The AAMFT Blog

AAMFT Supporting Federal Mental Health Legislation

AAMFT and many other mental healthcare associations have sent a letter to leaders in Congress in support of legislation that includes several important federal mental health reform provisions. The U.S. House of Representatives is scheduled to vote on this important legislation on November 30, with a vote in the Senate expected later in the week or the following week. AAMFT is a member of the Mental Health Liaison Group, a coalition of national organizations representing consumers, family members, advocates, professionals and providers.

Read the letter here.

Thanksgiving and Family Health

Did you know that Thanksgiving is National Family Health History Day?

This may well be an opportune moment to create something to be thankful for. Consistent with its familial and historical meaning, the Surgeon General has designated Thanksgiving Day as a day to think about health-promoting practices in the context of one’s whole family—past, present, and future. This health initiative began as a way to help focus attention on the importance of family health history. The purpose of the campaign is to raise awareness and encourage dialogue among family members about the specifics of their health background.

As marriage and family therapists, much of our work is informed by thinking of our broader context. We know that assessing family history and relational patterns is necessary for effective treatment and positive outcomes. The more we know about a client’s story, the better we can educate her or him about risk factors for challenges such as depression and anxiety. If a client presents with family precedents of depression, we know that he or she is at a higher risk for developing the condition. By knowing the client’s background, we can educate and validate a client who feels depressed, preventing symptoms from deteriorating.

For a long time, health care professionals have known that common diseases such as diabetes, heart disease, and cancer have a familial link. In the case of high blood pressure, for example, if one generation has it, the next generation is likely to have a similar condition. As in the case of our family mental health history, knowing the physiological illnesses experienced by our predecessors can help your doctor predict risk factors that may affect you and your family. In turn, the more information given to your healthcare provider, the better he or she can take the appropriate action to ensure better health for you and your family.

Interestingly, while we all tend to realize that family history is important to good health, we are often vague or hesitant about gathering this much-needed data. A recent survey conducted by the U.S. Department of Health and Human Services found that only one-third of Americans have attempted to gather and document their family health history.  This is staggeringly low given the known benefit of having your family data readily available. It invites the question: what keeps us from gathering this precious information?

The brief answer may be that it is hard to talk about conditions that may have brought great sorrow to your family. If a family member was lost to cancer, it may be hard to ask questions that could trigger a grief response. Similarly, if there is a family history of alcohol and drug abuse, direct lines of communication will be hard to access. Whatever the reason, when we avoid this kind of self-diagnosis, we are denying ourselves a unique benefit. By being prepared and planning, we can prevent or mitigate difficulties down the road. To help us overcome the psychological barrier to portraying our family history, it might be helpful to remember that it is just as unpleasant to craft our will and yet we know that the benefit of peace of mind is worth some discomfort.

When you bring up the topic this Thursday, you need not do so in an obtrusive or cheerless way. Express congenially your interest in the different generations that make up your family. In fact, it may be in the spirit of the original Thanksgiving Proclamation to set apart and observe some time during your celebratory gathering to get to know your family health history. Supported by this new-found context, you can take healthy living steps, including strategies for better mental health. Sharing the information you have found with your doctor is the next practical step, but you also stand to gain from the enhanced closeness with your family. 

Vanessa Bradden, LMFT is a staff member at AAMFT, collaborating with the Communications Department as a product development specialist. She has a private practice in Chicago and is an AAMFT Approved Supervisor. Vanessa’s clinical interests and expertise include working with individuals and couples coping with perinatal mood disorders, pregnancy loss as well as grief and other losses.

Mindful Self-Care Post Election

Imagine this scenario, Beth (an MFT and Secretary Clinton supporter) consults with a new client remarking on their indication of work-related problems, specifically relationship issues with co-workers. When questioned about the start of these issues, her client responds, “After the election. I am so sick and tired of hearing about the ‘wrong’ candidate winning. I believe in our new President-Elect and I grew tired of biting my tongue and decided to speak up. Which I suppose they interpreted as my antagonizing them.”

In another office, Randall (an MFT and President-Elect Trump supporter) notes that his new client listed their partner’s anxiety and panic attacks as having an adverse impact on their relationship. When asked for more details, Randall’s client indicates, “The anxiety and panic attacks have really accelerated since Donald Trump’s election. We are both having a difficult time with this election but he is really torn up. We are scared for our kid’s future and the future of everyone who felt threatened by his negative comments on the campaign trail.”

