Mandated exceptions & Permitted exceptions to confidentiality
What are preventive measure that break confidentiality when working with a client who presents a danger to self?
1. Consultation with a client's other health care providers 2. A 24-hour watch (family, friends) arranged without the client's permission 3. Involuntary hospitalization
What are preventive measure that do not break confidentiality when working with a client who presents a danger to self?
1. No self harm or self-care plan 2. Increased contact (Extra sessions, phone check ins) 3. Involve clients support system (release to speak to family or friends) 4. Referral to physician or psychiatrist for medication 5. Voluntary hospitalization
Tarasoff law or "Have the Duty to protect" is triggered when..
1. client, a close family member of a client, or a credible third party 2. has communicated to the therapist 3. the client's serious threat (which must be imminent) 4. of "physical violence" 5. to "a reasonably identifiable [intended] victim"
What are elements that should be included in record keeping pertaining to suicidal clients?
1. documentation of any concerns and other discussion of issues regarding potential suicide 2. assessment of clients- history of attempts, family history of suicide, medical history and psychiatric hospitalization, substance abuse, impulse control 3. Conclusion drawn from the client appearance, demeanor, behavior, and current mental or emotional state. 4. Interventions to try to prevent self-harm and the client's response 5. Records should detail the therapist's actions and the reasoning behind these decisions 6. Records should reflect any consultation a health care provider took in managing a suicidal client, including the practitioner's experience in working with suicidal clients.
what are the requirement of release authorization to disclose confidential information?
1. is handwritten by the person who signs it or no smaller than 14 point font 2. is clearly separate from any other language present on the same page and is execute by a signature which serves no other purpose than to execute the authorization. 3. Is signed and dated by the patient or the patient's representative 4. states the specific use and limitations on the use of medical information by the persons 8. stats a specific date after which the provider of healthcare is no longer authorized to disclose 9. advisees the person signing the authorization of the right to receive a copy
Mandate details of clients who stated they even inadvertently download, stream, or access images in which a minor is depicted in digital media-- total 7
1. only applies to client who report viewing this material after 01/1/2015 2. MH professional should disclose this limit of confidentially in any informed consent conversations 3. This mandate would include an 18 year old who "knowingly" receives a topless text from his 17-year old partner 4. This mandate would include anyone who forwards such material from a minor to anyone else. 5. This mandate would include anyone who suggests or coerces a minor into sending a sexualized image of him/herself 6. This mandate includes the viewing, not only the manufacture and distribution of sexualized images that involve a minor. 7. Like all mandated reports to law enforcement, the reporter is entitled to add any mitigating information that the person does not know direct signs of imminent direct harm to a specific child in real life.
What are other options for carrying out the duty to protect after fulfilling the mandate?
1. warn the intended victims or victims 2. warm someone likely to apprise the intended victims or victims ( a spouse or parent of the intended victims; an employee or supervisor of the intended victim) 3. Have the client dispose of the means 4. Institute a "No Violence" plan 5. Have the client voluntary or involuntary hospitalized.
What does the phrase "in his or her professional capacity" mean?
A MH professional is only bound by law to report child abuse when learning about the abuse while providing treatment services (including speaking engagements where the professional is hired or volunteers to speak as an expert ; when clinician engages in communication using their professional platforms i.e. social media, website)
traumatic condition
A condition of the body, such as a wound or external or internal injury, whether of a minor or a serious nature, caused by physical force
What is the Penal Code Section 11166
A mandated reporter shall make a report to a specified agency, whenever the mandated reporter in his or her professional capacity or within the scope of his or her employment, has knowledge of our observes a child whom the mandated reporter knows or reasonably suspect has been the victim of child abuse or neglect.
IF the suspected abuse occurred in a state mental hospital other than reporting to Adult Protective services...what else needs to be done?
A report must be made by phone as soon as possible to designated investigators of the State Department of Mental Health or the local law enforcement agency and written report by 24 hours
Unlawful corporal punishment or injury is defined as
A situation where any person willfully inflicts upon any child any cruel or inhuman punishment or injury resulting in a traumatic condition
What if the intent to hurt someone is not direct and the clinician is left to "determine"
A therapist must also have the duty to protect when s/he "determines" that the client poses a serious threat of violence to an "intended person". A explicit statement may not be required; body language and mental state may be sufficient to infer an imminent threat if the therapist, in his/her clinical judgement and after a risk assessment, determines sufficient danger to break confidentiality.
