Category Archives: Psychology

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Preparing for the Closure of a Psychology Practice

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Course excerpt from Ethics and Professional Wills

“Preparing well for the closing of psychology practice is an essential process that is often overlooked or indefinitely deferred, especially by younger clinicians, due to a variety of practical and psychological factors. Psychologists may feel they are too busy completing the immediate tasks involved in providing clinical care and running a practice to think about such a distant event. They might also perceive the closing of practice as not being a relevant issue in their current lives, thereby denying the possibilities of unexpected incapacitation or death. Certainly, anxiety in considering the prospect of especially premature death or incapacitation deters some individuals from focusing on developing such plans.

In reality, however, the task of closing your practice is inevitable, sooner or later; as Pope and Vasquez (2005) satirically state, “unless a therapist is invulnerable and immortal, it is a good idea to prepare . . .” such plans well in advance, in their view even before first opening your practice. To perform this task ethically involves careful pre-planning, done well in advance, balancing clinical, ethical, legal, financial, emotional and practical considerations. Specific plans depend upon a variety of factors, including whether the closing is planned or unplanned, temporary or permanent, and whether the psychologist is available to participate in the closing.

For example, the temporary closing of your practice for a maternity leave is a planned and temporary event. Based on a specific patient’s clinical needs, the pregnant psychologist might choose to transfer care to another provider or temporarily suspend care but make arrangements for coverage in case of an emergency. However, the sudden incapacitation or death of that psychologist is obviously an unplanned, typically permanent situation, with no chance of future professional availability. Psychologists in solo practice do not have the safety net characteristic of group or agency work environments, and thus have even greater practical concerns regarding unexpected closings, including the transfer of patient care to new providers.

The importance to your patients of preparing for the closing of a practice is underscored within the APA Ethical Principles of Psychologists and Code of Conduct (2016), via its inclusion as Ethics Standard 3.12: “Interruption of Psychological Services: Unless otherwise covered by contract, psychologists make reasonable efforts to plan for facilitating services in the event that psychological services are interrupted by factors such as the psychologist’s illness, death, unavailability, relocation, or retirement or by the client’s/patient’s relocation or financial limitations.” The focus of this course is on how to develop a clearly established plan to follow, or for colleagues to follow in the psychologist’s absence, in order to help patients by minimizing disruption to their care, and by addressing their anxieties or distress regarding the change.”

In the course ‘Ethics and Professional Wills’, the author provides practical information on how to meet the APA Ethics Code standards regarding the pre-planning for the closure of a practice, while being sensitive to the possible anxiety and/or resistance that surrounds this topic. Clinical consideration on how to best meet the patients’ needs are discussed and an outline of steps to take as you preplan for the closure of a practice is provided, along with useful templates to help get the process started. To learn more, click on the link below!

Click here to learn more

CE Credit: 1 Hour

Target Audience: Psychology CE

Learning Level: Introductory

Course Type: Online

Professional Development Resources is approved by the American Psychological Association (APA) to sponsor continuing education for psychologists. Professional Development Resources maintains responsibility for this program and its content. Professional Development Resources is also approved by the Florida Board of Psychology and the Office of School Psychology and is CE Broker compliant (#50-1635).

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Posted by on November 26, 2019 in Continuing Education, Ethics, Psychology


The Four Steps of Perspective Taking

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Course excerpt from High Functioning Autism in Children

Children with high functioning autism (HFA) differ from other children on the spectrum in that they wish to interact with others but lack the know-how. Thus, social skills training is an important component of remediation for children with HFA.

Michelle Garcia Winner (2007) created the “Social Thinking” program. This approach has gained popularity in recent years because it teaches children the “why” of social decision-making, not just rote social skills. This training can help children with the generalization of their social learning skills across various settings. Such interventions aim at teaching children the thought processes that underlie social behaviors so that they can think flexibly and tailor their behavior to a given situation.

