CHAPTER 48. STATE BOARD OF SOCIAL WORKERS, MARRIAGE
AND FAMILY THERAPISTS AND PROFESSIONAL COUNSELORS—
LICENSURE OF MARRIAGE AND FAMILY THERAPISTS

§ 48.1. Definitions.

 The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:

   AAMFT—The American Association for Marriage and Family Therapy.

   AMFTRB—The Association of Marital and Family Therapy Regulatory Boards.

   Accredited educational institution—A graduate school which is recognized as an institution of higher education or which is accredited by a regional accrediting association recognized by the Council for Higher Education Accreditation.

   Act—The Social Workers, Marriage and Family Therapists and Professional Counselors Act (63 P. S. § §  1901—1922).

   Board—The State Board of Social Workers, Marriage and Family Therapists and Professional Counselors.

   COAMFTE—The Commission on Accreditation for Marriage and Family Therapy Education.

   Client/patient—An individual, group or family for whom a licensed marriage and family therapist provides marriage and family therapy services. In the case of an individual with a legal guardian, such as a minor or legally incapacitated adult, the individual is the client/patient.

   Doctoral degree in marriage and family therapy—A doctoral degree which is awarded upon successful completion of a program in marriage and family therapy which is either accredited by COAMFTE, or, which includes coursework that meets the criteria in §  48.2 (relating to educational requirements).

   Field closely related to the practice of marriage and family therapy— Includes the fields of social work, psychology, counseling, child development and family studies, medicine, nursing, pastoral counseling, ministry, theology, education and sociology.

   Graduate level coursework in marriage and family therapy acceptable to the Board—Coursework that meets the criteria in §  48.2.

   Immediate family member—A parent/guardian, child, sibling, spouse or other family member with whom the client/patient resides.

   Institution of higher education—An independent institution of higher education, a community college, a State-related institution or a member institution of the State System. (See 22 Pa. Code §  33.102 (relating to definitions)).

   Master’s degree in marriage and family therapy—A master’s degree which is awarded upon successful completion of a program in marriage and family therapy which is either accredited by COAMFTE, or, which includes coursework that meets the criteria in §  48.2.

   MFT—Marriage and family therapist.

   Planned program of 60 semester hours or 90 quarter hours which is closely related to marriage and family therapy—A program which includes coursework that meets the criteria in §  48.2.

   Professional relationship—A therapeutic relationship which is deemed to exist for the period of time beginning with the first professional contact or consultation between a licensed marriage and family therapist and a client/patient and continuing thereafter until the last date of a professional service. If a licensed marriage and family therapist sees a client/patient on an intermittent basis, the professional relationship is deemed to start anew on each date that the licensed marriage and family therapist provides a professional service to the client/patient.

   Program recognized by a National accrediting agency—A master, doctor or postgraduate degree training program accredited by COAMFTE.

   Related field—Includes the fields of psychiatry, psychology, social work, counseling, art therapy, dance/movement therapy, drama therapy, music therapy, human services and counseling education.

   Sexual intimacies—Romantic, sexually suggestive, sexually demeaning or erotic behavior. Examples of this behavior include the following:

     (i)   Sexual intercourse, or any touching of the sexual or intimate parts of the person for the purpose of arousing or gratifying sexual desire in either person.

     (ii)   Nontherapeutic verbal communication or inappropriate nonverbal communication of a sexual or romantic nature.

     (iii)   Sexual invitations.

     (iv)   Soliciting or accepting a date from a client/patient.

     (v)   Masturbating in the presence of a client/patient or encouraging a client/patient to masturbate in the presence of the licensed marriage and family therapist.

     (vi)   Indecent exposure, kissing, hugging, touching, physical contact or self-disclosure of a sexual or erotic nature.

   Supervisee—An individual who is fulfilling the supervised experience requirement for licensure.

   Supervision—The act of overseeing, directing or instructing the activity or course of action of another.

   Supervisor—An individual providing supervision to a supervisee who meets the criteria in §  48.3 (relating to qualifications for supervisors).

   The provisions of this §  48.1 amended August 11, 2006, effective August 12, 2006, 36 Pa.B. 4469. Immediately preceding text appears at serial pages (294169) to (294170).

 Educational requirements are as follows:

 (1) Human development (3 courses minimum-9 semester or 12 quarter or 135 didactic contact hours).

     (i)   Courses in this area shall provide knowledge of individual personality development and its normal and abnormal manifestations.

     (ii)   Coursework shall cover human development across the life span, including special issues that affect an individual’s development (that is, culture, gender and human sexuality).

   (2)  Marriage and family studies (3 courses minimum-9 semester or 12 quarter or 135 didactic contact hours). Courses in this area shall be a fundamental introduction to family systems theory.

   (3)  Marriage and family therapy (3 courses minimum-9 semester or 12 quarter or 135 didactic contact hours).

     (i)   Courses in this area shall have a major focus on family systems theory and systemic therapeutic interventions.

     (ii)   This area shall provide a substantive understanding of the major theories of systems change and the applied practices evolving from each theoretical orientation.

   (4)  Professional studies (1 course minimum-3 semester or 4 quarter or 45 didactic contact hours).

     (i)   Courses in this area shall contribute to the professional development of the therapist.

     (ii)   Areas of study shall include the therapist’s legal responsibilities and liabilities, professional ethics as a marriage and family therapist, professional socialization, and the role of the professional organization, licensure or certification legislation, independent practice and interprofessional cooperation.

   (5)  Research (1 course minimum-3 semester or 4 quarter or 45 didactic contact hours). Courses in this area shall assist students in understanding and performing research.

   (6)  Practicum (minimum 1 year, 300 hours of supervised direct client contact with individuals, couples and families).

 To qualify as a supervisor, an individual shall meet one of the following criteria:

   (1)  Hold a license as an MFT and have received certification as an approved supervisor or supervisor-in-training by the AAMFT.

   (2)  Hold a license and have at least a master’s degree in a related field, and have 5 years experience within the last 10 years in that field.

   (3)  Until January 1, 2010, meet the following criteria:

     (i)   Practices as an MFT.

     (ii)   Have completed a 1-semester graduate course in MFT supervision (at least 30 contact hours) or the equivalent.

     (iii)   Have 5 years experience within the last 10 years as an MFT.

 Sections 47.2—47.4 (relating to applicability of general rules; meetings of the board; and licensure fees) apply to this chapter.

   The provisions of this §  48.4 adopted November 29, 2002, effective November 30, 2002, 32 Pa.B. 5885; corrected December 6, 2002, effective November 30, 2002, 32 Pa.B. 5957.

LICENSURE

§ 48.11. Licensure examination.

 (a)  The examination required as a prerequisite to being granted a license to hold oneself out as a licensed MFT is the AMFTRB National MFT Examination. It will be given annually and at other times deemed appropriate by the Board, in consultation with the third-party testing organization providing the examination to license applicants of the Board.

 (b)  The applicant shall apply to the testing organization for admission to the applicable licensure examination and shall pay the required fee at the direction of the testing organization.

 (c)  The applicant shall be responsible for directing that the testing organization send examination results and other information requested to the Board.

 (d)  The passing grade for the examination will be determined by the Board.

 General qualifications and requirements for applicants for licensure are as follows:

   (1)  The applicant is of good moral character.

   (2)  The applicant has not been convicted of a felony, which shall include a judgment, an admission of guilt or a plea of nolo contendere, under The Controlled Substance, Drug, Device and Cosmetic Act (35 P. S. § §  780-101—780-144), or of an offense under the laws of another jurisdiction, which, if committed in this Commonwealth, would be a felony under The Controlled Substance, Drug, Device and Cosmetic Act, unless the following apply:

     (i)   At least 10 years have elapsed from the date of conviction.

     (ii)   The applicant satisfactorily demonstrates to the Board that the applicant has made significant progress in personal rehabilitation since the conviction, so that licensure of the applicant would not be expected to create a substantial risk of harm to the health and safety of the applicant’s clients or the public or a substantial risk of further criminal violations.

