Privacy, Confidentiality, and Privilege Flashcards
CALIFORNIA LAWS THAT GUIDE THE SPECIFICS OF CLINICAL PRACTICE
1
Q
What is confidentiality?
A
Confidentiality is the patient’s right to have communications kept within the bounds of the professional patient-therapist relationship.
2
Q
What is privilege?
A
Privilege, or testimonial privilege, is the patient’s right to keep confidential communications from being disclosed in a legal proceeding.
3
Q
What is the key distinction between confidentiality and privilege?
A
Confidentiality involves keeping the therapist-patient information in confidence such that no person outside of the therapy relationship has access to the information (e.g., the patient’s spouse, employer, friend). In general, privilege involves keeping the patient-therapist information in confidence specifically during a legal proceeding.
4
Q
There are two basic principles that apply to lawful and ethical disclosure of confidential information. What are they?
A
Disclosure should never come as a surprise, and disclosure should only include information that is necessary and sufficient.
5
Q
What are the seven situations in which confidentiality may be broken?
A
- With patient consent
- In treatment emergencies
- In safety emergencies
- Quality care reviews
- The legal system
- Crimes involving hospitalized patients
- Mandatory reporting situations.
- For treatment purposes, in situations where the providers work in the same facility
6
Q
Written consent to disclose confidential information must include what information?
A
Written consent must include:
- the name of the person authorized to disclose the information
- the individual or agency to whom the disclosure may be made
- the date of consent
- Any limitations on what information may be released or how the information may be used.
7
Q
What are treatment emergencies?
A
A situation in which a therapist may breach confidentiality.
Treatment emergencies are situations in which information must be shared with health care providers to protect a patient from immediate physical harm.
For example, a therapist receives a phone call from emergency room personnel stating that the therapist’s patient has attempted a drug overdose. The therapist would be allowed to breach the patient’s confidentiality to reveal any information relevant to the patient’s immediate care, including information about the patient’s illicit drug use, as well as any prescribed psychotropic medication the patient is taking.
8
Q
What are safety emergencies?
A
A situation in which a therapist may breach confidentiality.
Safety emergencies involve situations in which the safety of the patient or another person is of concern.
The most common safety emergencies include potential suicide and violence. Grave disability is also considered a safety emergency.
9
Q
When an employer is paying for mental health care for its employees, what types of information can they have access to?
A
- Information that is relevant in a lawsuit (when the patient has raised the issue of his or her physical or mental health)
- Information on session attendance
- information that describes the patient’s functional limitations (which may entitle the patient to miss work or limit the patient’s fitness to perform at work)
However, the psychologist may not disclose the basis for the patient’s limitations (e.g., the patient’s diagnosis), or any other confidential patient information or communication.
10
Q
Who may be the holder of privilege?
A
- The patient
- The guardian or conservator: When the patient lacks legal capacity, and has a guardian or conservator, the guardian or conservator is the holder of privilege.
- The patients personal representative: If the patient is dead, the personal representative of the patient may be the holder of privilege.
11
Q
Who can claim or invoke privilege in legal proceedings?
A
- The holder of privilege
- Any person authorized by the holder of privilege
- The psychotherapist
12
Q
How does privilege work when more than one patient holds it? For example, in couples therapy…
A
When more than one patient holds the privilege (e.g., in couples therapy), one patient waiving privilege does not affect the other patient’s right to claim privilege.
13
Q
Under what circumstance does a patient involuntarily waive privilege?
A
Privilege is waived, any time a confidential communication is disclosed by the patient to unauthorized third persons.
For example, a patient tells his neighbor he raped a woman, and that he has shared this with his therapist. Should there be a legal proceeding, this specific information would no longer be privileged.
14
Q
EVIDENCE CODE 1016
A
No privilege exists in proceedings in which the patient (or any party claiming through or under the patient) raises the issue of the patient’s mental or emotional condition (e.g., worker’s compensation suit alleging stress secondary to employment).