Up until now, professionals have generally tried to teach children specific skills, such as greetings or initiating a topic of conversation and then practice with them to improve the development of these skills. This does not account for the fact that we cannot use social skills in the same way under different social situations. For example, “consider a 13-year-old boy who – based on the culture of his age – is actually expected to say “What’s up?” when greeting his peers, say “Hi” when greeting his teacher and then say “Hello” when brought into a formal meeting.” (For more detail, visit the Social Thinking website at )

According to Garcia Winner (2015):

The gap between teaching students behaviorally based, memorized social skills and the need to teach our students how to adapt their social skills based on the expectations of the situation and the people in the situation is the gap between the more tradition social skills teachings and Social Thinking. When teaching Social Thinking we are teaching students to become active social problem solvers who are not focused on memorizing what to do socially but instead are engaged in figuring out what people around them are doing, what they are expecting, what our students are seeking in their interactions with others and all this helps them to figure out how to interact in any given time or place and with different people. (para. 3)

Garcia Winner adds that social thinking is not only employed when we are involved in social interactions, it may be utilized any time we share a common space. For instance, social thinking is engaged when one is at the supermarket and moves their shopping cart out of the way, as a courtesy to a fellow shopper.

Instructing children on social skills involves the conveyance of the presence of other people’s minds, as well as social thoughts. To do this we can employ the four steps of perspective thinking.

The four steps listed and discussed here (adapted from can assist students with recognizing and considering the extent to which they think about other individuals, and adjusting their behaviors to suit, even in the absence of intentional communication. We may engage these four steps to accommodate just about any social interaction:

Step 1: Whenever you share a common space with another individual, both of you generate thoughts in regard to the other. You have thoughts about them, and they have thoughts about you.

Step 2: Initially, individuals will typically consider the intentions and motives of the other. If one person or the other appears suspicious, they will be scrutinized more closely by the other individual.

Step 3: Each individual will likely consider and estimate how the other person is assessing them, whether it be positive, negative, or neutral. Another aspect is that there may be a history between the two individuals, which impacts how these thoughts may be weighed.

Step 4: Steps may then be taken, in the form of behavior modification, to alter or maintain the perception that we wish to project for the other individual, and the other individual is likely reciprocal in this activity.

The four steps described above occur at an intuitive level (below immediate consciousness) within milliseconds. The initial three steps engage social thought, whereas only the last step involves behavior.

When discussing these steps with students, it can be explained that this process is based on the fundamental assumption that all of us innately wish other individuals to have reasonably “good” thoughts about us, even when our interactions are fleeting. Further, this assumption has the opposite concern embedded within it; we do not wish for other individuals to have “strange” or uneasy thoughts about us. It can indeed be a challenge for spectrum students to simply perceive that other individuals likely have thoughts that are different from their own, let alone mentioning that we all partake in having both good and weird thoughts about others. Most students with social learning difficulties rarely, if ever, stop to contemplate that they, too, can entertain strange thoughts about others.

In addition, many students with autism do not understand that social memories play a critical role in our day-to-day interactions. All of us have emotional social memories of individuals that are derived from how they make us think about them over time. People whose actions convey “good” thoughts in the minds of others are much more likely to be considered as “friendly” and have a far better likelihood of making friends than those who generate “weird” thought memories in the minds of others. In teaching social thinking, students should not only be helped to realize they have to be responsible for their own behaviors over time, but also be made aware of the associated social memories that people retain about them. The rationale behind someone calling a friend or co-worker to clarify or apologize for how their actions might have been interpreted is to instill improved social memories about themselves in their brains.

The Four Steps of Perspective Taking are engaged when we share space with others and are a requirement toward the appropriate behavior of student’s in the classroom. An unspoken rule in the classroom setting requires that all students and teachers participate in an awareness of, and mutual social thought about, the others in the class. Also, that each student, and the teacher, is responsible for monitoring and modifying their behaviors accordingly. A student who is not proficient in these four steps is typically considered to have a behavioral issue.

Students with social learning deficits must learn cognitively what many individuals do naturally and intuitively. Therefore, to assist them with grasping perspective-taking, lessons should be actively taught that include these four steps. To ponder this aspect in more depth, try spending a day observing/noting your own social thoughts, and how they impact your actions in the presence of others. Subsequently, one’s own social thinking may serve as a guide for instructing ASD students. For instance, teachers often discover that students with high functioning autism develop quite an interest in their own, and others’ thoughts, once the process is broken down into discrete elements that can be observed, discussed, and related to their own day to day lives.

