Note: This blogpost is currently being edited.
1A, T1. Comply with legal requirements regarding the maintenance/dissemination of confidential information to protect the client’s privacy.
K1. Knowledge of laws regarding confidential communications within the therapeutic relationship.
Q: How is the therapeutic relationship defined, as it relates between social worker and client?
Q: Which California Business and Professions code references confidentiality for LCSW’s?
A: California Business and Professions Code (BPC) Section 4992.3(n), specifically, “Failure to maintain confidentiality, except as otherwise required or permitted by law, of all information that has been received from a client in confidence during the course of treatment and all information about the client that is obtained from tests or other means.”
Q: What needs to occur first for therapist to break confidentiality?
A: Written consent from client OR legal mandate to breach confidentiality. There must be a strong legal justification.
Q: What should therapist do if there is a justification to breach confidentiality (whether mandated or permitted)?
A: Clearly document the decision-making process for the action. If there is a malpractice suit or other legal action, then this documentation becomes crucial for the therapist.
Q: Which additional legal standards are binding for LCSW’s?
A: California Welfare and Institutions Code Section 5328 (for practice in publicly funded settings).
A: California Civil Code Sections 56.10-56.16 (for practice in health care settings, generally).
A: NASW – professional org for Social Workers, which includes a Code of Ethics (parameters of confidentiality and the practitioner’s responsibilities).
K2. Knowledge of laws regarding the disclosure of confidential information to other individuals, professionals, agencies, or authorities.
Q: What are the three situations where mandated breach of confidentiality is required?
A1: The Tarasoff Law (Duty to Warn, Duty to Protect) applies if there is a believable and serious danger of violence to an identified victim by the client. If the therapist has foundation, the steps are to immediately notify the intended victim and notify law enforcement. Reference to “The Tarasoff ruling” and California Civil Code Section 43.92. I have written a comprehensive article on this topic.
A2. Child Abuse. A reasonable suspicion needs to exist with reference to California Penal Code Sections 11166-11174. If there is suspect abuse or neglect, then the action is to call CPS (Child Protective Service), with the written report within 36 hours.
A3: Elder/Dependent Adult Abuse. Either by a reasonable suspicion by therapist, or by direct communication to therapist by victim, of abuse (Welfare and Institutions Code Sections 15600-15755), then immediately call APS and file a written report within two days. “Elder” is a resident aged 65 or older. “Dependent” adult (age 18-64) who is dependent on another for their well-being.
Q: After the report (CPS or APS) is completed (orally and in writing), how do you address additional contact or followup by the agency?
A: Because additional communication with the agency is a breach of confidentiality, even if the agency initiates contact with therapist, the therapist would need to first get a signed release from client. Really?
Q: What are the three situations where permitted breach of confidentiality is allowed?
A1: If the client is a danger to self (suicide) or others or property of others (California Evidence Code 1024). The objective is creating safety for the client because of the current client mental or emotional state.
A2: When a client signs a release of confidential information (California Civil Code Sections 56-56.37), to speak to or obtain information about the client from identified 3rd party. This is like authorization to exchange information, where the therapist agrees to exchange minimal information necessary (because of advocacy on behalf of client).
A3: There is a court case where therapist is defendant (malpractice action, criminal action, disciplinary action) – per California Evidence Code 1020 – and can breach confidentiality because of action initiated by client, licensing board or district attorney.
Q: It’s permitted, but not mandated, to report potential suicide by client? Verify.
Q: What are the legal requirements for a release of information?
Q: What are the legal requirements for releasing outpatient psychotherapy records?
Q: What are the confidentiality stipulations around Group Therapy?
Q: What about Confidentiality and holding sensitive information?
Q: Confidentiality, Access to Records, and Minors.
Q: Confidentiality and Electronic Devices.
Q: Confidentiality and the Internet
Q: Telemental Health Standards and Guidelines
Q: BBS Consumer Information Regarding Online Psychotherapy
Q: Confidentiality and HIPAA
Q: Is it all the information to disclose or a subset? What are the decision points?