 I'd like to welcome everybody to today's presentation on Florida Laws and Rules Review. Now, this is part one of three. It's a three-hour class, so just kind of bear with me here. In this section, we're going to review the rules and statutes clinicians are responsible for knowing. Review the updated definition for supervision. Review the procedures for supervision if the supervisor is investigated or disciplined. Review the requirements for demonstrating knowledge of laws and rules. Review the procedures for renewing your license. And review the qualifications and training required to practice hypnosis. So what are you required to know? Well, there's a laundry list of things and I really suggest that you periodically go in and kind of review them to refresh your memory. And when I say periodically, I mean, once every couple of bienniums is probably good because this course is not going to cover everything you're responsible for knowing. And the board does not take ignorance as an excuse for not doing something you're supposed to. So reviewing it, make sure you remember what you're supposed to do, what you can and can't do. I mean, a lot of them are really pretty much common sense. So when you read them, you're like, oh, yeah, that makes sense. Chapter 491, clinical counseling and psychotherapy services. 456 is your health professions and occupations general provisions. Chapter 120 is the Administrative Procedures Act. Chapter 39, obviously, if you don't work with kids, you're probably not going to have to pay too much attention to this, but proceedings related to children. So if you're working with any youth, it's important to pay attention to that. Chapter 90 is the evidence code. Chapter 394 is the Mental Health Act. Chapter 397 is the Substance Abuse Services. And Chapter 415 covers Adult Protective Services. Mental Health Substance Abuse and Adult Protective Services, if you work with adults, are all important for you to review. The other place that there's stuff you need to know is the Florida Administrative Code. So looking at rules, Chapter 64B4 and Chapter 65E5. Now, if you work in a facility, you're really familiar with the Florida Administrative Code. And Chapter 65D-30 is what regulates a lot of things in treatment facilities. So don't be afraid of the statutes. Sometimes it takes a little bit of going through to figure out exactly what they're saying in legalese. But don't be afraid of them because they're there to guide you. So for the purposes of this presentation, the terms clinician when I use it refers to licensed clinical social workers, licensed marriage and family therapists, and licensed mental health counselors. That way I don't have to repeatedly say that whole laundry list of things. So clinician is anyone that is licensed under 490, 491. And when I use the term in practice, it means in the practice of clinical social work, marriage and family therapy, or mental health counseling. So let's start off with 64B4, the definition of supervision for clinical social work, marriage and family therapy, and mental health counseling. This was updated in February of 2016. So it is something that's new. Supervision is the relationship between the qualified supervisor and intern that promotes the development of responsibility, skills, knowledge, attitudes, and adherence to ethical, legal and regulatory standards in practice. So supervision is not just a matter of developing knowledge and skills in the supervisee. It's also incumbent upon a supervisor to make sure that supervisor knows the ethical codes, the laws and rules, and knows how to apply those to their specific situations. When can you breach confidentiality? What does confidentiality stand for? What is HIPAA? What is high tech? All those things that we want to look at. What is client abandonment? Because that's a big issue, making sure that interns know that it's not okay to just discharge somebody if they haven't shown up for a while. You need to follow up. Supervision is the contact between an intern and supervisor during which the intern apprises the supervisor of the diagnosis and treatment of each client. So when you meet for supervision, you're not just doing a case study. The supervisor should know about what's going on with each client, including those shows and what you did about it, because the supervisor is indirectly responsible for the treatment of that client. So it's ethically incumbent upon the supervisor to know what's going on with each person. I have my supervisors complete a worksheet each time that shows me, you know, if Jim Bob showed up, the general topics that were discussed, etc. So, you know, if you've got 15 clients, it doesn't take very long, but that way I have a record of what was covered. And, you know, I can ask about it when we go through the supervision session. The intern apprises the supervisor of the diagnosis and treatment of each client. Client cases are discussed. So some of the cases that are there may be presenting some issues or you may have your clinician identify a particular case that they want to discuss. You're not going to have time to go in depth on each particular case, but they may have a stumbling block with a particular case that you can discuss. The supervisor provides the intern with oversight and guidance in diagnosing and differential diagnosis. So sometimes my supervisors will come to me and they'll have a diagnosis and I might kind of throw out there. Well, let's consider this or have you ruled out this. We also provide supervisors with oversight and guidance in dealing with clients and treating them if you're running into what we normally call resistance. How do you deal with that? If you've got a client who is violating boundaries and maybe calling all the time or doesn't show up for their scheduled sessions and then needs an emergency session regularly. How do you handle that? What's the best way to deal with that? And the supervisor is also evaluating the intern's performance throughout the whole thing. An intern shall be credited for the time of supervision if the intern received at least 100 hours of supervision in no less than 100 weeks. So you can't just lop all your supervision on the front end or the back end. You need to have it pretty much every week or every other week provided at least 