Question - I need a reality check

[JeyRo]

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Let's just call this a hypothetical question. Let's say you work with some masters-level practitioner, oh, say, a social worker. And say that this social worker does, oh, let's say, caregiver support groups for wives of veterans at your hospital, as well as providing individual counseling sessions with a patient, specifically to address his violent and verbally abusive episodes with staff and other residents.

Let's say this therapist NEVER DOCUMENTS these contacts, and then when challenged on this, says that the contacts were "informal" and "not therapeutic" so they don't need to be documented.

This is all hypothetical mind you. I'm not saying any of this is really going on, not at all.

What would you say?

 

[MBellows]

Let's just call this a hypothetical question. Let's say you work with some masters-level practitioner, oh, say, a social worker. And say that this social worker does, oh, let's say, caregiver support groups for wives of veterans at your hospital, as well as providing individual counseling sessions with a patient, specifically to address his violent and verbally abusive episodes with staff and other residents.

Let's say this therapist NEVER DOCUMENTS these contacts, and then when challenged on this, says that the contacts were "informal" and "not therapeutic" so they don't need to be documented.

This is all hypothetical mind you. I'm not saying any of this is really going on, not at all.

What would you say?

Hypothetically, I would advise you to hypothetically consider hypothetically referring to the hospital's decidedly not hypothetical code of conduct on documentation and reporting of work done. This document should not only outline what they should be documenting, but also what the established steps are in addressing the matter.

 

[neuronic]

Hmm. If it is the VA, would not the patients have appts times? If so, then each would need a note and encounter. But it could depend on how the patient is being seen in the clinic. Regardless, documentation to cover one's own behind should be standard.

 

[Neuropsych2be]

This hypothetical situation is a (hypothetically speaking) legal nightmare in the making. If I were in this hypothetical situation I would consult the not so hypothetical policy and procedure documentation regarding documentation AND discuss this issue with the appropriate person within the organizational structure. Running a support group may not be considered something that requires documentation. A support group is not therapy. But individual counseling is another matter. This hypothetical person sounds like a real winner.

 

[JeyRo]

Hmm. If it is the VA, would not the patients have appts times? If so, then each would need a note and encounter. But it could depend on how the patient is being seen in the clinic. Regardless, documentation to cover one's own behind should be standard.

It's inpatient. No clinic, no consults.

When I was in school it was drummed into me that you need to document everything, "if you didn't document it, it didn't happen."

Let's also hypothetically say that this issue of not documenting has been going on for years with this hypothetical social worker, but I've gotten to the point where I just can't stand for it anymore. Sadly, I think her supervisor is complicit in this. I just find it so boggling that I'm even dealing with it.

Again, I'm not saying anything like this is necessarily going on..... 🙄

 

[Sanman]

I have heard of similar hypothetical situations in similar hypothetical settings:

Say, a social worker who had bee managing a pt for years for therapy visiting said pt on a hypothetical medical unit without mentioning it to any staff (on a weekly basis) including the hypothetical medical unit psychology intern or writing a note. Furthermore, said social worker did not mention to any of us that the pt's son was physically abusive toward him (a fact se hypothetically had knowledge of) and allowed said hypothetical medical unit to discharge him ( with a hypothetical terminal illness) into the son's care only to have him return to ER severely beaten and in serious condition.

 

[PHD12]

It's inpatient. No clinic, no consults.

When I was in school it was drummed into me that you need to document everything, "if you didn't document it, it didn't happen."

Let's also hypothetically say that this issue of not documenting has been going on for years with this hypothetical social worker, but I've gotten to the point where I just can't stand for it anymore. Sadly, I think her supervisor is complicit in this. I just find it so boggling that I'm even dealing with it.

Again, I'm not saying anything like this is necessarily going on..... 🙄

VA inpatient units usually have a head psychiatrist or clinic manager. I would ask to speak to this person and get her opinion. At the very least consult with colleagues. There are procedures in place at the VA for these sorts of things (I believe the clinic managers handle these issues).

 

[AcronymAllergy]

You could also try speaking with your VA's legal counsel. I forget the exact name of the position, but they'd probably be interested in this information.

