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?   

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Rules related to confidentiality are superceded in the LA Code of Evidence Article 510 when the information is relevant to child abuse.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.)

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? 

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.

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? 

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.

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 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.

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?

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.

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?

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.

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?

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.

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?

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.)

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?

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.

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?

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.

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?

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.

1. 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?

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.

2. 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?

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.

3. 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?

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.

4. 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?

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.

5. 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?

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.

1. I am a GSW and I work in a partial hospitalization program. The program has several incentive programs for pa- tients 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 uncomfort- able with the award system and have asked to be excused from participation.

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.

2. 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?

No. School social workers work in a "host agency" where the majority of personnel are not bound by confidential- ity 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 rele- vant 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.

3. 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?

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 so- cial 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?

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

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.

5. A social worker was in partnership with two other mental health professionals. The other mental health pro- fessionals 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?

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.

6. 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?

Since young people often make idle suicidal and homicidal threats, the piece you omitted was whether the so- cial 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 appro- priate 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.

7. 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?

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 author- ity. 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 situa- tions (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.

Spring 2001

1. 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?

2. 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?

3. If an individual with a bachelor’s or master’s degree in social work continues to work after January 1, 2001 without receiving either the RSW or GSW credential, what happens to them when they do apply for the credential?

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

5. An MSW working in a nursing home discovers that a patient has been sexually abused by a member of the staff. What is the MSW’s responsibility?

6. 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?

7. 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?

1. What do I do with client records after the client dies?

2. What is the age of majority?

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

4. 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?

5. 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.

1. 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?

2. 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?

3. 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?

4. 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?

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

6. 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?

1. 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?

2. 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?

3. A Substance Abuse Counselor licensed by the State of Louisiana recently was hired by our agency which provides mental health services to the community. As a social worker and this counselor’s supervisor, I am confused about what type of cases I may assign her.

4. 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?

5. I am a GSW working towards the LCSW license. If I miss a week of supervision because I am sick, does the Board allow me to count that month towards the licensure requirement?

6. I am a GSW who has been unable to find a social work job. I am anxious to begin working towards my LCSW so I can go into private practice. Recently members of my church asked me to volunteer my services as a psychotherapist for our congregation. If I work in this capacity at least 30 hours a week, can I begin supervision towards licensure?

7. Under the old Rules and Regulations, I began my supervision with a Board Certified Psychiatrist. Can I continue to be supervised by a psychiatrist after January 1, 2000 when the new Practice Act goes into effect?

8. Because I began supervision before January 1, 2000, can I continue to work part-time?

9. 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?

1. What is the difference between the required agency-based supervision for BSWs and GSWs and the supervision required for the LCSW?

2. Recently I was asked by my agency to supervise a social work student intern, but I have never taken a supervision workshop or applied for my Board Approved Supervisor status.

3. Will there be any changes to the Social Work Practice Act relative to MSWs contracting to perform social work services?

4. Is there any protection under the new act for licensed social workers who are supervised by nonlicensed social workers?

2. 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?

3. 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?

4. 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?

5. 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?