• clrs are legally obligated to parents/guardians when clg minor children & vulnerable adults - clrs have to pay attention to the legal rights of P/Gs
• clrs must take legal/ethical steps to prevent harm to clts who are less competent & unable to protect themselves

• every child regardless of age has a moral right to privacy-
• the legal rights to confidentiality & privilege of minors are more limited-clrs have an ethical obligation of privacy to minor clts & a legal obligation to P/Gs to keep their children safe

Legal status & rights of minors

• common law & US legal system holds that minors must exercise thru their parents any legal rights they may have & that minors have no legal standing to contract or bring lawsuits
• legal rights of children is right to be supported by their parents & not to be abused or neglected
• P/Gs need to consent to clg for their children-less competent adults or minors are unable to give valid inform consent -
• the law stipulates that clts under age 18 are not adults & are not competent make fully informed voluntary decision-privacy rigts of minors legally belong to P/Gs
• in many states-adolecents over a specified age who are able to understand the nature, risks, benefits of clg are given the right to legally consent
• laws in some states allow minors to give consent when there is an emergency situation or when they need tx for using dangerous drugs, pregnancy, birth control, sexually transmitted diseases
• emancipated minors who are under 18yrs but live separately from their parents, manage their own finances, & have been adjudicated legally emancipated by a judge can enter a contract for clg

• consent form should specify the minor clt & P/G is giving consent to clg

The rights of parents

• A.2.d. Inability to Give Consent

  When counseling minors or persons unable to give voluntary consent, counselors seek the assent of clients to services, and include them in decision making as appropriate. Counselors recognize the need to balance the ethical rights of clients to make choices, their capacity to give consent or assent to receive services, and parental or familial legal rights and responsibilities to protect these clients and make decisions on their behalf.

• B.5.b. Responsibility to Parents and Legal Guardians

  Counselors inform parents and legal guardians about the role of counselors and the confidential nature of the counseling relationship. Counselors are sensitive to the cultural diversity of families and respect the inherent rights and responsibilities of parents/guardians over the welfare of their children/charges according to law. Counselors work to establish, as appropriate, collaborative relationships with parents/guardians to best serve clts

• clrs have an ethical obligation to provide info to children & adolescents that will help these clts to be active partners in tx - this is respecting the clts autonomy

• clrs should understand that when they decide to withold info from P/Gs, they assume responsibility  if the info later leads to injuries for the clt
• ex. minor disclosing they are using drugs, sexually active, breaking laws,engage in risky behaviors
• when parents demand info from clg sessions & minor clts will not authorize the clr to release it - clr should establish a thorough understanding with all parties regarding the issue of confidentiality & its limits prior to initiating clg -balancing both parties rights

Responding to parents who demand confidential clg info

1. discus the issue with minor clt to see if he/she is willing to disclose or not
2. try to persuade the P/G that the clt's best interests are not served by revealing info. educate P/G about the clg process & assure them info that puts the clt at risk will be revealed
3. schedule a joint session with adult & minor & mediate at session
4. inform minor clt ahead of time then disclose info to P/G
5. secure supervisory approval prior to disclosing. if adult is not a P/G, get parental consent to disclose

• when clr is subpoenaed in child custody proceedings, clr should seek legal advice - parent is waiving privacy of clr-child clg - so clr must provide info thru depositions or testimony in hearings/trials
• clr should answer all questions factually & not give opinion -clr's responsibility is to provide requested info to noncustodial parents
• if there is a question on should noncustodial parents receive info, seek & follow legal advice based on laws in their state

Children at risk to harm to self or others

• when parents make demands, clr must oblige, at other times clrs make determination esp when clt has revealed info that put them or others at risk for harm
• prior to disclosure, seek consultation - other options encourage children to tell their parents, disclose to parents with children present, or inform the child before disclosing to parents & clrs should do everything to maintain the clg relationship

• if school system has policies in place, they must be followed
• if no policy, clr must weigh the risks involved- check his own values on the issue, he should consider some facts age of student, maturity, parents response would harm the clt
• if he decide to disclose inform the clt he cannot keep it a secret, try to negotiate a procedure that would be acceptable to her
• consult other school clrs on the matter to see how it has been handled in the past or how to proceed

• P/Gs must exercise any legal rights children have up until they reach the age 18, or unless a statue allows a younger age, or until the child is emancipated by court
• under FERPA, parents do not have access to clg case notes-kept in possession of the maker/clr - but they would gain access if subpoenaed
• P/Gs have legal right to assert privilege but courts have determined some parents may not have the best interests of th child in mind & have disallowed them this right
• courts will appoint a guardian ad litem to determine the best interests of a child to privilege 

