Note that although a JJS or CJS consent may be made irrevocable for a specified period of time, that time period must end no later than the final disposition of the juvenile or criminal justice proceeding. Thereafter, the adolescent may freely revoke consent. A sample criminal justice consent form appears in Figure Figure Consent Form: Criminal Justice System Referral. For most treatment professionals, the issue of reporting a client's threat to harm another or commit a crime is a troubling one. Many professionals believe that they have an ethical, professional, or moral obligation to prevent a crime when they are in a position to do so, particularly when the crime is a serious one.
There has been a developing trend in the law to require psychiatrists and other therapists to take "reasonable steps" to protect an intended victim when they learn that a client presents a "serious danger of violence to another. Regents of the University of California , 17 Cal. In that case, the California Supreme Court held a psychologist liable for monetary damages because he failed to warn a potential victim that his client threatened to kill that person and then did so.
The court ruled that if a psychologist knows that a client poses a serious risk of violence to a particular person, the psychologist has a duty "to warn the intended victim or others likely to apprise the victim of the danger, to notify the police, or to take whatever other steps are reasonably necessary under the circumstances. Although the Tarasoff ruling, strictly speaking, applies only in California, courts and legislatures in other States have adopted Tarasoff's reasoning to hold therapists liable for monetary damages when they have failed to warn someone threatened by a client.
In most instances, liability is limited to situations in which a client threatens violence to a specific identifiable victim; liability does not usually apply when a client makes a general threat without identifying the intended target. If an adolescent's counselor thinks the youth poses a serious risk of violence to someone, there are at least two--and sometimes three--questions that must be answered:. The first question can only be answered by an attorney familiar with the law in the State in which the program operates. If the answer to the first question is "no," then it is advisable to discuss the second question with a knowledgeable lawyer, too.
If the answer to question 1 or 2 is "yes," then how can the program warn the victim or someone able to take preventive action without violating the Federal confidentiality regulations? The problem is that there is a conflict between the Federal confidentiality requirements and the duty to warn imposed by States that have adopted the Tarasoff rule. Simply put, the Federal confidentiality law and regulations appear to prohibit the type of disclosure that the Tarasoff rule requires.
In the only case, as of this writing, that addresses this conflict between Federal and State law Hansenie v.
United States , F. When an adolescent makes a threat to harm himself or another and the program is confronted with conflicting moral and legal obligations, it can proceed in one of the following ways: The program can go to court and request a court order authorizing the disclosure. The program must take care that the court abides by the requirements of the Federal confidentiality regulations which are discussed below in detail.
The program can make a disclosure that does not identify the adolescent who has threatened to harm another as a client. This can be accomplished either by making an anonymous report or--for a program that is part of a larger nonsubstance use disorder treatment facility--by making the report in the larger facility's name. For example, a counselor employed by a substance abuse program that is part of a mental health facility could phone the police or the potential target of an attack, identify herself as "a counselor at the New City Mental Health Clinic," and explain the risk.
This would convey the vital information without identifying the adolescent as someone in substance use disorder treatment. Counselors at freestanding treatment programs cannot give the name of the program. The "nonclient-identifying disclosure" exception is discussed more fully below. If the adolescent has been mandated into treatment by the CJS or JJS, the program can make a report to the mandating CJS or JJS agency, so long as it has a CJS consent form signed by the adolescent that has been worded broadly enough to allow this sort of information to be disclosed.
However, the regulations limit what the justice agency can do with the information. Section 2. Thus, the referring justice agency can use the disclosure to revoke the adolescent's conditional release or probation or parole. If the justice agency wants to warn the victim or to notify another law enforcement agency of the threat, it must be careful that it does not mention that the source of the tip was someone at a substance use disorder treatment program or that the adolescent making the threat is in treatment for a substance use disorder.
However, the disclosure most likely cannot be used to prosecute the adolescent for a separate offense such as making the threat. The program can make a report to medical personnel if the threat presents a medical emergency that poses an immediate threat to the health of any individual and requires medical intervention.