What is the Tarasoff case?
A therapist treats a walk-in client, allows client to vent, client reveals that his girl friends broke up with him and he threatens to kill his girl friend. The therapist thought that the client was not a threat, but the client left and killed his girl friend.
What should we keep in mind when thinking of mutual affray
A wiliness or intent to fight, size and maturity
What to say when CPS social workers calls to follow up regarding a report made?
Can speak to the investigator but only about that same report without signed authorization of the client
TRUE or FALSE--domestic violence in and of itself represented a mandated report
FALSE. The fact that domestic violence is occurring in a household in which a child lives does not automatically necessitate a child abuse report. EVEN if the minor witnessed an act of domestic violence, this does not necessarily mean that child abuse report should be made.
True or false: You must be sure that abuse is present to make the report
False--Actual observation is not necessary. "Proof" or "evidence" is not necessary. A mandated reporter does not require certainty to arrive at "reasonable suspicion" You also not required to investigate if there is abuse.
What is the best option when attempting to avoid liability if a client presents intent to cause harm to another person?
Follow the Tarasoff Duty to protect mandate and notify the local law enforcement and warn the intended victim
does homelessness trigger a mandated report?
Homelessness in and of itself is not a neglect situation. The law is indented to help homeless children access services who may otherwise avoid seeking support for fear of triggering a report or being returned to the home from which they fled.
In terms of elder abuse/dependent adult abuse what must occur other than the reasonable suspension or knowledge to trigger the mandate?
It must occur in the state of CA and the alleged victim must live or have the intention of living in CA
Whom is considered "authorized recipients"
Law enforcement, Court personal, and BBS are authorized recipients. The client, and the parents are not.
What are the mandated exceptions related to the patriot act?
Law requires therapist to provide FBI agents with books, records, papers, documents, and other items as requested in a National Security Letter. The health care professional is prohibited from disclosing to the patient or anyone else who could notify the client that the FBI either sought or obtained the items.
As mandated reports should we disclose to the clients that a report was filed?
Mandated reporters are not required to disclose to client that a child abuse report is filed. However as treating professionals we may choose to do so if it is the best interest of the alleged victim of abuse.
What the phrase "to have knowledge of" mean?
Means the first hand observation, second or third hand information about the abuse of child who is not a client is reportable if the service provider is like acting like his or her professional capacity.
Does having the intention of transferring a communicable disease such as HIV/AID through consensual sex trigger the Duty to Protect mandate??
No, this does not fall under the Tarasoff duty to protect
What are the types of categories of dependent adult and elder abuse?
Physical abuse, abandonment, isolation, neglect, financial abuse, and abduction
Who can invoke a 5150?
Police officers Members of the attending staff of a county certified facility Other professionals designated by the county
5270.15 Code?
Provides that following 14 day treatment pursuant to 5250 a person could be certified for an additional 30 days of treatment if s/he is found to be gravely disabled as results of a mental disorder or impairment by chronic alcoholism an dis unwilling or unable to accept voluntary treatment
5300 Code
Someone who mental disorder cause continued imminent dangerousness to other may be held for an additional 180 days because they have either-- 1. attempted or inflicted physical harm upon another person, that the act having resulted in his or her being taking to custody 2. made a serious threat of substantial physical harm upon another person within 7 days of begin taken into custody with the threat having at least in part resulted in his/her taken into custody 3. attempted, inflicted, or made a serious threat of substantial physical harm upon another person after having taken into custody and while in custody
What if physical injury is inflicted to a minor by another minor?
Still reportable unless its was an accident or mutual affray between minors
True or False---Therapist has liability to foreseeable bystanders if s/he does not fulfill Tarasoff responsibility.
TRUE
True or False--All incidents of oral or anal sex or intrusion upon genial or anal opening involving any minor must be reported
TRUE
True or False: A therapist must comply with a mandated exception to confidentiality if presented with a receipt of a search warrant naming the therapist as the subject
TRUE
True or False: A therapist must comply with a mandated exception to confidentiality when a receipt of a coroner's request for information in the course of an investigation for the purpose of identifying a decedent or locating next of kin or when investigating deaths that may involve the public health records.
TRUE
True or False: depend adult or elder abuse must be reported if a clinician has knowledge or reasonable suspicion of physicals abuse, abandonment, isolation, neglect, financial abuse, or abduction of an elder or dependent adult.
