1 before the arizona board
TRANSCRIPT
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1 BEFORE THE ARIZONA BOARD
2 OF BEHAVIORAL HEALTH EXAMINERS
3 In the Matter of:
4 Steven Brinton, LCSW-1699, Licensed Clinical Social Worker, In the State of Arizona.
6 Respondent
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CASE NO. 2008-0005 CONSENT AGREEMENT
FOR SURRENDER OF LICENSE
9 In the interest of a prompt and speedy settlement of the above captioned matter,
consistent with the public interest, statutory requirements and responsibilities of the Arizona
11 State Board of Behavioral Health Examiners ("Board"), and pursuant to A.R.S. §§ 32-3281 (H)
12 and 41-1092.07(F)(5), Steven Brinton ("Respondent") and the Board enter into this Consent
13 Agreement, Findings of Fact, Conclusions of Law and Order ("Consent Agreement") as a final
14 disposition of this matter.
RECITALS
16 Respondent understands and agrees that:
17 1. Any record prepared in this matter, all investigative materials prepared or received
18 by the Board concerning the allegations, and all related materials and exhibits may be retained
19 in the Board's file pertaining to this matter.
2. Respondent has the right to a formal administrative hearing at which Respondent
21 can present evidence and cross examine the State's witnesses. Respondent hereby
22 irrevocably waives his right to such formal hearing concerning these allegations and irrevocably
23 waives his right to any rehearing or judicial review relating to the allegations contained in this
24 Consent Agreement.
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1 3. Respondent has the right to consult with an attorney prior to entering into this
2 Consent Agreement.
3 4. Respondent acknowledges and agrees that upon signing this Consent Agreement
4 and returning it to the Board's Executive Director, Respondent may not revoke his acceptance
of this Consent Agreement or make any modifications to it. Any modification of this original
6 document is ineffective and void unless mutually approved by the parties in writing.
7 5. The findings contained in the Findings of Fact portion of this Consent Agreement are
8 conclusive evidence of the facts stated herein and may be used for purposes of determining
9 sanctions in any future disciplinary matter.
6. This'Consent Agreement is subject to the Board's approval, and will be effective only
11 when the Board accepts it. In the event the Board in its discretion does not approve this
12 Consent Agreement, this Consent Agreement is withdrawn and shall be of no evidentiary value,
13 nor shall it be relied upon or introduced in any disciplinary action by any party hereto, except
14 that Respondent agrees that should the Board reject this Consent Agreement and this case
proceeds to hearing, Respondent shall assert no claim that the Board was prejudiced by its
16 review and discussion of this document or of any records relating thereto.
17 7. Respondent understands that once the Board approves and signs this Consent
18 Agreement, it is a public record that may be publicly disseminated as a formal action of the
19 Board, and that it shall be reported as required by law to the National Practitioner Data Bank
and the Healthcare Integrity and Protection Data Bank.
21 The Board issues the following Findings of Fact, Conclusions of Law and Order:
22 fiNDINGS OF FACT
23 1. Respondent is the holder of License No. LCSW-1699 for the practice of clinical
24 social work in Arizona.
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2. On 07/01/07, an employee of Aurora Behavioral Health, a psychiatric hospital, filed a
2 complaint against Respondent.
3 3. The complaint was filed on behalf of a patient ("Client") who had been admitted to
4 the hospital after a suicide attempt by overdose on Soma, Valium and alcohol. Client had also
hammered a nail through the top of her left foot.
6 4. Respondent was Client's therapist prior to her hospital admission. Client's last
7 therapy session with Respondent was approximately one week prior to her suicide attempt.
8 5. Client reported to hospital staff that she had feelings for Respondent, that
9 Respondent had made sexual remarks and advances towards her during her therapy sessions,
and that Respondent had told Client of his feelings for her.
11 6. Respondent provided a total of 159 therapy sessions to Client from December 2004
12' through June 2007. Client's sessions typically occurred on a weekly or bi-weekly basis.
13 7. Respondent failed to coordinate treatment with Client's primary care physician, who
14 prescribed Client's antidepressant medication.
8. Respondent failed to obtain a signed and dated informed consent to treatment for
16 Client.
17 9. Respondent failed to document any type of written assessment of Client.
18 10. Respondent failed to prepare a written treatment plan for Client.
19 11. The progress notes maintained by Respondent to document Client's therapy were
largely illegible, did not reflect the events described by Respondent in his complaint response,
21 and were not reflective of what occurred during Client's therapy sessions.
22 12. Respondent diagnosed Client with Dysthymia and documented this diagnosis in her
23 client record.
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1 13. Respondent has indicated that he also diagnosed Client with Post Traumatic Stress
2 Disorder at the beginning of her theraJ::Y and later diagnosed her with Dissociative Disorder. He
3 did not document these diagnoses in rer client record.
4 14. Respondent has been providing therapy to clients in private practice since 1991.
15. Respondent failed to obtail1 a signed and dated informed consent to treatment for
6 any of his private practice clients until August 2007.
7 16. Respondent failed to prepare a written treatment plan for any of his private practice
8 clients until August 2007.
9 17. The guidelines ('Treatment Guidelines") published by the International Society for
the Study of Dissociation ("ISSD") for lhe treatment of clients with Dissociative Identity Disorder
11 ("DID") indicate clinicians should vigorously manage eating disorders and substance abuse
12 behaviors of DID clients, including the development of specific treatment plans which may
13 include referral to specialized treatment programs.