Follow this link to learn more about teaching children perspective-taking and to learn strategies to ease transitions, prevent meltdowns, and teach organizational skills.

Click here to learn more

CE Credit: 4 Hours

Target Audience: Psychology CE Counseling CE | Speech-Language Pathology CEUs | Social Work CE | Occupational Therapy CEUs | Marriage & Family Therapy CE | Nutrition & Dietetics CE | School Psychology CE | Teaching CE

Learning Level: Introductory

Course Type: Online

Professional Development Resources is approved to sponsor continuing education by the American Psychological Association (APA); the National Board of Certified Counselors (NBCC ACEP #5590); the Association of Social Work Boards (ASWB Provider #1046, ACE Program); the American Occupational Therapy Association (AOTA Provider #3159); the Commission on Dietetic Registration (CDR Provider #PR001); the Alabama State Board of Occupational Therapy; the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy (#BAP346), Psychology & School Psychology (#50-1635), Dietetics & Nutrition (#50-1635), and Occupational Therapy Practice (#34); the Georgia State Board of Occupational Therapy; the New York State Education Department’s State Board for Mental Health Practitioners as an approved provider of continuing education for licensed mental health counselors (#MHC-0135); the Ohio Counselor, Social Worker & MFT Board (#RCST100501); the South Carolina Board of Professional Counselors & MFTs (#193); the Texas Board of Examiners of Marriage & Family Therapists (#114) and State Board of Social Worker Examiners (#5678); and is CE Broker compliant (all courses are reported within a few days of completion).


Becoming Celebrities: Media Exposure of Mass Shootings

Course excerpt from Counseling Victims of Mass Shootings

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Mass shootings leave many unanswered questions:

  • Why did the shooter do it?
  • What could have provoked him?
  • What can we do to prevent things like this from happening in the future?

Yet in asking these questions, often in a very public way, we are contributing to what may be one of the largest influencing factors of mass shootings.

According to a paper presented at the American Psychological Association’s annual convention by Jennifer B. Johnston, PhD, and Andrew Joy, BS, of Western New Mexico University, people who commit mass shootings in America tend to share three traits: rampant depression, social isolation, and pathological narcissism. Johnston and Joy issued a powerful message when they stated that what the shooter seeks most is fame, and it is up to the media to deny them that coverage.

After reviewing data amassed by media outlets, the FBI, advocacy organizations, and scholarly articles, Johnston and Joy, defined mass shootings as either attempts to kill multiple people who are not relatives, or attempts resulting in injuries or fatalities in public places. They concluded that the prevalence of these crimes has risen in relation to the amount of mass media coverage of events and the proliferation of social media sites that tend to glorify shooters and downplay victims. Further, the researchers stated that “media contagion” is largely responsible for the increase in these often deadly outbursts (Johnston & Joy, 2016).

“Mass shootings are on the rise and so is media coverage of them. We suggest that the media cry to cling to ‘the public’s right to know’ covers up a greedier agenda to keep eyeballs glued to screens, since they know that frightening homicides are their No. 1 ratings and advertising boosters” (Johnston, 2016).

Johnston and Joy also found that mass shooters share a consistent demographic profile. Most are white, ostensibly heterosexual males, largely between the ages of 20 and 50, who tend to see themselves as ‘victims of injustice,’ and share a belief that they have been cheated out of their rightful dominant place as white, middle-class males. The quest for fame also emerged as a predictable variable, and one that, according to Johnson, skyrocketed since the mid- 1990s in correspondence to the emergence of widespread 24-hour news coverage on cable news programs, and the rise of the internet during the same period. Johnston explains, “Unfortunately, we find that a cross-cutting trait among many profiles of mass shooters is the desire for fame” (Johnston, 2016).

Johnston isn’t the first to note this trend. Media contagion models have previously been proposed by researchers such as Towers et al. (2015), who found the rate of mass shootings has escalated to an average of one every 12.5 days, and one school shooting on average every 31.6 days, compared to a pre-2000 level of about three events per year.

