MN ORAL EXAM PREP

Name the 2 categories of mandate reporting

1. Duty to Warn, 2. Child or Vulnerable Adult Abuse

Other actions constituting criminal sexual conduct in the first to fourth degree

1. Sexual conduct/penetration of a minor that is less than 13 years old, 2. sexual penetration of a minor that is a least 13 but less than 16, and the offender is at least 2 years older; 3. sexual contact by an offender that knows that the person is mentally impaired, incapacitated, or physically helpless, 4. Sexual contact of a minor that is at least 13 but less than 16 years and the offender is 4 years older 5. Sexual contact and the offender uses force, coercion, or threat of injury 6. Nonconsentual sexual conduct

Documentation needed in a client's file

1. client data and presenting problem, 2. Treatment plan with diagnosis and goals, 3. Chronological progress notes with date and time of each session, 4. Records of consultation, 5. Termination statement including date, time, patient condition, and recommendation at the time. 6. Copies of all releases and other legal documentation, 7. Fee agreement with date and paid amount.

What are the 6 types of situations that warrant malpractice

1. procedure used was not within the domain of accepted professional practice, 2. the professional was not train in the technique/procedure; 3. did not use a procedure that was more helpful; 4. Possible consequences of treatment were not explained; 5. Informed consent was not obtained or documented; 6. Failure of duty to warn

MFT Coursework requirements

9 semester hours of human development, 9 semester hours of MFT studies, theory of family develop, functioning, cycle, 9 semester hours of MFT communication methods, assessment, and treatment planning, 3 semester hours of research covering design, method, and statistics, 3 semester hours in ethics, and clinical practicum in MFT at least 300 client contact hours with 150 of these hours being relational.

Health Professional Service Program

A MN program designed to protect the public from medical professionals who are unable to practice safely due to their use of alcohol/drugs or result of a mental or physical condition

Significant impairment in functioning

A condition, including significant suicidal ideation or homicidal ideation, which harmfully affects a person's activities of daily living in employment, housing, relationships, and education.

What is required in post-graduate experience in MFT?

A minimum of 1000 hours of clinical conduct including assessments, diagnosis, and treatment of mental illness; 2. maximum of 1000 hours can be individual, 3. 200 hours of supervision by board approved LMFT supervisor over 24 months, 4. Only 100 of the 200 total hours of supervision can be group

Who is considered to be in a position of authority

A parent, anyone acting in place of a parent, anyone charged with rights, duties, and responsibilities of the child, anyone charged with duty, responsibility for health, welfare, or supervision of a child or vulnerable adult.

Variance

A request for a different standard from MN rules, yet cannot be requested for MN statues. It must show alternative plan that is equal to or exceeds the rules and that adheres to the current rule that would cause such a burden. The approval of the variance would not negatively affect the public

You make a compliant to the board regarding a colleague and never hear what happened as a result of your compliant. What information is the Board allowed to share with you?

A statement of the results of the investigation and the actions of the board related to the complaint.

Diagnostic Assessment

A written summary of the history, strengths/vulnerabilities, general services of a person with mental illness, using diagnostic, interview, and other techniques.

Actions or circumstances would be grounds for the board to refuse or grant license or revoke a license

After a hearing if a therapist is judged to be: incompetent to practice MFT or found to engage in a manner that his harmful or dangerous, convicted by a court of a crime rendering the MFT unfit to practice, violated one or more rules of the board, committed bribery or fraud, knowingly made false statements on a form required by the board, or failed to obtain CEU's required.

Exemptions from CEU requirements

An MFT could be exempt from CEU requirements if he or she is retired from practice and do provide MFT services on a volunteer or paid basis, if the individual is disable and unable to practice and has a notarized statement from his or her doctor, or if the MFT has emeritus status

Procedure for admission for MFT licensure

An applicant needs to submit evidence of passing the national exam, complete and notarize their application, pay the application fee, submit form verifying supervised experience with orginal signatures, and have two endorsements. Any applicants whom have not taken the national exam and passes it, will also have to complete a criminal background check as well

Mature Minor

An individual that is at least 15 years old, whom is able to give consent, the proposed treatment is for the minor's benefit and is deemed necessary, the proposed treatment does not involve complex or high risk medical procedures

