Most practitioners and advocates feel that because of the California mandatory reporting laws, it is ethically preferable to tell appropriately aged children, teens and parents about the limits of confidentiality prior to taking a history. However, this is not required by law.
If you choose to disclose the conditions under which you are required by state law to report abuse, an efficient way to do so might be in new patient paperwork – or you could simply discuss this near the beginning of the visit:
“I just want you to know that everything we talk about today is confidential, except by law I must report if I am concerned you might hurt yourself or someone else, or if... (to child) someone might be hurting you.
(to adult) there is a possibility children or elders in the home are being hurt or neglected.”
Also you may decide to notify the patient that under California law and HIPAA, parents can obtain their children's medical records, with certain exceptions such as pregnancy.
Various privacy issues include:
A parent may or may not want you to document disclosure of domestic abuse, since the attorney for the other parent can request child’s records. Alternatives may be to place this information in social service records only, or have a confidential section of the child’s chart. On the other hand, this may be important information for other healthcare providers to know by looking at the chart, and documentation may help with future child custody disputes. It is helpful to phrase these statements in the third person, such as "mother reports that father is abusive."
If a child in the room is 3 or older, ask the parent about abuse in privacy, since the abusive parent may subsequently question the child about the visit, or it may be upsetting to the child.
A child may ask you to “promise not to tell” about revealed abuse, but you need to let her/him know that you might need to tell someone in order to keep her/him safe.
To contact the LPCH Ethics Committee:
Advocates suggest that you encourage the non-abusive parent to make a report to CPS from your office, if there is a reportable situation.
This would decrease the chance of “failure to protect” charges against that parent. You would still also need to report yourself.
Trust and Mandatory Reporting
Maintaining trust can be difficult with mandatory reporting laws (see Disclosing). One way to help overcome this issue is to call in report in the presence of the child/teen/parent, so that they know what was said, and/or to let them see the written report.