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Florida Laws and Rules Pertaining to the Mental Health Field for SW, MFT, MH, CAC CAP Back to Course Index

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Florida Laws and Rules

Pertaining to the Mental Health Field

SW, MFT, MH, CAC, CAP

 

COURSE INFORMATION:

Learning the laws and rules of the profession is critical to keep both clients and professionals safe.  We take this responsibility seriously and you should, as well.   This course is intended to prepare you for practicing in the state of Florida.  It awards eight hours of continuing education.  Please use this time to thoroughly explore the statutes and our interpretations.  If you need one on one time with an author beyond the interactive portion required please let us know at [email protected] and we will set this up for you.  

This course consists of two parts.  This is the written/test portion.  At any time during this portion or after completing it you can take part II, the interactive portion.  The interactive portion is completed through an online chat where we review specific statutes, case studies and real disciplinary incidents. 

The entrance to the online chat is located on the home page, bottom right.  This is also where you will find the times the chats are offered, as well. We offer one chat each week either right before or right after usual business hours.

The completion of this course requires that you take both part I and part II.  We will email your certificate to you upon completion of both parts.

 

Many years ago, as an Anger Management group leader, I frequently heard group members who had been charged with assault complain, “well, I didn’t even know it was illegal to shove someone” or “I can’t believe I got arrested for throwing a phone at him!”  In their minds, they were innocent of wrong doing by virtue of their ignorance.

As I began my career in a psychiatric hospital assessment office as a counselor on a 24 hour crisis unit housed on an inpatient unit, I learned many things the hard way. For example, I learned a lesson about procedures, laws and forms after I had not had the patient sign the right documents upon admission and after I had neglected to get the appropriate releases.  One of the most heinous acts was writing an entire assessment with a blue pen only to learn that black ink was required; I had to drive back to the hospital to rewrite the entire document!  To this day, I hate to write with any color pen other than black!  Many of the mistakes I made along the way could have been avoided with a little more training. 

 

This course is not designed to teach you the ins and outs of your organization, but it is a foundation for your understanding of which of Florida’s statutes pertain to the practice of counseling and what the licensing board regulations consist of.  I, as the primary author, am not an attorney.  This course has several authors and a contributing attorney.  This course is not an attempt to interpret the law, but instead to extrapolate the chapters that pertain to our practice.  So as not to interpret, much of the course is verbatim from the Florida Statutes, these sections are in italics.  You, as the learner, will also have the ability to interact with one of the authors through a live online chat during specific times monthly listed at BaysideCEU.com.  For those who do not have access to the internet, upon request a conference call can be set up with one of the authors.  

 

The course, even in its current edited version, continues to read as a legal brief in many parts.  As some portions that were not highlighted in this course may be appropriate for your scope of practice, it is recommended you continue to research the laws and new legislature, get involved! Unfortunately, learning by doing is still the best way of retaining information and making mistakes, as we all do, frequently ensures you will not repeat those behaviors, again the blue pen episodes comes to mind.   In the sink or swim philosophy in which so many of us begin our careers, perhaps this is at least a life preserver though we would probably prefer the whole life boat!  

 

This course has a great deal of information in it, but much of this information is working knowledge that you are trained on in your work locations and you will not be expected to memorize the document, but do not ever claim, I didn’t know I could be arrested for having sex with my 16 year old client, not that I think you need to be told, but you have been dutifully educated. You are responsible for knowing the legal issues pertaining to your profession.  It takes more than a course to stay up to date and in the know!

 

Knowledge is power and ignorance is not a defense.

 

 

 

 

 

 

FLORIDA STATUTES, CHAPTER 491

CLINICAL COUNSELING

 

Chapter 491 speaks directly concerning the Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling.  The board is made up of nine members appointed by the Governor and confirmed by the Senate. 

 

The nine members include, two licensed practicing clinical social workers, two licensed practicing marriage and family therapists, two licensed practicing mental health counselors and three citizens of the state who are not and have never been licensed in a mental health-related profession and who are in no way connected with the practice of any such profession.

 

The board adopts, implements and enforces the rules.

 

Don’t Make the Same Mistake!

Know the Florida Laws and Rules.

 

We regularly attend the Florida Board of Clinical Social Work, Marriage & Family Therapy and Mental Health Counseling board meetings and bring to you REAL disciplinary proceedings and the outcomes, with the names removed, to help drive home how important it is to really comprehend the statutes.  It’s crucial to helping clients and it is critical to your career.

 

Intern Practicing Without Supervision

 

An administrative complaint filed against XXX, an intern working toward his LMHC, for alleged violation of s.491.009(1)(w), F.S., through a violation of s.491.005(4)(c), F.S., regarding private practice without supervision on the premises while providing services.  XXX was present at the disciplinary hearing and was represented by counsel.

 

Outcome:  A settlement agreement was presented to the Board with the following terms:  appearance, fine of $250.00 and costs not to exceed $2,500 within 90 days; letter of concern; 8 hours CE laws and rules course; and a laws and rules affidavit within 30 days.

 

Actual costs:  $1,624.00

 

Statute states:

491.005 (4) MENTAL HEALTH COUNSELING,-Upon verification of documentation and payment of a fee not to exceed $200, as set by board rule,plus the actual per applicant cost to the department for puchase of the examination from the Professional Examination Service for the National Academy of Certified Clinical Mental Health Counselors or a similar national organization, the department shall issue a license as a mental health counselor to an applicant who the board certifies:

 

(c)Has had not less than 2 years of clinical experience in mental health counseling, which must be at the post-master’s level under the supervision of a licensed mental health counselor or the equivalent who is a qualified supervisor as determined by the board.  An individual who intends to practice in Florida to satisfy the clinical experience  requirements must register pursuant to s.491.0045 prior to commencing practice.  If a graduate has a master’s degree with a major related to the practice of mental health counseling that did not include all the coursework required under subparagraphs (b)1a.-b., as determined by the board, one of which must be a course in psychopathology or abnormal psychology.  A doctoral internship may be applied toward the clinical experince requirement.  The clinical experience requirement may be met work performed on or off the premises of the supervising mental health counselor or the equivalent, provided the off-premises work is not the independent private practice rendering of services that does not have a licensed mental health professional, as determined by the board, on the premises at the same time the intern is providing services.

 

 

INTERN

Anyone who intends to practice in Florida to satisfy the postgraduate or post-master’s level experience requirements must register as an intern prior to beginning field work.

 

The department will register as a clinical social worker intern, marriage and family therapist intern, or mental health counselor intern an applicant who the board certifies has:

(a)  Completed the application form and remitted a nonrefundable application fee not to exceed $200, as set by board rule;

(b)  1.  Completed the education requirements as specified in s. 491.005(1)(c), (3)(c), or (4)(c) for the profession for which he or she is applying for licensure, if needed;

and

      2.  Submitted an acceptable supervision plan, as determined by the board, for meeting the practicum, internship, or field work required for licensure that was not satisfied in his or her graduate program.

(c)  Identified a qualified supervisor.

 

 

A registered intern must be under supervision until they become licensed. 

 

LICENSES

There are four types of licenses:

1) Provisional license

2) Licensure by examination

3) Dual Licensure as a Marriage and Family Therapist

4) Licensure or certification by endorsement

 

PROVISIONAL LICENSE

The department shall issue a provisional clinical social worker license, provisional marriage and family therapist license, or provisional mental health counselor license to each applicant who the board certifies has:

(a)  Completed the application form and remitted a nonrefundable application fee not to

       exceed $100, as set by board rule; and

(b)  Earned a graduate degree in social work, a graduate degree with a major emphasis

       in marriage and family therapy or a closely related field, or a graduate degree in a

       major related to the practice of mental health counseling; and

(c)  Has met the following minimum coursework requirements:

1.   For clinical social work, a minimum of 15 semester hours or 22 quarter hours of the

      coursework required by s. 91.005(1)(b)2.b.

2.   For marriage and family therapy, 10 of the courses required by s. 491.005(3)(b)1.a.-c., as determined by the board, and atleast 6 semester hours or 9 quarter hours of the course credits must have been completed in the area of marriage and family systems, theories, or techniques.

3.  For mental health counseling, a minimum of seven of the courses required under s.

     491.005(b)1.a.-c.

 

A provisional licensee must work under the supervision of a licensed mental health professional. 

The provisional license expires 24 months after the date it is issued and may not be renewed or reissued.

 

LICENSURE BY EXAMINATION

There are three designations, Licensed Clinical Social Worker, Licensed Marriage and Family Therapist and Licensed Mental Health Counselor.

 

CLINICAL SOCIAL WORK

Upon verification of documentation and payment of a fee the department will issue a license as a clinical social worker to an applicant who the board certifies:

(a)  Has made application therefore and paid the appropriate fee.

(b)1.  Has received a doctoral degree in social work from a graduate school of social work which at the time the applicant graduated was accredited by an accrediting agency recognized by the United States Department of Education or has received a master’s degree in social work from a graduate school of social work which at the time the applicant graduated:

a.  Was accredited by the Council on Social Work Education;

b.  Was accredited by the Canadian Association of Schools of Social Work; or

c.  Has been determined to have been a program equivalent to programs approved by the Council on Social Work Education by the Foreign Equivalency Determination Service of the Council on Social Work Education. An applicant who graduated from a program at a university or college outside of the United States or Canada must present documentation of the equivalency determination From the council in order to qualify.

2.  The applicant’s graduate program must have emphasized direct clinical patient or client health care services, including, but  not limited to, coursework in clinical social work, psychiatric social work, medical social work, social casework, psychotherapy, or group therapy. The applicant’s graduate program must have included all of the following coursework:

        a.  A supervised field placement which was part of the applicant’s advanced

             concentration in direct practice, during which the applicant provided clinical

             services directly to clients.

        b.  Completion of 24 semester hours or 32 quarter hours in theory of human

             behavior and practice methods as courses in clinically oriented services,

             including a minimum of one course in psychopathology, and no more than one

             course in research, taken in a school of social work accredited or approved

             pursuant to subparagraph 1.

3.  If the course title which appears on the applicant’s transcript does not clearly identify the content of the coursework, the applicant shall be required to provide additional documentation, including, but not limited to, a syllabus or catalog description published for the course.

(c)  Has had not less than 2 years of clinical social work experience, which took place subsequent to completion of a graduate degree in social work at an institution meeting the 

accreditation requirements of this section, under the supervision of a licensed clinical social worker or the equivalent who is a qualified supervisor as determined by the board. An individual

who  intends to practice in Florida to satisfy clinical experience requirements must register pursuant to s. 491.0045 prior to commencing practice. If the applicant’s graduate program was not a program which emphasized direct clinical patient or  client health care services as described in subparagraph (b)2., the supervised experience requirement must take place after the applicant has completed a minimum of 15 semester hours or 22 quarter hours of the coursework required. A doctoral internship may be applied toward the clinical social work experience requirement.  The experience requirement may be met by work performed on or off the premises of the supervising clinical social worker or the equivalent, provided the off-premises work is not the independent private practice rendering of clinical social work that does not have a licensed mental health professional, as determined by the board, on the premises at the same time the intern is providing services.

(d)  Has passed a theory and practice examination provided by the department for this

       purpose.

(e)  Has demonstrated, in a manner designated by rule of the board, knowledge of the

      laws and rules governing the practice of clinical social work, marriage and family

      therapy, and mental health counseling.

Notwithstanding the provisions of paragraph (1)(b), coursework which was taken at a baccalaureate level shall not be considered toward completion of education requirements for licensure unless an official of the graduate program certifies in writing on the graduate school’s stationery that a specific course, which students enrolled in the same graduate program were ordinarily required to complete at the graduate level, was waived or exempted based on completion of a similar course at the baccalaureate level. If this condition is met, the board shall apply the baccalaureate course named toward the education requirements.

(b)  An applicant from a master’s or doctoral program in social work which did not emphasize direct patient or client services may complete the clinical curriculum content requirement by returning to a graduate program accredited by the Council on Social Work Education or the Canadian Association of Schools of Social Work, or to a clinical social work graduate program with comparable standards, in order to complete the education requirements for examination.

However, a maximum of 6 semester or 9 quarter hours of the clinical curriculum content requirement may be completed by credit awarded for independent study coursework as defined by board rule.

 

 

MARRIAGE AND FAMILY THERAPY

Upon verification of documentation and payment of a fee not to exceed $200, as set by board rule, plus the actual cost to the department for the purchase of the examination from the Association of Marital and Family Therapy Regulatory Board, or similar national organization, the department shall issue a license as a marriage and family therapist to an applicant who the board certifies:

(a)  Has made application therefore and paid the appropriate fee.

(b)1.  Has a minimum of a master’s degree with major emphasis in marriage and family therapy, or a closely related field, and has completed all of the following requirements:

a.  Thirty-six semester hours or 48 quarter hours of graduate coursework, which must include a minimum of 3 semester hours or 4 quarter hours of graduate- level course credits in each of the following nine areas: dynamics of marriage and  family systems; marriage therapy and counseling theory and techniques; family therapy and counseling theory and techniques; individual human development theories throughout the life cycle; personality theory or general

counseling theory and techniques; psychopathology; human sexuality theory and counseling techniques; psychosocial theory; and substance abuse theory and  counseling techniques. Courses in research, evaluation, appraisal, assessment, or testing theories and procedures; thesis or dissertation work; or practicums, internships, or fieldwork may not be applied toward this requirement.

b.  A minimum of one graduate-level course of 3 semester hours or 4 quarter hours in legal, ethical, and professional standards issues in the practice of marriage and family therapy or a course determined by the board to be equivalent.

c.  A minimum of one graduate-level course of 3 semester hours or 4 quarter hours in diagnosis, appraisal, assessment, and testing for individual or interpersonal disorder or dysfunction; and a minimum of one 3-semester-hour or 4-quarter-hour graduate-level course in behavioral research which interpretation and application of research data as it applies to clinical practice.  Credit for thesis or dissertation work, practicums, internships, or fieldwork may not be applied toward this requirement.

d.  A minimum of one supervised clinical practicum, internship, or field experience in a marriage and family counseling setting, during which the student provided 180 direct client contact hours of marriage and family therapy services under the supervision of an individual who met the requirements for supervision under paragraph (c). This requirement may be met by a supervised practice experience which took place outside the academic arena, but which is certified as equivalent to a graduate-level practicum or internship program which required a minimum of 180 direct client contact hours of marriage and family therapy services currently offered within an academic program of a college or university accredited by an accrediting agency approved by the United States Department of Education, or an institution which is publicly recognized as a member in good standing with the Association of Universities and Colleges of Canada or a training institution accredited by the Commission on Accreditation for Marriage and Family Therapy Education recognized by the United States Department of Education. Certification shall be required from an official of such college, university, or training institution.

  

2.  If the course title which appears on the applicant’s transcript does not clearly identify the content of the coursework, the applicant shall be required to provide additional documentation, including, but not limited to, a syllabus or catalog description published for the course.

The required master’s degree must have been received in an institution of higher
education which at the time the applicant graduated was: fully accredited by a regional accrediting body recognized by the Commission on Recognition of Postsecondary Accreditation; publicly recognized as a member in good standing with the Association of Universities and Colleges of Canada; or an institution of higher education located outside the United States and Canada, which at the time the applicant was enrolled and at the time the applicant graduated maintained a standard of training substantially equivalent  to the standards of training of those institutions in the United States which are accredited by a regional accrediting body recognized by the Commission on Recognition of Postsecondary Accreditation. Such foreign education and training must have been received in an institution or program of higher education officially recognized by the government of the country in which it is located as an institution or program to train students to practice as professional marriage and family therapists or psychotherapists. The burden of establishing that the requirements of this provision have  been met shall be upon the applicant, and the board shall require documentation, such as, but not limited to, an evaluation by a foreign equivalency determination service, as evidence that the applicant’s graduate degree program and education were equivalentto an accredited program in this country. An applicant with a master’s degree from a program which did not emphasize  marriage and family therapy may complete the coursework requirement in a training institution fully accredited by the Commission on Accreditation for Marriage and Family Therapy Education recognized by the United States Department of Education.

(c)  Has had not less than 2 years of clinical experience during which 50 percent of the applicant’s clients were receiving marriage and family therapy services, which must be at the masters level and family therapist with at least 5 years of experience, or the equivalent, who is a qualified supervisor as determined by the board. An individual who intends to practice in Florida to satisfy the clinical experience requirements must register pursuant  to s. 491.0045 prior to commencing practice. If a graduate has a master’s degree with a major emphasis in marriage and family therapy or a closely related field that did not include all the coursework required under sub-subparagraphs (b)1.a.-c.,  credit for the post-master’s level clinical experience shall not commence until the applicant has completed a minimum of 10 of the courses required under sub-subparagraphs (b)1.a.-c., as determined by the board, and at least 6 semester hours or 9 quarter hours of the course credits must have been completed in the area of

marriage and family systems, theories, or techniques. Within the 3 years of required

experience, the applicant shall provide direct individual, group, or family therapy

and counseling, to include the following categories of cases: unmarried dyads, married couples, separating and divorcing couples, and family groups including children. A doctoral internship may be applied toward the clinical experience requirement. The clinical experience requirement may be met by work performed on or off the premises of the supervising marriage and family therapist or the equivalent, provided the off-premises work is not the independent private practice rendering of marriage and family therapy services that does not have a licensed mental health professional, as determined by the board, on the premises at the same time the intern is  providing services.

(d)  Has passed a theory and practice examination provided by the department for this purpose.

(e)  Has demonstrated, in a manner designated by rule of the board, knowledge of the laws and rules governing the practice of  clinical social work, marriage and family therapy, and mental health counseling.

(f)  For the purposes of dual licensure, the department shall license as a marriage and family therapist any person who meets the requirements of s. 491.0057. Fees for dual licensure shall not exceed those stated in this subsection.

 

 

 

MENTAL HEALTH COUNSELING

Upon verification of documentation and payment of a fee not to exceed $200, as set by board rule, plus the actual per applicant cost to the department for purchase of the examination from the Professional Examination Service for the National Academy of Certified Clinical Mental Health Counselors or a similar national organization, the department shall issue a license as a mental health counselor to an applicant who the board certifies:

(a)  Has made application therefore and paid the appropriate fee.

(b)1.  Has a minimum of an earned master’s degree from a mental health counseling program accredited by the Council for the Accreditation of Counseling and Related Educational Programs that consists of at least 60 semester hours or 80 hours of clinical and didactic instruction, including a course in human sexuality and a course in substance abuse. If the master’s degree is earned from a program related to the practice of mental health counseling that is by the Council for the Accreditation of Counseling and Related Educational Programs, then the coursework and practicum,  internship, or fieldwork must consist of at least 60 semester hours or 80 quarter hours and meet the following requirements:

a.  Thirty-three semester hours or 44 quarter hours of graduate coursework, which must include a minimum of 3 semester hours or 4 quarter hours of graduate-level coursework in each of the following 11 content areas: counseling theories and practice; human growth and development; diagnosis and treatment of psychopathology; human sexuality; group theories and practice; individual evaluation and assessment; career and lifestyle assessment; research and program evaluation; social and cultural foundations; counseling in community settings; and substance abuse. Courses in research, thesis or dissertation work, practicums, internships, or fieldwork may not be applied toward this requirement.

b.  A minimum of 3 semester hours or 4 quarter hours of graduate-level coursework in legal, ethical, and professional standards issues in the practice of mental health counseling, which includes goals, objectives, and practices of professional counseling organizations, codes of ethics, legal considerations, standards of preparation, certifications and licensing, and the role identity and professional obligations of mental health counselors. Courses in research, thesis

or dissertation work, practicums, internships, or fieldwork may not be applied toward this requirement.

c.  The equivalent, as determined by the board, of at least 1,000 hours of university-sponsored supervised clinical practicum, internship, or field experience as required in the accrediting standards of the Council for Accreditation of Counseling and Related Educational Programs for mental health counseling programs. This experience may not be used to satisfy the post-master’s clinical experience requirement.