How quickly must you report suspected abuse or neglect

An oral report must be given within 24 hours and a written report within 72 hours excluding holidays and weekends

Children with Severe emotional disturbances

Any child that meets one of the following criteria: 1. moderate to severe impairment in the area of home, education, social or community functioning 2. received inpatient services within the last 3 years or at risk for inpatient services 3. currently in inpatient or residential treatment 4. Determined by a mental health professional that the client has psychosis or depression or a risk of harming self or others

Emotional Dependent

Any current or former client's emotional condition in the past or current to which the client is overly dependent upon the therapist to which he or she cannot say no to the therapist, and making him or her vulnerable to exploitation

Sexual Conduct

Any kissing, touching or caressing of the lips, breasts, genitals, inner thigh or buttock, under or over clothing, and is bidirectional. Any form of intercourse with the client or vice versa including, oral, anal, or vaginal sex. Any intrusion into any opening of the body or part of the therapist's body or object used by the therapist or vice versa, or any sexual solicitation by the therapist

Mental Health Practioner

Any person that provides services to a person with a mental illness and has: a bachelor's degree and 2000 hours or experience, 6000 hours of supervised experience, a grad student and formally trained clinical training, or other graduate degree and less than 4000 hours of post master's experience

Physical Abuse

Any physical injury or threat inflicted by a person responsible for a child or vulnerable adult's care other than by accidental means or any physical injury that cannot be reasonably explained by injury history

What constitutes as a significant relationship

Any relative by blood, marriage, or adoption, or an adult who resides regularly or intermittently in the same dwelling as the minor

Sexual Harassment

Any unwelcomed sexual advancements, requests for sexual favors, sexually motivated physical contact or other contact of sexual nature when: 1. submission is made as a factor or condition or interferes with employment, public accommodation, services, education or housing. 2, used to intimidate or to create a hostile environment 3. case of employment where the employer knows of harassment and fails to make timely action

What substances used by a pregnant woman is a mandated report to child protection?

Any use of a controlled substance for nonmedical purposes including prescription drugs (not prescribed to client) or illegal drugs (Narcotics)

You have been seeing a couple for awhile. When her husband is out of the room, the wife tells you that she is having an affair. What should you do?

As a LMFT, I can not disclose this secret. Instead, I would talk to the client about the no-secrets agreement that we created at the beginning of therapy, I would encouraged the client to talk to the partner about this secret. If the secret was not shared, I would let the couple know that my ability to be there for them and meet their needs has been compromised and that this is an issue. If not resolvable, then I would provide 3 referrals.

What does "cooperate professionally" mean in investigations with the board?

As a licensee, I should cooperate fully in the investigation, respond promptly to all requests made by the board, provide copies of client records, and removing identifying data if a release is not obtained

What is the role of an LMFT in a civil commitment process

As an MFT, I have no formal role in a civil commitment process. Only judges or doctors that have been appointed by a judge have a role in this process. As an MFT, I can still ask for a 72 hour hold, but it cannot go beyond this time.

Your practice is doing well, that you decide to hire an employee (another therapist) to take on new clients. Under what circumstances would you be liable for you new employee sexually exploiting clients?

As an employer, I would be liable if I knew that the employee was engaged in this behavior and did not take action; if I failed to review the employee's work history concerning sexual contacts with all past employers in the last 5 years (no criminal background check), or I failed or refused to disclose the occurrence of sexual contact with prospective employers (not responding to the criminal background check).

You are treating another LMFT for depression. She confides to you that combined with insomnia and depressed mood that she has been falling asleep in her sessions on a regular basis. What should you do with this information?

As the treating therapist, I would counsel her to suspend or limit her practice, counsel her to self report to health services board, and continue to treat. If she refused to do anything, the I would have to report her to the board, as LMFT's are required to report any conduct indicating that the licensee is medically or physically incompetent to provide services.

American Association For Marriage and Family Therapy (AAMFT)

Association board who promotes the profession of MFT

Categories to which a minor can give consent

Contraceptive care, STI, Pregnancy care, Abortion, Alcohol/drug use, emergency care, and in patient mental health if the minor is 16years or older. No abortion can happen with an emancipated minor until at least 48 hours after a written notice is given to the parents, unless in an emergency situation.

