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EthicsandRiskManagement2.0
LightUniversity2
WelcometoLightUniversityandthe“EthicsandRiskManagement2.0”programofstudy.Our prayer is that you will be blessed by your studies and increase your effectiveness inreaching out to others. We believe you will find this program to be academically sound,clinicallyexcellentandbiblically-based.Our faculty represents some of the best in their field – including professors, counselors andministers who provide students with current, practical instruction relevant to the needs oftoday’sgenerations.We have alsoworked hard to provide youwith a program that is convenient and flexible –givingyoutheadvantageof“classroominstruction”onlineandallowingyoutocompleteyourtrainingonyourowntimeandscheduleinthecomfortofyourhomeoroffice.Thetestmaterialcanbefoundatwww.lightuniversity.comandmaybetakenopenbook.Onceyouhavesuccessfullycompletedthetest,whichcoverstheunitswithinthiscourse,youwillbeawardedacertificateofcompletionsignifyingyouhavecompletedthisprogramofstudy.Thank you for your interest in this program of study. Our prayer is that you will grow inknowledge,discernment,andpeople-skillsthroughoutthiscourseofstudy.Sincerely,
RonHawkinsDean,LightUniversity
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LightUniversity3
TheAmericanAssociationofChristianCounselors
• Represents the largestorganizedmembership (nearly50,000)ofChristian counselorsandcaregiversintheworld,havingjustcelebratedits25thanniversaryin2011.
• Known for its top-tier publications (Christian Counseling Today, the Christian CounselingConnectionandChristianCoachingToday),professionalcredentialingopportunitiesofferedthroughtheInternationalBoardofChristianCare(IBCC),excellenceinChristiancounselingeducation, an arrayof broad-based conferences and live training events, radioprograms,regulatoryandadvocacyeffortsonbehalfofChristianprofessionals,apeer-reviewedEthicsCode, and collaborative partnerships such as Compassion International, the NationalHispanic Christian Leadership Conference and Care Net (to name a few), the AACC hasbecomethefaceofChristiancounselingtoday.
• With the needed vision and practical support necessary, the AACC helped launch the
International Christian Coaching Association (ICCA) in 2011, which now represents thelargest Christian life coaching organization in the world with over 2,000 members andgrowing.
OurMission
The AACC is committed to assisting Christian counselors, the entire “community of care,”licensedprofessionals,pastors,and laychurchmemberswith littleorno formal training. It isourintentiontoequipclinical,pastoral,andlaycaregiverswithbiblicaltruthandpsychosocialinsights that minister to hurting persons and helps them move to personal wholeness,interpersonalcompetence,mentalstability,andspiritualmaturity.
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OurVision
TheAACC’svisionhastwocriticaldimensions:First,wedesiretoservetheworldwideChristianChurch by helping foster maturity in Christ. Secondly, we aim to serve, educate, and equip1,000,000 professional clinicians, pastoral counselors, and lay helpers throughout the nextdecade.WearecommittedtohelpingtheChurchequipGod’speopletoloveandcareforoneanother.We recognize Christian counseling as a unique form of Christian discipleship, assisting thechurch in its call to bring believers to maturity in the lifelong process of sanctification—ofgrowingtomaturityinChristandexperiencingabundantlife.Werecognizesomearegiftedtodosointhecontextofaclinical,professionaland/orpastoralmanner.Wealsobelieveselected laypeoplearecalledtocareforothersandthattheyneedtheappropriatetrainingandmentoringtodoso.WebelievetheroleofthehelpingministryintheChurchmustbesupportedbythreestrongcords:thepastor,thelayhelper,andtheclinicalprofessional.ItistothesethreerolesthattheAACCisdedicatedtoserve(Ephesians4:11-13).
OurCoreValues
InthenameofChrist,theAmericanAssociationofChristianCounselorsabidesbythefollowingvalues:
VALUE1:OURSOURCEWearecommittedtohonorJesusChristandglorifyGod,remainingflexibleandresponsivetotheHolySpiritinallthatHehascalledustobeanddo.VALUE2:OURSTRENGTHWearecommittedtobiblicaltruths,andtoclinicalexcellenceandunityinthedeliveryofallourresources,services,trainingandbenefits.VALUE3:OURSERVICEWeare committed toeffectivelyandcompetently serve the communityof careworldwide—bothourmembership and the churchat large—withexcellenceand timeliness, andbyover-deliveryonourpromises.VALUE4:OURSTAFFWearecommittedtovalueandinvestinourpeopleaspartnersinourmissiontohelpotherseffectivelyprovideChrist-centeredcounselingandsoulcareforhurtingpeople.VALUE5:OURSTEWARDSHIPWe are committed to profitably steward the resourcesGod gives to us in order to continueservingtheneedsofhurtingpeople.
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LightUniversity• Establishedin1999undertheleadershipofDr.TimClinton—hasnowseennearly200,000
students from around the world (including lay caregivers, pastors and chaplains, crisisresponders,lifecoaches,andlicensedmentalhealthpractitioners)enrollincoursesthataredelivered via multiple formats (live conference and webinar presentations, video-basedcertificationtraining,andastate-of-theartonlinedistanceteachingplatform).
• Thesepresentations,courses,andcertificateanddiplomaprograms,offeroneofthemostcomprehensive orientations to Christian counseling anywhere. The strength of LightUniversity is partially determined by its world-class faculty—over 150 of the leadingChristianeducators,authors,mentalhealthcliniciansandlifecoachingexpertsintheUnitedStates. This core groupof facultymembers represents a literal “Who’sWho” inChristiancounseling. No other university in the world has pulled together such a diverse andcomprehensivegroupofprofessionals.
• Educational and training materials cover over 40 relevant core areas in Christian—
counseling, lifecoaching,mediation,andcrisis response—equippingcompetentcaregiversand ministry leaders who are making a difference in their churches, communities, andorganizations.
OurMissionStatement
TotrainonemillionBiblicalCounselors,ChristianLifeCoaches,andChristianCrisisRespondersbyeducating,equipping,andservingtoday’sChristianleaders.
AcademicallySound•ClinicallyExcellent•DistinctivelyChristian
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Video-basedCurriculum
• UtilizesDVDpresentations that incorporateover 150 of the leading Christian educators,authors,mentalhealthclinicians,andlifecoachingexpertsintheUnitedStates.
• Eachpresentationisapproximately50-60minutesinlengthandmostareaccompaniedbyacorrespondingtext(inoutlineformat)anda10-questionexaminationtomeasurelearningoutcomes.Therearenearly1,000uniquepresentationsthatareavailableandorganizedinvariouscourseofferings.
• Learning is self-directed and pacing is determined according to the individual time
parameters/scheduleofeachparticipant.• With the successful completion of each program course, participants receive an official
Certificate of Completion. In addition to the normal Certificate of Completion that eachparticipant receives, Regular and Advanced Diplomas in Biblical Counseling are alsoavailable.
Ø TheRegularDiploma isawardedbytakingCaringForPeopleGod’sWay,BreakingFreeandoneadditionalElectiveamongtheavailableCoreCourses.
Ø TheAdvancedDiplomaisawardedbytakingCaringForPeopleGod’sWay,BreakingFree,andanythreeElectivesamongtheavailableCoreCourses.
Credentialing
• LightUniversitycourses,programs,certificatesanddiplomasarerecognizedandendorsedbytheInternationalBoardofChristianCare(IBCC)anditsthreeaffiliateBoards:theBoardofChristianProfessional&PastoralCounselors(BCPPC);theBoardofChristianLifeCoaching(BCLC);andtheBoardofChristianCrisis&TraumaResponse(BCCTR).
• Credentialing is a separateprocess from certificate or diploma completion.However, theIBCC accepts Light University and Light University Online programs as meeting theacademic requirements for credentialing purposes. Graduates are eligible to apply forcredentialinginmostcases.
Ø Credentialinginvolvesanapplication,attestation,andpersonalreferences.
Ø CredentialrenewalsincludeContinuingEducationrequirements,re-attestation,andoccureitherannuallyorbienniallydependingonthespecificBoard.
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OnlineTesting
TheURLfortakingallquizzesforthiscourseis:http://www.lightuniversity.com/my-account/.
• TOLOGINTOYOURACCOUNT
Ø You should have received an email upon checkout that included your username,password,andalinktologintoyouraccountonline.
• MYDASHBOARDPAGE
Ø Once registered, youwill see theMyDVD Course Dashboard link by placing yourmousepointerovertheMyAccountmenuinthetopbarofthewebsite.Thispagewill include studentPROFILE informationand theREGISTEREDCOURSES forwhichyouareregistered.TheLOG-OUTandMYDASHBOARDtabswillbeinthetoprightofeachscreen.Clickingonthe>nexttothecoursewilltakeyoutothecoursepagecontainingthequizzes.
