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Florida Laws and Rules: Social Worker, Counselor, & MFT
6 CEUs Cultural Diversity & Ethical Boundaries: Freedom from Stereotypes

Section 1
FS 491.0147 Confidentiality and Privileged Communications
(Regulation is reprinted at the end of this section)

Question 1 | CE Answer Booklet | Table of Contents
Psychologist CEs, Counselor CEUs, Social Worker CEUs, MFT CEUs

FS 491.0147 Confidentiality and privileged communications
Summary of Changes

The changes in the regulations are as follows.
Summary of changes...
As indicated below, the regulations from 2015 to 2018 had no changes.

2015 Regs
FS 491.0147
Confidentiality and privileged communications.—Any communication between any person licensed or certified under this chapter and her or his patient or client shall be confidential. This secrecy may be waived under the following conditions:
(1) When the person licensed or certified under this chapter is a party defendant to a civil, criminal, or disciplinary action arising from a complaint filed by the patient or client, in which case the waiver shall be limited to that action.
(2) When the patient or client agrees to the waiver, in writing, or, when more than one person in a family is receiving therapy, when each family member agrees to the waiver, in writing.
(3) When, in the clinical judgment of the person licensed or certified under this chapter, there is a clear and immediate probability of physical harm to the patient or client, to other individuals, or to society and the person licensed or certified under this chapter communicates the information only to the potential victim, appropriate family member, or law enforcement or other appropriate authorities. There shall be no liability on the part of, and no cause of action of any nature shall arise against, a person licensed or certified under this chapter for the disclosure of otherwise confidential communications under this subsection.

2016 Regs
FS 491.0147
Confidentiality and privileged communications.—Any communication between any person licensed or certified under this chapter and her or his patient or client shall be confidential. This secrecy may be waived under the following conditions:
(1) When the person licensed or certified under this chapter is a party defendant to a civil, criminal, or disciplinary action arising from a complaint filed by the patient or client, in which case the waiver shall be limited to that action.
(2) When the patient or client agrees to the waiver, in writing, or, when more than one person in a family is receiving therapy, when each family member agrees to the waiver, in writing.
(3) When, in the clinical judgment of the person licensed or certified under this chapter, there is a clear and immediate probability of physical harm to the patient or client, to other individuals, or to society and the person licensed or certified under this chapter communicates the information only to the potential victim, appropriate family member, or law enforcement or other appropriate authorities. There shall be no liability on the part of, and no cause of action of any nature shall arise against, a person licensed or certified under this chapter for the disclosure of otherwise confidential communications under this subsection.

 2017 Regs
FS 491.0147
Confidentiality and privileged communications.—Any communication between any person licensed or certified under this chapter and her or his patient or client shall be confidential. This secrecy may be waived under the following conditions:
(1) When the person licensed or certified under this chapter is a party defendant to a civil, criminal, or disciplinary action arising from a complaint filed by the patient or client, in which case the waiver shall be limited to that action.
(2) When the patient or client agrees to the waiver, in writing, or, when more than one person in a family is receiving therapy, when each family member agrees to the waiver, in writing.
(3) When, in the clinical judgment of the person licensed or certified under this chapter, there is a clear and immediate probability of physical harm to the patient or client, to other individuals, or to society and the person licensed or certified under this chapter communicates the information only to the potential victim, appropriate family member, or law enforcement or other appropriate authorities. There shall be no liability on the part of, and no cause of action of any nature shall arise against, a person licensed or certified under this chapter for the disclosure of otherwise confidential communications under this subsection.

2018 Regs
FS 491.0147
Confidentiality and privileged communications.—Any communication between any person licensed or certified under this chapter and her or his patient or client shall be confidential. This secrecy may be waived under the following conditions:
(1) When the person licensed or certified under this chapter is a party defendant to a civil, criminal, or disciplinary action arising from a complaint filed by the patient or client, in which case the waiver shall be limited to that action.
(2) When the patient or client agrees to the waiver, in writing, or, when more than one person in a family is receiving therapy, when each family member agrees to the waiver, in writing.
(3) When, in the clinical judgment of the person licensed or certified under this chapter, there is a clear and immediate probability of physical harm to the patient or client, to other individuals, or to society and the person licensed or certified under this chapter communicates the information only to the potential victim, appropriate family member, or law enforcement or other appropriate authorities. There shall be no liability on the part of, and no cause of action of any nature shall arise against, a person licensed or certified under this chapter for the disclosure of otherwise confidential communications under this subsection.

- Florida Legislature. (2015-2018). Chapter 491 Clinical, Counseling, and Psychotherapy Services. 491.0147 Confidentiality and privileged communications. Retrieved February 1, 2019. Retrived from http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0491/Sections/0491.0147.html

 

Confidentiality and Privileged Communications
Application Example...
3 Concepts of Ethically Consulting Colleagues

♦ Concept #1 - Client’s Best Interests
The first concept of ethically consulting colleagues is considering the client’s best interests.  In general, the client’s own confidentiality becomes the foremost factor in deciding whether or not to consult a colleague.  Many of my own colleagues are hesitant to take a client’s case to a third party, especially after the inception of the HIPAA guidelines which regulate who can receive client information and who cannot. 