2.  If the course title which appears on the applicant’s transcript does not clearly identify the  additional documentation, including, but not limited to, a syllabus or catalog description published for the course.

Education and training in mental health counseling must have been received in an institution of higher education which at the time the applicant graduated was: fully accredited by a regional accrediting body recognized by the Commission on Recognition of Postsecondary Accreditation; publicly recognized as a member in good standing with the Association of Universities and Colleges of Canada; or an institution of higher education located outside the United States and Canada, which at the time the applicant was enrolled and at the time the applicant graduated maintained a standard of training substantially equivalent to the standards of training of those institutions in the United States which are accredited by a regional accrediting body recognized by the Commission on Recognition of Postsecondary Accreditation. Such foreign education and training must have been received in an institution or program of higher education officially recognized by the government of the country in which it is located as an institution or program to train students to practice as mental health counselors. The burden of establishing that the requirements of this provision have been met shall be upon the applicant, and the board shall require documentation, such as, but not limited to, an evaluation by a foreign equivalency determination service, as evidence that the applicant’s graduate degree program and education were equivalent to an accredited program in this country.

 

(c)  Has had not less than 2 years of clinical experience in mental health counseling, which must be at the post-master’s level under the supervision of a licensed mental health counselor or the equivalent who is a qualified supervisor as determined by the board. An individual who intends to practice in Florida to satisfy the clinical experience requirements must register pursuant to s. 491.0045 prior to commencing practice. If a graduate has a master’s degree with a major related to the practice of mental health counseling that did not include all the coursework required under sub-subparagraphs (b)1.a.-b., credit for the post-master’s level clinical experience shall not commence until the applicant has completed a minimum of seven of the courses required under sub-subparagraphs (b)1.a.-b., as determined by the board, one of which must be a course in psychopathology or abnormal psychology. A doctoral internship may be applied toward the clinical experience requirement. The clinical experience requirement may be met by work performed on or off the premises of the supervising mental health counselor or the equivalent, provided the off-premises work is not the independent private practice rendering of services that does not have a licensed mental health professional, as determined by the board, on the premises at the same time the intern is providing services.

(d)  Has passed a theory and practice examination provided by the department for this purpose.

(e)  Has demonstrated, in a manner designated by rule of the board, knowledge of the laws and rules governing the practice of clinical social work, marriage and family therapy, and mental health counseling.

 

 

This is the method utilized by an individual who is registered as an intern and has satisfied all of the educational requirements for the profession.   

 

DUAL LICENSURE AS A MARRIAGE AND FAMILY THERAPIST

The qualification for this dual licensure include a valid, active license for at least 3 years as psychologist, as a clinical social worker or mental health counselor or is certified under s. 464.012 as an advanced registered nurse practitioner who has been determined by the Board of Nursing as a specialist in psychiatric mental health and passing the examination provided by the department for marriage and family therapy.

 

LICENSURE OR CERTIFICATION BY ENDORSEMENT

If an applicant holds an active license in another state, and has practiced for 3 out of the last 5 years they may apply for licensure by endorsement if they meet the following criteria:

1.  Has demonstrated, in a manner designated by rule of the board, knowledge of the

     laws and rules governing the practice of clinical social work, marriage and family

     therapy, and mental health counseling.

2.  Meets the education requirements of this chapter for the profession for which

     licensure is applied.

3.  Has passed a substantially equivalent licensing examination in another state or has

     passed the licensure examination in this state in the profession for which the applicant

     seeks licensure.

4.  Holds a license in good standing, is not under investigation for an act that would

     constitute a violation of this chapter, and has not been found to have committed any

     act that would constitute a violation of this chapter. The fees paid by any

     applicant for certification as a master social worker under this section are

     nonrefundable.

   * The department shall not issue a license or certificate by endorsement to any    

      applicant who is under investigation in this or another jurisdiction for an act which

      would constitute a violation of this chapter until such time as the investigation is

      complete, at which time the provisions of s. 491.009 shall apply.

 

RENEWALS

A license must be renewed  every 2 years.  The board sets the rules and fees for renewal. 

 

INACTIVE STATUS

If an applicant requests, for example to save fees during a period where they will not be practicing, they can be put in inactive status and pay a $50.00 renewal fee every 2 years.  They can reactivate their license by submitting an application, fee, completing the continuing education requirements and complying with any other requirement such as a background check.  

 

CONTINUING EDUCATION

The board specifies requirements regarding the completion of continuing education for license renewal. Continuing education providers, programs, and courses and laws and rules courses and their providers and programs must be approved by the board.

No continuing education is required for the first renewal of licensure.  For each subsequent renewal, the licensee must complete 30 hours of approved continuing education credit.

The required courses include:

(a) Two hours on the prevention of medical errors; and

(b) Three hours relating to professional ethics and boundary issues or telehealth. These courses may be taken in any order, however, the same course may not be taken in consecutive renewal periods.

(3) Within six months of initial licensure and every third renewal thereafter, a licensee must complete a two-hour continuing education course on domestic violence.

(4) Every third renewal after initial licensure, a licensee must complete three hours of laws and rules continuing education units.

(5) Every third renewal, a qualified supervisor shall obtain four hours of supervisory training continuing education that meets the requirements in subsection 64B4-6.0025(4), F.A.C.

(6) A maximum of six of the required 30 hours of continuing education may be accrued for credit during each renewal period by attending programs designed for the purpose of enhancing the licensee’s administrative, office management, or other non-clinical skills.

(7) Continuing education hours completed by a licensee to satisfy any disciplinary action shall be in addition to those required for renewal.

 

 

DISCIPLINE

The following are actions that would constitute disciplinary action according to Florida Statue 491:

 

 (a)  Attempting to obtain, obtaining, or renewing a license, registration, or certificate

        under this chapter by bribery or fraudulent misrepresentation or through an error of

        the board or the department.

(b)  Having a license, registration, or certificate to practice a comparable profession

      revoked, suspended, or otherwise acted against, including the denial of certification

      or licensure by another state, territory, or country.

(c)  Being convicted or found guilty of, regardless of adjudication, or having entered a

       plea of nolo contendere to, a crime in any jurisdiction which directly relates to the

       practice of his or her profession or the ability to practice his or her profession.

      However, in the case of a plea of nolo contendere, the board shall allow the person

      who is the subject of the disciplinary  proceeding to present evidence in mitigation

      relevant to the underlying charges and circumstances surrounding the plea.

(d)  False, deceptive, or misleading advertising or obtaining a fee or other thing of value

      on the representation that beneficial results from any treatment will be guaranteed.

(e)  Advertising, practicing, or attempting to practice under a name other than one’s own.

(f)  Maintaining a professional association with any person who the applicant, licensee,

      registered intern, or certificate holder

     knows, or has reason to believe, is in violation of this chapter or of a rule of the

     department or the board.

(g)  Knowingly aiding, assisting, procuring, or advising any nonlicensed, nonregistered,

      or noncertified person to hold himself or herself out as licensed, registered, or

      certified under this chapter.

(h)  Failing to perform any statutory or legal obligation placed upon a person licensed,

       registered, or certified under this chapter.

(i)  Willfully making or filing a false report or record; failing to file a report or record

     required by state or federal law; willfully impeding or obstructing the filing of a

     report or record; or inducing another person to make or file a false report or record 

     or to impede or obstruct the filing of a report or record. Such report or record

     includes only a report or record which requires the signature of a person licensed,

     registered, or certified under this chapter.

(j)  Paying a kickback, rebate, bonus, or other remuneration for receiving a patient or

     client, or receiving a kickback, rebate, bonus, or other remuneration for referring a

     patient or client to another provider of mental health care services or to a

     provider of health care services or goods; referring a patient or client to oneself for

    services on a fee-paid basis when those services are already being paid for by some

     other public or private entity; or entering into a reciprocal referral agreement.

(k)  Committing any act upon a patient or client which would constitute sexual battery or

       which would constitute sexual misconduct as defined pursuant to s. 491.0111.

(l)  Making misleading, deceptive, untrue, or fraudulent representations in the practice of

     any profession licensed, registered, or certified under this chapter.

(m)  Soliciting patients or clients personally, or through an agent, through the use of

       fraud, intimidation, undue influence, or a form of overreaching or vexatious conduct.

(n)  Failing to make available to a patient or client, upon written request, copies of tests,

       reports, or documents in the possession or under the control of the licensee,

      registered intern, or certificate holder which have been prepared for and paid for by

      the  patient or client.

(o)  Failing to respond within 30 days to a written communication from the department

       or the board concerning any investigation by the department or the board, or failing

       to make available any relevant records with respect to any investigation about the

      licensee’s, registered intern’s, or certificate holder’s conduct or background.

(p)  Being unable to practice the profession for which he or she is licensed, registered, or

     certified under this chapter with reasonable skill or competence as a result of any

     mental or physical condition or by reason of illness; drunkenness; or  excessive use o

     of drugs, narcotics, chemicals, or any other substance. In enforcing this paragraph,

     upon a finding by the secretary, the secretary’s designee, or the board that probable

    cause exists to believe that the licensee, registered intern, or certificate holder is

    unable to practice the profession because of the reasons stated in this paragraph, the

    department shall have the authority to compel a licensee, registered intern, or

    certificate holder to submit to a mental or physical examination by psychologists,

     physicians, or other licensees under this chapter, designated by the department or

    board. If the licensee, registered intern, or certificate holder refuses to comply with

    such order, the department’s order directing the examination may be enforced by filing

    a petition for enforcement in the circuit court in the circuit in which the licensee,

    registered intern, or certificate holder resides or does business. The licensee,

    registered intern, or certificate holder against whom the petition is  filed shall not be

    named or identified by initials in any public court records or documents, and the

     proceedings shall be closed to the public. The department shall be entitled to the

    summary procedure provided in s. 51.011. A licensee, registered intern,  or certificate

    holder affected under this paragraph shall at reasonable intervals be afforded an

    opportunity to demonstrate that he or she can resume the competent practice for which

    he or she is licensed, registered, or certified with reasonable skill and safety to

    patients.

(q)  Performing any treatment or prescribing any therapy which, by the prevailing

      standards of the mental health professions in the community, would constitute

      experimentation on human subjects, without first obtaining full, informed, and written

     consent.

(r)  Failing to meet the minimum standards of performance in professional activities

     when measured against generally prevailing  peer performance, including the

     undertaking of activities for which the licensee, registered intern, or certificate holder

     is not  qualified by training or experience.

(s)  Delegating professional responsibilities to a person whom the licensee, registered

      intern, or certificate holder knows or has  reason to know is not qualified by training

      or experience to perform such responsibilities.

(t)  Violating a rule relating to the regulation of the profession or a lawful order of the

     department or the board previously entered in a disciplinary hearing.

(u)  Failure of the licensee, registered intern, or certificate holder to maintain in

      confidence a communication made by a patient or client in the context of such

      services, except as provided in s. 491.0147.

(v) Making public statements which are derived from test data, client contacts, or

     behavioral research and which identify or damage research subjects or clients.

(w)  Violating any provision of this chapter or chapter 456, or any rules adopted

      pursuant thereto.

(2)  The department, or, in the case of 1psychologists, the board, may enter an order

     denying licensure or imposing any of the penalties in s. 456.072(2) against any

      applicant for licensure or licensee who is found guilty of violating any provision of

      subsection (1) of this section or who is found guilty of violating any provision of s.

     456.072(1).

 

 

TITLES AND PRACTICE

The statutes specify the terminology and practice must be corroborated by the education, qualifications and license the professional holds.

 

THE FLORIDA STATUTE,

CHAPTER 90

 

PSYCHOTHERAPIST – PATIENT PRIVILEGE

 

Privilege means a person can prevent the disclosure of confidential communication made during assessment, diagnosis and/or treatment.  What can be said by a counselor or therapist, when and why.  Questions arise surrounding privilege pertaining to individual therapy, marriage and family and group sessions.  What happens when the court is involved? 

The Florida Statute, Chapter 90 provides specific rules regarding what may be revealed in court, the patients right to confidentiality and the exceptions.  It is crucial for a counselor to have a firm understanding of these laws and to ensure that their client understands the limitations to confidentiality.  It is a best practice to have a clear explanation of the limits to confidentiality in the clients consent forms that are signed prior to the first assessment or therapy session.

 

A counselor in private practice found two office staff browsing through client’s clinical records on their lunch hour.  They were talking about the clients, reading progress notes and such.  Should they be fired for breaching confidentiality?

 

Answer:  The counselor should reprimand the staff and advise them that the client’s communications are privileged information.  They have access to the files because they are necessary for the transmission of the information, but perusing them for entertainment is inappropriate. 

 

According to the Florida Statutes and for the purposes of this course a psychotherapist is defined as:

 

1) a person authorized to practice medicine in any state or nation, or reasonably believed by the patient so to be, who is engaged in the diagnosis or treatment of a mental or emotional condition, including alcoholism and other drug addiction; 

 

2) a person licensed or certified as a psychologist under the laws of any state or nation, who is engaged primarily in the diagnosis or treatment of a mental or emotional condition, including alcoholism and other drug addiction;

 

3) a person licensed or certified as a clinical social worker, marriage and family therapist, or mental health counselor under the laws of this state, who is engaged primarily in the diagnosis or treatment or a mental or emotional condition, including alcoholism and other drug addiction;

 

4) treatment personnel of facilities licensed by the state pursuant to chapter 394, chapter 395, or chapter 397, of facilities designated by the Department of Children and Family Services pursuant to chapter 394 as treatment facilities, or of facilities defined as community mental health centers pursuant to s. 394.907(1), who are engaged primarily in the diagnosis or treatment of a mental or emotional condition, including alcoholism and other drug addiction; or

 

5)  An advanced registered nurse practitioner certified under s. 464.012, whose primary scope of practice is the diagnosis or treatment of mental or emotional conditions, including chemical abuse, and limited only to actions performed in accordance with part I of chapter 464.

 

1By virtue of the fact that you are taking this course you likely fit in somewhere there.

 

The patient is the person who consults, or is interviewed by, a psychotherapist for purposes of diagnosis or treatment of a mental or emotional condition, including alcoholism and other drug addiction.

 

Florida law considers communication between a patient and a therapist as confidential, but with so many things there are exceptions.

  

Confidentiality is made vulnerable and certain information may be shared with persons who are present to further the interest of the patient in consultation, examination or interview, those persons necessary for the transmission of the communication such as translator, or those persons who are participating in the diagnosis and treatment under the direction of the psychotherapist. 

 

Privilege does not protect communications relevant to the process of ensuring involuntary hospitalization of a patient when necessary.  It also does not protect information gathered during court ordered examinations or for communications relevant to an issue of the mental or emotional condition of the patient in any proceeding in which the patient relies upon the condition as an element of his or her claim or condition as an element of the partys claim or defense. 

 

Janet is a 23 year old female voluntarily in outpatient counseling for her inability to control her anger.  She has been written up at work on two occasions for arguing with a co-worker and then with her boss.  During both incidents Janet lost control to the extent she slammed doors and file cabinet drawers.  She came to you for help on her own.  When she told her employer she was in counseling they were relieved.  She was hoping the counseling might save her from being fired and certainly help her control her outbursts.   The employer called you asking if in your opinion she was safe to be around co-workers and clients.  Can you talk with them?

 

Answer:  No.  Unless Janet signs a release with a specific name of a supervisor listed, you may not give any information about whether Janet is a client or not; how she is doing in treatment; if she is attending or not; or give your opinion as to whether she should be around her co-workers.  If, in your clinical opinion, Janet becomes a danger to herself or others, there are other issues to address.

This chapter also defines privilege between a victim and a sexual assault counselor:

 

(a)A rape crisis center is any public or private agency that offers assistance to victims of sexual assault or sexual battery and their families.

 

(b)A sexual assault counselor is any employee of a rape crisis center whose primary purpose is the rendering of advice, counseling, or assistance to victims of sexual assault or sexual battery.

 

(c)A trained volunteer is a person who volunteers at a rape crisis center, has completed 30 hours of training in assisting victims of sexual violence and related topics provided by the rape crisis center, is supervised by members of the staff of the rape crisis center, and is included on a list of volunteers that is maintained by the rape crisis center.

 

(d)A victim is a person who consults a sexual assault counselor or a trained volunteer for the purpose of securing advice, counseling, or assistance concerning a mental, physical, or emotional condition caused by a sexual assault or sexual battery, an alleged sexual assault or sexual battery, or an attempted sexual assault or sexual battery.

 

Communication between a sexual assault counselor or trained volunteer and a victim is confidential if it is not intended to be disclosed to third persons.  The exception include those persons present to further the interests of the victim in the consultation, examination or review; those person necessary for the transmission of the communication and those persons to whom disclosure is reasonably necessary to accomplish the purposes for which the sexual assault counselor or the trained volunteer is consulted.

    

A victim has a privilege to refuse to disclose, and to prevent any other person from disclosing, a confidential communication made by the victim to a sexual assault counselor or trained volunteer or any record made in the course of advising, counseling, or assisting the victim. Such confidential communication or record may be disclosed only with the prior written consent of the victim. This privilege includes any advice given by the sexual assault counselor or trained volunteer in the course of that relationship.

    

The privilege may be claimed by the victim, the victims attorney, a guardian of the victim, the personal representative of a deceased victim, and the sexual assault counselor or trained volunteer, but only on behalf of the victim.

 

Privilege regarding the domestic violence relationship is also covered:

 

(a) domestic violence center is any public or private agency that offers assistance to victims of domestic violence.

 

(b)A domestic violence advocate means any employee or volunteer who has 30 hours of training in assisting victims of domestic violence and is an employee of or volunteer for a program for victims of domestic violence whose primary purpose is the rendering of advice, counseling, or assistance to victims of domestic violence.

 

(c)A victim is a person who consults a domestic violence advocate for the purpose of securing advice, counseling, or assistance concerning a mental, physical, or emotional condition caused by an act of domestic violence, an alleged act of domestic violence, or an attempted act of domestic violence.

 

A communication between a domestic violence advocate and a victim is confidential if it relates to the incident of domestic violence for which the victim is seeking assistance and if it is not intended to be disclosed to third persons other than those persons present to further the interest of the victim in the consultation, assessment, or interview; those persons to whom disclosure is reasonably necessary to accomplish the purpose for which the domestic violence advocate is consulted.

 

A victim has a privilege to refuse to disclose, and to prevent any other person from disclosing, a confidential communication made by the victim to a domestic violence advocate or any record made in the course of advising, counseling, or assisting the victim. The privilege applies to confidential communications made between the victim and the domestic violence advocate and to records of those communications only if the advocate is registered under s. 39.905 at the time the communication is made. This privilege includes any advice given by the domestic violence advocate in the course of that relationship.

 

In summary, Chapter 90 focuses on privilege between a psychotherapist,  sexual assault counselor, domestic violence advocate and the client.  All communication is privileged and should not be released without consent.  If you are ordered by the court to divulge communication see advice from a supervisor and attorney.

 

 

Florida Statute Chapter 39

Children and Child Protection Laws

 

 

The Florida Statute, Chapter 39 provides an overview for proceedings relating to children and child protection laws.  Whether you are in private practice, a school counseling position or working in a facility it is important to familiarize yourself with these rules, particularly those related to child abuse reporting, investigating and terminating parental rights.