You discover that a colleague has been attempting to religiously convert clients. How do you handle this

Due to this writer believing that my colleague is engaging in unethical conduct, the I will need to report this to the board. I can also discuss this with my colleague and encourage him to report himself to the board as well.

What are the consequences of failure to report a neglect, physical, or sexual abuse to a child within the last 3 years?

Failure to report is a misdemeanor. Additional consequences are disciplinary action by the board and possible civil suit from the client/family

HIPAA

Health Information Portability and Accountability Act. It was established in 1996 as a federal legislation for electronic charting, yet has since grew into other privacy protections. As an MFT, it is most important that I know that when given the choice between the state and federal that I need to chose the higher standard to follow.

Your client tells you that her psychiatrist really creeps her out. What should you do?

I would ask the client to tell me more about the psychiatrist, as I would be curious in learning what about this interaction made her feel creeped out. I would ensure that she knew her rights to say no and treat assertive skills. If there was any misconduct or unethical issues, I would encourage the client to make a report and I would also make a report to my board.

A couple that you have been seeing for a long time invites you to their commitment ceremony. How do you respond?

I would congratulate them and tell them that I am honored by their request. I would tell them that I will only be able to be there in spirit because of our professional relationship, and that I want to keep this relationship professional in case they ever want to return to therapy.

You have been seeing a conflictual couple that triangulates their kids. They stop coming to therapy but the mom calls and asks you to attest against her husband as he started a nasty child support/custody battle. You remember the father saying hurtful things about the kids in previous sessions. What do you say?

I would empathize with the mother and inform her that you saw her and her husband in the context of couples therapy and thus would need a release from all parties involved. I would also explain that it is unethical for me to change roles to custody evaluator as this would be a dual role. I would explained that I do not perform custody evaluations or parental assessments and could not testify to custody, yet would be able to provide 3 referrals for custody evaluations or parental assessments.

You have volunteered to speak at a MAMFT event but are mistakenly referred to as a doctor. How do you proceed?

I would explain to the attendees and speaker that I haven't earned my doctorate as it is my responsibility to correct misinformation about myself.

Your client is receiving individual therapy from another therapist and wants couples counseling from you. When you ask the client to sign a release, she refuses, saying that you don't need to talk to her other therapist. How to do you proceed?

I would explain to the client that code of ethics regarding consultation with all other providers involved. I would insist on releasing even if the disclosure is limited, such as phone call with no documentation. If the client still resists signing the release, then I could withhold treatment, unless the client alleges ethical violations by the other therapist.

At your clinic, you are referred clients directly from child protection services. On a recent case, the child protection worker insists that you diagnose a parent with a borderline personality disorder. The child protection worker has a master's degree in social work and is competent to make the diagnosis but you disagree with her evaluation. How do you proceed?

I would explain to the worker that my diagnosis differs and inform her that you will continue to evaluate for signs of a personality disorder and change the diagnosis if needed. As an MFT therapist, I am not allowed to have referring agencies, insurance companies, and others exert influence over my evaluation of the client

You get a subpoena. What doe you do.

I would first contact my client to determine how to proceed. I would acknowledge the receipt of the subpoena by law. If I obtained a release from my client, then I would send the records desired. If the client will not provide a release. then I would respond to the subpoena requesting a court order from the judge to comply. The ultimate goal is to protect confidentiality.

At the end of treatment, a client brings me a gift. What do I do?

I would first make it clear to the client that he or she does not owe me anything for treatment as they have already paid for therapy. If the client continues to insist on the gift, I would consider the clinical and cultural aspects of accepting the gift or not accepting the gift, and then document my decision and rationale in the chart.

An irate parent learns that you are seeing her daughter for therapy and calls you demanding to know what you are doing in therapy. What do you do?

I would neither confirm or deny whether I was seeing the client as I cannot disclose who is a client or not. I would encouraged the individual on the phone to speak to their child directly about this matter.

A court attorney calls you about a report that you about a mandated report that you made on a duty to warn case, as they want to pursue charges for terroristic threats. Can you provide the attorney any information?