See the discussion of the medical emergency exception below. The program can obtain the client's consent. If none of these options is practical and if a counselor believes there is a clear and imminent danger to an adolescent client or another identified person, then it is probably wiser to err on the side of making an effective report about the danger to the authorities or to the threatened individual.
Although each case presents different questions, it is doubtful that any prosecution or successful civil lawsuit under the confidentiality regulations would be brought against a counselor who warned about potential violence when he believed in good faith that there was real danger to a particular individual. On the other hand, a civil lawsuit for failure to warn may well result if the threat is actually carried out. In any event, the counselor should at least try to make the warning in a manner that does not identify the individual as having a substance use disorder.
Duty-to-warn issues represent an area in which staff training, as well as a staff review process, may be helpful. For example, a troubled youth may engage in verbal threats as a way of "blowing off steam. Program training and discussions can assist staff in sorting out what should be done in each particular situation.
One more duty-to-warn issue needs to be discussed. Do providers have a duty to warn others when they know that an adolescent they are treating is infected with HIV? When would that duty arise? Even where no duty exists, should providers warn others at risk about an adolescent's HIV status? Finally, how can others be warned without violating the Federal confidentiality regulations and State confidentiality laws?
The answer to the first question is a matter of State law. Courts in some States have held that health care providers have a duty to warn third parties of the behavior of persons under their care if it poses a potential danger to others. In addition to these court decisions, some States have enacted laws that either permit or require health care providers to warn certain third parties. These persons may include sex partners at risk. Usually, these State laws prohibit disclosure of the infected person's identity, while allowing the provider to tell the person at risk that he may have been exposed.
It is important that providers consult with an attorney familiar with State law to learn whether the law imposes a duty to warn, as well as whether State law prescribes the ways in which a provider can notify the person at risk. For example, is the provider prohibited from disclosing the adolescent's name? Must the adolescent consent? Because the law in this area is still developing, it is also important to keep abreast of changes.
Two behaviors of infected persons can put others at risk of infection: Because HIV is not transmitted by casual contact, the simple fact that an adolescent is infected would not give rise to a duty to warn the adolescent's family or acquaintances who are not engaged in sex or needle-sharing with the adolescent. This still leaves open the question of when a duty arises. Would it be when an adolescent tells a counselor that he wants or plans to infect others? Or would it arise when an adolescent tells the counselor that he has already exposed others to HIV?
These are two different questions. A counselor whose adolescent client threatens to infect others should consider three questions in determining whether there is a duty to warn:. Is the adolescent making a threat or "blowing off steam"? Sometimes, wild threats are a way of expressing anger.
Such threats may be the adolescent's cry for additional support services. However, if the adolescent has a history of violence or of sexually abusing others, the threat should probably be taken seriously. Is there an identifiable potential victim? Most States that impose a duty to warn do so only when there is an identifiable victim or class of victims. Without an identifiable victim, it is difficult to warn anyone; and, unless public health authorities have the power to detain someone in these circumstances, there is little reason to inform them.
Does a State statute or court decision impose a duty to warn in this particular situation? Even if there is no State legal requirement that the program warn an intended victim or the police, does the counselor feel a moral obligation to warn someone? Clearly, there are no definitive answers in this area. As with other duty-to-warn issues, each case depends on the particular fact pattern presented and on State law.
If a provider believes that she has a duty to warn under State law or that there is real danger to a particular individual giving rise to a moral or ethical duty to warn that individual, she should do so in a way that complies with both the Federal confidentiality regulations and any State law or regulation regarding disclosure of medical or HIV-related information. Because a client is unlikely to consent to a disclosure to the potential victim, in an effort to comply with the Federal regulations, a provider could Seek a court order authorizing the disclosure.
The provider should consult State law to determine whether it imposes requirements in addition to those imposed by the Federal regulations. Make an "anonymous" warning--that is, a warning that does not disclose the adolescent's status as having a substance use disorder. The provider should also limit the way it issues the warning so as to expose the adolescent's identity as HIV-positive to as few people as possible. Suppose an HIV-infected adolescent tells his counselor that he has had unprotected sex or shared needles with someone? If the counselor knows who the person is, does she have a duty to warn the person or law enforcement?
