Billing and Record-Keeping for Familial Cancer Risk Counseling: A National Survey

We surveyed 111 genetic counselors providing cancer risk counseling (CRC) in order to document their billing and record-keeping practices. Of the 75 respondents, billing was generally done under the supervising physician with a wide variation in charges. Follow-up telephone interviews with 28 counselors who charge patients revealed that billing was usually done using the CPT codes for consultations, and the ICD-9 diagnostic codes for cancer (if applicable), a medical complaint, or a family history of cancer code. Most counselors exclude some clinical information from the patient's medical record. In consultation notes, 81% of counselors document a discussion of genetic testing, but only 37% document the patient's actual testing decision, and only 19% document test results. In anticipation of increased referrals for CRC, data are needed on the components of a CRC visit, the amount of time required to provide CRC, patient outcomes measures, and charges and reimbursement. The feasibility and advisability of keeping results separate from the patient's medical record also needs to be addressed.     

Privileged Communication in the Counselor‐Client Relationship

Determining the status of privileged communications between counselors and clients is a complex task. The scope of counselor‐client privilege varies considerably across states, and several sections of state codes directly and indirectly influence its status. This article presents an analysis of state laws related to privileged communication in the counselor‐client relationship and discusses prevalent legal exceptions. The authors offer implications for practice to assist counselors in balancing their ethical and legal obligations.     

School Counselors’ General Self-Efficacy,Ethical and Legal Self-Efficacy,and Ethical and Legal Knowledge

School counselors encounter ethical and legal situations that necessitate the knowledge and confidence to apply decision-making skills. We report the findings from a correlational investigation that examines practicing school counselors’ (N = 287) ethical and legal self-efficacy, ethical and legal knowledge, and general self-efficacy. Higher ethical and legal self-efficacy was associated with higher general self-efficacy and ethical and legal knowledge. The implications of these findings are discussed.     

Evolution of an Inpatient Pediatric Psychology Consultation Service: Issues Related to Reimbursement and the Use of Health and Behavior Codes

The purpose of this study was to evaluate an inpatient pediatric psychology consultation service, with particular focus on issues related to financial reimbursement for services. Information was gathered over a four year period (2001–2005) regarding number of consults, referral source and referral question, type of insurance, and reimbursement rates for health and behavior codes versus mental health codes. The financial impact of hiring an insurance verification specialist was also explored. Results indicated that reimbursement rates for health and behavior codes were higher than reimbursement rates for mental health codes. Health and behavior codes were rejected in 31% of cases that they were billed; the primary reason for rejection was that these codes were not a covered service by Medicaid. Hiring an insurance verification specialist was found to be a cost-effective method for improving the financial “bottom-line” for psychology services. Implications for practice are discussed.     

Conflict of interest in medicine in Lithuania: legal and ethical aspects

The current legal framework within the Lithuanian health system is described including a review of the physician’s autonomy, rights and duties, and patients’ rights including the right to reimbursement. The role of ethical codes and the law are discussed. An earlier version of this paper was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002.     

Ethical Challenges and Legal Issues for Mental Health Professionals Working With Family Caregivers of Individuals With Serious Mental Illness

Mental health professionals frequently work with family caregivers in the provision of psychotherapy services to individuals with serious mental illness. To address the need for ethical guidelines for working with family caregivers, an analysis of relevant ethical and legal issues is provided within the context of dynamic mental health care and legal systems. When working with family caregivers, practitioners utilize the American Psychological Association’s Ethics Code (2010), legal codes, and a complex decision-making plan; identify and communicate ethical obligations to family caregivers; consider the unmet needs of this population; avoid harm resulting from multiple relationships; and balance ethical duties of beneficence and respect for autonomy.     

Employment and Roles of Counselors in Mental Health Agencies

The authors studied the employment of counselors with master's degrees in multiservice mental health agencies. The study focused on the types of clients seen, the direct care services provided, and the administrative duties performed. Results suggested that the employment of counselors does not differ significantly from the employment of individuals with master's degrees in psychology and social work. Also, the data indicated that counselors are delivering direct care services that traditionally have been offered in mental health centers, that clients seen by counselors demonstrate a range of mental disorders, and that counselors are responsible for fulfilling various administrative duties.     

Accepting Fallibility: A Model for Personal Responsibility for Nonegregious Ethics Infractions

The profession's ethics standards require counselors to self‐monitor their professional actions and take responsibility for misconduct. However, the professional literature has focused on preventing misconduct and on response to serious violations and has offered little guidance regarding the minor infractions that all professionals are vulnerable to committing during their careers. The author presents a 4‐element model to guide counselors in ethically repairing damage when they recognize they have violated ethics codes or ethical principles in minor ways. The model uses the ethical principles that underlie the American Counseling Association's (1995) Code of Ethics and Standards of Practice and J. R. Rest's (1983, 1994) model of moral behavior as a foundation.     

Noncompetition Agreements: How Informed Are Counselors?

A noncompetition agreement is a contract between employer and employee prohibiting the practice of a trade or profession for a specified time or within a specified region upon an employee's leaving an employer's hire (A. Valiulis, 1985). The authors assessed American Mental Health Counselor Association members' knowledge of the legal bases for these contracts and their agreement with the legal opinions and also assessed the degree of similarity and dissimilarity between members' knowledge of and agreement with the legal opinions. Results showed that counselors are better prepared to look after the welfare of their clients than their own employment interests. Implications for counselor training are discussed.     

Disproportionate Diagnosis of Mental Disorders Among African American Versus European American Clients: Implications for Counseling Theory,Research, and Practice

Research generated by the professions of psychiatry and psychology reveals that African Americans are more often diagnosed with specific mental disorders (e.g., psychotic disorders) compared with European Americans. No research to date, however, has investigated whether professional counselors make differential diagnoses according to client race. This study (N = 1,648) found that counselors diagnosed African Americans with psychotic and childhood disorders at a disproportionately high rate. Implications for counseling theory and practice are discussed.     