• school clrs do not have a legal obligation to obtain parental permission before clg students-when parents enrol their children, they are informed that the children may participatein # of obligatory/optional services
• parents have a right to object to child counseling
• school clrs may breach confidentiality for issues: impending suicide, suicide pact, violent retaliation to victimization, use of illegal drugs, sex with multiple partners, HIV positive, armed robbery, serious depression signs - suicide pose an immediate threat

Confidentiality in working with minors in nonschool settings

• minor clts in inpatient facilty regadless of age are incapable of making crucial decisions for themselves - parents may be consulted over the course of clt's stay & tx teams will also be involved in determining the tx plans

• clrs must educate other members of the team/staff about maintaining the confidentiality & personal info they learn about the children
• if clrs disclose confidential info beyond the institutional walls, & P/Gs reputations are damaged, they could be sued for breach of contract, malpractice
• shool clrs have to maintain a balance betw disclosing to other officials vs potential harm that might be caused by sharing this info

Reporting suspected child abuse or neglect

• ACA code B2a-clrs have an ethical right to protect vulnerable persons from harm
• in cases of child abuse/neglect, state leglislators has determined that absolute confidentiality to be less important than the need to protect children

• clrs must know who (professionals) can make reports of suspected child abuse/neglect-whether reports can be made for current or prior abuse
• reporting statutes protect mandatory reporters from lawsuits that might be filed against them by those who have been reported-report is mandated by law
• clrs making report about past abuse - if not mandated by law may be sued
• if state statutes require that reports be made when perpetrator is the child's caretaker but clr report the suspected incident when the perpetrator is not -the clr is not protected by law
• the protective clauses of mandatory reporting protect clrs who make report in good faith-as long as clrs sincerely believe that the suspected CA/N is occurring or have occurred, they will be protected from lawsuits-suit won't hold as long as clr genuinely believes CA occurred even if it was proven later that nothing happened
• clr who are in conflict with a suspected perpetrator must ask another clr to gather the info & make the report -the suspected perpetrator may convince others that the report was made in bad faith-that clr knew the report was not true and made it anywayto cause problems for the perpetrator

• As soon as you suspect abuse or maltreatment you must report your concerns by telephone to the SCR. The SCR is open 24 hours a day, seven days a week, to receive your call.
• Mandated Reporter Hotline: 1-800-635-1522
  Public Hotline: 1-800-342-3720
• Oral reports must be followed within 48 hours by a written report to the local CPS

Contact Information for Mandated Reporters

• Within 48 hours of making a report to the State Central Registry, Mandated Reporters must send the completed 2221A to the field office in the borough where the subjects of the report reside.
• After making a report, the reporter should be contacted by a Child Protective Specialist within this timeframe who can provide mailing information for the local field office where the completed 2221A should be sent.
• This document can be mailed to the attention of the assigned Child Protective Specialist or hand delivered if there is a face-to-face interview completed within the

• The Child Protective Service (CPS) unit of the local department of social services is required to begin an investigation of each report within 24 hours.
• The investigation should include an evaluation of the safety of the child named in the report and any other children in the home, and a determination of the risk to the children if they continue to remain in the home.
• CPS may take a child into protective custody if it is necessary for the protection from further abuse or maltreatment.
• Based upon an assessment of the circumstances, CPS may offer the family appropriate services. The CPS caseworker has the obligation and authority to petition the Family Court to mandate services when they are necessary for the care and protection of a child.
• CPS has 60 days after receiving the report to determine whether the report is "indicated" or "unfounded".
• The law requires CPS to provide written notice to the parents or other subjects of the report concerning the rights accorded to them by the New York State Social Services Law.
• The CPS investigator will also inform the SCR of the determination of the investigation.first week of the investigation.

New York State and the New York State Child Protective System recognize certain professionals as holding the important role of mandated reporter of child abuse or maltreatment. These professionals can be held liable by both the civil and criminal legal systems for intentionally failing to make a report. Professions include:

• Social Worker
• Licensed Creative Arts Therapist
• Licensed Marriage and Family Therapist
• Licensed Mental Health Counselor
• Licensed Psychoanalyst
• Physician
• Surgeon
• Dentist
• Dental Hygienist
• Chiropractor
• Podiatrist
• Medical Examiner
• Coroner
• Osteopath
• Optometrist
• Resident
• Intern
• Registered Nurse
• Registered Physician’s Assistant
• Psychologist
• Mental Health Professional
• Substance Abuse Counselor
• Alcoholism Counselor
• Peace Officer
• District Attorney, or Assistant District Attorney
• Police Officer
• Investigator employed in the Office of the District Attorney or other law enforcement official
• School Official
• Social Services Worker
• Christian Science Practitioner
• Hospital personnel engaged in the admission, examination, care or treatment of persons
• Any employee or volunteer in a residential care program for youth, or any other child care or foster care worker
• Day Care Center Worker
• Provider of Family or Group Family Day Care
• Emergency Medical Technicians (EMTs)

Mandated reporters are required to report instances of suspected child abuse or maltreatment only when they are presented wth reasonable cause to suspect child abuse or maltreatment in their professional roles.