• QUIZZES
Ø Simplyclickonthefirstquiztobegin.• PRINTCERTIFICATE
Afterallquizzesaresuccessfullycompleted,a“PrintYourCertificate”buttonwillappearnearthetopofthecoursepage.YouwillnowbeabletoprintoutaCertificateofCompletion.Yournameandthecourseinformationarepre-populated.ContinuingEducationThe AACC is approved by the American Psychological Association (APA) to offer continuingeducationforpsychologists.TheAACCisaco-sponsorofthistrainingcurriculumandaNationalBoard of Certified Counselors (NBCC)ApprovedContinuing Education Provider (ACEPTM). TheAACC may award NBCC approved clock hours for events or programs that meet NBCCrequirements.TheAACCmaintainsresponsibilityforthecontentofthistrainingcurriculum.TheAACCalsoofferscontinuingeducationcreditforplaytherapiststhroughtheAssociationforPlayTherapy (APT Approved Provider #14-373), so long as the training element is specificallyapplicabletothepracticeofplaytherapy.It remains the responsibility of each individual to be aware of his/her state licensure andContinuing Education requirements. A letter certifying participation will be mailed to thoseindividuals who submit a Continuing Education request and have successfully completed allcourserequirements.
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PresenterBiographies
LoisDodds,Ph.D., isa licensedcounselorwithyearsofexperience inmulticulturalandcross-culturalsettingswithinternational,humanitarianworkers.Becauseofthisextensiveexperiencein nearly fifty countries, she has a keen sense of what “works” in Christian contexts. HerapproachincounselingisinformedbyherdecadesofservingtheBodyofChristworldwide.Shehasalsowrittenandtaughtwidely,withfifteenpublishedbooks,overonehundredarticles,anddozensofpresentationsatWorldCongresses,conferencesandretreats.Further,shehasalsobeenanadjunctprofessor forAzusaPacificUniversity for20years in theoverseasextensionprogramcalledOperationImpactthatgivesaMaster’sDegree inLeadershipandisoffered in20 countrieseachyear. She is co-founder,president, anddirectorofHeartstreamResources,which serves missionaries and other humanitarian workers. Her recently published series,GlobalServants:InternationalHumanitarianHeroes,providestheoryandpracticalapproachestoethicalandotherissues.JohnSandy, J.D.,Esq., is a licensedattorney inCaliforniaand Illinois.Hemaintainsaprivatelegalpractice inRiverside,California,whereheconcentrates in church law,business lawandlegal issues relevant to professional, pastoral and church-based counseling. John is also anordained minister, Board Certified Christian Counselor (BCBC), and Board Certified PastoralCounselor(BCPC).AsaministrypartneroftheCalifornia-basedInlandEmpireSouthernBaptistAssociation,Johnprovidespastoralcounselingtoindividuals,couplesandfamilies,andspiritualcaretoministryleadersandtheirfamilies,aswellasworkshopsandconsultingforchurchesonpastoralcounselingandministryadministrativeissues.DerrickStevenson,Ph.D.,iscurrentlythedirectorofTherapeuticServicesforWillis-Knighton’sInstitute for Behavioral Medicine and provides the leadership for Louisiana’s only RAPHAprogram. Prior to that, he was the coordinator of Willis-Knighton’s Hospice Program. Dr.StevensonholdsaMaster’sDegreefromNewOrleansBaptistSeminary,aswellasaMaster’sinSocial Work from Southern University of New Orleans, and a Doctorate in Counseling fromLouisianaBaptistUniversity.Dr.Stevenson is licensed inbothLouisianaandTexasasaSocialWorkPractitionerandiscertifiedbytheAmericanAssociationofChristianCounselors.Hehasservedon theGovernor’sAdvisoryCommitteeonHospiceCare andprovidedmany inservicetrainingsandlecturesongriefandloss.Currently,Dr.Stevensonoperatesasuccessfulprivatepractice in Shreveport and was the Host of the KWKH 1130AM daily radio show “The NextStep.”
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EthicsandRiskManagement2.0TableofContents:
ERM101:LegalandEthicalRiskManagement.......................................................................11JohnSandy,J.D.
ERM102:DualandMultipleRelationshipsforCounselors.....................................................37LoisDodds,Ph.D.ERM103:SuicideRiskAssessment.........................................................................................51DerrickStevenson,Ph.D.
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Abstract
Tomeet the growing needs of hurting people in the congregation, an increasing number of
churchesarecreatinglaycounselingministries.Additionally,localchurchesarealsoorganizing
anumberofspiritualcareministriesandinformalcareprograms.Bydevelopinglaycounseling
and spiritual care ministries, churches act in accordance with Scripture. Lawsuits against
churcheshave increasedover thepastdecade.Church leadersneedtobeawareof the legal
risks associated with spiritual care ministries, and they need to take preventative steps to
protectthechurchanditsworkersfromunnecessarylegalliability.Thissessionoverviewsthe
implementation of policies and procedures that reduce the risk for liability among lay
counselingministries.
LearningObjectives
1. Participants will learn important legal and liability issues relevant to church lay
counselingandspiritualcareministries.
2. Participantswillbeabletodevelopachurchlaycounselingand/orspiritualcareministry
policytoreducerisks.
3. Participantswill become familiarwith insurance riskmanagementoptions for church-
basedcounselingandspiritualcareministries.
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I. Introduction
A. TheHurtingChurch
1. In today’s society, church leaders recognize that the local churchmust serve as a
safeplaceforspiritualcareandbiblicalguidanceforlife’sproblemsanddecisions.
2. Spiritual care of the church flock should not merely be the responsibility of the
pastorsofyourchurch.
3. To meet the growing needs of hurting people in the congregation, an increasing
numberofchurchesarecreatinglaycounselingministries.
• Laycounselingministriesinvolvelayhelperscomingalongsidehurtingpeople.
• Theyprovidehopeandcareforlife’sproblemsbasedonbiblicalprinciples.
4. Inadditiontolaycounselingministries,localchurchesarealsoorganizinganumber
ofspiritualcareministriesandinformalcareprograms.
• Topicalsupportgroupministriesexistforgrief,divorce,parentingteensorthose
dealingwithpastsexualabuse.
• Recoveryprogramsprovideteachingsandtestimoniesofpeoplewhohavegone
throughstrugglesrelatedtovariousaddictionsandobtainedvictory.
• Marriagementoringprogramsenable trained couples to comealongsideother
couples.
5. By developing lay counseling and spiritual care ministries, churches act in
accordancewithScripture.
“Bearoneanother’sburdens,andtherebyfulfillthelawofChrist.”—Galatians6:2
“Andletusconsiderhowtostimulateoneanothertoloveandgooddeeds.”
—Hebrews10:24
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6. Spiritualcareministriescanbuildfellowshipandaccountabilityinchurches.
• They can serve as an effective and valuable outreach care ministry to the
community.
• They can greatly help the pastors by serving as an additional resource for
counselingandcongregationalcareneeds.
7. Organizingachurchspiritualcareministrycallsforprayer,planningandleadership
tocarryoutdesiredgoals.
• Thisisnotjustalegallydrivenguideline.Itisbiblical.
“Theprudentseestheevilandhideshimself,butthenaivegoon,andarepunished
forit.”—Proverbs22:3
“Without consultation, plans are frustrated, but with many counselors they
succeed.”—Proverbs15:22
B. ChurchLegality
1. Church leaders need to be aware of the legal risks associated with spiritual care
ministries, and theyneed to takepreventative steps toprotect the churchand its
workersfromunnecessarylegalliability.
2. Lawsuitsagainstchurcheshaveincreasedoverthepastdecade.
3. According to Peacemaker Ministries, born again Christians in the United States
annuallyfile4-8millionlawsuits,oftenagainstotherChristiansandcosting$20-40
billion.
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4. Brotherhood Mutual Insurance Company receives notice of an average of 80-90
sexualactsclaimsperyear.
• Brotherhood is a church insurance company of about 30,000 policyholders of
churchesinrelatedministries.
• On average, between 1-5 potential claim reports turn into actual counseling
claimseachyear.
• Whilecounselingclaimsarerelativelyrare,whentheydooccur,thepayoutcan
begreat.Thatisparticularlythecaseforsexualmisconduct.
5. By implementing risk management programs, a church can avoid unnecessary
litigation and its emotionally and financially destructive effects on the church and
thepeopleinvolved.
6. Churchleadersshouldaskthemselvesthefollowingquestions:
• Is the church aware of its legal and ethical risks regarding lay counseling and
otherspiritualcareministries?
• Is the church leadership involved in developing policies and procedures to
legally,ethicallyandbiblicallyaddresstheserisks?
• Arespiritualcareandcounselingpoliciesandproceduresregularly reviewedto
ensurethattheycomplywiththelaw?
• Are pastoral staff members and lay counselors trained to understand these
policiesandprocedures?
II. LegalandEthicalLiabilityIssues
A. SexualMisconduct
1. Sexual misconduct claims result in the costliest verdicts and settlements for
churchestoday.
