How Sturdy is that Digital Couch? Legal Considerations for Mental Health Professionals Who Deliver Clinical Services via the Internet

ABSTRACT

This article reviews legal issues related to providing mental health services via the Internet. It provides a general overview of the field and discusses jurisdiction, licensure, legal duties (competence, consent, confidentiality), and other legal concerns related to the business of online counseling. It surveys potential criminal and civil liability issues, noting procedural and substantive aspects of the relevant law. The author concludes that, although providers face a variety of challenges, their efforts in providing a service needed and desired by an important segment of the help-seeking population are worthwhile.     

Cyber Counseling for Queer Clients and Clinicians

Abstract

As the Internet grows, so does its use by mental health professionals and by clients seeking mental health services. Drawing on his own experience as an example, the author describes how the Internet can enhance clinical practice. Social service professionals can utilize the Internet to provide a supportive forum for patients grappling with issues of self-identity; facilitate communication between therapist and client; provide community education about mental health issues; provide referrals to local social service professionals; market a private psychotherapy practice; and provide patient billing, scheduling, and record keeping.     

A Survey of Campus Peer Counseling Activities

Abstract

The directors of counseling services at 200 colleges and universities were contacted by mail and asked to complete a survey regarding peer counseling activities on their campuses. One hundred fifty-six responses to this questionnaire were received; one hundred twenty-two indicated ongoing peer counseling activities in a wide variety of settings at their respective campuses. The most common client concerns confronted by peer counselors involved academic difficulties and relationships with friends and lovers. The survey identified a variety of peer counseling training programs, from one-weekend, intensive encounter-type experiences to full-year credit courses in counseling and therapy. Also examined were the funding resources available for peer counseling centers, which often proved quite marginal, and the amount of interaction between student counselors and professional mental health service staff members. Although the authors have been able to uncover a great many peer counseling programs on college campuses, there is a dearth of systematic research evaluating the effectiveness of the services provided by these centers or the appropriateness of various peer counselor training programs. Such work should be encouraged.     

Meeting Them Where They Are: An Exploratory Study of Staff and Shelter Resident Perceptions of Homeless Women's Needs

Abstract

Only a small number of studies have surveyed homeless people about their needs, and none has compared these perceptions with those of homeless service providers. In this small, preliminary, exploratory investigation, both shelter residents and staff at one homeless shelter dedicated to serving dually-diagnosed adult women were queried about shelter resident need. Residents and staff agreed on the need for immediate, non-change-oriented services (such as assistance with overdue bills and housing) and some shorter-term services (such as education and job skills training). The two groups disagreed on the need for longer-term, change-oriented services, such as substance abuse treatment, education about activities of daily living, and health/counseling services (with more staff than residents perceiving such need). Two potential recommendations are discussed. Staff could consider altering the timing of treatment plan creation to increase engagement with homeless clients. Shelter directors and funders could consider modifying the measurement of client outcomes to include client progression toward longer-term change.     

Obstacles to Help-Seeking for Sexual Offenders: Implications for Prevention of Sexual Abuse

ABSTRACT

Persons with potentially harmful sexual interests such as attraction to minors are unlikely to seek or receive treatment before a sexual offense has been committed. The current study explored barriers to help-seeking in a sample of 372 individuals in treatment for sexual offending. Results revealed that the shame and secrecy resulting from stigma associated with pedophilic interests often prevented our respondents from seeking professional counseling, and only about 20% tried to talk to anyone about their sexual interests prior to their arrest. Barriers to seeking and receiving psychological services included concerns about confidentiality, fears of social and legal consequences, personal shame or confusion about the problem, affordability, and challenges finding competent therapists who were adequately equipped to help them. Understanding and ultimately reducing obstacles to help-seeking can improve the quality of life for people with harmful sexual interests and potentially prevent sexual abuse of children or other vulnerable individuals.     

Asking About Sexual Orientation During Assessment for Drug and Alcohol Concerns: A Pilot Study

ABSTRACT

An assessment tool was designed to assist service providers in identifying lesbian, gay and bisexual (LGB) clients who present for assistance related to substance use concerns. Items were designed to facilitate self-disclosure of the individual's sexual orientation and identify concerns of LGB clients that will be relevant to treatment planning for substance use concerns. Therapists in general assessment and LGB-specialized services of a large treatment agency were trained to use the tool. This paper presents client and therapist comments made during the pilot study regarding the use and value of the assessment tool.     

