Frequently Asked Questions

Billing Practice

Continuing Education

Court Testimony/Subpoenas

Dual Relationships

Ethics

Exploitation

Licensure

Mandatory Reporting

Miscellaneous

Parental Rights

Practice of Social Work

Practice Violations

Record Keeping

Supervision

Therapeutic Relationships

Treatment


Billing

Q: Can a clinical manager for a mental health rehabilitation agency provide therapy for clients if these clients are also clients of the mental health rehabilitation agency for which the clinical manager works? Should these clients be as- signed to another clinical manager?

A: Your first question does not suggest a dual relationship because the social worker is providing social work services both as a clinical manager and as a therapist. However, he is wearing two different and potentially confusing social work hats with the client and he is now providing the "supervision" of his own work. So the answer to your second question is yes. If there is another clinical manager in this Mental Health Rehab Agency, why risk complicating the therapeutic relationship?


Q: A social worker employed by an agency is required to collect a co-pay fee from clients for their medication which is purchased through the agency. Is it a violation of the Louisiana Social Work Practice Act or the Board’s Rules, Standards and Procedures for a social worker to collect these fees for the agency?

A: No.


Continuing Education

Q: Must the three hours of ethics required every two (2) years for continuing education be consecutive hours?

A: No. You may acquire an hour here and an hour there to complete the requirement.


Q: Is there a process whereby a social worker on active duty in the armed services overseas can complete the continuing education requirement and maintain their social work credential?

A: Yes. The social worker can develop a self study plan through NASW or the internet and submit it to the LABSWE Board office for pre-approval. The social worker can also ask the Board to grant an extension to obtain the continuing education hours.


Q: A social worker planned to complete his last four hours of continuing education in June. However, he was unable to attend the event due to a death in his family. The end of the collection period is June 30. Does he lose his social work credential?

A: No. Rule No. 317 H., of the Board’s Rules, Standards and Procedures states, “In the case of extenuating circumstances, when the individual does not fulfill the continuing education requirements, the individual shall submit a written request for extension to the board for consideration.” This situation would certainly qualify as one of “extenuating circumstances”.


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Court Testimony/Subpoenas

Q: I am in private practice and do not want to do any court testimony for clients. Can I state in my professional disclosure statement (that I give to each client) that I will NOT do any court testimony and hold clients to that statement ? What if I receive a subpoena?

A: By law you must respond to any subpoena received (See Spring 2003 Newsletter for proper procedure). Confidentiality or your personal reluctance to appear in court are overruled when there are child, elder or disabled abuse issues involved. Custody or visitation issues relevant to the well being of a child are also subject to subpoena of you and your records. (See Rule 115.B.3.)


Dual Relationships

Q: Can the clinical manager of a mental rehab agency provide private therapy during agency work hours when the mental rehab agency is an LLC?

A: Standards of Practice 121 C 2 states that "A social worker shall not solicit a private fee or other remuneration for providing services to clients who are entitled to such available services through the social worker’s employer or agency without employer or agency approval." To accept a fee from a private pay client on company time is obviously fraudulent, but many social workers working in mental rehab agencies work for the agency on a part-time basis. With agency approval, the social worker may see private pay clients on site as well but, of course, not at the same time he is billing Medicaid for services rendered.


Q: Can an agency sell books to clients as a service? Can a social worker sell books to clients (at costs-not for profit) as a service?

A: Rule 113(c) (6) requires that “a social worker shall not engage in any type of business relationship other than the provision of social work services, including social work supervision.” The social worker may purchase from the client necessary goods which the client is providing for the general public but the Social Work Practice Act does not define the provision of social work services to include the sale of items such as books. Since we, as social workers try to encourage the client’s self determination and independence, it is difficult to imagine the “service” a waiting room full of books for sale provides. What happens when a client wants to return a book because he didn’t feel the content was helpful or maybe even found it offensive? Better to return it to Barnes and Nobles customer service than to the office where he is receiving social work services.


Q: I am a school social worker who has been counseling a middle school student regarding behavior problems which affect her school performance. Recently I began tutoring in an after school program at my school for which I am financially reimbursed. I do not suggest or assign students to this after school program. It came to my attention that the aforementioned student was about to be thrown out of the after school tutoring program due to behavior problems. I asked that this student be assigned to my tutorial group rather than be expelled from the program. Does this constitute a dual relationship? Because of our counseling relationship, I do not anticipate behavioral problems in my tutorial group with this student.

A: You are attempting to salvage the tutoring experience for your client. Perhaps a better way to do so would be to work with her in the therapeutic relationship to assess the behaviors that earned her dismissal from tutoring. She could then be allowed a second chance in another tutoring group with you supporting her efforts in your therapeutic role.

To “rescue” her does not help her develop self control. To assume that you will not have to discipline her in your tutorial group is a setup for disappointment. You may not only end up getting involved in discipline but being forced to eventually put her out of your tutorial group which is sure to affect your therapeutic relationship with this student. Dual relationships blur boundaries and cloud good social work judgment. This may get into a role confusing situation, if not an outright role conflict. It is best to reevaluate this situation.


Q: I am a social worker in full time private practice. I am also the author of two "self-help" books, a series of relaxation tapes, a Smoking Cessation Program and computer software designed to help with life organization. All these materials are displayed in my waiting room and may be purchased through my secretary. A colleague recently suggested that this availability of products at my office might be construed as a violation of the new ethical standards. Is he right or is he simply jealous of my accomplishments?