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2. Sexual misconduct in churches also causes significant emotional damage for the
victims,theirfamilies,congregationandstaffmembersofthechurch.
3. InanarticleinAACC’sChristianCounselingConnection,RalphEarldiscusseswhathe
seesasthetrendinanumberofministerswhofallintosinandboundaryviolations.
• He referencesa surveyby theFuller InstituteofChurchGrowth reporting that
37%ofclergysurveyedhavebeeninvolvedininappropriatesexualbehaviorwith
someonetheyworkwith.
4. According toa2009studyreleasebyBaylorUniversity,one inevery33women in
thecongregationor3%whoattendworshipserviceshavebeenthetargetofsexual
advancesbyareligiousleader.
5. Ministerswhoengage in sexualmisconductwith adults orminors potentially face
criminalandcivilliability.
• A minority of states has criminal laws relating to unlawful sexual contact
betweenaministerandacounselee.
• Civil liability for clergy who engage in sexual relations with adults or minors
resultsfromplaintiffswhosuefromtheoriessuchasclergymalpractice,breach
offiduciaryduty,intentionalinflictionofemotionaldistress,assaultandbattery
andsexualharassmentbetweencoworkers.
B. Negligence:Selection,RetentionandSupervisionofEmployeesandVolunteers
1. Thisriskisextremelyhighforlaycounselingministriesinthelocalchurch.
2. Negligenceisgenerallydefinedasthefailuretoexercisereasonablecare.
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3. Churchescannotguaranteesafety,butgenerallytheyareresponsiblefortheirown
negligenceiftheyassumeadutyofcarewithrespecttolaycounselingministries.
4. Examplenotes:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
C. Confidentiality
1. Ifapersonbeingcounseleddisclosesprivate,confidentialinformationtoapastoror
lay counselor in a non-public setting, the counselor must not divulge the
information.
“Ineverything,therefore,treatpeoplethesamewayyouwantthemtotreatyou,for
thisistheLawandtheProphets.”—Matthew7:12
2. Generally, courts will determine if there is a duty to keep communication
confidentialbyconsideringwhetherthepersoncommunicatingtheinformationhad
a reasonable expectation to believe that the information would be held in
confidence.
3. Breach of confidentiality can lead to liability for legal action such as slander,
defamationofcharacter, invasionofprivacyand intentional inflictionofemotional
distress.
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4. Therearesomeexceptionstokeepinginformationconfidential.Forexample,when
itislegallyrequiredtobedisclosed:
• Stateabusereportinglawrequirements
• Subpoena
5. Thecounseleemayalsospecificallyauthorizesharingconfidentialinformation.
D. AbuseReporting
1. TheUnitedStatesDepartmentofHealthandHumanServicesreportedthatin2009,
there were referrals to child protective services agencies across the nation of
approximately6millionchildren.
2. AWANAClubs International Inc. reporteda fewyearsago thatmore than30%of
girlsand10-20%ofboyswouldbeabusedbytheageof18.
3. Itisabsolutelycriticalthatyourchurchleaders,staffandlaycounselorsunderstand
the legal requirements forabusereporting inyourstateandcomplywiththe law
immediatelywhenevertheyidentifysuchasituation.
4. Ignoring an allegation of abuse and improperly responding to your state’s child
abuse reporting laws may subject your church and its leaders to civil and/or
criminalliabilityrisks.
5. Ingeneral,thestatechildabusereportinglawsdothefollowing:
• Definethetypeofchildabusethatisreportable.
• Describe what types of individuals are mandatory reporters and permissive
reporters.
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• Describereportingproceduresincludingstricttimetablesforreportingandwhat
agenciessuspectedchildabuseshouldbereportedto.
• Provideinformationaboutimmunityfromprosecutionforreportingabuse.
• Describethepenaltiesfornotreportingandfalsereporting.
6. Whatisreportablechildabuse?
• Inmoststates,childabuseisdefinedasincludingthefollowingtypesofactivity
thatimpactapersonundertheageof18:
Ø Physicalabuse
Ø Sexualabuse
Ø Emotionalabuse
Ø Neglect
• Thelawsgenerallyrequirereportingofactualandreasonablysuspectedcasesof
childabuse.
7. All states define the categories of personswhomust report abuse to designated
civilauthorities.
• Inafewstates,anypersonisrequiredtoreportabuse.
• Manystatesdefinegroupsofoccupationsthataremandatoryreporterssuchas:
doctors,dentists,schoolpersonnel,licensedpsychologistsandlawenforcement
officers.
• Manystatesrequiremembersoftheclergytobemandatoryreporters.
8. Evenifastate’slawrequiresclergytoreportchildabuse,pastorsneedtobeaware
that a number of states have exempted licensed, commissioned or ordained
ministers fromadutytoreportchildabuse if theabuse isdisclosed inasituation
thatwouldbeprotectedbythestate’sclergy-penitentprivilege.
• Since thisprivilege isa ruleofevidenceor civilprocedureapplicable toa trial,
the language of your state law must be reviewed carefully by your church’s
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attorney to determine the reasonableness of using this privilege as a defense
fromreportingchildabuse.
9. The state child abuse reporting statues generally encourage, but do not require,
personswhoarenotmandatoryreportersfromreportingreasonablesuspectedor
knownchildabuse.
10. Reportingprocedures:
• Generally, child abuse reporting statutes designate that amandatory reporter
filesanoralreportimmediatelytoaspecificstateagency.Thiscanbebetween
12-72hours.
• Statetoll-freenumberstocontactarecommon.
• Moststatesrequireafollow-upreportinwriting.
11. Generally, the laws in various United States’ jurisdictions allow for immunity for
legalliabilityfrommakinggoodfaithreportsofsuspectedchildabuse.
12. Criminalprosecution for failure to report childabuse isnotcommon,but itdoes
happen.
• Penaltiesforfailuretoreportchildabusevarybystate,buttheytypicallycallfor
shortprisontermsandfines.
13. Civillawsinafewstatesenablevictimsofchildabusetosuemandatoryreporters
formoneydamagesiftheyfailedtoproperlyreportchildabuse.
14. Anothercommonstatereportingabuseissueiselderabuse.
• Laws in many United States’ jurisdictions have developed over the past few
decades through the reporting of abuse to elders or adults with diminished
physicalormentalcapabilities.
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• Reportable abuse under these laws can include: physical, emotional or sexual
abuse, neglect, intimidation, physical restraint, abandonment and financial
manipulation.
15. Theelderabusereportinglawsaresimilartothechildabusereportinglawsinthat
they call for reporting to government agencies by mandated reporters within
certaintimeframes.
16. The lawsgenerally set forthcivilandcriminalpenalties for failure tocomplywith
thelaw.
E. StateLicensingLawsforMentalHealthPractitioners
1. Theselawsvarybystate.
2. Generally,pastorsemployedinachurcharefreetoprovidepastoralcounselingto
churchmembersandareexemptfromlicensing.
3. States differ, though, when there are exemptions for laypersons who do provide
counselingonbehalfofthechurch.
4. Statementalhealthlicensinglawswillnecessarilyimpactthechurch’slaycounseling
policyinanumberofways:
• Manystatesmerelyprohibitanon-licensedpersonfromrepresentingthatheor
she is licensed. Some states prohibit non-licensed persons from using certain
titlesordescriptionsofservice.
• Somestatesprovideexemptionsfromlicensureforemployeesorvolunteersfor
anonprofitorganizationsuchasyourchurch.
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• Churchestypicallydonotchargefeesforpastoralcounseling,butbeawarethat
theremaybealegalimpactifachurchdoeschargesometypeofremuneration
forservices.
• Be aware that state laws regarding advertising to the publicmay impact your
counseling ministry. Some states require licensure of individual counselors in
ordertoadvertisecounselingtothepublicatlarge.
• Moreandmorestatesaresettingforthguidelinesfore-counseling,andthelaw
variesbystate.
• Pastoral and lay counselors could be held to liability standards of secular
counselors if their counseling goes beyond spiritual counseling under some
state’slaws.
F. EthicalIssues
1. A lay counselor is likely to be confronted with counselee issues of depression,
suicideanddrugandalcoholabuse.
2. Counseling services must never be offered beyond the skill and training of the
counselor.
3. Recognizing which counseling situations aremost likely to expose a pastor or lay
counselortoariskofalawsuitifnotproperlyreferredisimportanttoknow.
4. Achurch’s lay counselingministrypolicy should set forthguidelines inadvance to
assurethatcounseleesareproperlyreferred.
5. Lay counselors and pastoral counselors must be discouraged from ever advising
counseleestoavoidmedicationsprescribedbytheirphysicians.
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• In general, church counselors and ministers should not interfere with a
counselee’s medical treatment or discourage a counselee from seeing a
physician.