 

Suzie is a 7 year old child who attends elementary school.  As a community crisis counselor you are called in by the school board to do an assessment because Suzie blurted out in class that she wishes she was dead.  While talking with Suzie you see bruises on her upper arms and she shows you a bruise on the back of her neck under her hair.  Do you have to report this to a governmental agency?  Who do you report your suspicions to?  Do you have to give your name?

 

Read on

 

There are several important points concerning children’s services to keep in mind.  Let’s explore some of the most pertinent definitions spelled out in the Chapter 39.  These definitions are sometimes shortened to the most relevant portions for the purposes of this course.  For a more complete definition and to view the entire list please refer to the Florida Statute, Chapter 39.

 

Abandoned or abandonment means a situation in which the parent or legal custodian of a child or, in the absence of a parent or legal custodian, the caregiver, while being able, has made no significant contribution to the child’s care and maintenance or has failed to establish or maintain a substantial and positive relationship with the child, or both. For purposes of this subsection, establish or maintain a substantial and positive relationship includes, but is not limited to, frequent and regular contact with the child through frequent and regular visitation or frequent and regular communication to or with the child, and the exercise of parental rights and responsibilities. Marginal efforts and incidental or token visits or communications are not sufficient to establish or maintain a substantial and positive relationship with a child. 

 

 

“Abuse” means any willful act or threatened act that results in any physical, mental, or sexual abuse, injury, or harm that causes or is likely to cause the child’s physical, mental, or emotional health to be significantly impaired. Abuse of a child includes acts or omissions. Corporal discipline of a child by a parent or legal custodian for disciplinary purposes does not in itself constitute abuse when it does not result in harm to the child.

 

The statute goes into a broad definition of harm.  Harm is in essence when a person inflicts or allows to be inflicted upon the child physical, mental, or emotional injury. Harm includes but is not limited to willful acts that cause injuries; giving children poison, alcohol or drugs; leaving a child without supervision or arrangement appropriate for the child’s age or mental or physical condition; inappropriate or excessively harsh disciplinary actions that result in among other things significant bruises or welts, committing or allowing to be committed sexual battery; the exploitation, neglect or abandonment of a child, and interfering with an investigation of child abuse.

 

Neglect occurs when a child is deprived of, or is allowed to be deprived of, necessary food, clothing, shelter, or medical treatment or a child is permitted to live in an environment when such deprivation or environment causes the child’s physical, mental, or emotional health to be significantly impaired or to be in danger of being significantly impaired. The foregoing circumstances shall not be considered neglect if caused primarily by financial inability unless actual services for relief have been offered to and rejected by such person. A parent or legal custodian legitimately practicing religious beliefs in accordance with a recognized church or religious organization who thereby does not provide specific medical treatment for a child may not, for that reason alone, be considered a negligent parent or legal custodian; however, such an exception does not preclude a court from ordering services for the child.

 

 

As a licensed professional you are required by law to report child abuse.  The reporting of child abuse is examined in part II of the Florida Statue 2013 Chapter 39.  This piece of legislature requires that any person who knows, or has reasonable cause to suspect, that a child is abused, abandoned, or neglected by a parent, legal custodian, caregiver, or other person responsible for the child’s welfare, as defined in this chapter, or that a child is in need of supervision and care and has no parent, legal custodian, or responsible adult relative immediately known and available to provide supervision and care shall report such knowledge or suspicion.  Your name, or the name of the reporter if not you, will be entered into the record of the report, but will be held confidential.

 

 

This report should be made immediately to the central abuse hotline on the single Florida statewide toll-free telephone number (1-800-962-2873); these calls are generally recorded.  Reports may also be made via fax, web-based chat, or web-based report.

 

The section gives specific instructions pertaining to the impregnation of those under the age of 16 by those over the age of 21. As a professional making a report you will have to provide your name to the hotline staff.  

 

If the alleged offender is 12 years of age or younger, the central abuse hotline will immediately electronically transfer the report or call to the county sheriffs office. The department will conduct an assessment and assist the family in receiving appropriate and send a written report of the allegation to the appropriate county sheriffs office within 48 hours after the initial report is made to the central abuse hotline.

 

If the alleged offender is 13 years of age or older, the central abuse hotline will immediately electronically transfer the report or call to the appropriate county sheriffs office and send a written report to the appropriate county sheriffs office within 48 hours after the initial report to the central abuse hotline.

 

In addition to the child abuse reporting requirements, if you have reasonable cause to suspect that a child died as a result of child abuse, abandonment, or neglect you must report this suspicion to the appropriate medical examiner.

 

Again, although the reports made to the hotline and all records held by the department concerning child abandonment, abuse or neglect are kept confidential you must give your name when making the report.  The protection of confidentiality is for those reporting, as well as to protect the rights of the child and the child’s parents or guardians.  It is important to note, the reports can be accessed by specific persons, officials and agencies.

 

The Statute specifically states: The name of any person reporting child abuse, abandonment, or neglect may not be released to any person other than employees of the department responsible for child protective services, the central abuse hotline, law enforcement, the child protection team, or the appropriate state attorney, without the written consent of the person reporting. This does not prohibit the subpoenaing of a person reporting child abuse, abandonment, or neglect when deemed necessary by the court, the state attorney, or the department, provided the fact that such person made the report is not disclosed. Any person who reports a case of child abuse or neglect may, at the time he or she makes the report, request that the department notify him or her that a child protective investigation occurred as a result of the report. Any person specifically listed in s. 39.201(1) who makes a report in his or her official capacity may also request a written summary of the outcome of the investigation. The department shall mail such a notice to the reporter within 10 days after completing the child protective investigation.

 

The Statute also offers protection from liability in the case of reporting suspected child abuse.  It explains that any person reporting in good faith any instance of child abuse, abandonment, or neglect to the department or any law enforcement agency, is immune from any civil or criminal liability which might otherwise result by reason of such action.

 

Privilege is not a protection from the legal responsibility of reporting suspected child abuse.  It is always a best practice to set the guidelines for confidentiality prior to beginning to work with a client.  They should be informed of the limitations of confidentiality and keep a signed copy of their understanding of their rights and these limitations in their file. 

 

A person who is required to report known or suspected child abuse, abandonment, or neglect and who knowingly and willfully fails to do so, or who knowingly and willfully prevents another person from doing so, is guilty of a misdemeanor of the first degree. 

 

 

Part IV:  Taking Children Into Custody and Shelter Hearings

 

Any person in charge of a hospital or similar institution, or any physician or licensed health care professional treating a child, may detain that child without the consent of the parents, caregiver, or legal custodian, whether or not additional medical treatment is required, if the circumstances are such, or if the condition of the child is such that returning the child to the care or custody of the parents, caregiver, or legal custodian presents an imminent danger to the childs life or physical or mental health.   If detainment is necessary the Department of Children and Family Services should be notified immediately,

whereupon the department  will begin a child protective.  The department will make every reasonable effort to immediately notify the parents or legal custodian that such child has been detained. If the department determines, according to the criteria set forth in this chapter, that the child should be detained longer than 24 hours, it will petition the court through the attorney representing the Department of Children and Family Services as quickly as possible and not to exceed 24 hours, for an order authorizing such custody in the same manner as if the child were placed in a shelter. The department will attempt to avoid the placement of a child in an institution whenever possible.

 

 

Termination of Parental Rights:

 

All the procedures concerning the termination of parental rights are according to the Florida Rules of Juvenile Procedure unless otherwise provided by law.

 

All proceeding to terminate parental rights can be initiated by any person who has knowledge of, or is informed of the facts which suggest the termination is appropriate.  

 

There are several situations where parental rights could be terminated.  One in which a counselor will likely be involved in is in a case where a parent is engaged in conduct toward the child or toward other children that demonstrates that the continuing involvement of the parent or parents in the parent-child relationship threatens the life, safety, well-being, or physical, mental, or emotional health of the child irrespective of the provision of services. 

 

As a counselor you will need to be aware of what conduct constitutes the need for termination.

 

 

FLORIDA CHAPTER 415

ADULT PROTECTIVE SERVICES ACT

 

One of the most vulnerable populations to abuse, neglect and exploitation is the elderly.  Sometimes cast aside with little regard and not much of a voice, they can easily fall prey to negative circumstances. Chapter 415 explores their rights and the statues put in place to protect them.  The intent of discovering and correcting abuse and neglect is primarily accomplished through social services and criminal investigations and to establish programs to help the elderly and disabled. 

 

Beverly has taken her mother in to her home.  The advantage is Beverly receives some monetary support as her mother has saved well over the years and has signed over power of attorney regarding financial matters; the disadvantage is her mother requires constant care. 

Beverly is concerned she will use all of her mother’s money on nursing aids and companions and won’t have gained anything but trouble.  In an effort to save on expenses, Beverly installs a webcam in her mother’s room and goes to work leaving her mother alone all day.  She visits her ailing mother via the internet several times a day to ensure she has not wandered off.  Is this neglect?

 

Answer:  Yes.

 

To put this legislature into practical terms for the counseling and social work field it is important to clarify the terms used in the statutes that relate specifically to our area. 

 

“Abuse” means any willful act or threatened act that causes or is likely to cause significant impairment to a vulnerable adult’s physical, mental, or emotional health. Abuse includes acts and omissions.

 

“Exploitation” may include, but is not limited to:

 

1.  Breaches of fiduciary relationships, such as the misuse of a power of attorney or the abuse of guardianship duties, resulting in the unauthorized appropriation, sale, or transfer of property;

 

2.  Unauthorized taking of personal assets;

 

3.  Misappropriation, misuse, or transfer of moneys belonging to a vulnerable adult from a personal or joint account; or

 

4.  Intentional or negligent failure to effectively use a vulnerable adult’s income and assets for the necessities required for that person’s support and maintenance.

 

“Neglect” means the failure or omission on the part of the caregiver to provide the care, supervision, and services necessary to maintain the physical and mental health of the vulnerable adult, including, but not limited to, food, clothing, medicine, shelter, supervision, and medical services, that a prudent person would consider essential for the well-being of a vulnerable adult.

 

The term “neglect” also means the failure of a caregiver to make a reasonable effort to protect a vulnerable adult from abuse, neglect, or exploitation by others. “Neglect” is repeated conduct or a single incident of carelessness which produces or could reasonably be expected to result in serious physical or psychological injury or a substantial risk of death.

 

Florida law mandates that a health professional or mental health professional knows or has reasonable cause to suspect, that a vulnerable adult has been or is being abused, neglected, or exploited should immediately report such knowledge or suspicion.

 

The Florida Department of Children and Family Services has established the central abuse hotline (1-800-962-2873) for reports at any hour of the day or night, any day of the week.

Reports Include:

                                                                                                                                                                

1.  Name, age, race, sex, physical description, and location of each victim alleged to have

      been abused, neglected, or exploited.

2.  Names, addresses, and telephone numbers of the victim’s family members.

3.  Name, address, and telephone number of each alleged perpetrator.

4.  Name, address, and telephone number of the caregiver of the victim, if different from

     the alleged perpetrator.

5.  Name, address, and telephone number of the person reporting the alleged abuse,

     neglect, or exploitation.

6.  Description of the physical or psychological injuries sustained.

7.  Actions taken by the reporter, if any, such as notification of the criminal justice

     agency.

8.  Any other information available to the reporting person which may establish the cause

     of abuse, neglect, or exploitation that occurred or is occurring.

 

As in the case of child abuse, you are presumed to be acting in good faith by making a report.  Unless this is proven otherwise you are immune from liability, civil or criminal that might be incurred through making the report. 

 

It is important to note, privileged communication does not apply to any situation involving known or suspected abuse, neglect, or exploitation of a vulnerable adult and does not constitute grounds for failure to report.  Failure to report known or suspected abuse, neglect, or exploitation of a vulnerable adult is a misdemeanor of the second degree. 

 

 

 

FLORIDA CHAPTER 397

SUBSTANCE ABUSE SERVICES

 

Problem use or abuse of alcohol or other drugs have a profound effect both on the individual, as well as the community Substance abuse impairment is a disease which affects the whole family and the whole society and requires a system of care that includes prevention, intervention, clinical treatment, and recovery support services that support and strengthen the family unit. Further, it is the intent of the Legislature to require the collaboration of state agencies, service systems, and program offices to achieve the goals of this chapter and address the needs of the public; to establish a comprehensive system of care for substance abuse; and to reduce duplicative requirements across state agencies. Chapter 397 is designed to provide for  abuse services.                                                                                                                                                                                                                                                                                                                                                                 

The recovery business is a highly regulated one.  We will explore an overview of Chapter 397 and the Marchmen Act in this course, however if you are operating a program or work regularly in this end of the industry we recommend you read the statutes with care and in their totality.  Staffing requirements, levels of care, marketing services and client rights are very clearly defined in the statutes, as well as on a national level, and they can be confusing. 

 

It is the goal of the Legislature to discourage substance abuse by promoting healthy lifestyles; healthy families; and drug-free schools, workplaces, and communities.  With regard to those in the mental health field, chapter 397 strives for a comprehensive continuum of accessible and quality substance abuse prevention, intervention, clinical treatment, and recovery support services in the least restrictive environment which promotes long-term recovery while protecting and respecting the rights of individuals, primarily through community-based private not-for-profit providers working with local governmental programs involving a wide range of agencies from both the public and private sectors.

These regulations are written to address identified needs, delivered without discrimination and with adequate provision for specialized needs.  It is the intent of the Legislature to provide an alternative to criminal imprisonment for substance abuse impaired adults and juvenile offenders by encouraging the referral of such offenders to service providers not generally available within the juvenile justice and correctional systems, instead of or in addition to criminal penalties.

 

 

Having an extra bedroom or two and a degree does not make you able to receive and treat those in need of services.  Chapter 397 states that the Department has the responsibility to designate addictions receiving facilities for the purpose of ensuring that only qualified service providers render services within the context of a secure facility setting.

 

To move forwards lets establish some definitions particularly focusing on those related to treatment and levels of care.

 

Addictions receiving facility is a secure, acute care facility that provides, at a minimum, detoxification and stabilization services; is operated 24 hours per day, 7 days per week; and is designated by the department to serve individuals found to be substance use impaired as described in s. 397.675 who meet the placement criteria for this component.

 

Authorized agent of the department means a person designated by the department to conduct any audit, inspection, monitoring, evaluation, or other duty imposed upon the department pursuant to this chapter. An authorized agent must be qualified by expertise and experience to perform these functions.

 

Beyond the safe management capabilities of the service provider refers to an individual who is in need of:

(a)Supervision;

(b)Medical care; or

(c)Services,

beyond that which the service provider or service component can deliver.

 

Clinical assessment means the collection of detailed information concerning an individuals substance use, emotional and physical health, social roles, and other areas that may reflect the severity of the individuals abuse of alcohol or drugs. The collection of information serves as a basis for identifying an appropriate treatment regimen.

 

Day or night treatment is a service provided in a nonresidential environment, with a structured schedule of treatment and rehabilitative services.

 

Day or night treatment with community housing means a program intended for individuals who can benefit from living independently in peer community housing while participating in treatment services for a minimum of 5 hours a day for a minimum of 25 hours per week.

 

Detoxification is a service involving subacute care that is provided on an inpatient or an outpatient basis to assist individuals to withdraw from the physiological and psychological effects of substance abuse and who meet the placement criteria for this component.

Intensive inpatient treatment includes a planned regimen of evaluation, observation, medical monitoring, and clinical protocols delivered through an interdisciplinary team approach provided 24 hours per day, 7 days per week, in a highly structured, live-in environment.

 

Intensive outpatient treatment is a service that provides individual or group counseling in a more structured environment, is of higher intensity and duration than outpatient treatment, and is provided to individuals who meet the placement criteria for this component.

 

Medication-assisted treatment for opiate addiction is a service that uses methadone or other medication as authorized by state and federal law, in combination with medical, rehabilitative, and counseling services in the treatment of individuals who are dependent on opioid drugs.

 

Outpatient treatment is a service that provides individual, group, or family counseling by appointment during scheduled operating hours for individuals who meet the placement criteria for this component.

 

Residential treatment is a service provided in a structured live-in environment within a nonhospital setting on a 24-hours-per-day, 7-days-per-week basis, and is intended for individuals who meet the placement criteria for this component.

 

Medication-assisted treatment (MAT) is the use of medications approved by the United States Food and Drug Administration, in combination with counseling and behavioral therapies, to provide a holistic approach to the treatment of substance abuse.

 

Medical monitoring means oversight and treatment, 24 hours per day by medical personnel who are licensed under chapter 458, chapter 459, or chapter 464, of individuals whose subacute problems are so severe that the individuals require intensive inpatient treatment by an interdisciplinary team.

 

Qualified professional means a physician or a physician assistant licensed under chapter 458 or chapter 459; a professional licensed under chapter 490 or chapter 491; an advanced registered nurse practitioner having a specialty in psychiatry licensed under part I of chapter 464; or a person who is certified through a department-recognized certification process for substance abuse treatment services and who holds, at a minimum, a bachelors degree. A person who is certified in substance abuse treatment services by a state-recognized certification process in another state at the time of employment with a licensed substance abuse provider in this state may perform the functions of a qualified professional as defined in this chapter but must meet certification requirements contained in this subsection no later than 1 year after his or her date of employment.

 

Screening means the gathering of initial information to be used in determining a persons need for assessment, services, or referral.

 

Secure facility except where the context indicates a correctional system facility, means a provider that has the authority to deter the premature departure of involuntary individuals whose leaving constitutes a violation of a court order or community-based supervision as provided by law. The term secure facility includes addictions receiving facilities and facilities authorized by local ordinance for the treatment of habitual abusers.

 

Service provider or provider means a public agency, a private for-profit or not-for-profit agency, a person who is a private practitioner, or a hospital licensed under this chapter or exempt from licensure under this chapter.

 

Substance abuse programs and services or drug control applies generally to the broad continuum of prevention, intervention, clinical treatment, recovery support initiatives, efforts to limit substance abuse, and initiatives and efforts by law enforcement agencies to limit substance abuse.

 

 

STATEWIDE DRUG POLICY COUNCIL

 

The Statewide Drug Policy Advisory Council was created to establish and institutionalize a rational process for long-range planning, information gathering, strategic decision-making, and funding for the purpose of limiting substance abuse.  The counsel endeavors to combat substance abuse with a comprehensive, integrated, and multidisciplinary approach.

 

The advisory council determines the most effective means of establishing clear and meaningful lines of communication between the advisory council and the public and private sectors.  They review and make recommendations to the Governor and Legislature substance abuse laws, funding, research, programs and services. They assist communities and families in pooling their knowledge and experiences with respect to the problem of substance abuse.

 

TREATMENT BASED DRUG COURT PROGRAMS

 

Each county may fund a treatment-based drug court program under which persons in the justice system assessed with a substance abuse problem will be processed in such a manner as to appropriately address the severity of the identified substance abuse problem through treatment services tailored to the individual needs of the participant.

 

Drug court programs integrate alcohol and other drug treatment services with justice system case processing.  Using a non-adversarial approach, prosecution and defense counsel promote public safety while protecting participants due process rights. Entry into any pretrial treatment-based drug court program must be voluntary. Entry into any postadjudicatory treatment-based drug court program as a condition of probation or community control must be based upon the sentencing courts assessment of the defendants criminal history, substance abuse screening outcome, amenability to the services of the program, total sentence points, the recommendation of the state attorney and the victim, if any, and the defendants agreement to enter the program.

 

Eligible participants are identified early and promptly placed in the drug court program.  Drug court programs provide access to a continuum of alcohol, drug, and other related treatment and rehabilitation services.  Abstinence is monitored by frequent testing for alcohol and other drugs. 