Supervision Needs of Correctional Mental Health Counselors

Supervision of mental health counselors and psychologists is a developing field within psychology. Supervision models and needs are being researched and defined. Supervision for correctional mental health counselors and psychologists is an important part of correctional psychology, but has received very little research attention. There are many aspects of correctional psychology that are unique from the field of psychology as a whole; this is certainly true for supervision of correctional mental health staff. This article examines the supervision needs of correctional mental health counselors and psychologists. An application of one supervision model to correctional psychology is presented.     

Medicare Advocacy for the Counselor Advocate

Medicare reimbursement for counselors would expand older adults' access to mental health services and increase counselors' professional opportunities. To enhance advocacy efforts, the author reviews Medicare's current role in meeting older adults' mental health needs, examines the program's unique political development, and identifies contemporary values that may influence Medicare's future. Implications for counselor advocacy efforts are discussed.     

The Power of Language and Labels: “The Mentally Ill” Versus “People With Mental Illnesses”

Undergraduate students (N = 221), adults in a community sample (N = 211), and professional counselors and counselors‐in‐training (N = 269) were given a measure of tolerance. Within each sample, half of the participants were given a version that used the term “the mentally ill” and half were given a version that used the term “people with mental illnesses.” Individuals receiving the version with the term “the mentally ill” had lower levels of tolerance. Professional counselors had the largest differences in tolerance on the basis of language.     

Counselors', Rehabilitation Providers', and Teachers' Perceptions of Mental and Physical Disabilities

The diversity perceptions of human service professionals may be critical indicators of effective service provision. Specifically, this study explored the disability perceptions of counselors, rehabilitation providers, and teachers (N = 172) enrolled in a large, southeastern university. A 76% response rate was achieved in the study, indicating clear differences by human service providers' preparation area and perceptions of disability type. Implications for preparation and future research are discussed.     

Exploring Genetic Counseling Communication Patterns: The Role of Teaching and Counseling Approaches

The educational and counseling models are often touted as the two primary professional approaches to genetic counseling practice. Yet, research has not been conducted to examine how these approaches are used in practice. In the present study, we conducted quantitative communication analyses of BRCA1 genetic counseling sessions. We measured communication variables that represent content (e.g., a biomedical focus) and process (e.g., passive listening) to explore whether genetic counselor approaches are consistent with prevailing professional models. The Roter Interaction Analysis System (RIAS) was used to code 167 pre-test genetic counseling sessions of members of a large kindred with an identified BRCA1 mutation. Three experienced genetic counselors conducted the sessions. Creating composite categories from the RIAS codes, we found the sessions to be largely educational in nature with the counselors and clients devoting the majority of their dialogue to providing biomedical information (62 and 40%, respectively). We used cluster analytic techniques, entering the composite communication variables and identified four patterns of session communication: Client-focused psychosocial, biomedical question and answer, counselor-driven psychosocial, and client-focused biomedical. Moreover, we found that the counselors had unique styles in which they combined the use of education and counseling approaches. We discuss the importance of understanding the variation in counselor communication to advance the field and expand prevailing assumptions.     

Analyzing the Impact of the Medicare Coverage Gap on Counseling Professionals: Results of a National Study

The authors surveyed 6,550 members of the American Counseling Association regarding the current impact of Medicare policy on counseling professionals. More than half of respondents (54.8%) had been directly affected by Medicare reimbursement barriers, including 70.0% of practicing counselors. Statistical analyses indicated significant associations between years in the profession, direct experience with the Medicare coverage gap, and participation in professional advocacy related to Medicare. Implications for counselors, counselor educators, and counseling scholarship are discussed.     

“It’s Challenging on a Personal Level”—Exploring the ‘Lived Experience’ of Australian and Canadian Prenatal Genetic Counselors

Prenatal genetic counselors work with clients who are at risk of having a child with a fetal anomaly, or who have been diagnosed with a fetal anomaly. This can raise challenging ethical, moral and legal issues for both clients and counselors. Few studies have explored whether this type of work impacts on genetic counselors themselves. Interviews were conducted with 15 prenatal genetic counselors, five from Toronto, Canada and ten from Melbourne, Australia. A qualitative approach was used to allow for an in-depth exploration of the experiences of genetic counselors working in the prenatal setting. While participants reported that working in a prenatal setting affected them in several ways, this paper focuses on one particular unanticipated finding—that of the impact experienced by counselors from both countries while working when pregnant.     

Ethics and Culture in Mental Health Care

This article examines the complex relationship between culture, values, and ethics in mental health care. Cultural competence is a practical, concrete demonstration of the ethical principles of respect for persons, beneficence (doing good), nonmaleficence (not doing harm), and justice (treating people fairly)—the cornerstones of modern ethical codes for the health professions. Five clinical cases are presented to illustrate the range of ethical issues faced by mental health clinicians working in a multicultural environment, including issues of therapeutic boundaries, diagnosis, treatment choice, confidentiality and informed consent, and the just distribution of limited health care resources.     

Commonalities in Values Among Mental Health Counselors

Mental health counselors (N = 161) from Buenos Aires, Argentina, who ascribed to distinct theoretical orientations were surveyed with regard to their personal and mental health values. Although on theoretical grounds value differences among counselors professing divergent orientations seem plausible, the empirical literature has failed to support these differences. What has been supported is a sizably shared professional culture characterized by a values profile beyond theoretical orientation. This article provides further empirical input on what the values commonalities are even among counselors who profess distinct theoretical orientations and have a different national origin from prior samples. Implications for clients are discussed.