Law & Ethics - Ii

Front 1

When a therapist has good reason to suspect suicidal behavior in a client, (s)he has an ______ and _______ obligation to breach confidentiality.

Back 1

Legal & ethical

Front 2

What is the single best predictor that a person may be a danger to them self?

Back 2

Having a history of past suicidal attempts

Front 3

What are some of the major risk factors to look for in assessing whether a person is a danger to them self?

Back 3

-ideation -severe depression
-plan - history in family of origin
-means -recent loss/stressful event
-impulse control -unemployment
-hopelessness/anger (women)
-medical problems -isolation
-other psych problems

Front 4

A therapist has a _____ and _____ obligation to protect innocent people who might be harmed by a dangerous client -- even if it requires breaking confidentiality.

Back 4

legal and ethical

Front 5

What 4 things do you need to have established to make a Tarasoff report?

Back 5

1. Someone who has made a threat (your client)
2. An intended and identifiable victim
3. The nature of the threat
4. Facts that make the threat "Serious" such as a plan, a proposed method, hx of violence, intensity and veracity of the threat

Front 6

When might you do a 5150 instead of a Tarasoff?

Back 6

When you can't adequately identify the victim, but you believe the harm will occur.

Front 7

What is the Tarasoff rationale?

Back 7

the client's privacy ends where public peril begins, so you must contact the intended victim and police, in an attempt to protect the victim (NOT just a duty to warn, but also a duty to protect)

Front 8

To make a CA CPS report do you have to be absolutely sure something happened or just have a reasonable suspicion?

Back 8

Reasonable suspicion - average professional in same position would have an objectively reasonable suspicion based on their education and training that abuse has occured. Must report even if no signs of abuse, if you have reasonable suspicion.

Front 9

In CA, if your 16 year old client reports that s/he has had consensual sexual intercourse with a 21 year old partner, do you report it?

Back 9

no

Front 10

In CA, if your 15 year old client reports s/he has had consensual sexual intercourse with a 21 year old partner, do you report it?

Back 10

YES. 21 is the cut off for sex with persons under 16 years of age. IF 20, definitely not. If 21, definitely do report.

Front 11

Do you report to CPS if your client is under 14 and the partner is also under 14, and the sex is consensual, and they are similar chronological or maturational age?

Back 11

no

Front 12

do you make a CPS report if your client is 13 and the partner is 14?

Back 12

yes

Front 13

Tarasoff v Regents of the UC (1976) covers what three duties?

Back 13

Duty to warn
Duty to protect
Duty to predict dangerousness

Front 14

If there is a high risk that your client is a danger to others but they refuse to be hospitalized, what can you do?

Which court ruling covers this?

Back 14

5150 - call police for hospitalization
AND
take reasonable care to warn the victim

Tarasoff v Regents of the UC

Front 15

What are some steps you can take if you believe that your client might (moderate risk) be a danger to them self?

Back 15

- more freq sessions
- contract (more successful w/children)
- safe planning -target issues related to poor impulse control
- close monitoring
- anger management

Front 16

Which court case addressed that a therapist must break confidentiality if there is an identifiable victim?

Back 16

Thompson v. County of Alameda (1980)

Front 17

Which court case established that "reasonable care" must be taken to prevent a patient from inflicting harm?

Back 17

Bradley Center v. Wessner (1982) - if you know who the potential victim is, you must do your best to warn victim & intervene somehow

Front 18

Which case extended the requirement that a therapist must make a reasonable effort to warn a client's identifiable victim to include anyone near the intended victim who might also be in danger?

Back 18

Hedlund v Superior Court of Orange County (1983)

Front 19

What did Hedlund v Superior Court of OC (1983) say?

Back 19

- if it is possible for you to warn the intended victim of your client, you MUST do so

+

You also MUST warn anyone who might be near the intended victim & who might also be in danger

Front 20

What did Bradley Center v Wessner (1982) establish?

Back 20

A therapist must take reasonable care to prevent a patient from inflicting harm

Front 21

What did Thompson V County of Alameda (1980) establish?

Back 21

In order for a clinician to be able to break confidentiality, there must be an identifiable victim

Front 22

What did Jablonski by Pahls v. US (1983) establish?

Back 22

That it is not sufficient for a therapist to just warn the intended victim of their client, they also have a DUTY to commit a dangerous individual

Front 23

Which court case said extended a clinician's duty to warn the (ID-able) intended victim to also include a duty to commit a dangerous individual?

Back 23

Jablonski by Pahls v. US (1983)

Front 24

What did Jaffee v. Redmond (1995) establish?

Back 24

That for all FEDERAL COURT CASES, communications btwn a licensed psychotherapist & their clients are privileged & protected from forced disclosure

Front 25

_____ v. ______ said that for all ______ court cases, communications between a licensed psychotherapist & their client are privileged & protected from forced disclosure

Back 25

Jaffee v. Redmond

FEDERAL court cases

Front 26

What did Ewing v. Goldstein (2004) establish?