“A possibility is that news of shootings is spread through social media in addition to mass media” (Johnston, 2016).

These trends suggest, and what Johnston and Joy advocate, is a fundamental shift in the way we respond to mass shootings – one that would include much less dramatic media exposure. She explains, “If the mass media and social media enthusiasts make a pact to no longer share, reproduce or re-tweet the names, faces, detailed histories or long-winded statements of killers, we could see a dramatic reduction in mass shootings in one to two years. Conservatively, if the calculations of contagion modelers are correct, we should see at least a one-third reduction in shootings if the contagion is removed” (Johnston, 2016).

Johnston’s suggestions follow those of the working group of suicidologists, researchers and the media commissioned by the Centers for Disease Control to tackle the problem of celebrity suicides. Finding that suicides widely reported in the media tended to have a contagious nature, the group recommended the media reduce its reporting of them. A clear decline in suicides was found a few years later in 1997 (Johnston, 2016).

Media reporting has an undeniable effect on us and, as Johnson points out, offers a reliable vehicle for mass shooters to satiate their need for fame, significance, and power. A secondary benefit to reducing media coverage of mass shootings is the impact upon the public, the media viewers.

Click Here to Learn More

Counseling Victims of Mass Shootings is a 3-hour online continuing education (CE) course that gives clinicians the tools they need to help their clients process, heal, and grow following the trauma of a mass shooting.

Sadly, mass shootings are becoming more widespread and occurring with ever greater frequency, often leaving in their wake thousands of lives forever changed. As victims struggle to make sense of the horror they have witnessed, mental health providers struggle to know how best to help them. The question we all seem to ask is, “Why did this happen?”

This course will begin with a discussion about why clinicians need to know about mass shootings and how this information can help them in their work with clients. We will then look at the etiology of mass shootings, exploring topics such as effects of media exposure, our attitudes and biases regarding mass shooters, and recognizing the signs that we often fail to see.

We will answer the question of whether mental illness drives mass shootings. We will examine common first responses to mass shootings, including shock, disbelief, and moral injury, while also taking a look at the effects of media exposure of the victims of mass shootings.

Then, we will turn our attention to the more prolonged psychological effects of mass shootings, such as a critical questioning and reconsideration of lives, values, beliefs, and priorities, and the search for meaning in the upheaval left in the wake of horrific events. This course will introduce a topic called posttraumatic growth, and explore the ways in which events such as mass shootings, while causing tremendous amounts of psychological distress, can also lead to psychological growth. This discussion will include topics such a dialectical thinking, the shifting of fundamental life perspectives, the opening of new possibilities, and the importance of community. Lastly, we will look at the exercises that you, the clinician, can use in the field or office with clients to promote coping skills in dealing with such horrific events, and to inspire psychological growth, adaptation, and resilience in the wake of trauma.

Course #31-09 | 2018 | 47 pages | 20 posttest questions

CE Credit: 3 Hours

Target Audience: Psychology CE | Counseling CE | Social Work CE | Marriage & Family Therapy CE | School Psychology CE | Teaching CE

Learning Level: Intermediate

Course Type: Online

Professional Development Resources is approved to sponsor continuing education by the American Psychological Association (APA); the National Board of Certified Counselors (NBCC ACEP #5590); the Association of Social Work Boards (ASWB Provider #1046, ACE Program); the American Occupational Therapy Association (AOTA Provider #3159); the Commission on Dietetic Registration (CDR Provider #PR001); the Alabama State Board of Occupational Therapy; the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy (#BAP346), Psychology & School Psychology (#50-1635), Dietetics & Nutrition (#50-1635), and Occupational Therapy Practice (#34); the Ohio Counselor, Social Worker & MFT Board (#RCST100501); the South Carolina Board of Professional Counselors & MFTs (#193); the Texas Board of Examiners of Marriage & Family Therapists (#114) and State Board of Social Worker Examiners (#5678); and is CE Broker compliant (all courses are reported within a few days of completion).

