Study guide

Question 1

You are a therapist who filed a child abuse report one week ago. You receive a call from a CPS social worker investigating the case. According to a law (AB2028; Hernandez) that amended the Confidentiality of Medical Information Act, how may you respond to the social worker’s request for relevant information?

Answer 1

You are permitted to respond to the social workers follow-up inquiries.
CORRECT. The Confidentiality of Medical Information Act (Civil Code 56.10) was amended by a law (AB2028; Hernandez) stating that as of January 1, 2011, mandated reporters of child abuse are expressly permitted to respond to follow-up inquiries from child abuse investigators.

Question 2

Susan is a 7-year-old client whose parents are going through a divorce. The parents are currently fighting over custody of Susan. Who holds Susan’s privilege at this time?

Answer 2

Susan
CORRECT. Unless the court has assigned an attorney to the child or a guardian ad litem, Susan would be the holder of her own privilege.

Question 3

Jim, age 42, brings in Pam, age 15, for therapy. Legally, Jim may consent to Pam’s treatment under all of the following circumstances, unless:

Answer 3

Jim is Pam’s adoptive parent.
INCORRECT. An adoptive parent has the same legal rights as a biological parent and can consent to a child’s treatment in therapy
2.
Jim is Pam’s uncle and has completed a Caregiver’s Authorization Affidavit form.
INCORRECT. A relative who is raising a child, such as an aunt, uncle, grandparent, older sibling, etc. can consent to a minor’s treatment. In such an instance, you would have the caregiver sign a Caregiver’s Authorization Affidavit.
3.
Jim is Pam’s stepparent.
CORRECT. A stepparent cannot legally consent to treatment of a minor.
4.
Jim is Pam’s biological parent in an intact marriage with Pam’s biological mother.
INCORRECT. A biological parent can consent to a child’s treatment.

Question 4

In therapy, Sal has made a serious and imminent threat toward an identifiable other person. Which legal precedent allows Andre to include statements made by Sal in therapy in order to properly warn the police and intended victim?

Answer 4

People v. Wharton
INCORRECT. People vs. Wharton established that threatening statements are not protected by privilege and are admissible in court.
2.
The Hedlund Decision
INCORRECT. The Hedlund decision established that a therapist who does not carry out his duty-to-warn responsibilities can also be held liable to foreseeable bystanders.
3.
Menendez v. Superior Court
CORRECT. Menendez vs. Superior Court established that a therapist can include statements made by a client when notifying the police and warning intended victim in order to convey the seriousness of the threat.
4.
Thompson v. Alameda
INCORRECT. Thompson vs. Alameda established that a Tarasoff duty-to-warn responsibility applies if two conditions are met: 1) there is a reasonably identifiable victim, and 2) there is imminent peril.

Question 5

Which court case allows a therapist to divulge confidential information regarding a threat of violence to others in order to convey the seriousness of the threat?

Answer 5

Bellah v. Greenson
INCORRECT. Bellah v. Greenson states Tarasoff duty does not apply to threats to self and property.

2.v. County of Alameda
INCORRECT. Thompson v. County of Alameda requires 2 conditions for Tarasoff to apply: there must be a reasonably identifiable victim and the peril must be foreseeable.
3.
Headland v. Superior Court of Orange County
INCORRECT. Hedlund v. Superior Court of Orange County makes a therapist liable for damages to foreseeable bystanders as well as the intended victim if a therapist does not fulfill his/her Tarasoff responsibility.
4.
Menendez v. Superior Court
CORRECT. Menendez v. Superior Court states that when a therapist is making a Tarasoff warning, they may include statements made by the patient that the therapist believes are necessary to convey the seriousness of the threat.

Question 6

You are meeting with a client for the first time. Which of the following must be covered prior to beginning the session?

Answer 6

Explaining the limits of confidentiality
INCORRECT. Explaining the limits of confidentiality is a good, ethical practice when covering your informed consent with a client, but it is not legally required.
2.
Explaining your “no secrets” policy
INCORRECT. Explaining your “no secrets” policy is a good, ethical practice when covering your informed consent with a client, but it is not legally required.
3.
Setting your fees
CORRECT. Setting your fees prior to the commencement of therapy is legally required. In addition, if a fictitious business name is being used, this must also be included in your informed consent.
4. Procedures for raising and collecting your fees
INCORRECT. Procedures for raising and collecting your fees may be included in your informed consent, but it is not legally required.

Question 7

Which of the following situations falls under the mandatory reporting duties of a therapist?

Answer 7

Spousal abuse
INCORRECT. Spousal abuse, or domestic violence, does not usually fall under the auspices of mandated reporting, unless the abused partner is an elder, dependent adult, or a minor). If a child is harmed by the domestic violence, then a child abuse report would be required.
2.
Suicidal ideations with plan and intent
INCORRECT. Therapists must ensure the safety of suicidal clients (Bellah v. Greenson), but this is not a mandate.
3.
A 15-year-old female having sexual intercourse with a 21-year-old male
CORRECT. According to child abuse laws pertaining to consensual sex with minors, a minor under 16 having sexual intercourse with an adult 21 or older does fall under the mandated reporting duties.
4.
A 14-year-old female having sexual intercourse with a 17-year-old male
INCORRECT. A 14-year-old having consensual sexual intercourse with a 17-year-old does not fall under the auspices of mandated reporting.