Thus, if a patient is claiming emotional suffering, the patient may not keep therapy records outside of the court, because these records may prove significant in the court’s decision making process.
15
Q
EVIDENCE CODE 1017
A
No privilege exists when the therapist is appointed by the court or by the Board of Prison Terms to examine the patient
16
Q
EVIDENCE CODE 1023
A
Privilege doesn’t exist in a proceeding initiated at the request of a defendant in a criminal action suit to determine his or her sanity
17
Q
EVIDENCE CODE 1025
A
There is no privilege in proceedings brought by the patient to establish his or her competence
18
Q
When do the exceptions to privilege, established by evidence code 1017, 1023, and 1025, not apply?
A
This exception to privilege doesn’t apply when the therapist is appointed by the court specifically to provide the criminal defendant’s lawyer with information upon which to base the defense. In other words, if the purpose of the exam is to help the lawyer and defendant put together their legal strategy, the information may remain in confidence between the lawyer and his or her client.
19
Q
EVIDENCE CODE 1018
A
No privilege exists if the services of a therapist were sought or obtained to aid anyone to commit a crime or to escape detection or apprehension after commission of a crime. Thus, a patient may not invoke privilege in an effort to hide civil or criminal wrongdoing from the courts.
20
Q
EVIDENCE CODE 1019
A
There is no privilege regarding communication that is specifically relevant to an issue between parties, who all claim through a deceased patient
21
Q
EVIDENCE CODE 1021
A
There is no privilege with regard to communication concerning a deceased patient’s intent related to a deed, will, or other document executed by the patient, affecting an interest in property
22
Q
EVIDENCE CODE 1022
A
There is no privilege with regard to communication concerning the validity of a deceased patient’s deed, will, or other document executed by the patient, that affects an interest in property
23
Q
EVIDENCE CODE 1020
A
No privilege exists when either the therapist or the patient alleges a breach of duty (e.g., malpractice suit initiated by the patient, use of a collection agency by the therapist because of nonpayment by the patient).
Thus, if a patient sues a therapist for negligence, the professional may use the therapy records in his or her defense.
24
Q
EVIDENCE CODE 1024
A
No privilege exists in a LEGAL proceeding, if the disclosure is necessary to prevent the danger presented by the patient to himself, others, or property
25
When does evidence code 1024 most frequently apply?
Evidence Code 1024 usually applies to legal proceedings, most commonly when a patient who is put on a 5250 (14-day hold) challenges the hold and requests a certification review hearing.
26
EVIDENCE CODE 1026
No privilege exists when the therapist or patient is required to make a report, if the report is open to public inspection.
27
EVIDENCE CODE 1027
No privilege exists if the patient is under 16 years of age, the therapist has reason to believe the child has been the victim of a crime, and the disclosure is in the best interest of the child.
In this situation, neither the patient nor the parent/guardian may invoke privilege to keep this information out of the court.
28
What is a subpoena?
A subpoena is a document served to someone who is not a party to a legal case.
The subpoena requires that the person served appear and testify, bring documents, or both.
If a subpoena is served, the person who receives it must not ignore it, as failure to respond to a subpoena may result in being held in contempt of court.
29
What happens if a therapist is subpoenaed, but the patient invokes privilege?
If the patient invokes privilege, the therapist may ask to be released from the subpoena.
If the therapist is not released, he or she must comply with the subpoena and appear at the specified time and place, bringing any documents required by the subpoena.
At the proceeding, the therapist will assert privilege on the patient’s behalf.
The judge will determine whether or not the material is protected by privilege.
The judge will either quash the subpoena if the material is deemed protected by privilege or issue an order if the material falls under an exception to privilege.
The therapist must follow the court order unless an appeal is made to a higher court.
30
In what area is the law very explicit about parental rights to the treatment information of a minor?
In circumstances in which a parent or guardian has sought the medical care or counseling for a drug or alcohol related problem of a minor child, the provider must generally disclose information about treatment upon parental request, even if the minor child does not consent to disclosure.
31
Under what circumstances can a minor consent to treatment?