A: The Board’s new Rules, Standards and Procedures contain several rules that prohibit dual relationships between social workers and their clients. Rule 113(A)(4) offers an example of exploitive behavior as entering into a sale, lease, or joint venture or other business venture with a client, supervisee or student. Rule 113 (B) recognizes the social worker’s affirmative duty "to maintain the best interests of clients and former clients as the predominant consideration during the existence of the social worker/client relationship and thereafter." Rule 113 (C) imposes a "burden of proof" whereby the social worker must be able to fully demonstrate that the client or former client was neither exploited nor harmed by the relationship. Specifically Rule 113(C)(6) requires that "a social worker shall not engage in any type of business relationship other than the provision of social work services, including social work supervision." Although the social worker may purchase from the client necessary goods which the client is providing for the general public, the converse is not true. The Social Work Practice Act does not define the provision of social work services to include the sale of items such as books, programs, software or tapes.

The selling, marketing, brokering or promoting of such materials by the social worker to the client introduces a business relationship other than the provision of social work services. There is a potential for a shift in focus from that which is predominately in the best interest of the client to that which also may be financially beneficial to the social worker.

Social workers who make individualized hypnotic or relaxation tapes for specific clients as part of the treatment process may charge for the tapes according to the time spent in preparation provided these fees are established in the social worker’s usual fee for service explanation prior to initial service delivery.

If a social worker has produced general marketable products, these would best be offered to the public in a retail setting. Clients can then shop for competitive prices. Even recommending to a client that such materials might be helpful is a questionable practice if the purchase of such materials would financially benefit the social worker. Your colleague is right. Clean up your waiting room.


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Ethics

Q: I am a GSW and I work in a partial hospitalization program. The program has several incentive programs for patients and I would like your input on whether these methods violate the standards of practice for GSWs. The first method is that clients who complete our program are given a certificate of completion and a small gift (nominal) at a "going away" party. Second, clients earn bonus points for completing certain tasks and they can use those bonus points in the agency "store" to purchase certain supplies. Third, there is an award and bonus points are given to the "client of the week" who is chosen by the professional staff. I am very uncomfortable with the award system and have asked to be excused from participation.

A: Does your partial hospitalization program serve developmentally disabled or chronically mentally ill clients? The "incentive programs" you describe sound like traditional behavior modification techniques. Certainly the first and second methods do not violate any standards of practice. The "Client of the Week" should be rotated throughout the population as a motivational tool to reward appropriate behavior and program participation. The use of these typical behavior therapy techniques should not create any ethical concerns.


Exploitation

Q: A social worker has a 17 year old client at a social services agency. The social worker accepts another job at a different agency that does not serve teenagers. Is there some capacity (supportive and/or mentoring) in which the social worker can continue to work with the 17 year old client?

A: You did not specify the type of social services agency or your former service role with this young client. However, I can understand the client wanting to continue therapy and not start over. If that is not possible at your new agency, you should carefully consider your motivation here. What is the purpose of the continued “work” with this client and whose needs would such “work” actually serve. Would not the 17 year old be assigned a new social worker at the agency? Appropriate termination and transfer of service providers seems in order in this situation. A “supportive and/or mentoring” role with a former client sounds like a personal relationship. Rule No. 113(C) (2) states that “A social worker may engage in a personal relationship except as prohibited by Rule No. 113(C) (4) [sexual contact] with a former clinical/therapeutic client.” but “The social worker has a continuing duty to safeguard the best interests of the client.” Rule No. 113(B) states that “while clients and former clients with whom the social worker has or had a clinical/therapeutic relationship are at greater risk, any relationship with a client or a former client exposes clients and former clients to the risk of exploitation.” Rule No. 113 (A) states, “It is a breach of this duty for a social worker to use the professional relationship to promote or advance the social worker’s emotional, financial, sexual or personal needs.”

You should complete an appropriate termination process with this client. A continued role in this young person’s life should be carefully considered and discussed with agency supervisors and other professionals who know both you and the client. Such consultation should enable you to safeguard your former client’s best interests.


Q: A social worker employed by a home health agency is asked to pick up groceries for a client. The client gives the social worker a check, made payable to the social worker, to cover the cost of the groceries. Is this practice a violation of the Louisiana Social Work Practice Act or the Board’s Rules, Standards and Procedures?

A: This practice is not a violation, but to eliminate any possible suspicion of wrong doing, the better practice might be to have the client make the check payable to the home health agency where the social worker is employed. The agency should then reimburse the social worker in a timely manner.


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Licensure

Q: What will happen to the license of BCSWs who do not complete the affidavit to change their status to LCSW on or before December 31, 2000?

A: See Rule 305.E. BCSWs who fail to complete the affidavit to change their status to LCSW will be assigned the GSW status on January 1, 2001.


Mandatory Reporting

Q: I work with people who are child sexual offenders. At times, I will get a referral from a state agency or a private physician and the person (client) who has been referred has been sexually inappropriate with a child and has not yet become involved in any legal proceeding (reports, arrests, etc.). My question is: When I received the telephone call from the client to set up their first appointment, should I inform them at that time that as a mandated reporter, I must make a report to the authorities and that anything they say to me can be used in legal proceedings against them?

A: Puzzling. Since the client had to admit to sexual abuse of a child in order to be referred to your highly specialized practice, why would the “state agency” or “private physician” (who are also mandatory reporters) not have reported the offense to the proper authorities? Prior to accepting a psychotherapy referral of this nature, it would seem good practice to receive affirmation from the agency/physician that the child abuse has been previously reported and to document such affirmation in your own case record.

You state that the client “has been” sexually inappropriate with a child. Is this a recent incident or did this occur many years ago? If there is a present danger to the young victim then you must be certain that a report is made in order to prevent additional harm. If this is a historical statement of fact, you do not have a duty to report but you do have responsibility to warn the client prior to treatment of the limits of confidentiality involved.

To do so by telephone is probably overkill. At the first session, you can help the new client understand that in the event that the historical offense is subject to investigation or prosecution, you may be compelled to testify in court or your records may be subpoenaed or obtained through a search warrant. You must also explain that you are a mandatory reporter of any new abusive behavior with children that might be revealed during the course of treatment.