This is not a true duty-to-warn case because the exposure has already occurred. The purpose of the "warning" is not to prevent a criminal act, but to notify an individual so that he can take steps to monitor health status or begin drug therapy. Thus, it is probably not helpful to call a law enforcement agency. Rather, the counselor might want to let the public health authorities know, particularly in States with mandatory partner notification laws. Public health officials can then find the person at risk and provide appropriate counseling.
How can programs notify the public health department without violating the confidentiality regulations? In some areas of the country, programs have signed qualified service organization agreements QSOAs with public health departments that provide services to the program for more information on QSOAs, see the subsection, Sharing Information With an Outside Agency That Provides Services to the Programs, below. This enables providers to report exposures to the department in situations like these.
Treatment of Adolescents with Substance Use Disorders.
The public health department can then help not only the person the counselor believes was exposed, but can also trace other contacts the adolescent may have exposed. In doing so, the public health department often does not identify the person who has put his contacts at risk. Certainly, the public health department would not have to tell the contact that the person is in treatment for a substance use disorder, and the QSOA would prohibit it from doing so.
A treatment program must also make sure that reporting an exposure by a client through a QSOA complies with any State law protecting medical or HIV-related information. If the provider does not have a QSOA with the public health department, it might try one of the following: The provider could inform the health department with the adolescent's consent. If the program notifies the public health department in a way that does not identify the adolescent as having a substance use disorder it would be complying with the Federal regulations.
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Court order. Again, State law must be consulted to determine whether it imposes requirements in addition to those imposed by the Federal regulations. One of these methods should enable the provider to alert the public health department, which is the most effective way to notify someone who may have been exposed. The provider should document the factors that impelled the decision to warn an individual of impending danger of exposure or to report an exposure to the public health department.
If the decision is later questioned, then notes made at the time the decision was made could prove invaluable. Finally, the provider should remember that any time a program warns someone of a threat an adolescent makes without the adolescent's consent, the program may be undermining the trust of other adolescents and thus its effectiveness.
This may be particularly true for a program serving HIV-positive adolescents. Other clients may learn of the disclosure, and the trust that the program worked so hard to build may be weakened. This is not to say that a disclosure should not be made--particularly when the law requires it. It is to say that a disclosure should not be made without careful thought.
The circumstances in which a duty to warn or notify arises may change over time as scientists learn more about the virus and its transmission and as better treatments are developed.
There is little doubt that the law will also change as States adopt new statutes and their courts apply statutes to new situations. Programs should develop a protocol about duty-to-warn cases, so that staff members are not left to make decisions on their own about when and how to report threats of violence and threats or reports of HIV transmission. Ongoing training and discussions can also assist staff members in sorting out what should be done in any particular situation.
What should a program do when an adolescent tells a counselor that she intends to go shoplifting at the mall, something the counselor knows he has done before. Does the program have a duty to tell the police? Does a program have a responsibility to call the police when an adolescent discloses to a counselor that he participated in a serious crime some time in the past? What can a program do when a client commits a crime at the program or against an employee of the program?
These are three very different questions that require separate analysis. By this time, the reader should know the answer to the first question: A program generally does not have a duty to warn another person or the police about an adolescent's intended actions unless the client presents a serious danger of violence to an identifiable individual.
Shoplifting rarely involves violence, and the counselor may not know which stores are to be victimized. Petty crime like shoplifting is an important issue that should be dealt with therapeutically. It is not something a program should necessarily report to the police. Suppose, however, that an adolescent client admits during a counseling session that he killed someone 3 months ago. Here the program is not warning anyone of a threat, but serious harm did come to another person. Does the program have a responsibility to report that? In a situation in which a program thinks it might have to report a past crime, there are generally three questions to consider:.
