Confidentiality

Question 1

A client is at high risk of suicide

Answer 1

Permitted exception to confidentiality

Question 2

A client is gravely disabled

Answer 2

Permitted exception to confidentiality if a client is not able to care for him/herself. Example given is a client who appears to be a danger to himself or others and who has a mental or emotional condition. (Schizo, etc.) Breaking of confidentiality would be to those I would need to contact in order to get the client the help he/she needed.

Question 3

Billing insurance

Answer 3

Permitted exception to confidentiality

Question 4

Disclosures to parents of minor clients

Answer 4

Permitted exception to confidentiality

Question 5

Disclosures to other mental health providers of client in order to prevent harm to patient

Answer 5

Permitted exception to confidentiality

Question 6

Probation office knowing about therapy attendance

Answer 6

Permitted exception to confidentiality

Question 7

Confidentiality

Answer 7

Legal and ethical requirement placed on the therapist that restrict the volunteering of information obtained in a therapeutic relationship.

Question 8

Client discloses crimes previously committed

Answer 8

Must maintain confidentiality unless the crime is against a protected class (child, dependent adult or elder)

Question 9

The client passes away. Can his/her records be accessed?

Answer 9

Confidentiality survives the death of a client or former client. There must be authorization from the personal representative or legal executor of the deceased client.

Question 10

Who must sign authorization for disclosure?

Answer 10

When treating more than one person, each member competent to do so and 12+ years of age is required to sign an authorization prior to the disclosure of any information whatsoever to third parties pertaining to the therapy.

Question 11

What does confidentiality look like in a group setting?

Answer 11

When treating clients in group therapy, the therapist has a responsibility to maintain confidentiality of all group members. Additionally, a therapist is ethically responsible to obtain agreement among all group members to respect the confidentiality of other group members.

Question 12

What if a client commits an act of theft or violence against the therapist?

Answer 12

A therapist is not obligated to maintain confidentiality.

Question 13

Mandated reporting of child abuse

Answer 13

Must be reported if a therapist has knowledge or reasonable suspicion of physical abuse, sexual abuse, willful cruelty or unjustified punishment, unlawful corporal punishment or injury or neglect.

Emotional abuse is an optional report.

Question 14

Mandated reporting of dependent adult or elder abuse

Answer 14

Must be reported if a therapist has knowledge or reasonable suspicion of physical abuse, abandonment, isolation, neglect, financial abuse, or abduction of an elder or dependent adult who is a resident of California.

Question 15

Tarasoff

Answer 15

A therapist has a legal duty to report to law enforcement when the client communicates “serious treat of physical violence against a reasonably identifiable victim or victims.”

Reporting to the intended victim is an option, not a requirement. Should consider the clinical situation before taking action to notify victim.

Question 16

A court order or order from a judge

Answer 16

Client does not have right to confidentiality.

Question 17

An order from a state board, commission or administrative agency (ex. BBS)

Answer 17

Client does not have right to confidentiality.

Question 18

Request from coroner for info in the course of an investigation for the purposes of identify a decedent or locating next of kin or when investigating deaths that may involve public health concerns.

Answer 18

Client does not have right to confidentiality.

Question 19

Search warrant for therapist’s office

Answer 19

Client does not have right to confidentiality.

Question 20

What should a therapist do when client or credible third party communicates serious threat of physical violence to the person?

Answer 20

Trumps confidentiality.

1) victim must be easily identifiable

2) therapist must notify law enforcement local to the client
- share specifics of the threat and relevant info (DSM diagnosis, history of violence)

3) notify potential victim if possible (victim must be easily identifiable)

Question 21

What if the threat is to a school?

Answer 21

Notify local police and school authorities.

Question 22

What if the gut feeling is very strong that the client might do something to someone?

Answer 22

1) assessing for harm to others
- if past assessments have hinted at possible harm to others and the “gut feeling” strengthens to the point of concern then may be ok to contact police.
- do a complete assessment of threats which come off as vague
- assessment should include an understanding if the client has a history of violence?

Question 23

Does HIV fall under the duty to warn?

Answer 23

No, it does not.

Question 24

Duty to protect - danger to self

Answer 24

Meeting standard of care = assessing levels of risk and intervening accordingly.

Assess for:

1) plans
2) means - would want client to agree to get rid of means
3) hopelessness/history of suicide

Question 25

Duty to protect - danger to self

Answer 25

Breaking confidentiality may include:

1) initiating a 5150 hold
2) contacting relative if deemed clinically appropriate

Also:

1) increasing contacts with clients in between sessions.
2) have client engage with support system and help facilitate contacts where appropriate
3) referral to psychiatrist for medication review
4) consult when client has high risk factors and document consultation

Question 26

No harm agreement for suicidal client

Answer 26

Not considered an intervention but is a good assessment tool.

Be sure to have FULL safety plan.

Assessment piece of no harm agreement centers around seeing how receptive the client is to the agreement

Question 27

Is DV reportable to the police?

Answer 27

Standard of care would be to provide resources to a client re: shelters, etc & to create a safety plan.

No, DV by itself is not reportable to the police. Exceptions to this include:

• If there is a child who witnessed the abuse and if the abuse is causing the child to suffer. Then report child abuse to CPS, not DV. (This would be considered a failure to protect the child). Exception to this would be if the DV was one or two time, then look at safety planning, not reporting to CPS.
• If the child is harmed in the course of the DV, report to CPS.
• if the victim is 65 or older then report to APS because it’s abuse of an elderly person.
• if a client seeks medical attention for DV, medical providers ARE required to report DV.

Question 28

Should I provide couples therapy to a couple experiencing DV?

Answer 28

No, it is contraindicated to do so.

The reason for the contraindication is because the therapy could increase the violence.

It should be recommended for each member of the couple to seek individual therapy.

Question 29

Do parents in prison lose their rights to access their minor child’s records?

Answer 29

No, they do not lose the right. They can still access.