 

The treatment-based drug court programs must include therapeutic jurisprudence principles and adhere to the following 10 key components:

 

  •         Drug court programs integrate alcohol and other drug treatment services with justice system case processing.
  •         Using a nonadversarial approach, prosecution and defense counsel promote public safety while protecting participants due process rights.
  •         Eligible participants are identified early and promptly placed in the drug court program.
  •         Drug court programs provide access to a continuum of alcohol, drug, and other related treatment and rehabilitation services.
  •         Abstinence is monitored by frequent testing for alcohol and other drugs.
  •         A coordinated strategy governs drug court program responses to participants compliance.
  •         Ongoing judicial interaction with each drug court program participant is essential.
  •         Monitoring and evaluation measure the achievement of program goals and gauge program effectiveness.
  •         Continuing interdisciplinary education promotes effective drug court program planning, implementation, and operations.
  •         Forging partnerships among drug court programs, public agencies, and community-based organizations generates local support and enhances drug court program effectiveness.

ADDICTION PROFESSIONALS

 

Certification for addiction professionals in the state of Florida is offered through the Florida Certification Board.  The board has a Code of Ethics for it’s certified members and the first principle is that Addiction Professionals will conform to applicable local, state and federal laws.  It is unlawful for any person or agency to act as a substance abuse service provider unless it is licensed or exempt from licensure under Chapter 397 of the Florida Statutes.

 

397.403 begins the directives for anyone or agency that would like to make application as a provider.

 

Substance abuse programs operated directly or under contract by the department, the Department of Corrections, the Department of Juvenile Justice, any other state agency, or any local correctional agency or authority, which programs constitute any service provider licensable components as defined in this chapter, are subject to licensure and regulation in accordance with rules jointly developed by the department and the state or local agency operating the program unless otherwise exempt.

 

 

COST OF SUBSTANCE ABUSE SERVICES

 

In an effort to protect the client, the following directives cover the issue of costs of substance abuse services:

 

(1)Before accepting an individual for admission and in accordance with confidentiality guidelines, both the full charge for services and the fee charged to the individual for such services under the providers fee system or payment policy must be disclosed to each individual or his or her authorized personal representative, or parent or legal guardian if the individual is a minor who did not seek treatment voluntarily and without parental consent.

 

(2)An individual or his or her authorized personal representative, or parent or legal guardian if the individual is a minor, is required to contribute toward the cost of substance abuse services in accordance with his or her ability to pay, unless otherwise provided by law.

 

(3)The parent, legal guardian, or legal custodian of a minor is not liable for payment for any substance abuse services provided to the minor without parental consent pursuant to s. 397.601, unless the parent, legal guardian, or legal custodian participates or is ordered to participate in the services, and only for the substance abuse services rendered. If the minor is receiving services as a juvenile offender, the obligation to pay is governed by the law relating to juvenile offenders.

 

(4)Service providers that do not contract for state funds to provide substance abuse services as defined in this chapter may establish their own admission policies regarding provisions for payment for services. Such policies must comply with other statutory and regulatory requirements governing state or federal reimbursements to a provider for services delivered to individuals. As used in this subsection, the term contract for state funds does not include Medicaid funds.

 

(5)Service providers that contract for state funds to provide substance abuse services as defined in this chapter must establish a fee system based upon an individuals ability to pay and, if space and sufficient state resources are available, may not deny an individual access to services solely on the basis of the individuals inability to pay.

 

All owners, directors, and chief financial officers of service providers are subject to level 2 background screening as provided under chapter 435. Inmate substance abuse programs operated directly or under contract with the Department of Corrections are exempt from this requirement.

 

All service provider personnel who have direct contact with children receiving services or with adults who are developmentally disabled receiving services are subject to level 2 background screening as provided under chapter 435.

 

Each service provider must ensure:

(a)Sufficient numbers and types of qualified personnel on duty and available to provide necessary and adequate safety and care.

(b)Adequate space for each individual served within a residential facility.

(c)Adequate infection control, housekeeping, and sanitation.

(d)Adequate disaster planning policies and procedures.

(2)The State Fire Marshal shall, in cooperation with the department, establish and enforce minimum fire safety standards, which standards must be included in the rules adopted by the department.

 

 

CLIENT RIGHTS

As treatment providers it is our responsibility to ensure that clients know and understand their rights.  Clients receiving substance abuse services from any service provider are guaranteed protection of the following rights taken verbatim from the Florida Legislature:

(1)  RIGHT TO INDIVIDUAL DIGNITY.–The individual dignity of the client must be respected at all times and upon all occasions, including any occasion when the client is admitted, retained, or transported. Substance abuse clients who are not accused of a crime or delinquent act may not be detained or incarcerated in jails, detention centers, or training schools of the state, except for purposes of protective custody in strict accordance with this chapter. A client may not be deprived of any constitutional right.

(2)  RIGHT TO NONDISCRIMINATORY SERVICES.–

(a)  Service providers may not deny a client access to substance abuse services solely on the basis of race, gender, ethnicity, age, sexual preference, human immunodeficiency virus status, prior service departures against medical advice, disability, or number of relapse episodes. Service providers may not deny a client who takes medication prescribed by a physician access to substance abuse services solely on that basis. Service providers who receive state funds to provide substance abuse services may not, provided space and sufficient state resources are available, deny a client access to services based solely on inability to pay.

(b)  Each client in treatment must be afforded the opportunity to participate in the formulation and periodic review of his or her individualized treatment or service plan to the extent of his or her ability to so participate.

(c)  It is the policy of the state to use the least restrictive and most appropriate services available, based on the needs and the best interests of the client and consistent with optimum care of the client.

(d)  Each client must be afforded the opportunity to participate in activities designed to enhance self-image.

(3)  RIGHT TO QUALITY SERVICES.–

(a)  Each client must be delivered services suited to his or her needs, administered skillfully, safely, humanely, with full respect for his or her dignity and personal integrity, and in accordance with all statutory and

regulatory requirements.

(b)  These services must include the use of methods and techniques to control aggressive client behavior that poses an immediate threat to the client or to other persons. Such methods and techniques include the use of restraints, the use of seclusion, the use of time-out, and other behavior management techniques. When authorized, these methods and techniques may be applied only by persons who are employed by service providers and trained in the application and use of these methods and techniques. The department must specify by rule the methods that may be used and the techniques that may be applied by service providers to control aggressive client behavior and must specify by rule the physical facility requirements for seclusion rooms, including dimensions, safety features, methods of observation, and contents.

(4)  RIGHT TO COMMUNICATION.–

(a)  Each client has the right to communicate freely and privately with other persons within the limitations imposed by service provider policy.

(b)  Because the delivery of services can only be effective in a substance abuse free environment, close supervision of each client’s communications and correspondence is necessary, particularly in the initial stages of treatment, and the service provider must therefore set reasonable rules for telephone, mail, and visitation rights, giving primary consideration to the well-being and safety of clients, staff, and the community. It is the duty of the service provider to inform the client and his or her family if the family is involved at the time of admission about the provider’s rules relating to communications and correspondence.

(5)  RIGHT TO CARE AND CUSTODY OF PERSONAL EFFECTS OF CLIENTS.–A client has the right to possess clothing and other personal effects. The service provider may take temporary custody of the client’s personal effects only when required for medical or safety reasons, with the reason for taking custody and a list of the personal effects recorded in the client’s clinical record.

(6)  RIGHT TO EDUCATION OF MINORS.–Each minor client in a residential service component is guaranteed education and training appropriate to his or her needs. The service provider shall coordinate with local education agencies to ensure that education and training is provided to each minor client in accordance with other applicable laws and regulations and that parental responsibilities related to such education and training are established within the provisions of such applicable laws and regulations. Nothing in this chapter may be construed to relieve any local education authority of its obligation under law to provide a free and appropriate education to every child.

(7)  RIGHT TO CONFIDENTIALITY OF CLIENT RECORDS.–

(a)  The records of service providers which pertain to the identity, diagnosis, and prognosis of and service provision to any individual client are confidential in accordance with this chapter and with applicable federal confidentiality regulations and are exempt from the provisions of s. 119.07(1) and s. 24(a), Art. I of the State Constitution. Such records may not be disclosed without the written consent of the client to whom they pertain except that appropriate disclosure may be made without such consent:

1.  To medical personnel in a medical emergency.

2.  To service provider personnel if such personnel need to know the information in order to carry out duties relating to the provision of services to a client.

3.  To the secretary of the department or the secretary’s designee, for purposes of scientific research, in accordance with federal confidentiality regulations, but only upon agreement in writing that the client’s name and other identifying information will not be disclosed.

4.  In the course of review of records on service provider premises by persons who are performing an audit or evaluation on behalf of any federal, state, or local government agency, or third-party payor providing financial assistance or reimbursement to the service provider; however, reports produced as a result of such audit or evaluation may not disclose client names or other identifying information and must be in accord with federal confidentiality regulations.

5.  Upon court order based on application showing good cause for disclosure. In determining whether there is good cause for disclosure, the court shall examine whether the public interest and the need for disclosure outweigh the potential injury to the client, to the service provider-client relationship, and to the service provider itself.

(b)  The restrictions on disclosure and use in this section do not apply to communications from provider personnel to law enforcement officers which:

1.  Are directly related to a client’s commission of a crime on the premises of the provider or against provider personnel or to a threat to commit such a crime; and

2.  Are limited to the circumstances of the incident, including the client status of the individual committing or threatening to commit the crime, that individual’s name and address, and that individual’s last known whereabouts.

(c)  The restrictions on disclosure and use in this section do not apply to the reporting of incidents of suspected child abuse and neglect to the appropriate state or local authorities as required by law. However, such restrictions continue to apply to the original substance abuse client records maintained by the provider, including their disclosure and use for civil or criminal proceedings which may arise out of the report of suspected child abuse and neglect.

(d)  Any answer to a request for a disclosure of client records which is not permissible under this section or under the appropriate federal regulations must be made in a way that will not affirmatively reveal that an identified individual has been, or is being diagnosed or treated for substance abuse. The regulations do not restrict a disclosure that an identified individual is not and never has been a client.

(e)1.  Since a minor acting alone has the legal capacity to voluntarily apply for and obtain substance abuse treatment, any written consent for disclosure may be given only by the minor client. This restriction includes, but is not limited to, any disclosure of client identifying information to the parent, legal guardian, or custodian of a minor client for the purpose of obtaining financial reimbursement.

2.  When the consent of a parent, legal guardian, or custodian is required under this chapter in order for a minor to obtain substance abuse treatment, any written consent for disclosure must be given by both the minor and the parent, legal guardian, or custodian.

(f)  An order of a court of competent jurisdiction authorizing disclosure and use of confidential information is a unique kind of court order. Its only purpose is to authorize a disclosure or use of client identifying information which would otherwise be prohibited by this section. Such an order does not compel disclosure. A subpoena or a similar legal mandate must be issued in order to compel disclosure. This mandate may be entered at the same time as, and accompany, an authorizing court order entered under this section.

(g)  An order authorizing the disclosure of client records may be applied for by any person having a legally recognized interest in the disclosure which is sought. The application may be filed separately or as part of a pending civil action in which it appears that the client records are needed to provide evidence. An application must use a fictitious name, such as John Doe or Jane Doe, to refer to any client and may not contain or otherwise disclose any client identifying information unless the client is the applicant or has given a written consent to disclosure or the court has ordered the record of the proceeding sealed from public scrutiny.

(h)  The client and the person holding the records from whom disclosure is sought must be given adequate notice in a manner which will not disclose client identifying information to other persons, and an opportunity to file a written response to the application, or to appear in person, for the limited purpose of providing evidence on the statutory and regulatory criteria for the issuance of the court order.

(i)  Any oral argument, review of evidence, or hearing on the application must be held in the judge’s chambers or in some manner which ensures that client identifying information is not disclosed to anyone other than a party to the proceeding, the client, or the person holding the record, unless the client requests an open hearing. The proceeding may include an examination by the judge of the client records referred to in the application.

(j)  A court may authorize the disclosure and use of client records for the purpose of conducting a criminal investigation or prosecution of a client only if the court finds that all of the following criteria are met:

1.  The crime involved is extremely serious, such as one which causes or directly threatens loss of life or serious bodily injury, including but not limited to homicide, sexual assault, sexual battery, kidnapping, armed robbery, assault with a deadly weapon, and child abuse and neglect.

2.  There is reasonable likelihood that the records will disclose information of substantial value in the investigation or prosecution.

3.  Other ways of obtaining the information are not available or would not be effective.

4.  The potential injury to the client, to the physician-client relationship and to the ability of the program to provide services to other clients is outweighed by the public interest and the need for the disclosure.

(8)  RIGHT TO COUNSEL.–Each client must be informed that he or she has the right to be represented by counsel in any involuntary proceeding for assessment, stabilization, or treatment and that he or she, or if the client is a minor his or her parent, legal guardian, or legal custodian, may apply immediately to the court to have an attorney appointed if he or she cannot afford one.

(9)  RIGHT TO HABEAS CORPUS.–At any time, and without notice, a client involuntarily retained by a provider, or the client’s parent, guardian, custodian, or attorney on behalf of the client, may petition for a writ of habeas corpus to question the cause and legality of such retention and request that the court issue a writ for the client’s release.

(10)  LIABILITY AND IMMUNITY.–

(a)  Service provider personnel who violate or abuse any right or privilege of a client under this chapter are liable for damages as determined by law.

(b)  All persons acting in good faith, reasonably, and without negligence in connection with the preparation or execution of petitions, applications, certificates, or other documents or the apprehension, detention, discharge, examination, transportation, or treatment of a person under the provisions of this chapter shall be free from all liability, civil or criminal, by reason of such acts.

 

In addition to these rights, it is also required that prior to accepting a client for admission both the full charge for services and the fee charged to the client for such services under the provider’s fee system or payment policy must be disclosed to each client or his or her authorized personal representative, or parent or legal guardian if the client is a minor who did not seek treatment voluntarily and without parental consent. It is also noted that a client or his or her authorized personal representative, or parent or legal guardian if the client is a minor, is required to contribute toward the cost of substance abuse services in accordance with his or her ability to pay, unless otherwise provided by law. The parents of a minor are not responsible for payment of services if the minor presents for treatment without parental consent, unless required by law, or the parent or guardian takes part in treatment.

 

 

VOLUNTARY ADMISSION FOR SUBSTANCE ABUSE TREATMENT

A person who wishes to enter treatment for substance abuse may apply to a service provider for voluntary admission.

 

Within the financial and space capabilities of the service provider, a person must be admitted to treatment when sufficient evidence exists that the person is impaired by substance abuse and the medical and behavioral conditions of the person are not beyond the safe management capabilities of the service provider.

 

The service provider must emphasize admission to the service component that represents the least restrictive setting that is appropriate to the persons treatment needs.

 

The disability of minority for persons under 18 years of age is removed solely for the purpose of obtaining voluntary substance abuse impairment services from a licensed service provider, and consent to such services by a minor has the same force and effect as if executed by an individual who has reached the age of majority. Such consent is not subject to later disaffirmance based on minority.

 

Except for purposes of law enforcement activities in connection with protective custody, the disability of minority is not removed if there is an involuntary admission for substance abuse services, in which case parental participation may be required as the court finds appropriate.

 

 

INVOLUNTARY ADMISSION FOR SUBSTANCE ABUSE TREATMENT

 

What can someone do when a person doesn’t see what he or she is in need of?  Involuntary admission to a treatment program is appropriate when  there is good faith reason to believe the person is substance abuse impaired and, because of such impairment:

 

1)Has lost the power of self-control with respect to substance use; and either

 

(2)(a)Has inflicted, or threatened or attempted to inflict, or unless admitted is likely to inflict, physical harm on himself or herself or another; or

(b)Is in need of substance abuse services and, by reason of substance abuse impairment, his or her judgment has been so impaired that the person is incapable of appreciating his or her need for such services and of making a rational decision in regard thereto; however, mere refusal to receive such services does not constitute evidence of lack of judgment with respect to his or her need for such services.

 

Service providers have certain responsibilities regarding involuntary admissions.

 

It is the responsibility of the service provider to ensure that a person who is admitted to a licensed service component meets the admission criteria specified in s. 397.675.  They must ensure that the medical and behavioral conditions of the person, as presented, are not beyond their safe management capabilities.  They must provide the least restrictive available setting that is responsive to the persons treatment needs. 

They have restrictions on census, and they must verify that this admission will not result in an excess of their licensed service capacity.  The service provider must determine whether the cost of services is within the financial means of the person or those who are financially responsible for the persons care,  They must take all necessary measures to ensure that each individual in treatment is provided with a safe environment, and to ensure that each individual whose medical condition or behavioral problem becomes such that he or she cannot be safely managed by the service component is discharged and referred to a more appropriate setting for care.

 

When, in the judgment of the service provider, the person who is being presented for involuntary admission should not be admitted because of his or her failure to meet admission criteria, because his or her medical or behavioral conditions are beyond the safe management capabilities of the service provider, or because of a lack of available space, services, or financial resources to pay for his or her care, the service provider must attempt to contact the referral source, which may be a law enforcement officer, physician, parent, legal guardian if applicable, court and petitioner, or other referring party, to discuss the circumstances and assist in arranging for alternative interventions.

 

When the service provider is unable to reach the referral source, the service provider must refuse admission and attempt to assist the person in gaining access to other appropriate services, if indicated.

 

Upon completing these efforts, the service provider must, within one workday, report in writing to the referral sources, in compliance with federal confidentiality regulations:

 

1.The basis for the refusal to admit the person, and

2.Documentation of the service providers efforts to contact the referral source and assist the person, when indicated, in gaining access to more appropriate services.

 

When, in the judgment of the service provider, the medical conditions or behavioral problems of an involuntary individual become such that they cannot be safely managed by the service component, the service provider must discharge the individual and attempt to assist him or her in securing more appropriate services in a setting more responsive to his or her needs. Upon completing these efforts, the service provider must, within 72 hours, report in writing to the referral source, in compliance with federal confidentiality regulations:

 

(a)The basis for the individuals discharge; and

(b)Documentation of the service providers efforts to assist the person in gaining access to appropriate services.

 

Upon giving his or her written informed consent, an involuntarily admitted individual may be referred to a service provider for voluntary admission when the service provider determines that the individual no longer meets involuntary criteria.

 

A client involuntarily admitted to a licensed service provider may only be released by a qualified professional. Notice of the release must be provided to the applicant in the case of an emergency admission or an alternative involuntary assessment for a minor, or to the petitioner and the court if the involuntary assessment or treatment was court ordered.

 

In the case of a minor, the release must be:

(1)To the individuals parent, legal guardian, or legal custodian or the authorized designee thereof;

(2)To the Department of Children and Family Services pursuant to s. 39.401; or

(3)To the Department of Juvenile Justice pursuant to s. 984.13.

 

 

A parent, legal guardian, or legal custodian who seeks involuntary admission of a minor is required to participate in all aspects of treatment as determined appropriate by the director of the licensed service provider.

 

 

PROTECTIVE CUSTODY WITHOUT CONSENT

 

Avery is enjoying spring break!  Laying on the beach drinking beer all day then hanging out at the motels bar all evening.  Staggering down the sidewalk and in and out of traffic, Avery meets Officer Notonmywatch.  The Officer suggests to Avery that he drive him to a detox facility.  Avery refuses and yells at the officer.  Officer Notonmywatch takes Avery into protective custody.  How long can the officer keep Avery in protective custody?

 

Answer:  72 hours.

Frequently, a person under the influence is not in the best frame of mind to protect themselves or others.  In a circumstance such as this an officer may need to place the person in a safe environment with or without their consent.