A minor may consent to treatment if:
1. he or she is an emancipated minor
2. he or she is a self-sufficient minor
3. in situations in which the minor is at risk or in which requiring parental consent might discourage the minor from receiving necessary treatment.
32
A minor may become emancipated in one of three ways. What are they?
1. Marrying legally
2. Enlisting in the military
3. Declaration of emancipation: The minor must be 14 or over, living separately from his/her parents with consent, and managing his or her own finances with income that is not derived from criminal activity
33
Self-sufficient minors may legally consent to medical and dental treatment. To be considered a self-sufficient minor, three criteria must be met. What are they?
1. Age: The self-sufficient minor must be 15 years of age or older.
2. Living Arrangements: The self-sufficient minor must be living apart from the
minor’s parent or guardian, whether with or without consent of the parent or guardian.
3. Finances: The self-sufficient minor must be managing his or her own finances, regardless of the source of the minor’s income.
34
Can a health care provider contact a self-sufficient minors parents?
Yes, they can contact the minor’s parent or guardian with or without the minor’s consent.
35
Effective January 1, 2011, pursuant to Senate Bill 543, a significant change in the laws related to the treatment of minors. Health and Safety Code (124260) took effect. Describe this change, which contests the long-established California Family Code (6924).
The Health and Safety Code does not require that the minor be a risk to self or others, or a victim of incest or child abuse, in order to receive outpatient mental health treatment without parental consent.
The rationale for this law is that requiring a minor to wait until he or she is in such dire circumstances as to be a danger or a victim is not clinically sound, and that it is preferable to intervene before a situation escalates into a crisis.
However, it seems that the regulation still stands that "the minor must be mature enough to participate intelligibly."
36
The long-established California Family Code (6924) stipulates that a minor 12 years of age or older may receive outpatient mental health treatment or residential shelter services if two conditions are met:
1) the minor must be mature enough to participate intelligently, and 2) the minor must either present a danger of serious physical or mental harm to himself or others, or have been the alleged victim of incest or child abuse.
37
Regarding the treatment of minors... How do we reconcile the Family Code and the Health and Safety Code?
The current interpretation is that the Health and Safety Code prevails, and a minor can be seen for mental health treatment without parental consent provided that the minor is 12 or older and mature enough to participate.
38
How do the Family Code and Health and Safety Code agree, regarding outpatient mental health treatment of a minor?
Both the Family Code and the Health and Safety Code note that outpatient mental health treatment should include the minor’s parent or guardian unless, in the professional person’s opinion, involvement would be inappropriate.
The professional must state in the records whether or not an attempt was made to contact the parent or guardian and the results of such an attempt, or, if an attempt was inappropriate, the reasons why.
39
What treatments are minors forbidden from receiving, without parental or guardian consent?
1. electroconvulsive therapy
2. psychosurgery
3. psychotropic medications
40
What is true about confidentiality and the treatment of a pregnant minor?
A minor of any age may consent to medical care related to the prevention or treatment of pregnancy including contraception and abortion.
The health care provider is not permitted to inform the minor’s parent or guardian.
41
What is true about confidentiality and the treatment of a minor with a communicable disease?
A minor 12 years of age or older who may have come in contact with a communicable or sexually transmitted disease may consent to medical care related to diagnosis or treatment of the disease.
The health care provider is not permitted to inform the minor’s parent or guardian without the minor’s consent.
The provider may only share the minor’s medical records with the minor’s signed consent.
42
What is true about confidentiality and the treatment of a minor who has been sexually assaulted?
A minor of any age, alleging to have been sexually assaulted or raped, may consent to medical care related to diagnosis, treatment, and collection of evidence.
However, the health care provider must attempt to contact the parent or guardian (unless the professional person believes the minor’s parent or guardian committed the sexual assault), and must record the date and time of the attempt, and whether the attempt was successful or not.
43
What is true about confidentiality and the treatment of a minor who has been raped?