1500 hours of face-to-face psychotherapy with clients. So that's 1500 hours in session, not 1500 hours at the facility, 1500 actual counseling hours and received at least one hour of supervision every two weeks. So you can do one hour every two weeks. You can do a half hour every week, but you can't do two hours a month. You have to have regular supervision. And part of that is so the supervisor can keep an eye or keep tabs on how each client is doing. And that makes sure that the clients who are being served by the intern are getting the highest quality possible care. The supervision shall focus on the raw data. Raw data means your actual sessions, the audio recordings, the video recordings, if the supervisor observes it, transcription of your audio recordings. So the supervision shall focus on the raw data from the intern's face-to-face psychotherapy with clients. The intern shall make the raw data directly available to the supervisor through such means as written clinical materials, direct observation, and video and audio recordings. So raw data is really important. You don't have to have raw data for every session every week, but it is important for the supervisor to be able to see some of the raw data to make sure that the supervisor is interpreting things in a way that is most helpful to the client. Supervision is distinguishable from personal psychotherapy and didactic instruction. When you're in supervision, the supervisor may identify issues that the supervisor is struggling with, but supervision is not the place to deal with those issues. Supervision is the place to deal with, okay, how can you keep those issues from impacting your client and what do you need to do next? So supervisors may make a referral for counseling or make other referrals, but it's important to understand that supervision is not counseling, and it's not just didactic instruction where we're teaching and they're implementing. We learn what's going on with them and we have a more of a collegial relationship. The supervisor and intern may utilize face-to-face electronic methods, not telephone only, so it has to be, if you use electronic, it has to be video. To conduct the supervisory sessions, however, the supervisor and intern must have in person face-to-face contact for at least 50% of the interactions. So people who do supervision virtually, you know, that's fine. However, it's important to realize you can't do it from a different state because you're not going to be able to have that 50% of face-to-face contact for the hours, you know, one hour every two weeks. Prior to utilizing any online or interactive methods for supervision, the supervisor and intern shall have at least one in-person face-to-face meeting. So if you are supervising somebody from a distance and you're going to do virtual supervision for 50% of their supervision, it's really important and required that you meet with them face-to-face for that initial session. And this is when you develop the learning plan, this is when you have the contract signed, this is when you do all that stuff anyway, and you get an idea of kind of where that client, supervisor is at. The supervisor and intern are responsible for maintaining the confidentiality, remember HIPAA and high tech of the clients during both in-person and online or interactive supervisory sessions. So doing supervision at Starbucks, no. Doing supervision in a place where confidentiality might be compromised, not going to work. We want to pay attention to HIPAA. If you're doing supervision via virtual means, you need to make sure that whatever platform you're using signs a business associate agreement, just like for counseling. Just saying that they meet HIPAA requirements is not enough. According to HIPAA and high tech, when you use electronic means, the provider of the internet services has to sign and you have to have a copy of the business associate agreement. If an intern obtains group supervision, each hour of group must alternate with an hour of individual supervision. So when I was going through clinical supervision, I remember there were semesters that I would have supervision at UF. And you know, that was great, but it was group supervision and it was always group supervision. So I was getting that every single week and it wasn't alternating with individual supervision. And I mean, think about it. You don't have the time in group soup to go through each client that each person has and do anything meaningful. So it makes sense that alternating is important. Group supervision must be conducted with all participants present and in person. So there is no using webinar meetings with even with video to do group supervision. If you're doing group supervision, it has to be in the same physical location. For the purposes of this section, individual supervision is defined as one qualified supervisor supervising no more than two interns. So you can have two people in the room, which helps as far as fees go in terms of making it more affordable. Once you get above two supervisees, two interns group supervision is defined as one qualified supervisor supervising more than two, but a maximum of six interns in the group. And again, when I was getting group supervision back in the day, there were more than six people in our group supervision course. So that wouldn't have even qualified as group supervision because we had like eight or 10 people in the course. So a maximum of six people can be present in group supervision and it has to alternate with individual supervision. What happens if your supervisor is disciplined or if you're a supervisor and you're disciplined? Well, that's kind of a sticky wicket. A licensee who is disciplined by a final order of the board shall not serve as a qualified supervisor until the licensee has complied with all of the obligations imposed by the final order. So if something happens and you have to go take continuing education in sexual misconduct or boundaries or anger management or whatever it is. The board determines that you're guilty and you have to do these things. You cannot supervise until you finish all of that and the board says, okay, you can start supervising again. Now, one of the frustrating or challenging things is within 15 days after filing of an administrative complaint against a qualified