Many Managed Care Contracts Week 3 Forum Post Res

In need of a 250 word response/discussion to each of the following forum posts. Agreement/disagreement/and/or continuing the discussion.

Original forum discussion/topic post is as follows:

In what types of situations would you break confidentiality? How can you prepare clients for the issues pertaining to confidentiality? What can you do to educate clients about the purpose of confidentiality and the legal restrictions on it? How might this be different depending on the context (school, group therapy, family counseling, counseling with minors)? In your peer responses, please reflect on how your peer’s choices, examples, etc. are similar or different from your choices.

forum post response #1

In what types of situations would you break confidentiality?

Within counseling, confidentiality is considered to be an ethical and legal issue that is imposed on therapists to protect client disclosures (Corey, Corey, Corey & Callanan, 2015). Although confidentiality is considered an ethical/legal issue, clients need to be aware that there are instances in which it can be broken. One of the main situations in which confidentiality can be broken is if the client is expressing concerns related to self-harm or wanting to harm others. Another instance in which it can be broken is if a client is disclosing information about known abuse to themselves or someone whom they know.

How can you prepare clients for the issues pertaining to confidentiality?

Our textbook indicates that establishing trust within the client-therapist relationship involves making the client aware of how certain information within their file will be used. For instance, clients may ask questions pertaining to how much information that the therapist is required to give to the insurance company as well as questions about HIPAA and how it influences the confidentiality of their counseling sessions (Corey, Corey, Corey, & Callanan, 2015). To prepare clients for the issues pertaining to confidentiality, the therapist should make the client aware that laws may require the therapist to reveal sensitive client information to a third party who is responsible for authorizing further treatments. Furthermore, many managed care contracts require that the therapist submits progress notes before payment for services is issued. Because of this, it is important to teach clients about the risks associated with sharing their health information with insurance companies before treatment even begins. This will allow the client to make the executive decision as to whether or not they want to obtain treatment from managed care or seek treatment somewhere else that does not require therapists to use managed care contracts.

What can you do to educate clients about the purpose of confidentiality and the legal restrictions on it?

It is very important to ensure that a client is well aware of the legal restrictions that pertain to confidentiality. In order to educate clients about it, a therapist can discuss confidentiality with their client at the beginning of their therapy sessions. The therapist should let the client know that, in some cases, confidentiality can be broken. Such cases include reporting abuse and/or disclosing progress of treatment to insurance companies (Corey, Corey, Corey, & Callanan, 2015). The easiest way to educate clients about the purpose of confidentiality and the legal restrictions on it is to use an informed consent document. Within this document, the client is informed about many things pertaining to the expectations of the client, the therapist and the overall counseling sessions. Furthermore, information about the limitations of confidentiality, mandatory reporting requirements, and financial considerations are also discussed (Corey, Corey, Corey, & Callanan, 2015).

How might this be different depending on the context (school, group therapy, family counseling, counseling with minors)?

Confidentiality can differ based on the setting in which the therapy is taking place. For instance, within a group therapy session, a person’s personal information is being disclosed with an entire group of people rather than just the therapist. Therefore, it is more of a risk that someone may break the confidentiality outside of the group. This can also be said for family therapy sessions, although within family sessions, the risks are much lower considering the fact that those involved are not strangers like they start out at within group therapy sessions. Looking at confidentiality as it pertains to school and/or minors, a therapist would need to discuss confidentiality and get consent with the parents or legal guardians of the minor before therapy can take place. Furthermore, if the therapist feels as though it is necessary to disclose information discussed within the therapy session to the minor’s parents, they can legally do so.