 

A person in circumstances which justify protective custody may consent to be assisted by a law enforcement officer to his or her home, to a hospital, or to a licensed detoxification or addictions receiving facility, whichever the officer determines is most appropriate.

 

 If a person in circumstances which justify protective custody fails or refuses to consent to assistance and a law enforcement officer has determined that a hospital or a licensed detoxification or addictions receiving facility is the most appropriate place for the person, the officer may, after giving due consideration to the expressed wishes of the person:

 

(a)  Take the person to a hospital or to a licensed detoxification or addictions receiving facility against the person’s will but without using unreasonable force; or

 

(b)  In the case of an adult, detain the person for his or her own protection in any municipal or county jail or other appropriate detention facility. 

Such detention is not to be considered an arrest for any purpose, and no entry or other record may be made to indicate that the person has been detained or charged with any crime. The officer in charge of the detention facility must notify the nearest appropriate licensed service provider within the first 8 hours after detention that the person has been detained. It is the duty of the detention facility to arrange, as necessary, for transportation of the person to an appropriate licensed service provider with an available bed. Persons taken into protective custody must be assessed by the attending physician within the 72-hour period and without unnecessary delay, to determine the need for further services.

 

The nearest relative of a minor in protective custody must be notified by the law enforcement officer, as must the nearest relative of an adult, unless the adult requests that there be no notification.

 

Once a client no longer meets the involuntary admission criteria or a 72 hour period has elapsed the client must be released by a qualified professional.  The client may also consent to remain voluntarily in treatment.  A client may only be retained in protective custody beyond the 72-hour period when a petition for involuntary assessment or treatment has been initiated.

 

 

EMERGENCY ADMISSION FOR SUBSTANCE ABUSE ISSUES

 

In the event a person meets the criteria for involuntary admission in s.397.675 they can be admitted to a hospital or to a licensed detoxification facility or addictions receiving facility for emergency assessment and stabilization, or to a less intensive component of a licensed service provider for assessment only.  Once at the facility it is necessary to obtain a  physician’s certificate and the completion of an application for emergency admission.

The following persons may request an emergency admission:

(1)  In the case of an adult, the certifying physician, the person’s spouse or guardian, any relative of the person, or any other responsible adult who has personal knowledge of the person’s substance abuse impairment.

(2)  In the case of a minor, the minor’s parent, legal guardian, or legal custodian.

 

Time Frames for Emergency Admissions:

 

Within 72 hours after an emergency admission to a hospital or a licensed detoxification or addictions receiving facility, the client must be assessed by the attending physician to determine the need for further services. Within 5 days after an emergency admission to a nonresidential component of a licensed service provider, the client must be assessed by a qualified professional to determine the need for further services. Based upon that assessment, a qualified professional of the hospital, detoxification facility, or addictions receiving facility, or a qualified professional if a less restrictive component was used, must either:

 

(1)  Release the client and, where appropriate, refer the client to other needed services;

       or

 

(2)  Retain the client when:

 

(a)  The client has consented to remain voluntarily at the licensed provider; or

 

(b)  A petition for involuntary assessment or treatment has been initiated, the timely filing of which authorizes the service provider to retain physical custody of the client pending further order of the court.

 

An addictions receiving facility may also admit a minor for involuntary assessment and stabilization when requested by the minor’s parent, guardian, or legal custodian. The minor must meet the criteria for involuntary admission in s. 397.675. Within 72 hours after involuntary admission of a minor, the minor must be assessed to determine the need for further services. Assessments must be performed by a qualified professional. If, after the 72-hour period, it is determined by the attending physician that further services are necessary, the minor may be kept for a period of up to 5 days, inclusive of the 72-hour period.

 

 

ASSESSMENT OF MINORS

 

In addition to protective custody, emergency admission, and involuntary assessment and stabilization, an addictions receiving facility may admit a minor for involuntary assessment and stabilization upon the filing of an application to an addictions receiving facility by the minors parent, guardian, or legal custodian.  Within 72 hours after involuntary admission of a minor, the minor must be assessed to determine the need for further services. Assessments must be performed by a qualified professional. If, after the 72-hour period, it is determined by the attending physician that further services are necessary, the minor may be kept for a period of up to 5 days, inclusive of the 72-hour period.

 

An application for alternative involuntary assessment for a minor must establish the need for immediate involuntary admission and contain the name of the minor to be admitted, the name and signature of the applicant, the relationship between the minor to be admitted and the applicant, and factual allegations with respect to:

 

        The reason for the applicants belief that the minor is substance abuse impaired; and

 

        The reason for the applicants belief that because of such impairment the minor has lost the power of self-control with respect to substance abuse; and either:

 

        The reason the applicant believes that the minor has inflicted or is likely to inflict physical harm on himself or herself or others unless admitted; or

 

        The reason the applicant believes that the minors refusal to voluntarily receive substance abuse services is based on judgment so impaired by reason of substance abuse that he or she is incapable of appreciating his or her need for such services and of making a rational decision regarding his or her need for services.

 

A minor who has been assessed must, within the time specified, be released or referred for further voluntary or involuntary treatment, whichever is most appropriate to the needs of the minor.

 

 

INVOLUNTARY ASSESSMENT AND STABILIZATION FOR SUBSTANCE ABUSE

 

Ruth’s husband would not initiate an emergency admission for Ruth’s alcohol and heroin addiction.  As her therapist, you want her to undergo an assessment and stabilization in a detoxification facility or hospital.  Although, Ruth refused your suggestion, you filed a petition with the court.  If the petition is granted, how long may Ruth be detained at the detoxification facility or hospital under involuntary assessment and stabilization? 

 

Answer:  5 days

 

A person determined by the court to appear to meet the criteria for involuntary admission under s. 397.675 may be admitted for a period of 5 days to a hospital or to a licensed detoxification facility or addictions receiving facility, for involuntary assessment and stabilization or to a less restrictive component of a licensed service provider for assessment only upon entry of a court order or upon receipt by the licensed service provider of a petition.

 

Involuntary assessment and stabilization may be initiated by the submission of a petition to the court.

(1)  If the person upon whose behalf the petition is being filed is an adult, a petition for involuntary assessment and stabilization may be filed by the respondent’s spouse or guardian, any relative, a private practitioner, the director of a licensed service provider or the director’s designee, or any three adults who have personal knowledge of the respondent’s substance abuse impairment.

 

(2)  If the person upon whose behalf the petition is being filed is a minor, a petition for involuntary assessment and stabilization may be filed by a parent, legal guardian, legal custodian, or licensed service provider.

A licensed service provider may admit a client for involuntary assessment and stabilization for a period not to exceed 5 days. The client must be assessed without unnecessary delay by a qualified professional. If an assessment is performed by a qualified professional who is not a physician, the assessment must be reviewed by a physician prior to the end of the assessment period.

 

Extension of time for completion of involuntary assessment and stabilization:

 

If the involuntary assessment and, if necessary, stabilization is not completed within 5 days a written request for an extension of time may be requested.  The additional time is not to exceed 7 days after the date of renewal.  This can be accomplished through the court system with or without a hearing depending upon circumstances. The original court order authorizing the involuntary assessment and stabilization, or a request for an extension of time to complete the assessment and stabilization that is timely filed pursuant to this section, constitutes legal authority to involuntarily hold the client for a period not to exceed 10 days in the absence of a court order to the contrary.

 

 

DISPOSITION AFTER INVOLUNTARY ASSESSMENT 

When it is appropriate based upon the involuntary assessment the qualified professional or facility must:

 

 (1)  Release the client and, where appropriate, refer the client to another treatment facility or service provider, or to community  services;

 

(2)  Allow the client, if the client has consented, to remain voluntarily at the licensed provider; or

 

(3)  Retain the client when a petition for involuntary treatment has been initiated, the timely filing of which authorizes the  service provider to retain physical custody of the client pending further order of the court. 

The disposition of the client who was assessed involuntarily must be provided to the petitioner and to the court within the regulations of confidentiality.

 

 

INVOLUNTARY TREATMENT FOR SUBSTANCE ABUSE ISSUES

 

In the event an individual a meets the criteria for involuntary admission provided in s. 397.675 and:

 

(1)  Has been placed under protective custody pursuant to s. 397.677 within the previous 10 days;

 

(2)  Has been subject to an emergency admission pursuant to s. 397.679 within the previous 10 days;

 

(3)  Has been assessed by a qualified professional within 5 days;

 

(4)  Has been subject to involuntary assessment and stabilization pursuant to s. 397.6818 within the previous 12 days; or

 

(5)  Has been subject to alternative involuntary admission pursuant to s. 397.6822 within the previous 12 days.

 

The involuntary treatment is not to exceed 60 days.  When the conditions justifying involuntary treatment no longer exist, the client must be released as provided in s. 397.6971. This includes when a client no longer meets the criteria for involuntary treatment and has given their informed consent to be transferred to a voluntary status or if the client was admitted on the belief that they were a danger to themselves or others and this threat no longer exists.  When the conditions justifying involuntary treatment are expected to exist after 60 days of treatment, a renewal of the involuntary treatment order may be requested pursuant to s. 397.6975 prior to the end of the 60-day period. The court may renew the involuntary treatment order, however the period is not to exceed 90 days.

 

 

FLORIDA CHAPTER 394

THE FLORIDA MENTAL HEALTH ACT

THE BAKER ACT

 

 

In an attempt to reduce the occurrence, severity, duration, and disabling aspects of mental, emotional, and behavioral disorders the legislature has addressed mental health issues through Chapter 394 of the Florida Statutes. 

 

This chapter’s intentions are that those in need will be provided with emergency service and temporary detention for evaluation when required. 

 

These individuals in need of care can be admitted to treatment facilities on a voluntary basis or on an involuntary basis when expert evaluation determines that it is necessary.  Patients admitted into a program have rights that are addressed in this portion on the Statutes.  One of the key aspects of the Statutes is that the least restrictive means of intervention be employed based on the individual needs of each person, within the scope of available services.

 

To address this portion with regard of what type of professional has the ability and responsibility to perform certain tasks it is important to understand the definition of certain terms used in the law:

 

“Clinical psychologist” means a psychologist as defined in s. 490.003(7) with 3 years of postdoctoral experience in the practice of clinical psychology, inclusive of the experience required for licensure, or a psychologist employed by a facility operated by the United States Department of Veterans Affairs that qualifies as a receiving or treatment facility under this part.

 

“Clinical social worker” means a person licensed as a clinical social worker under chapter 491.

 

Community facility means any community service provider contracting with the department to furnish substance abuse or mental health services under part IV of this chapter.

 

“Community mental health center or clinic” means a publicly funded, not-for-profit center which contracts with the department for the provision of inpatient, outpatient, day treatment, or emergency services.

 

“Law enforcement officer” means a law enforcement officer as defined in s. 943.10.

 

“Mental illness” means an impairment of the mental or emotional processes that exercise conscious control of one’s actions or of the ability to perceive or understand reality, which impairment substantially interferes with a person’s ability to meet the ordinary demands of living, regardless of etiology. For the purposes of this part, the term does not include retardation or developmental disability as defined in chapter 393, intoxication, or conditions manifested only by antisocial behavior or substance abuse impairment.

 

“Physician” means a medical practitioner licensed under chapter 458 or chapter 459 who has experience in the diagnosis and treatment of mental and nervous disorders or a physician employed by a facility operated by the United States Department of Veterans Affairs which qualifies as a receiving or treatment facility under this part.

 

“Psychiatric nurse” means a registered nurse licensed under part I of chapter 464 who has a master’s degree or a doctorate in psychiatric nursing and 2 years of post-master’s clinical experience under the supervision of a physician.

 

“Psychiatrist” means a medical practitioner licensed under chapter 458 or chapter 459 who has primarily diagnosed and treated mental and nervous disorders for a period of not less than 3 years, inclusive of psychiatric residency.

 

 

SCREENING OF MENTAL HEALTH PERSONNEL

 

It is the departments endeavor to protect those seeking mental health treatment. The department and the Agency for Health Care Administration will require level 2 background screening pursuant to chapter 435 for mental health personnel.   Mental health personnel includes all program directors, professional clinicians, staff members, and volunteers working in public or private mental health programs and facilities who have direct contact with individuals held for  examination or admitted for mental health treatment. 

 

Students in the health care professions who are interning, unless the primary purpose of the facility is not the treatment of minors are exempt from the fingerprinting and screening requirements if they are under direct supervision in the actual presence of a licensed health care professional.

 

A volunteer who assists on an intermittent basis for less than 10 hours per month is exempt from the fingerprinting and screening requirements if a person who meets the screening requirements is always present and has the volunteer within his or her line of sight.

 

Mental health personnel working in a facility licensed under chapter 395 who work on an intermittent basis for less than 15 hours per week of direct, face to face contact with patients, and who are not listed on the Department of Law Enforcement Career Offender Search or the Dru Soidin National Sex Offender Public Website, are exempt from the fingerprinting and screening requirements, except that persons working in a mental health facility where the primary purpose of the facility is the mental health treatment of minors must be fingerprinted and meet screening requirements.

 

UNLAWFUL ITEMS

 

Except as authorized by law or as specifically authorized by the person in charge of each hospital providing mental health services, it is unlawful to introduce into or upon the grounds of such hospital, or to take or attempt to take any of the following:

 

-Any intoxicating beverage or beverage which causes or may cause an intoxicating effect.

 

-Any controlled substance as defined in chapter 893.

 

-Any firearms or deadly weapon.

 

It is also unlawful to transmit or receive a patient with these items unless authorized by law or as specifically authorized by the person in charge of such hospital.

 

 

PATIENT RIGHTS

Client rights vary in substance across different levels of care and treatment settings.  The foundation for client rights is in federal statutes and regulations (Medicare, Medicaid, etc.), state statues, licensing requirements for the treatment providers, legal requirements and court mandates, as well as the differing professional codes of ethics. 

 

The Florida Statutes list the following patient rights:

 

1.  RIGHT TO INDIVIDUAL DIGNITY

All patients must be treated with dignity.  Unless the patient is a danger to themselves or others, procedures, restraining devices or vehicles used for those charged with crimes cannot be used.  If a patient has a mental illness they belong in an emergency receiving facility and a jail cannot substitutes for this environment.

 

2.  RIGHT TO TREATMENT

Several items are addressed through the right to treatment.  The first is that a facility cannot deny necessary treatment based on an individuals inability to pay for services.  The facility is able to exercise reasonable effort to collect appropriate fees from those that can pay through self payment, insurance and other appropriate means.  The second, treatment issues must be addressed in the least restrictive level of care necessary to ensure safety and therapeutic efforts. Thirdly, any client who is in a facility for a minimum of 12 hours must receive a physical examination by a health care provider authorized by law to provide physical examinations within 24 hours of admission.  The fourth issue addressed is that while in treatment clients have the right to take part in activities that will promote a positive self-image and support an improvement in their condition.  Within 5 days of admission a written individualized treatment plan must be completed with the patients input.  It is required that a space be provided for client comments.

 

3.  RIGHT TO EXPRESS AND INFORMED PATIENT CONSENT

Upon admission a patient must give express and informed consent for admission and treatment. If the patient has been adjudicated incapacitated or found to be incompetent to consent to treatment, express and informed consent to treatment must be given by the patient’s guardian or guardian advocate. If the patient is a minor, express and informed consent for admission and treatment should also be requested from the patient’s guardian. If a patient is under 18 the patients guardian  must give express and informed consent for admission and treatment unless the minor is seeking outpatient crisis intervention services.  It is not required that express and informed consent for admission and treatment be given by the minor being admitted if the guardian gives it. Prior to giving consent the person or persons giving consent should be told:  the reason for the admission, the proposed treatment, the purpose of the treatment to be provided, the common side effects thereof, alternative treatment modalities, the approximate length of care, and that any consent given by a patient may be revoked orally or in writing prior to or during the treatment period by the patient, the guardian advocate, or the guardian.

 

Informed Consent should be obtained in the case of any medical procedure utilizing general anesthetic or electroconvulsive treatment. 

 

When the department is the legal guardian of a patient, or is the custodian of a patient it is sometimes necessary to hold a hearing to determine the medical necessity of a medical procedure. 

 

In the situation where the consent cannot be obtained by the patient or the patient’s guardian or guardian advocate, the administrator of a receiving or treatment facility may, upon the recommendation of the patient’s attending physician can authorize emergency medical treatment, including a surgical procedure, if such treatment is deemed lifesaving, or if the situation threatens serious bodily harm to the patient.  

 

4.  QUALITY OF TREATMENT

Every patient should receive appropriate, skillful treatment that is directed at the patients wellness.

 

 A form stating the following must be accessible to patients:

1.  Criteria, procedures, and required staff training for any use of close or elevated levels of supervision, of restraint, seclusion, or isolation, or of emergency treatment orders, and for the use of bodily control and physical management techniques.

2.  Procedures for documenting, monitoring, and requiring clinical review of all uses of the procedures described in subparagraph 1. and for documenting and requiring review of any incidents resulting in injury to patients.

3.  A system for the review of complaints by patients or their families or guardians.

(c)  A facility may not use seclusion or restraint for punishment, to compensate for inadequate staffing, or for the convenience of staff. Facilities shall ensure that all staff are made aware of these restrictions on the use of seclusion and restraint and shall make and maintain records which demonstrate that this information has been conveyed to individual staff members.

 

5.  COMMUNICATION, ABUSE REPORTING, AND VISITS

Patients should be able to speak to friends and family outside of the facility unless it is determined that such communication is likely to be harmful to the person or others. A phone should be made available to patients that allows for free local calls and access to a long-distance service. The location of the phone should be conducive to confidential communication.  The ability to communicate should include the sending and receiving of sealed, unopened mail.  The only situation where the facility can delay or search correspondence is in the event there is reason to believe that it contains items or substances which may be harmful to the patient or others, in which case the administrator may direct reasonable examination of such mail and may regulate the disposition of such items or substances.

 

Unless a patient refuses someone, the facility must allow immediate access to a patient’s family members, guardian, guardian advocate, representative, Florida statewide or local advocacy council, or attorney, unless such access would be detrimental to the patient. When it is determined that it is necessary to restrict a form of communication or visitors, written notice of the  restriction and the reasons for such must be given to the patient, the patient’s attorney, and the patient’s guardian or guardian advocate. This information must also be written in the client’s chart and be reviewed at least every 7 days.

 

Reasonable rules can be created by the facility for the use of the phone, visiting hours and times for the receipt of mail but in no way can the rules interfere with a patient ability to report abuse.  Every patient should have access to a telephone in order to report an alleged abuse. The facility staff shall orally and in writing inform each patient of the procedure for reporting abuse.

A written copy of the procedure, including the telephone number of the central abuse hotline and reporting forms, must be posted clearly.

 

6.  CARE AND CUSTODY OF PERSONAL EFFECTS OF PATIENTS

Upon admission, for medical and safety reasons, a facility may take a patients personal possession and certain articles of clothing such as shoe strings.  If anything is taken from the patient it must be inventoried and a copy of the list should be given to the patient and when necessary their guardian. 

 

7.  VOTING IN PUBLIC ELECTIONS

A patient in a facility who is eligible to vote according to the laws of the state has the right to vote in the primary and general elections.

 

8.  HABEAS CORPUS

In the event a patient feels they are being held in a facility unjustly or any of their rights are being denied, at no fee, they are able to petition for a writ of habeas corpus to question the cause and legality of the detention.  This can also be done by a relative, friend, guardian, or an attorney.  If an administrator receives a petition they must file it with the clerk of court on the next court working day.  The patient should always receive a copy. 

