Monthly Archives: November 2007

Maintaining client files

Robert J. Walsh and Norman C. Dasenbrook November 1, 2007

Q: I am all set to start my private practice after attending your workshop in North Carolina. I have two questions. First, I’ve searched the ACA Ethical Standards Casebook, sixth edition, and your book, The Complete Guide to Private Practice for Licensed Mental Health Professionals, and I am unable to find “the number of years” a records custodian should hold on to client files in the event that the primary clinician is incapacitated or dies. Also, what is the number of years a counselor should hold on to client files after termination of a private practice?

A: We applaud your diligence in researching this question before beginning your private practice. We spoke to Larry Freeman and Martha McIntosh, the ethics gurus at the American Counseling Association. The ACA Code of Ethics does not specify the number of years records should be maintained in the event of the counselor’s death, incapacitation or termination of practice. Instead, the code of ethics states (in Standard B.6.g.), “Counselors store records following termination of services to ensure reasonable future access, maintain records in accordance with state and federal statutes governing records, and dispose of client records and other sensitive materials in a manner that protects client confidentiality.”  

The standard was written this way because requirements might vary from state to state. Therefore, your first step is to consult with the North Carolina Counseling Association or your state’s mental health counselors division. (For a listing of ACA state branches and links to their websites, visit the ACA website at www.counseling.org and click on the box labeled “Divisions/Regions/Branches” on the left-hand side of the page.) This is a great example of why it is imperative — though not necessarily cheap — for counselors to belong to their professional organizations at the state, division and national level.

As with other practice issues, informed counselors should be familiar with their state practice laws, federal statutes (HIPAA and others) and the ACA Code of Ethics. This is one reason we do not include a statement about the specific number of years to maintain files in our book. Another is the possible variance based on discipline (counseling, social work, marriage and family therapy and psychology). However, a good benchmark is to maintain records seven years for adults and 10 years for children after treatment or the closing of a practice.

Concerns have surfaced regarding possible changes in Current Procedural Terminology (CPT) codes used by counseling practitioners in agencies and mental health practices to file insurance claims. Some ACA members have forwarded information saying that an organization is offering a class with continuing education units to help practitioners learn all the CPT changes. The cost for this course is $239.

One member sent the following e-mail:

“(I have a) question (that) has to do with new CPT codes for mental health in 2008. I’ve not seen any info on this matter. I received an e-mail from an LCSW friend. I will forward you information (about the class teaching the new codes). Perhaps you can address these topics in your column. Others may or may not be aware.”

We researched these concerns and can provide the following information.

American Behavioral, a mental health managed care company, says it knows of no changes to the CPT coding developed and copyrighted by the American Medical Association (AMA). American Behavioral’s Network Development Coordinator, Rachael Millazzo, checked with her coding department and assured us that the CPT codes for mental health and psychotherapy will remain the same for the foreseeable future.

In addition, a review of the AMA website (https://catalog.ama-assn.org/Catalog/cpt/cpt_search.jsp) shows no changes in the CPT coding for psychotherapy. Further, Donna Zappia, director of Netsource Billing, a major billing service, states there are no changes in CPT codes by Medicare or any of the managed care or insurance companies. We recommend thoroughly researching any course or class on CPT code changes before signing up.

On another topic, ACA members have been asking why Blue Cross Blue Shield has reduced its reimbursement rate by 60 to 75 cents. Although only a small amount, counselors are concerned this might be the start of a trend.

Asked about this, Donna Zappia of Netsource Billing explained that Blue Cross Blue Shield and some other insurance companies tie their reimbursement rates to Medicare reimbursement rates. An adjustment to these rates by Congress took effect in June and is reflected across the industry by various managed care and insurance companies.

We don’t think this is a trend, but rather a policy being followed by the industry. No further cuts are expected. However, we will continue to monitor changes in reimbursement rates by managed care and insurance companies.

Yes, this is the last, last reminder about using your National Provider Identifier (NPI) number. We have updated counselors in this column for the past several months about the need to obtain and use your NPI number. There were several deadline extensions, but December 2007 was it! All managed care and insurance companies, as well as Medicare, will start returning claims filed without this number.

The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated the adoption of a standard unique identifier for health care providers. The National Plan and Provider Enumeration System collects identifying information on health care providers and assigns each a unique NPI.

Additional information is available on the NPPES website: https://nppes.cms.hhs.gov/NPPES/Welcome.do. Application/update forms can be downloaded at https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.npistart.