III. DevelopingaLayCounselingMinistryPolicy
A. PracticalApplication
1. Howdoesachurchcreateasafeministryenvironment?
2. Managinglegalriskisapartofministrytoday.
3. Taking proactive preventative riskmanagement steps tomanage legal risks helps
churchleadersbegoodstewardsoftheresourcesentrustedtothem.
B. First
1. Developministrygoals.
2. Churchleadersshoulddeterminewhomtheministrywouldserve.
• Willchurchcounselingbeavailabletochurchmembersandattendeesonly?
• Willitbeopentothecommunityatlarge?
• Willthechurchallowlaycounselorstoworkwithminors?
• Willdonationsbeaccepted?
3. Church leaders should also determinewhat issues the lay counselingministrywill
address and what issues will be beyond the competence and scope of ministry
workersbothethicallyandlegally.
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C. Second
1. Getthesupportofchurchleadership.
2. Itiscrucialtohavethefullunderstandingandsupportofchurchleadership.
3. Includechurchleadersinyourplanningprocess.Ensurethatthegoverningbodyof
your church not only understands the rationale for your ministry, but also fully
approvesoftheproposedguidelinesandpolicyofyourministry.
4. It is important to confirm that the policies and procedure you develop do not
conflictwiththechurch’sbylawsorothergoverningdocuments.
D. Third
1. Consultwithanattorney.
2. Theattorneyyourchurch selects shouldbe familiarwithvarious federalandstate
lawsthathaveanimpactonchurchesandspiritualcareministries.
3. Veryfewattorneysconcentrateonchurchlaworcounselinglawsoyoumaywantto
seekattorneyrecommendationsfromotherchurchesortrustedsources.
E. Fourth
1. Developalaycounselingpolicyandappropriateforms.
2. Theprimaryformsinclude:
• InformedConsentorLayCounselingAgreement
• Intakeforcounselees
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• Laycounselorapplicationform
3. Achurch’spoliciesandproceduresforlaycounselingandanyspiritualcareministry
shouldincludethefollowingessentialelements:
• Ascreeningprogramthatincludesallemployeesandvolunteersinvolvedinthe
ministry’sadministrationandcounselingactivities
• Administration guidelines that include confidentiality, abuse reporting, record
keepingandotheractivities
• Trainingforandsupervisionofthelaycounselors
• Acommunicationplanthatinformsleadersandmembersabouttheprogram
IV. EssentialElements
A. Screening
1. The success of your spiritual careministry depends greatly on the character and
qualityofyourlaycounselors.
2. Developing screening guidelines that can be consistently appliedwill benefit your
ministryinseveralways:
• Itallowschurch leaderstomakesurethattheapplicantsarespirituallymature
believerswhoareappropriateforlaycounselingministry.
• Itheightenstheprotectionfromincidencesofsexualabuse.
• Itdemonstrates to thoseseekingcounsel,and toacourt ifnecessary, that the
churchhasnotbeennegligentinscreeningpotentiallaycounselors.
3. Consider a potential lay counselor’s spiritual and emotional maturity and
appropriatespiritualgiftingsuchasmercy,exhortation,wisdomandteaching.
• ReviewtheprinciplesfoundinRomans12,Ephesians4and1Corinthians12.
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4. Evaluate the demographics of your congregation when choosing a team of lay
counselors.
• Considerthetypicalissuesthattheteamoflaycounselorswilllikelybeexpected
tohandle.
• Whenchoosingworkers forotherspiritual careministries, consider theunique
backgroundsthattheybringtotheministry(i.e.,divorce,grief,recovery,etc.).
5. The six-month rule: volunteers of spiritual careministries should bemembers or
regular attenders of the church for at least sixmonths before being put into the
positionoflaycounselor.
6. Nooneshouldbeexemptfromcompletinganapplication.
7. Require applicants to provide the names of at least two independent references
whocanbeaskedtoprovideinputontheapplicant’squalifications.
8. Criminalbackgroundchecksshouldbeapartofthechurch’shiringpolicy.
9. Consider developing a uniform set of questions that will help you gain a greater
understandingoftheapplicant’scharacterandbackground.
10. Volunteersshouldcompletearenewalapplicationeachyear.
B. AdministrativeGuidelines
1. Theformalityandthedetailsofcounselingpoliciesandprocedureswilldependon
thenumberofpastorsandtrainedvolunteersthattheministryhas.
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2. Knowing your state laws is critical in organizing a spiritual care ministry in your
church.
3. Church leaders should consultwith an attorney todeterminehow some key legal
issuesshouldbeplacedwithinthepolicies.
4. Understand what issues may impact your program due to state mental health
licensinglaws.
• Canlaycounselorsprovidelaycounselingforthechurch?
• Canthewordcounselingbeused?
• Whattitlescannotbeused?
• Canthechurchadvertiseitsservicestothegeneralpublic?
• Canfeesbecharged?
C. Confidentiality
1. If a counselee discloses confidential information to a pastor or lay counselor in a
non-public setting, then the information should not be divulged except for a
legitimatereasonthatcanbelegallyjustified.
2. There may be times when it is biblically or legally necessary to share certain
informationtoothers.
3. Churches are encouraged to set fourth an Informed Consent or Lay Counseling
Agreement.
4. Specifically, the counselee should understand the legal and biblical exceptions to
confidentialityinacounselingsituation.
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5. Examplesofexceptions:
• Statemandatedchildabuseandelderabuserequirements
• Disclosurerequiredbylaw(subpoena)
• Harmthreatenedtoothersorself
• Pastoralsupervisor
• Parentsandguardiansofminors
• Couples
6. Counselees should review, understand and sign an informed consent or lay
counselingagreement.
• Bysigningthisform,thecounseleemakesavoluntarydecisionastowhetherhe
orshewantstoconsenttothewaythechurchhandlesconfidentialinformation.
D. ChildandElderAbuse
1. Childandelderabusecanremainasecretforsometime.
2. Manytimespastorsandlayministersdonotreadilydetectorrespondtoincidences
of abuse because they are unaware of the behavioral or emotional signals that
accompanyabuse.
3. Forthesafetyofchildrenandelders,it isvitallyimportantthatcounselorsbecome
awareofhowtoidentifyvictimsofabuse.
4. Therearemanyverbal/behavioralindicatorsthatworkersshouldbecomeawareof.
• Your church or ministry may desire to invite a licensed psychologist or other
mental health practitioner to a lay counselor training meeting to discuss
indicatorsofabuse.
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5. Church leaders, staffand laycounselors shouldunderstand the legal requirements
forabusereportinginthestateandcomplywiththelaw.
6. Alllaycounselorsshouldknowwhichleadertocontactimmediatelyiftheysuspect
anystatemandatedreportingmatter.
7. Workcloselywithyourchurch’sattorneytodevelopproperprocedures.
E. RecordKeeping
1. Counseling files should be confidentiallymaintained in a safe and secure place at
yourchurch.
2. Any counselee information on computer hard drives, disks or other electronic
storagedevicesshouldbesecurefromunauthorizedaccess.
• Counseling files or other private information contained on portable devices
shouldbeencrypted.
3. Church leaders should discuss record retention guidelines with the church’s
attorney.
• For potential insurance or litigation purposes, it may be wise to keep some
recordsindefinitely.
F. SexualMisconduct
1. Achurchmusttakestepstodetersexualmisconduct.
2. Prohibit any minister or lay counselor from providing counseling privately with a
memberoftheoppositesex.
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3. Haveaparentorsecondadultpresentwhencounselingaminor.
4. Limitthehourswhencounselingwillbeavailableatthechurch.
5. Limit counseling sessions to 45-minute sessions to an hour and establish a set
numberofsessions.
6. Counselonlyinaspecificallylocatedofficeorroomthathasawindoworisinview
ofasecretaryoranotheradult.
7. Cautioncounselorsaboutphysicaltouchingthatmightbemisinterpreted.
G. EthicalConsiderations
1. Laycounselorsshouldunderstandandfollowthechurch’sguidelinesforreferralof
counselees to physicians, mental health practitioners and other professional
caregivers.
2. Lay counselors should not interfere with a counselee’s medically prescribed drug
regimen.
H. Forms
1. Informed consent or lay counseling agreement: sets forth the conditions under
whichthechurchwillprovidelaycounseling.
2. Inadditiontoconfidentiality,thisdocumentcouldalsodiscuss:
• Thenumberofcounselingsessionavailable
• Theabilityofthecounselororcounseleetoterminatecounselingatanytime
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• Conflictresolution(mediationparagraph)
• Clarity that lay counselorswill provide biblical counseling and not guidance as
licensedmentalhealthpractitioners
3. In situations where minors are being counseled, use a separate form that
accommodates confidentiality issues. If the counselee is aminor, have his or her
parentorguardiansignthedocument.
4. Theintakeformcontainsstandardbackgroundinformationaboutthecounselee.
5. Counselingprogressnotesarealsoimportant.
I. SpiritualCareMinistries
1. Other spiritual care ministries may not have the same formalized counseling
components.