 

9.  VIOLATIONS

Any violations of these rights are reported to the Agency for Health Care Administration.   The agency is authorized to impose sanctions based on their investigation.  

 

10.  LIABILITY FOR VIOLATIONS

Any person who violates or abuses any rights or privileges of patients provided by this part is liable for damages as determined by law. Any person who acts in good faith in compliance with the provisions of this part is immune from civil or criminal liability for his or her actions in connection with the admission, diagnosis, treatment, or discharge of a patient to or from a facility. However, this section does not relieve any person from liability if such person commits negligence.

 

11.  RIGHT TO PARTICIPATE IN TREATMENT AND DISCHARGE PLANNING

The patient should participate in the creation of their treatment plan and goals.  When it becomes time to discharge the patient they should be notified that they can continue treatment with anyone they choose.

 

12.  POSTING OF NOTICE OF RIGHTS OF PATIENTS

 The rights of patients should be posted clearly in treatment facilities.  The ADA information that applies and the telephone number for where to report abuse should in included. For the purposes of this course, I have reworded the rights in a language that is easily understood by the professional reader.  The facility should explain the rules in such a way, using language, that is easily understood by their population of patients.

 

PERSONS TO BE NOTIFIED UPON ADMISSION

When a patient is admitted voluntarily someone should be identified as a contact.  The patient can sign or more importantly not sign any releases they deem are appropriate with regard to this person.  The contact information should be put in the clinical record.  Information, including admission, should be released only at request of the patient, except in an emergency when necessary information can be determined by the facility.

 

If the patient was admitted on an involuntary basis, the patient should be asked for a contact, as well.  If they refuse to name a representative.  Let’s say, they are really angry because they see their family as the reason they are there in the first place, then the facility needs to select the representative.  The patient should be told who the facility has named and they have the right to replace the representative.  When selecting a representative the facility should choose a health care surrogate, spouse, adult child, parent, adult next of kin, adult friend or local advocacy council representative.  A licensed professional working with the patient, an employee of the facility, a creditor or a business associate should not be utilized in this capacity. 

 

In the case of an involuntary patient, notice should be given to the patient and the patient’s guardian, guardian advocate, attorney, and representative. Notice should be given both orally and in writing, in the language and terminology that the patient can understand, and, if needed, the facility should provide an interpreter for the patient. Notice to a patient’s guardian, guardian advocate, attorney, and representative should be given by United States mail and by registered or certified mail with the receipts attached to the patient’s clinical record. Hand delivery by a facility employee may be used as an alternative, with delivery documented in the clinical record. If notice is given by a state attorney or an attorney for the department, a certificate of service shall be sufficient to document service. A receiving facility should give prompt notice of the whereabouts of a patient who is being involuntarily held for examination, by telephone or in person within 24 hours after the patient’s arrival at the facility, unless the patient requests that no notification be made. Contact attempts shall be documented in the patient’s clinical record and should begin as soon as reasonably possible after the patient’s arrival. Notice that a patient is being admitted as an involuntary patient should be given to the Florida local advocacy council no later than the next working day after the patient is admitted.

 

The written notice of the filing of the petition for involuntary placement must contain the following:

 

1.  Notice that the petition has been filed with the circuit court in the county in which the patient is hospitalized and the address of such court.

2.  Notice that the office of the public defender has been appointed to represent the patient in the proceeding, if the patient is not otherwise represented by counsel.

3.  The date, time, and place of the hearing and the name of each examining expert and every other person expected to testify in support of continued detention.

4.  Notice that the patient, the patient’s guardian or representative, or the administrator may apply for a change of venue for the convenience of the parties or witnesses or because of the condition of the patient.

5.  Notice that the patient is entitled to an independent expert examination and, if the patient cannot afford such an examination, that the court will provide for one.

(d)  A treatment facility shall provide notice of a patient’s involuntary admission on the next regular working day after the patient’s arrival at the facility.

(e)  When a patient is to be transferred from one facility to another, notice shall be given by the facility where the patient is located prior to the transfer.

 

 

CONFIDENTIALITY OF CLINICAL RECORDS

Psychiatrists, psychologists, counselors, social workers and nurses, among others keep records for a myriad of reasons.  Most importantly to benefit the client, but also for accountability, to defend him/herself in a malpractice suit, billing purposes, in a hearing before a professional board or for continuity of care.  What is in those records, how they are stored and when and how they are released are all important factors for a professional to consider for both ethical purposes and to maintain a risk-managed practice.  The Florida Statutes require:

(1)  A clinical record shall be maintained for each patient. The record shall include

       data pertaining to admission and such other information as may be required under

       rules of the department. A clinical record is confidential and exempt from the

       provisions of s. 119.07(1). Unless waived by express and informed consent, by the

       patient or the patient’s guardian or guardian advocate or, if the patient is deceased,

      by the patient’s personal representative or the family member who stands next in line

      of interstate succession, the confidential status of the clinical record shall not be lost

      by either authorized or unauthorized disclosure to any person, organization, or

      agency.

(2)  The clinical record shall be released when:

(a)  The patient or the patient’s guardian authorizes the release. The guardian or

       guardian advocate shall be provided access to the appropriate clinical records of the

       patient. The patient or the patient’s guardian or guardian advocate may authorize

      the release of information and clinical records to appropriate persons to ensure the

      continuity of the patient’s health care or mental health care.

(b)  The patient is represented by counsel and the records are needed by the patient’s

       counsel for adequate representation.

(c)  The court orders such release. In determining whether there is good cause for

      disclosure, the court shall weigh the need for the information to be disclosed against

      the possible harm of disclosure to the person to whom such information pertains.

(d)  The patient is committed to, or is to be returned to, the Department of Corrections

      from the Department of Children and Family Services, and the Department of

     Corrections requests such records. These records shall be furnished without charge

      to the Department of Corrections.

(3)  Information from the clinical record may be released when:

(a)  A patient has declared an intention to harm other persons. When such declaration

      has been made, the administrator may authorize the release of sufficient information

     to provide adequate warning to the person threatened with harm by the patient.

(b)  The administrator of the facility or secretary of the department deems release to a

       qualified researcher as defined in administrative rule, an aftercare treatment

       provider, or an employee or agent of the department is necessary for treatment of

      the patient, maintenance of adequate records, compilation of treatment data,     

      aftercare planning, or evaluation of programs.

(4)  Information from clinical records may be used for statistical and research

       purposes if the information is abstracted in such a way as to protect the identity of

       individuals.

(5)  Information from clinical records may be used by the Agency for Health Care

      Administration, the department, and the Florida advocacy councils for the purpose

      of monitoring facility activity and complaints concerning facilities.

(6) Clinical records relating to a Medicaid recipient shall be furnished to the Medicaid

      Fraud Control Unit in the Department of Legal Affairs, upon request.

(7)  Any person, agency, or entity receiving information pursuant to this section shall

      maintain such information as confidential and exempt from the provisions of s.

      119.07(1).

(8)  Any facility or private mental health practitioner who acts in good faith in

      releasing information pursuant to this section is not subject to civil or criminal

      liability for such release.

(9) Nothing in this section is intended to prohibit the parent or next of kin of a person

      who is held in or treated under a mental health facility or program from requesting

      and receiving information limited to a summary of that person’s

     treatment plan and current physical and mental condition. Release of such

     information shall be in accordance with the code of ethics of the profession involved.

(10)  Patients shall have reasonable access to their clinical records, unless such access

      is determined by the patient’s physician to be harmful to the patient. If the patient’s

      right to inspect his or her clinical record is restricted by the facility, written

      notice of such restriction shall be given to the patient and the patient’s guardian,

      guardian advocate, attorney, and representative. In addition, the restriction shall be

      recorded in the clinical record, together with the reasons for it. The restriction of a

      patient’s right to inspect his or her clinical record shall expire after 7 days but may

     be renewed, after review, for subsequent 7-day periods.

(11)  Any person who fraudulently alters, defaces, or falsifies the clinical record of any

        person receiving mental health services in a facility subject to this part, or causes

        or procures any of these offenses to be committed, commits a misdemeanor of the

        second degree, punishable as provided in s. 775.082 or s. 775.083.

 

 

DISCHARGE OF VOLUNTARY PATIENTS

When a patient has sufficiently improved so that retention in the facility is no longer desirable they should be discharged.   When a patient is admitted voluntarily and then they or their representative revokes consent or requests discharge either orally or in writing at any time following admission to the facility, the patient must be discharged within 24 hours of the request, unless the request is rescinded or the patient is transferred to involuntary status.  The request should be noted in their record or chart immediately upon the request.  The 24-hour time period may be extended by a treatment facility when necessary for adequate discharge planning, but shall not exceed 3 days exclusive of weekends and holidays.  If the request for discharge is made by a person other than the patient, the discharge may be conditioned upon the express and informed consent of the patient.

 

When a voluntary patient, or an authorized person on the patient’s behalf, makes a request for discharge, the request for discharge, unless freely and voluntarily rescinded, must be communicated to a physician, clinical psychologist, or psychiatrist as quickly as possible, but not later than 12 hours after the request is made. If the patient meets the criteria for involuntary placement, the administrator of the facility must file with the court a petition for involuntary placement, within 2 court working days after the request for discharge is made. If the petition is not filed within 2 court working days, the patient shall be discharged. Pending the filing of the petition, the patient may be held and emergency treatment rendered in the least restrictive manner, upon the written order of a physician, if it is determined that such treatment is necessary for the safety of the patient or others.

 

 

INVOLUNTARY PATIENT REQUESTING VOLUNTARY STATUS

An involuntary patient who applies to be transferred to voluntary status shall be transferred to voluntary status immediately, unless the patient has been charged with a crime, or has been involuntarily placed for treatment by a court pursuant to s. 394.467 and continues to meet the criteria for involuntary placement. When transfer to voluntary status occurs, notice shall be given as provided in s. 394.4599.

 

 

INITIATION OF INVOLUNTARY EXAMINATION

You receive a call in your private practice at 3:00 on Tuesday afternoon.  The distraught wife of your previous client, a 32 year old male named John, is crying.  She states that her husband has lost it.  He left their house telling her goodbye forever.  “He told me I deserved a man that can provide for his family and function like a normal person.  He said that the depression just won’t let go of him and he is tired of fighting it.”  She explains that his boss called him and  the employer, although sympathetic to John, can no longer accept his frequent absences and nonproductive work ethic.  John was fired.  He said he just didnt want to live anymore.  “I tried to stop him, but he wouldn’t listen.  He said he was going to go to his mom’s house and drink himself to death.  What should I do?  He refuses to go back into the hospital, but I am afraid he will really hurt himself.”

 

According to the Florida Statutes, an involuntary examination may be initiated by any one of the following means:

 

1.  A court may enter an ex parte order stating that a person appears to meet the criteria for involuntary examination, giving the findings on which that conclusion is based. The ex parte order for involuntary examination must be based on sworn testimony, written or oral. If other less restrictive means are not available, such as voluntary appearance for outpatient evaluation, a law enforcement officer, or other designated agent of the court, shall take the person into custody and deliver him or her to the nearest receiving facility for involuntary examination. The order of the court shall be made a part of the patient’s clinical record. No fee shall be charged for the filing of an order under this subsection. Any receiving facility accepting the patient based on this order must send a copy of the order to the Agency for Health Care Administration on the next working day. The order shall be valid only until executed or, if not executed, for the period specified in the order itself. If no time limit is specified in the order, the order shall be valid for 7 days after the date that the order was signed.

 

2.  A law enforcement officer shall take a person who appears to meet the criteria for involuntary examination into custody and deliver the person or have him or her delivered to the nearest receiving facility for examination. The officer shall execute a written report detailing the circumstances under which the person was taken into custody, and the report shall be made a part of the patient’s clinical record. Any receiving facility accepting the patient based on this report must send a copy of the report to the Agency for Health Care Administration on the next working day.

 

3.  A physician, clinical psychologist, psychiatric nurse, or clinical social worker may execute a certificate stating that he or she has examined a person within the preceding 48 hours and finds that the person appears to meet the criteria for involuntary examination and stating the observations upon which that conclusion is based. If other less restrictive means are not available, such as voluntary appearance for outpatient evaluation, a law enforcement officer shall take the person named in the certificate into custody and deliver him or her to the nearest receiving facility for involuntary examination. The law enforcement officer shall execute a written report detailing the circumstances under which the person was taken into custody. The report and certificate shall be made a part of the patient’s clinical record. Any receiving facility accepting the patient based on this certificate must send a copy of the certificate to the Agency for Health Care Administration on the next working day.

 

 

INVOLUNTARY PLACEMENT CRITERIA

According to the Florida Statutes a person may be involuntarily placed for treatment upon a finding of the court by clear and convincing evidence that:

 

(1)  He or she is mentally ill and because of his or her mental illness:

      1.a.  He or she has refused voluntary placement for treatment after sufficient and

              conscientious explanation and disclosure of  the purpose of placement for

              treatment; or

         b.  He or she is unable to determine for himself or herself whether placement is

             necessary; and

      2.a.  He or she is manifestly incapable of surviving alone or with the help of willing

              and responsible family or friends, including available alternative services, and,

              without treatment, is likely to suffer from neglect or refuse to care for

              himself or herself, and such neglect or refusal poses a real and present threat of

              substantial harm to his or her well-being; or

         b.  There is substantial likelihood that in the near future he or she will inflict

              serious bodily harm on himself or herself or another person, as evidenced by

              recent behavior causing, attempting, or threatening such harm; and

 

(2)  All available less restrictive treatment alternatives which would offer an opportunity

       for improvement of his or her condition have been judged to be inappropriate.

 

 

INVOLUNTARY ADMISSION TO A TREATMENT FACILITY

Admission to a treatment facility needs to be supported by the opinion of a psychiatrist and the second opinion of a clinical psychologist or another psychiatrist, both of whom have personally examined the patient within the preceding 72 hours.  However, in counties of less than 50,000 population, if the administrator of the facility certifies that no psychiatrist or clinical psychologist is available to provide the second opinion, such second opinion may be provided by a licensed physician with postgraduate training and experience in diagnosis and treatment of mental and nervous disorders or by a psychiatric nurse. Such recommendation shall be entered on an involuntary placement certificate, which certificate shall authorize the receiving facility to retain the patient pending transfer to a treatment facility or completion of a hearing.

 

Once a patient is admitted on an involuntary basis, the facility shall file a petition for involuntary placement in the court in the county where the patient is located. Upon filing, the clerk of the court shall provide copies to the department, the patient, the patient’s guardian or representative, and the state attorney and public defender of the judicial circuit in which the patient is located. No fee shall be charged for the filing of a petition under this subsection. The process continues as follows:

 

*  Within 1 court working day after the filing of a petition for involuntary placement, the court shall appoint the public defender to represent the person who is the subject of the petition, unless the person is otherwise represented by counsel. The clerk of the court shall immediately notify the public defender of such appointment. Any attorney representing the patient shall have access to the patient, witnesses, and records relevant to the presentation of the patient’s case and shall represent the interests of the patient, regardless of the source of payment to the attorney.

 

*  Hearing on Involuntary placement will be held within 5 days, unless a continuance is granted.    

    One of the professionals who executed the involuntary placement certificate must be a witness.

 

The patient and the patient’s guardian or representative should be informed by the court of the right to an independent expert examination. The patient may refuse to testify at the hearing.

If the court concludes that the patient meets the criteria for involuntary placement, it shall order that the patient be transferred to a treatment facility or, if the patient is at a treatment facility, that the patient be retained there or be treated at any other appropriate receiving or treatment facility, or that the patient receive services from a receiving or treatment facility, on an involuntary basis, for a period of up to 6 months. The order shall specify the nature and extent of the patient’s mental illness. The facility shall discharge a patient any time the patient no longer meets the criteria for involuntary placement, unless the patient has transferred to voluntary status.

     

If at any time prior to the conclusion of the hearing on involuntary placement it appears to the court that the person does not meet the criteria for involuntary placement under this chapter, but instead meets the criteria for involuntary assessment, protective custody, or involuntary admission pursuant to s. 397.675, then the court may order the person to be admitted for involuntary assessment for a period of 5 days pursuant to s. 397.6811.

     

 

DISCHARGE OF INVOLUNTARY PATIENTS

Stan is a 52 year old patient at the private psychiatric hospital where you are employed.  He was brought to the hospital and admitted as an involuntary patient.  At the time of admission he was delusional and paranoid.  Two days after admission he has a better grasp on where he is and why he was admitted.  He is cooperative with treatment and motivated to explore medication management.  He asks to be admitted as a voluntary patient.

At any time a patient is found to no longer meet the criteria for involuntary placement the following should occur:

 

(a)  Discharge the patient, unless the patient is under a criminal charge, in which case the patient shall be transferred to the custody of the appropriate law enforcement officer;

(b)  Transfer the patient to voluntary status on his or her own authority or at the patient’s request, unless the patient is under criminal charge or adjudicated incapacitated; or

(c)  Place an improved patient, except a patient under a criminal charge, on convalescent status in the care of a community facility.

(2)  NOTICE.–Notice of discharge or transfer of a patient shall be given as provided in s. 394.4599.

 

 

Emergency Admission

Involuntary Assessment

Involuntary

Treatment

Hearings

None

*Scheduled and conducted within 10 days of initial petition

 

*Renewal: Court has an option as to whether or not to schedule a hearing

* Scheduled and conducted within 10 days of initial petition

 

*Renewal:  Scheduled and conducted within 15 days

Length of Stay

Not to exceed 72 hours.  If admitted to a less restrictive level of care, not to exceed 5 days

Not to exceed 5 days

Not to exceed 60 days

Extensions

None

7 days after the date of the renewal order for a total of 12 days from the date of admission

An additional 90 days after the date of the renewal order for a total of 150 days from the date of admission

* Additional extensions require new petitions for renewal

 

 

EVALUATION AND CRISIS INTERVENTION SERVICES FOR MINORS

When any minor age 13 years or older experiences an emotional crisis to such degree that he or she perceives the need for professional assistance, he or she shall have the right to request, consent to, and receive mental health diagnostic and evaluative services provided by a licensed mental health professional, as defined by Florida Statutes, or in a mental health facility licensed by the state. The evaluation should not include medication and other somatic methods, aversive stimuli, or substantial deprivation. If more than two visits during any 1-week period is necessary then parental consent is required for further services. 

 

When a  minor age 13 years or older perceives the need for professional assistance, he or she shall have the right to request, consent to, and receive outpatient crisis intervention services including individual psychotherapy, group therapy, counseling, or other forms of verbal therapy provided by a licensed mental health professional, as defined by Florida Statutes, or in a mental health facility licensed by the state. Such services shall not include medication and other somatic treatments, aversive stimuli, or substantial deprivation. Such services shall not exceed two visits during any 1-week period in response to a crisis situation before parental consent is required for further services, and may include parental participation when determined to be appropriate by the mental health professional or facility. The parent, parents, or legal guardian of a minor shall not be liable for payment for any such outpatient diagnostic and evaluation services or outpatient therapy and counseling services, as provided in this section, unless such parent, parents, or legal guardian participates in the outpatient diagnostic and evaluation services or outpatient therapy and counseling services and then only for the services rendered with such participation. The provisions of these services are voluntary.

 

 

ADMISSION AND PLACEMENT OF CHILDREN AND ADOLESCENTS IN MENTAL FACILITIES

A child or adolescent as defined in s. 394.492 may not be admitted to a state-owned or state-operated mental health treatment facility. A child may be admitted pursuant to s. 394.4625 or s. 394.467 to a crisis stabilization unit or a residential treatment center licensed under this chapter or a hospital licensed under chapter 395. The treatment center, unit, or hospital must provide the least restrictive available treatment that is appropriate to the individual needs of the child or adolescent.