Question 8

Mr. Bossel has been seeing you for counseling for 1 month. You receive a phone call from Mr. Bossel’s attorney who wants to subpoena your records. What is your first response?

Answer 8

Do not confirm or deny that Mr. Bossel is your client.
CORRECT. You cannot respond to the attorney until Mr. Bossel allows you to identify him as your client and assert or waive privilege on his behalf.
2.
Refuse to acknowledge that you are treating Mr. Bossel until you receive a written release.
INCORRECT. In a legal proceeding you would assert privilege, not seek a release.
3.
Call Mr. Bossel and ask for verbal permission to release the records.
INCORRECT. Your first response needs to be to the attorney’s inquiry. After this, you would call Mr. Bossel to see if he wished to waive or assert privilege.
4.
Prepare a summary of your records for photocopying.
INCORRECT. You would not prepare your records for photocopying unless Mr. Bossel agreed to waive privilege

Question 9

Elaine, a 44-year-old stepmother, calls you to make an appointment for her 9-year-old stepson, Louie. She tells you that he is “too hyper” and “talks back to his father and teachers.” Recently, he got into a fight with another boy in his class and his teacher suggested therapy. She tells you “it’s all his mother’s fault because she left and refuses to have any contact with him.” She wants to bring him this Thursday. You:

Answer 9

Inform her that a biological parent or legally adoptive parent must initiate an appointment for Louie.
CORRECT. It is true that a biological parent or legally adoptive parent must initiate an appointment for Louie. A legal guardian designated by the court can also initiate treatment, however stepparents generally do not go to court to seek guardianship status. As his stepmother, she can only initiate treatment if she has legally adopted him.
2.
Set the appointment for Louie.
INCORRECT. Setting an appointment for Louie when his custody status has not been explored and the legal relationship to his stepparent has not been clarified is not appropriate. Louie’s stepmother can only initiate treatment if she has legally adopted him.
3.
Set the appointment and have her bring his custody papers to the first session.
INCORRECT. While it is important to see his custody papers in the next session, it is also important that his biological parent or legally adoptive parent initiate treatment and is present to sign for consent to treat a minor. Setting an appointment without specifying this would be inappropriate.
4.
Refuse to speak with her and maintain Louie’s confidentiality.
INCORRECT. While it may be appropriate to speak with the stepmother about possible treatment, it is important to realize that only a biological parent or legally adoptive parent can initiate treatment. A legal guardian designated by the court can also initiate treatment, however stepparents generally do not go to court to seek guardianship status. In terms of Louie’s confidentiality, it begins when his treatment begins.

Question 10

Paul, an 11-year-old child, is skinny, has torn pants and presents as withdrawn. In observing him, you see no signs of marks or bruises and he exhibits no sexualized behavior. His mother tells you that she is “sick and tired” of Paul not listening to her. The mother chose you as her son’s therapist because “you’re in the neighborhood,” and she doesn’t want to have to drive him. She says, “My hands are already too full.” What do you do?

Answer 10

Call CPS to report neglect.
CORRECT. Paul’s circumstances appear to meet the definition of child neglect. Filing a report for neglect would be the best course of action.
2.
Teach the mother parenting skills.
INCORRECT. Teaching the mother parenting skills may be a part of the treatment plan, but you need to make a CPS report first.
3.
Ask Paul what his view of the family is.
INCORRECT. There is enough information from Paul’s physical presentation and his mother’s behavior and statements to create a reasonable suspicion.
4.
Call Paul’s teacher in order to obtain more information.
INCORRECT. At this stage, speaking with anyone other than Paul or his mother would constitute a breach of confidentiality.

Question 11

Which of the following would NOT be a factor in affecting your decision to treat a minor without parental consent?

Answer 11

The minor’s age.
INCORRECT. According to the provisions of Family Code Section 6924, in order to treat a minor without parental consent, s/he MUST be age 12 or older. See Rationale “B”
2.
The minor is a victim of child abuse.
CORRECT. Whether or not the minor is a victim of child abuse would NOT be a factor affecting your decision to treat her/him without parental consent. As of January 1, 2011 (SB543; Leno), mental health professionals, including LCSWs and ASWs, may treat a minor 12 or older without parental consent if the minor is mature enough to participate intelligently in therapy and there is no longer a requirement for the child to be a victim of child abuse or a danger to self or others.
3.
The minor’s level of maturity.
INCORRECT. According to the provisions of Family Code Section 6924, in order to treat a minor without parental consent the minor MUST be mature enough to participate intelligently in therapy. See Rationale “B”.
4.
There is a good reason not to include the parent(s).
INCORRECT. According to the provisions of Family Code Section 6924, you MUST conclude that there is good reason not to include the parent(s). See Rationale “B”.

