Laws and Ethics Course > Chapter 2 - The Laws and Regulations

Chapter 2: The Laws and Regulations

Each state governing board sets rules and regulations pertaining to the practice of the corresponding professions. You can usually find these regulations for your state by doing a web search for the board and following the links to the state's regulations. In this course the regulations for the state of California are more particularly made mention, because of the large number of healthcare professionals in the state, and the progressive nature of the governing board. It is also arguable that many of the California regulations pertain to the general practice of healthcare professionals. In California, the Board of Behavioral Sciences (BBS) has established a very thorough set of rules and regulations relating to the practice of social workers and marriage and family therapists. The California Board of Registered Nursing has likewise established laws and regulation for the practice of Nursing. In addition, because nurses have extensive interaction with patients and must respond to their behaviors, it is worthwhile for them to be aware of the ethical standards and issues related to social workers and therapists. To see the code applicable to BBS licenses you can link to: http://www.bbs.ca.gov/pdf/publications/lawsregs.pdf

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To see the code applicable to the California Board of Nursing you can go to the following link: http://www.rn.ca.gov/regulations/bpc.shtml

In June of 2005, California approved new legislative language pertaining to requirements of Public Health Nurses. You can see these regulations here: http://www.rn.ca.gov/regulations/title16.shtml

To see the Code of Ethics for the NBCC please go to this link: http://www.nbcc.org/code_of_ethics

The current National Board of Certified Counselors Code of Ethics has 95 stated Directives as found in the link above.

The following are some highlights from the laws and regulations mentioned:

Necessity of a License

Remember how happy you were when you received the notice that you had passed the exams and became a licensed social worker, therapist or registered nurse? This was not just about that moment or even the thousands of hours of internship, or studying for the exams.It was the culmination of all your education and that thought should still provide you with a sense of accomplishment and elation. Now you can provide services with confidence that your efforts will help others live a greater quality of life, and those who receive your services can have that same confidence in you.

As you know, consumers of healthcare services are protected by regulations that require individuals providing those services to be competent. This level of competence is acquired through formal education and supervised experience. Competence is then evaluated through an examination process. When the individual has received the education, the experiences, and shown a high level of competence (that's you!) then the state issues a license as a notice to the consumer that the individual is capable of providing such services. In California, one who presents him/herself as a licensed healthcare professional who has not meet these qualification is guilty of a misdemeanor.

The following are examples of Laws and Regulations (BBS, L&R Code) requiring individuals to possess a valid license from the state in California:

MFTs

Simply put, no person is allowed to practice marriage and family therapy that does not have a license to do so. They are also not allowed to advertise to provide marriage and family therapy services or use the initials that marriage and family therapists use to designate themselves such as MFT or MFCC. This makes it clear to the consumer that the person they are seeking services from is a licensed individual and can expect a certain level of service. It also prevents somebody not licensed from soiling the reputation of licensed individuals. The designation as a Marriage and Family Therapist separates that person as a professionally licensed healthcare provider.

The law reads thus:

"No person may engage in the practice of marriage and family therapy as defined by Section 4980.02, unless he or she holds a valid license as a marriage and family therapist, or unless he or she is specifically exempted from that requirement, nor may any person advertise himself or herself as performing the services of a marriage, family, child, domestic, or marital consultant, or in any way use these or any similar titles, including the letters M.F.T. or M.F.C.C., or other name, word initial, or symbol in connection with or following his or her name to imply that he or she performs these services without a license as provided by this chapter. Persons licensed under Article 4 (commencing with Section 4996) of Chapter 14 of Division 2, or under Chapter 6.6 (commencing with Section 2900) may engage in such practice or advertise that they practice marriage and family therapy but may not advertise that they hold the marriage and family therapist's license."(BBS, L&R Code)

LCSWs

Similar to MFTs, only licensed clinical social workers can claim to be LCSWs or provide services that LCSWs do as permitted by law. If someone that does not hold a license in good standing uses any words or symbols in an attempt to portray themselves as a Licensed Clinical Social Worker, they are guilty of a misdemeanor.

