1. It would NOT be necessary to file a Suspected Child Abuse Report if Anthony told you he

a.       Had a sexual relationship with his brother's classmate because he felt intimidated by him
b.      Had oral sex with his brother’s classmate
c.       Sustained any kind of physical injury after a fight with his brother
d.      Had any sexual contact with a 13-year-old friend
e.      Any of the above would require filing a report​

B is correct.  Refer to the document Mandated Reporting of Child Sexual Abuse.  Any sexual activity involving someone under 18 is reportable if there is evidence of coercion or exploitation.  Prior to a case law decision in April 2013, the correct answer would have been E. Before that decision, the child abuse reporting laws treated consensual and non-exploitive “sexual intercourse” differently than consensual and non-exploitive oral sex, anal sex, or penetration with an object.  The latter activities might be engaged in more often by same-sex couples, since sexual intercourse by definition is only physically possible for opposite-sex couples.  These activities used to mandate a child abuse report if anyone under 18 was involved, whereas sexual intercourse with a 15-year-old was only reportable if the partner was over 21.  Since the April 2013 decision, these activities are treated the same as sexual intercourse. It is criminal, but not necessarily reportable, for a person over 18 to have sexual intercourse with anyone under 18, but what is criminal is not always reportable under the child abuse reporting laws.

It would be legal to see Anthony without telling his parents if
 
a.       It appears his parents might harm him if they knew he was in therapy and why he was there
b.      His main reason for therapy is to discuss concerns about STDs
c.       He does not want his parents to know he is having problems
d.      He does not want his parents to know he is gay
e.      He is mature enough to participate intelligently in therapy.

E is correct. Refer to the document Consent to Treat Minors.  As of January 2011, the only legal criteria for allowing a minor over 12 years of age to consent to his/her own mental health treatment is that, in the therapist's opinion, the minor is mature enough to participate intelligently. However, the best clinical practice in most situations is to attempt to obtain parents' or guardians' consent to treatment and even give them access to the therapy records if they request it.  Often in working with adolescents where parents are cooperative and want their child to feel free to be self-disclosing, a therapist can obtain an informal agreement that the parents will not look at the records or ask about the content of the therapy. In Anthony's case, allowing him to consent to his own treatment, might help protect him from prematurely disclosing his sexual orientation to parents who might react in a way that is unsupportive or even abusive.

 3.       To help with Emily’s concerns about Joan’s plan to move and custody laws outside California, it is within the scope of practice for an MFT or LCSW to

a.       Advise her to get a restraining order
b.      Advise her to make a written contract with Joan agreeing to keep Justin in California
c.       Offer her a referral to an attorney who is knowledgeable about laws affecting LGBT families
d.      Discuss ways to communicate with Joan that might de-escalate the conflict
e.      Both C and D

E is correct.  Giving legal advice is outside the scope of practice for an MFT or LCSW, but helping a client improve relationships through better communication is not.  Appropriate, culturally sensitive referrals are part of supporting a client’s overall welfare.

 4.       Who can give legal consent to Justin’s treatment with you?

a.       Emily and Joan must both give consent
b.      Either Emily or Joan can give consent, without agreement from the other
c.       Justin can consent to his own treatment if getting consent from a parent would endanger him
d.      Justin’s grandparents can give consent if he is going to be living with them soon
e.      Emily and Joan cannot consent to Justin’s treatment without permission from the sperm donor who is his biological father

B is correct.  Refer to the document Consent to Treat Minors.  As an adoptive parent, Emily has the same rights as Joan when it comes to bringing Justin in for treatment.  It is not legally necessary to get consent from both parents, but clinically it often considered best practice to do so.  C would be true if Justin were over 12 years old.

5.       In considering Chloe’s safety and welfare, a therapist should be concerned about

a.       Possible domestic violence
b.      B. Possible lack of consistent access to health care that could disrupt hormone prescription
c.       The risk of a depressive or manic episode
d.      All of the above
 
D is correct.  Warning signs of all of the above appear in this vignette.
 
6.       If an MFT or LCSW wanted to help Chloe obtain hormones from an MD and wanted to follow the WPATH Standards of Care, the therapist would need to

a.      Write a recommendation letter including the mental health diagnosis
b.       Get a second recommendation letter from a therapist with a doctoral degree
c.      Require Chloe to dress in a more feminine manner for at least three months
d.     None of the above

 A is correct.  Refer to the document WPATH Standards of Care. The psychiatric diagnosis is a part of the recommendation letter.  A second letter is only required for genital surgery, and even then, neither letter needs to be from a doctoral level therapist.  The Standards of Care recommend a minimum of either three months of psychotherapy or living that long as the desired gender, before starting hormones. However, this is only a guideline, and dress is only one factor in gender presentation. Furthermore, there are many reasons why a transgender woman might choose not to present publicly in a traditional, extremely feminine way, ranging from personal style, to a felt sense of gender that is fluid or relatively non-binary, to a need to avoid harassment and violence.

 7.       A therapist would need to file a mandated report with Adult Protective Services if Martha

a.       Is physically attacked or threatened by her son-in-law
b.      Wants to move but has trouble finding affordable housing
c.       Is being financially exploited by the way her daughter manages her bills
d.      Goes to her daughter’s church and encounters disapproval for having had a long-term same-sex partner
e.      A or C

E is correct.  A mandated report means a therapist MUST make the report, at the cost of the client’s confidentiality, whether or not the client agrees.  While Adult Protective Services might be helpful with referrals for an adult over 65 who has financial and housing problems, these conditions do not mandate a report.  Physical abuse, intimidation, and fiscal abuse are all reportable.  Adults of any age are free to choose their religion and religions are free to espouse opinions, even hurtful ones, about the way people live.

 8.       It would be both legal and ethical for a therapist to help Martha by

a.       Giving her legal advice about her rights regarding inheritance and Social Security
b.      Offering to be her payee for Social Security
c.       Referring her to an attorney who is knowledgeable about inheritance laws and has experience with surviving members of same-sex couples
d.      Reducing her fee so she can afford to pay for therapy without her daughter’s help
e.      C and D

E is correct.  Legal advice is outside the scope of practice for an LCSW or an MFT.  Being someone’s payee while being her therapist would be an avoidable and most likely harmful dual relationship.  Referrals to other professions are appropriate and often needed to enhance the client’s safety and welfare.  While therapists are not obligated to reduce fees for clients with financial problems, there is no conflicting legal or ethical obligation that prevents a therapist from extending this kindness, unless the therapist’s fee structure is discriminatory, e.g. offering fee reductions only for women or only for men.

Answer Sheet

Law and Ethics with an LGBT Focus Part Two