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Helping Children Find Their Strengths

Course excerpt from Motivating Children to Learn

The primary aim of this course is to illustrate strategies and activities that can help motivate children to learn by removing obstacles that are in their way. A good starting point in this process is to teach them that there are many ways to be “smart.” One way to help children learn and understand their strengths is to understand the concept of multiple intelligences. There are nine different categories of intelligence. These intelligences can assist clinicians, parents, and teachers with identifying the best way for students to learn.

Child Learning

Below is a list of the different intelligence areas and the child’s preferred method of learning.

  • Visual/Spatial: Prefers using pictures, images, and spatial understanding.
  • Verbal/Linguistic: Prefers using words, both in speech and writing.
  • Logical/Mathematical: Prefers using logic, reasoning, and systems.
  • Interpersonal: Prefers to learn in groups or with other people.
  • Intrapersonal: Prefers to work alone and use self-study.
  • Aural/Musical/Rhythmic: Prefers using sound and music.
  • Naturalist: Prefers working outdoors with animals and plants.
  • Existential: Prefers dealing with abstract theories.
  • Bodily/Kinesthetic: Prefers using your body, hands, and sense of touch.

Hunt (2015) explains it this way: How does this knowledge help children learn? For example, a student who is a naturalist in Multiple Intelligences might classify insects while working in the plant area. We have them at the level of analyzing and in an area that they feel comfortable in—the plant area. A student in a kindergarten classroom who is mathematical might be comparing five items from the kitchen area. For a middle school or high school linguistic student, we might be writing two paragraphs contrasting poets from the 19th century. For a musical student, we might have them outline a chapter on banking while listening to music. Maybe this would be distracting to some students so you might have students use earbuds, so those who like to listen to music wouldn’t disturb the ones who do not like to listen to music. If you are a visual learner, we might have you show comparisons using a Venn diagram. An interpersonal learner could classify rocks with a partner, while an intrapersonal learner might compare two features from their project individually. An elementary level example for a kinesthetic learner might be to stand at the back counter while separating fruit and vegetable pictures.

A child needs to understand that his or her identity is not defined by their learning disability. In order to do so, children require help to identify their strengths and weaknesses. It is even more critical for a child who struggles in school to verbalize and recognize what they are good at. Most children with learning disabilities are told what their deficits are, and what areas they need to work on; however, few are told what their strengths are.

As parents and clinicians, we need to seek and cultivate our children’s innate gifts and strengths. This may require some detective work toward an appreciation of each child not just for what is acceptable and culturally valued in our society, but for their actual abilities. We need to ask ourselves the following questions:

  • What does my child/student/client enjoy doing?
  • What comes to him/her naturally?

When people align with their strengths they feel as if they come alive.

Examples of strengths include:

  • Works well/gets along well in groups
  • Is able to organize items and thoughts
  • Shows empathy and sensitivity to others
  • Accepts personal responsibility for actions (good and bad)
  • Participates in discussions at home, school and with friends
  • Uses inflection and expression when speaking
  • Figures out new words by looking at the context or by asking questions
  • Makes connections between reading material and personal experiences
  • Observes and understands patterns in nature and in numbers
  • Thinks logically

Knowing about strengths and weaknesses is helpful to children, but it has to be taken a few steps further in order to be useful to them. How can we help children use their personal strengths to build self-confidence and a positive attitude? Part of this depends on the child’s age. Young children love to tell you about themselves and are open to telling you what they like to learn. In contrast, older children and teens may have a hard time opening up. We need to point out their strengths:

  • “I noticed you love basketball, you seem so comfortable holding and dribbling the ball.”
  • “I noticed that you love to figure out math problems in your head.”

However, according to Anjum et al. (2013), Some children and adolescents, especially those with behavioral concerns may be reluctant to explore or believe their strengths because they have been conditioned to associate negatives about themselves. In such cases, the professional may first work on building the self-efficacy of children and adolescents by using evidence-based strategies such as cognitive-behavioral programs that can help them to believe that they have the ability to change. Once they focus and spend more time on what they are capable off, they will automatically spend less time in thinking about their shortcomings.