However, if a client is a self-harming risk or if you yourself cannot come to a decision in order to benefit your client, bringing in a third party may be the best option for the client’s health.  When I need to make a decision about disclosing vital case information to a colleague, I weigh the consequences and the positives. 

For instance, Jared, age 18, had told me that he had suicidal thoughts continually.  He stated, "I can’t stop thinking about how much better everybody’s life would be if I would just die.  I know my parents don’t give a damn, so why shouldn’t I help them along?  They probably wouldn’t even notice I’m gone.  You can’t tell anybody this, though.  I’m an adult now, I don’t give you permission to tell my parents, so don’t!" 

Because Jared was 18, he was considered independent of his parents, even though he had not even graduated from high school.  Obviously, you can see my dilemma.  Because he had not given me explicit authorization to disclose his information to his parents, I faced the decision of choosing between honoring his request, or seeking out his parents’ help. 

In this case, because the situation was of a delicate nature, I decided to consult my colleague, Joe, who had come across a similar case in his own work.  Joe stated, "Because Jared poses a threat to himself and if you feel that he is incapable of keeping himself from harm, it is ethically appropriate for you to tell his parents, or at least encourage him to do it himself.  However, you must accept the possible consequences of a strained client-therapist relationship." 

After consulting with Joe, I decided to inform Jared’s parents.  They agreed to monitor Jared and take the proper precautions in preventing him from harming himself.  Although the future sessions between Jared and I were strained for a few weeks after, they still yielded results and Jared found a second support system in his parents.

♦ Concept #2 - Conflicts of Interest
The second concept of ethically consulting a colleague is conflicts of interest. When first approaching a fellow professional with a client’s case, I believe it is important to unearth any conflicts of interest that may be present in order to avoid breaking unnecessary boundaries of confidentiality. 

For instance, some conflicts of interest include a client who knows the colleague personally, professionally, or through a family member.  Also, I believe if a fellow colleague has certain prejudices that may apply to the client, this could most definitely affect his or her judgment. 

Charlene was treating Michael, age 43, a pedophile.  At one point in the treatment, Charlene came across a difficult decision.  Michael’s new girlfriend was the mother of a nine-year-old girl.  Even though his girlfriend knew of his past actions, she felt that if she could monitor Michael and not let him alone with her daughter, she could prevent any abuse.  Although Charlene believed developing a healthy relationship with another person was a positive step for Michael, she was not sure whether or not the presence of the child would force him to regress. 

She took her question to Marion and asked her for her opinion.  Marion responded, "That sicko is around children!  He shouldn’t be out of prison!"  Puzzled by Marion’s strong reaction to her client, Charlene was even more surprised when Marion called the police and reported that Michael had molested the daughter, even though there was no such complaint from the mother or daughter.  Later, Charlene discovered that Marion had been molested at nine years old. 

Marion’s opinion about Michael resulted from bitterness about her own trauma as a child.  Had Charlene known of Marion’s possible conflict of interest, it would not have been ethically appropriate to ask her questions about a pedophile.  Think of your own cases.  Before consulting a colleague, could he or she have any possible conflicts of interest?

♦ Concept #3 - Proper Consultation Procedure
In addition to the client’s best interests and conflicts of interest, the third concept of ethically consulting a colleague is proper consultation procedure.  Because of the new emphasis on privacy brought about by the commencement of the new HIPAA regulations, clients and healthcare workers alike become wary when a third party becomes involved in a case.  Most often, the question arises, "Is this information going to be leaked to outside sources?" 

Because of this, many healthcare workers worry about malpractice lawsuits and clients fear losing their jobs or other loved ones becoming aware of their mental health problems.  To avoid this, I find that it relieves my mind to be up to date on the proper consultation procedure in order to ensure that I have not disclosed too much information.  My number one rule:  disclose the least amount of information necessary to achieve effective advice.  To do this, I sometimes make a mental checklist of details I will disclose and details I should avoid in order to preserve the confidentiality boundary. 

Jada, age 20, was suffering from acute schizophrenia and paranoid delusions.  Although she was medicated, she did not seem to be responding to the medication.  Because I could not be sure that Jada would be a threat to herself or those around her, I decided to consult my colleague, Jeff, who has an expertise in schizophrenic clients.  

Before my consultation with Jeff, I made a mental checklist of the information I deemed appropriate to share, and information I deemed should be left out of our conversation.  The details I decided to share with him included:  her diagnosis, symptoms, age, and time-frame of the disorder.  Those details that I decided to leave out of the conversation included:  her name, family situation, and economic class.  If Jeff needed more information, then I would decide during the consultation whether or not to divulge it. Think of your Jada.  If you needed to have a consultation with one of your colleagues, what would you include in the conversation?  What would you leave out?

Online Continuing Education QUESTION 1
Under what three conditions may confidentiality and privileged communication be waived? Record the letter of the correct answer the CE Answer Booklet.


 
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