Coordination Of Client Care During Therapist’s Absence

Earlier this year, I was hanging out on one of the discussion boards for mental health professionals on LinkedIn when I ran across a conversation about after hours emergency coverage. I was particularly impressed with how one Licensed Clinical Social Worker in New Jersey, Beth Answorth, addresses these situations with her clients and the clinicians who cover for her in her absence so I reached out to her back channel to learn more.

As part of Beth’s initial effort to provide informed consent to treatment, she includes the following information in her disclosure statement.

EMERGENCY COVERAGE:  My office is equipped with an answering machine, which I frequently check throughout the day and evening for updated messages.  I will make every reasonable attempt to respond to all messages within the same day, but it may be up to 24 hours before I return your call.

If you are in a “mental health emergency,” in which you are in need of an immediate therapeutic response, please contact the Anytown Memorial Psychiatric Hotline, at 123-45-9111.  Inform the responding clinician of your immediate mental health needs, and follow their responses.  Please inform the emergency clinician of your current status as a client enrolled in treatment with me, and sign any consents provided so that I may receive information regarding any emergency assessments &/or treatment recommendations.

When I am not available for more than 48 hours, I will provide a “covering clinician,” who will be available to respond to your emergency needs, either by telephone or with a face-to-face session.  The clinician will be provided with your first name and very basic potential clinical emergency information, so that he/she may appropriately and sensitively assist you in my absence.  This information will be discussed with you prior to my absence.  Upon my return, the “covering clinician” will inform me of any contacts (telephone or face-to-face session), and will then destroy any materials &/or information obtained in my absence.  Any fees which may be charged by the covering clinician will also be discussed with you in advance.”

Beth notes that during the initial intake with a new client, she spends a significant amount of time reviewing her disclosure statement including this section on coverage for after-hours emergencies.

Once treatment begins, when she believes a client is “at risk” for significant decompensation, Beth and her client together create a Coordination of Client Care Index Card** that includes the following information:

• Client’s first name,
• Client’s telephone number,
• Limited background information, and
• What the client may benefit from in an emergency coverage situation.**

This information is passed along to the therapist who is providing clinical coverage for Beth. Upon Beth’s return, the covering clinician simply returns the “card” to Beth where it is shredded during the client’s next session.

Beth says that she has had a few clients utilize an emergency telephone call to covering clinicians over the years and has consistently received positive feedback in terms of the “helpfulness” in preparing these cards.

The clients who used this system felt that they didn’t need to go into their entire treatment history and that the clinician’s telephone support was targeted and supportive . . . . My experience is that this system is empowering and comforting to the client, while I am on vacation.”

Beth has developed a thoughtful system for emergencies that demonstrates care for her client’s safety and comfort and also for her own ethical responsibilities, risk management, and personal comfort.  And, as either a client or a “covering” therapist, I would love to know that this kind of thoughtful planning and preparation takes place for coordination of every client’s care.

Beth has specifically asked for feedback on her emergency care system described here.  Please take a moment to share your thoughts with her by commenting below. And, if you use a similar or different system to ensure that your clients are taken care of in your temporary absence, let us know what you do so that we can learn from you, too!

[**You can download a PDF example of Beth’s emergency care system’s index card right here.]