14 18. Client disclosed issues inc.luding bulimia and substance abuse during her first mont
of therapy with Respondent.
16 19. Respondent failed to treat Client's bulimia and substance abuse issues or refer
17 Client to other professionals with expertise in these areas.
18 20. The ISSD's Treatment Guidelines for DID clients warn that there is a significant
19 potential for boundary violations with DID clients, that a clear statement of therapeutic
boundaries is needed at the beginninn of treatment, and that therapists must be very cautious to
21 foster clear boundaries in the therapeJtic relationship.
22 21. Respondent failed to document any efforts he took to establish clear therapeutic
23 boundaries with Client.
24 22. Client believed that her relationship with Respondent extended beyond that of client
therapist.
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23. Client's bishop, friends, husband, and Primary Care Physician ("PCP") were
2 concerned about the lack of appropriate boundaries in the relationship between Client and
3 Respondent.
4 24. Client's PCP documented his concern in an 11/16/06 progress note.
25. Respondent encourages the majority of his clients to consider participating in
6 Landmark Education ("Landmark") programs.
7 26. Shortly after Client's therapy began, Client hosted a Landmark Introduction session
8 at her home.
9 27. Client hosted the Landmark Introduction due to her belief that Respondent would
receive benefit from Landmark as a result.
11 28. Respondent attended thE: Landmark Introduction session at Client's home despite
12 his awareness of the associated dua relationship issues.
13 29. Two of Respondent's other clients also attended the Landmark Introduction session
14 in Client's home. One of the other clients was the Landmark Introduction leader.
30. A tape recording of a voice mail message left by Respondent on Client's home
16 telephone answering machine recorded Respondent requesting that Client send an "Orb" to a
17 third person to assist the person in completing a Landmark Forum.
31. An "Orb" is healing power believed to be possessed by Client and piscussed i 18
19 Client's therapy with Respondent.
32. Respondent requested that Client send the "Orb" to a third person despite hi
awareness of the dual relationship issues associated with this request. 21
33. Respondent dftl:.f12tT~e-n!M'fll(ly therapeutic basis for his request to Client.22 .~ ,,·~tt1<~··,-:;·." .' ..
34. Respondent voluntarily advised Client that Respondent's son ("Son") worked for a 23
painting company Client was considering, which Respondent's brother-in-law owned. 24
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1 35. Respondent took no action to discourage Client from hirin~ a painting company
2 employing two of his relatives d~spite Respondent's awareness of potential dual relationship
3 issues.
4 36. Although Respondent indicated he advised Client that Son worked for a painting
5 company she was considering, on 05/31/07 and 06/25/07, Client wrote two checks totaling $870
6 directly to Son for painting two roomsn her home.
7 37. The ISSD's Treatment Guidelines for DID clients indicate that offering regular,
8 unlimited telephone contact with DID clients is generally not helpful, and may be regressive.
9 38. Client stated that, from the beginning of her therapy, Respondent encouraged her t
10 contact him between sessions if she had questions or was struggling with anything.
11 39. Client's cellular phone records indicate that, during the last 6 months of Client's
12 therapy, Client and Respondent engaged in frequent telephone and/or text message
13 communications outside of Client's regularly scheduled therapy sessions.
14 40. Three of Client's friends observed telephone calls and text messages between
15 Client and Respondent. They described the content of the telephone calls and text messages in
16 terms such as "more like an adolescent dating relationship" and "on an intimate level".
17 41. Respondent failed to document his telephone and text message communications
18 with Client in the Client record.
19 42. The ISSD's Treatment Guidelines for DID clients do not generally recommend
20 physical contact with DID clients.
21 43. Respondent utilized "musd:l testing" with Client during the majority of her therap
22 sessions.
23 44. "Muscle testing" is not a professionally recognized behavioral health treatment.
24 45. Respondent touched Client's wrist when using "muscle testing" and also
25 occasionally stroked Client's arms as a supportive gesture.
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46. Client stated that Respondent touched her more extensively during the last six
2 months of her therapy, including holding Client's ankle, providing her foot massages, and
3 touching her stomach on four or five occasions. Respondent denied these allegations.
4 47. Client's friends stated Clk:mt told them about Respondent touching her feet andlor
stomach beginning before Client's 07107 hospitalization.
6 48. The 1880's Treatment Guidelines for DID clients indicate that transference and
7 counter-transference issues with DID clients are complex and must be meticulously managed.
B 49. Client developed romantic feelings towards Respondent and discussed her feelings
9 with him.
50. Respondent addressed Client's feelings by informing Client that he was not
11 available for a relationship.
12 51. Respondent indicated he was sexually propositioned on at least two occasions by
13 Client's alternate identity, "Jane".
14 52. Respondent indicated he addressed each of "Jane's" propositions by declining her
offer and explaining to "Jane", through Client, how accepting the offer would be harmful for all
16 involved.
17 53. Client indicated her feelin~ls for Respondent contributed to her suicide attempt.
1B 54. Respondent failed to there;; peutically address the transference issues apparent in his
19 therapeutic relationship with Client and failed to consult with other professionals regarding how
to address this issue.
21 CONCLUSIONS OF LAW
22 1. The Board has jurisdiction over Respondent pursuant to A.R.8. § 32-3251 et seq.
23 and the rules promulgated by the Board relating to Respondent's professional practice as a
24 licensed behavioral health professional.
2. The conduct and circumstances described in the Findings of Fact constitute a
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violation of ARS. § 32-3251 (12)(p), failing to conform to minimum practice standards as
developed by the Board, as it relates to AAC. R4-6-11 01, consent for treatment.