   (3)  The applicant has submitted an application for licensure on forms furnished by the Board. The application for licensure may be obtained by contact-ing the Board by mail at: State Board of Social Workers, Marriage and Family Therapists and Professional Counselors, Post Office Box 2649, Harrisburg, Pennsylvania 17105-2649, (717) 783-1389 or by e-mail at: socialwo@pados.state.pa.us.

   (4)  The applicant has submitted the required application licensure fee by check or money order, payable to the ‘‘Commonwealth of Pennsylvania.’’

   (5)  The applicant has submitted two certificates of recommendation on forms furnished by the Board.

   (6)  The applicant has submitted an affirmation signed by the applicant verifying the information on the application.

 (a)  Conditions for licensure. To be issued a license to hold oneself out as a licensed MFT, an applicant shall provide proof satisfactory to the Board, that the applicant has met the following conditions:

   (1)  Satisfied the general requirements for licensure in §  48.12 (relating to general qualifications for licensure).

   (2)  Passed the examination required by §  48.11 (relating to licensure examination).

   (3)  Successfully met one of the following educational requirements:

     (i)   By March 2, 2007, has completed a planned program of 60 semester hours or 90 quarter hours of graduate coursework which is closely related to marriage and family therapy as defined in §  48.1 (relating to definitions), including one of the following:

       (A)   A master’s degree in marriage and family therapy from an accredited educational institution.

       (B)   A master’s degree in a field closely related to the practice of marriage and family therapy as defined in §  48.1 from an accredited educational institution, with graduate level coursework in marriage and family therapy as defined in §  48.1 and §  48.2 (relating to educational requirements) from an accredited educational institution or from a program recognized by a National accrediting agency as defined in §  48.1.

     (ii)   Successfully completed a planned program of 60 semester hours or 90 quarter hours of graduate coursework which is closely related to marriage and family therapy as defined in §  48.1 including one of the following:

       (A)   A 48 semester hour or 72 quarter hour master’s degree in marriage and family therapy from an accredited educational institution.

       (B)   A 48 semester hour or 72 quarter hour master’s degree in a field closely related to the practice of marriage and family therapy as defined in §  48.1 from an accredited educational institution with graduate level coursework in marriage and family therapy as defined in §  48.1 from an accredited educational institution or from a program recognized by a National accrediting agency as defined in §  48.1.

     (iii)   Holds a doctoral degree in marriage and family therapy as defined in §  48.1 from an accredited educational institution.

     (iv)   Holds a doctoral degree in a field closely related to marriage and family therapy as defined in §  48.1 from an accredited educational institution with graduate level coursework in marriage and family therapy as defined in §  48.1 from an accredited educational institution from a program recognized by a National accrediting agency as defined in §  48.1.

   (4)  Has met the following experience requirements:

     (i)   Individuals who meet the education requirements of paragraph (3)(i) or (ii), shall have completed at least 3 years or 3,600 hours of supervised clinical experience meeting the criteria in subsection (b), obtained after the completion of 48 semester hours or 72 quarter hours of graduate coursework. Supervision for the supervised clinical experience shall be provided by a supervisor as defined in §  48.1.

     (ii)   Individuals who meet the education requirements of paragraph (3)(iii) or (iv) shall have completed at least 2 years or 2,400 hours of supervised clinical experience which meets the criteria in subsection (b), 1 year or 1,200 hours of which was obtained subsequent to the granting of the doctoral degree. Supervision for the supervised clinical experience shall be provided by a supervisor as defined in §  48.1.

 (b)  Supervised clinical experience. Experience acceptable to the Board means experience as a supervisee in a setting that is organized to prepare the applicant for the practice of marriage and family therapy consistent with the applicant’s education and training.

   (1)  At least one-half of the experience shall consist of providing services in one or more of the following areas:

     (i)   Assessment.

     (ii)   Couples therapy.

     (iii)   Family therapy.

     (iv)   Other systems interventions.

     (v)   Consultation.

     (vi)   Individual therapy.

     (vii)   Group therapy.

   (2)  Supervision for the clinical experience shall be provided by a supervisor as defined in §  48.1 and §  48.3 (relating to qualifications for supervisors). However, 1,800 hours shall be supervised by a supervisor meeting the qualifications in §  48.3(1) or (3).

   (3)  A supervisee shall disclose his status as a supervisee to each patient and obtain written permission to discuss the patient’s case with the supervisor.

   (4)  The supervisor shall oversee, direct, recommend and instruct the marriage and family therapy activities of the supervisee.

     (i)   A supervisor who is temporarily unable to provide supervision shall designate another supervisor as a substitute.

     (ii)   Although the supervisor shall continue to bear the ultimate responsibility for supervision, those to whom supervisory responsibilities are delegated shall be individually responsible for activities of the supervisee performed under their supervision.

   (5)  The supervisor, or one to whom supervisory responsibilities have been delegated, shall meet with the supervisee for a minimum of 2 hours for every 40 hours of supervised clinical experience. At least 1 of the 2 hours shall be with the supervisee individually and in person, and 1 of the 2 hours may be with the supervisee in a group setting and in person.

   (6)  A supervisor shall supervise no more than 6 supervisees at the same time. If this paragraph creates an undue hardship on a supervisee, the supervisor and supervisee may request an exception to this paragraph. The request shall state, in writing, the reasons why this paragraph creates a hardship on the supervisee and why the supervisee is not able to obtain a supervisor who meets the requirements of this paragraph. Before making a determination, the Board may require a personal appearance by the supervisee and supervisor.

   (7)  A supervisor who wishes to terminate supervision during the training period shall give the supervisee 2 weeks written notice to enable the supervisee to obtain another qualified supervisor. A supervisor may not terminate supervision when termination would result in abandonment of the supervisee’s client/patients.

   (8)  Supervised work activity will be counted toward satisfying the experience requirement only if it takes place in a single setting for either, first, at least 30 hours per week but no more than 50 hours per week during at least a 3-month period or, second, at least 15 hours per week for at least 6 months.

   (9)  The supervised clinical experience shall be completed in no less than 2 years and no more than 6 years, except that no less than 600 hours and no more than 1,800 hours may be credited in any 12-month period.

 (c)  Supervised clinical experience obtained within 5 years prior to March 2, 2002.

   (1)  For hours of supervised clinical experience obtained within 5 years prior to March 2, 2002, the applicant shall present evidence of having acquired at least one-half of those hours under the supervision of an MFT. The applicant shall also have acquired hours of supervision at a ratio of 2 hours of supervision per 40 hours of supervised clinical experience, one-half of which may be in group supervision and at least one-half of which shall be provided by an MFT.

   (2)  Supervised clinical experience obtained under this subsection is not subject to the requirements of §  48.14 (relating to standards for supervisors).

 Supervisors, and those to whom supervisory responsibilities are delegated, under §  48.13(a)(4) (relating to licensed MFT) shall comply with this section. Supervisors will be asked to attest to compliance on the verification of experience form which shall accompany the supervisee’s application for licensure. The Board reserves the right to require a supervisor by documentation or otherwise to establish to the Board’s satisfaction that compliance occurred.

   (1)  The supervisor shall be qualified by training and experience to practice in the supervisee’s areas of supervised practice.

   (2)  The supervisor may not be a relative of the supervisee by blood or marriage, may not be involved in a dual relationship which obliges the supervisor to the supervisee and may not engage in treatment of the supervisee.

   (3)  An individual whose license has been actively suspended or revoked by a licensing Board will not qualify as a supervisor.

     (i)   If during the period of supervision, the supervisor’s license is suspended or revoked, the supervisor shall immediately notify the supervisee and immediately cease supervision. Credit will be given for hours completed prior to the disciplinary action.

     (ii)   The supervisee shall obtain a new supervisor in order to complete the required experience.

   (4)  The supervisor shall be responsible for ensuring that the requirements of §  48.13(b) are met.

   (5)  The supervisor shall be accessible to the supervisee for consultation.

