Clinical Practice Audits: An Ounce of Prevention

Clinical Practice Audits provide a preventive approach to minimize the risk of legal and ethical problems and complaints. The concept is simple: Look now at your practices and make modifications to prevent future problems.
Whether you are a psychotherapist in private practice or an agency that provides counseling services, clinical practice audits involve a hands-on look at your practices and procedures and you receive specific recommendations and any necessary in-service training to bring you up-to-date.

Purpose

Licensing boards have increased their enforcement branches and are looking heavily at certain areas of practice, especially dual relationships and client confidentiality. It is common knowledge that California is a quite litigious state. Additionally, we are seeing the creation of groups such as the False Memory Syndrome Foundation trying to actively intimidate therapists and clients. Lawsuits have been filed against therapists treating clients with recovered memories and even against the authors of books as part of this endeavor. Local district attorneys are increasingly enforcing criminal penalties against therapists for failure to report child abuse and for sexual contact with clients.

The best defenses are two:

Good solid clinical practice to minimize the risk of suit or licensing complaints;
Good solid clinical practice to maximize your chances of prevailing if you are sued or a complaint is filed against you.

Topics Reviewed in an Audit

Being current on the Child Abuse and Neglect Reporting Act requirements and what constitutes "reasonable suspicion"

Dealing with suicidal clients, assessing lethality and finding the means to protect

Meeting your Tarasoff obligations and fulfilling your duty to protect

Looking at dual relationships, from sex with your client to bartering for services

Record-keeping and the current standard of practice

Maintaining confidentiality in your practice and in your office

Therapy with minors and confidentiality issues

Handling subpoenas for records and subpoenas for your testimony

Reconciling Tarasoff obligations with treatment of clients who are HIV+ or who have AIDS

The specific legal or ethical concerns unique to your practice and to your clients

The Audit Process

INITIAL CONSULTATION

The practice or agency is assessed as to the type of services, the number and licensing of the therapists, the perceived needs of the practitioners and audit options.

PROPOSAL

The practitioner or agency is provided with a detailed description of services available and a proposal of specialized services designed for the particular setting.

FIRST CONTACT

There is an on-site evaluation of facilities, physical set-up, record storage, training of staff and protection of confidentiality; review of record-keeping practices; review of forms, policies and procedures; and a review of the types of clients served and their particular needs.

SECOND CONTACT

Specific recommendations are made on the basis of the first visit including revision or inclusion of forms, suggestions regarding the implementation of policies and procedures, and in-house training is provided on current legal and ethical requirements with a focus on any special needs of the particular clientele and the provision of written materials.

CONCLUSION

Requested forms and written policies and procedures are provided along with written recommendations for further changes and for future reviews of the practice.

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