3. The conduct and circumstances described in the Findings of Fact constitute a
violation of AR8. § 32-3251 (12)(p), fcliling to conform to minimum practice standards as
developed by the Board, as it relates to AAC. R4-6-11 02, treatment plan.
4. The conduct and circumstances described in the Findings of Fact constitute a
violation of ARS. § 32-3251 (12)(p), failing to conform to minimum practice standards as
developed by the Board, as it relates to AAC. R4-6-11 03, client record.
5. The conduct and circumstances described in the Findings of Fact constitute a
violation of AR S. § 32-3251 (12)(1), any conduct, practice or condition that impairs the ability of
the licensee to safely and competently practice the licensee's profession.
6. The conduct and circumstances described in the Findings of Fact constitute a
violation of AR S. § 32-3251 (12)(y), engaging in a dual relationship with a client that could
impair the licensee's objectivity or professional judgment or create a risk of harm to the client.
For the purposes of this subdivision, "dual relationship" means a licensee simultaneously
engages in both a professional and non-professional relationship with a client that is avoidable
and non-incidental.
7. The conduct and circumstances described in the Findings of Fact constitute a
violation of ARS. 32-3251 (12)(z), eng aging in physical contact between a licensee and a client
if there is a reasonable possibility of physical or psychological harm to the client as a result of
that contact.
SURRENDER ORDER
Based upon the foregoing Findings of Fact and Conclusion of Law, the parties agree to
the provision and penalties imposed as follows:
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1 1. Respondent's license, LCSW-1699, shall be surrendered to the Board, effective
2 from the date of entry as signed below.
3 2. The surrender shall bE considered a revocation of Respondent's license.
4 3. This Consent AgreemEmt is conclusive evidence of the matters described herein
and may be considered by the Board in determining appropriate sanctions in the event a
6 subsequent violation occurs.
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Steven Brinton Date
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BOARD ACCEPTS, SIGNS AND DATES THIS CONSENT AGREEMENT
13 DatE=d this
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li: daY()f~~ 2J? ~ 14
y DEBRA RINAUDO, Executive Director Arizona Board of Behavioral Health Examiners
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19 ORIGINAL of the foregoing filed II 7W This IIfv-=.day of _ T ~~ _, 20~With:
Arizona Board of Behavioral Health Examiners 21 3443 N. Central Ave., Suite 1700
Phoenix, AZ 85012
22 COPY of the foregoing mailed via
23 Certified mail no. 2tJO "6 ClOst) 0001 This II h::-oay of _ J-v..,...v ~
24 Steven Brinton Address of Record Respondent
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COPY of the foregoing mailed via Certified mail no. 7 () 0"6 0 S-O () 000 i la?..df Sz?--..3
2 This I jk.day of :::f=Cj.....o.,.r ~ , 2()0G; to: I • ~ '/0 --n-J
3 Charles S. Hover, III Renaud Cook Drury Mesaros, PA
4 Phelps Dodge Tower One North Central, Suite 900 Phoenix, Arizona 85004-4417 Attorney for Respondent·
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7 Compliance Officer
8 602-542-1832
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1 BEFORE THE ARIZONA BOARD OF
2 BEHAVIORAL HEALTH EXAMINERS
3
4 In the Matter of:
Steven Brinton,
6 Holder of License No. LCSW-169~., For the Practice of Licensed Clinical
7 Social Work in the State of Arizona
8 Respondent.
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Complaint No. 2008-0005
ORDER ON RESPONDENT'S REQUEST FOR REVIEW OR REHEARING
On July 23, 2009, the Arizona Board of Behavioral Health Examiners ("Board") 11
received Respondent's Request for Review or Rehearing regarding the Board Order 12
dated June 24,2009. (A copy of the Board Order is attached hereto and its Findings of
14 Facts and Conclusions of Law are incorporated herein by this reference.) This matter
came before the Board for oral argument and decision on September 04, 2009.
16 Respondent was represented by his attorney, Charles S. Hover, III. After having
17 considered all the information and Hespondent's arguments, the Board granted
18 Respondent's request for review pursuant to A.A.C. R4-6-1002(A)(4) for the limited
19 purpose of modifying the June 24,2009, Board Order to clarify the practice restriction
and the process for closing Respondent's private practice.
21 ORDER
22 The Board Order dated June 24,2009, is MODIFIED as follows:
23 1. Respondent's licensE~, LCSW-1699, is placed on probation for a minimum
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period of 24 months, effective from the date of entry as signed below.
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1 Practice Restriction
2 2. While on probation and subject to the wind down provisions set forth
3 below, Respondent shall not engagl8 in private practice and shall only work at an
4 agency licensed by the Department of Health Services, Office of Behavioral Health
Licensing ("OBHL"). 6
3. Respondent shall notify the Board in writing within 5 days of securing 7
employment at an OBHL-licensed clgency. 8
PrivatEl Practice Closure Plan 9
4. Within 14 days of the effective date of this Order, Respondent shall submit
11 a written plan for closing his private practice for pre-approval by the Social Work
12 Credentialing Committee Chair or clesignee. At a minimum, the proposed plan must
13 include each of the following:
14 a. A written protocol for the secure storage, transfer and access of the
clinical records of Respondent's clients and former clients.