A minor 12 years of age or older and alleging to have been raped may consent to medical care related to diagnosis, treatment, and collection of evidence with regard to the alleged rape. The health care provider is not permitted to inform the minor’s parent or guardian without the minor’s consent.
The provider may only share the minor’s medical records with the signed consent of the minor.
44
What is the difference between sexual assault and rape, with regards to a minor's right to confidentiality?
In sexual assault, the health care provider IS required to attempt contact with the parent or guardian (unless the professional person believes the minor’s parent or guardian committed the sexual assault)
However, if the victim is over 12 years of age, and a victim of rape specifically, then the health care provider is NOT permitted to contact the parent or guardian without the minor's consent.
45
What is true about consent and the drug/alcohol treatment of a minor?
A minor 12 years of age or older may consent to medical care and counseling relating to the diagnosis and treatment of a drug or alcohol related problem.
Counseling services may only be rendered by a provider under a contract with the state or county to offer alcohol or drug abuse counseling services. (This excludes most private practice therapists.)
The treatment plan must include involvement of the parent or legal guardian, if appropriate.
The person rendering treatment has to state in the treatment record whether and when he or she attempted to contact the parent or legal guardian, and whether such attempt was successful or not, or the reason why, in the professional’s opinion, it would not be appropriate to contact the parent or legal guardian.
46
What types of drug or alcohol treatment is a minor prohibited from receiving, without the consent of a parent or guardian?
A minor may not receive methadone treatment or other replacement narcotics such as LAAM (levoalphacetymethadol) without parental consent.
47
What is different about the timelines established by California Law and the APA regarding record keeping timelines?
California law requires that a full set of treatment records be maintained on all patients for a minimum of seven years after treatment has been completed. Effective January 1, 2007, the Business and Professions Code (2919) requires that for minors, the treatment records be maintained for at least seven years from the date the patient reaches 18 years of age, or in other words, until the person is 25 years old.
The American Psychological Association provides a different set of standards that may be followed in the absence of superseding guidelines (e.g., when state law does not establish guidelines for record keeping). APA’s Record Keeping Guidelines (2007) state that psychologists may retain a full set of records for adults for seven years after the last date of service delivery, and for minors, psychologists may retain a full set of records for either seven years, or three years after the minor reaches the age of majority, whichever is later.
48
What are three guidelines to follow when using electronic record keeping?
Providers using electronic record keeping systems must ensure the safety and integrity of the records, by:
1. using an offsite backup storage system
2. an image mechanism that can copy signature documents
3. a mechanism to ensure that once input, the record is unalterable.
Original hard copies of patient records may be destroyed once the record has been electronically stored.
49
What are the two circumstances in which a parent may be denied access to a minor's treatment record?
1. If the minor was legally authorized to get treatment by himself or herself, the parent or guardian may be denied access to the treatment record.
2. California law states that if the provider determines that there could be either a detrimental effect on the therapy relationship, or that the minor’s physical or emotional well-being might be jeopardized, the parent or guardian may be denied access to the treatment record.
50
Under what circumstances can patients be denied access to their treatment record under California Law? What must the provider do in the instance of denying access to the treatment records?
California law states that the treatment provider may decline to permit inspection or to provide copies of the treatment records to any patient, if the provider believes:
there would be substantial possibility of adverse or detrimental consequences to the patient
When this is the case, the provider must document the date of the request and the reasons for refusing to permit inspection or provide copies of the records to the patient. The provider must include the specific adverse consequences anticipated if the patient were allowed access to the treatment records.
51
Where access to treatment records is concerned, which has legal precedence: California Law, or HIPAA?
HIPAA laws supersede California law with regards to adults, but not minors.
52
Under what circumstances can patients be denied access to their treatment record under HIPAA?
HIPAA states that access can be denied when the health care professional has determined that access is reasonably likely to endanger the life or physical safety of the individual or another person. In other words, access to the record may only be denied when it puts a person’s life or physical safety in danger. This is more conservative than California Law.
53
When a request is made by a patient, to inspect his or her treatment records, what must a provider do?