I would not be able to provide the county attorney with any additional information outside of the mandated report without a release of information from all clients seen in therapy or a court order.

You are working at an outpatient CD clinic and are seeing a 15 year old client who consented for his own treatment. You are concerned because he has begun to abuse meth, heroin, and prescription drugs. He insists that you do not talk to his parents and vows to eliminate use. At his next drug test, he again tests positive for multiple illegal substances. How do you proceed?

I would notify the parents as I'm allowed to do so when I am treating a minor, whom consented for his own treatment, if failure to do so would seriously jeopardize the health of the minor

A client has major depression for most of her life. The client learns about a new supplement from a neighbor who says it really helped with his depressive symptoms. She asks you if she should take it. What do you say?

I would thank the client for bringing this issue up as I need to know any information about medications or thinking about taking them. I would then tell my client that I am not a psychiatrist, pharmacist or a nutritionist so this is outside of my scope of practice. If the client is wanting more information on the medication or side effects, I would provide her with 3 competent referrals.

What basic information should be included in a report of suspected abuse or neglect

Identity of child or vulnerable adult, any person believed to be responsible for the abuse or neglect, nature/extent of abuse, and the name and address of the mandated reporter

Some reasons why the board may not renew a license

If I committed a felony, I committed fraud, if I were impaired, if I did not pay child support, was behind in taxes, or if my student loans were in default, if I was appointed a guardian, or if I was committed

Circumstances for suspension of an LMFT without a hearing

If the LMFT violated a statue or rule that would create serious risk of harm to the client. It would be effective immediately by serving them in person or to most replace place of address. The suspension would remain in place until a hearing was held.

Circumstances that would lead to an automatic suspension of an LMFT license

If the MFT was appointed a guardian or has been committed to a treatment facility per the court

What are some circumstances that the court would report a person to the board.

If the person was: appointed a guardian, was committed, guilty of a felony, guilty of fraud or abuse, guilty of violating narcotics laws or controlled substances, have a mental illness, or been found mentally incompetent.

When would an LMFT not be allowed to voluntarily terminate a license

If there was an active compliant against the licensure

A client that you are seeing has found out that they need to travel for work but are struggling right now and propose that they want to conduct therapy via Skye, while the client is out of town for a couple of days. Can you provide this service to the client?

In this instance, you would need to follow the guidelines of electronic transmission under MN state statue and rule, as the client is from this area and is temporarily out of state. The therapist is responsible for setting guidelines for these conversations on secure lines and maintaining client privacy, such as suggesting that their meetings be in private locations, such as a hotel room and with the therapist within an office space.

Malpractice

Is a legal concept that involves negligence that results in injury or loss the client. Failure to render professional services or to exercise the degree of skill that is ordinarily expected of other professionals in similar situations.

You have concerns about releasing progress notes to a client that could case harm to hurt him or herself. Are you required to release these records?

It depends. If prior to the patient's request, the therapist put in specific reasoning on what should be shared or not, then the therapist is not required to share this information. If it was not previously noted, then I would have a third-party, such as another therapist, review the record and determine what should be shared with the client.

MN Association for Marriage and Family Therapy (MAMFT)

It is designed to further educational opportunities and professional awareness of MFT's

What is fee splitting?

It is strictly prohibited. and is illegal It is when a therapist receives a kick back from another therapist for a referral, and can include: gift baskets, cash, or gift cards

Sexual Abuse Circumstance for mandate report

It occurred within the last three years, the offender is in a position of authority, the offender has a significant relationship with the victim, or the sexual abuse was a result of parental neglect

Responsibilities of Board Approved MFT Supervisor

Knowledge of clinical skills required of an MFT, Knowledge of literature in the field of MFT and professional ethics, basic skills, and service delivery of MFT, ensure all supervisee's work is done in appropriate professional settings, and devotes 10% of continuing education to supervision

Requirements for MFT Licensure

Must be 18 years or the age of majority, must complete all education and experience requirements, pass both the oral and written exams, have two endorsements, and agree to conduct self in accordance of the code of ethics

What 3 points do you need to know from your client to have enough information to break confidentiality for duty to warn

Must be able to clearly identify potential victim, have exact nature of specific, serious threat of physical violence, and have reason to believe that the alleged perpetrator is capable of carrying out the treat

What is a temporary emergency hold

No person can be held longer than 72 hours exclusive of weekends or holidays without a court hearing to determine if the hold should continue

My client is sexually attracted to me. What do I do?