To learn more about multiple intelligences, building on children’s strengths and practical techniques to support children in becoming more resilient learners, check out our new online CE course:

Motivating Children to Learn is a 4-hour online continuing education (CE/CEU) course that provides strategies and activities to help children overcome their academic and social challenges. This course describes the various challenges that can sidetrack children in their developmental and educational processes, leaving them with a sense of discouragement and helplessness. Such challenges include learning disabilities, autism spectrum disorder, ADHD, behavior disorders, and executive functioning deficits. Left unchecked, these difficulties can cause children to develop the idea that they are not capable of success in school, precipitating a downward spiral of poor self-esteem and – eventually – school failure. The good news is that much better outcomes can result when parents, teachers, and therapists engage children in strategies and activities that help them overcome their discouragement and develop their innate intelligence and strengths, resulting in a growth mindset and a love of learning. Detailed in this course are multiple strategies and techniques that can lead to these positive outcomes. Course #40-44 | 2018 | 77 pages | 25 posttest questions


Professional Development Resources is a nonprofit educational corporation 501(c)(3) organized in 1992. We are approved to sponsor continuing education by the American Psychological Association (APA); the National Board of Certified Counselors (NBCC); the Association of Social Work Boards (ASWB); the American Occupational Therapy Association (AOTA); the American Speech-Language-Hearing Association (ASHA); the Commission on Dietetic Registration (CDR); the Alabama State Board of Occupational Therapy; the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy, Psychology & School Psychology, Dietetics & Nutrition, Speech-Language Pathology and Audiology, and Occupational Therapy Practice; the Ohio Counselor, Social Worker & MFT Board and Board of Speech-Language Pathology and Audiology; the South Carolina Board of Professional Counselors & MFTs; the Texas Board of Examiners of Marriage & Family Therapists and State Board of Social Worker Examiners; and are CE Broker compliant (all courses are reported within a few days of completion).

Target Audience: PsychologistsCounselorsSocial WorkersMarriage & Family Therapist (MFTs)Speech-Language Pathologists (SLPs)Occupational Therapists (OTs)Registered Dietitian Nutritionists (RDNs)School Psychologists, and Teachers

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A Short Course on Encryption and Cloud Storage

Course excerpt from Ethics & Risk Management: Expert Tips 8

Encryption and cloud storage is a complicated area because it requires an analysis of the interplay of several variables, including confidentiality, encryption, cloud storage and HIPAA. Each of these variables is complex, but there are ways to make the situation more manageable.

Cloud storageEncryption and cloud storage. Let’s consider a few common questions:

“For the purposes of HIPAA, if you have adequately encrypted your data, does your cloud storage provider need to sign a Business Associate Agreement (BAA)?”

The bottom line is that there is no crystal-clear answer to this question. The Department of Health and Human Services (HHS) hasn’t specifically addressed this issue, so we are faced with the question of how to interpret the security rule.

There are two basic interpretations: “no,” and “yes.” Both have some support, and if you proceed with one interpretation you should consider the countervailing position.

First, the basics: HIPAA Covered Entities (CEs) who work with vendors are required to have their vendors sign BAAs. This is required because it allows the federal government to enforce the provisions of HIPAA on these third-party vendors.

The public policy at work is that CEs shouldn’t be allowed to offload their legal responsibilities to a third party that isn’t subject to regulatory oversight. BAAs are required whenever a third-party vendor has access to Protected Health Information (PHI).

Here’s where it gets complicated. PHI is identifiable data, but if the data are encrypted they are not identifiable. In such a case, why is a BAA necessary?

The interpretation against requiring a BAA for encrypted data finds some support in one of HIPAA’s safe harbor provisions, which states that losses of encrypted data do not trigger a breach notification (the letter CEs send out that apologetically admits to the disclosure of protected health information).

The reason why breach notifications is not required for encrypted data are that the data remain inaccessible if encrypted. The covered entity has essentially lost gibberish.

Thus, this interpretation goes, BAAs are also not required because the vendor does not have access to protected health information. That makes sense. However, it should be noted that this is a fairly permissive interpretation and HHS has declined to endorse this position.

The competing interpretation, which appears to be strongly supported by the official commentary on related regulations (especially the 2013 HITECH amendments to the HIPAA Privacy and Security Rules), is that BAAs are required even when the data are encrypted.