We hope to see you in Hawaii at the ACA Conference & Expo, where we will be presenting our preconference Learning Institute, “Starting, Maintaining and Expanding a Successful Private Practice” on March 27. Onsite private practice consultation will be available. Also come visit us in the exhibitor center and preview our book, The Complete Guide to Private Practice for Licensed Mental Health Professionals (www.counselingprivatepractice.com).

ACA members can e-mail their questions to Robert J. Walsh and Norman C. Dasenbrook at walshgasp@aol.com and access a series of “Private Practice Pointers” on the ACA website at www.counseling.org.

Letters to the editor: ct@counseling.org

Teaching and learning about sexuality counseling in Taiwan

Stuart Chen Hayes

In August 2005, Counseling Today published an article on same-gender parents raising children, and my family was one of three featured in the story. I made an offhand remark in the article about how my family would be traveling for two weeks in Taiwan in late 2005 and early 2006. American Counseling Association member Ta-Wei Wang, a doctoral student in counseling at National Changhua University of Education (NCUE) in Changhua, Taiwan, read the article online and e-mailed me, asking if I would do a guest lecture at the university during my trip. I agreed, and my partner, pediatric physical therapist Lance Chen-Hayes, provided translation in Mandarin.

After the lecture, I inquired about the possibility of collaborating further with the department chair at that time, Shuchu Chao. She was excited about the possibility, and we worked to apply for a Taiwanese National Science Foundation grant. I also applied for a sabbatical from my employer, Lehman College of the City University of New York. The grant was officially approved by NCUE in late 2006, and my sabbatical began following the Lunar New Year celebrations in 2007.

In addition to working at NCUE, the other main motivation for traveling to Taiwan was to allow Lance and my son to spend six months in intensive Mandarin immersion at a preschool located near the home of our son’s grandparents in Taichung. Because of the rapidly deteriorating health of our son’s grandfather, we arrived two weeks early. Rushed to the hospital just before we flew out from the United States, he remained hospitalized for three weeks, but ultimately returned home in better health. We were thankful for national health care in Taiwan and saw the benefits of such a system for all involved. (Imagine going to the doctor for free and paying only a couple of dollars for medications.)

Balancing worldviews

My teaching assignment included one master’s-level sexuality counseling course and one doctoral-level sexuality counseling course, neither of which had ever been offered in graduate counseling programs in Taiwan. Dr. Chao encouraged my teaching of sexuality counseling — she cofounded a center for gender and family counseling at NCUE, including the first marriage and family counseling program and institute in Taiwan. I also was asked to give several lectures on professional counselor education identity for school and community counselors, using national school counseling standards and  program models in Taiwan, unlearning oppression, and counseling same-gender couples and same-gender-parented families.

My first thought was that I didn’t want to impose my White, European-American worldview on Taiwanese students whose ethnicities were primarily Chinese or Aboriginal and who held East Asian or indigenous worldviews. Many of the students were hesitant to take my classes because they perceived their English skills as being poor (compared with my Mandarin skills, their English was outstanding). We decided the doctoral students’ English was more advanced, and my partner Lance volunteered to translate the master’s-level class. Sexuality counseling has a powerful emotional learning component best experienced in one’s original language. The students were thrilled that they didn’t need to translate for each other or stop the class every few minutes to converse in Mandarin and clarify what I had just said in English. 

In both classes, we studied not only sexuality, but the critical concepts of oppression and worldview. Students readily shared multiple personal and professional experiences as they related to multiple types of oppression (ableism, ageism, beautyism, classism, familyism, genderism, heterosexism, racism, religionism and sexism in particular).

The students also discussed the challenges Taiwanese face in balancing modern and traditional worldviews. For example, while many younger Taiwanese are very progressive politically and intellectually, when it comes to sexual orientation, fears about how their families will react continue to keep most individuals in the closet. It is often easier for them to come out when they become partnered than when they are single because they have evidence of someone being in their life who will care for them long term.

Another major area of interest was how to discuss a variety of hot-button sexuality issues in school counseling lesson plans and in community agency workshops. We discussed at length the Sexuality Information and Education Council of the United States’ Guidelines for Comprehensive Sexuality Education K-12 and how they could be useful in Taiwan. We spent significant time on readings from Larry Burlew and David Capuzzi’s Sexuality Counseling textbook, as well as an undergraduate healthy sexuality textbook and several textbooks on how parents, guardians and counselors can best discuss sexuality with children and adolescents. Among the books we used was  Justin Richardson and Mark Schuster’s Everything You Never Wanted Your Kids to Know About Sex (But Were Afraid They’d Ask). 

