Suicide – Military

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Tarasoff – Duty to Warn, Duty to Protect

Note: Blogpost in progress

Source info for this post

High-level definition of Tarasoff (Duty to Warn, Duty to Protect)

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Who were the actors?

-Prosenjit Poddar (UC Berkeley student)

-Tatiana Tarasoff (UC Berkeley student)

-University Health Science Psychologist

-Campus Police

 

What was lawsuit #1?

Negligence by campus police and the university health service

Outcome: Duty to warn the victim.  Social Worker must verbally tell intended victim that there is a foreseeable danger of violence.

What was lawsuit #2?

Outcome: Establish a duty to protect.  Implies a therapist determining that his or her patient presents a serious danger of violence to another and an obligation to use reasonable care to protect the intended victim against danger – warning, police notification, etc.

What was the back-story

Where is the case law

What is law/policy outcome of the case?

When a therapist determines, or pursuant to the standards of his profession should determine, that his patents presents a serious danger of violence to another, he incurs an obligation to use reasonable care to protect the intended victim against such danger.  The discharge of the duty may require the therapist to take one or more various steps, depending on the the nature of the case.  Thus, it may call for him to warn the intended victim or others likely to appraise the victims of that danger, to notify the police or take whatever steps are reasonably under the circumstances.

Has it been expanded on since?

Areas to discuss, as it relates to Duty to warn and Duty to protect:

 

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SOAP Note Purpose and Structure

Note: Post is published and still under development as of 20211010

Additional links to reference:

Free SOAP Notes Templates for Busy Healthcare Professionals

https://www.icanotes.com/2018/04/25/tips-for-writing-better-mental-health-soap-notes/

 

A SOAP (Subjective, Objective, Assessment, Progress/Plan) Note is a document used by a clinician (Licensed Clinical Social Worker or Associate Social Worker) while engaging with a client.  The outcome is a written record which can be used for maintaining an historical record, analyzing trends, efficacy of treatment/interventions, justification for escalation, and so forth.

Each clinician (Medical Doctor, Nurse, Social Worker) may have a different area of focus, detail and structure within their SOAP Notes.  For me (Social Worker), I’m going to start very simple, and customize as needed.  While I prefer paper to capture information, my plan is to create an electronic version of the SOAP Note in Microsoft Excel.  That way, I can search for keywords, etc.

This website gave a good overview for SOAP Notes for Social Workers.  Here is my interpretation of the four (4) key areas to observe and capture within each client interaction:

Subjective Data

Objectively, while withholding any judgment, recording (clinically important) statements made by client (person/s in front of me) during session.  The verbal statements are received as input and may include feelings, thoughts, actions, treatment objectives, concerns.  Typically, this would be something recent and top-of-mind, but also could be something from the past.  A good example is a client who says, “I had a good day”.  In this section, I’m not making meaning of the phrase, but it’s worthwhile to make note.

Objective Data

What I’m observing as a physical manifestation.  What I’m clinically measuring using a tool (FIT, Mini Mental-Health, etc).  In this section, I’m noting my observations, but I’m not making meaning of or interpreting it.  The physical observation can inform the verbal input.  For example, if the body language is tense with rapid breathing and red-faced, then that informs the verbal statement within the prior subjective section.  This section is classic grooming observations: clothing presentation; hair combed/brushed; shaven; general hygiene.  Observing items within the living space is important to note – carpet cleaned; hoarding; trash piles away from garbage can, etc.  In this section, I’m also observing “how” someone is relaying similar/identical information that they may have done in the past, noting the information is relayed with different intensity, for example.  If within the session I captured an assessment (FIT, Mini Health Status Exam), then I have the raw data and can interpret it within another section.

Assessment

Outcome of reviewing the above Subjective and Objective notes, where I’m synthesizing, assessing or understanding a through line or possible hypothesis of the data — making meaning of it all.  I can also be reflecting back on prior sessions and seeing patterns of change, ability for client recall, what’s working, what’s not working, etc.  Seeing how family dynamics over the course are impacting client progress, etc.

Progress and/or Plan

This is my opportunity to step back for a moment and see things at a higher level.  How is the client’s progress being evaluated.  Have the client’s symptoms changed – decreased increased, plateaued.  What specific changes has the client made.  What actions has the client completed that maybe a first.  What are the next actions regarding treatment (talk therapy, actions, meds, etc).

Additional items to include in a SOAP aka Progress Note

-What is the specific and tangible goal we’re heading to, so we have a point-of-reference when we arrive somewhere.

-Is there a RISK to self, to others, from others.  If that happens, what is the plan.

-Each session has a date, and a start and finish time. Everything is documented on the progress note, including any lateness or shortened sessions.

-What is the progress made towards a discharge plan

-What community support services does the client need and how to integrate this into treatment plan.

-What is the plan and scheduled day/time for next session.

-What’s getting in the way of client’s goals or progress – what are the stressors.