   (6)  The supervisor shall be empowered to recommend the interruption or termination of the supervisee’s activities in providing services to a client/patient and, if necessary, to terminate the supervisory relationship. Any hours accumulated for activities not approved by the supervisor will not count towards satisfying the 3,600 hours of supervised experience.

   (7)  The supervisor shall ensure that the supervisee’s status as a supervisee is made known to the supervisee’s patients, and also ensure that the supervisee has obtained written permission from each patient to discuss his case with the supervisor.

   (8)  The supervisor shall establish objectives to be achieved by the supervisee during supervision.

   (9)  The supervisor shall review issues of practice and ethics with the supervisee.

   (10)  The supervisor shall maintain notes or records of scheduled supervisory sessions and provide these records to the Board upon request.

   (11)  The supervisor shall observe client/patient sessions of the supervisee or review recordings of these sessions.

   (12)  In supervisory meetings, the supervisor shall discuss the supervisee’s level of work—for example, the supervisee’s areas of competence and areas of needed improvement.

   (13)  The supervisor shall provide the supervisee with recommendations bearing on further professional development, professional study and skills necessary for independent practice.

   (14)  The supervisor shall prepare written evaluations or reports of progress which shall delineate the supervisee’s strengths and weaknesses. These evaluations or reports shall be discussed with the supervisee on at least a quarterly basis.

   (15)  The supervisor shall encourage the supervisee to work with professionals in other disciplines as indicated by the needs of each client/patient and shall periodically observe these cooperative encounters.

   (16)  The supervisor shall encourage the supervisee to access multidisciplinary consultation, as necessary.

 A license will be issued without examination to an applicant who meets the following requirements. The applicant shall have:

   (1)  Satisfied the general requirements for licensure of §  48.12 (relating to general qualifications for licensure).

   (2)  Submitted an application provided by the Board and accompanied by the required fee.

   (3)  Submitted an application by February 19, 2002. (Editor’s Note: The act of February 13, 2002 (P. L. 83, No. 4) extended the deadline for the filing of an application by 1 year.)

   (4)  Demonstrated proof of practice of marriage and family therapy for at least 5 of the 7 years immediately prior to the date of application for license.

   (5)  Have successfully met one of the following education requirements:

     (i)   Have a doctoral degree in marriage and family therapy as defined in §  48.1 (relating to definitions) from an accredited educational institution.

     (ii)   Have a doctoral degree in a field closely related to the practice of marriage and family therapy as defined in §  48.1 from an accredited educational institution with graduate level coursework in marriage and family therapy acceptable to the Board as defined in §  48.1.

     (iii)   Have a master’s degree of at least 48 semester hours or 72 quarter hours in marriage and family therapy as defined in §  48.1 from an accredited educational institution.

     (iv)   Have a master’s degree of at least 48 semester hours or 72 quarter hours in a field closely related to marriage and family therapy as defined in §  48.1 from an accredited educational institution with graduate level course-work in marriage and family therapy acceptable to the Board as defined in §  48.1.

     (v)   Have a master’s degree of less than 48 semester hours or 72 quarter hours but not less than 36 semester hours or 54 quarter hours in marriage and family therapy as defined in §  48.1 from an accredited educational institution and have within the past 10 years completed sufficient continuing education satisfactory to the Board to equal the number of hours needed to achieve a total of 48 semester hours or 72 quarter hours at a ratio of 15 continuing education hours equaling 1 semester hour. Continuing education satisfactory to the Board shall meet the following requirements:

       (A)   Master’s level difficulty.

       (B)   Excludes courses in office management or practice building.

       (C)   Any course which is related to the practice of marriage and family therapy that has been approved for continuing education credit for licensed psychologists or licensed social workers, has been approved by the National Board for Certified Counselors, Inc. (NBCC), the Commission on Rehabilitation Counselor Certification (CRCC), the Certification Board for Music Therapists (CBMT), AATA, American Dance Therapy Association (ADTA) or the National Association for Drama Therapy (NADT), or has been offered by AAMFT or the Pennsylvania Association for Marriage and Family Therapy (PAMFT).

     (vi)   Have a master’s degree of less than 48 semester hours or 72 quarter hours but not less than 36 semester hours or 54 quarter hours in a field closely related to the practice of marriage and family therapy as defined in §  48.1, from an accredited educational institution with graduate level coursework in marriage and family therapy as defined in §  48.1 and have within the past 10 years completed sufficient continuing education satisfactory to the Board to equal the number of hours needed to achieve a total of 48 semester hours or 72 quarter hours at a ratio of 15 continuing education hours equaling 1 semester hour. Continuing education satisfactory to the Board shall meet the following requirements:

       (A)   Master’s level difficulty.

       (B)   Excludes courses in office management or practice building.

       (C)   Any course which is related to the practice of marriage and family therapy that has been approved for continuing education credit for licensed psychologists or licensed social workers, has been approved by NBCC, CRCC, CBMT, AATA, ADTA or NADT, or has been offered by AAMFT or PAMFT.

 (a)  A license shall be issued based on reciprocity to an applicant who meets the following requirements. The applicant shall have:

   (1)  Satisfied the general requirements for licensure in §  48.12 (relating to general qualifications for licensure).

   (2)  Provided a letter from other jurisdiction registration boards where the licensed MFT is licensed, certifying licensure and reporting any violations.

   (3)  Demonstrated qualifications at least equal to the qualifications required by the act and this chapter.

 (b)  The Board will accept an applicant’s examination grades taken in another jurisdiction, as furnished through the professional examination reporting service or from the jurisdiction which administered the examination, in lieu of taking the Commonwealth’s required examination.

   (1)  The applicant shall show that the examination taken in the other jurisdiction is similar to the one offered by the Commonwealth and that the applicant passed the examination with a grade at least equal to the passing grade set by the Commonwealth.

 To be issued a license by endorsement without examination as a marriage and family therapist, an applicant shall provide proof satisfactory to the Board, that the applicant has met the following conditions:

   (1)  Satisfied the general requirements for licensure of §  48.12 (relating to general qualifications for licensure).

   (2)  Satisfied the educational requirements in section 7(e)(2) of the act (63 P. S. §  1907(e)(2)) and §  48.13(a)(3) (relating to licensed MFT).

   (3)  Holds a marriage and family therapy license that is in good standing from another state. The applicant shall provide a letter from the other state’s licensing authority where the marriage and family therapist is licensed certifying licensure and reporting any disciplinary history.

   (4)  Demonstrates to the Board’s satisfaction that the applicant has completed a minimum of 3,000 hours of supervised clinical experience that conforms to the licensure requirements of the state in which the applicant is currently licensed.

   (5)  Demonstrates to the Board’s satisfaction that the applicant has, at a minimum, been actively engaged in the practice of marriage and family therapy for 5 of the last 7 years immediately preceding the filing of the application for licensure by endorsement with the Board.

   The provisions of this §  48.17 adopted August 26, 2011, effective August 27, 2011, 41 Pa.B. 4627.

SEXUAL MISCONDUCT

§ 48.21. Prohibited conduct.

 Sexual intimacies between a licensed marriage and family therapist and a current client/patient, or an immediate family member of a current client/patient, are prohibited.

   The provisions of this §  48.21 adopted August 11, 2006, effective August 12, 2006, 36 Pa.B. 4469.

 Licensed marriage and family therapists may not accept as client/patients individuals with whom they have engaged in sexual intimacies.

   The provisions of this §  48.22 adopted August 11, 2006, effective August 12, 2006, 36 Pa.B. 4469.

 (a)  Sexual intimacies between a licensed marriage and family therapist and a former client/patient, or an immediate family member of a former client/patient are prohibited for 7 years following the termination of the professional relationship.

 (b)  Following the passage of the 7-year period, licensed marriage and family therapists may engage in sexual conduct with a former client/patient, or an immediate family member of a former client/patient which is not exploitive. In determining whether the conduct is exploitive, the licensed marriage and family therapist shall consider all of the following:

   (1)  The amount of time that has passed since the professional relationship terminated.