The provider must generally permit inspection of the records within five working days after a written request is received. When inspecting the records, the patient or patient’s representative may be accompanied by one other person of the patient’s choosing.
54
What is the protocol after copies of treatment records are requested?
Copies of the treatment records (not to exceed a cost of $0.25 per page) must generally be transmitted within 15 days after receiving a written request. Providers are not allowed to withhold records because of any unpaid bills for services.
55
If a patient agrees to a treatment summary, in lieu of his or her records, what is the protocol?
California law notes that the provider may offer to prepare a treatment summary for the patient. If the patient agrees, the summary should be completed within 10 working days. If extenuating circumstances exist (e.g., extraordinary length of treatment record) the provider must notify the patient of this, and may take up to 30 days to deliver the summary.
56
When a patient provides written authorization for release of records to the Board of Psychology (BOP) or a court order mandates release of records of the board, how soon must they be provided? What is the penalty for failure to comply?
Records must be provided within 15 days.
The civil penalty, payable to the board, is $1,000 per day for each day the documents haven’t been provided, after the 15th day.
Additionally, failure to comply with a court order mandating the release of records to the Board of Psychology constitutes unprofessional conduct and may result in suspension or revocation of one’s license.
57
What is the therapists duty when a patient has communicated to the psychotherapist a serious threat of physical violence against a reasonably identifiable victim or victims.
In this situation, the therapist’s duty is to make “reasonable efforts to communicate the threat to the victim or victims and to a law enforcement agency.” Failure to act may result in potential civil liabilities.
58
Does the Tarasoff duty apply to situations in which a therapist hears from a third party that his or her patient has expressed a serious threat of physical violence against an identifiable victim?
No, unless the third party is a family member.
59
Does the therapist have a Tarasoff duty when the patient makes a threat toward someone’s property and it is clear that no person will potentially be at risk?
No
60
Does a threat made by a patient to property, in which people may potentially be harmed (e.g., a patient threatens to blow up a building), constitute a Tarasoff situation?
Yes
61
Can communications from family members regarding a patients intent to commit a violent act constitute a Tarasoff duty situation?
Yes
62
Regarding a 72-hour hold, what is the difference between section 5150 and section 5585?
Section 5150 applies if the person is an adult.
Section 5585 applies if the person is a minor.
63
When can section 5585 be implemented?
Section 5585 can only be implemented when the minor’s parent or guardian is not available to authorize voluntary treatment.
The facility must make every effort to notify the minor’s parent or legal guardian of the hospitalization, as soon as possible after the minor is hospitalized.
64
What does the Welfare and Institutions Code Sections 5150 and 5585 state?
When a person, as a result of a mental disorder, is a danger to others, or to himself or herself, or gravely disabled, any peace officer, a member of a mobile crisis team, or any professional person designated by the county may take the person into custody and place him or her in a designated and approved facility for up to 72 hours of treatment and evaluation. `
65
According to Welfare and Institutions Code Sections 5150 and 5585, what does "Danger to Self" refer to?
Danger to self specifically refers to suicidal intent.
Thus, a person who engages in prostitution or any other potentially destructive or reckless behavior (e.g., high speed auto driving) cannot be placed on a 5150 or 5585 hold.
66
According to Welfare and Institutions Code Sections 5150 and 5585, what does "Grave Disability" refer to?
Grave disability is typically defined as being unable to adequately provide for one’s food, clothing or shelter. A person is not considered “gravely disabled” if the person can survive safely with the assistance of family, friends, or others who are willing and able to help, and their willingness to help is specified in writing.
67
What does the Welfare and Institutions Code Section 5250 state?
after a person has been detained for 72 hours, he or she may be certified for up to 14 days of intensive treatment related to the mental disorder. Certification can take place if the person remains a danger to self, others, or is gravely disabled as a result of a mental disorder or impairment due to chronic alcoholism.
68
Under what circumstances may Section 5250 be implemented?
Section 5250 may only be implemented if the person has been advised of the need for additional voluntary treatment but has not been willing to accept treatment on a voluntary basis.
