Best Practices — Natalie Jambazian, LMFT

Best Practices FAQ'S — Am I Meeting Ethical Standards?

I have come across many questions from therapists regarding whether or not they are meeting the standard of care in our field. Below are some questions and answers I have compiled that can help you make sure you are meeting ethical guidelines with your clients and within BBS requirements.

1. Do you have to be HIPAA-compliant when you give your client a superbill?

When I called CAMFT, they said as long as you have the best interest in mind for your client's confidentiality you can send a superbill to your client, or bill via Simple Practice or Theranest. As long as they are giving the superbill to your client to give to the insurance company, themselves, you are being ethical.

2. Can a client see a new therapist without termination with another?

There was a situation presented to me from a colleague where she was referring her new client for treatment to another therapist, while she was on maternity leave. CAMFT stated that is it not unethical or illegal to do so as long as you coordinate with the other therapist. However, best practices would be not to see the client until they terminate with the other therapists.

3. Can a supervisor supervise you if you are working at a different company?

If you are working with a supervisor at a private practice, and as an associate you want to work elsewhere, your supervisor can, in fact, sign off on your hours, as long as the company you are working for meets the qualifications of the BBS and is providing mental health care. The associate must have a written agreement from the site director, as well as the supervisor.

4. If parents of a minor client are divorced and both parents have sole legal custody, but the other parent has sole physical custody, who gives the consent for treatment?

CAMFT advised me that if both parents have sole legal 50/50 custody and the custody papers mention that both parents have to make medical decisions, then both parents must consent for treatment. Although if the papers do not state who makes the decision for mental health, but do state both parents must make medical decisions for the minor, then both parents must be involved and consent for therapy.

5. If you are working with a couple and they want to see you individually, can you change the unit of treatment?

It is not illegal or unethical do so, however clinicians have to take preliminary precautions not to confuse who the patient is. Practitioners must be careful not to have a biased opinion for one partner over the other, or share any information with other. Recordkeeping becomes very important during this time, just in case your records become subpoenaed. You want to make sure files are separate for each unit of treatment and identify the patient. It can also lead to a conflict of interest with your clients. In the end, you as a clinician need to make a determination that will best meet the interests of your client's.

6. Can you be a therapist and coach at the same time?

This issue has been a particular topic amongst clinicians, and the question we need to ask ourselves is how well are we separating the two fields, and are we indeed doing so?

Life coaching has its own separate certification program, as well as their own code of ethics. There isn't an ethical code for us as MFT clinicians that prohibits us from becoming a coach as well, but the question arises if you are following the state and legal requirements in your state. Also, both are interchangeable as "clinician" or "coach." Therefore, to let your client know the difference would be meeting best practices.

7. Can you provide therapy for victims of crime?

Yes. Both social workers and LMFT/associates can be a provider and will be compensated by Victims of Crime (VOC).

8. Can you engage in telehealth if your client is going on a business trip outside of the state?

According to CAMFT attorneys and BBS, it would be violation of California law to engage in therapy that is outside of California. According to a CAMFT attorney, "To practice marriage and family therapy in Illinois, you must be licensed in Illinois as an MFT. If you practice as an MFT without having a valid license under Illinois law, a restraining order could be issued against you, and/or you could be held in contempt of court, and/or you could be found guilty of a criminal misdemeanor." For more information please visit http://www.camft.org/COS/The_Therapist/Legal_Articles/Cathy/My_Patient_is_Moving_to_Another_State.aspx.

9. What are HIPAA-compliant videoconferencing companies to use?

I have heard this question asked numerous times before, when clinicians do not have the resources to know which is HIPAA-compliant resources. Below is the list I have come across.

VSee: http://vsee.com
SecureVideo: https://securevideo.com
Thera-link: https://www.thera-link.com
CounSol.com: https://counsol.com Doxy.me: https:doxy.me
WeCounsel.com: http:www.wecounsel.com

10. Can you submit a superbill to insurance companies if you are out of network?

Having clear communication with your clients and discussing the responsibility for payment will ensure you are meeting the standard of care. Clients become upset when they feel like it is a 100% guarantee that they will be reimbursed. It is important to let your client know the risks and benefits associated with being "out of network" and what to expect.

For more information on any "best practices" questions you can go to http://www.camft.org/COS/The_Therapist/Legal_Articles/Articles.aspx.

Natalie Jambazian is a Licensed Marriage and Family Therapist. Natalie is currently an Anger Management facilitator through Anger Management Essentials and NAMA facilitating groups in Sherman oaks and Glendale. Anger Management 818 accepts both volunteer and court ordered clients, In addition, Natalie works with children, teens, and adults and her specialty includes but not limited to anger management, ADHD, PTSD, divorce, and grief. Natalie has received training in NLP, CBT, Mindfulness, and Trauma Focused Therapy. She is fluent in Armenian as her second dialect and can be reached at 818.334.8786 or via email at www.therapywithNatalie.org, Please visit her website at www.Angermanagement818.com.