   (2)  The nature and duration of the therapy.

   (3)  The circumstances of termination.

   (4)  The client/patient’s personal history, for example, unique vulnerabilities.

   (5)  The client/patient’s current mental status.

   (6)  Statements or actions made by the licensed marriage and family therapist during the course of therapy suggesting or inviting the possibility of a posttermination sexual or romantic relationship with the client/patient.

   (7)  The likelihood of adverse impact on the client/patient and immediate family members of the client/patient.

   The provisions of this §  48.23 adopted August 11, 2006, effective August 12, 2006, 36 Pa.B. 4469.

 (a)  A violation of § §  48.21—48.23 (relating to prohibited conduct; former sexual partners as clients/patients; and sexual intimacies with a former client/patient or an immediate family member of a former client/patient) will be deemed unprofessional conduct and will subject the licensed marriage and family therapist to discipline under section 11(a)(2) of the act (63 P. S. §  1911(a)(2)).

 (b)  The consent of a former client/patient or immediate family member of a former client/patient to engage in sexual intimacies with the licensed marriage and family therapist is not a defense in any disciplinary action brought under § §  48.21—48.23.

 (c)  With the exception of information contained in a professional record, neither opinion evidence, reputation evidence nor specific instances of the past sexual conduct of a former client/patient or immediate family member of a former client/patient may be admissible in a disciplinary action brought under § §  48.21—48.23.

 (d)  In a disciplinary proceeding brought under §  48.23(b), the Board will consider whether there has been exploitation of the client/patient in light of all of the relevant factors enumerated under §  48.23(b)(1)—(7).

 When the Board takes disciplinary or corrective action against a licensed marriage and family therapist under section 11(a) of the act (63 P. S. §  1911(a)), for conduct prohibited by § §  48.21—48.23 (relating to prohibited conduct; former sexual partners as clients/patients; and sexual intimacies with a former client/patient, or an immediate family member of a former client/ patient), the licensed marriage and family therapist will not be eligible for placement into an impaired professional program in lieu of disciplinary or corrective action.

   The provisions of this §  48.25 adopted August 11, 2006, effective August 12, 2006, 36 Pa.B. 4469.

CONTINUING EDUCATION

§ 48.31. Definitions.

 The following words and terms, when used in § §  48.32—48.42, have the following meanings, unless the context clearly indicates otherwise:

   Biennium—The period from March 1 of an odd-numbered year to February 28 of the next odd-numbered year.

   Certification—A statement signed by the licensee certifying that continuing education requirements have been met along with information and documentation relative to the course.

   Clock hour—50 to 60 minutes of instruction or participation in an approved course or program.

   Provider—An agency, organization, institution, association, center or individual approved by the Board to offer an organized course or program.

 For 2009 renewals and thereafter, the Board will require, as a condition of biennial renewal of a marriage and family therapist’s license, the completion during the preceding biennium of 30 clock hours of continuing education in acceptable courses and programs offered by approved providers which shall include at least 3 clock hours in ethical issues. Up to 20 clock hours may be obtained by home study. Excess clock hours may not be carried over to the next biennium.

   The provisions of this §  48.32 adopted December 22, 2006, effective December 23, 2006, 36 Pa.B. 7841.

 (a)  Only courses or programs offered by Board approved providers will be accepted for continuing education credit, except as provided in §  48.37 (relating to other sources of continuing education).

 (b)  Continuing education courses and programs must be appropriate for the master’s level practitioner and pertain to the practice of marriage and family therapy as defined in section 3 of the act (63 P. S. §  1903).

 (c)  The Board will not approve courses or programs in office management or in practice building.

 (d)  A licensee may accrue up to 20 of the required clock hours in home study courses offered by approved providers if the home study course has specific learning objectives which the provider evaluates to assure that learning has taken place. Home study courses must be indicated as such on the certificates of attendance.

   The provisions of this §  48.33 adopted December 22, 2006, effective December 23, 2006, 36 Pa.B. 7841.

 (a)  An agency, organization, institution, association, center or individual seeking to offer one organized course or program may apply to the Board as a provider by filing an application, along with a fee of $45, at least 90 days before the date the course or program commences.

 (b)  The application must include the following information:

   (1)  The full name and address of the applicant.

   (2)  The title of the course or program and core subjects covered.

   (3)  The dates and location of the course or program.

   (4)  The instructors’ names, titles, affiliations and degrees.

   (5)  The schedule of the course or program-syllabus, lecturer, time allocated, and the like.

   (6)  The total number of clock hours requested.

   (7)  The method of certifying attendance.

   (8)  The objectives.

   (9)  The course or program coordinator.

   (10)  The instruction and evaluation methods.

   (11)  Evidence of meeting the standards in §  48.35 (relating to standards for courses and programs).

 (c)  Statements made in the application must be sworn to be true and correct to the best of the applicant’s information, knowledge and belief.

 (d)  Upon approval as a qualified provider of a course or program, a Board approval number will be assigned and will be listed on the certificate of attendance. Approval is limited to the biennial period in which the course is given.

 (e)  The Board reserves the right to reject a submitted course or program which is outside the scope of practice of marriage and family therapy or is otherwise unacceptable because of presentation, content or failure to meet the criteria in §  48.35.

 (f)  Disapproval of a course or program will include a statement setting forth reasons. Applicants may submit a revised application within 10 days after receipt of disapproval. Revised applications must document alterations made to meet Board requirements. Notification on revised applications will occur as soon as possible within the Board’s capability.

 (g)  The Board may withdraw approval of a course or program for cause. The provider will be notified in writing of the reasons for withdrawal of approval. Withdrawal of approval will be made in accordance with 1 Pa. Code Part II (relating to General Rules of Administrative Practice and Procedure).

   The provisions of this §  48.34 adopted December 22, 2006, effective December 23, 2006, 36 Pa.B. 7841.

 (a)  A provider or licensee seeking Board approval of a course or program shall present evidence that the course or program is appropriate for the master’s level practitioner and has the following:

   (1)  Subject matter pertaining to the enhancement of the marriage and family therapist’s knowledge and practice skills related to helping people achieve adequate and productive personal, interpersonal and social adjustments in their individual lives, in their families and in their community.

   (2)  An established mechanism measuring the quality of the course or program being offered.

   (3)  Established criteria for selecting and evaluating faculty or source material.

   (4)  Established criteria for the evaluation of each course or program upon completion.

   (5)  A minimum total duration of at least 2 clock hours; however, the hours need not be contiguous.

 (b)  Providers shall comply with relevant Federal, State and local laws related to serving people with disabilities and provide adequate facilities and appropriate instructional materials to carry out the continuing education course or program.

 (c)  Providers shall insure that instructors have suitable qualifications and are of good reputation and character.

   The provisions of this §  48.35 adopted December 22, 2006, effective December 23, 2006, 36 Pa.B. 7841.

 (a)  In addition to providers approved under §  48.34 (relating to registration of continuing education providers who offer one course or program), the Board finds the following entities have currently met the standards in §  48.35 (relating to standards for courses and programs). Accordingly, the following are approved providers:

   (1)  Graduate and undergraduate programs accredited by the Council on Social Work Education.

   (2)  The Association of Social Work Boards.

   (3)  Accredited colleges and universities (graduate level courses and continuing education programs).

   (4)  Graduate and postgraduate training programs accredited by the Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE).

   (5)  Graduate programs accredited by the Council for Accreditation of Counseling and Related Educational Programs (CACREP).

   (6)  The following groups and the providers, courses or workshops approved by them:

     (i)   The National Association of Social Workers (NASW) and its state and local affiliates.

     (ii)   The Clinical Social Work Association (CSWA) and its state and local affiliates.

     (iii)   The National Board for Certified Counselors, Inc. (NBCC).

     (iv)   The Commission on Rehabilitation Counselor Certification (CRCC).

     (v)   The Certification Board for Music Therapists (CBMT).