16 . b. The procedure by which Respondent shall notify each client and
17 former client in a timely manner regarding the future location of the
18 clinical records of Respondent's clients and former clients and how
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those records can be accessed after the termination of Respondent's
practice. 21
c. A written protocol for developing an appropriate referral for 22
23 continuation of care for Respondent's current clients.
24 d. A list of RespondE:mt's current clients and the timeframe for terminating
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1 services to each client. The timeframe for terminating services shall no
2 exceed 45 days.
3 5. Within 1 week after RHspondent has transitioned services to all clients,
4 Respondent shall provide written notice to the Board that he has complied with the
requirement to transition all of his pl"ivate practice clients. As set forth in paragraph 4(d) 6
above, Respondent shall have 45 days from the effective date of this Order to close his 7
private practice and to cease providing any type of behavioral services via his private 8
practice.9
Psychological Evaluation
11 6. Respondent must obtain a psychological evaluation within 60 days of the
12 date of this Order. The psychologist shall be pre-approved by the Social Work
13 Credentialirm Committee Chair or designee. Within 30 days of the date of this Order,
14 Respondent shall submit the name of a licensed clinical psychologist for pre-approval
by the Social Work Committee Chair or designee. The recommendations of the
16 psychologist shall be forwarded to the Social Work Credentialing Committee for
17 consideration. Any recommendations made by the psychologist shall be incorporated
18 into the Order in the form of an amE~ndment.
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Cc,ntinuing Education
7. In addition to the continuing education requirements of A.R.S. § 32-3273,21
22 within 12 months of the effective date of this Order, Respondent shall complete a 3
semester graduate level course in studies that are limited to providing an understanding 23
24 of the use of assessment and diagnosis to develop appropriate treatment interventions
for behavioral health disorders. ThE~ course shall include the use of the current
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Diagnostic and Statistical Manual, the integration of diagnostic and other assessment
information, and the development of treatment plans. Upon completion, Respondent
shall submit to the Board an official transcript establishing completion of the required
course.
8. In addition to the continuing education requirements of A.R.S. § 32-3273,
within 12 months of the effective dalte of this Order, Respondent shall take and pass a
three semester credit hour graduate level ethics course from an accredited college or
university, pre-approved by the Sodal Work Credentialing Committee Chair or
designee. Upon completion, Respondent shall submit to the Board an official transcript
establishing completion of the required course.
9. In addition to the continuing education requirements of A.R.S. § 32-3273,
within 12 months of the effective date of this Order, Respondent shall take 6-clock hours
of continuing education in clinical recordkeeping. The continuing education shall be pre
approved by the Social Work Credentialing Committee Chair or designee. Upon
completion,_ Respondent shall submit a certificate of completion of the required
continuing education.
10. Continuing education completed by the Respondent after commencement
of the Board's investigation shall be considered when determining Respondent's
satisfaction of continuing education requirements required by this Order. Respondent
shall submit a written description and a certificate of completion or official transcript of
any continuing education or graduate level courses Respondent desires the Social
Work Credentialing Committee to consider as satisfying the continuing education
requirements.
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1 Licensee Name
2 11. Respondent shall practice social work using the name under which he is
3 licensed. If Respondent changes hi~) name, he shall advise the Board of the name
4 change as prescribed under the Board's regulations and rules.
Clinical Supervision 6
12. While on probation, R'3spondent shall submit to clinical supervision for a 7
minimum period of 24 months by a masters or higher level behavioral health 8
professional licensed at the independent level. Respondent's 24 month clinical 9
supervision requirement will begin upon Respondent's employment at an OBHL
11 licensed agency.
12 13. Within 30 days of the date of securing employment at an OBHL-licensed
13 agency, Respondent shall submit the name of a clinical supervisor for pre-approval by
14 the Social Work Committee Chair or designee. Also within 30 days of the date that
Respondent secures employment at an OBHL-licensed agency, the clinical supervisor
16 shall submit a letter disclosing his/her prior relationship to Respondent. In that letter, the
17 supervisor must address why he/she should be approved, acknowledge that he/she has
18 reviewed the Order and include the results of an initial assessment and a supervision
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plan regarding the proposed supervision of Respondent. The letter from the clinical
supervisor shall be submitted to the Board. 21
22 Focus and Frequency of Clinical Supervision
14. The focus of the supervision shall relate to establishing and maintaining 23
24 appropriate boundaries with clients, dual relationships, transference and counter-
transference issues, clinical assessment and treatment planning, use of professionally
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recognized behavioral health treatment methods, use of clinical consultation and client
referrals, and clinical recordkeeping, including monthly chart reviews by the clinical
supervisor. Respondent shall meet in person with the clinical supervisor for 1 hour for
every 40 hours worked.
9uarterly Reports
15. Once approved, the supervisor shall submit quarterly reports for review
and approval by the Social Work Credentialing Committee Chair or designee. The
quarterly reports shall include issues presented in this Order that need to be reported
and the supervisor shall notify the Board if more frequent supervision is needed. After
24 months, the supervisor shall submit a final summary report for review and approval
by the Social Work Credentialing Committee Chair or designee.
Change of Clinical Supervisor During Probation
16. If, during the period o'f Respondent's probation, the clinical supervisor
determines that he/she cannot continue as the clinical supervisor, he/she shall notify the
Board within 10 days of the end of ::3upervision and provide the Board with an interim
final report. Respondent shall advis.e the Social Work Credentialing Committee chair or
designee within 30 days of cessation of clinical supervision by the approved clinical
supervisor of the name of a new proposed clinical supervisor. The proposed clinical
supervisor shall provide the same documentation to the Board as was required of the
initial clinical supervisor.