69
A person who is being treated involuntarily under section 5250 is entitled to what?
The person certified is entitled to a certification review hearing within four days of the date of certification to determine whether there is probable cause that there is danger to self, others, or grave disability.
70
What are the three post-certification holds, after a 14-day hold (5250) expires?
1. Section 5260 - A second 14-day hold
2. Section 5270.15 - 30-day hold
3. Section 5300 - 180-day hold
71
Is a Section 5260 hold renewable?
This hold is not renewable. Thus, if at the end of the 5260 the patient continues to present an imminent threat of suicide, the patient may not be involuntarily confined any longer.
72
What is a Section 5270.15 hold?
According to Welfare and Institutions Code Section 5270.15, at the expiration of the 14-day hold (5250), a patient who remains gravely disabled may be certified for an additional 30 days.
If the patient remains gravely disabled at the end of the hold, they may not be involuntarily confined any longer, unless a petition for conservatorship has been filed during the hold.
73
What is a Section 5300 hold?
Welfare and Institutions Code Section 5300 states that at the expiration of the 14-day hold (5250), a patient who continues to present an imminent threat of danger to others may be confined for up to 180 additional days. The 180-day hold can be renewed.
74
When is a child abuse report mandated?
A child abuse report is mandated whenever a therapist learns about child abuse in his or her professional capacity.
This includes a patient informing the therapist about abuse taking place by a third party (e.g., the patient’s neighbor is abusing his or her child).
Reporting of child abuse is not mandated when a therapist learns of abuse outside of his or her professional capacity (e.g., the therapist’s neighbor is abusing his or her child).
75
When a minor reports abuse, is a report always mandated?
When a minor in treatment reports prior abuse, even if the abuse involved a single incident that took place many years ago, a child abuse report is mandated.
76
How is child abuse defined?
1. physical injury or death that is inflicted by other than accidental means on a child by another person
2. Child abuse includes sexual abuse of a child
3. willful cruelty, unjustifiable punishment, and unlawful corporal punishment or injury.
4. Child abuse also includes the neglect of a child.
77
Is a positive toxicology screening at the time of delivering a baby, sufficient basis for reporting child abuse or neglect?
A positive toxicology screening at the time of delivering a baby, in and of itself is not sufficient basis for reporting child abuse or neglect.
However, when maternal substance abuse is occurring, a further assessment must be conducted. If other factors that indicate risk are present, a report must be made.
78
What is the general guideline for determining when the physical abuse of a child has occurred?
The general guideline is that if bruises or marks are left, or the discipline involves using an object on bare skin (e.g. slapping with a belt or coat hanger on bare skin, or hitting with a closed fist), a child abuse report should be made.
79
Section 261.5 of the Penal Code states that any sexual intercourse between an adult and a minor under the age of 18 is what?
Statutory rape. Statutory rape is unlawful, and is considered either a misdemeanor or a felony.
80
While any sexual intercourse between an adult and a minor is unlawful, mandated reporters are only required to report violations of Section 261.5 (d). What does this section state?
This section specifically states that it is unlawful for a person 21 or older to engage in sexual intercourse with a partner who is under 16 years of age.
81
In consideration of Section 261.5 (d), is a report mandated when a 15-year-old has had consensual sex with a 21-year-old?
Yes, a report is mandated.
82
In consideration of Section 261.5 (d), is a report mandated when a 15-year old has consensual sex with a 20-year old?
While unlawful and considered statutory rape, this is not reportable as child abuse
83
If a child younger than 14 engages in consensual, lewd and lascivious conduct with someone 14 or older, is this reportable?
Case law makes it clear that if a child younger than 14 engages in consensual lewd and lascivious conduct with a person age 14 or older, the older person has violated Section 288a, even if that person is also a minor, and the violation is reportable.
Lewd and lascivious behavior with a child under the age of 14 (Section 288a and 288b) is unlawful, and generally requires a child abuse report.
84
How is severe neglect defined?