     (vi)   The American Art Therapy Association (AATA).

     (vii)   The American Dance Therapy Association (ADTA).

     (viii)   The National Association for Drama Therapy (NADT).

     (ix)   The American Psychological Association (APA).

     (x)   The Approved Continuing Education (ACE) Program developed by the Association of Social Work Boards.

     (xi)   The American Nurses Credentialing Center (ANCC).

   (7)  The following groups and their regional, state and local affiliates:

     (i)   The Child Welfare League of America.

     (ii)   The National Association of Black Social Workers.

     (iii)   The Family Service Association of America.

     (iv)   The Clinical Social Work Association (CSWA).

     (v)   The American Association for Marriage and Family Therapy (AAMFT).

     (vi)   The American Family Therapy Association (AFTA).

     (vii)   The National Council on Family Relations (NCFR).

     (viii)   The Council of Nephrology Social Workers.

     (ix)   The American Association of Sex Educators, Counselors and Therapists (AASECT).

     (x)   The American Association of Pastoral Counselors (AAPC).

     (xi)   The American School Counselor Association (ASCA).

     (xii)   The American Counseling Association (ACA).

     (xiii)   The American Mental Health Counselors Association (AMHCA).

     (xiv)   The National Rehabilitation Counseling Association (NRCA).

 (b)  The Board will consider for approval, as preapproved providers, other organizations who offer multiple courses and programs for marriage and family therapists. The request for approval shall be submitted to the Board in writing along with a rationale as to why the organization should be included as a preapproved provider.

 (c)  The approval given to providers is subject to reevaluation; however, a rescission of approval will be made only in accordance with 1 Pa. Code Part II (relating to General Rules of Administrative Practice and Procedure).

 (d)  The Board may approve participation in other continuing education courses or programs for credit so long as the licensee submits, prior to attendance, an application for program approval and supporting documentation provided in §  48.35, and upon completion of the course or program submits verification of attendance.

   The provisions of this §  48.36 adopted December 22, 2006, effective December 23, 2006, 36 Pa.B. 7841.

 (a)  Clock hours may be granted on a case-by-case basis for the following:

   (1)  Participation in clinical conferences, clinical rounds or training under a preceptor provided through hospitals, medical centers, schools and universities.

   (2)  First-time experience as a teacher.

   (3)  Publications of articles, books and research relating to the practice of marriage and family therapy.

   (4)  Services as a preceptor, lecturer or speaker.

 (b)  A licensee who wishes to obtain clock hours for credit under subsection (a)(1), (2) or (4) shall submit, prior to participating in the event, an application for approval along with a fee of $45 as provided by §  48.34(a) (relating to registration of continuing education providers who offer one course or program). A licensee seeking to obtain clock hours for a publication under subsection (a)(3) shall submit, after the publication of the article, book or research, an application for approval along with a fee of $45 as provided by §  48.34(a).

   The provisions of this §  48.37 adopted December 22, 2006, effective December 23, 2006, 36 Pa.B. 7841.

 (a)  Applicants for license renewal shall provide a signed statement certifying that the continuing education requirements have been met. The certification statement will be included on the application form for renewal of licensure.

 (b)  A licensee selected for audit shall provide information to document the licensee’s certification. The information must include the following:

   (1)  The date attended.

   (2)  The clock hours claimed.

   (3)  The title of course or program and description of content.

   (4)  The school, hospital, medical center or organization which sponsored the course or program.

   (5)  The instructor.

   (6)  The location of course or program.

   (7)  The Board approval number assigned to the course or program unless the provider is preapproved under §  48.36(a) (relating to preapproved providers of continuing education courses and programs for marriage and family therapists).

   The provisions of this §  48.38 adopted December 22, 2006, effective December 23, 2006, 36 Pa.B. 7841.

 The licensee shall retain documentation of completion of the prescribed number of clock hours for 4 years following the certification which shall be produced upon request by the Board or its auditing agents. The Board will utilize a random audit of renewals to determine compliance with the continuing education requirement.

 (a)  An individual applying for licensure in this Commonwealth for the first time shall be exempted from the continuing education requirement for the biennial renewal period following initial licensure.

 (b)  The Board may grant an extension or waive all or a portion of the continuing education requirement for biennial renewal upon request of a licensee. The request must be made in writing, with appropriate documentation, and shall include a description of circumstances sufficient to show why compliance is impossible. A waiver or extension request will be evaluated by the Board on a case-by-case basis. Waivers and extensions may be granted for serious illness, military service or other demonstrated hardship. The Board will send written notification of its approval or denial of a waiver or extension request.

   The provisions of this §  48.40 adopted December 22, 2006, effective December 23, 2006, 36 Pa.B. 7841.

 A licensee seeking to reinstate an inactive or lapsed license shall show proof of compliance with the continuing education requirement for the preceding biennium.

   The provisions of this §  48.41 adopted December 22, 2006, effective December 23, 2006, 36 Pa.B. 7841.

 (a)  A licensed marriage and family therapist who submits fraudulent clock hour reports will be subject to disciplinary action under section 11(a)(5) of the act (63 P. S. §  1911(a)(5)).

 (b)  The falsification of a clock hour report by a program provider will result in revocation of approval by the Board for further program offerings of that provider.

   The provisions of this §  48.42 adopted December 22, 2006, effective December 23, 2006, 36 Pa.B. 7841.

   This section cited in 49 Pa. Code §  48.31 (relating to definitions).

CHILD ABUSE REPORTING REQUIREMENTS

§ 48.51. Definitions relating to child abuse reporting requirements.

 The following words and terms, when used in this section and § §  48.52—48.57 (relating to child abuse reporting requirements), have the following meanings, unless the context clearly indicates otherwise:

   Child abuse—The term includes any of the following:

     (i)   A recent act or failure to act by a perpetrator which causes nonaccidental serious physical injury to a child under 18 years of age.

     (ii)   An act or failure to act by a perpetrator which causes nonaccidental serious mental injury to or sexual abuse or sexual exploitation of a child under 18 years of age.

     (iii)   A recent act, failure to act or series of acts or failures to act by a perpetrator which creates an imminent risk of serious physical injury to or sexual abuse or sexual exploitation of a child under 18 years of age.

     (iv)   Serious physical neglect by a perpetrator constituting prolonged or repeated lack of supervision or the failure to provide the essentials of life, including adequate medical care, which endangers a child’s life or development or impairs the child’s functioning.

   ChildLine—An organizational unit of the Department of Public Welfare, which operates a 24-hour-a-day Statewide toll-free telephone system for receiving reports of suspected child abuse, referring reports for investigation and maintaining the reports in the appropriate file.

   Individual residing in the same home as the child—An individual who is 14 years of age or older and who resides in the same home as the child.

   Perpetrator—A person who has committed child abuse and is a parent of the child, a person responsible for the welfare of a child, an individual residing in the same home as a child or a paramour of a child’s parent.

   Person responsible for the child’s welfare—

     (i)   A person who provides permanent or temporary care, supervision, mental health diagnosis or treatment, training or control of a child in lieu of parental care, supervision and control.

     (ii)   The term does not include a person who is employed by or provides services or programs in a public or private school, intermediate unit or area vocational-technical school.

   Recent acts or omissions—Acts or omissions committed within 2 years of the date of the report to the Department of Public Welfare or county agency.

   Serious mental injury—A psychological condition, as diagnosed by a physician or licensed psychologist including the refusal of appropriate treatment, that does one or more of the following:

     (i)   Renders a child chronically and severely anxious, agitated, depressed, socially withdrawn, psychotic or in reasonable fear that the child’s life or safety is threatened.

     (ii)   Seriously interferes with a child’s ability to accomplish age-appropriate developmental and social tasks.

   Serious physical injury—An injury that causes a child severe pain or significantly impairs a child’s physical functioning, either temporarily or permanently.