An interprofessional internship model for training master’s level social work and counseling students in higher education settings

ABSTRACT

The mental health needs of college students are steadily on the rise, which compels mental health service providers and educators to explore innovative ways to provide more collaborative, supportive, and interdisciplinary service models of practice and professional training. Graduate programs in social work and counseling are at the crux of producing internship training programs to help accommodate the influx of students with persistent mental health concerns across a variety of needs and cultures. This article describes an interprofessional internship program structured and designed to meet the clinical training needs of master’s level students matriculating in social work and counseling who aspire to provide mental health services in higher education settings. The interprofessional internship training model proposes an innovative interdisciplinary approach to field education which may result in positive training outcomes and learning experiences for social work and counseling students. This paper discusses the model’s emphasis on individual and interdisciplinary group supervision, objectives of the internship experience, internship site criteria, and professional and personal benefits to pre-service social workers and counselors. Recommendations for training and limitations of the model are provided.     

Availability of Caregiver Support Services

Abstract

This study examines the scope and range of existing resources for family caregivers from the perspective of the Area Agencies on Aging (AAAs), which are charged with implementing Title III-E of the reauthorized Older Americans Act. California is used as a case example because of its substantial experience in providing caregiver support services. In particular, we examine the extent and adequacy of resources available in California corresponding to each of the five Title III-E service areas, utilizing data from AAA Area Plans, a follow-up survey of AAAs, and an Internet search. AAAs identified more than 276 providers of caregiver support services, and our Internet search identified another 195. Nearly two-thirds of these programs offer access to respite care, while other support services (e.g., counseling, training, support groups) are less often available. Service gaps most frequently identified included culturally and linguistically appropriate caregiver services, transportation, respite care, financial assistance, and services in rural areas. These findings suggest the need for enhanced efforts to improve the service network for supporting family caregivers, as states implement the National Family Caregiver Support Program.     

Diversity in Diversity: Changing the Paradigm

SUMMARY

This essay discusses the growing complex diversity in client populations, emphasizes the need to support all legal statuses of clients, and advocates for a paradigm shift in culturally competent social work practice.     

An exploratory study examining needs,access, and competent social services for the transgender community in Phoenix,Arizona

ABSTRACT

Phoenix is the sixth largest city in the United States, with a vibrant yet underserved lesbian, gay, bisexual, transgender, and queer (LGBTQ) population. Despite an extensive community presence, social service delivery bias persists among members of the LGBTQ community, but more often among transgender individuals. Existing research has examined social services from the perspective of either the client or the practitioner. This exploratory study specifically examines social services in the Phoenix metropolitan area for the transgender community. Data collected from interviews with participants and providers contributed to an assessment of the current level of social services for the transgender community, with a specific emphasis on identifying service gaps and recommendations for culturally competent and comprehensive services.     

Risk Management in Online Human Services Practice

SUMMARY

The growing use of the Internet for human service practice has resulted in ethical and legal issues that have yet to be fully addressed by current professional codes of ethics and the courts. This paper describes issues and risk-management procedures related to online human service practice, including: use of novel and untested services, unclear jurisdiction, equivalence of face-to-face and online practice, duty to warn and to provide emergency services, privacy and security of online transactions, establishment of fiduciary relationships, online assessment, and fees for online services. In addition, risk-management issues related to human service agency Web sites including copyright, ownership of the Web site, posting of staff names, online fundraising, online threats and disruption of services, unsolicited e-mail, and agency e-mail policies are discussed.     

Data-Mining Client Concerns in Adolescent Mental Health Services

Summary

Via a practice-based research collaboration, clinicians, supervisors, and managers in an urban adolescent mental health program studied previously collected intake information concerning adolescent risk exposures, behaviors, worries, and self-assessed coping. In addition, desire to talk with a mental health counselor about specific risks and worries was systematically analyzed with the aim of generating practice insights into the clinical challenge of engaging urban adolescents in mental health services. Though provided with research consultation, practitioners were full participants in all aspects of the researchprocess. This organizational development process placed strains on the participants and organization, but many benefits were derived from it. One significant benefit was that mining the expressed concerns of clients gave participants a powerful vehicle for reshaping services. The organization came to see its clients as more than mere service recipients, resulting in a recommitment to Youth Development principles and a renewed effort to increase direct client participation in organizational life.     