Question 12

Paula comes in with her grandson, David, stating she has temporary custody while David’s parents are in a long-term inpatient detoxification program. What information do you need to determine whether you can treat David?

Answer 12

A court order showing Paula has joint custody
INCORRECT. A court order would not necessarily be established for this type of situation, but if it were, Paula would most likely be given sole custody, not joint custody, as the parents are in inpatient detoxification.
2.
A court order showing Paula holds David’s privilege
INCORRECT. David is the holder of privilege, unless a guardian ad litem is assigned by a court.
3.
A Caregiver’s Authorization Affidavit
CORRECT. A Caregiver’s Authorization Affidavit would be sufficient proof that Paula could consent for David’s treatment.
4.
A Caregiver’s Privilege Affidavit
INCORRECT. There is no such form as a Caregiver’s Privilege Affidavit.

Question 13

Jim, who has been diagnosed with Paranoid Schizophrenia, has had his involuntary confinement extended an additional 180 days. The reason for this, according to the language of Welfare and Institutions Code 5300, is that Jim:

Answer 13

Has a mental disorder that continues to cause him to be a danger to others.
CORRECT. According to W.I.C. 5300, someone whose mental disorder causes continued imminent dangerousness to others may be held for an additional 180 days.
2.
Is considered to be gravely disabled due to chronic alcoholism.
INCORRECT. According to W.I.C. 5260, someone who has threatened or attempted to take his/her own life, or someone who exhibits chronic alcoholism, may be held an additional 14 days beyond the original 14 days involuntary confinement was extended.
3.
Is experiencing auditory hallucinations and ideas of reference.
INCORRECT. Auditory hallucinations and ideas of reference are simply possible symptoms of Jim’s psychotic disorder.
4.
Is suicidal.
INCORRECT. Same as Rationale “B.”

Question 14

Emily, age 17, calls you seeking therapy. She tells you that she doesn’t want her parents to know that she’s seeing you. When you ask her what she wants to talk about, she says she wants to have sex with her boyfriend and that her parents do not understand her. You:

Answer 14

Assess her with her boyfriend.
INCORRECT. Assessing Emily and her boyfriend does not address Emily’s reason for calling you; Emily has contacted you seeking individual therapy
2.
Treat her without parental consent.
CORRECT. As of January 1, 2011 (SB543; Leno), mental health professionals, including LCSWs and ASWs, may treat a minor 12 or older without parental consent if the minor is mature enough to participate intelligently in therapy. Also, there is no longer a requirement for the child to be a victim of child abuse or a danger to self or others. However, you still must have a good reason not to include the parent(s) in therapy. Based on the information you are given, Emily meets these requirements and you may treat her without parental consent.
3.
Refer her to Planned Parenthood.
INCORRECT. Planned Parenthood might be appropriate if she is seeking low-cost birth control, but it is not clear that this is her issue.
4.
Explain that you need parental consent.
INCORRECT. See Rationale “B”.

Question 15

An elderly couple comes to see you. Harold, 68, has Alzheimer’s and is physically incapacitated. His wife, Jackie, is 72 and acts as his full-time caretaker. Jackie tells you that she has had it because he has been hitting her with his cane. How would you proceed?

Answer 15

Help her obtain information about nursing homes.
INCORRECT. A nursing home might be indicated if she cannot manage him alone at home anymore, but an APS report must be made first since she is over 65 and being abused.
2.
Refer her to a caregivers support group and educate her on the poor impulse control associated with Alzheimer’s.
INCORRECT. A support group for caregivers and information about poor impulse control in Alzheimer’s might help Jackie, but does not attend to the crisis issue or your legal responsibility to report elder abuse.
3.
Refer him to an anger management group for people with Alzheimer’s.
INCORRECT. This answer does not attend to the crisis or your mandate.
4.
Make a report to Adult Protective Services.
CORRECT. Jackie is over 65 and being physically abused.

Question 16

A 17-year-old client tells you her father molested her and that her school counselor has already reported the incident to Children’s Protective Services. She says that it caused a big upset at her house. What would you do?

Answer 16

Call her mother to confirm the daughter’s statement.
INCORRECT. Calling her mother to confirm the daughter’s statement is incorrect, since you do not know whether this client is seeing you without parental consent, and thus contacting the mother may break confidentiality.
2.
Since the abuse has been reported already, you do not need to do anything.
INCORRECT. Not doing anything is incorrect since you need to be certain the abuse was reported.
3.
Call a child protective agency to verify that a report was made.
CORRECT. Calling a child protective agency would be the appropriate course of action. They won’t allow you to verify the prior report because of confidentiality, but they will check their records to see if it is a duplicate report.
4.
Call the school counselor to confirm that a report was made.
INCORRECT. Calling the school counselor is an option, but it is not the best way to confirm whether the report was made or not.

