Transcript Confidentiality of Counseling Contacts

NCHERM CUBIT MODEL
TRAINING SLIDES FOR
THREAT ASSESSMENT TEAM MEMBERS
© 2009 NCHERM AND NaBITA.
ALL RIGHTS RESERVED.
UNDERSTANDING VIOLENCE
Who are the predators we keep hearing about and what do
They have in common? Very revealing are the first five
Indicators identified by the Safe School Initiative Final Report
by the U.S. Secret Service and U.S. Department of Education:
• Incidents of targeted violence at school rarely were
sudden, impulsive acts.
• Prior to most incidents, other people knew about the
attacker’s idea and/or plan to attack.
• Most attackers did not threaten their targets directly prior
to advancing the attack.
• There is no accurate or useful “profile” of students who
engaged in targeted school violence.
• Most attackers engaged in behavior prior to the incident
that caused others concern or indicated a need for help.
What do we know?
• Roughly 80% of school violence perpetrators
raised serious concerns about the potential for
violence amongst friends, family, peers, or
other community members prior to their acts
• Roughly 80% of school shooters and other
violent campus actors shared their plans, or
parts of their plans, with others prior to their
acts.
What do we know?
•91% of school violent
actors are cognitive
aggressors
Youth Risk Survey 2001
13,600 HS students
• 28.3% sad or hopeless almost every day> 2
wks stopped some activity due to symptoms
• 19 percent of students reported that they
seriously considered attempting suicide
• 14.8 percent had made a specific plan to
attempt suicide.
• 8.8 percent had attempted suicide in the
previous year [Grunbaum et al 2002].
Recent Suicide Data
• 1 FTE per 1700 students. Higher ratio smaller
schools
• 4 hours psychiatric consultation per week/
1000 students, up from 2.1 in 2004
• 25% clients on meds
• 366 schools 154 suicides, adjusted rate is
6.6/100,000
• 10% of attempters die over 10 years
• 45 of 76 suicides occurred during first week
post hospitalization
On the lookout for Icebergs
In 2001, a study by David Lisak, Ph.D., at the Univ.
of Massachusetts, Boston revealed:
• 120 male students (of a surveyed population of
1,882) were responsible for 483 total acts of sexual
violence (Lisak & Miller, 2002).
• 76 of those 120 men were responsible for 439 of
the acts of sexual aggression (6 acts each) (63%
multiple perpetrators, 37% one-time perpetrators)
• and 1,045 total acts of physical violence.
• 76 men. 1,000+ crimes. 14 acts each. And, Lisak’s
measures used very conservative definitions of
crimes.
HIPAA
• HOW DO YOU KNOW IF HIPAA APPLIES TO YOUR
CAMPUS HEALTH OR COUNSELING SERVICE?
• You may be surprised by the answer…do a twolevel analysis:
– 1) Does your counseling service or health service
transmit electronic data about patients, such as health
insurance or billing information? If not, HIPAA does not
apply. If so, ask…
– 2) Does your counseling or health service treat students
only, or other community members as well?
HIPAA
• If you treat only students, HIPAA does not apply.
• If you treat other community members, HIPAA will
apply.
• Here’s why…if you only treat students, the
Department of Education has stated that FERPA is
the governing law for these records, not HIPAA.
• So, let’s talk FERPA next…
FERPA
• If FERPA is the governing law for counseling and/or
health service records, we recognize the FERPA
specifically exempts health and counseling records
from the definition of educational records
protected by the Act.
• Thus, while FERPA is the governing law, it is
inapplicable, and the only law governing the
privacy of these records is the state statute on
privilege of health and mental health records, and
the professional ethical requirements imposed by
licensure.
MORE ON FERPA
• Who’s your dependent?
• FPCO relaxed its stance on proof of dependency,
and will allow us to use an opt in/out form at
registration
• For students who indicate they are dependents,
additional verification via tax returns in
unnecessary.
• Even if a student does not indicate they are a
dependent, a parent may still show they are via
the tax return method.
MORE ON FERPA
• What is the consequence of dependency?
• Colleges and universities MAY share ANY
information from a student’s educational
record with any parent/custodian claiming the
student as a dependent:
– Tommy got a D in biology
– Beth is cutting
– Pak is in fact a College Republican
MORE ON FERPA
• The Department of Education has liberalized
the emergency health and safety exception to
FERPA.
• FERPA allows us to share information as
necessary in a crisis, and that will apply to
most cases where a student is a potential
harm to themselves or others.
MORE ON FERPA
• What college administrators observe about
students (not sourced from protected
records) is not protected by FERPA.
• FERPA covers written records and recorded
media. What you see or what someone says
to you is not an educational record.
• Internally, officials can communicate to each
other when they find there is a “legitimate
educational interest.”
PRIVILEGE
• Three types of jurisdictions:
– No warning (Texas and Virginia)
– May warn (majority)
– Duty to warn (must warn)
• Privilege (or confidentiality) can be waived when
Tarasoff applies, or when a direct threat is posed (in
non-Tarasoff jurisdictions)
• Can be waived by the client
• Confidential information can be shared between
counselors and health providers
CLERY ACT TIMELY WARNING
• Was the Virginia Tech warning too little, too late?
• What should we do until the Department of
Education decides?
• Use the standard law enforcement criteria for
warning:
– Can we identify the nature of the threat?
– Can we identify the source of the threat?
– Can we give those being warned specific information
about steps they can take to protect themselves from
the threat posed?
• Distressed
DISRUPTION UNPACKED
– Emotionally troubled
– Individuals impacted by situational stressors and traumatic events
– Psychiatrically symptomatic
• Disturbed
– Behaviorally disruptive, unusual, and/or bizarrely acting
– Destructive, apparently harmful to others
– Substance abusing
• Dysregulated/Medically Disabled*
– Suicidal
– Parasuicidal (self-injurious, eating disordered)
– Individuals engaging in risk-taking behaviors (e.g., substance
abusing)
– Hostile, aggressive, relationally abusive
– Individuals deficient in skills that regulate emotion, cognition, self,
behavior, and relationships
– *Unable to self-care/psychotic break
WHAT IS A RED FLAG?
• Distress-level behavior rarely results in
violence
• Disturbed behavior, especially when repeated
or rapidly escalating, can be a red flag.
• Dysregulated behavior is a red flag.
– A suicidal student may be a homicidal student
– A suicidal student may be willing to risk other lives
to accomplish his or her mission
WHAT IS A RED FLAG?
• Alarming behavior that may show a lack of
control by the actor (stereotype)
• More often, flat affect and calm planning are
indicative.
• The “thousand-yard stare” shows a level of
detachment from self that is concerning
• Suicidal threats or gestures
– “I don’t need my hard drive any more”
– “No one cares about me”
WHAT IS A RED FLAG?
• In addition to suicidality, there is a correlation
between violence and a history of the actor
being subject to extreme bullying.
• Look for patterns in writing, class discussion
or class interaction.
– Themes of revenge
– Themes of annihilation
– Themes of “outsider” exclusion
REPORTING THESE BEHAVIORS
• Faculty have been reluctant to report disruptive
activities in the classroom. In Coping With the
Disruptive College Student (1994), Gerald
Amada identified four possible (and typical)
reasons:
– Faculty hope for a spontaneous resolution
– Faculty fear that they will not be supported by the
administration
– Faculty fear that reporting will be viewed as a
reflection of inadequacy as an educator
– Faculty fear retaliation.
What Does a BIT Do?
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Centralize reporting
Triage reports
Assess threat/risk
Assess available resources
Perform or empower interventions
Coordinate follow-up
Assess long-term success
Educate community