Social work and pastoral counseling: Empowering each other

ABSTRACT

This article addresses the divergent outcomes which can result from counseling services offered pastorally versus clinically. As faith leaders often have greater direct access than social workers to supporting religious populations, it is important to explore the intersection between religious pastoral support and clinical social work. Presenting six scenarios from the author’s own experiences as both a rabbi and social worker, this article processes each scenario first through the pastoral lens of an Orthodox rabbi, followed by the clinical lens of a social worker or other mental health professional. The client outcomes which are produced from each modality are radically different. This contrast demonstrates the distinction between the goals, values, and training of each profession, and highlights importance for future work to be done in linking religious and pastoral training to mental health services, as well as broadening the scope of cultural competence for social workers and therapists who may engage with tight-knit religious populations.     

Understanding Asian American Clients

Abstract

Asian Americans are the fastest growing ethnic minority in the United States today. Therefore, the Asian American population greatly needs the services of qualified cross-cultural counselors. An ethnic match between an Asian American client and his/her counselor is generally recommended. However, due to the limited number of qualified Asian American counselors and problems sometimes encountered with an ethnic match, an ethnic match between the counselor and client is very often not realistic nor always preferred. However, Western counselors who work with Asian Americans need to understand their clients' acculturation problems. They also need to understand the preventable mistakes often made in counseling Asian American clients.     

School Social Work

Abstract

This article addresses the need for social work students to understand basic legal concepts and their application in social work. It begins with a review of recent literature on teaching law within the social work curriculum. It then reports on the authors' April 1991 survey of accredited MSW programs, which showed that few schools require MSW students to study law, but that curricula have little room to expand. Finally, the article describes a flexible approach to infusing legal content into existing social work courses by focusing on six legal precepts: the definition and regulation of practice; client issues; privacy; advocacy; conflict/liability; and precedents.     

Informed Consent Agreements: Standards of Care for Digital Social Work Practices

The inclusion of remote digital practices (e-mail, texting, blogging, social media) to deliver social work services raises unique ethical and legal challenges for client and practitioner. Competent care necessitates providing clients with information that would materially affect clients’ decisions whether to assume the risks, benefits, and conditions associated with e-practices. As standards of care for distance service provision have not been firmly established, social workers are duty bound to be well-informed about current laws, duties, and obligations including specific rules governing the practice of social work in the states where they deliver remote services. This article identifies distinct threats to privacy and confidentiality associated with e-practices and offers suggested content for a comprehensive informed consent policy.     

Predictors of Divorcing Women's Use of Divorce Mediation

Abstract

This study examined the relations between perceived usefulness of mediation, problem susceptibility, mental health conditions, availability of social support, and the likelihood of using divorce mediation service. The sample comprised 124 divorcing women in Hong Kong who sought legal aid to settle matrimonial issues. A large proportion of participants indicated their willingness to use mediation. Logistic regression showed that likely users have higher appreciation of the helpfulness of the service, have poorer mental health, and to some extent, receive lower levels of social support from informal sources. Susceptibility to housing, finance, and child-care problems is not a significant predictor. The results strongly suggest the importance of promoting mediation services to the people in need.     

Adolescents Seeking Mental Health Services

Summary

Inner-city adolescents receiving mental health services often get inadequate medical care. However, when those who seek counseling are asked about their health concerns, they say they want to discuss them with their therapists. Based on responses to a clinical self-assessment questionnaire (Adquest), adolescent mental health clients reported sleep difficulties, weight and eating concerns, and frequent headaches and stomachaches. Age and gender differences in patterns of vulnerability and willingness to talk were explored.     

Technology Investment Trends

SUMMARY

Social service agencies across the country are investing in a wide range of technological, business process reengineering, and organizational change projects. These projects include:

? ? using technology to connect social workers to enable collaborative case management;

? ? building databases with sophisticated querying applications that allow quick, effective decision making at the front-line and management levels; and

? ? expanding the number of ways clients can access services through the use of the Internet, kiosks, electronic benefit transfers, etc.

Successful projects have a clearly identified business need and a strategy for addressing that need. This strategy includes understanding the process, organizational and technological context, evaluating alternative means of meeting the need, and developing a solid program management plan.