Question 17

You have determined that a child you are seeing in therapy is being abused. Upon contacting the child’s doctor and teacher they concur that child abuse is suspected. Legally:

Answer 17

Each must report separately.
INCORRECT. Legally, only one is required to report.
2.
Only one needs to report.
CORRECT. Each party has the duty to report child abuse, but only one needs to report. It would be important for the professionals involved to clearly decide which of them will make the call and do the necessary follow-up. An LCSW should document the plan for protecting this child, that is, who makes the report and when.
3.
Only one needs to report while the others write a follow-up report.
INCORRECT. Legally, only one is required to report. Follow up reports are not required.
4.
You must contact the parents.
INCORRECT. According to law, a mandated reporter does not have to contact the parents.

Question 18

You are treating a 15-year-old male who tells you that he has been forcing his 13-year-old girlfriend to have sex with him. He wants to bring her to the next session so you can help her to forgive him. How would you proceed?

Answer 18

Consider seeing her and report.
CORRECT. Whether or not you see the girl is a clinical issue, but a report is mandated because the sex was nonconsensual. Nonconsensual or forced sex with a minor is child abuse. In addition, even if the sex were consensual, it might be reportable because the intercourse was between someone under 14 with someone over 14.
2.
Report and notify her parents.
INCORRECT. Making a report is necessary but calling the girlfriend’s parents is not necessarily appropriate or legal, since you would be breaking confidentiality. Child Protective Services will notify the parents as necessary.
3.
See the couple to assess further.
INCORRECT. Further assessment does not need to take place because the young man has admitted to non-consensual sex with a minor.
4.
Explore why he feels he can “force” her to have sex.
INCORRECT. This is a clinical issue, and not relevant to your more immediate mandate.

Question 19

Georgia comes to counseling at her children’s urging. Her daughter drives her to therapy and drops her off at the first session saying, “I hope you can help my mom. Ever since my dad died she hasn’t been the same.” This case would be out of your scope of practice if:

Answer 19

You are not trained in grief and loss issues.
INCORRECT. If you are not trained in grief and loss issues, this would be a matter of scope of competence and training, not scope of practice.
2.
Georgia’s daughter refuses to participate in therapy.
INCORRECT. You can do therapy with Georgia alone if the daughter does not wish to participate, as long as you are dealing with relationship issues.
3.
Georgia needs psychotropic medication.
INCORRECT. If Georgia requires medication, she would need to be referred to a psychiatrist to get a prescription. However, you could still treat her for relationship issues.
4. Georgia is in the final stages of Alzheimer’s disease.
CORRECT. If Georgia were in the final stages of Alzheimer’s disease, she would be unable to participate in therapy.

Question 20

Which of the following caregivers cannot provide consent to treatment for a minor?

Answer 20

Foster parents
CORRECT. Although foster parents may consent to regular medical or dental care, only the legal guardian of the minor may make decisions about the child’s mental health treatment.
2.
Adoptive parents
INCORRECT. Adoptive parents legally have the same rights as biological parents for consenting to mental health treatment of a minor.
3.
A parent under the age of 18
INCORRECT. A minor parent can consent to treatment for their child(ren) as long as they are mature enough to understand the therapeutic process.
4.
A father who was never married to the minor’s mother
INCORRECT. Legally, either parent can make a unilateral decision regarding consent to treat a minor.

Question 21

Privilege could be waived in which instance?

Answer 21

A 13-year-old girl, who you are seeing without parental consent, has been abusing drugs.
INCORRECT. A 13-year-old girl, who you are seeing without parental consent, who has been abusing drugs, is not an exception to privilege. Privilege specifically has to do with the loss of confidentiality in court. There is no example of pending court proceedings.
2.
A client has told you he has been involved in a bank robbery in which there was a shooting.
INCORRECT. When a client tells the therapist about a bank robbery, the therapist must maintain confidentiality, and the client still holds the privilege.
3.
A 64-year-old woman complains to you that her daughter has been taking her social security checks.
INCORRECT. In cases of financial abuse, the therapist is not required to break confidentiality unless the client is an elder (65 or older). Again, the client would be the holder of the privilege.
4.
A client accused of assault and battery uses insanity as a defense in court.
CORRECT. If insanity is used as a defense for a crime, then the client has waived his or her right to privilege.

Question 22

How should physical abuse of a dependent adult be reported by an LCSW?

Answer 22

By telephone within 36 hours, and in writing as soon as possible.
INCORRECT. See Rationale “C”.

2. By telephone within two working days, and in writing as soon as possible.
   INCORRECT. See Rationale “C”.
3. By telephone as soon as possible, and in writing within two working days.
   CORRECT. Mandated reporters must report dependent adult abuse “immediately or as soon as possible by telephone, and shall prepare and send a written report within two working days.” This should not be confused with child abuse reporting, where the written report must be prepared and sent within 36 hours.
4. By telephone as soon as possible, and in writing within 48 hours.
   INCORRECT. See Rationale “C”.