• Mandated reporters are required to report suspected child abuse or maltreatment when they are presented with a reasonable cause to suspect child abuse or maltreatment in a situation where a child, parent, or other person legally responsible for the child is before the mandated reporter when the mandated reporter is acting in his or her official or professional capacity. “Other person legally responsible” refers to a guardian, caretaker, or other person 18 years of age or older who is responsible for the care of the child.

• Mandated reporters who are social services workers have expanded reporting requirements. Social services workers are required to report when, in their official or professional role, they are presented with a reasonable cause to suspect child abuse or maltreatment where any person is before the mandated reporter and the mandated reporter is acting in his or her official or professional capacity.

• For example, a doctor examining a child in her practice who has a reasonable suspicion of abuse must report her concern. In contrast, the doctor who witnesses child abuse when riding her bike while off-duty is not mandated to report that abuse.

• The mandated reporter’s legal responsibility to report suspected child abuse or maltreatment ceases when the mandated reporter stops practicing his/her profession. Of course, anyone may report any suspected abuse or maltreatment at any time and is encouraged to do so.

Reasonable Cause to Suspect

• Reasonable cause to suspect child abuse or maltreatment means that, based on your rational observations, professional training and experience, you have a suspicion that the parent or other person legally responsible for a child is responsible for harming that child or placing that child in imminent danger of harm. Your suspicion can be as simple as distrusting an explanation for an injury

Abuse

Abuse encompasses the most serious injuries and/or risk of serious injuries to children by their caregivers. An abused child is one whose parent or other person legally responsible for his or her care inflicts serious physical injury upon the child, creates a substantial risk of serious physical injury, or commits a sex offense against the child. Abuse also includes situations where a parent or other person legally responsible knowingly allows someone else to inflict such harm on a child.

Maltreatment (includes Neglect)

Maltreatment means that a child’s physical, mental or emotional condition has been impaired, or placed in imminent danger of impairment, by the failure of the child's parent or other person legally responsible to exercise a minimum degree of care by:

• failing to provide sufficient food, clothing, shelter, education; or
• failing to provide proper supervision, guardianship, or medical care (refers to all medical issues, including dental, optometric, or surgical care); or
• inflicting excessive corporal punishment, abandoning the child, or misusing alcohol or other drugs to the extent that the child was placed in imminent danger.

Poverty or other financial inability to provide the above is not maltreatment.

Note: The definitions of abuse and maltreatment are different for children in residential facilities operated or licensed by the state.

The list that follows contains some common indicators of abuse or maltreatment. This list is not all-inclusive, and some abused or maltreated children may not show any of these symptoms.

Indicators of Physical Abuse Can Include:

• Injuries to the eyes or both sides of the head or body (accidental injuries typically only affect one side of the body);
• Frequent injuries of any kind (bruises, cuts, and/or burns), especially if the child is unable to provide an adequate explanation of the cause. These may appear in distinctive patterns such as grab marks, human bite marks, cigarette burns, or impressions of other instruments;
• Destructive, aggressive, or disruptive behavior;
• Passive, withdrawn, or emotionless behavior;
• Fear of going home or fear of parent(s).

Indicators of Sexual Abuse Can Include:

• Symptoms of sexually transmitted diseases;
• Injury to genital area;
• Difficulty and/or pain when sitting or walking;
• Sexually suggestive, inappropriate, or promiscuous behavior or verbalization;
• Expressing age-inappropriate knowledge of sexual relations;
• Sexual victimization of other children.

Indicators of Maltreatment Can Include:

• Obvious malnourishment, listlessness, or fatigue;
• Stealing or begging for food;
• Lack of personal care—poor personal hygiene, torn and/or dirty clothes;
• Untreated need for glasses, dental care, or other medical attention;
• Frequent absence from or tardiness to school;
• Child inappropriately left unattended or without supervision.