 

[bmedclinic]

When I was in school it was drummed into me that you need to document everything, "if you didn't document it, it didn't happen."

This is what has been drummed into me as well. Furthermore, my ethics prof in grad school showed us a video of a psychologist getting reamed on the stand for something similar to this. Put the fear in me.

 

[JeyRo]

VA inpatient units usually have a head psychiatrist or clinic manager. I would ask to speak to this person and get her opinion. At the very least consult with colleagues. There are procedures in place at the VA for these sorts of things (I believe the clinic managers handle these issues).

Let's say I'm the only mental health professional at this inpatient unit short of three social workers (of which this hypothetical social worker is one?). At one point one of my other colleagues in a neighboring clinic encouraged me to advocate to have my title changed to "_____psychology coordinator" to reflect this.

This not documenting thing is on top of some really bad team dynamics between this (again, totally made-up) social worker and several other of her colleagues, including myself. My wife is an attorney and she's generally aghast every time I bring it up.

It's hard that her service chief seems indifferent to her behavior. At this point I'm getting to where I don't care what her service chief says, I'm just sick to my stomach to be working on the same cases as she is and not being able to actually know in any way the kind of work she is doing with them - short of quarterly assessments and occasional notes she writes, apparently just because she feels like it, she doesn't document s**t.... it's driving me bonkers.

Hypothetically. This is all just a made up story, of course - for the purposes of discussion.

 

[AcronymAllergy]

In addition to my comment above, I say just keep working your way up the chain of command. If that person's service chief has been notified and doesn't seem to care, keep on moving up to the point of getting to VISN leads or beyond. Eventually, someone's going to be far enough removed and cognizant enough of potential legal and ethical issues to respond.

 

[PHD12]

One of the most frustrating aspects of working at the VA is that they can't seem to get rid of really incompetent employees..

 

[JeyRo]

This hypothetical situation is a (hypothetically speaking) legal nightmare in the making. If I were in this hypothetical situation I would consult the not so hypothetical policy and procedure documentation regarding documentation AND discuss this issue with the appropriate person within the organizational structure. Running a support group may not be considered something that requires documentation. A support group is not therapy. But individual counseling is another matter. This hypothetical person sounds like a real winner.

I personally would err on the side of documenting when in comes to support groups. I find it strange that the argument is they are 'not therapeutic' - caregiver support may not be *psychotherapy* in the sense of necessarily being based on evidence-based psychotherapeutic techniques, but they are definitely being employed for therapeutic aims (e.g., to reduce stress, depression, increase access to community resources, etc).

And the risk management aspect is what drives me bonkers. It would be one thing if I was working independently in a clinic on a caseload completely independent of this (totally hypothetical) social worker. But this is a (hypothetical) case of me working with this social worker on on the same veterans!!!!

 

[bmedclinic]

In addition to my comment above, I say just keep working your way up the chain of command. If that person's service chief has been notified and doesn't seem to care, keep on moving up to the point of getting to VISN leads or beyond. Eventually, someone's going to be far enough removed and cognizant enough of potential legal and ethical issues to respond.

this is what I was about to type, too.
Given the earlier (I saw it on here a few days ago) news about a large VA study failing to document things and having huge issues with that, you'd think the VA would be all over CYA actions moving forward.

 

[CheetahGirl]

Let's just call this a hypothetical question. Let's say you work with some masters-level practitioner, oh, say, a social worker. And say that this social worker does, oh, let's say, caregiver support groups for wives of veterans at your hospital, as well as providing individual counseling sessions with a patient, specifically to address his violent and verbally abusive episodes with staff and other residents.

Let's say this therapist NEVER DOCUMENTS these contacts, and then when challenged on this, says that the contacts were "informal" and "not therapeutic" so they don't need to be documented.

This is all hypothetical mind you. I'm not saying any of this is really going on, not at all.

What would you say?

No hypothetical if ands or buts about these egregious errors! If this is occurring and you know about it, I'm sure VA administration would want to know. When I worked at a VA, they were pretty clear that documentation was necessary for accountability. The last thing a VA needs is a law suit because someone left a 'support group' and committed suicide. What is this person thinking?!?

