships, divorces, cohabitation, etc.)

4. Description of family of creation (biological children, adopted children, blended family?)

5. Strengths and weaknesses 6. Values 7. Self Care/hobbies

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Dynamic Formulation of the Problem: History that lead to the problem (i.e. depression as result of loss experienced, etc.)    

the dynamics of the development of the problem description of traits client’s reaction during conversation therapist’s feelings

DSM-IV CODES: Axis I: Axis II: Axis III: Axis IV: Axis V/GAF: Focus of Treatment and Recommendations:

________________________________________ (Counselor’s Name)

___________________ Date

________________________________________ (Counselor’s Signature

___________________ Date

________________________________________ (Supervisor’s Name)

___________________ Date

________________________________________ (Supervisor’s Signature)

___________________ Date

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Medical Billing & Accounting, Inc. P. O. Box 1737 Indianapolis, IN 46206-1737

317.955.2499 fax 317.955.2899

1) Please make sure PDI forms are complete and legible. I need client name, address, date of birth and phone number(s) in particular. If client is under 18 years of age, I also need this same information for their parent/guardian (center section of the “Personal Data Inventory Sheet”). If you see more than one member of a family as an identified client, each will need a completed PDI form. I also need a valid diagnosis code (most insurance companies will not reimburse for a “V” code and none of them will accept “deferred diagnosis 799.9) and a copy of the front and back of any insurance cards. I need this information the first time you see a client and when any of the information changes.

2) Charge receipts must be filled out fully. I need the date of service, the identified client’s name (first and last name, do not use nicknames). From the billing perspective, this can only be one person’s name, not a family name. I need the total fee (always $99 per hour), the subsidy amount (the difference between the full fee and the amount your client pays) and the amount paid. I need the CPT code, the type of service and the total minutes. If the receipt is for a payment only, please fill out the payment amount only. In this instance, the date should be the date that the payment was made. Missing data will result in the receipt being returned to you for correction and no hours will be recorded until the necessary information has been returned to me.

90791 – Initial intake interview (individual, family or couple) 90832 – Individual psychotherapy, 20-30 min ($49.50) 90834 – Individual psychotherapy, 45-50 min ($99.00) 90837 - Individual psychotherapy, 78-80 min ($148.50) 90785 – Interactive complexity, available in conjunction only with

Individual Therapy ($5.00)

90846 - Family therapy, patient is not present 90847 - Family therapy (also used for couples) 90853 - Group individual therapy (a group of unrelated individuals) 90849 - Group family therapy (a group of unrelated families) A word about the use of 90846. This CPT code reads “Family psychotherapy (without the patient present).”

For example, Joe Smith is your client. You have a session with his wife and children, Joe’s treatment is the focus of your session but Joe is not present. Joe’s name is entered as the “Client” on the charge receipt. This is the correct use of 90846. The type of service is “F”. This code is not acceptable for couples counseling.

3) Possession of an insurance card does not guarantee that your client is covered. It also does not guarantee that services rendered at CTS are covered services. It is your responsibility to make sure your client is eligible for coverage. It is your client’s responsibility to verify that services rendered at CTS are covered. It is also your client’s responsibility to let you know if your services require prior-authorization.

4) Verifying Medicaid eligibility is a necessary evil. There are now at least 9 different “types” of Medicaid.

That means 9 different sets of rules for everything from authorizations to billing. The type of Medicaid your client has can switch at any time depending on their status and their Primary Care Physician. The type of Medicaid is listed on the EDS Eligibility Verification and both you and I need a copy of that verification.

Please check the client’s eligibility at every visit.

If you or your clients have any questions or concerns, please feel free to give me a call at 317/955-2499 Thank you, Offsite Bookkeeper 152 Last Updated 9/2014