Generally, the answer to this question is no. In most States, there is no duty to tell the police about a crime committed in the past. Even those States that impose a duty to report rarely prosecute violations of the law. Whether or not citizens have a legal obligation to report past crimes to the police, State law may protect conversations between counselors of substance use disorder treatment programs and their clients and exempt counselors from any requirement to report past criminal activity by clients.
State laws vary widely on the protection they accord communications between clients and counselors. In some States, admissions of past crimes may be considered privileged, and counselors may be prohibited from reporting them; in others, admissions may not be privileged. Moreover, each State defines the kinds of relationships protected differently. Whether a communication about past criminal activity is privileged and therefore cannot be reported may depend on the type of professional the counselor is and whether she is licensed or certified by the State.
Any program that is especially concerned about this issue should ask a local attorney for an opinion letter about whether there is a duty to report and whether any counselor-client privilege exempts counselors from that duty. Any program that decides to make a report to law enforcement authorities about a client's prior criminal activity must do so without violating either the Federal confidentiality regulations or State laws.
A program that decides to report a client's crime can comply with the Federal regulations by following one of the first three methods described above in the discussion of duty to warn: It can make a report in a way that does not identify the adolescent as a client in substance use disorder treatment. If the adolescent is an offender who has been mandated into treatment by a criminal justice or juvenile justice agency, the program can make a report to that justice agency, if it has a CJS consent form signed by the adolescent that is worded broadly enough to allow this sort of information to be disclosed.
Note, however, that the regulations limit the actions law enforcement officials may take once they have received the information. Because of the complicated nature of this issue, any program considering reporting an adolescent's admission of criminal activity should seek the advice of a lawyer familiar with local law as well as the Federal regulations. Because past criminal activity may not indicate an emergency, the counselors do not have to decide immediately whether to report it. This issue can be addressed with the client as a treatment issue.
With the support of a program and proper legal advice, the adolescent may report the crime himself. The answer is more straightforward when an adolescent client has committed or threatens to commit a crime on program premises or against program personnel. In this situation, the regulations permit the program to report the crime to a law enforcement agency or to seek its assistance. One crime that an adolescent might well commit on program premises is drug possession--bringing drugs into the program either on her person or if the program is residential in her luggage.
When a program finds drugs on a client or in a client's personal property, what should it do? Should the program call the police? What should it do with the drugs? The answer to the first question has already been discussed above in the section dealing with reporting criminal activity. Generally, State law does not require programs to make such a report. As for the second question, State regulations often govern how a program may dispose of drugs, sometimes requiring that they be flushed down a toilet.
Programs should check with their State substance abuse agency if they are unsure about State mandates.
Adolescents in treatment for a substance use disorder may engage in risky activities such as renewed drug-taking, criminal behavior, risky sexual conduct, or other activity dangerous to themselves or others. If a counselor believes that the adolescent's conduct is dangerous and counseling seems not to be productive in reducing that behavior, what should he do?
This chapter has already examined what the counselor cannot do: He cannot call the adolescent's parents without the adolescent's consent and, unless there are unusual circumstances, he most likely cannot call law enforcement authorities.
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There are, however, some things he can do: If the adolescent has relapsed into substance use and the relapse has reached the point where it threatens her health and requires immediate medical intervention, the counselor could call the adolescent's family doctor under the "medical emergency" exception. Note that the situation must be a real medical emergency. For the other requirements of this section, see below. Alternatively, the program could apply for a court order that would authorize it to inform the adolescent's parents or other responsible adults.
Neither of these alternatives is very satisfactory. A program can use the "medical emergency" exception only in very limited circumstances, and obtaining a court order is time-consuming and expensive. There is a more satisfactory option: When a program admits an adolescent who has a history of risk-taking behavior, the program could ask the adolescent to sign a consent form that authorizes the program to tell an adult the adolescent trusts if the adolescent's behavior takes a dangerous turn. The adult named could be a parent or other relative, a minister or youth counselor, or anyone else with whom the adolescent has rapport.