Hmm. If it is the VA, would not the patients have appts times? If so, then each would need a note and encounter. But it could depend on how the patient is being seen in the clinic. Regardless, documentation to cover one's own behind should be standard.

I agree.

This hypothetical situation is a (hypothetically speaking) legal nightmare in the making. If I were in this hypothetical situation I would consult the not so hypothetical policy and procedure documentation regarding documentation AND discuss this issue with the appropriate person within the organizational structure. Running a support group may not be considered something that requires documentation. A support group is not therapy. But individual counseling is another matter. This hypothetical person sounds like a real winner.

I conducted support groups in a medical center inpatient unit (not a VA), but inpatient nonetheless. We were required to document everyone that was present and report on each person's mental status (at the very least). I disagree that support groups are not therapy (and I'm sure Yalom would too)....unless you consider those support groups meetings in Fight Club.

However, that's not the point here....I think that this "hypothetical figure" is making some major errors and the OP has every right to be frustrated. I support the OP in reporting this to a trusted VA supervisor or administrator that can modify this person's service delivery. It is not appropriate for other professionals in the care of these persons to be not able to access documentation of what is occurring. Not documenting something is malpractice, just go read your HIPAA manual about private health information...every patient is entitled to his/her medical record and documentation of what occurred while he/she was in the care of the institution.

Good luck, JeyRo, managing your frustration 😕 or Go get 'em, Tiger! 😉

 

[Sanman]

One of the most frustrating aspects of working at the VA is that they can't seem to get rid of really incompetent employees..

Hardly true of just the VA. The things I have seen on the private side of the fence look no better than the public side. The issue becomes that large infastructures let a lot of poor behavior get by and quality really is not rewarded in our current system of healthcare.

 

[psychRA]

I personally would err on the side of documenting when in comes to support groups. I find it strange that the argument is they are 'not therapeutic' - caregiver support may not be *psychotherapy* in the sense of necessarily being based on evidence-based psychotherapeutic techniques, but they are definitely being employed for therapeutic aims (e.g., to reduce stress, depression, increase access to community resources, etc).

I don't really get it, either. I've worked in residential settings, and I know that other disciplines have different guidelines for the frequency of documentation. For example, physical therapists (rec therapists, occupational therapist, etc.) tell me that they write weekly or monthly progress summaries rather than documenting daily visits, just because the intervention isn't changing drastically from visit to visit, and you wouldn't expect to measure progress every single visit, either. But they don't skip documentation altogether - they just have a different time frame than we do. Addiction therapists I've worked with don't seem to document group visits, which I don't fully understand, but they at least keep a written record of attendance from each group meeting. I don't see how you can rationalize not doing any documentation at all.

I've worked with high-risk populations before, and the settings have differed in terms of their expectations for note writing, but they've generally erred on the side of documenting most forms of therapeutic contact. I don't always document scheduling phone calls, unless I'm trying to show that I've attempted to reach someone who isn't showing up. I don't usually document a hallway conversation on a residential unit, or a 10-minute meeting with someone who stopped by my office to request help with their worksheets. And I'm probably not alone in saying that especially on a residential unit where appointments aren't always formal or scheduled in advance, staff can get busy and forget to write a note from time to time. It's not ideal, but it happens. However, it doesn't make any sense to say that groups and individual appointments are exempt from note writing. Yikes.

 

[minorityreport]

You need to report this individual ASAP!

 

[G Costanza]

In this case, would the notes help better serve the client or protect the social worker? If it's a standard of care issue where the patient may suffer, I say keep being the squeaky wheel all the way up to the state licensing board. If it's just to cover the social worker's own career, natural consequences.

This opinion is worth what you paid for it.

 

[erg923]

You need to report this individual ASAP!

You have pretty odd posts. Are you actually a psychology student?

Since the OP works collaboratively with this person, how do you think that might affect the dynamic there? Patient care? Thinking about the role of interpersonal skills, do we think "reporting" this person as the sole action and next step is the move to get optimal results for everyone involved? Perhaps this should be on the table as a measure of last resort?