   Sexual abuse or exploitation—The employment, use, persuasion, inducement, enticement or coercion of a child to engage in or assist another person to engage in sexually explicit conduct or a simulation of sexually explicit conduct for the purpose of producing a visual depiction, including photographing, videotaping, computer depicting or filming, of sexually explicit conduct or the rape, sexual assault, involuntary deviate sexual intercourse, aggravated indecent assault, molestation, incest, indecent exposure, prostitution, statutory sexual assault or other form of sexual exploitation of children.

   The provisions of this §  48.51 issued under section 6(2) of the Social Workers, Marriage and Family Therapists and Professional Counselors Act (63 P. S. §  1906(2)); and the Protective Services Law, 23 Pa.C.S. Chapter 63.

   The provisions of this §  48.51 adopted November 17, 2006, effective November 18, 2006, 36 Pa.B. 7022.

 (a)  General rule. Under 23 Pa.C.S. §  6311 (relating to persons required to report suspected child abuse), licensed marriage and family therapists who, in the course of their employment, occupation or practice of their profession, come into contact with children shall report or cause a report to be made to the Department of Public Welfare and the appropriate county agency when they have reasonable cause to suspect on the basis of their professional or other training or experience, that a child coming before them in their professional or official capacity is a victim of child abuse.

 (b)  Staff members of public or private agencies, institutions and facilities. Licensed marriage and family therapists who are staff members of a medical or other public or private institution, school, facility or agency, and who, in the course of their employment, occupation or practice of their profession, come into contact with children shall immediately notify the person in charge of the institution, school, facility or agency or the designated agent of the person in charge when they have reasonable cause to suspect on the basis of their professional or other training or experience, that a child coming before them in their professional or official capacity is a victim of child abuse. Upon notification by the licensed marriage and family therapist, the person in charge or the designated agent shall assume the responsibility and have the legal obligation to report or cause a report to be made in accordance with subsections (a), (c) and (d).

 (c)  Reporting procedure. Reports of suspected child abuse shall be made by telephone and by written report.

   (1)  Oral reports. Oral reports of suspected child abuse shall be made immediately by telephone to ChildLine, (800) 932-0313.

   (2)  Written reports. Written reports shall be made to the appropriate county agency within 48 hours after the oral report is made by telephone and must contain, at a minimum, the information required by the Department of Public Welfare in 55 Pa. Code §  3490.18 (relating to filing of a written report by a required reporter).

   The provisions of this §  48.52 issued under section 6(2) of the Social Workers, Marriage and Family Therapists and Professional Counselors Act (63 P. S. §  1906(2)); and the Protective Services Law, 23 Pa.C.S. Chapter 63.

   The provisions of this §  48.52 adopted November 17, 2006, effective November 18, 2006, 36 Pa.B. 7022.

 A licensed marriage and family therapist may take or cause to be taken photographs of the child who is subject to a report and, if clinically indicated, cause to be performed a radiological examination and other medical tests on the child. Medical summaries or reports of the photographs, X-rays and relevant medical tests taken shall be sent to the county children and youth social service agency at the time the written report is sent or as soon thereafter as possible. The county children and youth social service agency shall have access to actual photographs or duplicates and X-rays and may obtain them or duplicates of them upon request.

   The provisions of this §  48.53 issued under section 6(2) of the Social Workers, Marriage and Family Therapists and Professional Counselors Act (63 P. S. §  1906(2)); and the Protective Services Law, 23 Pa.C.S. Chapter 63.

   The provisions of this §  48.53 adopted November 17, 2006, effective November 18, 2006, 36 Pa.B. 7022.

 A licensed marriage and family therapist who has reasonable cause to suspect that a child died as a result of child abuse shall report that suspicion to the coroner of the county where death occurred or, in the case where the child is transported to another county for medical treatment, to the coroner of the county where the injuries were sustained.

   The provisions of this §  48.54 issued under section 6(2) of the Social Workers, Marriage and Family Therapists and Professional Counselors Act (63 P. S. §  1906(2)); and the Protective Services Law, 23 Pa.C.S. Chapter 63.

   The provisions of this §  48.54 adopted November 17, 2006, effective November 18, 2006, 36 Pa.B. 7022.

 Under 23 Pa.C.S. §  6318 (relating to immunity from liability), a licensed marriage and family therapist who participates in good faith in the making of a report, cooperating with an investigation, testifying in a proceeding arising out of an instance of suspected child abuse or the taking of photographs shall have immunity from civil and criminal liability that might result by reason of the licensed marriage and family therapist’s actions. For the purpose of any civil or criminal proceeding, the good faith of the licensed marriage and family therapist shall be presumed. The Board will uphold the same good faith presumption in any disciplinary proceeding that might result by reason of a licensed marriage and family therapist’s actions in participating in good faith in the making of a report, cooperating with an investigation, testifying in a proceeding arising out of an instance of suspected child abuse or the taking of photographs.

   The provisions of this §  48.55 issued under section 6(2) of the Social Workers, Marriage and Family Therapists and Professional Counselors Act (63 P. S. §  1906(2)); and the Protective Services Law, 23 Pa.C.S. Chapter 63.

   The provisions of this §  48.55 adopted November 17, 2006, effective November 18, 2006, 36 Pa.B. 7022.

 To protect children from abuse, the reporting requirements of § §  48.52—48.54 (relating to suspected child abuse-mandated reporting requirements; photographs, medical tests and X-rays of child subject to report; and suspected death as a result of child abuse—mandated reporting requirement) take precedence over the provisions of any client confidentiality, ethical principle or professional standard that might otherwise apply.

   The provisions of this §  48.56 issued under section 6(2) of the Social Workers, Marriage and Family Therapists and Professional Counselors Act (63 P. S. §  1906(2)); and the Protective Services Law, 23 Pa.C.S. Chapter 63.

   The provisions of this §  48.56 adopted November 17, 2006, effective November 18, 2006, 36 Pa.B. 7022.

 (a)  Disciplinary action. A licensed marriage and family therapist who willfully fails to comply with the reporting requirements in § §  48.52—48.54 (relating to suspected child abuse—mandated reporting requirements; photographs, medical tests and X-rays of child subject to report; and suspected death as a result of child abuse—mandated reporting requirement) will be subject to disciplinary action under section 11 of the act (63 P. S. §  1911).

 (b)  Criminal penalties. Under 23 Pa.C.S. §  6319 (relating to penalties for failure to report), a licensed marriage and family therapist who is required to report a case of suspected child abuse who willfully fails to do so commits a summary offense for the first violation and a misdemeanor of the third degree for a second or subsequent violation.

   The provisions of this §  48.57 issued under section 6(2) of the Social Workers, Marriage and Family Therapists and Professional Counselors Act (63 P. S. §  1906(2)); and the Protective Services Law, 23 Pa.C.S. Chapter 63.

   The provisions of this §  48.57 adopted November 17, 2006, effective November 18, 2006, 36 Pa.B. 7022.

   This section cited in 49 Pa. Code §  48.79 (relating to mandatory reporting).

CODE OF ETHICAL PRACTICE AND STANDARDS OF PROFESSIONAL CONDUCT

§ 48.71. Code of ethical practice and professional conduct.

 The Board subscribes to the code of ethics and practice standards for licensed marriage and family therapists (licensees) promulgated by the American Association for Marriage and Family Therapy (AAMFT) and the Board will use the AAMFT Code of Ethics in resolving ambiguities which may arise in the interpretation of this chapter, except that whenever any conflict exists between this chapter and the AAMFT Code of Ethics, this chapter shall prevail.

 (a)  Competency.

   (1)  In all communications with, or regarding, specific existing or prospective clients/patients, licensees may not misrepresent directly, indirectly or by implication their professional qualifications such as education, specialized training, experience or areas of competence.

   (2)  Licensees may practice only within the competency areas for which they are qualified by education, training and experience.

   (3)  Licensees shall maintain appropriate standards of care. The appropriate standard of care is defined as what an ordinary, reasonable licensee would have done in a similar circumstance. In areas in which recognized standards do not yet exist, licensees shall take whatever precautions are necessary to protect the welfare of their clients/patients.