The law reads thus:
  • "Only individuals who have received a license under this article may style themselves as "Licensed Clinical Social Workers." Every individual who styles himself or herself or who holds himself or herself out to be a licensed clinical social worker, or who uses any words or symbols indicating or tending to indicate that he or she is a licensed clinical social worker, without holding his or her license in good standing under this article, is guilty of a misdemeanor.
  • It is unlawful for any person to engage in the practice of clinical social work unless at the time of so doing such person holds a valid, unexpired, and unrevoked license under this article.
  • A clinical social worker licensed under this chapter is a licentiate for purposes of paragraph (2) of subdivision (a) of Section 805, and thus is a health care practitioner subject to the provisions of Section 2290.5 pursuant to subdivision (b) of that section." (BBS, L&R Code)

Application of Methods

The laws and regulations regarding healthcare professionals also address the application of methods for each license. This defines the purpose of the services and how the services are performed.

MFTs

Marriage and family therapists perform their services with individuals, couples and groups to enhance their lives and their relationships so they are more satisfying.When problems arise, marriage and family therapists are able to address these issues from different angles including using psychotherapy, education, interpretation of behaviors, thoughts and feelings and other applications from the education they have received.

"...the practice of marriage and family therapy shall mean that service performed with individuals, couples, or groups wherein interpersonal relationships are examined for the purpose of achieving more adequate, satisfying, and productive marriage and family adjustments. This practice includes relationship and pre-marriage counseling. The application of marriage and family therapy principles and methods includes, but is not limited to, the use of applied psychotherapeutic techniques, to enable individuals to mature and grow within marriage and the family, the provision of explanations and interpretations of the psychosexual and psychosocial aspects of relationships, and the use, application, and integration of the coursework and training required by Sections 4980.37, 4980.40, and 4980.41."(BBS, L&R Code)

LCSWs

The application for social workers covers a wide array of services and techniques that assist individuals, families and groups; with both their life satisfaction as individuals with relationships and in their community. LCSWs have an awareness about the psychosocial environment in which a person's experiences are played out, and in addition to psychotherapy, can also help the person influence their environment to make circumstances, and their responses to them, more satisfying.

"The practice of clinical social work is defined as a service in which a special knowledge of social resources, human capabilities, and the part that unconscious motivation plays in determining behavior, is directed at helping people to achieve more adequate, satisfying, and productive social adjustments. The application of social work principles and methods includes, but is not restricted to, counseling and using applied psychotherapy of a nonmedical nature with individuals, families, or groups; providing information and referral services; providing or arranging for the provision of social services; explaining or interpreting the psychosocial aspects in the situations of individuals, families, or groups; helping communities to organize, to provide, or to improve social or health services; or doing research related to social work.

Psychotherapy is the use of psychosocial methods within a professional relationship, to assist the person or persons to achieve a better psychosocial adaptation, to acquire greater human realization of psychosocial potential and adaptation, to modify internal and external conditions which affect individuals, groups, or communities in respect to behavior, emotions, and thinking, in respect to their intrapersonal and interpersonal processes."(BBS, L&R Code)

When an LCSW or MFT feels it would benefit the client, it is important to refer them to a psychiatrist for an evaluation for medication.It is out of the scope of LCSWs and MFTs to prescribe or tell a client that they should be on medication outside of what has been prescribed by a medical doctor.

Registered Nurses

The following is an excerpt from the Business and Professions Code of California regarding the Practice of Nursing:

Article 2
2725. Legislative intent; Practice of nursing

  • In amending this section at the 1973-74 session, the Legislature recognizes that nursing is a dynamic field, the practice of which is continually evolving to include more sophisticated patient care activities. It is the intent of the Legislature in amending this section at the 1973-74 session to provide clear legal authority for functions and procedures that have common acceptance and usage. It is the legislative intent also to recognize the existence of overlapping functions between physicians and registered nurses and to permit additional sharing of functions within organized health care systems that provide for collaboration between physicians and registered nurses. These organized health care systems include, but are not limited to, health facilities licensed pursuant to Chapter 2 (commencing with Section 1250) of Division 2 of the Health and Safety Code, clinics, home health agencies, physicians offices, and public or community health services.
  • The practice of nursing within the meaning of this chapter means those functions, including basic health care, that help people cope with difficulties in daily living that are associated with their actual or potential health or illness problems or the treatment thereof, and that require a substantial amount of scientific knowledge or technical skill, including all of the following:
    • Direct and indirect patient care services that ensure the safety, comfort, personal hygiene, and protection of patients; and the performance of disease prevention and restorative measures.
    • Direct and indirect patient care services, including, but not limited to, the administration of medications and therapeutic agents, necessary to implement a treatment, disease prevention, or rehabilitative regimen ordered by and within the scope of licensure of a physician, dentist, podiatrist, or clinical psychologist, as defined by Section 1316.5 of the Health and Safety Code.
    • The performance of skin tests, immunization techniques, and the withdrawal of human blood from veins and arteries.
    • Observation of signs and symptoms of illness, reactions to treatment, general behavior, or general physical condition, and (A) determination of whether the signs, symptoms, reactions, behavior, or general appearance exhibit abnormal characteristics, and (B) implementation, based on observed abnormalities, of appropriate reporting, or referral, or standardized procedures, or changes in treatment regimen in accordance with standardized procedures, or the initiation of emergency procedures.
  • Standardized procedures, as used in this section, means either of the following:
    • Policies and protocols developed by a health facility licensed pursuant to Chapter 2 (commencing with Section 1250) of Division 2 of the Health and Safety Code through collaboration among administrators and health professionals including physicians and nurses.
    • Policies and protocols developed through collaboration among administrators and health professionals, including physicians and nurses, by an organized health care system which is not a health facility licensed pursuant to Chapter 2 (commencing with Section 1250) of Division 2 of the Health and Safety Code.

  • The policies and protocols shall be subject to any guidelines for standardized procedures that the Division of Licensing of the Medical Board of California and the Board of Registered Nursing may jointly promulgate. If promulgated, the guidelines shall be administered by the Board of Registered Nursing.
  • Nothing in this section shall be construed to require approval of standardized procedures by the Division of Licensing of the Medical Board of California, or by the Board of Registered Nursing.
  • No state agency other than the board may define or interpret the practice of nursing for those licensed pursuant to the provisions of this chapter, or develop standardized procedures or protocols pursuant to this chapter, unless so authorized by this chapter, or specifically required under state or federal statute. State agency includes every state office, officer, department, division, bureau, board, authority, and commission.

  • (Added Stats 1939 ch 807 2. Amended Stats 1968 ch 348 1; Stats 1974 ch 355 1, ch 913 1; Stats 1978 ch 1161 172; Stats 1980 ch 406 1; Stats 1989 ch 886 52; Stats 1995 ch 279 15 (AB 1471); Stats 1996 ch 124 2 (AB 3470). Amended Stats 2003 ch 640 5 (SB 358).)

Hiring and Supervision of Interns and Associates

When hiring and or supervising an MFT intern (intern) or an Associate Clinical Social Worker (associate) the employee must provide appropriate supervision. Clinical supervision has been defined as "Responsibility for, and control of, the quality of clinical social work [or marriage and family therapy] services being provided." This direct supervision must be performed with a qualified licensed professional, and must be performed each week with face to face contact of at least one hour of individual supervision or two hours of group supervision.

The supervisor and the associate/intern will need to develop a plan of supervision that describes the goals and objectives of supervision. The supervisory responsibility is a very active one as the supervisor helps the associate/intern reach the level of competence required for licensure. This is done through the weekly direct supervision sessions, providing applicable, clinical experiences, and providing feedback and direction as laid out in the supervisory plan.

A noted difference between hours required for the intern and the associate is the associate cannot begin to accrue hours until after registered after graduating with a Masters and must gain 3200 hours of supervised clinical experience. The intern needs two years of professional experience and at least 3000 hours of supervised experience and no more than 1500 of those can be received prior to graduation. (BBS, L&R Code)

Licensed professional may not supervise more than two unlicensed individuals.

For a more detailed report of supervisory requirements and licensure requirements you can go to the BBS website at http://bbs.ca.gov
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Question No.2. It is within the scope of practice for an LCSW and MFT to:

a. Prescribe medication
b. Use psychotherapy to help people have more satisfying adjustments
c. Perform medical exams
d. Date their client

Question No.3. To provide marriage and family therapy services you need:

a. An LMFT license
b. An LCSW license
c. A Bachelors Degree
d. Either a or b

Question No.4.Licensed professional may not supervise more than ____ unlicensed individuals.

a. 5
b. 2
c. 1
d. 10
 
Laws and Ethics Course > Chapter 2 - The Laws and Regulations
Page Last Modified On: October 10, 2015, 03:50 AM