TRUE
True or false: Child abuse must be reported if a MH professional has knowledge or reasonable suspicion of physical abuse, sexual abuse, willful cruelty or unjustified punishment, unlawful corporal punishment.
TRUE
True or False: downloading, streaming, and accessing any images in which a minor is depicted in digital media is reportable
TRUE! even if its by accident
True or False: A therapist must take action to protect the public from a client's threatened harm to a reasonable identifiable other
TRUE-- Tarasoff duty to protect
True or False-- A therapist may consider making an exception to confidentiality if they believe a client who due to their mental disorder is in danger of self, others, or the property of others
TRUE--this would pertain to a client whos 1. has SI 2. engaged in dangerous or reckless behavior that present danger to self or others
How does one make a report is dependent adult and elder physical abuse with bodily harm occurs in a long term facility?
Telephone report must be made immediately to a local law enforcement and written report within 2 hours to law enforcement, facility's licensing agency, and local ombudsman
What if a client states that s/he inadvertently accessed sexual imagery involving a minor in any digital media?
The client must be reported immediately to the local law enforcement.
How can domestic violence result in a reportable mandate?
The criterion in determining whether or not a child abuse report is warranted is the EFFECT of the DV on the child. Thus if the child is injured as a result of DV, if the DV is caused a child unjustifiable mental suffering, or if the DV places the child in a situation in which his or her person or health is endangered, this would require a report.
Where do we report if it is out of state?
The must be made to an agency in CA, regardless of the location of the abuse, the abuser, or the victim, Reporting child abuse to an agency outside of CA fails to satisfy the duty to report, but also represents a breach of confidentiality by disclosing information not mandated or permitted by law.
Mandated to Report or Maintain Confidentiality--Consensual oral sex, anal sex, or penetration into the genial or anal opening with a foreign object with anyone under 18 (minor)
Therapist are mandated to report
Mandated to Report or Maintain Confidentiality--If there is consensual sexual intercourse between a minor under 16 and an adult 21 or order
Therapist are mandated to report
Mandated to Report or Maintain Confidentiality-Sexual activity involving a 14 year old and a 24 year old.
Therapist are mandated to report.
Mandated to Report or Maintain Confidentiality-if there is consensual sexual activity between a child under the age of 1 with a much younger or much more immature minor where there is intent to exploit the younger or less mature child's sexual naivete.
Therapist are mandated to report.
Mandated to Report or Maintain Confidentiality-if there is consensual sexual activity involving a minor under that age of 14 and any person 14 years or older.
Therapist are mandated to report.
Mandated to Report or Maintain Confidentiality- if there is ANY sexual activity between a minor 14 or 15 and an adult at least 10 years order than the minor.
Therapist are mandated to report. The age difference is determined by the birth date of the parties involved.
What if a therapist does not fulfill their mandate?
Therapist commit a misdemeanor, punishable by fine of $1000 and/or six months in county jail. In addition, a therapist who fails to report is civilly liable for the cost of subsequent damage or injury from abuse, including symptoms that arise many years after the unreported.
After the report is made what are the obligations of the therapist?
Therapist is legally obligated to keep the contents and the fact of a child abuse report confidential, and only disclose to "authorized recipients"
Mandated to Report or Maintain Confidentiality- Sexual activity between 15 year old and a 24 year old
Therapist to maintain confidentiality
Mandated to Report or Maintain Confidentiality- Sexual intercourse between 14 years old and 20 year old
Therapist to maintain confidentiality
Mandated to Report or Maintain Confidentiality-intercourse or other sexual activity involving minors 16 or older with others who are 14 years of age or older.
Therapist to maintain confidentiality
Code 5150
This law provides for a 72 hour hold of treatment and evaluation
What is the mandate part of the duty to protect (Tarasoff)
To notify local law enforcement within 24 hours and the intended victim or victims
Does each incident of child abuse need to be reported?
YEs, each new incident of child abuse must be reported, even if a previous report was made regarding the same child and/or the same abuser. Any new information to a reported child abuse must be reported.
Can a therapist report second or third hand information?
Yes, the information that therapist learns about third parties who are not clients, is reportable if the therapist learned of it while acting in his or her professional capacity or the scope of employment
Who can initiate a 5150?
a MH worker, child or adult protective services workers, and conservators.
