Confidentiality, minors, abuse reporting Flashcards
(72 cards)
Confidentiality vs privilege?
○ Confidentiality: code of ethics term; your responsibility as a tx to keep therapy private
○ Privilege: legal term; clt’s right to keep info about therapy from being shared in court
§ Privileged communications: communication btwn clt & tx considered ; court cannot force tx to share info
What does it mean to assert privilege?
a therapist can assert privilege by not giving up confidential info
Bellah v Greenson
○ Determined bc of special relationship w tx, tx does have responsibility to take reasonable steps to prevent a threatened suicide
§ “reasonable steps” —-> standard of care
California End of Life option
○ Terminally ill clts
○ “death with dignity act”
○ ELO Act (2 separate requests of physician at least 48hrs apart for a prescription for aid-in-dying medication) (p.142)
○ Must have no impaired judgement
MH professionals do not need to break confidentiality for this
§ Protected from liability
Also protected if refuse to participate in clt’s plan for ELO
5150
○ Tx can start this process, but usually a med professional must decide
○ 72-hour hold (often shorter than 72 hrs if assessed) (can also be longer on holidays/weekends)
§ If clt still threat to self after 72 hrs: can be held for 14 days
□ If still after that: can be held another 14 days
□ Beyond this: must voluntarily agree to tmt, have conservatorship, or present active danger to others
What does it mean to waive privilege?
a client can waive their right to privilege (authorize release of their info)
Exemptions for privileged communications?
○ Client sues therapist (malpractice suit)
○ Client claims psychological damages in civil suit
○ Court-ordered psychological evaluation
○ Client-initiated psychological evaluation (to estab. competency)
○ Child/Elder/Dependent Adult abuse
○ Imminent danger to self/others/property
○ Minor < 16 years victim of crime (clinical judgement if best interest)
Pre Tarasoff vs Post Tarasoff views on confidentiality?
pre tarasoff: Sacrasanct: confidentiality guaranteed, no exceptions
post tarasoff: confidentiality is balanced; “protective privilege ends where the public peril begins”
Tarasoff Two Step
Tarasoff: case law vs statute
○ Case law (1976):
§ Therapist determines client is serious danger to other
§ Intended victims
§ Range of options to discharge
§ Duty to Protect
§ Obligation to use “reasonable care*” to protect intended victims
§ No provision of immunity
○ Immunity statute (1986)
§ Client communicates serious threat of violence to therapist
§ Reasonably identifiable victims
§ Duty to Warn – (victim AND law enforcement)
§ Provides immunity ONLY when discharge duty to warn
Gap in case law: tx has to duty to protect, but nothing to protect them from liability for breaking confidentiality
Duty to warn
Examples of risk of harm to others assessments (name 2)
ACTION
LAS
ACTION
risk of harm to other assessment
Assessing risk of violence: ACTION
* Attitudes: does the client believe that violence is justified in these circumstances?
* Capacity : does the client have the means to carry out the threats (e.g., access to weapons)
* Threshold: does the client have a plan, and what is the extent that the client has put the plan into action
* Intent: does the client communicate specific vs. general comment that reveals serious harm to others
* Others’ reactions: have others encouraged or discouraged the client’s hostile actions?
* Noncompliance: does the client demonstrate an unwillingness to consider alternatives to violence?
(Borum & Reddy, 2001)
ACTION: correlates of risk: ***Is there a history of violence/assault? ***Has client carried out previous threats? *Is there a history of mental instability? – Emotional reactivity, anger outbursts, impulsivity *Is there a history of substance abuse?
LAS
risk of harm to others assessment scale 1-5 w/ indicators
LPS Act
- The LPS Act
- Section 5150: allows for 72 hr involuntary hold when danger to self/others or gravely disabled bc MH
- Heater vs. Southwood Psychiatric Center (1966)
○ NEED for probable cause & facts to back up involuntary holds
○ Otherwise can be sued for false imprisonment/medical malpractice - For therapists to get immunity after determining probable cause:
○ 1: assessment & evaluation
○ 2: finding an eligible professional
3: application
5150 foxtrot
Step 1: Assessment and Evaluation for Danger to Self or Others as a Result of a Mental Health Disorder
Step 1 Checklist:
* Mental Health Disorder: What facts show that your patient has a mental health disorder?
* Danger to Self or Others: What facts point to your patient as a danger to self or others?
* Nexus: What facts link your patient’s danger to self or others due to a mental health disorder?
Step 2: Finding a Dance Partner/ Eligible Professional for Writing a 5150 Application
Step 3: Writing a 5150 Application for a Patient who is a Danger to Self or Others as a Result of a Mental Health
Disorder
confidentiality: threat of harm to self
Required to PROTECT not to WARN
○ ACA b.2a (ALWAYS USE WHEN THREAT OF HARM TO SELF/OTHERS)
* Therapists assert privilege ((exemptions to privilege))
○ CA code 1024: no privilege if the tx has belief clt risk of harm & necessary to communicate that
SAFE-T suicide assessment
- 1: identify risk factors
○ Correlates to suicide
§ Current/past psych dx
§ Key sx
§ Suicidal beh
§ Fam hx
§ Stressors
§ Access to firearms- 2: protective factors : factors that offset or moderate risk / offer support
○ Internal:
○ External: - 3: suicide inquiry
○ Ideation:
○ Plan:
○ Behavior:
○ Intent:
○ Homicide inquiry: - 4: risk level/intervention
○ Do risk vs protective factors put them at high, moderate, or low?
○ Degree of suicidality?
○ Possible interventions - 5: document
- 2: protective factors : factors that offset or moderate risk / offer support
Nexus in 5150 foxtrot?
threat of harm to self is BECAUSE OF a MH disorder
Minors: parents with intact marriage
-either parent alone can consent to MH services
Minors: divorced parents
-if joint legal custody: usually either parent alone can consent to tmt ((Unless it says something otherwise in agreement))
-if both parties cannot agree; the party seeking tmt may have to get it sorted in court
-best to always have both parents involved
-issues when one parent withdraws consent after tmt already started
-tx need to decide if they can legally keep going w tmt
minors consenting to tmt?
12 yrs + and must be able to “intelligently participate in tmt” ; must document/have good reason as to why did not involve parents
Parent access to minor’s MH records—standard of care?
- When parents consent for tmt: parents have right to access minor’s MH records
- When minor consent for tmt: NOT permitted to share records w a parent w/o minor’s authorization
○ Involving parents in tmt does not = full access to all tmt records; Standard of care is “treatment summaries”
○ Discuss “holding information” policy with parent and child
- When minor consent for tmt: NOT permitted to share records w a parent w/o minor’s authorization
Corey 8 step model
“PIELCACA”
- Identify the PROBLEM
- Identify potential ISSUES (cultural context, ethical principles)
- Review relevant ETHICAL professional codes (ACA, CAMFT)
- Review relevant LAWS (admin, state, federal, case)
- Seek CONSULTATION (legal, cultural, professional)
SPECIFY EXACTLY WHO THIS IS - Consider possible/probable courses of ACTION
AT LEAST 3 OPTIONS THAT ARE SEPARATE - Enumerate CONSEQUENCES of options (+/-re: ethical principles)
“beneficence is compromised because ______” - Choose best course of ACTION
Test of justice
Test of publicity
Test of universality