Question 23

You receive a subpoena for one of your clients, a 9-year-old male. He is involved in a highly volatile custody situation. Who can waive privilege for a young child during a custody proceeding?

Answer 23

The parents of the minor
INCORRECT. During a custody hearing, the parents of a minor usually would not waive privilege for their child, as they may not maintain objectivity during such a proceeding. An appointed guardian ad litem or the court may waive the privilege.
2.
The child’s attorney
CORRECT. A child’s attorney may waive privilege if a conservator or guardian ad litem has not been assigned by the court.
3.
The parents’ attorney
INCORRECT. The parents’ attorney cannot waive privilege for a minor. The minor must have his or her own attorney, conservator or guardian ad litem, to waive privilege.
4.
A personal representative
INCORRECT. A personal representative is utilized when a client is deceased. This would not be the case for a child who is still living.

Question 24

Marsha, a 30-year-old client, tells you she was sexually abused by her father as a child. What is your legal responsibility in this situation?

Answer 24

Maintain confidentiality.
CORRECT. You would maintain confidentiality, as the client is now an adult. An ethical consideration would be to assess as to whether the father still has access to children. Until this is determined, confidentiality would be maintained.
2.
Report to CPS, as this client was sexually abused as a minor.
INCORRECT. Unless you determine the client’s father still has access to children and you have reasonable suspicion that abuse is occurring, you would maintain the confidentiality of an adult client.
3.
Investigate whether the client’s father still has access to minors.
INCORRECT. It is not your job to investigate whether the client’s father still has access to minors. If you have suspicion that a past perpetrator has access to children and you have reasonable suspicion that abuse is occurring, then you would need to make a report.
4. Advise the client to press charges against her father.
INCORRECT. You may want to provide the client with her options, which include information about making a report to the police, but you do not provide advice.

Question 25

Maintain confidentiality.
CORRECT. You would maintain confidentiality, as the client is now an adult. An ethical consideration would be to assess as to whether the father still has access to children. Until this is determined, confidentiality would be maintained
2. Report to CPS, as this client was sexually abused as a minor.
INCORRECT. Unless you determine the client’s father still has access to children and you have reasonable suspicion that abuse is occurring, you would maintain the confidentiality of an adult client.
3. Investigate whether the client’s father still has access to minors.
INCORRECT. It is not your job to investigate whether the client’s father still has access to minors. If you have suspicion that a past perpetrator has access to children and you have reasonable suspicion that abuse is occurring, then you would need to make a report.
4. Advise the client to press charges against her father.
INCORRECT. You may want to provide the client with her options, which include information about making a report to the police, but you do not provide advice.

Answer 25

Devising a safety plan for a female who is in a violent relationship.
INCORRECT. Devising a safety plan for a victim of domestic violence is an ethical responsibility, but there are no legal mandates if a client chooses to stay in that relationship, unless that person is in the special class of protected individuals.
2.
Making a report to an agency designated to take child abuse reports.
INCORRECT. Reporting to a child abuse agency is a legal mandate, not an ethical responsibility.
3.
Taking the necessary precautions to keep a high-risk, suicidal client safe.
CORRECT. There are no legal mandates to break confidentiality with a suicidal client; however, there is a legal responsibility to keep the client safe, as stated by Bellah versus Greenson.
4.
Making a report to an agency designated to take dependent adult reports.
INCORRECT. Reporting to a dependent adult abuse agency is a legal mandate for an LCSW, not an ethical responsibility.

Question 26

You have been treating the Carrington family, which includes 17-year-old Karen who is suffering from Anorexia Nervosa. You request and receive a copy of Karen’s medical file. In the report, it states that Karen has genital warts. After you read this file, you:

Answer 26

Discreetly destroy it.
INCORRECT. You do not want to destroy the file, because you may need to refer to it at a later time.
2.
Return the file to the doctor.
INCORRECT. It is not necessary to return the file to the doctor since the doctor has the information already.
3.
Put it in your file.
CORRECT. Since your records are confidential and kept in a safe place, the medical records should be filed. You may need to refer to them later.
4.
Give the report to Karen in a private session.
INCORRECT. It would be inappropriate for you to give the medical records to your client. The doctor is the person who should decide whether to share this report with Karen.

Question 27

You are seeing a suicidal, pregnant teenager without her parents’ knowledge. Which of the following is true regarding the release of her medical records?

Answer 27

The girl can request a release of her medical records.
CORRECT. Since the client is the holder of privilege, she would be able to request the release of her medical records.
2.
The state can request a release of her medical records.
INCORRECT. Although the court can waive her privilege, it does not have access to do so unless she is in a court proceeding.
3.
The therapist can request a release of her medical records.
INCORRECT. The therapist can never request the release of medical records without the consent of the client.
4.
Only her parents can request a release of her medical records.
INCORRECT. Since the question indicates you are treating this minor without parental consent, we can assume there is a reason why the parents are not involved in therapy. Therefore, they would not be the ones to request the records.