supervisor. This qualified supervisor shall provide written notice of the administrative complaint to all his or her supervisees. So this is before the investigation within 15 days of being notified that there was a complaint made against you. You need to notify all of your supervisees. So the supervisees may be going, oh my gosh, what am I going to do? So it's good to have, as a supervisor, it's always good to have a backup just in case, heaven forbid, you have an administrative complaint filed against you. And it doesn't have to be just a complaint about your supervision. It can be a complaint, an administrative complaint filed against your license for individual counseling that you've been doing. So you go through the investigative process and you're still able to supervise at this point. You've just notified your supervisees that you're under investigation. If you are found guilty, then within one day of the filing of the final order against your license, this qualified supervisor shall provide written notice of the final order and shall terminate all supervisory relationships. So you find out that you're guilty, there are sanctions against you. You have to terminate all supervisory relationships until which time the board, you've completed all the requirements of the board, and the board says, okay, you're cleared to go again. Now that's a lot of stuff in supervision, but we also, as clinicians, as individuals, not just as supervisors, are responsible for knowing laws and rules. And then for a long time, we've had to take the eight hour laws and rules course, and that's mandatory at the beginning. An applicant shall complete this approved course consisting of a minimum of eight hours, which shall include the following subject areas, regulation of professions and occupations, psychotherapist patient privilege, the Florida Mental Health Act, Chapter 397, which is your substance abuse, protection from abuse, neglect and exploitation, social counseling and psychotherapy services, and rules of the board. So all this stuff has to be covered in your eight hour course. Now the board independently approved the laws and rules courses. So if the course is being offered and it's board approved, it's going to cover these things. The laws and rules course must provide integration of the above subject areas into the competencies required for clinical practice and must include interactive discussion of clinical case examples, applying the laws and rules that govern appropriate clinical practice. So you're going to talk about things such as confidentiality. When does somebody become a client officially? You're going to talk about boundary issues and what's okay and what's not okay, et cetera, ideally in your initial laws and rules class. So both laws and rules course must include a testing mechanism on which a passing score of 80% must be obtained prior to issuing credit. Upon successful completion of the course, and this is an interesting thing. Upon successful completion of the course, the applicant shall receive a certificate of completion and submit a copy of that certificate of completion to the board. If you're a CE broker and even though it's going to be reported to CE broker, you're still required to send a copy of that certificate to the board. A laws and rules course offered by a board approved laws and rules course provider shall qualify for continuing education credit, even if the provider is not an approved continuing education provider. So basically what that means is there are some of us who are approved to provide continuing education in general. There are some people who only seek approval for this one course, and even if the person is not providing continuing education in general, as long as they're approved by the board to provide the eight hour laws and rules course, then it's okay to take it. For the purposes of this rule, an hour is defined as a 60 minute clock hour in which there's no less than 50 minutes of uninterrupted instruction. When we're talking about discussion, when we're talking about breaking into groups and stuff, that's still part of the instruction. It doesn't have to be 50 minutes of lecture. What they're talking about is the 10 minutes for breaks and go into the bathroom and getting drinks. Laws and rules courses may be offered and conducted online, but must comply with all aspects of this rule. Such courses must include real time or contemporaneous interactive discussions as required by subsection two. So if you take your laws and rules class online, cool, but that course has to have live text chat or video or audio chat in order to facilitate those interactive discussions. It can't just be an on demand whenever you want to sort of course. All right, great. You took your laws and rules class. You get licensed. How do you renew? The Department of Health shall renew an active license upon receipt of the biennial license fee by each biennium. By remitting the correct fee to the department, the licensee is affirming that all requirements for license renewal have been met. So when you pay that fee, you're saying, yes, I checked all the blocks. I met what I needed to do. I did all my continuing education. It's not going to block you from renewing if you haven't completed your continuing education or whatever requirements you have. So if you pay that fee, you're affirming that you have done that. So if they go and check CE broker, they're going to find that you completed everything. And if you haven't, you're in deep doo doo. Each biennial renewal period shall begin on the date established by the department, which right now is the end of March in odd numbered years. A licensee shall not be required to complete continuing education for the first renewal of the license. But for each subsequent renewal, the licensee must complete 30 hours of approved continuing education, including two hours on the prevention of medical errors and three hours relating to professional ethics and boundary issues. A maximum, now this is a cool part, a maximum of six of the required 30 hours of continuing education may be accrued for credit during one biennium by attending programs designed for the purpose of enhancing the licensee's administrative office management or other non-clinical skills. For example, we have a couple of courses