Ethics and Record Keeping

Aside from today’s talk on “Ethics and Record Keeping Practices in
Pennsylvania for the Mental Health Professional”, Dr. Allan Tepper put on a great performance in
his Workshop. He reminded me of a cross between Jerry Seinfeld, the comedian,
and Chef Robert from television. I’m sure that you all know Jerry Seinfeld, a little
sarcastic, but a very funny stand-up comedian. Chef Robert is a no nonsense
chef and businessman who visits selected restaurants to tell them what they are
doing wrong and what they can do better. Dr. Tepper presented a reality check,
including risks for noncompliance for record keeping and confidentiality. Just as Chef Robert tells it like it is for restaurant owners, Dr. Tepper told it like it is for licensed Mental Health
Professionals.

Regardless of the profession, few people enjoy hearing what
they might be doing wrong and what they could be doing better. Dr. Tepper asked some pointed questions of the audience on ethical issues regarding their practice. He did a nice job of pointing
out legal and ethical issues to their response without embarrassing anyone. His
sense of humor often saved the day, or at least the moment.

Dr. Tepper is an attorney, and a psychologist. He was
able to switch hats as needed during his workshop. He reminded the audience
that his topic was limited to record keeping and confidentiality. I have
previously heard Dr. Tepper speak on many ethical and legal topics in Mental
Health. Apparently, some of the audience also appreciated his broad expertise,
as the questions were sometimes beyond the scope of this workshop. He briefly
answered the question, and adroitly steered his response back to the topic.

In short, Dr. Tepper’s Workshop met his objectives. His presentation was not “high tech” (He used a flip chart! Thank goodness, he did not allow Power Point to get between him and his audience). The three hours went by very quickly and I learned a few things. Between the humor, his presentation addressed the Therapist –Client relationship (relationship beginning and end documented.), the expected content of the records (handout provided, or contact your licensing Board), Maintenance of
records (e.g. All Boards expect five years after last session but Insurance providers may expect up to 10 years), He also discussed the the recent updates to the “Duty to Warn” obligation. This is a complex issue regarding a client who threatens someone outside of the therapeutic relationship. (Emerich case law decision, PA 1999).

Dr. Tepper advised all licensed MHP’s to frequently check their Board’s Websites for updates on new statutes and regulations.

Adolescent Risk Taking Behavior

This was a great workshop today from Dr. Bradley Connor. His topic, “Risk Taking in Adolescence” included three learning objectives: 1. Demonstrate an etiological model of risky behavior in adolescence. 2. Identify in adolescents, when risky behavior becomes pathological. 3. Evaluate treatment modalities for treating pathological risky behavior for adolescents.

At the beginning of his presentation, Dr. Connor said that he talks fast. Boy, did he ever! My brain was on 78 RPM during his presentation! (that’s a very fast, old record player speed for the youngsters, under 60 years old). The good news for those of us able to keep up with his talk is that he presented a wealth of information in the three hours allotted for his workshop.

Dr. Connor presented research that discussed genetic and environmental etiology for risky behavior in adolescents. Most compelling was his ”Dual Process Model “ of risk taking behavior. He presented research that suggests that the “Mesocorticolimbic Dopamine Pathway” (It feels good!), part of the brain develops before the “Cognitive Control Pathway” (Is the risk worth the cost!). His research suggests that adolescents may take risks to feel excitement, before they are able to make a decision about the consequences. He pointed out that the full cognitive decision making process is typically not fully developed until age 25 for the adolescent.

Dr. Connor did a very nice job of defining the components of risk taking behavior. He discussed impulse control problems, and sensation seeking as separate issues. He described risky behavior related to sensation seeking as a lifelong personality trait that exits throughout the lifespan and across all cultures. Risk taking behavior is higher among boys than girls. His research suggests that this may also be a result of social influence to expect boys to take more risks than girls.

Dr. Connor’s talk showed that genetic and environmental factors play a role in adolescent risk taking behavior. Cerebral hormones such as dopamine, and the ability of the brain to process these chemicals is genetic, If the individual has difficulty metabolizing dopamine (genetics) then they are more sensitive to risk taking behavior. His research also suggests that environmental trauma such as physical, sexual abuse or sustained emotional trauma may contribute to risk taking behavior in adolescence.

Treatment methods that he suggested include: Prevention – Target children who show risky behavior in early years (elementary school), start communication and education. Open child-parent communication, offer alternative thrill seeking.Diversion-Difficult to replace learned habits of the“feel good” response for teenagers. Replace habits with alternative “feel good”activities such as adventure programs, sports programs.Motivation Enhancement Techniques to encourage behavior change, along with Cognitive Behavioral Therapy are effective in helping adolescents to reduce risk taking behavior.