Question 28

An LCSW can only break a client’s confidence under certain specified situations. Which of the following would you consider to be the most serious situation in which to break confidentiality?

Answer 28

You are seeing a client who is contemplating suicide and has a plan.
CORRECT. Section 1024 of the California Evidence Code allows for breaches of confidentiality in situations in which there is danger to self, others or property. With a suicidal client who has a plan, there is a high risk of dangerous behavior.
2.
You are seeing a 63-year-old woman whose son is physically abusing her.
INCORRECT. The reporting of elder abuse (age 65 or older) does not specifically apply to a 63-year-old woman unless she is dependent, which this vignette does not specify.
3.
You are treating a 12-year-old girl who is smoking marijuana.
INCORRECT. Drug abuse does not in and of itself constitute an instance to break confidentiality.
4.
Your client has just lost his job and tells you he is going to “get even” with his boss.
INCORRECT. A vague threat to “get even” is not as dangerous as a suicidal plan because it is not specific enough to be considered a definite Tarasoff situation.

Question 29

A family with a 16-year-old daughter and a 15-year-old son comes in to see you. The siblings are of equal height and build. The parents report that they have been referred to you by the school counselor because of the children’s frequent squabbles. You discover they both have hit the other hard enough to give each other black eyes. You would:

Answer 29

Set up a strict policy of no hitting; teach anger management skills to both siblings; and instruct the parents on recognizing the warning signs that lead to the children’s violence.
INCORRECT. Teaching anger management and parenting skills is important but will take time and does not address the need for immediate safety.
2.
Report the incidents to a children’s protective agency.
CORRECT. This vignette describes sibling abuse that has been occurring for a while. The parents are not in control of the situation
3.
Inform the parents that if they don’t contain the violence, you will report the incident to a children’s protective agency.
INCORRECT. Giving the parents another chance is not appropriate to avoid a mandated report.
4.
Take steps to contain the violence. Since the violence is between siblings that are close in age and evenly matched, it is not reportable since it is a mutual affray between minors.
INCORRECT. There is nothing in the law that indicates that evenly matched siblings can beat each other. Mutual affray between minors is not seen as an on-going situation

Question 30

Ajax, a 51-year-old ex-con, comes to therapy because he tells you he has been depressed ever since he left prison. He just doesn’t feel like he fits in anywhere and still feels terribly guilty for the murders he committed that have gone unpunished. He says he is tired of spending everyday looking over his shoulder and would be better off dead. What is your legal responsibility in this case?

Answer 30

Call the police because you have knowledge of a murder.
INCORRECT. Crimes your client has committed, even murders, are not reportable (note that past child abuse or murder of a child is an exception to this rule).
2.
Initiate an involuntary hospitalization because he is suicidal.
INCORRECT. Initiating a 5150 is too extreme for the information you have been provided. Ajax says he would be better off dead, but we do not know if he will agree to a “no-suicide” contract, if it’s possible to organize a 24-hour suicide watch, or if he is willing to hospitalize himself if necessary.
3.
Consider breaking confidentiality to ensure his safety.
CORRECT. Evidence Code 1024 gives therapists the permissive right to break confidentiality to ensure the safety of a client. This is the best answer of the choices you have.
4.
Notify his next of kin.
INCORRECT. Notifying his next of kin is not clear enough. If you are doing this to organize a 24-hour watch, then that would need to be stated. This answer leaves too much to be inferred.

Question 31

An LCSW in California who is a “covered entity” under HIPAA, when dealing with issues covered both by California law and federal law must follow:

Answer 31

Federal standards at all times.
INCORRECT. Following federal standards could leave a clinician in the position of violating state laws.
2.
Whichever law provides the most stringent standards.
CORRECT. In any instance in which there is a difference between HIPAA guidelines and California law, licensed health professionals must follow whichever law sets the most stringent standard.
3.
The standards of both California and federal law.
INCORRECT. It is not always possible to follow the standards of both California and federal law because they do not always agree.
4.
California law since their license is granted under California law.
INCORRECT. Following California law could leave a clinician in the position of violating federal laws.

Question 32

The Johnsons come in with their 7-year-old daughter, Elizabeth, who appears listless and stares off into space. The parents treat your questions about Elizabeth’s health with suspicion and reject your medical referral due to their religious convictions. What would be your response to this situation?

Answer 32

Work with the Johnsons on improving their communication patterns.
INCORRECT. This would be an inadequate response. See Rationale “4”.
2.
Discuss with the Johnsons their resistance to a medical referral.
INCORRECT. Again, this would be an inadequate response to the medical neglect and would not address your legal reporting requirement.
3.
Affirm the Johnsons’ right to their own religious beliefs.
INCORRECT. While the Johnsons are entitled to their beliefs, these beliefs cannot interfere with the safety and well-being of a child.
4.
Make an immediate report to Children’s Protective Services.
CORRECT. Although everyone is entitled to their religious beliefs, these beliefs cannot interfere with the safety and well-being of a child. The neglect of a child’s medical needs would constitute a mandated report to Children’s Protective Services.