Rules related to confidentiality are superceded in the LA Code of Evidence Article 510 when the information is relevant to child abuse. Any social worker’s records or testimony can be subpoenaed in legal proceedings involving the welfare of children, the elderly and physically or mentally impaired adults. (Rule 115.D.1., 2., and 5.)


Q: What is the proper protocol for reporting child abuse? Should you advise the child sexual offender that you must report the abuse? Or, should you report it and not tell the offender?

A: If you are already in a therapeutic relationship with the offender when you learn of the offense, your responsibility and intention as a mandatory reporter would probably be an important treatment issue for you to process with the client. If the offense occurred in the past and there is no current victim who is “seriously endangered,” you are not required to make such a mandatory report.

If there is a child in danger of continued abuse by the offender and you have obtained this information from another source (e.g. the child), you have no obligation to inform the offender of the report. Actually, agencies receiving such “good faith” reports of suspicion of child abuse are supposed to protect the identity of the informant.


Q: I have a client who’s former LCSW told him that when a child sexual offender does not live in the house with the child/victim, a social worker does not have to report the child abuse to the authorities. Is this correct?

A: Absolutely not. The abuse is not intra familial so the social worker need not report the abuse to OCS. Instead, the social worker should report an extra familial abuser to the police in order to protect the abused child as well as any other current or potential victims.


Q: I am a social worker and I visit a family member at a local nursing home. I have observed an abusive nurse on two separate occasions. He is verbally abusive to patients and I observed him shoving a patient into a wheel chair. As a social worker, am I required to make a report to the authorities and/or the administration of the nursing home?

A: A social worker has a duty to report abuse or neglect of residents of healthcare facilities such as nursing homes (Rule 115.D.3.) Under La. R.S. 40:2009.20. Such a report should be made to the police within twenty-four (24) hours. You are under no obligation to make a report to the nursing home administration. The administrator will be notified by the authorities investigating the complaint.


Q: A social worker running a group is told by a member of the group that she has knowledge that another individual (not a member of the group who was diagnosed with AIDs is having unprotected sex with the client’s sister. Does the social worker have any responsibility to notify the police, the client’s sister, the individual diagnosed with AIDS?

A: Such hearsay information without substantiation or conclusive evidence is dangerous ground. It would seem that the work of the group (and the social worker) would be to help the group member develop a plan to inform her sister of her suspicions and to urge and/or assist her sister to take appropriate protective medical steps.


Q: A 13 year old had an altercation with another boy which resulted in the 13 year old being placed in an inpatient treatment facility on a court order. The 13 year old told his social worker that he was going to kill the kid who got him put in the treatment center. The social worker calls the police and reports the 13 year old’s statement and the other boy’s name. The police come out and talk to the boy but do not agree to try and locate the other boy or his family and advise them of the threat since they do not know his address. Should the social worker try to locate the other boy and his family (if he is a minor) and notify them of the threat?

A: Since young people often make idle suicidal and homicidal threats, the piece you omitted was whether the social worker considered this to be a genuine Duty to Warn situation. Did the social worker believe that this 13 year old really had homicidal intent, a specific and workable plan to murder his classmate, access to an appropriate weapon and a willingness to follow through with this plan regardless of consequences? Unless he was due to be discharged that day, the social worker may have jumped the gun. If he was due to be discharged and the social worker believed he might indeed attempt to carry out his threat, then he/she must notify the po- lice "in the vicinity of the client and the victim(s)" and make "reasonable efforts to communicate the threat to the potential victim(s)" whose address should be contained in the altercation police report or court order.


Q: The daughter of a male client calls to tell a social worker that her father has been threatening to kill her mother. She asks that the social worker not tell her father that she has called but she asks the social worker to contact the police and advise them that her mother is in danger. When the social worker interviews her client, she gets no information that would make her think that he has been depressed, suicidal or that he is planning to harm his wife. He does tell her that he and his wife are having marital problems and that he thinks divorce is eminent. Does the social worker have a duty to contact the mother and the police based on the daughter’s telephone call?

A: No. Generally three criteria must be met for a duty to warn to exist: (1) there must be a serious threat of severe bodily harm, (2) the person making the threat must have the ability to carry it out and (3) there must be an identifiable victim. La R.S. 92800(2) (B) states that this duty is discharged if the social worker “makes a reasonable effort to communicate the threat to the potential victim or victims and to notify law enforcement authorities in the vicinity of the patient’s or potential victim’s residence”. In this situation, the social worker does not have any evidence of such a threat , except for the daughter’s report. We do not know the age of the daughter or whether she can be considered a reliable informant. If she is not the social worker’s client and the social worker has no reason to believe the father would harm his daughter for making this report, the social worker is not compelled to keep her confidence.

The social worker should, of course, explore the nature of the marital problems with her client, as well as the level of agreement on the solution of divorce and the level of violence or threats of violence inherent in the current marital discussions. If such exploration uncovers no suggestion of potential violence or homicidal intent, there is no duty to warn, but a family session with both mother and daughter present would seem indicated as soon as possible.


Q: If I believe my former therapist involved me and other clients in an inappropriate relationship which troubles me to this day, is there a time limitation to report such boundary violations to the Board?

A: Yes. Act 1289 of the 1995 Regular Session of the Louisiana Legislature states that “if the nature of the complaint is based on negligence or gross negligence, no proceeding may be initiated after two years from discovery by the complainant. However, under no circumstances shall such proceeding be initiated more than five years from the date of the act or omission.”


Q: A social worker has a 16-year-old female client who reports that she is having a sexual relationship with a 30-year-old man. Is the social worker required to report this information to the police, her parents, or both?