Forum post response #2

Confidentiality is when something is kept a secret or private. In the field of counseling and therapy it is important that a counselor makes their client aware that all they discuss remains confidential with the exception of a few issues or concerns. There is a few situations that I feel would be presented where as a professional and counselor confidentiality would be necessary to break. First as a mandated report now, I feel the same situations would carry over. First would be that of any form of child or elderly abuse. This would come if the client disclosed to me of physical, sexual, mental, financial, or emotional abuse. A second situation that I would feel is necessary to break confidentiality is that of suicide. Following the disclosure of suicide, I would ask if the client had a plan and of they have a means. If the client is able to disclose both of these (plan & means), I would then proceed with breaking confidentiality and notifying law enforcement, and possibly those who I work with. Third, I feel I would break confidentiality if it was disclosed to me that they were planning to murder and individual, thus would also have the follow up questions of plan and means.

The most prominent way to disclose to your client and prepare them for a break in confidentiality would be through that of the initial assessment and intake. Every client has the right to an informed consent Form. This form allows for the therapist/counselor and the client to have an ethical legal obligation in which information is disclosed about the therapy process, as well as the notification of confidentiality unless the therapist/counselor is presented with the previously mentioned situations (abuse, suicide, murder). As the therapist/counselor I would be sure to maintain an informed consent both verbally and in the means of a signed document.

Along with having the informed consent, I feel the best way to educate the client about the purpose of confidentiality and the legal restrictions on it would be by taking the time to explain the therapy process, and being sure that the client fully understands the benefits and risks of therapy which is to include the legalities of confidentiality and the means in which it can be broken. Also, the client has the right to ask any questions preceding anything you had just discussed with them within the initial assessment and intake.

The contexts may vary with confidentiality based upon the environment the therapy is taking place. For example within a school, the confidentiality may include not just the therapist and client, but could include the clients parents, teacher and possibly their principal. For a group therapy session, the confidentiality would be amongst the therapist, the client, and just those who may attend the group. When counseling with minors, the confidentiality may include the therapist, the client, the parent and or guardian, or if involved in the system the Foster Parents or Case Worker. But it is important that if the environment changes, those who now are involved are help to the same ethical standard as the therapist with not breaking or breaking the confidentiality.

Forum post response #3

I am not going to lie, this week has got me a little nervous. Reading the chapter about confidentiality was a little concerning. I definitely understand all the terms and statutes but I was still incredibly unsure in the case examples about what the best course of action. Of course most of them were about where counselors breached confidentiality but some of them had me scratching my head a bit. I’m more nervous, though, about accidentally breaching confidentiality. I didn’t realize how strict the rules are about who you can talk to about a client. I wouldn’t freely speak about a client, but it still kind of shocked me. I definitely know that if a client poses and danger to themselves or others, I would have to break confidentiality. Mental health professionals have a duty to warn and a duty to protect. So, it is important that we not only take the necessary measures to ensure the safety of the client but to also do what we can to protect a potential victim. I would also break confidentiality if ordered by the court or if the client waived their privileged communication rights. Educating the clients about confidentiality and the limits of it should be done in the initial session. Personally, I think it’s a very important part of informed consent. Failing to communicate the limitations of confidentiality and their rights as a client isn’t informed consent. I would also try to make it as simple as possible to the client. The information has to be simplified for the client to easily understand. Using a lot of legal terms and language can be confusing to some clients like teenagers, adults who may not have college education or someone with a learning disability. Another thing that I would do is to remind the client about the limits of confidentiality when sensitive information comes up. For example, if I am counseling a teenage girl who discloses that she is sexually active with her boyfriend, but is afraid to tell her parents, I would remind her that what she says in the sessions are confidential and that I wouldn’t tell her parents. It is also important when counseling minors that the parents understand the confidentiality. Before starting counseling with a minor, the parents need to understand that what the client and child speak about in the sessions aren’t shared with them unless, the child’s safety or the safety of others is compromised.I do have a question though, if the parents are concerned about the progress that their child is making in counseling, is that something that can be shared if it is kept to general information? If the therapist tells the parents that their child is doing better on a certain medication or doing better in terms of self-esteem/self-worth would that be considered breach of confidentiality? Or am I overthinking?