Case Study
Patient Demographic: Client Age: 32 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Counseling Setting: Community Mental Health Agency Type of Counseling: Individual Presenting Problem: Depressed Mood Diagnosis: Bipolar II 296.89 (F31.81), current episode depressed
Mental Status Exam: Mental Status Exam: The client is dressed casually and is somewhat disheveled. She avoids eye contact and displays a flat affect. The client admits to having suicidal thoughts in the past but currently denies both suicidal and homicidal ideations. Her speech is soft in volume and tone. She tends to provide one-word responses but is cooperative when asked to elaborate. The client denies audio-visual hallucinations, and her thought content is coherent. The client’s mood is depressed, and her affect is flat. She appears tired and reports she has insomnia at night and is sleeping most of the day. The client has experienced depression off-and-on, beginning in late adolesc
Presenting Problem: You work at a community mental health agency providing outpatient services to adults. Today, you are meeting with a 32-year-old female who presents with her husband for an initial intake session. The client’s husband is concerned about his wife’s depressive symptoms. She is experiencing sadness, decreased appetite, and hypersomnolence. The client also expresses hopelessness and has lost interest in doing the things she once enjoyed. Until recently, the client worked at an art gallery. When employed, she reports that she, “just couldn’t get out of bed” and was eventually let go due to excessive absences. After her employment ended, her depressive symptoms worsened. The client was able to recall a time nearly one year ago when she felt “almost the opposite” of how she feels now. During this time, she experienced increased energy and felt more inspired and creative. The client explains that she and her husband used to travel selling their art at juried art exhibitions most weekends, but it has been awhile since she has joined him.
Other Contexts: The client continues to benefit from counseling and presents today with a euthymic mood. She has met her treatment plan goals related to depressive symptoms and reports a better understanding of her illness. The client has begun painting again and accompanied her husband to an art show this past weekend. She expresses gratitude for your work together and is especially thankful that you have helped her get back into doing what she likes to do. At the end of the session, she gives you an original painting as a token of appreciation. She explains that the abstract painting conveys the emotional transformation she has experienced in counseling. You let the client know you would be joining a private practice in a few weeks. You explain you would be happy to see her again if needed and gave her your new business card with the address and contact information for the practice.  The client’s husband calls and requests the client’s records. You are hesitant to comply because there are documented conversations concerning marital discord

Question: The client’s husband calls and requests the client’s records. You are hesitant to comply because there are documented conversations concerning marital discord. According to the HIPAA Privacy Rule, how should you respond?
(A): You cannot provide the record to the husband because there is a potential for harm to the client.
(B): You cannot provide the record to the husband without first asserting counselor-client privilege.
(C): You cannot provide the record to the husband unless requested by a third-party payor.
(D): You cannot provide the record to the husband unless the client is aware of the request and does not object.

Correct Answer: You cannot provide the record to the husband unless the client is aware of the request and does not object.
Explanation: The HIPAA Privacy Rule contains provisions about confidential information disclosures to family members. According to the HIPAA Privacy Rule, “Specifically, a covered entity is permitted to share information with a family member or other person involved in an individual’s care or payment for care as long as the individual does not object” Specific state laws may differ. For answer A, the ACA Code of Ethics (2014) states, “Counselors limit the access of clients to their records or portions of their records, only when there is compelling evidence that such access would cause harm to the client” Since there is no indication that conversations about marital discord would create harm for the client, answer A is incorrect. However, some stipulations allow portions of a client’s record to be removed if there are multiple clients. The ACA Code of Ethics (2014) further states, “in situations involving multiple clients, counselors provide individual clients with only those parts of records that relate directly to them and do not include confidential information related to any other client” Since there is no information indicating that you provided couples counseling, this stipulation does not apply. Counselors must assert counselor-client privilege if records are subpoenaed. Privilege is a legal requirement rather than a HIPAA Privacy Rule. The release of records to third-party payers is prohibited without the client’s consent. Therefore, the correct answer is (C)
Competency: professional practice and ethics