A: Social workers are mandatory reporters of child abuse under the Children’s Code Article 603 (13) (b). Abuse is defined in Article 603 (1) as certain acts”. . . . . which seriously endanger the physical, mental or emotional health of the child and cites “. . . carnal knowledge of a juvenile . . . “ as one of those acts.

The Louisiana Legislature defines carnal knowledge of a juvenile in LSA-R.S. 14:80. This statute criminalizes the conduct of a person age seventeen (17) or more who engages in consensual sex with a person age twelve (12) or more but under the age of seventeen (17) if there is an age difference of greater than two (2) years between the two persons.

In our state, if the client were seventeen (17), the social worker would have no legal duty to report her sexual relationship with a thirty (30) year old man. At age sixteen (16), if the client is reporting “carnal knowledge of a juvenile, the social worker is obligated to report this crime to both the police and to the parents of this “minor child”.


Q: A social worker is asked to do an assessment of an adult female who has obviously been beaten. The woman has a mental health diagnosis. Is the social worker required to report this matter to the authorities?

A: An adult client (whether male or female) who has been subjected to an obvious beating requires an assessment to determine if the client is a “disabled person” (one “with a mental, physical, or developmental disability that substantially impairs the person’s ability to provide adequately for his own care or protection”). If the adult is disabled or is of the age of 60 years or older the social worker is required to report the abuse (also neglect and exploitation) to either an adult protection agency or to state and local law enforcement under La. R.S. 14:403.2(D).

If the adult female in this question is under 60 and is not disabled as previously defined, the social worker is not a mandatory reporter and should maintain client confidentiality. Nevertheless, the social worker should assist the client access medical, educational, legal and support services for battered women, if appropriate, and may also encourage the client to report the beating to appropriate law enforcement agencies.


Q: A social worker working in a nursing home discovers that a patient has been sexually abused by a member of the staff. What is the social worker’s responsibility?

A: The social worker’s responsibility is to report the incident immediately to the police. Good social work practice includes reporting to your immediate supervisor in the nursing home as well.


Q: An LCSW has another credentialed social worker as a client in her clinical practice. In the course of therapy, the client (social worker) reveals that she is having an affair and sexual relationship with one of her clients. Does the treating social worker have a duty to mandatory report this matter to the Social Work Board?

A: No, because the superceding ethical issue in this situation is one of confidentiality. The best interest of the client (the social worker seeking treatment) would not be served by such mandatory reporting of an ethical violation. The practitioner should be urged to 1) end the personal relationships with her own client and 2) provide that client with appropriate referrals for additional treatment opportunities, and 3) self-report the matter to the Board. The social worker (client) should continue to work in her own therapy to determine what led to this ethical infraction in order to ensure that it will not be repeated The affected client, however, has the right to report it to the Board at anytime.


Q: We work in a hospital/clinic setting. One of our clients is an inpatient at the facility who has threatened to harm family members. What is the social worker’s responsibility in regard to "duty to warn" ? We have been told that the facility uses a "team approach" and that the therapist who is providing family therapy will assume the responsibility of warning the family of any threats.

A: Generally three criteria must be met for a Tarasoff duty to warn to exist: (1) There must be a serious threat of severe bodily harm, (2) the person making the threat must have the ability to carry it out and (3) there must be an identifiable victim. If your hospital/clinic or agency has an established policy related to "duty to warn", your responsibility would be to report through appropriate channels and document in your progress notes all the steps you have taken to ensure that the "duty to warn" occurs and who is responsible for that action.

LA. R.S. 92800.2.B states that this duty is discharged by the psychiatrist, psychologist or social worker "if he makes a reasonable effort to communicate the threat to the potential victim or victims and to notify law enforcement authorities in the vicinity of the patient’s or potential victim’s residence."


Q: I work with post-conviction sex offenders under the guidelines of the Department of Public Safety and Corrections. I also work with victims of child abuse who are referred by Child Protection Services. What is my mandatory reporting duty with these clients? What do I do in cases where the victim is not identified? What about when the victim reports previous child abuse when he is now over the age of 18?

A: Obviously when your client has been referred by the Department of Public Safety and Corrections or by Child Protection Services, there is no need to report the abuse for which they have been referred. Additional evidence elicited in treatment of continued abuse or endangerment of the original victim or other minors would necessitate additional reporting to proper authorities. Under no circumstances should additional abuse of the original victim or any other minors go unreported merely because the abusive offender is in treatment.

When you have information of abuse where the victim’s identity is unknown, it is unlikely that Child Protection or law enforcement will be able to take action. It is recommended that you make the report anyway with as much information as is available and document the fact that the report was made in your own records.

Reporting child abuse of a victim who was a child at the time of the abuse but is now over 18 years of age at the time of the report may not result in an investigation by Child Protection or law enforcement personnel. However, this report may be of great significance if there are additional minors still accessible to the accused perpetrator.


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Miscellaneous

Q: What do the words "burden of proof" mean in regard to our social work Standards of Practice?

A: In most matters before the Board, the burden of proof is on the party alleging the misconduct which includes the complainant and the Assistant Attorney General presenting the case on behalf of the State of Louisiana against the respondent social worker. The burden of proof is substantiated by a preponderance of the evidence, which means simply that the fact to be established is more likely to be true than not. It is not proof beyond a reasonable doubt.

In Rule 113 (C) the words "burden of proof" are used in connection with the social worker’s responsibility when engaging in any dual relationship with a client or former client. "The social worker must fully demonstrate that the client or the former client was neither exploited nor harmed by such relationships."

Once it is established that the social worker engaged in a dual relationship with a client or former client, the complainant and the Assistant Attorney General representing the State of Louisiana are relieved of the burden of proof. The burden now rests on the social worker to prove that the complaining client was neither exploited nor harmed by the dual relationship "regardless of the intent of the social worker."