 

 

 

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Problems for veterans

A possible scenario:

Veteran is discharged from military service and finds themselves back in the United States.  Challenge could be one or more of the following:

  • Homeless with housing not affordable
  • Housed but soon to be homeless
  • Lease violations leading to eviction
  • Medical attention needed
  • Mental healthcare attention needed
  • Trauma: PTSD
  • Maturity affecting independent living
  • Co-dependency with other veterans (housed/homeless)
  • Substance abuse challenges
  • Relax and Stress Management
  • Dental/Vision attention needed
  • Physical Disability (TBI, missing limbs)
  • Other health problems
  • Income needed (possibly to get out of poverty) – find gainful employment
  • Financial Management assistance required
  • Legal problems
  • Case management/representation/advocacy needed/backlog

 

Note: Some of these ideas came from this website

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Registering as ASW with BBS

Desired Outcome:

Registering as an ASW (Associate Social Worker) with the BBS (Board of Behavioral Sciences) in California.  Note: The following applies for me, as I graduated from USC (University of Southern California) with a MSW (Master of Social Work) degree.  I also live and wish to work in California.

Why completing this registration is important?

Getting a job

I’ve found, in general, that being attractive to employers requires an ASW registration.  It means you can perform clinical work, under the supervision of a fully state-licensed mental healthcare worker.  The other reality, from perspective of an employer, is that an ASW can bill their services to insurance.

Continuous Learning

Between the ASW and the LCSW (Licensed Clinical Social Worker) are a series of courses that must be completed before sitting the final exam (ASWB, I think it’s called).  One course, which gets much attention, is Law and Ethics.  Even after the LCSW, it’s not over, as there are opportunities to do more learning and earn CEUs (Continuing Education Units).  The point is that the ASW continues where the MSW left off.

ASW leads to LCSW

There are different paths, and I’m on the path towards LCSW.  While my preference is Macro-focus, I recognize that having a LCSW is a solid foundation in understanding what is really happening on the frontlines.  Macro is much needed, but can also assume one really understands what’s happening before policy/programs can be created and integrated.

Private Practice autonomy

The LCSW can open doors to opening one’s own private practice.  My understanding is that most psychotherapists in the US are Social Workers.  Having a LCSW offers a lot of freedom and choice in one’s niche.  Of course, while being an ASW, you cannot have your own private practice — within the realm of ASW.  It’s OK for an ASW to work in a private practice headed by an LCSW.

Steps in the process:

Application (paper-based)

The Main Page for FAQ and forms for application for ASW.  I thought the form was very simple, short and clear.  Maybe what made it simple for me was that I didn’t have issues with last name, had graduated from a CA school, and live in CA.  The key is to fill out the form really accurately, and be consistent across all forms.  While I know the BBS are considering some automation of the process, they are currently wanting the paper form because of the “ink” signature.  Cost of Application: $150 (either check or money order).  Cost to mail: $7.65 to mail it with tracking and return signature.

Transcripts

The ASW registration requires transcripts from your school showing courses taken, grades, etc.  Because I still have access to the myUSC portal to USC, it was really easy to request the transcript.  The BBS have the option of the school sending electronically to an email address – that’s cheaper and faster.  While I could see my courses/grades online, the transcript still has to come directly from the school to (in this case) the BBS.  Cost: $12 for a PDF transcript.

Fingerprints (LiveScan)

Because we’re (theoretically) coming out of COVID-19, as of today – August 4, 2021 – I had some challenges finding a location that has LiveScan and can schedule.  My goal was to get the LiveScan appointment soon than later.  I could have sent the application first, waited for LiveScan, and then sent the results later.  But, my goal was to get everything done all at once.  Good thing is that Morro Bay Police Department had an opening today, so I got everything done today and mailed everything today to BBS.  LiveScan is the preference because the fingerprints are immediately sent to, in my case, Sacramento for background check processes.  I was told that, because I’ve done LiveScan before, that the turnaround maybe faster.  The agent said that it could take from 1 day to about a week to complete.  Note: Keep in mind the costs can vary by location and agency.  Cost: $84 ($49 plus $35).

Law and Ethics course and exam

When the ASW is registered and processed, then the first course is Law and Ethics.  This will be covered more in a different post, but here’s some general info:

  • If you graduate from a California school, and are registering with BBS in California, then (according to CSWE) the MSW program included the coursework for Law and Ethics, and you don’t have to do the course.  You can fast-track and just do the exam.
  • Must be taken within a year of registration
  • Must be taken (for each year you re-register) – not necessarily passed
  • But…  if you fail it, then you have to do some 12 hour course before taking it again.
  • After several years (in the 6th year, I think) you must pass it in order to get a new registration number – which carries over all your hours.
  • Bottom line: Pass it first time in first year.
  • I had purchased a course from the NASW on the topic.  I’ll be going through that in detail within different page/blogposts.
  • There are various programs (e.g. TDC) that are exam prep courses for ideally passing first time.  I’ve seen this cost around $265 for the course.

Summary

As of 20210804, now I wait.  The paperwork has been mailed; the fingerprints have been submitted, the transcripts have been emailed by now, and I’m just now short of a couple hundred dollars…

20211002 Update:  It took 30 days for the check to clear.  Day one is when check cleared (9/7/21).  Because of short staffing (COVID related) it can take up to 60 days to process.  That means it may be early November, 2021.  I’ve linked my email address with my BBS record, so I can review progress within CA Breeze.

 

 

 

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