Regardless of how you may have voted in the recent Presidential election, one thing is for certain, you are likely to experience your own professional challenges related to the outcomes. What will guide you when you have an excited supporter and you firmly backed the other candidate in your own life? How will you remain compassionate when the opinions expressed differ so vastly from your own? What will the impacts of a new administration be on our profession and industry as a whole? These challenges are real and undoubtedly you will at some point be affected by them.

Clinical issues – that may involve unpleasant political discourse -  must be differentiated from the rancorous rhetoric of the recent campaign. AAMFT has no tolerance for discrimination and our Code of Ethics clearly states so:

Standard 1.1. Non-Discrimination that marriage and family therapists provide professional assistance to persons without discrimination on the basis of race, age, ethnicity, socioeconomic status, disability, gender, health status, religion, national origin, sexual orientation, gender identity or relationship status. Communicating to clients that, as an AAMFT member, you believe in and abide by the Code helps establish your therapeutic relationship fundamentals.

As emotionally intense political conversations continue with our clients, peers, and legislators our professional and personal values will undoubtedly get tested. Taking time for self-care and reflection is vitally important.  We must remain mindful that our anxieties and turmoil are NOT our clients’ challenges.  We have an obligation when feeling therapeutically compromised or impaired to seek peer to peer consultation, engage in self of therapist work, work with an AAMFT Approved Supervisor, or pursue our own MFT services.

Systemically, we must keep in mind that change, regardless of pain and disruption, can provide opportunity at best. At worst, change creates obligations and responsibilities to act as protective agents for those needing protection. We share a responsibility to remain diligent regarding policy changes that threaten equality and inclusiveness. If there ever was a time, it is now, for you to support the Family TEAM so that AAMFT can rely on your actions in times of advocacy needs.

Tracy Todd, PhD, LMFT is the Executive Director of AAMFT.

 

Duty to Report a Colleague or other Licensee

In this post, we’ll examine the duty to report a colleague or another licensee, a topic that was briefly mentioned in an earlier post that provided a general overview of mandatory reporting considerations.

This topic is frequently asked about in consultations provided by AAMFT’s legal and ethics staff. Although the particulars of the situations that prompt calls to AAMFT vary, the approach to determining a path forward does not necessarily vary.

The starting point in the AAMFT Code of Ethics for determining whether a report is required in these situations is Standard 1.6, which states:

Marriage and family therapists comply with applicable laws regarding the reporting of alleged unethical conduct.

What Standard 1.6 means is that there is not an obligation to report a colleague based on the AAMFT Code of Ethics alone. Rather, MFTs are to look to applicable laws to determine whether they are required, or perhaps permitted, to report the colleague in question, and MFTs are to comply with those applicable laws. A therapist who fails to comply with an applicable law on this issue, could potentially be in jeopardy of violating the AAMFT Code of Ethics.

Some jurisdictions have laws that would require a report, while others may not. In those jurisdictions that require a report, they may limit reporting obligations to certain types of conduct (e.g. sexual misconduct with a client).

In some situations, Standard 2.2 of the AAMFT Code of Ethics may come into play. Two possible scenarios that immediately come to mind are when the MFT learns of the colleague’s conduct from a client, or when the colleague is a client of the MFT. As you’ll recall from earlier posts, Standard 2.2 states:

Marriage and family therapists do not disclose client confidences except by written authorization or waiver, or where mandated or permitted by law. Verbal authorization will not be sufficient except in emergency situations, unless prohibited by law. When providing couple, family or group treatment, the therapist does not disclose information outside the treatment context without a written authorization from each individual competent to execute a waiver. In the context of couple, family or group treatment, the therapist may not reveal any individual’s confidences to others in the client unit without the prior written permission of that individual.

In these scenarios, focusing in on the first sentence may be instructive: Marriage and family therapists do not disclose client confidences except by written authorization or waiver, or where mandated or permitted by law. If client confidentiality is at issue, MFTs will need to determine whether client confidentiality negates a reporting obligation or whether an exception to confidentiality exists.

Similar to other mandatory reporting scenarios, immunity may be conferred by statutes that require or encourage colleagues to report the unethical behavior or impaired practice of others. In order for that immunity to be effective, however, you may need first-hand knowledge of the behavior and will likely need to comply with specifics of your jurisdiction’s reporting requirements (e.g. pay close attention to where a report is to be directed).