Q: I have a bachelor’s degree in social work and I am licensed as a substance abuse counselor. Am I required to apply for the RSW registration if I am not working as a social worker? Can I contract fee for service as a substance abuse counselor?

A: As a licensed substance abuse counselor, your practice is regulated by the Substance Abuse Practice Act (LA R.S.37:3375). Subpart B of this section specifically provides "Nothing in this chapter shall be construed to authorize a substance abuse counselor to practice medicine, social work or psychology or to provide counseling for disorders other than substance abuse."

If you do not choose to register for the RSW, you may not use that designation or call yourself a social worker. As a licensed substance abuse counselor you must consult the Substance Abuse Board to determine their rules in regard to contracted services. There is not need to answer to two regulatory boards unless you step out of the scope of practice of substance abuse.

There is no need to answer to two regulatory boards unless you step out of the scope of practice of substance abuse counseling and begin to practice social work. If this occurs you would be required to meet the qualifications of R.S.


Q: If a client asks for a social work referral for a family member, how many names should be given?

A: "Commonly accepted practice" in the social work community is to provide at least three (3) names and if possible include both genders.


Parental Rights

Q: A social worker is seeing a minor child in his practice. The parents (named on child’s birth certificate) are not married. Can either parent make medical and treatment decisions for the child?

A: Yes. The inclusion of the father’s name on the birth certificate gives him parental rights to make medical and treatment decisions for his child, unless custody has been removed for cause.


Q: A social worker is seeing a child and the parents are not married. The dad is listed on the birth certificate and has just been released from prison and wants a report on the child and the therapy. He also wants to know where the mom and child are living. What are the social worker’s responsibilities?

A: The social worker’s relationship is with the mother and the child. If “a need to know” exists for the biological father, he must obtain a legal release from the mother. Where the mother and child are living is not information the social worker is free to reveal to anyone without the mother’s consent.


Q: When parents have joint custody, do both parents have to agree for a social worker to see a child or can either parent bring a child in for therapy? If one parent brings a child in for therapy, is the social worker required to let the other parent know?

A: When parents have joint custody, the domiciliary parent can make medical and educational decisions for the child but is required by the court’s agreement to let the other parent know what those decisions may be. If the domiciliary parent is not designated as the decision maker, both parents have the same decision making authority. You should request a copy of any joint custody decrees or orders if you feel uncertain about this issue. Ideally, both parents should be informed and involved in a young child’s therapy. There are also other situations (e.g. when the parents continue to fight through the child) when one parent’s fearful or spiteful refusal to give consent for treatment may prevent the child from obtaining appropriate and necessary help.


Q: A mother brings a 6-year-old child in for assessment and treatment. The parents are divorced and the child is having adjustment problems due to the divorce. The mother informs the social worker that she and her husband have joint custody of the child. Does the social worker have to obtain the permission of both parents before he can treat the child?

A: By obtaining a copy of the implementation order of the joint custody decree, before beginning assessment and treatment, the social worker can verify the lines of legal authority of the joint custody parents. While R.S. 9:336 obligates joint custody parents to exchange information concerning the health, education, and welfare of the child (children) and to confer with one another in exercising decision-making authority, mental health professionals cannot assume that such exchange is taking place. The joint custody or implementation order, which allocates the legal responsibilities and authorities of the joint custodial parents (R.S. 9:335), should identify the person who has health care decision-making authority. That order also will designate the domiciliary custodian (the parent with whom the child primarily resides). Unless the order specifies otherwise, the domiciliary custodian will be the person with authority to make all decisions affecting the child, however all major decisions made by the domiciliary custodian can be subject to court-ordered review when formally requested by the other parent.

Where the social worker has confirmed that the person authorizing social work services on behalf of the child is either the domiciliary custodian or otherwise has been granted specific authority for health care decisions by the implementation order, the social worker may obtain a consent for assessment and treatment from that person. Where the joint custody parent “authorizing” social work services does not produce verification of authority from the custody decree or implementation order, the social worker should obtain a consent from both joint custody parents.

In those situations in which the implementation order does not designate a domiciliary custodian or a health care decision maker, either parent may exercise the same type of decision-making authority as when the parents were living together.

Social workers also should be aware that the information concerning medical, dental, school records and the like should not be denied a parent solely because he or she is not the child’s custodial or domiciliary parent. (R.S. 9:351).

The social worker who initiates assessment and treatment without verification of authority runs a risk of providing services without a valid consent. On the other hand, verifying authority in advance promotes the best interest of the child, may foster communications between the joint custody parents and also protects the social worker.

The social worker does not have to have permission of both parents to treat the child. The custodial parent is responsible for making decisions related to the health and well being of the child. The custodial parent is also obligated to advise the parent who shares joint custody of any decisions that are made on behalf of the minor child.


Q: A social worker is seeing two teenage brothers, ages 16 and 17. The parents have joint custody but the boys live with their father. The mother dropped out of sight several months ago, but is back and wants copies of all the boys’ records. She also does not want the social worker to tell the boys she is giving the records to her. Does the social worker have to give the mother a copy of the boys’ records? How should the social worker handle this matter?

A: There are some mistaken notions about the respective authority of parents of minor children relating to healthcare decisions and access to minor’s healthcare records. The joint custody decree of implementation order usually allocates the legal authority of both parents. Generally, the joint custody decree will designate a domiciliary parent (parent with whom the child shall primarily reside) which parent shall be granted decision-making authority unless the order provides otherwise. All major decisions affecting the child are subject to court review on request of the other parent, although the law presumes such decisions made by the domiciliary parent were made in the best interest of the child.