Source Confidentiality

The Social Services Law provides confidentiality for mandated reporters and all sources of child abuse and maltreatment reports. OCFS and local CPS are not permitted to release to the subject of the report any data that would identify the source of a report unless the source has given written permission for them to do so. Information regarding the source of the report may be shared with court officials, police, and district attorneys, but only in certain circumstances.

Immunity from Liability

If a mandated reporter makes a report with earnest concern for the welfare of a child, he or she is immune from any criminal or civil liability that might result. This is referred to as making a report in “good faith.”

Protection from Retaliatory Personnel Action

Section 413 of the Social Services Law specifies that no medical or other public or private institution, school, facility or agency shall take any retaliatory personnel action against an employee who made a report to the SCR. Furthermore, no school, school official, child care provider, foster care provider, or mental health facility provider shall impose any conditions, including prior approval or prior notification, upon a member of their staff mandated to report suspected child abuse or maltreatment.

Penalties for Failure to Report

Anyone who is mandated to report suspected child abuse or maltreatment—and fails to do so—could be charged with a Class A misdemeanor and subject to criminal penalties. Further, mandated reporters can be sued in a civil court for monetary damages for any harm caused by the mandated reporter's failure to make a report to the SCR

• employed clrs must notify their supervisors/administrators prior to or after a CA report was made whether its company policy or not
• clr has an ethical/professional responsibilities to the clt even after the report is made
• clrs should provide their info when making a report, document time, person spoken to , and summary of discussion made

After a report was made

• clg should attempt tp maintain the clg relationship with clt or family, be concerned about the victim's wellbeing aid parties in dealing with the the process after the reporting
• state agency official or police officers will make contact for further info on the report

• some school districts have created policies that require clrs to report students destructive impulses or contemplation of illegal acts - if students are aware the clr will inform others about their decision to harm others, the will avoid clg & reduce the risk to decrease the risk of violence
• school clrs are responsible to address bullying-they should have classroom guidance activities aimed at helping students understand the effects of bullying & harassmt

Dual or multiple relationships

•  clrs have to carefully balance taking on other roles & friendships with teachers or parents due to clr=clt right to privacy & cofidentiality, revealing important info to others, reporting CA/N & maintaining the clg relationship
• clrs also become highly involve after the report withpolice officers, CPS caseworkers, attorneys, etc.

• clrs must understand child developmt, must not impose their own values regarding race, gender so
• school clrs must serve as advocates for students, must have cultural differences in acceptable child--rearing practices prior to making report

• clrs have a duty to protect adult clts who are vulnerable to maltx due to diminished capacity to protect themselves from harm

Elderly or vulnerable adult maltx

• forms of elderly maltx: self-inflicted-clt forget to take meds, or take incorrectly, skip meals, use alcohol to self-medicate, fail to maintain personal hygiene, physical violence-slapping, pinching, withhold meds, overmedicate, force feeding, misuse physical restraints
• psychological abuse-verbal berating, threats to institutionalize, abandonmt, intimidation, humiliation
• financial exploitation-caretaker misuse clt's personal income, deny clt things, steal their possessions or coerce them into signing for things/contract not in best interests
• perpetrator usually a family member or caretaker
• even when reported the elderly can refuse protective services

• Adult abuse is the mistreatment of an impaired adult, age 18 or over, who may be dependent on someone else for basic needs.
• Physical Abuse

  Non-accidental use of force that results in bodily injury, pain, or impairment. This includes, but is not limited to, being slapped, burned, cut, bruised or improperly physically restrained.

• Sexual Abuse

  Non-consensual sexual contact of any kind. This includes, but is not limited to, forcing sexual contact with self or forcing sexual contact with a third person.

• Emotional Abuse

  Willful infliction of mental or emotional anguish by threat, humiliation, intimidation or other abusive conduct. This includes, but is not limited to, isolating or frightening an adult.

• Financial Exploitation

  Improper use of an adult's funds, property, or resources by another individual. This includes, but is not limited to, fraud, embezzlement, forgery, falsifying records, coerced property transfers, or denial of access to assets.

• Active and Passive Neglect

  Active neglect is the willful failure by a caregiver to fulfill care-taking functions and responsibilities. This includes, but is not limited to, abandonment, deprivation of food, water, heat, cleanliness, eyeglasses, dentures, or health-related services.Passive neglect is the non-willful failure to fulfill care-taking responsibilities because of inadequate caregiver knowledge, infirmity, or disputing the value of prescribed services.