   (4)  Licensees shall maintain knowledge of current scientific and professional information related to the services they render.

   (5)  Licensees shall refer a client/patient to another professional and take steps to facilitate an orderly transfer of responsibility when the client’s/patient’s needs exceed the licensee’s competence level. Licensees shall notify client/patients promptly of the need to refer and seek the referral and transfer of services in relation to the clients’/patients’ needs and preferences.

 (b)  Informed consent.

   (1)  Licensees shall inform clients/patients in writing of:

     (i)   The purpose of the services being provided.

     (ii)   Risks and limits related to the services that are known to the licensee.

     (iii)   Reasonable alternatives to the services being provided.

     (iv)   Relevant costs, billing and overdue collection policies and their potential effect on the continuation of the professional relationship.

     (v)   The clients’/patients’ right to refuse or withdraw consent, and the time frame covered by the consent.

     (vi)   Other information the licensees reasonably might expect to affect the clients’/patients’ decisions to enter into or continue the professional relationship.

   (2)  Licensees shall use clear and understandable language when providing the information in paragraph (1) to clients/patients.

   (3)  Licensees shall provide services to clients/patients only in the context of a professional relationship based on valid informed consent.

   (4)  In instances when the client/patient is unable to read or understand the informed consent document or has trouble understanding the primary language contained in the informed consent document, licensees shall take steps to ensure the client’s/patient’s comprehension including providing a detailed verbal explanation or arranging for a qualified interpreter or translator, as needed. If a client/patient is not competent to provide informed consent because of age or mental condition, the licensee shall obtain consent from the client’s/patient’s parent, guardian, court-appointed representative or the holder of the client’s/patient’s power of attorney.

   (5)  When a client/patient is receiving legally-mandated services, licensees shall provide information about the nature and extent of the services and about the client’s/patient’s rights to the client/patient or the client’s/patient’s parent, guardian, court-appointed representative or the holder of the client’s/patient’s power of attorney, as applicable.

   (6)  Licensees who provide services by means of electronic means shall inform the client/patient of the reasonably foreseeable limitations and risks associated with those services.

 (c)  Delegation. A licensee may not delegate professional responsibilities to another person when the licensee delegating the responsibilities knows or has reason to know that the other person is not qualified by training, experience or licensure to perform those responsibilities.

 (d)  Confidentiality and privacy.

   (1)  Licensees shall have a primary obligation to protect the client’s/patient’s right to confidentiality and privacy as established by law and professional standards of practice. Confidential and private information shall only be revealed to others when the client/patient, or the client’s/patient’s parent, guardian, court-appointed representative or the holder of the client’s/patient’s power of attorney, has given informed consent, except in those circumstances in which failure to do so would violate a court order or specific Federal or State privacy statutes or regulations or result in clear and present danger to the client/patient or others. Unless specifically contraindicated by these situations, a client/patient shall be informed and written consent shall be obtained before the confidential and private information is revealed.

   (2)  Licensees shall discuss with clients/patients and the client’s/patient’ parent, guardian, court-appointed representative or the holder of the client’s/patient’s power of attorney, the nature of confidentiality and the limitation of the clients’/patients’ right to confidentiality. Licensees shall review with clients/patients circumstances when confidential information may be requested and when disclosure of confidential information is legally required. This discussion shall occur as soon as possible in the professional relationship and as needed throughout the course of the relationship.

   (3)  When licensees provide services to families, couples or groups, licensees shall seek agreement among the parties involved concerning each individual’s right to confidentiality and obligations to preserve the confidentiality of information shared by others. Licensees shall inform participants in family, group or couples counseling that the licensee cannot guarantee that all participants will honor the agreements. In the context of couple, family or group treatment, the licensee may not reveal any individual’s confidences to others in the client unit without the prior written permission of that individual.

   (4)  Licensees shall take reasonable steps to protect the confidentiality of information transmitted to other parties through the use of computers, electronic mail, facsimile machines, telephones and telephone answering machines, and other electronic or computer technology.

 (e)  Termination of services.

   (1)  Licensees may terminate services only after giving careful consideration to factors affecting the professional relationship and making an effort to minimize possible adverse effects. If an interruption or termination of services is anticipated, notification and referral for continued services shall be provided to the client/patient.

   (2)  Licensees may terminate services to a client/patient who has not paid an overdue fee balance if the following conditions are met:

     (i)   The financial contractual arrangements have been made clear to the client/patient.

     (ii)   The client/patient does not pose an imminent danger to self or others.

     (iii)   The clinical and other consequences of the current nonpayment have been addressed and discussed with the client/patient.

 (f)  Discrimination. Licensees shall comply with existing Federal and State antidiscrimination laws and may not practice, condone, facilitate or collaborate with any form of discrimination prohibited by those laws.

 (g)  Conduct with clients/patients.

   (1)  Licensees may not physically or verbally abuse or threaten clients/patients or family members of clients/patients.

   (2)  Licensees may not use derogatory language in their written or verbal communications to or about clients/patients. Licensees shall use accurate and respectful language in communications to and about clients/patients.

 (a)  Dual or multiple relationships defined. Dual or multiple relationships occur when the licensee engages in multiple or ongoing interactions with clients/patients, the clients’/patients’ romantic partners or immediate family members of clients/patients in more than one context, whether professional, social or business. Dual or multiple relationships can occur simultaneously or consecutively.

 (b)  Dual or multiple relationships prohibited.

   (1)  A licensee shall avoid dual or multiple relationships and conflicts of interest with any client/patient, which could impair the licensee’s professional judgment or increases the risk of client/patient exploitation.

   (2)  A licensee may not undertake or continue a professional relationship with a client/patient, supervisee or student when the objectivity or competency of the licensee is, or could reasonably be expected to be, impaired or when the relationship with the client/patient, supervisee or student is exploitative.

   (3)  A licensee shall carefully consider familial, social, emotional, financial, supervisory, political, administrative and legal relationships with a client/patient or a person related to or associated with the client/patient to assure that impaired judgment or exploitation does not occur within the professional relationship.

   (4)  Licensees shall always carefully consider the potentially harmful effects of dual or multiple relationships on their practice and on their clients/patients. A licensee shall refrain from entering into, or promising another to enter into, professional, social or business relationships with another person if it appears reasonably likely that the relationship might impair the licensee’s objectivity or otherwise interfere with the licensee’s effectiveness or might harm or exploit the client/patient.

   (5)  When a dual or multiple relationship cannot be avoided, a licensee shall take reasonable professional precautions, such as informed consent, consultation, supervision and documentation, to ensure that judgment is not impaired and that no exploitation occurs.

   (6)  If a licensee finds that, due to unforeseen factors, a potentially harmful dual or multiple relationship has arisen with a client/patient, the licensee shall attempt to resolve it with due regard for the best interests of the client/patient and maximum compliance with the act and this chapter.

 (c)  Conflicts of interest. When a licensee provides services to two or more people who have a relationship with each other, such as couples or family members, the licensee shall clarify with all parties which individuals will be considered clients/patients and the nature of the licensee’s professional obligation to the various individuals who are receiving services. A licensee who anticipates or should reasonably anticipate a conflict of interest among the individuals receiving services or who anticipates or should reasonably anticipate having to perform in potentially conflicting roles, such as a licensee who is asked or ordered to testify in a child custody dispute or divorce proceeding involving clients/patients, shall clarify the roles with the parties involved and take reasonable action to minimize any conflict of interest.

 (a)  Licensees may not sexually harass supervisees, students, trainees, employees, research subjects or colleagues.

 (b)  Sexual harassment includes unwelcome sexual advances, requests for sexual favors and other verbal or physical conduct of a sexual nature when one of the following occurs:

   (1)  Submission to the conduct is made either explicitly or implicitly a term or condition of an individual’s employment or academic association with a licensee.

   (2)  Submission to or rejection of the conduct by an individual is used as the basis for employment-related decisions affecting the individual or academic decisions affecting the individual.