Support for this position includes: HHS has not made the criteria for breach notifications the same as the criteria for needing a BAA.

The statutory exceptions for BAAs, such as those with incidental access (e.g., a janitor or electrician) or those who are mere “conduits,” do not apply to cloud storage providers. HHS has indicated that a data storage company is not a conduit because of the “persistent nature” of its contact with the data. Thus, it is persistency, and not the degree of access, that HHS has specifically indicated warrants consideration for the purposes of BAAs.

Commentary prior to the adoption of the security rule asked whether or not BAAs could be something that CEs could address, and thus render unnecessary. In other words, the question was asked, “if we as CEs take adequate security measures to ensure the protection of PHI, can we make BAAs unnecessary?” HHS specifically declined to make BAAs an “addressable” requirement.

Besides the issue of protecting PHI, BAs have additional responsibilities. These responsibilities include accessibility, data integrity, etc. If encryption enabled vendors to escape “business associate” (BA) status, HHS would have no jurisdiction. (From a risk management perspective, the execution of a BAA is something that many CEs do to “distribute” the risk.)

The definition of BA isn’t explicitly restricted to those who have access to PHI. The definition also includes those who perform “any other function or activity regulated by this subchapter.” (See 45 CFR 160.103(1)(i)(B)) The amount of functions and activities that are regulated under HIPAA is huge.

I want to emphasize that I understand the argument that where vendors have absolutely no access to PHI because the data are encrypted, the vendor doesn’t have encryption keys, etc., then HIPAA is (theoretically) a non-issue. It makes a lot of sense. However, we just don’t know at this time if HHS agrees with that position and we have some strong evidence that casts this position as too narrow.

However, the ambiguity also applies to the other interpretation: We don’t know if HHS agrees with the position that the storage of encrypted PHI (where the vendor has zero access to the PHI) still requires a BAA.

I hope this helps or at least provides some things to consider.

By Adam Alban, PhD, JD

Adam Alban, PhD, JD, hosts a website of general information for mental health professionals in California. He has an M.A. and PhD in clinical psychology from Michigan State University and a JD from American University in Washington, D.C. He operates a law practice specializing in legal assistance to mental health practitioners and also has a clinical psychology practice, the Alban Psychology Group. He may be reached at:

Ethics & Risk Management: Expert Tips 8 is a 3-hour online continuing education (CE) course that addresses a wide variety of ethics and risk management topics, written by experts in the field.

This online course provides instant access to the course materials (PDF download) and CE test. After enrolling, click on My Account and scroll down to My Active Courses. From here you’ll see links to download/print the course materials and take the CE test (you can print the test to mark your answers on it while reading the course document). Successful completion of the online CE test (80% required to pass, 3 chances to take) and course evaluation are required to earn a certificate of completion.

Professional Development Resources is approved to sponsor continuing education by the American Psychological Association (APA); the National Board of Certified Counselors (NBCC ACEP #5590); the Association of Social Work Boards (ASWB Provider #1046, ACE Program); the American Occupational Therapy Association (AOTA Provider #3159); the Commission on Dietetic Registration (CDR Provider #PR001); the Alabama State Board of Occupational Therapy; the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy (#BAP346), Psychology & School Psychology (#50-1635), Dietetics & Nutrition (#50-1635), and Occupational Therapy Practice (#34); the Ohio Counselor, Social Worker & MFT Board (#RCST100501); the South Carolina Board of Professional Counselors & MFTs (#193); and the Texas Board of Examiners of Marriage & Family Therapists (#114) and State Board of Social Worker Examiners (#5678).


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The Impact of Suicide

By Laura More, MSW, LCSW

Suicide PreventionThe health and economic consequences of suicide are substantial. Suicide and suicide attempts have far reaching consequences for individuals, families, and communities. In an early study, Crosby and Sacks (2002) estimated that 7% of the U.S. adult population, or 13.2 million adults, knew someone in the prior 12 months who had died by suicide. They also estimated that for each suicide, 425 adults were exposed, or knew about the death. In a more recent study in one state, researchers found that 48% of the population knew at least one person who died by suicide in their lifetime. Research also indicates that the impact of knowing someone who died by suicide and/or having lived experience (by personally having attempted suicide, having had suicidal thoughts, or having been impacted by suicidal loss) is much more extensive than injury and death. People with lived experience may suffer long-term health and mental health consequences ranging from anger, guilt, and physical impairment, depending on the means and severity of the attempt (Stone, Holland, Bartholow, et al., 2017).

