Mental Health Documentation in the Trump Era

Mental health therapists are increasingly concerned about things such as confidentiality in mental health records, and how to document politicized topics that are often discussed in counseling.

In this extended YouTube Livestream Q&A Session, Dr. Maelisa McCaffrey of QA Prep provides tips for mental health counselors on topics such as:
-Reviewing informed consent with clients and asking them their preferences for mental health documentation
-Whether or not to document client discussions about politics
-Documenting medical necessity in therapy through intake assessments, treatment planning, and progress notes
-Documenting gender identity, and discussion of gender identity in therapy
-Documenting discussions about abortion, pregnancy, fertility, etc. in counseling
-How to use AI effectively for progress notes and how to ask clients for consent to use AI in therapy

Video Chapters
00:00:00 Introduction
00:03:57 Topics to be reviewed in this video
00:06:54 Why are you nervous about documenting this topic in a progress note?
00:07:58 Informed consent and documenting sensitive topics in progress notes
00:11:37 The most important thing to remember from this video!
00:12:09 Let's do a reality check on the consequences of documenting sensitive topics
00:20:25 Questions about sensitive information in progress notes
00:38:32 Questions about transgender mental health clients
00:50:57 Questions about pregnancy and mental health documentation
01:00:25 Other mental health documentation questions

Other videos and resources related to today's questions and topics:
-What goes in a progress note?
   • What goes in a counseling progress note?  
-What goes in a counseling treatment plan?
   • What Goes in a Counseling Treatment Plan  
-Therapy notes interventions for insurance
   • Therapy Notes Interventions for Insurance  
-What should be included in informed consent for therapy?    • What should be included in informed consen...  

-The First Kiss, by Dr. Daryl Chow: https://amzn.to/4h6Oo94

-Directions for opting out of Medicare from Barbara Griswold: https://theinsurancemaze.com/medicare...

Want more support with your mental health documentation? Click here to check out the book, Stress-Free Documentation for Mental Health Therapists: https://amzn.to/4bfI1yG