Question 33

Helen comes to therapy and tells you that she and John have been married for 18 years and have two teenagers. Helen has never worked outside of the home. John wants a divorce, refuses to give her any money, and has moved out. In this case, if Helen tells you a Legal Aid representative wishes to speak with you, what information would you not include on a release of information?

Answer 33

Helen’s birthdate and social security number
INCORRECT. You would include Helen’s identifying information for record purposes.
2.
Your name and license number
INCORRECT. You would include your name and license number on a release of information form.
3.
Helen’s diagnosis
CORRECT. You would not include Helen’s diagnosis on a release of information form.
4.
Inclusive dates of information, which may be released
INCORRECT. You would include inclusive dates of when the release is effective until.

Question 34

Roger Kelly has worked the last three years at a record-pressing factory. He had been coming into work late, borrowing money from other employees, and creditors had begun calling him at work regarding overdue bills. He was recently fired from his job because of inadequate performance after a physical altercation with another employee. His boss terminated him and indicated that his recent change in attitude, unpredictable behavior, and job performance would have caused him to be terminated in any case.
Roger is so angry about the termination that he threatens to sabotage several machines at the record-pressing factory. How should the therapist proceed?

Answer 34

Maintain Roger’s confidentiality.
INCORRECT. The therapist might choose to maintain the client’s confidentiality but, based on Section 1024 of the Evidence Code, the therapist has a right to warn.
2.
Warn the manager of the factory because this is analogous to a Tarasoff situation.
INCORRECT. The therapist might choose to warn the manager based on Section 1024 of the Evidence Code, not because it is analogous to Tarasoff.
3. Ethically, the therapist may choose to break confidentiality according to the Landeros vs. Flood decision.
INCORRECT. Since the Landeros vs. Flood decision relates to civil action against therapists who do not report reasonable suspicion of child abuse, it is irrelevant to this vignette.
4.
Follow the guidelines as set forth in Section 1024 of the Evidence Code.
CORRECT. The Tarasoff Decision does not pertain to the protection of physical property. However, Evidence Code 1024 states that the therapist has a “right” to warn when property is threatened.

Question 35

You receive a phone call from a 13-year-old girl named Ginny. Ginny tells you sees the sign outside your office as she rides her bike to school every day. She says she finally got the courage to call. Ginny asks if she can make an appointment with you to “talk about stuff that’s really bugging me.” She says, “My mom is so nosy, I don’t want her to know I’m coming.” Legally, how may you proceed?

Answer 35

Set an initial appointment with Ginny and document your reasons for not including her parent at this time.
CORRECT. As of January 1, 2011 (SB543; Leno), mental health professionals, including LCSWs and ASWs, may treat a minor 12 or older without parental consent if the minor is mature enough to participate intelligently in therapy and there is no longer a requirement for the child to be a victim of child abuse or a danger to self or others. Also, according to the provisions of Family Code Section 6924, you still must conclude that there is good reason not to include the parent(s). Ginny meets the above requirements and legally, you could begin to treat her without parental consent. A therapist in this situation would always document in the therapy record his/her reason for not including the parent(s) in treatment.

Question 36

You’ve been seeing Glen, a computer programmer, for several months. He is dealing with feelings of depression and hopelessness following a layoff from a dot-com company. Glen has a history of cocaine and methamphetamine abuse and attempted suicide twice in the last year. Glen has been giving away prized possessions and, in his last session, he indicated that, “he knows the ultimate solution to his problems.” He has made a request to obtain his therapeutic records because he wants to know “just how crazy I am.” Which of the following would represent a legal response to this request?

Answer 36

You would refuse to divulge the records since you feel the information contained may be detrimental to his welfare.
CORRECT. According to California Health and Safety Code 123115 (b), a therapist has the right to refuse a client’s request for access to records. In this case, Glen’s deteriorating mental health could be further jeopardized by the adverse effect of learning his diagnosis, prognosis and the therapist’s heightened concern for his safety. If you refuse a client’s request for records there are several steps that you must take: document in your records the date of the request and the reason for your refusal, including the foreseen detrimental effect; advise the client that another mental health professional, chosen by them, can inspect the records with their written authorization. It is important to note that this designated mental health professional would not be permitted to copy the records for the client.