2. However,manyspiritualcareministriesinvolvefacilitatordrivensmallgroupswhere
someofthesameissuesapply.
3. Policies:Thegroupleaderwillnotprovidecounseling,butwillfacilitatediscussions,
set protections to guard against sexual misconduct, disallow dating between
facilitatorandattendees,considermeetinglocationsatthechurchratherthanatthe
home,guardagainstafacilitatormeetingalonewithanattendeeoftheoppositesex
andexplaintheimportanceofriskmanagementguidelinestoparticipants.
J. TrainingandSupervision
1. Itisessentialforaccountabilityandbuildingasafeenvironment.
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2. Well-organized training and supervision processes that address spiritual needs,
counseling methods, risk management and administrative protocols enhance the
successofyourministry.
3. Whoevermanagesthelaycounselingministryservesasthegatekeeperinhelpingto
protectcounselorsandthepeopletheyarecounseling.
• The manager’s role is twofold. The manager assures that the counselors are
effectively trained to provide competent spiritual care and provides
accountabilityandriskmanagementoversightoftheministry.
• Alaycounselingmanagershouldeitherbeapastorwithextensiveexperiencein
counselingoraChristianlicensedmentalhealthpractitioner.
• This manager can provide individuals with the informed consent and intake
form.
• Themanager can review the completed formsanddecidewhich lay counselor
shouldcounselaparticularindividual.
• Themanagercanmakereferrals.
4. Trainingprocedurescanvaryaccordingtothescopeofyourprogram.
5. Recommendingmodulesforinitiallaycounselingtraininginclude:
• Routineproblemsthatcounseleeswillbringaspresentingproblems
• Biblicalguidancepertainingtotypicalcounselingproblems
• Opportunitiestoroleplayandpracticetheskillsofcounseling
• Thechurch’slaycounselingpolicy
• Thelegalandethicalissuesinlaycounseling
• Referrals
6. The church should schedule ameeting for lay counselors to review and reinforce
theseguidelinesandprovideanynewinformation.
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7. Forotherspiritualcareministriesoutsideoflaycounselingthereshouldbetraining.
8. Thereareprepackagedprogramsforlaycounseling.
• Determineifitprovidesriskmanagementguidelinesforyourministry.
9. Leader training for all spiritual care ministries should include discussion of the
church’svolunteersfromalegalandethicalperspective.
10. Thereshouldbepropersupervisionofthelaycounselorsandforanyspiritualcare
ministryworker.
K. CommunicationsPlan
1. Educationaboutachurch’sspiritualcareministriesisimportant.
2. Potentialaudiencesinclude:
• Churchleaders
• Ministerialstaff
• SmallgroupandSundayschoolleaders
• Churchmembersandregularattenders
• Membersofthecommunity
3. The level of detail you provide about your program depends on whom you are
talkingto.
L. Insurance
1. Insuranceplays a key role inmanaging risks related to lay counseling and general
churchoperations.
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2. Insurance companies pay for risk-associated losses that a churchmay experience,
butcannoteasilyaffordtopay.
3. Itisrecommendedthatchurcheshaveaninsuranceauditonanannualbasis.
4. When you choose an insurance agent, be sure that the person is knowledgeable
aboutthechurchinsurancemarket.
5. Whenchoosinganinsurer,itisimportanttorememberthatthereismoretomaking
insurancedecisionsthansimplylookingatthecostofthecoverage.
• Thebestinsurancevaluemaynotbereflectedinthelowestprice.
• Lookatthebreadthofcoverage,theservicerecordandvalueaddedbenefits.
6. Ageneral liabilitypolicy:providescoverageforbodily injuryandpropertydamage
that results from negligent acts of the insurer (i.e., church, ministers, leaders,
volunteers,etc.).Itcanalsoincludecoverageformedicalpaymentsandpersonalor
emotionalinjurysuchasclaimsofdefamationorinvasionofprivacy.
7. Counseling acts liability coverage: optional coverage endorsement to a general
liabilitypolicy. Itprovides liabilityprotectionagainstclaimsofbodily,emotionalor
personalinjurythatresultfromcounselingactsofchurch,pastoralorlaycounselors.
8. Sexual acts liability coverage: protects against claims resulting from the alleged
sexual misconduct of individuals involved in church activities while performing
ministry duties. Usually this coverage is offered as an optional coverage
endorsementtoageneralliabilitypolicy.
9. Directors' and officers' liability coverage: People who sue a church also often
indicate members of the church board as additional named defendants. This
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coverage should provide liability protection and legal defense for most financial
damage claims that result from leadership decisions made on behalf of the
organization.
10. Excess umbrella liability coverage: Generally this optional coverage expands the
financial limits of protection beyond those that certain primary liability insurance
policiesprovide.
11. Professional liability insurancepolicies:Pastorsand licensedcounselorsmayhave
their own professional liability insurance policies. Coverage usually includes
protectionfromclaimsmadeagainstthemandtheirprofessionalcounselingduties
forwhichtheyarelicensed,certifiedortrained.Theyshouldcomparethecoverage
offered in their professional liability policies with the coverage included in the
church’sinsurancecoverage.
M. Conclusion
1. Anyministryatyourchurchinvolvessomedegreeofrisks.
2. Taking precautions to prevent liability exposure should be a part of the strategic
ministryplanningofeverychurchandministryorganization.
3. What action is your church taking to reduce the risks of liability in the counseling
ministry?
4. Whatelsecouldyourchurchbedoing?
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5. Taking the time to develop and implement a risk management policy for lay
counseling and all spiritual care ministries is an important act of service and
stewardship.
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ERM102:
DualandMultipleRelationshipsforCounselors
LoisDodds,Ph.D.
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AbstractForcounselors,understandingtheroleofdualrelationshipsiscritical.AsaChristian,thecallto
loveimploresthequestionofhowtoenterintoameaningfulrelationshipwithaclientwithout
crossingethicalboundaries.ThissessionexplorestheroleofthecounseloraspartoftheBody
ofChristandhisorherdutytobeinrelationshipwithclientswhilemaintaininganadherenceto
currentethicalstandards.
LearningObjectives
1. Participantswilllookatcurrentethicalstandardsrelatedtodualrelationships.
2. ParticipantswillinvestigatetheprimaryroleofacounselorasindicatedbyScripture.
3. ParticipantswillbeabletounderstandtheimportanceoftheBodyofChrist.
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I. Introduction
A. DualRelationships
1. BeingapartofacommunityisofhighvalueinaChristiancommunityoffaith.
2. Yousimplycannotisolateyourselffromthepeoplewhoyouserve.
• Ifyoudo,itreducestrust.Itcannotactuallydoharminthatsense.
3. Itisalsohardonyouifyouhappentobethecounselorbecausethosearethevery
peoplewhoyouneedforyourinteractionsinthecommunity.
• The larger communitywill really not be your own spiritual or social source of
help.
B. HistoricalPerspective
1. Thewaywepractice,orthewaywehavebeentaughttopracticeinthelastcouple
ofdecades,isanartifactofindustrializationandurbanization.
2. Industrializationandurbanizationhaverobbedpeopleofextendedfamily.
3. Thistrendisseenworldwide.
4. AsChristiancounselors,itistimetolookmorecloselyathowwepractice.
II. TheBodyofChrist
A. Introduction
1. ItisreallythebodyofChristthatshouldbeourfirstallegianceandmodel.
2. Whatdidtheselossesleadto?
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• Family
• Extendedfamily
• Tribe
• Clan
• Subculture
• Church
3. Wheredopeopleturnwhentheyneedhelp?
4. People are always searching for someway to get help and for someonewho can
helpandunderstand.
5. Intothisvacuumhasmovedwhatwecallprofessionalcounseling.
• Therearemanykindsofcounselors,andpeoplehavemanychoices.
6. If we look into Scripture to see what our primarymodel should be, it gives us a
beautifulpicture.
7. We need to figure out ways that we can show to people the love, respect and
couragethatChristwouldshow.
• Jesusmodeledforusawaytorelatetopeople.
• Itappliestousascounselors,anditappliestoeveryrealmofourlives.
• Wewant to impartknowledge,buildup, showempathyand strengthen.Allof
these,whichwewanttodoascounselors,arepartofwhatwedointhebodyof
Christ.
8. Jesusgaveuswhatwewouldcallahigherlaw:thelawoflove.
• Whilewedonotignoreorblotoutwhatisinourcodesofethics,wedowantto
lookcarefullyatwhattheyimply.
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• GodHimselfislove.TheTrinityisrelationship.
“Greaterlovehasnoonethanthis,thatonelaydownhislifeforhisfriends.”—John
15:13
9. Hecallsustolaydownourlivesforeachother.
“ThisisMycommandment,thatyouloveoneanother,justasIhavelovedyou.”