Normalize the client's experience by saying that therapy can be a very intense and intimate process so it is natural to have these kinds of feels and attractions come up, then work a goal into therapy and the treatment plan to apply the skills learned in family into the person's life. The therapist should document this in the record. If this attraction still interferes, then make three competent referrals.

What are the patient bill of rights?

Patients have the right to: have a therapist that has met training and experience, privacy, be free from discrimination, be free from exploitation, examine their public record, have access to their records, obtain a copy of the code of ethics, report complaints, and be informed of costs prior to treatment.

Mental Illness

Refers to an organic brain disorder or clinically significant disorder of thought, mood, perception, orientation, memory or behavior that meets DSM and ICD criteria and seriously limits capacity to function in daily living.

SPMI

SPMI stands for Significant Persistent Mental Illness. To qualify for this title, an individual must: 1. have had 2 or more episodes of inpatient treatment in the last 2 years 2. is treated by a crisis team 2 or more times in the past year 3. Continuous hospitalization or residential treatment exceeding 6 months in the last year 4. Adult with schizophrenia, bipolar, major depressive disorder, or borderline personality disorder 5. Committed and was eligible as a child with SED 6. written opinion that they are likely to have more episodes without treatment

What circumstances would compliments be considered sexual harassment?

Sexual Harassment is any verbal/physical behavior that can be considered sexually seductive or demeaning. Compliments about a person's body, clothing, weight, scent or sexual behavior. Harassing comments could be indicated via provocative language usage and nonverbal behavior

Sexual Exploitation

Sexual conduct that occurs between a therapist and client during the time period of the professional relationship within 2 years after the professional relationship ended or at any time the client is emotionally dependent upon the therapist. If sexual contact occurred by means of therapeutic deception.

Mental Health Professional

Someone who has reached the highest level of licensure in their field, has received 2 years of post graduate supervision, and can now independently practice in the state of Minnesota to provide clinical services to the mentally ill. EX: LMFT, LPCC, LP, LICSW, and some nurse practioners

MN Board of Marriage and Family Therapy

State regulatory board designed to license and oversee the practice of MFT's. Their primary focus is to protect clients

Circumstances of completing a mandate report for sexual abuse

The abuse must have occurred within the last three years, the offender is in a position of authority, has a significant relationship with the victim, or is the result of parental neglect

Possible consequences of misconduct

The board could: 1. deny, revoke, or suspend the right to practice, 2. impose limitations of conditions, 3. Impose civil penalties, 4. impose fees, 5. censure or reprimand, 6. take any action that would justify the case

If you are ordered by the board to submit to a chemical health, mental health, or physical health examination as part of an investigation and I fail to do so, what are the consequences?

The board is allow to consider any failure to submit to an examination as an admission of a violation of rules or statues enforced by the board, and thus can move to take disciplinary action as appropriate to the case

How can owing delinquent state taxes affect my licensure?

The board may not renew or issue a license if the licensee/applicant ones delinquent stated taxes in excess of $500

When releasing protected healthy information without consent of the client due to a situation of harm to self or others. What information needs to be documented in the chart?

The date and circumstance in which the information was shared, the person or agency to whom the information was shared, and a specific detail on what was shared

Neglect

The failure of caretakers to provide a child or a vulnerable adult with food, clothing, shelter, medical care, education, or supervision. It is also a failure to protect a child or vulnerable adult from conditions or actions in which imminent or seriously endanger their physical/mental health.

Requirements to become a MN state approved LMFT Supervisor

The individual must have practiced as an LMFT for 4 years or 4000 hours of experience in clinical practice, there is evidence that the MFT completed a board approved supervision training course for 3 semesters or 30 hour course, or have completed an AAMFT approved supervisory course; have met AAMFT approved supervisor status, and has completed an application

What are the requirement of renewing an MFT licensure?

The licensee is expected to complete 40 CEU's within 2 years, including 10% of these hours (4hours) towards ethics. The licensee is expected to report these CEU hours before December 31 on the odd reporting year, along with their renewal fee.