that are geared towards disaster prevention and records management. Those are more, those aren't clinical courses. Those are how do you prepare for this? How do you make sure that your clients are served in the event that there is a disaster? So there are a couple courses we have, for example, that are not technically clinical, but people can get a maximum of six hours for taking those courses. Within six months of initial licensure and every third renewal thereafter, a licensee must complete a two-hour continuing education course on domestic violence. Every third biennium after initial licensure, they also must complete a three-hour laws and rules continuing education course, like this. Every third biennium, a qualified supervisor shall obtain four hours of supervisory training that meets the requirements for continuing education. Okay, so this is every third biennium, which is every six years. I personally just go ahead and take these, these courses, every single renewal period, so I don't have to worry about is this the third biennium or the second or whatever. That's up to you. If you're really awesome at record keeping, then you may be squared away and able to do that. Continuing education hours earned by a licensee to satisfy any disciplinary action. So if you have to take ethics of boundary issues or something because you were disciplined by the board, these are in addition to your 30 hours required for renewal for each biennium. So it's important to understand that if you've been disciplined, this is like over and above. It's extra homework, so to speak. So on the board's website, they have a beautiful little chart that breaks it down for you. How many hours you have to have in general is 25 hours. You have to have medical errors, ethics and boundaries, and then laws and rules and domestic violence. And some of these are every third biennium. So what happens if you are a college student, or you decide to go back and take a course that's independent study. Well, for the purposes of this rule, independent study is defined as any course for which the institution granted credit for the course. So it has to be from a credit grants granting institution and did not publish an official course description of the content. So think about your doctoral seminars, think about your independent study courses that you may have taken during during your master's work, any of these courses that don't have an official syllabus that says this is what we're going to cover or don't have it kind of in the title. It's important to know that you can get credit for those any course labeled by the institution as independent study directed study or directed research also can can qualify and any course in which learning was not completed in the classroom setting with a member of the faculty of the institution which granted credit. So if you weren't in the classroom with your professor and no other students matriculated in the same course were present during the learning experience so maybe you're doing a practicum out somewhere and you're doing you have some learning activities that go along with that practicum. We get credit or at least where I came from we got credit for our practicum hours so that was covered but we would have to provide a syllabus of what was what we learned in it what was taught it can't just be practical learning in order to document that a course content area required by section 491.005 has been completed by independent study. The applicant shall submit an official transcript from the institution awarding credit for the independent study course. Again this says you just have to have a transcript from the awarding institution it is strongly recommended to also have some sort of a syllabus signed off by the supervising professor that indicates what you did and that it was accomplished. All right so the last little bit that we're going to talk about here is the quality qualifications necessary to practice hypnosis and a lot of people get kind of loosey goosey with hypnosis and they launch into guided imagery and self hypnosis and meditation and things that can cross this line I mean it starts getting there's a gray area there it's not necessarily just regressive hypnosis that we're talking about. So it's important to understand what the requirements are and the board doesn't clearly define exactly what's hypnosis and what's not hypnosis so there's some gray area but the intent is very clear before practicing hypnosis for any therapeutic purpose a clinician shall have successfully completed at least 50 hours of instruction in concepts and misconceptions of hypnosis induction techniques contraindications to hypnosis and the relationship of personality dynamics psychopathology and ethical issues to hypnosis. So you need to demonstrate some 50 hours of continuing education in these training areas. Such instruction must have met the standards for approval of continuing education and must have been taught by qualified teachers as defined in the rule so it can't just be anybody teaching hypnosis it has to be a qualified teacher of hypnosis an intern may not practice hypnosis unless practicing under the supervision of a qualified supervisor who has met the requirements to practice hypnosis so if you are being if you are you know under supervision and you want to practice hypnosis then your supervisor has to meet the requirements where he or she could practice hypnosis in order to be a qualified teacher of hypnosis the person must document completion of a minimum of 200 hours of graduate or postgraduate level hypnosis training and a minimum of three years of practical experience in the use of hypnosis and be licensed under 494.91 via practitioner of the healing arts as defined in section 485 or was not required to hold a license but can document the completion of the academic requirements for licensure for one of the stated professions so it's not just documenting proof that you completed the 200 hours but you have the person if they're not licensed has to document completion of the academic requirements of licensure so they theoretically have all the academic training to become a licensed clinical social worker etc. All right that brings us to the end of section one we will be back shortly or whenever you want to start playing section two