When confronted with the possibility of reporting a colleague or licensee based on alleged unethical conduct, consultation with a local attorney is advisable. As has been mentioned frequently before, it is critical that therapists know the law in their jurisdiction.

The Future of Family Therapy

Why the Foundation is More Important Now Than Ever

Let me state my case clearly from the outset—we must find a way to provide our financial support to the AAMFT Research & Education Foundation (hereafter, the Foundation) both collectively and individually. There are both historic and contemporary reasons why the Foundation is the key to ensuring the future of family therapy.

Many of you know that the Foundation, created in 1942, later became “AAMFT,” the professional association we now know. Why is this significant? The Foundation was created based on the cybernetic notion of systemic relationship, which was a new idea in that era. The cybernetic realization that what something is made of, or its internal organization, is less important than the information it carries in systemic relation to others changed science. The realization that systems are self-correcting allowed the introduction of purpose into scientific theory. The purpose of a system is its output. This idea allowed scientists to focus on relationships— marriages at first, then later, families. “Marriage and family” therapy emerged from putting cybernetic ideas about the importance of relationships into practice. The rocky roads of those early decades eventually led to a singular profession (recognized as one of the core mental health disciplines). Somehow, we have forgotten this history.

The idea that relationships are foundational to all biological life was indeed revolutionary when it emerged in the last century. Yet, we now live in a world that demands evidence of effectiveness. Along the way, this revolutionary idea became framed within the structure of a “scientific revolution” (Kuhn, 1970). In our successful quest to build the “profession” of marriage and family therapy, we have seriously neglected building the evidence in support of the idea and practice of family therapy. We were not originally organized by a profession, a license, or any of the other trappings that now come with our current professional experience.

Sprenkle (2012) recently offered a succinct summary of our current challenge. “Frankly, if CFTs (couple and family therapists), want to have their discipline taken seriously by the external world (including other disciplines, governments, insurance companies, and other third party payers), they will have to continue producing high-quality RCTs (randomized clinical trials) (p. 4).”

Some have criticized the reliability and validity of published research (e.g., Ioannidis, 2005). Further, there is a growing body of evidence to suggest that the pursuit of evidence-based treatments is itself a fairly fruitless endeavor since, as Wampold (2010) points out, “the research evidence indicates that a variety of treatments, when administered by therapists who believe in the treatment and when accepted by the clients, are equally effective” (p. 71). The more recent focus on common factors in our field suggests a recalibration of our research agenda. As Sparks & Duncan (2010) recommend, “a focus on common factors is empirically informed, enhances the viability of systems therapy in the market, facilitates a framework for training and research, and is accountable to clients, respecting their unique diversity” (p. 382).

Where is most family therapy research produced, and how cohesive and organized is the research agenda for our field? Much of it has historically been produced by family psychologists, psychiatrists, and family sociologists. And, the relative cohesiveness and organization of the research in our field has been lacking. As Sprenkle (2012) noted when reviewing a recent compilation of family therapy research, “certainly, good work can be carried out in other contexts, and non-programmatic research can also be valuable, but it appeared to be hard to keep up with the full-time researchers in medical-related contexts when it came to high output-strong methodology research” (pp. 7-8). Granted, the faculty in our COAMFTE-accredited programs contribute a share of the research produced, but much more is needed and in a more organized and coordinated fashion. Yet, in moving forward, we must remember our past: we were first organized by systemic ideas and practice.

Here’s where the Foundation comes in. As a field organized by an idea and a practice, we need a place where we can support the development of high-quality research that will advance the field and benefit the clients we serve. “There is a great need for more cost research, for more replications by research groups not professionally related to the founders of the models, for more research on mechanisms of change, and for more investigations that approximate real-world clinical practice to enhance ecological validity” (Sprenkle, 2012, p. 12).

The Foundation “exists to fund systemic and relational research, scholarship, and education in an effort to support and enhance the practice of systemic and relational therapies; advance the health care continuum; and improve client outcomes.” The Foundation can become a center for innovative research on systemic treatment, with full-time researchers devoted to cutting edge investigations. The problem, however, in fulfilling this mission is primarily a lack of funds. I hope you will join me in being a contributor to the Foundation so that important systemic research can be funded throughout the years.

www.aamftfoundation.org

References

Ioannidis, J. (2005). Why most published research findings are false. PLoS Med, 2(8), e124. doi: 10.1371/journal.pmed.0020124

Kuhn, T. (1970). The structure of scientific revolutions (2nd ed.). Chicago: University of Chicago Press.