1. Severe neglect refers to the negligent failure of the caretaker to protect the child from severe malnutrition.
2. Severe neglect is also described as willfully causing or permitting the health of the child to be endangered, including intentional failure to provide adequate food, clothing, shelter or medical care.
85
How is general neglect defined?
General neglect means the negligent failure of the caretaker to provide adequate food, clothing, shelter, medical care, or supervision, where no physical injury to the child has occurred.
86
When a child witnesses domestic violence, this frequently constitutes what?
Unjustifiable emotional suffering
If the mandated reporter deems that witnessing the domestic violence is causing unjustifiable emotional suffering, a child abuse report is mandated.
87
Suspected incidents of child abuse or neglect must be reported to any police department, sheriff’s department, or county welfare department (e.g., a child protective agency) within what time frame?
Immediately or as soon as is practically possible by telephone.
A written report must be prepared and sent, faxed, or electronically transmitted within 36 hours.
88
What are the three child abuse report designations?
1. Unfounded Reports: An unfounded report means a report found to be false, to be improbable, to involve an accidental injury, or not to constitute child abuse or neglect.
2. Substantial Reports: A substantial report is a report found to constitute child abuse or neglect, based on credible evidence.
3. Inconclusive Reports: An inconclusive report is one in which findings are inconclusive and there is insufficient evidence to determine whether abuse or neglect occurred.
89
How does California Law define an "elder" and a "dependent adult?"
“Elder” means any person residing in the state of California, 65 years of age or older.
“Dependent adult” means any person residing in the state of California, between the ages of 18 and 64, who has physical or mental limitations that restrict his or her ability to carry out normal activities, or to protect his or her rights.
90
When is a report of elder abuse not required?
A report of elder abuse is not required if the mandated reporter is told by the elder or dependent adult that he or she has been abused and neglected yet the reporter is not aware of any corroborating evidence, and the elder has been diagnosed with a mental illness or dementia, and the reporter reasonably believes the abuse did not occur.
Additionally, an elder abuse report is not required when a physical, mental or medical injury occurs in a long-term care facility, and there is a proper plan of care, properly provided and executed, and the reporter believes the injury was not the result of abuse.
91
What are the five classifications of elder/dependent adult abuse?
1. Physical Abuse
2. Neglect
3. Abandonment
4. Isolation
5. Financial Abuse
92
When a dependent adult/elder lives at home, what is the time frame/process by which a report of abuse must be made?
When the elder or dependent adult resides at home (not in a facility or hospital), the abuse report must be made to the adult protective services agency or to a local law enforcement agency.
Reports must be made immediately, or as soon as possible by telephone, or through a confidential Internet reporting tool. If reported by phone, a written report shall be sent, or an Internet report shall be made within two working days.
93
When a dependent adult/elder lives in a long term care facility, what is the time frame/process by which a report of abuse must be made?
When the abuse occurred in a long-term care facility (other than a state mental hospital or state developmental center), the report should be made to the local ombudsman and to a local law enforcement agency.
Reports must be made immediately, or as soon as possible by telephone, and a written report must be sent within two hours if serious bodily injury occurred, or within 24 hours in the absence of serious bodily injury.
(Ombudsman: an official appointed to investigate individuals' complaints against maladministration, especially that of public authorities.)
94
When a dependent adult/elder lives in a state mental hospital or state developmental center, what is the time frame/process by which a report of abuse must be made?
If the abuse occurred in a state mental hospital or state developmental center, the report should be made to the investigator of the State Department of State Hospitals or the State Department of Developmental Services and also to the local law enforcement agency.
Reports must be made immediately, or as soon as possible by telephone, and a written report must be sent within two hours.
95
Are psychologists ever required to report assault?
Providers of mental health services (e.g., psychologists) are not mandated to report assault, nor even permitted to report assault, unless the patient gives explicit written consent.
For example, a female patient tells a psychologist that she is the victim of spousal abuse, and there are bruises evident. If the psychologist makes a report without the patient’s consent, this would constitute a serious violation of confidentiality.