• Self Neglect

  This is the adult's inability, due to physical and/or mental impairments, to perform tasks essential to caring for oneself

Victims of adult abuse include:

• the frail elderly
• the developmentally disabled
• the chronically mentally ill
• the physically disabled
• substance abusers

According to a study by the National Center on Elder Abuse, adult/elder abuse in domestic settings is a widespread problem, affecting hundreds of thousands of vulnerable, impaired individuals across the country. However, it is largely hidden under the shroud of family secrecy. While younger, impaired adults can be victims of abuse, elderly persons are abused at a disproportionately higher rate. Elder abuse is grossly underreported. Some experts estimate that only 1 out of 14 domestic elder abuse incidents (excluding the incidents of self-neglect) comes to the attention of authorities. If this estimate is accurate, then domestic elder abuse cases reported to state adult protective services or aging agencies represent only the tip of the iceberg.

According to a Profile of the Protective Services for Adults Caseload in New York State (1997), authored by Irv Abelman, approximately 25,000 Adult Protective Services referrals were received by local social services departments. About two-thirds of the cases involved adults over 60. One-third of the cases involved abuse of the impaired adult by another person. The balance of the caseload involved adults who were neglecting their own needs.

Familial/Caregiver Risk Factors

• Substance abuse
• Unemployment by caregiver
• Lack of knowledge of duties, resources, and/or services
• Caregiver stress, fatigue and/or dissatisfaction
• History of violence
• Psychological and/or physical impairments
• Poor impulse control

Indicators of Physical Abuse, Sexual Abuse, or Active Neglect

• Bruises, welts, fractures, rope burns, signs of hair pulling
• Unexplained STDs (sexually transmitted diseases)
• Signs of malnutrition and/or dehydration such as weight loss or dry skin
• Soiled clothing or bed linens
• Unexpected or unexplained health problems
• Unexplained paranoia
• Excessive fear
• Insomnia, sleep deprivation, or need for excessive sleep
• Signs of excessive drugging, lack of medication, or other misuse such as decreased alertness

Indicators of Financial Abuse

• Unexplained or sudden inability to pay bills
• Unexplained or sudden withdrawal of money from accounts
• Disparity between assets and living conditions
• Extraordinary interest by family members or others in older person's assets

Sadly, the neglect and mistreatment of adults happens most often at home. Over half of all reported abuse cases in New York State involve the children or grandchildren of the abused. Other abusers include other relatives such as siblings and spouses, paid care providers, friends, and neighbors.

According to a 1997 profile of the Protective Services Caseload in New York State:

• 56.3% of abusers were male
• 74% of abusers were family members
• 34% of abusers were adult children
• 26% of abusers were spouses
• 26% of abusers were unrelated

In many instances, the abuser was financially dependent on the victim and/or had an incapacitating condition such as substance abuse, mental incapacity, or physical incapacity

• You can report suspected abuse to Protective Servic for Adults. Reports can be made anonymously, if desired. Contact information is found at the bottom of every page

How do I make a referral if I believe an adult is at risk of abuse or neglect?

• Call your local county Department of Social Services Adult Protective Services, which will investigate reports of adult and elder abuse. To obtain specific telephone numbers, call, 24 hours, 1-800-342-3009FREE  (press 6).
• Referrals for PSA are accepted Monday -Friday, during normal business hours. If an adult is in danger and needs immediate assistance you should contact local law enforcement.

What happens when I make a referral? Who responds?

• In responding to referrals PSA will visit the adult's home within 3 working days, or within 24 hours for a life threatening situation.
• Services will be provided that reduce the risk to the adult and which support the adult's ability to stay in the community for as long a possible.

What if the elderly or impaired adult refuses help?

• Competent adults have the right to exercise free choice in deciding whether to accept services. If an adult appears to be capable of understanding the risks and chooses to stay in an abusive or neglectful situation this can be a difficult decision for others to understand.
• PSA will offer services and try to convince the adult to accept help. If there are questions about the adult's mental capacity, then a mental health evaluation will be pursued to determine if court-ordered interventions should be provided

• if clt feels pressured to consider PAS, clr must invoke the duty to protect/warn clt
• clr must self-monitor to guard against making assumptions based the clt's race, SES, religion, spriritual beliefs, or age
• clr should determine whether they have competency & training to work with such clts
• they should conduct a thorough assessmt of clt or refer
• clr should consult with other professionals
• clr should document all consults, assessmt, tx plan, goals, options considered

• adults who are developmentally disabled, critically ill, seriously injured, mentally ill, or elderly could be declared incompetent by the court
• the court will appoint a guardian who has legal powers over the individual that a biological P/G with their child
• they will maintain their legal rights until a court declares otherwise