Sparks, J., & Duncan, B. (2010). Common factors in couple and family therapy: Must all have prizes? In B. Duncan, S. Miller, B. Wampold, & M. Hubble (Eds.), The heart & soul of change (2nd ed., pp. 357-391). Washington, DC: American Psychological Association.

Sprenkle, D. (2012). Intervention research in couple and family therapy: A methodological and substantive review and an introduction to the special issue. Journal of Marital & Family Therapy, 38(1), 3-29.

Wampold, B. (2010). The research evidence for common factors models: A historically situated perspective. In B. Duncan, S. Miller, B. Wampold, & M. Hubble (Eds.), The heart & soul of change (2nd ed., pp. 49-81). Washington, DC: American Psychological Association.

James P. Morris, PhD, is faculty and clinical coordinator, Online Marriage and Family Therapy Program, Abilene Christian University, Dallas, TX. Morris is a Clinical Fellow of AAMFT and a contributor to the Foundation.

 

Are You Truly HIPAA Compliant?

In a small rural mental health center, an employee unwittingly clicked on a phishing email, releasing malware which subsequently was used to encrypt the center’s electronic records database. The center did not have adequate encryption or backup of their data, and were unable to access client records because of the attack. They were then contacted by an unknown source, who demanded they pay $1000 ransom to gain access to their database. The center had no choice, and were forced to pay the ransom to gain access to their client records. 

This true story is a stark reminder of why we need to pay attention to HIPAA compliance. However, when family therapists hear the term “HIPAA,” many practitioners think that they are compliant when they have their Notice of Privacy Practices in place, or perhaps by purchasing “HIPAA Compliant” electronic record software. Many practitioners are simply unaware of the multitude of requirements placed upon them as HIPAA Covered Entities, or question if they are subject to HIPAA regulations at all. To simplify, if you transmit information electronically for purposes of payment by third party payers (e.g. insurers, government entities) even for one client, you are considered a Covered Entity (CE) under the regulations. As such, you are required to comply with federal HIPAA privacy and security regulations, as well as breach notification standards to protect client Protected Health Information (PHI).  PHI is:

Individually identifiable health information, including demographic data, that relates to: 1) the individual’s past, present or future physical or mental health or condition, 2) the provision of health care to the individual, or 3) the past, present, or future payment for the provision of health care to the individual, and that identifies the individual or for which there is a reasonable basis to believe it can be used to identify the individual (45 C.F.R. § 160.103). 

While therapists are typically very clear on confidentiality requirements set by our ethics code and state statute, protecting client digital data brings a new level of vigilance needed to honor client rights to privacy and confidentiality. For example, client PHI may be exposed through loss or theft of unencrypted mobile devices such as phones and laptops, failure to patch software systems allowing access to PHI by outsiders, or returning photocopiers to vendors with un-erased digital memories. However, allowing unauthorized staff to inappropriately view client PHI due to failure to have strict privacy and security policies and procedures is also considered a breach under HIPAA. 

No one else can complete your HIPAA compliance but you. There is no such thing as an external entity making you HIPAA compliant; you must set policies and procedures that adequately protect your client’s PHI. Here are just a few requirements for you to check your compliance efforts:

• Have you performed a security risk analysis which includes the evaluation of each of the 54 security standards or implementation specification set by the Department of Health and Human Services?
• Have you produced and followed a remediation plan born from the security risk analysis that details strategies for decreasing or eliminating risks to paper and electronic PHI?
• Do you have Business Associate Agreements in place with entities who create, receive, transmit or store PHI on your behalf (for example, with your billing or shredding service, electronic records vendor, attorney, and accountant and so on, if they have access to PHI)?
• Do you understand the protocol set by the standards for breach notification should client PHI be lost, stolen, or otherwise inappropriately used or disclosed?
• Can you produce your documentation of your HIPAA policies and procedures?
• Can you produce documentation of HIPAA training of any employees, volunteers, trainees, and other persons whose conduct is under your direct control as a Covered Entity?  
• Have you posted your Notice of Privacy Practices in your waiting room where clients can clearly see it, and on your practice or organization’s website?

Costs of noncompliance include reputational damage, ethical violation(s), legal costs, reparation costs, and fines and penalties set by the HITECH (Health Information Technology Economic and Clinical Health) Act. Additionally, if you ignore the regulations, there is a mandatory fine should the Office for Civil Rights, who is responsible for enforcement of the regulations, investigate your practice or organization. 

