Daily Archives: January 27, 2021

List the HIPAA violations committed in this case study (based on an actual 2003 incident).

The Misuse of Protected Information

Betty had to pick up her 14-year-old daughter, Traci, early from school due to a plumbing problem that closed the school early. Since Betty, the custodian of client records for an outpatient mental health center, was scheduled to work for several more hours, she allowed her daughter to complete her homework at the work desk near her. Since Betty had to run charts to clinicians at various times, her daughter was left unsupervised. Bored, Traci began browsing through patient charts that had been left on the desk and through client records on her mother’s computer (she gained access with the password she saw her mother use, posted inside her mother’s desk drawer). Traci even went as far as prank calling clients who had….

What, if any, violations of the HIPAA Privacy Rule have occurred here?

HIPAA and Protected Health Information

Allen is a licensed professional counselor at a Community Mental Health Center (CMHC). A physician at a local hospital requested a substance abuse evaluation on a current patient. No cooperative agreement exists between the hospital and the CMHC. When Allen arrives at the hospital, the charge nurse gives him the patient’s chart and invites him to sit in the records area to review the patient information prior to seeing the patient. Allen sees the patient, performs the evaluation, obtains all the necessary releases, and leaves documentation with the physician. While he is there, the physician asks Allen to see another client, and the charge nurse provides him with the client’s chart.

Discussion Questions

1. What, if any, violations of the HIPAA Privacy Rule….

What facets of this real-life case are operative in the decision of whether a violation has occurred?

FERPA Violation or Not?

A female student attending a public university in Oregon accused three players from the university basketball team of raping her in March 2015. One of her attackers had been suspended from a previous college team over similar allegations. The female student received counseling at the university’s counseling clinic. Nothing was done to the three athletes until May 2015 (well after basketball season), when university administration kicked them off the basketball team and expelled them from the university. When the female student learned that the coach had recruited one of the athletes despite his history of sexual assault, she filed a suit against the university for negligence and emotional distress. The university accessed the female student’s counseling records and sent them to its attorney. University….

Does this incident indicate a duty to warn?

Assessing When to Implement a Duty to Warn

Stan, a retail employee, escaped harm from a building during an active shooter incident by a pair of ethnic minority males. A few months later, Stan began experiencing symptoms of post-traumatic stress disorder and was sent to counseling through his employee assistance program (EAP) when his supervisor noticed an increase in conflicts with coworkers. In the most recent session, Stan became agitated and shouted to the counselor, “I hate those people. I’m going to kill them all,” after which he abruptly left the session.

Discussion Questions

1. Does this incident indicate a duty to warn?

2. What Tarasoff criteria are met or not met?

3. How should the counselor proceed?

What information should Jeff’s attorney be aware of regarding his rights of confidentiality?

Privacy Rights Records

When Jeff was 16 years old, he saw a counselor for conduct issues. During one of those sessions, Jeff volunteered that he had tried on his sister’s undergarments. Ten years later, Jeff is experiencing a life crisis. His estranged wife is suing for custody of their children, and Jeff is concerned that his childhood counseling record may be discoverable by the court.

Discussion Questions

1. If you were Jeff’s adolescent counselor, how might you have best documented the issue he described?

2. What information should and should not be entered into the clinical record?

3. Can you offer any reassurances regarding the retention and availability of his older record?

4. If you were his current counselor, how would you record this disclosure about his previous….

What obligations do you have to Sarah?

Termination Considerations

Sarah lost her home and two family members in a series of tornadoes that recently swept across her state. She began to experience symptoms of acute trauma and approached you for care as a disaster relief counselor. You began seeing Sarah regularly since arriving at the disaster site. Sarah has engaged well therapeutically, and appears to be making progress. You were notified by the Red Cross that your term of service will be up in a week and need to terminate with each of your assigned cases at the location. When you mention discontinuing services with Sarah, she becomes distressed.

Discussion Questions

1. What obligations do you have to Sarah?

2. How will you ensure her continued recovery?

3. To what resources can you refer her?


What would you have been thinking to yourself during the periods of silence?

Using Silence in Counseling

The following exchange between Carol and her counselor illustrates how important silence can be in a crisis. Carol is an adult female who presented to counseling with severe symptoms of depression, suicidal ideation, and an attempt to kill herself yesterday with an overdose of sleeping pills.

Carol: I just want to die. All of the emotional pain, sadness, and humiliation. I just had another miscarriage, my third one, and I’m almost certain I’ll never have children. (Pauses for 15 seconds to think.) On top of that, my husband is growing more distant too, and I worry he might leave me for someone who he can have a family with.

Counselor: So you’re also feeling worried about how this is going to impact your marriage,….

How effective was the counselor’s use of open and closed questions?

Effective Use of Open and Closed Questions during an Interview

The following dialogue provides a brief example of how the crisis counselor uses a blend of open and closed questions to obtain important information about Susan, who just discovered her husband is having an affair and is planning on leaving her. Susan presented with substantial suicidal ideation.

Susan: I’ve gotten to where I can’t even sleep at night. My mind just races, and I can’t stop thinking about everything.

Counselor: Tell me more about some of the thoughts you have been having as you lay in bed unable to sleep. (Open question to facilitate exploration and information gathering)

Susan: That I will never be in a happy relationship again. That my husband never really cared about me and….

What are some losses experienced by the couple and by the individuals in the couple?

Miscarriage and Infertility: Ambiguous Losses

What followed for Aisha was a self-described “week of hell”—the emergency room trip, a stomach pump, the nurse who rebuked her, saying, “You tried to kill yourself. You don’t deserve sympathy.” This humiliation preceded commitment in a private mental hospital, a court hearing to determine her sanity, and the requirement that, before leaving the hospital, Aisha schedule an appointment with a counselor.

Aisha and her husband of three years were facing not only the reality of never giving birth to their own children but also the possibility of a diagnosis of cancer. It was too much to bear, and after a day spent drinking with her husband and friends to calm down, Aisha went home and “tore the kitchen apart,” broke her arm….

What facts surrounding the death of her fiancé made recovery more difficult?

A Case of Bereavement-Related Withdrawal

Shayna, a woman in her mid-20s, presented for counseling several months after the death of her fiancé, Jerod, from a rare viral infection. While hospitalized for the virus, Jerod had a heart attack, lapsed into a coma, and died several days later. He was 25 years old. Shayna was distraught, as was Jerod’s family. The death was completely unexpected—and making sense of it was deferred for months as they awaited autopsy results. It was only after the autopsy that they discovered that a rare and fatal virus had crystallized in Jerod’s organs, and one by one his organs failed. Even then, the cause of death was not fully comprehensible. It did not make sense.

His mother and father were in their 40s; his….