Back 26

1. Duty to warn if info re: client threat to another is communicated to the therapist by the client, family member of the client, or a credible 3rd party and leads the therapist to believe that the client poses a serious risk of grave bodily injury to another

Front 27

What are the 4 steps you must take when you have a client that poses a danger to others?

Back 27

1. Attempt to ID dangerous clients
2. Take steps to protect 3rd parties from clients you judge as dangerous
3. Treat dangerous clients to reduce their dangerousness
4. Take reasonable precautions by VERY careful documentation

Front 28

What do you do if you get a call from a client's loved one warning you about what your client has been doing/saying?

Back 28

Ewing v Goldstein
1. Verify that it is an actual person
2. Don't acknowledge client but do hypothetical
3. If huge risk, listen & docu call & intervene appropriately
4. Consult

Front 29

What are the 4 necessary steps you must take in regard to protecting the public?

Back 29

1. Attempt to ID dangerous clients
2. Take steps to protect 3rd parties from these clients
3. Treat dangerous clients to reduce risk
4. Take reasonable precautions by careful docu

Front 30

What is the most common type of domestic emergency?

Back 30

Domestic Violence

Front 31

What determines whether or not a DV report is made?

Back 31

Service setting & function

(health practitioners employed in primary healthcare facility have to report)

Front 32

What is the purpose of a Temporary Restraining Order?

Back 32

-Legally restrain abuser from contacting, molesting, approaching, battering, or disturbing the peace of the ordered
-Order abuser to leave home even if owner
-Can determine temporary child custody and visitation rights in marital/non marital situations
-Can keep person from destroying property

Front 33

Who can grant a temporary restraining order (TRO)?

Back 33

The court or a PO

Front 34

What is a mutual restraining order (MRO) and when is it issued?

Back 34

Automatically issued in divorce or paternity suit

An MRO protects a spouse/former spouse, cohabitant/former, blood relative, child against parent, a significant other by

1. Forbidding transferring, disposing, pawning, etc of property w/o clearance of other party
2. Forbidding changing insurance papers during this time

Front 35

What are some concerns regarding confidentiality when working with couples or groups?

Back 35

1. It should be encouraged
2. There is no statutory privilege (legal protection) regarding info disclosed in gp sessions to client members

Front 36

What are some parental clues for finding child abuse?

Back 36

- Parent is unable to describe positive characteristics of child
-has unrealistic expectations of child
-unduly harsh & rigid about childrearing
-berates, humiliates, or belittles child
-can't see child realistically, attributes badness to child, misinterprets child's normal bx
-indifference to child

Front 37

What are the 4 basic areas in which child abuse may be revealed?

Back 37

1. Environmental
2. Parental clues
3. Physical indicators in child
4. Bx indicators in child

Front 38

Privilege
-Definition
-Who has it?
-When does it apply?

Back 38

Def: Right of clients not to have info about them revealed during legal proceedings

Who has it: The adult client, though therapist can claim on behalf but must give it up if client waves privilege

Hint 38

When? Legal Proceedings

Front 39

Privacy
- Definition

Back 39

The right of persons to choose what others may know about them & under what circumstances; especially relevant to insurance forms

Front 40

Confidentiality
-What is mandated?
-What are the exceptions to confidentiality?

Back 40

Def- Ethical & legal responsibility to safeguard clients from unauthorized disclosure of info revealed during treatment

Hint 40

Exceptions:
-Mandated reporting (child, elder, dep adult abuse)
-danger to self/others
- client request (written release of info)
-if judge court orders a breach
-Subpoena (if client refuses to wave privilege, go to court & explain that you can't)

Front 41

How does Sect 11165 of the CA Penal Code define Child Abuse?

Back 41

as involving:
1. Intentional/usually harmful Physical injury
2. Neglect (general, severe)
3. Sexual Abuse (assault, exploitation)
4. Mental suffering (if severe & unjustifiable)
5. Any of the above occurring in out of home care

Front 42

Reporting Child Abuse Procedures

Back 42

1. Assessment (effects, nature of abuse, stage of development)

2. Call (CYFS or 911 w/in 36 hrs & docu)

3. Written Report

Front 43

What are the major types of elder abuse?

Back 43

Physical Abuse (ex. under/over use of meds)

Sexual Abuse (unexplained diseases, etc)

Emotional/Psych Abuse (ex. bx usually attrib to dementia)

Neglect (ex. poor health)

Abandonment

Financial/material Exploitation

Self-neglect (refuses/fails to provide self care though mentally competent)

Front 44

What is  NOT child abuse/grounds for reasonable suspicion to report suspected child abuse?

Back 44

Children fighting
Consensual sexual activity w/other minors
Pregnancy (not enough for reasonable suspicion)
Knowing adult had been abused as children
Subs abuse during pregnancy
SIDS

Front 45

What does Penal Code 11160 say about who has to report Domestic Violence?

Back 45

Only mandates reporting when practitioner provides med services for a physical condition to a patient, so no provider of mental health care is req'd

Front 46

What kinds of consensual sexual activity amongst minors is reportable?