Let’s imagine you suffer the loss or theft of an unencrypted laptop, with contains data from over 500 clients. HIPAA regulations require that you report the loss to the Department of Health and Human Services and to your clients, absolutely no later than 60 days of the discovery of the breach. Your practice or organization name will also be published on the breach portal at the website of the Department of Health and Human Services, which has come to be known as the “Wall of Shame.” You also need to notify prominent local news media of the breach. If you have ignored the regulations, you can also add on a mandatory fine from $10,000 to $50,000.  While there is no private right of action under HIPAA regulations, state attorney generals can sue for HIPAA violations, and lawsuits do occur for invasion of privacy. What has quickly become a standard reparation for breaches of PHI is that the practice or organization pays for credit monitoring for the individual for 2-3 years post-breach. State privacy or breach notification laws may also be at hand. Lastly, it would be hard to imagine that the therapeutic relationship would not be injured or destroyed when a therapist has not maintained privacy and security of their client’s very personal information.

Perhaps you think you do not need to know about HIPAA because you do not fall into the realm of being a CE because you only take private pay clients. Be forewarned that in the legal arena HIPAA is increasingly being used to demonstrate the appropriate standard of care with regard to privacy and security of client PHI (cf. Acosta v. Bryum, in North Carolina, or Walgreen Company v. Abigail E. Hinchy in Indiana). For better or for worse, HIPAA is here to stay, and we must extend the rights to client confidentiality and privacy to all oral, paper, and electronic data. Our relationships with clients depend upon it. 

References

Acosta V. Byrum, 180 N.C. App. 562, 638 S.E.2d 246 (North Carolina, 2006). 

Hinchy v. Walgreen Co., et al, No. 49D06 11 08 CT029165 (Indiana, 2011). 

HIPAA, Public Law 104-191, 45 CFR §160.103

 

Lorna Hecker, PhD, LMFT, CHPS has authored the book HIPAA Demystified:  HIPAA Compliance for Mental Health Professionals (2016).  She is a professor in the MFT program at Purdue University Northwest, and director of educational services at Carosh Compliance Solutions in Crown Point, Indiana.  She is an AAMFT Clinical Fellow and Approved Supervisor, and is certified in healthcare privacy and security through the American Health Information Management Association. 

 

Opinion piece response: TMA Lawsuit

The Houston Chronicle recently published an opinion piece about the TMA lawsuit, from TMA President Don Read, which can be read here. Clinical Fellow Sarah Woods countered with the following response published here.

Therapy and mental health

Regarding "Court case highlights gaps in state's mental health care system" (HoustonChronicle.com, Oct. 11) and "Money is at the root of court case," the Texas Supreme Court heard arguments for a lawsuit against marriage and family therapists (MFTs). Who sued therapists? The Texas Medical Association.

TMA President Don Read suggests that Texas marriage and family therapists are taking this case to court. Please be clear- there is nothing family therapists in Texas want less than to be involved in this lawsuit.

Read neglects to mention in his essay that TMA's lawsuit is to remove MFT's ability to diagnose mental health conditions (which they've done for decades), given a semantics concern between two difference codes describing MFTs' scope of practice.

TMA has said MFTs are not trained to diagnose. They are-- with required coursework and thousands of supervised hours of practice before licensure. They're also endorsed by the American Psychiatric Association for diagnosing. Marriage and Family Therapy is one of five core mental health professions recognized by the US Department of Health and Human Services- all of which diagnose, as diagnosis does not require a medical doctor.

Read suggests MFTs suddenly wanted to diagnose for "money." While he's wrong about that, he is right that health insurance companies require a diagnostic code to cover mental health services. MFTs whose care is covered by Medicaid, CHIP, the Veterans Affairs and private or state agencies, will lose the ability to be reimbursed, rendering them unemployable. At best, Read's assertion that a ruling in TMA's favor won't change access to mental health care is short-sighted. 

 

Mandatory Reporting: A General Overview

“My client told me that [fill in the blank with the disclosure of your choice]. Am I required to report that?”

AAMFT’s legal and ethics consultation service regularly receives calls from therapists inquiring about their reporting obligations. Common variations of these scenarios include concerns about suspected child abuse or neglect, concerns about a colleague’s or another professional licensee’s conduct, concerns about domestic violence, and concerns about minors and sexual conduct.