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1 Early Release
2 17. After 12 months of clinical supervision and upon the supervisor's
3 recommendation, Respondent may request early release from the Order if all other
4 terms of this Order have been met.
General Provisions 6
18. Within 10 days of the effective date of this Order, Respondent shall 7
provide the Social Work Credentialing Committee Chair or designee with a signed 8
statement from Respondent's employer confirming Respondent provided the employer 9
with a copy of this Order. If Respondent does not provide the employer's statement to
11 the Board within 10 days of the effective date, the Board will provide Respondent's
12 employer with a copy of this Order.
13 19. If, during the period of Respondent's probation, Respondent changes
14 employment, Respondent shall immediately inform the Board of the new employment
and shall within 10 days of starting each new employment, provide the Social Work
16 Credentialing Committee Chair or designee with a signed statement from Respondent's
17 new employer confirming Respond1ent provided the employer with a copy of this Order.
18 If Respondent does not provide the employer's statement to the Board within 10 days of
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the effective date, the Board will provide Respondent's employer with a copy of the
Consent Agreement and Order. 21
20. Prior to the release of Respondent from probation, Respondent must 22
submit a written request to the Board for release from the terms of this Order at least 30 23
24 days prior to the date he would like to have this matter appear before the Board.
Respondent may appear before thE3 Board, either in person or telephonically.
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1 Respondent must provide evidence that he has successfully satisfied all terms and
2 conditions in this Order. The Board has the sole discretion to determine whether all
3 terms and conditions of this Order have been met and whether Respondent has
4 adequately demonstrated that he has addressed the issues contained in this Order. In
5 the event that the Board determines. that any or all terms and conditions of this Order
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have not been met, the Board may conduct such further proceedings as it determines 7
are appropriate to address those matters. 8
21. Respondent shall not provide clinical supervision while under probation. 9
10 22. Respondent shall bear all costs relating to probation terms required in this
Order.11
12 23. Respondent shall be responsible for ensuring that all documentation
13 required in this Order is provided to the Board in a timely manner.
14 24. This Order shall be effective on the date of entry below.
15 25. This Order is conclusive evidence of the matters described herein and
16 may be considered by the Board in determining appropriate sanctions in the event a
17 subsequent violation occurs.
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19 RIGHT TO APPEAL TO SUPERIOR COURT
20 Respondent is hereby notifiE~d that this Order is the final administrative decision
21 of the Board and that the RespondEmt has exhausted his administrative remedies.
22 Respondent is advised that an appE3al to superior court in Maricopa County may be
23 taken from this decision pursuant to Title 12, Chapter 7, article 6, within thirty-five (35)
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days from the date this decision is served. 25
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1 Dated this ;;S..f~ ,2009
2
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De ra Rinaudo, Executive Director 4 Arizona Board of Behavioral Health Examiners
ORIGINAL of t~~led this . 6 ;{~ day AlL9t........2009, with:
7 Board of Behavioral Health Examim~rs
3443 North Central Avenue, #1700 8 Phoenix, AZ 85012
9 COpi( of the fore' certified mail this ~ day~of~~&d~.-.L009, to:
Steven Brinton 11
Address of Record
12 Respondent
13 Charles S. Hover, III Renaud Cook Drury Mesaros, PA
14 Phelps Dodge Tower One North Central, Suite 900 Phoenix, AZ 85004-4417 Attorney for Respondent
16 c.OEY. of the foreg y interoffice mail this
1 7 Q(~ day 01!..fJfl!!!!!:.~~~~:t...!'I"'~W09, to:
18 Marc H. Harris Assistant Attorney General
19 1275 W. Washington, CIVILES Phoenix, AZ 85007
21 ~. <;::'_1 ~{H~22 compliance~ ~ 0 -_.
602-542-183223 DOC#565675
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BEFORE THE ARIZONA BOARD OF
BEHAVIORAL HEALTH EXAMINERS
In the Matter of:
Steven Brinton, Complaint No. 2008-0005
Holder of License No. LCSW-1699, For ORDER the Practice of Licensed Clinical Social Work in the State of Arizona
Respondent.
Pursuant to A.R.S. §§ 32-3281 (I) and (J), the Arizona State Board of Behavioral
Health Examiners ("Board") conducted a Formal Interview with Steven Brinton
("Respondent") on June 5, 2009. R:espondent knowingly and voluntarily appeared and
participated in the Formal Interview. The Board reviewed all documents submitted
regarding this matter and took testiimony from Respondent. After considering all the
information and testimony, the Board issues the following Findings of Fact, Conclusions
of Law and Order:
FINDINGS OF FACT
1. Respondent is the holder of License No. LCSW-1699 for the practice of
clinical social work in Arizona.
2. On 07/01/07, an employl3e of Aurora Behavioral Health, a psychiatric
hospital, filed a complaint against I~espondent.
3. The complaint was filed on behalf of a patient ("Client") who had been
admitted to the hospital after a suicide attempt by overdose on Soma, Valium and
alcohol. Client had also hammered a nail through the top of her left foot.
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4. Respondent was Client's therapist prior to her hospital admission. Client's
last therapy session with RespondEmt was approximately one week prior to her suicide
attempt.
5. Client reported to hospital staff that she had feelings for Respondent, that
Respondent had made sexual remarks and advances towards her during her therapy
sessions, and that Respondent had told Client of his feelings for her.