If a domiciliary parent is not designated, both parents have the same decision-making authority as parents living together. Even when a domiciliary parent is designated, the law obligates parents to exchange information concerning the health, education and welfare of the child and to confer with one another in exercising decision-making authority.

The law also makes it clear that access to the minor’s medical, dental and school records as well as other information “shall not be denied to a parent solely because he is not the child’s custodial or domiciliary parent.” La. R.S. 9§ 351. Therefore, under most circumstances, the father’s permission would not be required for the mother to have access to the social work records of her minor teenage sons. The social worker may not agree to shield the mother’s request for her sons’ records from their father or from the boys themselves. Such secrecy not only could be damaging to the therapeutic alliance but also could engender an information power-struggle between the parents concerning the very data they have a legal obligation to exchange.

Social workers treating or evaluating minor children in circumstances of divorce or separation of the parents should become aware of any joint custody decree or orders and may request a copy if there is any uncertainty. Depending upon the subject matter of the social work issues, and the stated ages of the boys, it may be appropriate to obtain a written consent from the boys prior to releasing their social work records to either parent.


Q: An LCSW has an adult client who lives at home with parents, and the parents pay for his therapy. The client is in school full-time and has a mental health diagnosis that affects his performance. His parents would like the social worker to write a letter to the dean of the school explaining his condition, so that the dean will allow him some flexibility. Does the social worker need a release from the client, the parents, or both to write the letter?

A: The social worker does not need a signed release from the parents unless the client is, for some reason, ruled incompetent. An adult client, regardless of who pays the bills, would have to authorize such action with a signed release.


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Practice of Social Work

Q: How does a GSW working as the salaried employee in an agency determine if he/she is practicing clinical social work?

A: Rule No. 505. A. of the Board’s Rules, Standards and Procedures requires that GSWs not pursuing LCSW licensure, or who are fulfilling the experience requirement toward licensure, may deliver clinical services which constitute psychotherapy only under the supervision of an LCSW. If you are unsure if you are practicing clinical social work which constitutes psychotherapy, you should review the definition of Clinical Social Work Practice and Psychotherapy listed in Rule No. 301 with your agency administration and/or supervisor to determine if your job description and duties meet the definitions.


Practice Violations

Q: I am an RSW working in a public social work agency. There are workers here who did not receive a degree in social work who are titled "social services workers" but they routinely refer to themselves as "social workers". What can I do about this?

A: Call the Board. Rule 303A states that "any person practicing social work without license, certification, provisional certification, or registration is subject to the provisions of R.S. 37:2720, including injunctive proceedings and prosecution".


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Record Keeping

Q: A social worker is seeing a mother and her four children. The children have two different biological fathers. One of the biological fathers has requested the records for his two children. Since the social worker saw the mother individually and as a family, how can the social worker protect the confidentiality of the two children who are not the biological children of this man?

A: This seems to be what the British describe as a sticky wicket! What sort of custody arrangement is there for both sets of children? If the requesting father shares joint custody of his children, he has a right to review the children’s records. Nonetheless, he does not have a right to review records relating the mother’s individual treatment without her signed written consent. If the second biological father also has joint custody of his children, then the first father must obtain both the mother’s and the second father’s signed written consent in order to review any records relating to the step-siblings of his biological children.


Q: I am a social worker employed as a school social worker. Am I required to keep records for six years or is it the school board’s responsibility to keep these records?

A: Social work records for children must be kept six (6) years past the age of majority (18). Your school system should have some location where confidential records can be perpetually stored when students have moved out of your individual caseload. Check with your social work supervisor.


Q: A school social worker maintains his own records on the children he sees. School administrators (not social workers) have asked to review his therapy notes due to a complaint that has been filed with the school system. Can the social worker release those records without a release from the parents of the children that the social worker has seen?

A: No. School social workers work in a "host agency" where the majority of personnel are not bound by confidentiality restraints. In order to release any information from a student’s therapeutic file, the social worker would have to obtain the parent’s informed written consent for such release to specific school administrators within a specific time frame. If the school social worker is being supervised by another social worker (or similar mental health pro- fessional), the supervisor can review the supervisee’s therapeutic records and is free to cite dates of service if relevant to a complaint filed against the school social worker. However, the supervisor would have to obtain parental consent in order to reveal any clinical content from these records to school administrators.


Q: A social worker was in partnership with two other mental health professionals. The other mental health professionals come into the office one weekend and take all their client records and leave. Their records contain the social worker’s original therapy notes. Is this a legal or an ethical problem?

A: Better luck next time. The Board assumes that you were working with a psychologist and/or a psychiatrist and that all of you were seeing and charting on the same clients. You did not indicate what type of "partnership" or legal arrangement was in place. This is a legal issue to determine who is considered "owner" of the records. To decide if it is also an ethical issue, you should contact the appropriate licensure boards.


Q: A social worker has seen a client for six sessions. At the seventh session, the client requests that the social worker destroy all of her records and discontinue taking any notes. The client verbalizes that she is afraid that the social worker’s records will be subpoenaed. Can the social worker comply with the client’s requests?

A: Social work records must comply with Rule N. 111. G., of the Board’s Rules, Standards and Procedures which states that “A social worker shall make and maintain records of services provided to a client.” The record at a minimum must contain an assessment or diagnosis, a plan which includes goals for the client, any revision of the assessment or diagnosis or of the plan, fees charged, and copies of releases of information and other pertinent legal forms. This record must be maintained for six (6) years after the last date of service.


Q: Who has access to social work records of a deceased client?