Regardless of the particular scenario that you are dealing with, Standard 2.2 in the AAMFT Code of Ethics is a starting point for analyzing potential reporting obligations. (We’ll leave aside questions about reporting a colleague for a future post.)

As previously discussed on this blog, Standard 2.2 states:

Marriage and family therapists do not disclose client confidences except by written authorization or waiver, or where mandated or permitted by law. Verbal authorization will not be sufficient except in emergency situations, unless prohibited by law. When providing couple, family or group treatment, the therapist does not disclose information outside the treatment context without a written authorization from each individual competent to execute a waiver. In the context of couple, family or group treatment, the therapist may not reveal any individual’s confidences to others in the client unit without the prior written permission of that individual.

For the purposes of this post, we’re going to focus in on the first sentence: Marriage and family therapists do not disclose client confidences except by written authorization or waiver, or where mandated or permitted by law.

When confronted with the possibility of breaking client confidentiality to fulfill a reporting obligation, MFTs must be aware of the law in their jurisdiction. Mandatory reporting scenarios are often governed by local law (e.g. state or provincial law). MFTs should be aware of all applicable laws that might mandate a disclosure, as well as all applicable laws that might create a permissive disclosure situation.

Common Mandatory Reporting Laws

Common mandatory reporting laws applicable to MFTs include those pertaining to the reporting of suspected child abuse and neglect, suspected elder abuse and neglect, and suspected abuse and neglect of vulnerable adults. In some jurisdictions MFTs may also be required to report when disclosures of domestic violence or intimate partner violence are made, but this is not as common as the other mandatory reporting scenarios. Some jurisdictions’ laws may not require a report from an MFT based on a disclosure of domestic violence in and of itself, by may require a report if the alleged domestic violence occurred in the presence of a minor.

When examining your jurisdiction’s laws on these issues, paying particular attention to definitions (e.g. definition of minor or child, definition of elder or vulnerable adult, definitions of reportable conduct), reporting timelines, the type of knowledge that creates a reporting obligation (e.g. reasonable suspicion, reasonable cause to believe), and the entity to which a report is to be made is advisable. In some situations, you may need to speak with a local attorney for interpretation of the law in question or for assistance applying that law to a particular situation.

Mandatory Reporting and Informed Consent

Taking guidance from Standard 2.1 in the AAMFT Code of Ethics, the duty to report should be one of the instances included in your “informed consent” document that may require a breach in confidentiality.

Standard 2.1 states:

Marriage and family therapists disclose to clients and other interested parties at the outset of services the nature of confidentiality and possible limitations of the clients’ right to confidentiality. Therapists review with clients the circumstances where confidential information may be requested and where disclosure of confidential information may be legally required. Circumstances may necessitate repeated disclosures.

Generally speaking, clients should be given notice that, as a mandatory reporter, you are required to breach confidentiality if clients disclose conduct that you are required by law to report. The exact language that you include in your informed consent documentation will vary based on your preferences and applicable laws.

Mandatory Reporting When You’re “Off the Clock”

Therapists may occasionally wonder about their reporting obligations when they observe or learn about suspected abuse or neglect in their personal lives or when they are “off the clock,” so to speak. In some jurisdictions the laws are written in a way that would require a report only when a person who is a mandatory reporter learns of the information in their official or professional capacity. In other states, the language may state otherwise, or may even be written in a way that requires anyone who suspects abuse or neglect to report, regardless of profession.

If a report is not required because a person who is otherwise a mandatory reporter witnesses something while the person is not acting in their official or professional capacity, the person typically could still choose to make a report if they wish.

Immunity

Most mandatory reporting laws provide immunity from civil and criminal liability for making a report. The immunity laws may even protect the therapist if the therapist was negligent in concluding that a report was required. However, some states require that, in order to be entitled to immunity, the mandated reporter must have acted “in good faith.” While these immunity provisions do not necessarily prevent a therapist from being sued, they do provide the therapist the opportunity to assert immunity as a defense.

Resources

Aside from consulting with a local attorney knowledgeable about mandatory reporting issues, other resources available to therapists who have questions about mandatory reporting obligations include peer consultation, supervision, the relevant protective agency based on the situation (e.g. child protective services, adult protective services), and your professional liability insurer. AAMFT’s legal and ethics consultation service is also available to members who wish to discuss their questions in a general manner.

As should be clear by now, because mandatory reporting obligations are largely matters of local law (e.g. state law, provincial law), it is critical that therapists know the law in their jurisdictions.