An adolescent entering treatment might consent to this arrangement because she may believe, as do many people entering treatment, that she will not suffer a relapse. An added benefit of this kind of request is that it demonstrates to the adolescent that the program respects her feelings and preferences, takes confidentiality seriously, and will not disclose information to others without the adolescent's consent. Note that if a counselor notifies the person named in the consent form, that person is bound by the regulations not to disclose the information further without the adolescent's consent, unless he can do so without revealing the fact that the adolescent is in treatment for a substance use disorder.
The adolescent can revoke her consent at any time. All 50 States and the District of Columbia have statutes requiring reporting when there is reasonable cause to believe or suspect that child abuse or neglect is occurring. Although many State statutes are similar, each has different rules about what kinds of conditions must be reported, who must report, and when and how reports must be made. When a program makes such a report, it should generally notify the family, unless the notification would place the child in further danger.
The program should also endeavor to continue to work with the family as the State investigates the complaint and the child protective process unfolds. Families should never be abandoned because of suspected abuse or neglect, and health care providers should be wary of making judgments until a comprehensive assessment has been completed by State authorities. Most States now require not only physicians but also educators and social service workers to report child abuse.
Most States require an immediate oral spoken report, and many now have toll-free numbers to facilitate reporting. Half of the States require that both oral and written reports be made. All States extend immunity from prosecution to persons reporting child abuse and neglect. Most States provide penalties for failure to report. Program staff will often need some form of training to review the State's child abuse and neglect laws and to clearly explain what the terms abuse and neglect really mean according to the law. A lay person's--or a professional's--idea of child neglect may differ greatly from the legal definition.
For example, in some States, a child living with a parent involved in extensive substance abuse, perhaps surrounded by a culture of drugs and alcohol, is not considered to be abused or neglected unless certain other conditions are met. Such legal definitions may go against the grain of what some staff members consider to be in the best interest of the child, but these are safeguards that have developed over time to protect the child, the parent, and the family unit. Because of the variation in State law, programs should consult an attorney familiar with State law to ensure that their reporting practices are in compliance.
Administrators, in turn, should shoulder the responsibility to make the required reports. The Federal confidentiality regulations permit programs to comply with State laws that require the reporting of child abuse and neglect. However, this exception to the general rule prohibiting disclosure of any information about a client applies only to initial reports of child abuse or neglect. Programs may not respond to followup requests for information or to subpoenas for additional information, even if the records are sought for use in civil or criminal proceedings resulting from the program's initial report.
The only situation in which a program may respond to requests for followup information is when the adolescent consents or the appropriate court issues an order under subpart E of the regulations. Reference has been made to other exceptions to the general rule prohibiting disclosure regarding an adolescent who seeks or receives substance use disorder treatment services. In the subsections that follow, six exceptions to the Federal confidentiality rules are examined in greater detail: Disclosures that do not reveal that the client as having a substance use disorder Disclosures authorized by court order Disclosures during medical emergencies Disclosures to an outside agency that provides a service to the program Disclosures of information within the program Disclosures of information to researchers, auditors, and evaluators.
Federal regulations permit substance use disorder treatment programs to disclose information about an adolescent if the program reveals no client-identifying information. Thus, a program may disclose information about an adolescent if that information does not identify him as having a substance use disorder or support anyone else's identification of the adolescent as having a substance use disorder.
There are two basic ways a program may make a disclosure that does not identify a client. The first way is obvious: A program can report aggregate data about its population summing up information that gives an overview of the clients served in the program or some portion of its population. Thus, for example, a program could tell the newspaper that, in the last 6 months, it screened 43 adolescent clients female and 33 male.
The second way has already been discussed: Thus, a program that provides services to adolescents with other problems or illnesses as well as substance use disorders may disclose information about a particular client e. A counselor employed by a program that is part of a general hospital could call the police about a threat an adolescent made, so long as the counselor did not disclose that the adolescent has a substance use disorder or is a client of the treatment program.