A: In LSA-R.S. 37:2718(B)(I), a social worker may not disclose any information they may have acquired from persons consulting him in his professional capacity that was necessary to enable them to render services to those persons except: (1) with the written consent of the client, or in the case of death or disability, with the written consent of his personal representative, other person authorized to sue, or the beneficiary of any insurance policy on his life, health or physical condition. The Practice Act does not define personal representative nor does it define other person authorized to sue. The Board’s Rules, Standards and Procedures relating to confidentiality in Rule 115 provide for a continuing privacy of information in subpart(G). That section provides that a social worker shall continue to maintain confidentiality of client information upon termination of the professional relationship including upon the death of the client, except as provided under applicable law. Likewise, Board Rule 115 (C)(1) authorizes the release of client records without the written consent of the client where the client’s authorized representative consents in writing to the release. Neither the Practice Act nor the Board’s Rules include the definition of this personal or authorized representative. General advices from Board’s counsel concluded that the surviving spouse of a deceased client should be able to execute a written consent or authorization in order to obtain the social work records of his or her deceased spouse.


Q: What do I do with client records after the client dies?

A: Hold on to your records. Client records remain in the possession of the social worker or the agency in which the social worker is employed. Although a client has a right to information in the social worker’s record while alive, this right is not a traditional property right heritable upon the client’s death.

Client confidentiality must be maintained after death except as provided under applicable law. Exceptions to maintenance of client confidentiality after death include, but are not limited to, when the confidential communications are relevant to a deceased client’s wrongful death, survivorship or workmen’s compensation proceeding asserted as a consequence of the death or injury of the deceased client. Confidentiality is also superceded if the communication to the social worker is relevant to the health condition of the client in a proceeding in which the client is either a party or relies upon the condition as an element of his claim or defense or even after the client’s death where a party is deriving his right from the client and relies upon the patient’s health condition as an element of his claim or defense. (LA Code of Evidence, Article 510 (B)(2)(b)(c).

If the client was a minor at the time of death, the parents consented to treatment and had the right to access social work records while the child was living. There would be no reason to deny access to those parents or legal guardians upon the child’s death. However, limitation to access the deceased client’s records whether a minor or an adult may still be required by LA. R.S. 40:1299.96 (A)(2)(d) in the event that the disclosure of the information would, in the judgment of the social worker, reasonably be expected to endanger the life or safety of any other person.

Access to a deceased client’s records is also accorded other state and federal regulatory agencies as well as peer review committees under R.S. 13:3715.3. The Louisiana State Board of Social Work Examiners may also access a deceased client’s records in its regulatory authority over claims against social workers under R.S. 13:3715.1 (J).

In all other respects, the maintenance of the social work records after the death of a client must be in compliance with Rule 111 (G) which requires that such records be kept "at least for a period of six years after the last date of service" for an adult client and for "six years after client reaches majority" for a minor client.


Q: What is the age of majority?

A: An individual reaches the age of majority on his or her 18th birthday.


Supervision

Q: Is it a violation of the Louisiana Social Work Practice Act or the Rules, Standards and Procedures for the weekly supervision to take place in the home of the supervisee or supervisor?

A: No. This is not a violation as long as the home provides a quiet and private space to conduct supervision and the location is convenient (not exploitive) to the supervisee. However, if there is any potential physical attraction between the supervisor and the supervisee, another site would probably be advisable. Such a meeting site also leaves the supervisor open to the appearance of impropriety even if none exists.


Q: My LCSW-BACS supervisor will not complete the Plan of Supervision and puts me off each time I question or remind her that the form must be filed within 60 days of the beginning date of supervision. What can I do to force my supervisor to complete the Plan of Supervision?

A: Call the licensure Board and report this non-compliance, then get a new supervisor. You are wasting your unofficial supervision time if the supervisor does not meet the sixty (60) day deadline.


Q: I have completed seven (7) months of supervision toward the LCSW license. Do I continue using the old supervision forms or will I be required to use the new supervision forms adopted by the Board on February 5, 2000?

A: You may continue to use the original supervision forms mailed to you. However, if you terminate with your current supervisor and begin with a new supervisor, there is the possibility that the supervision forms adopted February 5, 2000 will be issued. Even though the new supervision forms are supplied, you will continue under the "old" rules.


Q: I am a MSW and started supervision toward the BCSW license on September 3, 1999. My supervisor and I realized that we failed to mail the Contract for Supervision to the Board office and would like to mail it in today, February 28, 2000. Will the Board accept the form now and will I get credit for the supervision from September 3, 1999 through February 28, 2000?

A: Sorry. The Plan for Supervision (formerly known as the Contract for Supervision) must be submitted to the Board office within 60 days of the first supervisory session. Therefore, you will lose any supervision credit prior to 60 days upon receipt of the Plan of Supervision at the Board office.


Q: I am an LCSW and a Board Approved Clinical Supervisor (BACS). My cousin intends to work towards licensure and has asked me to be her supervisor. Is this ethical?

A: The Board discourages supervision between individuals who are related by blood, marriage, friendship, or prior therapy, due to the confusion and lack of focus which can result when these relationships are mixed with the supervisory relationship. Contact the Board for a list of BACS in your area, select three reputable social workers’ names and encourage your cousin to find her own supervisor.


Q: I am a GSW who works in the school system in Pupil Appraisal. I provide clinical services in the interview and evaluation of children and their families but I do not provide direct psychotherapy services to children and their parents. Do I have to be supervised?

A: Your question requires a complex answer so please read this reply carefully. The Rules, Standards and Procedures Chapter V. 501. state that "The GSW who pursues the LCSW credential, or who provides clinical services which constitute psychotherapy must be supervised." If you are pursuing the LCSW credential, you must be supervised by a BACS.

If you are not interested in pursuing the LCSW credential or are simply working to accumulate the additional hours of required experience and, as you describe, are not involved in clinical services which constitute psychotherapy, you do not have to be supervised. However, your employing agency ultimately is responsible and accountable and may require or provide access to LCSW supervision to ensure quality of services. You may also independently decide to secure LCSW supervision.