—John15:12
10. Ourfirstcallingisthelawoflove.
“Owenothingtoanyoneexceptto loveoneanother; forhewholoveshisneighbor
hasfulfilledthelaw.”—Romans13:8
11. If this is our first calling, then our practice needs to bewrapped in thismodel of
Jesus.
• Jesusrelatedtopeopleinmanyways.
B. WhatKindofLove?
“JustastheFatherhaslovedMe,Ihavealsolovedyou;abideinMylove.”
—John15:9
1. WearethechildrenofGod.
2. Loveisthegreatesthealer.
• Whatwepracticeincounselingarewaystomakethisloverealforpeople.
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C. Practice
1. Learntopracticethelawoflove.
2. Makethisadailyhabit.
3. InallofourinteractionswearetopracticetheloveofGod.
4. Wearetolivelivesworthyofourcalling.
• OurcallingistomakeGodvisible.Wedothatthroughourprofessionalrolesand
throughallofourrelationships.
• WearetobeimitatorsofGodasdearlylovedchildren.
D. Scriptures
1. ThelawofloveincludesmanyScripturesthathavetodowithoneanother.
2. AswethinkaboutbeingoneanotherinChristinourrelationshipsascounselors, it
includesmanythings:
• Thereisnohierarchy.Tobeagenuinepersonwhoistransparentandopen,does
not require any hierarchy. We are all considered to be of equal value. That
attitudeshouldpermeateourprofessionalrelationshipswiththosewecarefor.
Wecanhelppeoplebyrelatingtothemattheirlevel.
• WeareonebodyinChrist.Weareallneeded.Welookateachotherasequals.
Every person has a gift and brings it into the community. We may have a
specialized function, but we still participate as members of one body in
community.
3. Onefactorthatinfluencestoday’scodeofethicsisthematterofpeoplewhoviolate
barriersorboundaries.
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4. Incommunityweactuallyhavegreateraccountability.
• Rethinkwhatprovidesthebestaccountability.
5. Manycodesofethicshavebeenwrittenbecausesomebodyviolatedaboundaryof
somekind.
• Topreventthat,thevariouscodesofethicsbecamestricterandstricter.
6. Wehavemuchgreateraccountabilitywhenwearerelatingtogetherinacommunity
offaith.
E. Community
1. Whatiscommunity?
2. Communityisshared,voluntaryexperienceinwhichwecommitourselvestoagoal
andapurpose.
3. Wesharevalues.
4. Whenweareincommunity,wearenotlivinginisolation.
5. Community places particular values on the individual. Community implies
interpersonalrelationships.
6. Incommunity,westriveforimmediacyandopenness.Wequicklylearntotalkthings
overwitheachother.
7. Wehavetrustandaccountability.
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• InthebodyofChrist,thisistheforemostvenueinwhichwecanworkouthow
togrowup.
8. Incommunity,wealsohaveanappropriatedefinitionofboundaries.
9. Partofourroleincommunityistomodelhealthyliving.
• If we are isolated from community, then we are not going to be the kind of
modelthatGodcallsustobe.
10. Wehaveacceptance,affirmationandaplaceofbelonging.
• Thisisabsolutelycrucialforsomeonetogrowintoahealthyperson.Theyhave
tohaveawayofbelonging.
11. Incommunitywehavemutualityandreciprocity.
“Fathers,donotprovokeyourchildrentoanger,butbringthemupinthediscipline
andinstructionoftheLord.”—Ephesians6:4
12. Nurtureisawordthatisalmostlostinourculture.
• Nurtureisemotionalfood.
13. Wevaluediversityanduniqueness.
14. WearetomodeltheunityoftheTrinitywhenweareintheBodyofChrist.
15. Wearecreatedforgrowth.
• Communityistheoptimalplaceforgrowth.
16. WearecreatedintheimageofGod.
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• Ifwewanttogrowascounselors,wemustbeintheBodyofChristourselves.
17. Lovingcommunitybringshealing.
18. Thebasisforourworshipandserviceisspiritual.
19. Godgivesusdivineresources.
• Wecannotaskpeopletoliveadivinelifewithnaturalpower.
• Ifwearegoing to teachpeople to livegodly lives,offer themdivine resources
(i.e.,theBible,HisSpirit,HisWordwithinus,songs,etc.).
20. Wehavetofightevil.
21. Whenwepracticethisway,wearestrengthenedandallthosewhowecomfortand
counselwillalsobestrengthened.
• WhenweloveeachotherincommunityandinthebodyofChristitchangeswho
weareandwhatwehavetogivetoeachother.
22. WepracticetheknowledgeofGod.
23. Whenwelovepeople,weareincreasingwhatwecallthetherapeuticbenefit.
• Afteraperson’sdecision tochange, themost important thing thatweoffer in
counselingistherelationshipwiththeperson.
• Hisorherdesiretochangeandourabilitytorelatearethingsthatwehaveto
givetoeachother.
• YoucanalignyourselfwiththatpersonthroughtheloveofGod.
• Youalsomodel throughyour interactionwiththatpersonwhat itmeanstobe
healthyandhowtogrow.
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24. Wealsocanbringauniqueperspectiveintowhatevercontextorvenuewearein.
• Our humanness is such a powerful bond that many things in culture are less
important.
• ThebondofChrististhemostbeautifulandpowerfulthingthatwegivetoeach
other.
III. TheChallenge,EthicsandConclusion
A. TheSecular
1. Whatisthechallengethatwefaceifwearecounselorsinasecularsettingyetalso
inthebodyofChrist?
2. Wehavetosortoutthedissonancebetweencodesofethicsanddualrelationships.
• Wheredoesmyallegiancelie?
• Whatismyfirstmodel?
• HowcanIasaChristianbetotallyprofessionalandalsoahumanpersonwhois
abletolovetheotherperson?
3. AscounselorsintheBodyofChrist,wehavemanychallenges.
• Oneofthemistomaintainourownhealth.
• Ifwewithholdfromcommunity,thenitisgoingtobehardtokeepgoodhealth
becauseweneedeachother.
B. EightCodesofEthics
1. The term reasonable means the prevailing judgment of psychologists involved in
similaractivitiesandcircumstances.1
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• Psychologists may consider other materials and guidelines that have been
adoptedorendorsedbyscientificandprofessionalorganizationsaswellas the
dictatesoftheirownconscious.
2. Multiplerelationshipsthatwouldnotreasonablybeexpectedtocauseimpairment
orriskexploitationorharmarenotunethical.2
• Psychological protection and respect of civil and human rights is the central
importance of freedom of inquiry and expression in research, teaching and
publication.3
• Aphysicianshallrecognizearesponsibilitytoparticipateinactivitiescontributing
totheimprovementofacommunityandthebettermentofpublichealth.4
• Thephysicianshallnotbepartytoanytypeofpolicythatexcludes,segregatesor
demeansthedignityofanypatients.5
3. In addition to clients, the pastoral counselor interacts with other professionals,
studentsandemployers.Heorshemustconductalloftheserelationshipswithhigh
ethicalstandardsandneverexploitthepositionofauthorityortheinfluenceheor
sheholds.Thismeansnevertakingadvantageofanotherinanyway.6
4. Instead of banning dual relationships across the board, the recent revision of the
ethicalcodenowallowsprofessionalcounselorstointeractwithclientsoutsideofa
counselingsessionundercertaincircumstances.7
• Counselorsmaynowinteractwithaclientinanonprofessionalactivityaslongas
theinteractionispotentiallybeneficial.
• Focusingonassessingbeneficialversusharmfulinteractionsallowsthecounselor
toreallypartnerwiththeclient.
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5. Dual relationships that might impair the certified counselor’s objectivity and
professional judgment must be avoided and/or the counseling relationship
terminatedthroughreferraltoanotherprofessional.8
6. Somedualrelationshipsarenotunethical.Itiswrongwhenitisexploited.Basedon
an absolute application that harms membership bonds in the body of Christ, we
oppose the ethical legal view that all dual relationships are harmful. Some dual
relationshipsareworthwhileanddefensible.9
7. Therapistsareawareof their influentialpositionswith respect toclients,and they
avoid exploiting the trust and dependency of such persons. Therapists therefore
make every effort to avoid conditions andmultiple relationshipswith clients that
couldimpairthem,theirjudgmentorincreaserisks.10
8. TheNationalAssociationofSocialWorkers11:
• Principlesofsocialjustice
• Dignityandworthofpersons
• Importanceofhumanrelationships
• Integrity
• Culturalcompetency
• Socialdiversity
C. Conclusion
1. Howshouldwepracticegiventhesecodesofethics?
2. WearefirstofallpersonscreatedbyChristinhisimagetoserveoneanother.
• Ourprofessionalfulfillmentisaddedontothat.Itshouldnevertakeprecedence
overit.
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3. Godusesallofourgiftsandtalentstoserveothers.
4. WecanenjoymutualrelationshipsinthebodyofChristbecausetheyarenotabout
hierarchy,buttheyarereallyaboutbeingpersonstogether.