6. Respondent provided a total of 159 therapy sessions to Client from
December 2004 through June 200'7. Client's sessions typically occurred on a weekly or
bi-weekly basis.
7. Respondent failed to coordinate treatment with Client's primary care
physician, who prescribed Client's antidepressant medication.
8. Respondent failed to obtain a signed and dated informed consent to
treatment for Client.
9. Respondent failed to document any type of written assessment of Client.
10. Respondent failed to prepare a written treatment plan for Client.
11. The progress notes mclintained by Respondent to document Client's therapy
were largely illegible, did not reflect the events described by Respondent in his
complaint response, and were not reflective of what occurred during Client's therapy
sessions.
12. Respondent diagnosed Client with Dysthymia and documented this
diagnosis in her client record.
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13. Respondent has indicated that he also diagnosed Client with Post Traumatic
Stress Disorder at the beginning of her therapy and later diagnosed her with
Dissociative Disorder. He did not document these diagnoses in her client record.
14. Respondent has been providing therapy to clients in private practice since
1991.
15. Respondent failed to obtain a signed and dated informed consent to
treatment for any of his private practice clients until August 2007.
16. Respondent failed to prepare a written treatment plan for any of his private
practice clients until August 2007.
17. The guidelines ("Treatment Guidelines") published by the International
Society for the Study of Dissociation ("IS8D") for the treatment of clients with
Dissociative Identity Disorder ("DID") indicate clinicians should vigorously manage
eating disorders and substance abuse behaviors of DID clients, including the
development of specific treatment plans which may include referral to specialized
treatment programs.
18. Client disclosed issues including bulimia and substance abuse during her
first month of therapy with Respondent.
19. Respondent failed to treat Client's bulimia and substance abuse issues or
refer Client to other professionals with expertise in these areas.
20. The 18SD's Treatment Guidelines for DID clients warn that there is a
significant potential for boundary violations with DID clients, that a clear statement of
therapeutic boundaries is needed at the beginning of treatment, and that therapists
must be very cautious to foster cl43ar boundaries in the therapeutic relationship.
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21. Respondent failed to document any efforts he took to establish clear
therapeutic boundaries with Client.
22. Client believed that her relationship with Respondent extended beyond that
of client-therapist.
23. Client's bishop, friends, husband, and Primary Care Physician ("PCP") were
concerned about the lack of appropriate boundaries in the relationship between Client
and Respondent.
24. Client's PCP documented his concern in an 11/16/06 progress note.
25. Respondent encourages the majority of his clients to consider participating in
Landmark Education ("Landmark"} programs.
26. Shortly after Client's therapy began, Client hosted a Landmark Introduction
session at her home.
27. Client hosted the Landmark Introduction due to her belief that Respondent
would receive benefit from Landmark as a result.
28. Respondent attended the Landmark Introduction session at Client's home
despite his awareness of the associated dual relationship issues.
29. Two of Respondent's other clients also attended the Landmark Introduction
session in Client's home. One of the other clients was the Landmark Introduction leader.
30. A tape recording of a voice mail message left by Respondent on Client's
home telephone answering machine recorded Respondent requesting that Client send
an "Orb" to a third person to assist the person in completing a Landmark Forum.
31. An "Orb" is healing power believed to be possessed by Client and discussed
in Client's therapy with RespondE~nt.
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32. Respondent requested that Client send the "Orb" to a third person despite hi
awareness of the dual relationship iissues associated with this request.
33. Respondent did not identify any therapeutic basis for his request to Client.
34. Respondent voluntarily advised Client that Respondent's son ("Son") worked
for a painting company Client was considering, which Respondent's brother-in-law
owned.
35. Respondent took no adion to discourage Client from hiring a painting
company employing two of his relatives despite Respondent's awareness of potential
dual relationship issues.
36. Although Respondent indicated he advised Client that Son worked for a
painting company she was considering, on 05/31/07 and 06/25/07, Client wrote two
checks totaling $870 directly to Son for painting two rooms in her home.
37. The ISSD's Treatment Guidelines for DID clients indicate that offering
regular, unlimited telephone contact with DID clients is generally not helpful, and may
be regressive.
38. Client stated that, from Ithe beginning of her therapy, Respondent encouraged
her to contact him between sessions if she had questions or was struggling wit
anything.
39. Client's cellular phone records indicate that, during the last 6 months of
Client's therapy, Client and Respondent engaged in frequent telephone andlor text
message communications outside of Client's regularly scheduled therapy sessions.
40. Three of Client's friends observed telephone calls and text messages
between Client and Respondent. They described the content of the telephone calls and
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text messages in terms such as "more like an adolescent dating relationship" and "on an
intimate level".
41. Respondent failed to document his telephone and text message
communications with Client in the Client record.
42. The 1880's Treatment Guidelines for DID clients do not generally
recommend physical contact with DID clients.
43. Respondent utilized "muscle testing" with Client during the majority of he
therapy sessions.
44. "Muscle testing" is not al professionally recognized behavioral health
treatment.
45. Respondent touched Cllient's wrist when using "muscle testing" and also
occasionally stroked Client's arms as a supportive gesture.
46. Client stated that Respondent touched her more extensively during the last
six months of her therapy, including holding Client's ankle, providing her foot massages,
and touching her stomach on four or five occasions. Respondent denied these
allegations.
47. Client's friends stated Client told them about Respondent touching her feet
andlor stomach beginning before Client's 07107 hospitalization.