Question 37

You’ve been treating a woman who is in the midst of a divorce. You receive a subpoena in the mail from her husband’s lawyer asking for your client’s records. You:

Answer 37

Contact your client to determine if she wants you to waive or assert privilege.
CORRECT. Clients hold their own privilege and a therapist must consult with the client to determine whether privilege is to be waived or asserted.
2.
Would contact the husband’s lawyer and assert privilege.
INCORRECT. Calling the lawyer would breach your client’s confidentiality.
3.
Ignore the subpoena since there is no one to whom you can assert privilege.
INCORRECT. Ignoring the subpoena does not fulfill your legal responsibility and puts you at risk of being in contempt of court.
4. Must comply with the subpoena since it is an official court document and you would otherwise be in contempt of court.
INCORRECT. Therapists must always assert privilege on behalf of their client until directed to do otherwise by the client or by court order.

Question 38

You have been working with an attractive client, Christine, who has a diagnosis of Borderline Personality Disorder. During your assessment, Christine becomes tearful and tells you about her breakup with her last boyfriend. During the course of her story, Christine divulges details of the relationship, including how they met in her therapy. You begin to realize Christine’s ex-boyfriend was her therapist. What is your course of action in this case?

Answer 38

You give her a pamphlet informing her of her rights and how therapy should not include sexual relations.
CORRECT. You would give the client a copy of the Department of Consumer Affairs’ pamphlet “Professional Therapy Never Includes Sex,” allowing her to be informed of her choices and rights.
2. Being she has Borderline Personality Disorder, the client is probably misconstruing information. More assessment is needed to really understand what happened.
INCORRECT. Even though Borderline Personality Disorder is indicative of unstable relationships, your legal responsibility is to provide the client with the pamphlet “Professional Therapy Never Includes Sex.” She may be misperceiving information, but it is not your duty to disprove the client’s perceptions, only to provide her with the pamphlet.
3. Obtain a release of information from your client so you may speak with the ex-boyfriend/therapist to get his side of the story.
INCORRECT. You may want to obtain a release of information for continuity of care, but your initial legal responsibility is to provide the client with the pamphlet.
4.
Provide support and empathy to normalize the client’s experience of her breakup.
INCORRECT. Providing support and empathy are good therapeutic tools, but this does not fulfill your legal responsibilities.

Question 39

Which of the following is true about elder abuse?

Answer 39

We are mandated to report reasonable suspicion of abduction.
CORRECT. According to our legal mandates, as of 1/1/2003, knowledge or reasonable suspicion of elderly abduction must be reported to APS.

Question 40

When working with adults molested as children, it is important that you:

Answer 40

Ask the client if s/he knows if the perpetrator currently has access to children whom might be abused.
CORRECT. Working with the client to determine if the perpetrator has access to children is an important consideration in determining if a CPS report should be made. Depending on how long ago the molestation occurred (the statute of limitations for criminal cases is 7 years), whether the perpetrator is alive, where s/he is, an historical report may not be necessary. Access alone is not stated as a condition to report based on the Child Abuse and Neglect Reporting Act, 2001. However, if there is reasonable suspicion that children around the perpetrator could still be being abused a report is necessary.

Question 41

. You are meeting with a client for the first time. What information do you legally have to disclose before the end of the first session?

Answer 41

Your fee and if you are using a fictitious business name
CORRECT. Informed consent, by law, must include: fee disclosure (and the basis for how fees will be determined) and if a therapist is utilizing a fictitious business name (and the name and license designation of the owner(s) of the practice).

Question 42

The Jennings family saw you for counseling last year while the parents, Jack and Britte, unsuccessfully attempted to reunite after a year’s legal separation. Britte is now filing for a divorce and her lawyer has subpoenaed your records to help prove that Jack is unfit to have physical custody of the two children, ages 11 and 10. In order to release records, which of the following needs to happen?

Answer 42

Britte and Jack must agree to sign releases and waive privilege on behalf of themselves: A judge must waive privilege on behalf of the children.
CORRECT. In family therapy situations where the “client” is the family, nothing can be released without signed waivers from all legally responsible parties. When children are involved, neither parent automatically has the right to waive privilege. Only a judge can determine who will exercise the children’s privilege.

Question 43

Your 15-year-old client, Ben, tells you that he would like to bring his buddy, Joey, also 15, to his next session. To address Ben’s request you must:

Answer 43

Tell Ben that Joey will need parental consent before he can attend a session and explain your reasoning.
CORRECT. As of January 1, 2011 (SB543; Leno), mental health professionals, including LCSWs and ASWs, may treat a minor 12 or older without parental consent if the minor is mature enough to participate intelligently in therapy. There is no longer a requirement for the child to be a victim of child abuse or a danger to self or others. However, you still must have a good reason not to include the parent(s) in therapy. This question does not indicate a good reason why you would not include Joey’s parents i.e., seek their consent to see Joey for one session. To be honest with Ben, this would be your response about why you would say no to his request.

Question 44

Which of the following choices is correct regarding a client who reports that s/he had sexual contact with a former therapist?

Answer 44

There is a legal mandate to give the client the handbook “Professional Therapy Never Includes Sex.”
CORRECT. There IS a legal mandate to give the client the handbook “Professional Therapy Never Includes Sex” which a therapist can obtain from the Department of Consumer Affairs.