“Beyondallthesethingsputonlove,whichistheperfectbondofunit.”—Colossians
3:14
5. Aboveallelse,putonloveineveryrelationship.
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Endnotes1“EthicalPrinciplesofPsychologistsandCodeofConduct,”AmericanPsychologicalAssociation,accessedApril8,2014,www.apa.org/ethics/code/principles.pdf.2“MultipleRelationshipsandAPA’sNewEthicsCode:ValuesandApplications,”AmericanPsychologicalAssociation,accessedApril8,2014,www.apa.org/monitor/jan04/ethics.aspx.3“EthicalPrinciplesofPsychologistsandCodeofConduct,”AmericanPsychologicalAssociation,accessedApril8,2014,www.apa.org/ethics/code/code-1992.aspx.4“E-PrinciplesofMedicalEthics,”AmericanMedicalAssociation,accessedApril8,2014,www.utcourts.gov/resources/attorney/Convenience_Brief/American_Medical_Record_83-85.pdf.5AmericanPsychiatricAssociation,EthicsPrimeroftheAmericanPsychiatricAssociation(Arlington,Virginia:AmericanPsychiatricPublishing,2001).6“CodeofEthics,”AmericanAssociationofPastoralCounselors,accessedApril8,2014,www.aapc.org/policies/code-of-ethics/.7“AllowingDualRelationships,”AmericanCounselingAssociation,accessedApril8,2014,www.ct.counseling.org/2006/03/ct-online-ethics-update-9/.8“CodeofEthics,”NationalBoardofCertifiedCounselors,accessedApril8,2014,www.c.ymcdn.com/sites/www.flacounseling.org/resource/resmgr/imported/nbcc-codeofethics.pdf.9“AACCCodeofEthics,”AmericanAssociationofChristianCounselors,accessedApril8,2014,www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CCgQFjAA&url=http%3A%2F%2Faacc.net%2Fwp-images%2Ffammed%2Faacc_code_of_ethics.doc&ei=9T1EU5QZ6tGxBPvwgcgP&usg=AFQjCNFby-fRXzXpE8iwD3JL5eBEZStedQ&bvm=bv.64367178,d.cWc.10“CodeofEthics,”AmericanAssociationforMarriageandFamilyTherapy,accessedApril8,2014,www.aamft.org/imis15/content/legal_ethics/code_of_ethics.aspx.11“CodeofEthicsoftheNationalAssociationofSocialWorkers,”NationalAssociationofSocialWorkers,accessedApril8,2014,www.socialworkers.org/pubs/code/code.asp.
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AbstractSuicideisofhighconcernamongtheUnitedStates’population.Thissessiongoesoverstatistics,
definitionsandconsiderationsofsuicide.Therearecertainpredictorsofsuicide,butnosingle
predictororassessmentwillalwaysbe indicativeofsuicideorasuicideattemptbecause it is
statistically impossible to predict with 100% accuracy. In addition to implementing suicide
assessments,theprofessionalistheessentialelementofthesuicideriskassessmentprocessas
it:allowsfortheidentificationoffactorsthatincreaseordecreaserisks,addressesthepatient’s
immediate safety and develops a multiaxial diagnosis. At the conclusion of the session, the
presenter addresses interview questions for suicide risk assessment alongwith detailing the
importanceofdocumentation.
LearningObjectives
1. Participantswilloverviewsuicidestatistics.
2. Participantswilllearnpracticalapplicationsofriskassessments.
3. Participantswilllearntheimportanceofaprofessionalinterviewandevaluation.
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I. Introduction
A. Statistics
1. 1.3%ofalldeathsarefromsuicideintheUnitedStates.1
2. Onesuicideoccursevery16-17minutes.2
3. In2007,itwasthe11thleadingcauseofdeathforallAmericans.3
4. Thereare30,000suicideseveryyearintheUnitedStates.4
5. Suicidalideationisexperiencedbyatleast4%ofthegeneralpopulation.
6. 5-6%ofsuicidesoccurduringhospitalizations.
• 25%hadbeenadmittedtothehospitalduetoasuicideattempt
• 39%hadbeenadmittedforhavingsuicidalideations
• 78%deniedanysuicidalideationattheirlastcommunication
• 51%wereon15-minutechecks
• 54%diditinthebathroom
• 76%hungthemselves
B. Considerations
1. Evenpeoplewhoareseekingtreatmentafterasuicideattemptarestillabletofind
waystocommitsuicide.
2. Therefore, the problem is that we need to find a way to avert some of these
suicides.
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3. The better our assessments can be, the better our evaluations can be of these
patients.
C. APADefinitions
1. Suicide:aself-inflicteddeathwithevidencethatthepersonintendedtodie.
2. Suicide attempt: self-injurious behavior with a nonfatal outcome, usually
accompaniedbysomeevidencethatthepersonintendedtodie.
3. Aborted suicide attempt: the potential or potentially self-injurious behavior with
evidencethatthepersonintendedtodie,butstoppedtheattemptbeforeheorshe
wassuccessful.
4. Suicidalideation:thoughtsofservingastheagentofone’sowndeath.
5. Lethality of suicidal behavior: the objective danger to life associated with the
suicidalmethod.
6. Self-harm:thewillfulself-inflictingofapainful,destructiveorinjuriousactwithout
theintenttodie.
D. Predictors
1. Studies have recently shown us that white males over the age of 65 are at the
highestriskforsuicide.
• Amongblackmales,thesuicideriskpeaksbetweentheagesof35-45.
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2. Suicideisuncommoninchildren.Suicideratesjumpupinteenageyears,andthose
rateshaveincreasedeachyearsincethe1950s.
3. Havingevidenceofapsychiatricdiagnosisisagoodindicatorofsuicidepotential.
• Thehighestratesareamongpeoplewitheatingdisorders(38.4%).
• Thesuicidemortalityrateamongthosewithdepressionis23.1%.
• Consider people withmixed drug abuse, bipolar disorder, dysthymic disorder,
obsessive-compulsivedisorderandpanicdisorder.
• Whenyougettoschizophreniaandotherpersonalitydisorders,theratesdrop.
• Alcohol abuse has a comparatively lower rate of suicide as compared to
depression.
4. Amongthegeneralpopulation,thesuiciderateisonly0.1%(10.7per100,000)since
1990.5
5. Amongdepressedpeople,thesuicideratesare106per1000,000.
6. If you add in a family history of suicide and depression, it increases 15-25 times
higherthannormalratesamongthegeneralpopulation.
7. The higher predictors of suicide among depressed patients would include people
whohaveanintensesenseofhopelessness.
8. Peopleatriskforsuicidealsohavealossofcapacitytoreacttopositiveevents.
9. Moodcyclingisalsoaprettygoodindicator.
10. Therecanalsobeunusualpsychoticthinking.
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11. Whenpeoplearedepressed,theyexperienceturmoil(agitation,pacing,etc.).
12. Therearealsosomeweakerpredictors.
• Alcoholandsubstanceabuse
• Thelossofrolefunction
• Greatdissatisfactionwithlife
• Notlivingwithachildwhoislessthan18yearsold
• Sociallywithdrawn
13. Poorindicators:
• Suicidalideation
• Apriorsuicideattempt
• Medicalseverity
• Hospitalizationforattemptedsuicide
Ø 69% of patients hospitalized for a suicide attempt said that they were
depressed.
Ø 50%hadahistoryofnopriorattempts.
Ø Amongpatientswhocommitted suicidewhilehospitalized,only41% of
themwereexperiencingaformofpsychosis.
Ø 9% of those who commit suicide while in the hospital were on 1 to 1
checks.
14. High risks for suicide among thosewith a history ofmental illnesses (i.e., bipolar
disorder,depression,dysthymicdisorder,schizophrenia,etc.)arepeoplewhohave
globalinsomnia,anintensesenseofhopelessnessandimpulsivity.
15. Among patients that have been successful at committing suicide, there usually is
somerecentalcoholordrugabuse.
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16. Whenan individual firstenters treatmentandends treatment,heor she is at the
highestriskforsuicide.
17. Somepatientschronicallyhavesuicidalthoughtsandfrequentlyattemptsuicide.
• These are some of the most difficult people to deal with because they are
constantlytryingtoescapefromsomesevereemotionalpain.
• Takeitseriously,buttrytoassesstherisks.
18. Thereisanincreasedriskforsuicideifyoufindthatthepatienthashadanearlethal
orsevereattemptinthepast,isimpulsiveorhasexperiencedincest/sexualabuse.
19. Peoplewhohaveahistoryofabortedattemptsoraworseningmood,addictionor
anxietydisorderareatgreaterrisk.
20. Apersonwithanewemotionalturbulenceinhisorherlifeisalsoanindicatorthat
oneneedstobecomeawareof.
21. Frequentintensethoughtsofsuicidemaybethebestpredictorofsuicide,but75%
ofthosepatientsdenyorminimizetheriskfromthosethoughts.