What is the process to renew a licensure if it has been more than 5 years since the license was issued

The licensee will need to retake and pass the national exam, complete a reinstatement application and verify that the licensee has not practiced without licensure or anything that could lead or justify revocation or disciplinary action, include a letter stating why licensed should be reinstated, submit CEU requirements since license was issued, and pay the renewal fee or any late fees to which the license was expired

If the board imposes disciplinary action on a LMFT, what information becomes part of the public data?

The name and business address of the licensee, the nature of the misconduct, action take by the board, and all settlement agreements

Marriage and Family Therapy

The professional assessment, diagnosis, and treatment of psychological, emotional, and relational issues within the context of family systems. MFT's work with individuals, couples, families and/or larger systems. All perspectives are looked through a systemic lens and understands that the individual problems can be imbedded in interrelational issues

Multiple Relationships

The relationship between the therapist and another person that is both professional and one that is cohabitation, familial, personal involvement with the individual would affect services, and significant financial issues. These relationships are prohibited in our practice.

Petitions requirements for a variance

The request must have a specific rule for the variance request, a reason for request, alternative plan or practices taken if granted, and the length of time for the variance

Duty to Warn

The responsibility to take reasonable precautions to provide protection from violent behavior

Legal Custody

The right to make decisions about how to raise the child, including decisions about education, healthcare, and religious training

Joint Physical Custody

The right to make decisions about routine day to day activities of the child structured between both parent households

Physical Custody

The right to make decisions about routine day to day activities of the child, and where the child lives

Supervision

The supervisor talks full responsibility for the training, work, experience, and performance of MFT for supervisee including: planning for and evaluation for work product and face to face contact between the supervisor and supervisee

If a client is moving out of the state of Minnesota and wants to continue therapy with the therapist, can this service be provided electronically.

The therapist would need to adhere to any statues and rules regarding electronic transmission of therapy to the client in the state that the client resides as well as to the standard of the state in which the therapist is licensed. In this situation, the therapist would need to set clear, specific guidelines of these transmissions and under the standards of both states. The therapist is responsible to maintaining confidentiality.

What does a client need to understand in order to give consent?

Their treatment, the nature and purpose of the proposed treatment, the probability of treatment success, the risks and benefits of treatment, treatment alternatives, and the prognosis if treatment is not given

A pregnant client is drinking alcohol on a daily basis. How should you handle this information in the best interest of the client?

Therapists are exempt in reporting alcohol and marijuana use if they are providing prenatal psychological support through pregnancy. The issue of using these substances should be addressed as a part of treatment, within the treatment plan. If the client continues to use alcohol habitually, then it is reportable.

Nondiscrimination Rule for Clients

Therapists cannot discriminate based on age, sex, race, religion, national origin, physical handicap, political affiliation, social or economic status, or sexual orientation

Exceptions to Client privilege

Waiver or release of information, duty to warn, mandated report, court order, orders to release to regulatory boards for investigation, or parental notification when failure to do so would jeopardize the health of the minor

Are therapist obligated to provide a minor's treatment records to parents upon request?

Yes, UNLESS the minor has consented for their own treatment due to category of care or status of minor OR the parent is not the legal guardian

A child you are working with reports that he is sure that his mother is selling drugs. He has never seen the drugs at home but is worried about her getting in trouble with the police and wants her to stop. His worries have been disrupting his school performance and behaviors with peers. Is this a mandated report?

Yes, based on parental neglect. The sale of drugs falls under mandated report for controlled substances, and there is evidence of an emotional impact on the child.

Is parental consent always necessary to provide medical or mental health to minors?

Yes, unless in certain expectations can be applied, such as statutory law or a court decision

If it turns out that a minor did not have legal authority to give consent, is a medical or mental health provider protected from liability?

Yes. If the medical or mental health provider relies in good faith on the minor's claim of ability to give consent

Duties of the Board of Marriage and Family Therapy

adopt and enforce rules for Mn licensing to protect clients, develop exams to determine applicant qualifications, issue licenses, establish/implement procedures to ensure that MFT's comply with rules or statues, study and investigate the practice of MFT, formulate code of ethics, and establish CEU requirements