How does one make a report made when is occurs outside of a long term care facility i.e. someone's home
a call must be made immediately by phone to Adult Protective services or law enforcement. A written report must be filled within 2 working days
Code 5250?
a certification review hearing can determine if a person may involuntarily confined up to 14 additional days fore testing, evaluation, and trails of medication
Neglect defined for elders and dependent adults
a failure of the caregiver with providing natural necessaries. Neglect also includes self-neglect in which a dependent adult or elder can't adequality provide for his or her own needs due to physical or mental limitations
Willful cruelty or unjustifiable punishment of a child is defined as
a situation where a person willfully causes or permits any child to suffer, or inflicts thereon, unjustifiable physical pain or mental suffering, or having the care of custody of any child, willfully cause or permits the person or health of the child to be placed in a situation such his or her person or health is endangered. i.e. looking someone in the closet, not giving someone water, not letting them use the bathroom.
Financial abuse defined
applies to any person who secretes or misappropriates money or property to any wrongful use of with the intent to defraud. this includes stealing, acting as a conservator and using funds for personal use without consent. Includes "undue influence"
What are the examples of physical abuse of a dependent adult and elder?
battery, assault, assault with a deadly weapon, chemical resistant (drugs and meds), sexual assault, physical restraints/deprivation of food and water, and serious bodily harm
What does the phrase "undue influence" mean?
characterized by the misuse of trust, persuasion, and/or apparent authority and falls below the threshold of outright threat, fraud, coercion or theft.
The defining factor if the use of a belt or another object is report is depended on what?
if a traumatic condition occurred, not the means by which it occurred.
How does one make a report is dependent adult and elder abuse occurs in a long term facility?
if physical abuse without bodily injury then telephone report must be made within 24 hours to a local law enforcement and written report within 24 hours to law enforcement, facility's licensing agency, and local ombudsman For NON physical-- must be reported as soon as possible to law enforcement or local ombudsmen and a written report within 2 working days to law enforcement or a local ombudsman
When do reports need to be made?
immediately, and then the written report bust be completed 36 hours of receiving the information
When the Duty to protect mandate is trigger how should one communicate with the indented victim?
it is important to remain as discrete as possible and only rely the necessarily information
What if the alleged victim of child abuse is taken out of the state??
it is not a mandated report unless you have knowledge that the child is being endangered. For example, if one parent takes the child without the other parent's approval, it would, potentially, be kidnapping and that parent should contact a lawyer and or the police, but therapist specified would not break confidentiality.
How does one define neglect?
negligent treatment or maltreatment of a child by a person responsible for the child's welfare under circumstances indicating harm or threatened harm to the child's health or welfare. The term includes both acts and omissions on the part of the responsible party
Abuse or Neglect in Out-of-home Care
physical injury inflicted upon a child by another person by other than accidental means, sexual abuse, neglect, unlawful corporal punishment or injury or the willful cruelty or unjustifiable punishment of a child...where the person responsible for the child's welfare is a licensee, administrator, or employee of any facility licensed to care for children's, or an administrator or employee of a public or private school or other insinuation or agency.
Define physical abuse
physical injury or death inflicted by other than accidental means by another means
What are the three categories of child abuse?
physical, sexual, neglect
Define isolation
restricting a dependent adult or elder from social contact with others...by denying access to the mail, telephone, visitors, and/or preventing a dependent adult or an elder from leaving
Sexual abuse is defined as?
sexual abuse as sexual assault or sexual exploitation. Sexual assault includes rape, statutory rape, rape in concert, sodomy, lewd, or lascivious act upon a child, oral copulation, sexual penetration and child molestation.
Code 5260
someone who has threated or attempted to take his/her own life or someone who exhibits chronic alcoholism may be held an additional 14 days beyond the 14 days provided by the 5250 code. At the end of the 5260 14 day period there can be no further periods of the involuntary treatment unless the person qualifies as a person who is dangerous to others.
Abduction defined
taking dependent adults or elders out of CA or preventing them from returning to CA without their consent or against their will.
What does the term "reasonable suspicion mean"?
that it is objectively reasonable for a person to entertain a suspicion, based upon fats that could cause a reasonable person in a like position, drawing, when appropriate, on his or her training and experience, to suspect child abuse or neglect
Define abandonment
the willful withdrawal of support or care from a dependent adult or elder...by a person previously in a position of providing support or care... in which a reasonable person would continue to provide support and care