48. The 1880's Treatment Guidelines for DID clients indicate that transference
and counter-transference issues with DID clients are complex and must be meticulously
managed.
49. Client developed romantic feelings towards Respondent and disclJssed her
feelings with him.
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50. Respondent addressed Client's feelings by informing Client that he was not
available for a relationship.
51. Respondent indicated he was sexually propositioned on at least two
occasions by Client's alternate identity, "Jane".
52. Respondent indicated he addressed each of "Jane's" propositions by
declining her offer and explaining to "Jane", through Client, how accepting the offer
would be harmful for all involved.
53. Client indicated her feelings for Respondent contributed to her suicide
attempt.
54. Respondent failed to therapeutically address the transference issues
apparent in his therapeutic relationship with Client and failed to consult with other
professionals regarding how to address this issue.
CONCLUSIONS OF LAW
1. The Board has jurisdiction over Respondent pursuant to AR.S. § 32-3251 et
seq. and the rules promulgated by the Board relating to Respondent's professional
practice as a licensed behavioral health professional.
2. The conduct and circumstances described in the Findings of Fact constitute
a violation of AR.S. § 32-3251 (12:)(p), failing to conform to minimum practice standards
as developed by the Board. as it relates to AAC. R4-6-11 01, consent for treatment.
3. The conduct and circumstances described in the Findings of Fact constitute
a violation of AR.S. § 32-3251 (12)(p), failing to conform to minimum practice standards
as developed by the Board, as it relates to AAC. R4-6-1102, treatment plan.
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4. The conduct and circumstances described in the Findings of Fact constitute
a violation of A.R.S. § 32-3251 (12)(p), failing to conform to minimum practice standards
as developed by the Board, as it relates to A.A.C. R4-6-1103, client record.
5. The conduct and circumstances described in the Findings of Fact constitute
a violation of A.R. S. § 32-3251(12)(1), any conduct, practice or condition that impairs
the ability of the licensee to safely and competently practice the licensee's profession.
6. The conduct and circumstances described in the Findings of Fact constitute a
violation of A.R. S. § 32-3251 (12)(y), engaging in a dual relationship with a client that
could impair the licensee's objectivity or professional judgment or create a risk of harm
to the client. For the purposes of this subdivision, "dual relationship" means a licensee
simultaneously engages in both a professional and non-professional relationship with a
client that is avoidable and non-inc:idental.
7. The conduct and circumstances described in the Findings of Fact constitute a
violation of A.R.S. 32-3251 (12)(z), engaging in physical contact between a licensee and
a client if there is a reasonable possibility of physical or psychological harm to the client
as a result of that contact.
ORDER
Based on the foregoing, IT IS ORDERED as follows:
1. Respondent's license, LCSW-1699, will be placed on probation for a minimum
period of 24 months, effective from the date of entry as signed below.
jPractice Restriction
2. While on probation, Respondent shall not engage in private practice and shall
only work at an OBHL licensed a~lency.
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Psychological Evaluation
3. Respondent must obtain a psychological evaluation within 60 days of the date
of this Consent Agreement. The psychologist shall be pre-approved by the Social Work
Credentialing Committee Chair or designee. Within 30 days of the date of this Consent
Agreement, Respondent shall submit the name of a licensed clinical psychologist for
pre-approval by the Social Work Committee Chair or designee. The recommendations
of the psychologist shall be forwardled to the Social Work Credentialing Committee for
consideration. Any recommendations made by the psychologist shall be incorporated
into the Consent Agreement in the form of an amendment.
Ccmtinuing Education
4. In addition to the continuing education requirements of A.R.S. § 32-3273,
within 12 months of the effective date of this Consent Agreement, Respondent shall
complete a 3-semester graduate level course in studies that are limited to providing an
understanding of the use of asseS8ment and diagnosis to develop appropriate treatment
interventions for behavioral health disorders. The course shall include the use of the
current Diagnostic and Statistical Manual, the integration of diagnostic and other
assessment information, and the development of treatment plans. Upon completion,
Respondent shall submit to the Board an official transcript establishing completion of
the required course.
5. In addition to the continuing education requirements of A.R.S. § 32-3273,
within 12 months of the effective elate of this Consent Agreement, Respondent shall
take and pass a three semester clredit hour graduate level ethics course from an
accredited college or university, pre-approved by the Social Work Credentialing
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Committee Chair or designee. Upon completion, Respondent shall submit to the Board
an official transcript establishing completion of the required course.
6. In addition to the continuing education requirements of A.R.S. § 32-3273,
within 12 months of the effective date of this Consent Agreement, Respondent shall
take 6-clock hours of continuing education in clinical recordkeeping. The continuing
education shall be pre-approved by the Social Work Credentialing Committee Chair or
designee. Upon completion, Respondent shall submit a certificate of completion of the
required continuing education.
7. Continuing education completed by the Respondent after commencement of
the Board's investigation shall be considered when determining Respondent's
satisfaction of continuing education requirements required by this Consent Agreement.
Respondent shall submit a written description and a certificate of completion or official
transcript of any continuing education or graduate level courses Respondent desires the
Social Work Credentialing Committee to consider as satisfying the continuing education
requirements.
Licensee Name
8. Respondent shall practice social work using the name under which he is
licensed. If Respondent changes his name, he shall advise the Board of the name
change as prescribed under the Board's regulations and rules.