96
Are psychologists ever required to report an individuals HIV status?
Providers of mental health services (e.g., psychologists) may never breach a patient’s confidentiality with regard to HIV status.
97
It is illegal for a psychotherapist to engage in sexual contact with a patient or former patient under any of three conditions. What are they?
1. During Psychotherapy
2. Within two years of termination
3. Therapeutic Deception
98
With respect to EAP programs, how does confidentiality vary when an employee is self-referred, as compared to being referred by the employer for a fitness evaluation?
When the employee is self-referred, nothing may be divulged to the employer.
When the employee is referred by the employer for a fitness evaluation, you may reveal that they attended a meeting and any functional limitations you observed.
99
Can a therapist ever hold privilege for a patient?
No! They can INVOKE privilege on the patients behalf, but they can never be the holder of it.
100
With regards to sexual intercourse with a minor, what are the key ages to keep in mind when making a child abuse report?
<14 If both partners are under 14, it's consensual, and they're reasonably the same age... it's okay. If one IS 14, it's child abuse
14-15 Can have consensual sex with someone older, unless it's with someone 21 or older. Cannot have sex with someone younger than 14.
16+ You cannot make a report if they're having sex with someone older, no matter the age difference, as long as it's consensual.
101
If a 14/15 year old engages in lewd and lascivious activities with someone older, what is the rule of thumb for determining whether or not to make a child abuse report?
If the partner is <10 years their senior, no report needs to be made.
If the partner is 10+ years their senior, a report needs to be made.
102
When do you have to make a child abuse report for non-consensual sex?
Any time a minor engages in sex that is non-consensual (e.g., rape), a child abuse report is mandated.
The age of the perpetrator is irrelevant, and age guidelines for intercourse between consensual minors do not apply.
103
According to California law, elder abuse that occurs in a long-term facility (except a state mental hospital), should be reported to who?
The local ombudsman and the local law enforcement agency
104
When does the stipulation that a minor be "mature enough to participate intelligently" apply?
It applies only to general outpatient mental health treatment, NOT other situations, such as when a minor is seeking drug/alcohol treatment from a provider with a county or state contract.
105
What are the two categories of child sexual abuse?
Sexual assault and sexual exploitation (typically has to do with involving a minor in some form of prostitution or pornography)
106
When a psychologist feels threatened or endangered by a patient, are they obligated to provide pre-termination counseling or appropriate referrals?
No, under these conditions the therapist may terminate immediately.
107
Is the failure to make a child abuse report a misdemeanor or a felony?
Misdemeanor
108
When are you required to report spousal abuse?
When a member of the partnership is an elder, because this technically qualifies as elder abuse.
109
What is the difference between the ruling in Tarasoff V. The Regents of the University of California (1976), and the Tarasoff Statute later enacted by the California legislature?
Tarasoff V. The Regents, concluded that therapists have a duty to protect when a patient poses a serious threat of danger to others. The tarasoff statute restricted therapist duties to threats made directly by the patient.
110
What is the guideline regarding using confidential patient information for didactic purposes?
Confidential information may only be revealed if the patient has consented in writing. If there is no written consent, the confidential information must be disguised.
111
What type of treatment can self-sufficient minors legally consent to?
Medical and dental
112
Does a parent who does not have physical custody, still have the right to access their minor child's treatment records?
As long as they still share legal custody with the custodial parent, then they have the right to access the child's treatment records.
However, according to California law, the psychotherapist can still deny access if they believe it would be damaging to the minor, or to the treatment.
113
When the BOP requests a patients medical records, what must it be accompanied by?
The patient's written authorization
114
When a psychological assistant and a supervisor mutually agree to terminate the relationship, the supervisee must notify the board in what time frame?
The PA must notify the board within 30 days.
115
What are the two categories of sexual abuse?
1. Sexual assault
| 2. Sexual exploitation.
116
When an authorized professional initiates a 5150, they must also provide the confining facility with what?
A written statement of probable cause