   (3)  The conduct has the purpose or effect of unreasonably interfering with an individual’s work or academic performance or creating an intimidating, hostile or offensive working or academic environment.

 A licensee may not undertake or continue a professional relationship with a client/patient, supervisee or student when the objectivity or competency of the licensee is or could reasonably be expected to be impaired due to mental, emotional, physiological, pharmacological or substance abuse conditions. If such a condition develops after a professional relationship has been initiated, the licensee shall terminate the professional relationship in an appropriate manner and shall, either himself or through an appropriate designee, notify the client/patient of termination in writing and assist the client/patient in obtaining services from another professional.

 (a)  Protection of human subjects.

   (1)  A licensee shall plan, design, conduct and report research in a manner consistent with this chapter, the AAMFT Code of Ethics, applicable Federal and State laws, host institutional rules and scientific standards governing research with human subjects.

   (2)  A licensee shall obtain informed consent from participants by using language that the licensee believes would be understandable to the research participants and that:

     (i)   Accurately explains the purpose and procedures to be followed.

     (ii)   Identifies any procedures that are experimental or relatively untried.

     (iii)   Describes the attendant discomforts and risks that are most likely to occur and which are known to the licensee.

     (iv)   Describes the benefits or changes in individuals or organizations that might be reasonably expected.

     (v)   Discloses appropriate alternative procedures that may be advantageous for the subject.

     (vi)   Offers to answer any inquiries concerning the procedures.

     (vii)   Instructs that subjects are free to withdraw their consent and discontinue participation in the research project at any time.

   (3)  When a participant is not capable of giving informed consent, licensees shall provide an appropriate explanation, obtain agreement for participation and obtain informed consent from a participant’s parent, guardian, court-appointed representative or the holder of the participant’s power of attorney.

   (4)  Information obtained about research participants during the course of the research is confidential. The licensee shall explain to the participant whether the possibility exists that others may obtain access to the information, and also explain the plans for protecting the participant’s confidentiality as part of the procedure for obtaining informed consent.

 (b)  Reporting and publication of results.

   (1)  Licensees may not engage in fraudulent research, distort data, misrepresent data or deliberately bias their results.

   (2)  Licensees shall plan, conduct, report and publish accurately and in a manner that minimizes the possibility that results will be misleading.

 (c)  Other ethical obligations. In addition to the provisions of this section, a licensee’s ethical obligations with regard to research and publication are governed by this chapter and the AAMFT Code of Ethics.

 (a)  When setting fees, licensees shall ensure that the fees are fair, reasonable and commensurate with the services performed.

 (b)  Licensees may not accept goods or services as payment for professional services.

 (c)  Licensees shall make financial arrangements with clients/patients, third-party payors and supervisees that are reasonably understandable and conform to accepted professional practices.

 (d)  Prior to entering into the therapeutic or supervisory relationship, a licensee shall clearly disclose and explain to clients/patients and supervisees the following:

   (1)  Financial arrangements and fees related to professional services, including charges for canceled or missed appointments.

   (2)  The use of collection agencies or legal measures for nonpayment.

   (3)  The procedure for obtaining payment from the client/patient, to the extent allowed by law, if payment is denied by the third-party payor.

 (e)  Once services have begun, licensees shall provide reasonable notice of changes in fees or other charges.

 (f)  Licensees shall give reasonable notice to clients with unpaid balances of their intent to seek collection by agency or legal recourse. When this action is taken, licensees may not disclose clinical information.

 (g)  Licensees shall represent facts truthfully to clients, third-party payors and supervisees regarding services rendered.

 (h)  Licensees may not withhold records under their immediate control that are requested and needed for a client’s/patient’s treatment solely because payment has not been received for past services.

 (a)  For each client/patient, a licensee shall keep records of the dates of marriage and family therapy services, types of marriage and family therapy services, details of the services provided, termination of the professional relationship and billing information.

 (b)  Records kept by the licensee shall be retained for at least 5 years from the date of the last entry. Records held or owned by government agencies or educational institutions are not subject to this requirement.

 (c)  Licensees shall take reasonable steps to ensure that documentation in records is accurate, legible and reflects the services provided.

 (d)  Licensees shall include sufficient and timely documentation in records to facilitate the delivery of services and to ensure continuity of services provided to the client/patient in the future.

 (e)  Licensees’ documentation shall protect clients’/patients’ privacy to the extent that it is consistent with applicable Federal and State laws and regulations and should include information that is directly relevant to the delivery of services.

 (f)  Licensees shall store records following termination of services to ensure reasonable future access. Records shall be retained and stored as required by applicable Federal and State law and regulations.

 (g)  Licensees shall provide a client/patient with reasonable access to records concerning the client/patient. Licensees who are concerned that clients’/patients’ access to their records could cause serious harm to the client/patient or another person shall provide assistance in interpreting the records and consultation with the client/patient regarding the records. Licensees shall limit clients’/patients’ access to their records, or portions of their records, only in exceptional circumstances when there is compelling evidence that the access would cause serious harm to the client/patient or another person. Both the clients’/patients’ requests and the rationale for withholding some or all of the records shall be documented in the clients’/patients’ files. When providing clients/patients with access to their records, licensees shall take steps to protect the confidentiality of other individuals identified or discussed in such records.

 (h)  In the event of the licensee moving from the area or closing the licensee’s practice, a licensee shall arrange for the storage, transfer or disposal of client/patient records in ways that maintain confidentiality and safeguard the welfare of clients/patients.

 (a)  Licensees, supervisors and trainees have a responsibility to report alleged violations of the act or this chapter to the Board. If a licensee has knowledge or reason to suspect that a colleague or other licensee is incompetent, impaired or unethical, the licensee shall report that practitioner to the Board. Licensees shall make these reports in a manner that does not violate a client’s/patient’s right to confidentiality.

 (b)  Licensees shall comply with the mandatory reporting requirements in this chapter, including § §  48.51—48.57 (relating to child abuse reporting requirements).

 (c)  Licensees shall notify the Board within 30 days of changes of name or mailing information to ensure that the Board has the licensee’s current name and mailing address.

 (a)  Definition. Advertising is defined as the engagement in general informational activities, including those that enable the public, referral sources or others to choose professional services on an informed basis.

 (b)  Engagement in advertising.

   (1)  Licensees may engage in advertising that accurately represents their competencies, education, training and experience relevant to their professional practice. Licensees may not advertise their services and credentials in a manner that is false, misleading, deceptive or fraudulent.

   (2)  Licensees shall ensure that advertisements and publications in any media, such as directories, announcements, business cards, newspapers, radio, television, internet and facsimiles, convey information that is necessary for the public to make an appropriate selection of professional services. This information may include the following:

     (i)   Office information, such as name, address, telephone number and credit card acceptability.

     (ii)   Earned degrees and state or provincial licensures or certifications.

     (iii)   Professional association member status.

     (iv)   Description of practice.

   (3)  Licensees may not use names that could mislead the public concerning the identity, responsibility, source or status of those practicing under that name, and may not hold themselves out as being partners or associates of a firm if they are not partners or associates of the firm.

   (4)  Licensees may not use any professional identification, such as a business card, office sign, letterhead, internet, or telephone or association directory listing, if it includes a statement or claim that is false, fraudulent, misleading or deceptive.

   (5)  In representing their educational qualifications, licensees shall list and claim only those earned degrees from institutions accredited by regional accreditation sources recognized by the United States Department of Education, from institutions recognized by states or provinces that license or certify the licensee, or from equivalent foreign institutions.

   (6)  A licensee shall correct, whenever possible, false, misleading or inaccurate information and representations made by others concerning the licensee’s qualifications, services or products.

   (7)  Licensees shall make certain that the qualifications of their employees or supervisees are represented in a manner that is not false, misleading or deceptive.

   (8)  Licensees may not represent themselves as providing specialized services unless they have the required education, training or supervised experience.

   The provisions of this §  48.80 adopted September 17, 2010, effective September 18, 2010, 40 Pa.B. 5320.