 

A person under the age of 14 may not be admitted to a bed in a room or ward with an adult patient in a mental health unit or share common areas with an adult patient in a mental health unit. However, a person 14 years of age or older may be admitted to a bed in a room or ward in the mental health unit with an adult if the admitting physician documents in the case record that such placement is medically indicated or for reasons of safety. Such placement shall be reviewed by the attending physician or a designee or on-call physician each day and documented in the case record.

 

FLORIDA STATUTES, CHAPTER 456

PROFESSIONAL REGULATIONS

 

In order to promote the health, safety and welfare of the public the Legislature states that the profession of providing mental health and substance abuse services must be regulated. 

Under The Division of Quality Medical Assurance is each professional board which has adopted rules establishing a procedure for the biennial renewal of licenses.  

 

The board specifies the expiration dates of licenses and the process for tracking compliance with continuing education requirements, financial responsibility requirements, and any other conditions of renewal. 

 

1board

 

 

LICENSING PROVISIONS

Any person desiring to be licensed in a profession within the jurisdiction of the department shall apply to the department in writing to take the licensure examination. Applications can be requested by mail or found on the world wide web.  The board can charge an application fee.  

 

Upon receipt of the appropriate license fee, the department shall issue a license to any person certified by the appropriate board, or its designee, as having met the licensure requirements imposed by law or rule. The license shall consist of a wallet-size identification card and a wall card measuring 61/2 inches by 5 inches. In addition to the two-part license, the department, at the time of initial licensure, shall issue a wall certificate suitable for conspicuous display, which shall be no smaller than 81/2 inches by 14 inches. The licensee shall surrender to the department the wallet-size identification card, the wall card, and the wall certificate, if one has been issued by the department, if the licensee’s license is revoked.

 

Refusal of an initial license can occur under the following circumstances:

1)  When the applicant is under investigation or prosecution in any jurisdiction for an

     action that would constitute a violation of this chapter or the professional practice

     acts administered by the department and the boards, until such time as the

     investigation or prosecution is complete, and the time period in which the licensure

     application must be granted or denied shall be tolled until 15 days after the receipt of

     the final results of the investigation or prosecution.

2)  If an applicant has been convicted of a felony related to the practice or ability to

     practice any health care profession, the board, or the department when there is no

     board, may require the applicant to prove that his or her civil rights have been   

     restored.

 

In considering applications for licensure, the board may require a personal appearance of the applicant. If the applicant fails to appear before the board at either of the next two regularly scheduled board meetings, or fails to appear before the department within 30 days if there is no board, the application for licensure will be denied.

 

Daniel works in the discharge planning department of the hospital.  Dr. Smith has an agreement with Daniel based on a long term friendship.  Daniel refers all of the psychiatric patients needing outpatient counseling to Dr. Smith.  In return for the referral, Dr. Smith pays Daniel $25.00 per referral.  Daniel knows Dr. Smith is an excellent psychologist and he makes a little extra money on the side.  Is this unethical?

 

Read on

 

It is unlawful for any health care provider or any provider of health care services to offer, pay, solicit, or receive a kickback, directly or indirectly, overtly or covertly, in cash or in kind, for referring or soliciting patients.

 

CONTINUING EDUCATION

Any board that currently requires continuing education for renewal of a license, or the department if there is no board, should adopt rules to establish the criteria for continuing education courses.

 

Legislature mandates that the boards require the completion of a 2-hour course relating to prevention of medical errors as part of the licensure and renewal process. The 2-hour course should count towards the total number of continuing education hours required for the profession. The course should include a study of root-cause analysis, error reduction and prevention, and patient safety.

 

1-hour of continuing education on domestic violence and a course on human immunodeficiency virus and acquired immune deficiency syndrome are also required as part of biennial re-licensure or re-certification. The domestic violence course should consist of information on the scope of domestic violence, screening procedures for determining whether a patient has any history of being either a victim or a perpetrator of domestic violence, and instruction on how to provide such patients with information on, or how to refer such patients to, resources in the local community, such as domestic violence centers and other advocacy groups, that provide legal aid, shelter, victim counseling, batterer counseling, or child protection services. The HIV/AIDS course should consist of education on the modes of transmission, infection control procedures, clinical management, and prevention of human immunodeficiency virus and acquired immune deficiency syndrome.  The course should include information on current Florida law on acquired immune deficiency syndrome and its impact on testing, confidentiality of test results, treatment of patients, and any protocols and procedures applicable to human immunodeficiency virus counseling and testing, reporting, the offering of HIV testing to pregnant women, and partner notification issues.

 

 

LIMITED LICENSE

In order to permit practice by retired professionals the board has the ability to offer limited licensees under the following criteria:

 

1)  Any person desiring to obtain a limited license, when permitted by rule, shall submit to the board, or the department when there is no board, an application and fee, not to exceed $300, and an affidavit stating that the applicant has been licensed to practice in any jurisdiction in the United States for at least 10 years in the profession for which the applicant seeks a limited license. The affidavit shall also state that the applicant has retired or intends to retire from the practice of that profession and intends to practice only pursuant to the restrictions of the limited license granted pursuant to this section. If the applicant for a limited license submits a notarized statement from the employer stating that the applicant will not receive monetary compensation for any service involving the practice of her or his profession, the application and all licensure fees shall be waived.

2) The board, or the department when there is no board, may deny limited licensure to an applicant who has committed, or is under investigation or prosecution for, any act which would constitute the basis for discipline pursuant to the provisions of this chapter or the applicable practice act.

3) The recipient of a limited license may practice only in the employ of public agencies or institutions or nonprofit agencies or institutions which meet the requirements of s. 501(c)(3) of the Internal Revenue Code, and which provide professional liability coverage for acts or omissions of the limited licensee. A limited licensee may provide services only to the indigent, underserved, or critical need populations within the state. The standard for determining indigency shall be that recognized by the Federal Poverty Income Guidelines produced by the United States Department of Health and Human Services. The board, or the department when there is no board, may adopt rules to define underserved and critical need areas and to ensure implementation of this section.

4)  A board, or the department when there is no board, may provide by rule for supervision of limited licensees to protect the health, safety, and welfare of the public.

5)  Each applicant granted a limited license is subject to all the provisions of this chapter and the respective practice act under which the limited license is issued which are not in conflict with this section.

6)  This section does not apply to chapter 458 or chapter 459.

 

 

EXAMINATION

Legislature sets forth that each board  will provide, contract, or approve services for the development, preparation, administration, scoring, score reporting, and evaluation of all examinations.

 

ACTIVE, INACTIVE and DELINQUENT LICENSES

A licensee may practice a profession only if the licensee has an active status license. If a licensee has an inactive or delinquent license then they must apply for a license change to active and pay applicable fees.

 

 

RENEWALS

At least 90 days before the end of a licensure cycle the department sends a licensure renewal notification to an active or inactive status licensee at the licensee’s last known address of record with the department.  They will also forward a notice of pending cancellation of licensure to a delinquent licensee.

 

 

RECORDS

A release is required to transfer or disclose any patient records. However, such records may be furnished without written authorization under the following circumstances:

1.  To any person, firm, or corporation that has procured or furnished such examination or treatment with the patient’s consent.

2.  When compulsory physical examination is made pursuant to Rule 1.360, Florida Rules of Civil Procedure, in which case copies of the medical records shall be furnished to both the defendant and the plaintiff.

3.  In any civil or criminal action, unless otherwise prohibited by law, upon the issuance of a subpoena from a court of competent jurisdiction and proper notice to the patient or the patient’s legal representative by the party seeking such records.

4.  For statistical and scientific research, provided the information is abstracted in such a way as to protect the identity of the patient or provided written permission is received from the patient or the patient’s legal representative.

(b)  Absent a specific written release or authorization permitting utilization of patient information for solicitation or marketing the sale of goods or services, any use of that information for those purposes is prohibited.

(6)  Except in a medical negligence action or administrative proceeding when a health care practitioner or provider is or reasonably expects to be named as a defendant, information disclosed to a health care practitioner by a patient in the course of the care and treatment of such patient is confidential and may be disclosed only to other health care practitioners and providers involved in the care or treatment of the patient, or if permitted by written authorization from the patient or compelled by subpoena at a deposition, evidentiary hearing, or trial for which proper notice has been given.

(7)(a)1.  The department may obtain patient records pursuant to a subpoena without written authorization from the patient if the department and the probable cause panel of the appropriate board, if any, find reasonable cause to believe that a health care practitioner has excessively or inappropriately prescribed any controlled substance specified in chapter 893 in violation of this chapter or any professional practice act or that a health care practitioner has practiced his or her profession below that level of care, skill, and treatment required as defined by this chapter or any professional practice act and also find that appropriate, reasonable attempts were made to obtain a patient release.

2.  The department may obtain patient records and insurance information pursuant to a subpoena without written authorization from the patient if the department and the probable cause panel of the appropriate board, if any, find reasonable cause to believe that a health care practitioner has provided inadequate medical care based on termination of insurance and also find that appropriate, reasonable attempts were made to obtain a patient release.

3.  The department may obtain patient records, billing records, insurance information, provider contracts, and all attachments thereto pursuant to a subpoena without written authorization from the patient if the department and probable cause panel of the appropriate board, if any, find reasonable cause to believe that a health care practitioner has submitted a claim, statement, or bill using a billing code that would result in payment greater in amount than would be paid using a billing code that accurately describes the services performed, requested payment for services that were not performed by that health care practitioner, used information derived from a written report of an automobile accident generated pursuant to chapter 316 to solicit or obtain patients personally or through an agent regardless of whether the information is derived directly from the report or a summary of that report or from another person, solicited patients fraudulently, received a kickback as defined in s. 456.054, violated the patient brokering provisions of s. 817.505, or presented or caused to be presented a false or fraudulent insurance claim within the meaning of s. 817.234(1)(a), and also find that, within the meaning of s. 817.234(1)(a), patient authorization cannot be obtained because the patient cannot be located or is deceased, incapacitated, or suspected of being a participant in the fraud or scheme, and if the subpoena is issued for specific and relevant records.

(b)  Patient records, billing records, insurance information, provider contracts, and all attachments thereto obtained by the department pursuant to this subsection shall be used solely for the purpose of the department and the appropriate regulatory board in disciplinary proceedings. This section does not limit the assertion of the psychotherapist-patient privilege under s. 90.503 in regard to records of treatment for mental or nervous disorders by a medical practitioner licensed pursuant to chapter 458 or chapter 459 who has primarily diagnosed and treated mental and nervous disorders for a period of not less than 3 years, inclusive of psychiatric residency. However, the health care practitioner shall release records of treatment for medical conditions even if the health care practitioner has also treated the patient for mental or nervous disorders. If the department has found reasonable cause under this section and the psychotherapist-patient privilege is asserted, the department may petition the circuit court for an in camera review of the records by expert medical practitioners appointed by the court to determine if the records or any part thereof are protected under the psychotherapist-patient privilege.

(8)(a)  All patient records obtained by the department and any other documents maintained by the department which identify the patient by name are confidential and exempt from s. 119.07(1) and shall be used solely for the purpose of the department and the appropriate regulatory board in its investigation, prosecution, and appeal of disciplinary proceedings. The records shall not be available to the public as part of the record of investigation for and prosecution in disciplinary proceedings made available to the public by the department or the appropriate board.

(b)  Notwithstanding paragraph (a), all patient records obtained by the department and any other documents maintained by the department which relate to a current or former Medicaid recipient shall be provided to the Medicaid Fraud Control Unit in the Department of Legal Affairs, upon request.

(9)  All records owners shall develop and implement policies, standards, and procedures to protect the confidentiality and security of the medical record. Employees of records owners shall be trained in these policies, standards, and procedures.

(10)  Records owners are responsible for maintaining a record of all disclosures of information contained in the medical record to a third party, including the purpose of the disclosure request. The record of disclosure may be maintained in the medical record. The third party to whom information is disclosed is prohibited from further disclosing any information in the medical record without the expressed written consent of the patient or the patient’s legal representative.

(11)  Notwithstanding the provisions of s. 456.058, records owners shall place an advertisement in the local newspaper or notify patients, in writing, when they are terminating practice, retiring, or relocating, and no longer available to patients, and offer patients the opportunity to obtain a copy of their medical record.

(12)  Notwithstanding the provisions of s. 456.058, records owners shall notify the appropriate board office when they are terminating practice, retiring, or relocating, and no longer available to patients, specifying who the new records owner is and where medical records can be found.

(13)  Whenever a records owner has turned records over to a new records owner, the new records owner shall be responsible for providing a copy of the complete medical record, upon written request, of the patient or the patient’s legal representative.

(14)  Licensees in violation of the provisions of this section shall be disciplined by the appropriate licensing authority.

(15)  The Attorney General is authorized to enforce the provisions of this section for records owners not otherwise licensed by the state, through injunctive relief and fines not to exceed $5,000 per violation.

(16)  A health care practitioner or records owner furnishing copies of reports or records or making the reports or records available for digital scanning pursuant to this section shall charge no more than the actual cost of copying, including reasonable staff time, or the amount specified in administrative rule by the appropriate board, or the department when there is no board.

(17)  Nothing in this section shall be construed to limit health care practitioner consultations, as necessary.

(18)  A records owner shall release to a health care practitioner who, as an employee of the records owner, previously provided treatment to a patient, those records that the health care practitioner actually created or generated when the health care practitioner treated the patient. Records released pursuant to this subsection shall be released only upon written request of the health care practitioner and shall be limited to the notes, plans of care, and orders and summaries that were actually generated by the health care practitioner requesting the record.

(19)  The board, or department when there is no board, may temporarily or permanently appoint a person or entity as a custodian of medical records in the event of the death of a practitioner, the mental or physical incapacitation of the practitioner, or the abandonment of medical records by a practitioner. The custodian appointed shall comply with all provisions of this section, including the release of patient records.

 

Each board should provide regulations for the disposition of records of deceased practitioners, practitioner relocating or those terminating practice.  For the purposes of this course you will find these requirements in the Rule 64-B4 section.

 

CONFIDENTIALITY

Communications between a patient and a psychiatrist, as defined in s. 394.455, shall be held confidential and shall not be disclosed except upon the request of the patient or the patient’s legal representative. Provision of psychiatric records and reports shall be governed by s. 456.057. Notwithstanding any other provision of this section or s. 90.503, where:

(1)  A patient is engaged in a treatment relationship with a psychiatrist;

(2)  Such patient has made an actual threat to physically harm an identifiable victim or victims;

and

(3)  The treating psychiatrist makes a clinical judgment that the patient has the apparent capability to commit such an act and that it is more likely than not that in the near future the patient will carry out that threat, the psychiatrist may disclose patient communications to the extent necessary to warn any potential victim or to communicate the threat to a law enforcement agency. No civil or criminal action shall be instituted, and there shall be no liability on account of disclosure of otherwise confidential communications by a psychiatrist in disclosing a threat pursuant to this section.

 

DISCLOSURE OF HIV/AIDS

 (1)  A practitioner regulated through the Division of Medical Quality Assurance of the department shall not be civilly or criminally liable for the disclosure of otherwise confidential information to a sexual partner or a needle-sharing partner under the following circumstances:

(a)  If a patient of the practitioner who has tested positive for human immunodeficiency virus discloses to the practitioner the identity of a sexual partner or a needle-sharing partner;

(b)  The practitioner recommends the patient notify the sexual partner or the needle-sharing partner of the positive test and refrain from engaging in sexual or drug activity in a manner likely to transmit the virus and the patient refuses, and the practitioner informs the patient of his or her intent to inform the sexual partner or needle-sharing partner; and

(c)  If pursuant to a perceived civil duty or the ethical guidelines of the profession, the practitioner reasonably and in good faith advises the sexual partner or the needle-sharing partner of the patient of the positive test and facts concerning the transmission of the virus.

However, any notification of a sexual partner or a needle-sharing partner pursuant to this section shall be done in accordance with protocols developed pursuant to rule of the Department of Health.

(2)  Notwithstanding the foregoing, a practitioner regulated through the Division of Medical Quality Assurance of the department shall not be civilly or criminally liable for failure to disclose information relating to a positive test result for human immunodeficiency virus of a patient to a sexual partner or a needle-sharing partner.

 

 

ADVERTISEMENT STATEMENT FOR FREE OR DISCOUNTED SERVICES. 

In any advertisement for a free, discounted fee, or reduced fee service, examination, or treatment by a health care practitioner licensed under chapter 458, chapter 459, chapter 460, chapter 461, chapter 462, chapter 463, chapter 464, chapter 465, chapter 466, chapter 467, chapter 478, chapter 483, chapter 484, chapter 486, chapter 490, or chapter 491, the following statement shall appear in capital letters clearly distinguishable from the rest of the text:

 

THE PATIENT AND ANY OTHER PERSON RESPONSIBLE FOR PAYMENT HAS A RIGHT TO REFUSE TO PAY, CANCEL PAYMENT, OR BE REIMBURSED FOR PAYMENT FOR ANY OTHER SERVICE, EXAMINATION, OR TREATMENT THAT IS PERFORMED AS A RESULT OF AND WITHIN 72 HOURS OF RESPONDING TO THE ADVERTISEMENT FOR THE FREE, DISCOUNTED FEE, OR REDUCED FEE SERVICE, EXAMINATION, OR TREATMENT.

 

However, the required statement shall not be necessary as an accompaniment to an advertisement of a licensed health care practitioner defined by this section if the advertisement appears in a classified directory the primary purpose of which is to provide products and services at free, reduced, or discounted prices to consumers and in which the statement prominently appears in at least one place.

 

 

SEXUAL MISCONDUCT

Sexual misconduct is prohibited. Sexual misconduct is described as the violation of the professional relationship to engage or attempt to engage the patient or client, or an immediate family member, guardian, or representative of the patient or client in, or to induce or attempt to induce such person to engage in, verbal or physical sexual activity outside the scope of the professional practice of such health care profession.

 

The Board will refuse to admit a candidate to any examination and refuse to issue a license, certificate, or registration to any applicant if the candidate or applicant has:

(a)  Had any license, certificate, or registration to practice any profession or occupation revoked or surrendered based on a violation of sexual misconduct in the practice of that profession under the laws of any other state or any territory or possession of the United States and has not had that license, certificate, or registration reinstated by the licensing authority of the jurisdiction that revoked the license, certificate, or registration; or

(b)  Committed any act in any other state or any territory or possession of the United States which if committed in this state would constitute sexual misconduct.

 

IMPAIRED PRACTITIONERS

Mental health practitioners are human, and as such, are flawed.  If the department receives a complaint alleging that a licensee is impaired as a result of the misuse or abuse of alcohol or other drugs or due to a mental or physical condition which could affect his or her ability to practice they can investigate and if necessary discipline.  Impaired practitioner programs can be put in place to help those in need.  

 

 

CITATIONS AND DISCIPLINARY GUIDELINES

Chapter 456 gives each board the authority to give citations and outline disciplinary guidelines.  

 

 

COMPLIMENTARY OR ALTERNATIVE HEALTH CARE TREATMENTS

Nancy, who is licensed as a LCSW, also is trained as an herbalist.  She feels it is beneficial for all of her clients to be in balance hormonally while seeking counseling.  Does she have to explain to her clients what she is offering or can she sell it as medication?

 

A health care practitioner who offers to provide a patient with a complementary or alternative health care treatment must inform the patient of the nature of the treatment and must explain the benefits and risks associated with the treatment to the extent necessary for the patient to make an informed and prudent decision regarding such treatment option. In compliance with this subsection:

(a)  The health care practitioner must inform the patient of the practitioner’s education, experience, and credentials in relation to the complementary or alternative health care treatment option.