What isn't? (side 3)

Back 46

1. Any sex activity btwn minors <13 w/ those 15 or older; even if age approp bxs
2. Sex activity btwn 14-15yr old & an adult who is 10 years older
3. Sex. intercourse btwn child 15 or under & adult of opp sex over 21
4. Anal/oral sex when either is a minor 14 or older; even when sex would be okay

What isn't reportable?

Hint 46

Voluntary sex activity btwn kids who are both under 14 and of sim age/maturity. Voluntary sex btwn two 13 yr/old is okay.

Anything based on a hunch, intuition, or impression (not objective!)

Front 47

What does the W&I Code Sect 15610.07 consider as being Elder/Dependent Adult Abuse?

Back 47

Physical Abuse
Neglect
Fiduciary Abuse
Isolation
Abandonment
Abduction
Deprivation of goods & services
Otr treatment resulting in physical harm/pain/mental suffering

Front 48

What are the reporting procedures in cases of suspected Dep Adult/Elder Abuse cases?

Back 48

Complete form & written report and submit w/in 2 working days of making phone report.

Front 49

If an elder/dependent adult
-tells you they are being abused
-doesn't have anything to corroborate abuse
-has a mental illness/dementia

Do you report it?

Back 49

Only if you reasonably believe the abuse did occur.

Front 50

What is an emancipated minor?

Back 50

A minor who
- has entered a valid marriage
- is on active duty in armed forces of US
- has been emancipated by the court

Front 51

What must a minor due to get court-ordered emancipation?

Back 51

-be at least 14yrs old
-be willingly living apart from parents/guardian
-manage his/her own finances
-show an income unrelated to criminal activity

Front 52

What does legal custody mean in terms of their rights/responsibilities as a guardian/parent?

Back 52

Right & responsibility to make a decision concerning a child's health, education, & welfare

Front 53

You are presented with a potential client who is a minor with married parents/legal guardians. Who must give consent/authorization?

Back 53

Either parent

BUT if one is opposed/withdraws consent, request a court order and get a clinical consultation

Front 54

You are presented with a potential client who is a minor with DIVORCED parents. Who must give consent/authorization?

Back 54

The parent with documented LEGAL custody. If parent w/draws consent STOP seeing the child

If share, either can, but if one is opposed/withdraws consent request a court order, seek clinical consultation & stop therapy. If harmful to stop, seek legal consult.

Front 55

You are presented with a potential client who is a minor by their STEPparent. Who must give consent/authorization?

Back 55

The parent w/legal custody. Only the stepparent IF they have legally adopted the child

Front 56

You are presented with a potential client who is a minor with unmarried parents. Who must give consent/authorization?

Back 56

Bio mom has authority irregardless; if paternity isn't in question, father also has unilateral authority. If they disagree, get a court order

Front 57

You are presented with a potential client who is a minor with FOSTER parents. Who must give consent/authorization?

Back 57

Legal parent. Foster parents don't usually have this right (only for ordinary medical & dental care).

Front 58

You are presented with a potential client who is a minor by a relative other than their parent. Who must give consent/authorization?

Back 58

That relative IF he/she completes & signs authorization saying they have the same rights as guardians.

HOWEVER, if parental decision differs, it can supercede if doesn't harm child.

Therapist is NOT liable if caregiver lies

Front 59

An emancipated minor comes to you for treatment. Can you see the minor?

Back 59

Yes, b/c if they're living independently & managing own affairs, and over 15, they can consent to medical treatment.

Front 60

You are working in an outpatient mental health treatment and a 13 yr old comes to you for treatment w/o their parent. Can you see them?

Back 60

MAYBE

Rule: You can see a minor over 12 yrs of age IF
A. Therapist believes minor is mature enough to understand purpose, etc of therapy and consents to treatment
-->AND<---
B. There is a danger of severe phys or mental harm w/o treatment
------->OR<------
C. Is a victim of incest or child abuse

Front 61

If a minor comes to you w/o parental consent b/c they have been raped (12+ yrs old) and wants help, but refuses to tell parents, can you see them?
a. yes, but only if you are in a facility licensed by CA to service rape survivors
b. no, parental consent is always needed if below 15
c. yes
d. the law is unclear

Back 61

a.

Front 62

An 11yr old comes in reporting ___. Their parents don't know and they say that they won't see a therapist unless privacy is maintained.You remember the 12+ rule, so you double check and find that this is the one exception. What is their presenting problem? (cont'd)

Back 62

a. Drug/alcohol related problem
b. Communicable STD
c. Rape
d. Sexual Assault

Hint 62

d

Front 63

How old must a minor be to see you if their parent/guardian isn't available to give consent b/c the parent is away? What must they do?

Back 63

16+ yrs old
They must petition the court for consent to treatment

Front 64

What does

"Beyond parental control"

mean?

Back 64

when a child is classified as neglected, abused, or delinquent b/c court declares that parents have lost control and family services steps in

Front 65

What does

"Reunification"

mean? What role do you play?

Back 65

After child is declared "beyond parental control" and parent decides they want the child back, they must fulfill reqs (psychotherapy or parenting) to get child back.

What is the timeline?

Hint 65

<12 months -> in child's best interest to reunify
12-18m -> may/may not be in best interest
18+ -> stability is in child's best interest