Programs that provide only substance use disorder services cannot disclose information that identifies a client under this exception, because letting someone know a counselor is calling from the "XYZ Treatment Program" will automatically identify the adolescent as someone in the program. However, a free-standing program can sometimes make "anonymous" disclosures, that is, disclosures that do not mention the name of the program or otherwise reveal the adolescent's status as having a substance use disorder. Note that with the widespread use of caller identification, "anonymous" communications may not be so anonymous.
Soon, it may no longer be possible for a freestanding program to use this kind of anonymous communication. A State or Federal court may issue an order that will permit a program to make a disclosure about an adolescent that would otherwise be forbidden. A court may issue one of these authorizing orders, however, only after it follows certain special procedures and makes particular determinations required by the regulations.
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Before a court can issue an order authorizing a disclosure about an adolescent that is otherwise forbidden, the program and the adolescent whose records are sought must be given notice of the application for the order and some opportunity to make an oral or written statement to the court. Before issuing an authorizing order, the court must find that there is "good cause" for the disclosure.
A court can find "good cause" only if it determines that the public interest and the need for disclosure outweigh any negative effect that the disclosure will have on the client or the doctor-client or counselor-client relationship and the effectiveness of the program's treatment services. There are also limits on the scope of the disclosure that a court may authorize, even when it finds good cause.
The disclosure must be limited to information essential to fulfill the purpose of the order, and it must be restricted to those persons who need the information for that purpose. The court may order disclosure of "confidential communications" by an adolescent to the program only if the disclosure Is necessary to protect against a threat to life or of serious bodily injury Is necessary to investigate or prosecute an extremely serious crime including child abuse Is in connection with a proceeding at which the adolescent has already presented evidence concerning confidential communications e.
If the purpose of seeking the court order is to obtain authorization to disclose information to law enforcement authorities so that they can investigate or prosecute a client for a crime, the court must also find that 1 the crime involved is extremely serious, such as an act causing or threatening to cause death or serious injury; 2 the records sought are likely to contain information of significance to the investigation or prosecution; 3 there is no other practical way to obtain the information; and 4 the public interest in disclosure outweighs any actual or potential harm to the client, the doctor-client relationship, and the ability of the program to provide services to other clients.
When law enforcement personnel seek the order, the court must also find that the program had an opportunity to be represented by independent counsel. A program may make disclosures to public or private medical personnel "who have a need for information about [an adolescent] for the purpose of treating a condition which poses an immediate threat to the health" of the adolescent or any other individual. The medical emergency exception permits disclosure only to medical personnel. This means that the exception cannot be used as the basis for a disclosure to the police or other nonmedical personnel, including parents.
Under this exception, however, a program could notify a private physician or school nurse about a suicidal adolescent so that medical intervention can be arranged. The physician or nurse could, in turn, notify the adolescent's parents, so long as no mention is made of the adolescent's substance use disorder. Whenever a disclosure is made to cope with a medical emergency, the program must document the following information in the adolescent's records: The name and affiliation of the recipient of the information The name of the individual making the disclosure The date and time of the disclosure The nature of the emergency.
If a program routinely needs to share certain information with an outside agency that provides services to it, then it can enter into what is known as a QSOA. A QSOA is a written agreement between a program and a person or agency providing services to the program, in which that person or agency: A QSOA should be used only when an agency or official outside the program is providing a service to the program itself. An example is when laboratory analyses or data processing are performed for the program by an outside agency.
A QSOA is not a substitute for individual consent in other situations. Disclosures under a QSOA must be limited to information that is needed by others so that the program can function effectively. A QSOA may not be used between different programs providing substance use disorder treatment and other services. The Federal regulations permit some information to be disclosed to staff members within the same program. A question that frequently arises is whether this exception allows a program that treats adolescents and that is part of a larger entity, such as a school, to share confidential information with others who are not part of the assessment or treatment unit itself.
The answer to this question is among the most complicated in this area. In brief, there are circumstances under which the substance use disorder treatment unit can share information with other units. However, before such an internal communication system is set up within a large institution, it is essential that an expert in the area be consulted for assistance. The Federal confidentiality regulations require programs to notify clients of their right to confidentiality and to give them a written summary of the regulations' requirements.