:Clinical Supervision
9. While on probation, Respondent shall submit to clinical supervision for a
minimum period of 24 months by a masters or higher level behavioral health
professional licensed at the independent level. Within 30 days of the date of this
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Consent Agreement, Respondent shall submit the name of a clinical supervisor for pre
approval by the Social Work Committee Chair or designee. Also within 30 days of the
date of this Consent Agreement, the clinical supervisor shall submit a letter disclosing
his/her prior relationship to Respondent. In that letter, the supervisor must address why
he/she should be approved, acknowledge that he/she has reviewed the Consent
Agreement and include the results of an initial assessment and a supervision plan
regarding the proposed supervision of Respondent. The letter from the supervisor shall
be submitted to the Board.
Focus and Flreguency of Clinical Supervision
10. The focus of the supervision shall relate to establishing and maintaining
appropriate boundaries with clients, dual relationships, transference and counter
transference issues, clinical assessment and treatment planning, use of professionally
recognized behavioral health trea,tment methods, use of clinical consultation and client
referrals, and clinical recordkeeping, including monthly chart reviews by the Supervisor.
Respondent shall meet in person with the supervisor for 1 hour for every 40 hours
worked.
Quarterly Reports
11. Once approved, the supervisor shall submit quarterly reports for review and
approval by the Social Work Credentialing Committee Chair or designee. The quarterly
reports shall include issues presl:mted in this consent agreement that need to be
reported and the supervisor shall notify the Board if more frequent supervision is
needed. After 24 months, the supervisor shall submit a final summary report for review
and approval by the Social Work. Credentialing Committee Chair or designee.
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Change of Clinil:al Supervisor During Probation
12. If, during the period of Respondent's probation, the clinical supervisor
determines that he/she cannot continue as the clinical supervisor, he/she shall notify the
Board within 10 days of the end of supervision and provide the Board with an interim
final report. Respondent shall advise the Social Work Credentialing Committee chair or
designee within 30 days of cessation of clinical supervision by the approved clinical
supervisor of the name of a new proposed clinical supervisor. The proposed clinical
supervisor shall provide the same documentation to the Board as was required of the
initial clinical supervisor.
Early Release
13. After 12 months and upon the supervisor's recommendation, Respondent
may request early release from the Consent Agreement and Order if all other terms of
the Consent Agreement and Order have been met.
~3eneral Provisions
14. Within 10 days of the effective date of this Order, Respondent shall provide
the Social Work Credentialing Committee Chair or designee with a signed statement
from Respondent's employer confirming Respondent provided the employer with a copy
of this Consent Agreement and O'"der. If Respondent does not provide the employer's
statement to the Board within 10 clays of the effective date, the Board will provide
Respondent's employer with a copy of the Consent Agreement and Order.
15. If, during the period of Respondent's probation, Respondent changes
employment, Respondent shall immediately inform the Board of the new employment
and shall within 10 days of starting each new employment, provide the Social Work
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Credentialing Committee Chair or designee with a signed statement from Respondent's
new employer confirming Respondent provided the employer with a copy of this
Consent Agreement and Order. If Respondent does not provide the employer's
statement to the Board within 10 days of the effective date, the Board will provide
Respondent's employer with a COP)I of the Consent Agreement and Order.
16. Prior to the release of Respondent from probation, Respondent must submit
a written request to the Board for release from the terms of this Consent Agreement and
Order at least 30 days prior to the date he would like to have this matter appear before
the Board. Respondent may appeclr before the Board, either in person or telephonically.
Respondent must provide evidencl~ that he has successfully satisfied all terms and
conditions in this Consent Agreem~nt. The Board has the sole discretion to determine
whether all terms and conditions of this Consent Agreement and Order have been met
and whether Respondent has adequately demonstrated that he has addressed the
issues contained in this Consent A.greement and Order. In the event that the Board
determines that any or all terms and conditions of this Consent Agreement and Order
have not been met, the Board may conduct such further proceedings as it determines
are appropriate to address those matters.
17. Respondent shall not provide clinical supervision while under probation.
18. Respondent shall bear all costs relating to probation terms required in this
Consent Agreement and Order.
19. Respondent shall be msponsible for ensuring that all documentation
required in this Consent Agreement and Order is provided to the Board in a timely
manner.
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20. This Consent Agreement and Order shall be effective on the date of entry
below.
21. This Consent Agreement and Order is conclusive evidence of the matters
described herein and may be consildered by the Board in determining appropriate
sanctions in the event a subsequent violation occurs.
NOTICE
All parties are advised that they may file a Motion for Review or Rehearing
pursuant to A.R.S. 41-1092.09 and A.A.C. R4-6-1002, that any motion must be in
writing and filed within thirty (30) days of the service of this decision. Filing a request for
rehearing is a prerequisite for seeking judicial review of the Board's decision.
Dated this ----::~--'-Lf_+_- of -zr.£..>oA...",J,......=------' 2009
Q.L4 ~A.<" ~L~,= Debra Rinaudo, Executive Director Arizona Board of Behavioral Health Examiners
~lwAL of the n~led this o\oo'oL_~->--=,,---- day of ~' 2009, with:
Board of Behavioral Health Examiners 3443 North Central Avenue, #1700 Phoenix, AZ 85012
C.P.W~of the foregoffl~:nt sertified mail this -=c:J=----'I~o......:::...:....-- day of ~ , 2009, to:
Steven Brinton Address of Record Respondent
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Charles S. Hover, III Renaud Cook Drury Mesaros, PA Phelps Dodge Tower One North Central, Suite 900 Phoenix, Arizona 85004-4417 Attorney for Respondent
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