The economic toll of suicide on society is immense as well. According to conservative estimates, in 2013, suicide cost $50.8 billion in estimated lifetime medical and work-loss costs alone (Florence, Simon, Haegerich, Luo & Zhou, 2015). Adjusting for potential under-reporting of suicide and drawing upon health expenditures per capita, gross domestic product per capita, and variability among states in per capita health care expenditures and income, another study estimated the total lifetime costs associated with nonfatal injuries and deaths caused by self-directed violence to be approximately $93.5 billion in 2013 (Shepard, Gurewich, Lwin, Reed & Silverman, 2016). The overwhelming burden of these costs were from lost productivity over the life course, with the average cost per suicide being over $1.3 million. The true economic costs are likely higher, as neither study included monetary figures related to other societal costs such as those associated with the pain and suffering of family or other impacts (Stone, Holland, Bartholow, et al., 2017).

Suicide Prevention: Evidence-Based StrategiesSuicide Prevention: Evidence-Based Strategies is a 3-hour online continuing education (CE) course that reviews evidence-based research and offers strategies for screening, assessment, treatment, and prevention of suicide in both adolescents and adults. Suicide is one of the leading causes of death in the United States. In 2015, 44,193 people killed themselves. The Centers for Disease Control and Prevention (CDC) notes, “Suicide is a serious but preventable public health problem that can have lasting harmful effects on individuals, families, and communities.” People who attempt suicide but do not die face potentially serious injury or disability, depending on the method used in the attempt. Depression and other mental health issues follow the suicide attempt. Family, friends, and coworkers are negatively affected by suicide. Shock, anger, guilt, and depression arise in the wake of this violent event. Even the community as a whole is affected by the loss of a productive member of society, lost wages not spent at local businesses, and medical costs. The CDC estimates that suicides result in over 44 billion dollars in work loss and medical costs. Prevention is key: reducing risk factors and promoting resilience. This course will provide a review of evidence-based studies on this complex subject for psychologists, marriage & family therapists, professional counselors, and social workers. Information from the suicide prevention technical package from the Centers for Disease Control and Prevention will be provided. Included also are strategies for screening and assessment, prevention considerations, methods of treatment, and resources for choosing evidence-based suicide prevention programs. Course #30-97 | 2017 | 60 pages | 20 posttest questions

This online course provides instant access to the course materials (PDF download) and CE test. After enrolling, click on My Account and scroll down to My Active Courses. From here you’ll see links to download/print the course materials and take the CE test (you can print the test to mark your answers on it while reading the course document). Successful completion of the online CE test (80% required to pass, 3 chances to take) and course evaluation are required to earn a certificate of completion. Click here to learn more.

About the Author:

Laura More, MSW, LCSW, is a healthcare author and licensed clinical social worker. Laura was one of the founding partners of Care2Learn, a provider of online continuing education courses for the post-acute healthcare industry. She now provides healthcare authoring services. She has authored over 120 online continuing education titles, co-authored evidence-based care assessment area resources and a book, The Licensed Practical Nurse in Long-term Care Field Guide. She is the recipient of the 2010 Education Award from the American College of Health Care Administrators.

CE Information:

Professional Development Resources is approved to sponsor continuing education by the American Psychological Association (APA); the National Board of Certified Counselors (NBCC ACEP #5590); the Association of Social Work Boards (ASWB Provider #1046, ACE Program); the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy (#BAP346), Psychology & School Psychology (#50-1635); the Ohio Counselor, Social Worker & MFT Board (#RCST100501); the South Carolina Board of Professional Counselors & MFTs (#193); and the Texas Board of Examiners of Marriage & Family Therapists (#114) and State Board of Social Worker Examiners (#5678).


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