Like their peers in the United States, the Taiwanese students found certain topics particularly challenging to address, both in their professional settings and in their own families: issues related to masturbation, sexual orientation, gender identity/expression, abortion, HIV/

AIDS, prevention and counseling with sexual assault survivors and perpetrators, counseling sex workers and talking effectively to children and adolescents about sexuality.

When I took my first sexuality counseling course as a master’s student at Indiana University in the mid-1980s with the late Alan Bell, former research psychologist for the Kinsey Institute, the panels of guest speakers provided the most powerful learning experiences. Research has shown that sexuality education and counseling often become most salient when guest speakers are part of the classroom experience. When teaching the sexuality counseling course in the United States, I usually use large numbers of guest speakers. While lecturing in Taiwan, I substituted role plays and websites or simply “sat in” for the guest speakers. This approach worked well enough, but more Taiwanese-based guest speakers would have brought home these issues even more so.

As a gay man living temporarily in Taiwan, I found it refreshing to see how little physical violence is directed toward gay people in the Chinese culture. When I think about the need for gay people to always be wary of potential harm in the United States and many other parts of the globe, spending almost six months away from that atmosphere offered a taste of relief.

Opening a dialogue

An important part of the trip for me was learning about the history of counseling in Taiwan and how to increase the presence of counselor education identity and the Council for Accreditation of Counseling and Related Educational Programs, especially for school counseling. Counselor education has not enjoyed much visibility in Taiwan. Psychology is the primary undergraduate training for most counselors in Taiwan, and only a few U.S.-trained counselor educators are employed at graduate schools there.

A few years ago, Taiwan began to offer counselors a counseling psychology license at the master’s and doctoral levels. In talking with Taiwanese students and faculty, I learned that the nation has a large college counseling contingent with an identity and practice similar to that found in the United States. Taiwan also has a substantial community counseling community whose graduates tend to work in nonprofit and nongovernmental organizations.

Most interesting was the status of school counseling. I spoke in depth with Chin-Yen Chen, president of the Chinese Counseling Association, who shared that Taiwan has several thousand school counselors. But unlike the United States, most of these counselors are in the elementary grades and have the title “guidance teacher.” Few at the elementary level have degrees in school counseling; most, in fact, do little counseling. More of the “guidance teachers” working at the middle and high school levels have school counseling degrees. Our discussions centered on moving toward a school counseling identity for all three grade levels and pushing for full-time positions for school counselors, including use of the term “school counselor” as a certification title for persons who have completed a master’s degree in school counseling. 

Currently, most school counselors in Taiwan teach regular curriculum subjects for at least half of their jobs in middle and high schools; at the elementary level, this makes up almost all of their work. So, much like the history of school counseling in the United States, Taiwan struggles with identity and role issues and making the best use of school counselors’ time. I encouraged Taiwanese counselors and counselor educators to move toward a school counseling program-based model. I also discussed the use of the American School Counselor Association standards and school counseling program model in the United States and how Taiwan might adapt one or both of those to ensure high school graduation and college/career access and equity for every Taiwanese student. 

Taiwan has some unique equity issues. For example, there is no compulsory kindergarten and no compulsory education past the ninth grade. Legislation is pending to move toward compulsory high school through 12th grade for all students, but currently, a substantial segment of Taiwanese students do not finish high school. In addition, high-stakes testing determines career paths. Where students place on national college exams determines where and what they will be able to study. Although students work hard and study constantly, they are not guaranteed a place in a college that fits their interests or preferred career paths. This is an issue of equity and fairness that could benefit from lots of advocacy over time.

Taiwanese students were stunned at the data on achievement, opportunity, funding and attainment gaps in the United States, and they had creative ideas for lessening those gaps. My hope is that NCUE, the City University of New York, other Taiwan and U.S.-based counselor education programs, the Chinese Counseling Association and ACA, ASCA and the Association for Counselor Education and Supervision will partner over time to promote collaboration between our students and faculty.

Stuart Chen-Hayes is associate professor of counselor education at Lehman College of the City University of New York. Contact him at stuart.chen-hayes@lehman.cuny.edu.

Michael D’Andrea (michael.dandrea@gmail.com) and Judy Daniels (judydaniels@gmail.com) are the column coordinators for Dignity, Development & Diversity.

Letters to the editor: ct@counseling.org