(b)  The health care practitioner may, in his or her discretion, communicate the information orally or in written form directly to the patient or to the patient’s legal representative.

(c)  The health care practitioner may, in his or her discretion and without restriction, recommend any mode of treatment that is, in his or her judgment, in the best interests of the patient, including complementary or alternative health care treatments, in accordance with the provisions of his or her license.

  

.

CHAPTER 64B4-2

CLINICAL SOCIAL WORK,

MARRIAGE AND FAMILY THERAPY AND

MENTAL HEALTH COUNSELING

 

These regulations are the rules that pertain directly to the practice of clinical social work, marriage and family therapy and mental health counseling. 

 

This document gives the specific definitions of what constitutes experience, supervision, qualified supervisor and how to achieve the necessary requirements for licensure.  Although you will find more specific requirements by reading and researching the document in its entirety, an overview follows.

 

Two year of experience under supervision are required.  These two year consist of at least 1500 hours of providing psychotherapy face-to-face with clients accrued in no less than 100 weeks.  

 

At least 100 hours of supervision is required per 1500 hours of psychotherapy.  The intern is require to have at least one hour of supervision per 15 hours of psychotherapy.  If an intern obtains group supervision, the group supervision should be no more than 50% of the supervision and must be combined with individual supervision. For the purpose of this section, individual supervision is defined as one supervisor supervising no more than two (2) interns and group supervision is defined as one supervisor supervising more than 2 but a maximum of 6 interns in the group.

 

A qualified supervisor must be licensed in the specific profession with the applicable number of years of experience as specified in Rule 64B4.  There should be no conflict of interest between the intern and the supervisor.  These conflicts of interest would include: supervision provided by the applicants therapist, parents, spouse, former spouses, siblings, children, employees, or anyone sharing the same household, or any romantic, domestic or familial relationship.

 

LICENSURE

The regulations discuss the application process detailing the application forms, verification of supervision, documentation requirements of course content, the examination procedures, Laws and Rules requirements, supervision required prior to obtaining a license and the limited license opportunities. 

 

Rebecca has graduated with her masters in counseling.  She has been hired as an assessment counselor at a not for profit psychiatric hospital.  She is paying for supervision on a weekly basis.  What status of licensure should be apply for?

 

Answer:  Intern

 

 STATUS

 

Intern

 

 

Initial license

Examination

Endorsement

Dual as MFT

Renewal

Active

Inactive

Deliquent

Fail to Renew

 

Null and Void

Fail to Renew a second time

 

 

64B4-3.0085 Intern Registration

(1) An individual who intends to practice in Florida to satisfy the post-masters experience must register as an intern by submitting a completed application to the Board on Form DH-MQA 1175, Intern Registration Application (Revised 10/09), hereby adopted and incorporated by reference, which can be obtained from the Boards website at www.doh.state.fl.us/mqa/491. The application shall be accompanied by the application fee specified in Rule 64B4-4.015, F.A.C., which is non-refundable.

(2) An intern is required to identify a qualified supervisor by requesting that the supervisor submit a letter to the Board with the applicants name, supervisors name, supervisors license number, and a statement that he or she has agreed to provide supervision while the applicant is a registered intern.

(3) Prior to changing or adding another qualified supervisor, the registered intern must:

(a) Request that the new supervisor must submit a letter to the Board with the registered interns name, the interns license number, the supervisors name, the supervisors license number, and a statement that he or she has agreed to provide supervision to the registered intern; and

(b) Receive a communication from the Board indicating its approval of the new supervisor.

(4) Experience obtained under the supervision of the new qualified supervisor will not count toward completion of the experience requirement until the registered intern has received board approval of their new qualified supervisor.
Rulemaking Authority 491.004(5) FS. Law Implemented 491.0045 FS. HistoryNew 6-8-09, Amended 2-24-10, 10-17-10.

 

FEE SCHEDULES

CHAPTER 64B4-4 FEE SCHEDULE

 

The current fees are as follows:

Application Fee for Licensure by Endorsement:  $300.00

Biennial Licensure Fee:  $250.00

Reactivation Fee:  $50.00

Renewal of Inactive Status Fee:  $50.00

Change of Status Fee:  $105.00

Delinquency Fee:  $105.00

Continuing Education Provider Application Fee:  $200.00

Initial Licensure Fee:  $105.00

Provisional License Application Fee:  $100.00

Registered Intern Registration Fee:  $150.00

Registered Intern Biennial Renewal Fee:  $75.00

Wall Certificate and Duplicate License Fees:  $25.00

Registered Intern Delinquency Fee:  $25.00

 

DISCIPLINE

 

Rule 64B4 details the specific fines attached to violations.  The fines can range from probation, fines beginning at $25.00 up to $10,000.00 and permanent revocation of license. 

 

The following are actions for which the board will discipine:

(a) Attempting to obtain, obtaining, or renewing a license under Chapter 491, F.S., by

     bribery or fraudulent misrepresentation or through an error of the Board or the

     Department.(Sections 456.072(1)(h) & 491.009(1)(a), F.S.)

(b) Having a license or certificate to practice a comparable profession revoked,

     suspended, or otherwise acted against, including the denial of certification or

    licensure by another state, territory, or country.(Section 491.009(1)(b), F.S.)

(c) Being convicted or found guilty, regardless of adjudication, or having entered a plea

     of nolo contendere to, a crime in any jurisdiction which directly relates to the practice

     of the licensees profession or the licensees ability to practice that

     profession.(Section 456.072(1)(c) & 491.009(1)(c), F.S.)

(d) False, deceptive, or misleading advertising or obtaining a fee or other thing of value

      on the representation that beneficial results from any treatment will be

      guaranteed.(Section 491.009(1)(d), F.S.)

(e) Advertising, practicing, or attempting to practice under a name other than ones

     own.(Section 491.009(1)(e), F.S.)

(f) Maintaining a professional association with any person whom the applicant or

     licensee knows, or has reason to believe, is in violation of Chapter 491, F.S., or of a

    rule of the Department or this Board.(Section 491.009(1)(f), F.S.)

(g) Knowingly aiding, assisting, procuring, or advising a non-licensed person to hold

     oneself out as licensed under Chapter 491, F.S.(Section 456.072(1)(j) &

     491.009(1)(g), F.S.)

(h)1. Failing to perform any statutory or legal obligation placed upon a person licensed

        under Chapter 491, F.S.(Section 456.072(1)(k) & 491.009(1)(h), F.S.)

(i) Willfully making or filing a false report or record; failing to file a report or record

    required by state or federal law; willfully  impeding or obstructing the filing of a

   report or record; or inducing another person to make or file a false report or record or

   to impede or obstruct the filing of a report or record.(Section 456.072(1)(l) &

   491.009(1)(i), F.S.)

(j) Paying or receiving a kickback, rebate, bonus, or other remuneration for receiving a

     patient or client or referring a patient or  client to another provider of mental health

    care services or to a provider of health care services or goods; referring a patient

    or client to oneself for services on a fee-paid basis when those services are already

    being paid for by some other public or  private entity; or entering into a reciprocal

    referral agreement.(Section 491.009(1)(j), F.S.)

(k) Committing any act upon a patient or client, which would constitute sexual battery or

     which would constitute sexual misconduct.(Section 456.072(1)(u) & 491.009(1)(k),

     F.S.)

(l) Making misleading, deceptive, untrue, or fraudulent misrepresentations in the practice

      of any profession licensed under chapter 491, F.S., or employing a trick or scheme in

     or related to the practice of a profession.(Section 456.072(1)(a), (m) & 491.009(1)(l),

     F.S.)

(m) Soliciting patients or clients personally, or through an agent, through the use of

     fraud, intimidation, undue influence, or a  form of overreaching or vexatious

      conduct.(Section 491.009(1)(m), F.S.)

(n) Failing to make available to a patient or client, upon written request, copies of tests,

     reports, or documents in the possession or under the control of the licensee which

    have been prepared for and paid for by the patient or client.

(o) Failing to respond within thirty (30) days to a written communication from the

     Department or the Board concerning any  investigation by the Department or the

     Board, or failing to make available any relevant records with respect to the

     investigation about the licensees conduct or background.(Section 491.009(1)(o), F.S.)

(p) Being unable to practice the profession for which one is licensed under Chapter 491,

     F.S., with reasonable skill and competence as a result of any mental or physical

     condition or by reason of illness; drunkenness; or excessive use of drugs,

     narcotics, chemicals, or any other substance.(Section 456.072(1)(y) & 491.009(1)(p),

      F.S.)

(q) Violating provisions of Chapter 491 or 456, F.S., or any rule adopted pursuant

      thereto.(Section 491.009(1)(w), F.S.)

(r ) Performing any treatment or prescribing any therapy which, by the prevailing

      standards of the mental health professions in the community would constitute

     experimentation on human subjects, without first obtaining full, informed, and written

     consent.(Section 491.009(1)(q), F.S.)

(s) Failing to meet the MINIMUM standards of performance in professional activities

      when measured against generally  prevailing peer performance, including the

      undertaking of activities for which the licensee is not qualified by training or

      experience.(Section 491.009(1)(r), F.S.)

(t) Delegating professional responsibilities to a person whom the licensee knows or has

     reason to know is not qualified by  training or experience to perform such      

    responsibilities.(Section 456.072(1)(p) & 491.009(1)(s), F.S.)

(u) Violating a rule relating to the regulation of the profession or a lawful order of the

     Department or the Board previously  entered in a disciplinary hearing.(Section

     491.009(1)(t), F.S.)

(v) Failure of a licensee to maintain in confidence any communication made by a patient

     or client in the context of services,  except by written permission or in the face of clear

     and immediate probability of bodily harm to the patient or client or to     

     others.(Section 491.009(1)(u), F.S.)

(w) Making public statements which are derived from test data, client contacts, or

      behavioral research and which identify or  damage research subjects or

      clients.(Section 491.009(1)(v), F.S.)

(x) Having been found liable in a civil proceeding for knowingly filing a false report or

     complaint with the department or the agency against another licensee.(Section

     456.072(1)(g), F.S.)

(y) Except as provided in Section 465.016, F.S., failing to report to the department any

     person whom the licensee knows is in violation of Chapter 456, Part II, Chapter 491,

    F.S., or the rules of the Department or the Board.(Section 456.072(1)(i), F.S.)

(z) Exercising influence on the client for the purpose of financial gain of the licensee or a

     third party.(Section 456.072(1)(n), (F.S.)

(aa) Improperly interfering with an investigation or inspection authorized by statute, or

      with any disciplinary proceeding.

     (Section 4556.072(1)(r), F.S.)

(bb) Intentionally violating any rule adopted by the Board or the department, as

       appropriate.(Section 456.072(1)(b), F.S.)

(cc) Failing to comply with the educational course requirements for domestic

       violence.(Section 456.072(1)(s), F.S.)

(dd) Practicing or offering to practice beyond the scope permitted by law or accepting

       and performing professional

       responsibilities the licensee knows, or has reason to know, the licensee is not

       competent to perform.(Section 456.072(1)(o),

       F.S.)

(ee) Violating any provision of this part, the applicable professional practice act, a rule

       of the department or the board, or a  lawful order of the department or the board, or

       failing to comply with a lawfully issued subpoena of the department.

       (Section 456.072(1)(q), F.S.)

(ff) Failing to comply with the requirements for profiling and credentialing, including,

      but not limited to, failing to provide  initial information, failing to timely provide

      updated information, or making misleading, untrue, deceptive, or fraudulent

      representations on a profile, credentialing, or initial or renewal licensure

      application.(Section 456.072(1)(v), F.S.)

(gg) Using information about people involved in motor vehicle accidents which has been

      derived from accident reports made by law enforcement officers for the solicitation of

     the people involved in the accidents.

(hh) Failing to report to the Board within 30 days after the licensee has been convicted

        or found guilty of, or entered a plea of nolo contendere to, regardless of

       adjudication, a crime in any jurisdiction.(Section 456.072(1)(w), F.S.)

(ii) Testing positive for any drug on any confirmed preemployment or employer-ordered

      drug screening.(Section 456.072(1)(a), ( F.S.)

(jj) Having a license or certificate to practice any regulated profession revoked,

      suspended, or otherwise acted against, including the denial of certification or

      licensure by another state, territory, or country.(Section 456.072(1)(a), F.S.)

 

Minor Violations or Non Compliance Issues

Smaller infraction include:

(a) Failure to make available to a patient or client upon written request, reports, copies

      of test results, or documents in the possession or under the control of the licensee or

      certificate holder which have been prepared for and paid for by the patient

      or client.

(b) Failure to obtain an education course on human immunodeficiency virus and

     acquired immune deficiency syndrome within six (6) months of licensure as required

     by Section 491.0065, F.S.

(c) Lacking continuing education hours as required by Section 491.007(2), F.S.

(d) Practicing on an inactive license for three (3) months or less as prohibited by Section

     456.036(1), F.S.

(e) Practicing on a delinquent license for three (3) months or less as prohibited by

     Section 456.036(1), F.S.

(f) Failure to conspicuously display the valid license as required by Section

     491.0149(1)(a), F.S.

(g) Failure of a licensed clinical social worker to include the words licensed clinical

     social worker or the letters LCSW on  all promotional materials, including cards,

     brochures, stationery, advertisements, and signs, naming the licensee as required

      by Section 491.0149(1)(b)1., F.S.

(h) Failure of a licensed marriage and family therapist to include the words licensed

      marriage and family therapist or the letters LMFT on all promotional materials,

      including cards, brochures, stationery, advertisements, and signs, naming the

      licensee as required by Section 491.0149(1)(b)2., F.S.

(i) Failure of a licensed mental health counselor to include the words licensed mental

     health counselor or the letters LMHC on all promotional materials, including

     cards, brochures, stationery, advertisements, and signs, naming the licensee as

     required by Section 491.0149(1)(b)3., F.S.

(j) Failure of a registered intern to use the words registered intern on all promotional

     materials, including cards, brochures, stationery, advertisements, and signs, naming

     the licensee as required by Section 491.0149(2)(b), F.S.

(k) Failure of a provisional licensee to use the words provisional licensee on all

     promotional materials, including cards, brochures, stationery, advertisements, and

     signs, naming the licensee as required by Section 491.0149(3)(b), F.S.

(l) Failing to comply with the educational course requirements for domestic violence as

     required by Section 456.031(1)(a), F.S.

 

CONTINUING EDUCATION

In order to renew a license, the  licensee must complete 30 hours of approved continuing education credit including 1 hour on domestic violence during the two-year period ending on the last day of the biennial renewal period. In lieu of the domestic violence course, a licensee may complete a course in end of life care and palliative health care if the licensee has completed an approved domestic violence course in the immediately preceding biennium.

 

A maximum of six (6) of the required thirty (30) hours of continuing education may be accrued for credit during one biennium by attending programs designed for the purpose of enhancing the licensees administrative, office management, or other non-clinical skills.

 

A maximum of (6) of the required thirty (30) hours of continuing education may be earned for credit during one biennium by performing pro bono services to the indigent, underserved populations, or in areas of critical need within the State of Florida including but not limited to state mental institutions for the mentally retarded, the Department of Corrections, and health manpower shortages areas established by the United States Department of Health and Human Services. Such services must be approved by the board in advance.

 

Continuing education providers must maintain records of their presentations for three years after the biennium.  Licensees must maintain CEU certificates for two years after the biennium.

 

SPECIALIZATION HYPNOSIS

Before practicing hypnosis for any therapeutic purpose, other than stress management, self-hypnosis, guided imagery, or relaxation, a licensee shall have successfully completed at least 50 hours of instruction in concepts of and misconceptions of hypnosis induction techniques, contraindications to hypnosis, and the relationships of personality dynamics, psychopathology and ethical issues to hypnosis.

 

SEX THERAPIST

Any licensed clinical social worker, marriage and family therapist, or mental health

counselor who holds himself out as a sex therapist shall have completed:

(a) A minimum of 120 hours of approved education from twelve (12) of the following areas with a minimum of 10 hours in each area taken:

1. Sexual and reproductive anatomy and physiology,

2. Developmental sexuality,

3. Gender-identity issues,

4. Socio-cultural factors in sexual values and behavior,

5. Medical factors related to sexuality and sexual functioning,

6. Interaction between sexuality and dynamics of interpersonal and family relationships,

7. Sexual offender treatment,

8. Diagnosis of sexual dysfunctions, disorders, and deviancy,

9. Treatment of sexual dysfunctions, disorders, and deviancy,

10. Legal, ethical, and forensic issues in sex therapy,

11. Sexually transmitted diseases,

12. Risk assessment with sex offenders,

13. Psychopharmacological therapy with sexual dysfunctions, disorders and deviancy,

14. Research on sexual dysfunctions, disorders and deviancy,

15. Sexual abuse treatment,

16. Victimology/victim therapy

17. Group therapy in treatment of sexual dysfunctions, disorders, and deviancy; and,

(b) As of January 1, 1997, in addition to the minimum hours in (2)(a) of this rule, the following shall apply:

1. A minimum of 40 client contact hours in the clinical practice of sex therapy during a minimum period of time of six months;

2. A minimum of 20 hours of supervision, where each supervisory session is no more than one and one-half hours in length, by

a qualified supervisor as set forth in Rule 64B4-7.004, F.A.C. during a minimum period of time of six months.

3. For the purpose of this section, supervision is face-to-face contact between an intern or trainee and a supervisor during

which the applicant apprises the supervisor of the diagnosis and treatment of each sex therapy client, client cases are discussed, the supervisor provides the applicant with oversight and guidance in diagnosing, treating and dealing with sex therapy clients, and the supervisor evaluates the applicants performance. Supervision must:

a. Focus on the raw data from the clinical sex therapy work, which is made directly available to the supervisor through such

means as written clinical materials, direct observation and video and audio recordings:

b. Be a process which is distinguishable from personal psychotherapy, consulting or didactic instruction; and

c. During the supervisory period, 50% of the required supervision may be group supervision. If group supervision is obtained,

it must be combined with individual supervision. For the purpose of this section, individual supervision is defined as one supervisor supervising no more than two (2) supervisees and group supervision is defined as one supervisor supervising more than (2) but a maximum of six

(6) supervisees in the group.

(3) Any licensed clinical social worker, marriage and family therapist or mental health counselor who was previously qualified to hold himself out as a sex therapist based on the education requirements existing between February 25, 1990 and December 31,1996 may continue to use the title of sex therapist.

 

CHAPTER 64B4-9 CLIENT RECORDS

A professional must maintain responsibility for all records relating to his clients for 7 years after the date of last contact with the client.  In the event a professional is no longer available to clients due to terminating their practice or relocating, notification of the termination or relocation should be attempted through the use of publication in the newspaper.  The records should continue to be retained for 2 years after the termination or relocation of the practice.

 

          Records

      Number of Years Retained

Psychotherapy records

7 years

 

Child abuse reports

7 years or until the child turns 18

 

When a therapist dies

2 years

 

When a therapist terminates practice or relocates

2 years

 

 

Online Chat information for Florida Laws and Rules Course:  Please remember to check the times on the My Profile or Course Description pages of the site for the times for the interactive portion of the course.  It is an excellent forum to discuss any questions you may have or to share experiences with peers.

 

Certificate of completion:  Once you successfully complete BOTH the test and the interactive chat we will email the certificate to you within 24-48 hours.  We also attempt to include the processor at the Florida Board handling your application, as well. 

Any other course on our website you can print the certificate, but this course certificate must be signed by us.  If you are taking this course as continuing education for license renewal we will report the completion to CEBroker.