The regulations contain a sample notice. Programs can use their own judgment to decide when to permit adolescents to view or obtain copies of their records, unless State law allows clients or students the right of access to records. The Federal regulations do not require programs to obtain written consent from clients before permitting them to see their own records.
The Federal regulations require programs to keep written records in a secure room, a locked file cabinet, a safe, or other similar container. Substance use disorder treatment programs should try to find a lawyer who is familiar with local laws affecting their problems. As has already been mentioned, State law governs many concerns relating to treatment of adolescents.
A practicing lawyer with an expertise in adolescent substance use concerns is the best source for advice on such issues. Moreover, when it comes to certain issues, the law is still developing. For example, programs' duty to warn of clients' threats to harm others is constantly changing as courts in different States consider cases brought against a variety of different kinds of care providers.
Programs trying to decide how to handle such a situation need up-to-the minute advice on their legal responsibilities. This chapter was written for the Revision Panel by Margaret K. An adult with "decisional capacity" is one who is able to understand an explanation of her diagnosis, prognosis, and choices of treatment, as well as their risks and benefits, and likely outcome should treatment be refused.
In States where parental consent is not required for treatment, the Federal confidentiality regulations permit a program to withhold services if the minor will not authorize a disclosure that the program needs in order to obtain financial reimbursement for that minor's treatment. Program staff may need training about what the State's child abuse and neglect laws require, including what conditions are considered reportable.
See the discussion of child abuse reporting. Of course, a provider may turn an adolescent away for clinical reasons, that is, because it has determined that no treatment is needed or that the treatment it offers is inappropriate for the particular adolescent. In this case, the program might want to make a referral to another type of counseling service or to another substance use disorder treatment program.
The procedure for making a referral is discussed in section 2. Part 2. Only adolescents who have "applied for or received" services from a program are protected. If an adolescent has not yet been evaluated or counseled by a program and has not himself sought help from the program, the program is free to discuss the adolescent's substance use disorders with others, although it would not be wise to do so. But, from the time the adolescent applies for services or the program first conducts an evaluation or begins to counsel the youth, the Federal regulations govern. Although the rules concerning CJS consent probably apply to proceedings in juvenile court involving acts that, if committed by an adult, would be a crime, there appear to be no cases on point.
It is less likely that the special CJS consent rules would apply when an adolescent is adjudicated found to be in need of special supervision e. If an attorney is not immediately available, and someone wants information about child abuse and neglect rules within a particular State, contact the social service or child welfare agency for that area. Nationally, the Child Welfare League of America can also be called at Definitions of terms can also be accessed on the Internet.
State statute definitions are located at http: Additional information about dealing with subpoenas appears in Confidentiality: Legal Action Center, ed. Outcome evaluation that assesses clients' behavior at set times after completion of treatment the importance of which is mentioned in Chapter 2 poses particular problems under the Federal regulations. Computerization of records greatly complicates efforts to ensure security.
In criminal cases, for example, only the federal or a state government the prosecution may initiate a case; cases are almost always decided by a jury; punishment for serious felony charges often consists of imprisonment but may also include a fine paid to the government; to secure conviction, the prosecution must establish the guilt of the defendant "beyond a reasonable doubt"; and defendants are protected against conduct by police or prosecutors that violates their constitutional rights, including the right against unreasonable searches and seizures Fourth Amendment and the right against compelled self-incrimination Fifth Amendment.
In civil cases, by contrast, cases are initiated suits are filed by a private party the plaintiff ; cases are usually decided by a judge though significant cases may involve juries ; punishment almost always consists of a monetary award and never consists of imprisonment; to prevail, the plaintiff must establish the defendant's liability only according to the "preponderance of evidence"; and defendants are not entitled to the same legal protections as are the criminally accused. Importantly, because a single wrongful act may constitute both a public offense and a private injury, it may give rise to both criminal and civil charges.
A widely cited example is that of the former American football player O. Written By: Brian Duignan. Britannica Newsletters.
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