II. SuicideAssessment
A. Overview
1. Noscale,testorquestionnaireisenough.Weneedtodomorethanthat.
2. Newresearchtellsusthatthedenialofsuicidalideationisnotenough.
• Weneedtoverifyotherissuesrelatedtothepatient.
• Justthemsayingthattheyarenotsuicidalisnotenough.
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B. Goals
1. Weneedtobeabletosetrealisticgoalswhenitcomestosuicideriskassessment.
2. Itisstatisticallyimpossibletopredictsuicide.
3. We can gather enough information so that we can somehow categorize an
individual’srelativerisk.
C. HighRiskAlarms
1. Arecentsuicideattempt,particularlywithafirearmandanolderperson(overthe
ageof65),shouldbearedflag.
2. Accesstoafirearm:Anytimeapersonisthinkingaboutsuicide,youneedtoaskif
theyhaveaccesstofirearms.
• Doyouhavetheabilitytolockit?
• Whohasthecombination?
• Whohasthekey?
• Canyourfamilyremovethegunsandkeepthemtemporarily?
3. Thepresenceofasuicidenote:Ifsomeonehasgonethroughthetroubleofwriting
anote,thenthisissomethingyouneedtotakeextremelyseriously.
D. Factors
1. Considerbiologicalfactors.
• Familyriskfactors
• Demographics
• Pathology
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2. Lookatpredisposingfactors.
• Substanceabuse
• Difficultpersonalities
• Severeneurologicalproblems
3. Proximalfactors:
• Senseofhopelessness
• Intoxication
• Impulsivity
• Aggressiveness
• Negativeexpectancyfortreatment
• Severchronicpain
4. Immediatetriggers:
• Publichumiliationorshame
• Recentdefeat
• Majorlosses
• Worseningprognosis
E. Remember
1. Everypatientisanindividual,andeverystoryisuniqueanddifferent.
2. Thereisnotoneassessmentthatisgoingtopredicteverythingforthesepeople.
3. However,thereareriskassessmentsouttherethatarebeneficialtouse.
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F. RiskAssessment
1. Atypicalsuicideriskassessmentmightaskquestionslike:
• “Haveyoueverattemptedsuicidebefore?”
• “Areyoufeelinghopelessandhelplesstoday?”
2. Somesuicideriskassessmentsmighthavescalesonthem.
• “Onascaleof1to10,howwouldyourankyourchronicpain?”
• “Onascaleof1to10,areyoufeelingsuicidaltoday?”
3. Overtheyears,manyorganizationshavedevelopedtheirownuniquescales.
4. Ingeneral,suicideriskassessmentscaleshaverelativelylowpredictivevalue.
• They can, however, be a means for opening communication and testing the
sincerityandambivalenceofthepatient.
5. Thescorethatisproducedbythisscalemighthavevalidityintermsofclinicaldata
andstatisticalwork,butoveralltheuseofanassessmentscalealoneisabadidea.
6. Froma legalperspective,most courts considerassessmentsas tools,but theyare
nottheonlytools.
7. APA:“Ariskassessmentscalemaybeusedasaidstosuicideassessment,butshould
not be used as predictive instruments or as a substitute for a thorough clinical
evaluation.”
G. ScreeningTools
1. The Brief Symptom Inventory (BSI): It was formerly known as the Symptom
Checklist90.
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2. ThereisalsoatoolcalledtheBehavioralHealthMonitor.
3. TheOutcomeQuestionnaire45.2
4. ThemosteffectivetoolistheSuicideStatusFormIII(SSF-III).
5. Thebestriskassessmentisnotascale.Itisaprofessionalinterview.
H. TheProfessionalInterview
1. Theprofessionalevaluation istheessentialelementofthesuicideriskassessment
process.
2. Itallowsfortheidentificationoffactorsthatincreaseordecreaserisks.
3. Itaddressesthepatient’simmediatesafety.
4. Itdevelopsamultiaxialdiagnosis.
I. StrategiesforInterviews
1. Helpthepatientchronologizethediscussion.
• “Helpmeunderstandwhathashappenedtoyourecently.”
• “Walkmethrougheverystepofthelasttwodays.”
• “Whenpeopleareveryupsetthey_____________________.”
• “Describedyourthoughts.”
• “Whatareyouthinkingmostseriouslyabout?”
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2. Seekcollaborationwheneverthereisapotentialsuiciderisk.
• Asktheirfamily.
3. Normalizeanduseoverstatement.
• “Whensomeone isdepressedand feels veryupset, it isnormal to thinkabout
suicideorharmingoneself.”
4. Askthemchallengingorprohibitivequestionslike:
• “Youwillhavetopersuademethatyoudon’twanttodoit.”
• “Whatwouldittaketoleadyoutowanttoescapefromthisworld?”
• “Whatthingswouldhelpyoutogoonliving?”
5. Itisalsoimportantforyoutoconsiderhowimpulsivethepatientis.
• “Haveyoustartedtoactonasuicideplanbutstoppedbeforeyoudidanything?”
• “Howeasyisitforyoutoobtainafirearm?”
6. Itisalsoimportanttoaskquestionsaboutpastattempts.
• “Whatwasyourmostseriouspastsuicideattempt?”
• “Describe your thoughts at the time that you most seriously thought about
suicide.”
7. Otherimportantthingstocollect:
• Isthereasuicideplanandwhatisit?
• Hastherebeenanythingdonetoprepare(suicidalpreparation)?
• Hastherebeenanyrehearsal(suicidalrehearsal)?
• Lookatthehistoryofsuicide.
• Lookattheircurrentintent.
• Lookattheirimpulsivity,substanceabuse,significantlossfactorsandiftheyare
havinganyinterpersonalisolationandrelationshipproblems.
• Lookathealthproblems(chronicpain),legalproblemsandshame.
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8. Alwaysfindoutwhatyouragencyandstate’spoliciesare,relatedtohospitalization.
9. Itisimportantthatwealsolookatthenosuicidecontract.
• Inthepastthiswasconsideredaveryvalidthing.
• Ifyouaregoingtodoasuicideriskcontract,makesuretogetitinwriting,have
thepatientsignitandletitbeinhisorherownwords.
10. Whenyougetreadytodischargeorreleaseapatient,considerthefollowing:
• Haveyouseenimprovementintheriskfactorsthatyouhaveidentifiedandwere
reportedtoyou?
• Whathaschangedinthisperson’slifethatmakeshimorhernowwanttolive?
• Whatisgoingtobedifferentwhentheygohome?
• Isthispersonawillingpartnerinchanging?
• Howrealisticistheirsafetyplan?
• Dothetherapeuticexpectationsmatchthepatient’sskillsandabilities?
11. Guidelinesfordocumentation:
• Documentthereasonfortheassessment.
• Always talk about the strategies and procedures that you are using in your
assessment.
• Talkabout the factors thatpertain to the risksand identify those risks in your
assessment.
• Useclinical reasoningand judgmentsaspartofyourdocumentationas towhy
youcametothatconclusionaboutthepatient.
• Talkaboutprotections,treatmentsandrecommendations.
• Cover yourself by talking about alternatives that thepatient had andwhy you
chosetoleadthepatienttoaparticularalternative.
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12. The first rule of risk management is to carefully document your work and your
thinking. If the outcome is adverse, then there needs to be some clear rational
reasoningtowhatyoudid.
• Whatweretheexpectedbenefitstowhatyourecommended?
13. Ifyourdocumentationreflectsthatyoudideverythingthatyoupossiblycould,then
youareinabetterposition.
“Suicideispreparedwithintheabsenceoftheheartasagreatworkofart.”—Albert
Camus
14. Everysuicidehasitsownstory.
15. When the risk is the highest, that is the time when the patients are the most
secretiveabouttheirtrueintentions.
16. It is our job as clinicians to identify situations when patients are most likely to
developsuicidalideationandtakewhatevernecessarystepswecantoalleviatethat.
17. Once the story is known, the appropriate interventions must be administered to
preventthepatientfromeverwritinghisorherlastchapter.
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Endnotes1“SuicideStatistics,”Suicide.org,accessedApril17,2014,www.suicide.org/suicide-statistics.html.2Ibid.3“Suicides—UnitedStates,1999-2007,”CenterforDiseaseControlandPrevention,accessedApril17,2014,www.cdc.gov/mmwr/preview/mmwrhtml/su6001a11.htm.4“SuicideFacts,”SuicideAwarenessVoicesofEducation,accessedApril17,2014,www.save.org/index.cfm?fuseaction=home.viewPage&page_id=705D5DF4-055B-F1EC-3F66462866FCB4E6.5“SuicideRatesforAllAges,2010,”AmericanAssociationofSuicidology,accessedApril17,2014,www.suicidology.org/c/document_library/get_file?folderId=248&name=DLFE-800.pdf.
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Copyright2014LightUniversity
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