Those GSWs who are not pursing licensure or who are working to fulfill the additional hours of experience requirement toward licensure, may deliver clinical services which constitute psychotherapy only under the supervision of an LCSW. This would include school social workers who do provide direct psychotherapeutic services for children and their families in the school setting. The supervising LCSW for those not pursuing licensure does not have to be a BACS. Such supervision must total a minimum of 2 hours per month counted in increments of no fewer than 30 minutes. On-site supervision by the LCSW is preferred but supervision may be rendered individually, in a group setting, through telephone contact or by secure electronic media in order to meet the needs of the agency.


Q: Recently I was asked by my agency to supervise a social work student intern. I informed my supervisor that although I have five years of experience, I have never taken a supervision workshop or applied for my Board Approved Supervisor status. Even though our agency could have used the extra services a student might provide, I did not want to do anything unethical.

A: Think again. The Council on Social Work Education (CSWE) determines the educational criteria for field instructors of social work student interns. Some schools of social work may authorize RSWs and/or GSWs to be field instructors.


Q: I work in an agency that provides case management services. I am the only licensed social worker with the agency. The agency just promoted a non licensed social worker to be my supervisor. I feel uncomfortable being supervised by a nonlicensed social worker. Is there any protection under the new act for licensed social workers who are supervised by non licensed social workers? I do not want my license put in jeopardy by a non licensed social worker. Is there any way that I can protect myself? Also, does the new law allow unlicensed social workers to supervise licensed social workers and if so under what circumstance?

A: As a LCSW, you are licensed as an independent practitioner. As an agency employee, however, you can be supervised for administrative purposes by anyone.

A Graduate Social Worker (GSW) working in an agency providing clinical services must be supervised by an LCSW who oversees the clinical work. The lines of administrative supervision are established for you as an employee by the agency.


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Therapeutic Relationships

Q: A school system wants to require that all school personnel teach in the classroom. If social workers are required to teach in the classroom is there an ethical violation?

A: If a social worker is hired to only teach in a classroom, then the individual is not hired to act as a social worker in the school setting. If the social worker takes such a job, the individual is employed as a teacher. If you are describing the practice of asking school social workers to assume substitute teacher duties in the event of an emergency situations, such usage requires the mental health professional to assume a disciplinary role with students who may be or could later be in the social work caseload. Such action can seriously damage the present or potential therapeutic alliance thus making social work efforts to effect change with these students useless. This is not an ethical issue but a question of efficacy of social work practice.


Q: A social worker has seen a male client for a period of six months and has counseled him on issues related to his recent divorce. At their last session he states the full name of his ex-wife for the first time, and the social worker realizes that she saw the wife as a client more than a year before on issues related to her marital problems. Is the social worker required to tell the man and terminate their therapeutic relationship?

A: The social worker cannot tell her client that she previously treated his ex-wife without her former client’s written informed consent to release that information to her ex-husband. This would require the ex-husband’s written informed consent to be identified to his ex-wife as a current client, which would require the ex-wife’s written informed consent to be identified as a former client, etc., etc.

The social worker began with both clients in good faith. She has no previous or current personal or business relationship with either her client or her former client, so there is no dual relationship here. She should seek professional consultation if she suspects any bias in her thinking regarding her current client.


Q: I work for a state agency as a social worker. An individual was denied services at my agency due to their lack of eligibility. They have requested to see me in my private practice. Is this a violation of the Board’s Standards of Practice?

A: Rule 121.C.2. states that " A social worker shall not solicit a private fee or other remuneration for providing services to clients who are entitled to such available services through the social worker’s employer or agency without employer or agency approval". If a prospective client is not eligible to receive services at your agency, you would not be in violation of this Rule if you agreed to see the client in your private practice.


Treatment

Q: A social worker practicing in a substance abuse setting requires that clients attend AA meetings or he will not continue to see them at his clinic. Is this an ethical practice?

A: Yes. If AA meetings are a part of the clinician’s treatment plan and this requirement has been explained to the potential client at the onset of treatment, there is no ethical violation. The potential client is then free to agree to the proposed treatment plan or the social worker can provide the client with information regarding other referral sources.


Q: A social worker (first) has discovered that another social worker (second) is asking a client to pray and write letters to God concerning his homosexuality. What is the first social worker’s first step and subsequent steps in dealing with this?

A: The first step is to get more information. You would need to determine why the client sought treatment in the first place as well as the personal importance of the client’s religious values and belief system. Social workers begin where the client is. As the treatment social worker, simply follow the client’s lead at the beginning of treatment.

If after getting more information you believe that this social worker is imposing his/her religious values on the client, you should talk with the social worker and remind him/her of the client’s right to self-determination, the Standard of Practice, Chapter I, Rule No. 107.D. Nondiscrimination, as well as Rule 109. Competence. A., 2. and 3. (although some social workers are also trained as Pastoral Counselors, the question is has this social worker had “appropriate education, research, training, consultation, and supervision” in the techniques of prayer and letters to God?) If you do not feel satisfied with his/her response, you should report this social worker to the Board due to possible ethical violations.


Q: Is it ethical for a school social worker to see a child for behavior problems that is currently in therapy with a social worker at a local mental health center?

A: This is more of a practice issue than an ethical one. Certainly, the school social worker should not be involved with a child who is in therapy elsewhere without the consultation and consent of that therapist. In many cases, the mental health center social worker may be working on family or historical issues not readily addressed in the school setting. However, the emotional symptoms related to these underlying intra psychic issues, (e.g., anger, aggressive behavior, etc.) are frequently expressed in the school setting. Symptom control/eradication could be the therapeutic focus for the school social worker (i.e., in a group setting) to augment the mental health center social worker’s treatment plan for this child and the family.


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